bluuebunny/crossref_metadata_2025 huggingface dataset:
The limits of Quediini at last (Staphylinidae: Staphylininae): a rove beetle mega‐radiation resolved by comprehensive sampling and anchored phylogenomics
Authors: Brunke Adam J. , Hansen Aslak K. , Salnitska Maria , Kypke Janina L. , Predeus Alexander V. , Escalona Hermes , Chapados Julie T. , Eyres Jackson , Richter Robin , Smetana Aleš , Ślipiński Adam , Zwick Andreas , Hájek Jiří , Leschen Richard A.B. , Solodovnikov Alexey , Dettman Jeremy R.
Published: March 2021

Rove beetles of the tribe Quediini are abundant predators in humid microhabitats of forested, open, synanthropic or subterranean ecosystems, with just over 800 species distributed across the temperate and subtropical regions of the Northern Hemisphere. Previous molecular phylogenies included only a limited representation of this diversity but have already indicated thatQuedius, containing the majority of Quediini species, is polyphyletic. Six genera, historically associated with Quediini but now Staphylininaeincertae sedis, are known only from few pinned specimens and have never been sequenced. Recent synergy between target enrichment phylogenomics, low‐input sequencing of dry, pinned insect specimens and advances in alpha taxonomic knowledge have made comprehensive sampling of Quediini tractable. Here we developed a novel probe set specialized for anchored hybrid enrichment of 1229 single‐copy orthologous loci in Staphylinidae. In one of the largest target enrichment phylogenies of insects to‐date, we sequenced 201 ingroup taxa to clearly delimit monophyletic Quediini within Staphylininae and resolve relationships within this tribe, with 46% of sampled taxa derived from pinned specimens (0–45 years old). Maximum likelihood and coalescent phylogenetic analyses produced well‐resolved, congruent topologies that will serve as a framework for further exploration of this radiation and its necessary generic revision. The inclusion of nearly all remaining Staphylininaeincertae sedisgenera, all known only from pinned specimens, resulted in the creation of Quelaestrygonini Brunke,trib. n.and revised concepts for Cyrtoquediini and Indoquediini. Quediini was resolved as monophyletic with the transfer ofQ. elevatusandQ. nigropolitusto other tribes butQuediusand its subgeneraMicrosaurus,DistichaliusandRaphiruswere shown to be para‐ or polyphyletic. Based on the results of our analyses,VelleiopsisFairmaire, 1882syn. n.andMegaquediusCasey, 1915syn. n.are synonymized withMicrosaurusDejean, 1833 resulting in:Q.(Microsaurus)marginiventris(Fairmaire)comb. n.,Q.(M.)varendorffi(Reitter)comb.n.Several species ofQuediuswere transferred fromMicrosaurustoDistichalius(Q. aethiopsSmetana,Q. biannSmetana,Q. cingulatusSmetana andQ. taruniSmetana),DistichaliustoRaphirus(Q. fagelianusScheerpeltz) andMicrosaurustoRaphirus(Q. mixtusEppelsheim andQ. persicusKorge).
Kidney transplantation in the time of COVID‐19: Dilemmas, experiences, and perspectives
Authors: Cristelli Marina P. , Viana Laila A. , Fernandes Ruan de A. , Nakamura Monica R. , Foresto Renato D. , Stopa Martins Suelen B. , Alvarazi Jacqueline F. L. , Leite Valeria C. , de Oliveira Francisco R. , Carneiro Vanessa A. , Santos Daniel Wagner de C. L. , Aguiar Wilson F. , Vaz Maria Lucia dos S. , Tedesco‐Silva Helio , Medina‐Pestana José
Published: March 2021

Introduction

Hospital do Rim is a high‐volume kidney transplant (KT) center located in São Paulo, a city with 12.2 million inhabitants. Over the last 18 years, we performed 11 436 KT, 70% of which from deceased donors. To mitigate the effects of reduction in the number of transplants on the waiting list, sequential measures were implemented when COVID‐19 was declared pandemic.

Methods

The first step was to provide SARS‐COV‐2 RT‐PCR testing for all symptomatic employees and patients and the compulsory use of personal protective equipment in the hospital facilities. Living donor KT were postponed, and all deceased donors and recipients were tested before the transplantation. The immunosuppressive protocols were maintained, and telehealth strategies were developed.

Results

Among the 1013 employees, there were 214 cases of COVID‐19, nine required ward hospitalization, and no deaths occurred. In 26%, the probable source of contamination was occupational. From the first patient diagnosed with COVID‐19 in 03/20/2020 till 10/21/2020, 523 deceased KT were performed, a 21% increase compared with 2019, with no confirmed donor‐derived SARS‐CoV‐2 infection. Four patients were transplanted with a positive pretransplant SARS‐CoV‐2 test, but none of them developed the disease. Overall, of 11 875 KT followed in our center, 674 developed COVID‐19. Among the hospitalized, 53% required mechanical ventilation, and 45% required hemodialysis. Their overall mortality rate was 27.5%.

Conclusion

This experience shows the challenges that transplant centers faced as the pandemic unfolded and illustrates the effectiveness of the sequential measures implemented to provide a safe environment for transplantation.
Evaluation of a pre‐exposure prophylaxis (PrEP)/post‐exposure prophylaxis (PEP) deferral policy among blood donors
Authors: Saeed Sahar , Goldman Mindy , Uzicanin Samra , O'Brien Sheila F.
Published: March 2021

Background

The use of pre−/post‐exposure prophylaxis (PrEP/PEP) may interfere with routine HIV screening. As a result, blood services worldwide have adopted a variety of deferral policies to mitigate increased residual risk. In this study, we evaluated the operational impact of modifying the donor health questionnaire (DHQ) to include explicit questions to assess PrEP/PEP exposure.

