bluuebunny/crossref_metadata_2025 huggingface dataset:
White thrombus as a possible feature of atypical stroke etiology: Coxiella burnetii as the primary cause of acute ischemic stroke
Authors: Vinacci Gabriele , Tcheumeni Carole Nadine , Coskun Oguzhan , Saddiki Fatima Zohra , Maria Federico Di , Dinu Mugurel , Rodesch Georges , Billy Christophe , Lapergue Bertrand , Ille Olivier , Consoli Arturo
Published: May 2021

Acute ischemic stroke (AIS) is the most common neurologic complication of infective endocarditis. We describe a singular case report of a 62- year-old male with AIS related to the occlusion of the left middle cerebral artery. Thrombus-aspiration allowed retrieving a 6 millimeters white thrombus. The real-time polymerase chain reaction performed on the thrombus detected Coxiella Burnetii allowed the diagnosis of infective endocarditis (IE) and the identification of the specific pathogen. Coxiella Burnetii is an endemic, small, intracellular, gram-negative coccobacillus and it is a rare cause of IE. The management of AIS caused by IE remains controversial, although in the cases of major occlusion mechanical thrombectomy is associated with better clinical outcomes. IE patients could not present symptoms and signs related to the infection, therefore we underline the importance of the microbiological analysis of the retrieved thrombi especially when atypical etiology is suspected.
Acute thrombosis of a giant perimedullary arteriovenous fistula in a pediatric HHT patient
Authors: Devara Janaki , Iyer Vivek N , Warad Deepti M , Brinjikji Waleed , Aljobeh Ahmad , Lanzino Giuseppe , Demirel Nadir
Published: May 2021

Hereditary hemorrhagic telangiectasia (HHT) is an autosomal dominant hereditary disorder that results in arteriovenous malformations (AVMs) in the nose, mucocutaneous surfaces and visceral organs, including lung, brain, liver, bowel and rarely spinal cord. We describe a case of a young child with HHT who presented with acute paraparesis due to acute thrombosis of a spinal perimedullary arteriovenous fistula. Patient underwent coil embolization of spinal arteriovenous shunt with resolution of clinical symptoms. This case highlights the possibility of catastrophic complications in young children with HHT, the potential preventive role of screening for spinal AVMs in HHT and the importance of timely intervention.
Partial gravity compensation of a surgical robot
Authors: Maaroof Omar W , Saeed Saad Zaghlul , Dede Mehmet İsmet Can
Published: May 2021

Surgical robots are safety-critical devices that require multiple domains of safety features. This article focuses on the passive gravity compensation design optimization of a surgical robot. The limits of this optimization are related with the safety features including minimization of the total moving mass/inertia and compactness of the design. The particle swarm optimization method is used as a novel approach for the optimization of a parallel remote-center-of-motion mechanism. A compact design is achieved by partially balancing the mechanism, which also decreases the torque requirements from the actuators.
A female advantage? Gender and educational leadership practices in urban primary schools in Chile
Authors: Weinstein José , Sembler Matías , Weinstein Marisa , Marfán Javiera , Valenzuela Paulina , Muñoz Gonzalo
Published: May 2021

What differences are there, according to teachers’ opinions, in school leadership practices between male principals (MPs) and female principals (FPs) in urban primary schools in Chile? A national survey has been done to address this topic, which was answered by the principal and five teachers in 381 urban primary schools. Following Leithwood’s school leadership four-category model, 14 practices were considered and measured. Data were analysed by statistical procedures, including the decision tree technique, chi-squared automatic interaction detection (CHAID). Findings showed that in 9 out of 14 practices, FPs have a significantly more favourable evaluation from teachers. Data confirmed that, when compared to other personal traits of principals or school features, gender is the strongest independent variable related with leadership practices. Nonetheless, this advantage occurs in an overall scenario in which both FPs and MPs engage unevenly with the leadership practices across the dimensions of the model. This study does not aim to explain the female advantage, but to show the shape of leadership differences by gender regarding theoretically relevant practices. Nevertheless, its data allow ruling out some possible hypotheses for interpreting those differences. The article suggests that further research is needed to theoretically explain the reasons behind differences in leadership practice by FPs and MPs.
Lending a hand to storytelling: Gesture’s effects on narrative comprehension moderated by task difficulty and cognitive ability
Authors: McKern Nicola , Dargue Nicole , Sweller Naomi , Sekine Kazuki , Austin Elizabeth
Published: May 2021

