bluuebunny/crossref_metadata_2025 huggingface dataset:
A Reliable Framework for Secure Communication and Health Assessment of Soldiers in the Battlefield
Authors: Bin Ahmad Maaz , Asif Muhammad , Masood Khalid , Al Ghamdi Mohammad A. , Almotiri Sultan H. , Nagra Arfan Ali
Published: October 2022

Wars against the enemy are mandatory for the integrity of a nation. With the passage of time, the nature of war is being changed, to some extent from a conventional war to the network-centric warfare. The rate of soldiers death has increased in modern combat operations. The lack of secure connectivity and the health (mental and physical) of soldiers are among a few major reasons for the increased mortality. Mental health or stress level produces permanent changes in the physiological systems of a soldier and long-term diseases such as asthma, diabetes, and hypertension are activated with chronic stress. Although modern communication technologies may provide huge support in the efficient conduction of combat’s activities but it is at the cost of huge power consumption. The proposed research presents a computationally efficient and low-power framework that not only ensures secure communication but also provides a robust command and control system to monitor the mental stress, injury, and death of soldiers. In the suggested framework, the Advanced Encryption Standard (AES) is used for communication that is highly suitable for power constraint devices. A wearable sensor system is suggested that can be embedded in a soldier’s uniform to assist in the recording of real-time stress, injury, and death of soldiers. The system contains a heart-rate monitor to record variations in heartbeats, an EDA sensor for skin conductance, and a respiration sensor for respiration variations along with a holster unit for storage and transmission of biomedical signals. Furthermore, it also provides a mechanism to prevent misuse of soldiers’ communication equipment by the enemy thus ensuring more security. The experimental analysis shows that the proposed mental stress computation module achieved 83.33% accuracy. Moreover, a score-based comparison is performed with the existing techniques and it is found that the proposed mechanism outperformed its counterparts with 37.5% improvements in the features-based analysis. The flexibility, security, efficiency, and reliability of the framework make it appropriate for modern warfare scenarios.
Dynamic Incentive Mechanism for Large-scale Projects Based on the Reputation Effects
Authors: Han Haikun , Shen Juqin , Liu Bo , Han Han
Published: October 2022

Large-scale projects play an important role in social and economic development. Recently, large-scale projects are becoming more complex with more uncertainties and risks during the construction, which leads to more complex and extensive management problems. In a large-scale project, there is a principal-agent relationship between the contractor and owner. The contractor may take moral hazard behavior to pursue his/her own interests due to the information asymmetry and conflict of interest, which could damage to the public and owner’s interests. Based on the principal-agent theory, a dynamic incentive model combining explicit and implicit incentives was constructed in large-scale projects, after analyzing the mechanism of reputation effects. A comparison was made between two scenarios. One scenario considered reputation effects; the other did not consider reputation effects. The results show that the contractor would be more inclined to make optimal efforts in the large-scale project after reputation effects are introduced, and this optimal effort level will improve with the increased influence degree of reputation effects. However, the contractor’s degree of risk aversion will weaken the incentive effects. In addition, compared to an explicit incentive, the reputation mechanism of an implicit incentive will increase the owner’s benefits. The findings not only provide important support for the owner to formulate relevant incentive clauses in the construction contract, but also has important practical significance for the construction of the micro-institutional environment in construction projects. This study did not take into account factors such as regulatory efficiency when establishing the reputation incentive model. How to combine reputational incentives with the degree of supervision will be the direction of future research.
A Promising Asynchronous Online Intervention to Support General Educators’ Knowledge of Predictors of Postschool Success
Authors: Kwiatek Stephen M. , Mazzotti Valerie L. , Wood Charles L. , Vicchio Janie N.
Published: October 2022

Students with disabilities experience less postschool success than students without disabilities. Until recently, college and career readiness efforts did not appear to include an explicit focus on students with disabilities. Because most U.S. students with disabilities spend time in general education settings, general education teachers need strategies to prepare all students for college and careers. The predictors of postschool success appear ideal to support general education teachers with this effort. We investigated the use of an asynchronous online intervention to increase two general education teachers’ knowledge of three predictors of postschool success. Results were promising in that the intervention increased participants’ knowledge of the three predictors. We share limitations related to our research design and suggestions for future research and practice.
Treatment-Associated Acute Lymphoblastic Leukemia Following Autologous Hematopoietic Stem Cell Transplant and Lenalidomide Maintenance in Patients With Multiple Myeloma
Authors: Crosby James , Erzuah Tosha , Haider Mahvish , Smith Forrest , Ganti Shyam , Monohan Gregory , Elsouiedi Raymond
Published: October 2022

