bluuebunny/crossref_metadata_2025 huggingface dataset:
Start-up Village Entrepreneurship Programme: ‘From Local to Vocal’
Authors: Dixit Krishna , Sakunia Debashish
Published: February 2022

Rural entrepreneurship is one of the most attention-seeking segments nowadays, because if we want to solve the various problems in the third-most rising economy with rural composition at 68.8%, we need to open new rural ventures. So rural entrepreneurship defines itself by creating new employment opportunities and creating new ventures. Through this article, researchers want to stress readers on the current schemes for rural ventures and focus on the Start-up Village Entrepreneurship Programme (SVEP), introduced by the Ministry of Rural Development and supported by the National Rural Livelihoods Mission (NRLM), which provides sustainable employment to youths in villages. We have explained the whole process of SVEP by citing an example of two blocks of Chhattisgarh state then we measure the impact of this programme in 11 states on different social categories, gender-wise analysis in which female dominates, as well as overall impact among the different enterprise in India. It was found that the trading sector creates the highest overall impact among the new ventures. Among all the social categories we have, the list of beneficiaries includes OBC Category with the mean value of 475.90 in 2018, while 972.72 in 2019 followed by ST, SC, General and Minority. The result found could be a demographic dividend because of stratified random sampling.
Book review: Dwaipayan Sen, The Decline of the Caste Question: Jogendranath Mandal and the Defeat of the Dalit Politics in Bengal
Authors: Ansary Mustakim
Published: February 2022

Dwaipayan Sen, The Decline of the Caste Question: Jogendranath Mandal and the Defeat of the Dalit Politics in Bengal. New York, NY: Cambridge University Press, 2018, xii + 305 pp., ₹7725.00 (Hardcover). ISBN: 9781108417761.
Feminist NGOs: Building Resilience in Low-income Single Moms
Authors: Caragata Lea
Published: February 2022

This article discusses risk and protective factors impacting resilience through exploring how and why some mothers were able to achieve positive outcomes (economically, socially, as parents) in spite of adversity. By employing a qualitative research method and participatory action research, data were collected from 20 in-depth individual interviews, 3 focus groups with 18 participants and case profiles from the larger data set. The analysis counters the dominant individualism ideologies, which make the person solely responsible for their situation, and instead, argues that social structures can play important roles in building resilience and capacity. Practices of feminist NGOs reported in this study confirm this. The analysis has implications for changing practices in welfare bureaucracies and supporting feminist and similar NGOs.
Brain Networks of Connectionally Unique Basolateral Amygdala Cell Types
Authors: Hintiryan Houri , Dong Hong-Wei
Published: February 2022

Different brain regions structurally interconnected through networks regulate behavior output. Therefore, understanding the functional organization of the brain in health and disease necessitates a foundational anatomic roadmap to its network organization. To provide this to the research community, our lab has systematically traced thousands of pathways in the mouse brain and has applied computational measures to determine the network architecture of major brain systems. Toward this effort, the brain-wide networks of the basolateral amygdalar complex (BLA) were recently generated. The data revealed uniquely connected cell types within the same BLA nucleus that were constituents of distinct neural networks. Here, we elaborate on how these connectionally unique BLA cell types fit within the larger cortico-basal ganglia and limbic networks that were previously described by our team. The significance and utility of high quality, detailed anatomic data is also discussed.
Estimating shallow shear-wave velocity profiles in Alaska using the initial portion of P waves from local earthquakes
Authors: Skarlatoudis Andreas A , Thio Hong Kie , Somerville Paul G
Published: February 2022

The Alaska Regional Network and Transportable Array provide an invaluable waveform data set for studying ground motions in Alaska. However, the data set is useful only after the site effects at each station are well understood. Considering the large number of stations associated with these networks, it would be onerous to measure the sub-surface velocity structure beneath every station using geophysical exploration techniques involving arrays, such as active-source or passive-source non-invasive array methods. Instead, it is more economical to estimate the site conditions using waveforms recorded at the seismic stations. Most of the methods for estimating site response from recorded waveforms use the frequency-dependent ratio between the horizontal and vertical component of either ambient noise or S waves from earthquakes. We instead use the horizontal and vertical component of P waves to infer the sub-surface velocity structure. It has been demonstrated that the ratio of radial to vertical P waves is mostly sensitive to sub-surface shear velocity. Therefore, the sub-surface velocity structure can be estimated using an approach similar to teleseismic P receiver functions, but at much smaller scale and higher frequency. The results from this method are in good agreement with results from active-source or passive-source non-invasive array methods and have been widely used in the Central Eastern United States. The Alaska Regional Network and Transportable Array have recorded numerous earthquakes in the magnitude range of interest and at shallow depth, which provides an ideal opportunity for this study. VS30 is used to represent the site amplification of ground motions in all ground motion models that are used in generating the US Geological Survey’s National Seismic Hazard Maps, as well as in the professional practice of seismic hazard analysis. The results of this work provide a basis for improved site-specific hazard estimates in Alaska.
Ex vivo biomechanical analysis of flexible versus rigid annuloplasty rings in mitral valves using a novel annular dilation system
Authors: Zhu Yuanjia , Imbrie-Moore Annabel M. , Wilkerson Robert J. , Paulsen Michael J. , Park Matthew H. , Woo Y. Joseph
Published: February 2022

Background

Mitral annuloplasty rings restore annular dimensions to increase leaflet coaptation, serving a fundamental component in mitral valve repair. However, biomechanical evaluations of annuloplasty rings are lacking. We aim to biomechanically analyze flexible and rigid annuloplasty rings using an ex vivo mitral annular dilation model.

