bluuebunny/crossref_metadata_2025 huggingface dataset:
Massive Hemoptysis Caused by an Aortobronchial Fistula Related to Pedicle Screw Impingement
Authors: Li Long , Lao Yong-Hao
Published: March 2021

We report a case of a 50-year-old man with a 10-year history of pedicle screw internal fixation in the thoracic spine and heroin abuse, who presented with sudden-onset massive hemoptysis with hemorrhagic shock and asphyxia. Urgent contrast-enhanced chest computed tomography (CT) characteristically showed thoracic aortic perforation, a paravertebral pseudoaneurysm, and an intrapulmonary hematoma. Emergency percutaneous thoracic endovascular aortic repair (pTEVAR) with the preclose technique using a vascular closure device under local anesthesia achieved success without any complications. The current case highlights the importance of understanding massive hemoptysis caused by an aortobronchial fistula related to pedicle screw impingement in clinical practice and the value of pTEVAR with the preclose technique under local anesthesia in the emergency setting.
A Diagnostic Algorithm to Guide Operative Intervention of Zone 5 Flexor Injuries
Authors: Alluri Ram K. , Vakhshori Venus , Hill Ryan , Azad Ali , Ghiassi Alidad , Stevanovic Milan
Published: March 2021

Background: Given the importance of the neurovascular structures in the volar forearm, accurate diagnosis of zone 5 flexor injuries is critical. Purpose: We sought to test the hypothesis that tendinous injury would be more likely in the distal 50% of the forearm and muscle belly injury would be more likely in the proximal 50% of the forearm. Methods: From December 2015 to December 2016, we conducted a prospective clinical study of patients 18 years and older with zone 5 flexor lacerations. We excluded those with concomitant ipsilateral injuries in flexor zones 1 to 4, multiple lacerations in flexor zone 5, prior neurovascular injuries, crush injuries, patients who underwent operative exploration prior to transfer to our facility, and patients who were unable or unwilling to provide consent. Neurovascular and musculotendinous injuries on physical examination were recorded. All patients underwent operative exploration. Physical examination accuracy and the incidence of musculotendinous and neurovascular injury in the distal 50% of the forearm were compared with the proximal 50% of the forearm. Results: The distal 50% of the forearm (group 1, n = 14) had higher probability of tendon injury (64%), whereas lacerations of the proximal 50% of the forearm (group 2, n = 5) did not result in any tendinous injuries. Rather, all patients in group 2 had muscle belly injuries. There was no difference in the rate of neurovascular injury between groups. Physical examination alone was highly accurate in diagnosing nerve injuries (93%–100%) but less accurate in diagnosing arterial injuries (79%–80%) regardless of the location of injury. Conclusions: Due to the lack of tendinous injuries in proximal zone 5 lacerations, along with the accuracy of physical examination in determining the presence of neurovascular injuries, patients with lacerations in the proximal half of the forearm, without evidence of nerve or arterial injury, can likely be observed in lieu of immediate operative exploration.
Effectiveness of Tai Chi for Health Promotion of Older Adults: A Scoping Review of Meta-Analyses
Authors: Yang Fei-Chi , Desai Aishwarya B. , Esfahani Pelareh , Sokolovskaya Tatiana V. , Bartlett Doreen J.
Published: March 2021

Background. Tai Chi is a form of exercise that is accessible to people from different socioeconomic backgrounds, making it a potentially valuable activity for health promotion of older adults. Purpose. The objective of this scoping review was to summarize the current knowledge about the effectiveness of Tai Chi for older adults across a range of general health outcomes from published, peer reviewed, unique meta-analyses. Methods. Meta-analyses were retrieved from Medline, Embase, AMED, CINAHL, SPORTDiscus, PsychINFO, Web of Science, PubMed Health, and the Cochrane Library from database inception to late August 2019. Multistage deduplication and screening processes identified eligible full-length meta-analyses. Two people independently appraised 27 meta-analyses based on the GRADE system and organized results into 3 appendices subsequently collated into heterogeneous, statistically significant, and statistically insignificant tables. Results. “High” and “moderate” quality evidence extracted from these meta-analyses demonstrated that practicing Tai Chi can significantly improve balance, cardiorespiratory fitness, cognition, mobility, proprioception, sleep, and strength; reduce the incidence of falls and nonfatal stroke; and decrease stroke risk factors. Conclusions. Health care providers can now recommend Tai Chi with high level of certainty for health promotion of older adults across a range of general health outcomes for improvement of overall well-being.
Efficacy and safety of non-vitamin K antagonist oral anticoagulants combined with antiplatelet drugs for patients with peripheral artery disease: A systematic review and meta-analysis of randomized controlled trials
Authors: Lv Meina , Jiang Shaojun , Wu Tingting , Chen Wenjun , Zhang Jinhua
Published: March 2021

Background

The efficacy and safety of non-vitamin K antagonist oral anticoagulants (NOACs) combined with antiplatelet drugs in patients with peripheral artery disease remain largely unknown.

Objective

The aim of this meta-analysis was to explore the effects of NOACs combined with antiplatelet drugs versus antiplatelet drugs alone in this population.

Methods

A comprehensive search of randomized controlled trials published in PubMed, EMBASE, Web of Science, and the Cochrane Library in 30 September 2020 and before. According to the I2 statistic, a random or fixed-effect model was used to analyze the safety and effectiveness of NOACs combined with antiplatelet drugs in peripheral artery disease patients.

