bluuebunny/crossref_metadata_2025 huggingface dataset:
Development and validation of nonlinear dynamic engine airpath models for real-time advanced control application
Authors: Kamath Rohith , Kopold Richard , Venkobarao Vivek , Subramaniam CK
Published: August 2021

This paper proposes model reduction techniques for reducing engine airpath models in real-time (RT), for a control oriented application in an engine equipped with high pressure exhaust gas recirculation (EGR-HP) and single stage turbocharger. There are two major challenges addressed by authors: First, reducing the order without compromising the performance in terms of accuracy by decoupling the nonlinear coupled differential equations of airpath system in-order to use them in real-time processor-in-loop control application. A model reduction technique based on different dynamic characteristics between thermodynamic states followed by semi-implicit Euler (SIE) numerical method to solve coupled dynamic multi-input multi-output (MIMO) differential equation models is demonstrated. Second, the authors have proposed a novel method to calculate gas mass flow via compressor, coupled with engine airpath model in real-time. The proposed models of airpath system coupled with turbocharger models for a diesel engine is validated with experimental data to evaluate performance of pressures, temperatures, mass flows at relevant components. The developed airpath model is used for calculating thermodynamic properties in real-time for state of art engine control unit (ECU) in production engine and become basis for feedforward as well as closed loop control of airpath variables for real-time system. Authors further propose to use this modeling approach for calculating airpath system variables for exhaust aftertreatment system, injection system, and for virtualization of sensor values in airpath systems.
A Case Report: Is the Lack of Sufficient Radial Force Unfreezing the “Frozen Elephant Trunk”?
Authors: Öz Tugce , Prendes Carlota F. , Stana Jan , Konstantinou Nikolaos , Pichlmaier Maximillian , Tsilimparis Nikolaos
Published: August 2021

The “frozen elephant trunk” is a hybrid technique to treat aortic arch and proximal descending aortic pathologies in a single step. Despite its encouraging early and long-term results, some stent-graft-related adverse events have been reported. Here, we describe a possible treatment option to “re-freeze” the FET in case of loss of landing zone. We report a patient who developed significant kinking of the FET over the course of the first 2 postoperative years. The 1-year follow-up computed tomography angiography (CTA) showed significant kinking and proximal migration of the endograft portion of the FET, resulting in new thrombus formation. Due to kinking and thrombus progression in subsequent CTA follow-ups (2 years and 2½ years) with risk for peripheral embolization, a secondary endovascular repair was indicated. Transfemoral relining of the stent component with a thoracic aortic endovascular repair (Zenith®TX2®30142) stent-graft was performed. In the context of postoperative aneurysm sac shrinkage, the low radial force and lack of longitudinal stiffness of the hybrid graft may lead to proximal migration, thus secondary kinking, emphasizing the importance of an adequate degree of oversizing of the primary graft and an appropriate follow-up. Selection of a suitable graft for a particular pathology concerning the radial force and longitudinal stiffness is furthermore important.
Pharmacological Interventions for the Management of Cancer-Related Fatigue Among Cancer Survivors: Systematic Review and Meta-Analysis
Authors: Sun Xuemei , Chen Yancong , Cheung William KW , Wu Irene XY , Xiao Fang , Chung Vincent CH
Published: August 2021

Objective:

Current guidelines have different recommendations on applying pharmacological interventions for managing cancer-related fatigue (CRF) among cancer survivors. This systematic review aims to synthesize clinical evidence on pharmacological interventions for managing CRF.

Methods:

Five databases were searched for potential randomized controlled trials (RCTs) from their inception until October 2020. RCTs assessing the effect of pharmacological treatments for CRF among cancer survivors were considered eligible. Clinical significance was determined by comparing the estimated effect with that of minimal important difference (MID). The risk of bias of each included RCT was appraised using the Cochrane risk of bias tool for randomized trials 2. Data were synthesized using random-effect pairwise meta-analyses.

Results:

A total of 15 RCTs (1238 participants) were included. The majority presented some concerns of bias arising from the randomization process and selection of the reported results. Meta-analysis showed that psychostimulant and wakefulness agents had statistically significant while clinically insignificant effects on the treatment of CRF (pooled weighted mean difference [WMD]: 2.8, 95% confidence interval [CI]: 0.2-5.4, I2: 0%, 3 RCTs, MID: 3.0-6.0). Three natural products, including Renshen Yangrong Tang (mean difference [MD]: −16.1, 95% CI: −8.9 to −23.3, MID: −17.3 to −11.4), Tualang honey (MD: 11.2, 95% CI: 7.1-15.3, MID: 3.0-6.0), and Shenmai injection plus Peptisorb (MD: −1.6, 95% CI: −2.1 to −1.1, MID: −1.1 to −0.8) demonstrated statistically and clinically significant effect in reducing CRF.

