bluuebunny/crossref_metadata_2025 huggingface dataset:
Neonatal Device for Treatment of Hyperbilirubinemia by Phototherapy and Swaddling
Authors: Hsu Annika C. , Yueh Spencer L.
Published: May 2021

This paper details the development of a neonatal device for treatment of hyperbilirubinemia by phototherapy and swaddling. Hyperbilirubinemia is a condition which affects more than half of all neonates. It is commonly treated by phototherapy, but conventional phototherapy does not allow for swaddling which is extremely important to neonates. The functional goals of this device are to provide adequate phototherapy, to swaddle the neonate, and to enable access to the neonate during treatment. With feedback from neonatal intensive care unit physicians and nurses, we assembled a prototype of this device to demonstrate proof-of-concept. The prototype proves the feasibility and potential for the device concept. This paper describes the design criteria, features, comfort and safety details, and next considerations for future work.
A Miniature Laser Speckle Contrast Imager for Monitoring the Neuromodulatory Effect of Transcranial Ultrasound Stimulation
Authors: Zeng Yinuo , Acord Molly , Kaovasia Tarana Parvez , Miao Peng , Sun Junfeng , Tong Shanbao , Curry Eli , Aghabaglou Fariba , Theodore Nicholas , Thakor Nitish , Manbachi Amir
Published: May 2021

Transcranial ultrasound stimulation is a neuromodulation technique that is capable of exciting or suppressing the neural network. The neuromodulatory effect on cerebral hemodynamics has been monitored using optical methods like laser speckle contrast imaging in animal studies. However, the bulky size and stationary nature of the imaging system constrains the application of laser speckle contrast imaging on research that requires the animal to be in irregular body positions or to be awake. Here, we present a design using a miniature laser speckle contrast imager to monitor the cerebral blood flow changes during transcranial ultrasound stimulation in a rat model. We demonstrate its feasibility by showing that the results are comparable to those acquired from a traditional benchtop imaging system.
The Calibration of a Bioelectrical Impedance Spectroscopy Device
Authors: Choi JungHun
Published: May 2021

A Calibration is one of the key processes to design and implement of Bioelectrical Impedance Spectroscopy. Through the simulation, the specification of hardware can be determined and examined in the ideal condition. After the implementation of the device, the theoretical and measured values are different due to the uncertainties and noises from the environment. In this paper, the calibration procedure will be introduced and discussed for the different sets of electrodes. By adjusting the different values of the active electrodes and applying for the active shields, the measured value will be compared and discussed. Active electrodes and active shields will be a very effective way to isolate and minimize the noises and avoid unwanted stray capacitance values. Further investigations need to be followed to ensure the proposed way to reduce the noises and stray capacitances.
Design of an Ultrasound Probe Holder to Minimize Motion Artifact During Sonography
Authors: Mahapatra Smruti , Kaovasia Tarana Parvez , Ainechi Sufia , Ainechi Ana , Acord Molly , Curry Eli J. , Aghabaglou Fariba , Tyler Betty , Theodore Nicholas , Manbachi Amir
Published: May 2021

Standard diagnostic ultrasound imaging procedures heavily rely on a sonographer for image acquisition. Given the ultrasound probe is manually manipulated by the sonographer, there is a potential for noise artifacts like blurry acquired images caused by involuntary hand movements. Certain surgical procedures can also cause patients to exhibit involuntary “jumping” movements while on the operating table leading to further deterioration in ultrasound image quality. In this study, we attempt to mitigate these problems by fabricating a 3D-printed ultrasound probe holder. Due to the lightweight nature of the device, it can attach to surgical retractors without influencing the functionality of the retractor. Therefore, the 3D printed probe holder not only reduces relative motion between the probe and the patient, but also reduce the need for a sonographer during complex surgeries.
Design and Implementation of a Targeted Cardiocerebral Extracorporeal Oxygenation Membrane System
Authors: Tucker Aaron , Retherford Breanne , Rothweiler Paul , Selim Ahmed , Erdman Arthur
Published: May 2021

Outcomes for cardiac arrest (CA) are currently poor, even when CA is experienced in hospital. While the gold standard for treatment is extracorporeal membrane oxygenation (ECMO), cardiopulmonary resuscitation (CPR) is most often used to treat cardiac arrest. We propose a fundamental change in ECMO technology to increase access by reducing the amount of highly trained personnel required to perform this treatment. Additionally, we propose a design in which ECMO functionality is combined with functionality of an intra-aortic balloon pump (IABP) in order to further reduce cardiac workload in cases of cardiac arrest and cardiogenic shock.
Patient-Specific Three-Dimensional Computational Heart Modeling and Printing to Enhance Clinical Understandings and Treatment Planning: Congenital Recurrent Pulmonary Artery Stenosis and Transcatheter Pulmonary Valve Replacement
Authors: Tenhoff Amanda C. , Aggarwal Varun , Ameduri Rebecca , Deakyne Alex , Iles Tinen L. , Said Sameh M. , Griselli Massimo , Iaizzo Paul A.
Published: May 2021

Advances in the surgical and interventional management of children with congenital heart disease has improved survival and outcomes. Each such patient is born with specific anatomical variations which call for detailed evaluations so to plan for appropriate patient-specific management. Significant progress has been made in commercially available two-dimensional imaging – i.e. echocardiogram, CT, and MRI – yet using such, three-dimensional anatomical details can be difficult to accurately represent. In addressing this concern, it has been shown that patient-specific three-dimensional modeling can be useful for interventional procedural or surgical planning [1]. Here we present two cases for which patient-specific anatomical three-dimensional modeling and printing were utilized for (1) the pre-sizing and placement of stents within a complex bifurcation pulmonary artery stenosis; and (2) evaluating the candidacy of the patient’s anatomy for a transcatheter pulmonary valve placement. Detailed within this technical brief are de-identified case information, workflows for model generations, and results regarding clinical usage. In conclusion, we found these patient-specific models to be an advantageous resource for treatment planning in these two pediatric congenital heart disease cases.
A Soft Robotic Simulator for Transseptal Puncture Training
Authors: Thompson Nicholas A. , Kocheril Abraham G. , Hsiao-Wecksler Elizabeth T. , Krishnan Girish
Published: May 2021

