bluuebunny/crossref_metadata_2025 huggingface dataset:
A Severe Necrotizing Inflammatory Reaction of Leg Wounds Following Autologous Peripheral Blood Total Nucleated Cells Treatment in an Old Patient With Rheumatoid Arthritis and No-Option Chronic Limb-Threatening Ischemia: Is Cell Therapy Suitable for All Patients?
Authors: Vallini Valerio , Venturini Luigi , Carnesecchi Paolo , Andreini Roberto , Meini Simone
Published: March 2021

Chronic limb-threatening ischemia (CLTI) represents an unfavorable evolution of peripheral artery disease, characterized by pain at rest, ulceration, and gangrene and also by an increased risk of cardiovascular events, amputations, and death. According to scientific literature, in almost one third of cases affected by CLTI, defined as no-option CLTI patients, revascularization strategies are not feasible. In the past decade, several studies investigated the role of therapeutic angiogenesis through cell autologous therapy, administered through intramuscular injections or multiple local intralesional and perilesional injections. In this article, we report the case of a necrotizing inflammatory reaction in a patient affected by CLTI and chronic leg wounds that occurred on the multiple injection sites after autologous peripheral blood-derived mononuclear cells (PB-TNCs) transplantation. Since the patient was affected by corticosteroid-induced skin atrophy and rheumatoid arthritis, we hypothesize that an increased skin fragility and a mechanism of immune-mediated pathergy could have been main factors leading to worsening of wounds. This case report strongly suggests the urgent need to better define the indications and contraindications of cell therapy, and further studies of adequate methodology are required to definitively assess the efficacy and safety of autologous cell therapy by local injections of PB-TNCs in patients with chronic inflammatory disorder, such as rheumatoid arthritis, especially in case of concomitant marked skin atrophy. Pending definitive evidence from literature, a strong caution is needed in patients affected by chronic systemic inflammatory diseases, since multiple injections, acting as mechanical stimulus and pathergy trigger, might exacerbate a severe and uncontrolled inflammatory response.
Effect of enzymatic glycosylation on the structure and properties of wheat gluten protein fibers
Authors: Lei Duo , Ma Xiaojun
Published: March 2021

Wheat gluten proteins are good raw materials for preparing fibers due to their excellent viscoelasticity. However, protein fibers made directly from wheat gluten have poor mechanical properties. In this paper, transglutaminase was used to induce the glycosylation reaction between wheat gluten proteins and carboxymethyl chitosan. The glycated proteins were then made into fibers by wet spinning. After glycosylation modification, the breaking strength and breaking elongation of the wheat gluten protein fibers (WGPF) improved by 43% and 127%, respectively. Fourier transform infrared spectroscopy and sodium dodecyl sulfate-polyacrylamide gel electrophoresis analyses revealed that the glycosylation-modified WGPF molecules contained saccharide portions, which confirms the covalent attachment of carboxymethyl chitosan to the wheat gluten protein. Scanning electron microscopy showed that the number of pores in the cross-section of the modified WGPF was lower than that in the unmodified WGPF. The thermal stability and dyeability of the modified WGPF were also improved.
Neural network forecasting of the flow regimens of viscous fluids in a 3D reactor
Authors: Sohail Ayesha , Noor Maryam , Farwa Shabieh , Li Zhiwu , Akbar Sundas
Published: March 2021

In this research work, the turbulence in fluid flow through a turbulent reactor is investigated. The research was conducted in three steps; modeling, simulations and future forecasting for longer times, where numerical solvers fail to simulate the robust dynamics of turbulence. Advanced finite element solvers are used for the numerical simulations and for the forecasting purpose, artificial neural networks are used. Artificial intelligence is deployed for the transient analysis for longer times, where numerical solvers fail. Results are presented with the aid of tables and video graphic footage.
A novel adaptive support vector machine method for reliability analysis
Authors: Shi Zhaoyin , Lu Zhenzhou , Zhang Xiaobo , Li Luyi
Published: March 2021

For the structural reliability analysis, although many methods have been proposed, they still suffer from substantial computational cost or slow convergence rate for complex structures, the limit state function of which are highly non-linear, high dimensional, or implicit. A novel adaptive surrogate model method is proposed by combining support vector machine (SVM) and Monte Carlo simulation (MCS) to improve the computational efficiency of estimating structural failure probability in this paper. In the proposed method, a new adaptive learning method is established based on the kernel function of the SVM, and a new stop criterion is constructed by measuring the relative position between sample points and the margin of SVM. Then, MCS is employed to estimate failure probability based on the convergent SVM model instead of the actual limit state function. Due to the introduction of adaptive learning function, the effectiveness of the proposed method is significantly higher than those that employed random training set to construct the SVM model only once. Compared with the existing adaptive SVM combined with MCS, the proposed method avoids information loss caused by inconsistent distance scales and the normalization of the learning function, and the proposed convergence criterion is also more concise than that employed in the existing method. The examples in the paper show that the proposed method is more efficient and has broader applicability than other similar surrogate methods.
Intensive care physicians’ perceptions of the diagnosis & management of patients with acute hypoxic respiratory failure associated with COVID-19: A UK based survey
Authors: Dushianthan Ahilanandan , Cumpstey Andrew F , Ferrari Matteo , Thomas William , Moonesinghe Ramani S , Summers Charlotte , Montgomery Hugh , Grocott Michael PW
Published: March 2021

Background

Whilst the management of Coronavirus disease-2019 (COVID-19) has evolved in response to the emerging data, treating such patients remains a challenge, and many treatments lack robust clinical evidence. We conducted a survey to evaluate Intensive Care Unit (ICU) management of COVID-19 patients with acute hypoxic respiratory failure and compared the results with data from a similar survey focusing on Acute Respiratory Distress Syndrome (ARDS) that was conducted in 2013.