Study Design and Methods

We conducted a retrospective study between June 2019 and October 2020 of all blood donors attempting to donate at Canadian Blood Services. Sixteen‐months post‐implementation, we summarized self‐reported PrEP/PEP rates and their indications for use. We also assessed deferral rates and the sensitivity of using existing risk questions to defer people exposed to PrEP/PEP.

Results

Of 1,122,075 donations, 89 people (eight per 100,000 donations) reported PrEP (64%)/PEP (34%) use in the last 4 months. People exposed to PrEP were more likely to be men (94%) and taking PrEP for lifestyle reasons (87%). In contrast, indications for PEP use included occupational exposure (50%) and sexual assault (27%). Most donors who answered affirmatively to PrEP/PEP exposure were deferred (96%). If potential donors were not directly asked about their PrEP/PEP use, the majority would not have been deferred for any other reasons (PrEP 32/57 (56%) and PEP 15/30 (50%)).

Conclusion

Not all blood services have adopted direct questions to identify PrEP/PEP exposure; some rely on existing DHQ questions. In Canada, despite DHQ questions such as medication use in the last 3‐days, more than half of people exposed to PrEP/PEP would not have been identified and deferred.
CASE STUDY ON THE USAGE OF RESIDENTIAL RESIDUAL WASTE FOR ENERGY GENERATION VIA BIODIGESTER-PYROLYZER AND STEAM RANKINE CYCLE
Authors: Manegdeg Ferdinand , De Silos Paolo Yves , Medrano Jonathan
Published: March 2021

The design study concerns the creation of a waste-to-energy conversion plant in the City of Muntinlupa to lessen the amount of non-recyclable municipal solid wastes that ends up in the landfill. Using the developed criteria, the cluster that can be used are the biodegradable and residual waste portions of the municipal solid wastes. In consideration of the processes for power generation, Rankine cycle was seen as the best alternative powerplant type to use the biogas and synthetic gas produced from the biodigester and pyrolyzer, respectively. The powerplant project has a capacity of 8.6 MW, a return of investment of 12%, an internal rate of return of 19%, and a payback period of 5 years.
FIELD TRIALS ON THE SOIL CEMENT MIXING TECHNOLOGY TO REINFORCE EARTH LEVEES IN THE MEKONG DELTA, VIETNAM
Authors: Tran-Nguyen Hoang-Hung , Le Long Phi , Le Bao Khac , Ly Hien Minh Thi
Published: March 2021

The effectiveness of seepage cutoff and sliding stability of an earth levee reinforced by soil cement deep mixing technology (SCDM) was evaluated by field monitored data. Groundwater observation was conducted via nine ground water wells installed in the research site. Lateral displacement of the whole earth levee was measured by the 15-m inclinometer casing and a 0.5-m inclinometer probe. The research assessed effects of soilcrete reinforcement by comparing with simulations before applying widely in the Mekong Delta, Vietnam. The results indicate that the soilcrete walls can effectively prevent the seepage through the earth levee’s body and improve the factor of safety about 1.2 times.
REDUCTIVE LEACHING OF LOW GRADE MANGANESE ORE (LGMO) USING GLUCOSE IN SULPHURIC ACID: OPTIMIZATION CONDITION USING RESPONSE SURFACE METHODOLOGY
Authors: Muthalib Nurhidayah , Abdullah Norazharuddin , Ismail Suhaina
Published: March 2021

Manganese (Mn) is an important metal in producing a good quality steel, that the total Mn consumption in this industry reaches 85 to 90%. Despite of this huge demand, Mn faces a shortage supply due to depletion of high grade Mn ore. As an alternative, low grade manganese ore (LGMO) can be utilized to fulfill the industry demand. The aim of this work is to determine the optimum condition of the reductive leaching process of LGMO using Response Surface Methodology (RSM). The design of experiment (DOE) was made using RSM by Central Composite Design (CCD) with 22 and 3 central points. In this work, the effect of variables such as sulphuric acid concentration (X1) and weight of glucose (X2) were examined. The experimental data obtained from Analysis of Variance (ANOVA) were analyzed. Subsequently, the most significant variable was identified and fitted into a quadratic model. It is found that the interaction between sulphuric acid concentration and amount of glucose (X1X2) is the most important factor in manganese (Mn) extraction. The optimum leaching condition is obtained at 2.5 M sulphuric acid concentration and 2 g weight of glucose at 60 minutes leaching time. Within this experimental condition, a high level of Mn extraction ratio at 88.97% is achieved.
Towards a mechanistic approach for the development of non‐invasive brain‐computer interfaces for motor rehabilitation
Authors: Mrachacz‐Kersting Natalie , Ibáñez Jaime , Farina Dario
Published: March 2021

Brain‐computer interfaces (BCIs) designed for motor rehabilitation use brain signals associated with motor‐processing states to guide neuroplastic changes in a state‐dependent manner. These technologies are uniquely positioned to induce targeted and functionally relevant plastic changes in the human motor nervous system. However, while several studies have shown that BCI‐based neuromodulation interventions may improve motor function in patients with lesions in the central nervous system, the neurophysiological structures and processes targeted with the BCI interventions have not been identified. In this review, we first summarize current knowledge of the changes in the central nervous system associated with learning new motor skills. Then, we propose a classification of current BCI paradigms for plasticity induction and motor rehabilitation based on the expected neural plastic changes promoted. This classification proposes four paradigms based on two criteria: the plasticity induction methods and the brain states targeted. The existing evidence regarding the brain circuits and processes targeted with these different BCIs is discussed in detail. The proposed classification aims to serve as a starting point for future studies trying to elucidate the underlying plastic changes following BCI interventions.

