bluuebunny/crossref_metadata_2025 huggingface dataset:
Comparison of the Dosimetric Influence of Applicator Displacement on 2D and 3D Brachytherapy for Cervical Cancer Treatment
Authors: Wu Ailin , Tang Du , Wu Aidong , Liu Yunqin , Qian Liting , Zhu Lei
Published: September 2021

To compare the dosimetric influence of applicator displacement on two-dimensional brachytherapy (2D-BT) and three-dimensional brachytherapy (3D-BT) for cervical cancer. Nineteen patients who received computed tomography-guided tandem-and-ovoid (T&O) brachytherapy were retrospectively selected. Both 2D (point-based) and 3D (volume-based) plans with and without virtual applicator displacement in the 3 axes were created for each patient. Dose changes at point A, D90 of the high-risk clinical target volume (HR-CTV) and intermediate-risk CTV (IR-CTV), and the D0.1cc, D1cc, D2cc, and D5cc of organs-at-risk (OARs) caused by applicator displacement were evaluated. Both 2D-BT and 3D-BT plans were sensitive to T&O applicator displacement. The D90 of the CTV and the dose at point A were very sensitive to applicator displacement in the right–left direction ( X-axis). An applicator shift of >2 mm in the X-axis resulted in a change of >5% in the dose at point A and D90 of HR-CTV and IR-CTV. In addition, the doses to the OARs were mostly affected by applicator displacement in the anterior–posterior direction ( Z-axis). A displacement of <1.5 mm in the Z-axis was required to avoid a dose change of >10% for OARs. For both 2D-BT and 3D-BT plans, T&O displacement greater than  ± 2 mm in the X-axis or T&O applicator displacement  ± 1.5 mm in the Z-axis resulted in significant dose changes to the tumor and OARs. In comparison with 3D-BT plans, 2D-BT plans delivered a higher dose to the tumor, and the OARs received more undesirable doses when applicator displacement occurred. The influence of applicator displacement on the doses to the tumor and OARs differed between 2D-BT and 3D-BT. Physicians should take individual patient differences into account when selecting a brachytherapy plan to mitigate the influence of applicator displacement.
Overexpression of ICAT Inhibits the Progression of Colorectal Cancer by Binding with β-Catenin in the Cytoplasm
Authors: Hu Jiancong , Wang Zihan , Chen Junxiong , Yu Zhaoliang , Zhang Jingdan , Li Weiqian , Lin Mengmeng , Yang Xiangling , Liu Huanliang
Published: September 2021

Inhibitor of β-catenin and T-cell factor (ICAT) was first found as a polypeptide that blocks β-catenin–TCF interaction. Abundant evidence has shown that ICAT has different functions in diverse cancers’ progression. Nevertheless, the roles it plays in colorectal cancer (CRC) have not been described. Here, we documented that ICAT expression was higher in CRC tissue than in the adjacent normal tissue and that prognosis was better in high-ICAT expression patients. The overexpression of ICAT inhibited CRC cell proliferation both in vitro and in vivo. Wnt pathway transcriptional activity was suppressed in the CRC cells with ICAT overexpression, where the CCND1 and MYC expression, which occurs downstream of the Wnt signaling pathway, was inhibited. Co-immunoprecipitation experiments showed that ICAT bound with β-catenin in stable overexpression cell lines; immunofluorescence showed the co-localization of ICAT and β-catenin in the cytoplasm. Overall, our study reveals that ICAT inhibits CRC cell proliferation by binding to cytoplasm-located β-catenin, and prevents its translocation, which results in Wnt signaling pathway inactivation. It may provide a scientific foundation for focusing on ICAT in treatments for CRC.
Cast-OFF Trial: One Versus 4 to 5 Weeks of Plaster Cast Immobilization for Nonreduced Distal Radius Fractures: A Randomized Clinical Feasibility Trial
Authors: Boersma Emily Z. , Hekma Edo J. , Kraaijvanger Nicole , Mollen Roland M. H. G. , Nijhuis-van der Sanden Maria W. G. , Edwards Michael J. R.
Published: September 2021

Background

Distal radius fracture is a common fracture of which the incidence appears to be increasing worldwide. This pilot study investigated whether 1 week of plaster cast is feasible for nonreduced (stable fractures including nondisplaced and displaced fractures) distal radius fractures.

Methods

The study was a multicenter randomized clinical feasibility trial including patients from regional acute care providers. Patients with a nonreduced distal radius fracture were included in the study. Nonreduced fractures meant intra-articular or extra-articular fractures and including nondisplaced and minimal displaced fractures (dorsal angulation less than 5°-10°, maximum radial shortening of 2 mm, and maximum radial shift of 2 mm) not needing a reduction. Forty Patients were included and randomized. After 1 week of plaster cast, patients were randomized to 1 of the 2 treatment groups: plaster cast removed (intervention group) versus 4 to 5 weeks of plaster cast (control group).

Results

The analysis shows no significant differences between the 2 groups in having less pain, better function after 6 weeks, and better overall patient satisfaction. No difference was shown in secondary displacement between the 2 groups (control 1 vs intervention 0)

Conclusion

One week of plaster cast treatment for nonreduced distal radius fracture is feasible, preferred by patients, with at least the same functional outcome and pain scores.