Compelling evidence suggests observing iconic gestures benefits learning. While emerging evidence suggests typical iconic gestures benefit comprehension to a greater extent than atypical iconic gestures, it is unclear precisely when and for whom these gestures will be most helpful. The current study investigated factors that may moderate when and for whom gesture benefits narrative comprehension most, including the type of gesture, task difficulty, and individual differences in cognitive ability. Participants were shown a video narrative in which they observed either typical gestures (commonly produced gestures, highly semantically related to accompanying speech), atypical gestures (gestures that are seldom produced), or no gestures. The video narrative was either viewed with interference (background noise to increase task difficulty) or no interference (no background noise). To determine whether the effects of gesture observation and externally imposed task difficulty on narrative comprehension further depend on an individual’s cognitive abilities, participants completed four measures of cognitive abilities (immediate and delayed non-verbal memory, attention, and intellectual ability). Observing typical gestures significantly benefitted narrative comprehension compared with atypical and no gestures combined, which did not differ significantly. Participants with below average and average levels of delayed non-verbal memory benefitted more from typical gestures than atypical or no gestures compared with those with an above average level of delayed non-verbal memory. However, this interaction was only significant when the task was difficult (i.e., with interference) but not when the task was simple (i.e., no interference). This finding suggests that the type of iconic gesture observed may affect gesture’s beneficial effect on narrative comprehension, and that such gestures may be more beneficial in difficult tasks, but only for certain individuals.
Case reports of athletes affected by rhabdomyolysis: A systematic review
Authors: Dantas Guilherme Henrique Mattos , Nunes Rodolfo de Alkmim Moreira , Lopes Gustavo Casimiro , Neves Eduardo Borba , Castro Juliana Brandão Pinto de , Vale Rodrigo Gomes de Souza
Published: May 2021

Objective

To analyze intensity levels, modalities, types of physical activities, ambient temperature, and hydration levels during stimuli performed in training and competitionof studies that reported episodes of rhabdomyolysis in athletes.

Method

We conducted a systematic review following the PRISMA guidelines and registered on PROSPERO, as number CRD42020126107. MedLine (via PubMed), Cochrane, LILACS, SciELO, Web of Science, Scopus, CINAHL, SPORTDiscus, ScienceDirect, and PEDro databases were searched for case reports in which professional athletes, who had a technical team as support, were affected by rhabdomyolysis induced by the practice of physical activity. The descriptors and their synonyms “rhabdomyolysis”, “exercise”, and “athletes”, available in the Health Sciences Descriptors (DeCS) and Medical Subject Headings (MeSH), were used.

Results

After the screening process, 10 studies were includedand analyzed according to the CAse REport (CARE) guidelines.The sports of the case reports were soccer, football, swimming, wrestling, 24-hour cross-country skiing, and mixed martial arts (MMA).The age range of the athletes varied between 16 to 41 years old. The case reports described a total of 17 athletes (14 male and three female).The main aspects related to the diagnosis of rhabdomyolysis were ambient temperature, creatine kinase (CK) levels, the occurrence of renal impairment, and one or more signs of the classical triad (myalgia, dark urine, and muscle weakness).

Conclusion

It was observed difficulty in identifying concrete parameters to prevent and diagnose the rhabdomyolysis of premature form, however, controlling these variables may increase the chances of treatment success and decrease the risk of sequels.
How coach leadership is related to the coach-athlete relationship in elite sport
Authors: López de Subijana Cristina , Martin Luc J , Ramos Javier , Côté Jean
Published: May 2021

The purpose of this study was to explore the association between coach leadership and the coach-athlete relationship. Eighty-one elite athletes ( M = 20.4 years; SD = 3.8; 58% female and 42% male) responded to questionnaires pertaining to their coaches’ leadership behaviours and the quality of their relationship. The overall model for predicting the quality of the coach-athlete relationship according to perceived coach leadership behaviours explained 61% of the variance. Three transformational leadership behaviours were positively associated with the quality of the coach-athlete relationship: individualized consideration, appropriate role-modelling, and fostering acceptance of group goals and teamwork. Based on a gender comparison, men perceived higher levels of leadership pertaining to role-modelling and intellectual stimulation, in addition to higher levels of quality for the coach-athlete relationship. This research emphasizes the importance of engaging in transformational leadership behaviours with regards to associations with perceptions of the coach-athlete relationship in elite sport contexts.
Multi-institutional and multi-disciplinary care: A successfully managed aortic dissection in the third trimester of pregnancy
Authors: Petch S , McCarthy CM , McLoughlin J , Dunn LE , Franta J , Ní Mhuircheartaigh R , Nölke L , Kennelly M , Donnelly JC
Published: May 2021

Multi-disciplinary collaborative care for pregnant women with complex and emergent conditions is essential. Logistical planning, clear communication and human factor awareness are all non-clinical skills which need to be utilised in order to maximise outcomes. We describe the case of a proximal aortic dissection in the late third trimester of pregnancy diagnosed in a peripheral hospital that was transferred to a cardiothoracic centre for successful operative management 160 km away. This required the time-sensitive mobilisation and liaison of a receiving cardiothoracic, anaesthesiology and perfusionist team in conjunction with obstetric and midwifery support from an affiliated maternity hospital, as well as the national neonatal transport team. We emphasise the importance of multidisciplinary team management in complex cases and how imperative good inter-disciplinary communication is to ensure safe inter-hospital transfer.
The contribution of bile acid metabolism to the pathogenesis of Clostridioides difficile infection
Authors: Mullish Benjamin H. , Allegretti Jessica R.
Published: May 2021

