bluuebunny/crossref_metadata_2025 huggingface dataset:
Exogenous melatonin‐mediated regulation of K+/Na+ transport, H+‐ATPase activity and enzymatic antioxidative defence operate through endogenous hydrogen sulphide signalling in NaCl‐stressed tomato seedling roots
Authors: Siddiqui M. H. , Khan M. N. , Mukherjee S. , Basahi R. A. , Alamri S. , Al‑Amri A. A. , Alsubaie Q. D. , Ali H. M. , Al‐Munqedhi B. M. A. , Almohisen I. A. A.
Published: July 2021

Melatonin (Mel) and hydrogen sulphide (H2S) have emerged as potential regulators of plant metabolism during abiotic stress. Presence of excess NaCl in the soil is one of the main causes of reduced crop productivity worldwide. The present investigation examines the role of exogenous Mel and endogenous H2S in tomato seedlings grown under NaCl stress.

Effect of 30 µm Mel on endogenous synthesis of H2S was examined in roots of NaCl‐stressed (200 mm) tomato seedlings. Also, the impact of treatments on the oxidative stress markers, transport of K+ and Na+, and activity of H+‐ATPase and antioxidant enzymes was assessed.

Results show that NaCl‐stressed seedlings supplemented with 30 µm Mel had increased levels of endogenous H2S through enhanced L‐cysteine desulfhydrase activity. Mel in association with H2S overcame the deleterious effect of NaCl and induced retention of K+ that maintained a higher K+/Na+ ratio. Use of plasma membrane inhibitors and an H2S scavenger revealed that Mel‐induced regulation of K+/Na+ homeostasis in NaCl‐stressed seedling roots operates through endogenous H2S signalling. Synergistic effects of Mel and H2S also reduced the generation of ROS and oxidative destruction through the enhanced activity of antioxidant enzymes.

Thus, it is suggested that the protective function of Mel against NaCl stress operates through an endogenous H2S‐dependent pathway, wherein H+‐ATPase‐energized secondary active transport regulates K+/Na+ homeostasis.
Universal stress protein‐like gene from mulberry enhances abiotic stress tolerance in Escherichia coli and transgenic tobacco cells
Authors: Dhanyalakshmi K. H. , Nataraja K. N.
Published: July 2021

Universal stress proteins (USPs) are a conserved group of proteins initially identified and characterized in bacteria. USPs are induced under multiple stresses, and are important for stress acclimation. We cloned a USP‐like gene designated as MaUSP1‐like from mulberry and expressed in bacteria and tobacco to examine its relevance in abiotic stress tolerance.

Escherichia coli and tobacco cells expressing MaUSP1‐like gene were exposed to different abiotic stresses, and cell survival and growth was recorded to assess the stress effects.

MaUSP1‐like gene conferred tolerance to E. coli cells under NaCl‐induced salt stress, PEG8000‐induced desiccation stress, cadmium chloride‐induced heavy metal stress, and heat stress. Overexpression of MaUSP1‐like sustained cell division and growth in tobacco cells under salt stress.

The results demonstrate that MaUSP1‐like gene is capable of conferring cellular level tolerance in both prokaryotic and eukaryotic systems, under abiotic stress. The finding opened up an option to argue that maintenance of cellular level tolerance is crucial for sustenance of growth under stress and cellular level tolerance can be improved by overexpressing genes like USPs.
Targeted mutagenesis in Nicotiana tabacum ADF gene using shockwave‐mediated ribonucleoprotein delivery increases osmotic stress tolerance
Authors: Augustine Sruthy Maria , Cherian Anoop Vadakan , Seiling Kerstin , Di Fiore Stefano , Raven Nicole , Commandeur Ulrich , Schillberg Stefan
Published: July 2021

DNA‐free genome editing involves the direct introduction of ribonucleoprotein (RNP) complexes into cells, but this strategy has rarely been successful in plants. In the present study, we describe a new technique for the introduction of RNPs into plant cells involving the generation of cavitation bubbles using a pulsed laser. The resulting shockwave achieves the efficient transfection of walled cells in tissue explants by creating transient membrane pores. RNP‐containing cells were rapidly identified by fluorescence microscopy, followed by regeneration and the screening of mutant plants by high‐resolution melt analysis. We used this technique in Nicotiana tabacum to target the endogenous phytoene desaturase (PDS) and actin depolymerizing factor (ADF) genes. Genome‐edited plants were produced with an efficiency of 35.2% for PDS and 16.5% for ADF. Further we evaluated the physiological, cellular and molecular effects of ADF mutations in T2 mutant plants under drought and salinity stress. The results suggest that ADF acts as a key regulator of osmotic stress tolerance in plants.
Critical phosphorus requirements of Trifolium species: The importance of root morphology and root acclimation in response to phosphorus stress
Authors: Becquer Adeline , Haling Rebecca E. , Warren Anne , Alden Hull Rowan , Stefanski Adam , Richardson Alan E. , Ryan Megan H. , Kidd Daniel R. , Lambers Hans , Sandral Graeme A. , Simpson Richard J.
Published: July 2021