Level of Evidence

According to the Oxford 2011 level of evidence, the level of evidence of this study is 2.
Impact of renal impairment on short-term outcomes following endovascular thrombectomy for acute ischemic stroke: A systematic review and meta-analysis
Authors: Jeon Jin Pyeong , Chen Chih-Hao , Tsuang Fon-Yih , Liu Jianmin , Hill Michael D , Zhang Lei , Yang Pengfei , Wang Guoping , Cho Bang-Hoon , Kim Joon-Tae , Goyal Mayank , Cho Yong Jun , Chai Chung Liang
Published: September 2021

Background

The impact of renal impairment on the outcomes of patients with acute ischemic stroke treated with endovascular thrombectomy was relatively limited and contradictory. We performed a systematic review and meta-analysis to investigate this.

Aims

We registered a protocol in September 2020 and searched MEDLINE, EMBASE, and Google Scholar accordingly. Renal impairment was defined as an estimated glomerular filtration rate <60 mL/min/1.73 m2. Predefined outcomes included functional independence (defined as a modified Rankin Scale of 0, 1, or 2) at three months, successful reperfusion, mortality, and symptomatic intracerebral hemorrhage.

Summary of review

Eleven studies involving 3453 patients were included. For the unadjusted outcomes, renal impairment was associated with fewer functional independence (odds ratio (OR), 0.49; 95% confidence interval (CI), 0.39–0.62) and higher mortality (OR, 2.55; 95% CI, 2.03–3.21). Renal impairment was not associated with successful reperfusion (OR, 0.80; 95% CI 0.63–1.00) and symptomatic intracerebral hemorrhage (OR, 1.41; 95% CI, 0.95–2.10). For the adjusted outcomes, results derived from a multivariate meta-analysis were consistent with the respective unadjusted outcomes: functional independence (OR, 0.59; 95% CI, 0.45–0.77), mortality (OR, 2.23, 95% CI, 1.45–3.43), and symptomatic intracerebral hemorrhage (OR, 1.34; 95% CI, 0.85–2.10).

Conclusions

We presented the first systematic review to demonstrate that renal impairment is associated with fewer functional independence and higher mortality. Future endovascular thrombectomy studies should publish complete renal estimated glomerular filtration rate data to facilitate prognostic studies and permit estimated glomerular filtration rate to be analyzed in a continuous variable. Systematic Review Registration: PROSPERO CRD42020191309
Post-stroke fatigue is associated with resting state posterior hypoactivity and prefrontal hyperactivity
Authors: Cotter Georgia , Salah Khlif Mohamed , Bird Laura , E Howard Mark , Brodtmann Amy , Egorova-Brumley Natalia
Published: September 2021

Background

Fatigue is associated with poor functional outcomes and increased mortality following stroke. Survivors identify fatigue as one of their key unmet needs. Despite the growing body of research into post-stroke fatigue, the specific neural mechanisms remain largely unknown.

Aim

This observational study aimed to identify resting state brain activity markers of post-stroke fatigue.

Method

Sixty-three stroke survivors (22 women; age 30–89 years; mean 67.5 ± 13.4 years) from the Cognition And Neocortical Volume After Stroke study, a cohort study examining cognition, mood, and brain volume in stroke survivors following ischemic stroke, underwent brain imaging three months post-stroke, including a 7-minute resting state functional magnetic resonance imaging. We calculated the fractional amplitude of low-frequency fluctuations, which is measured at the whole-brain level and can detect altered spontaneous neural activity of specific regions.

Results

Forty-five participants reported experiencing post-stroke fatigue as measured by an item on the Patient Health Questionnaire-9. Fatigued compared to non-fatigued participants demonstrated significantly lower resting-state activity in the calcarine cortex ( p < 0.001, cluster-corrected pFDR = 0.009, k = 63) and lingual gyrus ( p < 0.001, cluster-corrected pFDR = 0.025, k = 42) and significantly higher activity in the medial prefrontal cortex ( p < 0.001, cluster-corrected pFDR = 0.03, k = 45).

Conclusions

Post-stroke fatigue is associated with posterior hypoactivity and prefrontal hyperactivity reflecting dysfunction within large-scale brain systems such as fronto-striatal-thalamic and frontal-occipital networks. These systems in turn might reflect a relationship between post-stroke fatigue and abnormalities in executive and visual functioning. This whole-brain resting-state study provides new targets for further investigation of post-stroke fatigue beyond the lesion approach.
Strategically Playing with Fire: SGLT Inhibitors as Possible Adjunct to Closed-Loop Insulin Therapy
Authors: Pasqua Melissa-Rosina , Tsoukas Michael A. , Haidar Ahmad
Published: September 2021

As closed-loop insulin therapies emerge into clinical practice and evolve in medical research for type 1 diabetes (T1D) treatment, the limitations in these therapies become more evident. These gaps include unachieved target levels of glycated hemoglobin in some patients, postprandial hyperglycemia, the ongoing need for carbohydrate counting, and the lack of non-glycemic benefits (such as prevention of metabolic syndrome and complications). Multiple adjunct therapies have been examined to improve closed-loop systems, yet none have become a staple. Sodium-glucose-linked cotransporter inhibitors (SGLTi’s) have been extensively researched in T1D, with average reductions in placebo-adjusted HbA1c by 0.39%, and total daily dose by approximately 10%. Unfortunately, many trials revealed an increased risk of diabetic ketoacidosis, as high as 5 times the relative risk compared to placebo. This narrative review discusses the proven benefits and risks of SGLTi in patients with T1D with routine therapy, what has been studied thus far in closed-loop therapy in combination with SGLTi, the potential benefits of SGLTi use to closed-loop systems, and what is required going forward to improve the benefit to risk ratio in these insulin systems.
Analysis of the Composition and Anti-Rheumatoid Arthritis Mechanism of Qintengtongbi Decoction Based on Network Pharmacology
Authors: Liang Guo-Cheng , Duan Wen-Gui , Chen Shu-Yin , Fang Jian-Kang
Published: September 2021