Clostridioides difficile infection (CDI) remains a major global cause of gastrointestinal infection, with significant associated morbidity, mortality and impact upon healthcare system resources. Recent antibiotic use is a key risk factor for the condition, with the marked antibiotic-mediated perturbations in gut microbiome diversity and composition that underpin the pathogenesis of CDI being well-recognised. However, only relatively recently has further insight been gained into the specific mechanistic links between these gut microbiome changes and CDI, with alteration of gut microbial metabolites – in particular, bile acid metabolism – being a particular area of focus. A variety of in vitro, ex vivo, animal model and human studies have now demonstrated that loss of gut microbiome members with bile-metabolising capacity (including bile salt hydrolases, and 7-α-dehydroxylase) – with a resulting alteration of the gut bile acid milieu – contributes significantly to the disease process in CDI. More specifically, this microbiome disruption results in the enrichment of primary conjugated bile acids (including taurocholic acid, which promotes the germination of C. difficile spores) and loss of secondary bile acids (which inhibit the growth of C. difficile, and may bind to and limit activity of toxins produced by C. difficile). These bile acid changes are also associated with reduced activity of the farnesoid X receptor pathway, which may exacerbate C. difficile colitis throughout its impact upon gut barrier function and host immune/inflammatory response. Furthermore, a key mechanism of efficacy of faecal microbiota transplant (FMT) in treating recurrent CDI has been shown to be restoration of gut microbiome bile metabolising functionality; ensuring the presence of this functionality among defined microbial communities (and other ‘next generation’ FMT products) designed to treat CDI may be critical to their success.
Selection of optimal first-line immuno-related therapy based on specific pathological characteristics for patients with advanced driver-gene wild-type non-small cell lung cancer: a systematic review and network meta-analysis
Authors: Sheng Lei , Gao Jing , Xu Qian , Zhang Xue , Huang Miao , Dai Xin , Li Song , Liu Lian
Published: May 2021

Background:

Although immune checkpoint inhibitors (ICIs) have improved survival for advanced wild-type non-small cell lung cancer (NSCLC), a lack of direct comparisons of various first-line treatments is clouding clinical decision-making. A network meta-analysis was conducted to compare current first-line treatments and identify the optimal regimen for patients with specific characteristics.

Methods:

PubMed, Embase, the Cochrane Central Register of Controlled Trials, Clinical Trials databases were searched from inception to 31 July 2020. Phase II/III randomized controlled trials (RCTs) comparing first-line treatments including chemotherapy, anti-angiogenesis, ICIs, and their combinations for previously untreated stage IIIB/IV or recurrent driver-gene wild-type NSCLC patients were included.

Results:

Twenty-six RCTs were identified and included, involving 16,977 patients and a total of 18 regimens. ICI-containing treatments led to significantly prolonged overall survival (OS) compared with ICI-free treatments (0.82, 0.72–0.93). ICI plus chemotherapy had significantly longer progression-free survival (PFS; 0.70, 0.58–0.86) and marginally longer OS (0.90, 0.79–1.05) compared with ICIs alone. Ranking highest in the Bayesian network meta-analysis, pembrolizumab plus chemotherapy, nivolumab plus ipilimumab and chemotherapy, had significantly superior OS than standard chemotherapy with or without bevacizumab treatments. Pembrolizumab-chemotherapy ranked first for OS, 1-year OS rate, and subgroups of non-squamous, PD-L1 ⩾1%, non-smoking, and liver metastasis; while nivolumab–ipilimumab–chemotherapy for squamous, PD-L1 <1%, brain metastasis NSCLC. Furthermore, the ICI-containing bevacizumab-free treatments, such as pembrolizumab plus chemotherapy, nivolumab and ipilimumab with or without chemotherapy, were not significantly different from atezolizumab plus chemotherapy and bevacizumab in OS.

Conclusions:

A combination of ICIs with chemotherapy, rather than double ICIs, is the best first-line treatment for advanced wild-type NSCLC, with synergy that leads to better long-term survival. The panoramic view of the relative efficacy of any two regimens with different rankings provides strong evidence for selecting optimal first-line ICIs according to patients’ clinical characteristics.
Viscosupplementation for the treatment of osteoarthritis. The contribution of EUROVISCO group
Authors: Conrozier Thierry , Raman Raghu , Chevalier Xavier , Henrotin Yves , Monfort Jordi , Diraçoglù Demirhan , Bard Hervé , Baron Dominique , Jerosch Jörg , Richette Pascal , Migliore Alberto
Published: May 2021

Viscosupplementation (VS) is a symptomatic treatment for knee and other joint osteoarthritis (OA). Despite a long history of use, conflicting opinions remain on the best clinical indications and the most appropriate patients to be treated with intra-articular hyaluronic acid (IA-HA), the optimal dosing regimen and the modalities of retreatment. A multidisciplinary committee of European experts on OA (EUROVISCO) was constituted to formulate recommendations, aimed at helping physicians in the decision-making and the optimal achievement of VS. Before each session members were tasked to collate an exhaustive literature review. Level of evidence and strength of recommendation were based on the level of agreement for each item according to the Delphi method. In 2015, a consensus position was proposed for 24 statements. Among those that obtained a consensual agreement, the working group stressed that VS is effective in mild/moderate knee OA but is not an alternative to surgery in advanced OA, and that dosing regimen must be supported by controlled trials. In 2018, two decision algorithms for the retreatment with IA-HA in knee OA were published. Among the key recommendations, the experts recommended to re-treat every year patients with high risk of OA progression, even if not symptomatic. In 2020, EUROVISCO published two sets of recommendations for the design of clinical trials on the disease-modifying effect of VS and for optimizing the results of VS. The working group underlined that an accurate analysis of radiological features and symptoms and a careful clinical examination may improve the chances of success of VS, as well as good technique of injection and the use of imaging guidance. Based on the exhaustive analysis of the literature and their own clinical experience, the EUROVISCO experts offer a wide range of recommendations intended to help practitioners, particularly in certain cases where the specific characteristics of the patients make the therapeutic decision difficult.
The Loyalty Program for Our Self-Esteem: The Role of Collective Self-Esteem in Luxury Hotel Membership Programs
Authors: Shin Minjung , Back Ki-Joon , Lee Choong-Ki , Lee Young-Sub
Published: May 2021