Secondary malignancies including leukemia are an increasing concern in patients with prior primary malignancies treated with alkylating agents or topoisomerase II inhibitors. These can also be referred to as therapy-related leukemia. Therapy-related leukemia most commonly results in myelodysplastic syndrome or acute myeloid leukemia. The alkylating agent can cause chromosomal aberrations typically manifest as deletions in chromosome 11 or loss of part of complete loss of chromosomes 5 and 7. Conversely, acute lymphoblastic leukemia (ALL) has been described following maintenance therapy with immunomodulatory (IMiD) drugs pomalidomide, thalidomide, and lenalidomide. We present a case of a 71-year-old man with a history of multiple myeloma (MM) maintained on lenalidomide after stem cell transplant who presented with treatment-associated ALL. At time of leukemic presentation, chromosomal analysis showed a near-triploid clone consistent with masked double low hyplodiploidy which is associated with a poor prognosis. The patient had a deletion of the long arm of chromosome 5 which has been described in prior case reports with ALL secondary to lenalidomide therapy. There are explicit mechanisms in the literature, which have been attributed to development of ALL after exposure to thalidomide or lenalidomide. At time of submission, there are 20 cases described in the literature linking ALL to IMiD drugs. We describe a case and review the mechanisms of lenalidomide-associated ALL.
A Rare Case of Metastatic Hepatocellular Carcinoma to the Hard Palate
Authors: Lyon Priscilla R. P. , Trevathan Sean , Talukdar Rudranath , Nguyen Dominic D. , McPhaul Christopher M. , Rampisela Debby
Published: October 2022

Extrahepatic metastasis of hepatocellular carcinoma (HCC) to the head and neck is unusual, especially the oral cavity/maxillofacial region. Metastatic HCC to the hard palate, however, is particularly rare. The most common site of HCC metastasis is the lung, followed by lymph nodes, bone, and adrenal gland. Importantly, oral cavity metastatic HCC may be misdiagnosed as a primary malignancy, such as a salivary gland carcinoma. In this article, we describe a young woman with metastatic HCC to the hard palate that was initially diagnosed as an acinic cell carcinoma.
Is Video-Based Analysis a Valid Method for Determining Mechanisms of Ankle Injuries During Gameplay in the National Basketball Association?
Authors: Zeblisky Peter , Collins Andrew P. , Cassinat Joshua , Riemenschneider Joel , Ebaugh Pierce , Shaath Mohamed K. , Service Benjamin C.
Published: October 2022

Background:

In the National Basketball Association (NBA), lower extremity injuries account for over 70% of games missed, with ankle injuries being the most common. High-quality video analysis has been successful for studying injury mechanism.

Purpose:

To (1) determine the validity of video-based analysis as a method to evaluate ankle injury mechanisms in NBA players and (2) analyze the circumstances associated with injury, games missed due to injury, and associated costs in player salary due to time missed.

Study Design:

Case series; Level of evidence, 4.

Methods:

Ankle injuries were identified using an injury report database, and corresponding videos were searched using YouTube.com to access high-quality video evidence of these injuries during the 2015-2020 NBA regular season. We reviewed 822 injuries, of which 93 had corresponding videos (video subset), in our final analysis. Variables including number of games missed, necessity for surgical treatment, and injury recurrence were reported for the entire cohort. In the video subset, the mechanism of injury and other corresponding situational data were evaluated.

Results:

The most common mechanism of injury occurred via ankle inversion (83.9%; n = 78; P < .001). These injuries were significantly associated with indirect contact with the player’s ankle (79.6%; n = 74; P < .001). There were significant differences based on player position, within both the video subset ( P = .008) and the entire cohort ( P < .001), with guards being injured the most frequently. The average number of games missed due to injury was 7 games in the video subset and 5 games in the entire cohort ( P = .14). There were significant differences between the groups in average player salary per game ($133,878 [video subset] versus $87,577 [entire cohort]; P < .001).

Conclusion:

Despite its low yield of 11.3%, video analysis proved to be a useful tool to determine ankle injury mechanisms as well as the distribution of injuries based on player position. However, this methodology was subject to selection bias, as evidenced by a $50,000 increase in player salary among the video cohort. These findings should be considered when using video analysis in future studies.
Caregiving in U.S. Gulf States During Natural Disasters and COVID-19
Authors: Boucher Nathan A. , McKenna Kevin , Dombeck Carrie B. , Clark Amy G. , Wang Ke , Olsen Jennifer M. , Shepherd-Banigan Megan
Published: October 2022

Objectives:

To ascertain common experiences and needs of a diverse group of caregivers challenged by hurricanes/floods and COVID-19.

Methods:

In-depth interviews with unpaid caregivers in U.S. Southeast/Gulf Coast states who had experienced caregiving during a natural disaster and during COVID-19.

Results:

Caregivers report challenges including daily living disruption, altered social supports, complicated health management, additional disaster planning, and emotional/financial impacts. Caregivers suggested helpful resources, policy options, and preparatory tools at individual, local, and health system levels to mediate discontinuity.