Methods

The questionnaire was refined from a previous survey of ARDS-related clinical practice using an online electronic survey engine (Survey Monkey®) and all UK intensivists were encouraged to participate. The survey was conducted between 16/05/2020 and 17/06/2020.

Results

There were 137 responses from 89 UK centres. Non-invasive ventilation was commonly used in the form of CPAP. The primary ventilation strategy was the ARDSnet protocol, with 63% deviating from its PEEP recommendations. Similar to our previous ARDS survey, most allowed permissive targets for hypoxia (94%), hypercapnia (55%) and pH (94%). The routine use of antibiotics was common, and corticosteroids were frequently used, usually in the context of a clinical trial (45%). Late tracheostomy (>7 days) was preferred (92%). Routine follow-up was offered by 66% with few centres providing routine dedicated rehabilitation programmes following discharge. Compared to the ARDS survey, there is an increased use of neuromuscular agents, APRV ventilation and improved provision of rehabilitation services.

Conclusions

Similar to our previous ARDS survey, this survey highlights variations in the management strategies used for patients with acute hypoxic respiratory failure due to COVID-19.
Health services, intersectoriality and social control: a comparative study on a conditional income transfer program
Authors: Neves José Anael , Zangirolani Lia Thieme Oikawa , de Medeiros Maria Angélica Tavares
Published: March 2021

The Bolsa Família Program (BFP) is one of the largest conditional cash transfer programs in the world, providing cash transfers and intersectoral actions. The aim of this study was to compare whether there is a difference in access to health services, intersectoral actions and social control, between families entitled or not, to the BFP. A cross-sectional study was carried out. A representative sample of a peripheral, socioeconomically vulnerable population from a large urban center in southeastern Brazil was calculated, totaling 380 families. Chi-square or Fisher’s exact tests and multiple correspondence analysis were used to compare groups. Families entitled to the BFP had worse living conditions in general and greater access to health services, such as: medical care ( p-value 0.009), community healthcare agent ( p-value 0.001) and home visits ( p-value 0.041). Being entitled or not affected the variability in the pattern of access to services by 31%; low access to intersectoral actions was identified in both groups; social control was incipient. There was an adequate focus on the program; greater access to health services was related to compliance with conditionalities; low access to intersectoral actions can restrict the interruption of the cycle of intergenerational transmission of poverty.
Exploring Chinese people’s attitudes towards “going through the backdoor”
Authors: Wang Tulips Yiwen , Bernardo Allan B. I.
Published: March 2021

The present investigation explored Chinese people's attitudes toward the social practice of going “through the back door” or zouhoumen. Zouhoumen is an informal approach to achieve one’s goal through personal connections (called guanxi). We propose that Chinese people distinguish between different acts of zouhoumen and propose at least two types that differ in terms of social cognitive aspects, and that the two types evoke different perceptions of fairness that shape attitudes towards zouhoumen. Two experiments (total N = 414) provided evidence for the differentiation between facilitative zouhoumen and expropriative zouhoumen and also explore the role of type of guanxi in attitudes towards the two types of zouhoumen. Both experiments indicated that facilitative zouhoumen was less unacceptable than expropriative zouhoumen, but there were no marked differences in attitudes between zouhoumen involving expressive or instrumental guanxi. The results support a more nuanced theoretical account of a pervasive social phenomenon in Chinese society that we assume is adaptive responses to features of Chinese historical socioeconomic context.
The Impact of Diabetic Neuropathy on Activities of Daily Living, Postural Balance and Risk of Falls - A Systematic Review
Authors: Khan Karolina Snopek , Andersen Henning
Published: March 2021

Objective:

The objective of this review is to discuss a compilation of the currently available literature regarding the impact of diabetic neuropathy (DN) on activities of daily living (ADL), postural stability, and risk of falls.

Methods:

A systematic electronic search strategy was conducted on PubMed/MEDLINE database, Cochrane Library, and Embase in March 2020. This narrative review included clinical cross-sectional studies assessing ADL, postural balance, and falls in adults with DN. All studies underwent a quality assessment based on the Newcastle Ottawa scale developed to assess cross-sectional studies.

Results:

Forty-two studies were identified. A total of 37 studies evaluated postural stability in DN, 10 studies assessed fall accidents, and three studies assessed ADL in individuals with DN. Seven studies assessed both postural stability and fall accidents, and one study assessed postural stability and ADL. Each of the studied outcome variables was assessed separately. Based on a quality assessment, eight studies were excluded resulting in an evaluation of 34 studies.

