bluuebunny/crossref_metadata_2025 huggingface dataset:
Impact of Educational Level on Versions (Basic and Complete) of the Montreal Cognitive Assessment
Authors: Adana Díaz Lila , Arango Andrea , Parra César , Rodríguez-Lorenzana Alberto , Yacelga-Ponce Tarquino
Published: September 2021

Background: One of the most marked problems in the use of screening instruments for the diagnosis of dementia or cognitive impairment in the elderly is the influence of educational level on the results of psychometric tests. The Montreal Cognitive Assessment (MoCA) questionnaire is one of the most widely used dementia screening instruments internationally and with greater proven validity. There is a version of this instrument called MoCA “Basic” which was developed to reduce education bias. The aim of the study was to compare the psychometric characteristics of the MoCA, full versus basic, versions in older adults. Method: Participants (N = 214) completed both versions of the MoCA, and screening measures to corroborate their health status. Results: Internal consistency was satisfactory in both versions: MoCA full (0.79) and MoCA basic (0.76). The overall correlation between both tests was high (0.73). There was no relationship between the dimensions included in each version. Educational level and age explained 33.8% of the total variance in MoCA Full and 31.8% in MoCA Basic. Among educational levels, there are statistically significant differences in participants with <6 years of education. Conclusions: The results confirm that both versions are reliable instruments and also show that in both versions the educational level of <6 years of education continues to have an impact on performance. Therefore, it can be considered that the MoCA Basic version for the Ecuadorian population with <6 years of education continues to imply literacy competencies.
Impact of Masks on Speech Recognition in Adult Patients with and without Hearing Loss
Authors: Ritter Elizabeth , Miller Craig , Morse Justin , Onuorah Princess , Zeaton Abdullah , Zanation Adam , Ebert Charles S. , Thorp Brian D. , Senior Brent , Kimple Adam
Published: September 2021

Introduction: The coronavirus 2019 pandemic has altered how modern healthcare is delivered to patients. Concerns have been raised that masks may hinder effective communication, particularly in patients with hearing loss. The purpose of this study is to determine the effect of masks on speech recognition in adult patients with and without self-reported hearing loss in a clinical setting. Methods: Adult patients presenting to an otolaryngology clinic were recruited. A digital recording of 36 spondaic words was presented to each participant in a standard clinical exam room. Each word was recorded in 1 of 3 conditions: no mask, surgical mask, or N95 mask. Participants were instructed to repeat back the word. The word recognition score was determined by the percent correctly repeated. Results: A total of 45 participants were included in this study. Overall, the mean word recognition score was 87% without a mask, 78% with a surgical mask, and 61% with an N95 mask. Among the 23 subjects (51.1%) with self-reported hearing loss, the average word recognition score was 46% with an N95 mask compared to 79% in patients who reported normal hearing (p < 0.001). Conclusion: Our results suggest that masks significantly decrease word recognition, and this effect is exacerbated with N95 masks, particularly in patients with hearing loss. As masks are essential to allow for safe patient-physician interactions, it is imperative that clinicians are aware they may create a barrier to effective communication.
Low Creatininuria due to Hyponatremia Is Reversible in Many Patients
Authors: Decaux Guy
Published: September 2021

Background: Chronic hyponatremia has been reported to be associated with low solute intake and low creatinine excretion (reflecting likely sarcopenia). We wanted to study the effect, on the long term, of correction of hyponatremia on solute and creatinine excretion in chronic SIADH. Methods: We made a retrospective review of clinical and biochemical data of patients with euvolemic hyponatremia. We analyzed 24-h urine solute and creatinine excretion in volunteers with hyponatremia induced by dDAVP over 4 days, in 12 patients with chronic SIADH (>1 month) before and after a few days of SNa correction and in 12 patients (6 women and 6 men) before and after 3 months of SNa correction by a vaptan or urea. Results: We confirm a low urine creatinine and solute excretion only in patients with chronic hyponatremia (>1 month). Correction of SNa (from 127 ± 2.3 mEq/L to 139 ± 2.8 mEq/L) for >3 months, in the 12 patients (mean age 58 ± 18), was associated with an increase in 24-h creatinine excretion (from 986 ± 239 to 1,238 ± 220 mg; p < 0.02) and in patients treated with a vaptan (n = 5) solute excretion increased from 656 ± 207 mmol/24 h to 960 ± 193 mmol/24 h (p < 0.02). Sodium excretion increased also in the 12 patients (from 100 ± 53 mEq/24 h to 169 ± 38 mEq/24 h; p < 0.01). Conclusion: Chronic hyponatremia (>1 month) is associated with a decrease in solute output (or intake) and in creatinine excretion. In many patients, these abnormalities are reversible in the long term.
Femtosecond Laser-Assisted Anterior Lamellar Keratoplasty as a Treatment Modality for Recalcitrant Post-Laser in situ Keratomileusis Epithelial Ingrowth
Authors: Singh Bhupesh , Sharma Sourabh , Bharti Neha , Samantaray Dharitri , Bharti Sudhank
Published: September 2021