Methods

Juvenile porcine mitral valves (n = 4) with intercommissural distance of 28 mm were dilated to intercommissural distances of 40 mm using a 3D-printed dilator and were sewn to an elastic mount. Fiber bragg grating sensors were anchored to native chordae to measure chordal forces. The valves were repaired using size 28 rigid and flexible annuloplasty rings in a random order. Hemodynamic data, echocardiography, and chordal force measurements were collected.

Results

Mitral annular dilation resulted in decreased leaflet coaptation height and increased mitral regurgitation fraction. Both the flexible and rigid annuloplasty rings effectively increased leaflet coaptation height compared to that post dilation. Rigid ring annuloplasty repair significantly decreased the mitral regurgitation fraction. Flexible annuloplasty ring repair reduced the chordal rate of change of force (7.1 ± 4.4 N/s versus 8.6 ± 5.9 N/s, p = 0.02) and peak force (0.6 ± 0.5 N versus 0.7 ± 0.6 N, p = 0.01) compared to that from post dilation. Rigid annuloplasty ring repair was associated with higher chordal rate of change of force (9.8 ± 5.8 N/s, p = 0.0001) and peak force (0.7 ± 0.5 N, p = 0.01) compared to that after flexible ring annuloplasty repair.

Conclusions

Both rigid and flexible annuloplasty rings are effective in increasing mitral leaflet coaptation height. Although the rigid annuloplasty ring was associated with slightly higher chordal stress compared to that of the flexible annuloplasty ring, it was more effective in mitral regurgitation reduction. This study may help direct the design of an optimal annuloplasty ring to further improve patient outcomes.
A novel use of small ballons to reduce the risk of subintimal hematoma formation during recanalization of chronic total occlusion: two case reports
Authors: Ma Yanzhuo , Song Xinxing , Kong Lingfeng , Wang Gang , Wang Xiaoye , Ru Leisheng
Published: February 2022

Background

Subintimal hematoma remains a major challenge associated with unnecessary technical complexity, failure of the antegrade approach or imperfection of revascularization in percutaneous coronary intervention (PCI) for chronic total occlusion (CTO). Some techniques and devices release the hematoma after its formation. Here, we describe a novel use of small ballons to prevent the hematoma formation during antegrade approach in two cases.

Case presentation

We report two cases of CTO-PCI in which balloon occlusion was successfully applied to prevent haematoma formation. The first case, a 72-year-old female with diabetes, was hospitalized because of unstable angina. Angiography showed right coronary artery (RCA) CTO, which initiated from the proximal part to the trifurcation at the distal part of the RCA. Considering the high likelihood and serious consequences of subintimal haematoma, a small balloon is employed to prevent subintimal hematoma formation. A balloon and microcatheter or double-lumen microcatheter are placed in the proximal coronary CTO lesion; then the balloon was dilated beside the catheter, most of the antegrade blood flow was sealed which reduced the likelihood of haematoma formation. The procedure was successfully completed without subintimal hematoma formation. The second case a 62-year-old male with unstable angina, was hospitalized for PCI. Angiography showed left anterior descending coronary artery CTO. Similar to case 1, we also used a small balloon to prevent hematoma formation. Both patients underwent PCI, which employed a small balloon to prevent hematoma formation and both procedures were successful without complications.

Conclusion

In patients who underwent CTO-PCI, balloon occlusion offers an alternative for reducing the incidence of subintimal haematomas.
Surface electroencephalography (EEG) during the acute phase of stroke to assist with diagnosis and prediction of prognosis: a scoping review
Authors: Sutcliffe Lou , Lumley Hannah , Shaw Lisa , Francis Richard , Price Christopher I.
Published: February 2022

Background

Stroke is a common medical emergency responsible for significant mortality and disability. Early identification improves outcomes by promoting access to time-critical treatments such as thrombectomy for large vessel occlusion (LVO), whilst accurate prognosis could inform many acute management decisions. Surface electroencephalography (EEG) shows promise for stroke identification and outcome prediction, but evaluations have varied in technology, setting, population and purpose. This scoping review aimed to summarise published literature addressing the following questions: 1. Can EEG during acute clinical assessment identify: a) Stroke versus non-stroke mimic conditions. b) Ischaemic versus haemorrhagic stroke. c) Ischaemic stroke due to LVO. 2. Can these states be identified if EEG is applied < 6 h since onset. 3. Does EEG during acute assessment predict clinical recovery following confirmed stroke.

Methods

We performed a systematic search of five bibliographic databases ending 19/10/2020. Two reviewers assessed eligibility of articles describing diagnostic and/or prognostic EEG application < 72 h since suspected or confirmed stroke.

