bluuebunny/crossref_metadata_2025 huggingface dataset:
Contribution of epididymal epithelial cell functions to sperm epigenetic changes and the health of progeny
Authors: Chen Hong , Alves Maíra Bianchi Rodrigues , Belleannée Clémence
Published: July 2021

BACKGROUND

Spermatozoa acquire their motility and fertilizing abilities during their maturation through the epididymis. This process is controlled by epididymal epithelial cells that possess features adapted to sense and respond to their surrounding environment and to communicate with spermatozoa. During the past decade, new intercellular communication processes have been discovered, including the secretion and transport of molecules from the epithelium to spermatozoa via extracellular vesicles (EVs), as well as sensing of the intraluminal milieu by cellular extensions.

OBJECTIVE AND RATIONALE

This review addresses recent findings regarding epididymal epithelial cell features and interactions between spermatozoa and the epididymal epithelium as well as epigenetic modifications undergone by spermatozoa during transit through the epididymal microenvironment.

SEARCH METHODS

A systematic search was conducted in Pubmed with the keyword ‘epididymis’. Results were filtered on original research articles published from 2009 to 2021 and written in the English language. One hundred fifteen original articles presenting recent advancements on the epididymis contribution to sperm maturation were selected. Some additional papers cited in the primary reference were also included. A special focus was given to higher mammalian species, particularly rodents, bovines and humans, that are the most studied in this field.

OUTCOMES

This review provides novel insights into the contribution of epididymal epithelium and EVs to post-testicular sperm maturation. First, new immune cell populations have been described in the epididymis, where they are proposed to play a role in protecting the environment surrounding sperm against infections or autoimmune responses. Second, novel epididymal cell extensions, including dendrites, axopodia and primary cilia, have been identified as sensors of the environment surrounding sperm. Third, new functions have been outlined for epididymal EVs, which modify the sperm epigenetic profile and participate in transgenerational epigenetic inheritance of paternal traits.

WIDER IMPLICATIONS

Although the majority of these findings result from studies in rodents, this fundamental research will ultimately improve our knowledge of human reproductive physiopathologies. Recent discoveries linking sperm epigenetic modifications with paternal environmental exposure and progeny outcome further stress the importance of advancing fundamental research on the epididymis. From this, new therapeutic options for infertile couples and better counseling strategies may arise to increase positive health outcomes in children conceived either naturally or with ART.
Norm Contestation and Normative Transformation in Global Peacebuilding Order(s): The Cases of China, Japan, and Russia
Authors: Jütersonke Oliver , Kobayashi Kazushige , Krause Keith , Yuan Xinyu
Published: July 2021

Focusing on the disconnect between mainstream “liberal” peacebuilding and the discourses and practices of “new” and “alternative” peacebuilding actors, this article develops a nonbinary approach that goes beyond norm localization to capture the ways in which major powers influence the nature, content, and direction of normative change. Within the context of their bilateral and multilateral contributions to the “global peacebuilding order,” what forms and types of interventions are conceived by these actors as peacebuilding? How, in turn, has the substantive content of their peacebuilding practices (re)shaped norms and narratives in international peacebuilding efforts? Based on extensive empirical research of the peacebuilding policies and activities of China, Japan, and Russia, this article analyzes the way in which these “top-top” dynamics between norms embedded in the liberal narrative and major powers with competing visions can influence peacebuilding as practiced and pursued in host states. In doing so, it brings together research on global norms and peacebuilding studies and offers a simple yet analytically powerful tool to better understand the evolution of global peacebuilding order(s) and the role of rising powers in (re)shaping global governance.
Light Chain Multiple Myeloma: High Serum Free Light Chain Concentrations Portend Renal Damage and Poorer Survival
Authors: Jin Yulan , Savage Natasha M , Bollag Roni J , Xu Hongyan , Singh Gurmukh
Published: July 2021

Background

Monoclonal immunoglobulins provide an indication of the tumor burden in patients with plasma cell neoplasms. Higher concentrations of serum free light chains in light chain predominant multiple myeloma have been shown to correlate with a poorer outcome. We examined the correlations of serum free light chain concentrations in light chain myelomas with survival, estimated glomerular filtration rate (eGFR) and other clinical and pathological parameters.

Methods

Records of patients with light chain multiple myelomas were reviewed. Highest concentration of serum free light chains for each patient were plotted to ascertain an inflection/change point. Survival, eGFR, and other clinical and pathological parameters were compared between the low and high light chain concentration groups.

Results

Plotting serum free light chain concentrations revealed an inflection point at a concentration of 455 mg/L apportioning patients in to 2 subgroups: 39 patients with low light chain concentrations and 26 patients with high concentrations. The high concentration group had more unfavorable pathology in bone marrow examination in terms of higher neoplastic plasma cell burden and high-risk cytogenetics. The survival rate and eGFR in the high concentration group were significantly worse than in the low concentration group.

