bluuebunny/crossref_metadata_2025 huggingface dataset:
How Young People in Scotland Experience the Right to Vote at 16: Evidence on ‘Votes-at-16’ in Scotland from Qualitative Work with Young People
Authors: Huebner Christine
Published: March 2021

Within the UK, Scotland offers a unique case study of ‘Votes-at-16’ in practice. Research provided evidence on the immediate effects of voting age reform on young people’s engagement with politics, but little is known about how young people experienced being allowed to vote from the age of 16 years. This article analyses qualitative evidence about young people’s experiences with the right to vote at 16 since the voting age reform in Scotland. Drawing on data from interviews with young people, we find that ‘Votes-at-16’ brought about a mix of experiences. In combination with the experience of the 2014 Scottish independence referendum it marked a uniquely mobilising life event that boosted confidence in youth voice and led to a perceived increase in political efficacy. It also raised frustrations with young people, however, about their lack of voting rights in other elections and about a perceived gap between expectations and reality regarding the role of schools. By examining young people’s experiences with ‘Votes-at-16’ in Scotland, this article contributes to debates about the implications of voting age reform in the Scotland and beyond.
Public Support for Votes at 16 in the UK: The Effects of Framing on Rights and Policy Change
Authors: Greenwood-Hau Joe , Gutting Raynee S
Published: March 2021

With votes at 16 implemented for local and devolved assembly elections in Scotland and Wales, the debate on the issue continues amongst politicians in England and Northern Ireland. Testing arguments that are often made in that debate, we analyse two survey experiments and show that framing on extending rights prompts higher support, whilst framing on policy change depresses support. These effects hold when priming on consistency of legal ages and are particularly strong amongst the very right-wing. A majority of the public remains opposed to votes at 16, but our results indicate the malleability of public opinion on the issue.
Phytochrome regulates cellular response plasticity and the basic molecular machinery of leaf development
Authors: Romanowski Andrés , Furniss James J , Hussain Ejaz , Halliday Karen J
Published: March 2021

Plants are plastic organisms that optimize growth in response to a changing environment. This adaptive capability is regulated by external cues, including light, which provides vital information about the habitat. Phytochrome photoreceptors detect far-red light, indicative of nearby vegetation, and elicit the adaptive shade-avoidance syndrome (SAS), which is critical for plant survival. Plants exhibiting SAS are typically more elongated, with distinctive, small, narrow leaf blades. By applying SAS-inducing end-of-day far-red (EoD FR) treatments at different times during Arabidopsis (Arabidopsis thaliana) leaf 3 development, we have shown that SAS restricts leaf blade size through two distinct cellular strategies. Early SAS induction limits cell division, while later exposure limits cell expansion. This flexible strategy enables phytochromes to maintain control of leaf size through the proliferative and expansion phases of leaf growth. mRNAseq time course data, accessible through a community resource, coupled to a bioinformatics pipeline, identified pathways that underlie these dramatic changes in leaf growth. Phytochrome regulates a suite of major development pathways that control cell division, expansion, and cell fate. Further, phytochromes control cell proliferation through synchronous regulation of the cell cycle, DNA replication, DNA repair, and cytokinesis, and play an important role in sustaining ribosome biogenesis and translation throughout leaf development.
Distinct cellular strategies determine sensitivity to mild drought of Arabidopsis natural accessions
Authors: Chen Ying , Dubois Marieke , Vermeersch Mattias , Inzé Dirk , Vanhaeren Hannes
Published: March 2021

The worldwide distribution of Arabidopsis (Arabidopsis thaliana) accessions imposes different types of evolutionary pressures, which contributes to various responses of these accessions to environmental stresses. Responses to drought stress have mostly been studied in the Columbia accession, which is predominantly used in plant research. However, the reactions to drought stress are complex and our understanding of the responses that contribute to maintaining plant growth during mild drought (MD) is very limited. Here, we studied the mechanisms with which natural accessions react to MD at a physiological and molecular level during early leaf development. We documented variations in MD responses among natural accessions and used transcriptome sequencing of a drought-sensitive accession, ICE163, and a drought-insensitive accession, Yeg-1, to gain insights into the mechanisms underlying this discrepancy. This revealed that ICE163 preferentially induces jasmonate- and anthocyanin-related pathways, which are beneficial in biotic stress defense, whereas Yeg-1 has a more pronounced activation of abscisic acid signaling, the classical abiotic stress response. Related physiological traits, including the content of proline, anthocyanins, and reactive oxygen species, stomatal closure, and cellular leaf parameters, were investigated and linked to the transcriptional responses. We can conclude that most of these processes constitute general drought response mechanisms that are regulated similarly in drought-insensitive and -sensitive accessions. However, the capacity to close stomata and maintain cell expansion under MD appeared to be major factors that allow to better sustain leaf growth under MD.
A Panel Regression Approach to Holdings-Based Fund Performance Measures
Authors: Ferson Wayne , Wang Junbo L
Published: March 2021

Portfolio performance measures using holdings data are panel regressions. The returns of a fund’s stocks are regressed on its lagged portfolio weights. Stock fixed effects isolate average performance from time-series predictive ability. Control variables condition for fund performance on the characteristics of the stocks held. The long-term performance of average holdings drives some of the classical measures, while predictive ability drives others. A “buy-and-hold drift,” where portfolio weights increase over time in the higher alpha stocks, affects performance measures. Investor flows respond to average performance net of the buy-and-hold drift. (JEL G11, G14, G23, G29).
The effects of transcranial direct current stimulation on attention and inhibitory control of children and adolescents with attention-deficit/hyperactivity disorder (ADHD)
Authors: Guimarães Rachel Silvany Quadros , Bandeira Igor D. , Barretto Bianca Lima , Barretto Thiago Lima , Wanke Thamires , Alves Clara Oliveira Carvalho , de Carvalho Chrissie Ferreira , Lucena Pedro H. , Rodrigues-Silva Luciana , Lucena Rita
Published: March 2021