Qintengtongbi Decoction (QTTBD) is a traditional prescription for rheumatoid arthritis (RA) treatment in Ruikang Hospital Affiliated to Guangxi University of Chinese Medicine, Nanning, southern China's Guangxi Zhuang Autonomous Region. However, there is not yet any analysis on its active compounds or action mechanism for treating RA. Moreover, the prescription has not been investigated from the perspective of network pharmacology. Therefore, this study aimed to analyze the compounds QTTBD and their potential pharmacological effects and the mechanism by which they treat RA via an integrated network pharmacology approach. With the aid of the relevant database tools and research indices, 188 compounds and 272 related drug targets genes/proteins were collected from QTTBD through the compound-target network, and 175 common gene targets between the QTTBD and RA were obtained by Venn 2.1. Finally, the top 10 gene targets and pathways were identified through the protein–protein interaction network, gene ontology, and KEGG pathway analysis: the gene targets include AKT1, IL6, TP53, VEGFA, MAPK3, TNF, CASP3, JUN, EGF, and EGFR; the pathways include oxytocin signaling pathway, amphetamine addiction, graft-versus-host disease, ovarian steroidogenesis, cGMP-PKG signaling pathway, Rap1 signaling pathway, allograft rejection, cytokine–cytokine receptor interaction, regulation of lipolysis in adipocytes and inflammatory mediator regulation of transient receptor potential channels. Therefore, it is concluded that a network pharmacology-based approach can help reveal and clarify the anti-RA role of QTTBD, and provide a scientific basis for further research into the mechanism.
An α-Sophoradiol Glycoside from the Root Wood of Erythrina senegalensis DC. (Fabaceae) with α-Amylase and α-Glucosidase Inhibitory Potential
Authors: Tchuente Djoko Cyrille , Gade Isaac Silvère , Atchade Alex De Theodore , Tamfu Alfred Ngenge , Mihaela Dinica Rodica , Sangu Eliezer , Tchoffo Djankou Madeleine , Henoumont Celine , Laurent Sophie , Talla Emmanuel
Published: September 2021

Phytochemical study of the roots of Erythrina senegalensis led to the isolation of a new α-sophoradiol glycoside, erythrinoside (1), together with four known compounds, lupeol (2), α-sophoradiol (3), isoneorautenol (4) and D-mannitol (5). The structures of the compounds were elucidated using spectroscopic data including 1D and 2D NMR, mass spectrometry and by comparison made with some data reported previously; the samples (extracts and compounds) were also subjected to antidiabetic assay. Erythrinoside and isoneorautenol exhibited good α-amylase inhibitory potential of 54.6% and 53.3%, respectively, compared to acarbose (72.5%) at 400 µg/mL. With α-glucosidase, all samples showed promising inhibition percentages above 50% at 200 µg/mL. In the α-glucosidase assay, the ethyl acetate extract (65.5%), methanol extract (72.1%), erythrinoside (63.3%) and isoneorautenol (66.0%) had percentage inhibitions closer to that of acarbose (69.0%) at 200 µg/mL. The methanol extract (IC50 = 81.2 ± 0.9 µg/mL) was more active than acarbose (IC50 = 94.5 ± 0.7 µg.mL) in the α-glucosidase assay. The inhibition of α-amylase and α-glucosidase indicates that E. senegalensis extracts and compounds could be used to manage diabetic conditions.
Survival and drug persistence in patients receiving inhaled treprostinil at doses greater than 54 µg (nine breaths) four times daily
Authors: Shapiro Shelley , Mandras Stacy , Restrepo‐Jaramillo Ricardo , Shen Eric , Broderick Meredith , Rao Youlan , Lee Dasom , Nelsen Andrew C.
Published: September 2021

Treprostinil is a prostacyclin approved for the treatment of pulmonary arterial hypertension. Commercial data sets indicate that approximately 20–25% of patients are prescribed a higher dose than the maximum recommended dosage of nine breaths per treatment session (bps) (54 μg), four times a day (QID) and numerous studies have demonstrated the safety of doses >9 bps QID. This phase 4, retrospective analysis of specialty pharmacy records assessed the effects of inhaled treprostinil at doses >9 bps QID. Patients receiving inhaled treprostinil between September 2009 and June 2018 were included, and a random sampling of 5000 patients was selected for further analysis. Subjects were grouped based on the highest dose reached for ≥2 months within a rolling six‐month window and were followed for up to three years. Of the total of 5000 patients analyzed, 28.5% received >9 bps QID. Survival rates were significantly higher in the >9 bps QID dosing group for years one, two, and three (P < 0.001). The time to transition to parenteral therapy was significantly longer for those at doses >9 bps (17.5 months) compared to doses ≤9 bps (9.5 moths; P < 0.0001). Drug persistence was also significantly higher for those taking >9 bps at years 1, 2, and 3 (P < 0.0001). Patients receiving inhaled treprostinil at doses >9 bps QID had a higher rate of survival and drug persistence over a three‐year period, suggesting that higher doses may provide clinically relevant benefits while remaining tolerable.
Emotional impact of COVID-19 lockdown and mitigation options: A cross-sectional survey of households in Ebonyi State, Nigeria
Authors: Elom Nwamaka A , Nwimo Ignatius O , Elom Sampson Omena , Alegu Deborah N , Afoke Eunice N , Okpata Onyekachi O , Ogodo Juliet O , Ilo Cajetan I , Okeworo Chukwuma G , Elom Chinyere O
Published: September 2021

Background:

Coronavirus disease 19 (COVID-19) has continued to plague households, leading to lockdown problems. Adopting appropriate mitigation strategies can reduce the impact on family members.

