bluuebunny/crossref_metadata_2025 huggingface dataset:
The association between hypoglycemia and glycemic variability in elderly patients with type 2 diabetes: a prospective observational study
Authors: Handa Takahisa , Nakamura Akinobu , Miya Aika , Nomoto Hiroshi , Kameda Hiraku , Cho Kyu Yong , Nagai So , Yoshioka Narihito , Miyoshi Hideaki , Atsumi Tatsuya
Published: April 2021

Background

This study aimed to explore predictive factors of time below target glucose range (TBR) ≥ 1% among patients’ characteristics and glycemic variability (GV) indices using continuous glucose monitoring data in elderly patients with type 2 diabetes.

Methods

We conducted a prospective observational study on 179 (71 female) Japanese outpatients with type 2 diabetes aged ≥ 65 years. The characteristics of the participants with TBR ≥ 1% were evaluated by multivariate logistic regression analysis. Receiver-operating characteristic (ROC) curve analyses of GV indices, comprising coefficient of variation (CV), standard deviation, and mean amplitude of glycemic excursions, were performed to identify the optimal index for the identification of patients with TBR ≥ 1%.

Results

In the multivariate logistic regression analysis, none of the clinical characteristics, including HbA1c and C-peptide index, were independent markers for TBR ≥ 1%, while all three GV indices showed significant associations with TBR ≥ 1%. Among the three GV indices, CV showed the best performance based on the area under the curve in the ROC curve analyses.

Conclusions

Among elderly patients with type 2 diabetes, CV reflected TBR ≥ 1% most appropriately among the GV indices examined.

Trial registration UMIN-CTR: UMIN000029993. Registered 16 November 2017
Draft genome sequence of a nontypeable Haemophilus influenzae strain used in the study of human respiratory infection
Authors: KC Rajendra , O’Toole Ronan F.
Published: April 2021

Objectives

Nontypeable Haemophilus influenzae (NTHi) is an important human respiratory bacterium that can cause a range of diseases including sinusitis, otitis media, conjunctivitis, pneumonia as well as acute exacerbations of chronic obstructive pulmonary disease (COPD). A number of studies have used NTHi clinical isolate RHH-3 as a laboratory strain for experimentation examining the effect of cigarette smoke and more recently, biomass smoke, on the susceptibility and response of cells lining the respiratory tract to infection. Therefore, definition of the genome content of RHH-3 is required to fully elucidate human-NTHi interactions associated with initial infection and subsequent development of respiratory disease.

Data description

Here, we present the draft genome sequence of NTHi RHH-3 collected from the sputum of a patient at the Royal Hobart Hospital, Tasmania, Australia. The assembled genome size was 1,839,376 bp consisting of 61 contigs (> 500 bp), with a G+C content of 38.1%. This draft genome data can be accessed at DDBJ/ENA/GenBank under the accession number JADPRR000000000.
Correction to: The MLH1 polymorphism rs1800734 and risk of endometrial cancer with microsatellite instability
Authors: Russell Holly , Kedzierska Katarzyna , Buchanan Daniel D. , Thomas Rachael , Tham Emma , Mints Miriam , Keränen Anne , Giles Graham G. , Southey Melissa C. , Milne Roger L. , Tomlinson Ian , Church David , Spurdle Amanda B. , O’Mara Tracy A. , Lewis Annabelle
Published: April 2021

An amendment to this paper has been published and can be accessed via the original article.
A model of on/off transitions in neurons of the deep cerebellar nuclei: deciphering the underlying ionic mechanisms
Authors: Berry Hugues , Genet Stéphane
Published: April 2021

The neurons of the deep cerebellar nuclei (DCNn) represent the main functional link between the cerebellar cortex and the rest of the central nervous system. Therefore, understanding the electrophysiological properties of DCNn is of fundamental importance to understand the overall functioning of the cerebellum. Experimental data suggest that DCNn can reversibly switch between two states: the firing of spikes (F state) and a stable depolarized state (SD state). We introduce a new biophysical model of the DCNn membrane electro-responsiveness to investigate how the interplay between the documented conductances identified in DCNn give rise to these states. In the model, the F state emerges as an isola of limit cycles, i.e. a closed loop of periodic solutions disconnected from the branch of SD fixed points. This bifurcation structure endows the model with the ability to reproduce the $\text{F}\to \text{SD}$
F
→
SD
transition triggered by hyperpolarizing current pulses. The model also reproduces the $\text{F}\to \text{SD}$
F
→
SD
transition induced by blocking Ca currents and ascribes this transition to the blocking of the high-threshold Ca current. The model suggests that intracellular current injections can trigger fully reversible $\text{F}\leftrightarrow \text{SD}$
F
↔
SD
transitions. Investigation of low-dimension reduced models suggests that the voltage-dependent Na current is prominent for these dynamical features. Finally, simulations of the model suggest that physiological synaptic inputs may trigger $\text{F}\leftrightarrow \text{SD}$
F
↔
SD
transitions. These transitions could explain the puzzling observation of positively correlated activities of connected Purkinje cells and DCNn despite the former inhibit the latter.
Region- and voxel-based quantification in human brain of [18F]LSN3316612, a radioligand for O-GlcNAcase
Authors: Lee Jae-Hoon , Veronese Mattia , Liow Jeih-San , Morse Cheryl L. , Montero Santamaria Jose A. , Haskali Mohammad B. , Zoghbi Sami S. , Pike Victor W. , Innis Robert B. , Zanotti-Fregonara Paolo
Published: April 2021

Background

Previous studies found that the positron emission tomography (PET) radioligand [18F]LSN3316612 accurately quantified O-GlcNAcase in human brain using a two-tissue compartment model (2TCM). This study sought to assess kinetic model(s) as an alternative to 2TCM for quantifying [18F]LSN3316612 binding, particularly in order to generate good-quality parametric images.