Transseptal puncture (TP) is the technique used to access the left atrium of the heart from the right atrium via the interatrial septum in increasingly common catheter-based procedures such as atrial fibrillation ablation. Through repetition, experienced TP operators develop manual skills to manipulate the transseptal catheter assembly inside the right atrium to their target on the fossa ovalis. New operators currently train on actual patients to develop this skill, resulting in increased risk of dangerous complications. To create low-risk training opportunities for new TP operators, we are developing a Soft Active Transseptal Puncture Simulator (SATPS), designed to match the dynamics, kinetostatics, and visualization of the heart during TP. The SATPS includes three main subsystems: (i) An anatomically accurate soft right atrium, fitted with pneumatic artificial muscles, mimics the dynamics of the heart felt by the operator through the catheter assembly. (ii) A replaceable, puncturable fossa ovalis simulates the tissue properties of the real fossa to provide accurate kinetostatic force feedback during tenting and puncture. (iii) A simulated intracardiac echocardiography environment gives the user live visual feedback representative of an ultrasound monitor during an actual TP procedure. The SATPS is an ongoing project, with validation and design improvements forthcoming.
Utilization of Optical Coherence Tomography to Assess Coronary Vessel Constriction after Ablation
Authors: Ramirez David A , Valenzuela Thomas F , Brigham Renee C , Iaizzo Paul A
Published: May 2021

Epicardial ablations are being utilized as alternative techniques to the current endocardial procedures. An epicardial approach offers some advantages, especially when treating ventricular arrhythmias, e.g., those that have epicardial or transmural sites of origin. However the potential collateral damage from these applied myocardial surface ablations has not been fully explored. In order to better visualize and understand such effects on acute coronary functioning, we have employed intracoronary optical coherence tomography (OCT) of ablated cardiac tissues. Ex-vivo swine hearts were reanimated utilizing Visible Heart® Laboratories methodologies, then the midsection of the LAD was anatomically characterized via OCT before and after an applied epicardial ablation: including using irreversible electroporation (IRE), and radiofrequency ablation (RF). Post-ablation OCT scans revealed detectable coronary diameter reductions stemming from applied adjacent epicardial ablations. These initial results demonstrate a need for further explorations to better understand and thus minimize collateral damage during epicardial ablations.
A Comparison of Modern Frameworks for the Development of Interoperable Healthcare Information Systems
Authors: Pimentel Julio C. G. , Pimentel Eric C. , Dao Son
Published: May 2021

Despite the strong consensus behind the need for an interoperable Healthcare Information System (HIS), the universal acceptance of a standard HIS framework has advanced very little and is yet to become a market reality. In an effort to advance this endeavor, this work provides a systematic comparison regarding two of the most relevant HIS frameworks recently proposed: The Integrated Clinical Environment (ICE) and the Healthcare Industry 4.0 Framework. The paper analyzes their differences and similarities and proposes a minimum set of requirements for prospective interoperable HIS architectures compliant with the Industry 4.0 design principles, goal-setting pillars, as well as support for closed-loop physiological systems. Finally, the paper discusses future works in the field.
Leg Joint Mechanics When Hopping at Different Frequencies
Authors: Qiao Mu
Published: May 2021

Although the dynamics of center of mass can be accounted for by a spring-mass model during hopping, less is known about how each leg joint (ie, hip, knee, and ankle) contributes to center of mass dynamics. This work investigated the function of individual leg joints when hopping unilaterally and vertically at 4 frequencies (ie, 1.6, 2.0, 2.4, and 2.8 Hz). The hypotheses are (1) all leg joints maintain the function as torsional springs and increase their stiffness when hopping faster and (2) leg joints are controlled to maintain the mechanical load in the joints or vertical peak accelerations at different body locations when hopping at different frequencies. Results showed that all leg joints behaved as torsional springs during low-frequency hopping (ie, 1.6 Hz). As hopping frequency increased, leg joints changed their functions differently; that is, the hip and knee shifted to strut, and the ankle remained as spring. When hopping fast, the body’s total mechanical energy decreased, and the ankle increased the amount of energy storage and return from 50% to 62%. Leg joints did not maintain a constant load at the joints or vertical peak accelerations at different body locations when hopping at different frequencies.
High titers and low fucosylation of early human anti–SARS-CoV-2 IgG promote inflammation by alveolar macrophages
Authors: Hoepel Willianne , Chen Hung-Jen , Geyer Chiara E. , Allahverdiyeva Sona , Manz Xue D. , de Taeye Steven W. , Aman Jurjan , Mes Lynn , Steenhuis Maurice , Griffith Guillermo R. , Bonta Peter I. , Brouwer Philip J.M. , Caniels Tom G. , van der Straten Karlijn , Golebski Korneliusz , Jonkers René E. , Larsen Mads D. , Linty Federica , Nouta Jan , van Roomen Cindy P.A.A. , van Baarle Frank E.H.P. , van Drunen Cornelis M. , Wolbink Gertjan , Vlaar Alexander P.J. , de Bree Godelieve J. , Sanders Rogier W. , Willemsen Lisa , Neele Annette E. , van de Beek Diederik , Rispens Theo , Wuhrer Manfred , Bogaard Harm Jan , van Gils Marit J. , Vidarsson Gestur , de Winther Menno , den Dunnen Jeroen
Published: May 2021

