bluuebunny/crossref_metadata_2025 huggingface dataset:
Study on tearing tests and the determination of fracture toughness of PVC-coated fabric
Authors: Bao Han , Wu Minger , Zhang Xubo
Published: February 2021

In this study, detailed uniaxial in-plane tearing tests including uniaxial central, single-edge notched, and trapezoidal tearing tests of a type of polyvinylchloride (PVC)-coated polyester fiber fabric were conducted. Two types of tearing failure modes, brutal and progressive, were examined. In addition to differences in the descending sections of the stress–displacement curves and the membrane surface morphology near the crack, it was found that the uniaxial central tearing test could be replaced by the corresponding single-edge notched tearing test to minimize the usage of test materials. The configuration of the single-edge notched specimen, including the gauge length and width, was investigated to determine the conditions under which the tearing resistance of the practically nearly infinite membrane surface can be studied with finite-size specimens. To obtain the fracture toughness GIC, which characterizes the ability of materials to prevent crack growth, a theoretical method and two test methods were introduced. After comparing the methods, the test method based on the area of the parallelogram obtained from the zigzag wave in the descending section of the load–displacement curves was proved to be superior. The value of GIC obtained with this simple test method was relatively stable, and it could be used to evaluate the tearing resistance and calculate the tearing strength of the coated fabrics.
Reconstruction of Extensive Soft Tissue Defects of Lower Extremity With the Extended Anterolateral Thigh Flap
Authors: Kim Jong-Ho , Yoo Hyokyung , Eun Seokchan
Published: February 2021

The anterolateral thigh flap is a classic flap used for various reconstruction defects. However, the flap viability of extended large skin paddles (ie, 240 cm2) was doubted by many surgeons. This study reports successful experience of reconstructing extensive soft tissue defects of lower extremity using extended large skin paddles. Twelve consecutive patients who had undergone reconstruction of defects using an extended anterolateral thigh flap were identified. Patient characteristics (age, sex, defect location, injured structures, and type of flap) and outcome data were analyzed retrospectively. One artery and 2 accompanying veins were anastomosed to vascularize each flap. Follow-up periods ranged from 10 to 91 months postoperatively. The average size of the flaps was 268.75 cm2 (range = 220-391 cm2). All flaps were perforator flaps with one perforator except that 2 perforators were used in 3 patients. Two patients suffered partial flap necrosis of the distal portion with delayed healing. In conclusion, the extended anterolateral thigh flap is a considerable option for massive defects requiring composite tissue coverage. This flap is advantageous for reconstructing various complex defects in the lower extremities, providing a pliable and vascularized tissue to cover exposed extensive defects including tendons, nerves, and bones.
Flight planning in multi-unmanned aerial vehicle systems: Nonconvex polygon area decomposition and trajectory assignment
Authors: Skorobogatov Georgy , Barrado Cristina , Salamí Esther , Pastor Enric
Published: February 2021

Nowadays, it is quite common to have one unmanned aerial vehicle (UAV) working on a task but having a team of UAVs is still rare. One of the problems that prevent us from using teams of UAVs more frequently is flight planning. In this work, we present the first open-source solution ( https://pypi.org/project/pode/ ) for splitting any complex area into multiple parts. The area of interest can be convex or nonconvex and can include any number of no-flight zones. Four solutions, based on the algorithm of Hert and Lumelsky, are tested with the aim of improving the compactness of the partitions. We also show how the shape of the partitions influences flight performance in a real case scenario.
Reliability optimization design of deformation of CNC lathe spindle considering thermal effect
Authors: Liu Haiyang , Zhang Yimin , Li Changyou , Gu Jianguo
Published: February 2021

Angular contact ball bearings are widely used in the field of rotating machinery due to their obvious advantages such as relatively good positioning accuracy, high speed rotating performance and low cost, which have already become the most important transmission components. The heterogeneous thermal deformation caused by the high speed effect of bearing parts will lead to excessive noise and even gluing, which can further significantly reduce the machining accuracy of machine tool. Therefore, it is vital to improve the deformation resisting capability and operational reliability of the whole system. For this purpose, this paper presents a reliability model for computerized numerical control (CNC) lathe spindle by considering thermal effect. A five-degree-of-freedom quasi-static model considering thermal deformation is firstly proposed to calculate contact load and contact angle. Then the transient thermal network method is used to solve the temperature value of multi-node spindle-bearing system, and the validity of the proposed model is verified by experiments at different speeds. Next the modified first-order and second-moment method (FOSM) is used to calculate the reliability and reliability sensitivity of CNC lathe spindle deformation model considering thermal effect. Finally, the constrained nonlinear optimization method for the reliability model is proposed and applied to CNC lathe spindle. The results show that the reliability of the optimized model is significantly improved and the reliability robustness is enhanced.
Twelve-month effects of everolimus on renal and lung function in lung transplantation: differences in chronic lung allograft dysfunction phenotypes
Authors: Patrucco Filippo , Allara Elias , Boffini Massimo , Rinaldi Mauro , Costa Cristina , Albera Carlo , Solidoro Paolo
Published: February 2021

Background:

Chronic lung allograft dysfunction (CLAD), a complication affecting the survival of lung transplanted patients, includes two clinical phenotypes: bronchiolitis obliterans syndrome (BOS) and restrictive allograft syndrome (RAS). Everolimus is used in CLAD because of its antiproliferative mechanism. In lung transplant patients treated with everolimus, the clinical course of renal and lung function has not yet been assessed systematically in CLAD, BOS and RAS patients for more than 6 months.