Differences in root morphology and acclimation to low‐phosphorus (P) soil were examined among eight legume species from the Trifolium Section Tricocephalum to understand how these root attributes determine P acquisition. Ornithopus sativus was included as a highly P‐efficient benchmark species. Plants were grown as microswards in pots with five rates of P supplied in a topsoil layer to mimic uneven P distribution within a field soil profile. Topsoil and subsoil roots were harvested separately to enable measurement of the nutrient‐foraging responses. Critical P requirement (lowest P supply for maximum yield) varied over a threefold range, reflecting differences in root morphology and acclimation of nutrient‐foraging roots to P stress. Among the species, there was a 3.2‐fold range in root length density, a 1.7‐fold range in specific root length, and a 2.1‐fold range in root hair length. O. sativus had the lowest critical P requirement, displayed a high root length density, the highest specific root length, and the longest root hairs. Acquisition of P from P‐deficient soil was facilitated by development of a large root hair cylinder (i.e. a large root–soil interface). This, in turn, was determined by the intrinsic root morphology attributes of each genotype, and the plasticity of its root morphology response to internal P stress. Root acclimation in low‐P soil by all species was mostly associated with preferential allocation of mass to nutrient‐foraging roots. Only O. sativus and four of the Trifolium species adjusted specific root length beneficially, and only O. sativus increased its root hair length in low‐P soil.
Punctuated equilibrium in multilevel contexts: How federal and state level forces feedback into shaping the local policy agenda in Mexico
Authors: Meza Oliver
Published: July 2021

The article uses the punctuated equilibrium theory to explain changes in the local policy agenda of municipal governments. It focuses onfeedback(negative and positive) as a key concept that associates intergovernmental institutions in a federalist system of governance and the budgetary punctuations and change in the municipal policy agenda. I analyze a 17‐year period of decentralization process along a generalized structural equation multinomial model. Findings show that decentralized resources, from state and federal governments, affect the municipal's local policy agenda. Such effects are conditional to an overall institutional setting, thus, providing additional insights into the contingency of institutional friction shaping feedback and policy change.
Igneous rocks related to porphyry Cu‐Au mineralization at the Dizon mine, Philippines
Authors: Midea William P. , Hattori Keiko , Valera Gabriel Theophilus V.
Published: July 2021

The Dizon Au‐rich porphyry Cu deposit, 0.67 Mt Cu and 174 t Au, is hosted by diorite and andesite porphyry intrusions, dated at ~2.5 Ma. Amphibole and Fe‐Ti oxides in relatively unaltered rocks were used to evaluate the magma conditions of intrusions. Parental magma for diorite porphyry was ~950°C at a depth of ~15 km, whereas the parental magmas for the andesite porphyry had lower temperatures, 760–820°C at a depth of ~5 km. The deposit formed at the locus of multiple intrusions, with evidence for injections of hot mafic magmas, including destabilization texture of plagioclase phenocrysts. Parental magmas at Dizon were oxidized, above FMQ + 2.0, and water‐rich, >5 wt%, comparable to conditions of many large porphyry deposits elsewhere in the world. The occurrence of thick opacitic bands of amphibole in the diorite porphyry at Dizon reflects the release of aqueous fluids from the magma; such magmatic fluids were likely responsible for magmatic hydrothermal mineralization of the Dizon porphyry deposit. Subduction of the Scarborough Seamount caused a compressive regime in the overlying plate, which likely contributed to favourable tectonic conditions for mineralization.
Women's Education, Spousal Agreement on Future Fertility Intentions, and Contraceptive Use in Pakistan
Authors: Bashir Saima , Guzzo Karen
Published: July 2021

In less egalitarian countries such as Pakistan, reproductive behaviors are gendered, with couples often disagreeing about their fertility goals. However, the dramatic changes in women's empowerment and messaging around reproductive behaviors in Pakistan in recent years may have affected how women's own characteristics and their concordance with their spouse on fertility goals are linked to contraception. Using matched couple data from two cycles of the Pakistan Demographic Health Survey (1990–1991 and 2017–2018), this paper examines the relative influence of husbands’ and wives’ fertility preferences, as well as women's education, on contraceptive use using linear probability models. Disagreement between couples declined modestly, by about four percentage points, over time. When disagreement about future fertility intentions occurs, wife's fertility preferences are more strongly related to contraceptive behavior, and this association has not changed over time. Although contraceptive use is positively associated with education, the link between women's education and contraceptive use has weakened over time due to increased use among uneducated women. Pakistani women's own fertility preferences are reflected in their contraceptive behavior, and contraceptive use is increasing among all women, even less educated women. Diffusion processes are likely at play, though more work is needed to identify these processes and potential barriers to contraceptive use.
Retos para la prevención y el control del consumo de tabaco y sus derivados en mujeres en Antioquia, Colombia
Authors: Ríos Jennifer Marcela López , Scarinci Isabel Cristina , Garcés Palacio Isabel Cristina
Published: July 2021

Introducción. El consumo de productos derivados del tabaco es una de las principales causas de muerte prevenible, y la brecha en el consumo entre hombres y mujeres es cada vez más estrecha. Objetivo. Describir las fortalezas y/o limitaciones para la implementación de programas encaminados a la prevención y el control del consumo de productos de tabaco en mujeres en Antioquia, Colombia. Métodos. Investigación cualitativa a través de 30 entrevistas semiestructuradas aplicadas en las nueve subregiones del Departamento. Las categorías de análisis se construyeron alrededor del continuum para el control del tabaco (prevención, cesación, humo de segunda mano y políticas públicas). Para los resultados se utilizó el análisis de contenido. Resultados. En Antioquia existen barreras para la implementación efectiva de los programas de prevención, control y cesación del consumo de tabaco, tales como falta de financiación, mayor enfoque en programas relacionados con sustancias psicoactivas, el mercadeo de la industria tabacalera, limitaciones en los planes de beneficios en salud para acceder al tratamiento y poca articulación entre actores del sector de salud, educación, cultura, deporte y comunidad. Además del desconocimiento, poca difusión e incumplimiento de la Ley 1335. Los participantes reportaron no conocer estrategias diferenciadas por género. Conclusión. En el continuum para el control del tabaco existen diversos factores que se constituyen en limitaciones para el establecimiento y desarrollo de programas para la prevención y el control del consumo de tabaco en mujeres en Antioquia, adicionalmente no se evidencia un enfoque diferencial de género.
Design, Synthesis, and Experiment of Foot-Driven Lower Limb Rehabilitation Mechanisms
Authors: Yu Chennan , Ye Jun , Jia Jiangming , Zhao Xiong , Chen Zhiwei , Chen Jianneng
Published: July 2021

