bluuebunny/crossref_metadata_2025 huggingface dataset:
Acute psychosis post‐COVID‐19 pneumonia
Authors: Abdalla Odai , Oskar Emma , Izadyar Shahram
Published: September 2022

COVID‐19 disease can be associated with several health‐related consequences that are directly or indirectly related to infection with severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2). Acute psychiatric illnesses in the setting of COVID‐19 infection are one of the reported consequences. In this case report, we discuss acute onset of psychosis in a young patient that we believe was related to post‐COVID‐19 infection. Some findings in the EEG in this patient, we believe, were related to use of antipsychotic medications and that caused challenges in the diagnosis. It is important to be aware of post‐COVID‐19 psychosis and challenges that may be encountered in the workup.
Cone‐beam computed tomography assessment of maxillary anterior alveolar bone remodelling in extraction and non‐extraction orthodontic cases using stable extra‐alveolar reference
Authors: Yang Chih Yau Michael , Atsawasuwan Phimon , Viana Grace , Tozum Tolga F. , Elshebiny Tarek , Palomo Juan Martin , Sellke Terry , Elnagar Mohammed H.
Published: September 2022

Objective

To explore alveolar cortical positional change in response to tooth movement in extraction and non‐extraction orthodontic cases, using cone‐beam computed tomography (CBCT) and stable extra‐alveolar references.

Materials and Methods

The pre‐treatment (T1) and post‐treatment (T2) CBCT scans of 25 extraction (EXT) and matched 25 non‐extraction (Non‐EXT) orthodontic cases were imported into Dolphin Imaging 3D, and oriented uniformly. Sagittal and axial CBCT cross‐sections were traced using customized software‐generated guides. The displacement of teeth and alveolar bone cortices were automatically measured using the palatal plane (PP) and the line perpendicular to PP and passing Sella as reference. Intra‐ and inter‐group differences between T1 and T2 were analysed. Subjects were also superimposed three‐dimensionally using Geomagic Control X for qualitative analysis of cortical remodelling.

Results

The EXT group showed incisor retraction, while the Non‐EXT group exhibited statistically significant incisor anterior tipping (P < .05). In EXT, both the labial and palatal cortices are resorbed. Non‐EXT showed labial cortex anterior modelling, and statistically significant palatal cortex resorption (P < .05). In both groups, statistically significant decrease in total and palatal alveolar widths, increase in labial widths, and palatal dehiscence were observed. Comparatively, EXT showed significantly more incisal total and palatal width decrease and palatal vertical bone loss.

Conclusion

Labial cortical remodelling was shown to follow anterior tooth movement, but the palatal cortical response to incisor retraction and labial cortical remodelling in general remained inconclusive. Narrowing of the alveolar housing and palatal dehiscence were observed regardless of extraction following orthodontic treatment.
Treatment of Scoliosis with One‐Stage Posterior Pedicle Screw System by Paraspinal Intermuscular Approach: A Minimum of Two Years of Follow‐Up
Authors: Song Qingxu , Leng Jiali , Qu Zhigang , Zhuang Xinming , Wang Yujian , Liu Yi , Wang Zhenyu
Published: September 2022

Objective

To evaluate the clinical efficacy of the treatment of scoliosis with a pedicle screw system through paraspinal intermuscular approach (PIA).

Methods

This is a retrospective case series study. A total of 10 patients diagnosed with scoliosis had surgical indications and treated with a pedicle screw system in one‐stage posterior surgery by PIA from March 2013 to April 2015 at the First Hospital of Jilin University were enrolled in this study. The average age of the patients was 14.9 years, including one male and nine females. The operative information and surgical results, including Cobb angle correction, correction loss, global balance (including Frontal Plane Balance [FPB] and Sagittal Plane Balance [SPB]), and fusion rate were reviewed. Functional outcomes including visual analog scale (VAS) back pain score, leg pain score, and Scoliosis Research Society‐22 questionnaire (SRS‐22) were used to evaluate the quality of life of patients preoperatively and at last follow‐up.

Results

Each patient was followed up at least six times. The average follow‐up time was 43.2 months. Mean scoliosis and kyphosis improved from 68.5° ± 18.1°to 18.7° ± 11.8° and from 34.4° ± 17.9°to 24.0° ± 6.7°, respectively (p < 0.05); at last follow‐up, it was 20.1° and 24.7°, respectively (p > 0.05). During the follow‐up, mean coronal and sagittal correction loss was 1.4° ± 1.2°and 0.7° ± 0.8°, respectively (p > 0.05). Mean FPB improved from 32.7 to 11.7 mm (p < 0.05); Mean SPB changed from 0.3 to −0.7 mm (p > 0.05). No dural tears were observed during the corrective surgery or wound infection or implant‐related complications. No pseudoarthrosis was identified according to the last follow‐up three‐dimensional (3D) CT scan. All the domains in SRS‐22 questionnaire show statistically significant improvement at the last follow‐up (p < 0.05). The VAS back pain scores improved from a mean preoperative score of 1.7 to a mean postoperative score of 0.2 (p < 0.05).