image
In Vivo Based Fluid–Structure Interaction Biomechanics of the Left Anterior Descending Coronary Artery
Authors: Carpenter Harry J. , Gholipour Alireza , Ghayesh Mergen H. , Zander Anthony C. , Psaltis Peter J.
Published: March 2021

A fluid–structure interaction-based biomechanical model of the entire left anterior descending coronary artery is developed from in vivo imaging via the finite element method in this paper. Included in this investigation is ventricle contraction, three-dimensional motion, all angiographically visible side branches, hyper/viscoelastic artery layers, non-Newtonian and pulsatile blood flow, and the out-of-phase nature of blood velocity and pressure. The fluid–structure interaction model is based on in vivo angiography of an elite athlete's entire left anterior descending coronary artery where the influence of including all alternating side branches and the dynamical contraction of the ventricle is investigated for the first time. Results show the omission of side branches result in a 350% increase in peak wall shear stress and a 54% decrease in von Mises stress. Peak von Mises stress is underestimated by up to 80% when excluding ventricle contraction and further alterations in oscillatory shear indices are seen, which provide an indication of flow reversal and has been linked to atherosclerosis localization. Animations of key results are also provided within a video abstract. We anticipate that this model and results can be used as a basis for our understanding of the interaction between coronary and myocardium biomechanics. It is hoped that further investigations could include the passive and active components of the myocardium to further replicate in vivo mechanics and lead to an understanding of the influence of cardiac abnormalities, such as arrythmia, on coronary biomechanical responses.
Influence of Courtyard Size on Stack Effect During Building Fires
Authors: Chen Yanqiu , Feng Qianhang , Wang Xiankun , Chen Junmin
Published: March 2021

This paper studied the stack effect in courtyards in buildings through the pressure difference between the top and the bottom in the courtyard through three-dimensional (3D) numerical simulations, which would provide engineering guidance for the fire protection design of courtyards in buildings. During the fire, the stronger the stack effect was, the pressure difference between the top and the bottom was more significant, the fire smoke reached the top of the courtyard more quickly, and the temperature and the smoke concentration at the top were influenced in a shorter time. The influence of the size of the courtyard in the stack effect was investigated. It was found that the stack effect was linearly negatively related to the width of the cross section W and the length of the cross section L, exponentially negatively related with the area of the cross section A, while it was exponentially positively related to the height of the courtyard H. The change in the walls without windows (W) affected ΔPmax and the stack effect more significantly compared with the change in walls with windows (L). When L/W ≤ 1, the stack effect was strengthened as L/W increased; when L/W > 1, the stack effect was weakened as L/W increased. The stack effect was the most significant when L/W = 1.
Influence of Fuel Properties on Gasoline Direct Injection Particulate Matter Emissions Over First 200 s of World-Harmonized Light-Duty Test Procedure Using an Engine Dynamometer and Novel “Virtual Drivetrain” Software
Authors: Bock Noah R. , Northrop William F.
Published: March 2021

The influence of fuel properties on particulate matter (PM) emissions from a catalytic gasoline particulate filter (GPF) equipped gasoline direct injection (GDI) engine was investigated using novel “virtual drivetrain” software and an engine mated to an engine dynamometer. The virtual drivetrain software was developed in labview to operate the engine on an engine dynamometer as if it were in a vehicle undergoing a driving cycle. The software uses a physics-based approach to determine vehicle acceleration and speed based on engine load and a programed “shift” schedule to control engine speed. The software uses a control algorithm to modulate engine load and braking to match a calculated vehicle speed with the prescribed speed trace of the driving cycle of choice. The first 200 s of the World-harmonized Light-duty Test Procedure (WLTP) driving cycle was tested using six different fuel formulations of varying volatility, aromaticity, and ethanol concentration. The first 200 s of the WLTP was chosen as the test condition because it is the most problematic section of the driving cycle for controlling PM emissions due to the cold start and cold drive off. It was found that there was a strong correlation between aromaticity of the fuel and the engine-out PM emissions, with the highest emitting fuel producing more than double the mass emissions of the low PM production fuel. However, the post-GPF PM emissions depended greatly on the soot loading state of the GPF. The fuel with the highest engine-out PM emissions produced comparable post-GPF emissions to the lowest PM producing fuel over the driving cycle when the GPF was loaded over three cycles with the respective fuels. These results demonstrate the importance of GPF loading state when aftertreatment systems are used for PM reduction. It also shows that GPF control may be more important than fuel properties, and that regulatory compliance for PM can be achieved with proper GPF control calibration irrespective of fuel type.
Survey of phytoseiid mites (Acari: Mesostigmata) in the Penghu Islands with two new records and descriptions of two new species

Authors: Liao Jhih-Rong , Ho Chyi-Chen , Ko Chiun-Cheng
Published: March 2021

Phytoseiidae (Acari: Mesostigmata) is a well-known mite family, and more than 2,700 species have been recorded worldwide. Prior this study, 64 phytoseiid species had been recorded in main island of Taiwan and its neighboring islands. Nevertheless, many areas are still unexplored and need further investigation, such as the Penghu Islands. The present study was based on phytoseiid mite materials collected from the Penghu Islands in 1989 and 2020. A list of identified phytoseiid mites is provided herein, 16 species, eight genera, and three subfamilies. Proprioseiopsis penghuensis sp. nov. and Neoseiulus xiaomenensis sp. nov. are new to science, and Amblyseius cinctus Corpuz-Raros & Rimando, A. fletcheri Schicha, Phytoseius rachelae Swirski & Shechter are new records for the country. The further comprehensive phytoseiid investigation in Penghu Islands is needed for exploring the relationships among environmental and agricultural changes, and phytoseiid mites.
Context Affects Quiet Eye Duration and Motor Performance Independent of Cognitive Effort
Authors: Runswick Oliver R. , Jewiss Matthew , Sharpe Ben T. , North Jamie S.
Published: March 2021

