bluuebunny/crossref_metadata_2025 huggingface dataset:
In-utero gastric perforation from combined duodenal and esophageal atresia without consistent polyhydramnios
Authors: Lyttle Bailey D , Liechty Kenneth , Corkum Kristine , Galan Henry , Behrendt Nicholas , Zaretsky Michael , Bruny Jennifer , Derderian S Christopher
Published: November 2021

We present a case in which prenatal imaging at 21-weeks’ gestation suggested duodenal atresia with a double-bubble sign and enlarged stomach. Fetal magnetic resonance imaging findings demonstrated dilation of the stomach and proximal duodenum favoring duodenal atresia but no indications of esophageal atresia. Subsequent prenatal imaging demonstrated interval spontaneous decompression of the stomach without the development of polyhydramnios, obscuring the diagnosis. Postnatally, initial abdominal radiography showed a gasless abdomen, and an oral gastric tube could not pass the mid-esophagus, raising concern for pure esophageal atresia. Intraoperative findings were consistent with duodenal atresia, pure esophageal atresia and a gastric perforation due to a closed obstruction. In this case report, we review the prenatal diagnostic challenges and the limited literature pertaining to this unique pathology.
Correlation between optical flux and polarization variations in flat-spectrum radio quasars on diverse time-scales
Authors: Pandey Ashwani , Rajput Bhoomika , Stalin C S
Published: November 2021

Study of the polarization behaviour in blazars is a powerful tool to discern the role of the magnetic field in the variable emission process in their relativistic jets. We present here the results of our systematic investigation on the correlation between optical flux and polarization variations for eight flat-spectrum radio quasars on various time-scales using data from the Steward Observatory that covers a period of ∼10 years. On long time-scales (∼several months), from a total of 79 observing cycles, we found a significant positive correlation between optical flux and optical polarization degree (PD) in 34 observing cycles, a negative correlation in three cycles, and no correlation in 42 cycles. On short time-scales (∼few days), in 47 out of a total of 55 epochs we found a positive correlation between optical flux and PD, while for the remaining eight epochs an anticorrelation was detected between the two quantities. Moreover, we noticed a significant positive correlation between optical and γ-ray fluxes in 14 epochs, and a negative correlation between the two in one epoch. While the observed optical flux changes fit the shock-in-jet model well, the observed changes in PD are not explainable by changes in the power-law spectral index of the relativistic electrons in the jet. Instead, the observed varied correlations between optical flux and PD could be due to multizone emission regions or the enhanced flux coinciding with the emergence of a new emission knot with its magnetic field either aligned or misaligned with the large-scale magnetic field.
Physical modelling of viscous disc evolution around magnetized neutron star. Aql X-1 2013 outburst decay
Authors: Lipunova Galina , Malanchev Konstantin , Tsygankov Sergey , Shakura Nikolai , Tavleev Andrei , Kolesnikov Dmitry
Published: November 2021

We present a model of a viscously evolving accretion disc around a magnetized neutron star. The model features the varying outer radius of the hot ionized part of the disc due to cooling and the varying inner radius of the disc due to interaction with the magnetosphere. It also includes hindering of accretion on the neutron star because of the centrifugal barrier and irradiation of the outer disc and companion star by X-rays from the neutron star and disc. When setting inner boundary conditions, we take into account that processes at the inner disc occur on a time-scale much less than the viscous time-scale of the whole disc. We consider three types of outflow from the disc inner edge: zero outflow, one based on MHD calculations, and a very efficient propeller mechanism. The light curves of an X-ray transient after the outburst peak can be calculated by a corresponding, publicly available code. We compare observed light curves of the 2013 burst of Aql X-1 in X-ray and optical bands with modelled ones. We find that the fast drop of the 0.3–10 keV flux can be solely explained by a radial shrinking of the hot disc. At the same time, models with the neutron star magnetic field >108 G have better fits because the accretion efficiency behaviour emphasizes the ‘knee’ on the light curve. We also find that a plato emission can be produced by a `disc-reservoir' with stalled accretion.
J01020100−7122208: an accreted evolved blue straggler that was not ejected from a supermassive black hole
Authors: De Brito Silva Danielle , Jofré Paula , Bourbert Douglas , Koposov Sergey E , Prieto Jose L , Hawkins Keith
Published: November 2021

J01020100−7122208 is a star whose origin and nature still challenges us. It was first believed to be a yellow supergiant ejected from the Small Magellanic Cloud, but it was more recently claimed to be a red giant accelerated by the Milky Way’s central black hole. In order to unveil its nature, we analysed photometric, astrometric, and high-resolution spectroscopic observations to estimate the orbit, age, and 16 elemental abundances. Our results show that this star has a retrograde and highly-eccentric orbit, $e=0.914_{-0.020}^{+0.016}$. Correspondingly, it likely crossed the Galactic disc at 550 pc from the Galactic Centre. We obtained a spectroscopic mass and age of $1.09\pm 0.10\, {\rm M}_\odot$ and 4.51 ± 1.44 Gyr, respectively. Its chemical composition is similar to the abundance of other retrograde halo stars. We found that the star is enriched in europium, having [Eu/Fe] = 0.93 ± 0.24, and is more metal-poor than reported in the literature, with [Fe/H]  = −1.30 ± 0.10. This information was used to conclude that J01020100−7122208 is likely not a star ejected from the central black of the Milky Way or from the Small Magellanic Cloud. Instead, we propose that it is simply a halo star that was likely accreted by the Milky Way in the distant past, but its mass and age suggest it is probably an evolved blue straggler.
Velocity monitoring of γ Cas stars reveals their binarity status
Authors: Nazé Yaël , Rauw Gregor , Czesla Stefan , Smith Myron A , Robrade Jan
Published: November 2021