Results

Three RCTs met the inclusion criteria, with a total sample size of 11,761 participants. Compared with antiplatelet drugs alone, NOACs combined with antiplatelet drugs resulted in lower risk of ischemic stroke events (OR = 0.75, 95%CI 0.57–0.98, p =  0.03), while other treatment effects were not worse than those of single antiplatelet drugs ( p ≥  0.05). In addition, although compared with single antiplatelet drugs alone, NOACs combined with antiplatelet drugs had a higher risk of major bleeding and clinically related nonmajor bleeding, their risk was not higher for intracranial hemorrhage, which may endanger the life of patients, or for fatal bleeding.

Conclusions

In summary, for peripheral artery disease patients, a combination of NOACs plus antiplatelet drugs may offer additional benefit in reducing ischemic stroke outcome, yet it may increase the risk of bleeding.
Racialized leaders leading Canadian universities
Authors: Cukier Wendy , Adamu Patience , Wall-Andrews Charlie , Elmi Mohamed
Published: March 2021

As of our most recent census data, racialized people comprise 22.3% of the Canadian population (Statistics Canada, 2016). Canadian universities have espoused commitments to diversity and inclusion but there has long been a gap between the rhetoric and practice. Research has demonstrated that under-representation is a problem at all levels of academia but particularly within the senior ranks. Drawing on an original dataset representing 324 senior university leaders, this study will empirically map the demographic composition of academic leaders across Canada, including presidents, vice-presidents, assistant vice-presidents, associate vice-presidents, provosts, and vice-provosts. Our findings suggest that racialized people in leadership are under-represented compared with their presence in the university population—consistent with the pyramid of exclusion where the representation of racialized people decreases as we move up the ranks. Taking a systems perspective informed by our critical ecology model we examine the overlapping societal-, organizational-, and individual-level mechanisms that impede the advancement of racialized people into leadership positions at universities in Canada.
Temporary application of lower body positive pressure improves intracranial velocities in symptomatic acute carotid occlusion or tight stenosis: A pilot study
Authors: Crassard Isabelle , Berthet Karine , Lavallée Philippa , Houot Marion , Payen Didier , Baron Jean-Claude , Amarenco Pierre , Lukaszewicz Anne-Claire
Published: March 2021

Background

Patients with isolated cervical carotid artery occlusion not eligible to recanalization therapies but with compromised intracranial hemodynamics may be at risk of further clinical events. Apart from lying flat until spontaneous recanalization or adjustment of the collateral circulation hopefully occurs, no specific treatment is currently implemented. Improving collateral flow is an attractive option in this setting. Lower body positive pressure (LBPP) is known to result in rapid venous blood shift from the lower to the upper body part, in turn improving cardiac preload and output, and is routinely used in acute hemorrhagic shock. We report here cerebral blood flow velocities measured during LBPP in this patient population.

Methods

This is a retrospective analysis of the clinical, physiological, and transcranial Doppler monitoring data collected during and 15 min after LBPP in 21 consecutive patients (10 females, median age: 54 years) with recently symptomatic isolated carotid occlusion/tight stenosis (unilateral in 18) mostly due to atherosclerosis or dissection. LBPP was applied for 90 min at a median 5 days after symptom onset.

Results

At baseline, middle-cerebral artery velocities were markedly lower on the symptomatic, as compared to asymptomatic, side. LBPP significantly improved blood flow velocities in both the symptomatic and asymptomatic middle-cerebral artery as well as the basilar artery, which persisted 15 min after discontinuing the procedure. LBPP also resulted in mild but significant increases in mean arterial blood pressure.

Conclusions

LBPP improved intracranial hemodynamics downstream recently symptomatic carotid occlusion/tight stenosis as well as in the contralateral and posterior circulations, which persisted after LBPP deflation. Randomized trials should determine if this easy-to-use, noninvasive, nonpharmacologic approach has long-lasting benefits on the intracranial circulation and improves functional outcome.
Drip-and-ship versus mothership for endovascular treatment of acute stroke: A comparative effectiveness analysis
Authors: Wu Xiao , Wira Charles R , Matouk Charles C , Forman Howard P. , Gandhi Dheeraj , Sanelli Pina , Schindler Joseph , Malhotra Ajay
Published: March 2021

Background

Triage for suspected acute stroke has two main options: (1) transport to the closest primary stroke center (PSC) and then to the nearest comprehensive stroke center (CSC) (Drip-and-Ship) or (2) transport the patient to the nearest CSC, bypassing a closer PSC (mothership). The purpose was to evaluate the effectiveness of drip-and-ship versus mothership models for acute stroke patients.

Methods

A Markov decision-analytic model was constructed. All model parameters were derived from recent medical literature. Our target population was adult patient with sudden onset of acute stroke within 8 h of onset over a one-year horizon. The primary outcome was quantified in terms of quality-adjusted-life-years (QALYs).

Results

The base case scenario show that the drip-and-ship strategy has a slightly higher expected health benefit, 0.591 QALY, as compared to 0.586 QALY in the mothership strategy when the time to PSC is 30 min and to CSC is 65 min, although the difference in health benefit becomes minimal as the time to PSC increases towards 60 min. Multiple sensitivity analyses show that when both PSC and CSC are far from place of onset (>1.5 h away), drip-and-ship becomes the better strategy. Mothership strategy is favored by smaller difference between distances to PSC and CSC, shorter transfer time from PSC to CSC, and longer delay in reperfusion in CSC for transferred patients. Drip-and-ship is favored by the reverse.

