bluuebunny/crossref_metadata_2025 huggingface dataset:
Teachers’ Transition Attitudes for Students With Disabilities in Two Regions of Botswana
Authors: Ookeditse Goitse , Mukhopadhyay Sourav
Published: November 2021

Postsecondary transition planning and programing is a fundamental process that allows students with disabilities (SWDs) to engage in adult roles such as higher education, employment, and independent living successfully. Despite the importance of the role of teachers regarding the effective implementation of transition practices and principles, teachers’ transition attitudes in Botswana are not clearly understood. Therefore, the purpose of this study was to explore teachers’ attitudes concerning the effective implementation of transition practices and principles to SWDs in Botswana secondary and vocational schools. The study further examined the differences between teachers on their attitudes toward delivery of transition services for SWDs based on demographic variables of gender, age, education qualification, teaching experience, school type, current position in school, and school region. A quantitative research approach entailing the use of a paper survey to collect data was adopted in this study. A total of 1,186 teachers participated in this study and mean scores were calculated to determine teachers’ transition attitudes. Moreover, t tests and one-way ANOVA tests were conducted to determine teachers’ attitude differences based on demographic variables. The findings of this study showed that generally teachers had somewhat positive attitudes toward transition practices and principles for SWDs. Furthermore, significant differences were noted on teachers’ attitudes based on all demographic variables except gender. The results indicate the importance of positive transition attitudes as well as the need to develop a national transition framework to guide and improve the transition process in Botswana.
Major League Missteps: How MLB Mishandled the Astros Cheating Scandal
Authors: Spackman Emily A. , Wilson Christopher , Gwynn Brendan , Boyle Kris
Published: November 2021

Major League Baseball (MLB) has been criticized for its handling of the Astros’ cheating scandal. Researchers used a case study method to test whether Situational Crisis Communication Theory (SCCT) should be expanded to include collaborative brand attack (CBA) as a crisis type. Researchers used traditional and extended SCCT to analyze MLB’s crisis response to determine which version fit best. Data were triangulated from sports news sources, MLB’s official statement and Twitter account, and social media influencer and stakeholder posts. Researchers asked which SCCT response MLB used and whether it was effective with stakeholders. Because of poor history, MLB’s accidental crisis response mismatched the level of stakeholder attribution of responsibility. Another question examined the role of social media. Major League Baseball underestimated the role of social media and SM influencers and, by underutilizing its Twitter feed, left stakeholders to attribute greater responsibility to MLB. Two final questions asked whether SCCT should be updated to include the CBA crisis type and whether it applied in this case. The results indicate the negative consequences of crisis/response mismatch and indicate that CBA should be incorporated into SCCT to address social media influence. This is the first known study to apply CBA in a sports context.
The Ratio of Stress to Nonstress Anterior Talofibular Ligament Length on Ultrasonography: Normative Values
Authors: Yokoe Takuji , Tajima Takuya , Kawagoe Shuichi , Yamaguchi Nami , Morita Yudai , Chosa Etsuo
Published: November 2021

Background:

Stress ultrasonography (US) has been shown to be a valid procedure for evaluating chronic anterior talofibular ligament (ATFL) injury. The ratio of stress/nonstress ATFL length (ATFL ratio) as measured on US is clinically useful; however, there are no published normative data concerning this ratio.

Purpose:

To report a normative value of the ATFL ratio on US and evaluate the relationships between sex, generalized joint laxity (GJL), and the grade of anterior drawer test (ADT).

Study Design:

Cross-sectional study; Level of evidence, 3.

Methods:

The ATFL lengths were prospectively measured in the stress and nonstress positions (manual maximal anterior drawer position) for participants with noninjured ankles from March 2020 to March 2021. GJL was defined as a Beighton score ≥4. A manual ADT was also performed. The ATFL ratio was calculated, and the relationships between sex, GJL, and ADT grade were evaluated.

Results:

A total of 333 ankles in 184 participants (mean age, 24.5 ± 2.7 years; range, 20-33 years) were eligible for the analysis. GJL was found in 69 ankles (20.7%). The mean ATFL ratio was 1.08 ± 0.04 (95% CI, 1.08-1.09; range, 1.01-1.24), and there was a significant difference between male (1.07 ± 0.04; 95% CI, 1.07-1.08; range, 1.02-1.23) and female (1.09 ± 0.04; 95% CI, 1.08-1.10; range, 1.01-1.24) ankles ( P = .001). In male ankles, the ATFL ratio was significantly greater in participants with GJL (1.11 ± 0.06 vs 1.07 ± 0.03; P = .02) or a higher grade of ADT (grade 2 vs grade 1: 1.11 ± 0.06 vs 1.07 ± 0.03, P = .002). These findings were not observed in female ankles.