The binary status of γ Cas stars has been discussed while theoretically examining the origin of their peculiar X-ray emission. However, except in two cases, no systematic radial velocity monitoring of these stars had been undertaken yet to clarify their status. We now fill this gap using TIGRE, CARMENES, and UVES high-resolution spectroscopy. Velocities were determined for 16 stars, revealing shifts and/or changes in line profiles. The orbit of six new binaries could be determined: the long periods (80–120 d) and small velocity amplitudes (5–7 km s−1) suggest low mass companions (0.6–1 M⊙). The properties of the known γ Cas binaries appear similar to those of other Be systems, with no clear-cut separation between them. One of the new systems is a candidate for a rare case of quadruple system involving a Be star. Five additional γ Cas stars display velocity variations compatible with the presence of companions, but no orbital solution could yet be formally established for them hence they only receive the status of ‘binary candidate’.
Evolution under Spatially Heterogeneous Selection in Solid Tumors
Authors: Li Guanghao , Yang Zuyu , Wu Dafei , Liu Sixue , Li Xuening , Li Tao , Li Yawei , Liang Liji , Zou Weilong , Wu Chung-I , Wang Hurng-Yi , Lu Xuemei
Published: November 2021

Spatial genetic and phenotypic diversity within solid tumors has been well documented. Nevertheless, how this heterogeneity affects temporal dynamics of tumorigenesis has not been rigorously examined because solid tumors do not evolve as the standard population genetic model due to the spatial constraint. We therefore, propose a neutral spatial (NS) model whereby the mutation accumulation increases toward the periphery; the genealogical relationship is spatially determined and the selection efficacy is blunted (due to kin competition). In this model, neutral mutations are accrued and spatially distributed in manners different from those of advantageous mutations. Importantly, the distinctions could be blurred in the conventional model. To test the NS model, we performed a three-dimensional multiple microsampling of two hepatocellular carcinomas. Whole-genome sequencing (WGS) revealed a 2-fold increase in mutations going from the center to the periphery. The operation of natural selection can then be tested by examining the spatially determined clonal relationships and the clonal sizes. Due to limited migration, only the expansion of highly advantageous clones can sweep through a large part of the tumor to reveal the selective advantages. Hence, even multiregional sampling can only reveal a fraction of fitness differences in solid tumors. Our results suggest that the NS patterns are crucial for testing the influence of natural selection during tumorigenesis, especially for small solid tumors.
Single-molecule mitochondrial DNA sequencing shows no evidence of CpG methylation in human cells and tissues
Authors: Bicci Iacopo , Calabrese Claudia , Golder Zoe J , Gomez-Duran Aurora , Chinnery Patrick F
Published: November 2021

Methylation on CpG residues is one of the most important epigenetic modifications of nuclear DNA, regulating gene expression. Methylation of mitochondrial DNA (mtDNA) has been studied using whole genome bisulfite sequencing (WGBS), but recent evidence has uncovered technical issues which introduce a potential bias during methylation quantification. Here, we validate the technical concerns of WGBS, and develop and assess the accuracy of a new protocol for mtDNA nucleotide variant-specific methylation using single-molecule Oxford Nanopore Sequencing (ONS). Our approach circumvents confounders by enriching for full-length molecules over nuclear DNA. Variant calling analysis against showed that 99.5% of homoplasmic mtDNA variants can be reliably identified providing there is adequate sequencing depth. We show that some of the mtDNA methylation signal detected by ONS is due to sequence-specific false positives introduced by the technique. The residual signal was observed across several human primary and cancer cell lines and multiple human tissues, but was always below the error threshold modelled using negative controls. We conclude that there is no evidence for CpG methylation in human mtDNA, thus resolving previous controversies. Additionally, we developed a reliable protocol to study epigenetic modifications of mtDNA at single-molecule and single-base resolution, with potential applications beyond CpG methylation.
Toxicity evaluation in rats following 28 days of inhalation exposure to xylitol aerosol
Authors: Tian Yushan , Wang Hongjuan , Chen Huan , Li Xianmei , Lu Fengjun , Ma Shuhao , Wang Wenming , Wu Jia , Tang Jiayou , Feng Pengxia , Fu Yaning , Han Shulei , Liu Tong , Hou Hongwei , Hu Qingyuan
Published: November 2021