High titers and low fucosylation of human anti–spike protein IgG promote alveolar macrophage activation and inflammation.
Influence of Taxonomic and Functional Content of Microbial Communities on the Quality of Fermented Cocoa Pulp-Bean Mass
Authors: Mota-Gutierrez Jatziri , Ferrocino Ilario , Giordano Manuela , Suarez-Quiroz Mirna Leonor , Gonzalez-Ríos Oscar , Cocolin Luca
Published: May 2021

Monitoring the composition, structure, functionalities and metabolic potential encoded at the level of DNA of fermented cocoa pulp-bean mass metagenome is of great importance for food safety and quality implications.
Coexpression of a β-
d
-Xylosidase from Thermotoga maritima and a Family 10 Xylanase from Acidothermus cellulolyticus Significantly Improves the Xylan Degradation Activity of the Caldicellulosiruptor bescii Exoproteome
Authors: Kim Sun-Ki , Russell Jordan , Cha Minseok , Himmel Michael E. , Bomble Yannick J. , Westpheling Janet
Published: May 2021

Caldicellulosiruptor
species are bacteria that grow at extremely high temperature, more than 75°C, and are the most thermophilic bacteria so far described that are capable of growth on plant biomass. This native ability allows the use of unpretreated biomass as a growth substrate, eliminating the prohibitive cost of preprocessing/pretreatment of the biomass.
Propionate Production from Carbon Monoxide by Synthetic Cocultures of Acetobacterium wieringae and Propionigenic Bacteria
Authors: Moreira João P. C. , Diender Martijn , Arantes Ana L. , Boeren Sjef , Stams Alfons J. M. , Alves M. Madalena , Alves Joana I. , Sousa Diana Z.
Published: May 2021

Syngas fermentation has great potential for the sustainable production of chemicals from wastes (via prior gasification) and flue gases containing CO/CO
2
. Research efforts need to be directed toward expanding the product portfolio of gas fermentation, which is currently limited to mainly acetate and ethanol.
Critical Determinants of Cytokine Storm and Type I Interferon Response in COVID-19 Pathogenesis
Authors: Ramasamy Santhamani , Subbian Selvakumar
Published: May 2021

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causes coronavirus disease 2019 (COVID-19), a rapidly evolving pandemic worldwide with at least 68 million COVID-19-positive cases and a mortality rate of about 2.2%, as of 10 December 2020. In about 20% of COVID-19 instances, the disease exhibits moderate to severe symptoms.
Genetic Analysis of Sirtuin Deacetylases in Hyphal Growth of
Candida albicans
Authors: Zhao Guolei , Rusche Laura N.
Published: May 2021

Candida albicans
is one of the most common causes of hospital-acquired systemic fungal infections in the United States. It can switch between ovoid yeast and elongated hyphal growth forms in response to environmental cues.
Do Primocolonizing Bacteria Enable Bacteroides thetaiotaomicron Intestinal Colonization Independently of the Capacity To Consume Oxygen?
Authors: Halpern David , Morvan Claire , Derré-Bobillot Aurélie , Meylheuc Thierry , Guillemet Mélanie , Rabot Sylvie , Gruss Alexandra
Published: May 2021

Aerobic bacteria are frequent primocolonizers of the human naive intestine. Their generally accepted role is to eliminate oxygen, which would allow colonization by anaerobes that subsequently dominate bacterial gut populations.
Development of a New Reverse Genetics System for Ebola Virus
Authors: Gan Tianyu , Zhou Dihan , Huang Yi , Xiao Shuqi , Ma Ziyue , Hu Xiaoyou , Tong Yimin , Yan Huimin , Zhong Jin
Published: May 2021

Ebola virus is among the most dangerous viral pathogens, with a case fatality rate of up to 90%. Since 2013, the two largest and most complex Ebola outbreaks in West Africa have revealed the lack of investigation on this notorious virus.
Effect of Subcutaneous Anti-CD20 Antibody-Mediated B Cell Depletion on Susceptibility to Pneumocystis Infection in Mice
Authors: Dai Guixiang , Noell Kristin , Weckbecker Gisbert , Kolls Jay K.
Published: May 2021

Anti-CD20 antibody therapy is used for both cancer and autoimmune disease but has been shown to be associated with
Pneumocystis
pneumonia in humans. This study shows that low-dose subcutaneous anti-CD20 can modulate B cell populations without grossly perturbing fungal immunity against
Pneumocystis
lung infection.
Clearance of Clostridioides difficile Colonization Is Associated with Antibiotic-Specific Bacterial Changes
Authors: Lesniak Nicholas A. , Schubert Alyxandria M. , Sinani Hamide , Schloss Patrick D.
Published: May 2021

The community of microorganisms, or microbiota, in our intestines prevents pathogens likeC. difficilefrom colonizing and causing infection. However, antibiotics can disturb the gut microbiota, which allowsC. difficileto colonize.C. difficileinfections (CDI) are primarily treated with antibiotics, which frequently leads to recurrent infections because the microbiota has not yet returned to a resistant state.
Early and middle Miocene ice sheet dynamics in the Ross Sea: Results from integrated core-log-seismic interpretation
Authors: Pérez Lara F. , Santis Laura De , McKay Robert M. , Larter Robert D. , Ash Jeanine , Bart Phil J. , Böhm Gualtiero , Brancatelli Giuseppe , Browne Imogen , Colleoni Florence , Dodd Justin P. , Geletti Riccardo , Harwood David M. , Kuhn Gerhard , Laberg Jan Sverre , Leckie R. Mark , Levy Richard H. , Marschalek James , Mateo Zenon , Naish Timothy R. , Sangiorgi Francesca , Shevenell Amelia E. , Sorlien Christopher C. , van de Flierdt Tina ,   International Ocean Discovery Program Expedition 374 Scientists
Published: May 2021