Purpose:

To assess the emotional impact of COVID-19 epidemic lockdown and mitigation measures among households in Ebonyi State.

Methods:

Cross-sectional survey design was used to study 516 participants. Emotional impact of COVID-19 lockdown ( r = 0.73) and mitigation options ( r = 0.92) questionnaire was used for data collection. Of the 516 copies of the questionnaire distributed, 493 copies (95.5% return rate) were used for data analysis. Data were analysed using descriptive statistics, standard deviations, and t-tests.

Results:

The data showed the emotional impact of the COVID-19 epidemic was high (2.97 ± 0.48) on households. They embraced friendly communication and communication with their partners, maintaining regular contact with their loved ones by phone, email, social media, or video conference to alleviate the COVID-19 lockdown. No significant differences were found in the emotional impact for location ( p > 0.05). Significant differences were not observed in many gender-based mitigation options. Conversely, a significant difference existed in the mitigation options based on location ( t = 3.143, p < 0.05). However, there was no significant difference in friendly interactions and communication with partners ( t = 0.354, p > 0.05), finding opportunities to develop excellent and promising news and images ( t = 0.770, p > 0.05) and maintaining regular communication with loved ones via phone, email, social media, and video conference ( t = 0.448, p > 0.05).

Conclusion:

The emotional impact of COVID-19 confinement was significant on family life and was more prevalent among men and urban dwellers. There is need to organise an awareness campaign on fundamental ways to overcome emotional distress using media targeting family members to promote emotional health.
More from less: Study on increasing throughput of COVID-19 screening and testing facility at an apex tertiary care hospital in New Delhi using discrete-event simulation software
Authors: Gowda Naveen R , Khare Amitesh , Vikas H , Singh Angel R , Sharma D K , Poulose Ramya , John Dhayal C
Published: September 2021

Background

One of the challenges has been coping with an increasing need for COVID-19 testing. A COVID-19 screening and testing facility was created. There was a need for increasing throughput of the facility within the existing space and limited resources. Discrete event simulation was used to address this challenge.

Methodology

A cross-sectional interventional study was done from September 2020 to October 2020. Detailed process mapping with all micro-processes was done. Patient arrival patterns and time taken at each step were measured by two independent observers at random intervals over two weeks. The existing system was simulated and a bottleneck was identified. Two possible alternatives to the problem were simulated and evaluated.

Results

Scenario 1 showed a maximum throughput of 316. The average milestone times of all the processes after the step of “Preparation of sampling kits” jumped 62%; from 82 to 133 min. Staff state times also showed that staff at this step was stretched and medical lab technicians were underutilized. Scenario 2 simulated the alternative with lesser time spent on sampling kit preparation with a 22.4% increase in throughput, but could have led to impaired quality check. Scenario 3 simulated with increased manpower at the stage of bottleneck with 26.5% increase in throughput and was implemented on-ground.

Conclusion

Discrete event simulation helped to identify the bottleneck, simulate possible alternative solutions without disturbing the ongoing work, and finally choose the most suitable intervention to increase throughput, without the need for additional space allocation. It therefore helped to optimally utilize resources and get “more from less.”
Combined Use of Tranexamic Acid and Rivaroxaban in Posterior/Transforaminal Lumbar Interbody Fusion Surgeries Safely Reduces Blood Loss and Incidence of Thrombosis: Evidence From a Prospective, Randomized, Double-Blind, Placebo-Controlled Study
Authors: Li Xiang , Jiao Guangjun , Li Jingyi , Ji Weibin , Hao Zhiwei , Gong Fangli , Chen Yunzhen
Published: September 2021

Study Design:

A prospective, randomized, double-blind, placebo-controlled study.

Objectives:

There are few studies examining the balance between preventing venous thrombus embolism (VTE) and reducing blood loss in posterior/transforaminal lumbar interbody fusion (PLIF/TLIF) surgeries. This study aimed to evaluate the efficacy and safety of the combine application of TXA and rivaroxaban in patients undergoing PLIF/TLIF and explore relevant factors related to blood loss and VTE.

Methods:

Patients in group A which was the control group received 0.9% NaCl solution intravenously. Group B was treated by an intravenous injection of 2 g tranexamic acid (TXA) and the local use of 1 g intraoperatively. Group C was treated the same as group B intraoperatively, and they received 10 mg rivaroxaban qd treatment postoperatively. Eligible patients with an Autar score ≤ 10 were randomly assigned to group A or group B. Patients with an Autar score >10 were allocated into group C.

Results:

The intraoperative blood loss and postoperative drainage were lower in groups B and C than in group A ( P < .001). The blood transfusion rate in group B was lower than that in group A ( P < .001), while the incidence of VTE in group C was lower ( P < .001). Four factors were found to be positively correlated with obvious total blood loss ( P < .05). The data showed that 5 factors were correlated with the development of a thrombus ( P < .1).