Conclusion:

The normative value of the ATFL ratio on stress US was 1.07 ± 0.04 in men and 1.09 ± 0.04 in women. The ATFL ratio was affected by the presence of GJL in men but not in women. These findings will be useful for future studies seeking to establish the cutoff value of the ATFL ratio for diagnosing chronic lateral ankle stability on stress US.
Orthostatic Headaches Associated With Spontaneous Intracranial Hypotension and Autonomic Dysfunction—A Case Series in Young Patients
Authors: Ghosh Ankita , Tran Yen X. , Grant Leon , Numan Mohammed T. , Patel Rajan , Butler Ian J.
Published: November 2021

Background: Orthostatic headaches can be noted in spontaneous intracranial hypotension and orthostatic intolerance. We present a case series of young patients diagnosed with spontaneous intracranial hypotension and were treated for the same but subsequently developed orthostatic intolerance. Methods: We retrospectively reviewed charts for seven young patients with orthostatic headaches related to spontaneous intracranial hypotension and orthostatic intolerance. Results: Patients were diagnosed with spontaneous intracranial hypotension. Diagnosis was confirmed by identifying epidural contrast leakage and three of seven patients were noted to have early renal contrast excretion on computerized tomography myelography. Patients were treated with epidural blood patches. All patients showed persistent symptoms of autonomic dysfunction after treatment of spontaneous intracranial hypotension and orthostatic intolerance was confirmed with head-up tilt table test. Conclusions: Patients with spontaneous intracranial hypotension failing to improve following epidural blood patching should be evaluated for orthostatic intolerance.
Utilizing True Wireless Stereo Earbuds in Automated Pure-Tone Audiometry
Authors: Guo Zhenyu , Yu Guangzheng , Zhou Huali , Wang Xianren , Lu Yigang , Meng Qinglin
Published: November 2021

True wireless stereo (TWS) earbuds have become popular and widespread in recent years, and numerous automated pure-tone audiometer applications have been developed for portable devices. However, most of these applications require specifically designed earphones to which the public may not have access. Therefore, the present study investigates the accuracy of automated pure-tone audiometry based on TWS earbuds (Honor FlyPods). The procedure for developing an automated pure-tone audiometer is reported. Calibration of the TWS earbuds was accomplished by electroacoustic measurements and establishing corrected reference equivalent threshold sound pressure levels. The developed audiometer was then compared with a clinical audiometer using 20 hearing-impaired participants. The average signed and absolute deviations between hearing thresholds measured using the two audiometers were 3.1 dB and 6.7 dB, respectively. The overall accuracy rate in determining the presence/absence of hearing loss was 81%. The results show that the proposed procedure for an automated air-conduction audiometer based on TWS earbuds is feasible, and the system gives accurate hearing level estimation using the reported calibration framework.
Patient-Reported Roles in Decision-Making Among Asian Patients With Advanced Cancer: A Multicountry Study
Authors: Ozdemir Semra , Malhotra Chetna , Teo Irene , Tan Si Ning Germaine , Wong Wei Han Melvin , Joad Anjum S. Khan , Hapuarachchi Thushari , Palat Gayatri , Tuong Pham Nguyen , Bhatnagar Sushma , Rahman Rubayat , Mariam Lubna , Ning Xiaohong , Finkelstein Eric Andrew
Published: November 2021

Purpose. We investigated 1) perceived roles in decision-making among advanced cancer patients in 5 Asian countries 2) associations of patient characteristics with these roles, and 3) the association of perceived roles with quality of life and perceived quality of care. Methods. We surveyed 1585 patients with stage IV solid cancer. Multinomial logistic regressions were used to analyze associations of patient characteristics with decision-making roles. Multivariate regressions were used to analyze associations of decision-making roles with quality of life and care. Results. The most common perceived-role was no patient involvement. Most patients (73%) reported roles consistent with their preferences. Being male, nonminority, higher educated, aware of advanced cancer diagnosis, and knowledge of cancer diagnosis for ≥1 year were associated with higher levels of patient involvement in decision-making. Compared to no patient involvement, joint decision-making (together with physicians/family) was associated with higher social (β = 2.49, P < 0.01) and spiritual (β = 2.64, P < 0.01) well-being, and better quality of physician communication (β = 9.73, P < 0.01) and care coordination (β = 13.96, P < 0.01) while making decisions alone was associated with lower emotional (β = −1.43, P < 0.01), social (β = −2.39, P < 0.01), and spiritual (β = −2.98, P < 0.01) well-being. Conclusions. Findings suggest that a substantial number of advanced cancer patients were not (and preferred not to be) involved in decision-making. Despite this finding, joint decision-making together with physicians/family was associated with better quality of life and care. Implications. Physicians should explain the benefits of shared decision making to patients and encourage participation in decision-making, while ensuring that patients feel supported and do not find decision-making overwhelming.
Conducting rapid qualitative research amongst people with experience of rough sleeping in London during the COVID-19 pandemic
Authors: Parkin Stephen , Neale Joanne , Roberts Emmert , Brobbin Eileen , Bowen Alice , Hermann Laura , Dwyer Georges-Jacques , Turner Richard , Henderson Juliet , Kuester Landon , McDonald Rebecca , Radcliffe Polly , Robson Deborah , Craft Sam , Strang John , Metrebian Nicola
Published: November 2021