Conclusion

This original one‐stage posterior PIA is safe and effective in the treatment of scoliosis, which is characterized with less blood loss, shorter operation time, and satisfactory bony fusion.
In VitroEffect of 445 nm Blue Laser and 660 nmLow‐LevelLaser on the Quantity and Quality of Human Gingival Fibroblasts
Authors: Motlagh Kimia Hafezi , Azizi Arash , Ghadim Nahid Moezzi
Published: September 2022

Low‐level laser therapy (LLLT) has several benefits in dentistry, including anti‐inflammatory effects and increased proliferation. This study aimed to investigate the effect of 445 nm blue laser and 660 nm low‐power laser on the quantity and quality of human gingival fibroblastsin vitro. In thisin vitroexperimental study, 445 nm and 660 nm lasers were irradiated on the samples six times. After examining the cells on the 7thand 14thdays, the data were analyzed using ANOVA PASS11 and thepost hocTukey test. The results showed the positive effect of the 660 nm laser on fibroblast proliferation. The viability on the 7thday was the highest in the control group, lowest in the 445 nm laser group and highest in the 660 nm laser group on the 14thday. In the morphological examination, the cells were spherical with narrow appendages in the control group, spindle‐shaped with lamellipodia appendages in the 660 nm laser group and spherical with no cytoplasmic appendages in the 445 nm laser group. Evidence of necrosis and granulation phenomenon was observed in the 445 nm laser group. The use of the 660 nm low‐power laser, compared with the 445 nm laser, has a positive effect on the quantity and quality of gingival fibroblasts.
Seasonal and inter‐annual variability in the heatwave tolerance of the kelpSaccharina latissima(Laminariales, Phaeophyceae)
Authors: Niedzwiedz Sarina , Diehl Nora , Fischer Philipp , Bischof Kai
Published: September 2022

The geographical distribution of organisms, such as the foundation kelp speciesSaccharina latissima, is mainly driven by temperature. Globally increasing sea surface temperature and further intensification of marine heatwaves have already resulted in local extinction of kelp populations worldwide. In the present study, we investigated temporal variation in the thermal susceptibility ofS. latissimaby assessing stress responses of field sporophytes sampled from Helgoland (German Bight) in June 2018, August 2018 and August 2019 in heatwave scenarios. We analyzed survival, growth, maximum quantum yield of photosystem II (Fv/Fm) and pigment composition. Survival decreased with increasing environmental and experimental temperatures. Growth revealed seasonal patterns, being higher in June than in August, whereasFv/Fmdecreased with increasing temperature, independent of the sampling time. We found an increase in the concentration of light harvesting pigments and in the de‐epoxidation state of the xanthophyll cycle with higher treatment temperature. This pattern was even more pronounced at higher environmental temperature prior to the experiment (June 2018 < August 2019 < August 2018). Our results show that the thermal tolerance ofS. latissimatowards heatwaves in summer is significantly affected by the environmental history it previously experienced.
Cost‐effectiveness of media reporting guidelines for the prevention of suicide
Authors: Flego Anna , Reifels Lennart , Mihalopoulos Cathrine , Bandara Piumee , Page Andrew , Fox Tina , Skehan Jaelea , Hill Nicole T. M. , Krysinska Karolina , Andriessen Karl , Schlichthorst Marisa , Pirkis Jane , Le Long Khanh‐Dao
Published: September 2022

Introduction

Media guidelines for the responsible reporting of suicide are a recognized universal suicide prevention intervention. While implemented in numerous countries, including Australia, little is known about whether they are cost‐effective. We aimed to determine the cost‐effectiveness of Mindframe, the national initiative implementing media guidelines in Australia.

Method

We conducted a modelled economic evaluation (5‐year time‐horizon) incorporating two types of economic analysis: (i) return‐on‐investment (ROI) comparing estimated cost savings from the intervention to the total intervention cost, and (ii) cost‐effectiveness analysis comparing the net intervention costs to health outcomes: suicide deaths prevented and quality‐adjusted life‐years (QALYs). We also included uncertainty analyses to propagate parameter uncertainty and sensitivity analyses to test the robustness of the model outputs to changes in input parameters and assumptions.

Results

The estimated ROI ratio for the main analysis was 94:1 (95% uncertainty interval [UI]: 37 to 170). The intervention was associated with cost savings of A$596M (95% UI: A$228M to A$1,081M), 139 (95% UI: 55 to 252) suicides prevented and 107 (95% UI: 42 to 192) QALYs gained. The intervention was dominant, or cost‐saving, compared with no intervention with results being robust to sensitivity analysis but varying based on the conservativeness of the parameters entered.

Conclusion

Mindframe was found to be cost‐saving, and therefore, worthy of investment and inclusion as part of national suicide prevention strategies.
Emergence of Exceptional Points in Periodic Metastructures With Hidden Parity-Time Symmetric Defects
Authors: Fang Yanghao , Kottos Tsampikos , Thevamaran Ramathasan
Published: September 2022