Conclusions:

The combination of TXA and rivaroxaban in PLIF/TLIF patients is safe and effective in reducing D-dimer levels associated with VTE and reducing blood loss.
Some Notes on the Missionary Research Series of the Lutterworth Press
Authors: Groves G. P.
Published: September 2021

This article was solicited by the Missionary Research Library in order to oring to the attention or American missionary interests the valuable Missionary Research Series published by the Lutterworth press in London, which is all too little known in Canada and the united states. a number of the finest products of missionary study during the recent years have been published in this series. The sponsorship of the project rests with the Department of Missions at the Selly Oak Colleges, Birmingham. Both that Department and the Lutterworth press are to be commended for this Joint contribution to the world mission of the Church. The support and encouragement of this enterprise by American missionary interests is urgently needed. The distribution and sale of the titles in the series must be considerably extended in the western hemisphere, If the project is to succeed and if the books are to have the consideration which they deserve. This article was written at the request of the Lutterworth press, following the appeal of the Library, by Dr. c. P. Gloves, the professor of Missions at the Selly Oak Colleges.—Editor.
Recent Dutch Missions Literature
Authors: Oussoren Arie H.
Published: September 2021

There has been a steady production of Dutch missionary literature during the years since the end of World War II. This literature and the thinking which it expresses are generally unknown in America. The Missionary Research Library has sought someone for the last four years to report on the Dutch literature of missions. Through the kindness of Dr. Oussóren this survey statement has been made available.–Ed.
List of theses in Foreign Missions and Related Subjects Accepted during the Academic Year 1959–1960
Authors: Person Laura
Published: September 2021

The compiler expresses gratitude to the professors of missions and all other persons who through reports, or otherwise, have made the following compilation of theses possible.

The theses reported are principally in the field of world missions and the ecumenical church, or are related to subjects of especial interest to students and scholars in missions, and were written during the years of 1959 and 1960. The annotations which follow various titles have been written by the professors who reported them. Theses which concern anthropology, rural, or agricultural missions are included in the general list and may be found as a group in the index. The report includes papers from 26 theological schools and seminaries and from 11 universities and colleges.

Inquiries concerning a title should not be addressed to the Missionary Research Library but to the sohool where a thesis has originated or, in the case of Ph.D. dissertations, to University Miorofilms, Ino., Ann Arbor, Michigan. An index to subjects will be found on page 8.
Bringing Our Missionary Methods under the Word of God
Authors: Newbigin Bishop Lesslie
Published: September 2021

The Presbyterian Church in the United States held a very significant Consultation on World Missions at Montreat, North Carolina, from the thirteenth to the nineteenth of October, 1962. Some 250 delegates/members and executives of the Board of World Missions of The Presbyterian Church in the U.S., other officials of that Church, representative missionaries, and nationals from the areas of its overseas mission work/$$, consultants and observers met for frank and intense discussion of problems of the Christian mission.

The following article is an address which Bishop Newbigin delivered before the Consultation on October 14. It deals with the foundational consideration which ought to characterize every inquiry into the motives, strategies, structures, and practices of the mission of Christ and His Church. The address is reproduced here by permission of the author and the Board of World Missions of the Presbyterian Church in the U.S.
A Short History of the Presbyterian Church among the Mountain Tribes in Taiwan
Authors: Cheng Lien-min
Published: September 2021

The author of this article is Professor of Church History at Taiwan Theological College, Taipei, Taiwan. The paper was prepared originally for the Fifth Theological Study Institute of the Association of Theological Schools in South-East Asia., held in Singapore in 1963. It has been revised and up-dated for this publication of it.

We think it particularly significant that this article should appear in print just prior to the Centennial celebrations of the introduction of Protestant Christianity into Taiwan. The celebrations will be held in Taiwan in June 1965.
World Hunger and the Christian Conscience
Authors: Riddle Katharine P.
Published: September 2021

The year 1965 was the year when the American Protestant churches, almost with one voice, declared intolerable the fact that more than half the people of the world live in perpetual hunger.1 Although the North Atlantic countries – predominantly Christian — enjoy a standard of living and a level of economic affluence unprecedented in history, hunger is still on the increase in Latin America, Africa, and Asia. The brutal disparity between the “haves” and the “have-nots” is an offense to the Christian conscience.

This situation caused the National Council of the Churches of Christ in the U.S.A. to call on its “Division of Overseas Ministries to press on with its analysis of United States church programs abroad with the view of making recommendations as to how the churches may, more effectively and more ecumenically, play their proper role in meeting the needs of the hungry.”2 In response to this mandate, a survey3 was conducted during 1965 by two agencies of the Division of Overseas Ministries, the Committee on Agriculture and Rural Life (CARL) and Church World Service. This article is based on the findings and recommendations that resulted from the survey and on the guidelines for future programming suggested by it.
Problem – and Promise – in African Journalism
Authors: Hilton Bruce
Published: September 2021

Twenty editors of Christian newspapers and magazines in Africa came together earlier this year to discuss the challenges of their work.

Arriving from points as widely scattered as Ethiopia and South Africa, Lagos and Nairobi, they spent nearly a month at the Africa Literature Center in Kitwe, Zambia, discussing both the theological and the practical. Nearly all serve in areas of rapid urbanization and technological revolution, and nearly all face restriction or censorship from their churches or their governments.

