bluuebunny/crossref_metadata_2025 huggingface dataset:
Epidemiology of pediatric uveitis and associated systemic diseases
Authors: Shin Yoonkyeom , Kang Ji-Man , Lee Junwon , Lee Christopher Seungkyu , Lee Sung Chul , Ahn Jong Gyun
Published: April 2021

Background

The early detection of uveitis associated with systemic inflammatory disease in children is important for proper treatment and prognosis. However, the diagnosis may be delayed because of difficulties in childhood examinations and early minor systemic symptoms. The objective of our study was to identify the pattern of childhood uveitis and investigate the frequency and clinical features of rheumatic diseases in pediatric patients with uveitis.

Methods

This retrospective observational study reviewed the medical records of children (age ≤ 18 years) with uveitis at a Korean tertiary hospital between January 2005 and December 2018. Data collected included the age at onset of uveitis, sex, anatomic location of ocular inflammation, comorbid disease (including systemic inflammatory disease), ocular complications, relevant laboratory data, and treatment. Fisher’s exact test was used to compare categorical variables and the Mann–Whitney U test was used to compare continuous variables. Ap-value of < 0.05 was considered statistically significant.

Results

A total of 155 pediatric patients with uveitis were included in this study. The median age at diagnosis was 13.0 years (interquartile range, 9.5–16.0 years). The male-to-female ratio was 1.09. The process was unilateral in 51.6% of children. Anterior uveitis, panuveitis, intermediate uveitis, and posterior uveitis represented 51.6, 26.5, 6.5, and 1.9% of the cases, respectively. Idiopathic uveitis (65.2%) was the most frequent type of uveitis. Systemic rheumatic disease associations were responsible for 28.4% of the cases, among which juvenile idiopathic arthritis (JIA) was the most frequent cause (14.8%). Human leukocyte antigen (HLA)-B27 and antinuclear antibody (ANA) positive rates were significantly higher in patients with JIA than in those with idiopathic uveitis (p = 0.006 andp = 0.007, respectively).

Conclusions

Approximately one-third of children with uveitis in Korea have a systemic rheumatic disease, of which JIA accounts for the majority of cases. HLA-B27 and ANA can serve as risk factors for JIA-associated uveitis.
'Does HPV affect my fertility?' Reproductive concerns of HPV-positive women: a qualitative study
Authors: Qaderi Kowsar , Mirmolaei Seyedeh Tahereh , Geranmayeh Mehrnaz , Farnam Farnaz , Sheikh Hasani Shahrzad
Published: April 2021

Background

Reproductive health changes can occur following infection with Human papillomavirus. HPV is the most prevalent sexually transmitted infection causing a variety of clinical manifestations ranging from warts to cancer. This study aimed to explore the reproductive concerns of women infected with HPV.

Methods

In this qualitative study, we used the conventional content analysis approach, with the aid of MAXQDA.10 software, to analyze data extracted from the face-to-face semi-structured interviews with 20 Iranian HPV-positive women (sampled by maximum variation purposive sampling). The accuracy of this research was ensured according to the four criteria proposed by Guba and Lincoln.

Results

Exploring participants' reproductive concerns, three main categories were identified from the interviews including concerns about fertility potential, pregnancy and non-pregnancy reproductive issues. HPV-positive women concerned about reduced female/ male fertility due to HPV, the impact of the HPV on the fetal health, adverse pregnancy outcomes such as miscarriage and preterm delivery, and mother-to-child transmission of HPV during breastfeeding. HPV-positive women with abnormal cytology results were anxious that becoming pregnant or taking hormonal contraception might worsen their abnormalities. Most married women were reluctant to use a condom. Participants requested further information about the potential reproductive risks of the HPV vaccine. They also wanted to know about the safety of HPV vaccine during pregnancy and breastfeeding.

Conclusions

HPV-positive women had some reproductive concerns that should be considered in the designing of educational-consulting interventions. Women need to be better understood and informed about the impact of HPV on their reproductive health. Health care providers may lack knowledge about these specific areas, and they could benefit from additional up-to-date information to address women's reproductive concerns.
Use of fertility awareness methods as a component of safer conception for women in HIV-serodifferent relationships in Kenya
Authors: Zia Yasaman , Velloza Jennifer , Oluoch Lynda , Momanyi Richard , Mbugua Sarah , Njoroge John , Gakuo Stephen , Mugo Edwin , Thuo Nicholas , Kiptinness Catherine , Njuguna Njambi , Ngure Kenneth , R. Mugo Nelly , Heffron Renee
Published: April 2021

Background

For couples affected by HIV, and serodifferent couples in particular, pregnancy desire is often juxtaposed against the risk of HIV transmission between the couple and the potential neonate leading to thinking about measures to minimize risk of HIV transmission. We assess the use of fertility awareness methods [FAM] and evaluate the drivers of alignment between indicators of fertility and sexual behavior among HIV-serodifferent couples desiring pregnancy.

Methods

HIV-serodifferent couples from Thika, Kenya were enrolled into an open-label pilot evaluation of safer conception strategies. Women responded to daily 7-item short message service [SMS] surveys on FAM and sexual activity. Menstrual cycles were categorized as having condomless sex aligned, not aligned, or partially aligned to the predicted peak fertility. We used binomial logit models with generalized estimating equations to assess alignment between condomless sex during peak fertility days and FAM results. We used Cox proportional hazards to compare pregnancy incidence among months with sex and peak fertility aligned and mis-aligned.

