bluuebunny/crossref_metadata_2025 huggingface dataset:
Preventing weight gain in adults: A systematic review and meta‐analysis of randomized controlled trials
Authors: Martin Julie C. , Awoke Mamaru Ayenew , Misso Marie L. , Moran Lisa J. , Harrison Cheryce L.
Published: May 2021

Weight gain prevention is a global public health priority to address escalating adiposity in adults. This review evaluates the efficacy of weight gain prevention trials targeting adults aged 18–50 years and adheres to the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) protocol. Trials of any duration from inception to May 2020 that evaluated a weight gain prevention intervention (using either prescriptive diet, prescriptive physical activity, prescriptive diet, and/or physical activity or non‐prescriptive lifestyle) and included weight or body mass index (weight [kg]/height [m2]) were eligible. Twenty‐nine trials across 34 publications (participants n = 37,407) were included. Intervention resulted in less weight gain compared with controls (−1.15 kg [95% CI −1.50, −0.80 kg] p < 0.001). Subgroup analysis demonstrated greater effectiveness with prescriptive (−1.60 kg [95% CI −2.00, −1.19] p < 0.001) compared with non‐prescriptive (−0.81 kg [95% CI 1.10, −0.53] p < 0.001) intervention types. Interventions had greatest impact in healthy weight (18.5–24.9 kg/m2) (−0.82 kg [95% CI −1.5, −0.50] p < 0.001) or overweight (25.0–29.9 kg/m2) (−1.48 kg [95% CI −1.85, −1.12] p < 0.001) compared with obese populations (≥30.0 kg/m2) (−0.56 kg [95% CI −1.40, 0.27] p = 0.19). These findings demonstrate that lifestyle intervention prevents cumulative weight gain in non‐obese adults, with future research required to inform cost‐effectiveness and implementation feasibility.
Person‐centred communication with cancer survivors: Exploring the meaning of follow‐up coaching conversations
Authors: Timmermann Connie , Ammentorp Jette , Birkelund Regner
Published: May 2021

Aim

The aim of this study was to explore the meaning of a coaching intervention for cancer survivors.

Background

Cancer survivors often experience existential concerns and worries after adjuvant treatment. A number of “care transition interventions” have been developed to improve person‐centred care by empowering patients. Several of these interventions include a “care transition coach”. A coaching approach to communication used in health care communication have among others shown to assists in establishing confidential relationships between health professionals, increase the patient's well‐being and support the patient's experience of being met and viewed as a whole person.

Design

This is a qualitative study using semi‐structured interviews to explore the meaning of a coaching intervention. In analyzing and interpreting the qualitative interviews Ricoeur's theory of interpretation was applied.

Method

The intervention consisted of two parts: (1) a two‐day training program in coaching for nurses and (2) a specially developed communication intervention for cancer survivors.

Results and discussion

The analysis of the transcribed interview material led to the development of two themes: (1) Support in moving forward in life, and (2) An opportunity to talk about existential thoughts and worries. Our results show how the experience of cancer, even when cured, leaves the survivors with profound existential worries. The cancer survivors described how coaching conversations allowed them to express their current concerns and provided them with an opportunity to discuss wider issues than treatment, symptoms, and after‐effects, which had been the main focus during treatment.

Conclusion

The time immediately after the end of adjuvant treatment can be challenging, with many existential concerns and opposing emotions. We found that the follow‐up coaching conversations performed helped the cancer survivors to process many of these difficult thoughts and feelings.
The novel HLA‐A*26:174 allele was identified in a Chinese individual
Authors: Wang Jielin , You Xuan , Tao Sudan , He Ji , Zhu Faming
Published: May 2021

HLA‐A*26:174 shows a single nucleotide substitution at position 148 G>T when compared to HLA‐A*26:01:01:01.
Modeling the Response of Structure–Tuned Liquid Damper Systems Under Large Amplitude Excitation Using Smoothed Particle Hydrodynamics
Authors: McNamara K. P. , Tait M. J.
Published: May 2021

The tuned liquid damper (TLD) is a system used to reduce the response of tall structures. Numerical modeling is a very important tool when designing TLDs. Many existing numerical models are capable of accurately capturing the structure–TLD system response at serviceability levels, covering the range where TLDs are primarily intended to perform. However, these models often have convergence issues when considering more extreme structural excitations. The goal of this study is to develop a structure–TLD model without convergence limitations at large amplitude excitations. A structure–TLD numerical model where the TLD is represented by a two-dimensional incompressible smoothed particle hydrodynamics (ISPH) scheme is presented. The TLD contains damping screens which are represented by a force term based on the Morison equation. The performance of the model is assessed by comparing to experimental data for a structure–TLD system undergoing large amplitude excitations consisting of 4-h random signals and shorter transient signals. The model shows very good agreement with the experimental data for the structural response. The free surface response of the TLD is captured accurately by the model for the lower excitation forces considered, however as the excitation force is increased there are some discrepancies. The large amplitude excitations also result in smoothed particle hydrodynamics (SPH) fluid particles penetrating the boundaries, resulting in degradation of the model performance over the 4-h simulations. Overall, the model is shown to capture the response of a structure–TLD system undergoing large amplitude excitations well.
Aerothermal Effect of Cavity Welding Beads on a Transonic Squealer Tip
Authors: Vieira Joao , Coull John , Ireland Peter , Romero Eduardo
Published: May 2021

High-pressure turbine blade tips are critical for gas turbine performance and are sensitive to small geometric variations. For this reason, it is increasingly important for experiments and simulations to consider real geometry features. One commonly absent detail is the presence of welding beads on the cavity of the blade tip, which are an inherent by-product of the blade manufacturing process. This paper therefore investigates how such welds affect the Nusselt number, film cooling effectiveness and aerodynamic performance.