We study the elastodynamics of a periodic metastructure incorporating a defect pair that enforces a parity-time (PT) symmetry due to judiciously engineered imaginary impedance elements—one having energy amplification (gain) and the other having an equivalent attenuation (loss) mechanism. We show that their presence affects the initial band structure of the periodic Hermitian metastructure and leads to the formation of numerous exceptional points (EPs) which are mainly located at the band edges where the local density of modes is higher. The spatial location of the PT-symmetric defect serves as an additional control over the number of emerging EPs in the corresponding spectra as well as the critical non-Hermitian (gain/loss) strength required to create the first EP—a specific defect location minimizes the critical non-Hermitian strength. We use both finite element and coupled-mode-theory-based models to investigate these metastructures and use a time-independent second-order perturbation theory to further demonstrate the influence of the size of the metastructure and the PT-symmetric defect location on the minimum non-Hermitian strength required to create the first EP in a band. Our findings motivate feasible designs for the experimental realization of EPs in elastodynamic metastructures.
Informed Sampling-Based Planning to Enable Legged Robots to Safely Negotiate Permeable Obstacles
Authors: Chen Yiyu , Lian Lingchen , Hsieh Yu-Hsiu , Nguyen Quan , Gupta Satyandra K.
Published: September 2022

Legged robots have a unique capability of traversing rough terrains and negotiating cluttered environments. Recent control development of legged robots has enabled robust locomotion on rough terrains. However, such approaches mainly focus on maintaining balance for the robot body. In this work, we are interested in leveraging the whole body of the robot to pass through a permeable obstacle (e.g., a small confined opening) with height, width, and terrain constraints. This paper presents a planning framework for legged robots manipulating their body and legs to perform collision-free locomotion through a permeable obstacle. The planner incorporates quadrupedal gait constraint, biasing scheme, and safety margin for the simultaneous body and foothold motion planning. We perform informed sampling for the body poses and swing foot position based on the gait constraint while ensuring stability and collision avoidance. The footholds are planned based on the terrain and the contact constraint. We also integrate the planner with robot control to execute the planned trajectory successfully. We validated our approach in high-fidelity simulation and hardware experiments on the Unitree A1 robot navigating through different representative permeable obstacles.
A filter representation of diffraction at infinite and finite wedges
Authors: Ewert Stephan D.
Published: September 2022

Diffraction of sound occurs at sound barriers, building and room corners in urban and indoor environments. Here, a unified parametric filter representation of the singly diffracted field at arbitrary wedges is suggested, connecting existing asymptotic and exact solutions in the framework of geometrical acoustics. Depending on the underlying asymptotic (high-frequency) solution, a combination of up to four half-order lowpass filters represents the diffracted field. Compact transfer function and impulse response expressions are proposed, providing errors below ±0.1 dB. To approximate the exact solution, a further asymptotic lowpass filter valid at low frequencies is suggested and combined with the high-frequency filter.
A Comparison of Sodium Citrate and Sodium Bicarbonate Ingestion: Blood Alkalosis and Gastrointestinal Symptoms
Authors: Urwin Charles S. , Snow Rodney J. , Condo Dominique , Snipe Rhiannon M.J. , Wadley Glenn D. , Convit Lilia , Carr Amelia J.
Published: September 2022

This study compared the recommended dose of sodium citrate (SC, 500 mg/kg body mass) and sodium bicarbonate (SB, 300 mg/kg body mass) for blood alkalosis (blood [HCO3−]) and gastrointestinal symptoms (GIS; number and severity). Sixteen healthy individuals ingested the supplements in a randomized, crossover design. Gelatin capsules were ingested over 15 min alongside a carbohydrate-rich meal, after which participants remained seated for forearm venous blood sample collection and completion of GIS questionnaires every 30 min for 300 min. Time-course and session value (i.e., peak and time to peak) comparisons of SC and SB supplementation were performed using linear mixed models. Peak blood [HCO3−] was similar for SC (mean 34.2, 95% confidence intervals [33.4, 35.0] mmol/L) and SB (mean 33.6, 95% confidence intervals [32.8, 34.5] mmol/L, p = .308), as was delta blood [HCO3−] (SC = 7.9 mmol/L; SB = 7.3 mmol/L, p = .478). Blood [HCO3−] was ≥6 mmol/L above baseline from 180 to 240 min postingestion for SC, significantly later than for SB (120–180 min; p < .001). GIS were mostly minor, and peaked 80–90 min postingestion for SC, and 35–50 min postingestion for SB. There were no significant differences for the number or severity of GIS reported (p > .05 for all parameters). In summary, the recommended doses of SC and SB induce similar blood alkalosis and GIS, but with a different time course.
The Bengal Water Machine: Quantified freshwater capture in Bangladesh
Authors: Shamsudduha Mohammad , Taylor Richard G. , Haq Md Izazul , Nowreen Sara , Zahid Anwar , Ahmed Kazi Matin Uddin
Published: September 2022

Global food security depends on the sustainability of irrigated agriculture. Rising groundwater withdrawals from seasonally humid, alluvial plains across tropical Asia have enabled dry-season rice cultivation. This groundwater pumpage increases available subsurface storage that under favorable conditions amplifies groundwater replenishment during the subsequent monsoon. We empirically quantified this nature-based solution to seasonal freshwater storage capture described as the “Bengal Water Machine,” revealing its potential and limitations. On the basis of a million piezometric observations from 465 monitoring wells, we show that the collective operation of ~16 million smallholder farmers in the Bengal Basin of Bangladesh from 1988 to 2018 has induced cumulative freshwater capture that volumetrically (75 to 90 cubic kilometers) is equivalent to twice the reservoir capacity of the Three Gorges Dam.
Risks of decoupling from China on low-carbon technologies
Authors: Davidson Michael R. , Karplus Valerie J. , Lewis Joanna I. , Nahm Jonas , Wang Alex
Published: September 2022