This research explores the social mechanism of luxury hotel membership programs and extends current loyalty program literature that has mainly examined membership programs from a mental-accounting perspective. By building upon the social identity theory, this study posits that luxury hotel membership programs provide social platforms, allowing members to construct a collective identity and collective self-esteem. Consequently, collective self-esteem is proposed as an antecedent of customer–brand relationship constructs, such as commitment, switching resistance, and word of mouth. Members from two South Korean luxury hotel membership programs were recruited to participate in a survey to test these constructs’ relationship, and findings demonstrate that membership programs’ effectiveness in cultivating a robust customer–brand relationship is contingent upon members’ collective self-esteem with the program. This correlation involves the four dimensions of collective self-esteem: membership esteem, private esteem, public esteem, and importance to identity. This study is preeminent to the current literature by identifying a critical psychological mechanism, which luxury hotel brand managers can leverage to successfully launch a membership program that ultimately cultivates enduring customer–brand relationships. The results of this study also suggest several managerial implications for hotel marketers to effectively design and manage membership programs by considering collective self-esteem’s four dimensions.
Effects of High-Speed Versus Traditional Resistance Training in Older Adults
Authors: Vieira Itamar P. , Lobo Patrícia C. B. , Fisher James , Ramirez-Campilo Rodrigo , Pimentel Gustavo D. , Gentil Paulo
Published: May 2021

Background:

The losses of strength, agility, balance, and functionality caused by aging are harmful to the elderly population. Resistance training (RT) may be an efficient tool to mitigate such neuromuscular decline and different RT methods can be used. Therefore, it is important to investigate the different responses to different training methods.

Hypothesis:

Eight weeks of traditional resistance training (TRT) are expected to promote similar results to high-speed training (HST) in physical functional performance (PFP) and quality of life in the elderly.

Study Design:

A clinical trial.

Level of Evidence:

Level 3.

Methods:

Participants (n = 24) with a mean age of 67.8 ± 6.3 years completed 8 weeks of RT. They were allocated into HST (n = 12) and TRT (n = 12). TRT involved training with 10 to 12 repetitions at controlled velocity until momentary muscle failure, while HST involved performing 6 to 8 repetitions at 40% to 60% of 1 repetition maximum (1RM) at maximum velocity. Pre- and posttraining, the participants were tested for (1) maximum strength in the 45° leg press and chest press; (2) PFP in the 30-second chair stand, timed-up-and-go (TUG), and medicine ball throw test; and (3) quality of life.

Results:

Both groups improved muscle strength in the 45° leg press, with greater increases for TRT (HST: +21% vs TRT: +49%, P = 0.019). There was no change in chest press strength for HST (−0.6%) ( P = 0.61), but there was a significant increase for the TRT group (+21%, P = 0.001). There was a similar improvement ( P < 0.05) for both groups in TUG (HST: 7%; TRT: 10%), chair stand (HST: 18%; TRT: 21%), and medicine ball throwing performance (HST: 9%; TRT: 9%), with no difference between groups ( P = 0.08-0.94). Emotional aspect significantly increased by 20% ( P = 0.04) in HST and 50% ( P = 0.04) in TRT.

Conclusion:

Both TRT and HST are able to promote improvements in functional performance in the elderly with greater in strength gains for TRT. Therefore, exercise professionals could choose based on individual characteristics and preferences.

Clinical Relevance:

The findings provide important insights into how health care professionals can prescribe HST and TRT, considering efficiency, safety, and individual aspects.
Anatomic Variations of Ethmoid Roof and Risk of Skull Base Injury in Endoscopic Sinus Surgery: Statistical Correlations
Authors: Fadda Gian Luca , Petrelli Alessio , Martino Federica , Succo Giovanni , Castelnuovo Paolo , Bignami Maurizio , Cavallo Giovanni
Published: May 2021

Background

Recent developments in endoscopic sinus surgery (ESS) have increased the need to investigate the complex anatomic variations in the ethmoid roof and skull base, to inform the surgeon about the risk of damaging these crucial areas during ESS.

Objective

To offer a detailed description of sinus anatomy focusing on the key surgical landmarks in ESS and frontal recess surgery to standardize a systematic approach during the preoperative sinuses imaging evaluation. Methodology: A total of 220 computed tomography (CT) scans were reviewed to obtain six sets of measurements: the depth of the cribriform plate (CP); the length of the lateral lamella of the cribriform plate (LLCP); the angle formed by the LLCP and the continuation of the horizontal plane passing through the CP; the position of the anterior ethmoidal artery (AEA) at the skull base; the extent of frontal sinus pneumatization (FSP); the type of superior attachment of the uncinate process (SAUP).