Measurements are performed on a linear cascade of high-pressure turbine blades at engine realistic Mach and Reynolds numbers. Two cooled blade tip geometries were tested: a baseline squealer geometry without welding beads, and a case with representative welding beads added to the tip cavity. Combinations of two tip gaps and several coolant mass flow rates were analyzed. Pressure sensitive paint was used to measure the adiabatic film cooling effectiveness on the tip, which is supplemented by heat transfer coefficient measurements obtained via infrared thermography. Drawing from all of this data, it is shown that the weld beads have a generally detrimental impact on thermal performance, but with local variations. Aerodynamic loss measured downstream of the cascade is shown to be largely insensitive to the weld beads.
Aerothermal Optimization of Turbine Squealer Tip Geometries With Arbitrary Cooling Injection
Authors: De Maesschalck C. , Andreoli V. , Paniagua G. , Gillen T. , Barker B.
Published: May 2021

The optimization of the turbine rotor tip geometry remains a vital opportunity to create more efficient and durable engines. Balancing the aerodynamic and thermal aspects, while maintaining the mechanical integrity, is key to reshape one of the most vulnerable and life-determining parts of the entire turbine. The ever-increasing turbine gas temperatures, combined with the difficulty of cooling the tip and the aerodynamically penalizing nature of the overtip leakage vortex, make the design of the tip a truly multidisciplinary challenge.

While many earlier efforts focused on uncooled geometries or studied the aerothermal impact with a fixed cooling configuration, the current paper presents the outcome of a multi-objective optimization where both the squealer rim geometry and the cooling injection pattern were allowed to vary simultaneously. This study explores a significantly wider design space, seeking a further synergistic aerothermal benefit through the combination of a quasi-fully arbitrary cooling arrangement, with mutating squealer rim structures. Specifically, the current manuscript presents the results of over 330 cooled and uncooled squealer tip geometries. The high-pressure turbine tip was automatically altered using a novel parametrization strategy adopting a maximum of 40 design variables to vary the squealer rim structures, as well as the size and location of the various cooling holes. The aerodynamic and thermal characteristics of every design were evaluated through Reynolds-averaged Navier–Stokes computational fluid dynamics (CFD) simulations with the k–ω shear-stress transport (SST) model for the turbulence closure, adopting an unstructured hexahedral grid typically containing more than 8 × 106 cells. A multi-objective differential evolution algorithm was used to obtain a Pareto front of designs which maximize the aerodynamic efficiency, while minimizing the overtip thermal loads. Eventually, a detailed investigation and robustness study was performed on a set of prime squealer geometries, to further investigate the aerodynamic flow topology and the effect of various cooling injection schemes on the heat transfer patterns.
Scaled reassigned spectrograms applied to linear transducer signals
Authors: Starkhammar Josefin , Reinhold Isabella , Erlöv Tobias , Sandsten Maria
Published: May 2021

This study evaluates the applicability of scaled reassigned spectrograms (ReSTS) on ultrasound radio frequency data obtained with a clinical linear array ultrasound transducer. The ReSTS's ability to resolve axially closely spaced objects in a phantom is compared to the classical cross-correlation method with respect to the ability to resolve closely spaced objects as individual reflectors using ultrasound pulses with different lengths. The results show that the axial resolution achieved with the ReSTS was superior to the cross-correlation method when the reflected pulses from two objects overlap. A novel B-mode imaging method, facilitating higher image resolution for distinct reflectors, is proposed.
Scattering of low-frequency acoustic waves from a moving source by the sea surface
Authors: Bennaceur Iannis , Cristol Xavier
Published: May 2021

This paper examines the scattering of a monochromatic acoustic wave by sea-surface gravity waves in the 1–200 Hz frequency range. The source is moving in a straight line at a constant speed, and the acoustic waves are traveling upward in a refractive channel. Considering the scales of the problem, the small perturbation method coupled with the normal-mode theory and an asymptotic analysis are used to derive the first-order scattered pressure field p1. This method, established by Labianca and Harper [J. Acoust. Soc. Am. 61(2), 378–389 (1977)], allows p1 to be expressed with normal-mode functions, which are computed numerically using the in-house modal propagation code MOCTESUMA for any sound-speed profile. The pressure field is calculated in a deep-water configuration with a moving source inside a summer thermocline. First, the spatial distribution of p1 is found to follow the diffraction grating formula. Particular attention is drawn to the border between the propagative and evanescent regimes in which singularities in the theory lead to computational difficulties. Subsequently, the power spectral density of the pressure field is computed and the Doppler sidebands, asymmetrically shifted from the carrier frequency, are examined.
Physical Activity, Screen Time, and Sleep Trajectories From Childhood to Adolescence: The Influence of Sex and Body Weight Status
Authors: Guimarães Roseane de Fátima , Mathieu Marie-Eve , Reid Ryan E.R. , Henderson Mélanie , Barnett Tracie Ann
Published: May 2021

