bluuebunny/crossref_metadata_2025 huggingface dataset:
Long-term pain relief after groin hernia repair for sports groin: A nationwide cohort study
Authors: Gamborg Sara , Öberg Stina , Rosenberg Jacob
Published: October 2021

Background:

The groin is a complex anatomical area with multiple structures that can be injured and cause pain. One condition with groin pain is the so-called “sports groin,” which can be treated with a groin hernia repair even though no hernia is present. The aim of this study was to assess the prevalence of chronic groin pain several years after a groin hernia repair performed in patients with a sports groin.

Methods:

This nationwide cohort study included adults who had a groin hernia repair for a sports groin through the years 1998–2011. The patients were identified through the Danish Hernia Database and in surgical records. Patients were asked to fill out four questionnaires several years after the repair: a visual analogue scale, the Activity Assessment Scale, the Inguinal Pain Questionnaire, and a questionnaire about treatment satisfaction.

Results:

Of 118 contacted patients, 71 gave informed consent and were included in the study (60%), and of these the response rate was 100%. The questionnaires were filled out median 14 years after surgery. Most of the patients were pain-free in the operated groin (87%), and only a few had physical impairment caused by groin pain (20%). Prior to surgery, 79% had groin pain that they could not ignore. Overall, 90% of the patients were satisfied with the treatment.

Conclusions:

Most patients were pain-free and without physical impairment several years after groin hernia repair for a sports groin and with high satisfaction rate.
Potential of alcohol fuels in active and passive pre-chamber applications in a passenger car spark-ignition engine
Authors: Burkardt Patrick , Wouters Christian , Pischinger Stefan
Published: October 2021

Both the shift from fossil to alternative fuels and the implementation of a pre-chamber combustion system allow for an increase in the efficiency of an internal combustion engine through optimizing its combustion process, while simultaneously reducing the engine-out emissions. The combination of alcohol-based fuels and pre-chamber combustion concepts has not been investigated on spark-ignition engines with high compression ratios in a passenger car size. This study presents investigations to show the potential in maximum achievable lean limit and net indicated efficiency. In particular, we present investigations of two alternative alcohol fuels on a direct-injection spark-ignition single-cylinder research engine for passenger car applications with a compression ratio of 16.4. The engine was operated with both an active and a passive pre-chamber, and the experimental results were compared to those of conventional spark-ignition operation. Direct injection was used for both the main combustion chamber and the pre-chamber. Methanol and ethanol were used as fuels for the main combustion chamber, whereas exclusively ethanol was used for the pre-chamber fueling. The performance of the alcohol fuels in all combustion configurations was evaluated in both part-load and high-load conditions. In particular, investigations of the combustion behavior over a variation of the excess air ratio at indicated mean effective pressures of 6 and 15 bar were performed. It can be concluded that with the use of methanol as fuel for the main combustion chamber, both higher excess air ratios and higher indicated efficiencies were achieved compared to the use of ethanol as the main combustion chamber fuel. In particular, a maximum net indicated efficiency of 48% at an excess air ratio of 2.0 was achieved with methanol. Moreover, active pre-chamber operation extended the lean limit to an excess air ratio of 2.3 compared to the maximum lean limit of 1.7 in passive pre-chamber operation.
Where are the entrepreneurs? A call to theorize the micro-foundations and strategic organization of entrepreneurial ecosystems
Authors: Roundy Philip T , Lyons Thomas S
Published: October 2021

The “entrepreneurial ecosystem” has become the dominant metaphor in theories explaining how location-specific forces influence entrepreneurship. Despite the progress made by scholars studying entrepreneurial ecosystems, in this essay we contend that the ecosystem metaphor has created an implicit tendency in entrepreneurship theory to emphasize macro-, ecosystem-level dynamics rather than the causal and mediating mechanisms linking entrepreneurs and their local ecosystems. To accompany the macro-dynamics focus in entrepreneurial ecosystem theory, we call for a micro-foundations approach that emphasizes the bidirectional connections between entrepreneurs’ strategizing and organizing activities and their ecosystems. We offer an agenda of theory development opportunities at the intersection of strategic organization and entrepreneurial ecosystems.
Point-of-care contrast enhanced lung ultrasound and COVID-19
Authors: Tee Alice , Yusuf Gibran Timothy , Wong Adrian , Rao Deepak , Tran Sa , Sidhu Paul S
Published: October 2021

Objectives

Bedside lung ultrasound has been indispensable during the coronavirus disease 2019 (COVID-19) pandemic, allowing us to rapidly assess critically unwell patients. We demonstrate the unique application of contrast-enhanced ultrasound with the aim of further understanding this disease.

Methods

Patient demographics were recorded alongside recent cross-sectional imaging and inflammatory markers. Ultrasound was conducted by experienced operators in a portable setting. Conventional six-point lung ultrasound method was used to evaluate B-lines, small (subpleural) consolidation and the pleura. Areas of small consolidation were targeted after intravenous administration of ultrasound contrast.

Results

The areas of small consolidations, a potential sign of pneumonia on B-mode lung ultrasound, usually enhance on contrast-enhanced ultrasound. Our study revealed these areas to be avascular, indicating an underlying thrombotic/infarction process. Findings were present in 100% of the patients we examined. We have also shown that the degree of infarction correlates with CT severity (r = 0.4) and inflammatory markers, and that these areas improve as patients recover.

