bluuebunny/crossref_metadata_2025 huggingface dataset:
Children as courseware collaborators: Using participatory research to produce courseware integrating science and sustainable development
Authors: Vilbar Aurelio P
Published: May 2021

UNESCO’s 2014 report on education for sustainable development (ESD), Shaping the Future We Want, shows that there have been worldwide advances in integrating ESD into school curriculums. Although there is a global curriculum in ESD, children as the end users of the curriculum are not actively involved in constructing sustainable discourses. Cognisant of children’s role in materials development, this research investigates how teachers can collaborate with children in producing teacher-made courseware using participatory action research (PAR). The study was conducted with 37 teachers enrolled in a graduate course on second-language teaching. Its goal was to produce courseware that promotes ESD and science concepts, such as global warming and the environment. Using PAR, the children collaborated with the teachers in designing the content. Interviews, focus-group discussions and surveys show that the courseware promoted excitement, science and ESD concepts, but suggested revising and trimming some videos and reading texts.
Recontextualizing Literary Classics With Modernity: A Social Semiotic Analysis of a Comic Adaptation of Journey to the West
Authors: Zhong Zenan , Chen Shukun , Xuan Winfred Wenhui
Published: May 2021

A large number of literary classics have been transformed into comic works with varied adaptation strategies. As a typical example, Cai Zhizhong’s comic adaptation of Journey to the West has made successful attempts in rewriting the story with modern elements that carry socio-cultural values. Under the general theoretical frameworks of social semiotics, this article seeks to explain what and how these elements are presented and explore how such elements are infused with values that affiliate people of different communities and provoke thoughts on cultural diversity and global issues. It is found that (a) modern elements have been presented with particular ideational, interpersonal, and textual semiotic options and (b) different values have been implanted into these elements through bondicons, iconization, and visual attitudes.
Peripheral Inotropes in Critically Ill Children: Is It Safe?
Authors: Mooli Ravi K. , Sadasivam Kalaimaran
Published: May 2021

Many children needing pediatric intensive care units care require inotropes, which are started peripherally prior to securing a central venous access. However, many hospitals in low- and middle-income countries (LMIC) may not have access to central lines and the vasoactive medications are frequently given through a peripheral venous access. Aim: The aim of our study was to describe the role of peripheral vasoactive inotropes in children. Methods: Children requiring peripheral vasoactive medications were included in this study. We retrospectively collected data at 2 time points on use and complications of peripheral vasoactive medications. Results: Eighty-four children (51 pre-COVID era and 33 COVID pandemic) received peripheral vasoactive medications. Only 3% of children (3/84) developed extravasation injury, all of whom recovered completely. Conclusions: Results from our study suggest that extravasation injury due to peripheral inotrope infusion is very low (3%) and it may be safely administered in children at a diluted concentration.
Self-collected versus clinician-collected cervical samples for the detection of HPV infections by 14-type DNA and 7-type mRNA tests
Authors: Aranda Flores C. E. , Gomez Gutierrez G. , Ortiz Leon J. M. , Cruz Rodriguez D. , Sørbye S. W.
Published: May 2021

Background

HPV self-sampling has been widely supported by the scientific community following a strong body of literature on the subject. Self-sampling is important in cervical cancer screening as it has been shown to improve participation. It is well documented that HPV-testing has proven superior to cytology with regards to sensitivity in detection of CIN and cancer. The value of self-collected samples is reliant on the quality of the molecular testing performed, as well as the patients’ preference in sampling procedure and compliance to follow up on positive test results. Due to the incompatibility of self-samples and cytology, triage of HPV-DNA positives by testing for molecular biomarkers is highly warranted.

Methods

Our objective was to compare the detection rate of genital Human Papillomavirus (HPV) infection in self- and clinician-collected samples by a 14-type HPV-DNA test and a 7-type mRNA E6/E7 test.

Results

Five hundred five women were recruited. Each study participant had two sample collection procedures performed upon the same visit, alternating order in execution of the self-collection or the clinician-taken procedure first or second, 1010 samples in total. HPV-DNA prevalence was 22.8% in self-collected versus 19.2% in clinician-collected samples (P = 0.19). Overexpression of mRNA E6/E7 from 7 HPV types was 7.1 and 6.3%, respectively (P = 0.71). The difference between HPV-DNA and HPV-mRNA positivity rates were statistically significant in both self-collected (22.8% versus 7.1%, P < 0.001) and clinician-collected samples (19.2% versus 6.3%, P < 0.001). Overall agreement between the two collection methods was fair, with a concordance rate of 78.2% (390/505), k = 0.34 (95% CI: 0.25–0.44), P < 0.001, for the HPV-DNA test and 92.5% (467/505), k = 0.40 (95% CI, 0.25–0.56), P < 0.001, for the mRNA test, respectively. 96.8% of the participants reported they felt confident carrying out the self-collection themselves, and 88.8% reported no discomfort at all performing the procedure.

Conclusions

This comparative study of two sampling methods reports fair agreement of HPV positivity rates between the self-collected and clinician-collected specimens using Abbott hrHPV and PreTect HPV-Proofer’7 tests. Only one third of HPV-DNA positive women had overexpression of mRNA E6/E7.

Trial registration

ISRCTN77337300.
Assessment of nasopharyngeal Streptococcus pneumoniae colonization does not permit discrimination between Canadian children with viral and bacterial respiratory infection: a matched-cohort cross-sectional study
Authors: Pernica Jeffrey M. , Inch Kristin , Alfaraidi Haifa , Van Meer Ania , Carciumaru Redjana , Luinstra Kathy , Smieja Marek
Published: May 2021

Background

Readily-available diagnostics do not reliably discriminate between viral and bacterial pediatric uncomplicated pneumonia, both of which are common. Some have suggested that assessment of pneumococcal carriage could be used to identify those children with bacterial pneumonia. The objective of this study was to determine if nasopharyngeal pneumococcal colonization patterns differed between children with definite viral disease, definite bacterial disease, and respiratory disease of indeterminate etiology.