Background: Behavioral trajectories from childhood to adolescence may differ and are poorly understood. The authors estimated the trajectories of moderate to vigorous physical activity (MVPA), screen time, and sleep duration during this period, by sex and initial weight status. Methods: Data from Quebec Adiposity and Lifestyle Investigation in Youth, an ongoing cohort study in Canada on the natural history of obesity, were used. Participants predisposed to obesity attended baseline (8–10 y old, n = 630) and follow-up visits 2 years (n = 564) and 7 years (n = 359) after baseline. Participants with completed self-reported and accelerometer-based data were included in the analyses (n = 191, 353, and 240 for MVPA, screen time, and sleep, respectively). The authors performed group-based trajectory analyses and multinomial logistic regression models. Results: Two MVPA, 3 screen time, and 2 sleep trajectories were identified. Girls were more likely than boys to belong to trajectory with lower MVPA means (odds ratio [OR] = 6.45; 95% confidence interval [CI], 3.08 to 13.49), yet less likely to belong to the trajectory with higher screen time (OR = 0.47; 95% CI, 0.23 to 0.97) and lower sleep duration (OR = 0.46; 95% CI, 0.27 to 0.78). Overweight or obesity at baseline was associated with a greater likelihood of belonging to the trajectory with lower MVPA (OR = 10.99; 95% CI, 1.31 to 91.14) and higher screen time (OR = 2.01; 95% CI, 1.04 to 4.06), respectively. Conclusions: It appears to be gender- and weight-based determinants of behavioral trajectories in this sample. These results may provide guidance for interventions in similar populations.
Reliability of a Clinical Test for Measuring Eccentric Knee Flexor Strength Using a Handheld Dynamometer
Authors: Oliveira Gabriel dos Santos , Ribeiro-Alvares João Breno de Araujo , de Lima-e-Silva Felipe Xavier , Rodrigues Rodrigo , Vaz Marco Aurélio , Baroni Bruno Manfredini
Published: May 2021

Context: Eccentric knee flexor strength assessments have a key role in both prevention and rehabilitation of hamstring strain injuries. Objective: To verify the reliability of a clinical test for measuring eccentric knee flexor strength during the Nordic hamstring exercise using a commercially available handheld dynamometer. Design: Reliability study. Setting: Physical Therapy Laboratory, Federal University of Health Sciences of Porto Alegre (Brazil). Participants: Fifty male amateur athletes (soccer or rugby players; 24 [3] y). Main Outcome Measures: Eccentric knee flexor strength. Results: When compared with a load cell–based device, the clinical test using a handheld dynamometer provided smaller force values (P < .05) with large effect sizes (.92–1.21), moderate intraclass correlation (.60–.62), typical error of 30 to 31 N, and coefficient of variation of 10% to 11%. Regarding the test–retest reproducibility (2 sessions separated by 1 week), the clinical test provided similar force values (P > .05) with only small effect sizes (.20–.27), moderate to good correlation (.67–.76), typical error of 23 to 24 N, and coefficient of variation of 9% to 10%. Conclusion: The clinical test with handheld dynamometer proposed by this study can be considered an affordable and relatively reliable tool for eccentric knee flexor strength assessment in the clinical setting, but results should not be directly compared with those provided by load cell–based devices.
Effects of Visual Biofeedback on Symmetrical Movements During Bridge Exercise With Sling
Authors: Kim Soo-Yong , Oh Jae-Seop , Kang Min-Hyeok
Published: May 2021

Context: Asymmetrical movements of trunk and lower-extremity are common during the bridge exercise on the unstable condition. However, no studies have investigated whether visual biofeedback of pressing pressure on the unstable surface changes muscle activation patterns of trunk and hip extensors and pelvic rotation during the bridge exercise. Objective: To investigate how visual biofeedback of pressing pressure influences symmetrical activity of lumbar and hip extensor and pelvic rotation. Design: Cross-sectional study. Setting: Laboratory. Participants: Twenty healthy males participated in this study. Interventions: The participants performed 2 versions of the bridge exercise: the standard bridge exercise and the bridge exercise with visual biofeedback using amount of pressing pressure on the sling. Main Outcome Measures: Surface electromyography was used to measure the symmetry (ie, the difference between dominant and nondominant sides) of muscle activation in the bilateral erector spinae, gluteus maximus, and hamstring muscles, and motion sensors were used to assess pelvic rotation. Symmetry of pressing pressure was measured using a tension meter. Results: The differences between the dominant and nondominant pressing pressures and differences between the electromyography activity of the dominant and nondominant erector spinae, gluteus maximus, and hamstring were significantly smaller during the bridge exercise with visual biofeedback than during the standard bridge exercise (P < .05). In addition, there was significantly less pelvic rotation during the bridge exercise with visual biofeedback than during the standard bridge exercise (P < .05). Conclusions: The present findings suggest that visual biofeedback strategy may be a useful method for enhancing the symmetrical activation of the erector spinae, gluteus maximus, and hamstring and for reducing pelvic rotation during the bridge exercise on the unstable surface.
The Host Cellular Immune Response to Infection by Campylobacter Spp. and Its Role in Disease
Authors: Callahan Sean M. , Dolislager Carolina G. , Johnson Jeremiah G.
Published: May 2021

Campylobacter
spp. are the leading cause of bacterium-derived gastroenteritis worldwide, impacting 96 million individuals annually. Unlike other bacterial pathogens of the gastrointestinal tract,
Campylobacter
spp. lack many of the classical virulence factors that are often associated with the ability to induce disease in humans, including an array of canonical secretion systems and toxins.
A Murine Model for Enhancement of Streptococcus pneumoniae Pathogenicity upon Viral Infection and Advanced Age
Authors: Joma Basma H. , Siwapornchai Nalat , Vanguri Vijay K. , Shrestha Anishma , Roggensack Sara E. , Davidson Bruce A. , Tai Albert K. , Hakansson Anders P. , Meydani Simin N. , Leong John M. , Bou Ghanem Elsa N.
Published: May 2021