The purpose is to present the outcomes of anterior lamellar keratoplasty for a case of post-laser in situ keratomileusis (LASIK) epithelial ingrowth. A 40-year-old male patient presented with epithelial ingrowth 14 years after primary LASIK with a microkeratome blade in the right eye following trauma. Multiple stromal bed washing was done over a period of 3 years, but recurrence of epithelial ingrowth was seen every time. Femtosecond laser-assisted anterior lamellar keratoplasty was performed in the right eye. Twelve months after the procedure, the patient’s corrected distance visual acuity improved to 6/9, and no recurrence was noted. Femtosecond laser-assisted anterior lamellar keratoplasty is an effective treatment modality in cases of recurrent recalcitrant epithelial ingrowth seen after LASIK.
Epithelial-Specific TLR4 Knockout Challenges Current Evidence of TLR4 Homeostatic Control of Gut Permeability
Authors: Crame Elise E. , Bowen Joanne M. , Secombe Kate R. , Coller Janet K. , François Maxime , Leifert Wayne , Wardill Hannah R.
Published: September 2021

Introduction: Toll-like receptor 4 (TLR4) is a highly conserved immunosurveillance protein of innate immunity, displaying well-established roles in homeostasis and intestinal inflammation. Current evidence shows complex relationships between TLR4 activation, maintenance of health, and disease progression; however, it commonly overlooks the importance of site-specific TLR4 expression. This omission has the potential to influence translation of results as previous evidence shows the differing and distinct roles that TLR4 exhibits are dependent on its spatiotemporal expression. Methods: An intestinal epithelial TLR4 conditional knockout (KO) mouse line (Tlr4ΔIEC, n = 6–8) was utilized to dissect the contribution of epithelial TLR4 expression to intestinal homeostasis with comparisons to wild-type (WT) (n = 5–7) counterparts. Functions of the intestinal barrier in the ileum and colon were assessed with tissue resistance in Ussing chambers. Molecular and structural comparisons in the ileum and colon were assessed via histological staining, expression of tight junction proteins (occludin and zonular occludin 1 [ZO-1]), and presence of CD11b-positive immune cells. Results: There was no impact of the intestinal epithelial TLR4 KO, with no differences in (1) tissue resistance–ileum (mean ± standard error of mean [SEM]): WT 22 ± 7.2 versus Tlr4ΔIEC 20 ± 5.6 (Ω × cm2) p = 0.831, colon WT 30.8 ± 3.6 versus Tlr4ΔIEC 45.1 ± 9.5 p = 0.191; (2) histological staining (overall tissue structure); and (3) tight junction protein expression (% area stain, mean ± SEM)–ZO-1: ileum–WT 1.49 ± 0.155 versus Tlr4ΔIEC 1.17 ± 0.07, p = 0.09; colon–WT 1.36 ± 0.26 versus Tlr4ΔIEC 1.12 ± 0.18 p = 0.47; occludin: ileum–WT 1.07 ± 0.12 versus Tlr4ΔIEC 0.95 ± 0.13, p = 0.53; colon–WT 1.26 ± 0.26 versus Tlr4ΔIEC 1.02 ± 0.16 p = 0.45. CD11b-positive immune cells (% area stain, mean ± SEM) in the ileum were mildly decreased in WT mice: WT 0.14 ± 0.02 versus Tlr4ΔIEC 0.09 ± 0.01 p = 0.04. However, in the colon, there was no difference in CD11b-positive immune cells between strains: WT 0.53 ± 0.08 versus Tlr4ΔIEC 0.49 ± 0.08 p = 0.73. Conclusions: These data have 2 important implications. First, these data refute the assumption that epithelial TLR4 exerts physiological control of intestinal physiology and immunity in health. Second, and most importantly, these data support the use of the Tlr4ΔIEC line in future models interrogating health and disease, confirming no confounding effects of genetic manipulation.
Clinical Decision Support Systems
Authors: Teufel Andreas , Binder Harald
Published: September 2021

Background: By combining up-to-date medical knowledge and steadily increasing patient data, a new level of medical care can emerge. Summary and Key Messages: Clinical decision support systems (CDSSs) are an arising solution to handling rich data and providing them to health care providers in order to improve diagnosis and treatment. However, despite promising examples in many areas, substantial evidence for a thorough benefit of these support solutions is lacking. This may be due to a lack of general frameworks and diverse health systems around the globe. We therefore summarize the current status of CDSSs in medicine but also discuss potential limitations that need to be overcome in order to further foster future development and acceptance.
Efeitos do uso dos orçamentos estático e flexível na inovação de processos e produtos
Authors: Mannes Silvana , Frare Anderson Betti , Beuren Ilse Maria
Published: September 2021

Este estudo analisa os efeitos do uso dos orçamentos estático e flexível na inovação de processos e produtos. Uma survey foi realizada com gestores de empresas beneficiadas pela Lei n° 11.196, de 21 de novembro de 2005, denominada de Lei do Bem, e obteve-se 133 respostas válidas. Para testar as hipóteses aplicou-se a modelagem de equações estruturais, por mínimos quadrados parciais. Adicionalmente, fez-se a análise de mapas de importância-desempenho. Os resultados indicam relação positiva e significativa tanto do orçamento estático como do orçamento flexível com inovação de processos e inovação de produtos. O orçamento estático apresenta maior importância em prol da inovação de processos, enquanto o orçamento flexível exibe maior importância na inovação de produtos. De maneira geral, os achados reforçam a complementaridade dos orçamentos estático e flexível em relação à inovação tecnológica. Esses resultados contribuem para a literatura de Sistemas de Controle Gerencial, em específico sobre a utilidade dos orçamentos, além de contribuições práticas para a gestão, como no caso das empresas inovadoras beneficiadas pela Lei do Bem.
Identificação das unidades de paisagem em trecho do centro da cidade de Macaé, Rio de Janeiro, Brasil
Authors: Pereira Fernanda de Abreu , Aliprandi Danielly Cozer
Published: September 2021