Results

A total of 6929 SMS surveys across 252 menstrual cycles of 65 women were included. Reporting “sticky” cervical mucus (adjusted odds ratio [aOR]: 2.25, 95% confidence interval [95% CI]: 1.30, 3.90) and positive ovulation prediction kit [OPK] result (aOR: 2.07, 95% CI: 1.11, 3.86) were associated with increased likelihood of alignment of condomless sex during peak fertility. Pregnancy incidence was statistically similar among periods with sex aligned and not aligned with peak fertility.

Conclusions

Among women engaged in a comprehensive safer conception program, a moderate percentage of women aligned condomless sex and predicted peak fertility days at least once. While FAM, particularly cervical mucus and OPK, are an inexpensive option for couples to consider using as a component of their safer conception strategies, antiretroviral-based strategies remain important to minimize risk.
Practical strategies for handling breakdown of multiple imputation procedures
Authors: Nguyen Cattram D. , Carlin John B. , Lee Katherine J.
Published: April 2021

Multiple imputation is a recommended method for handling incomplete data problems. One of the barriers to its successful use is the breakdown of the multiple imputation procedure, often due to numerical problems with the algorithms used within the imputation process. These problems frequently occur when imputation models contain large numbers of variables, especially with the popular approach of multivariate imputation by chained equations. This paper describes common causes of failure of the imputation procedure including perfect prediction and collinearity, focusing on issues when using Stata software. We outline a number of strategies for addressing these issues, including imputation of composite variables instead of individual components, introducing prior information and changing the form of the imputation model. These strategies are illustrated using a case study based on data from the Longitudinal Study of Australian Children.
Mitochondrial alternative oxidase contributes to successful tardigrade anhydrobiosis
Authors: Wojciechowska Daria , Karachitos Andonis , Roszkowska Milena , Rzeźniczak Wiktor , Sobkowiak Robert , Kaczmarek Łukasz , Kosicki Jakub Z. , Kmita Hanna
Published: April 2021

Anhydrobiosis can be described as an adaptation to lack of water that enables some organisms, including tardigrades, to survive extreme conditions, even some that do not exist on Earth. The cellular mechanisms underlying anhydrobiosis are still not completely explained including the putative contribution of mitochondrial proteins. Since mitochondrial alternative oxidase (AOX), described as a drought response element in plants, was recently proposed for various invertebrates including tardigrades, we investigated whether AOX is involved in successful anhydrobiosis of tardigrades. Milnesium inceptum was used as a model for the study. We confirmed functionality of M. inceptum AOX and estimated its contribution to the tardigrade revival after anhydrobiosis of different durations. We observed that AOX activity was particularly important for M. inceptum revival after the long-term tun stage but did not affect the rehydration stage specifically. The results may contribute to our understanding and then application of anhydrobiosis underlying mechanisms.
The value of serum progesterone level on day of human chorionic gonadotrophin administration / metaphase II oocyte ratio in predicting IVF/ICSI outcome in patients with normal ovarian reserve
Authors: Mahran Ahmad , Khairy Mohammed , Elkhateeb Reham , Hegazy Abdel Rahman , Abdelmeged Ayman , Batiha Gaber El-Saber , Alsharif Khalaf F. , Hetta Helal F. , Bahaa Haitham Ahmed
Published: April 2021

Background

The clinical implication of the increased serum progesterone level on the day of HCG administration in assisted reproduction treatment (ART) is still controversial. The current study aimed to compare the predictive value of serum progesterone on day of HCG administration / metaphase II oocyte (P/MII) ratio on IVF/ ICSI outcome to serum progesterone (P) level alone and the ratio of serum progesterone/estradiol level (P/E2) ratio in prediction of pregnancy rates after ART.

Material & methods

Two hundred patients admitted to the IVF/ICSI program at Minia IVF center in Egypt in the period from October 2016 to May 2018 were included in this study. Serum Progesterone (P) and Estradiol (E2) levels were estimated on the day of HCG administration. The ratio between serum P and the number of MII oocytes (P/MII ratio) was calculated and the predictive values of the three parameters (P, P/E2 ratio and P/MII ratio) in prediction of cycle outcomes were measured.

Results

P/ MII oocyte ratio was significantly lower in patients who attained clinical pregnancy (n = 97) as compared with those who couldn’t whilst there was no significant difference in P and P/E2 ratio between the two groups. Using a cut off value of 0.125, the sensitivity and specificity of progesterone/ MII ratio in prediction of no pregnancy in IVF/ICSI were 75.7 and 77.1% respectively with the area under The Receiver operating curve (ROC-AUC) = 0.808. The respective values of the ROC-AUC for the P and P/E2 ratio were 0.651 and 0.712 with sensitivity and specificity of 71.2 and 73.5%for P level and of 72.5 and 75.3% for P/E2 ratio. Implantation or clinical pregnancy rates were significantly different between patients with high and low P/MII ratio irrespective of day of embryo transfer (day 3 or 5).