Conclusions

We confirmed the theory of immune thrombus by identifying the presence of microthrombi in the lungs of 100% of our patients, despite 79% having had a recent negative CT pulmonary angiogram study. contrast-enhanced ultrasound can be utilised to add confidence to an uncertain COVID-19 diagnosis and for prognosticating and monitoring progress in confirmed COVID-19 patients. Contrast-enhanced ultrasound is clearly very different to CT, the gold standard, and while there are specific pathologies that can only be detected on CT, contrast-enhanced ultrasound has many advantages, most notability the ability to pick up microthrombi at the periphery of the lungs.
Drawing individual images benefits recognition accuracy in the Deese–Roediger–McDermott paradigm
Authors: Namias Jacob M. , Huff Mark J , Smith Allison , Maxwell Nicholas P
Published: October 2021

We examined the effects of drawing on correct and false recognition within the Deese–Roediger–McDermott (DRM) false memory paradigm. In Experiment 1, we compared drawing of a word’s referent using either a standard black pencil or coloured pencils relative to a read-only control group. Relative to reading, drawing in either black or coloured pencil similarly boosted correct recognition and reduced false recognition. Signal-detection analyses indicated that drawing reduced the amount of encoded memory information for critical lures and increased monitoring, indicating that both processes contributed to the false recognition reduction. Experiment 2 compared drawing of individual images of DRM list items relative to drawing integrated images using sets of DRM list items. False recognition was lower for drawing of individual images relative to integrated images—a pattern that reflected a decrease in encoded memory information but not monitoring. Therefore, drawing individual images improves memory accuracy in the DRM paradigm relative to a standard read-control task and an integrated-drawing task, which we argue is due to the recruitment of item-specific processing.
Marketing Scholarship and the Sustainable Development Goals: Thoughts on Moving Forward
Authors: Rosenbloom Al
Published: October 2021

This article is a commentary on how marketing scholarship can be more relevant as it tackles the human development challenges presented by the Sustainable Development Goals (SDGs). The commentary argues that as businesses are transforming themselves into purpose-driven organizations, marketing needs to be a part of that transformation. SDG 1 No Poverty and SDG 12 Sustainable Consumption and Production are discussed within the article. The commentary also tackles the institutional barriers that work against path-breaking SDG marketing scholarship: normative promotion and publication expectations along with the practitioner-academic research divide. Without realigning the incentives that reward original, boundary-spanning SDG marketing scholarship, the marketing discipline will be stuck in a cycle of rewarding one behavior while hoping for another.
Discordant Atrioventricular Connections in Situs Inversus, Dextrocardia with Double Outlet Right Ventricle, Pulmonary Stenosis, and Anomalous Coronary Artery: A Rare Case Report
Authors: Nguyen Hien S. , Pham Thanh T. , Tran Long D. , Tran Manh T. , Vuong Dung H. , Tong Phuc D.
Published: October 2021

We report a case of a 2-year-old female presenting with cyanosis since birth and having rare cardiac anatomy of visceral situs inversus, dextrocardia, discordant atrioventricular connections with double outlet right ventricle, atrial communication, subaortic interventricular communication, anteriorly leftward aorta with right aortic arch, single coronary artery with a branch crossing right ventricle outflow tract, pulmonary stenosis, and bilateral superior vena cava. Corrective repair with atrial switch (Senning technique), intracardiac baffle, and right ventricle outflow reconstruction was successfully performed with challenges from altered anatomical location and orientation of the heart and abnormal coronary artery.
Phytochemical and Therapeutic Potential of Citrus grandis (L.) Osbeck: A Review
Authors: Anmol Rusat Jahin , Marium Shabnam , Hiew Fei Tsong , Han Wan Chien , Kwan Lee Kuan , Wong Alicia Khai Yeen , Khan Farzana , Sarker Md. Moklesur Rahman , Chan Siok Yee , Kifli Nurolaini , Ming Long Chiau
Published: October 2021

Citrus grandis or Citrus maxima, widely recognized as Pomelo is widely cultivated in many countries because of their large amounts of functional, nutraceutical and biological activities. In traditional medicine, various parts of this plant including leaf, pulp and peel are used for generations as they are scientifically proven to have therapeutic potentials and safe for human use. The main objective of this study was to review the different therapeutic applications of Citrus grandis and the phytochemicals associated with its medicinal values. In this article different pharmacological properties like antimicrobial, antitumor, antioxidant, anti-inflammatory, anticancer, antiepileptic, stomach tonic, cardiac stimulant, cytotoxic, hepatoprotective, nephroprotective, and anti-diabetic activities of the plant are highlighted. The enrichment of the fruit with flavonoids, polyphenols, coumarins, limonoids, acridone alkaloids, essential oils and vitamins mainly helps in exhibiting the pharmacological activities within the body. The vitamins enriched fruit is rich in nutritional value and also has minerals like calcium, phosphorous, sodium and potassium, which helps in maintaining the proper health and growth of the bones as well as the electrolyte balance of the body. To conclude, various potential therapeutic effects of Citrus grandis have been demonstrated in recent literature. Further studies on various parts of fruit, including pulp, peel, leaf, seed and it essential oil could unveil additional pharmacological activities which can be beneficial to the mankind.
Creating a Gender-Equal Organisation: Headway
Authors: Iyer Sunder Seethalakshmi , Roy Shruti , Jacob Supriya , Sasidhar Vrinda , Agrawal Arpita
Published: October 2021