Methods

Three groups of subjects were recruited: children with critical respiratory illness, previously healthy children with respiratory illness admitted to the ward, and previously healthy children diagnosed in the emergency department with non-severe pneumonia. Subjects were categorized as follows: a) viral infection syndrome (eg. bronchiolitis), b) bacterial infection syndrome (ie. pneumonia complicated by effusion/empyema), or c) ‘indeterminate’ pneumonia. Subjects’ nasopharyngeal swabs underwent quantitative PCR testing for S. pneumoniae. Associations between categorical variables were determined with Fisher’s exact, chi-square, or logistic regression, as appropriate. Associations between quantitative genomic load and categorical variables was determined by linear regression.

Results

There were 206 children in Group 1, 122 children in Group 2, and 179 children in Group 3. Only a minority (227/507, 45%) had detectable pneumococcal carriage; in those subjects, there was no association of quantitative genomic load with age, recruitment group, or disease category. In multivariate logistic regression, pneumococcal colonization > 3 log copies/mL was associated with younger age and recruitment group, but not with disease category.

Conclusions

The nasopharyngeal S. pneumoniae colonization patterns of subjects with definite viral infection were very similar to colonization patterns of those with definite bacterial infection or indeterminate pneumonia. Assessment and quantification of nasopharyngeal pneumococcal colonization does not therefore appear useful to discriminate between acute viral and bacterial respiratory disease; consequently, this diagnostic testing is unlikely to reliably determine which children with indeterminate pneumonia have a bacterial etiology and/or require antibiotic treatment.
Effect of cognitive behavioral therapy-based counseling on perceived stress in pregnant women with history of primary infertility: a controlled randomized clinical trial
Authors: Golshani Farideh , Hasanpour Shirin , Mirghafourvand Mojgan , Esmaeilpour Khalil
Published: May 2021

Background

Given the prevalence of infertility and consequences of stress, anxiety, and depression during pregnancy and after childbirth, this study aimed to determine the effect of group cognitive behavioral therapy (CBT)-based counseling on perceived stress (primary outcome), anxiety, depression, and quality of life (QoL) of pregnant women with a history of primary infertility.

Method

This controlled randomized clinical trial was conducted on 56 pregnant women with a history of primary infertility referred to Infertility Clinic of Al-Zahra Teaching Hospital of Tabriz. The participants were divided into the intervention (n = 28) and control (n = 28) groups using block randomization. The intervention group received group CBT-based counseling after the 14th week of the pregnancy: six in-person sessions and two telephone sessions once per week. The control group received routine care. The Perceived Stress Scale (PSS), Edinburgh Postnatal Depression Scale (EPDS), Van den Bergh’s Pregnancy-Related Anxiety Questionnaire (PRAQ), and Quality of Life in Pregnancy (Gravidarum) (QOL-GRAV) were completed through interviews before and 4 weeks after the intervention by the researcher.

Results

There was not any between-group difference in socio-demographic characteristics, except the gestational age and husband educational level (p > 0.05). Both of these variables were adjusted in ANCOVA. After the intervention, the mean scores of perceived stress (mean difference: − 7.3; confidence interval: 95%, from − 0.9 to − 5.6;p < 0.001) and anxiety (mean difference:-14.7; confidence interval: 95%. from − 20.6 to - 8.8; p < 0.001) were significantly lower in the intervention group. The mean depression score in the intervention group was lower than the control; however, this between-group difference was not significant (mean difference: − 1.95; confidence interval: 95% from − 3.9 to 0.2;p = 0.052). The mean score of quality of life in pregnancy was significantly higher in the intervention group than the control (mean difference: − 5.4; confidence interval: 95% from 3.4 to 7.4;p < 0.001).

Conclusion

CBT counseling can affect the perceived stress, anxiety, and quality of life of pregnant women with a history of primary infertility. As a result, this counseling approach is recommended along with other counseling approaches to improve the mental health of pregnant women with a history of infertility.

Trial registration

IRCT Registration Number:IRCT20111219008459N12, registered on 10/11/ 2018.
Comparison of prevalence and risk factors of somatization between Chinese health care workers and non-health care workers during COVID-19 outbreak
Authors: Song Xiuli , Zhou Yongjie , Rao Wenwang , Zhang Xiangyang
Published: May 2021

Background

This study aimed to compare prevalence and risk factors of somatization (SOM) between health care workers and non-health care workers during COVID-19 outbreak in China.

Methods

From 14 February to 29 March 2020, an online survey was performed in both 605 health care workers and 1151 non-health care workers. Based on the somatization dimension score of the Symptom Checklist-90, participants were divided into non-SOM group and SOM group.

Results

Health care workers had higher prevalence rate of SOM (p < 0.001) than non-health care workers, with an OR of 1.70 (95% CI, 1.22–2.36, p = 0.002). Multiple logistic regression analysis revealed that in non-health care workers, the risk factors of SOM included other ethnicities, insomnia, and suicide, while in health care workers, the risk factors included working 6–8 h per day, and working ≥10 h per day during COVID-19 outbreak.

Conclusions

Our research suggests that both non-health care workers and health care workers have a relatively high prevalence of somatization. However, the related factors for somatization in both groups are significantly different, showing that medical service-related factors are associated with somatization in health care workers, while demographic and clinical factors are associated with somatization in non-health care workers.
Intraoperative hypothermia in patients undergoing Total knee arthroplasty: a cross-sectional study from a developing country
Authors: Ukrani Ronika Devi , Arif Aiman , Sadruddin Anum , Hasan Obada , Noordin Shahryar
Published: May 2021

Background

Intraoperative hypothermia is associated with various risk factors, morbidity, and mortality in patients undergoing total knee arthroplasty (TKA), increasing the emotional and financial burden on patients. This study aimed to identify risk factors of intraoperative hypothermia in patients undergoing TKA.

