bluuebunny/crossref_metadata_2025 huggingface dataset:
A precision medicine framework for personalized simulation of hemodynamics in cerebrovascular disease
Authors: Frey Dietmar , Livne Michelle , Leppin Heiko , Akay Ela M. , Aydin Orhun U. , Behland Jonas , Sobesky Jan , Vajkoczy Peter , Madai Vince I.
Published: May 2021

Background

Cerebrovascular disease, in particular stroke, is a major public health challenge. An important biomarker is cerebral hemodynamics. To measure and quantify cerebral hemodynamics, however, only invasive, potentially harmful or time-to-treatment prolonging methods are available.

Results

We present a simulation-based approach which allows calculation of cerebral hemodynamics based on the patient-individual vessel configuration derived from structural vessel imaging. For this, we implemented a framework allowing segmentation and annotation of brain vessels from structural imaging followed by 0-dimensional lumped simulation modeling of cerebral hemodynamics. For annotation, a 3D-graphical user interface was implemented. For 0D-simulation, we used a modified nodal analysis, which was adapted for easy implementation by code. The simulation enables identification of areas vulnerable to stroke and simulation of changes due to different systemic blood pressures. Moreover, sensitivity analysis was implemented allowing the live simulation of changes to simulate procedures and disease progression. Beyond presentation of the framework, we demonstrated in an exploratory analysis in 67 patients that the simulation has a high specificity and low-to-moderate sensitivity to detect perfusion changes in classic perfusion imaging.

Conclusions

The presented precision medicine approach using novel biomarkers has the potential to make the application of harmful and complex perfusion methods obsolete.
Co-administration of combretastatin A4 nanoparticles and anti-PD-L1 for synergistic therapy of hepatocellular carcinoma
Authors: Zhao Bonan , Dong Zhipeng , Liu Weixing , Lou Fangning , Wang Qiyan , Hong Hao , Wang Yue
Published: May 2021

Background

According to data estimated by the WHO, primary liver cancer is currently the fourth most common malignant tumor and the second leading cause of death around the world. Hepatocellular carcinoma (HCC) is one of the most common primary liver malignancies, so effective therapy is highly desired for HCC.

Results

In this study, the use of poly(l-Aspartic acid)-poly(ethylene glycol)/combretastatin A4 (CA4-NPs) was aimed to significantly disrupt new blood vessels in tumor tissues for targeted hepatic tumor therapy. Here, PEG-b-PAsp-g-CA4 showed significantly prolonged retention in plasma and tumor tissue. Most importantly, CA4-NPs were mainly distributed at the tumor site because of the triple target effects—enhanced permeability and retention (EPR) effect, acid-sensitive (pH = 5.5) effect to the tumor microenvironment (TME), and good selectivity of CA4 for central tumor blood vessel. Considering that CA4-NPs might induce severe hypoxic conditions resulting in high expression of HIF-1α in tumor tissues, which could induce the overexpression of PD-L1, herein we also used a programmed death-ligand 1 antibody (aPD-L1) to prevent immunosuppression. This way of complementary combination is able to achieve an ideal treatment effect in tumor site where CA4-NPs and aPD-L1 could respond to the inner area and peripheral area, respectively. As a result, a significant decrease in tumor volume and weight was observed in the combination group of CA4-NPs plus aPD-L1 compared with CA4-NPs or aPD-L1 monotherapy in subcutaneous Hepa1-6 hepatic tumor models.

Conclusions

We presented a new idea that co-administration of CA4-NPs and aPD-L1 possessed notable anti-tumor efficacy for HCC treatment.

Graphic abstract
Conceptual framework for task shifting and task sharing: an international Delphi study
Authors: Orkin Aaron M. , Rao Sampreeth , Venugopal Jeyasakthi , Kithulegoda Natasha , Wegier Pete , Ritchie Stephen D. , VanderBurgh David , Martiniuk Alexandra , Salamanca-Buentello Fabio , Upshur Ross
Published: May 2021

Background

Task shifting and sharing (TS/S) involves the redistribution of health tasks within workforces and communities. Conceptual frameworks lay out the key factors, constructs, and variables involved in a given phenomenon, as well as the relationships between those factors. Though TS/S is a leading strategy to address health worker shortages and improve access to services worldwide, a conceptual framework for this approach is lacking.