In March 2020, the ‘Everyone In’ initiative was introduced by the UK government as a public health response to COVID-19. This initiative sought to temporarily accommodate people experiencing rough sleeping in hotels in all local authority areas throughout England. In London, ‘Everyone In’ involved the procurement of vacant accommodation in over 100 hotels and temporarily re-housed approximately 2000 individuals. A rapid qualitative study was undertaken within two hotels to explore experiences of the initiative from the perspective of people accommodated in the hotels. This article describes how standard qualitative methods were adapted and implemented to complete the study whilst meeting COVID-19 social distancing guidelines. The research involved a longitudinal design of a two-stage qualitative interview that sought to capture residents’ experience of ‘Everyone In’ at two points in time (while in the hotel and when residents had left the hotel). Adapted qualitative methods were employed by a team of 13 researchers. These adaptations included socially distanced leaflet dropping, telephone-based participant recruitment, a remote, multistage, longitudinal qualitative telephone interviewing and rapid framework analysis. 35 hotel residents were recruited into the study (two subsequently withdrew participation). A total of 299 (of a possible 330) short interviews were completed by 33 participants (26 male and 7 female) as part of the multi-stage, longitudinal design of the study. This study indicates that adapted qualitative research methods employed during a pandemic can be successfully applied to obtain insights and experiences (of individuals and groups) otherwise difficult to reach and/or complex to understand.
Effect and implementation experience of intensive adherence counseling in a public HIV care center in Uganda: a mixed-methods study
Authors: Lukyamuzi Zubair , Etajak Samuel , Katairo Thomas , Mukunya David , Tetui Moses , Ssenyonjo Aloysius , Wanyenze Rhoda K.
Published: November 2021

Background

Intensive adherence counseling (IAC) is an intervention recommended by the World Health Organization to improve anti-retroviral therapy (ART) adherence among people living with HIV on ART with unsuppressed viral load; and in 2016, the intervention was implemented in Uganda. This study evaluated the effect and experiences of providing IAC in an urban HIV care center in Kampala, Uganda.

Methods

This was a sequential explanatory mixed-method study that compared viral load suppression during IAC implementation (intervention) to the period before IAC at Kisenyi Health centre IV. Data were abstracted from patient files and viral load register. The effect of IAC on viral load suppression and associated factors were analyzed using modified Poisson regression with robust standard errors. Using in-depth interviews and an inductive analysis approach in Atlas-ti 8. We also explored experiences of providing IAC among healthcare workers.

Results

A total of 500 records were sampled: 249 (49.8%) in the intervention period and 251 (51.2%) in the pre-intervention period. The mean age was lower during the intervention period 33.1 (± 12.0) than 36.5 (± 13.4) in the pre- intervention period, p = 0.002. More clients were currently on Protease-based regimen in the pre-intervention period 179 (71.3%) than 135 (54.2%) in the intervention period, p ≤ 0.001. In the intervention period, all eligible clients received IAC [249/249 (100.0%)]. Overall, 325 (65.0%) received IAC and of these, 143 (44.1%) achieved viral load suppression compared to 46 (26.3%) who received regular counseling. Receiving IAC significantly increased viral load suppression by 22% (aPR 1.22, 95% CI 1.01–1.47). Clients on Protease-based regimen were less likely to suppress than those on Efavirenz or Nevirapine-based regimens (aPR 0.11, 95% CI 0.08–0.15). All the interviewed healthcare workers lauded IAC for improving ART adherence. However, patient and health care system related factors hindered adherence during IAC.

Conclusions

The full potential of IAC in achieving viral load suppression in this setting has not been reached due to a combination of the patient and health care system related factors. Provision of adequate IAC necessities and use of patient centered approach should be emphasized to obtain the maximum benefit of the intervention.
Shaping ability of 2Shape and NeoNiTi rotary instruments in preparation of curved canals using micro-computed tomography
Authors: Faisal Ibrahim , Saif Rajab , Alsulaiman Mona , Natto Zuhair S.
Published: November 2021

Background

Various systems of nickel-titanium (NiTi) instrument have long been commercially available. However, the preparation of narrow and curved root canals has always been challenging. The purpose of this study was to compare the shaping ability of two NiTi systems (2Shape and NeoNiTi) in severely curved root canals with different morphological patterns using micro-computed tomography (Micro-CT).

Methods

A total of 22 human extracted permanent teeth of mandibular first molars, with the exact mesial angle of curvature of 25 and 35 degrees, according to Schneider’s technique, were distributed randomly into two groups (group I: 2Shape, group II: NeoNiTi) based on the rotary system used (n = 22). The groups were subdivided into two subgroups corresponding to the angle of canal curvature (25° and 35°) (n = 11). Canals were scanned using Micro-CT pre- and post-preparation to assess the volume of dentin removed; canal transportation; and canal centering ratio at 3, 6, and 9 mm from the apex. The Mann–Whitney U test was utilized to determine any significant differences between the two systems. The level of statistical significance was set at p < 0.05.

Results

There was no significant difference between the two groups in volume of dentin removed; canal transportation; and centering ability for 25° and 35° canal curvatures at 3, 6, and 9 mm from the apex (coronal, middle, and apical) thirds (p > 0.05). At the middle third, the NeoNiTi group demonstrated a statistically significant increase in volume of dentin removed for 35° canal curvatures compared to the 2Shape group.

Conclusion

Within the limitation of our in vitro study, 2Shape and NeoNiTi systems with severely curved canals were confirmed to be relatively safe in preparation and to respect original canal anatomy. Nevertheless, NeoNiTi instruments produced more centered preparation and minimal canal deviation compared to the 2Shape system.
Quality of care in public sector family planning services in KwaZulu-Natal, South Africa: a qualitative evaluation from community and health care provider perspectives
Authors: Kriel Yolandie , Milford Cecilia , Cordero Joanna Paula , Suleman Fatima , Steyn Petrus S. , Smit Jennifer Ann
Published: November 2021

Background

Quality of care is a multidimensional concept that forms an integral part of the uptake and use of modern contraceptive methods. Satisfaction with services is a significant factor in the continued use of services. While much is known about quality of care in the general public health care service, little is known about family planning specific quality of care in South Africa. This paper aims to fill the gap in the research by using the Bruce-Jain family planning quality of care framework.