Conclusions:

Existing evidence showed promising effects of 3 natural products in reducing CRF among cancer survivors. The results from this study need to be further confirmed with well-designed and adequately powered RCTs that use validated instruments for the measurement of CRF.
Optimal analysis of TSM fitting considering contact interface TECs of meshing gears
Authors: Wang Xigui , Tang Jie , Wang Yongmei , Ruan Jiafu , An Siyuan
Published: August 2021

The pre-research project aims to propose a method of optimizing tooth surface modification (TSM) fitting under thermoelastic lubrication (TEL) conditions to reveal the most popular and concerned mechanism issues in the field of mechanical engineering. This is an exploratory study, mainly considering the gear comprehensive error and TSM state of TEL contact interfaces are extremely harsh, which complicates simulation analysis and optimal design. TSM simulation has fitted numerically agreement with optimized results obtained experimentally, which means that they can, whether isolated or by using a multiscale coupling method, start to be adopted to revise, and verify meta-models for thermoelastic characteristics (TECs) under TEL problems. This subject involves the TSM fitting of the theoretical teeth surface superimposed structure, and performs 3D and diagonal modification optimization design, obtains the modified surface position and normal vectors, according to load teeth contact analysis (LTCA), a variety of optimized modification models are established and complex curved surfaces are analyzed to fit the actual gear teeth surface thermoelastic contact numerical simulation, which has been further demonstrated and expressed in the type experiment combined with actual key working conditions and multiple influencing parameters, which is of great significance to the development of modern gear transmission system.
The protective mechanism of folic acid on hyperhomocysteinemia-related arterial injury in spontaneously hypertensive rats: Folic acid against arterial inflammation
Authors: Zhang Lihua , Li Zhongliang , Xing Changcheng , Ma Xiaoshan , Xu Rui
Published: August 2021

Background

Hypertension associated with hyperhomocysteinemia (HHcy) is correlated with a high risk of vascular diseases. Studies found that folic acid (FA) supplementation can reduce the risk of cardiovascular and cerebrovascular events. The aim of the present study was to explore the potential mechanisms of FA attenuating HHcy-related arterial injury in spontaneously hypertensive rats (SHRs).

Methods

24 SHRs were randomized into the control group, the HHcy group, and the HHcy + FA group (8 per group). The SHRs in the HHcy group and the HHcy + FA group were given DL-Hcy intraperitoneally to mimic hypertension associated with HHcy. The SHRs in the HHcy + FA group were given FA by gavage to mimic an FA-fortified diet. The histopathology and immunohistochemistry of rat aorta and carotid artery were analyzed, and the relative expression levels of immune/inflammation and oxidative stress molecules in arterial tissue were detected by quantitative real-time polymerase chain reaction (qRT-PCR) and Western blot.

Results

FA significantly reduced the expression levels of nuclear factor-κ-gene binding (NF-κB) p65/Rela and interleukin-6 (IL-6) in rat arterial tissues, as well as the levels of plasma HHcy and serum malondialdehyde (MDA) in hypertension associated with HHcy rats ( p < 0.05). At the same time, FA significantly increased the serum superoxide dismutase (SOD) level in hypertension associated with HHcy rats, and even the SOD level of the HHcy + FA group was higher than that of the control group ( p < 0.05). However, HHcy induced the opposite results of the above indicators in SHRs compared with the control group ( p < 0.05).

Conclusions

The arterial protection mechanisms of FA are related to reducing the concentration of HHcy to eliminate the tissue toxicity of HHcy, inhibiting NF-κBp65/Rela/IL-6 pathway molecules to regulate inflammatory response, and promoting the potential anti-oxidative stress pathway molecules to reduce oxidative stress level.
Facing dominant master narratives on gender and sexuality: Identity reconstruction of women in situations of inequality
Authors: de la Mata Manuel L , Cala María Jesús , Sala Arianna
Published: August 2021

The article is based on a conception of identity and self as a situated narrative construction in which memory plays a central role. To construct self-narratives, individuals internalise cultural master narratives in specific socio-cultural settings. For that reason, the analysis of self-identity needs to go beyond the individual to integrate interpersonal and socio-cultural levels, as well. Starting from this theoretical perspective, two studies of identity reconstruction of women facing situations of inequality and violence (lesbian women and women after gender-based violence) in Spain were examined. These two groups were confronted with gendered master narratives that place women in a subordinate situation. The two studies applied a similar methodology, based on the use of Bruner’s self-indicators. The analysis of the cases was focused on three issues: the dynamics of master versus alternative narratives in identity (re)construction and their relation to social reproduction and change, the need to consider the three levels of analysis (socio-cultural, interpersonal and individual) and the role of voice and silence in these processes. Finally, the involvement or memory in identity reconstruction was considered.
Streaming media and the dynamics of remembering and forgetting: The Chernobyl case
Authors: Gambarato Renira Rampazzo , Heuman Johannes , Lindberg Ylva
Published: August 2021

The aim of this study is to elucidate the mnemonic conditions established in the ever-increasing production and use of cultural memory in streaming media environments. To gain in-depth insight into how memories are selected for remembering and sorted for forgetting, the focus is the HBO Chernobyl mini-series. The case study of HBO’s Chernobyl is selected to qualitatively explore cultural memories across the series throughout the complexities of globally connected technologies and markets, where different cultures and languages, as well as media framings, come into play. Theoretically, the article is based on conceptualization of cultural memory studies and streaming media platforms. Methodologically, the case study is supported by the multidimensional analytical lens developed by Erll, adopted to elucidate how the cultural memory of Chernobyl is activated, mediated, and shaped by the streaming series. These three dimensions involve the intra-medial aspects of how memory is expressed within the representation itself, the inter-medial relations which designate the interplay with previous representations of the same historical event, and the pluri-medial contexts in which novels and films appear and exert their influence on cultural memory. In the three-dimension analysis, we address the construction and circulation of cultural memory from the production to the reception of the mini-series in multiple media environments and across borders, depicting the social, cultural, and political impact of streaming media productions.
Real-world efficacy and safety of nab-paclitaxel plus gemcitabine-cisplatin in patients with advanced biliary tract cancers: a multicenter retrospective analysis
Authors: Cheon Jaekyung , Lee Choong-kun , Sang Yun Beom , Choi Hye Jin , Kim Min Hwan , Ji Jun Ho , Ko Kwang Hyun , Kwon Chang-Il , Kim Dae Jung , Choi Sung Hoon , Kim Chan , Kang Beodeul , Chon Hong Jae
Published: August 2021