Conclusions

As noted for light chain predominant multiple myeloma, high serum free light chain concentration in light chain multiple myelomas are associated with higher renal disease burden and shorter survival. Monitoring of serum free light chain concentrations and customizing treatments to address this parameter are warranted.
Lactate-Based Scoring System in the Diagnosis of Necrotizing Fasciitis
Authors: Daniels Marc , Oberländer Henrik , Schiefer Jennifer , Sonnenberg Philipp , Jörres Achim , Lefering Rolf , Fuchs Paul Christian , Seyhan Harun
Published: July 2021

Necrotizing fasciitis (NF) is a rare and quickly progressing infection and leads to 100% mortality if untreated. Quick diagnosis and an early and radical surgical treatment are essential for stopping bacterial progression. Unfortunately, the absence of clear clinical signs makes the diagnosis often challenging. Therefore, we searched for easy determinable predictive laboratory markers for NF. This is the first study which includes lactate values in a new score. A retrospective analysis of patients with NF (n = 44) and patients with erysipelas (n = 150) was performed. Lactate values, patients’ demographics, clinical presentations, site of infection, comorbidities, microbiological and laboratory findings, antibiotic therapies, and LRINEC and modified LRINEC scores were analyzed. Logistic regression analysis was used to derive adjusted weights, and final simple point score was assessed with a ROC curve analysis. Patients with NF had a mean age of 57 years and patients with erysipelas 65 years. The median hospital length of stay was 8 and 49 days in patients with erysipelas and NF, respectively. Although only one patient (0.7%) in the group of erysipelas died, the mortality rate of patients with NF was 9/44 (20.5%). The lactate values were statistically significant higher in the NF group, 4.1 vs 2.0 mmol/l (P < .001). The new created CologNe-FaDe-score shows the highest AUC-value with 0.907. With the help of lactate values, the CologNe-FaDe-score consists of easily practicable and highly available parameters, which could sensitize diagnosis.
Surgical outcomes of bone sarcoma of the foot
Authors: Tsuda Yusuke , Fujiwara Tomohiro , Stevenson Jonathan D , Abudu Adesegun
Published: July 2021

Objective

Limb-salvage following resection of bone sarcomas of the foot are challenging due to the complicated anatomy, adjacent neurovascular structures and few durable reconstruction options.

Methods

We retrospectively analysed 50 patients with primary malignant bone sarcoma of the foot who underwent surgery including chondrosarcoma (n = 23), Ewing’s sarcoma (n = 14) and osteosarcoma (n = 13).

Results

Median follow-up was 68 months. The primary sites were metatarsal (n = 18), phalanges (n = 15), calcaneus (n = 13) and others (n = 4). The 5-year disease-specific survivals were 100, 83 and 83% in chondrosarcoma, Ewing’s sarcoma and osteosarcoma, respectively. Below knee amputation, ray/toe amputation, excision and curettage were performed in 21, 24, 2 and 3 patients, respectively. Below knee amputation was performed in 94% of mid/hindfoot tumours. Surgical margins were wide/radical, marginal and intralesional margin in 42, 5 and 3 patients. Three patients (6%) developed local recurrence, whereas, local recurrence was not observed in patients with wide/radical margins. Postoperative complications occurred in 3 patients (6%; surgical site infection n = 2 and delayed wound healing n = 1). Mean MSTS functional score was 26 points (range, 19–30).

Conclusions

Good local control was achieved with acceptable functional outcomes and post-operative complications; almost all mid/hindfoot tumours required below knee amputation achieving wide/radical margins without local recurrence.
Meta-Analysis of Adherence Promotion Interventions in Pediatric Asthma
Authors: Fidler Andrea , Sweenie Rachel , Ortega Adrian , Cushing Christopher C , Ramsey Rachelle , Fedele David
Published: July 2021

Background

Youth with asthma commonly have suboptimal adherence to inhaled corticosteroids (ICS). It is critical to systematically evaluate the effectiveness of ICS adherence promotion interventions and discern which techniques are most effective.

Objective

This study aims to (1) quantify the extent to which interventions improve ICS adherence in pediatric asthma, (2) explore differences in effect size estimates based on intervention and study characteristics, and (3) characterize the risk of bias across interventions.

Methods

We conducted literature searches across five databases. Included studies quantitatively measured ICS adherence as an intervention outcome among youth (<18 years old) diagnosed with asthma and were published after 1997. We analyzed aggregate effect sizes and moderator variables using random-effects models and characterized risk of bias using the Cochrane Collaboration tool.

Results

Thirty-three unique studies met inclusion criteria. At post-intervention, the aggregate effect size for pediatric ICS adherence promotion interventions was small but significant (n = 33, g = 0.39, 95% confidence interval [CI] = 0.24–0.54); however, the aggregate effect size at follow-up was not statistically significant (n = 6, g = 0.38, 95% CI = −0.08 to 0.83). Method of adherence measurement and intervention format were significant moderators. Most interventions had a high risk of performance bias and an unclear risk of bias in one or more domains.

Conclusions

ICS adherence promotion interventions are effective among youth with asthma. Additional longitudinal research is needed to quantify a more precise measure of intervention effectiveness over time, and moderators of intervention effectiveness should be reassessed as the literature base expands.
Variations in Nomenclature of Clinical Variants between Annotation Tools
Authors: Park Kyoung-Jin , Park Jong-Ho
Published: July 2021

Background

Accurate nomenclature of variants is an essential element for genetic diagnosis and patient care.

Objective

To investigate annotation differences of clinical variants between annotation tools.

Methods

We analyzed 218,156 clinical variants from the Human Gene Mutation Database. Multiple nomenclatures based on RefSeq transcripts were provided using ANNOVAR and snpEff.