Attention-deficit/hyperactivity disorder (ADHD) is characterized by a persistent pattern of inattention and hyperactivity/impulsivity. Despite the proven efficacy of pharmacological treatment, many individuals continue to suffer socially and academically and some experience significant side effects that negate the use psychotropic drugs. Transcranial direct current stimulation (tDCS) is a cortical neuromodulation feature that has shown positive results in the treatment of various neuropsychiatric conditions.

Objectives:

To investigate the effect of tDCS on the performance of children and adolescents with ADHD in the neuropsychological tests of visual attention, verbal, and inhibitory control.

Methodology:

Triple blind, randomized, sham-controlled, cross-over trial involving tDCS in children and adolescents with ADHD. Initial screening will be performed using Swanson, Nolan, and Pelham – IVand Wechsler intelligence scale for children fourth edition vocabulary and cube subtests. Individuals will be evaluated pre-tDCS and post-tDCS with the Wechsler intelligence scale for children fourth edition Digitus subtest, neuropsychological assessment battery second edition inhibiting responses subtest, Corsi cubes, and visual attention test-4.
Subgingival microbiome dynamic alteration associated with necrotizing periodontal disease
Authors: Jia Jia , Zhou You , Wang Xinwen , Liu Yuan
Published: March 2021

Rationale:

Necrotizing periodontal diseases (NPDs) are a group of infectious diseases varying in severity, and microorganisms are responsible for these diseases. Currently, the oral microbiota in early disease has been poorly investigated; thus, the causative pathogen and dynamic alteration of the microbiome in NPDs remain unclear.

Patient concerns:

We report a case of a 33-year-old female patient with severe gingival pain and localized necrotizing ulcerative gingival lesions. Conventional therapy was performed, but the necrotizing lesion continued to develop.

Diagnoses:

X-ray examination showed marginal alveolar bone loss in the involved teeth. Histological examination of a biopsy from the gingival lesion showed chronic inflammatory cell infiltration in the tissue, and no cancer cells were observed. Subgingival swabs were taken from the ulcerative gingiva and the gingiva that was not yet affected, and the composition of the microbiota was analyzed by targeted pyrosequencing of the V3-V4 hypervariable regions of the small subunit ribosomal RNA. We found that Neisseria spp., Corynebacterium spp., and Prevotella spp. were clearly enriched in the lesion site. However, Fusobacteria was more abundant in the not-yet-affected gingiva, and Leptotrichia spp. were the most abundant phylotype.

Interventions:

After clinical assessment, a tooth with poor prognosis was extracted, and minocycline hydrochloride was locally administered in the involved tooth pocket every day. Additionally, the patient received 100 mg of hydrochloric acid doxycycline twice per day.

Outcomes:

Remarkable improvement was obtained after 3 days, and the lesion completely healed after 1 week. The follow-up examination 1 year later showed a complete recovery with no recurrent episodes of pain.

Lessons:

Changes in the subgingival microbiome can occurr before clinical symptoms appears, and Fusobacteria may be involved in the imbalance of the subgingival flora in the early stage of NPDs. Moreover, Neisseria is a potential bacterial candidate that deserves further study.
Suspected myocarditis in patients with COVID-19
Authors: Laganà Natascia , Cei Marco , Evangelista Isabella , Cerutti Scilla , Colombo Alessandra , Conte Lucia , Mormina Enricomaria , Rotiroti Giuseppe , Versace Antonio Giovanni , Porta Cesare , Capra Riccardo , Vacirca Valerio , Vitale Josè , Mazzone Antonino , Mumoli Nicola
Published: March 2021

Although myocarditis can be a severe cardiac complication of COVID-19 patients, few data are available in the literature about the incidence and clinical significance in patients affected by SARS-CoV-2. This study aims to describe the prevalence and the clinical features of suspected myocarditis in 3 cohorts of patients hospitalized for COVID-19. We retrospectively evaluated all the consecutive patients admitted for COVID-19 without exclusion criteria. Suspect myocarditis was defined according to current guidelines. Age, sex, in-hospital death, length of stay, comorbidities, serum cardiac markers, interleukin-6, electrocardiogram, echocardiogram, and therapy were recorded. Between March 4 to May 20, 2020, 1169 patients with COVID-19 were admitted in 3 Italian Medicine wards. 12 patients (1%) had suspected acute myocarditis; 5 (41.7%) were men, mean age was 76 (SD 11.34; median 78.5 years); length of stay was 38 days on average (SD 8, median value 37.5); 3 (25%) patients died. 8 (66.7%) had a history of cardiac disease; 7 (58.33%) patients had other comorbidities like diabetes, chronic obstructive pulmonary disease, or renal insufficiency. Myocarditis patients had no difference in sex prevalence, rate of death, comorbidities, elevations in serum cardiac markers as compared with patients without myocardial involvement. Otherwise, there was a significantly higher need for oxygen-support and a higher prevalence of cardiac disease in the myocarditis group. Patients with suspected myocarditis were older, had a higher frequency of previous cardiac disease, and significantly more prolonged hospitalization and a lower value of interleukin-6 than other COVID-19 patients. Further studies, specifically designed on this issue, are warranted.
Image-based diagnosis of residual or recurrent nasopharyngeal carcinoma may be a phantom tumor phenomenon
Authors: Lee Ching-Chi , Lee Jih-Chin , Huang Wen-Yen , Juan Chun-Jung , Jen Yee-Min , Lin Li-Fan
Published: March 2021