Extensive literature has shown the effect of “quiet eye” (QE) on motor performance. However, little attention has been paid to the context in which tasks are executed (independent of anxiety) and the mechanisms that underpin the phenomenon. Here, the authors aimed to investigate the effects of context (independent of anxiety) on QE and performance while examining if the mechanisms underpinning QE are rooted in cognitive effort. In this study, 21 novice participants completed golf putts while pupil dilation, QE duration, and putting accuracy were measured. Results showed that putting to win was more accurate compared with the control (no context) condition, and QE duration was longer when putting to win or tie a hole compared with control. There was no effect of context on pupil dilation. Results suggest that, while the task was challenging, performance scenarios can enhance representativeness of practice without adding additional load to cognitive resources, even for novice performers.
Low ABA concentration promotes root growth and hydrotropism through relief of ABA INSENSITIVE 1-mediated inhibition of plasma membrane H
+
-ATPase 2
Authors: Miao Rui , Yuan Wei , Wang Yue , Garcia-Maquilon Irene , Dang Xiaolin , Li Ying , Zhang Jianhua , Zhu Yiyong , Rodriguez Pedro L. , Xu Weifeng
Published: March 2021

ABI1 interacts with the C terminus of AHA2 and dephosphorylates Thr
947
to negatively regulate root growth and hydrotropism.
Endoscopy-assisted magnetic navigation of biohybrid soft microrobots with rapid endoluminal delivery and imaging
Authors: Wang Ben , Chan Kai Fung , Yuan Ke , Wang Qianqian , Xia Xianfeng , Yang Lidong , Ko Ho , Wang Yi-Xiang J. , Sung Joseph Jao Yiu , Chiu Philip Wai Yan , Zhang Li
Published: March 2021

Biohybrid soft microrobots are rapidly delivered to tortuous and tiny lumens deep inside the digestive system.
Micrometer-sized electrically programmable shape-memory actuators for low-power microrobotics
Authors: Liu Qingkun , Wang Wei , Reynolds Michael F. , Cao Michael C. , Miskin Marc Z. , Arias Tomas A. , Muller David A. , McEuen Paul L. , Cohen Itai
Published: March 2021

Voltage-driven shape-memory actuators enable multistable micropositioners, origami metamaterials, and memory arrays.
Structure-switching aptamer sensors for the specific detection of piperaquine and mefloquine
Authors: Coonahan Erin S. , Yang Kyung-Ae , Pecic Stevan , De Vos Maarten , Wellems Thomas E. , Fay Michael P. , Andersen John F. , Tarning Joel , Long Carole A.
Published: March 2021

Aptamer-based fluorescent sensors specifically detect the antimalarial drugs piperaquine and mefloquine from patient samples and crushed tablets.
Effector function does not contribute to protection from virus challenge by a highly potent HIV broadly neutralizing antibody in nonhuman primates
Authors: Hangartner Lars , Beauparlant David , Rakasz Eva , Nedellec Rebecca , Hozé Nathanaël , McKenney Katherine , Martins Mauricio A. , Seabright Gemma E. , Allen Joel D. , Weiler Andrea M. , Friedrich Thomas C. , Regoes Roland R. , Crispin Max , Burton Dennis R.
Published: March 2021

Effector function is not required for a potent HIV envelope–specific broadly neutralizing antibody to protect nonhuman primates from SHIV infection.
GDE2-RECK controls ADAM10 α-secretase–mediated cleavage of amyloid precursor protein
Authors: Nakamura Mai , Li Yuhan , Choi Bo-Ran , Matas-Rico Elisa , Troncoso Juan , Takahashi Chiaki , Sockanathan Shanthini
Published: March 2021

GDE2 controls surface amounts of the metalloprotease inhibitor RECK to promote ADAM10 α-secretase activity and prevent Aβ production and synapse loss.
Older but Not Wiser: the Age-Driven Changes in Neutrophil Responses during Pulmonary Infections
Authors: Simmons Shaunna R. , Bhalla Manmeet , Herring Sydney E. , Tchalla Essi Y. I. , Bou Ghanem Elsa N.
Published: March 2021

Elderly individuals are at increased risk of life-threatening pulmonary infections. Neutrophils are a key determinant of the disease course of pathogen-induced pneumonia.
Hemoglobin Induces Early and Robust Biofilm Development in
Streptococcus pneumoniae
by a Pathway That Involves
comC
but Not the Cognate
comDE
Two-Component System
Authors: Akhter Fahmina , Womack Edroyal , Vidal Jorge E. , Le Breton Yoann , McIver Kevin S. , Pawar Shrikant , Eichenbaum Zehava
Published: March 2021

Streptococcus pneumoniae
grows in biofilms during both asymptomatic colonization and infection. Pneumococcal biofilms on abiotic surfaces exhibit delayed growth and lower biomass and lack the structures seen on epithelial cells or during nasopharyngeal carriage.
Development of a Measles and Rubella Multiplex Bead Serological Assay for Assessing Population Immunity
Authors: Coughlin Melissa M. , Matson Zachary , Sowers Sun B. , Priest Jeffrey W. , Smits Gaby P. , van der Klis Fiona R. M. , Mitchell Alexandria , Hickman Carole J. , Scobie Heather M. , Goodson James L. , Alexander James P. , Rota Paul A. , Bankamp Bettina
Published: March 2021