Conclusion

Drip-and-ship has a slightly higher utility than mothership. This study assesses the complex issue of prehospital triage of acute stroke patients and can provide a framework for real-world data input.
Discursive strategies for addressing patients’ disalignment with diagnosis in online medical consultations in China
Authors: Yu (张宇) Zhang
Published: March 2021

While online medical consultations (OMCs) have become increasingly popular, not least in times when epidemics make access to medical facilities difficult, research exploring the interactive value of OMC is still in its infancy. This study examines patients’ disalignment with speculative diagnosis and its management by doctors in OMC interactions, which to my best knowledge are not examined. From a discourse analytic perspective, this study adopts Du Bois’s notion of stance-taking to approach text-based interactions collected from a widely used OMC website in China. This study finds that patients’ disalignment is often based on hard evidence, which is different from the major findings of previous studies. When addressing such disalignment, doctors adopt varied discursive strategies, which are hardly mentioned in prior studies, in particular, strategies that address the affective aspect of patients’ disalignment. This study thus provides a different perspective on disalignment and its management in the clinical context.
Semiotics of rape in Pakistan: What’s missing in the digital illustrations?
Authors: Riaz Mehvish
Published: March 2021

What remains invisible in the discourse, contributes to perpetuating multilayered inequalities through discourse. Stereotypical representations, under-representations, hyper-representations, or misrepresentations regulate rape myths, and consequently, particular ways of seeing and behaving of those inside or outside the cultural boundaries. It has, therefore, been studied if and how rape victims and perpetrators have been visually represented and framed in the digital illustrations on rape in Pakistan. Discrepancies concerning identity construction of the rape victims and rapists as well as the depiction of multifarious socio-semiotic dimensions of rape have been analyzed. Thirty-five digital illustrations appearing in 32 blogs and news articles published on rape cases in Pakistan have been purposively selected and studied based on ideational metafunction suggested by Kress and van Leeuwen. Results reveal under-representation of rapists and perpetrators, law enforcement, survivors, and existing myths regarding revenge rape, child abuse, gang rape, marital rape, and gender-based victimhood. The study has implications for semiotics, rape studies, gender studies, and digital discourse.
Hemophagocytic lymphohistiocytosis in pregnancy evolving towards fulminant hepatitis
Authors: Simard Camille , Tardif Marie-Lou
Published: March 2021

Background

Hemophagocytic lymphohistiocytosis is a rare disorder, especially in pregnancy, characterized by excessive immune activation leading to hemophagocytic activity.

Case Report

A 34-year-old woman presented at 31 weeks’ gestation with fever, cytopenias, hyperferritinemia and fulminant hepatitis. Bone marrow biopsy was non-contributory, and no trigger was identified. Liver biopsy confirmed the diagnosis of hemophagocytic lymphohistiocytosis, and she received dexamethasone and etoposide, which was changed to anakinra to allow breastfeeding. Prompt diagnosis and treatment of hemophagocytic lymphohistiocytosis is crucial to the survival of pregnant women, but no consensus exists regarding the most appropriate therapy during pregnancy.

Conclusion

Hemophagocytic lymphohistiocytosis is life-threatening and associated with significant morbidity and mortality. Important treatment considerations in pregnancy include maternal health, fetal prematurity and treatment toxicity. Anakinra has been successfully used in pregnancy and provides a promising alternative.
Network Pharmacology Validation of Therapeutic Mechanisms of Tanshinone IIA in Colorectal Cancer
Authors: Sun Zhiyuan , Dong Jinxiang , Song Lijie , Li Fuqiang , Wu Xue , Qiu Zhidong , Wu Donglu
Published: March 2021

Curative therapies with fewer adverse effects are required for cancer treatment. Medicinal plants represent a promising source of novel therapeutic candidates. We employed network pharmacology to predict potential molecular mechanisms of salvia root-derived tanshinone IIA (Tan IIA) in the treatment of colorectal cancer (CRC), followed by empirical validation. The Traditional Chinese Medicine System Pharmacology (TCMSP), DrugBank, and GeneCards databases were queried to identify overlapping Tan IIA (therapeutic)- and CRC (disease)-relevant protein targets. Cytoscape and STRING were used to generate component-target and protein-protein interaction (PPI) networks, respectively, and topology analysis identified highly connected nodes within the latter. Target proteins were subjected to gene ontology (GO)-based biological process annotation using DAVID, and to biological pathway enrichment analysis using the Kyoto encyclopedia and genome (KEGG) database. Enriched biological processes included cell cycling and proliferation, and enriched KEGG pathways included neuroactive ligand-receptor interaction, PI3K-Akt, and cancer. Network pharmacology results predicted that Tan IIA impacts multiple targets and pathways, but that its therapeutic effect is predominantly attributable to cell cycle regulation, inhibition of cell proliferation, and induction of apoptosis. Investigation of the in vitro impact of Tan IIA on proliferation, viability, and cell cycling of 2 hoursuman CRC cell lines (SW480 and SW620), using the CCK-8 method and flow cytometry, demonstrated that Tan IIA significantly inhibits cell proliferation via inducing cell cycle arrest in the G2/M phase. Network pharmacology-predicted hypotheses were thus empirically validated, providing a basis for in-depth study of the therapeutic mechanisms of Tan IIA in the context of CRC.
Applying Social Science to Bring Resident Stakeholders into Pollution Governance: A Rural Environmental Justice Public Health Case Study
Authors: Steiner Sherrie M. , Marshall Jordan M. , Mohammadpour Atefeh , Thompson Aaron W.
Published: March 2021