This article explains the challenges faced by women employees in the corporate world and how a focused development programme can help organisations foster female talent and make significant progress towards creating a gender inclusive culture. In today’s complex and dynamic age, where technology, processes and business models change rapidly, women struggle to balance their career aspirations with their personal challenges, societal pressures and their own deep-set inhibitions. This leads to a widening gender gap from entry-level positions to senior leadership roles. The situation, therefore, necessitates a seismic shift in the thought process of female employees to help them overcome internal and external challenges, fast-track capability improvement and make deep behavioural impacts to foster career growth. This article highlights the need for a structured development programme to help organisations invest in their women employees in mid-management roles and create a pathway for them to achieve their career goals. All actions are documented in the programme to culminate into actionable insights for participants and deep cognitive insights for L&D and organisations.
Overcoming Disabilities Through Sports: The Inspiring Story of Rahul Ramugade
Authors: Sen Aniruddha
Published: October 2021

Parasports, and sports for disabled persons, has been a lesser known area in India, with all efforts to support disabled individuals focusing on broader social and health infrastructure inputs and employment avenues. This article looks at how sports for disabled people (parasports) can be a powerful enabler and tool for empowerment, through the journey of Rahul Ramugade, a Mumbai-based parasportsperson who has been part of the national wheelchair cricket team, and has also formed and led the Mumbai Wheelchair Cricket team.
IBM: A Long and Illustrious Legacy of Focusing on Gender Diversity
Authors: Rastogi Prachi
Published: October 2021

This article includes some key initiatives run by IBM to ensure gender balance at senior levels. IBM’s stand for creating a work environment where everyone brings their whole selves to work and creates a positive impact on the society goes strength to strength. Being an upstander, an ally and a listener are a few things IBMers do to create a safe and inclusive workplace.
Shen Qi Li Xin formula improves chronic heart failure through balancing mitochondrial fission and fusion via upregulation of PGC-1α
Authors: Sui Yan-Bo , Xiu Jian , Wei Jin-Xuan , Pan Pei-Pei , Sun Bi-Hong , Liu Li
Published: October 2021

Background

Our previous study proved that Shen Qi Li Xin formula (SQLXF) improved the heart function of chronic heart failure (CHF) patients, while the action mechanism remains unclear.

Methods

H&E staining and TUNEL staining were performed to measure myocardial damages. Western blot was used to examine the expression of proteins. Moreover, CCK-8 assay and flow cytometry were used to measure cell viability and cell apoptosis, respectively. Concentrations of ATP and ROS in cells, and mitochondrial membrane potential (MMP) were detected to estimate oxidative stress.

Results

In vivo, we found that SQLXF improved cardiac hemodynamic parameters, reduced LDH, CK-MB and BNP production, and attenuated myocardial damages in CHF rats. Besides, SQLXF promoted mitochondrial fusion-related proteins expression and inhibited fission-related proteins expression in CHF rats and oxygen glucose deprivation/reoxygenation (OGD/R)-induced cardiac myocytes (CMs). In vitro, our data show that certain dose of SQLXF inhibited OGD/R-induced CMs apoptosis, cell viability decreasing and oxidative stress.

Conclusion

Overall, certain dose of SQLXF could effectively improve the cardiac function of CHF rats through inhibition of CMs apoptosis via balancing mitochondrial fission and fusion. Our data proved a novel action mechanism of SQLXF in CHF improvement, and provided a reference for clinical.
AdmixSim 2: a forward-time simulator for modeling complex population admixture
Authors: Zhang Rui , Liu Chang , Yuan Kai , Ni Xumin , Pan Yuwen , Xu Shuhua
Published: October 2021

Background

Computer simulations have been widely applied in population genetics and evolutionary studies. A great deal of effort has been made over the past two decades in developing simulation tools. However, there are not many simulation tools suitable for studying population admixture.

Results

We here developed a forward-time simulator, AdmixSim 2, an individual-based tool that can flexibly and efficiently simulate population genomics data under complex evolutionary scenarios. Unlike its previous version, AdmixSim 2 is based on the extended Wright-Fisher model, and it implements many common evolutionary parameters to involve gene flow, natural selection, recombination, and mutation, which allow users to freely design and simulate any complex scenario involving population admixture. AdmixSim 2 can be used to simulate data of dioecious or monoecious populations, autosomes, or sex chromosomes. To our best knowledge, there are no similar tools available for the purpose of simulation of complex population admixture. Using empirical or previously simulated genomic data as input, AdmixSim 2 provides phased haplotype data for the convenience of further admixture-related analyses such as local ancestry inference, association studies, and other applications. We here evaluate the performance of AdmixSim 2 based on simulated data and validated functions via comparative analysis of simulated data and empirical data of African American, Mexican, and Uyghur populations.