Conclusions

In patients with normal ovarian response, serum progesterone on day of HCG / MII oocyte ratio can be a useful predictor of pregnancy outcomes and in deciding on freezing of all embryos for later transfer instead of high progesterone level alone.
A clinical and cost-effectiveness trial of a parent group intervention to manage challenging restricted and repetitive behaviours in young children with autism spectrum disorder: study protocol for a randomised controlled trial
Authors: Grahame Victoria , Dixon Linda , Fletcher-Watson Sue , Garland Deborah , Glod Magdalena , Goodwin Jane , Grayson Zoe , Heron Saoirse , Honey Emma , Iversen Rebecca , Kasim Adetayo S. , Kernohan Ashleigh , Kharatikoopaei Ehsan , Le Couteur Ann , Mackie Leila , Mathias Ayesha , Probert Helen , Riby Deborah , Rob Priyanka , Rogan Leanne , Thompson Sarah , Vale Luke , Walls Eamonn , Webb Elspeth Imogen , Weetman Christopher , Wolstenhulme Faye , Wood Ruth , Rodgers Jacqui
Published: April 2021

Background

Restricted and repetitive behaviours vary greatly across the autism spectrum, and although not all are problematic some can cause distress and interfere with learning and social opportunities. We have, alongside parents, developed a parent group based intervention for families of young children with autism, which aims to offer support to parents and carers; helping them to recognise, understand and learn how to respond to their child’s challenging restricted repetitive behaviours.

Methods

The study is a clinical and cost-effectiveness, multi-site randomised controlled trial of the Managing Repetitive Behaviours (MRB) parent group intervention versus a psychoeducation parent group Learning About Autism (LAA) (n = 250; 125 intervention/125 psychoeducation; ~ 83/site) for parents of young children aged 3–9 years 11 months with a diagnosis of autism.

All analyses will be done under intention-to-treat principle. The primary outcome at 24 weeks will use generalised estimating equation (GEE) to compare proportion of children with improved RRB between the MRB group and the LAA group. The GEE model will account for the clustering of children by parent groups using exchangeable working correlation. All secondary outcomes will be analysed in a similar way using appropriate distribution and link function.

The economic evaluation will be conducted from the perspective of both NHS costs and family access to local community services. A ‘within trial’ cost-effectiveness analysis with results reported as the incremental cost per additional child achieving at least the target improvement in CGI-I scale at 24 weeks.

Discussion

This is an efficacy trial to investigate the clinical and cost-effectiveness of a parent group based intervention designed to help parents understand and manage their child’s challenging RRB. If found to be effective, this intervention has the potential to improve the well-being of children and their families, reduce parental stress, greatly enhance community participation and potential for learning, and improve longer-term outcomes.

Trial registration

Trial ID: ISRCTN15550611 Date registered: 07/08/2018. Sponsor and Monitor: Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust R&D Manager Lyndsey Dixon, Address: St Nicholas Hospital, Jubliee Road, Gosforth, Newcastle upon Tyne NE3 3XT, lyndsey.dixon@cntw.nhs.uk, Tel: 0191 246 7222
Tactile cortical responses and association with tactile reactivity in young children on the autism spectrum
Authors: Espenhahn Svenja , Godfrey Kate J. , Kaur Sakshi , Ross Maia , Nath Niloy , Dmitrieva Olesya , McMorris Carly , Cortese Filomeno , Wright Charlene , Murias Kara , Dewey Deborah , Protzner Andrea B. , McCrimmon Adam , Bray Signe , Harris Ashley D.
Published: April 2021

Background

Unusual behavioral reactions to sensory stimuli are frequently reported in individuals on the autism spectrum (AS). Despite the early emergence of sensory features (< age 3) and their potential impact on development and quality of life, little is known about the neural mechanisms underlying sensory reactivity in early childhood autism.

Methods

Here, we used electroencephalography (EEG) to investigate tactile cortical processing in young children aged 3–6 years with autism and in neurotypical (NT) children. Scalp EEG was recorded from 33 children with autism, including those with low cognitive and/or verbal abilities, and 45 age- and sex-matched NT children during passive tactile fingertip stimulation. We compared properties of early and later somatosensory-evoked potentials (SEPs) and their adaptation with repetitive stimulation between autistic and NT children and assessed whether these neural measures are linked to “real-world” parent-reported tactile reactivity.

Results

As expected, we found elevated tactile reactivity in children on the autism spectrum. Our findings indicated no differences in amplitude or latency of early and mid-latency somatosensory-evoked potentials (P50, N80, P100), nor adaptation between autistic and NT children. However, latency of later processing of tactile information (N140) was shorter in young children with autism compared to NT children, suggesting faster processing speed in young autistic children. Further, correlational analyses and exploratory analyses using tactile reactivity as a grouping variable found that enhanced early neural responses were associated with greater tactile reactivity in autism.

Limitations

The relatively small sample size and the inclusion of a broad range of autistic children (e.g., with low cognitive and/or verbal abilities) may have limited our power to detect subtle group differences and associations. Hence, replications are needed to verify these results.

Conclusions

Our findings suggest that electrophysiological somatosensory cortex processing measures may be indices of “real-world” tactile reactivity in early childhood autism. Together, these findings advance our understanding of the neurophysiological mechanisms underlying tactile reactivity in early childhood autism and, in the clinical context, may have therapeutic implications.
Sodium alginate-bioglass-encapsulated hAECs restore ovarian function in premature ovarian failure by stimulating angiogenic factor secretion
Authors: Huang Yating , Ma Zhijie , Kuang Xiaojun , Zhang Qiuwan , Li Haiyan , Lai Dongmei
Published: April 2021

Background

Human amniotic epithelial cells (hAECs) exhibit a strong capability to restore ovarian function in chemotherapy-induced premature ovarian failure (POF). However, the therapeutic efficacy of hAECs is usually affected by the limited number and proliferative ability of grafted hAECs in target organs. The transplantation of stem cells encapsulated in sodium alginate-bioglass (SA-BG) composite hydrogel has recently been shown to be an effective strategy for tissue regeneration. The current study aims to investigate the therapeutic potential of hAECs or hAEC-derived conditioned medium (CM) encapsulated in SA-BG in mice with chemotherapy-induced POF.