Xylitol has reported to decrease gingival inflammation and nasopharyngeal pneumonia, which indicated that xylitol may have potential application in respiratory diseases. Although some studies have reported the inhalation toxicity of xylitol, however, the longest period tested was only for 14 days. The inhalation toxicity of xylitol is insufficient. This work investigated the potential subacute toxicity of xylitol according to the OECD TG 412. Rats were randomly divided into a control group and different dosage groups (2 g/m3, 3 g/m3, 5 g/m3), and exposed for 6 hours/day, 5 days/week for 28 days. At the end of the exposure or recovery period, clinical signs, mortality, body weight, food consumption, hematology, blood biochemistry, gross pathology, organ weight, and histopathology were examined. Compared with the control group, rats of both sexes in the exposure groups exhibited no significant changes in body weight, organ mass, and food uptake. After the xylitol exposure, aspartate aminotransferase activity in the xylitol group (3 g/m3) was significantly higher than that in the control group, while other blood indicators and pathological changes of liver and the analysis of the recovery group showed no changes, suggesting that xylitol exerted no observable toxic effect on the liver. Finally, other observations including the histopathology of target organs and hematology also showed no alterations. These results indicated that xylitol had no significant inhalation toxicity at doses up to 5 g/m3. These subacute inhalation toxicity results of xylitol showed that its no-observed-adverse-effect concentration (NOAEC) in rats was determined to 5 g/m3.
In-vivo production of branched-chain amino acids, branched-chain keto acids, and β-hydroxy β-methylbutyric acid
Authors: Ten Have Gabriella A.M. , Engelen Marielle P.K.J. , Deutz Nicolaas E.P.
Published: November 2021

Purpose of review

The branched-chain amino acids (BCAA), branched-chain keto acids (BCKA), and β-hydroxy β-methylbutyric acid (HMB) have regained interest as food ingredients in health and disease. To support nutritional strategies, it is critical to gain insight into the whole body and transorgan kinetics of these components. We, therefore, reviewed the most recent literature in this field on in vivo analysis of BCAA, BCKA, and HMB kinetics in health and disease.

Recent findings

With a new comprehensive metabolic flux analysis BCAA, BCKA, and HMB whole body production, interconversion and disposal rates can be measured simultaneously. Recent studies have provided us with a better understanding of whole-body and transorgan kinetics under postabsorptive, postprandial, hibernating, and lactating conditions. In human pathophysiological conditions like COPD, obesity, and diabetes, the added value of BCAA kinetic measurements over the commonly used concentration measurements only, is discussed.

This article highlights the importance of implementing BCAA, BCKA, and HMB kinetic studies to further advance the field by gaining more mechanistic insights and providing direction to the development of new targeted (nutritional) strategies.
Number of cells in parathyroid tissue in primary hyperparathyroidism cases and its relationship with serum calcium value
Authors: Javadov Mirkhalig , Karatay Emrah , Ulusan Kivilcim , Ozpek Adnan , Idiz Oğuz , Duren Mete , Sari Serkan , Demircan Firat , Demirel Gulderen , Dagdeviren Husniye , Yigit Ayse , Kelestimur Fahrettin , Aysan Erhan
Published: November 2021

Background:

The relationship between serum calcium (Ca) level to serum parathyroid hormone (PTH), phosphorus (P) levels and tissue properties of the parathyroid gland is unknown in primary hyperparathyroidism cases. Revealing this relationship may be useful for understanding the etiopathogenesis of primary hyperparathyroidism and determining the time of treatment.

Methods:

Ninety patients (71 females, 19 males, age range; 27–73 years, average age; 46) who underwent single gland excision with the diagnosis of primary hyperparathyroidism were studied. The patients were divided into 2 groups as serum Ca level <12 and serum Ca level ≥12. Age and sex of the patients, mean cell number of the gland, mean volume of the gland, serum levels of PTH, P, and histopathologic type of hyperplasia were evaluated.

Results:

The mean cell number per cubic centimeter is 22.9 (10–220 range) million in all glands. Serum Ca level was <12 in 82 (91.1%) of the patients, and ≥12 in 8 (8.9%) cases. Mean cell number of the gland, mean volume of the gland, existence of cystic hyperplasia of the gland, serum levels of PTH and P were statistically significant between the 2 groups (P < .001, P < .001, P < .05, P < .001, P < .05 respectively).

Conclusion:

In primary hyperparathyroidism cases serum Ca level is not related to age and sex but directly related to proportionals to the cell number and volume of the gland and serum levels of PTH, inversely related to cystic hyperplasia and serum levels of P. Early surgical intervention should be planned since the serum Ca level will be high in large adenomas with a noncystic radiological appearance.
Outcomes of septic cirrhosis patients admitted to the intensive care unit
Authors: Chebl Ralphe Bou , Tamim Hani , Sadat Musharaf , Qahtani Saad , Dabbagh Tarek , Arabi Yaseen M.
Published: November 2021

The aim of this study is to examine the outcome of septic patients with cirrhosis admitted to the intensive care unit (ICU) and predictors of mortality.

Single center, retrospective cohort study.

The study was conducted in Intensive care Department of King Abdulaziz Medical City, Riyadh, Saudi Arabia.

Data was extracted from a prospectively collected ICU database managed by a full time data collector. All patients with an admission diagnosis of sepsis according to the sepsis-3 definition were included from 2002 to 2017. Patients were categorized into 2 groups based on the presence or absence of cirrhosis.

The primary outcome of the study was in-hospital mortality. Secondary outcomes included ICU mortality, ICU and hospital lengths of stay and mechanical ventilation duration.