Serosurveys are important tools for estimating population immunity and providing immunization activity guidance. The measles and rubella multiplex bead assay (MBA) offers multiple advantages over standard serological assays and was validated by comparison with the enzyme-linked immunosorbent assay (ELISA) and the measles plaque reduction neutralization (PRN) assay.
Genome Sequences of 26 White Sucker Hepatitis B Virus Isolates from White Sucker, Catostomus commersonii, Inhabiting Transboundary Waters from Alberta, Canada, to the Great Lakes, USA
Authors: Adams Cynthia R. , Blazer Vicki S. , Sherry Jim , Cornman Robert S. , Iwanowicz Luke R.
Published: March 2021

We report 26 genome sequences of the white sucker hepatitis B virus (WSHBV) from the white sucker,
Catostomus commersonii
. The genome length ranged from 3,541 to 3,543 bp, and nucleotide identity was 96.7% or greater across genomes. This work suggests a geographical range of this virus that minimally extends from the Athabasca River, Alberta, Canada, to the Great Lakes, USA.
Draft Genome Sequences of Seven Extended-Spectrum β-Lactamase-Producing Escherichia coli Strains Isolated from New Zealand Waterways
Authors: Burgess Sara A. , Francois Margaux , Midwinter Anne C. , Biggs Patrick J.
Published: March 2021

Draft genomes of seven extended-spectrum β-lactamase (ESBL)-producing
Escherichia coli
strains recovered from New Zealand waterways are described. The mean genome size was 5.1 Mb, with 4,724 coding sequences. All genomes contained the ESBL gene
bla
CTX-M
, and one carried a plasmid-mediated AmpC gene,
bla
CMY-2
. A multidrug-resistant genotype was detected in three isolates.
Atypical case of syphilitic hepatitis
Authors: Goldberg Elliott , Edwards Bathai , Krill Kaleigh
Published: March 2021

A 31-year-old immunocompetent, heterosexual man with no relevant medical history presented with 1 week of jaundice, abdominal pain, cough and headache. Examination revealed scleral icterus, right upper quadrant tenderness and hepatomegaly. Initial investigations revealed hyperbilirubinaemia and elevated transaminases. Serum studies were positive for antinuclear antibodies, antimitochondrial antibodies, and herpes simplex virus IgM. Despite being started on intravenous acyclovir, his bilirubin and transaminase levels continued to rise. He was subsequently tested for syphilis given his maculopapular rash on the soles of his feet and it returned positive. He improved clinically with the initiation of penicillin. In this case, we will discuss the presentation, diagnosis and treatment of syphilitic hepatitis.
IJV thrombophlebitis: be wary of the occult
Authors: Oshinyemi Pamela , Lee Charlotte , Gough-Palmer Antony , McKay-Davies Iain
Published: March 2021

A 43-year-old woman was referred to the Ear, Nose and Throat Department with a 3-day history of left-sided neck pain and swelling associated with fevers and night sweats. She also reported a cough, oral thrush and a dental extraction more than a month previously. A CT scan of the neck with contrast revealed left internal jugular vein (IJV) thrombophlebitis and the patient was initially managed for suspected Lemierre’s syndrome. Subsequent investigations revealed a locally advanced metastatic colorectal adenocarcinoma as the cause of her thrombosis, which was deemed inoperable. The patient was referred to oncology and commenced on palliative chemotherapy.

The incidence of thrombophlebitis in patients with cancer is high. Although the IJV is a relatively uncommon site of thrombus formation, IJV thrombophlebitis is associated with significant morbidity and mortality. As it may be the first manifestation of an occult malignancy, a neoplastic cause should always be considered.
Atypical cutaneous and musculoskeletal manifestation of SARS-CoV-2: ‘COVID-19 toes’ and spasticity in a 48-year-old woman
Authors: Kopacz Avery , Ludwig Cameron , Tarbox Michelle
Published: March 2021

Establishing accurate symptomatology associated with novel diseases such as COVID-19 is a crucial component of early identification and screening. This case report identifies an adult patient with a history of clotting dysfunction presenting with rare cutaneous manifestations of COVID-19, known as ‘COVID-19 toes’', previously described predominantly in children. Additionally, this patient presented with possible COVID-associated muscle spasticity of the lower limbs, as well as a prolonged and atypical timeline of COVID-19 infection. The rare occurrence of ‘COVID-19 toes’' in this adult patient suggests that her medical history could have predisposed her to this symptom. This supports the coagulopathic hypothesis of this manifestation of COVID-19 and provides possible screening questions for patients with a similar history who might be exposed to the virus. Additionally, nervous system complaints associated with this disease are rare and understudied, so this novel symptom may also provide insight into this aspect of SARS-CoV-2.
Acute cerebellar ataxia and peripheral neuropathy due to an atypical infection
Authors: Venkatesh Manjunath Hoskote , Viswanathan Stalin , Selvaraj Jayachandran , Pillai Vivekanandan
Published: March 2021

This 18-year-old boy presented to the hospital with symptoms of cerebellar dysfunction preceded by an acute febrile illness with rash. Examination showed evidence of left-sided cerebellar dysfunction and polyneuropathy. Empirical treatment for leptospirosis and scrub typhus was initiated. MRI was normal. Other organ dysfunctions in the form of thrombocytopenia and transaminitis were also observed. He recovered without sequelae. A diagnosis of acute cerebellar ataxia and polyneuropathy due to scrub typhus was made.
Myopia control effect of defocus incorporated multiple segments (DIMS) spectacle lens in Chinese children: results of a 3-year follow-up study
Authors: Lam Carly SY , Tang Wing Chun , Lee Paul H , Zhang Han Yu , Qi Hua , Hasegawa Keigo , To Chi Ho
Published: March 2021

Aims

To determine myopia progression in children who continued to wear the defocus incorporated multiple segments (DIMS) lenses or switched from single vision (SV) to DIMS lenses for a 1-year period following a 2-year myopia control trial.