Methods

C57BL/6 mice were intraperitoneally injected with chemotherapy drugs to induce POF. hAECs or CM were harvested and encapsulated in SA-BG composite hydrogel, which were transplanted onto the injured ovaries of mice with POF. Follicle development, granulosa cell function, and ovarian angiogenesis were evaluated by morphological methods. To further elucidate the effect of SA-BG-encapsulated hAECs/CM on vascularization, the tube formation of human umbilical vein epithelial cells (hUVECs) was conducted in vitro. Cytokine array and ELISA were used to analyze and quantify the effects of bioactive components released by SA-BG on the secretion of angiogenic factors by hAECs.

Results

The transplantation of SA-BG-encapsulated hAECs/CM restored follicle development, repaired granulosa cell function, and enhanced ovarian angiogenesis in POF mice. The further study showed that SA-BG significantly promoted the tube formation of hUVECs in vitro. Moreover, encapsulating hAECs could facilitate the effect of SA-BG on inducing the formation of the capillary tube in a paracrine manner. In addition, we found that SA-BG extracts significantly enhanced the viability of hAECs and stimulated the secretion of pro-angiogenic factors of hAECs. Notably, compared with SA-BG/CM, SA-BG/hAECs achieve better therapeutic effects, possibly because stimulation of BG enhanced the viability and paracrine capacity of hAECs.

Conclusions

The present study initially demonstrates that SA-BG-encapsulated hAECs or CM can exert a therapeutic effect on chemotherapy-induced POF mainly by protecting granulosa cell function and enhancing ovarian vascularization, which might provide a novel strategy for the delivery of hAECs for treating POF.
Regulatory roles and mechanisms of alternative RNA splicing in adipogenesis and human metabolic health
Authors: Chao Yunqi , Jiang Yonghui , Zhong Mianling , Wei Kaiyan , Hu Chenxi , Qin Yifang , Zuo Yiming , Yang Lili , Shen Zheng , Zou Chaochun
Published: April 2021

Alternative splicing (AS) regulates gene expression patterns at the post-transcriptional level and generates a striking expansion of coding capacities of genomes and cellular protein diversity. RNA splicing could undergo modulation and close interaction with genetic and epigenetic machinery. Notably, during the adipogenesis processes of white, brown and beige adipocytes, AS tightly interplays with the differentiation gene program networks. Here, we integrate the available findings on specific splicing events and distinct functions of different splicing regulators as examples to highlight the directive biological contribution of AS mechanism in adipogenesis and adipocyte biology. Furthermore, accumulating evidence has suggested that mutations and/or altered expression in splicing regulators and aberrant splicing alterations in the obesity-associated genes are often linked to humans’ diet-induced obesity and metabolic dysregulation phenotypes. Therefore, significant attempts have been finally made to overview novel detailed discussion on the prospects of splicing machinery with obesity and metabolic disorders to supply featured potential management mechanisms in clinical applicability for obesity treatment strategies.
Ambient backscatter communication-based smart 5G IoT network
Authors: Liu Qiang , Sun Songlin , Yuan Xueguang , Zhang Yang’an
Published: April 2021

In this paper, we propose an ambient backscatter communication-based smart 5G IoT network. The network consists of two parts, namely a real-time data transmission system based on ambient backscatter communication and a real-time big data analysis system based on the combination of shallow neural networks and deep neural networks. The real-time data transmission system based on ambient backscatter communication can extend the standby time of data collection equipment, reduce the size of the equipment, and increase the comfort of wearing. The real-time big data analysis system combining the shallow neural network and the deep neural network can greatly reduce the pressure caused by the frequent deep neural network calculations of the MEC and greatly reduce the energy consumed by the MEC for remote real-time monitoring.
Convergence analysis of a general inertial projection-type method for solving pseudomonotone equilibrium problems with applications
Authors: Rehman Habib ur , Kumam Poom , Gibali Aviv , Kumam Wiyada
Published: April 2021

In this paper, we introduce a new algorithm by incorporating an inertial term with a subgradient extragradient algorithm to solve the equilibrium problems involving a pseudomonotone and Lipschitz-type continuous bifunction in real Hilbert spaces. A weak convergence theorem is well established under certain mild conditions for the bifunction and the control parameters involved. Some of the applications to solve variational inequalities and fixed point problems are considered. Finally, several numerical experiments are performed to demonstrate the numerical efficacy and superiority of the proposed algorithm over other well-known existing algorithms.
A call for consistency with the terms ‘wetter’ and ‘drier’ in climate change studies
Authors: Roth Nina , Jaramillo Fernando , Wang-Erlandsson Lan , Zamora David , Palomino-Ángel Sebastián , Cousins Sara A. O.
Published: April 2021