Results

The length of the LLCP was statistically significantly correlated with the different Keros classification types, the angle formed by the LLCP with the continuation of the horizontal plane passing through the CP, and with the AEA position at the skull base. The depth of the olfactory fossa was correlated with FSP.

Conclusions

According to the Keros and Gera classifications, the data obtained from these evaluations allow the assessment of anatomic-radiological risk profiles and can help identify those patients who are high risk for ethmoid roof injury.
The role of idecabtagene vicleucel in patients with heavily pretreated refractory multiple myeloma
Authors: Oriol Albert , Abril Laura , Torrent Anna , Ibarra Gladys , Ribera Josep-Maria
Published: May 2021

The development of several treatment options over the last 2 decades has led to a notable improvement in the survival of patients with multiple myeloma. Despite these advances, the disease remains incurable for most patients. Moreover, standard combinations of alkylating agents, immunomodulatory drugs, proteasome inhibitors, and monoclonal antibodies targeting CD38 and corticoids are exhausted relatively fast in a proportion of high-risk patients. Such high-risk patients account for over 20% of cases and currently represent a major unmet medical need. The challenge of drug resistance requires the development of highly active new agents with a radically different mechanism of action. Several immunotherapeutic modalities, including antibody–drug conjugates and T-cell engagers, appear to be promising choices for patients who develop resistance to standard combinations. Chimeric antigen-receptor-modified T cells (CAR-Ts) targeting B-cell maturation antigen have demonstrated encouraging efficacy and an acceptable safety profile compared with alternative options. Multiple CAR-Ts are in early stages of clinical development, but the first phase III trials with CAR-Ts are ongoing for two of them. After the recent publication of the results of a phase II trial confirming a notable efficacy and acceptable safety profile, idecabtagene vicleucel is the first CAR-T to gain regulatory US Food and Drug Administration approval to treat refractory multiple myeloma patients who have already been exposed to antibodies against CD38, proteasome inhibitors, and immunomodulatory agents and who are refractory to the last therapy. Here, we will discuss the preclinical and clinical development of idecabtagene vicleucel and its future role in the changing treatment landscape of relapsed and refractory multiple myeloma.
On Stereoscopic Art
Authors: Wade Nicholas J.
Published: May 2021

Pictorial art is typically viewed with two eyes, but it is not binocular in the sense that it requires two eyes to appreciate the art. Two-dimensional representational art works allude to depth that they do not contain, and a variety of stratagems is enlisted to convey the impression that surfaces on the picture plane are at different distances from the viewer. With the invention of the stereoscope by Wheatstone in the 1830s, it was possible to produce two pictures with defined horizontal disparities between them to create a novel impression of depth. Stereoscopy and photography were made public at about the same time and their marriage was soon cemented; most stereoscopic art is now photographic. Wheatstone sought to examine stereoscopic depth without monocular pictorial cues. He was unable to do this, but it was achieved a century later by Julesz with random-dot stereograms The early history of non-photographic stereoscopic art is described as well as reference to some contemporary works. Novel stereograms employing a wider variety of carrier patterns than random dots are presented as anaglyphs; they show modulations of pictorial surface depths as well as inclusions within a binocular picture.
Exogenous Bimodal Cues Attenuate Age-Related Audiovisual Integration
Authors: Ren Yanna , Zhang Ying , Hou Yawei , Li Junyuan , Bi Junhao , Yang Weiping
Published: May 2021

Previous studies have demonstrated that exogenous attention decreases audiovisual integration (AVI); however, whether the AVI is different when exogenous attention is elicited by bimodal and unimodal cues and its aging effect remain unclear. To clarify this matter, 20 older adults and 20 younger adults were recruited to conduct an auditory/visual discrimination task following bimodal audiovisual cues or unimodal auditory/visual cues. The results showed that the response to all stimulus types was faster in younger adults compared with older adults, and the response was faster when responding to audiovisual stimuli compared with auditory or visual stimuli. Analysis using the race model revealed that the AVI was lower in the exogenous-cue conditions compared with the no-cue condition for both older and younger adults. The AVI was observed in all exogenous-cue conditions for the younger adults (visual cue > auditory cue > audiovisual cue); however, for older adults, the AVI was only found in the visual-cue condition. In addition, the AVI was lower in older adults compared to younger adults under no- and visual-cue conditions. These results suggested that exogenous attention decreased the AVI, and the AVI was lower in exogenous attention elicited by bimodal-cue than by unimodal-cue conditions. In addition, the AVI was reduced for older adults compared with younger adults under exogenous attention.
About the Acceptance of Wearing Face Masks in Times of a Pandemic
Authors: Carbon Claus-Christian
Published: May 2021