Background:

A recent phase II trial reported prolonged survival in patients with advanced biliary tract cancer (BTC) following treatment with nab-paclitaxel plus gemcitabine-cisplatin (Gem/Cis/nab-P). We aimed to evaluate the clinical outcomes of Gem/Cis/nab-P in Asian patients with advanced BTC in a real-world setting.

Methods:

We reviewed the data of patients who received Gem/Cis/nab-P for the management of advanced BTC between September 2019 and April 2021 at four institutes in Korea. Patients were classified into the Gem/Cis/nab-P and nab-P addition groups depending on the starting point of nab-P administration.

Results:

A total of 178 patients treated with Gem/Cis/nab-P were included in the study. Of these, 43.8% had intrahepatic cholangiocarcinoma (CCA), 34.8% had extrahepatic CCA, and 21.3% had gall bladder cancer. A total of 117 (65.7%) patients received Gem/Cis/nab-P as the first-line treatment, while 61 (34.3%) were treated with gemcitabine-cisplatin-based chemotherapy followed by nab-P addition. The objective response rate (ORR) and disease control rate in all patients were 42.1% and 84.8%, respectively. The ORR in the Gem/Cis/nab-P group was 47.9%, while that in the nab-P addition group was 31.1%. The median progression-free survival and overall survival were 8.5 months [95% confidence interval (CI), 6.9–10.1] and 14.6 months (95% CI, 10.2–19.0), respectively. In patients who received Gem/Cis/nab-P as initial treatment, the median PFS was 9.4 months (95% CI, 7.9–10.9) and the median OS was not-reached (95% CI, not available). Anemia ( n = 42, 23.6%), neutropenia ( n = 40, 22.5%), and thrombocytopenia ( n = 16, 9.0%) were the most common grade 3–4 toxicities. A total of 20 patients (11.2%) had conversions from unresectable to resectable disease and underwent surgery with curative intent.

Conclusion:

Gem/Cis/nab-P showed favorable real-life efficacy and safety outcomes in Korean patients with advanced BTC, which was consistent with the phase II trial outcomes.
Specificity of CSR Ties That (Un)Bind Brand Attachment
Authors: Romano Fernanda M. , Devine Alua , Tarabashkina Liudmila , Soutar Geoffrey , Quester Pascale
Published: August 2021

Corporate social responsibility (CSR) influences brand personality, trust, firm attitudes, and purchase intentions. Yet, little attention has been paid to its effects on brand attachment. This study integrated message specificity, self-identity, and attachment theories to explain how socially responsible communication can be used to influence brand attachment. We show that CSR boosted brand attachment when messages contained specific (rather than generic) information that fostered positive brand elaborations, but eroded it when specific information was interpreted negatively. This effect was present only when socially responsible engagement was personally relevant to consumers, pointing to significant variations in message effectiveness. CSR was also more effective when firms announced socially responsible support for the first time and less effective when firms already had a CSR track record, pointing to a ceiling effect.
Disciplined Vision Casting: A Method for Exploring Possible Futures in the Era of the UN Sustainable Development Goals
Authors: Ramirez Edward , Tajdini Saeed
Published: August 2021

This conceptual essay introduces Disciplined Vision Casting (DVC) as a new method for exploring alternative futures. Drawing on scenario planning, introspection, and creative writing, DVC casts a set of future scenarios, based on a combination of guiding uncertainties found in the literature. Marketing scholars stand to benefit from leveraging DVC as it provides them with a laboratory for exploring undiscovered contexts and circumstances that may challenge widely held beliefs. DVC allows the researcher to cross the interdisciplinary barriers to study the confluence of a variety of technological and economic forces on society. As such, this novel method of projecting into the future offers the researchers a stimulus for theory development and a low-cost and readily implementable method of foreseeing potential future events, thus assisting them as they reimagine the discipline in the era of UN Sustainable Development Goals and other global sustainability initiatives.
Assessing the Adoption of e-Health Technology in a Developing Country: An Extension of the UTAUT Model
Authors: Gu Dongxiao , Khan Salman , Khan Ikram Ullah , Khan Safeer Ullah , Xie Yi , Li Xingguo , Zhang Gongrang
Published: August 2021