Methods

The current study reanalyzed data from a previous study of 10 healthy volunteers who underwent both test and retest PET scans with [18F]LSN3316612. Kinetic analysis was performed at the region level with 2TCM using 120-min PET data and arterial input function, which was considered as the gold standard. Quantification was then obtained at both the region and voxel levels using Logan plot, Ichise's multilinear analysis-1 (MA1), standard spectral analysis (SA), and impulse response function at 120 min (IRF120). To avoid arterial sampling, a noninvasive relative quantification (standardized uptake value ratio (SUVR)) was also tested using the corpus callosum as a pseudo-reference region. Venous samples were also assessed to see whether they could substitute for arterial ones.

Results

Logan and MA1 generated parametric images of good visual quality and their total distribution volume (VT) values at both the region and voxel levels were strongly correlated with 2TCM-derived VT (r = 0.96–0.99) and showed little bias (up to − 8%). SA was more weakly correlated to 2TCM-derived VT (r = 0.93–0.98) and was more biased (~ 16%). IRF120 showed a strong correlation with 2TCM-derived VT (r = 0.96) but generated noisier parametric images. All techniques were comparable to 2TCM in terms of test–retest variability and reliability except IRF120, which gave significantly worse results. Noninvasive SUVR values were not correlated with 2TCM-derived VT, and arteriovenous equilibrium was never reached.

Conclusions

Compared to SA and IRF, Logan and MA1 are more suitable alternatives to 2TCM for quantifying [18F]LSN3316612 and generating good-quality parametric images.
LPWAN-based hybrid backhaul communication for intelligent transportation systems: architecture and performance evaluation
Authors: Shahgholi Taghi , Sheikhahmadi Amir , Khamforoosh Keyhan , Azizi Sadoon
Published: April 2021

Increased number of the vehicles on the streets around the world has led to several problems including traffic congestion, emissions, and huge fuel consumption in many regions. With advances in wireless and traffic technologies, the Intelligent Transportation System (ITS) has been introduced as a viable solution for solving these problems by implementing more efficient use of the current infrastructures. In this paper, the possibility of using cellular-based Low-Power Wide-Area Network (LPWAN) communications, LTE-M and NB-IoT, for ITS applications has been investigated. LTE-M and NB-IoT are designed to provide long range, low power and low cost communication infrastructures and can be a promising option which has the potential to be employed immediately in real systems. In this paper, we have proposed an architecture to employ the LPWAN as a backhaul infrastructure for ITS and to understand the feasibility of the proposed model, two applications with low and high delay requirements have been examined: road traffic monitoring and emergency vehicle management. Then, the performance of using LTE-M and NB-IoT for providing backhaul communication infrastructure has been evaluated in a realistic simulation environment and compared for these two scenarios in terms of end-to-end latency per user. Simulation of Urban MObility has been used for realistic traffic generation and a Python-based program has been developed for evaluation of the communication system. The simulation results demonstrate the feasibility of using LPWAN for ITS backhaul infrastructure mostly in favor of the LTE-M over NB-IoT.
General methods of convergence and summability
Authors: García-Pacheco Francisco Javier , Kama Ramazan , Listán-García María del Carmen
Published: April 2021

This paper is on general methods of convergence and summability. We first present the general method of convergence described by free filters of $\mathbb{N} $
N
and study the space of convergence associated with the filter. We notice that $c(X)$
c
(
X
)
is always a space of convergence associated with a filter (the Frechet filter); that if X is finite dimensional, then $\ell _{\infty }(X)$

ℓ
∞

(
X
)
is a space of convergence associated with any free ultrafilter of $\mathbb{N} $
N
; and that if X is not complete, then $\ell _{\infty }(X)$

ℓ
∞

(
X
)
is never the space of convergence associated with any free filter of $\mathbb{N} $
N
. Afterwards, we define a new general method of convergence inspired by the Banach limit convergence, that is, described through operators of norm 1 which are an extension of the limit operator. We prove that $\ell _{\infty }(X)$

ℓ
∞

(
X
)
is always a space of convergence through a certain class of such operators; that if X is reflexive and 1-injective, then $c(X)$
c
(
X
)
is a space of convergence through a certain class of such operators; and that if X is not complete, then $c(X)$
c
(
X
)
is never the space of convergence through any class of such operators. In the meantime, we study the geometric structure of the set $\mathcal{HB}(\lim ):= \{T\in \mathcal{B} (\ell _{\infty }(X),X): T|_{c(X)}= \lim \text{ and }\|T\|=1\}$
HB
(
lim
)
:
=
{
T
∈
B
(

ℓ
∞

(
X
)
,
X
)
:
T

|

c
(
X
)

=
lim
 and 
∥
T
∥
=
1
}
and prove that $\mathcal{HB}(\lim )$
HB
(
lim
)
is a face of $\mathsf{B} _{\mathcal{L}_{X}^{0}}$