Ongoing and future hydroclimatic changes have large environmental and societal impacts. In terrestrial ecosystems, these changes are usually described with the terms ‘wetter’ and ‘drier’, which refer to the change in the quantity and/or presence of water, either as water fluxes or stocks. We conducted a literature review of almost 500 recent climate change studies to quantitatively investigate the consistency of the use of these terms across disciplines, regarding the hydroclimatic variables they are related to. We found that although precipitation is prevalently used to describe ‘wetter’ and ‘drier’ conditions, many other variables are also used to refer to changes in water availability between research fields, pointing to a varied perspective on the use of these terms. Some studies do not define the terms at all. In order to facilitate meta-analyses across disciplines, we therefore highlight the need to explicitly state which hydroclimatic variables authors are referring to. In this way, we hope that the terms ‘wetter’ and ‘drier’ used in scientific studies are easier to relate to hydroclimatic processes, which should facilitate the application by authorities and policy makers.
Crustal architecture of a metallogenic belt and ophiolite belt: implications for mineral genesis and emplacement from 3-D electrical resistivity models (Bayankhongor area, Mongolia)
Authors: Comeau Matthew J. , Becken Michael , Kuvshinov Alexey V. , Demberel Sodnomsambuu
Published: April 2021

Crustal architecture strongly influences the development and emplacement of mineral zones. In this study, we image the crustal structure beneath a metallogenic belt and its surroundings in the Bayankhongor area of central Mongolia. In this region, an ophiolite belt marks the location of an ancient suture zone, which is presently associated with a reactivated fault system. Nearby, metamorphic and volcanic belts host important mineralization zones and constitute a significant metallogenic belt that includes sources of copper and gold. However, the crustal structure of these features, and their relationships, are poorly studied. We analyze magnetotelluric data acquired across this region and generate three-dimensional electrical resistivity models of the crustal structure, which is found to be locally highly heterogeneous. Because the upper crust (< 25 km) is found to be generally highly resistive (> 1000 Ωm), low-resistivity (< 50 Ωm) features are conspicuous. Anomalous low-resistivity zones are congruent with the suture zone, and ophiolite belt, which is revealed to be a major crustal-scale feature. Furthermore, broadening low-resistivity zones located down-dip from the suture zone suggest that the narrow deformation zone observed at the surface transforms to a wide area in the deeper crust. Other low-resistivity anomalies are spatially associated with the surface expressions of known mineralization zones; thus, their links to deeper crustal structures are imaged. Considering the available evidence, we determine that, in both cases, the low resistivity can be explained by hydrothermal alteration along fossil fluid pathways. This illustrates the pivotal role that crustal fluids play in diverse geological processes, and highlights their inherent link in a unified system, which has implications for models of mineral genesis and emplacement. The results demonstrate that the crustal architecture—including the major crustal boundary—acts as a first‐order control on the location of the metallogenic belt.
Magnesium sulfate intravenous infusion versus intrathecal injection for prevention of post-spinal shivering during lower limb fracture surgery: a randomized controlled study
Authors: Mohamed Sherif Abdullah , El Mekawy Nevan Mohamed , Abdelfattah Raed Mohamed , Elsonbaty Ahmed Ibrahim Abdelkhalik , Elsonbaty Mohamed Ibrahim Abdelkhalik
Published: April 2021

Background

Shivering is a prevalent adverse event after spinal anesthesia, often disturbing to medical staff and hazardous to patients. Intravenous magnesium sulfate [MgSO4] has been proven to be effective in prevention of post-spinal shivering. However, the risk of intravenous route to develop hypermagnesemia in certain patients encouraged us to do this study in order to investigate the effectiveness of intrathecal MgSO4as an alternative to the intravenous route in prevention of post-spinal shivering. The enrolled 135 patients were allocated to 3 groups, 45 patients each, groups: intrathecal [T], IV MgSO4infusion [M], and control [C]. Group T (no. = 45) received 50 mg MgSO4added to heavy bupivacaine 0.5% intrathecally, while group M (no. = 45) received IV MgSO4as 50 mg/kg in 100 cc saline within 20 min as a loading dose then infused as 2 mg/kg/h after performing spinal anesthesia. The vital signs, duration and shivering grades, temperature, and adverse effects were recorded.

Results

T and M groups showed a significant difference from control as regard the incidence of shivering with 40%, 26.7%, and 64.4% for T, M, and C groups, respectively, patients needed rescue pethidine were 17.7%, 11.1%, and 60% for group T, M, and C, respectively, and shivering duration (min) was 24.86 ± 7.411, 20.47 ± 6.61, and 45 ± 36.2 for groups T, M, and C, respectively with a statistically insignificant difference between group T and M as regards these parameters.

Conclusions

Intrathecal MgSO4has the potentiality to be used as an alternative to IV route regarding prevention of post-spinal shivering. This makes advantage for intrathecal magnesium use in patients at risk for magnesium toxicity.
Trialists perspectives on sustaining, spreading, and scaling-up of quality improvement interventions
Authors: Laur Celia , Corrado Ann Marie , Grimshaw Jeremy M. , Ivers Noah
Published: April 2021

Background

Quality improvement (QI) evaluations rarely consider how a successful intervention can be sustained long term, nor how to spread or scale to other locations. A survey of authors of randomized trials of diabetes QI interventions included in an ongoing systematic review found that 78% of trials reported improved quality of care, but 40% of these trials were not sustained. This study explores why and how the effective interventions were sustained, spread, or scaled.

Methods

A qualitative approach was used, focusing on case examples. Diabetes QI program trial authors were purposefully sampled and recruited for telephone interviews. Authors were eligible if they had completed the author survey, agreed to follow-up, and had a completed a diabetes QI trial they deemed “effective.” Snowball sampling was used if the participant identified someone who could provide a different perspective on the same trial. Interviews were transcribed verbatim. Inductive thematic analysis was conducted to identify barriers and facilitators to sustainability, spread, and/or scale of the QI program, using case examples to show trajectories across projects and people.