Conclusions:

Diabetic neuropathy has a negative impact on postural balance and gait kinematics combined with an increased fall risk. Because of the few number of studies available, we were unable to evaluate the impact of DN on ADL. Our findings are in concordance with previous reviews, supporting the evidence for DN as a critical measure negatively impacting postural stability and fall risk in individuals with diabetes. Further clinical investigative studies are needed.
Making the Case for the Socially Relevant Social Scientist
Authors: Iloh Constance , Connor Carol
Published: March 2021

In the twenty-first century, the role and possibilities of academics could not be more significant. As such, social relevance must be inextricably linked to our goal and work as academics, thinkers, and scholars. The purpose of this article is to put forth and highlight the socially relevant social scientist as a viable and necessary component of the academic enterprise. In particular, we highlight three functions meaningful to the socially relevant social scientist: genre flexibility, social street credibility, and relational research. The article also addresses graduate education and tenure and promotion as two areas greatly in need of revisiting to cultivate and sustain socially relevant social scientists.
Lower gastrointestinal bleeding in a patient receiving sevelamer: Case report
Authors: Schoot Tessa S , Römkens Tessa EH , Hoogeveen Ellen K
Published: March 2021

Phosphate binders such as sevelamer are widely used in patients with chronic kidney disease to lower serum phosphate levels. We present a case of a 67-year-old woman with lower gastrointestinal bleeding after 9 days of using sevelamer carbonate (Renvela®). Sigmoidoscopy revealed multiple deep ulcers (diameter 10–15 mm) and mucosal oedema. Histologic examination showed deposition of sevelamer crystals in these rectal ulcers. We hypothesized that the lower gastrointestinal bleeding was caused by deposition of sevelamer crystals. After cessation of sevelamer, gastrointestinal bleeding stopped. Deposition of sevelamer crystals in the gastrointestinal tract is a rare complication of sevelamer therapy. There are only 17 other recorded cases of gastrointestinal deposition of sevelamer crystals. This adverse effect should be considered in all patients taking sevelamer who present with gastrointestinal symptoms, such as gastrointestinal bleeding and abdominal pain. When sevelamer is discontinued, symptoms and mucosal damage appear to revert.
Cardioprotective effects of Ginsenoside compound-Mc1 and Dendrobium Nobile Lindl against myocardial infarction in an aged rat model: Involvement of TLR4/NF-κB signaling pathway
Authors: Sun Yongle , Geng Jing , Wang Deyu
Published: March 2021

Aging is the crucial co-morbidity that prevents the full cardioprotection against myocardial ischemia/reperfusion (I/R) injury. Combination therapy as a promising strategy may overcome this clinical problem. This study aimed to investigate the cardioprotective effects of Ginsenoside compound-Mc1 (GMc1) and Dendrobium Nobile Lindl (DNL) in myocardial I/R injury and explore the involvement of the TLR4/NF-κB signaling pathway in aged rats. In vivo I/R injury and myocardial infarction was established by temporary coronary ligation in 22–24 months’ old Sprague Dawley male rats. GMc1 (10 mg/kg) and DNL (80 mg/kg) were administered intraperitoneally for 4 weeks and orally for 14 days, respectively, before I/R injury. Infarct size was measured through triphenyl-tetrazolium-chloride staining. ELISA assay was conducted to quantify the levels of cardiotroponin, and myocardial content of TNF-α and glutathione. Western blotting was employed to detect the expression of TLR4/MyD88/NF-κB proteins. GMc1 and DNL significantly reduced the infarct size to a similar extent ( p < 0.05) but their combined effect was greater than individual ones ( p < 0.01). Combination therapy significantly restored the left ventricular end-diastolic and developed pressures at the end of reperfusion as compared with the untreated group ( p < 0.01). Although the GMc1 and DNL reduced the levels of inflammatory cytokine TNF-α and increased the contents of antioxidant glutathione significantly, their individual effects on the reduction of protein expression of TLR4/MyD88/NF-κB pathway were not consistent. However, their combination could significantly reduce all parameters of this inflammatory pathway as compared to untreated I/R rats ( p < 0.001). Therefore, the combined treatment with GMc1 and DNL increased the potency of each intervention in protecting the aged hearts against I/R injury. Reduction in the activity of the TLR4/MyD88/NF-κB signaling pathway and subsequent modulation of the activity of inflammatory cytokines and endogenous antioxidants play an important role in this cardioprotection.
Effects of dexmedetomidine on the onset and duration of action in non-depolarizing neuromuscular relaxant rocuronium
Authors: Shan Jiaqi , Wang Xiaofeng , Zhang Xiaoli , Zhang Junfeng
Published: March 2021