For most technologies, the cure is likely worse than the disease
Hallucinating symmetric protein assemblies
Authors: Wicky B. I. M. , Milles L. F. , Courbet A. , Ragotte R. J. , Dauparas J. , Kinfu E. , Tipps S. , Kibler R. D. , Baek M. , DiMaio F. , Li X. , Carter L. , Kang A. , Nguyen H. , Bera A. K. , Baker D.
Published: September 2022

Deep learning generative approaches provide an opportunity to broadly explore protein structure space beyond the sequences and structures of natural proteins. Here, we use deep network hallucination to generate a wide range of symmetric protein homo-oligomers given only a specification of the number of protomers and the protomer length. Crystal structures of seven designs are very similar to the computational models (median root mean square deviation: 0.6 angstroms), as are three cryo–electron microscopy structures of giant 10-nanometer rings with up to 1550 residues and
C
33
symmetry; all differ considerably from previously solved structures. Our results highlight the rich diversity of new protein structures that can be generated using deep learning and pave the way for the design of increasingly complex components for nanomachines and biomaterials.
Polio returns in rich countries, but big outbreaks are unlikely
Authors: Roberts Leslie
Published: September 2022

As New York state declares an emergency, experts are far more worried about a resurgence in low-income countries
Molecular Determinants of Tissue Specificity of Flavivirus Nonstructural Protein 1 Interaction with Endothelial Cells
Authors: Lo Nicholas T. N. , Roodsari Susan Z. , Tin Nicole L. , Wong Marcus P. , Biering Scott B. , Harris Eva
Published: September 2022

Flavivirus NS1 is secreted into the bloodstream from infected cells during a viral infection. Dengue virus NS1 contributes to severe dengue pathology such as endothelial dysfunction and vascular leak independently of the virus.
Evidence for Quinol Oxidation Activity of ImoA, a Novel NapC/NirT Family Protein from the Neutrophilic Fe(II)-Oxidizing Bacterium Sideroxydans lithotrophicus ES-1
Authors: Jain Abhiney , Coelho Anaísa , Madjarov Joana , Paquete Catarina M. , Gralnick Jeffrey A.
Published: September 2022

Fe(II)-oxidizing bacteria play an important role in biogeochemical cycles. At circumneutral pH, these organisms perform extracellular electron transfer, taking up electrons from Fe(II) outside the cell, potentially through a porin-cytochrome complex in the outer membrane encoded by the Mto pathway.
DNA Methyltransferase Regulates Nitric Oxide Homeostasis and Virulence in a Chronically Adapted Pseudomonas aeruginosa Strain
Authors: Han Shuhong , Liu Jihong , Li Mianhuan , Zhang Yizhou , Duan Xiangke , Zhang Yingdan , Chen Hao , Cai Zhao , Yang Liang , Liu Yang
Published: September 2022

Pseudomonas aeruginosa
is an opportunistic pathogen which causes acute and chronic infections that are difficult to treat. Comparative genomic analysis has showed broad genome diversity among
P. aeruginosa
clinical strains and revealed their different regulatory traits compared to the laboratory strains.
Linking the Pinware, Baraboo, and Picuris orogens: Recognition of a trans-Laurentian ca. 1520–1340 Ma orogenic belt
Authors: Daniel Christopher G. , Indares Aphrodite , Medaris Jr. L. Gordon , Aronoff Ruth , Malone David , Schwartz Joshua
Published: September 2022

It is proposed that the Pinware orogen of eastern Canada, the Baraboo orogen of the midcontinent, and the Picuris orogen of the southwestern United States delineate a previously unrecognized, ~5000-km-long, ca. 1520–1340 Ma trans-Laurentian orogenic belt. All three orogenic provinces are characterized by Mesoproterozoic sedimentation, magmatism, metamorphism, and deformation—the hallmarks of a tectonically active plate margin. Tectonism was diachronous, with the earliest stages beginning ca. 1520 Ma in eastern Canada and ca. 1500 Ma in the southwest United States. Magmatic zircon age distributions are dominated by Mesoproterozoic, unimodal to multimodal age peaks between ca. 1500 and 1340 Ma. The onset of magmatism in the Pinware and Baraboo orogens was ca. 1520 Ma, and onset for the Picuris orogen was ca. 1485 Ma. Detrital zircon age distributions within each orogenic province yield maximum depositional ages between ca. 1570 and 1450 Ma. Minimum depositional ages generally fall between ca. 1500 and 1435 Ma, as constrained by crosscutting intrusions, metatuff layers, or the age of subsequent metamorphism. Metamorphic mineral growth ages from zircon, garnet, and monazite yield peak ages between ca. 1500 and 1350 Ma and tend to be older in the Pinware and Baraboo orogens than in the Picuris orogen. The 40Ar/39Ar cooling ages for hornblende, muscovite, and biotite yield significant peak ages between ca. 1500 and 1350 Ma in the Baraboo and Picuris orogens. We propose that the Pinware-Baraboo-Picuris orogen formed in a complex, diachronous, convergent margin setting along the southern edge of Laurentia from ca. 1520 to 1340 Ma.
Drainage initiation, expansion, and channel-head arrest in heterogenous bedrock landscapes of the Colorado Plateau
Authors: Steelquist A.T. , Lapôtre M.G.A. , Hilley G.E.
Published: September 2022