Streptococcus pneumoniae
(pneumococcus) resides asymptomatically in the nasopharynx (NP) but can progress from benign colonizer to lethal pulmonary or systemic pathogen. Both viral infection and aging are risk factors for serious pneumococcal infections. Previous work established a murine model that featured the movement of pneumococcus from the nasopharynx to the lung upon nasopharyngeal inoculation with influenza A virus (IAV) but did not fully recapitulate the severe disease associated with human coinfection.
Genomic Analysis of the Yet-Uncultured Binatota Reveals Broad Methylotrophic, Alkane-Degradation, and Pigment Production Capacities
Authors: Murphy Chelsea L. , Sheremet Andriy , Dunfield Peter F. , Spear John R. , Stepanauskas Ramunas , Woyke Tanja , Elshahed Mostafa S. , Youssef Noha H.
Published: May 2021

A wide range of microbial lineages remain uncultured, yet little is known regarding their metabolic capacities, physiological preferences, and ecological roles in various ecosystems. We conducted a thorough comparative genomic analysis of 108 genomes belonging to the Binatota (UBP10), a globally distributed, yet-uncharacterized bacterial phylum.
Systems Analysis of Gut Microbiome Influence on Metabolic Disease in HIV-Positive and High-Risk Populations
Authors: Armstrong Abigail J. S. , Quinn Kevin , Fouquier Jennifer , Li Sam X. , Schneider Jennifer M. , Nusbacher Nichole M. , Doenges Katrina A. , Fiorillo Suzanne , Marden Tyson J. , Higgins Janine , Reisdorph Nichole , Campbell Thomas B. , Palmer Brent E. , Lozupone Catherine A.
Published: May 2021

The gut microbiome in people living with HIV (PLWH) is of interest since chronic infection often results in long-term comorbidities. Metabolic disease is prevalent in PLWH even in well-controlled infection and has been linked with the gut microbiome in previous studies, but little attention has been given to PLWH.
Anti-amphiphysin positive stiff-person syndrome due to invasive ductal carcinoma in a male patient
Authors: Connolly Christopher , Cobain Erin , Hughes Tasha
Published: May 2021

Stiff-person syndrome (SPS) is a rare progressive neurological disorder characterised by painful muscle spasms and progressive muscle rigidity, leading in some cases to impaired ambulation. Anti-amphiphysin positive SPS is a paraneoplastic variant, frequently associated with breast carcinomas and small cell lung cancers. We report the case of a 53-year-old patient who developed symptoms of anti-amphiphysin positive SPS 3 years before being diagnosed with invasive ductal carcinoma. Specifically, computed tomography (CT) of the chest, abdomen and pelvis, positron emission tomography-CT (PET-CT), mammogram, colonoscopy and magnetic resonance imaging (MRI) did not identify malignancy during the 3 years following the onset of symptoms. Following diagnosis of invasive ductal carcinoma and completion of curative-intent oncological treatment, the patient experienced improvement, though not complete resolution, in his SPS symptoms. This case highlights the importance of thorough oncological workup when clinical presentation and diagnostic testing are suggestive of anti-amphiphysin positive SPS.
Rapid resolution of choroidal metastatic tumour secondary to lung cancer following treatment with alectinib
Authors: AL-Janabi Ahmed , Han May Thu , Busby Deborah , Burton Benjamin J L
Published: May 2021

A 64-year-old man presented with reduced vision in the right eye (visual acuity of 6/24 Snellen). The patient reported having a chronic cough and recent weight loss with difficulty in swallowing and abnormal liver function test 8 months prior to his presentation. He was a chronic smoker for 45 years, having quit a year earlier. Fundus examination showed a unifocal large yellow–brown subretinal mass involving the posterior segment of the eye and associated with subretinal fluid. The patient was diagnosed with a choroidal metastasis and was referred urgently to the oncology team who confirmed the presence of non-small cell lung cancer with distant metastases. He started treatment with alectinib (second-generation tyrosine kinase inhibitor). A few weeks later, his vision improved and, on examination, there was complete resolution of the choroidal mass and the associated subretinal fluid. Alectinib led to rapid resolution of his choroidal secondary and has excellent ocular safety profile.
Rhabdomyolysis and severe biphasic disturbance of calcium homeostasis secondary to COVID-19 infection
Authors: Li Adrian Po Zhu , Thomas Stephen , Gokmen Refik , Kariyawasam Dulmini
Published: May 2021

We report a case of severe hypercalcaemia secondary to rhabdomyolysis in a woman with COVID-19 (SARS CoV-2) infection. The patient presented with myalgia and anuria with an acute kidney injury requiring haemodialysis. Creatine kinase peaked at 760 000 IU/L. A biphasic calcaemic response was observed with initial severe hypocalcaemia followed by severe, symptomatic hypercalcaemia, persistent despite haemodialysis. Control of the calcium levels was achieved by continuous haemofiltration.
Subfoveal retinal pigment epithelium inflammatory lesion presenting as a sign of reactivation of tubercular multifocal choroiditis
Authors: Kaza Hrishikesh , Gala Jignesh Manshibhai , Rani Padmaja Kumari
Published: May 2021