Conclusions

AdmixSim 2 is a flexible simulation tool expected to facilitate the study of complex population admixture in various situations.
A representation and deep learning model for annotating ubiquitylation sentences stating E3 ligase - substrate interaction
Authors: Luo Mengqi , Li Zhongyan , Li Shangfu , Lee Tzong-Yi
Published: October 2021

Background

Ubiquitylation is an important post-translational modification of proteins that not only plays a central role in cellular coding, but is also closely associated with the development of a variety of diseases. The specific selection of substrate by ligase E3 is the key in ubiquitylation. As various high-throughput analytical techniques continue to be applied to the study of ubiquitylation, a large amount of ubiquitylation site data, and records of E3-substrate interactions continue to be generated. Biomedical literature is an important vehicle for information on E3-substrate interactions in ubiquitylation and related new discoveries, as well as an important channel for researchers to obtain such up to date data. The continuous explosion of ubiquitylation related literature poses a great challenge to researchers in acquiring and analyzing the information. Therefore, automatic annotation of these E3-substrate interaction sentences from the available literature is urgently needed.

Results

In this research, we proposed a model based on representation and attention mechanism based deep learning methods, to automatic annotate E3-substrate interaction sentences in biomedical literature. Focusing on the sentences with E3 protein inside, we applied several natural language processing methods and a Long Short-Term Memory (LSTM)-based deep learning classifier to train the model. Experimental results had proved the effectiveness of our proposed model. And also, the proposed attention mechanism deep learning method outperforms other statistical machine learning methods. We also created a manual corpus of E3-substrate interaction sentences, in which the E3 proteins and substrate proteins are also labeled, in order to construct our model. The corpus and model proposed by our research are definitely able to be very useful and valuable resource for advancement of ubiquitylation-related research.

Conclusion

Having the entire manual corpus of E3-substrate interaction sentences readily available in electronic form will greatly facilitate subsequent text mining and machine learning analyses. Automatic annotating ubiquitylation sentences stating E3 ligase-substrate interaction is significantly benefited from semantic representation and deep learning. The model enables rapid information accessing and can assist in further screening of key ubiquitylation ligase substrates for in-depth studies.
Methicillin-resistant Staphylococcus aureus colonization of infectious and non-infectious skin and soft tissue lesions in patients in Tehran
Authors: Khalili Haniyeh , Najar-Peerayeh Shahin , Mahrooghi Mona , Mansouri Parvin , Bakhshi Bita
Published: October 2021

Background

The most common clinical manifestations of Staphylococcus aureus strains in the community are skin and soft-tissue infections. S. aureus could colonize the body sites and complicate the pathogenesis of skin diseases. S. aureus colonization is a risk factor for severe conditions such as bone and joint infections, pneumonia, bacteremia, and endocarditis. This study aimed to investigate the prevalence of S. aureus strains in skin and soft tissue infections and other skin disorders in patients referring to dermatology clinics and to evaluate the antibiotic resistance pattern and molecular characteristics of S. aureus isolates.

Methods

Skin swabs were collected from the lesional sites in 234 outpatients referring to dermatology clinics in three hospitals in Tehran. Antibiotic susceptibility, biofilm formation, and hemolysis tests were performed for isolates. PCR was done for SCCmec typing, agr grouping, and virulence genes detecting.

Results

The prevalence of S. aureus strains among patients with skin and soft-tissue infections and other skin lesions was 44.77% (30/67) and 44.91% (75/167), respectively. Also, 59 (56.19%) isolates were MRSA, 35.57% were HA-MRSA, and 30.5% were CA-MRSA. The psmα gene was more prevalent (62.8%) among isolates, followed by hlaα (56.1%), tsst-1 (15.2%) eta (13.3%), etb (6.6%), and pvl (2.8%). The agr specificity groups I, II, III, and IV were identified in 49.5, 21.9, 11.4, and 14.2% of S. aureus isolates, respectively. Most (56%) S. aureus isolates produced a moderate biofilm, and 23.8% of them produced strong biofilms. α-hemolysin (46.6%), β-hemolysin (25.7%), γ-hemolysin (19%), and both α and β-hemolysin (5.7%) were also produced by isolates.

Conclusion

The present study results indicated high colonization of skin lesions by HA-MRSA and CA-MRSA clones; MRSA strains were more resistant to antibiotics, contained various toxin genes, and were able to form biofilms. Therefore, they could play a vital role in the pathogenesis of various skin diseases; also, they could spread and cause infections in other body sites. Eradication and decolonization strategies could prevent recurrent infections and the spread of resistant strains and improve skin conditions.
Clonality, virulence genes, and antibiotic resistance of Staphylococcus aureus isolated from blood in Shandong, China
Authors: Wang Xuezhi , Lin Dongzi , Huang Zengqi , Zhang Jinmei , Xie Wenyan , Liu Pen , Jing Huaiqi , Wang Jiazheng
Published: October 2021

Background

Bloodstream infection (BSI) caused by Staphylococcus aureus (S. aureus) can be life-threatening and pose a great challenge to infection control and clinical treatment. However, little information exists regarding the characterization of S. aureus in BSI patients in Shandong, China. To identify the clonality, virulence genes, and antibiotic resistance of S. aureus in blood, a total of 101 nonrepetitive blood isolates were collected. The antibiotic resistance phenotypes were determined, and virulence genes were analyzed with polymerase chain reaction (PCR). Finally, the genetic relatedness was investigated with Staphylococcus chromosomal cassette mec (SCCmec) typing for methicillin-resistant S. aureus (MRSA) isolates, Staphylococcal protein A (spa), and multilocus sequence typing (MLST) for all of 101 isolates.

