bluuebunny/crossref_metadata_2025 huggingface dataset:
A Single Bout of Upper-Body Exercise Has No Effect on Postprandial Metabolism in Persons with Chronic Paraplegia
Authors: FARROW MATTHEW T. , MAHER JENNIFER L. , NIGHTINGALE TOM E. , THOMPSON DYLAN , BILZON JAMES L. J.
Published: February 2021

Purpose

The acute effects of a single bout of upper-body exercise on postprandial metabolism in persons with spinal cord injury are currently not well understood. The primary aim of this study was to evaluate the effects of a single bout of upper-body high-intensity interval exercise (HIIE) and moderate-intensity continuous exercise (MICE) in comparison with a no-exercise control (REST) condition on postprandial metabolic responses in persons with chronic paraplegia.

Methods

Ten participants (eight males, two females; age, 49 ± 10 yr; time since injury, 22 ± 13 yr) with chronic paraplegia took part in a randomized crossover study, consisting of three trials: HIIE (8 × 60 s at 70% peak power output [PPEAK]), MICE (25 min at 45% PPEAK), and REST, at least 3 d apart. Exercise was performed in the fasted state, and participants consumed a mixed-macronutrient liquid meal 1-h postexercise. Venous blood and expired gas samples were collected at regular intervals for 6-h postmeal consumption.

Results

There were no significant differences in postprandial incremental area under the curve for triglycerides (P = 0.59) or glucose (P = 0.56) between conditions. Insulin incremental area under the curve tended to be lower after MICE (135 ± 85 nmol·L−1 per 360 min) compared with REST (162 ± 93 nmol·L−1 per 360 min), but this did not reach statistical significance (P = 0.06, d = 0.30). Participants reported a greater fondness (P = 0.04) and preference for HIIE over MICE.

Conclusions

After an overnight fast, a single bout of upper-body exercise before eating has no effect on postprandial metabolism in persons with chronic paraplegia, irrespective of exercise intensity. This suggests that alternative exercise strategies may be required to stimulate postprandial substrate oxidation for this population.
MRI-based Measurement of Effects of Strength Training on Intramuscular Fat in People with and without Spinal Cord Injury
Authors: BOLSTERLEE BART , BYE ELIZABETH A. , EGUCHI JUNYA , THOM JEANETTE , HERBERT ROBERT D.
Published: February 2021

Introduction

The accurate quantification of the proportion of fat in human muscles could help monitor disease status and test effectiveness of interventions in people with neurological conditions whose skeletal muscles are frequently infiltrated with fat.

Methods

We compared two commonly used magnetic resonance imaging methods to quantify fat in muscles. Measurements were obtained before and after 6 or 8 wk of strength training in a total of 116 muscles spanning the range of intramuscular fat proportions observed in able-bodied young adults and people with spinal cord injury.

Results

We successfully measured fat proportions in all muscles using the mDixon method but were unable to obtain plausible measurements with the T1-weighted method from muscles of able-bodied individuals or from the leaner 23% of muscles of people with spinal cord injury (muscles with less than approximately 8% fat). In muscles with more fat, measurements obtained with the two methods agreed well (intraclass correlation coefficient, 0.88; mean absolute difference, 5%). We also found that, compared with the T1-weighted method, the mDixon method provides a more detailed characterization of fat infiltration in muscle and a less variable measurement of the effect of training on the proportion of fat. The mDixon method showed that 6 or 8 wk of strength training did not appreciably change the proportion of intramuscular fat in either people with spinal cord injury or able-bodied people.

Conclusion

On the basis of these findings, we recommend the use of mDixon methods in preference to T1-weighted methods to determine the effectiveness of interventions aimed at reducing intramuscular fat.
Climate Change, Air Pollution, and Physical Inactivity: Is Active Transportation Part of the Solution?
Authors: ALESSIO HELAINE M. , BASSETT DAVID R. , BOPP MELISSA J. , PARR BRIAN B. , PATCH GRETCHEN S. , RANKIN JANET W. , ROJAS-RUEDA DAVID , ROTI MELISSA W. , WOJCIK JANET R.
Published: February 2021

Active transportation is defined as self-propelled, human-powered transportation modes, such as walking and bicycling. In this article, we review the evidence that reliance on gasoline-powered transportation is contributing to global climate change, air pollution, and physical inactivity and that this is harmful to human health. Global climate change poses a major threat to human health and in the future could offset the health gains achieved over the last 100 yr. Based on hundreds of scientific studies, there is strong evidence that human-caused greenhouse gas emissions are contributing to global climate change. Climate change is associated with increased severity of storms, flooding, rising sea levels, hotter climates, and drought, all leading to increased morbidity and mortality. Along with increases in atmospheric CO2, other pollutants such as nitrogen dioxide, ozone, and particulate matter (e.g., PM2.5) are released by combustion engines and industry, which can lead to pulmonary and cardiovascular diseases. Also, as car ownership and vehicle miles traveled have increased, the shift toward motorized transport has contributed to physical inactivity. Each of these global challenges has resulted in, or is projected to result in, millions of premature deaths each year. One of the ways that nations can mitigate the health consequences of climate change, air pollution, and chronic diseases is through the use of active transportation. Research indicates that populations that rely heavily on active transportation enjoy better health and increased longevity. In summary, active transportation has tremendous potential to simultaneously address three global public health challenges of the 21st century.
Heat Reacclimation Using Exercise or Hot Water Immersion
Authors: GERRETT NICOLA , ALKEMADE PUCK , DAANEN HEIN
Published: February 2021

Introduction

The aim of this study was to compare the effectiveness of exercise versus hot water immersion heat reacclimation (HRA) protocols.