A foot-driven rehabilitation mechanism is suitable for home healthcare due to its advantages of simplicity, effectiveness, small size, and low price. However, most of the existing studies on lower limb rehabilitation movement only consider the trajectory of the ankle joint and ignore the influence of its posture angle, which makes it difficult to ensure the rotation requirements of the ankle joint and achieve a better rehabilitation effect. Aiming at the shortcomings of the current research, this article proposes a new single degree-of-freedom (DOF) configuration that uses a noncircular gear train to constrain the three revolute joints (3R) open-chain linkage and expounds its dimensional synthesis method. Then, a parameter optimization model of the mechanism is established, and the genetic algorithm is used to optimize the mechanism parameters. According to the eight groups of key poses and position points of the ankle joint and the toe, the different configurations of the rehabilitation mechanism are synthesized and compared, and it is concluded that the newly proposed 3R open-chain noncircular gear-linkage mechanism exhibits better performance. Finally, combined with the requirements of rehabilitation training, a lower limb rehabilitation training device is designed based on this new configuration, and a prototype is developed and tested. The test results show that the device can meet the requirements of the key position points and posture angles of the ankle joint and the toe and verify the correctness of the proposed dimensional synthesis and optimization methods.
Directional infrasound sensing using acoustic metamaterials
Authors: Rouse Jerry W. , Bowman Daniel , Walsh Timothy F.
Published: July 2021

Natural and anthropogenic infrasound may travel vast distances, making it an invaluable resource for monitoring phenomena such as nuclear explosions, volcanic eruptions, severe storms, and many others. Typically, these waves are captured using pressure sensors, which cannot encode the direction of arrival—critical information when the source location is not known beforehand. Obtaining this information therefore requires arrays of sensors with apertures ranging from tens of meters to kilometers depending on the wavelengths of interest. This is often impractical in locations that lack the necessary real estate (urban areas, rugged regions, or remote islands); in any case, it requires multiple power, digitizer, and telemetry deployments. Here, the theoretical basis behind a compact infrasound direction of arrival sensor based on the acoustic metamaterials is presented. This sensor occupies a footprint that is orders of magnitude smaller than the span of a typical infrasound array. The diminutive size of the unit greatly expands the locations where it can be deployed. The sensor design is described, its ability to determine the direction of arrival is evaluated, and further avenues of study are suggested.
Iterative adaptive frequency-domain equalization based on sliding window strategy over time-varying underwater acoustic channels
Authors: Jing Lianyou , Zheng Tonghui , He Chengbing , Yin Hongxi
Published: July 2021

This letter provides a novel iterative adaptive frequency-domain equalization for time-varying underwater acoustic (UWA) channels. The proposed scheme adopts a modified frequency-domain block least mean square algorithm to update the filter weights. A sliding window strategy is developed to deal with the rapid time-varying characteristics of UWA channels. The proposed method enhances the performance through an iterative structure. Experimental results show that the bit error rates of the proposed method can be one order of magnitude lower than those of conventional schemes.
Targeting aging cells improves survival
Authors: Cox Lynne S. , Lord Janet M.
Published: July 2021

Drugs that remove senescent cells cut coronavirus deaths in old mice
Autonomous biocompatible piezoelectrics
Authors: Berger Shlomo
Published: July 2021

Implants that work with muscles should monitor, correct, and be self-energized
Complete Genome Sequence of Arcanobacterium phocisimile Strain DSM 26142, Isolated from a Harbor Seal
Authors: Borowiak Maria , Alssahen Mazen , Malorny Burkhard , Lämmler Christoph , Siebert Ursula , Plötz Madeleine , Abdulmawjood Amir
Published: July 2021

Bacteria of the genus
Arcanobacterium
can be found in a variety of hosts. The species
Arcanobacterium phocisimile
was originally identified in a free-living harbor seal in the German North Sea in 2004. Here, we announce the complete genome sequence of
Arcanobacterium phocisimile
strain DSM 26142.
Complete Genome Sequence of Escherichia coli O157:H7 Phage UAE_MI-01, Isolated from Bird Feces
Authors: Sultan-Alolama Mohamad Ismail , El-Tarabily Khaled A. , Vijayan Ranjit
Published: July 2021