Methods

This formative qualitative study was conducted in South Africa, Zambia, and Kenya to explore the uptake of family planning and contraception. The results presented in this paper are from the South African data. Fourteen focus group discussions, twelve with community members and two with health care providers, were conducted along with eight in-depth interviews with key informants. Thematic content analysis using the Bruce-Jain Quality of Care framework was conducted to analyse this data using NVIVO 10.

Results

Family planning quality of care was defined by participants as the quality of contraceptive methods, attitudes of health care providers, and outcomes of contraceptive use. The data showed that women have limited autonomy in their choice to either use contraception or the method that they might prefer. Important elements that relate to quality of care were identified and described by participants and grouped according to the structural or process components of the framework. Structure-related sub-themes identified included the lack of technically trained providers; integration of services that contributed to long waiting times and mixing of a variety of clients; and poor infrastructure. Sub-themes raised under the process category included poor interpersonal relations; lack of counselling/information exchange, fear; and time constraints. Neither providers nor users discussed follow up mechanisms which is a key aspect to ensure continuity of contraceptive use.

Conclusion

Using a qualitative methodology and applying the Bruce-Jain Quality of Care framework provided key insights into perceptions and challenges about family planning quality of care. Identifying which components are specific to family planning is important for improving contraceptive outcomes. In particular, autonomy in user choice of contraceptive method, integration of services, and the acceptability of overall family planning care was raised as areas of concern.
Mesenchymal stem/stromal cells in cancer therapy
Authors: Lan Tianxia , Luo Min , Wei Xiawei
Published: November 2021

The multipotent mesenchymal stem/stromal cells (MSCs), initially discovered from bone marrow in 1976, have been identified in nearly all tissues of human body now. The multipotency of MSCs allows them to give rise to osteocytes, chondrocytes, adipocytes, and other lineages. Moreover, armed with the immunomodulation capacity and tumor-homing property, MSCs are of special relevance for cell-based therapies in the treatment of cancer. However, hampered by lack of knowledge about the controversial roles that MSC plays in the crosstalk with tumors, limited progress has been made with regard to translational medicine. Therefore, in this review, we discuss the prospects of MSC-associated anticancer strategies in light of therapeutic mechanisms and signal transduction pathways. In addition, the clinical trials designed to appraise the efficacy and safety of MSC-based anticancer therapies will be assessed according to published data.
Serum zinc levels and in vivo beta-amyloid deposition in the human brain
Authors: Kim Jee Wook , Byun Min Soo , Yi Dahyun , Lee Jun Ho , Kim Min Jung , Jung Gijung , Lee Jun-Young , Kang Koung Mi , Sohn Chul-Ho , Lee Yun-Sang , Kim Yu Kyeong , Lee Dong Young ,   for the KBASE Research Group
Published: November 2021

Background

Despite the known associations between zinc levels and Alzheimer’s disease (AD) dementia and related cognitive impairment, the underlying neuropathological links remain poorly understood. We tested the hypothesis that serum zinc level is associated with cerebral beta-amyloid protein (Aβ) deposition. Additionally, we explored associations between serum zinc levels and other AD pathologies [i.e., tau deposition and AD-signature cerebral glucose metabolism (AD-CM)] and white matter hyperintensities (WMHs), which are measures of cerebrovascular injury.

Methods

A total of 241 cognitively normal older adults between 55 and 90 years of age were enrolled. All the participants underwent comprehensive clinical assessments, serum zinc level measurement, and multimodal brain imaging, including Pittsburgh compound B-positron emission tomography (PET), AV-1451 PET, fluorodeoxyglucose (FDG)-PET, and magnetic resonance imaging. Zinc levels were stratified into three categories: < 80 μg/dL (low), 80 to 90 μg/dL (medium), and > 90 μg/dL (high).

Results

A low serum zinc level was significantly associated with increased Aβ retention. In addition, apolipoprotein E ε4 allele (APOE4) status moderated the association: the relationship between low zinc level and Aβ retention was significant only in APOE4 carriers. Although a low zinc level appeared to reduce AD-CM, the relationship became insignificant on sensitivity analysis including only individuals with no nutritional deficiency. The serum zinc level was associated with neither tau deposition nor the WMH volume.

Conclusions

Our findings suggest that decreased serum zinc levels are associated with elevation of brain amyloid deposition. In terms of AD prevention, more attention needs to be paid to the role of zinc.
Spears and shields: attacking and defending deep model co-inference in vehicular crowdsensing networks
Authors: Wu Maoqiang , Ye Dongdong , Zhang Chaorui , Yu Rong
Published: November 2021