Conclusions:

Our data describe combined caregiver experiences of hurricanes/floods and the pandemic. Caregivers experience unique burdens related to care recipient diagnosis, location, and veteran status. Access to community supports varies as they manage the tasks required for care recipients’ health and safety. Our findings indicate the need for public health reinforcement of caregiving though caregiver pre-planning and targeted support. Bolstering understanding of communities’ caregiving capacity though first responder trainings and caregiver registries may enhance health and safety.
Fournier’s Gangrene: A Rare Infectious Entity in an Adolescent with Type II Diabetes
Authors: Sanders Sara C. , Balamohan Archana , Smith Emily S. , Taylor Maxwell D. , Cantu Rebecca M.
Published: October 2022

Fournier’s gangrene is a rapidly progressive necrotizing fasciitis of the perineum and external genital organs that is uncommon in the pediatric age group. We present a case report of a 17-year-old obese male with comorbidities of type II diabetes, hypertension, and tobacco use, who presented to the hospital with vague systemic symptoms and pain in the gluteal area. On examination, he was febrile and had erythema and induration of his left scrotum, perineum, and gluteal region. Imaging obtained due to rapid progression of symptoms was consistent with a diagnosis of Fournier’s gangrene. He was managed with broad-spectrum antibiotics, aggressive surgical debridement, and a diverting colostomy. This case brings to light to a classically adult diagnosis that should be considered in adolescents, especially given the rising numbers of risk factors in this population, such as diabetes, obesity, and smoking.
Management of End-Stage Achalasia
Authors: Csendes Juhasz Attila , González Arestizábal Tomás , Lanzarini Sobrevia Enrique
Published: October 2022

Background:

End-stage Achalasia correspond to the final stage in the evolution of this disease, characterized by the presence of severe dysphagia and weight loss despite aggressive treatment, associated to massive esophageal dilatation and tortuosity of the esophagus, with loss of its axis and adopting a sigmoid-shape or L-shape distal esophagus. It is also called advanced sigmoid esophagus. The diagnosis is based on radiological evaluations, but different authors use different criteria to define end-stage. This fact makes difficult to compare the results, due to a great heterogeneity of the patients.

Methods:

Total of 65 reports contently treatment of patients with end stage achalasia were carefully review.

Results:

Until the year 2000 subtotal esophagectomy with gastric or long-colon interposition was employed as primary treatment or after several medical and endoscopic failed treatments. The mean mortality rate range 3% to 5%, with a high morbidity rate and 10 to 12 days of hospital stay. From 2000 to 2015 Laparoscopic Heller Myotomy (LHM) was employed as the primary treatment, with a mortality rate of 0%, low postoperative morbidity (6%-8%) and 2 days of Hospital stay. The long-term follow up was satisfactory in near 2/3 of the patients with end-stage esophagus. In the last years POEM (Peroral endoscopic Myotomy) has been employed mainly by Asian authors, reporting 0% mortality, high rate of postoperative morbidity (over 20%), a hospital stay of 5 to 7 days and a very short follow up, usually less than 2 years. Although the control of dysphagia is high, the main problem with this technique is the marked increase in pathologic acid reflux to the esophagus, with values near to 50% of the patients. It is not known the late effect 10 to 15 years after this procedure of this severe reflux in an aperistaltic esophagus, with retention of food and acid inside the esophageal lumen.

Conclusion:

Up to now Laparoscopic Heller Myotomy seems the best option for these patients with severe end-stage esophagus. If there is a failure after this procedure, thoracoscopic esophagectomy would be the best option.
Does Achalasia Subtype III Need to Be Treated Differently Than Type I and II? Con Argument
Authors: Worrell Stephanie G.
Published: October 2022

Prior to the introduction of high-resolution manometry (HRM), achalasia was a singular diagnosis based on water-perfused pull-through manometry. With the introduction of high-resolution manometry and the Chicago classification system, we have become more astute to the variations in motility disorders that result in failure of the lower esophageal sphincter with disordered esophageal peristalsis. However, as a clinician, is the treatment for each subtype really different? Further, after you have established a diagnosis and ruled-out any causes of pseudo-achalasia, should you treat Type III achalasia any different than Type I or II achalasia?
Out-of-plane performance evaluation of energy-dissipating hysteretic infill wall system under cyclic loading
Authors: Pachappoyil Nidhin S , Agarwal Pankaj
Published: October 2022

An innovative energy-dissipating hysteretic (EDH) infill system is conceptualized and designed with the help of slotted concrete blocks interlinked with energy-dissipating link elements. Full-scale reinforced concrete frames infilled with the EDH infill system and the conventional brick infill system are tested initially under in-plane cyclic test followed by out-of-plane cyclic test. A specially designed double-leaf airbag test setup maneuvered with hydraulic actuators is fabricated for out-of-plane testing of the infilled frames. The hysteresis performance of both the infill wall systems is compared experimentally. A cyclic pushover test in the out-of-plane direction is also carried out to assess the amount of damage and the residual capacity of the EDH infill system. The test results reveal that the out-of-plane performance with prior in-plane damage of the EDH infill is significantly improved over the conventional brick infill system in terms of lateral strength, stiffness degradation, deformation capacity, energy dissipation, and effective damping. A numerical model of the EDH infill system is developed based on the elastomeric properties of the energy-dissipating links in the OpenSees software platform.
MCM2 in human cancer: functions, mechanisms, and clinical significance
Authors: Sun Yaoqi , Cheng Zhongping , Liu Shupeng
Published: October 2022

Background

Aberrant DNA replication is the main source of genomic instability that leads to tumorigenesis and progression. MCM2, a core subunit of eukaryotic helicase, plays a vital role in DNA replication. The dysfunction of MCM2 results in the occurrence and progression of multiple cancers through impairing DNA replication and cell proliferation.