B

L
X
0

if X has the Bade property, where $\mathcal{L}_{X}^{0}:= \{ T\in \mathcal{B} (\ell _{\infty }(X),X): c_{0}(X) \subseteq \ker (T) \} $

L
X
0

:
=
{
T
∈
B
(

ℓ
∞

(
X
)
,
X
)
:

c
0

(
X
)
⊆
ker
(
T
)
}
. Finally, we study the multipliers associated with series for the above methods of convergence.
Three solutions for a partial discrete Dirichlet boundary value problem with p-Laplacian
Authors: Wang Shaohong , Zhou Zhan
Published: April 2021

By employing critical point theory, we investigate the existence of solutions to a boundary value problem for a p-Laplacian partial difference equation depending on a real parameter. To be specific, we give precise estimates of the parameter to guarantee that the considered problem possesses at least three solutions. Furthermore, based on a strong maximum principle, we show that two of the obtained solutions are positive under some suitable assumptions of the nonlinearity.
Three solutions to Dirichlet problems for second-order self-adjoint difference equations involving p-Laplacian
Authors: Xiong Feng , Zhou Zhan
Published: April 2021

This paper derives several sufficient conditions for the existence of three solutions to the Dirichlet problem for a second-order self-adjoint difference equation involving p-Laplacian through the critical point theory. Furthermore, by using the strong maximum principle, we prove that the three solutions are positive under appropriate assumptions on the nonlinearity. Finally, we present three examples to confirm our results.
Correction to: Economic burden of antibiotic resistance in China: a national level estimate for inpatients
Authors: Zhen Xuemei , Lundborg Cecilia Stålsby , Sun Xueshan , Zhu Nina , Gu Shuyan , Dong Hengjin
Published: April 2021

An amendment to this paper has been published and can be accessed via the original article.
Identification of blood-derived candidate gene markers and a new 7-gene diagnostic model for multiple sclerosis
Authors: Chen Xin , Hou Huiqing , Qiao Huimin , Fan Haolong , Zhao Tianyi , Dong Mei
Published: April 2021

Background

Multiple sclerosis (MS) is a central nervous system disease with a high disability rate. Modern molecular biology techniques have identified a number of key genes and diagnostic markers to MS, but the etiology and pathogenesis of MS remain unknown.

Results

In this study, the integration of three peripheral blood mononuclear cell (PBMC) microarray datasets and one peripheral blood T cells microarray dataset allowed comprehensive network and pathway analyses of the biological functions of MS-related genes. Differential expression analysis identified 78 significantly aberrantly expressed genes in MS, and further functional enrichment analysis showed that these genes were associated with innate immune response-activating signal transduction (p = 0.0017), neutrophil mediated immunity (p = 0.002), positive regulation of innate immune response (p = 0.004), IL-17 signaling pathway (p < 0.035) and other immune-related signaling pathways. In addition, a network of MS-specific protein–protein interactions (PPI) was constructed based on differential genes. Subsequent analysis of network topology properties identified the up-regulated CXCR4, ITGAM, ACTB, RHOA, RPS27A, UBA52, and RPL8 genes as the hub genes of the network, and they were also potential biomarkers of MS through Rap1 signaling pathway or leukocyte transendothelial migration. RT-qPCR results demonstrated that CXCR4 was obviously up-regulated, while ACTB, RHOA, and ITGAM were down-regulated in MS patient PBMC in comparison with normal samples. Finally, support vector machine was employed to establish a diagnostic model of MS with a high prediction performance in internal and external datasets (mean AUC = 0.97) and in different chip platform datasets (AUC = (0.93).

Conclusion

This study provides new understanding for the etiology/pathogenesis of MS, facilitating an early identification and prediction of MS.
Determinants of full childhood immunization among children aged 12–23 months in sub-Saharan Africa: a multilevel analysis using Demographic and Health Survey Data
Authors: Fenta Setegn Muche , Biresaw Hailegebrael Birhan , Fentaw Kenaw Derebe , Gebremichael Shewayiref Geremew
Published: April 2021

Background

Sub-Saharan Africa is one of the highest under-five mortality and low childhood immunization region in the world. Children in Sub-Saharan Africa are 15 times more likely to die than children from high-income countries. In sub-Saharan Africa, more than half of under-five deaths are preventable through immunization. Therefore, this study aimed to identify the determinant factors of full childhood immunization among children aged 12–23 months in sub-Saharan Africa.

Methods

Data for the study was drawn from the Demographic and Health Survey of nine sub-Saharan African countries. A total of 21,448 children were included. The two-level mixed-effects logistic regression model was used to identify the individual and community-level factors associated with full childhood immunization

Result

The prevalence of full childhood immunization coverage in sub-Saharan Africa countries was 59.40% (95% CI: 58.70, 60.02). The multilevel logistic regression model revealed that secondary and above maternal education (AOR = 1.38; 95% CI: 1.25, 1.53), health facility delivery (AOR = 1.51; 95% CI: 1.41, 1.63), fathers secondary education and above (AOR = 1.28, 95% CI: 1.11, 1.48), four and above ANC visits (AOR = 2.01; 95% CI: 1.17, 2.30), PNC visit(AOR = 1.55; 95% CI: 1.46, 1.65), rich wealth index (AOR = 1.26; 95% CI: 1.18, 1.40), media exposure (AOR = 1.11; 95% CI: 1.04, 1.18), and distance to health facility is not a big problem (AOR = 1.42; 95% CI: 1.28, 1.47) were significantly associated with full childhood immunization.