Methods

Twenty-four participants completed a heat stress test (HST; 33°C, 65% RH), which involved cycling at a power output equivalent to 1.5 W·kg−1 for 35 min whereby thermophysiological variables were measured. This was followed by a graded exercise test until exhaustion. HST1 was before a 10-d controlled hyperthermia (CH) heat acclimation (HA) protocol and HST2 immediately after. Participants completed HST3 after a 28-d decay period without heat exposure and were then separated into three groups to complete a 5-d HRA protocol: a control group (CH-CON, n = 8); a hot water immersion group (CH-HWI, n = 8), and a controlled hyperthermia group (CH-CH, n = 8). This was followed by HST4.

Results

Compared with HST1, time to exhaustion and thermal comfort improved; resting rectal temperature (T
re), end of exercise T
re, and mean skin temperature (T
sk) were lower; and whole body sweat rate (WBSR) was greater in HST2 for all groups (P < 0.05). After a 28-d decay, only WBSR, time to exhaustion, and mean T
sk returned to pre-HA values. Of these decayed variables, only WBSR was reinstated after HRA; the improvement was observed in both the CH-CH and the CH-HWI groups (P < 0.05).

Conclusion

The data suggest that HRA protocol may not be necessary for cardiovascular and thermal adaptations within a 28-d decay period, as long as a 10-d CH-HA protocol has successfully induced these physiological adaptations. For sweat adaptations, a 5-d CH or HWI-HRA protocol can reinstate the lost adaptations.
Effect of Leg Eccentric Exercise on Muscle Damage of the Elbow Flexors after Maximal Eccentric Exercise
Authors: CHEN TREVOR C. , CHEN HSIN-LIAN , CHENG LI-FU , CHOU TAI-YING , NOSAKA KAZUNORI
Published: February 2021

Purpose

The magnitude of muscle damage induced by maximal eccentric exercise is attenuated when the same exercise is repeated by homologous muscle of the ipsilateral or contralateral limb. It is not known if the muscle damage–protective effect is also transferred to nonhomologous muscles. The present study investigated the effects of unilateral knee extensor (KE) or flexor (KF) eccentric exercise on muscle damage induced by elbow flexor (EF) eccentric exercise of the ipsilateral or contralateral side.

Methods

Young healthy sedentary men were assigned to four experimental groups (n = 13 per group) that performed five sets of six maximal eccentric contractions (MaxEC) of the KE or KF of the same or opposite side of the arm that performed MaxEC of the EF 1 wk later, and a control group that performed two bouts of MaxEC of the EF using a different arm for each bout separated by 1 wk. Changes in several indirect muscle damage markers were compared among the groups by mixed-design, two-way ANOVA.

Results

Changes in maximal voluntary concentric contraction torque, range of motion, muscle soreness, and plasma creatine kinase activity after KE or KF MaxEC were not different (P > 0.05) between legs, but greater (P < 0.05) after KF than KE MaxEC. The changes in the variables after EF MaxEC in the experimental groups were not different (P > 0.05) from the first bout of the control group but larger (P < 0.05) than the second bout of the control group, and no differences between the ipsilateral and contralateral sides were evident.

Conclusions

These results showed that no protective effect on EF MaxEC was conferred by the leg exercises, suggesting that muscle damage protection was not transferred from KE or KF to EF.
Health Outcomes after Pregnancy in Elite Athletes: A Systematic Review and Meta-analysis
Authors: KIMBER MIRANDA L. , MEYER SARAH , MCHUGH TARA-LEIGH , THORNTON JANE , KHURANA RSHMI , SIVAK ALLISON , DAVENPORT MARGIE H.
Published: February 2021

Purpose

This study aimed to evaluate postpartum maternal health and training outcomes of females who were competing or training as elite athletes before or during pregnancy.

Methods

Online databases were searched up to August 26, 2020. Studies of any design and language were eligible if they contained information on the relevant population (postpartum athletes [any period after pregnancy]), exposure (engaged in the highest level of sport immediately before or during pregnancy), comparators (sedentary/active controls), and outcomes: maternal (breastfeeding initiation and duration, postpartum weight retention or loss, bone mineral density, low back or pelvic girdle pain, incontinence [prevalence or severity of stress, urge or mixed urinary incontinence, fecal incontinence], injury, anemia, diastasis recti, breast pain, depression, anxiety) and training (<6 wk time to resume activity, training volume or intensity, performance level).

Results

Eleven studies (n = 482 females, including 372 elite athletes) were included. We identified “very low” certainty evidence demonstrating a higher rate of return to sport before 6 wk postpartum among elite athletes compared with nonelite athletes (n = 145, odds ratio = 6.93, 95% confidence interval = 2.73–17.63, I
2 = 11). “Very low” certainty evidence from three studies (n = 179) indicated 14 elite athletes obtained injuries postpartum (7 stress fractures, 9 “running injuries”). “Very low” certainty evidence from five studies (n = 262) reported that 101 (40.5%) elite athletes experienced improved performance postpartum.