Results

Of the 101 S. aureus isolates, 24 MRSA isolates and 77 methicillin-susceptible S. aureus (MSSA) isolates were identified. Overall, MRSA isolates had higher resistance rates than MSSA isolates when exposed to any of the 15 antibiotics tested in this study except for trimethoprim/sulfamethoxazole. Among the 17 virulence genes tested in this study, hla, hld, and hlg could be detected in all isolates. MRSA isolates were more likely to carry seb and hlb genes, while MSSA isolates were more likely to carry seg and sei genes. Thirty-five sequence types (STs) and 49 spa types were identified, of which ST59-t437 and ST398-t571 were the most abundant. These two genotypes were also the most abundant ST-spa types in MRSA and MSSA isolates, but their abundances shifted over time, with ST398-t571 being the predominant genotype from 2016 to 2017, and ST59-t437 from 2018 to 2020. Besides, all the ST59-t437 isolates harbored hlgb gene, whereas most (88.9%) ST398-t571 did not. In addition, twenty-four MRSA isolates were subject to SCCmec typing. SCCmec IVa was the most prevalent SCCmec type, and all the ST59-t437 MRSA isolates were SCCmec IVa. We also observed 15 new STs, and some of them were MRSA.

Conclusion

These findings provide additional observations and epidemiological data for blood S. aureus isolates, which can improve future infection-control measures and aid in potential clinical treatments in hospitals and other clinical settings.
Cerebral ventriculomegaly in myotonic dystrophy type 1: normal pressure hydrocephalus-like appearances on magnetic resonance imaging
Authors: Iida Saya , Seino Hiroko , Nagahata Fumiko , Tatsuo Soichiro , Maruyama Sho , Kon Seiko , Takada Hiroto , Matsuzaka Masashi , Sugimoto Koichiro , Kakeda Shingo
Published: October 2021

Background

Cerebral ventriculomegaly is an abnormal feature characteristic of myotonic dystrophy type 1 (DM1). This retrospective study investigated the morphologic changes accompanied by ventriculomegaly in DM1 on brain MRI.

Methods

One hundred and twelve adult patients with DM1 and 50 sex- and age-matched controls were assessed. The imaging characteristics for evaluations included the z-Evans Index (ventriculomegaly), callosal angle (CA), enlarged perivascular spaces in the centrum semiovale (CS-EPVS), temporo-polar white matter lesion (WML) on 3D fluid-attenuated inversion recovery (FLAIR), disproportionately enlarged subarachnoid-space hydrocephalus (DESH), and pathological brain atrophy. The “z-Evans Index” was defined as the maximum z-axial length of the frontal horns to the maximum cranial z-axial length. To determine the imaging characteristics and genetic information (CTG repeat numbers) that were associated with the z-Evans Index, we used binominal logistic regression analyses.

Results

The z-Evans Index was significantly larger in the patients than in the controls (0.30 ± 0.05 vs. 0.24 ± 0.02; p < 0.01). The z-Evans Index was independently associated with the callosal angle (p < 0.01) and pathological brain atrophy (p < 0.01) but not with age, gender, CTG repeat numbers, or CS-EPVS. Of the 34 patients older than 49 years, 7 (20.6%) were considered to have DESH.

Conclusions

Our MRI study revealed a normal pressure hydrocephalus (NPH)-like appearance as a morphologic finding accompanied by ventriculomegaly in DM1 that tends to occur in elderly patients.
OsANN4 modulates ROS production and mediates Ca2+ influx in response to ABA
Authors: Zhang Qian , Song Tao , Guan Can , Gao Yingjie , Ma Jianchao , Gu Xiangyang , Qi Zhiguang , Wang Xiaoji , Zhu Zhengge
Published: October 2021

Background

Plant annexins are calcium- and lipid-binding proteins that have multiple functions, and a significant amount of research on plant annexins has been reported in recent years. However, the functions of annexins in diverse biological processes in rice are largely unclear.

Results

Herein, we report that OsANN4, a calcium-binding rice annexin protein, was induced by abscisic acid (ABA). Under ABA treatment, the plants in which OsANN4 was knocked down by RNA interference showed some visible phenotypic changes compared to the wild type, such as a lower rooting rate and shorter shoot and root lengths. Moreover, the superoxide dismutase (SOD) and catalase (CAT) activities of the RNAi lines were significantly lower and further resulted in higher accumulation of O2.- and H2O2 than those of the wild-type. A Non-invasive Micro-test Technology (NMT) assay showed that ABA-induced net Ca2+ influx was inhibited in OsANN4 knockdown plants. Interestingly, the phenotypic differences caused by ABA were eliminated in the presence of LaCl3 (Ca2+ channel inhibitor). Apart from this, we demonstrated that OsCDPK24 interacted with and phosphorylated OsANN4. When the phosphorylated serine residue of OsANN4 was substituted by alanine, the interaction between OsANN4 and OsCDPK24 was still observed, however, both the conformation of OsANN4 and its binding activity with Ca2+ might be changed.

Conclusions

OsANN4 plays a crucial role in the ABA response, partially by modulating ROS production, mediating Ca2+ influx or interacting with OsCDPK24.
Insufficient procedural anticoagulation during leadless pacing led to catheter-related thrombosis in a hemodialysis patient
Authors: Chen Qiang , Ma Yong Jiang , Zhang Chun Hong , Zhang Li Wei
Published: October 2021

Background

Leadless pacemaker was a promising innovation than traditional transvenous pacemaker, the procedural complications were prone to be bleeding-related. However, very few reports also concerned about the thrombus formation during the procedure.