Electronic healthcare services are becoming an increasingly essential form of information and communication technology (ICT) that enables the fast and smooth delivery of health care, specifically in countries with scarce resources such as Pakistan. A better understanding of factors contributing to the adoption of electronic health care is needed, yet this remains an under-researched phenomenon. Grounded in the united theory of acceptance and use of technology, this article attempts to fill the gap by proposing and empirically testing the contribution of trust, privacy, task-technology fit, and personal innovativeness of patients’ intentions to adopt electronic health technology. A survey questionnaire was used to collect data from 353 patients in major hospitals in Islamabad, Pakistan. This study used Partial Least Square Structural Equation Modeling for the analysis. Results indicate that the intention to adopt electronic health technology is determined mostly by effort expectancy, social influence, facilitating conditions, task-technology fit, trust, privacy, and personal innovativeness in information technology. The study concludes with several managerial implications and future research directions, which give further opportunities to researchers and practitioners in the field of e-health technology.
Return-to-Sport Criteria After Upper Extremity Surgery in Athletes—A Scoping Review, Part 2: Ulnar Collateral Ligament of the Elbow Procedures
Authors: Griffith Rebecca , Bolia Ioanna K. , Fretes Nickolas , Murray Iain R. , Meyer John , Weber Alexander E. , Gamradt Seth C. , Petrigliano Frank A.
Published: August 2021

Background:

There is a lack of consensus to guide patient return to sport (RTS) after elbow ulnar collateral ligament surgery (eUCLS).

Purpose:

To describe the reported RTS criteria after eUCLS in the athletic population.

Study Design:

Scoping review; Level of evidence, 4.

Methods:

This scoping review was performed by adhering to the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses–Scoping Review) guidelines. We searched 5 electronic databases (MEDLINE, Scopus, SPORTDiscus, Embase, Google Scholar Advanced) and the gray literature for English-language studies that reported at least 1 RTS criterion in athletes after eUCLS. Data were extracted and summarized as frequencies or arithmetic mean and standard deviation.

Results:

Included were 14 studies and 1335 athletes with a mean age of 21.4 ± 1.1 years. Time from surgery (range, 6-16 months) was the most common RTS criterion used, and it was reported by all 14 of the included articles. RTS criteria reported less often were pain (3/14; 21%), successful completion of a throwing program (3/14; 21%), muscle strength of the forearm muscles (1/14; 7%), and “normal” range of motion and muscle strength of the elbow and shoulder joints on the operated upper extremity (1/14; 7%). All studies used 1 to 5 of the above RTS criteria.

Conclusion:

Only 14 studies reported 1 or more RTS criteria after eUCLS in athletes, and time was the most common RTS criterion used. Our results highlight the need for a coordinated effort among surgeons, physical therapists, and athletic trainers in order to establish evidence-based RTS criteria after eUCLS in athletes so athletes can safely to sport and prolong their athletic careers.
Development and Validation of the “Tübingen Inventory to Measure Teachers’ Profession-Specific Value Orientations” (TIVO)
Authors: Merk Samuel , Drahmann Martin , Cramer Colin
Published: August 2021

Broadly understood, values represent orientation guidelines for daily action, thinking, and feeling. Thus, they affect teachers’ everyday work and are among their professional competencies. While general values and some single profession-specific values of teachers (e.g., responsibility) have already been investigated empirically, the current study aims to cover a broader range of profession-specific values by developing and validating the Tübingen Inventory to Measure Teachers’ Profession-Specific Value Orientations (TIVO), based on three independent studies with pre-service (Studies 1 and 2; N1 = 334, N2 = 239) and in-service teachers (N3 = 308). The results demonstrate that the TIVO is appropriate to assess four profession-specific values in a second-order model: caring, justice, responsibility, and truthfulness as first-order factors, with fairness as a second-order factor loading on the latter three first-order factors. The results from preregistered experiments and confirmatory factor analysis provide consistent evidence for the construct validity of the TIVO.
Genome-wide identification of the MADS-box transcription factor family in autotetraploid cultivated alfalfa (Medicago sativa L.) and expression analysis under abiotic stress
Authors: Dong Xueming , Deng Hao , Ma Wenxue , Zhou Qiang , Liu Zhipeng
Published: August 2021

Background

Alfalfa, the “queen of forage”, is the most extensively cultivated forage legume in the world. The development and yield of alfalfa are seriously limited by abiotic stress. MADS-box transcription factors are one of the largest gene families and play a pivotal role in plant development and abiotic stress. However, little is known regarding the MADS-box transcription factors in autotetraploid cultivated alfalfa.

Results

In the present study, we identified 120 MsMADS-box genes in the alfalfa genome. Phylogenetic analysis indicated that 75 type-I MsMADS-box genes were classified into the Mα, Mβ, and Mγ subgroups, and 45 type-II MsMADS-box genes were classified into 11 subgroups. The promoter region of MsMADS-box genes containing several hormone and stress related elements. Chromosomal location analysis revealed that 117 MsMADS-box genes were unevenly distributed on 32 chromosomes, and the remaining three genes were located on unmapped scaffolds. A total of nine pairs of segmental duplications and four groups of tandem duplications were found. Expression analysis showed that MsMADS-box genes were differentially expressed in various tissues and under abiotic stresses. qRT-PCR analysis revealed that the expression profiles of eight selected MsMADS-box genes were distinct under various stresses.

Conclusions

In this study, MsMADS-box genes were identified in the cultivated alfalfa genome based on autotetraploid level, and further confirmed by Gene Ontology (GO) analysis, phylogenetic analysis, sequence features and expression analysis. Taken together, these findings will provide clues for further study of MsMADS-box functions and alfalfa molecular breeding.