A total of 7906 patients were admitted to the ICU with sepsis during the study period, of whom 497 (6.29%) patients had cirrhosis. 64.78% of cirrhotic patients died during their hospital stay compared to 31.54% of non-cirrhotic. On multivariate analysis, cirrhosis patients were at greater odds of dying within their hospital stay as compared to non-cirrhosis patients (Odds ratio {OR} 2.53; 95% confidence interval {CI} 2.04 – 3.15) independent of co-morbidities, organ dysfunction or hemodynamic status. Among cirrhosis patients, elevated international normalization ratio (INR) (OR 1.69; 95% CI 1.29-2.23), hemodialysis (OR 3.09; 95% CI 1.76-5.42) and mechanical ventilation (OR 2.61; 95% CI 1.60–4.28) were the independent predictors of mortality.

Septic cirrhosis patients admitted to the intensive care unit have greater odds of dying during their hospital stay. Among septic cirrhosis patients, elevated INR and the need for hemodialysis and mechanical ventilation were associated with increased mortality.
The effect and safety of ropinirole in the treatment of Parkinson disease
Authors: Zhu Jiali , Chen Min
Published: November 2021

Background:

It is necessary to conduct a meta-analysis of the clinical randomized controlled trials (RCTs) on ropinirole in the treatment of Parkinson disease (PD), to explore the effects and safety of ropinirole, and to provide a theoretical basis for clinically safe and rational drug use.

Methods:

RCTs on the effectiveness and safety of ropinirole in the treatment of PD were searched. We searched Dutch medical literature database, Pubmed, Cochrane Library, China National Knowledge Infrastructure, Wanfang Knowledge Service Platform up to December 15, 2020. The Cochrane risk bias assessment tool was used to evaluate the quality of the included literature, and the RevMan5.3 software was used for meta-analysis.

Results:

A total of 12 RCTs with 3341 patients were included. The changes of Parkinson Disease Rating Scale Part II score (mean difference = –2.23, 95% confidence interval [CI] –2.82 to –1.64) and Parkinson Disease Rating Scale Part III scores (mean difference = –4.93, 95%CI –5.25 to –4.61) in the ropinirole group was significantly lower than that in the control group. The incidence of dizziness (odd risk [OR] = 1.85, 95%CI 1.50–2.28), nausea (OR = 2.17, 95%CI 1.81–2.59), vomiting (OR = 2.73, 95%CI 1.47–5.09), and lethargy (OR = 2.19, 95%CI 1.39–3.44) in the ropinirole group was significantly higher than that in the control group (all P < .05), and there were no significant differences in the incidence of headache (OR = 1.14, 95%CI 0.79–1.65) and insomnia (OR = 1.06, 95%CI 0.72–1.55) were found between 2 groups (all P > .05).

Conclusions:

Ropinirole can help improve the ability of daily living and exercise function of PD patients, but it will increase the incidence of related adverse reactions, which needs to be further confirmed by subsequent large-scale, high-quality RCTs.
Effects of respiratory training on ventilation potential and extubation time in patients with tracheotomy
Authors: Hu Tingting , Jiang Jianmei , Deng Xiaoling , Xiang Wei , Tan Chuan
Published: November 2021

Background:

In the early treatment of critical patients, tracheotomy is often performed to improve ventilation. Clinical practices usually start respiratory training after the artificial airway is removed. It is still controversial whether respiratory training during tube occlusion has effects on patients’ ventilation potential and tube occlusion time. Therefore, this study used Meta-analysis to evaluate the effects of respiratory training on patients’ ventilation potential and tube occlusion time during tracheotomy in patients with tube occlusion, so as to provide evidence for rehabilitation treatment.

Methods:

Wanfang, Chinese Biomedical Literature Database, Chinese National Knowledge Infrastructure, the Chongqing VIP Chinese Science and Technology Periodical Database, PubMed, Embase, and Web of Science were searched through the computer and the randomized controlled trials of respiratory training on ventilation potential and extubation time in patients experiencing tracheotomy were collected as well. The searching time is limited to October 2021. The language restrictions are Chinese and English. Meta-analysis is performed by using RevMan5.4.

Results:

The results of this meta-analysis will be submitted to a peer-reviewed journal for publication.

Conclusion:

This study will provide the latest evidence for the rehabilitation training of patients who underwent tracheotomy.

OSF Registration Number:

DOI 10.17605/OSF.IO/6UCQF.
Pazopanib-induced severe acute liver injury
Authors: Choi Jin-Wook , Yoo Jeong-Ju , Kim Sang Gyune , Kim Young Seok , Chin Susie
Published: November 2021

Rationale:

Drug-induced liver injury (DILI) is the most common cause of acute liver failure in the United States. Painkillers and fever antipyretics are the most common cause of DILI. Hepatic injury can be provoked by DILI as hepatocellular or cholestatic type.

Patient concerns:

A 48-year-old woman presented jaundice accompanied by nausea and vomiting. The patient was an inactive hepatitis B carrier with low viral titer and was diagnosed renal cell carcinoma (RCC) with hepatic metastasis requiring pazopanib treatment. Prior to administration of pazopanib, tenofovir administration was started to prevent exacerbation of hepatitis B. The patient was referred to clinic of gastroenterology department due to sudden elevation of bilirubin after 5 weeks of pazopanib treatment.

Diagnoses:

Abdominal ultrasound and computed tomography showed non-specific finding other than metastatic nodule in the liver and liver cirrhosis. After then, the patient was performed liver biopsy, and the biopsy result was acute cholestatic hepatitis with centrilobular area necrosis and portal inflammation. Therefore, considering the clinical history and biopsy results, the patient was diagnosed as DILI due to pazopanib.