Conclusion

The full childhood immunization coverage in sub-Saharan Africa was poor with high inequalities. There is a significant variation between SSA countries in full childhood immunization. Therefore, public health programs targeting uneducated mothers and fathers, rural mothers, poor households, and those who have not used maternal health care services to promote full childhood immunization to improve child health. By enhancing institutional delivery, antenatal care visits and maternal tetanus immunization, the government and other stakeholders should work properly to increase child immunization coverage. Furthermore, policies and programs aimed at addressing cluster variations in childhood immunization need to be formulated and their implementation must be strongly pursued.
COVID-19 Life Events-Anxiety Inventory (C-19LAI): development, reliability, and validity study on Egyptian population
Authors: Madkor Omaima Refat Elsayed , Elsorady Khalid E. , Abdelhady Dina H. , AbdulJawad Passant , Aly El Gabry Dina
Published: April 2021

Background

The COVID-19 Life Events-Anxiety Inventory (C-19LAI) is a newly developed tool and the only Arabic tool for assessing and measuring anxiety related to different life events during the COVID-19 pandemic. The aim of the study was to test the validity and reliability of this newly designed tool. We used a cross sectional validation multiphasic study and applied the tool on 500 subjects together with the State-Trait Anxiety Inventory (STAI).

Results

The COVID-19 Life Events-Anxiety Inventory (C-19LAI) showed validity of 73.6% and sensitivity of 85.2%, with acceptable reliability of α = 0.815 and 0.947, respectively. The Life Events Scale and Anxiety Scale of the C-19LAI correlated significantly (p ≤ 0.01) with the State-Trait Anxiety Inventory (r = 0.289 and r = 0.407, respectively).

Conclusion

The COVID-19 Life Events-Anxiety Inventory (C-19LAI) Scale is a reliable and valid scale that can measure anxiety and events related to anxiety during the COVID 19 pandemic.
Making the Best of Limited Resources: Improving Outcomes in Head and Neck Cancer
Authors: Fagan Johannes J. , Noronha Vanita , Graboyes Evan Michael
Published: April 2021

The overwhelming majority of head and neck cancers and related deaths occur in low- and middle-income countries, which have challenges related to burden of disease versus access to care. Yet the additional health care burden of the COVID-19 pandemic has also impacted access to care for patients with head and neck cancer in the United States. This article focuses on challenges and innovation in prioritizing head and neck cancer care in Sub-Saharan Africa, the Indian experience of value-added head and neck cancer care in busy and densely populated regions, and strategies to optimize the management of head and neck cancer in the United States during the COVID-19 pandemic.
Sex-Dependent Association of Vitamin D With Insulin Resistance in Humans
Authors: Chen Xin , Chu Chang , Doebis Cornelia , von Baehr Volker , Hocher Berthold
Published: April 2021

Background

Animal studies suggested that vitamin D might decrease insulin resistance. Estrogen increased insulin sensitivity and glucose tolerance in rodents. However, sex-specific association of vitamin D with insulin resistance in humans remains unclear.

Objectives

To investigate the sex-dependency of the association of insulin resistance and 25-hydroxyvitamin D [25(OH)D] in a large Caucasian population.

Methods

Cross-sectional study from out-patients’ blood samples with measurements of 25(OH)D and homeostatic model assessment of insulin resistance (HOMA-IR) drawn at exactly the same day (n = 1887). This cohort was divided into 3 groups: (1) group with vitamin D deficiency (n = 1190), (2) group with vitamin D sufficiency (n = 686), and (3) vitamin D excess groups (n = 11); the vitamin D excess group was excluded from further analysis due to the small size.

Results

Analysis of the entire study population showed that serum 25(OH)D was inversely associated with HOMA-IR [Spearman correlation coefficient (rs) = −0.19, P < 0.0001]. When considering the vitamin D status, this association was only seen in the vitamin D deficiency group but not in the vitamin D sufficient group. The correlation was sex-dependent: HOMA-IR was inversely correlated with vitamin D in women with vitamin D deficiency (rs = −0.26, P < 0.0001) but not in men with vitamin D deficiency (rs = 0.01, P = 0.714). After multivariate linear regression analysis considering confounding factors, this relationship was again only seen in women.

Conclusion

Vitamin D was inversely and independently associated with insulin resistance only in women with vitamin D deficiency. Based on our data, we suggest that in particular vitamin D deficient women might benefit from vitamin D substitution by improving insulin resistance. This, however, needs to be proven in adequately designed double-blind placebo-controlled clinical studies.
Episodic Positional Dizziness
Authors: Kerber Kevin A.
Published: April 2021

PURPOSE OF REVIEW

This article provides a summary of the evaluation and treatment of patients presenting with episodic positional dizziness.

RECENT FINDINGS

Positional components are nearly ubiquitous among diagnoses of dizziness, so it can be challenging to classify patients with episodic positional dizziness simply based on the history of present illness. Overreliance on the presence of a report of positional components has likely resulted in misapplication or misinterpretation of positional testing and negative experiences with maneuvers to treat positional dizziness. The prototypical episodic positional dizziness disorder is benign paroxysmal positional vertigo (BPPV). BPPV is caused by free-floating particles in a semicircular canal that move in response to gravity. The diagnosis is made by identifying the characteristic patterns of nystagmus on the Dix-Hallpike test. Particle repositioning for BPPV is supported by randomized controlled trials, meta-analyses, and practice guidelines. Other disorders that can present with episodic positional dizziness are migraine dizziness, central lesions, and light cupula syndrome.