Multifocal choroiditis (MFC) can be associated with ocular tuberculosis (TB). Inflammatory peripapillary choroidal neovascular membrane (PPCNVM) is uncommon in TB MFC. Subretinal pigment epithelial inflammatory lesions are suggestive of acute inflammation or reactivation of inflammation in the setting of MFC. We present a case of MFC, of tubercular aetiology, during course of treatment of PPCNVM developed a subfoveal retinal pigment epithelial lesion. Clinical examination suggested a recurrence of PPCNVM, with the new macular lesions posing a dilemma of new onset inflammatory choroidal neovascular membrane (CNVM) at the macula versus reactivation of choroiditis at the posterior pole. Multimodal imaging helped differentiate the lesion from CNVM and give the appropriate antitubercular treatment to prevent future recurrences.
Tenofovir-induced osteomalacia with hypophosphataemia
Authors: Iatan Iulia , Lee Todd C , McDonald Emily G
Published: May 2021

Tenofovir disoproxil fumarate (TDF) is an antiretroviral drug widely used as a first-line treatment of hepatitis B virus (HBV) and HIV. Increasing evidence has emerged associating its use with the development of Fanconi syndrome, renal insufficiency and bone disease. We report a case of a 61-year-old woman with a remote history of liver transplant for cirrhosis due to HBV. Over 1 year, the patient had recurrent falls, generalised myalgias and arthralgias, misdiagnosed as fibromyalgia. We discuss a complication of her transplant treatment regimen with the drug TDF leading to a rare but reversible disorder: tenofovir-induced Fanconi osteomalacia with renal phosphate wasting. Though recognised, this rare disorder was initially likely missed due to clinical unfamiliarity with the diagnosis, concomitant psychiatric symptoms and premature diagnostic closure.
IgG4-related disease: an atypical presentation of steroid-responsive renal mass
Authors: Ng Shu Hui , Tay Jing Shin , Lai Ee Ling
Published: May 2021

IgG4-related disease (IgG4-RD) is a systemic fibroinflammatory disease characterised by dense lymphoplasmacytic infiltration rich in IgG4-positive plasma cells, storiform fibrosis and obliterative phlebitis. Serum IgG4levels are typically elevated but half of the patients had normal serum IgG4levels. IgG4-RD represents a spectrum of diseases that involve various organs such as the pancreas, liver, kidneys, and salivary glands often manifesting as diffuse organ enlargement or a mass-like lesion mimicking cancer. An increased incidence of malignancy among patients with IgG4-RD has been reported. Thus, differentiating malignancy from IgG4-RD manifestation is important as the treatment differs. Glucocorticoids are considered first-line therapy and should be started early to prevent fibrosis. Patients usually have an excellent clinical response to steroids, and poor steroid response is indicative of an alternative diagnoses such as malignancy. This case report describes a case of IgG4-RD with renal mass in a young man that resolved with glucocorticoid therapy alone.
Symptomatic nodular myopathy: an atypical presentation of sarcoidosis
Authors: Ellatif Mostafa , Bhasin Parthdev , Urigo Carlo , Sahu Ajay
Published: May 2021

Symptomatic myopathy is a very rare extrapulmonary manifestation of sarcoidosis that may not be readily recognised in the absence of a known history of sarcoid. Nodular myopathy is the most uncommon subtype of musclar sarcoidosis and, when encountered, establishing the diagnosis can be challenging. We present a case of symptomatic nodular myopathy as a first presentation of sarcoidosis in a young man who required a multidisciplinary approach to diagnose. The patient presented to our radiology department following a short period of flu-like illness and multiple soft tissue lesions. Biopsy of the lesions demonstrated noncaseating granulomata, and a diagnosis of sarcoidosis was established after important differential diagnoses were excluded. We present a literature review of sarcoid-related myopathy and the multimodality imaging characteristics of the different subtypes.
Cerebral paradoxical embolisation in a patient with cystic fibrosis with patent foramen ovale: a comparative review of literature
Authors: Ahmed Taha , Lodhi Samra Haroon , Anstead Michael I , Messerli Adrian W
Published: May 2021

A 52-year-old woman with cystic fibrosis presented to the emergency department with expressive aphasia and right-sided hemiparesis. CT scan of the brain revealed a left middle cerebral artery territory infarct. A diagnosis of cerebral paradoxical embolisation associated with patent foramen ovale and a history of deep venous thrombosis was made. The patient underwent endovascular thrombectomy and percutaneous closure of patent foramen ovale. Current literature, including five published case reports, pertaining to the subject is discussed. The unique aspects of the case are highlighted, including the particular risk of cerebral paradoxical embolisation in patients with cystic fibrosis. The result of this case report, in context to previously reported literature, suggests that clinicians should be aware of paradoxical embolisation in patients with cystic fibrosis via an intracardiac shunt, particularly with implanted vascular access devices and a history of deep venous thrombosis.
Polyneuropathy following COVID-19 infection: the rehabilitation approach
Authors: Saif Ahmad , Pick Anton
Published: May 2021

A range of neurological manifestations associated with COVID-19 have been reported in the literature, but the pathogenesis of these have yet to be fully explained. The majority of cases of peripheral nervous system disease published thus far have shown a symmetrical pattern. In contrast, we describe the case of a patient with asymmetrical predominantly upper-limb sensorimotor polyneuropathy following COVID-19 infection, likely due to a multifactorial pathological process involving critical illness neuropathy, mechanical injury and inflammatory disease. His presentation, management and recovery contribute to the understanding of this complex condition and informs rehabilitation approaches.
Adipose-specific C-C motif chemokine ligand (CCL) 19 overexpression drives the mice to both insulin resistance and weight gain
Authors: Hayashi Masato , Iwashita Misaki , Nishimura Yuki , Shinjo Takanori , Sano Tomomi , Yamashita Akiko , Fukuda Takao , Sanui Terukazu , Asano Tomoichiro , Nishimura Fusanori
Published: May 2021

Introduction

Enlarged adipose tissue is characterized by infiltration of activated immune cells and increased expression of chemokines recruiting these cells including C-C motif ligand 19 (CCL19), although the role of adipose CCL19 is still inconclusive.