The transition between hillslopes and channels defines landscape characteristics such as drainage density, ridge spacing, and hillslope length. Previous studies of the location of this transition have demonstrated that soil advection and diffusion work either individually or in concert to set the limits of channelization in largely soil-mantled landscapes. However, no such model explaining the limits of channelization in bedrock landscapes has been established. In this study, we explore the morphologic signatures and processes of channel initiation, headward elongation, and eventual arrest in the bedrock landscape of the Raplee Ridge monocline, Utah, USA. The monocline provides an opportunity to test whether a threshold shear stress controls the initiation of channels through inspection of slope and upstream drainage area at varyingly incised portions of the landscape. Using a combination of lidar and structure-from-motion data, we find that incised and unincised channels occupy overlapping but separable portions of slope-upstream area space, while geomorphic mapping and field-based observations allow for further distinction between erosional processes with threshold shear stress values that range from ∼60 Pa to 160 Pa. We develop a conceptual model of the initiation and expansion of these bedrock channels using field observations, in which channels first initiate by vertical plucking of blocks, disaggregate limestone by block sliding, elongate upslope by knickpoint retreat in variably erosive lithologies, and eventually arrest at predictable landscape positions due to block buttressing. These results suggest that shear stress-controlled processes play a fundamental role in setting the degree of channelization in bedrock landscapes; however, the thresholds for channel erosion can change in response to local geologic factors such as lithology and structural geometry. This implies that detailed geologic knowledge may be necessary for the interpretation and modeling of fluvial channels in terrestrial bedrock landscapes and those on other planets.
Rare cause of voice muffling: pyogenic vallecular cyst
Authors: Ting Lorna Kang Ni , Idris Anuar , Mat Baki Marina
Published: September 2022

A vallecular cyst is a benign laryngeal cyst that rarely causes symptoms in adults. We report a rare case of an infected vallecular cyst in a man who is in his 60s with diabetes mellitus. The patient presented to us with acute onset of voice muffling and respiratory distress. He showed signs of sepsis and upper airway obstruction. He had spikes of high-grade fever with an elevated total white cell count (predominantly neutrophil count) and C reactive protein level. Plain cervical X-ray revealed a large, smooth, lobulated mass in the vallecular area. Direct laryngoscopic findings supported the diagnosis of an infected vallecular cyst with suppuration, which originated from the vallecula fossa. The cyst was drained and excised completely, and the pus culture revealed the presence ofKlebsiella pneumoniae. The patient responded well to the administration of intravenous cefuroxime for 2 weeks according to the sensitivity and culture test. He was discharged after the completion of the course of antibiotics, having recovered fully. This case illustrates the versatility of a plain cervical X-ray in giving clues about this rare, unexpected pathology.
Pain management of pemphigus vulgaris
Authors: Muniandy Rajesh Kumar , Nagalingam Nagarajan , Liew Sat Lin , Michelle Voo Sook Yee
Published: September 2022

Pemphigus is a rare autoimmune bullous disease which affects the mucous membranes and skin. Pemphigus vulgaris (PV) is the most prevalent type of pemphigus. PV presents with extremely painful, non-healing oral erosions. However, there are only a handful of reports addressing the pain management of PV. We would like to present a case of a painful PV, which was successfully managed.
Oncocytic adrenocortical tumour presenting as an incidentaloma: a diagnostic challenge
Authors: Cardona Attard Carol D , Gauci Zachary , Gatt Noel , Scicluna Warren , Cachia Mario J
Published: September 2022

Oncocytic adrenocortical neoplasms are a rare histopathological subtype of adrenal tumours which are usually benign and, if malignant, are less likely to metastasise. We report a case of a non-functioning oncocytic adrenocortical tumour, identified incidentally in a middle-aged woman. It was initially reported as a left-sided 3.5×3.4×5.6 cm adrenal adenoma. It however increased in size to 5.4×4.0×4.3 cm on follow-up scans. Subsequent review of the scans revealed an indeterminate lesion with a precontrast density of 30 Hounsfield units, an absolute washout of 42.6% and a relative washout of 28.6%. As a result, laparoscopic left adrenalectomy was performed. Histology confirmed oncocytic adrenocortical carcinoma when using the Lin-Weiss-Bisceglia system, though it was deemed benign when using the Helsinki scoring system. There has been no evidence of recurrence to date. This case highlights the potential pitfalls in the diagnosis of oncocytic neoplasms and the increased specificity of the Helsinki score in assessing metastatic potential.
Ptosis, facial numbness and parotid gland mass as the first symptoms of an extranodal NK/T cell lymphoma, nasal type
Authors: Rycek Kristien , Maris Mieke , Van Hende Vanessa , Loose David
Published: September 2022