To determine the impact of two varying doses of dexmedetomidine (DEX) on the onset and duration of neuromuscular blockade of rocuronium (ROC) under the condition of sevoflurane anesthesia. Eighty-one patients, American Society of Anesthesiologists Class I–II, were stochastically allocated to control group (group C) and two DEX groups (group D1 and group D2). In group D1 and group D2, DEX (0.5 and 1.0 µg/kg, respectively) was administrated 10 min before induction of general anesthesia. In group C, equivalent saline was infused by the same way. We monitored heart rate (HR), blood pressure, and train-of-four (TOF) values of all subjects in the period of anesthesia. We recorded times to reach TOF value 0 (T0, from injection of ROC to disappearance of all four twitches) as the onset time and TOF value 25% (T25, ratio of fourth twitch to first twitch,) as clinical duration of neuromuscular blockade. A total of 81 patients were randomized, 75 of whom accepted treatment, including group D1 ( n = 25), D2 ( n = 25), and C ( n = 25). T0 time of three groups was found to be similar. The duration of action for ROC in group D2 was 62.76 ± 6.33 min, which was much longer than that in group D1 and group C, which were 42.64 ± 3.92 and 42.56 ± 4.04 min ( p < 0.05), respectively. At T2 (after DEX administration) and T4 time point (10 min after trachea intubation), compared with group C, the changes of heart rate (HR) and blood pressure in DEX groups (group D1 and group D2) show greatly differences. Otherwise, there were no obvious differences among different groups at the other monitoring point-in-time. DEX infusion in general anesthesia has no obvious effect on the onset of ROC, but it is capable of prolonging its clinical effect time, which can provide reference for rational application of DEX and ROC in general anesthesia.
Assessment of Potential Risk Factors for 2019-Novel Coronavirus (2019-nCov) Infection among Health Care Workers in a Tertiary Care Hospital, North India
Authors: Sharma Sugandhi , Mohindra Ritin , Rana Kirtan , Suri Vikas , Bhalla Ashish , Biswal Manisha , Singh Mini P. , Goyal Kapil , Lakshmi Pinnaka Venkata Maha
Published: March 2021

Introduction

Health care workers (HCWs) are at the forefront to fight against COVID-19 pandemic. They are at more risk of contracting the infection. This study was planned to assess potential risk factors of 2019-novel coronavirus infection among HCWs working in a health facility and to evaluate the effectiveness of infection prevention and control measures among them.

Methods

A study was conducted in a tertiary care hospital among HCWs who were directly or indirectly involved in the management of a confirmed or suspected case of COVID-19. The socio-demographic characteristics, history of exposure, IPC measures followed and clinical symptoms were compared between health care workers in COVID and non-COVID areas.

Results

Majority (45%) of HCWs were nurses, followed by hospital/sanitary/technical attendants (30%) and doctors (24%). Out of a total of 256 HCWs, 2% tested positive. Around 80% of HCWs had ever attended any IPC training. A statistically significant association was found between posting area of HCWs and their exposure to COVID patients (duration of exposure, PPE has worn by HCWs, direct contact of HCWs with the patient’s material) and COVID positivity ( P value <.001).

Conclusion

If health care workers were trained and take adequate precautions then the risk of getting an infection is minimized.
The Effect of Cervical Fusion on Functional Sagittal Spinal Alignment Based on the Inflection Point: Case Series Study
Authors: Park Moon Soo , Moon Seong-Hwan , Kim Young-Woo , Lim Jin Kyu , Jung Jong Ho , Kim Tae Soung , Reidler Jay S. , Riew K. Daniel
Published: March 2021

Study Design:

A retrospective radiologic study.

Objective:

The inflection point is the disc space between a lordotic and kyphotic segment of spine. To our knowledge, there has been no study evaluating changes in functional sagittal alignment determined by inflection points after cervical fusion surgery. The purpose is to identify changes in functional sagittal alignment after cervical fusion as determined by functional segments between cervicothoracic and thoracolumbar inflection points.

Methods:

Standing radiographs of the sagittal whole spine were taken in 62 patients who underwent cervical fusion procedures. We identified cervicothoracic and thoracolumbar inflection points in the sagittal plane and measured Cobb angles of resulting “functional” cervical, thoracic, and lumbar segments. We also measured the C2 and T1 sagittal vertical axis (SVA) distance to S1 and the anatomic cervical lordosis, thoracic kyphosis, lumbar lordosis, spinopelvic parameters, and T1 sagittal slope. We compared the pre- and post-op values.

Results:

The functional cervical segment and T1 sagittal slope increased postoperatively. C2 and T1 SVA distance to S1 decreased postoperatively. In patients with a single level fusion or lower instrumented vertebra (LIV) proximal or equal to C6, functional cervical segment, and anatomic cervical lordosis increased postoperatively. In those with multiple level fusion or LIV distal or equal to C7, the C2 SVA distance to S1 decreased postoperatively.

Conclusions:

After cervical fusion surgery, functional cervical sagittal parameters determined by the inflection point improve without changes in the anatomic sagittal parameters. Postoperative changes in functional sagittal parameters were affected by the number of fused levels and LIV.
COVID 19 and Dental Education: Transitioning from a Well-established Synchronous Format and Face to Face Teaching to an Asynchronous Format of Dental Clinical Teaching and Learning
Authors: Nasseripour Melanie , Turner Jonathan , Rajadurai Susha , San Diego Jonathan , Quinn Barry , Bartlett Anitha , Volponi Ana Angelova
Published: March 2021

The Covid-19 pandemic made it necessary to adopt and establish complete or partial online delivery of our clinical teaching and learning. We developed an alternative approach with a combination of Problem based Learning asynchronous fora and Teacher-facilitated synchronous online discussions. Our aim is to share our educational practice and highlight the requirements and constraints, advantages and challenges of such an approach. It allowed a more student-centred experience, but clinical simulation and face-to-face patient care remain necessary. The Covid-19 pandemic has changed the landscape of dental education for the foreseeable future, with a reduced number of patients in dental clinics. Further study is therefore necessary to understand the lived experience of students and teachers to the adopted online teaching and learning approach.
Sonographic Diagnosis of Bilateral Tubal Pregnancies
Authors: Matuzak Amber R.
Published: March 2021