Conclusion

Compared with controls, “very low” quality evidence suggests that elite athletes return to physical activity early in the postpartum period and may have an increased risk of injury. Additional high-quality evidence is needed to safely guide return to sport of elite athletes in the postpartum period.
Effects of 150- and 450-mL Acute Blood Losses on Maximal Oxygen Uptake and Exercise Capacity
Authors: SKATTEBO ØYVIND , JOHANSEN ESPEN SPRO , CAPELLI CARLO , HALLÉN JOSTEIN
Published: February 2021

Purpose

This study investigated whether maximal oxygen uptake (V˙O2max) and exercise capacity are affected by small acute blood loss (150 mL) and elucidated compensatory mechanisms.

Methods

Thirteen male subjects (V˙O2max, 63 ± 9 mL·kg−1·min−1; mean ± SD) performed incremental exercise to exhaustion on a cycle ergometer in three experimental conditions: in euvolemia (control; blood volume [BV], 6.0 ± 0.7 L) and immediately after acute BV reductions of 150 mL (BVR150mL) and 450 mL (BVR450mL). Changes in plasma volume (PV) and BV during exercise were calculated from hematocrit, hemoglobin concentration, and hemoglobin mass (carbon monoxide rebreathing).

Results

The reduction in V˙O2max per milliliter of BVR was 2.5-fold larger after BVR450mL compared with BVR150mL (−0.7 ± 0.3 vs −0.3 ± 0.6 mL·min−1·mL−1, P = 0.029). V˙O2max was not significantly changed after BVR150mL (−1% ± 2%, P = 0.124) but reduced by 7% ± 3% after BVR450mL (P < 0.001) compared with control. Peak power output only decreased after BVR450mL (P < 0.001). At maximal exercise, BV was restored after BVR150mL compared with control (−50 ± 185 mL, P = 0.375) attributed to PV restoration, which was, however, insufficient in restoring BV after BVR450mL (−281 ± 184 mL, P < 0.001). The peak heart rate tended to increase (3 ± 5 bpm, P = 0.062), whereas the O2 pulse (−2 ± 1 mL per beat, P < 0.001) and vastus lateralis tissue oxygenation index (−4% ± 8% points, P = 0.080) were reduced after BVR450mL, suggesting decreased stroke volume and increased leg O2 extraction.

Conclusion

The deteriorations of V˙O2max and of maximal exercise capacity accelerate with the magnitude of acute blood loss, likely because of a rapid PV restoration sufficient to establish euvolemia after a small but not after a moderate blood loss.
Randomized Trial Examining the Effect of a 12-wk Exercise Program on Hedonic Eating
Authors: UNICK JESSICA L. , DUNSIGER SHIRA I. , LEBLOND TIFFANY , HAHN KORINA , THOMAS J. GRAHAM , ABRANTES ANA M. , STROUD LAURA R. , WING RENA R.
Published: February 2021

Nonhomeostatic (or hedonic) eating can be detrimental to weight control efforts, yet the effect of exercise on hedonic eating is unclear.

Purpose

This efficacy trial tests the hypothesis that exercise training favorably affects hedonic eating (i.e., overeating, stress-induced overeating, disinhibited eating, eating when tempted), in a sample of women who are overweight or obese.

Methods

Participants were inactive at baseline, self-identified as “stress eaters,” and were randomized to 12 wk of moderate-intensity exercise training (EX; combination of supervised and objectively confirmed unsupervised sessions) or to a no-exercise control condition (CON). EX participants were given an exercise goal of 200 min·wk−1. No dietary instructions or weight control strategies were provided. Assessments occurred at baseline and 12 wk. Overeating episodes, stress-induced overeating, and dietary temptations were measured over 14 d at each assessment using ecological momentary assessment. Disinhibition and dietary restraint were assessed via a questionnaire.

Results

Forty-nine participants (age, 40.4 ± 10.8 yr; body mass index, 32.4 ± 4.1 kg·m−2) enrolled, and 39 completed this study. Adherence to the exercise intervention was high (99.4% of all prescribed exercise). At week 12, the proportion of eating episodes that were characterized as overeating episodes was lower in EX versus CON (21.98% in EX vs 26.62% in control; P = 0.001). Disinhibition decreased in EX but not in CON (P = 0.02) and was driven by internal factors. There was a trend such that CON was more likely to give into dietary temptations (P = 0.08). Stress-induced overeating was low and did not differ between conditions (P = 0.61).

Conclusions

Exercise training reduced the likelihood of overeating and eating in response to internal cues in women who self-identified as stress eaters. This may be one pathway by which exercise affects body weight.
Physical Activity Engagement Worsens Health Outcomes and Limits Exercise Capacity in Growth-restricted Mice
Authors: FERGUSON DAVID P. , LESZCZYNSKI ERIC C. , MCPEEK ASHLEY C. , PENDERGRAST LOGAN A. , VISKER JOSEPH R. , TRIPLETT ASHLEY N.
Published: February 2021

Introduction

A total of 161 million children a year are growth restricted, leading to a 47% increased risk of chronic disease in adulthood. Physical activity (PA) reduces the risk of mortality from chronic disease. The purpose of the present investigation was to determine the effect of a PA intervention (wheel running) on cardiac and skeletal muscle capacities in gestational (GUN) and postnatal (PUN) growth-restricted mice as compared with nonrestricted controls (CON).