Case presentation

A hemodialysis patient with diabetic gangrene of right foot suffered from catheter-related thrombosis during leadless pacing, resulting in failure of recapture the pacemaker. A low activated clotting time (ACT) level of 104 s confirmed the insufficiency of anticoagulation. Finally, the whole delivery catheter had to be removed from the delivery sheath, another new pacemaker system was applied and successfully implanted after adjusting the ACT level to 248 s.

Conclusion

Catheter-related thrombosis could be a large obstacle for leadless pacemaker implantation. In addition to routine anticoagulation, ACT monitoring might be necessary during the procedure.
Ustekinumab trough concentration affects clinical and endoscopic outcomes in patients with refractory Crohn’s disease: a Chinese real-world study
Authors: Yao Jia-yin , Zhang Min , Wang Wei , Peng Xiang , Zhao Jun-zhang , Liu Tao , Li Zhi-wei , Sun Hai-tian , Hu Pinjin , Zhi Min
Published: October 2021

Background

Ustekinumab (UST), a newly-used biologic targeting p40 subunit of IL12 and IL23 in China, exerts a confirmed therapeutic effect on the induction and maintenance therapies for refractory Crohn’s disease (CD). Therapeutic drug monitoring based on trough and antibody concentration is of core importance when treating patients who lose response to UST. We aimed to analyze the UST exposure–response relationship in CD treatment in the real-world setting.

Methods

We retrospectively enrolled patients with CD who received UST between March 1, 2020 and May 31, 2021, at the inflammatory bowel disease (IBD) center of the Sun Yat-Sun Affiliated Sixth Hospital. Baseline characteristic information, biomarker examination, clinical outcomes determined by the Crohn’s disease activity index (CDAI), and endoscopic outcomes evaluated using a simple endoscopic score for Crohn’s disease (SES-CD) at week 16/20 were collected. The optimal UST cut-off trough concentration was identified using receiver operating characteristic curve (ROC) analysis.

Results

Nineteen eligible patients were included in the study, the mean age was 29.1 ± 9.1 years and the mean disease duration was 5.5 ± 4.7 years. At the initiation of the study, 89.5% of the patients had been exposed to prior biologics, 42.1% had previous CD-related surgeries, and 52.6% had perianal diseases. At week 16/20 after the UST initiation, clinical response, clinical remission, endoscopic response, and endoscopic remission were 89.5%, 84.2%, 42.2%, and 73.7%, respectively. The cut-off optimal trough concentration for UST was 1.12 μg/mL, as determined by the ROC with an area under the curve (AUC) of 0.78, sensitivity of 87.5%, and specificity of 72.7%. Patients with a UST trough concentration > 1.12 μg/mL had a significantly higher rate of endoscopic remission than those without (70.0% vs. 11.1%, P = 0.02).

Conclusions

UST is an effective therapeutic option for refractory CD treatment. A UST trough concentration above 1.12 μg/mL was associated with endoscopic remission at week 16/20 after UST initiation.

Trial registration This study was approved and retrospectively registered by the Ethics Committee of Sun Yat-Sen University (2021ZSLYEC-066, March 29, 2021) and the Clinical Trial Registry (NCT04923100, June 10, 2021).
GIST of the stomach masquerading as recurrent falls in an older adult: a case report and review
Authors: Tee Louis Y. , Sim Lynette , Tan Li Feng , Lum Jeffrey , Seetharaman Santhosh Kumar
Published: October 2021

Background

Gastric tumors become increasingly prevalent with advanced age but can be challenging to diagnose in older adults who may present with non-specific symptoms. Here, we report a rare case of an occult gastric tumor associated with mesenteric panniculitis that presented with recurrent falls precipitated by vertigo.

Case presentation

We describe a diagnostically challenging case of cryptogenic gastric tumor associated with mesenteric panniculitis in a 74-year-old female who presented with abdominal bloating and recurrent falls precipitated by vertigo, dehydration, acute kidney injury and electrolyte deficiencies, but had no alarm symptoms. Her symptoms resolved after laparoscopic wedge resection of the gastric tumor.

Conclusions

Our case highlights that while alarm symptoms such as dysphagia, weight loss, gastrointestinal bleeding and vomiting are considered indications for endoscopy, clinicians should also maintain a high index of suspicion for gastric tumors in older patients who may present with atypical symptoms.
Barriers to accessing internet-based home Care for Older Patients: a qualitative study
Authors: Zhao Baosheng , Zhang Xiaoman , Huang Rendong , Yi Mo , Dong Xiaofei , Li Zhenxiang
Published: October 2021

Background

Due to the increasingly ageing society and the shortage of nursing human resources in China, the imbalance between the home care needs of older patients and the inadequate supply of nursing services is increasing. Based on this medical situation, China is implementing internet-based home care (with the nurses who provide this care called online nurses or sharing nurses) based on the concept of the sharing economy, internet technology and knowledge from the home care experience in other countries. Internet-based home care follows an online application/offline service model. Patients place orders through an app, nurses grab orders instantly, and managers dispatch orders through a web platform based on various factors such as nurses’ qualifications, professionalism and distance from the patient. In this way, home care is provided for patients with limited mobility, such as older or disabled patients, patients in rehabilitation and terminal patients. Only by fully understanding the barriers to accessing internet-based home care can we provide quality nursing services to older patients and achieve the sustainable development of internet-based home care.