Results

From 5892 abstracts, 210 full text articles were screened and 39 retained. Studies were small and heterogeneous. Amongst 21 reports of diagnostic data, consistent associations were reported between stroke, greater delta power, reduced alpha/beta power, corresponding ratios and greater brain asymmetry. When reported, the area under the curve (AUC) was at least good (0.81–1.00). Only one study combined clinical and EEG data (AUC 0.88). There was little data found describing whether EEG could identify ischaemic versus haemorrhagic stroke. Radiological changes suggestive of LVO were also associated with increased slow and decreased fast waves. The only study with angiographic proof of LVO reported AUC 0.86 for detection < 24 h since onset. Amongst 26 reports of prognostic data, increased slow and reduced fast wave EEG changes were associated with future dependency, neurological impairment, mortality and poor cognition, but there was little evidence that EEG enhanced outcome prediction relative to clinical and/or radiological variables. Only one study focussed solely on patients < 6 h since onset for predicting neurological prognosis post-thrombolysis, with more favourable outcomes associated with greater hemispheric symmetry and a greater ratio of fast to slow waves.

Conclusions

Although studies report important associations with EEG biomarkers, further technological development and adequately powered real-world studies are required before recommendations can be made regarding application during acute stroke assessment.
Association between orthostatic blood pressure dysregulation and geriatric syndromes: a cross-sectional study
Authors: Roca Frédéric , Rougette Kevin , Zmuda Louise , Noel Gabrielle , Larose Solène , Bordage Mathilde , Chassagne Philippe
Published: February 2022

Background

Orthostatic blood pressure dysregulation, including orthostatic hypotension (OH) and orthostatic hypertension (OHT), is common in the elderly. The association between OH and, to a lesser extent, OHT with geriatric syndromes is controversial and little investigated.

Our objective was to assess the association between orthostatic blood pressure dysregulation and geriatric syndromes in an ambulatory outpatient population.

Methods

This observational study included all outpatients for whom a one-visit comprehensive geriatric assessment was performed during a year. OH was defined as a decrease of at least 20 mmHg in systolic blood pressure (SBP) and/or 10 mmHg in diastolic blood pressure (DBP) after 1 or 3 min of standing. OHT was defined as an increase of more than 20 mmHg in SBP after 1 or 3 min of standing. Comorbidities, drugs regimen, a history of previous falls, nutritional, frailty, functional and cognitive status were compared between patients with OHT or OH and controls (NOR).

Results

Five hundred thirty patients (mean age: 82.9 ± 5.1 years) were included. 19.6% had an OH and 22.3% an OHT. OHT patients were more frequently female, had more diabetes and a lower resting SBP than patients with NOR. OH patients had a higher resting SBP than NOR. After adjusting for age, sex, resting SBP and diabetes, OHT was associated with a low walking speed (OR = 1.332[1.009–1.758]; p = 0.043) and severe cognitive impairment at MMSe score (OR = 1.629[1.070–1.956]; p = 0.016) compared to NOR. Conversely, OH was associated with a lower grip strength (p = 0.016) than NOR.

Conclusion

OHT and OH are common in elderly but associated with different geriatric phenotypes.
Transmission of multidrug-resistant tuberculosis within family households by DTM-PCR and MIRU-VNTR genotyping
Authors: Chen Jun , Chen Lifeng , Zhou Meng , Wu Gang , Yi Fenglian , Jiang Chen , Duan Qionghong , Zhou Meilan
Published: February 2022

Background

Drug-resistant tuberculosis (TB) continues to be a public health threat. There are few studies on transmission and genotyping of MDR-TB family households in China. This study aimed to investigate transmission of multidrug-resistant tuberculosis (MDR-TB) within family households by deletion-targeted multiplex polymerase chain reaction (DTM-PCR), mycobacterial interspersed repetitive unit variable number tandem repeats (MIRU-VNTR) genotyping.

Methods

Among 993 MDR-TB patients registered from Wuhan Institute for Tuberculosis Control, drug resistance and the time interval between the index patients and secondary patients were analyzed in 49 MDR-TB patients from 23 families, in which 22 MDR-TB strains from 11 families who had matched strains were genotyped by DTM-PCR and standard 24-loci MIRU-VNTR genotyping method.

Results

The time interval between the index patients and the secondary patients ranged from half a month to 110 months. Thirteen secondary patients developed active MDR-TB within two years and accounted for 50% (13/26) of all secondary patients. Among eleven pairs of MDR-TB families, six pairs had identical genotypes, the cluster rate was 54.5% (12/22); three pairs had a single MIRU-VNTR locus variation. If a single MIRU-VNTR locus variation was tolerated in the cluster definition, the cluster rate raised to 81.8% (18/22).

Conclusions

The family households of MDR-TB patients are at risk for infection of MDR-TB. To reduce transmission, MDR-TB patients should be diagnosed earlier and promptly treated in an effective manner, meanwhile, the close family contacts should be screened for TB infection.
Preoperative versus postoperative chemo-radiotherapy for locally advanced gastric cancer: a multicenter propensity score-matched analysis
Authors: Li Ning , Xiang Xiaoyong , Zhao Dongbin , Wang Xin , Tang Yuan , Chi Yihebali , Yang Lin , Jiang Liming , Jiang Jun , Shi Jinming , Liu Wenyang , Fang Hui , Tang Yu , Chen Bo , Lu Ningning , Jing Hao , Qi Shunan , Wang Shulian , Liu Yueping , Song Yongwen , Li Yexiong , Zhang Liyuan , Jin Jing
Published: February 2022

Background

Peri-operative chemo-radiotherapyplayed important rolein locally advanced gastric cancer. Whether preoperative strategy can improve the long-term prognosis compared with postoperative treatment is unclear. The study purpose to compare oncologic outcomes in locally advanced gastric cancer patients treated with preoperative chemo-radiotherapy (pre-CRT) and postoperative chemo-radiotherapy (post-CRT).