Materials and methods

All adult patients (⩾18 years) who underwent TKA from January 2016 to December 2017 at a tertiary-care hospital in Pakistan were included in this retrospective, cross-sectional study. Temperature < 36 °C was defined as hypothermia.

Results

The study included 286 patients (77.6% female) with a mean age of 61.4 ± 10.4 years. The overall proportion of intraoperative hypothermia was 26.6%. Of the total patients, 66.1% underwent bilateral TKA whereas 33.9% underwent unilateral TKA. 73.8% of the patients were ASA Level 2. Only 13.3% of patients had postoperative hypothermia.

Conclusion

Intraoperative hypothermia was significantly associated with age, bilateral procedure, ASA level and postoperative hypothermia in patients undergoing TKA. The surgeon and the operative team should be aware of the risk factors and the adverse outcomes associated with intraoperative hypothermia, especially in resource constrained settings to plan preventive strategies.

Trial registration

This study was retrospectively registered on ClinicalTrials.gov on 3rd October 2020. The registration ID is NCT04575246.
Brain HIV-1 latently-infected reservoirs targeted by the suicide gene strategy
Authors: Saeb Sepideh , Ravanshad Mehrdad , Pourkarim Mahmoud Reza , Daouad Fadoua , Baesi Kazem , Rohr Olivier , Wallet Clémentine , Schwartz Christian
Published: May 2021

Reducing the pool of HIV-1 reservoirs in patients is a must to achieve functional cure. The most prominent HIV-1 cell reservoirs are resting CD4 + T cells and brain derived microglial cells. Infected microglial cells are believed to be the source of peripheral tissues reseedings and the emergence of drug resistance. Clearing infected cells from the brain is therefore crucial. However, many characteristics of microglial cells and the central nervous system make extremely difficult their eradication from brain reservoirs. Current methods, such as the “shock and kill”, the “block and lock” and gene editing strategies cannot override these difficulties. Therefore, new strategies have to be designed when considering the elimination of brain reservoirs. We set up an original gene suicide strategy using latently infected microglial cells as model cells. In this paper we provide proof of concept of this strategy.
Measurement of operative femoral anteversion during cementless total hip arthroplasty and influencing factors for using neck-adjustable femoral stem
Authors: Sun Jingyang , Zhang Bohan , Geng Lei , Zheng Qingyuan , Li Juncheng , Cao Wenzhe , Ni Ming , Zhang Guoqiang
Published: May 2021

Background

Placement of femoral stem in excessive anteversion or retroversion can cause reduced range of motion, prosthetic impingement, and dislocation. The aim of this study was to assess the operative femoral anteversion in patients treated with total hip arthroplasty (THA) and analyze the need of adjusting stem anteversion.

Methods

We retrospectively included 101 patients (126 hips) who underwent cementless THA with a manual goniometer to determine the femoral anteversion between October 2017 and December 2018. The operative femoral anteversion we measured was recorded during THA. We further divided those hips into three subgroups based on the range of operative femoral anteversion: group 1 (<10°), group 2 (10–30°), and group 3 (>30°) and compared the differences of their demographic data. Univariate and multivariate logistic regression were used to identify the influencing factors for the need of neck-adjustable femoral stem. The clinical and radiographic outcomes were also assessed. Perioperative complications were recorded.

Results

After THA, the Harris hip scores improved from 52.87 ± 15.30 preoperatively to 90.04 ± 3.31 at the last follow-up (p < 0.001). No implant loosening, stem subsidence, and radiolucent lines were observed on radiographs. No severe complications occurred and no components needed revision at the latest follow-up. The mean operative femoral anteversion was 14.21° ± 11.80° (range, −9 to 60°). Patients with femoral anteversion more than 30° were about 10 years younger than others. Femoral anteversion >30° was more common in patients with developmental dysplasia of the hip (DDH). There were totally 14 hips treated with the neck-adjustable femoral stem. From the univariate analysis, we can observe that female sex, diagnosis of DDH (compared with osteonecrosis), and higher operative femoral anteversion and its value >30° (compared with <10°) are associated with higher rates of using the neck-adjustable femoral stem. However, all these factors were no longer considered as independent influencing factors when mixed with other factors.

Conclusions

This study highlighted the significance of operative femoral anteversion. Identification of abnormal femoral anteversion could assist in adjusting stem anteversion and reduce the risk of dislocation after THA.
Pancreatic ductal adenocarcinoma concomitant with pancreatic metastases of clear-cell renal cell carcinoma: a case report
Authors: Haeberle Lena , Busch Melanie , Kirchner Julian , Fluegen Georg , Antoch Gerald , Knoefel Wolfram Trudo , Esposito Irene
Published: May 2021

Background

Metastatic spread to the pancreas is a rare event. Renal cell carcinoma represents one possible site of origin of pancreatic metastases. Renal cell carcinoma often metastasizes late and exclusively to the pancreas, suggesting a special role of renal cell carcinoma among primaries metastasizing to the pancreas. Even rarer, renal cell carcinoma may occur simultaneously with pancreatic ductal adenocarcinoma.

Case presentation

We present the case of a 78-year-old male Caucasian patient with a history of clear-cell renal cell carcinoma treated with oncological left nephrectomy 20 years before. The patient was diagnosed with pancreatic ductal adenocarcinoma by fine-needle aspiration cytology. At our institution, he received neoadjuvant therapy with folic acid, fluorouracil, irinotecan, oxaliplatin for borderline-resectable pancreatic ductal adenocarcinoma, and subsequently underwent total pancreatectomy. Upon resection, pancreatic ductal adenocarcinoma as well as two metachronous metastases of clear-cell renal cell carcinoma occurring simultaneously and cospatially with pancreatic ductal adenocarcinoma were diagnosed in the pancreatic body.