A cidade de Macaé, localizada no interior do estado do Rio de Janeiro, conhecida como a capital nacional do petróleo, recebeu este título por ser um polo importante para a gestão da atividade petrolífera brasileira. As interferências dessa atividade atingiram diversos aspectos da cidade, como a economia, o crescimento populacional, a expansão urbana e, consequentemente, a paisagem. Com o interesse em caracterizar a paisagem, foi utilizado o método de unidades de paisagem aplicado em um trecho da cidade. Este artigo possui mapas de análise elaborados para observar diferentes aspectos do trecho, com objetivo de auxiliar no diagnóstico das unidades de paisagem existentes. Como ferramenta de subsídio, foram estudados autores referência no tema de mapeamento temático, assim como observação do local. Por fim, foram identificadas as unidades de paisagem e apontadas suas características e potencialidades.
Gay, Roxane. Ayiti. New York: Grove Atlantic, 2018.
Authors: Pellegrino de Oliveira Priscilla
Published: September 2021

Resenha do livro AYITI, de Roxane Gay.
O Local e Além: As poéticas em trânsito de Paula Tavares e Conceição Lima
Authors: Amorim Bernardo Nascimento
Published: September 2021

O artigo apresenta apontamentos acerca de traços característicos das poéticas de Paula Tavares e Conceição Lima, com referências aos dois primeiros livros da angolana, Ritos de passagem (1985) e O lago da lua (1999), e ao segundo e ao terceiro da são-tomense, A dolorosa raiz do micondó (2006) e O país de Akendenguê (2011). Procuro pensar sobre como tais poetas lidam com a herança que seus predecessores lhes legaram, demonstrando de que forma, consciente e propositalmente conectadas com determinados lugares, ambas fazem também o elogio da travessia, constituindo-se como exemplares de uma postura avessa a qualquer monolitismo.
Um nome, um destino: uma onomástica na ficção de Nelson Rodrigues
Authors: Rabelo Adriano de Paula
Published: September 2021

Os nomes dos personagens são uma das mais importantes chaves de interpretação de uma obra ficcional, a ponto de chegarem a determinar os rumos da ação. Muito especialmente, eles dizem muito sobre quem são tais personagens, por que fazem o que fazem, como representam aspectos da realidade de uma determinada sociedade. Nas peças, romances, contos e folhetins de Nelson Rodrigues, escritor que tinha plena consciência desse poder expressivo dos nomes, a ponto de refletir frequentemente sobre isso em de suas crônicas ensaísticas, os nomes dados a seus personagens constituem um dos elementos a que o leitor ou espectador de seus trabalhos deve prestar grande atenção. Este artigo resulta de um amplo levantamento dos nomes de seus personagens, classificando-os em categorias e analisando brevemente seus sentidos, suas peculiaridades, suas relações com as personalidades que nomeiam.
Fine structure of spermatogenesis in the spider crab Lissa chiragra (Fabricius, 1775) (Eubrachyura, Epialtidae)
Authors: Gaber Ibrahim , Al-Mahasneh Abdallah
Published: September 2021

This article uses the male spider crab Lissa chiragra, collected from Ras el Tin beach on the Mediterranean Sea at Alexandria, Egypt, between January and December 2017, as a model for a descriptive study of the functional morphology of the different structures of spermatogenesis with the aid of the transmission electron microscope. This study divides the seminiferous tubule into three zones, i.e., the germinal, transformation, and evacuation zone. The transformation or maturation zone occupies the central area. The evacuation zone lies at a pole opposite to the germinal zone. The anterior vas deferens is a tube where the formation of the spermatophore occurs by means of secretions from the epithelium. The ejaculatory duct is located between the muscles of the coxae of the fifth walking legs. This study concluded that the complex acrosome vesicle is formed during spermiogenesis and the cytoplasm includes the membrane system, constituted by the endoplasmic reticulum, Golgi apparatus, and vesicles associated with microtubules, and a few mitochondria. The Golgi apparatus is developed and is organized progressively to produce various vesicles. The cytoplasm forms a ring at the base of the nuclear extensions. The merger of the plasma and nuclear membranes, results in a pentalaminar membranous structure in some regions of the cell surface.
Kalanchoe benbothae (K. subg. Fernandesiae; Crassulaceae subfam. Kalanchooideae), a new southern African species endemic to KwaZulu-Natal in the Maputaland-Pondoland Region of Endemism
Authors: SMITH GIDEON F. , CROUCH NEIL R.
Published: September 2021

Since 2016 the number of species of Kalanchoe (Crassulaceae subfam. Kalanchooideae) known from southern Africa has increased by more than 50%, from 13 to 20. We here describe the 21st species known from the subcontinent. As far as could be determined, this new species, K. benbothae, is endemic to northeastern KwaZulu-Natal, the eastern-most province of South Africa, with the entire natural geographical distribution range of the species falling within the Maputaland-Pondoland Region of Endemism. Kalanchoe benbothae fits in K. subg. Fernandesiae, a cluster of species with large, paddle- to soup plate-sized leaves, and dense, elongated, often club-shaped inflorescences. The closest relative of K. benbothae is K. luciae, which was described just over 110 years ago, and was the second representative of K. subg. Fernandesiae to have been described. Kalanchoe benbothae differs from K. luciae mostly in its reproductive morphology (corolla lobe colour and orientation, anther colour and presentation, filament length, pistil shape, and size and shape of the nectar scales).
Perioperative Antibiotic Use in Sleep Surgery: Clinical Relevance
Authors: Abdelwahab Mohamed , Marques Sandro , Previdelli Isolde , Capasso Robson
Published: September 2021

Objective

Upper airway surgery is a common therapeutic approach recommended for patients with obstructive sleep apnea (OSA) to decrease disease burden. We aimed to evaluate the effect of perioperative antibiotic prescription on complication rates.