Results

The concordance rate between ANNOVAR and snpEff was approximately 85%. Based on the Human Genome Variation Society (HGVS) nomenclature, snpEff was more accurate than ANNOVAR (coding variants, 99.3% vs 84.9%; protein variants, 94.3% vs 79.8%). When annotating each variant with ANNOVAR and snpEff, the accuracy of nomenclature was 99.5%.

Conclusions

There were substantial differences between ANNOVAR and snpEff annotations. The findings of this study suggest that simultaneous use of multiple annotation tools could decrease nomenclature errors and contribute to providing standardized clinical reporting.
A bottom-heavy initial mass function for the likely-accreted blue-halo stars of the Milky Way
Authors: Hallakoun Na’ama , Maoz Dan
Published: July 2021

We use Gaia DR2 to measure the initial mass function (IMF) of stars within 250 pc and masses in the range of 0.2 < m/M⊙ < 1.0, separated according to kinematics and metallicity, as determined from Gaia transverse velocity, vT, and location on the Hertzsprung–Russell diagram (HRD). The predominant thin-disc population (vT < 40 km s−1) has an IMF similar to traditional (e.g. Kroupa) stellar IMFs, with star numbers per mass interval dN/dm described by a broken power law, m−α, and index $\alpha _\textrm {high}=2.03^{+0.14}_{-0.05}$ above m ∼ 0.5, shallowing to $\alpha _\textrm {low}=1.34^{+0.11}_{-0.22}$ at m ≲ 0.5. Thick-disc stars (60 km s−1 <vT < 150 km s−1) and stars belonging to the ‘high-metallicity’ or ‘red-sequence’ halo (vT > 100 km s−1 or vT > 200 km s−1, and located above the isochrone on the HRD with a metallicity [M/H] > −0.6) have a somewhat steeper high-mass slope, $\alpha _\textrm {high}=2.35^{+0.97}_{-0.19}$ (and a similar low-mass slope $\alpha _\textrm {low}=1.14^{+0.42}_{-0.50}$). Halo stars from the ‘blue sequence’, which are characterized by low metallicity ([M/H] < −0.6), however, have a distinct, bottom-heavy IMF, well described by a single power law with $\alpha =1.82^{+0.17}_{-0.14}$ over most of the mass range probed. The IMF of the low-metallicity halo is reminiscent of the Salpeter-like IMF that has been measured in massive early-type galaxies, a stellar population that, like Milky Way halo stars, has a high ratio of α elements to iron, [α/Fe]. Blue-sequence stars are likely the debris from accretion by the Milky Way, ∼10 Gyr ago, of the Gaia-Enceladus dwarf galaxy, or similar events. These results hint at a distinct mode of star formation common to two ancient stellar populations – elliptical galaxies and galaxies possibly accreted early-on by ours.
The central densities of Milky Way-mass galaxies in cold and self-interacting dark matter models
Authors: Sameie Omid , Boylan-Kolchin Michael , Sanderson Robyn , Vargya Drona , Hopkins Philip F , Wetzel Andrew , Bullock James , Graus Andrew , Robles Victor H
Published: July 2021

We present a suite of baryonic cosmological zoom-in simulations of self-interacting dark matter (SIDM) haloes within the ‘Feedback In Realistic Environment’ (FIRE) project. The three simulated haloes have virial masses of $\sim 10^{12}\, \text{M}_\odot$ at z = 0, and we study velocity-independent self-interaction cross sections of 1 and 10 ${\rm cm^2 \, g^{-1}}$. We study star formation rates and the shape of dark matter density profiles of the parent haloes in both cold dark matter (CDM) and SIDM models. Galaxies formed in the SIDM haloes have higher star formation rates at z ≤ 1, resulting in more massive galaxies compared to the CDM simulations. While both CDM and SIDM simulations show diverse shape of the dark matter density profiles, the SIDM haloes can reach higher and more steep central densities within few kpcs compared to the CDM haloes. We identify a correlation between the build-up of the stars within the half-mass radii of the galaxies and the growth in the central dark matter densities. The thermalization process in the SIDM haloes is enhanced in the presence of a dense stellar component. Hence, SIDM haloes with highly concentrated baryonic profiles are predicted to have higher central dark matter densities than the CDM haloes. Overall, the SIDM haloes are more responsive to the presence of a massive baryonic distribution than their CDM counterparts.
Estimating Teff, radius, and luminosity of M-dwarfs using high-resolution optical and NIR spectral features
Authors: Khata Dhrimadri , Mondal Soumen , Das Ramkrishna , Baug Tapas
Published: July 2021

We estimate effective temperature (Teff), stellar radius, and luminosity for a sample of 271 M-dwarf stars (M0V-M7V) observed as a part of CARMENES (Calar Alto high-Resolution search for M dwarfs with Exo-earths with Near-infrared and optical Echelle Spectrographs) radial-velocity planet survey. For the first time, using the simultaneously observed high-resolution ($R\sim 90\, 000$) spectra in the optical (0.52–0.96 $\mu$m) and near-infrared (0.96–1.71 $\mu$m) bands, we derive empirical calibration relationships to estimate the fundamental parameters of these low-mass stars. We select a sample of nearby and bright M-dwarfs as our calibrators for which the physical parameters are acquired from high-precision interferometric measurements. To identify the most suitable indicators of Teff, radius, and luminosity (log L/L⊙), we inspect a range of spectral features and assess them for reliable correlations. We perform multivariate linear regression and find that the combination of pseudo-equivalent widths and equivalent width ratios of the Ca ii at 0.854 $\mu$m and Ca ii at 0.866 $\mu$m lines in the optical and the Mg i line at 1.57 $\mu$m in the near-infrared give the best fitting linear functional relations for the stellar parameters with root mean square errors of 99K, 0.06 R⊙, and 0.22 dex, respectively. We also explore and compare our results with literature values obtained using other different methods for the same sample of M dwarfs.
Constraining mechanism associated with fast radio burst and glitch from SGR J1935
Authors: Wang Wei-Hua , Xu Heng , Wang Wei-Yang , Du Shuang , Cheng Quan , Zheng Xiao-Ping , Xu Ren-Xin
Published: July 2021