Vehicular CrowdSensing (VCS) network is one of the key scenarios for future 6G ubiquitous artificial intelligence. In a VCS network, vehicles are recruited for collecting urban data and performing deep model inference. Due to the limited computing power of vehicles, we deploy a device-edge co-inference paradigm to improve the inference efficiency in the VCS network. Specifically, the vehicular device and the edge server keep a part of the deep model separately, but work together to perform the inference through sharing intermediate results. Although vehicles keep the raw data locally, privacy issues still exist once attackers obtain the shared intermediate results and recover the raw data in some way. In this paper, we validate the possibility by conducting a systematic study on the privacy attack and defense in the co-inference of VCS network. The main contributions are threefold: (1) We take the road sign classification task as an example to demonstrate how an attacker reconstructs the raw data without any knowledge of deep models. (2) We propose a model-perturbation defense to defend against such attacks by injecting some random Laplace noise into the deep model. A theoretical analysis is given to show that the proposed defense mechanism achieves$$\epsilon$$ϵ-differential privacy. (3) We further propose a Stackelberg game-based incentive mechanism to attract the vehicles to participate in the co-inference by compensating their privacy loss in a satisfactory way. The simulation results show that our proposed defense mechanism can significantly reduce the effects of the attacks and the proposed incentive mechanism is very effective.
Strategic study of total innovation management and its relationship with marketing capabilities in palm conversion and complementary industries
Authors: Baniasadi Neda , Samari Davoud , Hosseini Seyyed Jamal Farajollah , Najafabadi Maryam Omidi
Published: November 2021

Given the role and importance of processing and complementary industries in preventing waste from agricultural products, the establishment of such industries can be considered as one of the most appropriate solutions for agricultural development. For this purpose, the data were collected for data processing and complementary industries in the fields of packing, pricing, customer orientation, in south of Iran. Method: According to the goals and assumptions, descriptive–analytical research and its survey method is a survey. According to the Cochran formula, 155 people are involved in marketing, packaging and processing of palm in Kerman province. To answer the research questions, SPSS software and AMOS software were used to analyze the results. Findings "Indigenous Knowledge in packing”. Using communication tools in marketing impact of customer-orientation approach are Top Priorities in "marketing Date". The "packaging" factor is the most important factor in the marketing development of date conversion and complementary industries.
The role of institutional quality in the international trade of a Latin American country: evidence from Colombian export performance
Authors: Abreo Carlos , Bustillo Ricardo , Rodriguez Carlos
Published: November 2021

This paper analyses the relevance of Colombian institutional quality in recent years in terms of the performance of its exports within a framework of trade openness. Based on the trade gravity model, we examine the effect of governance on the evolution of Colombian exports through an econometric approach that identifies, on the one hand, the influence of institutional quality, and on the other hand, the influence of the institutional distance between Colombia and its trading partners. We use a panel data set for 2005–2018, through which the export flows from Colombia to 136 of its trading partners are considered. The findings indicate that Colombian institutional quality and the institutional distance between the country and its partners are statistically significant and affect its foreign sales. Similarly, there is a prominent influence of regulatory quality and the rule of law variables in the performance of Colombian exports in relation to other variables included in the model. We conclude that the Colombian government must improve its institutional quality considerably as a fundamental step towards boosting its overseas sales, not least because the country’s institutional distance from the world average is notable, which also affects its exports.
CD44 promotes hepatocellular carcinoma progression via upregulation of YAP
Authors: Zhang Jun , He Xilin , Wan Yajie , Zhang Honghong , Tang Tao , Zhang Meng , Yu Shiyi , Zhao Weiyong , Chen Liming
Published: November 2021

Hepatocellular carcinoma (HCC) is a common malignancy in human. CD44 is a transmembrane glycoprotein which is frequently overexpressed in cancer of various origins. The function and mechanism of CD44 in HCC remains elusive. In this study, we reported that CD44 was overexpressed in HCC to promote the proliferation and migration of HCC cells via oncogenic YAP, which is the key downstream regulator in Hippo pathway. These findings suggest that CD44-YAP is a probable important axis in pathogenesis of HCC, providing an insight in to HCC pathogenesis as well as potential targets for the intervention of HCC.
Pre-existing cardiovascular disease increases risk of atrial arrhythmia and mortality in cancer patients treated with Ibrutinib
Authors: Avalon Juan Carlo , Fuqua Jacob , Miller Tyler , Deskins Seth , Wakefield Chelby , King Austin , Inderbitzin-Brooks Sonya , Bianco Christopher , Veltri Lauren , Fang Wei , Craig Michael , Kanate Abraham , Ross Kelly , Malla Midhun , Patel Brijesh
Published: November 2021

Background

Ibrutinib is a Bruton’s tyrosine kinase inhibitor used in the treatment of hematological malignancies. The most common cardiotoxicity associated with ibrutinib is atrial arrhythmia (atrial fibrillation and flutter). It is known that patients with cardiovascular disease (CVD) are at an increased risk for developing atrial arrhythmia. However, the rate of atrial arrhythmia in patients with pre-existing CVD treated with ibrutinib is unknown.

Objective

This study examined whether patients with pre-existing CVD are at a higher risk for developing atrial arrhythmias compared to those without prior CVD.

Methods

A single-institution retrospective chart review of patients with no prior history of atrial arrhythmia treated with ibrutinib from 2012 to 2020 was performed. Patients were grouped into two cohorts: those with CVD (known history of coronary artery disease, heart failure, pulmonary hypertension, at least moderate valvular heart disease, or device implantation) and those without CVD. The primary outcome was incidence of atrial arrhythmia, and the secondary outcomes were all-cause mortality, risk of bleeding, and discontinuation of ibrutinib. The predictors of atrial arrhythmia (namely atrial fibrillation) were assessed using logistic regression. A Cox-Proportional Hazard model was created for mortality.