Some nasopharyngeal carcinoma (NPC) patients may present convincing radiological evidence mimicking residual or recurrent tumor after radiotherapy. However, by means of biopsies and long term follow-up, the radiologically diagnosed residuals/recurrences are not always what they appear to be. We report our experience on this “phantom tumor” phenomenon. This may help to avoid the unnecessary and devastating re-irradiation subsequent to the incorrect diagnosis.

In this longitudinal cohort study, we collected 19 patients of image-based diagnosis of residual/recurrent NPC during the period from Feb, 2010 to Nov. 2016, and then observed them until June, 2019. They were subsequently confirmed to have no residual/recurrent lesions by histological or clinical measures. Image findings and pathological features were analyzed.

Six patients showed residual tumors after completion of radiotherapy and 13 were radiologically diagnosed to have recurrences based on magnetic resonance imaging (MRI) criteria 6 to 206 months after radiotherapy. There were 3 types of image patterns: extensive recurrent skull base lesions (10/19); a persistent or residual primary lesion (3/19); lesions both in the nasopharynx and skull base (6/19). Fourteen patients had biopsy of the lesions. The histological diagnoses included necrosis/ inflammation in 10 (52.7%), granulation tissue with inflammation in 2, and reactive epithelial cell in 1. Five patients had no pathological proof and were judged to have no real recurrence/residual tumor based on the absence of detectable plasma EB virus DNA and subjective judgment. These 5 patients have remained well after an interval of 38–121 months without anti-cancer treatments.

Image-based diagnosis of residual or recurrent nasopharyngeal carcinoma may be unreliable. False positivity, the “phantom tumor phenomenon”, is not uncommon in post-radiotherapy MRI. This is particularly true if the images show extensive skull base involvement at 5 years or more after completion of radiotherapy. MRI findings compatible with NPC features must be treated as a real threat until proved otherwise. However, the balance between under- and over-diagnosis must be carefully sought. Without a pathological confirmation, the diagnosis of residual or recurrent NPC must be made taking into account physical examination results, endoscopic findings and Epstein-Barr virus viral load. A subjective medical judgment is needed based on clinical and laboratory data and the unique anatomic complexities of the nasopharynx.
Plasma metabolites were associated with spatial working memory in major depressive disorder
Authors: Du Yue , Wei Jinxue , Yang Xiao , Dou Yikai , Zhao Liansheng , Qi Xueyu , Yu Xueli , Guo Wanjun , Wang Qiang , Deng Wei , Li Minli , Lin Dongtao , Li Tao , Ma Xiaohong
Published: March 2021

Major depressive disorder (MDD) is a common disease with both affective and cognitive disorders. Alterations in metabolic systems of MDD patients have been reported, but the underlying mechanisms still remains unclear. We sought to identify abnormal metabolites in MDD by metabolomics and to explore the association between differential metabolites and neurocognitive dysfunction.

Plasma samples from 53 MDD patients and 83 sex-, gender-, BMI-matched healthy controls (HCs) were collected. Liquid chromatography-tandem mass spectrometry (LC-MS/MS) system was then used to detect metabolites in those samples. Two different algorithms were applied to identify differential metabolites in 2 groups. Of the 136 participants, 35 MDD patients and 48 HCs had completed spatial working memory test. Spearman rank correlation coefficient was applied to explore the relationship between differential metabolites and working memory in these 2 groups.

The top 5 metabolites which were found in sparse partial least squares-discriminant analysis (sPLS-DA) model and random forest (RF) model were the same, and significant difference was found in 3 metabolites between MDD and HCs, namely, gamma-glutamyl leucine, leucine-enkephalin, and valeric acid. In addition, MDD patients had higher scores in spatial working memory (SWM) between errors and total errors than HCs. Valeric acid was positively correlated with working memory in MDD group.

Gamma-glutamyl leucine, leucine-enkephalin, and valeric acid were preliminarily proven to be decreased in MDD patients. In addition, MDD patients performed worse in working memory than HCs. Dysfunction in working memory of MDD individuals was associated with valeric acid.
An elevated C-reactive protein level in an inpatient rehabilitation setting after joint replacement
Authors: Aggarwal Arun , Sinha Vikram , Chan Eric , Parapuram Anuka
Published: March 2021

C-reactive protein (CRP) is part of a battery of “routine bloods” performed by residents on patients when they are admitted into a rehabilitation unit. Generally, an elevated CRP is considered to be an indicator of an acute infective process. Numerous studies have indicated that the CRP peaks on the 2nd or 3rd day post total hip arthroplasty (THR) and total knee arthroplasty (TKR) and returns to normal by day 7. When the CRP level remains elevated, it is generally felt that infection should be excluded.

We performed a prospective study on 45 consecutive patients admitted into a rehabilitation unit post hip and knee arthroplasty over a 6 months period, to evaluate the incidence of an elevated CRP on admission, to determine whether an isolated elevated CRP on admission to a rehabilitation setting should not be considered as an indicator of an infective process.