Methods:

We retrospectively evaluated the 12-month follow-up of renal and lung function of lung-transplanted patients switched to everolimus and evaluated the reduction in immunosuppressant dosage (ISD) and mortality. Subgroups were based on indication for everolimus treatment: CLAD and non-CLAD patients, BOS and RAS among CLAD patients.

Results:

We included 26 patients, 17 with CLAD (10 BOS, seven RAS). After 1 year from the everolimus switch, we observed renal function improvement (serum creatinine −17%, estimated glomerular filtration rate +24%) and stable pulmonary function [forced expiratory volume in the first second (FEV1) −0.5%, forced vital capacity (FVC) +0.05%]. RAS patients had progressive functional loss, whereas BOS patients had FEV1 improvement and FVC stability. All-cause mortality was higher in the CLAD versus non-CLAD group (41% versus 11%), without differences between BOS and RAS patients ( p > 0.05). All patients had significant and persistent ISD reduction.

Conclusion:

Lung transplant patients treated with everolimus had improvements in renal function and reduced ISD. We observed sustained improvements in lung function for CLAD related to BOS subgroup results, whereas RAS confirmed the 1-year worsening functional trend. Data seem to suggest one more piece of the puzzle in CLAD phenotyping.
Personal protective equipment use by healthcare workers in intensive care unit during the early phase of COVID-19 pandemic in Italy: a secondary analysis of the PPE-SAFE survey
Authors: Ippolito Mariachiara , Ramanan Mahesh , Bellina Davide , Catalisano Giulia , Iozzo Pasquale , Di Guardo Andrea , Moscarelli Alessandra , Grasselli Giacomo , Giarratano Antonino , Bassetti Matteo , Tabah Alexis , Cortegiani Andrea
Published: February 2021

Background:

Italy was the first Western country to be heavily affected by COVID-19. Healthcare workers (HCWs) were exposed to a high risk of occupational infection, partially due to insufficient personal protective equipment (PPE) supplies. This study aimed to describe the practices, availability, training, confidence in PPE use and the adverse effects due to extended PPE use, as reported by HCWs in Italy. We also aimed to provide a comparison between Italian data and those from other countries.

Methods:

This study was a secondary analysis of a previously published international study, the PPE-SAFE Survey, conducted in April 2020. Data were analysed from the original study database.

Results:

We analysed the responses from 380 healthcare workers based in Italy, out of the 2711 respondents to the international survey. Among the Italian respondents, FFP2 and FFP3 respirators or equivalent were the most used masks for routine tasks (respectively 188/380, 50%; and 163/380, 43%). The median time of wearing PPE without taking a break was 5 h [interquartile range (IQR) 4–6], with statistically significant difference from other countries [median 4 h (IQR 2–5) p < 0.0001]. In Italy, 249 out of 380 (65%) HCWs had never performed a formal fit test for a N95 mask or equivalent and 91/380 (24%) never had a partner for donning and doffing procedures. Most of the respondents (299/380, 79%) had received formal training in PPE use at any time.

Conclusion:

Most of the surveyed Italian HCWs reported working at above usual capacity, long shifts with PPE without breaks and routine use in intensive care unit of aerosol protection (e.g. FFP2/FFP3), hazmat suits and face shields/visors. The correct adherence to safety procedures (e.g. donning/doffing in pairs, performing fit test) has substantial scope for improvement in the future.
Early MRI outcomes in participants with a first clinical demyelinating event at risk of multiple sclerosis in the ORACLE-MS study
Authors: Freedman Mark S , Coyle Patricia K , Comi Giancarlo , L Scarberry Susan , Damian Doris , Hyvert Yann , Dangond Fernando , Galazka Andrew , Jack Dominic , Lebson Lori A , Leist Thomas P
Published: February 2021

Background

In the Phase 3, 96-week ORACLE-MS study, cladribine tablets 10 mg (3.5 or 5.25 mg/kg cumulative dosage over two years) significantly reduced lesions associated with multiple sclerosis versus placebo in participants following a first clinical demyelinating event (FCDE).

Objective

To determine the timing of effects of cladribine tablets on lesion activity assessed by magnetic resonance imaging (MRI).

Methods

This post hoc analysis assessed the effect of cladribine tablets versus placebo in ORACLE-MS on secondary MRI endpoints including T1 gadolinium-enhancing (Gd+), new or enlarging T2 lesions, and combined unique active lesions assessed on MRI scans performed at screening and every 3 months thereafter.

Results

Compared to placebo, cladribine tablets 3.5 mg/kg treatment appeared to lead to a trend of reductions in the mean number of T1 Gd+ lesions by Week 13 (first post-baseline scan: 0.37 vs. 1.00), new or enlarging T2 (0.20 vs. 1.01) and combined unique active (0.29 vs. 1.91) lesions by Week 24. Low lesion counts were maintained with cladribine tablets throughout 96 weeks. Similar results were observed with the 5.25 mg/kg dosage.