Our study is the first to systematically identify and characterize the MADS-box transcription factors in autotetraploid cultivated alfalfa (Medicago sativa L.), and eight MsMADS-box genes were significantly involved in response to various stresses.
Long term clinical outcomes of patients with ischemic stroke in primary care – a 9-year retrospective study
Authors: Han Jinghao , Choi Yue Kwan , Leung Wing Kit , Hui Ming Tung , Leung Maria Kwan Wa
Published: August 2021

Background

We aim to document the long-term outcomes of ischemic stroke patients and explore the potential risk factors for recurrent cardiovascular events and all-cause mortality in primary care.

Methods

A retrospective cohort study performed at two general out-patient clinics (GOPCs) under Hospital Authority (HA) in Hong Kong (HK). Ischemic stroke patients with at least two consecutive follow-up visits during the recruitment period (1/1–30/6/2010) were included. Patients were followed up regularly till the date of recurrent stroke, cardiovascular event, death or 31/12/2018. The primary outcome was the occurrence of recurrent cerebrovascular event including transient ischemic stroke (TIA), ischemic stroke or hemorrhagic stroke. The secondary outcomes were all-cause mortality and coronary artery disease (CAD). We fit cox proportional hazard model adjusting death as competing risk factor to estimate the cause-specific hazard ratio (csHR).

Results

A total of 466 patients (mean age, 71.5 years) were included. During a median follow-up period of 8.7 years, 158 patients (33.9%) died. Eighty patients (17.2%) had recurrent stroke and 57 (12.2%) patients developed CAD. Age was an independent risk factor for recurrent stroke, CAD and death. Statin therapy at baseline had a protective effect for recurrent stroke (csHR = 0.476; 95% confidence interval [CI] 0.285–0.796, P = 0.005) after adjusting death as a competing risk factor and all-cause mortality (HR = 0.693, 95% CI 0.486–0.968, P = 0.043). In addition, female sex, antiplatelet and a higher diastolic blood pressure (DBP) at baseline were also independent predictors for survival.

Conclusions

Long term prognosis of ischemic stroke patients in primary care is favorable. Use of statin was associated with a significant decrease in stroke recurrence and mortality. Patients who died had a significant lower DBP at baseline, highlighted the need to consider both systolic and diastolic blood pressure in our daily practice.
Health-related quality of life in outpatients with chronic liver disease: a cross-sectional study
Authors: Gazineo Domenica , Godino Lea , Bui Virna , El Mouttaqi Latifa , Franciosi Eugenia , Natalino Alessandra , Ceci Grazia , Ambrosi Elisa
Published: August 2021

Background

The symptoms and complications related to chronic liver disease (CLD) have been shown to affect patient well-being. Currently there is limited research data on how CLD severity may affect both health-related quality of life (HRQOL) and the development of depressive symptoms in CLD patients. Moreover, the ongoing advances in CLD treatment, and its effect on HRQOL, highlight the need for further studies. Therefore, the aim of the present study was to evaluate if the CLD severity may affect the HRQOL and the development of depressive symptoms.

Methods

A cross-sectional study was conducted. Patients with CLDs were identified at their regular visits to the outpatient clinic of the Sant’Orsola-Malpighi Hospital in Bologna, between September 2016 and July 2017. HRQOL was measured with Short Form 12 (SF-12) and Nottingham Health Profile (NHP) questionnaires; depressive symptoms were measured with Beck Depression Inventory-II (BDI). CLD severity was measured using the MELD score and the sample was stratified into five classes according to it. Group comparisons were conducted using the Kruskal–Wallis test.

Results

Two hundred and fifty-four patients were included. Mean age was 62.84 years (SD 11.75) and 57.9% were male. Most participants were affected by compensated cirrhosis (140.2%) and chronic hepatitis (40.2%), with a disease duration ≥ 5 years (69.3%). Regarding the MELD score, 67.7% of patients belonged to Class I, 29.9% to Class II, and 2.4% to Class III. There were not patients belonging to the Classes IV and V.

No statistically significant differences were found in all SF-12 and NHP domains between the MELD classes, except for CLD impact on sexual life and holidays (p = 0.037 and p = 0.032, respectively). A prevalence rate of 26% of depressive symptoms was reported, no statistically significant differences were found in BDI-II total scores between the three MELD classes.

Conclusions

All domains of HRQOL and depression were altered in CLDs patients, nevertheless CLD severity was not confirmed as an affecting factor for HRQOL.
Revisiting the dengue epidemic of 2011 in Paraguay: molecular epidemiology of dengue virus in the Asuncion metropolitan area
Authors: Rojas Alejandra , Moreira Soares Adriana , Mendoza Laura Patricia , Acosta María Eugenia , Aria Laura , Páez Malvina , Herebia Lilian , Vallejos María Asunción , de Guillén Yvalena , Aquino Victor Hugo
Published: August 2021

Background

Dengue is one of the most important re-emerging viral diseases and the most common human arthropod-borne viral infection worldwide. Any of the fourDengue virusserotypes (DENV-1 to 4) can cause asymptomatic infections or clinical manifestations that range in severity from a mild, self-limited illness, to a severe disease characterized by a shock syndrome that can lead to death. Paraguay suffers periodic epidemic outbreaks of dengue since 1988 when the DENV-1 was introduced in the country. Epidemics caused by all four serotypes have been reported and the country. Although dengue is endemic in Paraguay, few studies have described the molecular epidemiology of DENV in the country, which is important to understand the local and global spread, as well as the evolution of this pathogen.