Results

Eleven of 44 eligible trialists participated in an interview. Four reported that the intervention was “sustained” and nine were “spread,” however, interviews highlighted that these terms were interpreted differently over time and between participants. Participant stories highlighted the varied trajectories of how projects evolved and how some research careers adapted to increase impact. Three interacting themes, termed the “3C’s,” helped explain the variation in sustainability, spread, and scale: (i) understanding theconceptsof implementation, sustainability, sustainment, spread, and scale; (ii) having the appropriatecompetencies; and (iii) the need for individual, organizational, and systemcapacity.

Conclusions

Challenges in defining sustainability, spread and scale make it difficult to fully understand impact. However, it is clear that from the beginning of intervention design, trialists need to understand the concepts and have the competency and capacity to plan for feasible and sustainable interventions that have potential to be sustained, spread and/or scaled if found to be effective.
Cystitis treatment with phytotherapy within the Rif, Northern Morocco
Authors: Chaachouay Noureddine , Orch Hicham , Zidane Lahcen
Published: April 2021

Background

Cystitis is often caused by a bacterial infection, which is the most widespread type among other urinary infections. This investigation was aimed to document detailed ethnobotanical information of medicinal plants used to heal cystitis problems because of their effective therapeutic properties. The study was carried in the Rif, from March 1, 2015, to April 15, 2017. Semi-structured direct interviews were carried with 657 interviewees to collect the indigenous therapeutic knowledge. Surveys included interviewed demographic profile and ethnomedicinal information. UR and MUV were applied in data analysis.

Results

A total of 60 plant species distributed in 51 genera and 31 families were commonly used by our interviewees in the therapy of cystitis. Apiaceae was designed by the highest number of species (7 species);Capparis spinosaL. was the medicinal plant most frequently prescribed by regional people. Leaves were the most commonly used plant part (41.5%), and the majority of herbal remedies were prepared from decoction (55 %).

Conclusions

This research is the first contribution to the ethnobotanical study of this region. It is suggested that the ingredients of natural plant species documented are being investigated to discover the therapeutic effects and mechanisms of action. Primary consideration must be paid to the preservation of medicinal species, comprehensive documentation of popular medicinal data, and biological validation of listed species.

Graphical abstract
Geophysics Bright Spots
Authors: Behura Jyoti
Published: April 2021

Welcome to the latest installment of Geophysics Bright Spots. There are a number of interesting articles in the latest issue of Geophysics. Here is a list of what piqued the editors' interests.
Seismic Soundoff
Authors: Geary Andrew
Published: April 2021

In this episode, Andrew Geary speaks with Kerry Key and Chloe Gustafson about their massive freshwater discovery off the east coast of the United States. Key and Gustafson discuss how they used existing geophysical techniques in a new way to discover the fresh water. Hear the full episode at https://seg.org/podcast/post/11355 .
Palbociclib for Residual High-Risk Invasive HR-Positive and HER2-Negative Early Breast Cancer—The Penelope-B Trial
Authors: Loibl Sibylle , Marmé Frederik , Martin Miguel , Untch Michael , Bonnefoi Hervé , Kim Sung-Bae , Bear Harry , McCarthy Nicole , Melé Olivé Mireia , Gelmon Karen , García-Sáenz José , Kelly Catherine M. , Reimer Toralf , Toi Masakazu , Rugo Hope S. , Denkert Carsten , Gnant Michael , Makris Andreas , Koehler Maria , Huang-Bartelett Cynthia , Lechuga Frean Maria Jose , Colleoni Marco , Werutsky Gustavo , Seiler Sabine , Burchardi Nicole , Nekljudova Valentina , von Minckwitz Gunter
Published: April 2021

PURPOSE

About one third of patients with hormone receptor–positive, human epidermal growth factor receptor 2–negative breast cancer who have residual invasive disease after neoadjuvant chemotherapy (NACT) will relapse. Thus, additional therapy is needed. Palbociclib is a cyclin-dependent kinase 4 and 6 inhibitor demonstrating efficacy in the metastatic setting.

PATIENTS AND METHODS

PENELOPE-B ( NCT01864746 ) is a double-blind, placebo‐controlled, phase III study in women with hormone receptor–positive, human epidermal growth factor receptor 2–negative primary breast cancer without a pathological complete response after taxane‐containing NACT and at high risk of relapse (clinical pathological staging-estrogen receptor grading score ≥ 3 or 2 and ypN+). Patients were randomly assigned (1:1) to receive 13 cycles of palbociclib 125 mg once daily or placebo on days 1-21 in a 28-day cycle in addition to endocrine therapy (ET). Primary end point is invasive disease-free survival (iDFS). Final analysis was planned after 290 iDFS events with a two-sided efficacy boundary P < .0463 because of two interim analyses.