Methods

A low-protein cross-fostering FVB mouse model was used to induce growth restriction during gestation and the first 21 d of postnatal life. Mouse pups were recovered on a healthy diet until mature and provided wheel access for 3 wk. At completion of the PA intervention, mice underwent maximal exercise testing on a treadmill, echocardiography, and skeletal muscle histology.

Results

After the PA intervention, CON mice had a 45% improvement in maximal exercise capacity (P = 0.0390) because of cardiac and skeletal muscle adaptations, but GUN and PUN mice did not. Alarmingly, PUN female mice exposed to wheels had 11.45% lower left ventricular volume (P = 0.0540) and 18% lower left ventricle area (P = 0.0585), with blood flow velocities indicative of cardiac fibrosis (GUN had elevated isovolumetric contraction time P = 0.0374; GUN females and PUN males had longer isovolumetric relaxation time P = 0.0703). PUN male mice had mixed skeletal muscle responses with an oxidative shift in the diaphragm (P = 0.0162) but a glycolytic shift in the extensor digitorum longus (P = 0.0647). PUN female mice had a glycolytic shift in the soleus after wheel running.

Conclusions

Unexpectedly, growth-restricted mice were nonresponders to a PA intervention and displayed negative cardiac outcomes.
Mobile Health Augmented Cardiac Rehabilitation (MCard) in Post-Acute Coronary Syndrome Patients: A randomised controlled trial protocol
Authors: Hisam Aliya , Haq Zia Ul , Khan Zohaib , Doherty Patrick , Pell Jill
Published: February 2021

Objectives: To determine the effectiveness of mobile health augmented cardiac rehabilitation (MCard) on health-related quality of life (HRQoL), clinical and behavioural outcomes in post-ACS.

Methods: A single-centre, single-blinded, two-arm randomised controlled trial is planned at Armed Forces Institute of Cardiology (AFIC), Pakistan. The duration was two years, that is from January 2019 till December 2020. A total of 160 participants were recruited and randomly allocated to the control group or the intervention group. Intervention is a mobile health augmented cardiac rehabilitation (MCard), a medically supervised cardiac rehabilitation program for 23-24 weeks. The phase one includes individual counselling during the hospital stay and in phase two includes communication of standardised messages related to healthy lifestyle modification through a specifically designed software.

Results: This clinical trial results will give insight into the impact of MCard in improving the health outcomes (HRQoL, clinical and behavioural) of participants. If proven to be effective, this technology can be scaled up and implemented in other cardiac centres in the country. It utilises fewer human resources and can be delivered at a lower cost.

Conclusion: The study protocol will be giving evidence either MCard can contribute to improving the HRQoL, clinical and behavioural outcomes of post-ACS patients following hospital discharge. Considering the COVID-9 situation, this is the perfect time to implement and evaluate the effectiveness of MCard on health outcomes among post-ACS patients.

doi: https://doi.org/10.12669/pjms.37.3.3664

How to cite this:Hisam A, Zia-Ul-Haq, Khan Z, Doherty P, Pell J. Mobile Health Augmented Cardiac Rehabilitation (MCard) In Post-Acute Coronary Syndrome Patients: A randomised controlled trial protocol. Pak J Med Sci. 2021;37(3):890-896. doi: https://doi.org/10.12669/pjms.37.3.3664

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Oral versus Vaginal Micronized Progesterone for the treatment of threatened miscarriage
Authors: Parveen Rashida , Khakwani Mehnaz , Tabassum Sobia , Masood Sajjad
Published: February 2021

Objectives: This study was planned with an aim to find out the effectiveness of oral versus vaginal micronized progesterone for the treatment of threatened miscarriage.

Methods: This randomized controlled trial was conducted at The Department of Obstetrics and Gynaecology, Nishtar Hospital Multan, from August 2019 to January 2020. A total of 136 pregnant women, aged 18 to 45 years having vaginal bleeding were included and divided into two groups (68 women in each group). Participants in the Group-A were given oral micronized progesterone as 200mg twice a day while Group-B participants were given vaginal progesterone suppository 400mg once a day. All women were followed up until 20th week of their pregnancy. Outcome was labeled as prevention of miscarriage if woman had no bleeding per vagina and pregnancy went beyond 20th weeks of gestation.

Results: In a total of 136 women enrolled, mean age was noted to be 30.85+3.34 years. Overall, mean gestational age was noted to be 9.3+2.7 weeks. A total of 98 women (49 in each group) completed the follow up and were included in the final analysis regarding outcome. Among Groups-A, 45 (91.8) had prevention of miscarriage while 4 (9.2%) had miscarriage in comparison to 36 (73.5%) in Group-B had prevention of miscarriage whereas 13 (26.5%) had miscarriage and this difference was statistically significant in between the both study groups as women in Group-A had significantly better outcome in terms of prevention of miscarriage. (P value = 0.0164).