Bilateral tubal pregnancy (BTP) is a very rare form of ectopic twin gestation. Many times, they occur after the use of assisted reproductive therapy. Most cases of BTP are diagnosed during laparoscopy. This case report demonstrates a rare preoperative, sonography diagnosis of a spontaneous BTP which occurred after a tubal ligation. The sonogram revealed two corpus luteal cysts, both located on the right ovary, which suggests that the left tubal pregnancy most likely occurred as a result of ovum transmigration. This case demonstrates the important role that sonography plays in the early diagnosis of ectopic pregnancies as well as the importance of thoroughly examining the entire pelvis during a pelvic sonogram.
Sonographic Diagnostic of an Adventitial Bursitis on the Distal Forearm: A Case Report
Authors: Poenaru Daniela
Published: March 2021

A bursa is a thin sac filled with viscous fluid to facilitate friction and gliding. In the human body, there are two types of bursae: synovial bursae in well-defined positions and adventitial bursae, which develop in sites where friction or pressure increases. This case study is on a young woman with an old distal radial extremity fracture, with occupational exposure to pressure on distal ulnar forearm. She noticed a small and painful mass, with some mobility on the above-mentioned site. Sonography was used to detect a small fluid accumulation with features of adventitial bursitis. This case presents a rare localization of an adventitial bursitis. It is believed to have developed over the distal ulnar epiphysis, with a small bone malalignment, after an old and consolidated fracture, of the distal radial extremity.
The Sonographic Appearance of Seminal Megavesicles, an Association With Autosomal Dominant Polycystic Kidney Disease: A Series Review
Authors: Carr Georgia
Published: March 2021

Megavesicles are an uncommon diagnostic finding during sonography of the bladder, especially when the examination is performed transabdominally. Although megavesicles are more likely seen with transrectal ultrasonography, computed tomogram (CT), vesiculography, or magnetic resonance imaging (MRI), it has been noted during transabdominal sonography for patients suffering from autosomal dominant polycystic kidney disease (ADPKD). When seminal vesicles become dilated, they are often visualized during transabdominal sonography. Two patient cases are provided of seminal megavesicles, associated with ADPKD and have documented sonographic findings. Both patient cases of megavesicles were discovered incidentally during the course of a renal sonogram. The importance of these diagnostic findings and the possible pathogenesis are provided.
Evidence of genetic structure in the wide-ranging bearded vulture (Gypaetus barbatus (Linnaeus, 1758))
Authors: Streicher Melanie , Krüger Sonja , Loercher Franziska , Willows-Munro Sandi
Published: March 2021

Background

The bearded vulture is sparsely distributed across a wide geographic range that extends over three continents (Africa, Europe and Asia). Restriction to high-altitude mountainous habitats, low breeding rates, lack of food and a heightened level of persecution have left many local populations severely diminished or extinct. Understanding the genetic connectivity and population structure of this threatened vulture species is critical for accurately assessing their conservation status, and for appropriately managing local populations through captive breeding programmes or translocations. Previous genetic assessments of the species were mainly focused on the European and Asian populations and included limited representation of the geographically isolated southern African population. A single mitochondrial study, which focused on the African populations of the bearded vulture, detected limited genetic differentiation between populations in Ethiopia and southern Africa, with reduced haplotype diversity in the southern Africa population. In this study, we extend the previous genetic assessments of the species by examining the phylogeography and genetic connectivity of global G. barbatus populations using a panel of 14 microsatellite loci.

Results

Analyses revealed spatially correlated genetic differentiation between regional populations and low levels of gene flow between these population fragments. In contrast to the mitochondrial data, the microsatellite data support the management of genetically different populations as separate entities.

Conclusions

Low genetic diversity and geographic isolation are known to adversely affect the evolutionary potential of a species in the long-term. The high inbreeding found in the southern African G. barbatus and, to a lesser extent, the northern African populations highlights the need for conservation programmes to effectively manage populations of this species and maintain extant genetic diversity.
Genetic testing and serological screening for SARS-CoV-2 infection in a COVID-19 outbreak in a nursing facility in Japan
Authors: Chong Yong , Tani Naoki , Ikematsu Hideyuki , Terazawa Nobuto , Nakashima Hitoshi , Shimono Nobuyuki , Akashi Koichi , Tanaka Yosuke
Published: March 2021

Background

The Pandemic of coronavirus disease (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has critically impacted the spread of infection within nursing facilities. We evaluated the usefulness of genetic and serological tests conducted during a COVID-19 outbreak in a nursing facility in Japan.

Methods

After the first identification of SARS-CoV-2 infection, a comprehensive, facility- and/or unit-wide PCR testing from nasopharyngeal swabs was repeatedly performed in a three-unit facility including 99 residents with dementia and 53 healthcare personnel. Additionally, PCR testing was conducted separately for residents and staff with fever of ≥37.5 °C. Facility-wide serological testing, including rapid kit testing and quantitative assay, was conducted twice over 1 month apart.