Conclusion

In participants with an FCDE, cladribine tablets appeared to reduce lesion numbers within 13 weeks (time of first evaluation).
Expression of cPLA2γ mRNA and protein differs the response of PBMC from severe and non-severe asthmatics to bacterial lipopolysaccharide and house dust mite allergen
Authors: Pniewska-Dawidczyk Ewa , Kupryś-Lipińska Izabela , Turek Gabriela , Kacprzak Dorota , Wieczfinska Joanna , Kleniewska Paulina , Kuna Piotr , Pawliczak Rafal
Published: February 2021

Chronic inflammation in asthmatics is initiated/exacerbated by many environmental factors, such as bacterial lipopolysaccharide and allergens. Phospholipase A2 and histone acetyltransferase/deacetylases are enzymes involved in inflammatory process, particularly in lipid inflammatory mediators production and control of transcription of many inflammatory genes, respectively. The aim of the study was to identify differences in the inflammatory process in patients with severe and non-severe asthma, taking as a criterion expression of two groups of enzymes: phospholipases A2 and histone acetyltransferases/deacetylases. Thirty-two patients with severe, non-severe atopic to house dust mite asthmatics and 14 healthy volunteers were recruited. Peripheral blood mononuclear cells were stimulated with Dermatophagoides pteronyssinus allergen (nDer p1) and bacterial lipopolysaccharide (LPS). The expression of phospholipases A2 and histone acetyltransferases and deacetylases were assessed using TaqMan Low Density Array Cards. The protein expression was analyzed with immunoblot. Increased expression of phospholipase A2 Group IVC ( PLA2G4C) and cytosolic phospholipase A2 gamma (cPLA2γ) protein was observed in peripheral blood mononuclear cells (PBMC) from severe asthmatics in response to LPS and nDer p1, compared to non-severe asthmatics. nDer p1-stimulated PBMC from severe asthmatics exhibit induced expression of HDAC1 and similar trend was observed in protein concentration. Decreased expression of EP300 occurred in PBMC of severe asthmatics. PBMC from non-severe asthmatics showed decreased expression of HDAC2 and PLA2G15 after LPS treatment. In conclusion, in response to LPS and dust mite allergen, PBMC from severe and non-severe asthmatics modulate expression of selected phospholipase A2, histone acetyltransferases and deacetylases, while increased expression of cPLA2γ characterizes PBMC response from severe asthmatics.
Co-occurrence of Deficits in Beat Perception and Synchronization Supports Implication of Motor System in Beat Perception
Authors: Tranchant Pauline , Lagrois Marie-Élaine , Bellemare Antoine , Schultz Benjamin G. , Peretz Isabelle
Published: February 2021

The main goal of this study was to test the hypothesis that disorders in entrainment to the beat of music originate from motor deficits. To this aim, we adapted the Beat Alignment Test and tested a large pool of control subjects, as well as nine individuals who had previously showed deficits in synchronization to the beat of music. The tasks consisted of tapping (Experiment 1) and bouncing (Experiment 2) in synchrony with the beat of non-classical music that varied in genre, tempo, and groove, and then judging whether a superimposed metronome was perceived as on or off the beat of the same selection of music. Results indicate concomitant deficits in both beat synchronization and the detection of misalignment with the beat, supporting the hypothesis that the motor system is implicated in beat perception.
Implementing the Mindfulness-Based Interventions; Teaching Assessment Criteria (MBI:TAC) in Mindfulness-Based Teacher Training
Authors: Griffith GM , Crane RS , Baer R , Fernandez E , Giommi F , Herbette G , Koerbel L
Published: February 2021

The Mindfulness-Based Interventions: Teaching Assessment Criteria (MBI:TAC) was originally developed as a tool to assess the teaching competence of mindfulness-based program (MBP) teachers. The tool was made freely available and has since been used by mindfulness-based teacher training organisations internationally. During this time the MBI:TAC has evolved in its usage, from an assessment tool to one which informally supports how MBP teachers are trained. In this article, we first examine the rationale for implementing the MBI:TAC in MBP teacher training; second, we offer practical guidance on ways of integrating the tool into teacher training pathways with awareness of its potential and possible pitfalls; and third, we offer guidance on using the tool as a framework for giving effective feedback to trainees on their teaching practice. Implementing the MBI:TAC in teacher training may support the quality and integrity of MBP teacher training, and thus ensure high quality MBP teachers graduating. In turn this may help avoid the ‘implementation cliff’ – that is, the quality of an intervention delivery is delivered in optimal conditions when it is being researched, and drops in quality when delivered in sub-optimal, ‘real world’ conditions.
Moving Beyond the Neck and Arm: The Pain Experience of People With Degenerative Cervical Myelopathy Who Have Pain
Authors: Boerger Timothy , Alsouhibani Ali , Mowforth Oliver , Hamilton Joseph , Lalkhen Abdul , Davies Benjamin M. , Kotter Mark R. N.
Published: February 2021

Study Design:

Cross-sectional internet survey of people living with degenerative cervical myelopathy.

Objective:

The purpose of this study was to quantify pain distribution, severity, and interference in persons with degenerative cervical myelopathy.

Methods:

Eighty-two participants with degenerative cervical myelopathy were recruited for this internet survey. This survey utilized the Michigan Body Map and brief pain inventory (BPI) to assess anatomical distribution and severity of pain as well as the patient derived modified Japanese Orthopedic Association scale (p-mJOA) for myelopathic severity and SF-36 for measures of health-related quality of life. Internal consistency was evaluated with Cronbach’s alpha. Pearson’s correlations were assessed with p-mJOA and SF-36. Multivariate analysis of variance was used to determine if history of prior surgery or concomitant pain diagnosis impacted experience of pain.