The discovery of fast radio burst (FRB) 200428 from galactic SGR J1935+2154 makes it possible to measure rotational changes accompanied by FRBs and to test several FRB models which may be simultaneously associated with glitches. Inspired by this idea, we present order of magnitude calculations to the scenarios proposed. FRB models such as global starquakes, crust fractures, and collisions between pulsars and asteroids/comets are discussed. For each mechanism, the maximum glitch sizes are constrained by the isotropic energy release during the X-ray burst and/or the SGR J1935+2154-like radio burst rate. Brief calculations show that, the maximum glitch sizes for different mechanisms differ by order(s) of magnitude. If glitches are detected to be coincident with FRBs from galactic magnetars in the future, glitch behaviours (such as glitch size, rise time-scale, the recovery coefficient, and spin-down rate offset) are promising to serve as criterions to distinguish glitch mechanisms and in turn to constrain FRB models.
Tax Justice Beyond National Borders—International or Interpersonal?
Authors: Stark Johanna
Published: July 2021

Recent times have seen growing calls for considerations of justice to be given a greater role in international taxation. The main driver of these calls are distributive concerns, although agreement is still missing as to what this means both in principle and in practice. This article asks whether it is the task of international tax law at all to implement principles of distributive justice beyond the national context and gives an overview of how the ‘global justice debate’ in contemporary political philosophy bears on this question. When it comes to distributive duties with respect to taxing rights, it is crucial to differentiate between the collective and the individual level. Absent a robust assumption of a benevolent and capable government on the recipient side, the reallocation of taxing rights from state to state does not necessarily help when it comes to fulfilling duties of justice towards individuals.
Mental health impacts of COVID-19 on healthcare workers in the Eastern Mediterranean Region: a multi-country study
Authors: Ghaleb Yasser , Lami Faris , Al Nsour Mohannad , Rashak Hiba Abdulrahman , Samy Sahar , Khader Yousef S , Al Serouri Abdulwahed , BahaaEldin Hala , Afifi Salma , Elfadul Maisa , Ikram Aamer , Akhtar Hashaam , Hussein Ahmed Mohamud , Barkia Abdelaziz , Hakim Huda , Taha Hana Ahmad , Hijjo Yasser , Kamal Ehab , Ahmed Abdirizak Yusuf , Rahman Fazalur , Islam Khwaja Mir , Hussein Moshtaq Hassan , Ramzi Shahd Raid
Published: July 2021

Background

Healthcare workers (HCWs) fighting against the COVID-19 pandemic are under incredible pressure, which puts them at risk of developing mental health problems. This study aimed to determine the prevalence of depression, anxiety, and stress among HCWs responding to COVID-19 and its associated factors.

Methods

A multi-country cross-sectional study was conducted during July–August 2020 among HCWs responding to COVID-19 in nine Eastern Mediterranean Region (EMR) countries. Data were collected using an online questionnaire administered using KoBo Toolbox. Mental problems were assessed using the Depression, Anxiety, and Stress Scale (DASS-21).

Results

A total of 1448 HCWs from nine EMR countries participated in this study. About 51.2% were male and 52.7% aged ≤ 30 years. Of all HCWs, 57.5% had depression, 42.0% had stress, and 59.1% had anxiety. Considering the severity, 19.2%, 16.1%, 26.6% of patients had severe to extremely severe depression, stress, and anxiety, respectively. Depression, stress, anxiety, and distress scores were significantly associated with participants’ residency, having children, preexisting psychiatric illness, and being isolated for COVID-19. Furthermore, females, those working in a teaching hospital, and specialists had significantly higher depression and stress scores. Married status, current smoking, diabetes mellitus, having a friend who died with COVID-19, and high COVID-19 worry scores were significantly associated with higher distress scores.

Conclusions

Mental problems were prevalent among HCWs responding to COVID-19 in EMR. Therefore, special interventions to promote mental well-being among HCWs responding to COVID-19 need to be immediately implemented.
Uses and Misuses of Recorded Mental Health Lived Experience Narratives in Healthcare and Community Settings: Systematic Review
Authors: Yeo Caroline , Rennick-Egglestone Stefan , Armstrong Victoria , Borg Marit , Franklin Donna , Klevan Trude , Llewellyn-Beardsley Joy , Newby Christopher , Ng Fiona , Thorpe Naomi , Voronka Jijian , Slade Mike
Published: July 2021