Bacteriophage UAE_MI-01 is an
Escherichia coli
O157:H7 phage that was isolated from the feces of wild pigeons (
Columba livia domestica
) in Abu Dhabi, United Arab Emirates. All previously reported
E. coli
O157:H7 phages were isolated from ruminants. Here, we report the genetic features of this phage based on its complete genome sequence. UAE_MI-01 has the potential to be used as a therapeutic agent and as an industrial food preservative.
Complete Genome Sequence of Pseudomonas amygdali pv. tabaci Strain 6605, a Causal Agent of Tobacco Wildfire Disease
Authors: Matsui Hidenori , Nishimura Takafumi , Asai Shuta , Masuda Sachiko , Shirasu Ken , Yamamoto Mikihiro , Noutoshi Yoshiteru , Toyoda Kazuhiro , Ichinose Yuki
Published: July 2021

Pseudomonas amygdali
pv.
tabaci
strain 6605 is the bacterial pathogen causing tobacco wildfire disease that has been used as a model for elucidating virulence mechanisms. Here, we present the complete genome sequence of
P. amygdali
pv.
tabaci
6605 as a circular chromosome from reads using a PacBio sequencer.
Coding-Complete Genome Sequences of 11 SARS-CoV-2 B.1.1.7 and B.1.351 Variants from Metro Manila, Philippines
Authors: Velasco John Mark , Chinnawirotpisan Piyawan , Valderama Maria Theresa , Joonlasak Khajohn , Manasatienkij Wudtichai , Huang Angkana , Diones Paula Corazon , Navarro Fatima Claire , Vila Vicente , Tabinas Henry , Chua Domingo , Fernandez Stefan , Jones Anthony , Klungthong Chonticha
Published: July 2021

Here, we report the complete genome sequences of 11 SARS-CoV-2 variants from the Philippines. Lineage analysis showed 3 B.1.1.7 and 8 B.1.351 sequences. One B.1.1.7 sequence contained two additional mutations, F318N and V320F, with V320F located in the receptor-binding domain of the S1 subunit.
Genome Sequences of Measles Virus D4 and D8 Genotypes from India
Authors: Bhattad Divya R. , Kamble Madhukar B. , Vaidya Sunil R.
Published: July 2021

The genomes of 15 measles viruses isolated in 2006 to 2017 from patients <16 years of age with fever and skin rashes from four states and two union territories of India were sequenced. Study genomes were phylogenetically analyzed using 143 Indian and global genomes. The study reconfirms two lineages of D4 isolates and three lineages of D8 isolates from India.
Staged formation of the supergiant Olympic Dam uranium deposit, Australia
Authors: Ehrig Kathy , Kamenetsky Vadim S. , McPhie Jocelyn , Macmillan Edeltraud , Thompson Jay , Kamenetsky Maya , Maas Roland
Published: July 2021

The origins of many supergiant ore deposits remain unresolved because the factors responsible for such extreme metal enrichments are not understood. One factor of critical importance is the timing of mineralization. However, timing information is commonly confounded by the difficulty of dating ore minerals. The world's largest uranium resource at Olympic Dam, South Australia, is exceptional because the high abundance of U allows U-Pb dating of ore minerals. The Olympic Dam U(-Cu-Au-Ag) ore deposit is hosted in ca. 1.59 Ga rocks, and the consensus has been that the supergiant deposit formed at the same time. We argue that, in fact, two stages of mineralization were involved. Paired in situ U-Pb and trace element analyses of texturally distinct uraninite populations show that the supergiant size and highest-U-grade zones are the result of U addition at 0.7–0.5 Ga, at least one billion years after initial formation. This conclusion is supported by a remarkable clustering of thousands of radiogenic 207Pb/206Pb model ages of Cu sulfide grains at this time. Upgrading of the original ca. 1.59 Ga U deposit to its present size at 0.7–0.5 Ga may have resulted from perturbation of regional fluid flow triggered by global climatic (deglaciation) and tectonic (breakup of Rodinia) events.
Magnetostratigraphy across the end-Permian mass extinction event from the Meishan sections, southeastern China
Authors: Zhang Min , Qin Hua-Feng , He Kuang , Hou Yi-Fei , Zheng Quan-Feng , Deng Cheng-Long , He Yan , Shen Shu-Zhong , Zhu Ri-Xiang , Pan Yong-Xin
Published: July 2021

The end-Permian mass extinction (EPME) has been recorded as the most severe biodiversity crisis in Earth's history, although the timing of the marine and terrestrial extinctions remains debatable. We present a new high-resolution magnetostratigraphic succession across the EPME and the Permian-Triassic boundary (PTB) from the Meishan sections in southeastern China, which contain the global boundary stratotype section and point (GSSP) for the base of the Triassic (also the Induan Stage) and the base of the Changhsingian Stage. We identified five normal and five reverse magnetozones, including MS1n to MS5n and MS1r to MS5r, from oldest to youngest, in the Changhsingian and Induan Stages. The Induan Stage was determined to consist of two polarity intervals, where the upper one is reverse (MS5r), and the lower one is normal (MS5n). The Changhsingian Stage is dominated by normal polarity, intercalated with four short-term reverse magnetozones (MS1r to MS4r). Consequently, the PTB and the Wuchiapingian-Changhsingian boundary are clearly located in MS5n and MS1n, respectively. These new magnetostratigraphic results provide a potential reference geomagnetic polarity pattern with which to refine the geomagnetic polarity time scale for the EPME and the Permian-Triassic transition.
Precession-driven climate cycles and time scale prior to the Hirnantian glacial maximum
Authors: Sinnesael M. , McLaughlin P.I. , Desrochers A. , Mauviel A. , De Weirdt J. , Claeys P. , Vandenbroucke T.R.A.
Published: July 2021