Episodic positional dizziness is a common presentation of dizziness. Neurologists should prioritize identifying and treating BPPV; doing so provides an important opportunity to deliver effective and efficient care. Providers should also recognize that positional components are common in most causes of dizziness and, therefore, should not over-rely on this part of the history of presentation when considering the diagnosis and management plan.
Vertigo Related to Central Nervous System Disorders
Authors: Saha Kamala
Published: April 2021

PURPOSE OF REVIEW

This article provides an overview of the numerous causes of vertigo and dizziness that are due to central nervous system (CNS) pathology and guides clinicians in formulating a differential diagnosis and treating patients with CNS causes of vertigo.

RECENT FINDINGS

Specific autoimmune vestibulocerebellar syndromes may now be tested for, and this article discusses the antibodies known to cause such syndromes. Superficial siderosis can be more accurately diagnosed with imaging studies, and treatment using iron chelation has recently been studied but has not yet been established as an effective treatment. Central autonomic network damage in the brain can cause central orthostatic hypotension in some neurodegenerative diseases, and medication has been approved for treatment.

CNS causes of vertigo are numerous and important for clinicians to recognize. Examination findings are still an extremely valuable way to diagnose central vertigo; therefore, learning how to differentiate central from peripheral vertigo based on examination is an important skill. CNS causes of vertigo often have available treatments.
Neutrophil transendothelial migration hotspots – mechanisms and implications
Authors: Grönloh Max L. B. , Arts Janine J. G. , van Buul Jaap D.
Published: April 2021

During inflammation, leukocytes circulating in the blood stream exit the vasculature in a process called leukocyte transendothelial migration (TEM). The current paradigm of this process comprises several well-established steps, including rolling, adhesion, crawling, diapedesis and sub-endothelial crawling. Nowadays, the role of the endothelium in transmigration is increasingly appreciated. It has been established that leukocyte exit sites on the endothelium and in the pericyte layer are in fact not random but instead may be specifically recognized by migrating leukocytes. Here, we review the concept of transmigration hotspots, specific sites in the endothelial and pericyte layer where most transmigration events take place. Chemokine cues, adhesion molecules and membrane protrusions as well as physical factors, such as endothelial junction stability, substrate stiffness, the presence of pericytes and basement membrane composition, may all contribute to local hotspot formation to facilitate leukocytes exiting the vasculature. In this Review, we discuss the biological relevance of such hotspots and put forward multiple mechanisms and factors that determine a functional TEM hotspot.
A thermal stressor, propranolol and long-term memory formation in freshly collected Lymnaea
Authors: Swinton Cayley , Swinton Erin , Phillips Iain , Lukowiak Ken
Published: April 2021

A heat stressor (1 h at 30°C) in Lymnaea stagnalis before operant conditioning training of aerial respiration is sufficient to enhance long-term memory (LTM) formation in ‘average’ cognitive ability, laboratory-reared, inbred snails. However, in freshly collected outbred snails, the same heat stressor blocks LTM formation in ‘smart’ cognitive phenotype but not in average cognitive phenotype strains. Here, we hypothesize that (1) preventing the stress associated with the heat stressor before training allows LTM to form in the smart phenotype strains; and (2) alleviating the stress before a memory recall session allows a formed LTM to be recalled in the smart phenotype strains. We found that an injection of propranolol, which mitigates the stressor, before snails experience the heat stressor enabled two strains of the smart phenotype snails to form LTM, consistent with our first hypothesis. However, the injection of propranolol before a memory test session did not alleviate a memory recall block in the smart phenotype snails. Thus, our second hypothesis was not supported. Therefore, smart cognitive phenotype snails encountering a heat stressor have an inability to form LTM, but this inability can be overcome by the pre-injection of propranolol.
Drosophila acquires seconds-scale rhythmic behavior
Authors: Ikarashi Masayoshi , Tanimoto Hiromu
Published: April 2021

Detection of the temporal structure of stimuli is crucial for prediction. While perception of interval timing is relevant for immediate behavioral adaptations, it has scarcely been investigated, especially in invertebrates. Here, we examined whether the fruit fly, Drosophila melanogaster, can acquire rhythmic behavior in the range of seconds. To this end, we developed a novel temporal conditioning paradigm utilizing repeated electric shocks. Combined automatic behavioral annotation and time–frequency analysis revealed that behavioral rhythms continued after cessation of the shocks. Furthermore, we found that aging impaired interval timing. This study thus not only demonstrates the ability of insects to acquire behavioral rhythms of a few seconds, but highlights a life-course decline of temporal coordination, which is also common in mammals.
Heat Injury in Open-Water Swimming: A Narrative Review
Authors: Murphy Micheal , Polston Keith , Carroll Michael , Alm John
Published: April 2021

Swimming is one of the most popular sports in the world with open-water swimming (OWS) gaining more and more prominence since being featured in the Federation Internationale De Natation World Aquatics Championships in 1992 and the Olympic Games in 2000. The aim of this review is to analyze the existing literature on heat injury in OWS. Relevant literature was located via computer-generated citations during November of 2020 through online computer searches of multiple major databases. Athletes participating in OWS are exposed to environmental conditions that place them at risk for unique medical conditions such as heat injury. Clinicians providing care for OWS athletes should be educated and trained to recognize these conditions and minimize risks to optimize athlete safety. This article identifies medical challenges related to heat injury in OWS while investigating water temperature recommendations, physiological effects of hyperthermia, risk mitigation strategies, and treatment measures.
Imaging after percutaneous thermal and non-thermal ablation of hepatic tumour: normal appearances, progression and complications
Authors: Bréhier Germain , Besnier Louis , Delagnes Anaïs , Oberti Frédéric , Lebigot Jérôme , Aubé Christophe , Paisant Anita
Published: April 2021