Mental health lived experience narratives are first-person accounts of people with experience of mental health problems. They have been published in journals, books and online, and used in healthcare interventions and anti-stigma campaigns. There are concerns about their potential misuse. A four-language systematic review was conducted of published literature characterizing uses and misuses of mental health lived experience narratives within healthcare and community settings. 6531 documents in four languages (English, Danish, Swedish, Norwegian) were screened and 78 documents from 11 countries were included. Twenty-seven uses were identified in five categories: political, societal, community, service level and individual. Eleven misuses were found, categorized as relating to the narrative (narratives may be co-opted, narratives may be used against the author, narratives may be used for different purpose than authorial intent, narratives may be reinterpreted by others, narratives may become patient porn, narratives may lack diversity), relating to the narrator (narrator may be subject to unethical editing practises, narrator may be subject to coercion, narrator may be harmed) and relating to the audience (audience may be triggered, audience may misunderstand). Four open questions were identified: does including a researcher’s personal mental health narrative reduce the credibility of their research?: should the confidentiality of narrators be protected?; who should profit from narratives?; how reliable are narratives as evidence?)
Perceived daily sleep need and sleep debt in adolescents: associations with daily affect over school and vacation periods
Authors: Shen Lin , Wiley Joshua F , Bei Bei
Published: July 2021

Study Objectives

To describe trajectories of daily perceived sleep need and sleep debt, and examine if cumulative perceived sleep debt predicts next-day affect.

Methods

Daily sleep and affect were measured over two school weeks and two vacation weeks (N = 205, 54.1% females, M ± SDage = 16.9 ± 0.87 years). Each day, participants wore actigraphs and self-reported the amount of sleep needed to function well the next day (i.e. perceived sleep need), sleep duration, and high- and low-arousal positive and negative affect (PA, NA). Cumulative perceived sleep debt was calculated as the weighted average of the difference between perceived sleep need and sleep duration over the past 3 days. Cross-lagged, multilevel models were used to test cumulative sleep debt as a predictor of next-day affect. Lagged affect, day of the week, study day, and sociodemographics were controlled.

Results

Perceived sleep need was lower early in the school week, before increasing in the second half of the week. Adolescents accumulated perceived sleep debt across school days and reduced it during weekends. On weekends and vacations, adolescents self-reported meeting their sleep need, sleeping the amount, or more than the amount of sleep they perceived as needing. Higher cumulative actigraphy sleep debt predicted higher next-day high arousal NA; higher cumulative diary sleep debt predicted higher NA (regardless of arousal), and lower low arousal PA the following day.

Conclusion

Adolescents experienced sustained, cumulative perceived sleep debt across school days. Weekends and vacations appeared to be opportunities for reducing sleep debt. Trajectories of sleep debt during vacation suggested recovery from school-related sleep restriction. Cumulative sleep debt was related to affect on a daily basis, highlighting the value of this measure for future research and interventions.
Effect of upper airway fat on tongue dilation during inspiration in awake people with obstructive sleep apnea
Authors: Jugé Lauriane , Olsza Ida , Knapman Fiona L , Burke Peter G R , Brown Elizabeth C , Stumbles Emma , Bosquillon de Frescheville Anne France , Gandevia Simon C , Eckert Danny J , Butler Jane E , Bilston Lynne E
Published: July 2021

Study Objectives

To investigate the effect of upper airway fat composition on tongue inspiratory movement and obstructive sleep apnea (OSA).

Methods

Participants without or with untreated OSA underwent a 3T magnetic resonance imaging (MRI) scan. Anatomical measurements were obtained from T2-weighted images. Mid-sagittal inspiratory tongue movements were imaged using tagged MRI during wakefulness. Tissue volumes and percentages of fat were quantified using an mDIXON scan.

Results

Forty predominantly overweight participants with OSA were compared to 10 predominantly normal weight controls. After adjusting for age, BMI, and gender, the percentage of fat in the tongue was not different between groups (analysis of covariance [ANCOVA], p = 0.45), but apnoeic patients had a greater tongue volume (ANCOVA, p = 0.025). After adjusting for age, BMI, and gender, higher OSA severity was associated with larger whole tongue volume (r = 0.51, p < 0.001), and greater dilatory motion of the anterior horizontal tongue compartment (r = −0.33, p = 0.023), but not with upper airway fat percentage. Higher tongue fat percentage was associated with higher BMI and older age (Spearman r = 0.43, p = 0.002, and r =0.44, p = 0.001, respectively), but not with inspiratory tongue movements. Greater inspiratory tongue movement was associated with larger tongue volume (e.g. horizontal posterior compartment, r = −0.44, p = 0.002) and smaller nasopharyngeal airway (e.g. oblique compartment, r = 0.29, p = 0.040).

Conclusions

Larger tongue volume and a smaller nasopharynx are associated with increased inspiratory tongue dilation during wakefulness in people with and without OSA. This compensatory response was not influenced by higher tongue fat content. Whether this is also true in more obese patient populations requires further investigation.
Breaking Borders: How Barriers to Global Mobility Hinder International Partnerships in Academic Medicine
Authors: Wondimagegn Dawit , Ragab Lamis , Yifter Helen , Wassim Monica , Rashid Mohammed A. , Whitehead Cynthia R. , Gill Deborah , Soklaridis Sophie
Published: July 2021