Paleozoic astrochronologies are limited by uncertainties in past astronomical configurations and the availability of complete stratigraphic sections with precise, independent age control. We show it is possible to reconstruct a robust Paleozoic ~104-yr-resolution astrochronology in the well-preserved and thick Upper Ordovician reference record of Anticosti Island (Canada). The clear imprint of astronomical cycles, including ~18 k.y. precession, potential obliquity, and short and long eccentricity, constrains the entire Vauréal Formation (~1 km thick) to only ~3 m.y. in total, representing ~10 times higher accumulation rates than previously suggested. This ~104 yr resolution represents an order of magnitude increase in the current standard temporal resolution for the Katian and even allows for the detection of sub-Milankovitch climate-scale variability. The loss of a clear precession signal in the uppermost Vauréal Formation might be related to contemporaneous global cooling prior to the Hirnantian glacial maximum as indicated by the δ18O record. Complementary to the study of cyclostratigraphy of longer and often simplified records, it is important to recognize stratigraphic hiatuses and complexities on the ~104 yr scale to achieve robust sub-eccentricity-scale Paleozoic astrochronologies.
Supplemental Material: Cenozoic structural evolution of the Catalina metamorphic core complex and reassembly of Laramide reverse faults, southeastern Arizona, USA
Authors: Favorito D.A. , Seedorff E.
Published: July 2021

Spot map data for geochronology samples discussed in Appendix A.
Association between type 2 diabetes and chronic low back pain in general practices in Germany
Authors: Jacob Louis , Rathmann Wolfgang , Koyanagi Ai , Haro Josep Maria , Kostev Karel
Published: July 2021

Introduction

There are conflicting results on the association between type 2 diabetes and chronic low back pain (CLBP). Therefore, the goal was to investigate the relationship between type 2 diabetes and CLBP in individuals followed in general practices in Germany.

Research design and methods

Adults diagnosed for the first time with type 2 diabetes in 809 general practices in Germany between 2005 and 2018 (index date) were included. Adults without type 2 diabetes were matched (1:1) to those with type 2 diabetes by sex, age, index year, and the annual number of medical consultations (index date: a randomly selected visit date). The association between type 2 diabetes and the 10-year incidence of CLBP was analyzed in conditional Cox regression models adjusted for a wide range of comorbidities, including hypertension, lipid metabolism disorders, and obesity.

Results

There were 139 002 individuals included in this study (women: 58.0%; mean (SD) age 62.5 (13.4) years). There was a positive association between type 2 diabetes and the incidence of CLBP in the overall sample (HR=1.23, 95% CI: 1.13 to 1.35). Sex-stratified analyses showed a higher risk of CLBP in women (HR=1.68, 95% CI: 1.43 to 1.90) and a lower risk in men with than in their counterparts without type 2 diabetes (HR=0.83, 95% CI: 0.71 to 0.97).

Conclusions

Newly diagnosed type 2 diabetes was associated with an increased risk of CLBP. There were important sex differences in the type 2 diabetes-CLBP relationship, and more research is warranted to investigate the underlying factors explaining these differences.
The impacts of government reimbursement negotiation on targeted anticancer medication price, volume and spending in China
Authors: Zhang Yichen , Wushouer Haishaerjiang , Han Sheng , Fu Mengyuan , Guan Xiaodong , Shi Luwen , Wagner Anita
Published: July 2021

Introduction

New targeted therapies have changed cancer treatment in the past decades. However, high prices of targeted anticancer medications have increased economic burden for both patients and health insurance systems. In July 2017, China implemented combined medication price negotiation and mandatory reimbursement policies for 15 targeted anticancer medications. This study assesses effects of the policy on hospital procurement prices, volumes and spending.

Methods

Using a quasi-experimental interrupted time series design, we analysed procurement data from the Chinese Medical Economic Information of 789 public hospitals in 30 provinces between January 2016 and September 2018. The intervention group consisted of 15 targeted anticancer medications with negotiated prices in 2017. The comparison group consisted of six targeted anticancer medications without negotiated prices by 2018. The effective date of the policy was September 2017.

Results

After the implementation of the 2017 medication price negotiation and reimbursement policy, cost per defined daily dose (DDD) of the 15 targeted anticancer medications dropped US$71.21 on average from an average US$169.24/DDD before (p=0.000). Compared with what would have happened without the intervention, cost/DDD of price-negotiated medications decreased by 48.9% (p=0.000), procurement volumes increased by 143.0% (p=0.000) and hospital medication spending decreased by 6.9% (p=0.146).

Conclusions

The 2017 medication price negotiation and reimbursement policy decreased targeted medication procurement costs per DDD, increased volumes procured and at least temporarily contained spending. These changes should result in better access to and affordability of targeted anticancer medications in China.
Effect of needle type on plane block spread in a cadaveric porcine model
Authors: Hughey Scott , Cole J , Booth G J , Gliniecki R , Stedjelarsen E
Published: July 2021

Introduction

Plane blocks are an increasingly common type of regional anaesthesia technique in the perioperative period. Increased spread of local anaesthesia during plane blocks is thought to be related to an increased area of pain coverage. This study sought to assess differences in injectate spread comparing Tuohy needles with standard insulated stimulating block needles.

Methods

10 Yorkshire-Cross porcine cadavers were used in this study. Immediately following euthanasia, the cadavers underwent bilateral ultrasound-guided transversus abdominis plane (TAP) block injection with radiopaque contrast dye, with one side placed with a 20 g Tuohy needle, and the other side with a 20 g insulated stimulating block needle. Injectate spread was assessed using plain film X-ray and area of spread was measured to compare differences.