Methods

This was a cross-sectional study of a convenience sample. Suspected dengue patients of any age were recruited from the Emergency Laboratory of the Central Hospital of the Institute of Social Welfare, Asuncion, Paraguay, from February to June of 2011. A DENV antigen test was used to confirm the infection. The protein E gene sequences of isolated viruses were sequenced for phylogenetic analysis.

Results

Dengue was confirmed in 55.1% of the participants (n = 98/178). The most frequent clinical findings were fever, headache, and myalgia. Identity analyses of the protein E gene sequence of 56 viruses isolated showed the circulation of DENV-1 (n = 45) and DENV-2 (n = 11) in the Asuncion metropolitan area in 2011. Molecular epidemiology analyses suggest that DENV-1 was introduced into Paraguay from Argentina, while the DENV-2 from Brazil, replacing previous virus lineages.

Conclusions

We have analyzed the molecular epidemiology of DENV-1 and DENV-2 isolated in Paraguay in 2011. We found strong evidence that DENV-1 was introduced into Paraguay from Argentina, while the DENV-2 from Brazil, replacing previous virus lineages. Molecular epidemiology studies are of great interest to analyze the dynamic of DENV spread, which are useful for early implementation of containment measures to reduce the risk of explosive epidemics caused by this virus.
The impact of COVID-19 pandemic on HIV care continuum in Jiangsu, China
Authors: Shi Lingen , Tang Weiming , Hu Haiyang , Qiu Tao , Marley Gifty , Liu Xiaoyan , Chen Yuheng , Chen Yunting , Fu Gengfeng
Published: August 2021

Background

The COVID-19 pandemic seriously threatens general public health services globally. This study aimed to evaluate the impact of the COVID-19 pandemic on the HIV care continuum in Jiangsu province, China.

Methods

Data on newly diagnosed HIV persons for analysis were retrieved from Chinas’ web-based Comprehensive Response Information Management System (CRIMS) for HIV/AIDS from 2016 to 2020. We recorded data for the first 3 months (January to March, 2020) of strictly implementing COVID-19 measures from publicly available disease databases of the Jiangsu provincial Health Committee. We used seasonal autoregressive integrated moving average (SARIMA) and exponential smoothing in forecasting the parameters. Subgroup differences were accessed using Chi-square tests.

Results

Compared to the estimated proportions, the HIV testing rates decreased by 49.0% (919,938) in the first three months of implementing COVID-19 measures. Of an estimated 1555 new HIV diagnosis expected in the same period, only 63.0% (980) new diagnoses were recorded. According to actual data recorded during the said period, 980 positively tested persons received confirmatory tests, of which 71.4% (700) were reportedly linked to care. And only 49.5% (235) out of the expected 475 newly diagnosed HIV persons received CD4 cell count testing. Meanwhile 91.6% (208) of newly diagnosed HIV persons who received CD4 count tests reportedly initiated antiretroviral therapy (ART) compared to the 227 expected. Compared to the same period from 2016 to 2019, PLWH less than 30 years old and migrants were more likely to be affected by the COVID-19 policies.

Conclusions

The COVID-19 pandemic negatively impacted HIV healthcare systems in Jiangsu, China. Further measures that can counter the impact of the pandemic are needed to maintain the HIV care continuum.
The causes and frequency of kidney allograft failure in a low-resource setting: observational data from Iraqi Kurdistan
Authors: Ali Alaa Abbas , Almukhtar Safaa E. , Abd Kais H. , Saleem Zana Sidiq M. , Sharif Dana A. , Hughson Michael D.
Published: August 2021

Background

In the developing world, transplantation is the most common long-term treatment for patients with end-stage renal disease, but rates and causes of graft failure are uncertain.

Methods

This was a retrospective outcomes study of renal transplant patients seen in Iraqi Kurdistan nephrology clinics in the year 2019. In 2019, 871 renal transplant patients were registered and outcomes followed through 12/31/2020. Indicated renal biopsies were obtained on 431 patients at 1 day to 18 years post-transplantation. Outcomes were compared with United States Renal Data System (USRDS) living donor reports.

Results

All donors were living. The recipient age was 38.5 ± 13.3 years, 98.2% were < 65 years old, 3.7% had previous transplants, and 2.8% had pretransplant donor-specific antibodies (DSA). Gehan-Breslow estimated failure rates for all-cause, return to HD, and death with functional graft were 6.0, 4.2, and 1.9% at 1 year and 18.1, 13.7, and 5.1% at 5 years post-engraftment (USRDS 2000; 1 year: 7.0, 5.0, 2.6%; 5 year: 22.3, 15.2, 10.6%. USRDS 2010; 1 year: 3.7, 2.4, 1.4%; 5 year: 15.3, 9.6, 7.3%). The median graft survival was 15 years. Acute tubular injury (ATI), infarction, and acute T cell-mediated rejection accounted for 22.2% of graft loss, with > 75% of these failures taking place in the first year. Most graft failures occurred late, at a median post-transplant time of 1125 (interquartile range, 365–2555) days, and consisted of interstitial fibrosis and tubular atrophy (IF/TA) (23.8%), transplant glomerulopathy (13.7%), and acquired active antibody-mediated rejection (12.0%). The significant predictors of graft loss were C4d + biopsies (P < 0.01) and advanced IF/TA (P < 0.001).