Results:

Michigan body map distribution and brief pain inventory severity and interference were correlated with p-mJOA and SF-36 scores (p < 0.05). Pain was moderate to severe in 78% of participants. Pain was commonly widespread. Pain scales were sufficiently internally consistent (α > 0.9). History of surgery or other pain diagnosis did not impact experience of pain in myelopathy.

Conclusions:

Pain is commonly identifiable in large areas of the body, is frequently moderate to severe in intensity and impacts quality of life and severity of myelopathy in a cohort of individuals with myelopathy who have pain.
Locus Minoris Resistentiae: Two Cases of Malignant Metastasis and Review of Literature
Authors: Farmand Donya , Valdez Michael C. , Moosavi Leila , Cobos Everardo
Published: February 2021

Locus minoris resistentiae refers to a region of decreased resistance within the body. This occurs from changes to the microenvironment secondary to previous trauma and results in increased vulnerability. As a result, infection, inflammatory processes, and malignancy may localize to this area. In this article, we describe 2 unique cases of malignancy, primary prostate carcinoma and serous carcinoma of the ovary, both of which disseminated to sites of prior trauma. We review the available literature, discuss proposed pathophysiology, and highlight the need for further investigations along with increased clinician awareness.
An Uncommon Presentation of DRESS Syndrome Secondary to Leflunomide Use: A Case Report
Authors: Rao Suman , Sunkara Akhila , Srivastava Nimisha , Sampat Parth , Ramos Christopher , Albert Emily
Published: February 2021

Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a constellation of symptoms that manifest as a result of certain medications. Several antipsychotics, antibiotics, and sulfa-containing drugs are known to be implicated in the etiology of DRESS syndrome. The clinical presentation of this disorder consists of a diffuse rash, lymphadenopathy, and systemic organ damage. Our patient presented with symptoms consistent with DRESS syndrome after being started on leflunomide, which is not commonly associated with DRESS. The diagnostic workup comprised of monitoring inflammatory markers on laboratory work, an excisional lymph node biopsy (to rule out malignancy), and a skin biopsy (to assess the etiology of the rash). Our patient received systemic steroids, dose-adjusted based on expert opinion. Further research is required to explore the association between leflunomide and DRESS and address guidelines for the management of DRESS.
A Glimpse of the Structural Biology of the Metabolism of Sphingosine-1-Phosphate
Authors: Ren Ruobing , Pang Bin , Han Yufei , Li Yihao
Published: February 2021

As a key sphingolipid metabolite, sphingosine-1-phosphate (S1P) plays crucial roles in vascular and immune systems. It regulates angiogenesis, vascular integrity and homeostasis, allergic responses, and lymphocyte trafficking. S1P is interconverted with sphingosine, which is also derived from the deacylation of ceramide. S1P levels and the ratio to ceramide in cells are tightly regulated by its metabolic pathways. Abnormal S1P production causes the occurrence and progression of numerous severe diseases, such as metabolic syndrome, cancers, autoimmune disorders such as multiple sclerosis, and kidney and cardiovascular diseases. In recent years, huge advances on the structure of S1P metabolic pathways have been accomplished. In this review, we have got a glimpse of S1P metabolism through structural and biochemical studies of: sphingosine kinases, S1P transporters and S1P receptors, and the development of therapeutics targeting S1P signaling. The progress we summarize here could provide fresh perspectives to further the exploration of S1P functions and facilitate the development of therapeutic molecules targeting S1P signaling with improved specificity and therapeutic effects.
Dynamic Inconsistency and Incentive Design: Insights from Behavioural Economics for HR Managers
Authors: Gaurav Sarthak
Published: February 2021

Behavioural economics is a thriving field that offers descriptive models of human decision-making that deviate from the standard model of decision-making in economics. This article presents insights from behavioural economics that can help address dynamic inconsistency, that is, time-inconsistency problems of employees and inform incentive design strategies. The author argues that lessons from behavioural economics can be applied to design solutions that can transform HR practices. HR managers and leaders stand to benefit from the emerging evidence from the lab and field in behavioural economics that calls for a rethinking of the conventional understanding of human behaviour.
The micropolitics of conflicts in total institutions – The case of special approved homes for youths in Sweden
Authors: Stenström Albin , Pettersson Tove
Published: February 2021

This article focuses on conflicts between youths and staff at special approved homes in Sweden. We direct a special focus at the institutional micropolitics within which these conflicts arise and which the conflicts also contribute to form. Drawing on the work of Emerson and Messinger, our point of departure is an interactionist analysis of the micropolitics of trouble. One focal aspect in our study is the recurring patterns of conflicts – a pattern we have chosen to label the ‘conflict script’. The conflict script is a process set in motion when the staff explicitly state that they have ‘had enough’. Once started, it becomes an imperative and is therefore, in a sense, a consistent micropolitical measure. The conflict script generates immutable positions – the staff cannot back down, since their authority is at stake, and the youths know that resistance will result in the use of coercion. However, what leads to the staff having ‘had enough’ varies between interactions, which thus produces inconsistent micropolitics. The conflict script is central to understanding how trivial breaches of the rules, or other forms of disturbances, can escalate into situations that involve the use of force in the form of physical restraint and isolation.
Efficacy of scroto-inguinal microsurgical varicocelectomy in treating male infertility
Authors: Phan Hai Thanh , Nguyen Thanh Xuan , Nguyen Du Vinh , Vu Hoai Anh , Le Duc Anh , Pham Nhu Hien
Published: February 2021

Background

Varicocele presents as the most frequent cause of infertility in men. Most reports showed that varicocelectomy has a significant impact on male fertility and reproductive outcome. This study aims to evaluate the safety and effectiveness of scrotal–inguinal microsurgical varicocelectomy in treating male infertility.