Conclusions

Renal cell carcinoma metastases of the pancreas are rare and often occur decades after the initial diagnosis of renal cell carcinoma. The combination of renal cell carcinoma metastases and pancreatic ductal adenocarcinoma is even rarer. However, the possibility should be considered by clinicians, radiologists, and pathologists. The special role of renal cell carcinoma as a site of origin of pancreatic metastasis should be further elucidated.
Acute kidney injury in SARS-CoV2-related pneumonia ICU patients: a retrospective multicenter study
Authors: Geri Guillaume , Darmon Michael , Zafrani Lara , Fartoukh Muriel , Voiriot Guillaume , Le Marec Julien , Nemlaghi Saafa , Vieillard-Baron Antoine , Azoulay Elie
Published: May 2021

Background

While acute kidney injury (AKI) is frequent in severe SARS-CoV2-related pneumonia ICU patients, few data are still available about its risk factors.

Methods

Retrospective observational study performed in four university affiliated hospitals in Paris. AKI was defined according to the KIDGO guidelines. Factors associated with AKI were picked up using multivariable mixed-effects logistic regression. Independent risk factors of day 28 mortality were assessed using Cox model.

Results

379 patients (median age 62 [53,69], 77% of male) were included. Half of the patients had AKI (n = 195, 52%) including 58 patients (15%) with AKI stage 1, 44 patients (12%) with AKI stage 2, and 93 patients (25% with AKI stage 3). Chronic kidney disease (OR 7.41; 95% CI 2.98–18.4), need for invasive mechanical ventilation at day 1 (OR 4.83; 95% CI 2.26–10.3), need for vasopressors at day 1 (OR 2.1; 95% CI 1.05–4.21) were associated with increased risk of AKI. Day 28 mortality in the cohort was 26.4% and was higher in patients with AKI (37.4 vs. 14.7%,P < 0.001). Neither AKI (HR 1.35; 95% CI 0.78–2.32) nor AKI stage were associated with mortality (HR [95% CI] for stage 1, 2 and 3 when compared to no AKI of, respectively, 1.02 [0.49–2.10], 1.73 [0.81–3.68] and 1.42 [0.78–2.58]).

Conclusion

In this large cohort of SARS-CoV2-related pneumonia patients admitted to the ICU, AKI was frequent, mostly driven by preexisting chronic kidney disease and life sustaining therapies, with unclear adjusted relationship with day 28 outcome.
Democratising utopian thought in participatory agenda setting
Authors: Gudowsky Niklas , Bechtold Ulrike , Peissl Walter , Sotoudeh Mahshid
Published: May 2021

Engaging non-experts in matters of science and technology has been increasingly stressed in both rhetoric and action during the past decades. Under the call for moving participation upstream, agenda setting processes have been identified as viable entry point for laypeople’s experiential and value-based knowledge into science, technology and innovation governance (STI). Harnessing visioning for target setting promises to elicit such knowledge, whilst at the same time evading the dilemma of informing participants about STI that does not exist prior to engagement. To test such claims, we investigate a large-scale citizen-visioning exercise employed as an initiation of a transdisciplinary research and innovation agenda setting process, namely CIMULACT. In a comparable Europe-wide process, more than 1000 laypeople (citizens) produced 179 visions of desirable futures which built the basis for co-creating future research topics for advising the EU research and innovation programme Horizon 2020. We provide in depth insights into the visioning methodology for inclusion of citizens into STI agenda setting, and discuss room for methodological improvement regarding potential loss and gains of creativity and diversity of opinions considering empirical results of ex-post participant evaluation questionnaires (n ≈ 964). The discussed data shows a generally positive evaluation of the process and engagement, since citizens are in retrospective content with the process and visions, they would participate again in a similar event, and they are in favour of the EU to continue hosting such events in the future. However, citizens were rather sceptic whether the results actually (can/will) have an impact on the stated aim of integration in research and innovation agenda setting.
Irritable bowel syndrome in midlife women: a narrative review
Authors: Yang Pei-Lin , Heitkemper Margaret M. , Kamp Kendra J.
Published: May 2021

Midlife women between the ages of 40 and 65 years have reported multiple challenges due to menopausal, developmental, and situational transitions from younger to older adulthood. During the midlife period, many women seek health care for gastrointestinal symptoms and irritable bowel syndrome (IBS). Multiple factors including stress, poor sleep, diet, and physical inactivity may contribute to IBS or gastrointestinal symptoms in midlife women. As such, a comprehensive assessment and treatment approach is needed for midlife women suffering gastrointestinal symptoms. This article reviews the main aspects of the menopausal transition, sex hormonal changes, abdominal and pelvic surgery, psychosocial distress, behavioral factors, and gut microbiome, as well as their relevance on IBS and gastrointestinal symptoms in midlife women. Also, management strategies for IBS in midlife women are discussed. To date, gastrointestinal symptoms during midlife years remain a critical area of women’s health. Additional research is needed to better understand the contributors to gastrointestinal symptoms in this group. Such efforts may provide a new window to refine or develop treatments of gastrointestinal symptoms for midlife women.
Patient reported physical and mental health changes associated with a comprehensive cardiovascular risk reduction program for women with breast cancer receiving potentially cardiotoxic chemotherapy
Authors: Fradley Michael G. , Alomar Mohammed , Kilpatrick Marcus W. , Shields Bernadette , Tran Nhi , Best Amey , Bianco Erika , Armanious Merna , Vautier R. Ashton , Kip Kevin , Beckie Theresa M. , Ismail-Khan Roohi
Published: May 2021

Objective

Women with breast cancer (BCA) and cardiovascular disease (CVD) risk factors are at increased risk of developing cardiovascular complications when exposed to potentially cardiotoxic cancer therapy. The benefit of aggressive CVD risk factor modification to reduce adverse treatment-related psychologic and biologic effects is not well established.

Methods

Using a single group pre-test, post-test design, 33 women with BCA receiving anthracycline and/or trastuzumab therapy participated in a 6-month comprehensive CVD risk reduction program involving formal cardio-oncology evaluation along with regular motivational counseling for improved nutrition and physical activity. Study parameters were assessed at baseline and 6 months with paired t-tests used to evaluate changes after the intervention.