We present a case of a patient visiting the ear, nose and throat department with a parotid gland mass, ptosis and facial numbness. CT imaging confirmed a mass in the parotid gland; however, it also revealed a mass in the left maxillary sinus. MRI, positron emission tomography combined with CT and nasal biopsy confirmed the diagnosis of a extranodal natural killer/T cell lymphoma, nasal type. Because this is a rare clinical entity in Western society, patients are typically diagnosed in an advanced stage; symptoms resemble chronic rhinosinusitis and histopathological analysis is challenging. In this atypical case, the patient presented with symptoms of ptosis, parotid gland mass and facial numbness instead of nasal symptoms. In this case, we want to emphasise that diagnosing a sinonasal NK/T-cell lymphoma is often challenging.
Comparative effect of metformin versus sulfonylureas with dementia and Parkinson’s disease risk in US patients over 50 with type 2 diabetes mellitus
Authors: Newby Danielle , Linden Andrew Brent , Fernandes Marco , Molero Yasmina , Winchester Laura , Sproviero William , Ghose Upamanyu , Li Qingqin S , Launer Lenore J , Duijn Cornelia M van , Nevado-Holgado Alejo J
Published: September 2022

Introduction

Type 2 diabetes is a risk factor for dementia and Parkinson’s disease (PD). Drug treatments for diabetes, such as metformin, could be used as novel treatments for these neurological conditions. Using electronic health records from the USA (OPTUM EHR) we aimed to assess the association of metformin with all-cause dementia, dementia subtypes and PD compared with sulfonylureas.

Research design and methods

A new user comparator study design was conducted in patients ≥50 years old with diabetes who were new users of metformin or sulfonylureas between 2006 and 2018. Primary outcomes were all-cause dementia and PD. Secondary outcomes were Alzheimer’s disease (AD), vascular dementia (VD) and mild cognitive impairment (MCI). Cox proportional hazards models with inverse probability of treatment weighting (IPTW) were used to estimate the HRs. Subanalyses included stratification by age, race, renal function, and glycemic control.

Results

We identified 96 140 and 16 451 new users of metformin and sulfonylureas, respectively. Mean age was 66.4±8.2 years (48% male, 83% Caucasian). Over the 5-year follow-up, 3207 patients developed all-cause dementia (2256 (2.3%) metformin, 951 (5.8%) sulfonylurea users) and 760 patients developed PD (625 (0.7%) metformin, 135 (0.8%) sulfonylurea users). After IPTW, HRs for all-cause dementia and PD were 0.80 (95% CI 0.73 to 0.88) and 1.00 (95% CI 0.79 to 1.28). HRs for AD, VD and MCI were 0.81 (0.70–0.94), 0.79 (0.63–1.00) and 0.91 (0.79–1.04). Stronger associations were observed in patients who were younger (<75 years old), Caucasian, and with moderate renal function.

Conclusions

Metformin users compared with sulfonylurea users were associated with a lower risk of all-cause dementia, AD and VD but not with PD or MCI. Age and renal function modified risk reduction. Our findings support the hypothesis that metformin provides more neuroprotection for dementia than sulfonylureas but not for PD, but further work is required to assess causality.
The challenge of ensuring elderly people can access their health insurance entitlements: a mixed methods study on the Republic of Srpska’s Protector of Patients’ Health Insurance Entitlements
Authors: Stojisavljević Stela , Đikanović Bosiljka , Vončina Luka , Scott Kerry , Shroff Zubin , Manigoda Dijana , Štrbac Savka , Bosančić Borut , Mathauer Inke
Published: September 2022

Introduction

Healthcare utilisation requires knowing one’s entitlements and how to access them (navigation) and having access to grievance redressal when entitlements are denied. To ensure citizen access to and use of health insurance entitlements, the Health Insurance Fund established an initiative called the Protector of Patients’ Health Insurance Entitlements (PPHIE). PPHIEs are supposed to provide patient navigation and grievance redressal services. This paper explores to what extent this initiative meets its objectives and is used by the elderly in rural areas.

Methods

This study employed a mixed methods approach. We conducted in-depth interviews with elderly patients in rural areas, PPHIEs, health providers and health insurance managers (N=39), as well as focus groups (N=5) and a household survey (N=715) with elderly rural patients. Qualitative data were analysed using content analysis, and the household survey results were analysed using descriptive statistics.

Results

The majority of elderly patients were not aware of the PPHIE initiative and instead received patient navigation support from their healthcare providers. The PPHIE programme was poorly publicised among the population. Although PPHIEs had a mandate to pursue grievance redressal they rarely did so, and their role in the system was more symbolic than functional.

Conclusion

While healthcare providers have (by default) filled the navigation role left by inactive PPHIEs, the grievance redressal role remains unfilled. Information about health insurance entitlements and access to grievance redressal must be provided through visible, accessible and efficient mechanisms that should be continuously monitored and improved.
Cleaning up plastics in healthcare waste: the transformative potential of leadership
Authors: Rasheed Fawzia N , Walraven Gijs
Published: September 2022

This article argues that plastics ought to be included under the category of ‘hazardous’ healthcare waste and suggests that health professionals should strive for alternatives as part of their mission to improve health. The focus of this paper is on replacing, rather than recycling, plastics. The rationale for this stance stems from the unbridled escalation of plastics use, the fact that few countries have significant recycling capacity, and because the process of recycling as well as the end products of recycled plastics remain hazardous to health and the environment.

Issues related to incinerated plastic, plastics in single-use items, plastic blister packs and containers for medicines, as well as plastics which are unrelated to healthcare but which nevertheless make up a substantial part of general healthcare waste are discussed. Suggestions are put forward to dramatically reduce plastics in all such cases.