Methods

We prospectively studied preoperatively and postoperatively (at 3 and 6 months) 86 consecutive patients diagnosed with varicocele, abnormal semen parameters, and infertility, undergoing scrotal–inguinal microsurgical varicocelectomy. Semen test was performed before surgery and at 3 months and 6 months after surgery. The reproductive events were short-term followed up.

Results

The median age of the patient was 32.9 ± 5.1 (20–43). Two cases (2.7%) had a minor infection of the scrotum incision, who were well treated by appropriate antibiotics. After operation, total sperm count and the percentage of motile sperms at 3 months and 6 months were significantly higher than those pre-varicocelectomy, respectively. In total, 26.7% (23/86) of all couples achieved a spontaneous pregnancy. Late complications such as testicular atrophy, hydroceles, and recurrent varicocele have not occurred.

Conclusions

Scrotal–inguinal microsurgical varicocelectomy is an acceptable method in treating male infertility due to high rate of reproductive outcomes and very low rate of complications.
Renal leiomyoma: a case report and literature review
Authors: Gerdharee Sajal , van Wyk Abrie , van Deventer Heidi , van der Merwe Andre
Published: February 2021

Background

Renal leiomyomas are exceptionally rare, benign, mesenchymal tumours originating from smooth muscle in the kidney. Historically, because of their small size, most renal leiomyoma cases were discovered incidentally based on autopsy findings. However, since the advent and improved access to imaging modalities such as ultrasound and computed tomography (CT), renal leiomyomas are being discovered more frequently. Although usually incidental discoveries, clinical presenting signs and symptoms comprise abdominal or flank pain, a palpable flank mass, and haematuria in 20% of those with symptoms.

Case presentation

We study the case of an incidentally found, asymptomatic, left kidney mass that presented in a 60-year-old female. Initial suspicions on CT imaging of either renal cell carcinoma or oncocytoma resulted in a radical nephrectomy of the left kidney. Postoperative pathological examination of the mass revealed a renal leiomyoma; a rare, benign tumour that is mostly indistinguishable from malignant tumours on imaging.

Conclusions

With the current availability of ultrasonography and CT, they are often discovered incidentally, and the radiological differential diagnoses are often inadequate or challenging in such cases. The gold standard management of these suspicious cancer cases is still a radical nephrectomy with postoperative pathological and immunohistochemical analysis. Due to its benign nature, patients enjoy excellent prognoses without recurrence. We discuss and briefly review the relevant literature of the clinical, imaging and pathological features of renal leiomyomas and those of the differential diagnoses.
Genomic insight into diet adaptation in the biological control agent Cryptolaemus montrouzieri
Authors: Li Hao-Sen , Huang Yu-Hao , Chen Mei-Lan , Ren Zhan , Qiu Bo-Yuan , De Clercq Patrick , Heckel Gerald , Pang Hong
Published: February 2021

Background

The ladybird beetleCryptolaemus montrouzieriMulsant, 1853 (Coleoptera, Coccinellidae) is used worldwide as a biological control agent. It is a predator of various mealybug pests, but it also feeds on alternative prey and can be reared on artificial diets. Relatively little is known about the underlying genetic adaptations of its feeding habits.

Results

We report the first high-quality genome sequence forC. montrouzieri. We found that the gene families encoding chemosensors and digestive and detoxifying enzymes among others were significantly expanded or contracted inC. montrouzieriin comparison to published genomes of other beetles. Comparisons of diet-specific larval development, survival and transcriptome profiling demonstrated that differentially expressed genes on unnatural diets as compared to natural prey were enriched in pathways of nutrient metabolism, indicating that the lower performance on the tested diets was caused by nutritional deficiencies. Remarkably, theC. montrouzierigenome also showed a significant expansion in an immune effector gene family. Some of the immune effector genes were dramatically downregulated when larvae were fed unnatural diets.

Conclusion

We suggest that the evolution of genes related to chemosensing, digestion, and detoxification but also immunity might be associated with diet adaptation of an insect predator. These findings help explain why this predatory ladybird has become a successful biological control agent and will enable the optimization of its mass rearing and use in biological control programs.
Differentiation in the genetic basis of stem trichome development between cultivated tetraploid cotton species
Authors: Yuan Rong , Cao Yuefen , Li Tengyu , Yang Feng , Yu Li , Qin Yuan , Du Xiongming , Liu Fang , Ding Mingquan , Jiang Yurong , Zhang Hua , Paterson Andrew H. , Rong Junkang
Published: February 2021

Background

Cotton stem trichomes and seed fibers are each single celled structures formed by protrusions of epidermal cells, and were found sharing the overlapping molecular mechanism. Compared with fibers, cotton stem trichomes are more easily observed, but the molecular mechanisms underlying their development are still poorly understood.