Study Design

Retrospective cohort (national database).

Setting

Tertiary referral center.

Methods

This is a retrospective study of a large national health care insurance database (Truven MarketScan) from 2007 to 2015. Subjects diagnosed with OSA who had uvulopalatopharyngoplasty (UPPP) were included and stratified in single versus multilevel surgery. Other variables included smoking, age, sex, antibiotic prescription, and comorbidities based on the Elixhauser index. Evaluated outcomes were postoperative bleeding, intubation, pneumonia, superficial surgical site infection, tracheostomy, and hospital readmission. A multivariate regression model was created to assess each complication.

Results

A total of 5,798,528 subjects received a diagnosis of OSA, of which 39,916 were >18 years old and underwent UPPP, either alone or with additional procedures. The mean age was 43 years, and 73.4% were male. Antibiotic prescription was associated with less bleeding in UPPP alone, UPPP with nasal surgery, and UPPP with nasal and tongue surgery (P <. 001, P <. 001, and P =. 006, respectively). It was also associated with a lower prevalence of surgical site infection, pneumonia, tracheostomy, intubation, and hospital readmission (P <. 001). On a multivariate model, antibiotic prescription was significantly associated with a decreased rate of complications.

Conclusions

Although former studies recommended against the use of antibiotics after tonsillectomy, our results suggest that antibiotic prescription after UPPP for OSA was associated with less bleeding, surgical site infection, pneumonia, intubation, tracheostomy, and hospital readmission 30 days postoperatively.
Migraine evolution after the cessation of CGRP(-receptor) antibody prophylaxis: a prospective, longitudinal cohort study
Authors: Raffaelli Bianca , Terhart Maria , Overeem Lucas Hendrik , Mecklenburg Jasper , Neeb Lars , Steinicke Maureen , Reuter Uwe
Published: September 2021

Background

National and international guidelines recommend stopping migraine prophylaxis with CGRP(-receptor) monoclonal antibodies after 6–12 months of successful therapy. In this study, we aimed to analyze the course of migraine for four months after the cessation of CGRP(-receptor) antibodies use.

Methods

This longitudinal cohort study included patients with migraine who received a CGRP-(receptor) antibody for ≥8 months before treatment cessation. We analyzed headache data in the four-week period prior to mAb treatment initiation (baseline), in the month before the last mAb injection, in weeks 5–8 and 13–16 after last treatment. Primary endpoint of the study was the change of monthly migraine days from the month before last treatment to weeks 13–16. Secondary endpoints were changes in monthly headache days and monthly days with acute medication use.

Results

A total of 62 patients equally distributed between prophylaxis with the CGRP-receptor antibody erenumab and the CGRP antibodies galcanezumab or fremanezumab participated in the study. Patients reported 8.2 ± 6.6 monthly migraine days in the month before last treatment. Monthly migraine days gradually increased to 10.3 ± 6.8 in weeks 5–8 (p = 0.001) and to 12.5 ± 6.6 in weeks 13–16 (p < 0.001) after drug cessation. Monthly migraine days in weeks 13–16 were not different from baseline values (−0.8 ± 5.4; p > 0.999). Monthly headache days and monthly days with acute medication use showed a similar pattern.

Conclusions

The cessation of CGRP(-receptor) antibodies migraine prophylaxis was associated with a significant increase of migraine frequency and acute medication intake over time.
Refractory Yet Transient Neonatal Hypocalcemia Due to Hitherto Undiagnosed Asymptomatic Maternal Hyperparathyroidism: A Case Report
Authors: Boddu Sirisha Kusuma , Kharidehal Neelima , Balla Kalyan Chakravarthy
Published: September 2021

Hypocalcemia is one of the common causes of neonatal seizures and can result in significant morbidity. Among the multitude of etiologies, hypoparathyroidism as a consequence of maternal hyperparathyroidism is an uncommon one. We describe a neonate who presented with hypocalcemic seizures with relative hypoparathyroidism that unmasked a previously undiagnosed and asymptomatic maternal hyperparathyroidism, and explore the difficulties encountered in the management. Despite initial recalcitrance of hypocalcemia to therapy, parathyroid suppression was transient and recovered completely in few months.
The cost-effectiveness of new first-line therapies approved in advanced hepatocellular carcinoma
Authors: Giuliani Jacopo , Mantoan Beatrice , Bonetti Andrea
Published: September 2021

The introduction of targeted agents (lenvatinib) and immune-based therapies (atezolizumab in combination with bevacizumab) for first-line advanced hepatocellular carcinoma provided new therapeutic options. The aim of this paper was to assess the cost-effectiveness of lenvatinib and the combination of atezolizumab plus bevacizumab in first-line for advanced hepatocellular carcinoma. Pivotal phase III randomized controlled trials were considered. Incremental cost-effectiveness ratio was calculated as the ratio between the difference of the costs in the intervention and in the control groups (pharmacy costs) and the difference between the effect in the intervention and in the control groups (progression free survival). One thousand four hundred and fifty five patients were included. The lowest cost for month of progression free survival-gain was associated with lenvatinib, with 139.24 € per month progression free survival-gained. Combining pharmacological costs of drugs with the measure of efficacy represented by progression free survival, lenvatinib is a cost-effective treatment in first-line for advanced hepatocellular carcinoma.
The quest of finding the self in the Bedhaya: Unravelling the psychological significance of the Javanese sacred dance
Authors: Rahapsari Satwika
Published: September 2021