The purpose of this engaged public sociology study was to use social science to bring resident stakeholders into the process of governing pollution production in a rural community. The community has cancer clusters. Residents have concerns about direct exposure to pollution production in their neighborhood by a steel recycling plant that has been cited numerous times for environmental violations. The facility has been under voluntary remediation since 2009, but neighborhood residents were marginalized from the governance process. This case study details how social science was used to bring neighborhood residents’ concerns about direct exposure to toxic air pollution into remediation governance. A curricula-as-research model was developed to provide an engagement framework that guided the case study as it progressed through a series of six stages over five years. The principal investigator maintained this collaboration by integrating the project into courses, securing small grants, developing an affordable air pollution monitoring method, and convening multiple community meetings. The air monitoring results are analyzed and discussed. Finally, the impact of the case study on the company, the state environmental management agency, local government, the nonprofit partner, and residents’ sense of human agency is evaluated.
Modernization through capitalization: The hidden costs of Ethiopia’s Gibe III Dam and NESTown initiative
Authors: Norgaard Stefan Peter
Published: March 2021

Building on recent work by Timothy Mitchell, this article interrogates the concept of capitalization, understood here specifically as models of extracting or capturing streams of future revenue for the present. In the context of urbanizing Ethiopia, national political and business leaders, international-development actors, and academics leverage agrarian–industrial transformations to persuade and justify monetizing the future through capitalization. I argue that far from a speculative mechanism to gain competitive advantage and accrue more investments later, Ethiopian development projects reveal how capitalization has a very physical and tangible footprint, serving to commodify the future, now. Ethiopian capitalization requires deep political and juridical continuities, revealed in institutional and developmental through lines from the country’s Derg regime to present governance by the Ethiopian People’s Revolutionary Democratic Front (EPRDF). Drawing on historical and contemporary archival analysis, I conceptually interrogate the process and effects of capitalization in Ethiopia first theoretically, and then through two spatially distinct cases of agrarian–industrial transformation in Ethiopia—the Gibe III Dam and the ongoing transformation of the New Ethiopian Sustainable Town (NESTown) initiative by private developers and government actors. Gibe III echoes past large-scale hydroelectric projects and NESTown echoes a history of villagization, “planned cities,” and high-modernist state-building. The cases show how historical and contemporary visions for “development” in Ethiopia steer toward models of greater capitalization, with outcomes that destroy ecosystems and livelihoods. These findings reveal capitalization’s presence and footprints, and suggest more radical institutional arrangements that do not force Ethiopia to financialize its future.
Increased mortality associated with uncontrolled diabetes mellitus in patients with pulmonary cryptococcosis: a single US cohort study
Authors: Archuleta Solana , Gharamti Amal A. , Sillau Stefan , Castellanos Paula , Chadalawada Sindhu , Mundo William , Bandali Mehdi , Oñate Jose , Martínez Ernesto , Chastain Daniel B. , DeSanto Kristen , Shapiro Leland , Schwartz Ilan S. , Franco-Paredes Carlos , Henao-Martínez Andrés F.
Published: March 2021

Background:

Diabetes mellitus is an established risk factor for bacterial infections, but its role in cryptococcosis is unclear. The study aimed to determine whether uncontrolled diabetes (HbA1c >7%) was an independent risk factor for mortality in cryptococcosis.

Methods:

A retrospective case–control study partially matched by age and gender was performed in patients tested for Cryptococcus infection at the University of Colorado Hospital from 2000 to 2019. A multivariable logistic regression model was used to identify mortality predictors. Cox proportional hazard model was used for survival analysis.

Results:

We identified 96 cases of cryptococcosis and 125 controls. Among cases, cryptococcal meningitis (49.0%) and pneumonia (36.5%) constituted most infections. Cases with pulmonary cryptococcosis with uncontrolled diabetes had a higher mortality at 10 weeks (50% versus 7%, p = 0.006) and 1 year (66.7% versus 13.8%, p = 0.005) compared to pulmonary cases with controlled or no diabetes. Unadjusted Cox proportional hazard model found an increased rate of death for uncontrolled diabetes at 10 weeks [hazard ratio 8.4, confidence interval (CI): 1.4–50.8, p = 0.02] and 1 year (hazard ratio 7.0, CI: 1.7–28.4, p = 0.007) among pulmonary cryptococcosis cases. Multivariable analysis showed a significantly increased odds of 10 weeks [odds ratio (OR) = 4.3, CI: 1.1–16.5, p = 0.035] and 1 year (OR = 5.0, CI: 1.4–18.3, p = 0.014) mortality for uncontrolled diabetes among pulmonary cryptococcosis cases. After adjustment for gender, age, and case/control, for every 1% increase in HbA1c levels, the odds of pulmonary cryptococcosis mortality at 1 year increased by 11% (OR = 1.6, CI 95%: 1.1–2.3, p = 0.006).