Conclusions

Kurdistan transplant patients had graft failure rates similar to living donors reported by the USRDS for the year 2000 but higher than reported for 2010. Compared to USRDS 2010, Kurdistan patients had a moderate excess of HD failures at one and 5 years post-engraftment. Nevertheless, prolonged survival is the norm, with chronic disorders and acquired DSA being the leading causes of graft loss.
Acceptability of mentor mother peer support for women living with HIV in North-Central Nigeria: a qualitative study
Authors: Odiachi Angela , Al-Mujtaba Maryam , Torbunde Nguavese , Erekaha Salome , Afe Abayomi J. , Adejuyigbe Ebun , Galadanci Hadiza S. , Jasper Tongdiyen L. , Cornelius Llewellyn J. , Sam-Agudu Nadia A.
Published: August 2021

Background

Mentor mothers provide psychosocial and other support to pregnant and post-partum women living with HIV (WLHIV), which has been shown to enhance maternal-infant outcomes in the prevention of mother-to-child transmission of HIV (PMTCT). Our objective was to assess the acceptability of mentor mothers as a PMTCT intervention, and to explore opinions on mentor mother program composition and delivery among stakeholders in North-Central Nigeria.

Methods

We conducted nine focus group discussions and 31 in-depth interviews with 118 participants, including WLHIV, pregnant women, male partners, health workers, traditional birth attendants, community leaders, PMTCT program implementers, and policymakers. Participants were purposively recruited from health facilities and surrounding communities in the Federal Capital Territory and Nasarawa State. Transcripts were manually analysed using a Grounded Theory approach, where theory was derived from the data collected.

Results

Most participants were female (n = 78, 67%), and married (n = 110, 94%). All participant groups found  mentor mothers acceptable as women providing care to pregnant and postpartum women, and as WLHIV supporting other WLHIV. Mentor mothers were uniquely relatable as role models for WLHIV because they were women, living with HIV, and had achieved an HIV-negative status for their HIV-exposed infants. Mentor mothers were recognized as playing major roles in maternal health education, HIV treatment initiation, adherence, and retention, HIV prevention for male partners and infants, and couple HIV disclosure. Most WLHIV preferred to receive mentor mothers’ services at health facilities rather than at home, due to concerns about HIV-related stigma and discrimination through association with mentor mothers. Key mentor mother needs were identified as training, remuneration, and validation as lay health workers.

Conclusions

Mentor mothers are an acceptable PMTCT intervention among stakeholders in North-Central Nigeria. However, stigma and discrimination for both mentor mothers and their clients remain a critical challenge, and mentor mother needs such as training, pay, and a sustainably supported niche in health systems require focused attention.

Trial registration

Clinicaltrials.gov registration number (NCT 01936753), registered on September 3, 2013 (retrospectively registered).
Antenatal dexamethasone use and respiratory distress in late preterm infants: results from first Vietnamese matched cohort study
Authors: Ho Tran Tuan Hung , Truong Quang Vinh , Nguyen Thi Kim Anh , Le Minh Tam , Nguyen Vu Quoc Huy
Published: August 2021

Background

Respiratory distress syndrome (RDS) is one of the leading causes of early neonatal morbidity and mortality in late preterm infants (LPIs) worldwide. This matched cohort study aimed to assess how the antenatal dexamethasone use affect the respiratory distress (RD) proportion in preterm newborns between 34 0/7 weeks and 36 6/7 weeks of gestation.

Methods

This was a prospective cohort study on 78 women with singleton pregnancy who were in threatened preterm birth and had not received prior dexamethasone, who were admitted between 34 0/7 weeks and 36 6/7 weeks at Hue University of Medicine and Pharmacy Hospital from June 2018 to May 2020. The matched control group without dexamethasone use included 78 pregnant women diagnosed with threatened late preterm births who were at similar gestational ages and estimated fetal weights as the treatment group. The treatment group received 6 mg intramuscular dexamethasone every 12 h for a total of 4 doses or until delivery. Primary outcome was the rate of neonatal RD. Secondary neonatal outcomes included the need for respiratory support, neonatal intensive care unit (NICU) admission, hypoglycemia, necrotizing enterocolitis, intraventricular hemorrhage, and neonatal death. Statistical analyses were performed by using SPSS software, version 26.0.

Results

The proportion of RD in LPI was significantly lower in the treatment group than in the matched control group (10.3% vs. 23.1%, respectively), adjusted Odds Ratio [aOR] 0.29; 95% confidence interval [CI] 0.10 – 0.83 and p = 0.021. Neonatal hypoglycemia was more common in the dexamethasone group than in the matched group (25.6% vs. 12.8%, respectively; aOR, 2.59; 95% CI, 1.06 – 6.33; p = 0.037). There were no significant between-groups differences in the incidence of respiratory support, NICU admission or length of hospital stay.