Methods

We used an online Delphi process to engage an international panel of scholars with experience in knowledge synthesis concerning TS/S and develop a conceptual framework for TS/S. We invited 55 prospective panelists to participate in a series of questionnaires exploring the purpose of TS/S and the characteristics of contexts amenable to TS/S programmes. Panelist responses were analysed and integrated through an iterative process to achieve consensus on the elements included in the conceptual framework.

Results

The panel achieved consensus concerning the included concepts after three Delphi rounds among 15 panelists. The COATS Framework (Concepts and Opportunities to Advance Task Shifting and Task Sharing) offers a refined definition of TS/S and a general purpose statement to guide TS/S programmes. COATS describes that opportunities for health system improvement arising from TS/S programmes depending on the implementation context, and enumerates eight necessary conditions and important considerations for implementing TS/S programmes.

Conclusion

The COATS Framework offers a conceptual model for TS/S programmes. The COATS Framework is comprehensive and adaptable, and can guide refinements in policy, programme development, evaluation, and research to improve TS/S globally.
The roles and mechanisms of hypoxia in liver fibrosis
Authors: Cai Jingyao , Hu Min , Chen Zhiyang , Ling Zeng
Published: May 2021

Liver fibrosis occurs in response to any etiology of chronic liver injury. Lack of appropriate clinical intervention will lead to liver cirrhosis or hepatocellular carcinoma (HCC), seriously affecting the quality of life of patients, but the current clinical treatments of liver fibrosis have not been developed yet. Recent studies have shown that hypoxia is a key factor promoting the progression of liver fibrosis. Hypoxia can cause liver fibrosis. Liver fibrosis can, in turn, profoundly further deepen the degree of hypoxia. Therefore, exploring the role of hypoxia in liver fibrosis will help to further understand the process of liver fibrosis, and provide the theoretical basis for its diagnosis and treatment, which is of great significance to avoid further deterioration of liver diseases and protect the life and health of patients. This review highlights the recent advances in cellular and molecular mechanisms of hypoxia in developments of liver fibrosis.
Absence of the CXCR4 antagonist EPI-X4 from pharmaceutical human serum albumin preparations
Authors: Gilg Andrea , Harms Mirja , Olari Lia-Raluca , Urbanowitz Ann-Kathrin , Bonig Halvard , Münch Jan
Published: May 2021

Background

Endogenous Peptide Inhibitor of CXCR4 (EPI-X4) is a natural antagonist of the CXC chemokine receptor 4 (CXCR4). EPI-X4 is a 16-mer peptide that is released from human serum albumin (HSA) by acidic aspartic proteases such as Cathepsin D and E. Since human serum albumin (HSA) is an important medicinal substance we asked whether different pharmaceutical HSA products contain EPI-X4 which could have been generated during manufacturing and whether HSA can serve as a substrate for cathepsins despite of the presence of stabilizers like caprylate.

Methods

Eight pharmaceutical HSA preparations representing all currently used fractionation technologies were analyzed. The previously described specific EPI-X4 ELISA was used for quantification; in vitro EPI-X4 generation by acidification in the presence or absence of cathepsins was followed by quantification with ELISA.

Results

None of the pharmaceutical HSA preparations tested contained EPI-X4. Acidification of HSA did not generate EPI-X4. Addition of cathepsins D and E to acidified HSA yielded high concentrations of EPI-X4 in all HSA preparations, indistinguishable between individual products.