Conclusions

MCM2 is a vital regulator in DNA replication. The overexpression of MCM2 was detected in multiple types of cancers, and the dysfunction of MCM2 was correlated with the progression and poor prognoses of malignant tumors. According to the altered expression of MCM2 and its correlation with clinicopathological features of cancer patients, MCM2 was thought to be a sensitive biomarker for cancer diagnosis, prognosis, and chemotherapy response. The anti-tumor effect induced by MCM2 inhibition implies the potential of MCM2 to be a novel therapeutic target for cancer treatment. Since DNA replication stress, which may stimulate anti-tumor immunity, frequently occurs in MCM2 deficient cells, it also proposes the possibility that MCM2 targeting improves the effect of tumor immunotherapy.
Visible-Light-Stimulated Synaptic Phototransistors Based on CdSe Quantum Dot/In–Ga–Zn–O Hybrid Channels
Authors: Fu En-bo , Liu Yu , Hou Xiang-Rui , Feng Ye , Yang Chun-lei , Shao Yan
Published: October 2022

Light-stimulated synaptic devices are promising candidates for the development of artificial intelligence systems because of their unique properties, which include broad bandwidths, low power consumption, and superior parallelism. The key to develop such devices is the realization of photoelectric synaptic behavior in them. In this work, visible-light-stimulated synaptic transistors based on CdSe quantum dot (CdSe QD)/amorphous In–Ga–Zn–O hybrid channels are proposed. This design can not only improve the charge separation efficiency of the photogenerated carriers, but also can induce delayed decay of the photocurrent. The improved charge separation efficiency enhances the photoelectric properties significantly, while the delayed decay of the photocurrent led to the realization of photoelectric synaptic behaviors. This simple and efficient method of fabricating light-stimulated phototransistors may inspire new research progress into the development of artificial intelligence systems.
Transcriptomic stability or lability explains sensitivity to climate stressors in coralline algae
Authors: Page Tessa M. , McDougall Carmel , Bar Ido , Diaz-Pulido Guillermo
Published: October 2022

Background

Crustose coralline algae (CCA) are calcifying red macroalgae that play important ecological roles including stabilisation of reef frameworks and provision of settlement cues for a range of marine invertebrates. Previous research into the responses of CCA to ocean warming (OW) and ocean acidification (OA) have found magnitude of effect to be species-specific. Response to OW and OA could be linked to divergent underlying molecular processes across species.

Results

Here we showSporolithon durum, a species that exhibits low sensitivity to climate stressors, had little change in metabolic performance and did not significantly alter the expression of any genes when exposed to temperature and pH perturbations. In contrast,Porolithon onkodes, a major coral reef builder, reduced photosynthetic rates and had a labile transcriptomic response with over 400 significantly differentially expressed genes, with differential regulation of genes relating to physiological processes such as carbon acquisition and metabolism. The differential gene expression detected inP. onkodesimplicates possible key metabolic pathways, including the pentose phosphate pathway, in the stress response of this species.

Conclusions

We suggestS. durumis more resistant to OW and OA thanP. onkodes, which demonstrated a high sensitivity to climate stressors and may have limited ability for acclimatisation. Understanding changes in gene expression in relation to physiological processes of CCA could help us understand and predict how different species will respond to, and persist in, future ocean conditions predicted for 2100.
Feasibility of dried blood spot for hepatitis C diagnosis in vulnerable subjects and people living in remote areas from Brazil
Authors: Villar Livia Melo , de Lima Marjorie Parra , Cruz Helena Medina , de Paula Vanessa Salete , Scalioni Leticia de Paula , Flores Geane Lopes , Carvalho-Costa Filipe Anibal , Parente Cynara Carvalho , Coelho Maria Rosangela Cunha Duarte , de Albuquerque Ana Cecilia Cavalcanti , Milagres Flavio Augusto Pádua , Cruz Marcelo Santos , Andrade Tarcisio Matos , Motta-Castro Ana Rita Coimbra , da Mota Jurema Corrêa , Lewis-Ximenez Lia Laura , Bastos Francisco Inácio
Published: October 2022

Background

Agile, accessible and cheap diagnosis of hepatitis C virus (HCV) infection is essential to achieve the elimination of this infection, worldwide, as mandated by the World Health Organzation as part of its strategy for 2030. Dried blood spots (DBS) can be an attractive alternative for sample collection among people living in remote areas and vulnerable populations due to the less invasive collection, its biosafety, and storage & transportation of samples at room temperature.

Design

This study aims to estimate the usefulness of dried blood spot samples for the diagnosis and the assessment of HCV infection rates in three different settings in Brazil. Cross-sectional analysis of a sample collection from different populations, aiming to assess the performance of the testing algorithms and respective procedures among different populations with diverse background infection rates.

Methods

We reported the evaluation of DBS as alternative samples for detecting anti-HCV in different groups in real life conditions: (I) Vulnerable subjects living in remote areas of Southeast, North and Northeast Brazil (n = 1464); (II) Beauticians (n = 288); (III) People who use non-injectable drugs (n = 201); (IV) patients referred to outpatient care (n = 275).

Results

General assay accuracy was 99%, with a weighted kappa value of 0.9, showing an excellent performance. Sensitivities ranged from 87.5% to 100.0% between groups and specificities were above 99.2%. A total of 194 individuals had HCV RNA in serum and concordance of anti-HCV detection in DBS was 98.4%.