Results

Patients were followed for a median of 1.1 years. Among 217 patients treated with ibrutinib, the rate of new-onset atrial arrhythmia was nearly threefold higher in the cohort with CVD compared to the cohort without CVD (17% vs 7%, p = 0.02). Patients with CVD also demonstrated increased adjusted all-cause mortality (OR 1.9, 95% CI 1.06-3.41, p = 0.01) and decreased survival probability (43% vs 54%, p = 0.04) compared to those without CVD over the follow-up period. There were no differences in risk of bleeding or discontinuation between the two cohorts.

Conclusions

Pre-existing cardiovascular disease was associated with significantly higher rates of atrial arrhythmia and mortality in patients with hematological malignancies managed with ibrutinib.
Association between angiotensinogen (AGT), angiotensin-converting enzyme (ACE) and angiotensin-II receptor 1 (AGTR1) polymorphisms and COVID-19 infection in the southeast of Iran: a preliminary case-control study
Authors: Kouhpayeh Hamid Reza , Tabasi Farhad , Dehvari Mohammad , Naderi Mohammad , Bahari Gholamreza , Khalili Tahereh , Clark Courtney , Ghavami Saeid , Taheri Mohsen
Published: November 2021

Background

The COVID-19 pandemic remains an emerging public health crisis with serious adverse effects. The disease is caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV--2) infection, targeting angiotensin-converting enzyme-2 (ACE2) receptor for cell entry. However, changes in the renin-angiotensin system (RAS) balance alter an individual’s susceptibility to COVID-19 infection. We aimed to evaluate the association between AGT rs699 C > T, ACE rs4646994 I/D, and AGTR1 rs5186 C > A variants and the risk of COVID-19 infection and the severity in a sample of the southeast Iranian population.

Methods

A total of 504 subjects, including 258 COVID-19 positives, and 246 healthy controls, were recruited. Genotyping of the ACE gene rs4646994, and AGT rs699, and AGTR1 rs5186 polymorphisms was performed by polymerase chain reaction (PCR) and PCR-restriction fragment length polymorphism (PCR-RFLP), respectively.

Results

Our results showed that the II genotype of ACE rs4646994 and the I allele decreased the risk of COVID-19 infection. Moreover, we found that the TC genotype and C allele of AGT rs699 increased the risk of COVID-19 infection. The AGTR1 rs5186 was not associated with COVID-19 infection. Also, we did not find any association between these polymorphisms and the severity of the disease. However, we found a significantly higher age and prevalence of diabetes and hypertension in patients with severe disease than a non-severe disease.

Conclusions

These findings suggest that ACE rs4646994 and AGT rs699 polymorphisms increase the risk of COVID-19 infection in a southeast Iranian population.
Automated artificial intelligence-based analysis of skeletal muscle volume predicts overall survival after cystectomy for urinary bladder cancer
Authors: Ying Thomas , Borrelli Pablo , Edenbrandt Lars , Enqvist Olof , Kaboteh Reza , Trägårdh Elin , Ulén Johannes , Kjölhede Henrik
Published: November 2021

Background

Radical cystectomy for urinary bladder cancer is a procedure associated with a high risk of complications, and poor overall survival (OS) due to both patient and tumour factors. Sarcopenia is one such patient factor. We have developed a fully automated artificial intelligence (AI)-based image analysis tool for segmenting skeletal muscle of the torso and calculating the muscle volume.

Methods

All patients who have undergone radical cystectomy for urinary bladder cancer 2011–2019 at Sahlgrenska University Hospital, and who had a pre-operative computed tomography of the abdomen within 90 days of surgery were included in the study. All patients CT studies were analysed with the automated AI-based image analysis tool. Clinical data for the patients were retrieved from the Swedish National Register for Urinary Bladder Cancer. Muscle volumes dichotomised by the median for each sex were analysed with Cox regression for OS and logistic regression for 90-day high-grade complications. The study was approved by the Swedish Ethical Review Authority (2020-03985).

Results

Out of 445 patients who underwent surgery, 299 (67%) had CT studies available for analysis. The automated AI-based tool failed to segment the muscle volume in seven (2%) patients. Cox regression analysis showed an independent significant association with OS (HR 1.62; 95% CI 1.07–2.44; p = 0.022). Logistic regression did not show any association with high-grade complications.

Conclusion

The fully automated AI-based CT image analysis provides a low-cost and meaningful clinical measure that is an independent biomarker for OS following radical cystectomy.
Molecular study of Pompe disease in Egyptian infants
Authors: Essawi Mona , ElBagoury Nagham , Ashaat Engy , Sharaf-Eldin Wessam , Fateen Ekram
Published: November 2021

Background

Pompe disease (PD) is a serious genetic disorder caused by deficiency of acid α-glucosidase (GAA) and subsequent glycogen accumulation inside lysosomes. This study included a cohort of 5 Egyptian infants (1–8 months old) with far lower than average normal GAA activity and clinical signs of PD in 4 of the 5 cases. The fifth case was discovered by newborn screening (NBS). Molecular analysis of the GAA gene was performed to confirm the diagnosis and identify the underlying mutation.

Results

The study identified the causative mutations [c.1193T > C (p.Leu398Pro), c.1134C > G (p.Tyr378*) & c.1431del (p.Ile477Metfs*43)] in 4 cases. However, molecular analysis reversed the expected pathologic state in the fifth infant, where his reduced enzymatic activity was related to the presence of pseudodeficiency allele c.868A > G (p.Asn290Asp) in addition to heterozygous disease-causing mutation c.2238G > C (p.Trp746Cys).