Conclusion

Medicinal HSA preparations per se do not contain EPI-X4, but will replenish its precursor which can be cleaved to EPI-X4 in vivo, environmental conditions permitting.
A new approach of inducing proprioceptive illusion by transcutaneous electrical stimulation
Authors: Rangwani Rohit , Park Hangue
Published: May 2021

Background

Neurotraumas or neurodegenerative diseases often result in proprioceptive deficits, which makes it challenging for the nervous system to adapt to the compromised sensorimotor conditions. Also, in human machine interactions, such as prosthesis control and teleoperation, proprioceptive mismatch limits accuracy and intuitiveness of controlling active joints in robotic agents. To address these proprioceptive deficits, several invasive and non-invasive approaches like vibration, electrical nerve stimulation, and skin stretch have been introduced. However, proprioceptive modulation is still challenging as the current solutions have limitations in terms of effectiveness, usability, and consistency. In this paper, we propose a new way of modulating proprioception using transcutaneous electrical stimulation. We hypothesized that transcutaneous electrical stimulation on elbow flexor muscles will induce illusion of elbow joint extension.

Method

Eight healthy human subjects participated in the study to test the hypothesis. Transcutaneous electrodes were placed on different locations targeting elbow flexor muscles on human subjects and experiments were conducted to identify the best locations for electrode placement, and best electrical stimulation parameters, to maximize induced proprioceptive effect. Arm matching experiments and Pinocchio illusion test were performed for quantitative and qualitative analysis of the observed effects. One-way repeated ANOVA test was performed on the data collected in arm matching experiment for statistical analysis.

Results

We identified the best location for transcutaneous electrodes to induce the proprioceptive illusion, as one electrode on the muscle belly of biceps brachii short head and the other on the distal myotendinous junction of brachioradialis. The results for arm-matching and Pinocchio illusion tests showed that transcutaneous electrical stimulation using identified electrode location and electrical stimulation parameters evoked the illusion of elbow joint extension for all eight subjects, which supports our hypothesis. On average, subjects reported 6.81° angular illusion of elbow joint extension in arm-matching tests and nose elongated to 1.78 × height in Pinocchio illusion test.

Conclusions

Transcutaneous electrical stimulation, applied between the the synergistic elbow flexor muscles, consistently modulated elbow joint proprioception with the illusion of elbow joint extension, which has immense potential to be translated into various real-world applications, including neuroprosthesis, rehabilitation, teleoperation, mixed reality, and etc.
Leaf area index estimation model for UAV image hyperspectral data based on wavelength variable selection and machine learning methods
Authors: Zhang Juanjuan , Cheng Tao , Guo Wei , Xu Xin , Qiao Hongbo , Xie Yimin , Ma Xinming
Published: May 2021

Background

To accurately estimate winter wheat leaf area index (LAI) using unmanned aerial vehicle (UAV) hyperspectral imagery is crucial for crop growth monitoring, fertilization management, and development of precision agriculture.

Methods

The UAV hyperspectral imaging data, Analytical Spectral Devices (ASD) data, and LAI were simultaneously obtained at main growth stages (jointing stage, booting stage, and filling stage) of various winter wheat varieties under various nitrogen fertilizer treatments. The characteristic bands related to LAI were extracted from UAV hyperspectral data with different algorithms including first derivative (FD), successive projections algorithm (SPA), competitive adaptive reweighed sampling (CARS), and competitive adaptive reweighed sampling combined with successive projections algorithm (CARS_SPA). Furthermore, three modeling machine learning methods including partial least squares regression (PLSR), support vector machine regression (SVR), and extreme gradient boosting (Xgboost) were used to build LAI estimation models.

Results

The results show that the correlation coefficient between UAV and ASD hyperspectral data is greater than 0.99, indicating the UAV data can be used for estimation of wheat growth information. The LAI bands selected by using different algorithms were slightly different among the 15 models built in this study. The Xgboost model using nine consecutive characteristic bands selected by CARS_SPA algorithm as input was proved to have the best performance. This model yielded identical results of coefficient of determination (0.89) for both calibration set and validation set, indicating a high accuracy of this model.

Conclusions

The Xgboost modeling method in combine with CARS_SPA algorithm can reduce input variables and improve the efficiency of model operation. The results provide reference and technical support for nondestructive and rapid estimation of winter wheat LAI by using UAV.
Delayed embolization associated with increased mortality in pelvic fracture with hemodynamic stability at hospital arrival
Authors: Aoki Makoto , Abe Toshikazu , Matsumoto Shokei , Hagiwara Shuichi , Saitoh Daizoh , Oshima Kiyohiro
Published: May 2021

Background

Embolization is widely used for controlling arterial hemorrhage associated with pelvic fracture. However, the effect of a delay in embolization among hemodynamically stable patients at hospital arrival with a pelvic fracture is unknown. Therefore, our aim was to investigate the association between the time to embolization and mortality in hemodynamically stable patients at hospital arrival with a pelvic fracture.