We found all patients (100%) had elevated CRP's on admission, ranging from 8.6 mg/L to 139.2 mg/L, between days 5–7 post-operatively. By day 14, CRP's reduced, but 91% of patients still had elevated CRP's, ranging from 2.1 mg/L to 47.3 mg/L after THR and 4.8 mg/L to 40 mg/L after TKR at day 14.

These results suggest that even in uncomplicated elective joint arthroplasty, CRP's can remain elevated up to 14 days post-procedure, in the absence of an infective process.

An isolated elevated CRP on admission to a rehabilitation setting should not be considered as an indicator of an infective process, but rather part of the normal post-operative inflammatory response. The elevated CRP should be monitored and only an upward trend requires further investigation and management.
Effect of Chinese herbal medicine for patients with benign thyroid nodules in adults
Authors: Ouyang Shuang , Li Weihong , Yu Peng , Li Han , Cai Haiyang , Wu Jing
Published: March 2021

Background:

Thyroid nodules (TN) are discrete lesions within the thyroid gland and are a common clinical problem detected in 19% to 68% of people. TN are more common as age increases and occur more frequently in women. TN can cause pressure symptoms, cosmetic complaints, and thyroid dysfunction. Treatment for benign thyroid nodules includes thyroid hormone therapy, surgery, radioiodine treatment, percutaneous ethanol injection therapy, and laser or radiofrequency treatment to shrink nodules. In China and many other countries, doctors use Chinese herbal medicines (CHM) to treat TN. However, systematic review and meta-analysis has not been found to assess the effects and safety of CHM in curing TN at present. Hence, the systematic review is conducted to scientifically and methodically evaluate the value of its effectiveness and safety of CHM on TN.

Methods:

Literatures related to CHM for TN from the establishment of the database to November 2020 will be retrieved from the following databases: PubMed, Excerpta Medica Database (EMBASE), MEDLINE, Web of Science, Cochrane Library, SpringerLink, WHO International Clinical Trials Registry Platform (ICTRP), Wanfang Database, China National Knowledge Infrastructure (CNKI), Chinese Biomedical Literature Database (CBM), and Chinese Scientific Journal Database (VIP). There are no language restrictions for retrieving literatures. Case reports, animal studies, editorials, expert opinions, reviews without original data, and studies on pediatric population were excluded. Eligible randomized clinical trials (RCTs) evaluating the effectiveness and safety of CHM in TN patients will be put in the study including nodule volume reduction ≥50%, pressure symptoms, cosmetic complaints, quality of life, and adverse events. By scanning the titles, abstracts and full texts, 2 reviewers will independently select studies, extract data, and assess the quality of study. Meta-analysis of RCTs will be conducted using Review Manager 5.1 software. The results will be presented as risk ratio for dichotomous data, and standardized or weighted mean difference for continuous data.

Result:

This study will provide high-quality available evidence for the treatment of TN with CHM based on nodule volume reduction ≥50%, pressure symptoms, cosmetic complaints, quality of life, and adverse events.

Conclusion:

The systematic review will to evaluate the efficacy of CHM in treating benign thyroid nodules in adults and provide evidence for clinicians.

INPLASY registration number:

INPLASY2020120093.
Efficacy and safety of Buyang Huanwu decoction in the treatment of varicose veins of the lower extremities
Authors: Li Chuanyong , Fan Weijian , Pan Zhichang , Zheng Guangfeng , Zhang Qiang , Rong Jianjie
Published: March 2021

Background:

Varicose veins of the lower extremities are common chronic venous diseases in the clinic. Although Western medicine has various surgical methods to treat varicose veins in the lower extremities, there are still a variety of complications. Some studies have shown that Buyang Huanwu decoction treatment of varicose veins of the lower extremities has a certain effect, and can reduce the occurrence of postoperative complications, but there is no evidence of evidence-based medicine. The research carried out in this scheme is to systematically evaluate the efficacy and safety of Buyang Huanwu decoction in the treatment of varicose veins in the lower extremities, and to provide reliable evidence for guiding clinical practice.

Methods:

This is a randomized, double-blind, placebo-controlled, parallel-group clinical trial, which studies the effectiveness and safety of Buyang Huanwu decoction in the treatment of varicose veins of the lower extremities. The patients are randomly and evenly divided into treatment group and control group, the former one is given Buyang Huanwu decoction and the latter one is given placebo. The study will last 49 days, including a 7-day washout period, 14-day intervention and 28-day follow-up, focusing on its efficacy and safety indicators. Observation indicators include: TCM syndrome score, Venous Clinical Severity Score (VCSS), Venous Disability Scote (VDS), Aberdeen Varicose Vein Questionnaire (AVVQ), Hemorheology Indicators, Adverse Reactions, etc. Data analysis is performed using SPSS 25.0 software.

Discussion:

This study will evaluate the effectiveness and safety of Buyang Huanwu decoction and provide clinical evidence for the treatment of varicose veins of the lower extremities.

Trial registration:

OSF Registration number: DOI 10.17605/OSF.IO/WGJXT.
Myeloid tumors accompanying systemic mastocytosis, basophilia, and abnormal platelet-derived growth factor receptor β
Authors: Li Yanfen , Jing Yu , Wan Hua , Liu Daihong
Published: March 2021

Introduction:

Myeloid neoplasms with platelet-derived growth factor receptor β (PDGFRB) rearrangement usually present with eosinophilia in the peripheral blood and bone marrow. Here we report a case of systemic mastocytosis related myeloid neoplasms with basophilia and PRKG2–PDGFRB fusion gene.