Conclusions

DBS samples could be used for anti-HCV detection in different populations recruited in real life conditions and ambulatory settings, with a high overall sensitivity and specificity.
Dietary acid load, alternative healthy eating index score, and bacterial vaginosis: is there any association? A case-control study
Authors: Noormohammadi Morvarid , Eslamian Ghazaleh , Kazemi Seyyedeh Neda , Rashidkhani Bahram
Published: October 2022

Background:

Changing the dietary pattern may be an alternative treatment for bacterial vaginosis, the prevalent vaginal infection in women.

Methods:

One hundred and forty-three bacterial vaginosis-affected women diagnosed by Amsel criteria and 151 healthy controls aged 18 to 45 entered the current case-control research. To calculate the alternative healthy eating index and dietary acid load score, food consumption was recorded with an accurate and precise food frequency questionnaire. The dietary acid load was measured by potential renal acid load (PRAL) and net endogenous acid production (NEAP) indices. Using logistic regression models, the association between the alternative healthy eating index and dietary acid load score with bacterial vaginosis was investigated.

Results:

The last tertile of the alternative healthy eating index had a 75% decreased odds of experiencing bacterial vaginosis in the adjusted model (adjusted odds ratio (aOR) = 0.25, 95% confidence interval (CI) = 0.12–0.53, P for trend = 0.001). Besides, vegetables (aOR = 0.34, 95% CI = 0.17–0.69, P for trend = 0.003), nuts and legumes (aOR = 0.44, 95% CI = 0.23–0.87, P for trend = 0.028), and meats (aOR = 0.31, 95% CI = 0.16–0.60, P for trend = 0.001) intake was linked to a decreased bacterial vaginosis odds. However, sugar-sweetened beverages and fruit juice (aOR = 3.47, 95% CI = 1.68–7.17, P for trend < 0.001), trans fatty acids (aOR = 2.29, 95% CI = 1.18–4.43, P for trend = 0.005), and sodium (aOR = 3.44, 95% CI = 1.67–7.06, P for trend = 0.002) intake were directly associated with bacterial vaginosis odds. There was no evidence of a link between dietary acid load and bacterial vaginosis.

Conclusion:

According to the present study’s findings, there is no correlation between dietary acid load and the likelihood of developing bacterial vaginosis. However, following a plant-based dietary pattern based on the healthy eating index may lead to a lower odds of bacterial vaginosis.
Health related quality of life of patients undergoing in-centre hemodialysis in Rwanda: a cross sectional study
Authors: Shumbusho Gloria , Hategeka Celestin , Vidler Marianne , Kabahizi Jules , McKnight Marla
Published: October 2022

Background:

There are few studies assessing the quality of life of patients with chronic and end stage kidney disease in sub-Saharan Africa. We aimed to describe the health-related quality of life (HRQOL) of patients undergoing in-centre maintenance hemodialysis in Rwanda using the KDQOL™-36 and determine sociodemographic and clinical factors associated with their quality of life.

Methods:

We conducted a multicenter, cross-sectional study between September 2020 and July 2021. Patients over the age of 18 receiving maintenance in-centre hemodialysis for at least three months at the Rwandan tertiary hospitals were administered the KDQOL™-36 questionnaire to assess physical and mental health functioning, the effect, burden and symptoms and problem of kidney disease. Sociodemographic and clinical information was collected for all eligible patients. Using mixed effects linear regression models, we explored factors associated with overall KDQOL and its domains, while accounting for clustering of patients within hemodialysis centres.

Results:

Eighty-nine eligible patients were included in the study. The majority of participants were younger than 60 years old (69.7%), male (66.3%), had comorbidities (91%), and 71.6% were categorized as level 3 on a 4 tier in-country poverty scale. All participants had health insurance coverage, with 67.4% bearing no out of pocket payments for hemodialysis. The median (IQR) quality of life score was 45.1 (29.4) for overall HRQOL, 35.0 (17.9) for PCS and 41.7 (17.7) for MCS. Symptoms and problem of kidney disease, effect of kidney disease, and burden of kidney disease scored 58.3 (43.8), 56.3 (18.8) and 18.8 (37.5), respectively. A notable difference of KDQOL scores between hemodialysis centres was observed. Overall KDQOL was associated with male sex (adjusted ß coefficient [aß]: 8.5, 95% confidence interval [CI]: 2.8, 14.3); being employed (aß: 8.2, 95% CI: 2.2, 14.3); dialysis vintage of 13–24 months (aß: 10.5, 95% CI: 3.6, 17.6), hemoglobin of 10-11 g/dl (aß: 7.3, 95% CI: 0.7, 13.7) and comorbidities (e.g., ≥ 3 comorbidities vs. none) (aß: -29.8, 95% CI: -41.5, -18.3).