Results

The mental component summary score assessed by SF-36V2 improved significantly after program completion (45.0 to 48.8, effect size 0.37, p = 0.017), however the physical component summary score declined (46.2 to 40.9, effect size − 0.53, p = 0.004). Despite this decline in perceived physical health, markers of health-related fitness and nutritional status were maintained or improved. Systolic and diastolic blood pressure also improved after the intervention (136.7 to 124.1 mmHg, p = 0.001 and 84.0 to 78.7 mmHg, p = 0.031, respectively). No significant change in resting heart rate, body mass index, lipids, hemoglobin A1C, or left ventricular ejection fraction was observed.

Conclusions

Patient-reported mental health improved significantly in women with BCA enrolled in a comprehensive CVD risk reduction program despite exposure to potentially cardiotoxic therapies. This study provides preliminary data for future randomized controlled trials evaluating the effects CVD risk reduction program in high-risk breast cancer cohorts.
Salt intake was higher among males and those with high BMI and waist circumference: introduction to the Malaysian Community Salt Survey (MyCoSS), a population-based salt intake survey in Malaysia
Authors: Ambak Rashidah , He Feng J , Othman Fatimah , Michael Viola , Mohd Yusoff Muhammad Fadhli , Aris Tahir
Published: May 2021

Background

Recognising that excessive dietary salt intake is associated with high blood pressure and adverse cardiovascular health, the Ministry of Health Malaysia conducted the Malaysian Community Salt Survey (MyCoSS) among Malaysian adults. This paper introduced MyCoSS projects and presented findings on the salt intake of the Malaysian adult population.

Methods

MyCoSS was a nationally representative survey, designed to provide valuable data on dietary salt intake, sources of salt in the diet, and knowledge, perception, and practice about salt among Malaysian adults. It was a cross-sectional household survey, covering Malaysian citizens of 18 years old and above. Multi-stage-stratified sampling was used to warrant national representativeness. Sample size was calculated on all objectives studied, and the biggest sample size was derived from the knowledge on the effect of high salt on health (1300 participants). Salt intake was estimated using a single 24-h urine collection and its sources from a food frequency questionnaire. Knowledge, attitude, and practice were determined from a pre-tested questionnaire. All questionnaires were fully administered by trained interviewers using mobile devices. Anthropometric indices (weight, height, and waist circumference) and blood pressure were measured using a standardised protocol. Ethical approvals were obtained from the Medical Research Ethics Committee, Ministry of Health Malaysia, and Queen Mary University of London prior to conducting the survey.

Results

Findings showed that the average sodium intake of Malaysian adults (3167 mg/day) was higher than the WHO recommendation of 2000 mg/day. Daily intake was significantly higher among males and individuals with higher BMI and higher waist circumference.

Conclusion

Salt intake in the Malaysian population was higher than the WHO recommendation. MyCoSS’s findings will be used for the development and implementation of national salt reduction policy. A successful implementation of a national salt reduction programme in Malaysia will benefit the whole population.
COVID-19 vaccination may cause FDG uptake beyond axillary area
Authors: Fleury Vincent , Maucherat Bruno , Rusu Daniela , Dumont Frédéric , Rousseau Caroline
Published: May 2021

Background

The vaccination immune response may induce false-positive 18F-FDG PET/CT uptake.

Case presentation

An extended supraclavicular lymph nodal activation after coronavirus disease 2019 (COVID-19) vaccination revealed on 18F-FDG PET/CT mimics a Virchow nodule in a patient with medical history of well-differentiated appendicular adenocarcinoma.

Conclusion

This case highlights a nodal activation beyond axillary area and the importance of documenting vaccination history at the time of scanning to avoid false-positive results.
Role of multidetector computed tomography in evaluation of resectability of pancreatic cancer
Authors: Azzaz Hossam Elsayed Mohammed , Abdullah Mohamed Shawky , Habib Rehab Mohammed
Published: May 2021

Background

Pancreatic cancer is one of the most significant causes and one of the most lethal malignant neoplasms in the world of cancer death in the developed nations. It was named the “silent killer” for its quiet course, late clinical presentation, and the trend of rapid growth. The aim of this study is to detect the reliability of multidetector CT (MDCT) as diagnostic tool in assessing the possibility of eradicating pancreatic cancer.

Results

Twenty-four patients (57%) were not suitable for surgery with non-resectable mass; the remaining eighteen patients (43%) were considered suitable according to MDCT criteria for surgical resection of the tumor. Fourteen out of the sixteen patients (87.5%) had a successful removal of the lump, while the remaining two cases (12.5%) during surgery, the mass was unresectable. The results of the pathology specimens showed that fourteen out of the fourteen patients (100%) had successful operation with no cancer cells in the margin, and a positive predictive value of 87.5% and accuracy of 89.47%.

Conclusions

The advancement of MDCT expertise improves the outcome of pancreatic cancer resectability.
Can DWI-MRI be an alternative to DCE-MRI in the diagnosis of troublesome breast lesions?
Authors: Hashem Lamiaa Mohamed Bassam , Gareer Sherihan W. Y. , Hashem Aya Mohamed Bassam , Fakhry Sherihan , Tohamey Yasmin Mounir
Published: May 2021

Background

Dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) has always been a problem solver in troublesome breast lesions. Despite its many advantages, the encountered low specificity results in unnecessary biopsies. Diffusion-weighted MRI (DW-MRI) is a well-established technique that helps in characterizing breast lesions according to their water diffusivity. So this work aimed to assess the diagnostic performance of DW-MRI in troublesome breast lesions and see if it can replace DCE-MRI study.