Methods

From January 2009 to April 2019, 222 patients from 2 centers with stage T3/4 and/or N positive gastric cancer who received pre-CRT and post-CRT were included. After propensity score matching (PSM), comparisons of local regional control (LC), distant metastasis-free survival (DMFS), disease-free survival (DFS) and overall survival (OS) were performed using Kaplan-Meier analysis and log-rank test between pre- and post-CRT groups.

Results

The median follow-up period was 30 months. 120 matched cases were generated for analysis. Three-year LC, DMFS, DFS and OS for pre- vs. post-CRT groups were 93.8% vs. 97.2% (p = 0.244), 78.7% vs. 65.7% (p = 0.017), 74.9% vs. 65.3% (p = 0.042) and 74.4% vs. 61.2% (p = 0.055), respectively. Pre-CRT were significantly associated with DFS in uni- and multi-variate analysis.

Conclusion

Preoperative CRT showed advantages of oncologic outcome compared with postoperative CRT.

Trial registration

ClinicalTrial.gov NCT01291407, NCT03427684 and NCT04062058, date of registration: Feb 8, 2011.
Association between obesity and lung function in South African adolescents of African Ancestry
Authors: Engwa Godwill Azeh , Anye Chungag , Nkeh-Chungag Benedicta Ngwenchi
Published: February 2022

Background

There is a growing body of literature on the increasing prevalence of obesity in adolescents of Sub-Saharan African ancestry. However, limited data is available on the impact of obesity on pulmonary function. This study assessed the relationship between obesity and lung function in South African adolescents of African ancestry.

Methods

This was a cross-sectional study involving 10–14 year old adolescents recruited from middle schools of the Eastern Cape Province of South Africa. Anthropometric measurements were performed. Body mass index (BMI) was converted to percentiles for age and sex and used to classified obesity. Spirometry was performed to assess lung function. Chi-square test of association and binary regression analysis were used to assess the relationship between obesity and airway obstruction. Adjusted linear regression was used to determine the relationship between obesity and lung function parameters.

Results

A total of 540 adolescents were recruited for the study among which 77 (14.3%) were obese. Lung function parameters: forced vital capacity (FVC) and forced expiratory volume in 1 s (FEV1) were higher (p < 0.001) in obese than in non-obese adolescents while peak expiratory flow (PEF) % and FEV1/FVC ratio were lower (p < 0.05) in obese than non-obese adolescents. Obesity was associated (χ2 = 9.614; p < 0.01) with airway obstruction and obese adolescents were over 1.5 times more likely to have pulmonary obstruction (OR: 1.57; p < 0.05) than their non-obese counterparts. Anthropometric measures were positively associated (p < 0.05) with FVC, FEV1, PEF and/or FEV25-75 but negatively associated with FEV1/FVC ratio.

Conclusions

Obesity was associated with airway obstruction in South Africa adolescents of African ancestry.
Maternal anemia and baby birth size mediate the association between short birth interval and under-five undernutrition in Ethiopia: a generalized structural equation modeling approach
Authors: Shifti Desalegn Markos , Chojenta Catherine , Holliday Elizabeth G. , Loxton Deborah
Published: February 2022

Background

Studies assessing the association between short birth interval, a birth-to-birth interval of less than 33 months, and under-five undernutrition have produced inconclusive results. This study aimed to assess the relationship between short birth interval and outcomes of stunting, underweight, and wasting among children aged under-five in Ethiopia, and potential mediation of any associations by maternal anemia and baby birth size.

Method

Data from the 2016 Ethiopia Demographic and Health Survey (EDHS) was used. Stunting, wasting, and underweight among children aged under-five were outcome variables. Generalized Structural Equation Modeling (GSEM) was used to examine associations between short birth interval and outcomes, and to assess hypothesized mediation by maternal anemia and baby birth size.

Results

Significant associations between short birth interval and stunting (AOR = 1.49; 95% CI = 1.35, 1.66) and underweight (AOR = 1.43; 95% CI = 1.28, 1.61) were found. There was no observed association between short birth interval and wasting (AOR = 1.05; 95% CI = 0.90, 1.23). Maternal anemia and baby birth size had a significant partial mediation effect on the association between short birth interval and stunting (the coefficient reduced fromβ = 0.337,p < 0.001 toβ = 0.286,p < 0.001) and underweight (the coefficient reduced fromβ = 0.449,p < 0.001 toβ = 0.338,p < 0.001). Maternal anemia and baby birth size mediated 4.2% and 4.6% of the total effect of short birth interval on stunting and underweight, respectively.

Conclusion

Maternal anemia and baby birth size were identified as mediators of the association between short birth interval and under-five undernutrition status. Policies and programs targeting the reduction of under-five undernutrition should integrate strategies to reduce maternal anemia and small baby birth size in addition to short birth interval.
Gender differences in nutritional status and determinants among infants (6–11 m): a cross-sectional study in two regions in Ethiopia
Authors: Samuel Aregash , Osendarp Saskia J. M. , Feskens Edith J. M. , Lelisa Azeb , Adish Abdulaziz , Kebede Amha , Brouwer Inge D.
Published: February 2022

Background

A limited number of studies suggest that boys may have a higher risk of stunting than girls in low-income countries. Little is known about the causes of these gender differences. The objective of the study was to assess gender differences in nutritional status and its determinants among infants in Ethiopia.