Methods

A multicenter, retrospective cohort study was undertaken using data from the Japan Trauma Data Bank between 2004 and 2018. Hemodynamically, stable patients with a pelvic fracture who underwent an embolization within 3 h were divided into six groups of 30-min blocks of time until pelvic embolization (0–30, 30–60, 60–90, 90–120, 120–150, and 150–180 min). We compared the adjusted 30-day mortality rate according to time to embolization.

Results

We studied 620 hemodynamically stable patients with a pelvic fracture who underwent pelvic embolization within 3 h of hemorrhage. The median age was 68 (48–79) years and 55% were male. The median injury severity score was 26 (18–38). Thirty-day mortality was 8.9% (55/620) and 24-h mortality was 4.2% (26/619). A Cochran–Armitage test showed that a 30-min delay for embolization was associated with increased 30-day (p = 0.0186) and 24-hour (p = 0.033) mortality. Mortality within 0–30 min to embolization was 0%. The adjusted 30-day mortality rate increased with delayed embolization and was up to 17.0% (10.2–23.9) for the 150–180 min group.

Conclusion

Delayed embolization was associated with increased mortality in pelvic fracture with hemodynamic stability at hospital arrival. When you decide to embolize pelvic fracture patients, the earlier embolization may be desirable to promote improved survival regardless of hemodynamics.
Overview on population screening for carriers with germline mutations in mismatch repair (MMR) genes in China
Authors: Zhang Min , Chen Tianhui
Published: May 2021

DNA mismatch repair (MMR) genes play an important role in maintaining genome stability. Germline mutations in MMR genes disrupt the mismatch repair function and cause genome instability. Carriers with MMR germline mutations are more likely to have MMR deficiency and microsatellite instability (MSI) than non-carriers and are prone to develop colorectal cancer (CRC) and extracolorectal malignancies, known as Lynch syndrome (LS). MMR gene testing for suspected mutation carriers is a reliable method to identify the mutation types and to discover mutation carriers. Given that carriers of MMR germline mutations have a higher risk of LS-related cancers (LS-RC) and a younger age at onset than non-carriers, early surveillance and regular screening of relevant organs of carriers are very important for early detection of related cancers. This review mainly focuses on the general status of MMR carriers, the approaches for early detection and screening, and the surveillance of MMR mutation carriers in China. Population screening of MMR germline mutation carriers in China will be helpful for early detection, early diagnosis and treatment of MMR mutation carriers, which may improve the 5-year survival, and reduce mortality and incidence rate in the long term.
Levetiracetam versus fosphenytoin as a second-line treatment after diazepam for status epilepticus: study protocol for a multicenter non-inferiority designed randomized control trial
Authors: Nakamura Kensuke , Marushima Aiki , Takahashi Yuji , Kimura Akio , Asami Masahiro , Egawa Satoshi , Kaneko Junya , Kondo Yutaka , Yonekawa Chikara , Hoshiyama Eisei , Yamada Takeshi , Maruo Kazushi , Inoue Yoshiaki ,   IENE ECT with the LIFE study group
Published: May 2021

Background

Status epilepticus (SE) is an emergency condition for which rapid and secured cessation is important. Phenytoin and fosphenytoin, the prodrug of phenytoin with less severe adverse effects, have been recommended as second-line treatments. However, fosphenytoin causes severe adverse events, such as hypotension and arrhythmia. Levetiracetam reportedly has similar efficacy and higher safety for SE; however, evidence to support its use for adult SE is lacking. In the present study, a non-inferiority designed multicenter randomized controlled trial (RCT) is being conducted to compare levetiracetam with fosphenytoin after diazepam as a second-line treatment for SE.