Conclusion:

Uncontrolled diabetes is associated with worse outcomes in pulmonary cryptococcosis, including a 4-fold and 6-fold increased odds of death at 10 weeks and 1 year, respectively. Glucose control interventions should be explored to improve clinical outcomes in patients with pulmonary cryptococcosis.
Clinical examination of the sacroiliac joint
Authors: Líška D , Zelník R , Hegedüšová N
Published: March 2021

Introduction:

Sacroiliac joint (SIJ) can be a nociceptive source of the pain in lower back. Clinical diagnosis of SIJ pain remains yet problematic. The cause of SIJ pain is multifactorial. The pain may be a result of an inflammatory disease, arthrosis, traumatic injury, infectious process or overload. The potential role in SIJ examination have pain provocation tests.

Objective:

To review and further discuss the validity of some of the mostly used clinical provocation tests such as Distraction test, Thigh Thrust test, Compression test, Sacral Thrust test, Patrick’s (FABER), Gaenslen’s test, Standing Flexion Test, Gillet Test and Shimpi Prone test.

Method:

A literature search was conducted using PubMed. Reviewed were studies between 2005 and 2020 in English, Slovak and Czech with keywords: sacroiliac joint, sacroiliac assessment, provocation tests. The methodology of studies was not considered.

Discussion:

It is challenging to determine whether SIJ is the actual source of the pain by using only one of the provocation tests. Therefore, it is beneficial to combine more compression tests, what will also increase the validity of testing. Other widely used SIJ tests are palpation test, however their validity is poor.
Conservative treatment of chronic unreduced shoulder dislocations in Cameroon: Key results concerning 33 cases
Authors: Theophile Nana C , Pius Fokam , Nchinda E Choffor , Farikou I , Handy Daniel E , Chichom-Mefire A
Published: March 2021

Introduction:

Chronic unreduced shoulder dislocations are rare in orthopaedics. The aim of this study is to report how conservative treatment of chronic unreduced shoulder dislocations is done and evaluate the functional outcome in a low-middle income environment.

Patients and methods:

This was a hospital based prospective observational study carried out from January 2008 to January 2018. Cases of unreduced shoulder dislocations of at least 1 month duration were included in the study. Closed reduction was done by progressive soft maneuvers described by Kocher. Epi Info software was used to analyze this data. Results were represented on tables to ease organization and comprehension.

Results:

One of the 33 had a bilateral chronic unreduced anterior dislocation. The ages ranged from 21 to 80 years, with a mean age of 42.71 ± 16.13 years. The male to female ratio was 3.2:1. The duration of dislocation ranged from 1 to 120 months. Majority of the cases 79.4% (n = 27) had successful closed reduction. The average score was 78.04/100, representing a good score.

Conclusion:

Although treatment by non-operative method is a challenge, fair to good functional outcome can be obtained if this procedure is carried out under general anesthesia and adequate relaxation.
Injury Profile of Mixed Martial Arts Competitions in the United States
Authors: Ross Austin J. , Ross Bailey J. , Zeoli Tyler C. , Brown Symone M. , Mulcahey Mary K.
Published: March 2021

Background:

The popularity of mixed martial arts (MMA) continues to grow in the United States. Although prior work has provided valuable insight concerning injuries in the sport, much of the available literature is limited by factors such as small sample sizes, varying athlete demographics, and inconsistent data collection methods.

Purpose:

To report injury rates and types in MMA and analyze potential variance between competition and match variables.

Study Design:

Descriptive epidemiology study.

Methods:

We performed a retrospective review of injuries sustained by fighters during MMA contests between 2018 and 2019 using ringside physician postmatch injury reports from Wisconsin and Arizona. The prevalence of overall injuries and specific injury types was compared by location (Arizona vs Wisconsin), competition level (amateur vs professional), match result (decisions vs any other result), and match winners versus losers.

Results:

In 503 contests, 285 (57%) had at least 1 injury. In these 285 matches, participants experienced 401 injuries: 197 (49%) in professional bouts and 204 (51%) in amateur bouts. The match injury rate was higher in professional bouts than in amateur contests (68% vs 51%; P < .001). Amateur fighters had more contusions and hematomas (31% vs 22%; P < .001), while professional fighters had more lacerations (39% vs 23%; P < .001). Losers exhibited a higher match injury rate than winners (48% vs 24%; P < .001). Winners experienced a higher proportion of fractures (19% vs 9%; P = .005), and losers experienced more concussions (17% vs 2%; P < .001).

Conclusion:

Professional fighters and losers of MMA bouts exhibited higher injury rates relative to amateurs and winners. The prevalence of specific injury types varied by competition level, match result, and match winners versus losers. The results of this study may be used to better understand the current injury profile in MMA and to develop targeted strategies for injury prevention.
Knowledge and Confidence of Final-Year Medical Students Regarding Critical Care Core-Concepts, a Comparison between Problem-Based Learning and a Traditional Curriculum
Authors: Al Ansari Mariam , Al Bshabshe Ali , Al Otair Hadil , Layqah Layla , Al-Roqi Abdullah , Masuadi Emad , Alkharashi Nawaf , Baharoon Salim
Published: March 2021

Background:

Medical undergraduates should be prepared to recognize life threating critical conditions. Undergraduate medical curriculum development to incorporate more critical care education is an essential requirement. Problem Based Learning curriculum has a potential advantage in providing more focused critical care education to medical undergraduate.