Results

In our prospective study, we included 86 patients with mammography and/or ultrasound-detected 90 probably benign or probably malignant (BIRADS 3 or 4) breast lesions. Among the studied cases, 49/90 lesions were benign, and 41/90 were malignant. Combined analysis of morphological and kinetic findings in DCE-MRI had achieved the highest sensitivity of 95.1%. DW-MRI alone was less sensitive (73.2%) yet more specific (83.7%) than DCE-MRI (77.6%). Diagnostic accuracy of DCE-MRI was higher (85.6%) as compared to DW-MRI which was (78.9%).

Conclusion

DCE-MRI is the cornerstone in the workup of troublesome breast lesions. DW-MRI should not be used as supplementary tool unless contrast administration is contraindicated. Combining both DCE-MRI and DW-MRI is the ultimate technique for better lesion evaluation.
Hepatic ischemia reperfusion injury: effect of moderate intensity exercise and oxytocin compared to l-arginine in a rat model
Authors: ELKady Amr H. , Elkafoury Bataa M. , Saad Dalia A. , Abd el-Wahed Doaa M. , Baher Walaa , Ahmed Mona A.
Published: May 2021

Background

Hepatic ischemia reperfusion (IR) injury is considered as a main cause of liver damage and dysfunction. The l-arginine/nitric oxide pathway seems to be relevant during this process of IR. Although acute intense exercise challenges the liver with increased reactive oxygen species (ROS), regular training improves hepatic antioxidant status. Also, oxytocin (Oxy), besides its classical functions, it exhibits a potent antistress, anti-inflammatory, and antioxidant effects. This study was designed to evaluate the hepatic functional and structural changes induced by hepatic IR injury in rats and to probe the effect and potential mechanism of moderate intensity exercise training and/or Oxy, in comparison to a nitric oxide donor, l-arginine, against liver IR-induced damage.

Results

Compared to the sham-operated control group, the hepatic IR group displayed a significant increase in serum levels of ALT and AST, plasma levels of MDA and TNF-α, and significant decrease in plasma TAC and nitrite levels together with the worsening of liver histological picture. L-Arg, Oxy, moderate intensity exercise, and the combination of both Oxy and moderate intensity exercises ameliorated these deleterious effects that were evident by the significant decrease in serum levels of ALT and AST, significant elevation in TAC and nitrite, and significant decline in lipid peroxidation (MDA) and TNF-α, besides regression of histopathological score regarding hepatocyte necrosis, vacuolization, and nuclear pyknosis. Both the moderate intensity exercise-trained group and Oxy-treated group showed a significant decline in TNF-α and nitrite levels as compared to l-Arg-treated group. The Oxy-treated group showed statistical insignificant changes in serum levels of ALT, AST, and plasma levels of nitrite, MDA, TAC, and TNF-α as compared to moderate intensity exercise-trained group.

Conclusion

The combination of both moderate intensity exercise and Oxy displayed more pronounced hepatoprotection on comparison with l-Arg which could be attributed to their more prominent antioxidant and anti-inflammatory effects but not due to their NO-enhancing effect.
Serum allergen-specific IGE to common aeroallergens among allergic rhinitis patients in Egypt
Authors: Elkady Hossam Moustafa , Atef Ahmed
Published: May 2021

Background

Allergic rhinitis is the most prevalent allergic disease, and the prevalence and sensitization patterns differ among countries. Identifying the most common inhalant allergen in each region plays a key role in the diagnosis and management of allergic rhinitis. There are no data available about the most prevalent aeroallergen among allergic rhinitis patients in Egypt. The aim of this study is to evaluate the prevalence of positive serum allergen-specific IGE to common inhalant allergens among allergic rhinitis patients in Egypt. A cross-sectional study was conducted on 354 allergic rhinitis patients, serum allergen-specific IGE was measured by using the Immuno CAP system to 16 common regional aeroallergens including (pollens, mite, molds, animal dander, and cockroach).

Results

The overall rate of sensitization to any allergen was 74.6%. Dermatophagoides pteronyssinus, birch pollens, and Dermatophagoides farina were the most prevalent allergens (29.7%, 23.7%, and 18.6%), respectively. Cladosporuim molds were the least prevalent individual allergens (1.7%).

Conclusion

Our data suggest that Dermatophagoides pteronyssinus and birch pollens were the predominant allergen sources among allergic rhinitis patient in Egypt.
Ιερά σε φυσικό περιβάλλον
Authors: Λυκίδου Αργυρώ
Published: May 2021