The increasing number of liver tumours treated by percutaneous ablation leads all radiologists to be confronted with the difficult interpretation of post-ablation imaging. Radiofrequency and microwave techniques are most commonly used. Recently, irreversible electroporation treatments that do not induce coagulation necrosis but cellular apoptose and respect the collagen architecture of bile ducts and vessels have been introduced and lead to specific post-ablation features and evolution. Ablations cause ‘normal’ changes in ablation and periablation zones. It is necessary to know these post-ablation features to avoid the misinterpretation of recurrence or complication that would lead to unnecessary treatments. Another challenge for the radiologist is to detect as early as possible the residual unablated tumour or the disease progression (local progression and tumour seeding) that will require a new treatment. Finally, the complications, frequent or rarer, should be recognised to be managed adequately. The purpose of this article is therefore to describe the large spectrum of normal and pathological aspects related to the treatment of hepatic tumour by percutaneous thermal ablation and irreversible electroporation ablation.
Organochlorine pesticide exposure and risk of prostate cancer development and progression: a systematic review
Authors: Brureau Laurent , Multigner Luc , Hamdy Freddie , Blanchet Pascal , Bryant Richard
Published: April 2021

Background: There is an increasing body of evidence linking the exposure of an individual to pesticides such as organochlorine pesticides (OPCs) and an increased risk of developing diseases such as cancer. Exposure to OPCs has been suggested to increase the risk of developing hormone-dependant cancers such as prostate cancer (PCa). However, there is a relative paucity of information about the influence of exposure to these pesticides on the evolution of PCa, including risk of tumour development, progression to metastasis, and disease recurrence following therapy.

Methods: We used several databases such as PubMed MEDLINE Database, Web of Science, and Scopus, in order to conduct a systematic review of the available epidemiological data implicating an association between exposure to OCPs and biochemical recurrence (BCR) of PCa. We searched all peer-reviewed articles published up to July 31st 2020. Pre-defined eligibility criteria for the inclusion of studies were that they be original studies, reviews, previous meta-analyses, or case–control or cohort studies.

Results: Agent Orange is the most widely-studied OCP in the context of any possible causal role in the recurrence of PCa following radical prostatectomy, or in the progression to advanced disease. Only two studies didn’t demonstrate a significant association between exposure to OCPs and subsequent BCR following radical prostatectomy. Another study identified a significant association between exposure to Oxychlordane and PCB44 and progression to advanced PCa.

Conclusion: This review confirmed a relative lack of high-quality evidence regarding this topic. However, the available evidence to date suggests the presence of a potential causal relationship between exposure to OPCs and PCa development and progression.
Trajectory Tracking with Input Constraint based on LMI Approach of a Nonholonomic Mobile Robot
Authors: Nabila Auliya , Agustinah Trihastuti
Published: April 2021

Nonholonomic Mobile Robot (NMR) is a mode of transportation that is widely used in industry. To achieve flexibility in carrying out its duties, an adequate control system is needed in transportation arrangements so that it is used as an object of research. The problem that is taken in this study is about tracking control for several reference trajectories with input constraint.To solve this problem two controllers were designed, kinematics controller and dynamics controller. Kinematics controller is designed so that the additional speed converges to the desired speed by adjusting the gain value , , and . Dynamic controller is designed using  performance to overcome the input constraint and the Lyapunoc inequality is soleved by Linear Matric Inequalities (LMI) so the gain state-feedback can be obtained. Simulation results show that the designed controller is capable of tracking according to the reference trajectory with input constraint given.
Knowledge of postpartum depression among mothers at immunisation clinics in Mushin, Nigeria
Authors: Abazie Ogechi Helen , Usoro Iniobong Inyang
Published: April 2021

Background

Postpartum depression is the most common psychological disorder affecting women during the postpartum period, yet this condition often goes undiagnosed. Studies show that the onset of postpartum depression can occur at any time following delivery, up to three months postpartum; in some cases, up to a year postpartum. This study aimed to assess knowledge of postpartum depression in mothers attending immunisation clinics at selected primary healthcare centres in Mushin, Nigeria. This study will help identify areas for improvement in educating women on postpartum depression, leading to early identification, treatment and reduced cases of the illness.

Methods

This was a descriptive quantitative study using multistage sampling to select participants from two purposively selected comprehensive health centres. Simple random sampling was used to select 240 mothers to participate in the study, who were given self-structured questionnaires on sociodemographic data and knowledge of postpartum depression. Data were analysed using the Statistical Package for Social Sciences version 22. Descriptive statistics were used to present demographic variables and objectives. Inferential statistics, the chi-square test, was used to test hypotheses at P<0.005.

Results

The majority of participants (60.8%) had poor knowledge of postpartum depression. There is a statistically significant relationship between age and knowledge of postpartum depression (P=0.000). There is no significant relationship between education level and knowledge of postpartum depression.