Conclusion:

Patients on in-centre hemodialysis in Rwanda have reduced KDQOL scores, particularly in the burden of kidney disease and physical composite summary domains. Higher overall KDQOL mean score was associated with male sex, being employed, and dialysis vintage of 13–24 months, hemoglobin of 10-11 g/dl and absence of comorbidities. The majority of patients receiving in-centre hemodialysis have higher socioeconomic status reflecting the social and financial constraints to access and maintain dialysis in resource limited settings.
A pregnant woman with thymoma-associated pure red cell aplasia
Authors: Shibata Megumi , Kaneko Kayoko , Umehara Nagayoshi , Matsui Hitoshi , Kawai Toshinao , Nakadate Hisaya , Murashimia Atsuko , Sago Haruhiko
Published: October 2022

Background

Pure red cell aplasia (PRCA) is a hematological disorder characterized by anemia with severe reticulocytopenia caused by a marked reduction in erythroid precursors in the bone marrow. PRCA is known to be associated with pregnancy, but thymoma-associated PRCA during pregnancy is very rare, and its successful management has not been reported.

Case presentation

A 37-year-old primiparous woman with severe anemia was referred to our center at 27 weeks’ gestation. She was diagnosed with PRCA based on bone aspiration findings at 33 weeks’ gestation. Magnetic resonance imaging (MRI) revealed an anterior mediastinal mass 4 cm in size suspected of being thymoma. She was therefore diagnosed with thymoma-associated PRCA during pregnancy. Surgery for thymoma was planned after delivery, since the imaging findings were suggestive of early-stage thymoma (Masaoka stage I or II). With transfusion of a total 3,360 ml of red blood cells (RBCs) during pregnancy, the patient gave birth to a baby girl weighing 2,548 g at 40 weeks’ gestation. The baby showed transient congenital cutaneous candidiasis. The placental pathology revealed subamniotic inflammation with a fungal structure. Treatment with topical anti-fungal cream immediately ameliorated the baby’s skin lesion. Maternal anemia did not improve after delivery; however, the thymoma did not increase in size. At five months after delivery, the mother underwent thymectomy with oral cyclosporine A. A pathological examination revealed Masaoka stage II-a thymoma. She completely had recovered from anemia at six months after surgery. Cyclosporine A treatment was discontinued three years after surgery. Remission has been sustained for four years since surgery.

Conclusions

A very rare case of thymoma-associated PRCA during pregnancy was diagnosed without any subjective symptoms and was expectantly managed, resulting in a good prognosis. Although bone marrow aspiration during pregnancy is an invasive test, it is important to confirm the diagnosis. Conservative management with blood transfusion was possible for early-stage thymoma-associated PRCA during pregnancy. Active surveys, including MRI, for PRCA during pregnancy led to the detection of thymoma at an early stage and the achievement of a preferable pregnancy outcome.
Pars plana vitrectomy and subretinal tissue plasminogen activator for large exudative submacular hemorrhage: a case series
Authors: Patikulsila Direk , Winaikosol Pawara , Choovuthayakorn Janejit , Watanachai Nawat , Chaikitmongkol Voraporn , Kunavisarut Paradee
Published: October 2022

Background

To evaluate anatomical and functional outcomes of patients with large submacular hemorrhage (SMH) who treated by pars plana vitrectomy (PPV) in combination with subretinal tissue plasminogen activator (TPA) injection, intraocular gas tamponade, and with additional post-operative interventions.

Methods

Medical records of 9 patients who presented with large SMH secondary to age-related macular degeneration (AMD) and underwent PPV, subretinal TPA injection, and gas tamponade at Chiang Mai university hospital between January 2012 and January 2020 were reviewed. Collected data included preoperative visual acuity (VA), SMH extent and duration, intraoperation and post-operation complications, post-operative anatomical and VA responses, and the need for administer post-operation additional treatments.

Results

Overall, five patients were male and four patients were female with a mean (SD) age of 66.9 (7.7) years and a mean (SD) follow-up of 21.1 (16.1) months. A mean (SD) duration of SMH was 15.1 (10.9) days with a mean (SD) extent of SMH was 6.2 (3.4) disc diameters. At 1-month post-operation, complete SMH displacement was noted in eight (88.9%) patients. The mean (SD) VA significantly improved from LogMAR 1.9 (0.4) to 1.1 (0.4), (P = 0.004). During follow-up, eight patients (88.9%) were given additional therapy (anti-vascular endothelial growth factor (anti-VEGF) monotherapy, photodynamic therapy, or in combination). At final follow-up, a mean (SD) LogMAR VA of 0.9 (0.4) was significantly improved compared to baseline (P = 0.004). For intra- and post-operation complications, none developed intraoperative retinal break and retinal detachment.

Conclusions

Vitrectomy with subretinal TPA injection, intraocular gas tamponade, and additional post-operation treatments provide benefit for anatomical and visual outcomes for patients with large SMH. It may consider as one of effective treatment in this group of patients.
Predictors of abnormal electroencephalogram and neuroimaging in children presenting to the emergency department with new-onset afebrile seizures
Authors: Ali Noman , Haider Sohaib , Mustahsan Syed , Shaikh Murk , Raheem Ahmed , Soomar Salman Muhammad , Waheed Shahan
Published: October 2022

Background

Electroencephalogram and neuroimaging in pediatric patients with new-onset afebrile seizures are performed to detect any underlying pathological severe condition that may require emergent neuro-intervention and guide prognosis. This study aims to determine the predictors of abnormal EEG and neuroimaging in children presenting to the emergency department with new-onset afebrile seizures.