Η παρούσα διδακτορική διατριβή πραγματεύεται τα ιερά που έχουν εντοπιστεί στα όρη, το ορεινό δίκτυο και τα σπήλαια της αρχαίας Μακεδονίας και της Θάσου. Πρόκειται για συνολικά δεκαεννέα ιερά που χωρίζονται σε τρεις ενότητες. Στην πρώτη ενότητα ανήκουν τα ιερά που ιδρύθηκαν σε κορυφή όρους και είναι τα ιερά του Διός στην Ψαλίδα Καστοριάς, στην κορυφή Άγιος Αντώνιος του Ολύμπου, στον Ίταμο Σιθωνίας και στον Άθω, της Αρτέμιδος στον λόφο Ιβάνη και της Μητέρας των θεών στη Λευκόπετρα Βερμίου. Στη δεύτερη ενότητα ανήκουν τα ιερά που βρίσκονται στο ορεινό οδικό δίκτυο και είναι τα ιερά του Απόλλωνος στις Πόρτες Ξηρολίμνης, του Ήρωα Αυλωνείτη στα Κηπιά Παγγαίου και ένα ιερό στον Προφήτη Λαγκαδά. Στην τρίτη ενότητα ανήκουν τα σπήλαια με λατρευτικό χαρακτήρα, τα οποία είναι: τα σπήλαια των Νυμφών στη Μίεζα στο Βέρμιο, στον Άθω, και το Παγγαίο και την ευρύτερη περιοχή του, το σπήλαιο του Ποσειδώνος στο ύψωμα Παππούς του Ολύμπου, το σπήλαιο του Διονύσου στην Άφυτη και το φαράγγι του Απόλλωνος και του Πανός στον Μαύρο Βράχο. Επίσης στη Θάσο ερευνώνται τα σπήλαια του Πανός, μιας Κουροτρόφου θεότητας στη Δρακότρυπα και το σπήλαιο της Αρτέμιδος στην Αλυκή.Οι παραπάνω χώροι βρίσκονται μακριά από οικιστικούς σχηματισμούς, επομένως ένα από τα ζητούμενα της έρευνας είναι οι σχέσεις εξάρτησης των ιερών με τις γειτονικές κοινότητες. Στο πλαίσιο αυτό μελετάται η ιστορία της ευρύτερης γεωγραφικής περιοχής, ενώ γίνεται προσπάθεια να αναγνωριστούν οι πληθυσμοί που επισκέπτονταν αυτούς τους ιερούς χώρους. Στο δεύτερο μέρος της εργασίας παρουσιάζονται αντίστοιχα ιερά του υπόλοιπου ελλαδικού χώρου. Πρόκειται για ένα μεγάλο σύνολο ιερών που εξετάζονται με βάση τη λατρευόμενη θεότητα και με απώτερο σκοπό να εντοπιστούν διαφορές και ομοιότητες στην αντίληψη του χώρου και της λατρείας. Τα περισσότερα από τα ιερά που μελετήθηκαν στον χώρο της αρχαίας Μακεδονίας και της Θάσου έχουν μακραίωνη λειτουργία που φθίνει προς τα ελληνιστικά και ρωμαϊκά χρόνια, κάτι που παρατηρείται κυρίως στα σπήλαια. Ωστόσο η ρωμαϊκή κατάκτηση σηματοδότησε μια νέα εποχή και για κάποια από τα ιερά που εξετάστηκαν παραπάνω, καθώς αναδιοργανώθηκαν ή παρατηρήθηκαν αλλαγές στη λατρεία.
Βιοχημικές και βιοφυσικές μελέτες πρωτεϊνικών μορίων που σχετίζονται με το ανοσοποιητικό σύστημα
Authors: Μαυρίδης Γεώργιος
Published: May 2021

Το μείζον σύμπλοκο ιστοσυμβατότητας τάξης 1 (MHC I) αποτελεί ένα διαμεμβρανικό ετεροδιμερές πρωτεϊνικό σύμπλοκο, το οποίο εκφράζεται σε όλα τα εμπύρηνα κύτταρα και παρουσιάζει αντιγονικά πεπτίδια (συνήθως μήκους 8-10 αμινοξέων) στα CD8+ Τ-κυτταροτοξικά λεμφοκύτταρα διαδραματίζοντας κομβικό ρόλο στην επίκτητη ανοσολογική απόκριση. Αμινοτελικά εκτεταμένοι πρόδρομοι αντιγονικοί επίτοποι εισέρχονται στο ενδοπλασματικό δίκτυο (ER), όπου υφίστανται επεξεργασία από την αμινοπεπτιδάση 1 του ενδοπλασματικού δικτύου (ΕRAP1) ώστε να μετατραπούν σε ώριμους επιτόπους και ύστερα να δεσμευτούν στα μόρια MHC I. Η ERAP1 καθορίζει την παραγωγή αντιγονικών πεπτιδίων, παίζει κομβικό ρόλο στη ρύθμιση της επίκτητης ανοσολογικής απόκρισης και αποτελεί ελκυστικό αναδυόμενο στόχο για την ανοσοθεραπεία του καρκίνου και τη ρύθμιση της αυτοανοσίας. Ωστόσο τα κριτήρια επιλογής βάσει των οποίων η ERAP1 επεξεργάζεται αποτελεσματικά ένα τεράστιο αριθμό πρόδρομων αντιγονικών πεπτιδίων δεν είναι πλήρως κατανοητά. Πρόσφατες μελέτες έχουν προτείνει ότι η ERAP1 μπορεί να καταβολίσει αντιγονικά πεπτίδια τόσο όταν τα τελευταία βρίσκονται ελεύθερα στο διάλυμα όσο και όταν είναι προσδεμένα στα μόρια MHC I. Αν και οι δύο αυτοί μηχανισμοί έχουν βασικές διαφορές στο πως επιλέγουν πεπτίδια, δεν είναι ξεκάθαρο ακόμα ποιος μηχανισμός είναι κυρίαρχος. Στην παρούσα διδακτορική διατριβή προσεγγίστηκε το ανωτέρω ερώτημα ως εξής: α) πραγματοποιήθηκε σχηματισμός in vitro συμπλόκων MHC I με επιλεγμένα πεπτίδια διαφορετικού μεγέθους, β) μελετήθηκε η θερμοδυναμική και κινητική σταθερότητα των συμπλόκων με βιοφυσικές και βιοχημικές μεθόδους και γ) μελετήθηκε ενζυμικά η δράση της ERAP1 ως προς τον καταβολισμό πεπτιδίων ελεύθερων στο διάλυμα και στα προσχηματισμένα σύμπλοκα MHC I. Σε όλες τις περιπτώσεις, διαπιστώθηκε ότι υπόστρωμα του ενζύμου αποτελούν τα πεπτίδια που βρίσκονται ελεύθερα στο διάλυμα. Αντίθετα, τα πεπτίδια που βρίσκονται δεσμευμένα στα σύμπλοκα MHCI είτε προστατεύονται πλήρως από την ενζυ μική δράση είτε ο φαινομενικός καταβολισμός τους οφείλεται σε ταχεία αποδέσμευση από το σύμπλοκο και ακολούθως καταβολισμό στο διάλυμα. Εν κατακλείδι, τα αποτελέσματα αυτά ξεκάθαρα στηρίζουν τον μηχανισμό κατά τον οποίο η ERAP1 καταβολίζει πεπτίδια που είναι ελεύθερα στο διάλυμα και ως αποτέλεσμα η επιλογή αντιγονικών πεπτιδίων βασίζεται στην απ’ ευθείας αλληλεπίδραση του ενζύμου με ελεύθερα πεπτίδια πριν τη δέσμευση στα MHC I.
Periodization of American Comic Book – A New Proposal
Authors: Przywalny Dawid
Published: May 2021