Patient's concerns:

A 53-year-old male patient felt fatigue with thrombocythemia and normal hemoglobin over 2 years. Considering the possibility of primary thrombocytosis, the patient was treated with hydroxyurea and interferon. Then the therapy was stopped due to adverse events and worsen condition.

Diagnosis:

Acute myelogenous leukemia (AML) diagnosis was confirmed by bone marrow morphology and flow cytometry. PDGFRB rearrangement was detected by fluorescence in situ hybridization (FISH) test, with chromosome karyotype 46,XY,t(4:5)(q21:q33). PRKG2–PDGFRB fusion was observed by next generation sequencing (NGS) and verified by RT-PCR followed by Sanger sequencing. The results of bone marrow aspiration, bone marrow biopsy, and immunophenotyping showed systemic mastocytosis-related myeloid tumor with basophilia.

Interventions:

Imatinib 400 mg/d was given on the day of admission. Azacitidine 75 mg/m2 was given for induction therapy for 10 days, and followed by one course of DHAG consolidating therapy. Imatinib was taken orally continuously.

Outcomes:

On the 8th day of treatment, the patient's diet and fatigue improved. The hematological and bone marrow morphological remission was achieved on the 25th day. Cytogenetic complete remission was achieved 3 months later and continued to present (December 20, 2020). PRKG2–PDGFRB fusion gene turned negative 7 months later from diagnosis.

Lessons:

Patients with increased basophilic granulocyte and/or mast cells in peripheral blood and/or bone marrow should be screened for PDGFRB abnormality and myeloid or lymphatic tumor. Patients bearing PDGFRB abnormality have a good response to imatinib.
Primary renal carcinoid tumors
Authors: Chen You , Shu Yuqing , He Laichang , Wu Kaifu
Published: March 2021

Rationale:

Primary renal carcinoid tumors are very rare and only about 100 cases have been reported in the medical literature. There are even fewer articles on the imaging manifestations of primary renal carcinoid tumors.

Patient concerns:

We present 3 cases of patients with lumbago and hematuria. These were cases of primary renal carcinoid tumors with initial suspicion of suprarenal epithelioma.

Diagnoses:

Renal lesions were detected on abdomen computed tomography (CT) imaging. The 3 cases presented as solid/cystic solid renal mass with uniform or non-uniform density, calcification in the mass, and enhanced heterogeneity.

Interventions:

The laparoscopic partial/radical nephrectomy were performed.

Outcomes:

The postoperative histological diagnosis were primary renal carcinoid tumors. Case 2 been lost to follow-up in 3 patients, and the other 2 patients (Case 1 and 3) are still alive. Case 1 had intrahepatic metastases.

Lessons:

Primary renal carcinoid tumors mostly present as solid mass/cystic solid mass with calcification and delayed enhancement of heterogeneity on CT imaging, but the diagnosis depends on pathological diagnosis. Hence, raising awareness of the CT features of the rare tumor in the kidney may broaden the knowledge base of radiologists.
Non-apnea sleep disorder and its risk for all kinds of injuries
Authors: Lim Zhu Wei , Wang I-Duo , Liu Feng-Cheng , Chung Chi-Hsiang , Hu Je-Ming , Tsai Pei-Yi , Chien Wu-Chien
Published: March 2021

Non-apnea sleep disorder (NASD) increases the risk of motor vehicle accidents. However, systemic review of NASD and its risk for all causes of injury is lacking. The aim of the present study was to provide a detailed demographic data on NASD and all causes of injury in a 14-year follow up.

Our study utilized outpatient and inpatient data from the Longitudinal Health Insurance Database between 2000 and 2013 in Taiwan. We enrolled 989,753 individuals aged ≥20 years who were diagnosed with NASD as outpatients ≥3 times or inpatients ≥1 time. We matched the study cohort with a comparison cohort by age, index date and comorbidities at a ratio of 1:4. We used Cox proportional hazards regression to analyze the association of NASD and the cause of injury.

In this 14-year follow up study, patients with NASD had 12.96% increased risk of injury compared to that of the control cohort. Fall was the first place of the cause of injury with 670.26 per 105 PYs. In the stratified age group, patients aged ≧65 years had the highest risk of injury (adjusted HR= 1.381; P < .001). Kaplan–Meier analysis showed that the incidence of injury between the with- and without-NASD cohorts started from the first year and persisted until the end of the follow-up.

Our study demonstrates that NASD patients were associated with higher risk of all causes of injuries, with falling being the most prevalent diagnosis. The general public should be more aware of this neglected issue of NASD.
Co-occurrence of TCF3-PBX1 gene fusion, and chromosomal aberration in a pediatric pre-B cell acute lymphoblastic leukemia with clitoris swelling
Authors: He Guo-qian , Guo Xia , Jiang Ming-yan , Xu Rong-rong , Dai Yi-ling , Luo Lili , Gao Ju
Published: March 2021

Rationale:

Clitoris swelling as the initial clinical presentation of acute lymphoblastic leukemia (ALL) is extremely rare. These patients may be misdiagnosed with acute myeloid leukemia or solid tumor, and the main treatment can also be delayed.

Patient concerns:

A 2.10-year-old girl was referred to the pediatric surgery clinic with a worsening onset of clitoris swellings. The patient was afebrile and well appearing. Multiple retroperitoneal mass were confirmed by computed tomography (CT) and high serum neuron-specific enolase level was high. She was scheduled for an abdominal biopsy from the retroperitoneal mass suspicious of neuroblastoma.