Results

In this study,Gossypium hirsutum(Gh) andG. barbadense(Gb)were found to differ greatly in percentages of varieties/accessions with glabrous stems and in trichome density, length, and number per trichopore.Ghvarieties normally had long singular and clustered trichomes, whileGbvarieties had short clustered trichomes. Genetic mapping using five F2populations from crosses between glabrous varieties and those with different types of stem trichomes revealed that much variation among stem trichome phenotypes could be accounted for by different combinations of genes/alleles on Chr. 06 and Chr. 24. The twenty- six F1generations from crosses between varieties with different types of trichomes had varied phenotypes, further suggesting that the trichomes of tetraploid cotton were controlled by different genes/alleles. Compared to modern varieties, a greater proportion ofGhwild accessions were glabrous or had shorter and denser trichomes; whereas a smaller proportion ofGbprimitive accessions had glabrous stems. A close correlation between fuzz fiber number and stem trichome density was observed in bothGhandGbprimitive accessions and modern varieties.

Conclusion

Based on these findings, we hypothesize that stem trichomes evolved in parallel with seed fibers during the domestication of cultivated tetraploid cotton. In addition, the current results illustrated that stem trichome can be used as a morphological index of fiber quality in cotton conventional breeding.
A gap existed between physicians’ perceptions and performance of pain, agitation-sedation and delirium assessments in Chinese intensive care units
Authors: Chen Kai , Yang Yan-Lin , Li Hong-Liang , Xiao Dan , Wang Yang , Zhang Linlin , Zhou Jian-Xin
Published: February 2021

Background

Pain, agitation-sedation and delirium management are crucial elements in the care of critically ill patients. In the present study, we aimed to present the current practice of pain, agitation-sedation and delirium assessments in Chinese intensive care units (ICUs) and investigate the gap between physicians’ perception and actual clinical performance.

Methods

We sent invitations to the 33 members of the Neuro-Critical Care Committee affiliated with the Chinese Association of Critical Care Physicians. Finally, 24 ICUs (14 general-, 5 neuroscience-, 3 surgical-, and 2 emergency-ICUs) from 20 hospitals participated in this one-day point prevalence study combined with an on-site questionnaire survey. We enrolled adult ICU admitted patients with a length of stay ≥24 h, who were divided into the brain-injured group or non-brain-injured group. The hospital records and nursing records during the 24-h period prior to enrollment were reviewed. Actual evaluations of pain, agitation-sedation and delirium were documented. We invited physicians on-duty during the 24 h prior to the patients’ enrollment to complete a survey questionnaire, which contained attitude for importance of pain, agitation-sedation and delirium assessments.

Results

We enrolled 387 patients including 261 (67.4%) brain-injured and 126 (32.6%) non-brain-injured patients. There were 19.9% (95% confidence interval [CI]: 15.9–23.9%) and 25.6% (95% CI: 21.2–29.9%) patients receiving the pain and agitation-sedation scale assessment, respectively. The rates of these two types of assessments were significantly lower in brain-injured patients than non-brain-injured patients (p = 0.003 and < 0.001). Delirium assessment was only performed in three patients (0.8, 95% CI: 0.1–1.7%). In questionnaires collected from 91 physicians, 70.3% (95% CI: 60.8–79.9%) and 82.4% (95% CI: 74.4–90.4%) reported routine use of pain and agitation-sedation scale assessments, respectively. More than half of the physicians (52.7, 95% CI: 42.3–63.2%) reported daily screening for delirium using an assessment scale.

Conclusions

The actual prevalence of pain, agitation-sedation and delirium assessment, especially delirium screening, was suboptimal in Chinese ICUs. There is a gap between physicians’ perceptions and actual clinical practice in pain, agitation-sedation and delirium assessments. Our results will prompt further quality improvement projects to optimize the practice of pain, agitation-sedation and delirium management in China.

Trial registration

ClinicalTrials.gov, identifierNCT03975751. Retrospectively registered on 2 June 2019.
Prevalence and antimicrobial resistance profiles of respiratory microbial flora in African children with HIV-associated chronic lung disease
Authors: Abotsi Regina E. , Nicol Mark P. , McHugh Grace , Simms Victoria , Rehman Andrea M. , Barthus Charmaine , Mbhele Slindile , Moyo Brewster W. , Ngwira Lucky G. , Mujuru Hilda , Makamure Beauty , Mayini Justin , Odland Jon Ø. , Ferrand Rashida A. , Dube Felix S.
Published: February 2021

Background

HIV-associated chronic lung disease (CLD) is common among children living with HIV (CLWH) in sub-Saharan Africa, including those on antiretroviral therapy (ART). However, the pathogenesis of CLD and its possible association with microbial determinants remain poorly understood. We investigated the prevalence, and antibiotic susceptibility of Streptococcus pneumoniae (SP), Staphylococcus aureus (SA), Haemophilus influenzae (HI), and Moraxella catarrhalis (MC) among CLWH (established on ART) who had CLD (CLD+), or not (CLD-) in Zimbabwe and Malawi.

Methods

Nasopharyngeal swabs (NP) and sputa were collected from CLD+ CLWH (defined as forced-expiratory volume per second z-score < − 1 without reversibility post-bronchodilation with salbutamol), at enrolment as part of a randomised, placebo-controlled trial of azithromycin (BREATHE trial - NCT02426112), and from age- and sex-matched CLD- CLWH. Samples were cultured, and antibiotic susceptibility testing was conducted using disk diffusion. Risk factors for bacterial carriage were identified using questionnaires and analysed using multivariate logistic regression.