Methods

128 children participated in this study. The children who had worn DIMS lenses continued to wear DIMS lenses (DIMS group), and children who had worn SV lenses switched to wear DIMS lenses (Control-to-DIMS group). Cycloplegic spherical equivalent refraction (SER) and axial length (AL) were measured at 6-month interval. Historical controls were age matched to the DIMS group at 24 months and used for comparing the third-year changes.

Results

Over 3 years, SER and AL changes in the DIMS group (n=65) were −0.52±0.69D and 0.31±0.26 mm; these changes were not statistically significant over time (repeated measures analysis of variance, p>0.05).

SER (−0.04±0. 38D) and AL (0.08±0.12 mm) changes in the Control-to-DIMS group (n=55) in the third year were less compared with the first (mean difference=0.45 ± 0.30D, 0.21±0.11 mm, p<0.001) and second (0.34±0.30D, 0.12±0.10 mm, p<0.001) years.

Changes in SER and AL in both groups over that period were significantly less than in the historical control group (DIMS vs historical control: mean difference=−0.18±0.42D, p=0.012; 0.08±0.15 mm, p=0.001; Control-to-DIMS versus historical control: adjusted mean differences=−0.30±0.42D, p<0.001; 0.12±0.16 mm, p<0.001).

Conclusions

Myopia control effect was sustained in the third year in children who had used the DIMS spectacles in the previous 2 years and was also shown in the children switching from SV to DIMS lenses.
Proof-of-concept single-arm trial of bevacizumab therapy for brain arteriovenous malformation
Authors: Muster Rachel , Ko Nerissa , Smith Wade , Su Hua , Dickey Melissa A , Nelson Jeffrey , McCulloch Charles E , Sneed Patricia K , Clarke Jennifer L , Saloner David A , Eisenmenger Laura , Kim Helen , Cooke Daniel L
Published: March 2021

Brain arteriovenous malformations (bAVMs) are relatively rare, although their potential for secondary intracranial haemorrhage (ICH) makes their diagnosis and management essential to the community. Currently, invasive therapies (surgical resection, stereotactic radiosurgery and endovascular embolisation) are the only interventions that offer a reduction in ICH risk. There is no designated medical therapy for bAVM, although there is growing animal and human evidence supporting a role for bevacizumab to reduce the size of AVMs. In this single-arm pilot study, two patients with large bAVMs (deemed unresectable by an interdisciplinary team) received bevacizumab 5 mg/kg every 2 weeks for 12 weeks. Due to limitations of external funding, the intended sample size of 10 participants was not reached. Primary outcome measure was change in bAVM volume from baseline at 26 and 52 weeks. No change in bAVM volume was observed 26 or 52 weeks after bevacizumab treatment. No clinically important adverse events were observed during the 52-week study period. There were no observed instances of ICH. Sera vascular endothelial growth factor levels were reduced at 26 weeks and returned to baseline at 52 weeks. This pilot study is the first to test bevacizumab for patients with bAVMs. Bevacizumab therapy was well tolerated in both subjects. No radiographic changes were observed over the 52-week study period. Subsequent larger clinical trials are in order to assess for dose-dependent efficacy and rarer adverse drug effects.

Trial registration number:NCT02314377.
Outcomes and care priorities for older people living with frailty and advanced chronic kidney disease: a multiprofessional scoping review protocol
Authors: Hurst Helen , Jones Elizabeth , Ormandy Paula , Brettle Alison , Nixon Andrew Christopher , Young Hannah , Mooney Andrew , Winterbottom Anna , Bekker Hilary , Brown Edwina , Murtagh Fliss EM , Da Silva-Gane Maria , Coyle David , Finnigan Robert
Published: March 2021

Introduction

Reported outcomes for older people with advanced chronic kidney disease (CKD) often focus on survival and mortality and little attention is paid to symptom burden and health-related quality of life. Recognising frailty and providing interventions that may improve outcomes have been studied in the general population with a growing research interest within CKD.

Methods and analysis

A scoping review will be undertaken following a recommended process to understand relevant research and priorities for older people living with frailty and advanced CKD. Databases will be searched and following a systematic process by a core team, a final list of included studies will be analysed. Focus groups will then be conducted with older people with advanced CKD to incorporate stakeholder views.

Ethics and dissemination

Our scoping review will use robust methodology to identify relevant literature focused on outcomes and care priorities for older people with advanced CKD. Ethical approval will be sought to conduct the focus groups. The result of this review will be disseminated through patient networks and national conferences. The interdisciplinary team collaborating plan to continue work in this area to improve the care and management of older people with advanced CKD.
Prevalence and correlates of sex-selective abortions and missing girls in Nepal: evidence from the 2011 Population Census and 2016 Demographic and Health Survey
Authors: Channon Melanie Dawn , Puri Mahesh , Gietel-Basten Stuart , Stone Lucy Williams , Channon A
Published: March 2021

Objectives

These were to: (1) produce national and subnational estimates of the sex ratio at birth (SRB) and number of missing girl births in Nepal and (2) understand the socioeconomic correlates of these phenomena.

Design

Observational secondary data analysis of (1) the 2011 population census of Nepal and (2) the Nepal Demographic and Health Survey (DHS) 2006, 2011 and 2016.

Setting

Nepal.

Participants

(1) 2 567 963 children age 0–4 in the 2011 population census and (2) 27 329 births recorded in DHSs.