Oscillations in ice sheet extent during early and middle Miocene are intermittently preserved in the sedimentary record from the Antarctic continental shelf, with widespread erosion occurring during major ice sheet advances, and open marine deposition during times of ice sheet retreat. Data from seismic reflection surveys and drill sites from Deep Sea Drilling Project Leg 28 and International Ocean Discovery Program Expedition 374, located across the present-day middle continental shelf of the central Ross Sea (Antarctica), indicate the presence of expanded early to middle Miocene sedimentary sections. These include the Miocene climate optimum (MCO ca. 17–14.6 Ma) and the middle Miocene climate transition (MMCT ca. 14.6–13.9 Ma). Here, we correlate drill core records, wireline logs and reflection seismic data to elucidate the depositional architecture of the continental shelf and reconstruct the evolution and variability of dynamic ice sheets in the Ross Sea during the Miocene. Drill-site data are used to constrain seismic isopach maps that document the evolution of different ice sheets and ice caps which influenced sedimentary processes in the Ross Sea through the early to middle Miocene. In the early Miocene, periods of localized advance of the ice margin are revealed by the formation of thick sediment wedges prograding into the basins. At this time, morainal bank complexes are distinguished along the basin margins suggesting sediment supply derived from marine-terminating glaciers. During the MCO, biosiliceous-bearing sediments are regionally mapped within the depocenters of the major sedimentary basin across the Ross Sea, indicative of widespread open marine deposition with reduced glacimarine influence. At the MMCT, a distinct erosive surface is interpreted as representing large-scale marine-based ice sheet advance over most of the Ross Sea paleo-continental shelf. The regional mapping of the seismic stratigraphic architecture and its correlation to drilling data indicate a regional transition through the Miocene from growth of ice caps and inland ice sheets with marine-terminating margins, to widespread marine-based ice sheets extending across the outer continental shelf in the Ross Sea.
Consideration of pulmonary thromboembolism in paediatric patients presenting to the emergency department with abdominal pain
Authors: Ibrahim Wasyla , Mushtaq Farhat
Published: May 2021

Venous thromboembolism (VTE) is a recognised complication of lower limb trauma in adult patients and classically presents with cardiopulmonary symptoms. However, the risk of VTE and its presenting signs and symptoms are less well documented in the paediatric population. We report the case of a child who presented to our emergency department with abdominal pain 2 weeks after lower limb fracture, who was subsequently found to have a pulmonary thromboembolism (PTE). This case report highlights the importance of having a high index of suspicion for VTE in the paediatric population if there are predisposing risk factors and to consider PTE as a differential cause of abdominal pain. To the authors’ knowledge, no case has been described in which a child presenting with abdominal pain was consequently found to have a pulmonary embolism.
Fulminant methicillin-sensitiveStaphylococcus aureusinfection: from pinprick to multiorgan failure
Authors: Danyalian Aunie , Padron Ivett , Almeida Patricia , Danckers Mauricio
Published: May 2021

A woman in her 60s with diabetes presented to our institution with altered mental status. Preceding symptoms included headaches, nausea and vomiting. One month prior to presentation, she cut her left thumb and developed a pustule, which she occasionally manipulated with a non-sterile needle. On arrival, the patient was in shock, with a Glasgow Coma Scale of 3, requiring emergent intubation and intensive care unit admission. Her initial imaging studies revealed a large pericardial effusion and cerebral subcortical hypodensities. She suffered from a cardiopulmonary arrest with return of spontaneous circulation, with bedside echocardiogram revealing cardiac tamponade. She underwent emergent pericardiocentesis which revealed purulent drainage. Blood, pericardial fluid, cerebrospinal fluid, sputum and urine cultures returned positive for methicillin-sensitiveStaphylococcus aureus. The hospital course was further complicated by refractory septic shock and fulminant multiorgan failure, ultimately leading to her demise.
Massive lateral neck mass: aberrant ectopic thyroid malignancy
Authors: Singh Vartika , Srinivas Teerthanath , Bhat Shubha , Goel Shreya
Published: May 2021

Lateral aberrant ectopic thyroid is very rare, comprising only 1%–3% of all the ectopic thyroid tissue. Clinically, these lesions are mistaken for lymph node swelling or metastatic tumour. Primary carcinoma in lateral aberrant ectopic thyroid with normal active native thyroid is very uncommon. We report a case of papillary carcinoma in lateral aberrant ectopic thyroid tissue, with a completely normal native thyroid gland in a 53-year-old man, who presented with a massive swelling in the lateral aspect of the neck clinically and radiologically diagnosed as a malignant soft tissue tumour with differential diagnosis of malignant lymphoma. Fine needle aspiration cytology revealed metastatic papillary carcinoma. In toto excision of the soft tissue mass along with subtotal thyroidectomy was performed. Histology of the mass revealed papillary carcinoma of lateral aberrant ectopic thyroid, while the thyroid gland did not show evidence of malignancy. The postsurgical period was uneventful, and the patient underwent radioiodine ablation.
Vaccination as a possible trigger for immune-mediated necrotising myopathy
Authors: Cavalcanti Julia Francesca Bonato , Silva Maria Beatriz Almeida , Alves de Siqueira Carvalho Alzira
Published: May 2021