Reproduced here are a few of the papers read by seminar participants. They reveal something of life on that changing continent; they also reflect problems that are common to those who try to edit Christians journals anywhere in the world today.
Some Ideas on the Direction of Chinese Theological Development
Authors: Chao Jonathan Tien-En
Published: September 2021

(An analysis of the features contributing to the lack of Chinese theological productivity and a presentation of some ideas on the biblical direction of Chinese theological development; together with a preliminary bibliography.

(Since the beginning of the Cultural Revolution in August 1966, there has been no word of any theological activity in mainland China. The last remaining theological center, Nanking Theological Seminary, has been closed.)
Long-term medication reduction in controlled glaucoma with iTrack ab-interno canaloplasty as a standalone procedure and combined with cataract surgery
Authors: Khaimi Mahmoud A.
Published: September 2021

Purpose:

To evaluate the long-term effectiveness of iTrack (Nova Eye Medical, Fremont, USA) ab-interno canaloplasty performed as a standalone procedure, or combined with cataract surgery, in reducing antiglaucoma medication dependence and maintaining intraocular pressure within target range in patients with controlled primary open-angle glaucoma.

Methods:

This is a retrospective, single-center, case series study of patients who underwent iTrack ab-interno canaloplasty as a standalone procedure ( n = 34) or in combination with cataract surgery ( n = 11). Eyes with controlled mild or moderate glaucoma (intraocular pressure ⩽17 mmHg) were included; those with prior glaucoma surgeries were excluded. The primary outcome was the mean reduction in glaucoma medication and the secondary outcome was the maintenance of controlled intraocular pressure postoperatively.

Results:

A total of 35 patients (45 eyes) with a mean age of 73 ± 9.7 years were included in the study. For all eyes, a significant decrease (61%) in the mean number of medications was seen at 36 months (1.89 ± 0.93 versus 0.60 ± 0.82; p < 0.001), with 56% (14/25) of eyes medication free. No significant difference was observed in the reduction of medication use whether iTrack was performed with or without cataract surgery at 12 and 36 months. Mean baseline intraocular pressure of 14.42 ± 2.2 mmHg for all eyes was maintained at the 12-, 24-, and 36-month follow-up visits (14.6 ± 3.65, 15.06 ± 2.26, and 14.19 ± 2.91, respectively), with no significant difference between the two groups ( p = 0.08).

Conclusion:

The iTrack ab-interno canaloplasty significantly reduced medication dependency and maintained intraocular pressure within target range in patients with controlled mild or moderate primary open-angle glaucoma, while showing a good safety profile, both as a standalone procedure or in combination with cataract surgery.
Reductive Otoplasty and Facial Debulking in a Pediatric Patient With PIK3CA-Related Overgrowth
Authors: Das Rishub K. , Rahman Barry G. , Phillips James D. , Borst Alexandra J. , Jaeger Nolan , Golinko Michael S.
Published: September 2021

Overgrowth syndromes encompass a number of rare genetic diseases with heterogeneous clinical phenotypes. Accordingly, there is a strong imperative to collect data and classify these disorders to aid in diagnosis and management. Recent advances in the genetics of overgrowth syndromes have identified mutations in the PIK3CA gene. These somatic mutations manifest in progressive segmental overgrowth of fibrous and adipose tissue and bone, vascular malformations, and in some cases, increased risk for malignancy. Targeted medical therapy is under investigation for the management of PROS, but treatment of overgrowth relies on surgical debulking. Macrotia in PIK3CA-related overgrowth spectrum (PROS) has not been reported in the literature. In this case, we discuss a novel approach to reductive otoplasty and facial soft tissue debulking in a pediatric patient with PROS.
DKK1 activates noncanonical NF-κB signaling via IL-6–induced CKAP4 receptor in multiple myeloma
Authors: Li Xin , Wang Jingjing , Zhu Shuai , Zheng Jinxin , Xie Ying , Jiang Hongmei , Guo Jing , Wang Yixuan , Peng Ziyi , Wang Mengqi , Wang Jingya , Wang Sheng , Zhong Yuping , Liu Zhiqiang
Published: September 2021

Proteasome inhibitors, such as bortezomib (BTZ), represent the key elements in chemotherapy regimens for multiple myeloma (MM), whereas acquired chemoresistance and ultimately relapse remain a major obstacle. In the current study, we screened differently expressed cytokines in bortezomib-resistant MM cells and found that Dickkopf-1 (DKK1) level was remarkably augmented, whereas CD138 level was significantly suppressed. DKK1 in vitro specifically enhanced the resistance of myeloma cells to bortezomib treatment, and excessive DKK1 drove CD138 downregulation via inhibition of canonical Wnt signaling. Notably, DKK1 mainly induced drug resistance in MM cells via the receptor of CKAP4. Mechanistically, CKAP4 transduced DKK1 signal and evoked NF-κB pathway through recruiting and preventing cullin associated and neddylation dissociated 1 from hampering the assembly of E3 ligase-mediated ubiquitination of IκBα. In addition, we found that interleukin-6 (IL-6) stimulated CKAP4 expression to generate drug resistance, and disturbance of DKK1-CKAP4 axis improved sensitivity to BTZ treatment of MM and attenuated bone destruction in a mouse model. Collectively, our study revealed the previously unidentified role of DKK1 in myeloma drug resistance via Wnt signaling dependent and independent manners, and clarified the importance of antagonism of DKK1-IL-6 loop in bone marrow microenvironment.
Anti-cysteine/spacer antibodies that open ADAMTS13 are a common feature in iTTP
Authors: De Waele Laure , Curie Alexandre , Kangro Kadri , Tellier Edwige , Kaplanski Gilles , Männik Andres , Tersteeg Claudia , Joly Bérangère S. , Coppo Paul , Veyradier Agnès , De Meyer Simon F. , Roose Elien , Vanhoorelbeke Karen
Published: September 2021