The Bedhaya is the avant-garde of Yogyakarta and Surakarta (Java, Indonesia) court dance. This classical dance replete with Javanese symbols, spirituality and cultural values embedded in its aesthetic elements. Furthermore, the Bedhaya was created not for entertainment but rather as a meditative medium that would allow individuals to gain wisdom and higher consciousness. These noble characteristics of the dance suggest that the Bedhaya has psychological purposes for the performers and the spectators. We may gain insight into the process of attaining mental growth through studying the embodied wisdom and aesthetic ideal of the Bedhaya, which reflects the development of the human’s psyche. Therefore, the author proposes an interpretation of Bedhaya’s underlying symbolism, aesthetic experience, and potential as means of psychological growth. The paper’s primary argument is delivered by studying a set of theoretical ideas that present Bedhaya as a distinguished aesthetic with psychological capacities. Further, art as an embodiment of cultural wisdom and ethics is also discussed by connecting Bedhaya and other artistic forms drawn from varied cultures.
Student teachers’ experience with improvisation activities for spontaneous speech practice in English
Authors: Zondag Anke
Published: September 2021

Because most real-life foreign language speech is naturally unpredictable, spontaneous speech should be practiced in the foreign language classroom. Student teachers of English as a foreign language (EFL) may benefit from practising methodology for spontaneous speech practice. This article reports the findings for a study into EFL student teachers’ experiences with using improvisation activities, exploring the relevance of improvisation activities for spontaneous speech practice. The data include semi-guided texts and reluctant speakers’ interviews. The findings showed that improvisation activities facilitated spontaneous speech practice and strengthened speaking confidence through enjoyment. The ‘spontaneous speech mindset’ enabled participants to explore linguistic and creative boundaries. The study showed that application of improvisation activities is an excellent method for spontaneous speech practice in EFL teacher education.
One-Stage Hybrid Total Aortic Arch and Descending Thoracic Aortic Repair is a Safe and Secure Procedure With Less Postoperative Complications for Extended Aortic Arch Aneurysms
Authors: Mizuno Tomohiro , Hachimaru Tsuyoshi , Fujiwara Tatsuki , Oishi Kiyotoshi , Takeshita Masashi , Yashima Masafumi , Okumura Yushi , Nagaoka Eiki , Oi Keiji , Arai Hirokuni
Published: September 2021

Purpose

Hybrid aortic arch repair (HAR) has been implemented for extended aortic arch and descending thoracic aortic disease since 2012 in our institution. This study aimed to estimate the early and mid-term efficacy and safety of HAR.

Materials and Methods

From 2007 to 2019, 56 patients underwent HAR for extended aortic arch disease, and 75 patients underwent total arch replacement (TAR) for arch-limited disease. HAR comprises 3 procedures: replacement of the aorta, reconstruction of all arch vessels, and thoracic endovascular aortic repair (TEVAR) from zone 0 to the descending aorta after cardiopulmonary bypass is off in 1 stage. The type II-1 HAR procedure, in which the ascending aorta and aortic arch distal to the brachiocephalic artery are replaced, was the most frequently selected procedure (40/56 patients). The outcomes of the type II-1 HAR procedure were compared with those of TAR using the Cox regression analysis.

Results

The median follow-up period was 36 months. In HAR, the operative mortality, in-hospital mortality, and postoperative permanent neurological deficits were not observed. The paraplegia rate was 1.8%. TEVAR-related complications occurred in 3 patients. Among the patients with non-ruptured atherosclerotic aortic arch aneurysm (31 type II-1 HAR patients and 36 TAR patients, the postoperative respiratory support time in those who underwent type II-1 HAR was quicker than in those who underwent TAR (p<0.01). The rate of 6 year freedom from all-cause death in type II-1 HAR (83.1%) was numerically higher than that in TAR (74.7%), and the rate of 6 year freedom from surgery-related complications in type II-1 HAR (90.3%) was numerically lower than that in TAR (96.9%) due to the occurrence of TEVAR-related complications, and the rate of 6 year freedom from reintervention to the descending thoracic aorta in type II-1 HAR (100%) seemed to be better than that in TAR (83.7%). However, Cox regression analysis did not reveal any statistical difference between the 2 procedures.

Conclusions

HAR, especially the type II-1 procedure, can treat extended aortic arch disease with acceptable survival outcomes. The development of TEVAR technology will further improve the outcomes of HAR in the future.
Badminton stroke identification using wireless inertial sensor and neural network
Authors: Ooi Jian Hui , Gouwanda Darwin
Published: September 2021

Objective evaluation is essential in sports to monitor athlete performance, provide relevant and timely feedback, and minimize the risk of injury. Activity recognition is the first step in sport skill and technique performance analysis. This study investigated the use of wearable inertial sensors and a neural network (NN) to identify badminton strokes. The study also explored the effect of different NN configurations and a different number of sensors on the classification. Sensors were placed at the dominant wrist, left ankle, and right ankle. Six different strokes, ranging from soft hitting net shots to smashes, were performed with a total of 3300 repetitions from six well-trained badminton players. An automated window segmentation method was developed to identify the stroke instances. A scaled conjugate gradient training algorithm with two hidden layers and 55 neurons in each layer was found to be the best approach to classify badminton strokes with an accuracy of 97.69%. Even just wearing the inertial sensor on the wrist was sufficient, providing an accuracy of 95.09%. These results demonstrate the viability of using inertial sensors and NN to recognize badminton strokes, which can be applied in training and competitive environments.
Pharmacotherapeutic approach toward urological medications and vaccination during COVID-19: a narrative review
Authors: Shafiekhani Mojtaba , Dehghani Anahita , Shahisavandi Mina , Nabavizadeh Seyed Ali , Kabiri Maryam , Hassani Amir Hossein , Haghpanah Abdolreza
Published: September 2021