Conclusion: The use of oral micronized progesterone was found to be significantly more effective than vaginal progesterone in women with threatened miscarriage.

doi: https://doi.org/10.12669/pjms.37.3.3700

How to cite this:Parveen R, Khakwani M, Tabassum S, Masood S. Oral versus Vaginal Micronized Progesterone for the treatment of threatened miscarriage. Pak J Med Sci. 2021;37(3):628-632. doi: https://doi.org/10.12669/pjms.37.3.3700

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Aftermath of traumatic tympanic membrane perforation: Our findings at a tertiary care hospital in Pakistan
Authors: Wahid Fazali , Saleem Muhammad , Muhammad Raza , Khan Muhammad Riaz
Published: February 2021

Objectives: To determine the outcome of traumatic tympanic membrane perforation in a teaching hospital at Peshawar, Pakistan.

Methods: This prospective observational study was performed in the Department of ENT and Head and Neck Surgery, MTI/LRH, Peshawar, Pakistan from January 2016 to December 2019 after approved from Institutional Research and Ethical Board. All consented patients fulfilling inclusion criteria were enrolled. Sample size was calculated 114 using online sample size calculator (OpenEpi). Every patient was evaluated properly, subsequently otoscopy and PTA was performed. Required information was recorded and analyzed using SPSS (version 25).

Results: Out of 114 patients 81 (71.1%) were males and 33(28.9%) were female with male: female ratio of 2.5:1. Patient’s age ranged from 6- 55 years with mean ± SD age of 26.41 ± 9.7 years. Majority of Patients, 46.5%( 53) were in 2nd decade. Amongst the causes slap outnumbered (80, 70.2%), and left ear was involved predominately (67, 58.7%) affecting mainly anterio-inferior quadrant (50, 43.9%). Small size perforation was most common finding (64, 56.1%). Majority of patients (72, 63.2%) presented in a week time and single perforation was the commonest (107, 93.%). Most of traumatic TM perforation got healed spontaneously (97, 85.1%).

Conclusion: It is concluded that spontaneous healing of traumatic membrane perforation occurs in more than 90% cases provided the ear is kept dry and not accompanied by unfavorable conditions.

doi: https://doi.org/10.12669/pjms.37.3.3923

How to cite this:Wahid FI, Saleem M, Muhammad R, Khan MR. Aftermath of traumatic tympanic membrane perforation: Our findings at a tertiary care hospital in Pakistan. Pak J Med Sci. 2021;37(3):874-878. doi: https://doi.org/10.12669/pjms.37.3.3923

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Prevention of Bortezomib-Induced Polyneuropathy in Multiple Myeloma Patients
Authors: Garrido David , Riva Eloisa
Published: February 2021

Bortezomib (Velcade®) is a proteasome pathway inhibitor that has improved multiple myeloma (MM) overall survival. Bortezomib-induced peripheral neuropathy (BIPN) is a frequent adverse event, requiring delay, dose reduction or cessation of therapy. Although most of the symptoms resolve after discontinuation or dose-reduction, almost 25% develop chronic symptoms, affecting quality of life and limiting the therapeutic choices.
There is limited evidence regarding the strategies to prevent bortezomib-induced polyneuropathy (BIPN). We conducted a review of the published data to summarize the available information regarding BIPN prevention strategies.
Our search included literature published in the Cochrane Library databases, Medline/PubMed, SciELO, Google Scholar, and Trip Database in the last ten years, including observational analytic studies, experimental studies, systematic reviews, and metanalysis, which reported the efficacy of interventions to prevent BIPN.
Eight studies have been included. The subcutaneous administration of bortezomib has shown a protective effect of all grades of BIPN (OR=0.40, 95% CI 0.27 to 0.59, p<0.001) and grade 3 to 4 (OR = 0.45, 95% CI 0.25 to 0.82, P<0.05), as evidenced in a metanalysis. Cumulative dose of bortezomib > 30 mg/m2 is significantly associated with a higher risk of BIPN.
Other therapies as Acetyl-l-carnitine (ALC), dexamethasone in partnered dosing (day of/after bortezomib), high-dose intravenous mecobalamin (HDIME), and the combination of docosahexaenoic acid, α-lipoic acid, vitamin C 60 mg, and vitamin E have been assessed but their efficacy for BIPN prevention has not been confirmed.
We conclude that the subcutaneous route of administration of bortezomib effectively prevents BIPN while other strategies lack robust evidence to be recommended.
Opening Up While Closing Up: Balancing China's State Secrecy Needs and Military-Civil Fusion
Authors: Yang Zi
Published: February 2021

executive summary: This essay analyzes China's state secrecy system and assesses its influence on the Military-Civil Fusion (MCF) strategy that aims to strengthen the defense industry. main argumentMCF seeks to reinvigorate China's state-owned defense sector with nonstate inputs and integrate the defense economy with the nation's overall economic development. As a result, greater transparency and sharing of information between state and nonstate MCF participants has occurred. As defense sector openness increases, a major concern for the Chinese government is the safekeeping of state secrets. The state secrecy system led by the Chinese Communist Party has jurisdiction over the whole of MCF, and stringent rules regulating nearly every level of the initiative have been instituted. Yet the rigidity of this system could hamper progress and impede the realization of MCF goals. policy implications • China maintains an elaborate bureaucracy to safeguard state secrets. As the country's security environment tightens, the secrecy system is positioned to gain additional influence over MCF. • MCF has further opened up the state-dominated defense industry to nonstate actors, prompting greater transparency regarding the inner workings of China's defense industry. This development could lead to a clearer understanding of emerging MCF industry leaders as well as Chinese defense enterprises' interactions with nonstate partners that serve as the intermediaries of foreign engagement. • State secrecy requirements add uncertainty to MCF's future. As market forces demand additional information sharing, the state secrecy bureaucracy will likely oppose such needs. Ultimately, the Chinese government must decide whether to give precedence to market forces or security priorities.
Adapting or Atrophying? China's Belt and Road after the Covid-19 Pandemic
Authors: Ye Min
Published: February 2021