Diagnoses:

The child was eventually diagnosed as having precursor B cell ALL with central nervous system involved, with TCF3-PBX1 fusion gene and additional chromosomal aberrations, based on examinations of the bone marrow and brain magnetic resonance imaging.

Interventions:

Before the diagnosis of leukemia, the patient was given symptomatic treatment for 1 week. She was treated with chemotherapy in accordance with the Chinese Children's Cancer Group protocol 2015 after confirmed diagnosis.

Outcomes:

After induction chemotherapy for ALL, although the girl had transiently clinical remission, the bone marrow aspirate indicated a poor outcome. Our patient discontinued treatment and discharged. From literature review, there was only 1 case of in acute myeloid leukemia with clitoris swelling as the initial symptom.

Lessons:

The clinical symptoms of ALL with clitoris swelling are not typical, with a high rate of misdiagnosis. When the cause of clitoris swelling is unknown, ALL should be considered. Bone marrow aspiration must be done before doing a more invasive investigation like biopsy.
Postoperative recovery of patients with differential requirements for sevoflurane after abdominal surgery
Authors: Li Jia , Wei Yi Yong , Zhang Dong Hang
Published: March 2021

An association between animals and volatile anaesthetic requirements has been shown; however, evidence related to the postoperative outcome of human patients is lacking. Our aim was to investigate whether there is a difference in the requirement for sevoflurane among people undergoing gastrointestinal surgery.

We observed 390 adult patients who underwent gastrointestinal surgery with an American Society of Anesthesiologists physical status of I or II with an expected surgery duration of > 2 hours. We used the bispectral index (BIS) to guide the regulation of end-tidal sevoflurane concentration (ETsevo). The mean ETsevo from 20 minutes after endotracheal intubation to 2 hours after the start of surgery was calculated for all patients. Differential sevoflurane requirements were identified according to ETsevo. The BIS, ETsevo, heart rate, mean arterial pressure, dose of sufentanil and cisatracurium, tracheal extubation time, incidence of intraoperative awareness, and incidence of postoperative nausea and vomiting were compared between patients with a low requirement for sevoflurane (group L) and patients with a high requirement for sevoflurane (group H).

The mean ETsevo of the 390 patients was 1.55% ± 0.26%. Based on our definition, patients with an ETsevo of < 1.29% were allocated to the low requirement group (group L; n = 69), while patients with an ETsevo of > 1.81% were allocated to the high requirement group (group H; n = 78). The ETsevo of group L was significantly lower than the ETsevo of group H (1.29% ± 0.014% vs 1.82% ± 0.017%, P < .001). There was no significant difference in the ETsevo, BIS, heart rate, mean arterial pressure, dose of sufentanil and cisatracurium, tracheal extubation time, incidence of intraoperative awareness, and incidence of postoperative nausea and vomiting. The tracheal extubation time in the L group was significantly shorter than that in the H group. No intraoperative awareness occurred.

There was a significant difference in the requirement for sevoflurane in adult patients. The tracheal extubation time in group L was significantly shorter than that in group H.
Efficacy of acupuncture for persistent and intractable hiccups
Authors: Zhang Yu , Jiang Xudong , Wang Zhijie , He Mingming , Lv Zimeng , Yuan Qing , Qin Weixun
Published: March 2021

Background:

Persistent and intractable hiccups are a common clinical symptom that cause considerable physical pain to patients and severely damage their quality of lives. An increasing number of studies have demonstrated that acupuncture applied at acupoints dominated by Cuanzhu (BL2) can be used as one of the nonpharmacological therapies for controlling intractable hiccups. However, there is insufficient evidence evaluating the safety and effectiveness of those interventions. Therefore, this study is intended to conduct a systematic review and meta-analysis to provide evidence for a further study investigating alternative treatment options for persistent and intractable hiccups.

Methods and Analysis:

Randomized controlled trials (RCTs) of adult patients aged >18 years who meet the criteria for intractable hiccup diagnosis will be included, regardless of gender, nationality, and education level. Eight electronic databases will be searched, including 4 Chinese databases (CNKI, SinoMed, Wanfang Database, and Chinese Scientific Journal Database), 4 English databases (Web of Science, Medline, Embase, and Cochrane Library), from their date of establishment to September 2020. Two independent reviewers will evaluate the title summary for each RCT. Disagreements will be discussed with a third commentator. Data integration, heterogeneity analysis, subgroup analysis, and sensitivity analysis, will be performed using R-3.3.2 software. The RevMan 5.3 software will be used for the meta-analysis, and the “risk of bias” assessment will be conducted based on the methodological quality of the included trials recommended by the Cochrane Handbook 5.1. The quality evaluation of this study will be completed by the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE).

Results:

This study will summarize all the selected trials aimed at estimating the effectiveness, as well as safety, of applying acupuncture at acupoints dominated by Cuanzhu (BL2) to persistent and intractable hiccups.

Conclusions:

This systematic review will provide evidence to assess the validity and safety of applying acupuncture at acupoints dominated by Cuanzhu (BL2) for persistent and intractable hiccups, which may provide clinicians with more choices in the treatment of this disease.