RESULTS

One thousand two hundred fifty patients were randomly assigned. The median age was 49.0 years (range, 19-79), and the majority were ypN+ with Ki-67 ≤ 15%; 59.4% of patients had a clinical pathological staging-estrogen receptor grading score ≥ 3. 50.1% received aromatase inhibitor, and 33% of premenopausal women received a luteinizing hormone releasing hormone analog in addition to either tamoxifen or an aromatase inhibitor. After a median follow-up of 42.8 months (92% complete), 308 events were confirmed. Palbociclib did not improve iDFS versus placebo added to ET-stratified hazard ratio, 0.93 (95% repeated CI, 0.74 to 1.17) and two-sided weighted log-rank test (Cui, Hung, and Wang) P = .525. There was no difference among the subgroups. Most common related serious adverse events were infections and vascular disorders in 113 (9.1%) patients with no difference between the treatment arms. Eight fatal serious adverse events (two palbociclib and six placebo) were reported.

CONCLUSION

Palbociclib for 1 year in addition to ET did not improve iDFS in women with residual invasive disease after NACT.
Impact of Variant Reclassification in Cancer Predisposition Genes on Clinical Care
Authors: Chiang Jianbang , Chia Tze Hao , Yuen Jeanette , Shaw Tarryn , Li Shao-Tzu , Binte Ishak Nur Diana , Chew Ee Ling , Chong Siao Ting , Chan Sock Hoai , Ngeow Joanne
Published: April 2021

PURPOSE

Genetic testing has clinical utility in the management of patients with hereditary cancer syndromes. However, the increased likelihood of encountering a variant of uncertain significance in individuals of non-European descent such as Asians may be challenging to both clinicians and patients. This study aims to evaluate the impact of variant reclassification in an Asian country with variants of uncertain significance reported in cancer predisposition genes.

METHODS

A retrospective analysis of patients seen at the Cancer Genetics Service at the National Cancer Centre Singapore between February 2014 and March 2020 was conducted. The frequency, direction, and time to variant reclassification were evaluated by comparing the reclassified report against the original report.

RESULTS

A total of 1,412 variants of uncertain significance were reported in 49.9% (845 of 1,695) of patients. Over 6 years, 6.7% (94 of 1,412) of variants were reclassified. Most variants of uncertain significance (94.1%, 80 of 85) were downgraded to benign or likely benign variant, with a smaller proportion of variants of uncertain significance (5.9%, 5 of 85) upgraded to pathogenic or likely pathogenic variant. Actionable variants of uncertain significance upgrades and pathogenic or likely pathogenic variant downgrades, which resulted in management changes, happened in 31.0% (39 of 126) of patients. The median and mean time taken for reclassification were 1 and 1.62 year(s), respectively.

CONCLUSION

We propose a clinical guideline to standardize management of patients reported to have variants of uncertain significance. Management should be based on the patient’s personal history, family history, and variant interpretation. For clinically relevant or suspicious variants of uncertain significance, follow-up is recommended every 2 years, as actionable reclassifications may happen during this period.
Leftover Opioid Analgesics and Disposal Following Ambulatory Pediatric Surgeries in the Context of a Restrictive Opioid-Prescribing Policy
Authors: Stone Amanda L. , Qu’d Dima , Luckett Twila , Nelson Scott D. , Quinn Erin E. , Potts Amy L. , Patrick Stephen W. , Bruehl Stephen , Franklin Andrew D.
Published: April 2021

BACKGROUND:

Opioid analgesics are commonly prescribed for postoperative analgesia following pediatric surgery and often result in leftover opioid analgesics in the home. To reduce the volume of leftover opioids and overall community opioid burden, the State of Tennessee enacted a policy to reduce initial opioid prescribing to a 3-day supply for most acute pain incidents. We aimed to evaluate the extent of leftover opioid analgesics following pediatric ambulatory surgeries in the context of a state-mandated restrictive opioid-prescribing policy. We also aimed to evaluate opioid disposal rates, methods of disposal, and reasons for nondisposal.

METHODS:

Study personnel contacted the parents of 300 pediatric patients discharged with an opioid prescription following pediatric ambulatory surgery. Parents completed a retrospective telephone survey regarding opioid use and disposal. Data from the survey were combined with data from the medical record to evaluate proportion of opioid doses prescribed that were left over.

RESULTS:

The final analyzable sample of 185 patients (62% response rate) were prescribed a median of 12 opioid doses (interquartile range [IQR], 12–18), consumed 2 opioid doses (IQR, 0–4), and had 10 opioid doses left over (IQR, 7–13). Over 90% (n = 170 of 185) of parents reported they had leftover opioid analgesics, with 83% of prescribed doses left over. A significant proportion (29%, n = 54 of 185) of parents administered no prescribed opioids after surgery. Less than half (42%, n = 71 of 170) of parents disposed of the leftover opioid medication, most commonly by flushing down the toilet, pouring down the sink, or throwing in the garbage. Parents retaining leftover opioids (53%, n = 90 of 170) were most likely to keep them in an unlocked location (68%, n = 61 of 90). Parents described forgetfulness and worry that their child will experience pain in the future as primary reasons for not disposing of the leftover opioid medication.