Conclusion

This study presents the first molecular analysis of GAA gene in Egypt and has thrown some light on the importance of PD molecular diagnosis to provide precise diagnosis and enable therapeutic commencement in affected subjects.
Dietary quality and nutrient intake in adults with obsessive–compulsive disorder
Authors: Nguyen Thomas P. , Cribb Lachlan , Ng Chee H. , Byrne Gerard J. , Castle David , Brakoulias Vlasios , Blair-West Scott , Oliver Georgina , Ee Carolyn , Dean Olivia M. , Camfield David A. , Bousman Chad , Dowling Nathan , Roy Rajshri , Berk Michael , Sarris Jerome
Published: November 2021

Background

Many mental disorders, including depression, bipolar disorder and schizophrenia, are associated with poor dietary quality and nutrient intake. There is, however, a deficit of research looking at the relationship between obsessive–compulsive disorder (OCD) severity, nutrient intake and dietary quality.

Aims

This study aims to explore the relationship between OCD severity, nutrient intake and dietary quality.

Method

A post hoc regression analysis was conducted with data combined from two separate clinical trials that included 85 adults with diagnosed OCD, using the Structured Clinical Interview for DSM-5. Nutrient intakes were calculated from the Dietary Questionnaire for Epidemiological Studies version 3.2, and dietary quality was scored with the Healthy Eating Index for Australian Adults – 2013.

Results

Nutrient intake in the sample largely aligned with Australian dietary guidelines. Linear regression models adjusted for gender, age and total energy intake showed no significant associations between OCD severity, nutrient intake and dietary quality (all P > 0.05). However, OCD severity was inversely associated with caffeine (β = −15.50, 95% CI −28.88 to −2.11, P = 0.024) and magnesium (β = −6.63, 95% CI −12.72 to −0.53, P = 0.034) intake after adjusting for OCD treatment resistance.

Conclusions

This study showed OCD severity had little effect on nutrient intake and dietary quality. Dietary quality scores were higher than prior studies with healthy samples, but limitations must be noted regarding comparability. Future studies employing larger sample sizes, control groups and more accurate dietary intake measures will further elucidate the relationship between nutrient intake and dietary quality in patients with OCD.
Plasma Volume Expansion and Fluid Kinetics of 20% Albumin During General Anesthesia and Surgery Lasting for More Than 5 Hours
Authors: Gunnström Michaela , Zdolsek Joachim H. , Hahn Robert G.
Published: November 2021

BACKGROUND:

Intraoperative administration of crystalloid for plasma volume expansion may be reduced by use of hyperoncotic albumin. However, the degree of plasma volume expansion with administration of 20% albumin is poorly quantitated. We estimated the amount of volume expansion attributable to 20% albumin administration in patients undergoing surgery for more than 5 hours.

METHODS:

Twenty percent albumin was delivered at 3 mL/kg by intravenous infusion during 30 minutes to 15 patients (mean ± standard deviation [SD] age; 46 ± 15 years) undergoing surgery. Blood samples and urine were collected for 5 hours. Mass balance calculations and volume kinetics were used to estimate plasma volume expansion and capillary leakage of albumin and fluid.

RESULTS:

Administration of 20% albumin was associated with an increase in plasma volume amounting to 1.7 times the infused volume. After correction for hemorrhage, the median (and 25th to 75th percentiles) intravascular half-life for the administered albumin mass was 20.4 (14.2–34.7) hours. The plasma volume decreased with a half-life of 21.7 (16.1–26.8) hours. Urinary excretion was 3 times greater than the infused volume of albumin, but kinetic analysis suggested that other flows of fluid to and from the plasma occurred more slowly than previously found in volunteers. Hemodynamic support with norepinephrine increased urinary excretion and contracted the plasma volume.

CONCLUSIONS:

Albumin (20%) increased the plasma volume by 1.7 times the infused volume. Our results do not support that the transcapillary leakage of albumin is accelerated by anesthesia and surgery.
Clutch may predict growth of hatchling Burmese pythons better than food availability or sex
Authors: Josimovich Jillian M. , Falk Bryan G. , Grajal-Puche Alejandro , Hanslowe Emma B. , Bartoszek Ian A. , Reed Robert N. , Currylow Andrea F.
Published: November 2021

Identifying which environmental and genetic factors affect growth pattern phenotypes can help biologists predict how organisms distribute finite energy resources in response to varying environmental conditions and physiological states. This information may be useful for monitoring and managing populations of cryptic, endangered, and invasive species. Consequently, we assessed the effects of food availability, clutch, and sex on the growth of invasive Burmese pythons (Python bivittatus Kuhl) from the Greater Everglades Ecosystem in Florida, USA. Though little is known from the wild, Burmese pythons have been physiological model organisms for decades, with most experimental research sourcing individuals from the pet trade. Here, we used 60 hatchlings collected as eggs from the nests of two wild pythons, assigned them to High or Low feeding treatments, and monitored growth and meal consumption for 12 weeks, a period when pythons are thought to grow very rapidly. None of the 30 hatchlings that were offered food prior to their fourth week post-hatching consumed it, presumably because they were relying on internal yolk stores. Although only two clutches were used in the experiment, we found that nearly all phenotypic variation was explained by clutch rather than feeding treatment or sex. Hatchlings from clutch 1 (C1) grew faster and were longer, heavier, in better body condition, ate more frequently, and were bolder than hatchlings from clutch 2 (C2), regardless of food availability. On average, C1 and C2 hatchling snout-vent length (SVL) and weight grew 0.15 cm d−1 and 0.10 cm d−1, and 0.20 g d−1 and 0.03 g d−1, respectively. Additional research may be warranted to determine whether these effects remain with larger clutch sample sizes and to identify the underlying mechanisms and fitness implications of this variation to help inform risk assessments and management.