Interventions:

After the biopsy, empirical steroid therapy was initiated and after 7 weeks of pazopanib discontinuation.

Outcomes:

The total bilirubin level returned to normal from peak level of 24.61 to 1.52 mg/dL.

Lessons:

In patients with renal cell carcinoma, pazopanib treatment requires clinical caution as it causes rare complications such as severe jaundice and acute cholestatic hepatitis.
Prevalence of refractive errors and color vision deficiency in a population of industry-workers in Abhar, Iran
Authors: Ahadi Masoumeh , Ebrahimi Afsaneh , Rahmani Saeed , Baghban Alireza Akbarzadeh
Published: November 2021

Visual impairment due to refractive errors and color vision deficiency (CVD) can affect the visual abilities of workers in workplace. Identifying the prevalence of common visual problems helps us to prevent and treat occupational ocular problems.

This study was conducted on 2600 males referring from companies for a routine medical exam to Occupational Medicine Center. In all subjects, visual acuity and refraction were measured. Assessment of color vision was performed by Ishihara color test. In present study, right eyes of subjects were selected to statistical analysis.

The mean spherical equivalent was –0.19 ± 1.39 diopter with a range of –11.00 to +10.00 diopter. Whereas 71% of persons were emmetropic, 20% and 9% of them were myopic and hypermetropic, respectively. From a total subjects, 164 of them had CVD with prevalence of color blindness of 6.3%. In comparison with normal subjects, CVD had no significant effect on refractive findings of our subjects (P > .05).

Our data present the prevalence of refractive errors and color blindness among Iranian industry-workers. Compared with other studies, our subjects have a lower prevalence of refractive errors, and similar rate of prevalence of color blindness.
The self-rated health status and key influencing factors in middle-aged and elderly
Authors: Zhang Yu-Ling , Wu Bin-Jiang , Chen Pei , Guo Ying
Published: November 2021

To evaluate the self-rate health (SRH) status and explore influence factors of middle-aged and elderly in China.

China Health and Retirement Longitudinal Survey was conducted in 2011, 2013, 2015 and 2018. Data of the China Health and Retirement Longitudinal Survey in 2018 was used in our study and a total of 17898 participants were included. SRH status was graded as “very good, good, average, bad, very bad.” Participants who answered “very good” and “good” were regarded as self-rated good health and who answered “average,” “bad” and “very bad” were regarded as self-rated poor health. Odds ratio and 95% confidence interval of Logistics regression were calculated to evaluate the correlation between SRH and chronic diseases, demographic characteristics and lifestyle of middle-aged and elderly participants.

A total of 4476 (25.01%) participants reported they had good health, and 13422 (74.99%) reported they had poor health. 9975 participants self-rated they had no chronic disease (55.73%), and 7923 (44.27%) participants self-rated they suffered from one and above chronic diseases. The prevalence of chronic diseases showed significant odds ratio and trend with SRH poor rate of participants. The more kinds of chronic diseases they suffered from, the poorer SRH was reported in middle-aged and elderly participants. Except for the chronic diseases, participants with higher age, living in rural, with high Center for Epidemiological Survey-Depression Scale score of depression and fewer time of physical activities also correlated with higher SRH (poor) rate.

The SRH (good) rate was very low in middle-aged and elderly, participants who accompanied with more kinds of chronic diseases, fewer physical activities, higher age and living in the rural had a worse health status. A more comprehensive and integrated health framework should be strengthened to improve the health of middle-aged and elderly in China.
A petroclival glioma mimicking trigeminal schwannoma
Authors: Xie Hui-Min , Richard Seidu A. , Lan Zhigang
Published: November 2021

Rationale:

Glioma in the petroclival region is very rare. Also, very few cases of primary gliomas have been reported to have radiographic as well as intraoperative features of extra-axial lesions resulting in diagnostic dilemma in the literature. We present a rare case of petroclival glioma mimicking trigeminal schwannoma in a young female.

Patient concerns:

We present a 21-years old female with a 3-month history of pain in the right eye with no visual impairment. Cranial nerves examination revealed mild deficits in the trigeminal nerve, facial nerve, auditory nerve, oculomotor as well as the trochlear nerve.

Diagnoses:

Magnetic resonance imaging detected an extra-axial mass with mixed signal intensities in the right petroclivus area. Immunohistochemical established glioma with world health organization (WHO) grade II.

Interventions:

The lesion was resected via 2 successive operations in 6 months interval. The patient was further treated with radiotherapy and post-radiotherapy temozolamide.

Outcomes:

Two years follow-up revealed no recurrence of the lesions and she is well. Nevertheless, he is still being followed diligently to uncover any recurrence.

Lessons:

The extra-axial nature as well as petroclival location of the glioma makes our case very unique and very rare. The imaging characteristics were very extraordinary for a glioma which resulted in diagnostic dilemma. Thus, the definitive diagnosis was based on the histopathological evaluation of the excised tumor.
Community-based point-of-care testing to identify new HIV infections
Authors: Mamulwar Megha , Prasad V. Sam , Nirmalkar Amit , Goli Sarita , Jadhav Sachin , Kumbhar Shamali , Kale Varsha , Michael Elizabeth , Ford Teresa Marie , Nazarov Denys , Honig Lyle , Gangakhedkar Raman , Thakar Madhuri
Published: November 2021

The World Health Organization recommends point-of-care testing (POCT) to detect human immunodeficiency virus (HIV) infected individuals in the community. This will help improve treatment coverage through detection of HIV infection among those who are unaware of their status.