Results

A total of 410 participants (336 CLD+, 74 CLD-) were enrolled (median age, 15 years [IQR = 13–18]). SP and MC carriage in NP were higher in CLD+ than in CLD- children: 46% (154/336) vs. 26% (19/74), p = 0.008; and 14% (49/336) vs. 3% (2/74), p = 0.012, respectively. SP isolates from the NP of CLD+ children were more likely to be non-susceptible to penicillin than those from CLD- children (36% [53/144] vs 11% [2/18], p = 0.036). Methicillin-resistant SA was uncommon [4% (7/195)]. In multivariate analysis, key factors associated with NP bacterial carriage included having CLD (SP: adjusted odds ratio (aOR) 2 [95% CI 1.1–3.9]), younger age (SP: aOR 3.2 [1.8–5.8]), viral load suppression (SP: aOR 0.6 [0.4–1.0], SA: 0.5 [0.3–0.9]), stunting (SP: aOR 1.6 [1.1–2.6]) and male sex (SA: aOR 1.7 [1.0–2.9]). Sputum bacterial carriage was similar in both groups (50%) and was associated with Zimbabwean site (SP: aOR 3.1 [1.4–7.3], SA: 2.1 [1.1–4.2]), being on ART for a longer period (SP: aOR 0.3 [0.1–0.8]), and hot compared to rainy season (SP: aOR 2.3 [1.2–4.4]).

Conclusions

CLD+ CLWH were more likely to be colonised by MC and SP, including penicillin-non-susceptible SP strains, than CLD- CLWH. The role of these bacteria in CLD pathogenesis, including the risk of acute exacerbations, should be further studied.
Initiation of hepatitis C treatment in two rural Rwandan districts: a mobile clinic approach
Authors: Kamali Innocent , Barnhart Dale A. , Nyirahabihirwe Françoise , de la Paix Gakuru Jean , Uwase Mariam , Nizeyumuremyi Esdras , Walker Stephen , Mazimpaka Christian , de Dieu Gatete Jean , Makuza Jean Damascene , Serumondo Janvier , Kateera Fredrick , d’Amour Ndahimana Jean
Published: February 2021

Background

To eliminate hepatitis C, Rwanda is conducting national mass screenings and providing to people with chronic hepatitis C free access to Direct Acting Antivirals (DAAs). Until 2020, prescribers trained and authorized to initiate DAA treatment were based at district hospitals, and access to DAAs remains expensive and geographically difficult for rural patients. We implemented a mobile clinic to provide DAA treatment initiation at primary-level health facilities among people with chronic hepatitis C identified through mass screening campaigns in rural Kirehe and Kayonza districts.

Methods

The mobile clinic team was composed of one clinician authorized to manage hepatitis, one lab technician, and one driver. Eligible patients received same-day clinical consultations, counselling, laboratory tests and DAA initiation. Using clinical databases, registers, and program records, we compared the number of patients who initiated DAA treatment before and during the mobile clinic campaign. We assessed linkage to care during the mobile clinical campaign and assessed predictors of linkage to care. We also estimated the cost per patient of providing mobile services and the reduction in out-of-pocket costs associated with accessing DAA treatment through the mobile clinic rather than the standard of care.

Results

Prior to the mobile clinic, only 408 patients in Kirehe and Kayonza had been initiated on DAAs over a 25-month period. Between November 2019 and January 2020, out of 661 eligible patients with hepatitis C, 429 (64.9%) were linked to care through the mobile clinic. Having a telephone number and complete address recorded at screening were strongly associated with linkage to care. The cost per patient of the mobile clinic program was 29.36 USD, excluding government-provided DAAs. Providing patients with same-day laboratory tests and clinical consultation at primary-level health facilities reduced out-of-pocket expenses by 9.88 USD.

Conclusion

The mobile clinic was a feasible strategy for providing rapid treatment initiation among people chronically infected by hepatitis C, identified through a mass screening campaign. Compared to the standard of care, mobile clinics reached more patients in a much shorter time. This low-cost strategy also reduced out-of-pocket expenditures among patients. However, long-term, sustainable care would require decentralization to the primary health-centre level.
Association of sudden sensorineural hearing loss with dementia: a nationwide cohort study
Authors: Tai Shu-Yu , Shen Cheng-Ting , Wang Ling-Feng , Chien Chen-Yu
Published: February 2021

Background

Impaired cochlear blood perfusion and microvascular damage can cause sudden sensorineural hearing loss (SSHL), which is a potential risk factor for dementia. This study explored the association between SSHL and dementia.

Methods

This retrospective cohort study used a random sample of 1000,000 individuals from Taiwan’s National Health Insurance Research Database. We identified 3725 patients newly diagnosed with SSHL between January 1, 2000, and December 31, 2009, and propensity score matching according to age, sex, index year, comorbidities, and medications was used to select the comparison group of 11,175 patients without SSHL. Participants were stratified by age (<65 and ≧65 years) and sex for the subgroup analyses. The outcome of interest was all cause dementia (ICD-9-CM codes 290.0, 290.4, 294.1, 331.0). Both groups were followed up until December 31, 2010, for diagnoses of dementia. Cox regression models were used to estimate the hazard ratio (HR) of dementia.