Methods

We analyzed data for 2036 children (6–11 months old) collected as the baseline for a multiple micronutrient powders effectiveness study in two regions of Ethiopia in March–April 2015. Child, mother, and household characteristics were investigated as determinants of stunting and wasting. Multiple logistic regression models were used separately for boys and girls to check for gender differences while adjusting for confounders. The study is registered at http://www.clinicaltrials.gov/ with the clinical trials identifier of NCT02479815.

Results

Stunting and wasting prevalence is significantly higher among boys compared to girls, 18.7 vs 10.7% and 7.9 vs 5.4%, respectively. Untimely initiation of breastfeeding, not-exclusive breastfeeding at the age of 6 months, region of residence, and low maternal education are significant predictors of stunting in boys. Untimely introduction to complementary food and low consumption of legumes/nuts are significant predictors of stunting in both boys and girls, and low egg consumption only in girls. Region of residence and age of the mother are significant determinants of wasting in both sexes. Analysis of interaction terms for stunting, however, shows no differences in predictors between boys and girls; only for untimely initiation of breastfeeding do the results for boys (OR 1.46; 95%CI 1.02,2.08) and girls (OR 0.88; 95%CI 0.55,1.41) tend to be different (p = 0.12).

Conclusion

In Ethiopia, boys are more malnourished than girls. Exclusive breastfeeding and adequate dietary diversity of complementary feeding are important determinants of stunting in boys and girls. There are no clear gender interactions for the main determinants of stunting and wasting. These findings suggest that appropriate gender-sensitive guidance on optimum infant and young child feeding practices is needed.
The clinical impact of preoperative biliary drainage on isolated infectious complications (iiC) after pancreatic head resection—a retrospective study
Authors: Krueger Colin M. , Chikhladze Sophia , Adam Ulrich , Patrzyk Maciej , Kramer Axel , Riediger Hartwig
Published: February 2022

Background

The perioperative morbidity after pancreatoduodenectomy (PD) is mostly influenced by intraabdominal complications which are often associated with infections. In patients with preoperative biliary drainage (PBD), the risk for postoperative infections may be even elevated. The aim of this study is to explore if isolated infectious complications without intraabdominal focus (iiC) can be observed after PD and if they are associated to PBD and antibiotic prophylaxis with potential conclusions for their treatment.

Methods

During a 10-year period from 2009 to 2019, all consecutive PD were enrolled prospectively in a database and analyzed retrospectively. Bacteriobilia (BB) and Fungibilia (FB) were examined by intraoperatively acquired smears. A perioperative antibiotic prophylaxis was performed by Ampicillin/Sulbactam. For this study, iiC were defined as postoperative infections like surgical site infection (SSI), pneumonia, unknown origin etc. Statistics were performed by Fisher’s exact test and Mann Whitney U test.

Results

A total of 426 PD were performed at the Vivantes Humboldt-hospital. The morbidity was 56% (n = 238). iiC occurred in 93 patients (22%) and accounted for 38% in the subgroup of patients with postoperative complications. They were not significantly related to BB and PBD but to FB. The subgroup of SSI, however, had a significant relationship to BB and FB with a poly microbial profile and an accumulation of E. faecalis, E. faecium, Enterobacter, and Candida. BB was significantly more frequent in longer lay of PBD. Resistance to standard PAP and co-existing resistance to broad spectrum antibiotics is frequently found in patients with iiC. The clinical severity of iiC was mostly low and non-invasive therapy was adequate. Their treatment led to a significant prolongation of the hospital stay.

Conclusions

iiC are a frequent problem after PD, but only in SSI a significant association to BB and FB can be found in our data. Therefore, the higher resistance of the bacterial species to routine PAP, does not justify broad spectrum prophylaxis. However, the identification of high-risk patients with BB and PBD (length of lay) is recommended. In case of postoperative infections, an early application of broad-spectrum antibiotics and adaption to microbiological findings from intraoperatively smears may be advantageous.
The value of transthoracic echocardiography in the detection of extra-cardiac lesions
Authors: Yan Lei , Ruan Qinyun , Qu Chaoyang , Huang Chunyan , Fu Liyun
Published: February 2022

Objective

Transthoracic echocardiography (TTE) is generally recognized as the top choice for detecting myocardial and cardiac cavity lesions. Sonographers mostly focus on myocardium, cardiac cavity and cardiac hemodynamics, whereas the abnormal extra-cardiac lesions are easily remain unrecognized. The aim of this study was to investigate the ultrasonic image features in abnormal extra-cardiac lesions and the value of TTE in the detection of extra-cardiac lesions.

Methods

49 cases of abnormal extra-cardiac lesion detected by TTE from January 2014 to December 2019 were collected, which were confirmed by surgical pathology. The two-dimensional ultrasonic characteristics and the relationships with the cardiac and great vessels were summarized on the basis of multi-view by TTE. All patients were also examined by computed tomography (CT).

Results

In 49 patients with abnormal extra-cardiac lesions, 37 malignant cases and 12 benign cases were included. There were 41 cases (41/49, 86.67%) of mediastinal lesions and 8 cases (8/49, 16.33%) of lung lesions. The maximum diameter ranged from 3.2 cm to 13.66 cm, and the median diameter was about 7.4 cm, among which 29 cases (29/49, 59.18%) were larger than 5 cm. 4 cases (4/49, 8.16%) of cystic anechoic lesions were pericardial cyst. 2 cases (2/49, 4.08%) of cystic-solid echogenic lesions were teratoma. The remaining 43 cases (43/49, 87.76%) presented as solid hypoechoic or heterogeneous masses. 6 cases compressed the heart and 21 cases encroached on the heart and vessels. Diagnosis coincidence rates of TTE and CT were respectively 77.55% and 93.88%, with a statistical difference (p = 0.012).