executive summary: This article analyzes Chinese policy discourse and activities before and after the Covid-19 outbreak and evaluates the prospects of China's Belt and Road Initiative (BRI). main argumentFrom January to June 2020, China experienced the full cycle of Covid-19: outbreak, containment, economic reopening, and return of political life. The country's policy discourse and activities during the cycle show that the BRI strategy maintains a high level of continuity after the pandemic. Specifically, motivations for the initiative today are similar to those at its launch in 2013, and interests developed during its implementation have grown following the Covid-19 outbreak, albeit with different emphases. Overall, Chinese "middle elites" will continue to help stabilize BRI and globalization during the Covid-19 pandemic and beyond. policy implications • The Covid-19 pandemic has intensified geopolitical and societal tensions between China and other countries. Yet beyond political and popular rhetoric, Chinese policy elites are pragmatic and remain committed to BRI and globalization. They offer a stabilizing force against the potential "deglobalization" wave in a post-pandemic world. • China's motivations and activities behind BRI have continued during the Covid-19 cycle. As the country recovers from the pandemic, it is likely to pursue BRI with more deliberation at home and more opportunities abroad. • Inevitably, post-pandemic globalization will have different priorities. In BRI, plans for some hard infrastructure projects are likely to give way to softer and more socially inclusive areas of cooperation, such as information technology, medicine, education, and the environment. • Going beyond the pandemic, we need to pay attention to discourse and activities by professional and policy communities in China and other countries. The "middle elites" are likely to foretell and shape future trajectories in BRI and globalization.
Pyongyang's Failure: Explaining North Korea's Inability to Normalize Diplomatic Relations with the United States
Authors: Pardo Ramon Pacheco
Published: February 2021

executive summary: This article analyzes North Korea's failure to normalize diplomatic relations with the U.S. and argues that this failure is largely the result of Pyongyang's poor choice of bargaining tactics. main argumentNormalization of diplomatic relations with the U.S. is a long-term North Korean foreign policy goal, dating back to 1974. Since the end of the Cold War, normalization has become a realistic prospect. Indeed, the four U.S. presidents between 1992 and 2019 reached agreements with North Korea making explicit reference to diplomatic normalization. North Korea, however, has failed in its goal even as other Communist countries and nuclear powers that are not signatories to the Nuclear Non-Proliferation Treaty have established—or maintained—diplomatic relations with the U.S. A key reason behind this failure is Pyongyang's poor choice of bargaining tactics to negotiate with Washington. As a weak power negotiating with a more powerful counterpart, North Korea can choose whether to soft balance or bandwagon, whether to use brinkmanship, and whether to engage with multilateral regimes. Informed by its political culture, North Korea's most common choices have included a weak commitment to soft balancing, including with South Korea; a decisive use of brinkmanship; and a rejection of international regimes. These choices have antagonized successive U.S. administrations, preventing North Korea from achieving diplomatic normalization. policy implications • North Korea has a long history of making poor choices to successfully bargain with the U.S. to achieve diplomatic normalization, one of its key long-term policy goals. Pyongyang should refrain from brinkmanship, pursue soft balancing with third parties such as South Korea, and participate in multilateral regimes. • The U.S. should nudge North Korea toward this choice of bargaining tactics, given the benefits. These benefits include lower tensions on the Korean Peninsula, a clear choice presented to Pyongyang, and the possibility of discussing denuclearization. • The U.S. should approach relations with North Korea fully aware that normalization of diplomatic relations is a long-term foreign policy ambition that could persuade Pyongyang to contemplate denuclearization in the future. Without diplomatic normalization, however, denuclearization is not a realistic goal.
Indonesia between the United States and China in a Post-Covid-19 World Order
Authors: Sulaiman Yohanes , Delanova Mariane , Jati Rama Daru
Published: February 2021

executive summary: This essay examines the changing relationship between the U.S. and China, the impacts of the Covid-19 pandemic on both their relationship and each country's external influence, and the implications for Southeast Asia, particularly Indonesia. main argumentThe tension between the U.S. and China had already begun to rise before the Covid-19 pandemic, as China has been challenging U.S. global leadership for some time. But the pandemic has worsened this rivalry by reducing trust between the two powers. The U.S. has blamed China for what it sees as Beijing's mishandling of the pandemic's outbreak, and the new Biden administration is likely to maintain a hostile policy. China, on the other hand, will keep deflecting such accusations because accepting the blame will set back its ambition to be global leader and undermine the legitimacy of the Chinese Communist Party domestically. The pandemic has already cost China dearly, as states now see the country as less trustworthy. The post-Covid-19 world will be one that is far more dangerous and conflict-prone due to this lack of trust between great powers and between states in general. The adverse impacts will be strongly felt by Southeast Asia, and especially Indonesia, whose leadership in ASEAN could be eroded. policy implications • With rising tension between the U.S. and China, both countries will try to pull Southeast Asian states into their orbits. • In the case of China, its ham-fisted policies in the South China Sea will prevent the country from rallying Southeast Asian states fully to its side. • Given the strategic importance of Southeast Asia in the Sino-U.S. rivalry, the U.S. needs to prioritize rebuilding its relationships with regional states that were neglected by the Trump administration. • Indonesia has a difficult role to play in balancing the interests of both the U.S. and China while maintaining its informal leadership of ASEAN. Therefore, it needs to leverage its position within ASEAN to craft a common policy to achieve its national foreign policy objectives, notably maintaining regional stability, especially in the South China Sea.
Hybrid registration of retinal fluorescein angiography and optical coherence tomography images of patients with diabetic retinopathy
Authors: Golkar Ehsan , Rabbani Hossein , Dehghani Alireza
Published: February 2021