Immune-mediated necrotising myopathy is a rare autoimmune myopathy characterised by severe progressive muscle weakness, elevated levels of creatine kinase (CK), and necrosis with minimal inflammatory cell infiltration on muscle biopsy. We report a case of a previously healthy 42-year-old woman who presented with progressive muscle weakness 2 weeks after immunisation for yellow fever, tetanus/diphtheria and hepatitis B. Her symptoms started from the lower limbs and progressed to the upper limbs and cervical region associated with dysphagia, making her wheelchair bound. Electromyography showed a myopathic pattern, with a CK level of 12.177 U/L (reference value: 26–190 U/L), and biceps brachial muscle biopsy confirmed necrosis and regeneration fibres. The immunoblot test was positive for antisignal recognition particle. She was successfully treated with prednisone (1 mg/kg/day). Although considered safe, vaccines may cause allergic reactions or trigger autoimmune disorders. Currently, a causal relationship between them cannot be established.
Calcinosis cutis in a renal transplant patient
Authors: Nguyen Nguyen T , Shakir Mohamed K M , Hoang Thanh Duc
Published: May 2021

Calcinosis cutis is an unusual disorder characterised by calcium–phosphate deposition into cutaneous and subcutaneous tissues. There are five subtypes: dystrophic, metastatic, idiopathic, iatrogenic and calciphylaxis. Our objective was to report a patient with a history of haemodialysis-dependent end-stage renal disease (ESRD) who developed metastatic calcinosis cutis, which is usually associated with abnormalities of calcium–phosphate metabolism in renal failure. In our patient, the serum calcium and phosphate levels were normal. Additionally, we describe the diagnostic approach and the difficulties involved in the management of calcinosis cutis in patients with haemodialysis-dependent ESRD.
Child mortality associated with maternal HIV status: a retrospective analysis in Rwanda, 2005-2015
Authors: Remera Eric , Chammartin Frédérique , Nsanzimana Sabin , Forrest Jamie Ian , Smith Gerald E , Mugwaneza Placidie , Malamba Samuel S , Semakula Muhammed , Condo Jeanine U , Ford Nathan , Riedel David J , Nisingizwe Marie Paul , Binagwaho Agnes , Mills Edward J , Bucher Heiner
Published: May 2021

Introduction

Child mortality remains highest in regions of the world most affected by HIV/AIDS. The aim of this study was to assess child mortality rates in relation to maternal HIV status from 2005 to 2015, the period of rapid HIV treatment scale-up in Rwanda.

Methods

We used data from the 2005, 2010 and 2015 Rwanda Demographic Health Surveys to derive under-2 mortality rates by survey year and mother’s HIV status and to build a multivariable logistic regression model to establish the association of independent predictors of under-2 mortality stratified by mother’s HIV status.

Results

In total, 12 010 live births were reported by mothers in the study period. Our findings show a higher mortality among children born to mothers with HIV compared with HIV negative mothers in 2005 (216.9 vs 100.7 per 1000 live births) and a significant reduction in mortality for both groups in 2015 (72.0 and 42.4 per 1000 live births, respectively). In the pooled reduced multivariable model, the odds of child mortality was higher among children born to mothers with HIV, (adjusted OR, AOR 2.09; 95% CI 1.57 to 2.78). The odds of child mortality were reduced in 2010 (AOR 0.69; 95% CI 0.59 to 0.81) and 2015 (AOR 0.35; 95% CI 0.28 to 0.44) compared with 2005. Other independent predictors of under-2 mortality included living in smaller families of 1–2 members (AOR 5.25; 95% CI 3.59 to 7.68), being twin (AOR 4.93; 95% CI 3.51 to 6.92) and being offspring from mothers not using contraceptives at the time of the survey (AOR 1.6; 95% CI 1.38 to 1.99). Higher education of mothers (completed primary school: (AOR 0.74; 95% CI 0.64 to 0.87) and secondary or higher education: (AOR 0.53; 95% CI 0.38 to 0.74)) was also associated with reduced child mortality.

Conclusions

This study shows an important decline in under-2 child mortality among children born to both mothers with and without HIV in Rwanda over a 10-year span.
Why do people purchase antibiotics over-the-counter? A qualitative study with patients, clinicians and dispensers in central, eastern and western Nepal
Authors: Adhikari Bipin , Pokharel Sunil , Raut Shristi , Adhikari Janak , Thapa Suman , Paudel Kumar , G C Narayan , Neupane Sandesh , Neupane Sanjeev Raj , Yadav Rakesh , Shrestha Sirapa , Rijal Komal Raj , Marahatta Sujan B , Cheah Phaik Yeong , Pell Christopher
Published: May 2021

Introduction

Over-the-counter (OTC) use of antibiotics contributes to the burgeoning rise in antimicrobial resistance (AMR). Drawing on qualitative research methods, this article explores the characteristics of OTC sales of antibiotic in Nepal, its drivers and implications for policy.

Methods

Data were collected in and around three tertiary hospitals in eastern, western and central Nepal. Using pre-defined guides, a mix of semi-structured interviews and focus group discussions were conducted with dispensers at drug stores, patients attending a hospital and clinicians. Interviews were audio-recorded, translated and transcribed into English and coded using a combination of an inductive and deductive approach.

Results

Drug shops were the primary location where patients engaged with health services. Interactions were brief and transactional: symptoms were described or explicit requests for specific medicine made, and money was exchanged. There were economic incentives for clients and drug stores: patients were able to save money by bypassing the formal healthcare services. Clinicians described antibiotics as easily available OTC at drug shops. Dispensing included the empirical use of broad-spectrum antibiotics, often combining multiple antibiotics, without laboratory diagnostic and drug susceptibility testing. Inappropriately short regimens (2–3 days) were also offered without follow-up. Respondents viewed OTC antibiotic as a convenient alternative to formal healthcare, the access to which was influenced by distance, time and money. Respondents also described the complexities of navigating various departments in hospitals and little confidence in the quality of formal healthcare. Clinicians and a few dispensers expressed concerns about AMR and referred to evadable policies around antibiotics use and poor enforcement of regulation.