This article describes the authors’ personal experiences of collaborating across international borders in academic research. International collaboration in academic medicine is one of the most important ways by which research and innovation develop globally. However, the intersections among colonialism, academic medicine, and global health research have created a neocolonial narrative that perpetuates inequalities in global health partnerships. The authors critically examine the visa process as an example of a racist practice to show how the challenges of blocked mobility increase inequality and thwart research endeavors. Visas are used to limit mobility across certain borders, and this limitation hinders international collaborations in academic medicine. The authors discuss the concept of social closure and how limits to global mobility for scholars from low- and middle-income countries perpetuate a cycle of dependence on scholars who have virtually barrier-free global mobility—these scholars being mainly from high-income countries. Given the current sociopolitical milieu of increasing border controls and fears of illegal immigration, the authors’ experiences expose what is at stake for academic medicine when the political sphere, focused on tightening border security, and the medical realm, striving to build international research collaborations, intersect. Creating more equitable global partnerships in research requires a shift from the current paradigm that dominates most international partnerships and causes injury to African scholars.
Airway management in the adult patient with an unstable cervical spine
Authors: d’Arville Asha , Walker Matthew , Lacey Jonathan , Lancman Benn , Hendel Simon
Published: July 2021

Purpose of review

The ideal airway management of patients with unstable spinal injury presents a perennial challenge for anaesthesiologists. With competing interests, potentially catastrophic complications, and a scarcity of evidence to support common practices, it is an area rich with dogma and devoid of data. This review seeks to highlight recent evidence that improves our assurance that what we do to manage the airway in the unstable cervical spine is supported by data.

Recent findings

The increasing range of available technology for intubation provides important opportunities to investigate the superiority (or otherwise) of various techniques – and a chance to challenge accepted practice. Long-held assumptions regarding spinal immobilisation in the context of airway management may require refinement as a true base of evidence develops.

Video laryngoscopy may replace direct laryngoscopy as the default technique for endotracheal intubation in patients with suspected or confirmed spinal instability. Immobilisation of the unstable cervical spine, manually or with rigid cervical collars, is increasingly controversial. It may be that hard collars are used in specific circumstances, rather than as universal precaution in the future.

There are no recent data of significantly high quality to warrant wholesale changes to recommended airway management practice and in the absence of new information, limiting movement (in the suspected or confirmed unstable cervical spine) remains the mainstay of clinical practice advice.
Role of regional anesthesia in Enhanced Recovery After Surgery (ERAS) protocols
Authors: Mancel Leander , Van Loon Kathleen , Lopez Ana M.
Published: July 2021

Purpose of review

Enhanced Recovery After Surgery (ERAS) protocols and interventional locoregional anesthesia (LRA) techniques continuously evolve. This review outlines the latest recommendations for the use of regional anesthesia in ERAS protocols and emerging interventional analgesia techniques.

Recent findings

Research in ultrasound-guided regional anesthesia has led to a refinement of the traditional techniques and the introduction of a number of new approaches to complement ERAS strategies. The efficacy and versatility of LRA enable its use in an increasing number of ERAS indications.

The implementation of ERAS protocols in different surgical procedures reduces overall complications and recovery time. Multimodal analgesia strategies with regional anesthesia techniques are some of the key interventions contributing to the improvement in postoperative outcomes.
Effect of berbamine on invasion and metastasis of human liver cancer SMMC-7721 cells and its possible mechanism
Authors: Yu Bin-bin , Liu Li-li , Yan Jia-dong , Cao Jian-bo , Cao Ying
Published: July 2021

Berbamine is a bisbenzylisoquinoline alkaloid extracted from Berberis poiretii of Berberis of Berberidaceae. It has been reported that it can significantly inhibit the proliferation of a variety of malignant tumor cells, including liver cancer. However, the effect of berbamine on the invasion and metastasis of liver cancer has not been reported. The present study demonstrated that berbamine inhibited the migration and invasion of SMMC-7721 cells in a concentration-dependent manner and obviously increased the gap junction function and the expression of Cx32 in SMMC-7721 cells compared with control group. However, after silencing Cx32, berbamine had no significant effect on cell invasion and metastasis. Before silencing Cx32, the expression of PI3K and P-AKT were decreased after berbamine treated on SMMC-7721 cells for 24 h. After silencing Cx32, the expression of PI3K and P-AKT were increased in SMMC-7721 cells. The expression of PI3K and P-AKT had no significant effect after berbamine treated on SMMC-7721 cells for 24 h with silencing Cx32. In conclusion, the results of the present study suggest that berbamine could inhibit the SMMC-7721 cell migration and invasion, and its mechanism may be related to the regulation of PI3K/AKT signaling pathway by enhancing the expression of Cx32.
Plasma Metabolites in Early Sepsis Identify Distinct Clusters Defined by Plasma Lipids
Authors: Rogers Angela J. , Leligdowicz Aleksandra , Contrepois Kévin , Jauregui Alejandra , Vessel Kathryn , Deiss Thomas J. , Belzer Annika , Liu Tom , Lippi Matthew , Ke Serena , Ross Erin , Zhou Hanjing , Hendrickson Carolyn , Gomez Antonio , Sinha Pratik , Kangelaris Kirsten N. , Liu Kathleen D. , Calfee Carolyn S. , Matthay Michael A.
Published: July 2021

OBJECTIVES:

Unbiased global metabolomic profiling has not been used to identify distinct subclasses in patients with early sepsis and sepsis-associated acute respiratory distress syndrome. In this study, we examined whether the plasma metabolome reflects systemic illness in early sepsis and in acute respiratory distress syndrome.

DESIGN:

Plasma metabolites were measured in subjects with early sepsis.