One year after the prevalence of the novel coronavirus pandemic, some aspects of the physiopathology, treatment and progression of coronavirus 2019 disease (COVID-19) have remained unknown. Since no comprehensive study on the use of urological medications in patients with COVID-19 has been carried out, this narrative review aimed to focus on clinically important issues about the treatment of COVID-19 and urologic medications regarding efficacy, modifications, side effects and interactions in different urologic diseases. In this review, we provide information about the pharmacotherapeutic approach toward urologic medications in patients with COVID-19 infection. This study provides an overview of medications in benign prostatic hyperplasia, prostate cancer, impotence and sexual dysfunction, urolithiasis, kidney transplantation and hypertension as the most frequent diseases in which the patients are on long-term medications. Also, the effect of urologic drugs on the efficacy of vaccination is briefly discussed.
Higher Education for Development: The Role of University Towns in China
Authors: Mei Weihui , Symaco Lorraine Pe
Published: September 2021

China’s expansion in higher education has also given rise to developing university towns in sub-cities to deal with increasing enrollments and contribute to broader socio-economic development. Taking Xiasha University Town in Hangzhou as a case study, this paper adopts a tripartite framework of teaching, research, and service to investigate the role of university towns in human capital and skills development, regional innovation, and social and community services. This paper is the first to systematically evaluate Hangzhou’s largest university town after more than two decades since its development; it also provides a more nuanced and contextual approach to university town developments similar to others in China or broader learning region integrations globally. Documentary research and interviews from relevant stakeholders were utilized to collect data. This study presents the three dimensions contextualized within Xiasha and points to issues that can further improve such through a more efficient resource-sharing scheme, a focused discipline orientation, more significant investments in research and development, and a more active role in community engagement.
Determinants of Nutrition Care Practice by Midwives and Nurses in the Antenatal and Postnatal Care Settings: A Multi-Site Cross-Sectional Survey From Ghana
Authors: Kumbiley Jacqueline , Amalba Anthony , Aryee Paul Armah , Azure Simon Agongo , Mogre Victor
Published: September 2021

Aim. Midwives and nurses are critical in nutrition care for pregnant women and lactating mothers. Ghanaian nurses and midwives’ perception of the adequacy and their satisfaction with nutrition education received during training in school, level of nutrition care competencies, and nutrition practice behavior is unknown. We evaluated the adequacy of nutrition education received in nursing and midwifery school; nutrition care competencies; self-efficacy and the nutrition care practice of midwives and nurses. We also evaluated determinants of nutrition care practice during routine antenatal and postnatal care. Methods. Cross-sectional study conducted among midwives and nurses working at antenatal and postnatal clinics in Ghana. Data was collected using a self-administered questionnaire. Data analysis was done using descriptive statistics, correlation, and linear regression. Findings. Almost 90% (n = 267) of the participants received nutrition education during training, 77.5% were unsatisfied with the amount of time allocated for nutrition education and 40% felt inadequately prepared from school to provide nutrition care. Self-efficacy ranged from moderate to low. Determinants of nutrition care practice were age of respondents ( B = 0.04; P = .002), nutrition-related knowledge ( B = 0.05; P = .016), adequacy of nutrition education ( B = 0.14; P = .006), nutrition training after school ( B = 0.38; P = .010) and nutrition care self-efficacy ( B = 0.03; P = .048). Conclusion. Notable knowledge gaps in basic nutrition, inadequate preparedness, and poor confidence to provide nutrition care was common. There is a need to improve the nutrition education experiences of midwives and nurses through curricula revision and refresher training courses.
The promise and perils of immunotherapy
Authors: Lesch Stefanie , Gill Saar
Published: September 2021

Advances in understanding the ways in which the immune system fails to control tumor growth or prevent autoimmunity have led to the development of powerful therapeutic strategies to treat these diseases. In contrast to conventional therapies that have a broadly suppressive effect, immunotherapies are more akin to targeted therapies because they are mechanistically driven and are typically developed with the goal of “drugging” a specific underlying pathway or phenotype. This means that their effects and toxicities are, at least in theory, more straightforward to anticipate. The development of functionalized antibodies, genetically engineered T cells, and immune checkpoint inhibitors continues to accelerate, illuminating new biology and bringing new treatment to patients. In the following sections, we provide an overview of immunotherapeutic concepts, highlight recent advances in the field of immunotherapies, and discuss controversies and future directions, particularly as these pertain to hematologic oncology or blood-related diseases. We conclude by illustrating how original research published in this journal fits into and contributes to the overall framework of advances in immunotherapy.
Novel population of human monocyte and osteoclast progenitors from pluripotent stem cells and peripheral blood
Authors: Root Sierra H. , Aguila Héctor L.
Published: September 2021