Conclusion

Although the diagnostic coincidence rate of TTE is slightly lower than that of CT, TTE has certain diagnostic value for extra-cardiac lesions.
Innovative curriculum is needed to address residents’ attitudes toward older adults: the case of geriatric trauma
Authors: Guttman Matthew P. , Haas Barbara , Kim Michael , Mador Brett , Nathens Avery B. , Ahmed Najma , Wheeler Sarah , Gotlib Conn Lesley
Published: February 2022

Background

Medical trainees’ negative perceptions towards older adult care have been widely reported, catalyzing targeted curricula in geriatric medicine. Little is known about surgical residents’ attitudes toward and perceptions of the educational value of caring for injured older adults. This information is needed to ensure the surgical workforce is adequately trained to care for this growing patient population. In this study, we assessed surgical trainees’ attitudes towards geriatric trauma care to inform a curriculum in geriatric trauma.

Methods

We surveyed North American general surgery trainees’ beliefs and attitudes toward caring for older trauma patients, and the educational value they ascribed to learning about older trauma patient care. Descriptive statistics were used to report participant characteristics and responses.

Results

Three hundred general surgery trainees from 94 post-graduate programs responded. Respondents reported too much time co-ordinating care (56%), managing non-operative patients (56%), and discharge planning (65%), all activities important to the care of older trauma patients. They recognized the importance of geriatric trauma care for their future careers (52%) but were least interested in reading about managing geriatric trauma patients (28%). When asked to rank clinical vignettes by educational value, respondents ranked the case of an older adult as least interesting (74%). As respondents progressed through their training, they reported less interest in geriatric trauma care.

Conclusions

Our survey results demonstrate the generally negative attitudes and beliefs held by postgraduate surgical trainees towards the care of older adult trauma patients. Future work should focus on identifying specific changes to the postgraduate surgical curriculum which can effectively alter these attitudes and beliefs and improve the care for injured older adults.
Does hospital volume affect outcomes after abdominal cancer surgery: an analysis of Swiss health insurance claims data
Authors: Wirth Kevin , Näpflin Markus , Graber Sereina M. , Blozik Eva
Published: February 2022

Background

Medical treatment quality has been shown to be better in high volume than in low volume hospitals. However, this relationship has not yet been confirmed in abdominal cancer in Switzerland and is relevant for referral of patients and healthcare planning. Thus, the present study investigates the association between hospital volumes for surgical resections of colon, gastric, rectal, and pancreatic carcinomas and outcomes.

Methods

This retrospective analysis is based on anonymized claims data of patients with mandatory health insurance at Helsana Group, a leading health insurance in Switzerland. Outcome parameters were length of hospital stay, mortality and cost during the inpatient stay as well as at 1-year follow-up. Hospital volume information was derived from the Quality Indicators dataset provided by the Swiss Federal Office of Public Health. The impact of hospital volume on the different treatment outcomes was statistically tested using generalized estimating equations (GEE) models, taking into account the non-independence of observations from the same hospital.

Results

The studies included 2′859 resections in patients aged 18 years and older who were hospitalized for abdominal cancer surgery between 2014 and 2018. Colon resections were the most common procedures (n = 1′690), followed by rectal resections (n = 709). For rectal, colon and pancreatic resections, an increase in the mean number of interventions per hospital and a reduction of low volume hospitals could be observed. For the relationship between hospital volume and outcomes, we did not observe a clear dose-response relationship, as no significantly better outcomes were observed in the higher-volume category than in the lower-volume category. Even though a positive “routine effect” cannot be excluded, our results suggest that even hospitals with low volumes are able to achieve comparable treatment outcomes to larger hospitals.

Conclusion

In summary, this study increases transparency on the relationship between hospital volume and treatment success. It shows that simple measures such as defining a minimum number of procedures only might not lead to the intended effects if other factors such as infrastructure, the operating team or aggregation level of the available data are not taken into account.
A selective inhibitor of the NLRP3 inflammasome as a potential therapeutic approach for neuroprotection in a transgenic mouse model of Huntington’s disease
Authors: Chen Kai-Po , Hua Kuo-Feng , Tsai Fu-Ting , Lin Ting-Yu , Cheng Chih-Yuan , Yang Ding-I. , Hsu Hsien-Ta , Ju Tz-Chuen
Published: February 2022

Background

Huntington’s disease (HD) is a neurodegenerative disorder caused by the expansion of the CAG repeat in the huntingtin (HTT) gene. When the number of CAG repeats exceeds 36, the translated expanded polyglutamine-containing HTT protein (mutant HTT [mHTT]) interferes with the normal functions of many cellular proteins and subsequently jeopardizes important cellular machineries in major types of brain cells, including neurons, astrocytes, and microglia. The NACHT, LRR, and PYD domain-containing protein 3 (NLRP3) inflammasome, which comprises NLRP3, ASC, and caspase-1, is involved in the activation of IL-1β and IL-18 and has been implicated in various biological functions. Although the existence of the NLRP3 inflammasome in the brain has been documented, the roles of the NLRP3 inflammasome in HD remain largely uncharacterized. MCC950 is a highly selective and potent small-molecule inhibitor of NLRP3 that has been used for the treatment of several diseases such as Alzheimer’s disease. However, whether MCC950 is also beneficial in HD remains unknown. Therefore, we hypothesized that MCC950 exerts beneficial effects in a transgenic mouse model of HD.