Research design and methods

Adipocyte-specificCcl19knock-in (KI) mice were generated, and the mice were fed either a normal diet or 40% or 60% fat diet (FD) to investigate the effects of CCL19 on the induction of inflammation and lipid metabolism.

Results

Ccl19KI mice exhibited increased inflammatory signs in adipose tissue and enlarged subcutaneous white and brown adipose tissue than those of wild-type (WT) mice. The adipose tissue ofCcl19KI mice was characterized by increased extracellular signal-regulated kinase 1/2 and decreased AMP-activated protein kinase α phosphorylation. The protein expression of peroxisome proliferator-activated receptor γ coactivator 1α and uncoupling protein 1 was significantly reduced in brown adipose tissue ofCcl19KI mice compared with that in WT mice. The most remarkable changes between genotypes were observed in mice fed a 40% FD.

Conclusion

A 40% FD enhanced the effects of CCL19 overexpression, and these mice could be a suitable model to study metabolic disorders in overweight Asians.
Histological and transcriptional characterization of the pancreatic acinar tissue in type 1 diabetes
Authors: Granlund Louise , Hedin Anders , Wahlhütter Miriam , Seiron Peter , Korsgren Olle , Skog Oskar , Lundberg Marcus
Published: May 2021

Introduction

Despite a reduced function and volume of the exocrine pancreas in type 1 diabetes, the acinar cells remain understudied in type 1 diabetes research. The hypothesis of this study is that the acinar tissue is altered in subjects with type 1 diabetes compared with subjects without diabetes.

Research design and methods

The cell density, expression of digestive enzymes, and transcriptome of acinar tissue at varying distances from islets were analyzed using histology, immunostaining, and AmpliSeq RNA sequencing of laser capture microdissected tissue. Pancreases examined were from organ donors with or without type 1 diabetes.

Results

We demonstrate preserved acinar nuclei density and find no support of acinar atrophy in type 1 diabetes. Staining for digestive enzymes (amylase, lipase, and trypsin) demonstrated an evenly distributed expression in the exocrine parenchyma; although occasional amylase-negative regions appeared in tissue that had been formalin-fixed and paraffin-embedded, this phenomenon was not evident in frozen tissue. Gene set enrichment analysis of whole transcriptome data identified transcriptional alterations in type 1 diabetes that were present in the acinar tissue independent of the distance from islets. Among these, the two most enriched gene sets wereMyc Targets V2andEstrogen Response Early.

Conclusion

Taken together, these new data emphasize the involvement of the entire pancreas in type 1 diabetes pathology. The alteration of the gene setsMyc Targets V2andEstrogen Response Earlyis a possible link to the increased incidence of pancreatic cancer in type 1 diabetes.
Accuracy of breath test for diabetes mellitus diagnosis: a systematic review and meta-analysis
Authors: Wang Wenting , Zhou Wenzhao , Wang Sheng , Huang Jinyu , Le Yanna , Nie Shijiao , Wang Weijue , Guo Qing
Published: May 2021

The review aimed to investigate the accuracy of breath tests in the diagnosis of diabetes mellitus, identify exhaled volatile organic compounds with the most evidence as potential biomarkers, and summarize prospects and challenges in diabetic breath tests. Databases including Medline, PubMed, EMBASE, Cochrane Library and Science Citation Index Expanded were searched. Human studies describing diabetic breath analysis with more than 10 subjects as controls and patients were included. Population demographics, breath test conditions, biomarkers, analytical techniques and diagnostic accuracy were extracted. Quality assessment was performed with the Standards for Reporting Diagnostic Accuracy and a modified QUADAS-2 (Quality Assessment of Diagnostic Accuracy Studies 2). Forty-four research with 2699 patients with diabetes were included for qualitative data analysis and 14 eligible studies were used for meta-analysis. Pooled analysis of type 2 diabetes breath test exhibited sensitivity of 91.8% (95% CI 83.6% to 96.1%), specificity of 92.1% (95% CI 88.4% to 94.7%) and area under the curve (AUC) of 0.96 (95% CI 0.94 to 0.97). Isotopic carbon dioxide (CO2) showed the best diagnostic accuracy with pooled sensitivity of 0.949 (95% CI 0.870 to 0.981), specificity of 0.946 (95% CI 0.891 to 0.975) and AUC of 0.98 (95% CI 0.97 to 0.99). As the most widely reported biomarker, acetone showed moderate diagnostic accuracy with pooled sensitivity of 0.638 (95% CI 0.511 to 0.748), specificity of 0.801 (95% CI 0.691 to 0.878) and AUC of 0.79 (95% CI 0.75 to 0.82). Our results indicate that breath test is a promising approach with acceptable diagnostic accuracy for diabetes mellitus and isotopic CO2is the optimal breath biomarker. Even so, further validation and standardization in subject control, breath sampling and analysis are still required.
Correct diagnosis of childhood pneumonia in public facilities in Tanzania: a randomised comparison of diagnostic methods
Authors: Salisbury Taylor , Redfern Alice , Fletcher Erin K , Arkedis Jean , Bundala Felix , Connor Alison , Kapologwe Ntuli A , Massaga Julius , Mkongwa Naibu , Musa Balowa , Lee Cammie
Published: May 2021

Objective

This study compares two methods for clinical diagnosis of childhood pneumonia that aim to estimate rates of underdiagnosis and overdiagnosis of childhood pneumonia by examining the sensitivity of Integrated Management of Childhood Diseases implementation in routine care against lung ultrasound (LUS) diagnosis.