Osteoclasts are multinuclear cells of monocytic lineage, with the ability to resorb bone. Studies in mouse have identified bone marrow clonal progenitors able to generate mature osteoclast cells (OCs) in vitro and in vivo. These osteoclast progenitors (OCPs) can also generate macrophages and dendritic cells. Interestingly, cells with equivalent potential can be detected in periphery. In humans, cells with OCP activity have been identified in bone marrow and periphery; however, their characterization has not been as extensive. We have developed reproducible methods to derive, from human pluripotent stem cells, a population containing monocyte progenitors able to generate functional OCs. Within this population, we have identified cells with monocyte and osteoclast progenitor activity based on CD11b and CD14 expression. A population double positive for CD11b and CD14 contains cells with expected osteoclastic potential. However, the double negative (DN) population, containing most of the hematopoietic progenitor activity, also presents a very high osteoclastic potential. These progenitor cells can also be differentiated to macrophage and dendritic cells. Further dissection within the DN population identified cells bearing the phenotype CD15−CD115+ as the population with highest monocytic progenitor and osteoclastic potential. When similar methodology was used to identify OCPs from human peripheral blood, we confirmed a published OCP population with the phenotype CD11b+CD14+. In addition, we identified a second population (CD14−CD11bloCD115+) with high monocytic progenitor activity that was also able to form osteoclast like cells, similar to the 2 populations identified from pluripotent stem cells.
Thrombosis and novel hemophilia therapies: the fine line between clotting and bleeding
Authors: Hoffman Maureane
Published: September 2021

The availability of novel nonfactor therapeutics is revolutionizing the management of hemophilia in individuals with inhibitory antibodies, as well as making prophylaxis more convenient even in the absence of inhibitors. Unfortunately, the use of these products has been associated with thrombotic events that are not typically seen with factor replacement. These are primarily seen when a patient on a nonfactor therapy experiences breakthrough bleeding and concomitantly receives another hemostatic agent. This video addresses thrombotic complication in 3 nonfactor products: (1) emicizumab, a bispecific antibody that mimics the cofactor activity of factor VIII; (2) fitusiran, an small interfering RNA that knocks down synthesis of antithrombin; and (3) concizumab, an antibody that blocks inhibition of factor Xa by tissue factor pathway inhibitor. The latter 2 agents were developed on the premise that hemostasis in hemophilia could be “rebalanced” by reducing the levels of anticoagulant activity to compensate for the defect in procoagulant activity. Each of these approaches increases peak levels of thrombin achieved in assays on plasma from treated subjects and reduces bleeding rates in individuals with or without inhibitors. However, we do not yet have a good mechanistic model for precisely how these approaches affect hemostasis in vivo. It is not only the total amount of active thrombin produced that determines the effectiveness of hemostasis but also how thrombin generation is regulated. Therefore, it is currently difficult to predict how these new agents will interact with other perturbations or therapeutic manipulations of the coagulation system.
Association between cardiovascular disease- and inflammation-related serum biomarkers and poor lung function in elderly
Authors: Egervall K. , Rosso A. , Elmståhl S.
Published: September 2021

Background

Cardiovascular disease (CVD) is a common comorbidity in chronic obstructive pulmonary disease (COPD) and reduced lung function is an important risk factor for CVD and CVD-related death. However, the mechanisms behind the increased risk for CVD in COPD patients are not fully understood.

Methods

We examined the association between CVD- and inflammation-related serum biomarkers, and pulmonary function in a geriatric population. 266 biomarkers related to CVD and inflammation were analyzed in blood samples from 611 subjects aged 66–86 years who participated in the Good Aging in Skåne study. Serum levels were assessed by a proximity extension assay. Pulmonary function was measured using the lower limit of normality (LLN) spirometry criteria, i.e., forced expiratory volume in 1 s (FEV1)/forced vital capacity (FVC)  <  LLN. Logistic regression models were implemented and multiple comparisons were accounted for.

Results

10.3% of the study participants fulfilled pulmonary function decline criteria according to LLN. Out of the 266 biomarkers, only plasminogen activator, urokinase receptor (PLAUR) was statistically significantly associated with decreased pulmonary function. We could not find a statistically significant association between pulmonary function decline and other biomarkers previously linked to COPD, such as interleukin 6, tumor necrosis factor and surfactant protein D.

Conclusion

We found that serum levels of PLAUR are associated with pulmonary function decline in older adults. PLAUR is activated following inflammation and promotes matrix metallopeptidase (MMP) activation and extracellular matrix (ECM) degradation. This implies that PLAUR could play a role in the early phase of COPD pathogenesis.
multiMarker: software for modelling and prediction of continuous food intake using multiple biomarkers measurements
Authors: D’Angelo Silvia , Gormley Isobel Claire , McNamara Aoife E. , Brennan Lorraine
Published: September 2021

Background

Metabolomic biomarkers offer potential for objective and reliable food intake assessment, and there is growing interest in using biomarkers in place of or with traditional self-reported approaches. Ongoing research suggests that multiple biomarkers are associated with single foods, offering great sensitivity and specificity. However, currently there is a dearth of methods to model the relationship between multiple biomarkers and single food intake measurements.

Results

Here, we introduce multiMarker, a web-based application based on the homonymous R package, that enables one to infer the relationship between food intake and two or more metabolomic biomarkers. Furthermore, multiMarker allows prediction of food intake from biomarker data alone. multiMarker differs from previous approaches by providing distributions of predicted intakes, directly accounting for uncertainty in food intake quantification. Usage of both the R package and the web application is demonstrated using real data concerning three biomarkers for orange intake. Further, example data is pre-loaded in the web application to enable users to examine multiMarker’s functionality.