Conclusions

The majority of women in this study had poor knowledge of postpartum depression. To tackle this, midwives should aim to reinforce health education on mental and emotional health and assess the emotional and mental health status of women during the antenatal and postpartum periods. It is also key for midwives to refer women on time if they suspect postpartum depression.
The three pathways to becoming a midwife: self-assessed confidence in selected competencies in intrapartum care from seven African countries
Authors: Lindgren Helena , Hildingsson Ingegerd , Christensson Kyllike , Bäck Lena , Mudokwenyu–Rawdon Christina , Maimbolwa Margaret C , Laisser Rose Mjawa , Omoni Grace , Chimwaza Angela , Mwebaza Enid , Kiruja Jonah , Sharma Bharati
Published: April 2021

Background/Aims

Globally, there are three pathways to become a midwife: midwifery post nursing, direct entry midwifery and integrated nursing and midwifery. There is limited knowledge on the effectiveness of pre-service midwifery education. The aim of this study was to describe and compare midwifery students' confidence in intrapartum skills and associated factors such as type and level of education.

Methods

A multi-country cross-sectional study was conducted, where midwifery students were approached in the final months of their education programme. Data were collected using a questionnaire, based on the basic skills by the International Confederation of Midwives. Intrapartum care comprised 40 skills.

Results

In total, 1407 midwifery students from seven sub-Saharan countries responded. The 40 skills were grouped into six domains; three related to care during the first and second stage of labour and three related to care during the third stage of labour. Sex and age were significantly associated with confidence, with female students and those 26–35 years old having higher levels of confidence. Students enrolled in a direct entry programme were more confident than other students in all three domains of care related to the first and second stage of labour.

Conclusions

Direct entry was found to result in higher confidence for midwifery students than post nursing programmes or integrated programmes. Further research is needed for evaluation of competence.
Prevalence of caregiver burden among caregivers of end-stage renal disease patients and the associating factors: A cross-sectional study in a chronic kidney disease clinic in Muang District, Lamphun Province, Thailand
Authors:   Lamphun Hospital, Promsakun K , Yingchankul N ,   Department of Family Medicine, Faculty of Medicine, Chiang Mai University
Published: April 2021

Objectives To study the prevalence of and factors related to caregiver burden amongst caregivers of end-stage renal disease patients. Methods A cross-sectional study was conducted in which data was collected from July 2019 to December 2019 from a total of 152 caregivers aged 18 years and over recruited into this study. Paid caregivers were excluded. The data collected included patient factors, caregiver factors, social support assessment, the Thai version of the Zarit Burden Interview for assessing caregiver burden along with the EQ-5D-5L questionnaire for assessing quality of life. . Results The prevalence of caregiver burden in cases of end-stage renal disease was 18.42%. Factors associated with caregiver burden included single or divorced status, inadequate income, owing money, need for more information and knowledge in caring for patients, low social support, and low quality of life (p < 0.05). Conclusion Caregiver burden screening should be done for individuals providing end-stage chronic kidney disease care including their need for additional information on patient care as well as their economic and social situation. It is important that caregivers be screened as well as supervised. Chiang Mai Medical Journal 2021;60(1):41-52. doi 10.12982/CMUMEDJ.2021.04
Cardiorespiratory safety of respiratory muscle training using NU_spiroBreathe in healthy subjects
Authors:   Department of Physical Therapy / Exercise and Rehabilitation Sciences Research Unit, Faculty of Allied Health Sciences, Naresuan University, Wiwatmanitsakul J , Poowaruttanawiwit P ,   Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Naresuan University, Rachapradit N ,   Department of Mechanical Engineering, Faculty of Engineering, Naresuan University, Chidnok W ,   Department of Physical Therapy / Exercise and Rehabilitation Sciences Research Unit, Faculty of Allied Health Sciences, Naresuan University
Published: April 2021

Objectives This study investigated responses of cardiorespiratory parameters of healthy subjects from respiratory muscle training using a NU_spiroBreathe device. Methods Nine healthy female subjects with sedentary lifestyles were asked to perform respiratory muscle training using a NU_spiroBreathe device with 10 cmH2O resistance (10 repetitions/set, 3 sets). Cardiorespiratory parameters (blood pressure; pulse rate; oxygen saturation) were assessed before and during respiratory muscle training sessions and after a 30-minute recovery period. The data were analyzed using the k-related sample Friedman test. Results There were no significant changes in cardiorespiratory parameters before, during or after a 30-minutes recovery period from respiratory muscle training using NU_spiroBreathe device (p > 0.05). Conclusions Respiratory muscle training using an NU_spiroBreathe device does not change cardio-respiratory parameters and is safe for use by healthy subjects. Chiang Mai Medical Journal 2021; 60(1):53-62. doi 10.12982/CMUMEDJ.2021.05
Self-leadership and job performance of nurses in regional hospitals in Thailand
Authors:   Sriphat Medical Center, Faculty of Medicine, Chiang Mai University, Wongbud N , Chitpakdee B ,   Nursing Administration Department, Faculty of Nursing, Chiang Mai University, Akkadechanunt A ,   Nursing Administration Department, Faculty of Nursing, Chiang Mai University
Published: April 2021