Results

All 10 animals underwent successful ultrasound-guided TAP block placement. In all 10 animals, the area of contrast spread was greater with the Tuohy than stimulating needle. Wilcoxon signed-rank test was used to analyse the difference between the groups. The average difference between the two sides was 33.02% (p=0.002).

Conclusions

This is the first study to demonstrate differences in injectate spread with different needle types. This suggests enhanced spread with Tuohy needle compared with standard block needle, and may encourage its use during plane blocks.
Factors associated with low back pain in air force fighter pilots: a cross-sectional study
Authors: Gomes Sâmara Raquel Alves , Mendes P R F , Costa L D O , Bulhões L C C , Borges D T , Macedo Ld B , Brasileiro J
Published: July 2021

Introduction

Low back pain in military pilots is a frequent condition which constantly leads to absences from work, decreased concentration and performance during flight, as well as changes in work functions.

Methods

This is a cross-sectional analytical study including 28 fighter pilots who underwent an evaluation comprising muscle strength and fatigue resistance, trunk mobility and application of questionnaires to identify associated clinical factors.

Results

It was observed that 68% of the pilots reported low back pain with an average pain intensity of 3.7 at numerical pain scale in the last week. No significant differences were observed regarding the range of motion and trunk muscle strength when pilots with low back pain were compared with asymptomatic pilots. However, lateral right trunk muscle (mean difference=16, 95% CI 0.6 to 33.0]) and lateral left trunk muscle (mean difference=22, 95% CI 1 to 44) fatigue sooner in pilots with low back pain when the two groups were compared (p=0.04 for both).

Conclusion

There was a high rate of low back pain complaints among fighter pilots. There was also a significant reduction in fatigue resistance of the lateral trunk muscles in symptomatic pilots when compared with asymptomatic pilots. These factors must be considered in the physical training of this population.
Local anaesthetics combined with vasoconstrictors in patients with cardiovascular disease undergoing dental procedures: systematic review and meta-analysis
Authors: Guimaraes Caio Chaves , Lopes Luciane Cruz , Bergamaschi Cristiane de Cássia , Ramacciato Juliana Cama , Silva Marcus Tolentino , Araújo Jimmy de Oliveira , de Andrade Natalia Karol , Motta Rogério Heládio Lopes
Published: July 2021

Objectives

There is a lack of evidence about the use of local anaesthetics (LAs) in patients with cardiovascular diseases (CVD) in dental procedures. Thus, this study evaluated the safety of using LA with vasoconstrictor to determine the risk of cardiovascular events in patients with CVD.

Design

Systematic review and meta-analysis.

Methods

We have searched in Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (via Ovid), EMBASE (via Ovid), Healthstar (via Ovid), CINAHL, Web of Science and ClinicalTrials.gov for randomised controlled trials (RCTs) up to January 2020. We have included RCTs involving adults with CVD within two groups: intervention group with LA with vasoconstrictor and control group with LA without vasoconstrictor. The primary outcomes assessed were death, mortality by a specific cause, stroke, acute myocardial infarction, hospitalisation, pain, bleeding and arrhythmias. The secondary outcomes were ST segment depression, anxiety, adverse effects and changes in haemodynamic parameters. The data were pooled using random effects meta-analyses and the confidence in the estimates was verified using the Grading of Recommendations Assessment, Development and Evaluation (GRADE).

Results

Ten RCTs (n=478 participants) were included. Most of them had a high risk of bias. There were more cases of pain and bleeding in groups without vasoconstrictor. Meta-analysis demonstrated a decrease in the systolic blood pressure with the use of LA with vasoconstrictor (standard mean difference −0.95, 95% CI −1.35 to −0.55) after procedure. Overall, for the other outcomes assessed there was no statistical difference. The quality of evidence was considered low according to the GRADE profile.

Conclusions

The results suggest that the use of LA with vasoconstrictors (epinephrine in low doses) is safe in patients with some types of CVD. However, the low quality of evidence demonstrated that literature needs further studies in order to confirm these results.

Protocol registration

PROSPERO (CRD42016045421).
Determinants of drug prices: a systematic review of comparison studies
Authors: Janssen Daalen Jules M , den Ambtman Anouk , Van Houdenhoven Mark , van den Bemt Bart J F
Published: July 2021

Objective

In this systematic review on drug price comparison studies, we report on recent determinants of drug prices in a national and international context to facilitate regulation of drug prices by purchasers and policymakers worldwide. Determinants of drug prices were divided into non-modifiable and modifiable and were categorised as pertaining to a country’s income level, pharmaceutical market system and its policies and government.

Primary outcome

Determinants of drug prices or price variance.

Design

We systematically searched PubMed, EMBASE, Web of Science and Cochrane Library for peer-reviewed articles published between 2004 and 22 July 2020 that reported an association of the primary outcome with one or more determinants. We performed a best-evidence synthesis of these associations for determinants covered in at least three studies.

Results

31 publications were included. Only one publication described net drug prices and 30 described retail drug prices. Five modifiable determinants were associated with lower retail prices: generic market portion, discounts, tendering policies, central (governmental) purchasing and pricing regulation schemes. The originators market portion and a system in which mark-ups are common were associated with higher retail prices. Retail prices were highest in the USA, even compared with other high-income countries. A positive association between national income level and drug retail prices could not be established among middle-income and high-income countries. Retail prices were highest in low-income countries when adjusted for purchasing power parity.