Wearing face masks in times of COVID-19 is one of the essential keystones for effectively decreasing the rate of new infections and thus for mitigating the negative consequences for individuals as well as for society. Acceptance of wearing masks is still low in many countries, making it extremely difficult to keep the pandemic at bay. In an experimental study, participants ( N = 88) had to assess how strange they felt when wearing a face mask while being exposed to displays of groups of varying numbers of mask wearers. Three different types of face masks were shown: simple homemade masks, FFP2 masks, and loop scarfs. The higher the frequency of people wearing masks in the displayed social group, the less strange the participants felt about themselves, an essential precondition for accepting wearing masks. This effect of a descriptive social norm was particularly effective when people saw others wearing less intrusive masks, here, simple homemade masks.
Diabetic kidney disease: update on clinical management and non-glycaemic effects of newer medications for type 2 diabetes
Authors: de Bhailís Áine M. , Azmi Shazli , Kalra Philip A.
Published: May 2021

Type 2 diabetes is a leading cause of chronic kidney disease worldwide and continues to increase in prevalence. This in turn has significant implications for healthcare provision and the economy. In recent years there have been multiple advances in the glucose-lowering agents available for the treatment of diabetes, which not only modify the disease itself but also have important benefits in terms of the associated cardiovascular outcomes. The cardiovascular outcome trials of agents such as glucagon-like peptide-1 receptor agonists (GLP-RAs) and sodium glucose cotransporter 2 inhibitors (SGLT-2) have demonstrated significant benefits in reducing major adverse cardiovascular events, admissions for heart failure and in some cases mortality. Secondary analysis of these trials has also indicated significant renoprotective benefit. Canagliflozin and Renal Outcomes in Type 2 Diabetes Mellitus and Nephropathy (CREDENCE) a renal-specific trial, has shown major benefits with canagliflozin for renal outcomes in diabetic kidney disease, and similar trials with other SGLT-2 inhibitors are either underway or awaiting analysis. In this article we review current goals of treatment of diabetes and the implications of advancing renal impairment on choice of treatments. Areas discussed include the diagnosis of diabetic kidney disease and current treatment strategies for diabetic kidney disease ranging from lifestyle modifications to glycaemic control. This review focuses on the role of GLP-RAs and SGLT-2 inhibitors in treating those with diabetes and chronic kidney disease with some illustrative cases. It is clear that these agents should now be considered first choice in combination with metformin in those with diabetes and increased cardiovascular risk and/or reduced renal function, and in preference to other classes such as dipeptidyl peptidase-4 (DPP-4) inhibitors or sulphonylureas.
Association of interleukin-17A rs2275913 polymorphism with rheumatoid arthritis susceptibility in Sudanese population
Authors: Osman Rgda Mohamed , Noma Mounkaila , Ahmed Abdallah Elssir , Abdelbagi Hanadi , Omer Rihab Ali , Ali Musab M , Mohammed Alameen Ayman Ali , Edris Ali Mahmoud , Muneer Mohamed S. , Siddig Omayma , Hassan Rowa , Ahmed Eiman Siddig , Hassan Lamis Ahmed , Bakheet Osama El Hadi , Ahmed Ayman , Mohamed Nouh Saad , Siddig Emmanuel Edwar
Published: May 2021

Objectives:

Rheumatoid arthritis is a chronic inflammatory autoimmune disease. This study aimed to determine the association of interleukin-17A-197G/A polymorphism with rheumatoid arthritis in Sudanese patients.

Methods:

A case–control study was conducted between March and December 2018. Clinical and demographic data of the study participants were collected and analyzed. Polymerase chain reaction restriction fragment length polymorphism molecular technique was done to investigate interleukin-17A-197G/A polymorphisms. All statistical tests were considered statistically significant when p < 0.05.

Results:

The study population included 266 participants aged between 1 and 85 years, with an average of 40 years, classified into 85 (31.2%) cases (mean age 48.5 ± 11.3 years), and 181 (68.8%) controls (mean age 35.3 ± 15.9 years). The interleukin-17A homozygote AA genotype was more frequent among the control group compared to the case group; 95 (52.5%) and 7 (8.2%), respectively. The homozygote GG and the heterozygote AG genotypes were proportionally not different among the cases and control groups; 13 (54.2%) and 11 (45.8%), and 65 (46.4%) and 75 (53.6%), respectively. According to the distribution of interleukin-17A genotypes, a statistically significant difference was observed among cases with the interleukin-17A AA and AG genotypes, p values 0.001 and 0.004, respectively. For the association interleukin-17A genotypes and family history a negatively significant association was reported (95% confidence interval, –0.219, p value = 0.001). There was also a negatively significant association of interleukin-17A genotypes and anti-cyclic citrullinated peptide (95% confidence interval, −0.141, p value = 0.002).