Objectives Self-leadership is an important factor for nurses which influences the quality of nursing care and job performance. This descriptive-correlational study was conducted to explore self-leadership and job performance as well as the relationship between self-leadership and job performance of nurses working in regional hospitals. Methods The participants were 438 nurses working in regional hospitals located in the northern region of Thailand who had been selected using a multi-stage sampling method. Research instruments included a demographic data questionnaire, the Revised Self-Leadership Questionnaire (RSLQ) and the Nursing Performance Scale which were translated into the Thai language by the researcher. Cronbach’s alpha coefficient reliabilities of RSLQ, task performance and contextual performance were 0.93, 0.91 and 0.92, respectively. The data were analyzed using descriptive statistics and Spearman’s rank correlation coefficient. Results The study found that self-leadership of the nurses in regional hospitals was at the moderate level (X = 3.60, SD = 0.52). Self-leadership dimensions of behavior-focused strategies (X = 3.58, SD = 0.52) and constructive thought pattern strategies (X = 3.53, SD = 0.60) were also at moderate levels, while natural reward strategies (X = 3.71, SD = 0.60) was at a high level. Task performance of the nurses (X = 56.82, SD = 9.76) was at a high level, while contextual performance of the nurses (X = 63.29, SD = 10.76) was at a moderate level. Self-leadership of nurses was statistically significantly positively related to task performance and contextual performance at 0.05 (r = 0.40, 0.50 respectively, p < 0.05). Conclusions Self-leadership of nurses was statistically significantly positively related to job performance. Nursing administrators can use data obtained from the research as a basis for planning to enhance the self-leadership of nurses, which can improve the quality of performance and result in positive outcomes for enhance nursing service. Chiang Mai Medical Journal 2021;60(1):99-112. doi 10.12982/CMUMEDJ.2021.09
Glenoid erosion is a risk factor for recurrent instability after Hill-Sachs remplissage
Authors: Cavalier Maxime , Johnston Tyler Robert , Tran Laurie , Gauci Marc-Olivier , Boileau Pascal
Published: April 2021

Aims

The aim of this study was to identify risk factors for recurrent instability of the shoulder and assess the ability to return to sport in patients with engaging Hill-Sachs lesions treated with arthroscopic Bankart repair and Hill-Sachs remplissage (ABR-HSR).

Methods

This retrospective study included 133 consecutive patients with a mean age of 30 years (14 to 69) who underwent ABR-HSR; 103 (77%) practiced sports before the instability of the shoulder. All had large/deep, engaging Hill-Sachs lesions (Calandra III). Patients were divided into two groups: A (n = 102) with minimal or no (< 10%) glenoid bone loss, and B (n = 31) with subcritical (10% to 20%) glenoid loss. A total of 19 patients (14%) had undergone a previous stabilization, which failed. The primary endpoint was recurrent instability, with a secondary outcome of the ability to return to sport.

Results

At a mean follow-up of four years (1.0 to 8.25), ten patients (7.5%) had recurrent instability. Patients in group B had a significantly higher recurrence rate than those in group A (p = 0.001). Using a multivariate logistic regression, the presence of glenoid erosion of > 10% (odds ratio (OR) = 35.13 (95% confidence interval (CI) 8 to 149); p = 0.001) and age < 23 years (OR = 0.89 (0.79 to 0.99); p = 0.038) were associated with a higher risk of recurrent instability. A total of 80 patients (78%) could return to sport, but only 11 athletes (65%) who practiced high-risk (collision or contact-overhead) sports. All seven shoulders which were revised using a Latarjet procedure were stable at a mean final follow-up of 36 months (11 to 57) and returned to sports at the same level.

Conclusion

Patients with subcritical glenoid bone loss (> 10%) and younger age (≤ 23 years) are at risk of failure and reoperation after ABR-HSR. Furthermore, following this procedure, one-third of athletes practicing high-risk sports are unable to return at their pre-instability level, despite having a stable shoulder. Cite this article: Bone Joint J 2021;103-B(4):718–724.
Factors influencing periprosthetic femoral fracture risk
Authors: Konow Tobias , Baetz Johanna , Melsheimer Oliver , Grimberg Alexander , Morlock Michael
Published: April 2021

Aims

Periprosthetic femoral fractures (PPF) are a serious complication of total hip arthroplasty (THA) and are becoming an increasingly common indication for revision arthroplasty with the ageing population. This study aimed to identify potential risk factors for PPF based on an analysis of registry data.

Methods

Cases recorded with PPF as the primary indication for revision arthroplasty in the German Arthroplasty Registry (Endoprothesenregister Deutschland (EPRD)), as well as those classified as having a PPF according to the International Classification of Diseases (ICD) codes in patients’ insurance records were identified from the complete datasets of 249,639 registered primary hip arthroplasties in the EPRD and included in the analysis.

Results

The incidence of PPFs was higher (24.6%; 1,483) than reported in EPRD annual reports listing PPF as the main reason for revision (10.9%; 654). The majority of fractures occurred intraoperatively and were directly related to the implantation process. Patients who were elderly, female, or had comorbidities were at higher risk of PPFs (p < 0.001). German hospitals with a surgical volume of < 300 primary procedures per year had a higher rate of PPFs (p < 0.001). The use of cemented and collared prostheses had a lower fracture risk PPF compared to uncemented and collarless components, respectively (both p < 0.001). Collared prostheses reduced the risk of PPF irrespective of the fixation method and hospital’s surgical volume.

Conclusion

The high proportion of intraoperative fractures emphasises the need to improve surgeon training and surgical technique. Registry data should be interpreted with caution because of potential differences in coding standards between institutions. Cite this article: Bone Joint J 2021;103-B(4):650–658.