CONCLUSIONS:

Despite Tennessee’s policy aimed at reducing leftover opioids, a significant proportion of prescribed opioids were left over following pediatric ambulatory surgeries. A majority of parents did not engage in safe opioid disposal practices. Given the safety risks related to leftover opioids in the home, further interventions to improve disposal rates and tailor opioid prescribing are warranted after pediatric surgery.
Long-term monitoring for the surveillance of the conservation status of Tursiops truncatus in an EU Natura2000 site in the Mediterranean Sea. A pilot study in the Tuscan Archipelago
Authors: ARCANGELI ANTONELLA , CROSTI ROBERTO , CAMPANA ILARIA , CAROSSO LARA , GREGORIETTI MARTINA , MAINARDI GIULIA , MAZZUCATO VERONICA , CASTELLI ALBERTO
Published: April 2021

A pilot study, using the dataset from the research network ‘FLT Med Net’, which regularly monitors transborder regions in the Mediterranean Sea using ferries as platform for systematic surveys, was undertaken to assess common bottlenose dolphin range and population trends within the Natura 2000 EU marine site “Tutela del Tursiops truncatus”. The site was recently designated by the Tuscany Region (Italy) within the requirement of the EU Habitats Directive. In order to evaluate the conservation status of bottlenose dolphin according to the surveillance scheme of the Directive, two six-year periods (2007-2012; 2013-2018) were compared to assess trends in distribution-occurrence (range); Sightings Per Unit of Effort and Density (population). In total, 18146 NM were surveyed along two fixed transects, recording 90 sightings of Tursiops truncatus and a total of 268 specimens. Between the two periods, slight but not statistically significant differences were assessed, with decreasing trend in range and population  of the species; no variation was detected in mean group sizes. Travelling was the most common behaviour, and juveniles were present in 20% of the sightings, concentrated during spring and summer. The consistent FLT Med Net dataset was found to be appropriate to evaluate important parameters for the assessment of trends in the conservation status of Tursiops truncatus at the Natura2000 site scale.
Comparison of gender, age, and body mass index for spatiotemporal parameters of bilateral gait pattern
Authors: Abualait Turki , Ahsan Mohammad
Published: April 2021

Background: Studies on the gaits parameters have been identified on the patient population. Most researchers confirm that the patients walk differently than normal people and they may have a greater risk of falls. Consistent finding and description of gender, age, and body mass index differences in gait studies is rare in healthy subjects. 

This research was performed to compare spatiotemporal parameters of gait between gender, as per their age and body mass index level.  

Methods: A cross-sectional study was conducted with forty-five young adults (F=20, M=25). Stadiometer and Physilog 4 inertial sensors were used for data collection. A gait analyzer 5.2 software (GaitUp, S.A. Lausanne, Switzerland) was used to determine spatiotemporal parameters.  

Results: No statistically significant differences were found in any bilateral foot gait parameters with respect to gender, age, and body mass index. Females were found with higher total double support and cadence than males. Cadence also increases with age. Obese people showed lower gait speed, cadence, and total double support. 

Conclusion: These findings may be beneficial to those who have abnormal gait pattern due to age, body mass index differences, decreased muscle strength, spasticity, and joint mobility. This important information should be considered to rehabilitate patients with abnormal gait patterns to controlling dynamic balance and risk of falling.
Case Report: Successful primary percutaneous coronary intervention in octogenarian with acute-on-chronic kidney disease and total atrioventricular block after acute myocardial infarction
Authors: Andrianto Andrianto , Laksmi Ni Putu Anggun , Herdyanto Rio
Published: April 2021

Myocardial infarction (MI) is frequently complicated by the worsening of renal function. Undergoing primary percutaneous coronary intervention (PCI) becomes crucial to a patient with ST-segment elevation myocardial infarction (STEMI). With appropriate management of MI, acute-on-chronic kidney disease (ACKD) requiring dialysis post-MI remains an important clinical predictor of elevated in-hospital mortality among patients with MI. 

In this study, we reported an octogenarian patient suffering from STEMI with ACKD and total atrioventricular block (TAVB). She underwent insertion of a temporary pacemaker and primary PCI. Renal function was improved after dialysis by decreasing the amount of serum creatinine from 8.1 mg/dL at admission to 1.05 mg/dL after primary PCI and dialysis. Primary PCI should still be considered for patients with acute MI, even though these patients have kidney disease, to save the heart muscle and even indirectly improve the kidney function itself.
Evaluating participants' perceptions of a functional physical fitness assessment for those aged 60 years and over conducted in the community by student physiotherapists
Authors: Candy Elizabeth , Bunn Lisa , Virgo Pauline , Byrne Christopher , Bannigan Katrina
Published: April 2021

Background/aims

Physical fitness is crucial in preserving independence and quality of life for older adults. A functional physical fitness assessment has been designed specifically for those aged 60 years and over. This study explored older people's perceptions of this assessment, conducted by student physiotherapists, and the feasibility of a larger study to evaluate the long-term effects of its use.

Methods

A total of five scheduled drop-in sessions were arranged. Participants aged 60 years and over were recruited. Physiotherapy students conducted the assessment and participants completed follow-up physical activity status and quality of life questionnaires as well as an evaluation of the session. Focus groups were conducted to explore participant's perceptions and experiences. Data was analysed using descriptive statistics and thematic analysis.

Results

Overall, 91 adults (aged 60–93 years) participated, 75 (46 (61%) women and 10 (13%) men) completed questionnaires, and seven attended focus groups. In total, 100% of the 91 participants suggested that those aged 60 years and over would benefit from functional fitness assessment, and 79% perceived this would lead to increased physical activity. Focus group participants reported they enjoyed working with students and suggested that regular assessment would provide a yardstick for their level of fitness, that they would like to repeat their tests next year and that ‘they were mentally a positive thing’.

Conclusions

Functional fitness assessments were perceived as useful and encouraged older adults to increase their activity levels. Students successfully completed the tests in non-healthcare settings. This study suggests that a large trial designed to assess the benefit of regular functional fitness assessment for the over 60s in community settings is feasible.