Conclusion:

This study is the first study in Sudan established the association between interleukin-17A-197G/A (rs2275913) polymorphisms and susceptibly to rheumatoid arthritis. These findings appeal for further research in Sudan to investigate the exact role of IL-17A in immunopathology and disease severity among Sudanese rheumatoid arthritis
Newborn twins with perineal grooves
Authors: Rabinovich Hannah M , Montez Kimberly G
Published: May 2021

Twin girls born at term were noted to have hypertrophic and erythematous mucosal sulci extending from the posterior vaginal fourchette to the anterior ridge of the anus on their newborn exams. Pregnancy was complicated by gestational hypertension and dichorionic diamniotic twin pregnancy. No known traumas were sustained during delivery to either twin. Dermatology and obstetrics/gynecology were consulted who confirmed the diagnosis of perineal groove. Primary care follow-up was recommended, with referral to pediatric gynecology if the lesions did not epithelize by 2 years of age. Our case of perineal grooves is unique in that, to our knowledge, it is the first reported case of perineal grooves identified in both twins. Clinicians in the newborn nursery and primary care settings should perform routine genitourinary and anal examinations on all newborns to identify this benign lesion, which may limit misdiagnosis, inappropriate treatments, and invasive workups in the future.
Plant-inspired damage control – An inspiration for sustainable solutions in the Anthropocene
Authors: Speck Olga , Langer Max , Mylo Max D
Published: May 2021

The proclamation of the Anthropocene occurred simultaneously with consideration of the contribution of biomimetic products towards a more sustainable future. One major challenge is the purposeful handling of consumer goods in order to save resources and avoid waste. This can be achieved by damage control. In recent years, damage control exerted by plants has turned out to be a treasure trove of functional principles that can be transferred to technical systems. Plants prevent damage to themselves through the formation of gradient transitions by means of geometrical characteristics and biomechanical properties. Furthermore, they can respond structurally and mechanically to withstand higher stresses without damage. Damage management in plants includes the self-repair of wounds and the formation of abscission zones, the latter ensuring the controlled disintegration of biological materials systems. Plant-inspired solutions of damage control can contribute to Sustainable Development Goal 12 ‘responsible consumption and production patterns’ through the efficient use of resources and the reduction of waste generation.
Maternal multiple sclerosis is not a risk factor for neurodevelopmental disorders in offspring
Authors: Carta Alessandra , Zarbo Ignazio R , Scoppola Chiara , Pisuttu Giulia , Conti Marta , Melis Maria C , Martino Federica De , Serra Antonella , Biancu Maria A , Guerini Franca R , Bazzardi Riccardo , Sotgiu Stefano
Published: May 2021

Background

Childhood neurodevelopmental disorders (NDDs), including specific learning disorders (SLD), attention deficit/hyperactivity disorder (ADHD) and autism spectrum disorder (ASD), are pathogenically linked to familial autoimmunity and maternal immune-mediated diseases during pregnancy.

Objective

We studied maternal MS as a potential risk factor for NDDs occurrence in offspring.

Methods

MS and control mothers were subjected to questionnaires to ascertain NDD diagnosis in their progeny and the occurrence of both autoimmune and neurodevelopment disorders in their families. Suspected NDD cases were evaluated to confirm or rule out the diagnosis.

Results

Of the 322 MS women, 206 (64%) have 361 children; of these, 27 (7.5%) were diagnosed with NDD (11% ADHD; 22% ASD; 67% SLD). NDD-risk in offspring was associated to family history of autoimmunity and to NDDs both in MS and non-MS mother families ( r = 0.75; p = 0.005) whereas it was not associated to maternal MS.

Conclusions

For the first time, we demonstrate that maternal MS does not predispose children to higher risk for NDD. On a mechanistic view, we suggest that the intrinsic organ-specific nature of MS does not impair the mother–child cross-talk in decidua nor does it influence fetal neurodevelopment.
Assessment of immediate and non-immediate hypersensitivity contrast reactions by skin tests and provocation tests: A review
Authors: Bansie Rakesh D , Karim A Faiz , van Maaren Maurits S , Hermans Maud AW , van Daele Paul LA , Gerth van Wijk Roy , Rombach Saskia M
Published: May 2021

Introduction:

Allergic and nonallergic hypersensitivity reactions to iodinated contrast media (ICM) and gadolinium-based contrast media are classified as immediate or non-immediate hypersensitivity reactions (IHR and NIHR), respectively. Skin tests and provocation tests are recommended for the evaluation of hypersensitivity reactions to contrast agents; however provocations are not common in clinical practice.

Methods:

A MEDLINE search was conducted to investigate studies comprising both skin tests and provocation tests that evaluated hypersensitivity reactions to ICM.

Results:

Nineteen studies were identified that reported on skin tests, followed by provocations. In the case of IHR to ICM, 65/69 (94%) patients with a positive skin test for the culprit media tolerated a challenge with a skin-test-negative alternative ICM. In IHR to ICM with a negative skin test for the culprit media, provocations were positive in 3.2%–9.1% patients. In the case of a NIHR to ICM with a positive skin test, provocation with a skin-test-negative agent was tolerated in 75/105 (71%) of cases. In NIHR with a negative skin test for the culprit agent, re-exposure to the culprit or an alternative was positive in 0%–34.6% patients. Provocations with the same ICM in skin test positive patients with IHR or NIHR were positive for a majority of the patients, although such provocation tests were rarely performed. Data on hypersensitivity reactions, skin tests and provocations with gadolinium-based contrast media were limited; however, they exhibited a pattern similar to that observed in ICM.