Primary and secondary outcomes

We estimate the SRB, and number and proportion of missing girls in the year and 5 years before the census by district. We also calculate conditional sex ratios (the SRB dependant on parity and sex of previous children) by province, time, education and wealth.

Results

We find that 11 districts have significantly skewed sex ratios at birth in the 2011 population census, with the highest SRBs observed in Arghakhanchi (SRB=127) and Bhaktapur (SRB=123). 22 540 girl births were missing in the 5 years before the 2011 population census. Sex-selective abortion is geographically concentrated, especially in the Kathmandu Valley and Lumbini Province, with 53% of missing girls found in only 11 out of 75 districts.

DHS data confirm this, with elevated conditional sex ratios observed in Bagmati and Lumbini Provinces; conditional sex ratios where previous births were all female also became more skewed over time. Skewed sex ratios are concentrated among wealthier more educated groups.

Conclusions

It is clear that sex selection will persist and develop in Nepal unless a coordinated effort is made to address both the demand for and supply of this service. Policies should be holistic and encompass economic and legal gender equity, and strengthen monitoring mechanisms to prevent technology misuse, without jeopardising the right to safe, free and legal abortion.
How much could a low COVID-19 pandemic change the injury trends? A single-institute, retrospective cohort study
Authors: Kuo Ling-Wei , Fu Chih-Yuan , Liao Chien-An , Liao Chien-Hung , Wu Yu-Tung , Huang Jen-Fu , Hsieh Chi-Hsun , Cheng Chi-Tung
Published: March 2021

Objectives

COVID-19 has changed the epidemiology of trauma. However, Taiwan is a country with a low COVID-19 threat, and people’s daily lives have remained mostly unchanged during this period. The purpose of this study is to investigate whether the trend of trauma incidence and the service of trauma care is affected by the relatively minor COVID-19 pandemic in Taiwan.

Design

A single-institute, retrograde cohort study.

Setting

An observational study based on the trauma registry of Chang Gung Memorial Hospital (CGMH).

Participants

Trauma patients presented to the emergency department of CGMH in the period of 1 January to 30 June 2020 (week 1 to week 26) were designated as the COVID-19 group, with 1980 patients in total. Patients of the same period in 2015–2019 were designated as the pre-COVID-19 group, with 10 334 patients overall.

Primary and secondary outcome measures

The primary outcome is the incidence of trauma admission. Differences in trauma mechanism, severity, location and outcome were also compared in both groups.

Results

A decrease in trauma incidence during March and April 2020 was noticed. Significant change (p<0.001) in trauma mechanisms was discovered, with decreased burn (5.8% vs 3.6%) and assault (4.8% vs 1.2%), and increased transport accidents (43.2% vs 47.2%) and suicide (0.2% vs 1.0%) in the COVID-19 cohort. A shift in injury locations was also found with a 5% decrement of workplace injuries (19.8% vs 14.8%, p<0.001).

Conclusion

The limited COVID-19 outbreak in Taiwan has led to a decreased incidence of trauma patients, and the reduction is mostly attributed to the decline in workplace injuries.
Surgical service monitoring and quality control systems at district hospitals in Malawi, Tanzania and Zambia: a mixed-methods study
Authors: Clarke Morgane , Pittalis Chiara , Borgstein Eric , Bijlmakers Leon , Cheelo Mweene , Ifeanyichi Martilord , Mwapasa Gerald , Juma Adinan , Broekhuizen Henk , Drury Grace , Lavy Chris , Kachimba John , Mkandawire Nyengo , Chilonga Kondo , Brugha Ruairí , Gajewski Jakub
Published: March 2021

Background

In low-income and middle-income countries, an estimated one in three clinical adverse events happens in non-complex situations and 83% are preventable. Poor quality of care also leads to inefficient use of human, material and financial resources for health. Improving outcomes and mitigating the risk of adverse events require effective monitoring and quality control systems.

Aim

To assess the state of surgical monitoring and quality control systems at district hospitals (DHs) in Malawi, Tanzania and Zambia.

Methods

A mixed-methods cross-sectional study of 75 DHs: Malawi (22), Tanzania (30) and Zambia (23). This included a questionnaire, interviews and visual inspection of operating theatre (OT) registers. Data were collected on monitoring and quality systems for surgical activity, processes and outcomes, as well as perceived barriers.

Results

53% (n=40/75) of DHs use more than one OT register to record surgical operations. With the exception of standardised printed OT registers in Zambia, the register format (often handwritten books) and type of data collected varied between DHs. Monthly reports were seldom analysed by surgical teams. Less than 30% of all surveyed DHs used surgical safety checklists (n=22/75), and <15% (n=11/75) performed surgical audits. 73% (n=22/30) of DHs in Tanzania and less than half of DHs in Malawi (n=11/22) and Zambia (n=10/23) conducted surgical case reviews. Reports of surgical morbidity and mortality were compiled in 65% (n=15/23) of Zambian DHs, and in less than one-third of DHs in Tanzania (n=9/30) and Malawi (n=4/22). Reported barriers to monitoring and quality systems included an absence of formalised guidelines, continuous training opportunities as well as inadequate accountability mechanisms.

Conclusions

Surgical monitoring and quality control systems were not standard among sampled DHs. Improvements are needed in standardisation of quality measures used; and in ensuring data completeness, analysis and utilisation for improving patient outcomes.
Clinical characteristics and outcomes of adult patients admitted with COVID-19 in East London: a retrospective cohort analysis
Authors: Cheng Daryl , Calderwood Claire , Skyllberg Erik , Ainley Adam
Published: March 2021

Background

Descriptions of clinical characteristics of patients hospitalised withCOVID-19, their clinical course and short-term inpatient and outpatient outcomes in deprived urban populations in the UK are still relatively sparse. We describe the epidemiology, clinical course, experience of non-invasive ventilation and intensive care, mortality and short-term sequelae of patients admitted to two large District General Hospitals across a large East London National Health Service Trust during the first wave of the pandemic.