To support needed reforms and to guide best practice for single-use plastics in particular, a call for a reliable reference source is made—similar to the Essential Medicines Lists, which would share updated information on the most problematic items in use and environmentally friendly alternatives in each case.

It is argued that concerted action by health professionals to improve healthcare waste, beginning with plastics, would send much needed market signals to industry to produce environmentally-friendly products for healthcare and would likely lead to solutions for domestic waste, too.
Hodges’ model: the Sustainable Development Goals and public health – universal health coverage demands a universal framework
Authors: Jones Peter , Wirnitzer Katharina
Published: September 2022

Background to issue

Future sustainable healthcare delivery and systems need reflective practitioners and critical thinkers to engage the public to achieve health policy aims and objectives. Therefore, this descriptive review introduces a generic conceptual framework, adopting a specific theme to illustrate and demonstrate a model of care or any other context. Whatever the purpose, context or philosophical stance in healthcare and health literacy, there is no standardised generic conceptual framework to structure reflection and critical thinking. This work presents a pragmatic solution focused on the one-to-one relationship of learner–mentor, patient–clinician, public health professional–public and groups.

Methods

The method is constructivist, an educational exercise, practical and the target group can be defined/viewed as student, teacher, patient, carer or member of the public in a health promotion campaign, for example. The building blocks are health and care concepts that arise clinically in practice, or for a student writing an assignment. As will be explained, concepts (including the Sustainable Development Goals) are assigned by the subject(s)—in this instance the authors—to a domain of knowledge.

Results

As two-by-two tables, the results represent the structure of the conceptual framework, framing the content in a series of four knowledge (care) domains. The contents, ultimately the Sustainable Development Goals, may then be linked and relationships discussed. Results are produced gradually, building a cognitive or mind-map. The results, it must be stressed, are therefore qualitative.

Conclusion

Drawing on educational theory and practice, the results are explored and justified using the theme of nutrition, and the often stated desirability in education of reflective practice and critical thinking abilities. Providing a series of cross-disciplinary, the reader will gain insight into the potential of Hodges’ model to facilitate integrated, person-centred and care that improves parity of esteem, supporting students and qualified personnel in their learning careers.
Oncological big data platforms for promoting digital competencies and professionalism in Chinese medical students: a cross-sectional study
Authors: Liu Jiahao , Jiao Xiaofei , Zeng Shaoqing , Li Huayi , Jin Ping , Chi Jianhua , Liu Xingyu , Yu Yang , Ma Guanchen , Zhao Yingjun , Li Ming , Peng Zikun , Huo Yabing , Gao Qing-Lei
Published: September 2022

Objectives

Advancements in big data technology are reshaping the healthcare system in China. This study aims to explore the role of medical big data in promoting digital competencies and professionalism among Chinese medical students.

Design, setting and participants

This study was conducted among 274 medical students who attended a workshop on medical big data conducted on 8 July 2021 in Tongji Hospital. The workshop was based on the first nationwide multifunction gynecologic oncology medical big data platform in China, at the National Union of Real-World Gynecologic Oncology Research & Patient Management Platform (NUWA platform).

Outcome measures

Data on knowledge, attitudes towards big data technology and professionalism were collected before and after the workshop. We have measured the four skill categories: doctor‒patient relationship skills, reflective skills, time management and interprofessional relationship skills using the Professionalism Mini-Evaluation Exercise (P-MEX) as a reflection for professionalism.

Results

A total of 274 students participated in this workshop and completed all the surveys. Before the workshop, only 27% of them knew the detailed content of medical big data platforms, and 64% knew the potential application of medical big data. The majority of the students believed that big data technology is practical in their clinical practice (77%), medical education (85%) and scientific research (82%). Over 80% of the participants showed positive attitudes toward big data platforms. They also exhibited sufficient professionalism before the workshop. Meanwhile, the workshop significantly promoted students’ knowledge of medical big data (p<0.05), and led to more positive attitudes towards big data platforms and higher levels of professionalism.

Conclusions

Chinese medical students have primitive acquaintance and positive attitudes toward big data technology. The NUWA platform-based workshop may potentially promote their understanding of big data and enhance professionalism, according to the self-measured P-MEX scale.
Prevalence of nail biting and its chronological relationship with tics in child and adolescent outpatients with Tourette syndrome: a single-centre, retrospective observational study
Authors: Hsueh Chang-Wei , Chen Chia-Wen
Published: September 2022

Objective

To evaluate the prevalence of nail biting in child and adolescent outpatients at a single institution and the chronological relationship between nail biting and tics in patients with Tourette syndrome (TS) with or without attention-deficit hyperactivity disorder (ADHD).

Design

Retrospective observational study.

Setting

Teaching hospital in Taiwan.

Participants

All participants were aged 4–18 years, including 535 patients with TS, 230 patients with provisional tic disorder and 1460 patients without neurological or psychiatric disorders (controls).

Outcome measures

Presence of nail biting, starting age for nail biting and starting age for motor and/or vocal tics.

Results

Nail biting was more commonly observed in patients with TS (56.6%) than in patients with provisional tic disorder (27.4%) or controls (15.0%), regardless of sex (all p<0.020). Nail biting was also more common in patients with TS with ADHD than in those without (75.0% vs 47.6%; p<0.001), but the starting age was significantly later in those with concomitant ADHD than without (5.3 vs 3.8 years; p<0.001). In patients with TS, the onset of nail biting occurred earlier than that of tics, regardless of ADHD status.