Results

During the average 5-year follow-up period, the incidence rate of dementia in the SSHL cohort was 6.5 per 1000 person-years compared with 5.09 per 10,000 person-years in the comparison group. After adjustment for potential confounders, patients with SSHL were 1.39 times more likely to develop dementia than those without SSHL (95% confidence interval = 1.13–1.71). When stratified by patients’ age and sex, the incidence of dementia was 1.34- and 1.64-fold higher in patients with SSHL aged ≥65 years (P = .013) and in women (P = .001), respectively, compared with the comparison group. Women with SSHL who were < 65 years old had the highest risk (2.14, 95% CI = 1.17–4.11,P = .022). In addition, a log-rank test revealed that patients with SSHL had significantly higher cumulative incidence of dementia than those without SSHL (P = .002).

Conclusions

Patients with SSHL, especially women aged < 65 years, were associated with higher risk of dementia than those without SSHL. Thus, clinicians managing patients with SSHL should be aware of the increased risk of dementia.
Molecular profile of KRAS G12C-mutant colorectal and non-small-cell lung cancer
Authors: Araujo Luiz Henrique , Souza Bianca Mendes , Leite Laura Rabelo , Parma Sabrina A. F. , Lopes Natália P. , Malta Frederico S. V. , Freire Maíra C. M.
Published: February 2021

Background

KRAS is the most frequently mutated oncogene in cancer, however efforts to develop targeted therapies have been largely unsuccessful. Recently, two small-molecule inhibitors, AMG 510 and MRTX849, have shown promising activity in KRAS G12C-mutant solid tumors. The current study aims to assess the molecular profile of KRAS G12C in colorectal (CRC) and non-small-cell lung cancer (NSCLC) tested in a clinical certified laboratory.

Methods

CRC and NSCLC samples submitted for KRAS testing between 2017 and 2019 were reviewed. CRC samples were tested for KRAS and NRAS by pyrosequencing, while NSCLC samples were submitted to next generation sequencing of KRAS, NRAS, EGFR, and BRAF.

Results

The dataset comprised 4897 CRC and 4686 NSCLC samples. Among CRC samples, KRAS was mutated in 2354 (48.1%). Most frequent codon 12 mutations were G12D in 731 samples (14.9%) and G12V in 522 (10.7%), followed by G12C in 167 (3.4%). KRAS mutations were more frequent in females than males (p = 0.003), however this difference was exclusive of non-G12C mutants (p < 0.001). KRAS mutation frequency was lower in the South and North regions (p = 0.003), but again KRAS G12C did not differ significantly (p = 0.80). In NSCLC, KRAS mutations were found in 1004 samples (21.4%). As opposed to CRC samples, G12C was the most common mutation in KRAS, in 346 cases (7.4%). The frequency of KRAS G12C was higher in the South and Southeast regions (p = 0.012), and lower in patients younger than 50 years (p < 0.001). KRAS G12C mutations were largely mutually exclusive with other driver mutations; only 11 NSCLC (3.2%) and 1 CRC (0.6%) cases had relevant co-mutations.

Conclusions

KRAS G12C presents in frequencies higher than several other driver mutations, and may represent a large volume of patients in absolute numbers. KRAS testing should be considered in all CRC and NSCLC patients, independently of clinical or demographic characteristics.
Implementation of transbronchial lung cryobiopsy in a tertiary referral center for interstitial lung diseases: a cohort study on diagnostic yield, complications, and learning curves
Authors: Davidsen Jesper Rømhild , Skov Inge Raadal , Louw Ida Guldbæk , Laursen Christian B.
Published: February 2021

Background

Transbronchial lung cryobiopsy (TBLC) has been introduced as an alternative to surgical lung biopsy (SLB) in the diagnostics of interstitial lung diseases (ILD). Despite controversy on safety, TBLC is increasingly implemented in ILD centers with an apparent diagnostic yield comparable to SLB. The aim of this study was to assess TBLC implementation experiences from a tertiary Danish ILD center regarding diagnosis, complications, and learning curves for TBLC performance.

Methods

TBLC was prospectively performed in a cohort of patients with unclassifiable ILD based on a preceding multidisciplinary clinical and radiological revision. TBLC was performed as an outpatient procedure with the patients in general anesthesia using a flexible bronchoscope with 1.9 or 2.4 mm cryoprobes. Learning curves for TBLC performance were calculated using cumulated sum (CUSUM) scores for diagnostic yield, pneumothorax, and bleeding.

Results

From February 2017 to March 2020 141 patients (86 (61%) men, median age 69 years [IQR, 60–74 years]) had TBLC performed. A histological and confirmative diagnosis was made in 101 patients (75.2%) and 124 patients (87.9%, i.e. clinical diagnostic yield), respectively, in whom idiopathic interstitial pneumonias constituted the majority (67.3%) of the clinical diagnoses. We observed 2 deaths (1.4%) within 30 days of TBLC, but no procedure-related mortality or severe bleeding. Moderate bleeding occurred in 23 patients (16.3%), pneumothorax in 21 patients (14.9%) with only 14 patients (9.9%) requiring a pleural drain. Based on the CUSUM score analysis, the diagnostic yield obtained was satisfactory throughout the period.

Conclusion

This study reports experiences of outpatient TBLC implementation in a tertiary referral ILD center from the largest investigated TBLC cohort in Scandinavia The diagnostic yield and prevalence of complications obtained by TBLC from this single center study on unclassifiable ILD support outpatient TBLC as a valuable and safe alternative to SLB to diagnose ILD in well-selected patients. The learning curves for TBLC were acceptable in the hands of experienced bronchoscopists.