Methods

A retrospective analysis was carried out on a cohort of 1946 patients with a clinical or laboratory diagnosis of COVID-19, including descriptive statistics and survival analysis. A more detailed analysis was undertaken of a subset of patients admitted across three respiratory units in the trust.

Results

Increasing age, male sex and Asian ethnicity were associated with worse outcomes. Increasing severity of chest X-ray abnormalities trended with mortality. Radiological changes persisted in over 50% of cases at early follow-up (6 weeks). Ongoing symptoms including hair loss, memory impairment, breathlessness, cough and fatigue were reported in 70% of survivors, with 39% of patients unable to return to work due to ongoing symptoms.

Conclusions

Understanding the acute clinical features, course of illness and outcomes of COVID-19 will be crucial in understanding the effect of differences in risk, as well as the effectiveness of new interventions and vaccination between the successive waves of the pandemic.
Drug level monitoring in palliative patients
Authors: Bartlett Joanne , Freshwater Elizabeth
Published: March 2021

Palliative medicine is always patient centred and promotes the principle that no unnecessary investigations are performed. The case is reported of a patient with suspected carbamazepine toxicity presenting as progression of symptoms of primary brain tumour. A comparison is made of the symptoms and signs of toxicity versus tumour, and an aid for deciding when to perform therapeutic drug level monitoring for some common drugs.
Neuroinflammation predicts disease progression in progressive supranuclear palsy
Authors: Malpetti Maura , Passamonti Luca , Jones Peter Simon , Street Duncan , Rittman Timothy , Fryer Timothy D , Hong Young T , Vàsquez Rodriguez Patricia , Bevan-Jones William Richard , Aigbirhio Franklin I , O'Brien John Tiernan , Rowe James Benedict
Published: March 2021

Introduction

In addition to tau pathology and neuronal loss, neuroinflammation occurs in progressive supranuclear palsy (PSP). However, the prognostic value of the in vivo imaging markers for these processes in PSP remains unclear. We test the primary hypothesis that baseline in vivo imaging assessment of neuroinflammation in subcortical regions predicts clinical progression in patients with PSP.

Methods

Seventeen patients with PSP–Richardson’s syndrome underwent a baseline multimodal imaging assessment, including [11C]PK11195 positron emission tomography (PET) to index microglial activation, [18F]AV-1451 PET for tau pathology and structural MRI. Disease severity was measured at baseline and serially up to 4 years with the Progressive Supranuclear Palsy Rating Scale (PSPRS) (average interval of 5 months). Regional grey-matter volumes and PET ligand binding potentials were summarised by three principal component analyses (PCAs). A linear mixed-effects model was applied to the longitudinal PSPRS scores. Single-modality imaging predictors were regressed against the individuals’ estimated rate of progression to identify the prognostic value of baseline imaging markers.

Results

PCA components reflecting neuroinflammation and tau burden in the brainstem and cerebellum correlated with the subsequent annual rate of change in the PSPRS. PCA-derived PET markers of neuroinflammation and tau pathology correlated with regional brain volume in the same regions. However, MRI volumes alone did not predict the rate of clinical progression.

Conclusions

Molecular imaging with PET for microglial activation and tau pathology can predict clinical progression in PSP. These data encourage the evaluation of immunomodulatory approaches to disease-modifying therapies in PSP and the potential for PET to stratify patients in early phase clinical trials.
Woven EndoBridge device shape modification can be mitigated with an appropriate oversizing strategy: a VasoCT based study
Authors: Caroff Jildaz , Cortese Jonathan , Girot Jean-Baptiste , Mihalea Cristian , Aguiar Guilherme , Vergara Martinez Jeickson , Ikka Léon , Chalumeau Vanessa , Rehem Marcelle , Gallas Sophie , Ozanne Augustin , Moret Jacques , Spelle Laurent
Published: March 2021

Background

The Woven EndoBridge (WEB) shape modification (WShM) during follow-up may be a potential cause of poor angiographic outcomes. WShM predisposing factors have not yet been determined. Our systematic use of rotational cone beam computed tomography (VasoCT) imaging during follow-up allowed us to perform the first quantitative analysis of the shape of WEBs over time. Our goal was to identify possible strategies to reduce the occurrence of this phenomenon.

Methods

All patients treated in our hospital with a WEB device between October 2015 and January 2019 were included. Using VasoCT acquisitions, systematically performed after implantation and during follow-up, we analyzed WEB morphology. WShM was defined as the percentage reduction in the distance between the two WEB markers.

Results

Sixty-three aneurysms treated with a WEB device were finally included in this analysis. At the last follow-up (mean 15.5 months), mean WShM was 48%±24. The mean WShM was significantly higher in the aneurysm recurrence group than in the adequate occlusion group (51±6.5% vs 36±3.4%, difference 15% points (95% CI 0.7 to 30); p<0.05). Conversely, the extent of WShM did not directly correlate with occlusion rates. Indeed, 32% of completely occluded aneurysms presented severe WShM (≥50%). Importantly, the absence of WShM guaranteed complete occlusion in our study (n=12). We demonstrated that oversizing the width of the WEB significantly correlated with WShM reduction during follow-up (r=−0.38, p=0.002).

Conclusion

WShM can be partly overcome by use of an appropriate width oversizing strategy that could lead to improved angiographic results.