Conclusions

The findings point to the need for clear policy guidance and rigorous implementation of prescription-only antibiotics.
Association between proton pump inhibitor use and gastric cancer: a population-based cohort study using two different types of nationwide databases in Korea
Authors: Seo Seung In , Park Chan Hyuk , You Seng Chan , Kim Jae Young , Lee Kyung Joo , Kim Jinseob , Kim Yerim , Yoo Jong Jin , Seo Won-Woo , Lee Hyung Seok , Shin Woon Geon
Published: May 2021

Objective

The association between proton pump inhibitor (PPI) use and gastric cancer related toHelicobacter pylorieradication has not been fully investigated in geographical regions with high risk of gastric cancer. We aimed to evaluate the association between PPIs and gastric cancer in Korea.

Design

This study analysed the original and common data model versions of the Korean National Health Insurance Service database from 2002 to 2013. We compared the incidence rates of gastric cancer after 1-year drug exposure, between new users of PPIs and other drugs excluding PPIs, by Cox proportional hazards model. We also analysed the incidence of gastric cancer among PPI users afterH. pylorieradication.

Results

The analysis included 11 741 patients in matched PPI and non-PPI cohorts after large-scale propensity score matching. During a median follow-up of 4.3 years, PPI use was associated with a 2.37-fold increased incidence of gastric cancer (PPI≥30 days vs non-PPI; 118/51 813 person-years vs 40/49 729 person-years; HR 2.37, 95% CI 1.56 to 3.68, p=0.001). The incidence rates of gastric cancer showed an increasing trend parallel to the duration of PPI use. InH. pylori-eradicated subjects, the incidence of gastric cancer was significantly associated with PPI use over 180 days compared with the non-PPI group (PPI≥180 days vs non-PPI; 30/12 470 person-years vs 9/7814 person-years; HR 2.22, 95% CI 1.05 to 4.67, p=0.036).

Conclusion

PPI use was associated with gastric cancer, regardless ofH. pylorieradication status. Long-term PPIs should be used with caution in high-risk regions for gastric cancer.
Real-time EndoFaster improvesHelicobacter pyloridetection in chronic active gastritis
Authors: Zullo Angelo , Germanà Bastianello , Galliani Ermenegildo , Iori Andrea , De Pretis Giovanni , Manfredi Guido , Buscarini Elisabetta , Guarnieri Giovanni , Cannizzaro Renato , Buonocore Matteo Rossano , Monica Fabio
Published: May 2021

Helicobacter pyloriis the most frequent cause of chronic active gastritis (CAG), namely the first step for gastric cancer development. When infection is not detected at histology, another test is advised. EndoFaster is novel device that reveal the presence ofH. pyloriby determining ammonium concentration in the gastric juice during endoscopy. We evaluated whether this test may improve etiological diagnosis in CAG patients. In 595 consecutive patients who underwent upper endoscopy gastric juice was analysed with EndoFaster and standard biopsies were taken. CAG with typical bacteria was detected in 102 (17.1%) patients, and CAG withoutH. pyloriwas found in 36 (6.3%) cases. EndoFaster detected the infection in 22 (61.1%) of these patients. Neither ongoing proton pump inhibitor therapy nor previous eradication therapy affect the test accuracy. By using EndoFaster, another test to search for the infection inH. pylori-negative CAG patients may be avoided in more than 60% of cases, impacting on both patients discomfort and health resources use.
The Care-coordination Approach to Learning Lupus Self-Management: a patient navigator intervention for systemic lupus inpatients
Authors: White Ashley A , Ba Aissatou , Faith Trevor Daniel , Ramakrishnan Viswanathan , Dismuke-Greer Clara L , Oates Jim C , Williams Edith Marie
Published: May 2021

Objective

The Care-coordination Approach to Learning Lupus Self-Management (CALLS) study was designed to improve SLE disease self-management. This study aims to assess the benefits of the intervention compared with existing lupus care.

Methods

Participants were randomly assigned to participate in 12-weekly phone sessions with the patient navigator that included structured educational content, care coordination and patient-centred support services, or a usual care control condition. Validated measures of health literacy, self-efficacy, patient activation and disease activity were collected. We used least squares means and linear mixed-effects regression models for each outcome variable to assess the changes in outcome, from baseline to postintervention and to estimate the difference in these changes between the intervention and control group.

Results

Thirty participants were enrolled and 14 were randomised to the treatment group. For perceived lupus self-efficacy, there was a significant increase in mean score for the intervention group, but not for the control group. With regard to disease activity, the experimental group experienced a slight decrease in mean flare score in the previous 3 months, whereas the control group experienced a slight increase, but this finding did not reach statistical significance. Trends were similar in self-reported global disease activity, but none of the findings were significant. Health literacy and patient activation measure scores remained largely unchanged throughout the study for the two groups.

Conclusion

These findings suggest that the CALLS intervention may work to improve aspects of SLE disease self-management. Future research will be needed to validate these findings long-term.