Methods

To evaluate the effects of MCC950 in HD, we used the R6/2 (B6CBA-Tg[HDexon1]62Gpb/1J) transgenic mouse model of HD, which expresses exon 1 of the human HTT gene carrying 120 ± 5 CAG repeats. Male transgenic R6/2 mice were treated daily with MCC950 (10 mg/kg of body weight; oral administration) or water for 5 weeks from the age of 7 weeks. We examined neuronal density, neuroinflammation, and mHTT aggregation in the striatum of R6/2 mice vs. their wild-type littermates. We also evaluated the motor function, body weight, and lifespan of R6/2 mice.

Results

Systematic administration of MCC950 to R6/2 mice suppressed the NLRP3 inflammasome, decreased IL-1β and reactive oxygen species production, and reduced neuronal toxicity, as assessed based on increased neuronal density and upregulation of the NeuN and PSD-95 proteins. Most importantly, oral administration of MCC950 increased neuronal survival, reduced neuroinflammation, extended lifespan, and improved motor dysfunction in R6/2 mice.

Conclusions

Collectively, our findings indicate that MCC950 exerts beneficial effects in a transgenic mouse model of HD and has therapeutic potential for treatment of this devastating neurodegenerative disease.
Orbital volume changes during growth and development in human children assessed using cone beam computed tomography
Authors: Smith Eric A. , Halbach Caroline S. , Robertson Adriana Z. , Peterson Aden M. , Harrison Andrew R. , Grünheid Thorsten , Larson Brent E. , Mokhtarzadeh Ali
Published: February 2022

Objectives

To measure growth-related changes in orbital volume from childhood to the late teenage years using cone-beam computed tomography (CBCT) scans.

Methods

This retrospective cohort study involved 65 (24 male, 41 female) healthy Caucasian children (ages 6–18 years) with existing serial craniofacial CBCT scans. CBCT scans were available for 292 orbits. Each orbit was transformed into a closed space with well-defined boundaries, and orbital volume was measured using manual segmentation. A novel statistical analysis was applied to extract the maximum amount of longitudinal information from the data. Intra- and inter-operator correlation coefficients were calculated from replications performed on a random subset of 10% of the sample.

Results

Orbital volume increased at a rate of 1–2% annually until the late teenage years. Intra- and inter-operator agreement between repeated measurements were >90%.

Conclusions

Orbital volume increases by 1–2% per year throughout childhood continuing until the late teenage years. This annual increase is large enough to be clinically relevant as it may lead to less-than-optimal long term surgical outcomes when reconstructive surgery for the pediatric anophthalmic socket is required.
Compound genetic etiology in a patient with a syndrome including diabetes, intellectual deficiency and distichiasis
Authors: Le Collen Lauriane , Delemer Brigitte , Spodenkiewicz Marta , Cornillet Lefebvre Pascale , Durand Emmanuelle , Vaillant Emmanuel , Badreddine Alaa , Derhourhi Mehdi , Mouhoub Tarik Ait , Jouret Guillaume , Juttet Pauline , Souchon Pierre François , Vaxillaire Martine , Froguel Philippe , Bonnefond Amélie , Doco Fenzy Martine
Published: February 2022

Background

We studied a young woman with atypical diabetes associated with mild intellectual disability, lymphedema distichiasis syndrome (LDS) and polymalformative syndrome including distichiasis. We used different genetic tools to identify causative pathogenic mutations and/or copy number variations.

Results

Although proband’s, diabetes mellitus occurred during childhood, type 1 diabetes was unlikely due to the absence of detectable autoimmunity. DNA microarray analysis first identified a de novo, heterozygous deletion at the chr16q24.2 locus. Previously, thirty-three pathogenic or likely pathogenic deletions encompassing this locus have been reported in patients presenting with intellectual deficiency, obesity and/or lymphedema but not with diabetes. Of note, the deletion encompassed two topological association domains, whose one included FOXC2 that is known to be linked with LDS. Via whole-exome sequencing, we found a heterozygous, likely pathogenic variant in WFS1 (encoding wolframin endoplasmic reticulum [ER] transmembrane glycoprotein) which was inherited from her father who also had diabetes. WFS1 is known to be involved in monogenic diabetes. We also found a likely pathogenic variant in USP9X (encoding ubiquitin specific peptidase 9 X-linked) that is involved in X-linked intellectual disability, which was inherited from her mother who had dyscalculia and dyspraxia.

Conclusions

Our comprehensive genetic analysis suggested that the peculiar phenotypes of our patient were possibly due to the combination of multiple genetic causes including chr16q24.2 deletion, and two likely pathogenic variants in WFS1 and USP9X.
Atheroprotective mechanism by which folic acid regulates monocyte subsets and function through DNA methylation
Authors: Xiang Yang , Liang Bin , Zhang Xiaokang , Qiu Xueping , Deng Qianyun , Yu Li , Yu Hong , Lu Zhibing , Zheng Fang
Published: February 2022

Background

Recent studies have suggested that folic acid can restore abnormal DNA methylation and monocyte subset shifts caused by hyperhomocysteinemia (HHcy) and hyperlipidemia (HL). However, the exact mechanism of action is still not fully understood. In this study, we further investigated the reversal effect and underlying mechanism of folic acid on the shift in monocyte subsets induced by aberrant lipids and Hcy metabolism via DNA methylation in vitro and in vivo.