Objectives:

We aimed to evaluate the final year medical students’ knowledge and confidence in key critical care concepts in Problem Based Learning (PBL) curriculum compared to those in Traditional (Lecture) Based Learning curriculum. We also aimed to evaluate undergraduate’s level of satisfaction with the exposure to critical care education during medical education and training.

Materials and methods:

This is a cross-sectional anonymous self-administered survey questionnaire completed by two groups of final-year medical students (PBL and TBL) from three Saudi medical schools to assess the degree of undergraduate exposure to critical care and their knowledge of key critical care assessment parameters.

Results:

The responses of 279 final year medical students was analyzed (70% response rate). The majority (53%) was male and the mean age 23.9 ± 1.4 years. Only 13% of students felt confident to manage hypovolemic shock and 15% could recognize the signs of a threatened airway. One third of the students (29%) correctly identified the critical level of lactic acid in shock and less than 2% of the sample responded correctly to all the questions related to the formal assessment of critically ill patients. Lectures were the main source of information in acute care. More than two-thirds (46%) of the sample indicated that they received tuition in critical care, however the total duration spent in a critical care rotation or teaching was 1 day or less. The medical students, who completed their training with a Problem-Based Learning curriculum, had a higher knowledge base and were more confident in many critical care concepts. Only 6.5% choose critical care as their likely future career.

Conclusion:

Medical undergraduates in PBL have an overall better knowledge on key concepts and assessment tools applicable to evaluating and managing critically ill patients compared to students in TBL. However the gap in knowledge and confidence in assessing ill patients in both groups is evident. Critical care was not chosen as a preferred future career in all surveyed students. There is a need for institutional support and endorsement of undergraduate critical care exposure and education in Saudi Universities both to better prepare medical students for their imminent post-graduates exposure to ill patients and to help in closing the gap in critical care physicians through promoting the specialty.
Modeling and prediction of expected informal growth in the Greater Cairo Region, Egypt
Authors: Badwi Ibrahim Mohamed , El_Barmelgy Mohamed M , El_Din Ouf Ahmed Salah
Published: March 2021

Informal settlement growth is a vital challenge for developing countries, which requires monitoring and assessment by urban planners and city managers. Rural migration to urban areas leads to the unplanned expansion that grows within and beyond the city’s official boundaries. Although informal housing (IH) is growing fast, very little attention is oriented toward exploring tools and procedures for predicting its future expansion. Many studies have shown that informal housing is widespread and represents one of the most dominant features of urbanization in Egypt. Modern simulation and modeling technologies provide new methodologies to explore the complexity of urban growth. As a result, many planning models were developed and successfully used to simulate the spread of planned settlements in developed nations. However, the implementation of these models rarely achieves realistic simulation in the case of unplanned growth due to the developer’s field of study and the available resources. The main objective is to simulate the expected informal housing by modeling its causative land use factors in the Greater Cairo Region. This paper develops a predictive model that anticipates the spatial distribution of unplanned growth and where informal housing is likely to occur over a period based on known growth factors. The proposed Informal Housing Growth Model derives its principles from cellular automata and geographic information system technologies. This model uses a multi-criteria concept, including parameters and conditions related to informal growth, and can be adapted to other growth factors.
Combined Central Retinal Vein and Cilioretinal Artery Occlusion in the Setting of Intravenous Immunoglobulin Administration
Authors: Tsui Jonathan Cin-Bon , Crabtree Gordon Scott
Published: March 2021

Purpose:

This work reports a case of combined vascular occlusion in the setting of intravenous immunoglobulin (IVIg) administration.

Methods:

The authors describe a case of combined central retinal vein and cilioretinal artery that occurred in the setting of IVIg administration.

Results:

A 52-year-old White man presented with a unilateral subjective scotoma that began during IVIg administered for the treatment of statin-induced necrotizing autoimmune myopathy. Examination and optical coherence tomography imaging revealed a combined nonischemic central retinal vein and cilioretinal artery occlusion.

Conclusions:

To the authors’ review and knowledge, this is the first reported case of combined central retinal vein and cilioretinal artery occlusion occurring in the setting of IVIg administration. This rare adverse effect is an entity to be considered in patients who are treated with IVIg.
Predictive factors of stereopsis outcomes following strabismus surgery
Authors: Eshaghi Mohammad , Arabi Amir , Banaie Shahram , Shahraki Toktam , Eshaghi Sarvin , Esfandiari Hamed
Published: March 2021

Purpose:

To determine the predictive factors of post-operative stereopsis in patients with strabismus.

Method:

In this retrospective study, records of patients who received surgical treatment for strabismus were reviewed. All types of strabismus were included. Pre- and post-treatment stereoacuity were measured using the Titmus Stereo Fly test, and predictive factors of stereopsis were evaluated.