This study was planned with an objective to investigate the feasibility and acceptability of POCT for HIV in the community.

A community-based cross-sectional study was conducted in rural and peri-urban areas of Pune, India. These sites were selected based on the distance from the nearest HIV testing center. Testing locations were identified in consultation with the local stakeholders and grass-root health workers to identify and capture the priority population. The POCT was performed on blood samples collected by the finger-prick method.

The proportion of participants seeking HIV tests for the first time was 79.6% that signifies the feasibility of POCT. The acceptability in the peri-urban and rural areas was 70.2% and 69.7%, respectively. POCT was performed at construction sites (24.9%), nearby industries (16.1%) and parking areas of long-distance trucks (8.1%) in the peri-urban area. Three newly diagnosed HIV-infected participants (0.1%) were detected from the peri-urban areas but none from the rural areas. Two of the newly diagnosed participants and their spouses were linked to care.

There was a high acceptability of POCT and wider coverage of priority population with a strategy of testing at places preferable to the study population. Therefore, we believe that community-based POCT is a promising tool for improving HIV testing coverage even in low prevalence settings with the concentrated HIV epidemic.
Saliva testing as noninvasive way for monitoring exercise-dependent response in teenage elite water polo players
Authors: Ferlazzo Nadia , Currò Monica , Saija Caterina , Naccari Francesco , Ientile Riccardo , Di Mauro Debora , Trimarchi Fabio , Caccamo Daniela
Published: November 2021

Excessively increased training volume and/or intensity and competition can lead to development of overtraining syndrome, causing a performance decrement in athletes. Tracking individual response to exercise intensity is crucial for establishing recovery strategies.

We assessed the exercise intensity-dependent variability of stress response biomarkers, namely cortisol (C), testosterone (T), s-IgA, and advanced oxidation protein products (AOPP), in saliva samples of teenage elite water polo players. Saliva was collected on a day of training match (T1) and a day of competitive match (T2), at morning, before and after match.

Cortisol/proteins and testosterone/proteins concentrations decreased throughout day T1, whereas increased throughout day T2. The highest values were measured after match on day T2 (2.5 ± 0.5 vs 14.6 ± 6.3 ng/mg; 0.061 ± 0.024 vs 0.371 ± 0.15 ng/mg, respectively). sIgA/proteins and AOPP/proteins concentrations increased throughout both days, and were higher after T2 match than T1 one (respectively, 1073.0 ± 438.2 vs 71.0 ± 17.3 μg/mg; 78.05 ± 24.2 vs 15.98 ± 3.16 nmol/mg, P = .003). Significant differences between concentrations of different biomarkers recorded on T1 and T2 were found only for AOPP, suggesting an increased oxidative stress on day T2. Free testosterone/cortisol ratio on day T2 was lower than that at morning (0.053 ± 0.021 vs 0.107 ± 0.031), indicating an increased catabolic response after competitive match.

A highly significant positive correlation was found between Cortisol/Proteins and Testosterone as well as s-IgA/Proteins on day T1, and between Cortisol/Proteins and AOPP on day T2.

In conclusion, we found that different types of activities, such a training or competitive session can affect the hormonal response, immunity, and oxidative stress, thereby modulating athletic performance.

Our findings also confirm the usefulness of saliva testing as noninvasive way for monitoring the individual response to changes in exercise intensity in teenage elite water polo players.
A didactic unit for the evaluation of the use of assistive technology for access to computers in occupational therapy
Authors: Pousada Thais , Jiménez Estíbaliz , Díez Emiliano
Published: November 2021

Assistive technology (AT) is an umbrella term that refers to different devices that facilitate the performance of activity for people. Future occupational therapists (OT) must acquire specific competencies to undertake the correct selection of such devices, specifically for those that facilitate access and use the computer.

To create a didactic unit to improve the competencies of OT students about assessment of AT to access computers.

The didactic unit was implemented with 95 students in OT Bachelor's degree, involving teachers from 2 Spanish universities. The procedure included: definition of competencies and learning results; determination of evidence; didactic unit design, and implementation.

The main result was the didactic unit, which included 4 content blocks, each one with several activities defined. The evaluation of the students was continuous, where 48.6% of them achieved a score of between 1.9 and 2.00 (the maximum).

The application of the didactic unit allowed to check that students have improved their competencies and knowledge about assessment and prescription of AT for access to a computer.

The selection of competencies and learning results helped in determining and embedding expertise and professional skills concerning AT for computer access.
The transcriptional activity profile of inhibitor apoptosis protein encoding genes in colon cancer patients
Authors: Waniczek Dariusz , Nowak Marcin , Lorenc-Góra Justyna , Muc-Wierzgoń Małgorzata , Mazurek Urszula , Bichalska-Lach Magda , Lorenc Zbigniew
Published: November 2021

The inhibitor of apoptosis family proteins (IAPs) plays a crucial role in the process of carcinogenesis by regulating apoptosis and maintaining the tissue balance.

In this study, a transcriptomic analysis of IAP-encoding genes in colon cancer was performed using oligonucleotide microarrays.