Results

Our results showed that intermediate monocytes were significantly increased but had the lowest global 5-methylcytosine (5-mC) levels in coronary artery disease (CAD) patients, which might lead to a decrease in the global 5-mC levels of peripheral blood leukocytes (PBLs). We also discovered that ARID5B might mediate the increased proportion of intermediate monocytes, as this factor was related to the proportion of monocyte subsets and the expression of CCR2. The expression of ARID5B was inversely associated with the hypermethylated cg25953130 CpG site, which was induced by HL and HHcy. ARID5B could also regulate monocyte CCR2, MCP-1, and TNF-α expression, adhesion and migration, macrophage polarization, and monocyte/macrophage apoptosis, which might explain the regulatory effect of ARID5B on monocyte subset shifting. Folic acid reversed HL- and HHcy-mediated aberrant global and cg25953130 DNA methylation, reduced the proportion of intermediate monocytes, and inhibited the formation of atherosclerotic plaques.

Conclusion

Folic acid plays a protective role against atherosclerosis through the regulation of DNA methylation, ARID5B expression, and monocyte subsets.
Cell-type heterogeneity: Why we should adjust for it in epigenome and biomarker studies
Authors: Qi Luo , Teschendorff Andrew E.
Published: February 2022

Most studies aiming to identify epigenetic biomarkers do so from complex tissues that are composed of many different cell-types. By definition, these cell-types vary substantially in terms of their epigenetic profiles. This cell-type specific variation among healthy cells is completely independent of the variation associated with disease, yet it dominates the epigenetic variability landscape. While cell-type composition of tissues can change in disease and this may provide accurate and reproducible biomarkers, not adjusting for the underlying cell-type heterogeneity may seriously limit the sensitivity and precision to detect disease-relevant biomarkers or hamper our understanding of such biomarkers. Given that computational and experimental tools for tackling cell-type heterogeneity are available, we here stress that future epigenetic biomarker studies should aim to provide estimates of underlying cell-type fractions for all samples in the study, and to identify biomarkers before and after adjustment for cell-type heterogeneity, in order to obtain a more complete and unbiased picture of the biomarker-landscape. This is critical, not only to improve reproducibility and for the eventual clinical application of such biomarkers, but importantly, to also improve our molecular understanding of disease itself.
Avascular necrosis of the talus causing meniscoid lesions in the ankle joint: a case report
Authors: Hamoudi Ceyran , Doljencu Andrei , Illes Tamás
Published: February 2022

Background

Meniscoid lesions have been reported in patients with chronic ankle injuries, especially in soccer athletes, and such lesions cause soft-tissue impingement and pain. To our knowledge, we are the first to report a meniscoid lesion in the ankle joint presenting as a long-term sequela of avascular necrosis of the talus that developed in childhood.

Case presentation

In this paper, we describe a 55-year-old Caucasian male patient who presented with a 1-year history of intermittent locking, “giving way,” weight-bearing pain, and swelling over the anterior aspect of the ankle joint. Imaging showed a rare case of avascular necrosis of the talus associated with an unstable plica-like lesion that was removed arthroscopically after unsuccessful conservative treatment.

Conclusion

We demonstrate that unstable meniscoid lesions of the ankle joint can be treated successfully with arthroscopic debridement. We obtained satisfactory short-term clinical results at the 2-year follow-up, even though advanced osteoarthritis was present.
Advances in electrical impedance tomography-based brain imaging
Authors: Ke Xi-Yang , Hou Wei , Huang Qi , Hou Xue , Bao Xue-Ying , Kong Wei-Xuan , Li Cheng-Xiang , Qiu Yu-Qi , Hu Si-Yi , Dong Li-Hua
Published: February 2022

Novel advances in the field of brain imaging have enabled the unprecedented clinical application of various imaging modalities to facilitate disease diagnosis and treatment. Electrical impedance tomography (EIT) is a functional imaging technique that measures the transfer impedances between electrodes on the body surface to estimate the spatial distribution of electrical properties of tissues. EIT offers many advantages over other neuroimaging technologies, which has led to its potential clinical use. This qualitative review provides an overview of the basic principles, algorithms, and system composition of EIT. Recent advances in the field of EIT are discussed in the context of epilepsy, stroke, brain injuries and edema, and other brain diseases. Further, we summarize factors limiting the development of brain EIT and highlight prospects for the field. In epilepsy imaging, there have been advances in EIT imaging depth, from cortical to subcortical regions. In stroke research, a bedside EIT stroke monitoring system has been developed for clinical practice, and data support the role of EIT in multi-modal imaging for diagnosing stroke. Additionally, EIT has been applied to monitor the changes in brain water content associated with cerebral edema, enabling the early identification of brain edema and the evaluation of mannitol dehydration. However, anatomically realistic geometry, inhomogeneity, cranium completeness, anisotropy and skull type, etc., must be considered to improve the accuracy of EIT modeling. Thus, the further establishment of EIT as a mature and routine diagnostic technique will necessitate the accumulation of more supporting evidence.