Conclusions

Administration of antenatal dexamethasone to women at risk for late preterm birth could help to lower the proportion of respiratory distress in late preterm infants.
The combined effect of dichloroacetate and 3-bromopyruvate on glucose metabolism in colorectal cancer cell line, HT-29; the mitochondrial pathway apoptosis
Authors: Nikravesh Hojatolla , Khodayar Mohammad Javad , Behmanesh Babak , Mahdavinia Masoud , Teimoori Ali , Alboghobeish Soheila , Zeidooni Leila
Published: August 2021

Background

5-Fluorouracil (5-FU) is regarded as the first line treatment for colorectal cancer; however, its effectiveness is limited by drug resistance. The ultimate goal of cancer therapy is induction of cancer cell death to achieve an effective outcome with minimal side effects. The present work aimed to assess the anti-cancer activities of mitocans which can be considered as an effective anticancer drug due to high specificity in targeting cancer cells.

Methods

MTT (3–4,5-dimethylthiazol-2-yl-2,5-diphenyltetrazolium bromide) assay was performed to determine the effects of our mitocans on cell viability and cell death. Apoptosis and necrosis, caspase 3 activity, mitochondrial membrane potential and ROS production in HT29 cell lines were analyzed by ApopNexin™ FITC/PI Kit, Caspase- 3 Assay Kit, MitoTracker Green and DCFH-DA, respectively. Moreover, quantitative real-time polymerase chain reaction (qRT-PCR) was performed to detect the expression level of pro-apoptotic (Bax) and anti-apoptotic (Bcl-2) genes in HT29 cell lines.

Results

Treatment with mitocans (3Br-P + DCA) inhibited the growth of HT29. Moreover, 3Br-P + DCA significantly induced apoptosis and necrosis, activation of caspase 3 activity, depolarize the mitochondrial membrane potential, and ROS production. At a molecular level, 3Br-P + DCA treatment remarkably down-regulated the expression of Bcl-2, while up-regulated the expression of Bax.

Conclusion

Mitocans, in particular the combined drug, 3Br-P + DCA, could be regarded and more evaluated as a safe and effective compound for CRC treatment. Targeting hexokinase and pyruvate dehydrogenase kinase enzymes may be an option to overcome 5-FU -mediated chemo-resistant in colorectal cancer.
Elevated serum lactate as a predictor of outcomes in patients following major abdominal surgery at a tertiary hospital in Uganda
Authors: Henry Kiyemba , Merab Kadondi , Leonard Muyanja , Ronald Kintu-Luwaga , Nasser Kakembo , Moses Galukande
Published: August 2021

Introduction

Major abdominal surgery is still a great contributor to postoperative morbidity and mortality in developing countries. Major abdominal surgery leads to hypoperfusion, which has an impact on postoperative morbidity and mortality. Lactate, a biomarker for hypoperfusion is under utilized in Uganda. The study aimed to investigate the association between elevated serum lactate and outcomes (in-hospital mortality, SSI and length of hospital stay) in patients following major abdominal surgery.

Methods

A prospective observational cohort study was done with 246 eligible patients recruited. Stratified sampling was carried out till desired sample size was achieved. Demographic and perioperative data were collected, serum lactate levels were measured at induction and immediately after surgery with serial measurements being done after 12, 24 h post operatively. Participants were followed up to assess outcomes. Data analysis was done using STATA version 14.0.

Results

A total of 130 patients (52.8%) had elevated serum lactate levels. Elevated serum lactate predicted in-hospital mortality and surgical site infection. The accuracy of elevated serum lactate to predict mortality with AUROC of 0.7898 was exhibited by the 24 h lactate values. Elevated serum lactate predicted surgical site infection accurately with AUROC 0.6432. Length of hospital is strongly associated with elevated serum lactate with p-value of 0.043. Patients with elevated serum lactate on average have a longer length of hospital stay at 5.34 ± 0.69.

Conclusion

Elevated serum lactate was associated with in-hospital mortality, surgical site infection and longer length of hospital stay. Serum lactate levels done at 24 h were most predictive of mortality and surgical site infection.
Palliative care providers’ use of digital health and perspectives on technological innovation: a national study
Authors: Mills Jason , Fox Jennifer , Damarell Raechel , Tieman Jennifer , Yates Patsy
Published: August 2021

Background

While the need for digital health capability and technological innovation in palliative care services is growing rapidly, relatively little is known about the current uptake and views of individual palliative care practitioners. This study aims to explore palliative care practitioners’ current use of and perspectives on digital health innovation in palliative care.

Methods

A descriptive cross-sectional survey with a web-based questionnaire was used. Participants were multidisciplinary palliative care practitioners in Australia.

Results

Surveys were returned by 170 medical, nursing, and allied health practitioners working in palliative care. Most respondents reported using a variety of digital health technology associated with clinical information systems, mobile devices, SMS text messaging, teleconferencing, and Wi-Fi. These technologies were used for the purpose of communicating with other health professionals, accessing web-based or mobile health palliative care resources, collecting or managing patient data, and providing information or education. However, few reported electronic access to patients’ advance care planning documentation or could update these data. Respondents were moderately confident in their ability to use digital health, held positive beliefs that palliative care could be enhanced through digital health, and were generally supportive of ongoing innovation through digitally-enable models of care. Palliative care providers would most like to see digital health innovations in the areas of client health records, telehealth, and personal health tracking.

Conclusion

This is the first national study of digital health in Australian palliative care providers. It contributes new knowledge in this important area of palliative care practice to guide policy and education, whilst informing future directions for research.