Diabetic retinopathy (DR) is a common ophthalmic disease among diabetic patients. It is essential to diagnose DR in the early stages of treatment. Various imaging systems have been proposed to detect and visualize retina diseases. The fluorescein angiography (FA) imaging technique is now widely used as a gold standard technique to evaluate the clinical manifestations of DR. Optical coherence tomography (OCT) imaging is another technique that provides 3D information of the retinal structure. The FA and OCT images are captured in two different phases and field of views and image fusion of these modalities are of interest to clinicians. This paper proposes a hybrid registration framework based on the extraction and refinement of segmented major blood vessels of retinal images. The newly extracted features significantly improve the success rate of global registration results in the complex blood vessel network of retinal images. Afterward, intensity-based and deformable transformations are utilized to further compensate the motion magnitude between the FA and OCT images. Experimental results of 26 images of the various stages of DR patients indicate that this algorithm yields promising registration and fusion results for clinical routine.
Absolute distance measurement using laser interferometric wavelength leverage with a dynamic-sideband-locked synthetic wavelength generation
Authors: Yan Liping , Xie Jiandong , Chen Benyong , Lou Yingtian , Zhang Shihua
Published: February 2021

Absolute distance measurement with laser interferometry has the advantages of high precision and traceability to the definition of meter but its accuracy is primarily limited by the phase demodulation. Among kinds of absolute distance interferometric measurements, the multi-wavelength interferometry is widely used but seriously limited by the generation of suitable synthetic wavelength and the stability of adopted synthetic wavelength. Inspired by the mechanical lever, we hereby establish a principle of laser interferometric wavelength leverage (LIWL) for absolute distance measurement. By keeping the phase difference in two single wavelengths constant, LIWL achieves the measurement of large distance with respect to synthetic wavelengths by detecting nanometer displacement with respect to a single wavelength. The merit of LIWL is eliminating the influence of phase demodulation error. And a dynamic-sideband locking method based on a high-frequency electro-optic modulator is proposed, which can flexibly and quickly generate variable synthetic wavelengths from tens of kilometer to millimeter with high stability. Experimental setup was constructed and absolute distance measurements were performed. Experimental results show that a measurement range of 100 m with residual error of less than 15 µm has been achieved by comparing the LIWL system and an incremental laser interferometer.
Virtual view synthesis for 3D light-field display based on scene tower blending
Authors: Chen Duo , Sang Xinzhu , Wang Peng , Yu Xunbo , Gao Xin , Yan Binbin , Wang Huachun , Qi Shuai , Ye Xiaoqian
Published: February 2021

Three-dimensional (3D) light-field display has achieved a great improvement. However, the collection of dense viewpoints in the real 3D scene is still a bottleneck. Virtual views can be generated by unsupervised networks, but the quality of different views is inconsistent because networks are separately trained on each posed view. Here, a virtual view synthesis method for the 3D light-field display based on scene tower blending is presented, which can synthesize high quality virtual views with correct occlusions by blending all tower results, and dense viewpoints on 3D light-field display can be provided with smooth motion parallax. Posed views are combinatorially input into diverse unsupervised CNNs to predict respective input-view towers, and towers of the same viewpoint are fused together. All posed-view towers are blended as a scene color tower and a scene selection tower, so that 3D scene distributions at different depth planes can be accurately estimated. Blended scene towers are soft-projected to synthesize virtual views with correct occlusions. A denoising network is used to improve the image quality of final synthetic views. Experimental results demonstrate the validity of the proposed method, which shows outstanding performances under various disparities. PSNR of the virtual views are about 30 dB and SSIM is above 0.91. We believe that our view synthesis method will be helpful for future applications of the 3D light-field display.
Experimental analysis of the measurement precision of spectral water-leaving radiance in different water types: comment
Authors: Zibordi Giuseppe
Published: February 2021

This work aims at commenting requirements and conclusions in a recent paper [Wei et al.,Opt. Express29,2780(2021)10.1364/OE.413784] presenting an evaluation of the precision of water-leaving radiance measurements from a near-surface method. Specifically, this work challenges the uncertainty requirements indicated for satellite ocean color system vicarious calibration resulting from an erroneous interpretation of literature, and an incorrect application of radiometry principles leading to a misestimate of the difference between radiances collected by nadir-view optical sensors operated below and above the water surface.
Fecal Microbiota Transplantation: The Evolving Risk Landscape
Authors: Gupta Sanchit , Mullish Benjamin H. , Allegretti Jessica R.
Published: February 2021