Methods

This single-center cross-sectional study was conducted at a tertiary care hospital in Karachi, Pakistan, from July 01, 2019, to June 30, 2021. All patients aged one month to 18 years who presented with new-onset afebrile seizures were included. Demographic and clinical data were recorded, including age, gender, seizure type, duration of seizure, associated signs and symptoms, and disposition. Multivariable regression analysis was applied to determine the predictors of abnormal EEG and CT scan or MRI findings.

Results

Out of 201 participants, most patients were in the infantile age group (41.3%), with an equal gender distribution. The most common type of seizure was generalized onset 152 (75.6%). EEG was performed on a total of 126 patients (62.7%) and out of these patients, 67 patients (53.1%) had abnormal findings. In a multivariable analysis, the age group of 5 to 10 years and seizure duration of more than 5 min were significantly associated with higher odds of abnormal EEG findings. In contrast, only the focal onset of seizure was significantly associated with higher odds of abnormal neuroimaging findings.

Conclusion

The study emphasizes the need for a protocol regarding the performance of EEG and neuroimaging in children presenting to the ED with new-onset afebrile seizures that would aid emergency physicians in the direction of appropriate management, thus ensuring a better quality of patient care and outcomes.
Transcriptomics and miRNomics data integration in lymphoblastoid cells highlights the key role of immune-related functions in lithium treatment response in Bipolar disorder
Authors: Cattane Nadia , Courtin Cindie , Mombelli Elisa , Maj Carlo , Mora Cristina , Etain Bruno , Bellivier Frank , Marie-Claire Cynthia , Cattaneo Annamaria
Published: October 2022

Background

Bipolar Disorder (BD) is a complex mental disease characterized by recurrent episodes of mania and depression. Lithium (Li) represents the mainstay of BD pharmacotherapy, despite the narrow therapeutic index and the high variability in treatment response. However, although several studies have been conducted, the molecular mechanisms underlying Li therapeutic effects remain unclear.

Methods

In order to identify molecular signatures and biological pathways associated with Li treatment response, we conducted transcriptome and miRNome microarray analyses on lymphoblastoid cell lines (LCLs) from 20 patients diagnosed with BD classified as Li responders (n = 11) or non-responders (n = 9).

Results

We found 335 mRNAs and 77 microRNAs (miRNAs) significantly modulated in BD responders versus non-responders. Interestingly, pathway and network analyses on these differentially expressed molecules suggested a modulatory effect of Li on several immune-related functions. Indeed, among the functional molecular nodes, we found NF-κB and TNF. Moreover, networks related to these molecules resulted overall inhibited in BD responder patients, suggesting anti-inflammatory properties of Li.

From the integrative analysis between transcriptomics and miRNomics data carried out using miRComb R package on the same samples from patients diagnosed with BD, we found 97 significantly and negatively correlated mRNA-miRNA pairs, mainly involved in inflammatory/immune response.

Conclusions

Our results highlight that Li exerts modulatory effects on immune-related functions and that epigenetic mechanisms, especially miRNAs, can influence the modulation of different genes and pathways involved in Li response. Moreover, our data suggest the potentiality to integrate data coming from different high-throughput approaches as a tool to prioritize genes and pathways.
Promoting health and social equity through family navigation to prevention and early intervention services: a proof of concept study
Authors: Waid Jeffrey , Tomfohrde Olivia , Kutzler Courtney
Published: October 2022

Background

Health and social inequality are associated with multiple adverse childhood experiences including poverty, mental illness, and child maltreatment. While effective interventions currently exist for many health and social problems, large segments of the population experience barriers accessing needed services. In alignment with broader public health efforts to reduce health and social inequality in one state in the U.S.A., the current study describes the development and formative evaluation of a brief, low cost, portable model of prevention-oriented family service navigation called Navigate Your Way.

Methods

Caregivers of children experiencing significant unmet health or social service needs were recruited to the study. Participants completed an initial and closing telephone interview which included measures of past and current family health and social service utilization, service barriers, parenting stress, and child internalizing/externalizing behaviors. Between interviews participants created a family service plan and received 10 weeks of telephone and web-mediated family navigation, at which time process and fidelity of implementation data were collected. Frequency and descriptive statistics are provided for participant demographic characteristics, service barriers, intervention engagement, and primary and secondary study outcomes. Paired samples t-tests examined changes in study outcomes between initial and closing telephone interviews.

Results

Thirty two caregivers enrolled, twenty-nine completed the study. The age range was 20–59 (M = 39.5, SD = 10.0). The majority identified as female (96.9%, n = 31), racial/ethnic minority (56.2%, n = 18), and reported an average 10 barriers to care (M = 10.4, SD = 4.1). The most frequently reported service needs were mental health care, housing, food security, transportation, and health insurance. The mean duration of intervention delivery was 83 days. Most participants (82.8%, n = 24) were connected to one or more health or social services. Caregivers reported significant improvements to youth internalizing behaviors (d = 2.5, p = .05) and high levels of overall satisfaction with the navigation approach.