Adenocarcinoma and healthy colon tissue samples were collected from 32 patients (16 females and 16 males) who underwent surgery due to colon cancer. The mRNA was extracted from tissue samples and tested using oligonucleotide microarrays (Affymetrix). The results were validated using the qRT-PCR technique. Hierarchical grouping was used to allocate 37 samples of normalized mRNA concentrations into 4 groups, with statistically significant differences in gene expression between these groups. The group of genes associated with colon cancer, including IAP-encoding gene - BIRC5 (Survivin), was selected for further testing.

Our study confirmed an increased expression of BIRC5 in colon cancer tissue when compared to the control group. Increased levels of Neuronal Apoptosis Inhibitory Proteins were detected only in low-stage colon cancer, while the expression of Human X Chromosome-Encoded inhibitor of apoptosis family proteins decreased in colon cancer.

The transcriptional activity of IAP-encoding genes varied, depending on the severity of colon cancer. The concentration of mRNA, encoding BIRC5 was elevated in samples obtained from more advanced colon cancer. Hence BIRC5 could be used as a complementary parameter for the diagnosis and prognosis of colon cancer.
Familial adenomatous polyposis associated with desmoid tumors presenting with abdominal abscess
Authors: Liu Ailing , Liu Hua , Ding Xueli , Wu Jun , Tian Zibin , Mao Tao
Published: November 2021

Rationale:

Familial adenomatous polyposis (FAP) associated with desmoids tumors (DTs) complicated by abscess formation is rare. The management is not easy and the choice of the best treatment may be controversial.

Patient concerns:

A 33-year-old man was admitted to our hospital for abdominal pain, fever, chills, nausea, and vomiting. He had a family history of FAP, and history of abdominal surgery.

Diagnoses:

An abdominal enhanced chest computed tomography (CT) scan revealed a soft tissue mass in the abdominal wall and an irregular mesenteric soft tissue mass with internal fistula and intra-abdominal abscess. A CT-guided biopsy of the abdominal wall mass revealed DTs.

Interventions:

The patient was given oral antibiotics for 6 months, and ultimately underwent surgery.

Outcomes:

The patient had no evidence of recurrence on follow-up at 10 months.

Lessons:

This case indicates that for patients with FAP who have a history of abdominal surgery and a progressively enlarging mass and abscess in the abdomen, it is necessary to consider the possibility of DTs. FAP-related DTs are rarely complicated by abscess formation. Antibiotic therapy plus surgical resection of the tumor may be effective and make good prognosis.
Limb-salvage surgery using personalized 3D-printed porous tantalum prosthesis for distal radial osteosarcoma
Authors: Chen Ge , Yin Yiran , Chen Chang
Published: November 2021

Rationale:

Three-dimensional (3D) printing has been widely utilized for treating the tumors of bone and soft tissue. We herewith report a unique case of distal radial osteosarcoma who was treated with a 3D printed porous tantalum prosthesis.

Patient concerns: A 58-year-old Chinese male patient presented to our clinic complaining about a 6-month history of a progressive pain at his right hand, associated with a growing lump 2 months later.

Diagnosis:

Osteosarcoma of distal radius confirmed by percutaneous biopsy and tumor biopsy.

Interventions:

A limb-salvage surgery was performed with a 3D printed porous tantalum prosthesis, combined with the postoperative chemotherapy for 4 cycles.

Outcomes:

At 2-year follow-up, complete pain relief and satisfactory functional recovery of his right wrist were observed.

Lessons:

Personalized 3D printed prosthesis is an effective and feasible method for treating the osteosarcoma and reconstruction of complex bone defects.
Clinical outcomes in acute pancreatitis with relative bradycardia at fever onset
Authors: Okamoto Takeshi , Arashiyama Makoto , Nakamura Kenji , Tsugitomi Ryosuke , Fukuda Katsuyuki
Published: November 2021

While some acute pancreatitis (AP) patents with fever do not exhibit a corresponding increase in heart rate, the clinical significance of this phenomenon has not been studied. We investigated the clinical relevance of relative bradycardia (RB) in febrile AP.

A retrospective electronic chart review was conducted on consecutive patients admitted for AP at a tertiary referral center in Japan from January 1, 2010, to May 31, 2018. Presence of RB was determined at the first instance of fever, based on formulas used in previous studies.

Fever at or during admission was observed in 115 patients, of which 33% had RB. Fever was observed at presentation in 48% and within 48 hours in 94% of cases. Etiologies were alcoholic in 48% and gallstones in 17% of cases. RB patients were older (median age: 62 vs 51 years, P = .028) but had shorter median postfever lengths of stay (8 vs 12 days, P = .003), lower median Ranson scores (1 vs 2, P < .001), and were less likely to develop delirium (11% vs 38%, P = .002). Nineteen of 21 severe AP cases based on the Ranson score were nonbradycardia (P = .011). RB was also associated with lower white blood cell count, C-reactive protein, and lactate levels. On computed tomography, necrosis (P = .028) and moderate or severe pancreatitis (P = .041) were less frequently observed in patients with RB. There was a significant inverse correlation between RB and the Ranson score (−.305, P = .001). While RB was an independent predictors of postfever length of stay (LOS) in multiple regression analysis when the Ranson score was excluded (P = .010), it ceased to be significant when the Ranson score was included (P = .141).