PROSPERO registration number:

CRD42020114900.
BRAF V600E mutation as a novel mechanism of acquired resistance to ALK inhibition in ALK-rearranged lung adenocarcinoma
Authors: Sui Aixia , Song Huiling , Li Yitong , Guo Litao , Wang Kai , Yuan Mingming , Chen Rongrong
Published: March 2021

Rationale:

Patients with lung adenocarcinoma harboring EML4-ALK rearrangements respond well to multiple ALK tyrosine kinase inhibitors (TKIs). However, the tumor will invariably progress due to acquired resistance. Comprehensive genomic profiling appears to be a promising strategy to reveal the underlying molecular mechanisms of ALK-TKIs resistance.

Patient concerns:

A patient with right lung adenocarcinoma harboring an ALK rearrangement received targeted therapy with multiple ALK-TKIs. He sought for follow-up treatment after his disease progressed again.

Diagnosis:

The patient had a tumor diagnosed with stage I (T1bN0M0) lung adenocarcinoma.

Interventions:

Due to the surgical contraindication, the patient did not undergo surgical resection. Instead, he received crizotinib as the first-line therapy with the progression-free survival of 20 months. Then he switched to alectinib treatment, however the disease rapidly progressed again.

Outcomes:

Next-generation sequencing was performed and revealed that 7 somatic mutations were identified. Among them, 2 mutations, ALK I1171T and BRAF V600E, may be responsible for the resistance of this patient to ALK-TKIs. BRAF V600E mutation may explain the patient's resistance to lorlatinib.

Lessons:

We present a case of ALK-rearranged lung adenocarcinoma with acquired resistance to ALK inhibition, in which the BRAF V600E mutation is a novel resistance mechanism. This provides evidence that BRAF V600E mutation is one mechanism of ALK-TKI resistance.
Exercise interventions for post-stroke depression
Authors: Zhang Wei , Liu Yi , Yu Jing , Zhang Qin , Wang Xiaoyan , Zhang Yongqing , Gao Yongli , Ye Lei
Published: March 2021

Background:

Post-stroke depression (PSD) is one of the most common neuropsychiatric complications after stroke and is associated with increased risk of death and poor functional outcomes. Strong evidence shows that exercise has benefits for depression. However, it is not clear whether exercise has benefits specifically for PSD. This study aims to explore the effects of exercise on PSD and to establish safe and effective exercise prescriptions.

Methods and analysis:

The PubMed, Cochrane Library and EMBASE, databases will be searched using prespecified search strategies. Randomized controlled trials and non-randomized prospective controlled cohort studies regarding exercise for PSD will be included. The primary outcomes are depression scale and stroke outcome. The secondary outcomes are the occurrence of adverse events, cognitive function, quality of life indices, and the expression of nerve cell factors. The methodological quality of each study will be evaluated by the physiotherapy evidence database scale. The heterogeneity will be evaluated using the I
2 test. If I
2 > 50%, random effects models will be used in the analysis; otherwise, fixed effects models will be used to pool the data.

Results:

This study will assess the efficacy and safety of exercise for PSD.

Conclusions:

Our findings will be helpful for clinicians to re-examine the clinical decision-making in the treatment of PSD, by assessing the efficacy of a promising treatment modality for patients with PSD.

Ethics and dissemination:

Ethical approval is not required because this study is a secondary analysis. The results of this study will be disseminated through journals and academic exchanges.

Systematic review registration number:

INPLASY202110100.
Causes of Renal Allograft Injury in Recipients With Normal Donor-derived Cell-free DNA
Authors: Xie Wen Yan , Kim Kevin , Goussous Naeem , Drachenberg Cinthia B. , Scalea Joseph R. , Weir Matthew R. , Bromberg Jonathan S.
Published: March 2021

Background.

Donor-derived cell-free DNA (dd-cfDNA) is a noninvasive biomarker for the early detection of organ transplant rejection and other causes of graft injury. For nonrejection renal injuries, there is little information about the performance characteristics of this biomarker. We highlight some of the possible causes of kidney injury that may arise in patients with normal dd-cfDNA levels.

Methods.

We performed a retrospective analysis of solitary renal transplant cases between January 2017 and November 2019. Those who had an abnormal laboratory or pathological finding within 1 mo of a normal dd-cfDNA test were selected. Subgroups were stratified for those who had normal or abnormal/rising serum creatinine, and differences between the groups were analyzed.

Results.

Of 414 individuals who received a kidney transplant, 24 (7.5%) had a total of 41 normal dd-cfDNA values and 51 abnormal laboratory tests or histologic findings. The most common graft-injuring event was BK virus viremia (24 of 51). Other abnormal findings included urinary traction infections (n = 4), CMV viremia (n = 4), and biopsies demonstrating antibody-mediated rejection (AMR) (n = 2), T cell–mediated rejection (n = 1), focal segmental glomerulosclerosis (n = 2), nondonor-specific antibody chronic AMR (n = 1), and interstitial fibrosis and tubular atrophy (n = 7). Subgroup analysis of those with normal dd-cfDNA and normal/stable versus abnormal/rising creatinine showed that BK virus viremia was the most common abnormal finding in both groups at 53% and 38% respectively. On biopsy, 1 case of acute T cell–mediated rejection (1B and 2B) was seen with normal/stable creatinine, whereas 1 of nonspecific C4d focally positive and 1 of nondonor-specific antibody AMR were seen with abnormal/rising creatinine.

Conclusions.