Results

A total of 322 PCR and 257 antibody tests were performed. 37 (24.3%) of the 152 individuals (25/99 residents, 25.3%; 12/53 staff, 22.6%) were identified as PCR-positive. Seven residents died with a mortality of 7.1% (7/99). Among the 37 individuals, 10 (27.0%) were asymptomatic at the time of testing. PCR positivity was concentrated on one unit (Unit 1) (20/30 residents, 66.7%; 9/14 staff, 64.3%). The other units showed a limited spread of infection. In unit-wide and separate tests, PCR positivity detection was highly prevalent (22.9 and 44.4%, respectively) in Unit 1, compared with that in the other units. Serological testing identified two additional infected residents with a negative PCR result and showed that no staff was newly identified as infected.

Conclusions

Thorough PCR testing, in combination with comprehensive and separate tests, is critical for managing COVID-19 outbreaks in nursing facilities, particularly, in units considered an epicenter. Serological testing is also beneficial for tracing contacts, confirming the number of infected individuals, and authorizing the termination of the outbreak.
Clinical characteristics and outcome of critically ill COVID-19 patients with acute kidney injury: a single centre cohort study
Authors:   On behalf of the University Hospital Southampton Critical Care Team and the REACT COVID investigators, Lowe R. , Ferrari M. , Nasim-Mohi M. , Jackson A. , Beecham R. , Veighey K. , Cusack R. , Richardson D. , Grocott MPW , Levett DZH , Dushianthan A.
Published: March 2021

Background

Acute kidney injury (AKI) is a common manifestation among patients critically ill with SARS-CoV-2 infection (Coronavirus 2019) and is associated with significant morbidity and mortality. The pathophysiology of renal failure in this context is not fully understood, but likely to be multifactorial. The intensive care unit outcomes of patients following COVID-19 acute critical illness with associated AKI have not been fully explored. We conducted a cohort study to investigate the risk factors for acute kidney injury in patients admitted to and intensive care unit with COVID-19, its incidence and associated outcomes.

Methods

We reviewed the medical records of all patients admitted to our adult intensive care unit suffering from SARS-CoV-2 infection from 14th March 2020 until 12th May 2020. Acute kidney injury was defined using the Kidney Disease Improving Global Outcome (KDIGO) criteria. The outcome analysis was assessed up to date as 3rd of September 2020.

Results

A total of 81 patients admitted during this period. All patients had acute hypoxic respiratory failure and needed either noninvasive or invasive mechanical ventilatory support. Thirty-six patients (44%) had evidence of AKI (Stage I-33%, Stage II-22%, Renal Replacement Therapy (RRT)-44%). All patients with AKI stage III had RRT. Age, diabetes mellitus, immunosuppression, lymphopenia, high D-Dimer levels, increased APACHE II and SOFA scores, invasive mechanical ventilation and use of inotropic or vasopressor support were significantly associated with AKI. The peak AKI was at day 4 and mean duration of RRT was 12.5 days. The mortality was 25% for the AKI group compared to 6.7% in those without AKI. Among those received RRT and survived their illness, the renal function recovery is complete and back to baseline in all patients.

Conclusion

Acute kidney injury and renal replacement therapy is common in critically ill patients presenting with COVID-19. It is associated with increased severity of illness on admission to ICU, increased mortality and prolonged ICU and hospital length of stay. Recovery of renal function was complete in all survived patients.
MiR-105-3p acts as an oncogene to promote the proliferation and metastasis of breast cancer cells by targeting GOLIM4
Authors: Lin Bo , Liu Chunhua , Shi Enyi , Jin Qiu , Zhao Wenhui , Wang Juan , Ji Runyuan
Published: March 2021

Background

Dysregulated miRNAs are involved in carcinogenesis of the breast and may be used as prognostic biomarkers and therapeutic targets during the cancer process. The purpose of this study was to explore the effect of miR-105-3p on the tumourigenicity of breast cancer and its underlying molecular mechanisms.

Methods

Reverse transcription-quantitative polymerase chain reaction (RT-qPCR) was applied to detect the expression of miR-105-3p in breast cancer tissues and cell lines. The impacts of miR-105-3p on the proliferation, migration, invasion and apoptosis of human breast cancer cells (MCF-7 and ZR-75-30) were evaluated by CCK-8 assays, Transwell chamber assays, TUNEL assays and western blot analyses. In addition, bioinformatics and luciferase reporter assays were used to determine the target genes of miR-105-3p.

Results

The expression of miR-105-3p was elevated in breast cancer tissues and increased with tumour severity. Downregulation of miR-105-3p could inhibit cell proliferation, suppress cell migration/invasion, and promote cell apoptosis in MCF-7 and ZR-75-30 cells. Furthermore, Golgi integral membrane protein 4 (GOLIM4) was identified as the direct target gene of miR-105-3p by bioinformatics and luciferase reporter assays. In addition, silencing GOLIM4 restored the anti-breast cancer effects induced by miR-105-3p downregulation.