Conclusion

The proposed software advance the field of Food Intake Biomarkers providing researchers with a novel tool to perform continuous food intake quantification, and to assess its associated uncertainty, from multiple biomarkers. To facilitate widespread use of the framework, multiMarker has been implemented as an R package and a Shiny web application.
Endovascular Thrombectomy preceded by intravenous Alteplase versus endovascular Thrombectomy alone in Han Chinese patients treated for acute ischemic stroke with large vessel occlusion: a single-center retrospective analysis
Authors: Han Ruodong , Li Bowen , Yue Yajie , Wu Guozhu , Yan Xiuxia
Published: September 2021

Background

The American Heart Association/ American Stroke Association and the Chinese Stroke Association guidelines are recommending intravenous alteplase intervention before endovascular thrombectomy if patients are eligible to do so but the benefits of endovascular thrombectomy are different in Chinese patients with stroke than those of the white patients. The objective of the study was to compare outcomes of patients with acute ischemic stroke treated with endovascular thrombectomy with intravenous alteplase against those treated with endovascular thrombectomy alone.

Methods

A report is a retrospective analysis of comparing demographics, imaging, clinical and adverse outcomes in the Han Chinese patient who underwent mechanical thrombectomy for acute ischemic stroke with large vessel occlusion, with or without preceding intravenous alteplase administration. Patients with terminus and non-terminus intracranial occlusions and ≤ 2 points neurologic deficit underwent endovascular thrombectomy preceded by 0.9 mg/ kg intravenous alteplase (ET cohort, n = 184) and those who had contra-indication for intravenous alteplase were treated with endovascular thrombectomy alone (EA cohort, n = 141).

Results

The most common procedural complications were embolization into new territory (p = 0.866) and uneventful artery vasospasm (p = 0.712). Insignificant differences were reported for any procedural complications (p = 0.991), imaging outcomes, the modified Rankin scale score (p = 0.663), and death (28 vs. 24, p = 0.761) within 90 days between patients of both cohorts. At the discharge of the hospital, the National Institutes of Health Stroke Scale scores of patients of the ET cohort were lower than those of the EA cohort (8.58 ± 3.79 vs. 10.23 ± 4.97, p = 0.003). The Barthel Index of survivors at 90 days after endovascular thrombectomy was higher for patients of the ET cohort than those of the EA cohort (87.47 ± 12.58 vs. 84.01 ± 13.47, p = 0.032). The most common adverse effect was asymptomatic intracranial hemorrhage (p = 0.297). Insignificant differences were reported for adverse effects after thrombectomy between survivors of both cohorts.

Conclusions

Outcome measures in Han Chinese patients with acute ischemic stroke treated with endovascular thrombectomy alone were statistically the same as those treated with endovascular thrombectomy plus intravenous alteplase.

Level of evidence

Iii

Technical efficacy stage

4.
Global socioeconomic inequality in the burden of communicable and non-communicable diseases and injuries: an analysis on global burden of disease study 2019
Authors: Emadi Mehrnoosh , Delavari Sajad , Bayati Mohsen
Published: September 2021

Background

Examining the distribution of the burden of different communicable and non-communicable diseases and injuries worldwide can present proper evidence to global policymakers to deal with health inequality. The present study aimed to determine socioeconomic inequality in the burden of 25 groups of diseases between countries around the world in 2019.

Methods

In the current study data according to 204 countries in the world was gathered from the Human Development Report and the Global Burden of Diseases study. Variables referring to incidence, prevalence, years of life lost (YLL), years lived with disability (YLD) and disability adjusted life years (DALY) resulting by 25 groups of diseases and injuries also human development index was applied for the analysis. For measurement of socioeconomic inequality, concentration index (CI) and curve was applied. CI is considered as one of the popular measures for inequality measurement. It ranges from − 1 to + 1. A positive value implies that a variable is concentrated among the higher socioeconomic status population and vice versa.

Results

The findings showed that CI of the incidence, prevalence, YLL, YLD and DALY for all causes were − 0.0255, − 0.0035, − 0.1773, 0.0718 and − 0.0973, respectively. CI for total Communicable, Maternal, Neonatal, and Nutritional Diseases (CMNNDs) incidence, prevalence, YLL, YLD and DALY were estimated as − 0.0495, − 0.1355, − 0.5585, − 0.2801 and − 0.5203, respectively. Moreover, estimates indicated that CIs of incidence, prevalence, YLL, YLD and DALY for Non-Communicable Diseases (NCDs) were 0.1488, 0.1218, 0.1552, 0.1847 and 0.1669, respectively. Regarding injuries, the CIs of incidence, prevalence, YLL, YLD and DALY were determined as 0.0212, 0.1364, − 0.1605, 0.1146 and 0.3316, respectively. In the CMNNDs group, highest and lowest CI of DALY were related to the respiratory infections and tuberculosis (− 0.4291) and neglected tropical diseases and malaria (− 0.6872). Regarding NCDs, the highest and lowest CI for DALY is determined for neoplasms (0.3192) and other NCDs (− 0.0784). Moreover, the maximum and minimum of CI of DALY for injuries group were related to the transport injuries (0.0421) and unintentional injuries (− 0.0297).

Conclusions

The distribution of all-causes and CMNNDs burden were more concentrated in low-HDI countries and there are pro-poor inequality. However, there is a pro-rich inequality for NCDs’ burden i.e. it was concentrated in high-HDI countries. On the other hand, the concentration of DALY, YLD, prevalence, and incidence in injuries was observed in the countries with higher HDI, while YLL was concentrated in low-HDI countries.