Objective

The goal of this study was to use qualitative methods to explore barriers to accessing internet-based home care for older patients.

Methods

Based on Levesque’s access to health care framework, semi-structured personal interviews were conducted with 19 older patients in a descriptive qualitative study using directed content analysis.

Results

We identified four barriers to accessing internet-based home care for older patients: barriers to perceiving, seeking, paying for, and engaging in internet-based home care. Specific barriers included traditional perceptions, barriers to internet use, high payment costs, uneven quality of services, and concerns about privacy and patient safety.

Conclusions

Internet-based home care brings new risks and challenges. In order to enable older patients to better enjoy it, it is necessary to strengthen publicity, optimize the network application process, improve the health insurance system, formulate unified nursing service standards, and address safety risks.
Are there gender differences in the trajectories of self-rated health among chinese older adults? an analysis of the Chinese Longitudinal Healthy Longevity Survey (CLHLS)
Authors: Cui Shichen , Yu Yushan , Dong Weizhen , Xu Tingke , Huang Yunyun , Zhang Xiangyang , Chen Chun
Published: October 2021

Background

Self-rated health (SRH) is a good predictor of morbidity and mortality. Extensive research has shown that females generally report poorer SRH than males but still tend to live longer. Previous studies used cross-sectional or pooled data for their analyses while ignoring the dynamic changes in males’ and females’ SRH statuses over time. Furthermore, longitudinal studies, especially those that focus on older adults, typically suffer from the incompleteness of data. As such, the effect of dropout data on the trajectories of SRH is still unknown. Our objective is to examine whether there are any gender differences in the trajectories of SRH statuses in Chinese older adults.

Methods

The trajectories of SRH were estimated using the pattern-mixture model (PMM), a special latent growth model, under non-ignorable dropout data assumption. We analyzed the Chinese Longitudinal Healthy Longevity Survey (CLHLS) data of 15,613 older adults aged 65 years and above, collected from 2005 to 2014.

Results

The results demonstrated the effect of non-ignorable dropout data assumptions in this study. The previous SRH score was negatively associated with the likelihood of dropping out of the study at the next follow-up survey. Our results showed that both males and females in China perceive their SRH as decreasing over time. A significant gender difference was found in the average SRH score (female SRH was lower than male SRH) in this study. Nonetheless, based on the results obtained using the PMM, there are no gender differences in the trajectories of SRH at baseline as well as in the rate of decline among the total sample. The results also show that males and females respond to SRH predictors similarly, except that current drinking has a more pronounced positive effect on males and healthcare accessibility has a more pronounced positive effect on females.

Conclusions

Our results suggest that missing data have an impact on the trajectory of SRH among Chinese older adults. Under the non-ignorable dropout data assumptions, no gender differences were found in trajectories of SRH among Chinese older adults. Males and females respond to SRH predictors similarly, except for current drinking habit and healthcare accessibility.
Changes in late-life systolic blood pressure and all-cause mortality among oldest-old people in China: the chinese longitudinal healthy longevity survey
Authors: Gao Hui , Wang Kan , Ahmadizar Fariba , Zhao Wensui , Jiang Yu , Zhang Lei , Yu Li , Zhou Fangjia , Gu Jialing , Zhuang Jianlin , Xia Zhao-lin
Published: October 2021

Background

Blood pressure targets for oldest-old people have been long debated due to the concern that more stringent targets are associated with increased mortality. We aimed to investigate the association between changes of late-life systolic blood pressure (SBP), mean SBP and SBP variability (SBPV), and all-cause mortality in oldest-old.

Methods

Based on the community-based Chinese Longitudinal Healthy Longevity Survey with follow-up conducted in the 3-year interval, we assembled a retrospective cohort of 6639 participants ≥ 80 years with available blood pressure measurements at baseline and second wave. The primary exposures were mean SBP and SBPV (defined as the annual difference in SBP divided by mean SBP) measured between baseline and second wave. The primary outcome was all-cause mortality assessed from the second wave.

Results

During 21443.1 person-years of follow-up, 4622 death was recorded. U-shaped associations of mortality with mean SBP and SBPV were identified; the value of 137 mmHg and 4.0 %/year conferred the minimum mortality risk, respectively. The associations of a larger SBPV with an increased mortality risk were observed for both rises and large falls in SBP. The hazard ratio was 1.11 (comparing lowest versus middle quintile; 95 % CI: 1.01, 1.22) with large falls in SBPV and 1.08 (comparing highest versus middle quintile; 95 % CI: 0.98, 1.18) with large rises in SBPV.

Conclusions

U-shaped associations between late-life SBP and SBPV and all-cause mortality were found. Our study suggests that a stable SBP level in the middle range is related to lower mortality risk in the oldest-old.
Diagnostic accuracy and clinical applicability of the Swedish version of the 4AT assessment test for delirium detection, in a mixed patient population and setting
Authors: Johansson Yvonne A. , Tsevis Theofanis , Nasic Salmir , Gillsjö Catharina , Johansson Linda , Bogdanovic Nenad , Kenne Sarenmalm Elisabeth
Published: October 2021

Background

Delirium is common in older hospitalized patients. It has serious consequences e.g., poor health outcomes, mortality and increased costs. Despite that, many cases are undetected. Early detection of delirium is important in improving outcomes and use of assessment tools improves detection rates. The 4AT is a brief screening tool for delirium detection, which has not previously been translated into Swedish. The study aim was to evaluate diagnostic accuracy and clinical applicability of a Swedish version of the screening tool 4AT for delirium detection.