Trial registration number

NCT04400240.
Histological evaluation of acute ischemic stroke thrombi may indicate the occurrence of vessel wall injury during mechanical thrombectomy
Authors: Mereuta Oana Madalina , Abbasi Mehdi , Fitzgerald Seán , Dai Daying , Kadirvel Ram , Hanel Ricardo A , Yoo Albert J , Almekhlafi Mohammed A , Layton Kennith F , Delgado Almandoz Josser E , Kvamme Peter , Mendes Pereira Vitor , Jahromi Babak S , Nogueira Raul G , Gounis Matthew J , Patel Biraj , Aghaebrahim Amin , Sauvageau Eric , Bhuva Parita , Soomro Jazba , Demchuk Andrew M , Thacker Ike C , Kayan Yasha , Copelan Alexander , Nazari Pouya , Cantrell Donald Robert , Haussen Diogo C , Al-Bayati Alhamza R , Mohammaden Mahmoud , Pisani Leonardo , Rodrigues Gabriel Martins , Puri Ajit S , Entwistle John , Meves Alexander , Arturo Larco Jorge L , Savastano Luis , Cloft Harry J , Kallmes David F , Doyle Karen M , Brinjikji Waleed
Published: May 2021

Background

Several animal studies have demonstrated that mechanical thrombectomy (MT) for acute ischemic stroke (AIS) may cause vessel wall injury (VWI). However, the histological changes in human cerebral arteries following MT are difficult to determine.

Objective

To investigate the occurrence of VWI during MT by histological and immunohistochemical evaluation of AIS clots.

Methods

As part of the multicenter STRIP registry, 277 clots from 237 patients were analyzed using Martius Scarlett Blue stain and immunohistochemistry for CD34 (endothelial cells) and smooth muscle actin (smooth muscle cells).

Results

MT devices used were aspiration catheters (100 cases), stentriever (101 cases), and both (36 cases). VWI was found in 33/277 clots (12%). There was no significant correlation between VWI and MT device. The degree of damage varied from grade I (mild intimal damage, 24 clots), to grade II (relevant intimal and subintimal damage, 3 clots), and III (severe injury, 6 clots). VWI clots contained significantly more erythrocytes (p=0.006*) and less platelets/other (p=0.005*) than non-VWI clots suggesting soft thrombus material.

Thrombolysis correlated with a lower rate of VWI (p=0.04*). VWI cases showed a significantly higher number of passes (2 [1–4] vs 1 [1–3], p=0.028*) and poorer recanalization outcome (p=0.01*) than cases without VWI.

Conclusions

Histological markers of VWI were present in 12% of AIS thrombi, suggesting that VWI might be related to MT. VWI was associated with soft thrombus consistency, higher number of passes and poorer revascularization outcome. There was no significant correlation between VWI and MT device.
Chronic airflow obstruction and ambient particulate air pollution
Authors: Amaral Andre F S , Burney Peter G J , Patel Jaymini , Minelli Cosetta , Mejza Filip , Mannino David M , Seemungal Terence A R , Mahesh Padukudru Anand , Lo Li Cher , Janson Christer , Juvekar Sanjay , Denguezli Meriam , Harrabi Imed , Wouters Emiel F M , Cherkaski Hamid , Mortimer Kevin , Jogi Rain , Bateman Eric D , Fuertes Elaine , Al Ghobain Mohammed , Tan Wan , Obaseki Daniel O , El Sony Asma , Studnicka Michael , Aquart-Stewart Althea , Koul Parvaiz , Lawin Herve , Nafees Asaad Ahmed , Awopeju Olayemi , Erhabor Gregory E , Gislason Thorarinn , Welte Tobias , Gulsvik Amund , Nielsen Rune , Gnatiuc Louisa , Kocabas Ali , Marks Guy B , Sooronbaev Talant , Mbatchou Ngahane Bertrand Hugo , Barbara Cristina , Buist A Sonia
Published: May 2021

Smoking is the most well-established cause of chronic airflow obstruction (CAO) but particulate air pollution and poverty have also been implicated. We regressed sex-specific prevalence of CAO from 41 Burden of Obstructive Lung Disease study sites against smoking prevalence from the same study, the gross national income per capita and the local annual mean level of ambient particulate matter (PM2.5) using negative binomial regression. The prevalence of CAO was not independently associated with PM2.5 but was strongly associated with smoking and was also associated with poverty. Strengthening tobacco control and improved understanding of the link between CAO and poverty should be prioritised.
Lung function in children with cystic fibrosis in the USA and UK: a comparative longitudinal analysis of national registry data
Authors: Schlüter Daniela K , Ostrenga Josh S , Carr Siobhán B , Fink Aliza K , Faro Albert , Szczesniak Rhonda D , Keogh Ruth H , Charman Susan C , Marshall Bruce C , Goss Christopher H , Taylor-Robinson David
Published: May 2021

Rationale

A previous analysis found significantly higher lung function in the US paediatric cystic fibrosis (CF) population compared with the UK with this difference apparently decreasing in adolescence and adulthood. However, the cross-sectional nature of the study makes it hard to interpret these results.

Objectives

To compare longitudinal trajectories of lung function in children with CF between the USA and UK and to explore reasons for any differences.

Methods

We used mixed effects regression analysis to model lung function trajectories in the study populations. Using descriptive statistics, we compared early growth and nutrition (height, weight, body mass index), infections (Pseudomonas aeruginosa, Staphylococcus aureus) and treatments (rhDnase, hypertonic saline, inhaled antibiotics).

Results

We included 9463 children from the USA and 3055 children from the UK with homozygous F508del genotype. Lung function was higher in the USA than in the UK when first measured at age six and remained higher throughout childhood. We did not find important differences in early growth and nutrition, or P.aeruginosa infection. Prescription of rhDNase and hypertonic saline was more common in the USA. Inhaled antibiotics were prescribed at similar levels in both countries, but Tobramycin was prescribed more in the USA and colistin in the UK. S. aureus infection was more common in the USA than the UK.