Conclusion:

In both ICM and gadolinium-based contrast media, the risk of an immediate repeat reaction is low when skin tests are negative. In contrast, a provocation with a skin-test-positive contrast medium showed a high risk of an immediate repeat hypersensitivity reaction. Therefore, a thorough medical history is necessary, followed by skin tests. A provocation is recommended, for diagnostic work-up, when the diagnosis is uncertain.
Single sample scoring of hepatocellular carcinoma: A study based on data mining
Authors: Zhu Dan , Wu Zeng-Hong , Xu Ling , Yang Dong-Liang
Published: May 2021

Hepatocellular carcinoma (HCC) is a high mortality malignancy and the second leading cause of cancer-related deaths. Because the immune system plays a dual role by assisting the host barrier and tumor progression, there are complex interactions with considerable prognostic significance. Herein, we performed single-sample gene set enrichment (ssGSEA) to explore the tumor microenvironment (TME) and quantify the tumor-infiltrating immune cell (TIIC) subgroups of immune responses based on the HCC cohort of The Cancer Genome Atlas (TCGA) database. We evaluate molecular subpopulations, survival, function, and expression differential associations, as well as reveal potential targets, and biomarkers for immunotherapy. We combined the TME score and the 29 immune cell types in the low, medium, and high immunity groups. The stromal score, immune score, and ESTIMATE score were positively correlated with immune activity but negatively correlated with the tumor purity. There were 23 human leukocyte antigen (HLA)-related genes that were significantly different. However, KIAA1429 was not significant among the different immunity groups. Besides, programmed death-ligand 1 (PD-L1) and cytotoxic T-lymphocyte-associated antigen 4 (CTLA-4) expression increased with the increase of immune activity. This may provide valuable information for HCC immunotherapy. We also found that there was no significant difference in naïve B cells, macrophages M1, activated mast cells, resting natural killer (NK) cells, and T cells gamma delta among the different immunity groups. The Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway analysis revealed that the differential proteins were mainly enriched in alpha-linolenic acid (ALA) metabolism, cytokine-cytokine receptor interaction, glycosaminoglycan biosynthesis-heparan sulfate/heparin, glycosphingolipid biosynthesis-ganglio series and proteasome. Our findings provide a deeper understanding of the immune scene, uncovering remarkable immune infiltration patterns of various subtypes of HCC using ssGSEA. This study advances the understanding of immune response and provides a basis for research to enhance immunotherapy.
Keloidal pathophysiology: Current notions
Authors: Huang Chenyu , Ogawa Rei
Published: May 2021

Introduction:

Keloids are pathological scars that are notorious for their chronic and relentless invasion into adjacent healthy skin, with commonly seen post-therapeutic recurrence after monotherapies.

Methods:

An English literature review on keloid pathophysiology was performed by searching the PubMed, Embase and Web of Science databases, to find out the up-to-date relevant articles. The level of evidence was evaluated based on the included studies with the highest level of evidence first.

Results:

Keloid morphology, signs, symptoms and the histopathological changes that occur in the local cells and extracellular matrix components are described. The theories on the pathophysiology of keloidogenesis that have been proposed to date are also covered; these include endocrinological, nutritional, vascular, and autoimmunological factors. In addition, we describe the local mechanical forces (and the mechanosignalling pathways by which these forces shape keloid cell activities) that promote keloid formation and determine the direction of invasion of keloids and the body sites that are prone to them.

Conclusion:

A better understanding of this pathological entity, particularly its mechanobiology, will aid the development of new diagnostic and therapeutic strategies for use in the clinic to prevent, reduce or even reverse the growth of this pathological scar.

Lay Summary

Keloids are skin scars that are famous for their chronic invasion into healthy skin, with commonly seen recurrence after surgeries. Cells such as lymphocytes, macrophages, mast cells and endothelial cells are involved in keloid growth. Particularly, endocrinological, nutritional, vascular, autoimmunological and mechanical factors actively take part in keloid progression.
Chinese Traditional Culture Education: Implementing the Child’s Position and Perspective in the Elementary School Textbook Morality and Law
Authors: Zhang (章乐) Le
Published: May 2021

Purpose:

Failure to clarify the position of children in Chinese culture is a significant issue faced by Chinese traditional culture education (CTCE). Indeed, moral education needs to establish child’s perspective and position in Chinese society and incorporate these into the curricula on the excellent Chinese traditional culture. This study explores how the elementary school textbook, Morality and Law, has approached CTCE.

Design/Approach/Methods:

First, this article analyzes practical difficulties in CTCE: omission child’s position. Second, this article explores the child's position needed by CTCE based on Rousseau, Montessori, and Dewey’s contemporary views on children. At last, this article explores the strategy of how to implement the child’s position in CTCE based on Morality and Law.

Findings:

In respect to CTCE, Morality and Law positions children in various ways. In terms of its educational goal, the textbook is intended to improve children’s cultural education and appreciation. While the textbook’s editors mainly select positive content, negative content is also included. Always taking the child into consideration, the textbook incorporates systemized knowledge into children’s own lives, particularly insofar as the teaching strategy uses events or experiences in which children are interested.

Originality/Value:

Following the reform of China’s curriculum at the start of the 21st century, moral education textbooks were developed on the basis of the child’s position but remained weak in terms of traditional culture education. The approach adopted in Morality and Law and illustrated in this study bridges the gap between children and traditional culture, improves the effectiveness of CTCE, and provides other countries with insight based on China’s experiences in cultural education.