Method

This diagnostic test accuracy study used a quantitative and a qualitative approach and evaluated the patients’ and the health care professionals’ experiences of the tool. Study included 200 patients ≥65 years from a university hospital and a county hospital in two Swedish regions. Medical specialties were geriatric stroke/neurology, geriatric multimorbidity, severe cognitive impairment, orthopaedic, and urology. The translated 4AT was tested against the reference standard DSM-IV-TR criteria, based on the Organic Brain Syndrome scale and patient records. The 4AT was assessed simultaneously and independently by two assessors. Additionally, data was collected through patient record reviews, and questions about applicability to the patients (n = 200) and the assessors (n = 37). Statistical analyses, and qualitative content analyses were conducted.

Results

By reference standard 18% had delirium, and by 4AT 19%. The overall percent agreement was 88%, AUROC 0.808, sensitivity 0.70 (95% CI 0.51–0.84) and specificity 0.92 (95% CI 0.87–0.96). In the ward for severe cognitive impairment (n = 63) the 4AT was less sensitive and less specific. In the other wards (n = 132) sensitivity was 0.77 (95% CI 0.50–0.93), specificity 0.93 (95% CI 0.87–0.97), and AUROC 0.848. Interrater reliability (Kappa) was 0.918, p = < 0.001 (n = 144). The 4AT was well tolerated by patients, easy to use for health care professionals, and took a few minutes to conduct.

Conclusion

The Swedish version of 4AT is an accurate and applicable tool to use in clinical practice for detecting delirium in hospitalized patients across different medical specialities, and to use by different professionals and levels of seniority. To improve patient outcomes, we recommend the 4AT to be incorporated in clinical practice in health care settings in Sweden.
Modifiable risk factors for homebound progression among those with and without dementia in a longitudinal survey of community-dwelling older adults
Authors: Yang Mia , Pajewski Nicholas , Espeland Mark , Easterling Douglas , Williamson Jeff D.
Published: October 2021

Background

Being homebound is independently associated with increased mortality but the homebound population is heterogeneous. In order to improve precision medicine, we analyzed potentially modifiable factors that contribute to homebound progression (from independent to needing assistance, to homebound), stratified by dementia status.

Methods

Using National Aging and Trends Survey (NHATS), a nationally-representative, longitudinal annual survey from 2011 to 2017 (n = 11,528), we categorized homebound progression if one transitioned from independent or needing assistance to homebound, including competing risks of institutionalization or death between 2011 and last year of data available for each unique respondent. Using proportional hazards regression, we calculated hazard ratios of potentially modifiable risk factors on homebound progression.

Results

Depressive symptoms, mobility impairment, and pain increased risk of homebound progression regardless of dementia status. Social isolation increased risk of homebound progression only among those without dementia at baseline.

Conclusion

Future clinical care and research should focus on the treatment of depressive symptoms, mobility, and pain to potentially delay progression to homebound status.
Social networks and cognitive function in older adults: findings from the HAPIEE study
Authors: Nie Yifan , Richards Marcus , Kubinova Ruzena , Titarenko Anastasiya , Malyutina Sofia , Kozela Magdalena , Pajak Andrzej , Bobak Martin , Ruiz Milagros
Published: October 2021

Background

Social networks are associated with better cognitive health in older people, but the role of specific aspects of the social network remains unclear. This is especially the case in Central and Eastern Europe. This study examined associations between three aspects of the social network (network size of friends and relatives, contact frequency with friends and relatives, and social activity participation) with cognitive functions (verbal memory, learning ability, verbal fluency, processing speed, and global cognitive function) in older Czech, Polish, and Russian adults.

Methods

Linear regression estimated associations between baseline social networks and cognitive domains measured at both baseline and follow-up (mean duration of follow-up, 3.5 ± 0.7 years) in 6691 participants (mean age, 62.2 ± 6.0 years; 53.7% women) from the Health, Alcohol and Psychosocial factors In Eastern Europe (HAPIEE) study.

Results

Cross-sectional analyses, adjusted for country, age, and sex, showed positive associations of global cognitive function with social activity participation and network size of friends and relatives, but not with contact frequency in either network. Further adjustment for sociodemographic, behavioural, and health characteristics attenuated the associations with network size of relatives (P-trend = 0.074) but not with network size of friends (P-trend = 0.036) or social activities (P-trend< 0.001). In prospective analyses, network size and social activity participation were also linked with better cognition in simple models, but the associations were much stronger for social activities (P-trend< 0.001) than for network size of friends (P-trend = 0.095) and relatives (P-trend = 0.425). Adjustment for baseline cognition largely explained the prospective associations with network size of friends (P-trend = 0.787) and relatives (P-trend = 0.815), but it only slightly attenuated the association with social activities (P-trend< 0.001). The prospective effect of social activities was largely explained by sociodemographic, health behavioural, and health covariates (P-trend = 0.233). Analyses of specific cognitive domains generally replicated the cross-sectional and prospective findings for global cognitive function.

Conclusions

Older Central and Eastern European adults with larger social networks and greater social activities participation had better cognitive function, but these associations were stronger at baseline than over the short-term follow-up.