Results:

A total of 194 patients (132 females and 62 males) with a mean age of 14.8 ± 8.4 years were included. There was a statistically significant improvement in stereopsis following surgery ( p value < 0.001). Patients with a higher amount of deviation at baseline had poorer stereopsis on the final examination ( p value < 0.001). Stereopsis improvement was more prominent in the pure horizontal strabismus group, compared to combined horizontal and vertical deviations. Baseline and the final stereopsis were higher in the “exotropia” group as compared to the “esotropia” group ( p value = 0.003 and 0.0155, respectively); however, the within group change of stereopsis was not significantly different between these two groups ( p value = 0.144). Post surgical residual deviation was associated with a poorer stereopsis ( p value = 0.002, r = 0.251). A longer duration of strabismus before surgery was associated with poorer final stereopsis levels ( p value = 0.026). The presence of amblyopia before surgery was associated with poorer stereopsis on last examination ( p value < 0.001 for both correlations).

Conclusion:

Based on the result of this study, final stereopsis after strabismus surgery could be affected by the type, duration, and the amount of deviation before surgery, amblyopia, and post operative ocular deviation.
TB research and innovation in Latin America
Authors: Manga Selene
Published: March 2021

The production of tuberculosis (TB) research and innovation in Latin America during the past decade has notably improved. Its role in the acceleration of the decline of the average annual TB incidence rate by 2.5% from 2017 to 2018 is still unclear, but it is looking promising that the region will meet the End TB Strategy targets set for 2030.

Well performed and high-quality research and evidence is critical for improving national TB control programme outcomes. In Latin America, this need is most apparent when responding to the multidrug-resistant TB epidemic.

There is an urgent need for technological breakthroughs to accelerate by an average of 17% per year if the decline in TB incidence rate is to meet the target set for 2030. Intensified research and innovation, identified as one of the three essential pillars of the End TB Strategy, has scarcely been achieved in the region due to political and economic context. This will be analysed further in this article.
Comparison of seven in silico tools for evaluating of daphnia and fish acute toxicity: case study on Chinese Priority Controlled Chemicals and new chemicals
Authors: Zhou Linjun , Fan Deling , Yin Wei , Gu Wen , Wang Zhen , Liu Jining , Xu Yanhua , Shi Lili , Liu Mingqing , Ji Guixiang
Published: March 2021

Background

A number of predictive models for aquatic toxicity are available, however, the accuracy and extent of easy to use of these in silico tools in risk assessment still need further studied. This study evaluated the performance of seven in silico tools to daphnia and fish: ECOSAR, T.E.S.T., Danish QSAR Database, VEGA, KATE, Read Across and Trent Analysis. 37 Priority Controlled Chemicals in China (PCCs) and 92 New Chemicals (NCs) were used as validation dataset.

Results

In the quantitative evaluation to PCCs with the criteria of 10-fold difference between experimental value and estimated value, the accuracies of VEGA is the highest among all of the models, both in prediction of daphnia and fish acute toxicity, with accuracies of 100% and 90% after considering AD, respectively. The performance of KATE, ECOSAR and T.E.S.T. is similar, with accuracies are slightly lower than VEGA. The accuracy of Danish Q.D. is the lowest among the above tools with which QSAR is the main mechanism. The performance of Read Across and Trent Analysis is lowest among all of the tested in silico tools. The predictive ability of models to NCs was lower than that of PCCs possibly because never appeared in training set of the models, and ECOSAR perform best than other in silico tools.

Conclusion

QSAR based in silico tools had the greater prediction accuracy than category approach (Read Across and Trent Analysis) in predicting the acute toxicity of daphnia and fish. Category approach (Read Across and Trent Analysis) requires expert knowledge to be utilized effectively. ECOSAR performs well in both PCCs and NCs, and the application shoud be promoted in both risk assessment and priority activities. We suggest that distribution of multiple data and water solubility should be considered when developing in silico models. Both more intelligent in silico tools and testing are necessary to identify hazards of Chemicals.
m7GDisAI: N7-methylguanosine (m7G) sites and diseases associations inference based on heterogeneous network
Authors: Ma Jiani , Zhang Lin , Chen Jin , Song Bowen , Zang Chenxuan , Liu Hui
Published: March 2021

Background

Recent studies have confirmed that N7-methylguanosine (m7G) modification plays an important role in regulating various biological processes and has associations with multiple diseases. Wet-lab experiments are cost and time ineffective for the identification of disease-associated m7G sites. To date, tens of thousands of m7G sites have been identified by high-throughput sequencing approaches and the information is publicly available in bioinformatics databases, which can be leveraged to predict potential disease-associated m7G sites using a computational perspective. Thus, computational methods for m7G-disease association prediction are urgently needed, but none are currently available at present.

Results

To fill this gap, we collected association information between m7G sites and diseases, genomic information of m7G sites, and phenotypic information of diseases from different databases to build an m7G-disease association dataset. To infer potential disease-associated m7G sites, we then proposed a heterogeneous network-based model, m7G Sites and Diseases Associations Inference (m7GDisAI) model. m7GDisAI predicts the potential disease-associated m7G sites by applying a matrix decomposition method on heterogeneous networks which integrate comprehensive similarity information of m7G sites and diseases. To evaluate the prediction performance, 10 runs of tenfold cross validation were first conducted, and m7GDisAI got the highest AUC of 0.740(± 0.0024). Then global and local leave-one-out cross validation (LOOCV) experiments were implemented to evaluate the model’s accuracy in global and local situations respectively. AUC of 0.769 was achieved in global LOOCV, while 0.635 in local LOOCV. A case study was finally conducted to identify the most promising ovarian cancer-related m7G sites for further functional analysis. Gene Ontology (GO) enrichment analysis was performed to explore the complex associations between host gene of m7G sites and GO terms. The results showed that m7GDisAI identified disease-associated m7G sites and their host genes are consistently related to the pathogenesis of ovarian cancer, which may provide some clues for pathogenesis of diseases.