Methods

This multicenter, prospective, and open-label RCT is conducted in emergency departments. Between December 23, 2019, and March 31, 2023, 176 patients with convulsive SE transported to an emergency room will be randomized into a fosphenytoin group and levetiracetam group at a ratio of 1:1. The definition of SE is “continuous seizures longer than 5 min or discrete seizures longer than 2 min with intervening consciousness disturbance.” In both groups, diazepam is initially administered at 1–20 mg, followed by intravenous fosphenytoin at 22.5 mg/kg or intravenous levetiracetam at 1000–3000 mg. The primary outcome is the seizure cessation rate within 30 min. Seizure recurrence within 24 h, severe adverse events, and intubation rate within 24 h are secondary outcomes.

Discussion

The present study was approved and conducted as an initiative study of the Japanese Association for Acute Medicine. If non-inferiority is identified, the society will pursue an application for the national health insurance coverage of levetiracetam for SE via a public knowledge-based application.

Trial registration

Japan Registry of Clinical Trials jRCTs031190160. Registered on December 13, 2019
Can we decrease the duration of basal thumb joint distraction for early osteoarthritis from 8 to 6 weeks? Study protocol for a non-inferiority randomized controlled trial
Authors: Ottenhoff Janna S. E. , Teunis Teun , Braakenburg Assa , Mink van der Molen Aebele B.
Published: May 2021

Background

To our knowledge, to date, 52 patients with thumb carpometacarpal osteoarthritis (CMC1 OA) were treated with joint distraction. So far, most patients experienced improved physical function and less pain. After 2 years, only 1 patient proceeded to trapeziectomy. This study assesses if we can safely lower the distraction duration from 8 to 6 weeks for CMC1 joint distraction, maintaining the improvement in physical function and pain.

Methods

This is a monocenter randomized controlled non-inferiority trial that includes patients younger than 65 years of age with ongoing symptoms of CMC1 OA and an established indication for surgery. All patients will be treated with CMC1 joint distraction. The primary outcome is to assess whether 6 weeks of joint distraction is not inferior to 8 weeks in terms of physical function at 1 year after surgery. Secondary outcomes will identify differences between groups at 1 year in pain intensity, patient satisfaction, hand health status, adverse event rates, treatment failure, differences in thumb strength and range of motion, and radiographic changes.

Discussion

If safe, the duration of basal thumb joint distraction can be reduced to 6 weeks, reducing patient burden. Because this is a relatively new treatment, this trial will provide greater knowledge of potential adverse events. This knowledge allows for more informed decision making for patients considering CMC1 distraction treatment. Future studies can directly compare joint distraction to other treatments of CMC1 joint arthritis like splinting and trapeziectomy.

Trial registration

Central Committee on Research Involving Human Subjects (CCMO), NL68225.100.18; registered on 9 August 2019. Medical Research Ethics Committees United (MEC-U), R19.003; registered on 9 August 2019. Netherlands Trial Register, NL8016; registered on 15 September 2019.
Connecting the Dots: a cluster-randomized clinical trial integrating standardized autism spectrum disorders screening, high-quality treatment, and long-term outcomes
Authors: McClure Leslie A. , Lee Nora L. , Sand Katherine , Vivanti Giacomo , Fein Deborah , Stahmer Aubyn , Robins Diana L.
Published: May 2021

Background

Autism spectrum disorder (ASD) affects one in 54 children in the United States of America, and supporting people with ASD across the lifespan presents challenges that impact individuals, families, and communities and can be quite costly. The American Academy of Pediatrics has issued recommendations for routine ASD screening at 18 and 24 months, but some research suggests that few pediatricians perform high-fidelity, standardized screening universally. Furthermore, the United States Preventive Services Task Force (USPSTF) found insufficient evidence to recommend for or against universal ASD screening. The objective of this study is to test the hypothesis that children with ASD who have high fidelity; standardized screening will achieve superior outcomes at 5 years of age compared to children receiving usual care ASD detection strategies.