Conclusion

Telephone and web-mediated service navigation is a feasible and practical approach to supporting families in rapidly connecting to health and social care. Future research investigating the efficacy and implementation of Navigate Your Way in routine settings is indicated.
A case report: anatomical translocation in tibial insertion of semitendinosus tendon after tibial lengthening
Authors: Xu Juncai , Fu Dejie , Peng Yang , Yang Pengfei , Xiong Ran , Lei Kai , Guo Lin
Published: October 2022

Background

There is the most common method for arthroscopic anterior cruciate ligament (ACL) reconstruction by using the semitendinosus and gracilis tendons and single-tunnel technique. However, anatomic translocation of hamstring tendon attachment is very rare.

Case presentation

A 45-year-old male who need to receive right knee ACL reconstruction due to sprain injury while playing table tennis was found to have a translocation at tibial attachment of semitendinosus tendon. The tibial insertion of left semitendinosus was then explored by ultrasound and found to be identical to the contralateral limb. The patient has a history of bilateral tibial lengthening.

Conclusions

This is the first case as far as we know that reported anatomic translocation of the tibial attachment of the hamstring tendon after tibial lengthening. Surgeons should be aware of this specific situation when hamstring tendon need to be harvested to avoid unnecessary complications.
Cognitive enhancing supplements and medications in United States Resident Physicians
Authors: Etheridge Tyler , Kennedy Brandon , Millar Morgan M. , Brintz Ben J. , Wu Chaorong , Pettey Jeff
Published: October 2022

Background:

The use of cognitive-enhancing medications and supplements among healthy adults continues to rise. Limited data exists on their use among resident physicians. Given their highly competitive and stressful lifestyle, we sought to evaluate the prevalence, motivations, and side effects of using cognitive-enhancing supplements and medications among resident physicians at a large United States academic institution.

Methods:

An anonymous web-based survey was circulated to resident physicians inquiring about using cognitive-enhancing supplements and medications, as well as personal characteristics such as gender, marital and parental status, medical diagnoses, and medical specialty. Before circulation, we performed a pilot study. Weighted logistic regression analyses estimated the impact of personal characteristics on the probability of using both supplements and medications.

Results:

Survey response rate was 46.4%. Of respondents, 48.6% were female, 45.9% were married, 70.9% were without children, and 67.2% were in a non-surgical medical specialty. Few respondents had a related medical diagnosis, with attention deficit hyperactivity disorder being the most common (7.1%). Male, non-married, surgical residents were more likely to take supplements (odds ratio (OR) = 1.06, 1.05, and 1.05). Males, without children, and those who felt pressure to perform well, were afraid of being left behind, felt pressure because colleagues take them, or felt they could not reach their current level of training without medications were more likely to take medications (OR = 1.11, 1.04, 1.05, and 1.08). Adverse effects with medications were common.

Conclusion:

Supplement and medication use for cognitive enhancement was high among resident physicians at a single institution despite few having a related medical diagnosis. This study raises awareness of the growing pressure in competitive residency environments to use cognitive enhancement regardless of the potential side effects.
Clinical impact of lipid injectable emulsion in internal medicine inpatients exclusively receiving parenteral nutrition: a propensity score matching analysis from a Japanese medical claims database
Authors: Takagi Kosei , Murotani Kenta , Kamoshita Satoru , Kuroda Akiyoshi
Published: October 2022

Background

Although guidelines recommend lipid injectable emulsions (ILEs) be used as a part of parenteral nutrition, many patients in Japan receive lipid-free parenteral nutrition. Furthermore, little is known about the effect of ILEs on clinical outcomes in medical inpatients managed with parenteral nutrition. The aim of this study was to investigate the clinical impact of ILEs on internal medicine inpatients receiving parenteral nutrition.

Methods

A propensity score matching (PSM) analysis was performed using a medical claims database covering 451 hospitals in Japan. Participants included the following internal medicine inpatients, ages ≥ 18 years, fasting > 10 days, and receiving exclusively parenteral nutrition, between 2011 and 2020. Participants were divided into 2 groups: those who did and did not receive ILEs. The primary endpoint was in-hospital mortality. The secondary endpoints included intravenous catheter infection, activities of daily living (ADL), hospital length of stay (LOS), and total medical costs. To adjust for energy doses, logistic or multiple regression analyses were performed using energy dose as an additional explanatory variable.

Results

After PSM, 19,602 matched pairs were formed out of 61,437 patients. The ILE group had significantly lower incidences than the non-ILE group of in-hospital mortality (20.3% vs. 26.9%; odds ratio [OR], 0.69; 95% confidence interval [CI], 0.66–0.72;p< 0.001), deteriorated ADL (10.8% vs. 12.5%; OR, 0.85; 95% CI, 0.79–0.92;p< 0.001), and shorter LOS (regression coefficient, − 0.8; 95% CI, − 1.6–0.0;p= 0.045). After adjusting for energy dose, these ORs or regression coefficients demonstrated the same tendencies and statistical significance. The mean total medical costs were $21,009 in the ILE group and $21,402 in the non-ILE group (p= 0.08), and the adjusted regression coefficient for the ILE vs. the non-ILE group was − $860 (95% CI, − $1252 to − $47).

Conclusions

ILE use was associated with improved clinical outcomes, including lower in-hospital mortality, in internal medicine inpatients receiving parenteral nutrition.