Conclusion

The m7GDisAI web server can be accessed at http://180.208.58.66/m7GDisAI/, which provides a user-friendly interface to query disease associated m7G. The list of top 20 m7G sites predicted to be associted with 177 diseases can be achieved. Furthermore, detailed information about specific m7G sites and diseases are also shown.
Transcriptome analyses of 7-day-old zebrafish larvae possessing a familial Alzheimer’s disease-like mutation in psen1 indicate effects on oxidative phosphorylation, ECM and MCM functions, and iron homeostasis
Authors: Dong Yang , Newman Morgan , Pederson Stephen M. , Barthelson Karissa , Hin Nhi , Lardelli Michael
Published: March 2021

Background

Early-onset familial Alzheimer’s disease (EOfAD) is promoted by dominant mutations, enabling the study of Alzheimer’s disease (AD) pathogenic mechanisms through generation of EOfAD-like mutations in animal models. In a previous study, we generated an EOfAD-like mutation, psen1Q96_K97del, in zebrafish and performed transcriptome analysis comparing entire brains from 6-month-old wild type and heterozygous mutant fish. We identified predicted effects on mitochondrial function and endolysosomal acidification. Here we aimed to determine whether similar effects occur in 7 day post fertilization (dpf) zebrafish larvae that might be exploited in screening of chemical libraries to find ameliorative drugs.

Results

We generated clutches of wild type and heterozygous psen1Q96_K97del 7 dpf larvae using a paired-mating strategy to reduce extraneous genetic variation before performing a comparative transcriptome analysis. We identified 228 differentially expressed genes and performed various bioinformatics analyses to predict cellular functions.

Conclusions

Our analyses predicted a significant effect on oxidative phosphorylation, consistent with our earlier observations of predicted effects on ATP synthesis in adult heterozygous psen1Q96_K97del brains. The dysregulation of minichromosome maintenance protein complex (MCM) genes strongly contributed to predicted effects on DNA replication and the cell cycle and may explain earlier observations of genome instability due to PSEN1 mutation. The upregulation of crystallin gene expression may be a response to defective activity of mutant Psen1 protein in endolysosomal acidification. Genes related to extracellular matrix (ECM) were downregulated, consistent with previous studies of EOfAD mutant iPSC neurons and postmortem late onset AD brains. Also, changes in expression of genes controlling iron ion transport were observed without identifiable changes in the prevalence of transcripts containing iron responsive elements (IREs) in their 3′ untranslated regions (UTRs). These changes may, therefore, predispose to the apparent iron dyshomeostasis previously observed in 6-month-old heterozygous psen1Q96_K97del EOfAD-like mutant brains.
Differential polarization and the expression of efferocytosis receptor MerTK on M1 and M2 macrophages isolated from coronary artery disease patients
Authors: Mohd Idrus Fatin Najiah , Ahmad Nurul Shuhadah , Hoe Chee Hock , Azlan Maryam , Norfuad Farisha Alia , Yusof Zurkurnai , Wan Isa Wan Yus Haniff , Mohamed Ali Akbar Ali , Yvonne-Tee Get Bee
Published: March 2021

Background

Differential polarization of macrophage into M1 and M2 mediates atherosclerotic plaque clearance through efferocytosis. Higher expression of Mer proto-oncogene tyrosine kinase (MerTK) on M2 macrophage helps in maintaining macrophage efferocytic efficiency. In healthy individuals, macrophage polarization into M1 and M2 occurs in tissues in concomitance with the acquisition of functional phenotypes depending on specific microenvironment stimuli. However, whether the macrophage differential polarization and MerTK expression vary in coronary artery disease (CAD) patients remain unknown.

Objective

This study aimed to elucidate the polarization of M1 and M2 macrophage from CAD patients as well as to investigate the expression of MerTK in these macrophage phenotypes.

Methods

A total of 14 (n) CAD patients were recruited and subsequently grouped into “no apparent CAD”, “non-obstructive CAD” and “obstructive CAD” according to the degree of stenosis. Thirty ml of venous blood was withdrawn to obtain monocyte from the patients. The M1 macrophage was generated by treating the monocyte with GMCSF, LPS and IFN-γ while MCSF, IL-4 and IL-13 were employed to differentiate monocyte into M2 macrophage. After 7 days of polarization, analysis of cell surface differentiation markers (CD86+/CD80+ for M1 and CD206+/CD200R+ for M2) and measurement of MerTK expression were performed using flow cytometry.

Results

Both M1 and M2 macrophage expressed similar level of CD86, CD80 and CD206 in all groups of CAD patients. MerTK expression in no apparent CAD patients was significantly higher in M2 macrophage compared to M1 macrophage [12.58 ± 4.40 vs. 6.58 ± 1.37, p = 0.040].

Conclusion

Differential polarization of macrophage into M1 and M2 was highly dynamic and can be varied due to the microenvironment stimuli in atherosclerotic plaque. Besides, higher expression of MerTK in patients with the least coronary obstructive suggest its vital involvement in efferocytosis.