Conclusions

MiR-105-3p acts as an oncogene to promote the proliferation and metastasis of breast cancer cells by targeting GOLIM4, which provides a new target for the prevention and treatment of breast cancer.
Intensity of end-of-life health care and mortality after systemic anti-cancer treatment in patients with advanced lung cancer
Authors: Oselin Kersti , Pisarev Heti , Ilau Keit , Kiivet Raul-Allan
Published: March 2021

Background

We aimed to study the mortality and intensity of health care in patients with advanced lung cancer who received systemic anti-cancer treatment (SACT) compared with patients who were not eligible for SACT (no-SACT).

Methods

A retrospective cohort of patients with lung cancer, who were treated at the North Estonia Medical Centre from 2015 to 2017, was linked to population-based health care data from the Estonian Health Insurance Fund. We calculated 14- and 30-day mortality after SACT and used a composite measure of intensity of care, comprised from the following: emergency department visit, admission to hospital, admission to intensive care unit, receipt of radiotherapy or systemic treatment.

Results

The median overall survival (OS) of patients who received at least one cycle of SACT (n = 489) was 9.1 months and in patients with no-SACT (n = 289) 1.3 months (hazard ratio [HR] = 4.23, 95% CI = 3.60–5.00). During the final 30 days of life, intensive EOL care was received by 69.9% of the SACT patients and 43.7% of the no-SACT patients. Intensive EOL care in the last 30 days of life is more probable among patients in the SACT group (odds ratio [OR] = 3.58, 95% CI = 2.54–5.04, p <  0.001), especially in those with a stage IV disease (OR = 1.89, 95% CI = 1.31–2.71, p = 0.001). In the SACT group 6.7 and 14.7% of patients died within 14 days and 30 days after the last cycle, respectively.

Conclusions

Significant proportion of patients with advanced lung cancer continue to receive intensive care near death. Our results reflect current patterns of EOL care for patients with lung cancer in Estonia. Availability of palliative care and hospice services must be increased to improve resource use and patient-oriented care.
Incidence of neural tube defects and their risk factors within a cohort of Moroccan newborn infants
Authors: Forci Khenata , Bouaiti El Arbi , Alami Mohamed Hassan , Mdaghri Alaoui Asmaa , Thimou Izgua Amal
Published: March 2021

Background

Neural tube defects (NTDs) are a group of birth defects that result from a partial or complete failure of the neural tube to close during embryogenesis. Their prevalence varies between 0.5 to 2 per 1000 births in countries without folic acid supplementation. The aim of our study is to assess the NTDs incidence and describe the risk factors within Moroccan newborn infants.

Method

This is a descriptive study over a period of 5 and a half years including all births at “Les Orangers” Maternity and Reproductive Health Hospital of Rabat with notification of NTD cases, whether isolated or combined with other anomalies. Data were reported on pre-established sheets and on the teratovigilance registry. Statistical analysis was performed with SPSS version 18 statistical software.

Results

During the study period, 43,923 births were recorded including 44 cases of neural tube defects, an incidence rate of 1 per 1000 births, with a female predominance; sex ratio = 0.8. These defects included anencephaly (50%), spina bifida (38.6%) and encephalocele (11.4%). The risk factors detected during this study include consanguinity (34%), consumption of fenugreek or other plants (36%), diabetes (4.5%) and medication (2.2%). A family history of malformation was reported in 6.8% of cases and among siblings in 4.5% of cases. The average maternal age was 30.38 ± 6.88 and the average gestational age was 36.80 ± 5.11. A quarter of mothers did not benefit from any medical monitoring during pregnancy while 59% did not take folic acid supplementation during the first trimester of pregnancy and none of them took B9 vitamin during the periconceptional period. The antenatal diagnosis was performed in 63% of cases. The mortality rate was 3.8 per 10,000 and 16% of cases evolved positively.

Conclusion

NTDs require high intensity and multidisciplinary care which stresses the importance, in our context, of strengthening and optimizing acid folic supplementation strategies during the periconceptional period.
Correspondence: systematic reviews do not always capture context of real-world intervention programmes for childhood obesity (response to Littlewood, et al., 2020 in BMC Public Health)
Authors: Wild Cervantée E. K. , Cave Tami L. , Willing Esther J. , Derraik José G. B. , Grant Cameron C. , Hofman Paul L. , Anderson Yvonne C.
Published: March 2021

In a recent issue of the BMC Public Health journal, Littlewood et al. described the results of a systematic review of interventions to prevent or treat childhood obesity in Māori or Pacific Island peoples. They found that studies to date have had limited impact on improving health outcomes for Māori and Pacific Island peoples, and suggest this may be due to a lack of co-design principles in the conception of the various studies. Ensuring that interventions are appropriate for groups most affected by obesity is critical; however, some inaccuracies should be noted in the explanation of these findings. There is a risk with systematic reviews that the context of intervention trials is lost without acknowledging the associated body of literature for programmes that refer to the ongoing commitment to communities and groups most affected by obesity.
Ultrasound and non-ultrasound imaging techniques in the assessment of diaphragmatic dysfunction
Authors: Laghi Franco A. , Saad Marina , Shaikh Hameeda
Published: March 2021