Conclusions

Literature on determinants of net drug prices is extremely sparse. Various healthcare system interventions, market-specific and governmental regulations are consistently associated with lower retail prices. Some interventions are easily implementable in developing or middle-income countries, such as tendering, central purchasing and fixed pricing regulation schemes. Net drug price comparison studies are needed to overcome the lack of price transparency and to quantify the effectiveness of policy measures on net drug prices.
Cohort profile of Acutelines: a large data/biobank of acute and emergency medicine
Authors: ter Avest Ewoud , van Munster Barbara C , van Wijk Raymond J , Tent Sanne , Ter Horst Sanne , Hu Ting Ting , van Heijst Lisanne E , van der Veer Felien S , van Beuningen Fleur E , ter Maaten Jan Cornelis , Bouma Hjalmar R
Published: July 2021

Purpose

Research in acute care faces many challenges, including enrolment challenges, legal limitations in data sharing, limited funding and lack of singular ownership of the domain of acute care. To overcome these challenges, the Center of Acute Care of the University Medical Center Groningen in the Netherlands, has established a de novo data, image and biobank named ‘Acutelines’.

Participants

Clinical data, imaging data and biomaterials (ie, blood, urine, faeces, hair) are collected from patients presenting to the emergency department (ED) with a broad range of acute disease presentations. A deferred consent procedure (by proxy) is in place to allow collecting data and biomaterials prior to obtaining written consent. The digital infrastructure used ensures automated capturing of all bed-side monitoring data (ie, vital parameters, electrophysiological waveforms) and securely importing data from other sources, such as the electronic health records of the hospital, ambulance and general practitioner, municipal registration and pharmacy. Data are collected from all included participants during the first 72 hours of their hospitalisation, while follow-up data are collected at 3 months, 1 year, 2 years and 5 years after their ED visit.

Findings to date

Enrolment of the first participant occurred on 1 September 2020. During the first month, 653 participants were screened for eligibility, of which 180 were approached as potential participants. In total, 151 (84%) provided consent for participation of which 89 participants fulfilled criteria for collection of biomaterials.

Future plans

The main aim of Acutelines is to facilitate research in acute medicine by providing the framework for novel studies and issuing data, images and biomaterials for future research. The protocol will be extended by connecting with central registries to obtain long-term follow-up data, for which we already request permission from the participant.

Trial registration number

NCT04615065.
Cancer related fatigue—light therapy: updated meta-analysis of randomised controlled trials
Authors: Hung Chao-Ming , Zeng Bing-Yan , Zeng Bing-Syuan , Sun Cheuk-Kwan , Cheng Yu-Shian , Su Kuan-Pin , Wu Yi-Cheng , Chen Tien-Yu , Lin Pao-Yen , Liang Chih-Sung , Hsu Chih-Wei , Chu Che-Sheng , Chen Yen-Wen , Yeh Pin-Yang , Wu Ming-Kung , Tseng Ping-Tao , Matsuoka Yutaka J
Published: July 2021

Background

Moderate-to-severe cancer related fatigue occurs in 45% of patients with cancer and interferes with many aspects of quality of life. Although physical exercise has level 1 evidence for improvement of cancer related fatigue, it has a relatively high behavioural demand compared with other non-pharmacological interventions. The aim of this updated meta-analysis was to address the efficacy of light therapy in improving cancer related fatigue in patients with cancer.

Methods

We included randomised controlled trials investigating the efficacy of bright white light (BWL) therapy in ameliorating cancer related fatigue in patients with cancer. This meta-analysis was conducted using a random-effects model. The target outcomes were changes in cancer related fatigue associated with BWL or dim red light (DRL).

Results

There were 9 articles with 231 participants included. The main results revealed that daily morning BWL for 30 min was associated with significantly better improvement in fatigue severity compared with DRL (k=5, Hedges’g=−0.414, 95% CI −0.740 to −0.087, p=0.013). The subgroup without psychiatric comorbidities (k=4, Hedges’g=−0.479, 95% CI −0.801 to −0.156, p=0.004) was associated with significantly better improvement in fatigue severity with BWL than with DRL. In contrary, BWL was not associated with significantly different changes in depression severity or quality of life compared with DRL. Finally, BWL was associated with similar acceptability (ie, dropout rate) and safety profile (ie, any discomfort) as those of DRL.

Conclusions

This meta-analysis provides an updated evidence on the rationale for application of BWL in ameliorating cancer related fatigue in patients with different types of cancer.

Trial registration number

INPLASY202140090.
Treatment of ruptured intracranial aneurysms with the Woven EndoBridge device: a systematic review
Authors: Monteiro Andre , Lazar Audrey L , Waqas Muhammad , Rai Hamid H , Baig Ammad A , Cortez Gustavo M , Dossani Rimal H , Cappuzzo Justin M , Levy Elad I , Siddiqui Adnan H
Published: July 2021