Immune-mediated thrombotic thrombocytopenic purpura (iTTP) is caused by an autoantibody-mediated deficiency in ADAMTS13. In healthy individuals, ADAMTS13 has a folded conformation in which the central spacer (S) domain interacts with the C-terminal CUB domains. We recently showed that ADAMTS13 adopts an open conformation in iTTP and that patient immunoglobulin G antibodies (IgGs) can open ADAMTS13. Anti-ADAMTS13 autoantibodies in patients with iTTP are directed against the different ADAMTS13 domains, but almost all patients have autoantibodies binding to the cysteine/spacer (CS) domains. In this study, we investigated whether the autoantibodies against the CS and CUB domains can disrupt the S-CUB interaction of folded ADAMTS13, thereby opening ADAMTS13. To this end, we purified anti-CS and anti-CUB autoantibodies from 13 patients with acute iTTP by affinity chromatography. The successfully purified anti-CS (10/13 patients) and anti-CUB (4/13 patients) autoantibody fractions were tested further in our ADAMTS13 conformation enzyme-linked immunosorbent assay to study whether they could open ADAMTS13. Interestingly, all purified anti-CS fractions (10/10 patients) were able to open ADAMTS13. On the other hand, only half of the purified anti-CUB fractions (2/4 patients) opened ADAMTS13. Our finding highlights that anti-CS autoantibodies that open ADAMTS13 are a common feature of the autoimmune response in iTTP.
Combination brentuximab vedotin and bendamustine for pediatric patients with relapsed/refractory Hodgkin lymphoma
Authors: Forlenza Christopher J. , Gulati Nitya , Mauguen Audrey , Absalon Michael J. , Castellino Sharon M. , Franklin Anna , Keller Frank G. , Shukla Neerav
Published: September 2021

In patients with relapsed/refractory (R/R) Hodgkin lymphoma (HL), achieving a complete metabolic response (CMR) after salvage therapy is associated with superior outcomes, and optimal treatments must be identified. The combination of brentuximab vedotin and bendamustine (BVB), although highly active in adult patients, has not been extensively evaluated in pediatric patients with R/R HL. We performed a multicenter, retrospective review of pediatric patients <21 years of age with R/R HL treated with BVB from January 2016 through July 2019. Response was assessed by local radiologists according to Lugano classification criteria. Twenty-nine patients (17 relapsed, 12 refractory) with a median age of 16 years (range, 10-20) were treated with BVB and received a median of 3 cycles of therapy (range, 2-7). Patients received an infusion of 1.8 mg/kg of BV on day 1 with bendamustine 90 mg/m2 on days 1 and 2 of 3-week cycles. Nineteen patients (66%) achieved a CMR (95% CI, 46-82). An objective response was observed in 23 patients (objective response rate, 79%; 95% CI, 60-92). The most common grade 3 and 4 toxicities were hematologic, and 3 patients (10%) experienced grade 3 infusion reactions. Seventeen of 18 patients underwent successful mobilization and collection of stem cells. Sixteen patients (13 autologous, 3 allogeneic) received a consolidative transplant after BVB. The 3-year post-BVB event-free and overall survival were 65% (95% CI, 46-85) and 89% (95% CI, 74-100), respectively. For pediatric patients with R/R HL, BVB was well tolerated and compared favorably with currently accepted salvage regimens.
Short-acting β2-agonist prescriptions are associated with poor clinical outcomes of asthma: the multi-country, cross-sectional SABINA III study
Authors: Bateman Eric D. , Price David B. , Wang Hao-Chien , Khattab Adel , Schonffeldt Patricia , Catanzariti Angelina , van der Valk Ralf J.P. , Beekman Maarten J.H.I.
Published: September 2021

Background

To gain a global perspective on short-acting β2-agonist (SABA) prescriptions and associated asthma-related clinical outcomes in patients with asthma, we assessed primary health data across 24 countries in five continents.

Methods

SABINA III was a cross-sectional study that employed electronic case report forms at a study visit (in primary or specialist care) to record prescribed medication(s), over-the-counter (OTC) SABA purchases and clinical outcomes in asthma patients (≥12 years old) during the past 12 months. In patients with ≥1 SABA prescriptions, associations of SABA with asthma symptom control and severe exacerbations were analysed using multivariable regression models.

Results

Of 8351 patients recruited (n=6872, specialists; n=1440, primary care), 76.5% had moderate-to-severe asthma and 45.4% experienced ≥1 severe exacerbations in the past 12 months. 38% of patients were prescribed ≥3 SABA canisters; 18.0% purchased OTC SABA, of whom 76.8% also received SABA prescriptions. Prescriptions of 3–5, 6–9, 10–12 and ≥13 SABA canisters (versus1–2) were associated with increasingly lower odds of controlled or partly controlled asthma (adjusted OR 0.64 (95% CI 0.53–0.78), 0.49 (95% CI 0.39–0.61), 0.42 (95% CI 0.34–0.51) and 0.33 (95% CI 0.25–0.45), respectively; n=4597) and higher severe exacerbation rates (adjusted incidence rate ratio 1.40 (95% CI 1.24–1.58), 1.52 (95% CI 1.33–1.74), 1.78 (95% CI 1.57–2.02) and 1.92 (95% CI 1.61–2.29), respectively; n=4612).