Conclusions

Children with CF and homozygous F508del genotype in the USA had better lung function than UK children. These differences do not appear to be explained by early growth or nutrition, but differences in the use of early treatments need further investigation.
The tundra phenology database: more than two decades of tundra phenology responses to climate change
Authors: Prevéy Janet S. , Elmendorf Sarah Claire , Bjorkman Anne , Alatalo Juha M. , Ashton Isabel , Assmann Jakob J. , Björk Robert G. , Björkman Mats P. , Cannone Nicoletta , Carbognani Michele , Chisholm Chelsea , Clark Karin , Collins Courtney G. , Cooper Elisabeth J. , Elberling Bo , Frei Esther R. , Henry Gregory R.H. , Hollister Robert D. , Høye Toke Thomas , Jónsdóttir Ingibjörg Svala , Kerby Jeffrey T. , Klanderud Kari , Kopp Christopher , Levesque Esther , Mauritz Marguerite , Molau Ulf , Myers-Smith Isla H. , Natali Susan M. , Oberbauer Steven F. , Panchen Zoe , Petraglia Alessandro , Post Eric , Rixen Christian , Rodenhizer Heidi , Rumpf Sabine B. , Schmidt Niels Martin , Schuur Ted , Semenchuk Philipp , Smith Jane Griffin , Suding Katharine , Totland Ørjan , Troxler Tiffany , Wahren Henrik , Welker Jeffrey M. , Wipf Sonja , Yang Yue
Published: May 2021

Observations of changes in phenology have provided some of the strongest signals of the effects of climate change on terrestrial ecosystems. The International Tundra Experiment (ITEX), initiated in the early 1990s, established a common protocol to measure plant phenology in tundra study areas across the globe. Today, this valuable collection of phenology measurements depicts the responses of plants at the colder extremes of our planet to experimental and ambient changes in temperature over the past decades. The database contains 150 434 phenology observations of 278 plant species taken at 28 study areas for periods of 1–26 years. Here we describe the full data set to increase the visibility and use of these data in global analyses and to invite phenology data contributions from underrepresented tundra locations. Portions of this tundra phenology database have been used in three recent syntheses, some data sets are expanded, others are from entirely new study areas, and the entirety of these data are now available at the Polar Data Catalogue ( https://doi.org/10.21963/13215 ).
Saikosaponin-d protects against liver fibrosis by regulating the estrogen receptor-β/NLRP3 inflammasome pathway
Authors: Lin Liubing , Zhou Mengen , Que Renye , Chen Yirong , Liu Xiaolin , Zhang Kehui , Shi Zhe , Li Yong
Published: May 2021

Liver fibrosis is the most common pathway in most types of chronic liver damage, characterized by an imbalance of ECM degradation and synthesis. Saikosaponin-d (SSd) possesses anti-inflammatory and anti-fibrotic effects. However, the underlying mechanism by which SSd represses hepatic stellate cell (HSC) activation remains unclear. Here, we found that SSd remarkably alleviated carbon tetrachloride (CCl4)-induced liver fibrosis, as evidenced by decreased collagen levels and profibrotic marker (COl1a1 and α-smooth muscle actin (SMA)) expression. SSd repressed CCl4-induced NOD-like receptor family pyrin-domain-containing-3 (NLRP3) activation in fibrotic livers, as suggested by decreased levels of NLRP3, IL-18, and IL-β. The primary HSCs of CCl4 mice exhibited a significant increase in profibrotic marker expression and NLRP3 activation, but SSd treatment reversed this effect. SSd also repressed TGF-β-induced profibrotic marker expression and NLRP3 activation in vitro. Mechanistically, TGF-β decreased the expression of estrogen receptor-β (ERβ) in HSCs, whereas SSd treatment reversed this effect. ERβ inhibition enhances NLRP3 activation in HSCs. More importantly, ERβ or NLRP3 inhibition partially destroyed the function of SSd in liver fibrosis. In summary, the current data suggest that SSd prevents hepatic fibrosis by regulating the ERβ/NLRP3 inflammasome pathway and suggests SSd as a potential agent for treating liver fibrosis.
Establishing the first hidden-charm pentaquark with strangeness
Authors: Chen Hua-Xing , Chen Wei , Liu Xiang , Liu Xiao-Hai
Published: May 2021

We study the $$P_{cs}(4459)^0$$

P

cs

(
4459
)

0

recently observed by LHCb using the method of QCD sum rules. Our results support its interpretation as the $${{\bar{D}}}^* \varXi _c$$

D

¯

∗

Ξ
c

hadronic molecular state of either $$J^P=1/2^-$$

J
P

=
1
/

2
-

or $$3/2^-$$

3
/

2
-

. Within the hadronic molecular picture, the three LHCb experiments observing $$P_c$$

P
c

and $$P_{cs}$$

P

cs

states (Aaij et al., Phys Rev Lett 115:072001, 2015; Aaij et al., Phys Rev Lett 122:222001, 2019; Aaij et al., arXiv:2012.10380 [hep-ex], 2012) can be well understood as a whole. This strongly supports the existence of hadronic molecules, whose studies can significantly improve our understanding on the construction of the subatomic world. To verify this picture, we propose to further investigate the $$P_{cs}(4459)^0$$

P

cs

(
4459
)

0

to examine whether it can be separated into two states, and to search for the $${{\bar{D}}} \varXi _c$$

D

¯

Ξ
c

molecular state of $$J^P=1/2^{-}$$

J
P

=
1
/

2
-

.
Towards Automation of Short-Term Financial Distress Detection: A Real-World Case Study
Authors: Sutiene Kristina , Luksys Kestutis , Kundeliene Kristina
Published: May 2021

The bankruptcy prediction research domain continues to evolve with the main aim of developing a model suitable for real-world application in order to detect early stages of financial distress of a company. The recent developments in computing, combined with the potential applications of big data technologies and artificial intelligence solutions have already made possible the integration of timely and recent information about business activities in order to monitor the financial health of companies. Therefore, this paper focuses on the predictions made a few months prior to the potential default of a company with the aim of identifying the determinants that signal about the insolvency. The experiments include in-depth analysis of model performances using different dataset configurations.