Fecal microbiota transplantation (FMT) has been recommended in clinical guidelines for the treatment of recurrent Clostridioides difficile infection (CDI). However, it is considered investigational by most regulatory agencies. As the adoption of FMT has increased from a small group of CDI experts alone to more widespread use, there has been a corresponding increase in concern regarding potential risk. FMT is largely considered a safe procedure although risks described range from mild gastrointestinal symptoms to serious infection. Currently, there is variability in how “FMT” is characterized specifically regarding testing approach, which, in turn, impacts the risk profile. This has been highlighted by the rare cases of multidrug-resistant organisms, Shiga toxin–producing Escherichia and enteropathogenic E. coli, recently reported, where these organisms were not screened. These cases have prompted additional screening mandates from the US Food and Drug Administration (FDA), which has maintained its policy of enforcement discretion for the use of FMT for CDI not responding to standard therapy. Here, we examine the evolving risk landscape of FMT.
How the North American Consensus Protocol Affects the Performance of Glucose Breath Testing for Bacterial Overgrowth Versus a Traditional Method
Authors: Baker Jason R. , Chey William D. , Watts Lydia , Armstrong Moira , Collins Kristen , Lee Allen A. , Dupati Ajith , Menees Stacy , Saad Richard J. , Harer Kimberly , Hasler William L.
Published: February 2021

INTRODUCTION:

The North American Consensus guidelines for glucose breath testing (GBT) for small intestinal bacterial overgrowth (SIBO) incorporated changes in glucose dosing and diagnostic cutoffs. We compared GBT positivity based on hydrogen and methane excretion and quantified symptoms during performance of the North American vs older modified Rome Consensus protocols.

Methods:

GBT was performed using the North American protocol (75 g glucose, cutoffs >20 parts per million [ppm] hydrogen increase after glucose and >10 ppm methane anytime) in 3,102 patients vs modified Rome protocol (50 g glucose, >12 ppm hydrogen and methane increases after glucose) in 3,193 patients with suspected SIBO.

Results:

Positive GBT were more common with the North American vs modified Rome protocol (39.5% vs 29.7%, P < 0.001). Overall percentages with GBT positivity using methane criteria were greater and hydrogen criteria lower with the North American protocol (P < 0.001). Peak methane levels were higher for the North American protocol (P < 0.001). Times to peak hydrogen and methane production were not different between protocols. With the North American protocol, gastrointestinal and extraintestinal symptoms were more prevalent after glucose with both positive and negative GBT (P
< 0.04) and greater numbers of symptoms (P < 0.001) were reported.

DISCUSSION:

GBT performed using the North American Consensus protocol was more often positive for SIBO vs the modified Rome protocol because of more prevalent positive methane excretion. Symptoms during testing were greater with the North American protocol. Implications of these observations on determining breath test positivity and antibiotic decisions for SIBO await future prospective testing.
Hepatitis Flare During Immunotherapy in Patients With Current or Past Hepatitis B Virus Infection
Authors: Wong Grace Lai-Hung , Wong Vincent Wai-Sun , Hui Vicki Wing-Ki , Yip Terry Cheuk-Fung , Tse Yee-Kit , Liang Lilian Yan , Lui Rashid Nok-Shun , Mok Tony Shu-Kam , Chan Henry Lik-Yuen , Chan Stephen Lam
Published: February 2021

INTRODUCTION:

Immunotherapy has dramatically improved the survival of patients with advanced or metastatic malignancies. Recent studies suggest that immunotherapy may increase the risk of hepatitis, whereas it may also induce functional cure of chronic hepatitis B virus (HBV) infection. We evaluated the incidence of hepatitis flare, HBV reactivation, hepatitis B surface antigen (HBsAg) seroclearance or seroreversion in patients with current or past HBV infection who had received immunotherapy.

METHODS:

This was a territory-wide observational cohort study in Hong Kong. We identified patients through electronic medical records based on the prescriptions of immune checkpoint inhibitors from July 1, 2014, to December 31, 2019. Patients who were HBsAg positive or HBsAg negative with results for antibody to hepatitis B surface or core antigen (anti-HBs or anti-HBc) were included.

RESULTS:

A total of 990 patients (397 HBsAg-positive, 593 HBsAg-negative with 482 anti-HBc and/or anti-HBs positive, and 111 both anti-HBc and anti-HBs negative) were identified. All of HBsAg-positive and 15.9% HBsAg-negative patients were put on oral antiviral treatment. Hepatitis flare (alanine aminotransferase >2 times of the upper limit of normal) occurred in 39.3% HBsAg-positive and 30.4% HBsAg-negative patients. High baseline alanine aminotransferase and combination of immunotherapy increased the risk of hepatitis. HBV reactivation (≥2 log increase in HBV DNA from baseline) occurred in 2 HBsAg-positive patients; HBsAg seroclearance and seroreversion was observed in 1 HBsAg-positive and 1 HBsAg-negative patient, respectively (<1%).

DISCUSSION:

Hepatitis flare occurs in approximately 40% of HBsAg-positive patients and 30% of HBsAg-negative patients during immunotherapy. HBV reactivation, HBsAg seroclearance, and HBsAg seroreversion are rare. Current or past HBV infection has no impact on the emergence of hepatic flare associated with immunotherapy.