The Woven EndoBridge (WEB) device is a barrel-shaped nitinol mesh deployed within the aneurysmal sac. The absence of metallic mesh in the aneurysm’s parent vessel lumen obviates the need for potent antiplatelet therapy, making this device appealing for acutely ruptured aneurysms not amenable to clipping or coiling. To assess the literature regarding WEB treatment of these aneurysms, we performed a comprehensive systematic search of PubMed, MEDLINE, and EMBASE databases following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Keywords were combined with Boolean operators to increase search sensitivity and specificity (‘woven endobridge device’ AND ‘ruptured’). Nine studies comprising 377 acutely ruptured aneurysms were included. Overall, 82.7% were wide-necked, 85.9% were located in the anterior circulation, and 26.9% of patients presented with poor subarachnoid hemorrhage grade. Intraprocedure and postprocedure complications occurred in 8.4% (95% CI 3.6% to 13.3%) and 1% (95% CI 0% to 2%), respectively. The post-treatment rebleeding rate was 0%. Rates of adequate occlusion (complete occlusion to neck remnant) and retreatment at last follow-up were 84.8% (95% CI 73% to 96.6%) and 4.5% (95% CI 2.2% to 6.8%), respectively. The favorable outcome rate (modified Rankin Scale score 0–2) was 62.2% (95% CI 53% to 71.4%); mortality was 13.6% (95% CI 9.7% to 17.6%). WEB treatment of acutely ruptured aneurysms results in high adequate occlusion rates, low perioperative complication rates, no rebleeding, and low recurrence requiring retreatment. This device is promising for acutely ruptured aneurysms not amenable to clipping or coiling, considering the lower need for antiplatelet regimens during the procedure or follow-up.
Endovascular thrombectomy without versus with intravenous thrombolysis in acute ischemic stroke: a non-inferiority meta-analysis of randomized clinical trials
Authors: Lin Chun-Hsien , Saver Jeffrey L , Ovbiagele Bruce , Huang Wen-Yi , Lee Meng
Published: July 2021

Objective

To conduct a meta-analysis of randomized trials to comprehensively compare the effect of endovascular thrombectomy (EVT) versus intravenous thrombolysis (IVT) plus EVT on functional independence (modified Rankin Scale (mRS) 0–2) after acute ischemic stroke due to large vessel occlusions (AIS-LVO).

Methods

We searched Pubmed, EMBASE, CENTRAL, and clinicaltrials.gov from January 2000 to February 2021 and abstracts presented at the International Stroke Conference in March 2021 to identify trials comparing EVT alone versus IVT plus EVT in AIS-LVO. Five non-inferiority margins established in the literature were assessed: −15%, −10%, −6.5%, −5%, and −1.3% for the risk difference for functional independence at 90 days.

Results

Four trials met the selection criteria, enrolling 1633 individuals, with 817 participants randomly assigned to EVT alone and 816 to IVT plus EVT. Crude cumulative rates of 90-day functional independence were 46.0% with EVT alone versus 45.5% with IVT plus EVT. Pooled results showed the risk difference of functional independence was 1% (95% CI −4% to 5%) between EVT alone versus IVT plus EVT. The lower 95% CI bound of −4% fell within the non-inferiority margins of −15%, −10%, −6.5%, and −5%, but not −1.3%. Pooled results also showed the risk difference between EVT alone versus IVT plus EVT was 1% (95% CI −3% to 5%) for mRS 0–1, and 1% (95% CI −1% to 3%) for symptomatic intracranial hemorrhage.

Conclusions

This meta-analysis suggests that EVT alone is non-inferior to IVT plus EVT for several, but not the most stringent, non-inferiority margins.
Making your geriatric and palliative programs a strength: TQIP guideline implementation and the VRC perspective
Authors: Ho Vanessa P , Adams Sasha D , O'Connell Kathleen M , Cocanour Christine S , Arbabi Saman , Powelson Elisabeth B , Cooper Zara , Stein Deborah M
Published: July 2021

Background

Older patients compose approximately 30% of trauma patients treated in the USA but make up nearly 50% of deaths from trauma. To help standardize and elevate care of these patients, the American College of Surgeons (ACS) Trauma Quality Improvement Program’s best practice guidelines for geriatric trauma management was published in 2013 and that for palliative care was published in 2017. Here, we discuss how palliative care and geriatrics quality metrics can be tracked and used for performance improvement and leveraged as a strength for trauma verification.

Methods

We discuss the viewpoint of the ACS Verification, Review, and Consultation and three case studies, with practical tips and takeaways, of how these measures have been implemented at different institutions.

Results

We describe the use of (1) targeted educational initiatives, (2) development of a consultation tool based on institutional resources, and (3) application of a nurse-led frailty screen.

Discussion

Specialized care and attention to these vulnerable populations is recommended, but the implementation of these programs can take many shapes.

Level of evidenceV
Bayesian neural network-based uncertainty modelling: application to soil compressibility and undrained shear strength prediction
Authors: Zhang Pin , Yin Zhen-Yu , Jin Yin-Fu
Published: July 2021

This study adopts the Bayesian neural network (BNN) integrated with a strong non-linear fitting capability and uncertainty, which has not previously been used in geotechnical engineering, to propose a modelling strategy in developing prediction models for soil properties. The compression index Cc and undrained shear strength su of clays are selected as examples. Variational inference (VI) and Monte Carlo dropout (MCD), two theoretical frameworks for solving and approximating BNN, respectively, are employed and compared. The results indicate that the BNN focused on identifying patterns in datasets, and the predicted Cc and su show excellent agreement with the actual values. The reliability of the predicted results using BNN is high in the area of dense datasets. In contrast, the BNN demonstrates low reliability in the predicted result in the area of sparse datasets. Additionally, a novel parametric analysis method in combination with the cumulative distribution function is proposed. The analysis results indicate that the BNN-based models are capable of capturing the relationships of input parameters to the Cc and su. BNN, with its strong prediction capability and reliable evaluation, therefore, shows great potential to be applied in geotechnical design.