Methods

This is a cluster-randomized, controlled clinical trial in 3 sites in the USA. Pediatric practices will be randomized to implement universal, standardized, high-fidelity toddler screening or usual care, with randomization stratified by the practice size. The study will enroll 3450 children, approximately half in each group. From this sample, we anticipate 100 children to be diagnosed with ASD. Children in both groups receiving an ASD diagnosis will be administered the Early Start Denver Model, an evidence-based early intervention addressing social, communication, and cognitive functioning. Treatment will last for 1 year, with up to 20 h per week of therapy for children with ASD.

Results

Primary outcomes measured at baseline, following treatment, and at 4 and 5 years of age include ASD symptom severity (Brief Observation of Social Communication Change (BOSCC)) and cognitive functioning (Mullen Scales of Early Learning (MSEL) and Differential Abilities Scale-II (DAS-II)). Secondary outcomes in children include measures of adaptive functioning, ASD symptoms, and kindergarten readiness; secondary analyses will also examine stress and empowerment among parents. Several novel exploratory measures will be included as well. The study will utilize a modified intention-to-treat analysis.

Conclusions

This trial will evaluate the impact of universal, standardized, high-fidelity screening for ASD among children at 18 months of age, with a goal of providing evidence to support this strategy to detect ASD in toddlers in order to start treatment as young as possible and maximize outcomes.

Ethics and dissemination

This study was approved by the Institutional Review Board at Drexel University (IRB protocol: 1607004653). All findings will be provided by the principal investigator via email; data will be available through the NIMH Data Archive (https://nda.nih.gov/).

Trial registration

ClinicalTrials.gov NCT03333629. Registered on November 7, 2017
Recruiting for research on sensitive topics in schools: an experience with Vaxcards, a collectable vaccine card game
Authors: Epstein D. S. , Enticott J. C. , Larson H. J. , Barton C.
Published: May 2021

Undertaking recruitment for research in schools is an effective way to recruit young people for research participation but it is not without its challenges. Gaining access and coordinating many levels of different organisations and stakeholders whose cooperation and approval are crucial all add time and sometimes logistical challenges for the research team. In addition, recruiting around sensitive research topics can elicit additional barriers to successful research.

The research team aimed to conduct a pragmatic cluster randomised controlled trial involving schools in a local government region in Victoria, Australia, to assess the effect of a vaccination-based educational card game called “Vaxcards” on vaccine consent returns. Schools were contacted via phone and email to determine which staff member would best be a contact point for a face-to-face meeting to discuss the methods and purpose of the study. Email follow-ups were scheduled to follow up non-responsive schools and consent forms. The minimum required sample size was 13.

Of 31 eligible schools, 13 were recruited. The research team encountered several unanticipated challenges before achieving the recruitment target. The most common reasons for non-participation were being too busy with other commitments, concerns regarding the topic of vaccination being too sensitive, and concerns that key stakeholders in the school would not approve of the research topic of vaccination. One school required a review by a private research ethics board that rejected the study. Significant hesitancy and misinformation about vaccine science was observed that affected engagement with a small number of schools.

This paper highlights the challenges of recruiting schools in the context of public anxieties about vaccines and has several important learning lessons for successful recruitment about sensitive topics. This includes navigating approval processes for research in schools, the importance of local champions, dealing with misinformation and the importance of strong relationships and organisational trust.

Trial registration

Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12618001753246. Prospectively registered on 25 October 2018 8:24:21 AM
A novel nanoemulsion-based microalgal growth medium for enhanced biomass production
Authors: Nigam Harshita , Malik Anushree , Singh Vikram
Published: May 2021

Background

Microalgae are well-established feedstocks for applications ranging from biofuels to valuable pigments and therapeutic proteins. However, the low biomass productivity using commercially available growth mediums is a roadblock for its mass production. This work describes a strategy to boost algal biomass productivity by using an effective CO2 supplement.