Conclusions

This study indicates an association between high SABA prescriptions and poor clinical outcomes across a broad range of countries, healthcare settings and asthma severities, providing support for initiatives to improve asthma morbidity by reducing SABA overreliance.
Activation of immune cell proteasomes in peripheral blood of smokers and COPD patients: implications for therapy
Authors: Kammerl Ilona E. , Hardy Sophie , Flexeder Claudia , Urmann Andrea , Peierl Julia , Wang Yuqin , Vosyka Oliver , Frankenberger Marion , Milger Katrin , Behr Jürgen , Koch Andrea , Merl-Pham Juliane , Hauck Stefanie M. , Pilette Charles , Schulz Holger , Meiners Silke
Published: September 2021

Background

Immune cells contain a specialised type of proteasome,i.e.the immunoproteasome, which is required for intracellular protein degradation. Immunoproteasomes are key regulators of immune cell differentiation, inflammatory activation and autoimmunity. Immunoproteasome function in peripheral immune cells might be altered by smoking and in chronic obstructive pulmonary disease (COPD), thereby affecting immune cell responses.

Methods

We analysed the expression and activity of proteasome complexes in peripheral blood mononuclear cells (PBMCs) isolated from healthy male young smokers as well as from patients with severe COPD and compared them with matching controls.

Results

Proteasome expression was upregulated in COPD patients as assessed by quantitative reverse transcriptase-PCR and mass spectrometry-based proteomic analysis. Proteasome activity was quantified using activity-based probes and native gel analysis. We observed distinct activation of immunoproteasomes in the peripheral blood cells of young male smokers and severely ill COPD patients. Native gel analysis and linear regression modelling confirmed robust activation and elevated assembly of 20S proteasomes, which correlated significantly with reduced lung function parameters in COPD patients. The immunoproteasome was distinctly activated in COPD patients upon inflammatory cytokine stimulation of PBMCsin vitro. Inhibition of the immunoproteasome reduced pro-inflammatory cytokine expression in COPD-derived blood immune cells.

Conclusions

Given the crucial role of chronic inflammatory signalling and the emerging involvement of autoimmune responses in COPD, therapeutic targeting of the immunoproteasome might represent a novel therapeutic concept for COPD.
Nailfold capillaroscopy by smartphone-dermatoscope for connective tissue disease diagnosis in interstitial lung disease: a prospective observational study
Authors: Jee Adelle S. , Parker Matthew J.S. , McGill Neil , Bleasel Jane F. , Webster Susanne , Troy Lauren K. , Corte Tamera J.
Published: September 2021

Nailfold capillaroscopy (NFC) is a non-invasive tool validated for systemic sclerosis diagnosis. The role and interpretation of NFC in interstitial lung disease (ILD) patients for the diagnosis of connective tissue disease associated ILD (CTD-ILD) remains undefined.

In a prospective study, quantitative and qualitative NFC by smartphone-dermatoscope (3M Dermlite-DL4ΤΜ attached to iPhone-6plusΤΜ) was performed in 96 patients with well-defined CTD-ILD (n=27) and non-CTD ILD (n=69; idiopathic interstitial pneumonia n=42, interstitial pneumonia with autoimmune features n=27) by ILD-multidisciplinary meeting. NFC scoring was performed by two independent, blinded specialist rheumatologists. Comprehensive baseline clinical, serological, physiological and radiological data were included. Multivariable models for CTD diagnosis in ILD, comprising nailfold characteristics at empirical thresholds determined by receiver operating characteristic curve analysis and clinical variables, were explored.

In 94 patients with complete NFC data (total 687 images, median eight images per patient from eight digits), low capillary density (<6 capillaries/millimetre), increased giant capillaries (≥3), avascular areas (≥2) and microhaemorrhages all strongly enhanced the discrimination of CTD-ILD from non-CTD ILD (OR 5.00–7.47) independent of clinical covariates. In multivariable analysis, low capillary density and microhaemorrhages were independent predictors of CTD in ILD additional to the risk conferred by serology and radiology. Microhaemorrhages were also a strong predictor of CTD (adjusted OR 13.45, p=0.006) independent of clinical manifestations. All pre-specified qualitative NFC classification schemes identified CTD-ILD (OR range 3.27–8.47).

NFC performed by smartphone-dermatoscope is an accessible, clinically feasible tool that may improve the identification of CTD further to routine clinical assessment of the ILD patient.
An impacted urethral stone: a rare cause of acute urinary retention in women—case report
Authors: Hamza Babatunde K. , Bello Ahmad , Tolani Musliu Adetola , Makama Jerry G. , Yusuf Nuhu
Published: September 2021

Background

Urethral calculi are rare, representing 1–2% of all calculi affecting the urinary tract. Impacted urethra calculi are commoner in males due to anatomical differences between the male and female urethra. The treatment approach is determined by the size and location of the stone, associated anomalies and available facilities.

Case presentation

We present the case of 35-year-old woman who presented with acute urinary retention secondary to an impacted urethral stone. The calculus could not be removed through the external urethral meatus due to the size of the stone. She had cystolithotomy after retrograde manipulation to the bladder. She did well postoperatively. This line of management was based on the size of the stone, and the available facilities which are typical of many hospitals in developing countries.

Conclusions

Urethral calculi are extremely rare in women. The treatment should be individualized.