Conclusion

Nail biting was more prevalent and occurred earlier than tics in patients with TS, regardless of ADHD status, in the study population.
Telephone-based cognitive behavioural therapy for patients with postoperative bariatric surgery to manage COVID-19 pandemic-related mental health issues and distress (TELE-BARICARE): a protocol for a randomised controlled trial
Authors: Sockalingam Sanjeev , Leung Samantha Eve , Agic Branka , Ma Clement , Hawa Raed , Wnuk Susan , Dash Satya , Jackson Timothy , Akbar Nadine , Forhan Mary , Cassin Stephanie E
Published: September 2022

Introduction

Bariatric surgery is currently the most effective treatment for obesity, and is performed yearly in over 8000 patients in Canada. Over 50% of those who live with obesity also have a history of mental health disorder. The COVID-19 pandemic has made it difficult for people living with obesity to manage their weight even after undergoing bariatric surgery, which combined with pandemic-related increases in mental health distress, has the potential to adversely impact obesity outcomes such as weight loss and quality of life. Reviews of virtual mental health interventions during COVID-19 have not identified any interventions that specifically address psychological distress or disordered eating in patients with obesity, including those who have had bariatric surgery.

Methods and analysis

A randomised controlled trial will be conducted with 140 patients across four Ontario Bariatric Centres of Excellence to examine the efficacy of a telephone-based cognitive behavioural therapy intervention versus a control intervention (online COVID-19 self-help resources) in postoperative bariatric patients experiencing disordered eating and/or psychological distress. Patients will be randomised 1:1 to either group. Changes in the Binge Eating Scale and the Patient Health Questionnaire 9-Item Scale will be examined between groups across time (primary outcomes). Qualitative exit interviews will be conducted, and data will be used to inform future adaptations of the intervention to meet patients’ diverse needs during and post-pandemic.

Ethics and dissemination

This study has received ethics approvals from the following: Clinical Trials Ontario (3957) and the University Health Network Research Ethics Committee (22–5145), the Board of Record. All participants will provide written informed consent prior to enrolling in the study. Results will be made available to patients with bariatric surgery, the funders, the supporting organisations and other researchers via publication in peer-reviewed journals and conference presentations.

Trial registration number

NCT05258578.
Recurrent 17q12 microduplications contribute to renal disease but not diabetes
Authors: Cannon Stuart , Clissold Rhian , Sukcharoen Kittiya , Tuke Marcus , Hawkes Gareth , Beaumont Robin N , Wood Andrew R , Gilchrist Mark , Hattersley Andrew T , Oram Richard A , Patel Kashyap , Wright Caroline , Weedon Michael N
Published: September 2022

Background

17q12 microdeletion and microduplication syndromes present as overlapping, multisystem disorders. We assessed the disease phenotypes of individuals with 17q12 CNV in a population-based cohort.

Methods

We investigated 17q12 CNV using microarray data from 450 993 individuals in the UK Biobank and calculated disease status associations for diabetes, liver and renal function, neurological and psychiatric traits.

Results

We identified 11 17q12 microdeletions and 106 microduplications. Microdeletions were strongly associated with diabetes (p=2×10−7) but microduplications were not. Estimated glomerular filtration rate (eGFR mL/min/1.73 m2) was consistently lower in individuals with microdeletions (p=3×10−12) and microduplications (p=6×10−25). Similarly, eGFR <60, including end-stage renal disease, was associated with microdeletions (p=2×10−9, p<0.003) and microduplications (p=1×10−9, p=0.009), respectively, highlighting sometimes substantially reduced renal function in each. Microduplications were associated with decreased fluid intelligence (p=3×10−4). SNP association analysis in the 17q12 region implicated changes toHNF1Bas causing decreased eGFR (NC_000017.11:g.37741642T>G, rs12601991, p=4×10−21) and diabetes (NC_000017.11:g.37741165C>T, rs7501939, p=6×10−17). A second locus within the region was also associated with fluid intelligence (NC_000017.11:g.36593168T>C, rs1005552, p=6×10−9) and decreased eGFR (NC_000017.11:g.36558947T>C, rs12150665, p=4×10–15).

Conclusion

We demonstrate 17q12 microdeletions but not microduplications are associated with diabetes in a population-based cohort, likely caused byHNF1Bhaploinsufficiency. We show that both 17q12 microdeletions and microduplications are associated with renal disease, and multiple genes within the region likely contribute to renal and neurocognitive phenotypes.
Treatment of CIDP
Authors: Fehmi Janev , Bellanti Roberto , Misbah Siraj A , Bhattacharjee Anupam , Rinaldi Simon
Published: September 2022

Chronic inflammatory demyelinating polyneuropathy is a disabling but treatable disorder. However, misdiagnosis is common, and it can be difficult to optimise its treatment. Various agents are used both for first and second line. First-line options are intravenous immunoglobulin, corticosteroids and plasma exchange. Second-line therapies may be introduced as steroid-sparing agents or as more potent escalation therapy. It is also important to consider symptomatic treatment of neuropathic pain and non-pharmacological interventions. We discuss the evidence for the various treatments and explain the practicalities of the different approaches. We also outline strategies for monitoring response and assessing the ongoing need for therapy.