Setting

We conducted observations in 83 public health facilities (dispensaries, health centres and district hospitals) in Pwani, Dodoma and Tabora, Tanzania between October and December 2017.

Methods

We used a novel method to estimate rates of underdiagnosis and overdiagnosis of childhood pneumonia by comparing directly observed public provider diagnoses to the results of diagnoses made by trained clinicians using Mindray DP-10 ultrasound machines. We perform multivariate analysis to identify confounding effects and robustness checks to bound the result. We also explore a number of observable characteristics correlated with higher rates of agreement between provider diagnoses and ultrasound diagnoses.

Results

We observed 93 providers conducting exams on patients aged 2 months–5 years who presented respiratory symptoms or were given a respiratory diagnosis by the provider. Of these 957 patients, 110 were excluded from analysis resulting in a final sample of 847.

17.6% of cases identified as pneumonia via LUS examinations in our sample were diagnosed as pneumonia by providers, suggesting that a significant number of pneumonia cases for which care is sought in the public sector go undiagnosed. Provider knowledge of breath counting and years of experience are positively correlated with higher agreement. While clinical examination rates are not statistically correlated with agreement, it is notable that providers conducted a clinical examination on only about one-third of patients in the sample.

Conclusion

Our results suggest that provider training and knowledge of clinical examination protocols for pneumonia diagnosis are predictive of correct diagnosis of pneumonia and should be further explored in future research as a tool for improving quality of care.
‘Relieved to be seen’—patient and carer experiences of psychosocial assessment in the emergency department following self-harm: qualitative analysis of 102 free-text survey responses
Authors: Quinlivan Leah M , Gorman Louise , Littlewood Donna L , Monaghan Elizabeth , Barlow Steven J , Campbell Stephen M , Webb Roger T , Kapur Navneet
Published: May 2021

Objectives

We sought to explore patient and carer experiences of psychosocial assessments following presentations to hospital after self-harm.

Design

Thematic analysis of free-text responses to an open-ended online survey.

Setting

Between March and November 2019, we recruited 88 patients (82% women) and 14 carers aged ≥18 years from 16 English mental health trusts, community organisations, and via social media.

Results

Psychosocial assessments were experienced as helpful on some occasions but harmful on others. Participants felt better, less suicidal and less likely to repeat self-harm after good-quality compassionate and supportive assessments. However, negative experiences during the assessment pathway were common and, in some cases, contributed to greater distress, less engagement and further self-harm. Participants reported receiving negative and stigmatising comments about their injuries. Others reported that they were refused medical care or an anaesthetic. Stigmatising attitudes among some mental health staff centred on preconceived ideas over self-harm as a ‘behavioural issue’, inappropriate use of services and psychiatric diagnosis.

Conclusion

Our findings highlight important patient experiences that can inform service provision and they demonstrate the value of involving patients/carers throughout the research process. Psychosocial assessments can be beneficial when empathetic and collaborative but less helpful when overly standardised, lacking in compassion and waiting times are unduly long. Patient views are essential to inform practice, particularly given the rapidly changing service context during and after the COVID-19 emergency.
Do statins reduce mortality in older people? Findings from a longitudinal study using primary care records
Authors: Gitsels Lisanne Andra , Bakbergenuly Ilyas , Steel Nicholas , Kulinskaya Elena
Published: May 2021

Objective

Assess whether statins reduce mortality in the general population aged 60 years and above.

Design

Retrospective cohort study.

Setting

Primary care practices contributing to The Health Improvement Network database, England and Wales, 1990–2017.

Participants

Cohort who turned age 60 between 1990 and 2000 with no previous cardiovascular disease or statin prescription and followed up until 2017.

Results

Current statin prescription was associated with a significant reduction in all-cause mortality from age 65 years onward, with greater reductions seen at older ages. The adjusted HRs of mortality associated with statin prescription at ages 65, 70, 75, 80 and 85 years were 0.76 (95% CI 0.71 to 0.81), 0.71 (95% CI 0.68 to 0.75), 0.68 (95% CI 0.65 to 0.72), 0.63 (95% CI 0.53 to 0.73) and 0.54 (95% CI 0.33 to 0.92), respectively. The adjusted HRs did not vary by sex or cardiac risk.

Conclusions

Using regularly updated clinical information on sequential treatment decisions in older people, mortality predictions were updated every 6 months until age 85 years in a combined primary and secondary prevention population. The consistent mortality reduction of statins from age 65 years onward supports their use where clinically indicated at age 75 and older, where there has been particular uncertainty of the benefits.
Atrial fibrillation and risk of incident heart failure with reduced versus preserved ejection fraction
Authors: Nicoli Charles D , O’Neal Wesley T , Levitan Emily B , Singleton Matthew J , Judd Suzanne E , Howard George , Safford Monika M , Soliman Elsayed Z
Published: May 2021

Objective

Associations between atrial fibrillation (AF) and heart failure (HF) have been established. We compared the extent to which AF is associated with each primary subtype of HF, with reduced (HFrEF) versus preserved ejection fraction (HFpEF).