AP patients with RB at fever onset had milder disease and shorter LOS compared to those with higher heart rates at fever onset. RB may be useful as a simple, early predictor of shorter LOS before the Ranson score can be calculated.
Prognostic markers compared to CD3+TIL in locally advanced nasopharyngeal carcinoma
Authors: Al-Rajhi Nasser , Mohammed Shamayel F. , Khoja Hatim A. , Al-Dehaim Mohammad , Ghebeh Hazem
Published: November 2021

Locally advanced nasopharyngeal carcinoma (LA-NPC) is more prevalent in some geographic regions, including Saudi Arabia. Typically, Tumor-Node-Metastasis (TNM) staging is used in NPC. However, it is inadequate to assess the prognosis of LA-NPC.

Therefore, we analyzed and compared several previously reported prognostic factors in LA-NPC patients, retrospectively, including CD3+tumor-infiltrating lymphocytes (TIL) and peripheral blood hemoglobin, EBV DNA copy number, ratios of albumin-to-alkaline phosphatase ratio (AAPR), neutrophils, or platelets-to-lymphocytes (NLR, PLR). The studied cohort was 83 LA-NPC patients previously recruited for a randomized phase II trial with a different aim.

Univariate cox regression analysis showed no significant correlation between any of the tested variables with disease-free survival (DFS) or overall survival (OS) with the exception of low CD3+ TIL infiltration, which correlated significantly with DFS (HR = 6.7, P = <.001) and OS (HR = 9.1, P = .043). Similarly, in a validated multivariate cox regression analysis, only low CD3+ TIL correlated significantly with DFS (HR = 7.0, P < .001 for TIL) and OS (HR = 9.4, P = .040).

Among tested parameters, CD3+ TIL was the only independent prognostic marker for DFS and OS in LA-NPC patients treated with CCRT. This study supports the use of CD3+TIL, over other factors, as an independent prognostic factor in LA-NPC.
[Un]Forgetting History: Preparing Public Health Professionals to Address Structural Racism
Authors: Rosario Carrie , Al Amin Saif , Parker Cedric
Published: November 2021

Context:

Structural racism, a fundamental cause of health inequities, must be dismantled to fulfill society's interest in ensuring conditions in which all people have opportunities conducive to health. Correspondingly, the Ten Essential Public Health Services center equity, and Council on Education for Public Health (CEPH) accreditation criteria require public health students to learn about racism. However, little guidance is provided to help faculty empower future generations of public health professionals to challenge it.

Program:

In response to the 2020 murders of George Floyd, Ahmaud Arbery, and Breonna Taylor, faculty at UNC Greensboro denounced racism and recommitted to anti-racist pedagogy and praxis. In this article, we discuss integrated ways a graduate-level public health assessment and planning course empowered students to name structural racism, understand how it operates, and collaborate for action.

Implementation:

Specifically, we highlight (1) our use of the book The Color of Law as means to understand racism as a structural intervention; (2) the Harvard Case Teaching Method as an organizing framework to make the classroom a critically engaged democratic setting; (3) change experts from local health and nonprofit organizations engaged in policy making to address social determinants and disparities resulting from structural racism (eg, housing, health care access, food insecurity); and (4) engagement with a minority-owned nonprofit to allow for practice applying knowledge and skills to address local inequities.

Discussion:

Our 4-pronged pedagogical approach provides an innovative, tangible example for other public health programs as they reflect upon academic institutions' unique power and role in addressing the public health crisis of structural racism.
The Power of Connections: AAP COVID-19 ECHO Accelerates Responses During a Public Health Emergency
Authors: Bernstein Henry H. , Calabrese Trisha , Corcoran Peter , Flint Laurence E. , Munoz Flor M.
Published: November 2021

Context:

Pediatric providers across the United States have sought guidance on how to care for the nation's children during the uncertain historic times of the COVID-19 pandemic. The health care community has been challenged by the unprecedented burden of caring for patients when they have evolving guidelines and limited information about the effects of the virus on children.

Program:

In response, the American Academy of Pediatrics (AAP) rapidly launched a national initiative to increase child health professionals' knowledge, skills, and self-efficacy. This COVID-19 ECHO (Extension for Community Healthcare Outcomes) program created communities of learners among child health professionals and subject matter expert faculty using didactic and case-based presentations that foster an “all-teach, all-learn” approach.

Implementation:

The initial AAP COVID-19 ECHO program hosted more than 900 participants in 127 individual virtual sessions, with approximately 25 participants per session. The evolving nature of the pandemic necessitated dynamic and continuous bidirectional flow of concerns and information relevant to participants. Session topics were selected in a “just-in-time” fashion based on participant feedback from the prospective postsession surveys and faculty recommendations; speakers brought data and expert recommendations.

Evaluation:

To assess impact, the AAP used a mixed-methods approach to evaluate the program's effectiveness in meeting its educational objectives. The 2-phase evaluation collected quantitative and qualitative data through an integrated feedback structure that utilized prospective postsession and retrospective postprogram surveys, along with postprogram focus groups.

Discussion:

As the COVID-19 pandemic surges and another influenza season is upon us, the ECHO model is an effective strategy for facilitating bidirectional communication and education to build child health professionals' knowledge, skills, and self-efficacy during an unprecedented and ongoing public health emergency.

Key Points

The ECHO model is an effective strategy for health care organizations to facilitate bidirectional communication and education in building health professionals' clinical knowledge, skills, and self-efficacy during the unprecedented and ongoing public health emergency of the COVID-19 pandemic.