Low levels of serum dd-cfDNA do not preclude detection of active graft-injuring events and that subclinical injuries may be developing. Context is important in the interpretation of dd-cfDNA, so renal biopsy remains a part of the diagnostic pathway for allograft dysfunction and maintenance of allograft health.
Comparing Vaccination Strategies in Canada Under Different Assumptions
Authors: Ruse Timothy
Published: March 2021

This paper estimates the outcomes of two different COVID-19 vaccination strategies in Canada for the mRNA vaccines currently approved for Emergency Use Authorization (EUA), modelled on the vaccination and effectiveness of the Pfizer vaccine which is likely to be more widely administered in Canada. The first strategy is the manufacturer recommended standard of two doses (two-dose strategy) given within 21 days apart versus a strategy of giving a larger group a single dose of vaccine (first-dose-for-most strategy) by delaying the second injection.

Three parameters are varied in the course of 36 estimation scenarios of the population-level effects of the two vaccination strategies. The first is the effectiveness of a single dose of vaccine at preventing disease, the second is the effectiveness of the vaccine at preventing transmission of the virus, and the third is the rate of transmission of the virus during the course of the simulations.

Over the course of the different scenarios, the first-dose-for-most strategy was superior in reducing disease transmission in all scenarios where vaccination is assumed to have an effect on viral transmission. The results for fatalities was mixed, with the first-dose-for-most strategy being superior in cases where a higher first-dose effectiveness at preventing disease was assumed.

Finally, in the best-guess scenarios where a 75% reduction in disease transmission and a 92.6% effectiveness at preventing disease from a single dose were used, the first-dose-for-most strategy was superior in a situation with reduced vaccine doses available, and switching to the first-dose-for-most strategy earlier helped to prevent a higher proportion of cases and deaths.
Self-reported symptoms, self-reported viral testing result and seroprevalence of SARS CoV-2 among a community sample in Essex County New Jersey: A brief report
Authors: Raymond Henry F. , Datta Pratik , Ukey Rahul , Wang Peng , Martino Richard J. , Krause Kristen D. , Rosmarin-DeStefano Corey , Pinter Abraham , Halkitis Perry N. , Gennaro Maria L.
Published: March 2021

Background

SARS-CoV-2, the virus that causes COVID-19, has rapidly spread globally beginning in late 2019. Early areas impacted by this pandemic in the US include Essex County, New Jersey. Beyond understanding the prevalence of active infections and deaths, it is important to understand the true burden of infection in the community, as indicated by seroprevalence of antibodies directed to the virus. Understanding the spectrum of disease is key to the effectiveness of primary prevention and control measures and the design of interventions against transmission of infection.

Methods

We utilized venue-based-sampling (VBS), implemented by a community partner, to sample members of the community in Essex County. In VBS the venues are randomized as a proxy for randomizing the attendees of the venues. We asked standard demographic questions, questions about symptoms and PCR testing and previous antibody testing. Participants provide a blood sample collected by finger stick with the Neoteryx Mitra Collection device. Samples were tested using a novel ELISA based approached developed by our team.

Results

From September 15, 2020 to December 22, 2020, we conducted 92 randomly selected sampling events where we approached 1349 individuals for screening. Of these, 924 consented and had complete data for analysis. Only 6.5% of the sample reported any COVID-19 like symptoms while 45.9% had sought out a COVID-19 test. In total 13 (1.4%) participants received a positive SARS-CoV-2 PCR test result. While 33 participants (2.6%) sought a SARS-CoV-2 antibody test, only 0.5% of the sample reported a positive antibody result. Testing in this study identified 83 (9.0%) participants positive for SARS-CoV-2 antibodies.

Conclusion

We recruited a large sample of the population of Essex County, New Jersey using VBS, electronic surveys, novel sample collection and lab methods. Our findings suggest that the burden of SARS-Cov-2 is slightly more than six times than that suggested by PCR testing. This burden is higher than most estimates obtained through studies of remnant blood samples from hospitals (4.2%), samples from staff at a public-school system (2.9%), and residents of a California county recruited with targeted Facebook ads (1.5%). (9-11) Moreover, with only 6.5% of the sample reporting any COVID-19-like symptoms, our finding suggests that the number of asymptomatic persons may be close to 1.5 times greater than anyone reporting symptoms.
Stem canker caused byPhomopsis spp. induces changes in polyamine levels and chlorophyll fluorescence parameters in pecan leaves
Authors: Mantz Guillermo Martin , Rossi Franco Ruben , Viretto Pablo Esteban , Noelting María Cristina , Maiale Santiago Javier
Published: March 2021

Pecan plants are attacked by the fungusPhomopsis spp.that causes stem canker, a serious and emerging disease in commercial orchards. Stem canker, which has been reported in several countries, negatively affects tree canopy health, eventually leading to production losses. The purpose of this study was to inquire into the physiology of pecan plants under stem canker attack byPhomopsis spp. To this end, pecan plants were inoculated with an isolate ofPhomopsis spp.and several parameters, such as polyamines, proline, sugars, starch, chlorophyll fluorescence and canopy temperature were analysed. Under artificial inoculation, a high disease incidence was observed with symptoms similar to those in plants showing stem canker under field conditions. Furthermore, the infected stem showed dead tissue with brown necrotic discolouration in the xylem tissue. The free polyamines putrescine, spermidine, and spermine were detected and their levels decreased as leaves aged in the infected plants with respect to the controls. Chlorophyll fluorescence parameters, such as Sm, ψEO, and QbRC decreased under plant infection and therefore the K-band increased. Canopy temperature and proline content increased in the infected plants with respect to the controls while sugar content decreased. These data suggest that stem canker caused byPhomopsis spp.induces physiological changes that are similar to those observed in plants under drought stress. To our knowledge, this is the first study that documents the physiological and biochemical effects derived from pecan-Phomopsisinteraction.