Periodization of American Comic Book – A New Proposal The article aims to present a new proposal for the periodization of the history of American comic books. The introduction deals with the problems of other propositions: the academic one created by Arthur Asa Berger and the so-called Olympic / Mainstream that is mainly used by industry artists and readers. The most critical short comings of these periodization are also listed, including them being outdated. The new proposal complements the deficiencies of the previous two: in its actuality, it focuses on the transformations of the comics genre caused by the socio-political implications of the events of September 11, 2001. Each epoch was given specific time frames, cut-off dates, events, and characteristics.
Presidential Rhetoric on Foreign Crises: George W. Bush on Georgia and Barack Obama on Ukraine
Authors: Rzepecka Marta
Published: May 2021

Presidential Rhetoric on Foreign Crises: George W. Bush on Georgia and Barack Obama on Ukraine

This article offers a critique of the rhetorical responses of President George W. Bush to the 2008 Russia-Georgia conflict and of President Barack Obama to the 2014 Russia-Ukraine conflict. Its central objective is to identify parallels and differences between the situations calling for presidential rhetoric on the crises in Georgia and Ukraine and determine how the president’s reactions to the conflicts were similar or different, judging the responses against Theodore Otto Windt, Jr.’s analytical framework for foreign crisis rhetoric.
Discontinuation of the liposomal delivery of bupivacaine has no effect on pain management after primary total knee arthroplasty
Authors: Feng James E. , Ikwuazom Chibuokem P. , Mahure Siddharth A. , Waren Daniel P. , Slover James D. , Schwarzkopf Ran S. , Long William J. , Macaulay William B.
Published: May 2021

Aims

Liposomal bupivacaine (LB) as part of a periarticular injection protocol continues to be a highly debated topic in total knee arthroplasty (TKA). We evaluated the effect of discontinuing the use of LB in a periarticular protocol on immediate postoperative pain scores, opioid consumption, and objective functional outcomes.

Methods

On 1 July 2019, we discontinued the use of intraoperative LB as part of a periarticular injection protocol. A consecutive group of patients who received LB as part of the protocol (Protocol 1) and a subsequent group who did not (Protocol 2) were compared. All patients received the same opioid-sparing protocol. Verbal rating scale (VRS) pain scores were collected from our electronic data warehouse and averaged per patient per 12-hour interval. Events relating to the opiate administration were derived as morphine milligram equivalences (MMEs) per patient per 24-hour interval. The Activity Measure for Post-Acute Care (AM-PAC) tool was used to assess the immediate postoperative function.

Results

A total of 888 patients received Protocol 1 and while 789 received Protocol 2. The mean age of the patients was significantly higher in those who did not receive LB (66.80 vs 65.57 years, p = 0.006). The sex, BMI, American Society of Anesthesiologists physical status score, race, smoking status, marital status, operating time, length of stay, and discharge disposition were similar in the two groups. Compared with the LB group, discontinuing LB showed no significant difference in postoperative VRS pain scores up to 72 hours (p > 0.05), opioid administration up to 96 hours (p > 0.05), or AM-PAC scores within the first 24 hours (p > 0.05).

Conclusion

The control of pain after TKA with a multimodal management protocol is not improved by the addition of LB compared with traditional bupivacaine. Cite this article: Bone Joint J 2021;103-B(6 Supple A):102–107.
Costs of unicompartmental compared with total knee arthroplasty
Authors: Burnett III Robert A. , Yang JaeWon , Courtney P. Maxwell , Terhune E. Bailey , Hannon Charles P. , Della Valle Craig J.
Published: May 2021

Aims

The aim of this study was to compare ten-year longitudinal healthcare costs and revision rates for patients undergoing unicompartmental knee arthroplasty (UKA) and total knee arthroplasty (TKA).

Methods

The Humana database was used to compare 2,383 patients undergoing UKA between 2007 and 2009, who were matched 1:1 from a cohort of 63,036 patients undergoing primary TKA based on age, sex, and Elixhauser Comorbidity Index. Medical and surgical complications were tracked longitudinally for one year following surgery. Rates of revision surgery and cumulative mean healthcare costs were recorded for this period of time and compared between the cohorts.

Results

Patients undergoing TKA had significantly higher rates of manipulation under anaesthesia (3.9% vs 0.9%; p < 0.001), deep vein thrombosis (5.0% vs 3.1%; p < 0.001), pulmonary embolism (1.5% vs 0.8%; p = 0.001), and renal failure (4.2% vs 2.2%; p < 0.001). Revision rates, however, were significantly higher for UKA at five years (6.0% vs 4.2%; p = 0.007) and ten years postoperatively (6.5% vs 4.4%; p = 0.002). Longitudinal-related healthcare costs for patients undergoing TKA were greater than for those undergoing UKA at one year ($24,771 vs $22,071; p < 0.001) and five years following surgery ($26,549 vs $25,730; p < 0.001); however, the mean costs of TKA were comparable to UKA at ten years ($26,877 vs $26,891; p = 0.425).

Conclusion

Despite higher revision rates, patients undergoing UKA had lower mean healthcare costs than those undergoing TKA up to ten years following the procedure, at which time costs were comparable. In the era of value-based care, surgeons and policymakers should be aware of the costs involved with these procedures. UKA was associated with fewer complications at one year postoperatively but higher revision rates at five and ten years. While UKA was significantly less costly than TKA at one and five years, costs at ten years were comparable with a mean difference of only $14. Lowering the risk of revision surgery should be targeted as a source of cost savings for both UKA and TKA as the mean related healthcare costs were 2.5-fold higher in patients requiring revision surgery. Cite this article: Bone Joint J 2021;103-B(6 Supple A):23–31.