SETTING:

Patients were admitted from the emergency department to the ICU in a plasma sample collected within 24 hours of ICU admission. Metabolic profiling of 970 metabolites was performed by Metabolon (Durham, NC). Hierarchical clustering and partial least squares discriminant clustering were used to identify distinct clusters among patients with early sepsis and sepsis-associated acute respiratory distress syndrome.

INTERVENTIONS:

None.

MEASUREMENTS AND MAIN RESULTS:

Among critically ill patients with early sepsis (n = 197), three metabolically distinct subgroups were identified, with metabolic subtype driven by plasma lipids. Group 1, with 45 subjects (23% of cohort), had increased 60-day mortality (odds ratio, 2; 95% CI, 0.99–4.0; p = 0.04 for group 1 vs all others). This group also had higher rates of vasopressor-dependent shock, acute kidney injury, and met Berlin acute respiratory distress syndrome criteria more often (all p < 0.05). Conversely, metabolic group 3, with 76 subjects (39% of cohort), had the lowest risk of 60-day mortality (odds ratio, 0.44; 95% CI, 0.22–0.86; p = 0.01) and lower rates of organ dysfunction as reflected in a lower Simplified Acute Physiology Score II (p < 0.001). In contrast, global metabolomic profiling did not separate patient with early sepsis with moderate-to-severe acute respiratory distress syndrome (n = 78) from those with sepsis without acute respiratory distress syndrome (n = 75).

CONCLUSIONS:

Plasma metabolomic profiling in patients with early sepsis identified three metabolically distinct groups that were characterized by different plasma lipid profiles, distinct clinical phenotypes, and 60-day mortality. Plasma metabolites did not distinguish patients with early sepsis who developed acute respiratory distress syndrome from those who did not.
Effect of Inhaled Xenon on Cardiac Function in Comatose Survivors of Out-of-Hospital Cardiac Arrest—A Substudy of the Xenon in Combination With Hypothermia After Cardiac Arrest Trial
Authors: Saraste Antti , Ballo Haitham , Arola Olli , Laitio Ruut , Airaksinen Juhani , Hynninen Marja , Bäcklund Minna , Ylikoski Emmi , Wennervirta Johanna , Pietilä Mikko , Roine Risto O. , Harjola Veli-Pekka , Niiranen Jussi , Korpi Kirsi , Varpula Marjut , Scheinin Harry , Maze Mervyn , Vahlberg Tero , Laitio Timo
Published: July 2021

OBJECTIVES:

This explorative substudy aimed at determining the effect of inhaled xenon on left ventricular function by echocardiography in comatose survivors of out-of-hospital cardiac arrest.

DESIGN:

A randomized two-group single-blinded phase 2 clinical drug trial.

SETTING:

A multipurpose ICU in two university hospitals.

PATIENTS:

Of the 110 randomized comatose survivors after out-of-hospital cardiac arrest with a shockable rhythm in the xenon in combination with hypothermia after cardiac arrest trial, 38 patients (24–76 yr old) with complete echocardiography were included in this study.

INTERVENTIONS:

Patients were randomized to receive either inhaled xenon combined with hypothermia (33°C) for 24 hours or hypothermia treatment alone. Echocardiography was performed at hospital admission and 24 ± 4 hours after hypothermia.

MEASUREMENTS AND MAIN RESULTS:

Left ventricular ejection fraction, myocardial longitudinal systolic strain, and diastolic function were analyzed blinded to treatment. There were 17 xenon and 21 control patients in whom echocardiography was completed. Clinical characteristics did not differ significantly between the groups. At admission, ejection fraction was similar in xenon and control patients (39% ± 10% vs 38% ± 11%; p = 0.711) but higher in xenon than control patients after hypothermia (50% ± 10% vs 42% ± 10%; p = 0.014). Global longitudinal systolic strain was similar in xenon and control patients at admission (–9.0% ± 3.8% vs –8.1% ± 3.6%; p = 0.555) but better in xenon than control patients after hypothermia (–14.4.0% ± 4.0% vs –10.5% ± 4.0%; p = 0.006). In patients with coronary artery disease, longitudinal strain improved in the nonischemic myocardial segments in xenon patients. There were no changes in diastolic function between the groups.

CONCLUSIONS:

Among comatose survivors of a cardiac cause out-of-hospital cardiac arrest, inhaled xenon combined with hypothermia was associated with greater recovery of left ventricular systolic function in comparison with hypothermia alone.
Exosomes in HIV infection
Authors: Chen Jing , Li Chuanyun , Li Rong , Chen Huan , Chen Dexi , Li Weihua
Published: July 2021

Purpose of review

The exosomes play a critical role in HIV infection, which constitute a pathway to release intracellular material and exchange material and information between cells. Exosomes have become a hotspot in the field of AIDS research. This review introduces the formation process of HIV particles and exosomes, and summarizes the role of exosomes in the progression of HIV disease from multiple aspects.

Recent findings

Many components of the exosomes involved in HIV transfer and replication affect the occurrence, development, and outcome of AIDS, and are closely related to HIV infection. Exosomes can have a dual impact on HIV infection, and play an important role in activating the latent reservoir of HIV and affecting the chronic inflammation of HIV. The biological information carried by exosomes is also of great significance for the prediction of HIV disease.