Diaphragm muscle dysfunction is increasingly recognized as an important element of several diseases including neuromuscular disease, chronic obstructive pulmonary disease and diaphragm dysfunction in critically ill patients. Functional evaluation of the diaphragm is challenging. Use of volitional maneuvers to test the diaphragm can be limited by patient effort. Non-volitional tests such as those using neuromuscular stimulation are technically complex, since the muscle itself is relatively inaccessible. As such, there is a growing interest in using imaging techniques to characterize diaphragm muscle dysfunction. Selecting the appropriate imaging technique for a given clinical scenario is a critical step in the evaluation of patients suspected of having diaphragm dysfunction. In this review, we aim to present a detailed analysis of evidence for the use of ultrasound and non-ultrasound imaging techniques in the assessment of diaphragm dysfunction. We highlight the utility of the qualitative information gathered by ultrasound imaging as a means to assess integrity, excursion, thickness, and thickening of the diaphragm. In contrast, quantitative ultrasound analysis of the diaphragm is marred by inherent limitations of this technique, and we provide a detailed examination of these limitations. We evaluate non-ultrasound imaging modalities that apply static techniques (chest radiograph, computerized tomography and magnetic resonance imaging), used to assess muscle position, shape and dimension. We also evaluate non-ultrasound imaging modalities that apply dynamic imaging (fluoroscopy and dynamic magnetic resonance imaging) to assess diaphragm motion. Finally, we critically review the application of each of these techniques in the clinical setting when diaphragm dysfunction is suspected.
Cadaveric biomechanical analysis of multilevel lateral lumbar interbody fusion with and without supplemental instrumentation
Authors: Lai Oujie , Chen Yunlin , Chen Qixin , Hu Yong , Ma Weihu
Published: March 2021

Background

This study was to evaluate and compare the biomechanical features of multilevel lateral lumbar interbody fusion (LLIF) with or without supplemental instrumentations.

Methods

Six human lumbar specimens were tested under multidirectional nondestructive moments (7.5 N·m), with a 6 degree-of-freedom spine simulator. The overall and intervertebral range of motion (ROM) were measured optoelectronically. Each specimen was tested under the following conditions at L2–5 levels: intact; stand-alone; cage supplemented with lateral plate (LP); cage supplemented with unilateral or bilateral pedicle screw/rod (UPS or BPS).

Results

Compared with intact condition, the overall and intersegmental ROM were significantly reduced after multilevel stand-alone LLIF. The ROM was further reduced after using LP instrumentation. In flexion-extension (FE) and axial rotation (AR), pedicle screw/rod demonstrated greater overall ROM reduction compared to LP (P < 0.01), and bilateral greater than unilateral (P < 0.01). In lateral bending (LB), BPS demonstrated greater overall ROM reduction compared to UPS and LP (P < 0.01), however, UPS and LP showed similar reduction (P = 0.245). Intervertebral ROM reductions showed similar trend as the overall ones after using different types of instrumentation. However, at L2/3 (P = 0.57) and L3/4 (P = 0.097) levels, the intervertebral ROM reductions in AR were similar between UPS and LP.

Conclusions

The overall and intervertebral stability increased significantly after multilevel LLIF with or without supplemental instrumentation. BPS provided the greatest stability, followed by UPS and LP. However, in clinical practice, less invasive adjunctive fixation methods including UPS and LP may provide sufficient biomechanical stability for multilevel LLIF.
Natural combinatorial genetics and prolific polyamine production enable siderophore diversification in Serratia plymuthica
Authors: Cleto Sara , Haslinger Kristina , Prather Kristala L. J. , Lu Timothy K.
Published: March 2021

Background

Iron is essential for bacterial survival. Bacterial siderophores are small molecules with unmatched capacity to scavenge iron from proteins and the extracellular milieu, where it mostly occurs as insoluble Fe3+. Siderophores chelate Fe3+for uptake into the cell, where it is reduced to soluble Fe2+. Siderophores are key molecules in low soluble iron conditions. The ability of bacteria to synthesize proprietary siderophores may have increased bacterial evolutionary fitness; one way that bacteria diversify siderophore structure is by incorporating different polyamine backbones while maintaining the catechol moieties.

Results

We report thatSerratia plymuthicaV4 produces a variety of siderophores, which we term thesiderome, and which are assembled by the concerted action of enzymes encoded in two independent gene clusters. Besides assembling serratiochelin A and B with diaminopropane,S. plymuthicautilizes putrescine and the same set of enzymes to assemble photobactin, a siderophore found in the bacteriumPhotorhabdus luminescens. The enzymes encoded by one of the gene clusters can independently assemble enterobactin. A third, independent operon is responsible for biosynthesis of the hydroxamate siderophore aerobactin, initially described inEnterobacter aerogenes. Mutant strains not synthesizing polyamine-siderophores significantly increased enterobactin production levels, though lack of enterobactin did not impact the production of serratiochelins. Knocking out SchF0, an enzyme involved in the assembly of enterobactin alone, significantly reduced bacterial fitness.

Conclusions

This study shows the natural occurrence of serratiochelins, photobactin, enterobactin, and aerobactin in a single bacterial species and illuminates the interplay between siderophore biosynthetic pathways and polyamine production, indicating routes of molecular diversification. Given its natural yields of diaminopropane (97.75 μmol/g DW) and putrescine (30.83 μmol/g DW),S. plymuthicacan be exploited for the industrial production of these compounds.