Methods

We included 25 787 participants free of baseline HF from the REGARDS (REasons for Geographic And Racial Differences in Stroke) cohort. Baseline AF was ascertained from ECG and self-reported history of physician diagnosis. Incident HF events were determined from physician-adjudicated review of hospitalisation medical records and HF deaths. Based on left ventricular ejection fraction (LVEF) at the time of HF event, HFrEF, HFpEF, and mid-range HF were defined as LVEF <40%, ≥50% and 40%–49%, respectively. Multivariable Cox proportional-hazards models examined the association between AF and HF. The Lunn-McNeil method was used to compare associations of AF with incident HFrEF versus HFpEF.

Results

Over a median of 9 years of follow-up, 1109 HF events occurred (356 HFpEF, 388 HFrEF, 77 mid-range and 288 unclassified). In a model adjusted for sociodemographics, cardiovascular risk factors, and incident coronary heart disease, AF was associated with increased risk of all HF events (HR 1.67, 95% CI 1.38 to 2.01). The associations of AF with HFrEF versus HFpEF events did not differ significantly (HR 1.87 (95% CI 1.38 to 2.54) and HR 1.65 (95% CI 1.20 to 2.28), respectively; p value for difference=0.581). These associations were consistent in sex and race subgroups.

Conclusions

AF is associated with both HFrEF and HFpEF events, with no significant difference in the strength of association among these subtypes.
Gradient changes in bioprosthetic valve thrombosis: duration of anticoagulation and strategies to improve detection
Authors: Naser Jwan A , Petrescu Ioana , Ionescu Filip , Nkomo Vuyisile T , Pislaru Cristina , Schaff Hartzell V , Pellikka Patricia A , Connolly Heidi M , Egbe Alexander C , Pislaru Sorin V
Published: May 2021

Objective

Bioprosthetic valve thrombosis (BPVT) is increasingly recognised as a major cause of prosthetic dysfunction in the first years postimplantation. How early abnormal gradients can be detected prior to diagnosis and how fast they normalise with anticoagulant therapy is unknown. We set forth to (1) evaluate patterns of increase in gradients prior to BPVT diagnosis and (2) characterise time-course of response to anticoagulation.

Methods

Patients treated with warfarin for BPVT (1999–2019) with clinically significant reduction of mean gradients (≥25%) were identified retrospectively. Recovery was defined as gradient decrease ≥50%, to postimplantation or to normal-range gradients per position, model and size. Time-to-BPVT (implantation—BPVT diagnosis), potential diagnostic delay (first abnormal gradient by position, model and size—BPVT diagnosis) and time-to-recovery (BPVT diagnosis—complete resolution) were recorded.

Results

77 patients were identified; 32 (42%) aortic (23 surgical—12 porcine, 11 pericardial; 9 transcatheter); 24 (31%) mitral; 21 (27%) tricuspid. Median time-to-BPVT was 24, 21 and 10 months, respectively. Potential diagnostic delay was median 21 months for aortic, 4 months for mitral, but 0 for tricuspid. Recovery was significantly faster in mitral than aortic (median 2.5 vs 4.8 months, p=0.038) and tricuspid (median 5.9 months, p=0.025) positions. Porcine aortic valves responded faster than pericardial aortic valves (median 2.9 vs 20.3 months, p=0.004).

Conclusion

Gradients start to increase months before the clinical BPVT diagnosis. Recovery is faster in mitral and surgical aortic porcine valves; a longer warfarin trial seems indicated in tricuspid and surgical aortic pericardial valves.
Reverse Engineering of Object Oriented Systems to ALF
Authors: Nawaz Asad , Rana Tauseef , Azam Farooque , Anwar Muhammad Waseem
Published: May 2021

In Model Driven Software Engineering (MDSE), Action Language for Foundational UML (ALF) is a new standard for specifying the structure and behavior of a system textually. To update/transform existing systems with respect to advance business needs and/or by the change in the dependent technology, this standard can play a vital role in reverse engineering a system for technology change. In this paper, using ALF, we propose a reverse engineering approach for transforming object oriented system. Our work is the first attempt to use ALF in reverse engineering. Using a case study (an ATM system) of significant size developed in C[Formula: see text], we validate the feasibility of our approach. In this paper, to support our approach by a computer application, we created a tool CPP2ALF; this tool converts the C[Formula: see text] code to srcML code by using a third party srcML-tool and then generates the ALF code by using the generated srcML code.
Flexor Synovectomy as an Adjunct to Carpal Tunnel Release in Primary Carpal Tunnel Syndrome: A Meta-Analysis
Authors: Chiang Jenny , An Vincent Vinh Gia , Graham David , Lawson Richard , Sivakumar Brahman
Published: May 2021

Background: Carpal tunnel release (CTR) aims to achieve surgical decompression of the median nerve for the treatment of carpal tunnel syndrome (CTS). Flexor tenosynovectomy (FS) has been carried out as an adjunct to routine CTR, on the basis that chronic flexor tenosynovitis has been implicated as an etiological factor in idiopathic CTS. However, the benefits of this additional procedure remains unclear. As such, we aimed to compare functional outcomes, nerve function and complication rates from CTR with and without FS.

Methods: A systematic review of published literature was performed for original data English language studies comparing outcomes of CTR with and without FS in the treatment of primary CTS. Mean weighted differences and their 95% confidence interval were used for analysis.

Results: Three studies comprising 292 wrists were included. Meta-analysis showed no improvement in post-operative grip strength, symptom severity score, functional status score, median nerve motor latency or major complications with FS. Recurrence rate was not reported in the 3 selected articles.

Conclusions: The available evidence suggests FS is an unnecessary adjunct which provides no benefit to CTR, and should not be used routinely to treat primary CTS. Larger studies are needed to validate our findings. FS may have a role in recurrent or secondary CTS.