The present review summarizes the role of exosomes in HIV disease progression in various aspects in order to further understand the underlying mechanism affecting the infection and providing a new idea for the clinical diagnosis and treatment of AIDS.
Role of Hypertension on the Severity of COVID-19: A Review
Authors: Peng Mei , He Jia , Xue Ying , Yang Xue , Liu Shao , Gong Zhicheng
Published: July 2021

The novel coronavirus disease (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has rapidly evolved into a global pandemic. The substantial morbidity and mortality associated with the infection has prompted us to understand potential risk factors that can predict patient outcomes. Hypertension has been identified as the most prevalent cardiovascular comorbidity in patients infected with COVID-19 that demonstrably increases the risk of hospitalization and death. Initial studies implied that renin–angiotensin–aldosterone system inhibitors might increase the risk of viral infection and aggravate disease severity, thereby causing panic given the high global prevalence of hypertension. Nonetheless, subsequent evidence supported the administration of antihypertensive drugs and noted that they do not increase the severity of COVID-19 infection in patients with hypertension, rather may have a beneficial effect. To date, the precise mechanism by which hypertension predisposes to unfavorable outcomes in patients infected with COVID-19 remains unknown. In this mini review, we elaborate on the pathology of SARS-CoV-2 infection coexisting with hypertension and summarize potential mechanisms, focusing on the dual roles of angiotensin-converting enzyme 2 and the disorders of renin–angiotensin–aldosterone system in COVID-19 and hypertension. The effects of proinflammatory factors released because of immune response and gastrointestinal dysfunction in COVID-19 are also discussed.
Herbalism for Modern Obstetrics
Authors: Feigel Melissa L. , Kennard Anne , Lannaman Kia
Published: July 2021

More pregnant and nursing mothers are using herbal remedies than health care providers realize. Lack of familiarity with herbalism in addition to the sparsity of high-quality research for many complementary and alternative medicines are barriers for the western practitioner to engage a patient about herbal therapies. This review provides historical information and available evidence for Traditional Chinese and Western herbal medicines commonly sought by pregnant and nursing mothers. We will review herbs commonly used for: nausea and vomiting, constipation, gestational diabetes, threatened miscarriage, immune system support, parturition preparation, postpartum depression, postpartum bleeding and pain, wound healing, and lactation support.
Surgery for stage 5 retinopathy of prematurity
Authors: Martínez-Castellanos María Ana , Ortiz-Ramirez Greacia Yael
Published: July 2021

Purpose of review

Our understanding of the pathogenesis and surgical management of stage 5 retinopathy of prematurity has come a long way. Despite of new technologies in retinal surgical devices, the dissection of thick membranes is still a challenge. We use a capsulotomy ‘plug on tip’ 0.05 mm designed for capsular fimosis. This diathermy instrument is used to cut the lens capsule by low power waves transmitted from the tip of an active incising electrode and make incisions in the tissue. We tested this technique with 226 infants of which all 226 eyes retrolental membrane were removed. In 6–46 months follow-up, light perception or better visual function was achieved in 92%.

Recent findings

Despite of new technologies in retinal surgical devices, the dissection of thick membranes is still a challenge. Sometimes, we need to use tools that were made for another purpose and adapt it to our current techniques.

Achieving at least a vision of light perception in eyes that were considered untreatable is a good outcome as light perception maintains the circadian circle and helps in the brain development.

Video abstract

http://links.lww.com/COOP/A47
West Syndrome in Children With Congenital Zika Virus Infection
Authors: Bustamante Amador Jorge , García-Segovia Roberto , García Boyano Miguel , Miño-León Greta
Published: July 2021

Congenital Zika infection has been linked with a characteristic phenotype including neurologic sequelae. However, West syndrome has not been previously well described as a consequence. We aim to show this association through a retrospective descriptive study performed in Ecuador. Among 147 infants with congenital Zika infection, 7.5% suffered from West syndrome. Vigabatrin seems to be effective to control the spasms.
Salmonella Paratyphi B; Public Health and Parental Choice
Authors: Fidler Katy , Dudley Julia , Cloke Rachel , Nicholls Margot , Greig David R. , Dallman Timothy J. , Chattaway Marie Anne , Godbole Gauri
Published: July 2021

Background:

Salmonella Paratyphi B (Paratyphoid B) is a rare infection and a notifiable disease in England. Disease is typically mild, and chronic carriage in children has been described in endemic countries. Almost all cases in England are imported, with very few cases of community transmission reported.

Methods:

The aim of this work was to describe an unusual cluster of Paratyphoid B cases transmitted within England, examining clinical, epidemiologic and microbiologic data. Detailed phylogenetic analysis is presented to corroborate public health epidemiologic links between cases.

Results:

One child had recently returned from an endemic area and had mild gastrointestinal symptoms. One year later, 2 other children with no travel history developed invasive disease requiring hospitalization. Epidemiologic links confirmed person-to-person spread between these three cases. All isolates of S. Paratyphi B (n = 93) received by the Gastrointestinal Bacteria Reference Unit between 2014 and 2019 were typed using whole genome sequencing. Three cases of Paratyphoid B were identified in the same geographical location over a 2-year period. S. Paratyphi B strains isolated from the stool and blood of the three cases were closely linked (0–5 single-nucleotide polymorphisms) using whole genome sequencing.

Conclusions:

This case series highlights the potential public health risks of paratyphoid B and the range of pediatric complications associated with this illness, especially in younger children. Although rare, chronic carriage of Paratyphoid B can lead to transmission in nonendemic areas and should be considered in all children presenting with signs of enteric fever even where there is no history of foreign travel.