This article has an associated First Person interview with the first author of the paper.
Clinical efficacy of linagliptin combined with irbesartan in patients with diabetic nephropathy
Authors: Liu Jie , Zhang Jing , Hou Ming-hui , Du Wei-xuan
Published: November 2021

Objective: To determine the clinical efficacy of linagliptin combined with irbesartan in patients with diabetic nephropathy (DN).

Methods: Seventy-two patients who were admitted to our department of endocrinology in our hospital during January 2018 and June 2019 were randomly divided into a control group (administered with irbesartan only, n=36) and a treatment group (treated with irbesartan and linagliptin, n=36). The course of treatment lasted for three months. FBG (fasting blood glucose), 2hPBG (2h postprandial blood sugar), HbA1C (hemoglobin A1c), Cys-C (cystatin C), SCr (serum creatinine), BUN (blood urea nitrogen), UACR (urine albumin-to-creatinine ratio), CRP (C-reactive protein), IL-6 (interleukin-6), and SOD (superoxide dismutase) were tested pre- and post-treatment to evaluate the clinical efficacy and adverse effects of the two treatment plans after three months of treatment.

Results: Compared with the pre-treatment levels, FBG, 2hPBG, HbA1c, Cys-C, SCr, BUN, UACR, CRP, IL-6, and SOD in both groups were significantly improved following the three-month treatment (P<0.05, respectively). Post-treatment levels of FBG, 2hPBG, HbA1c, Cys-C, SCr, BUN, UACR, CRP, and IL-6 in the treatment group were significantly lower than in the control group (P<0.05, respectively), while the treatment group exhibited a higher level of SOD compared with the control group (P<0.05). No serious adverse reaction occurred in either group (P>0.05).

Conclusion: Combined-modality treatment with linagliptin and irbesartan shows favorable clinical efficacy in treating diabetic nephropathy as it effectively protects the kidneys and improves kidney function by inhibiting inflammatory and oxidative stress responses.

doi: https://doi.org/10.12669/pjms.38.1.4417

How to cite this:Liu J, Zhang J, Hou M, Du W. Clinical efficacy of linagliptin combined with irbesartan in patients with diabetic nephropathy. Pak J Med Sci. 2022;38(1):52-56. doi: https://doi.org/10.12669/pjms.38.1.4417

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.
Diagnostic accuracy of computer aided reading of chest x-ray in screening for pulmonary tuberculosis in comparison with Gene-Xpert
Authors: Nishtar Tahira , Burki Shamsullah , Ahmad Fatima Sultan , Ahmad Tabish
Published: November 2021

Background & Objectives: Pakistan ranked fifth amongst 22 high-burden Tuberculosis countries, and it is  an epidemic in Pakistan, hence screening is performed nationally, as part of the ambitious ZERO TB drive. Our objective was to assess the diagnostic accuracy of Computer Aided Detection (CAD4TB) software on chest Xray in screening for pulmonary tuberculosis in comparison with gene-Xpert.

Methods: The study was conducted by Radiology Department Lady Reading Hospital Peshawar in affiliation with Indus Hospital network over a period of one year. Screening was done by using mobile Xray unit equipped with CAD4TB software with scoring system. All of those having score of more than 70 and few selected cases with strong clinical suspicion but score of less than 70 were referred to dedicated TB clinic for Gene-Xpert analysis.

Results: Among 26,997 individuals screened, 2617 (9.7%) individuals were found presumptive for pulmonary TB. Sputum samples for Gene-Xpert were obtained in 2100 (80.24%) individuals, out of which 1825 (86.9%) were presumptive for pulmonary TB on CAD4TB only. Gene-Xpert was positive in 159 (8.7%) patients and negative in 1,666(91.3%). Sensitivity and specificity of CAD4TB and symptomatology with threshold score of ≥70 was 83.2% and 12.7% respectively keeping Gene-Xpert as gold standard.

Conclusion: Combination of chest X-ray analysis by CAD4TB and symptomatology is of immense value to screen a large population at risk in a developing high burden country. It is significantly a more effective tool for screening and early diagnosis of TB in individuals, who would otherwise go undiagnosed.

Abbreviations: TB = Tuberculosis, WHO = World Health Organization, CAD4TB = Computer aided detection for tuberculosis, CXR = Chest X-Ray, CAR = Computer aided reading.

doi: https://doi.org/10.12669/pjms.38.1.4531

How to cite this:Nishtar T, Burki S, Ahmad FS, Ahmad T. Diagnostic accuracy of computer aided reading of chest x-ray in screening for pulmonary tuberculosis in comparison with Gene-Xpert. Pak J Med Sci. 2022;38(1):62-68.   doi: https://doi.org/10.12669/pjms.38.1.4531

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.