Results

In the present study, a novel nanoemulsion-based media has been tested for the growth of freshwater microalgae strain Chlorella pyrenoidosa. Two different nanoemulsion-based media were developed using 1% silicone oil nanoemulsion (1% SE) and 1% paraffin oil nanoemulsion (1% PE) supplemented in Blue-green 11 media (BG11). After 12 days of cultivation, biomass yield was found highest in 1% PE followed by 1% SE and control, i.e., 3.20, 2.75, and 1.03 g L−1, respectively. The chlorophyll-a synthesis was improved by 76% in 1% SE and 53% in 1% PE compared with control. The respective microalgal cell numbers for 1% PE, 1% SE and control measured using the cell counter were 3.00 × 106, 2.40 × 106, and 1.34 × 106 cells mL−1. The effective CO2 absorption tendency of the emulsion was highlighted as the key mechanism for enhanced algal growth and biomass production. On the biochemical characterization of the produced biomass, it was found that the nanoemulsion-cultivated C. pyrenoidosa had increased lipid (1% PE = 26.80%, 1% SE = 23.60%) and carbohydrates (1% PE = 17.20%, 1% SE = 18.90%) content compared to the control (lipid = 18.05%, carbohydrates = 13.60%).

Conclusions

This study describes a novel nanoemulsion which potentially acts as an effective CO2 supplement for microalgal growth media thereby increasing the growth of microalgal cells. Further, nanoemulsion-cultivated microalgal biomass depicts an increase in lipid and carbohydrate content. The approach provides high microalgal biomass productivity without altering morphological characteristics like cell shape and size as revealed by field emission scanning electron microscope (FESEM) images.

Graphical abstract
Simulated dynamics of southern cattle fever ticks (Rhipicephalus (Boophilus) microplus) in south Texas, USA: investigating potential wildlife-mediated impacts on eradication efforts
Authors: Wang Hsiao-Hsuan , Grant William E. , Teel Pete D. , Lohmeyer Kimberly H. , Pérez de León Adalberto A.
Published: May 2021

Background

Cattle fever ticks (CFT), Rhipicephalus (Boophilus) annulatus and R. (B.) microplus, are vectors of microbes causing bovine babesiosis and pose a threat to the economic viability of the US livestock industry. Efforts by the Cattle Fever Tick Eradication Program (CFTEP) along the US-Mexico border in south Texas are complicated by the involvement of alternate hosts, including white-tailed deer (Odocoileus virginianus) and nilgai (Boselaphus tragocamelus).

Methods

In the present study, we use a spatially explicit, individual-based model to explore the potential effects of host species composition and host habitat use patterns on southern cattle fever ticks (SCFT, R. (B.) microplus) infestation dynamics and efficacy of eradication schemes.

Results

In simulations without eradication efforts, mean off-host larval densities were much higher when cattle were present than when only white-tailed deer and nilgai were present. Densities in mesquite and meadows were slightly higher, and densities in mixed brush were much lower, than landscape-level densities in each of these scenarios. In eradication simulations, reductions in mean off-host larval densities at the landscape level were much smaller when acaricide was applied to cattle only, or to cattle and white-tailed deer, than when applied to cattle and nilgai. Relative density reductions in mesquite, mixed brush, and meadows depended on host habitat use preferences. Shifting nilgai habitat use preferences increasingly toward mixed brush and away from mesquite did not change mean off-host larval tick densities noticeably at the landscape level. However, mean densities were increased markedly in mesquite and decreased markedly in mixed brush, while no noticeable change in density was observed in meadows.

Conclusions

Our results suggest that continued integration of field data into spatially explicit, individual-based models will facilitate the development of novel eradication strategies and will allow near-real-time infestation forecasts as an aid in anticipating and preventing wildlife-mediated impacts on SCFT eradication efforts.

Graphical Abstract
Heart rate detection properties of dry-electrode ECG compared to conventional 3-lead gel-electrode ECG in newborns
Authors: Pike Hanne , Eilevstjønn Joar , Bjorland Peder , Linde Jørgen , Ersdal Hege , Rettedal Siren
Published: May 2021

Objective

To compare the accuracy of heart rate detection properties of a novel, wireless, dry-electrode electrocardiogram (ECG) device, NeoBeat®, to that of a conventional 3-lead gel-electrode ECG monitor (PropaqM®) in newborns.

Results

The study population had a mean gestational age of 39 weeks and 2 days (1.5 weeks) and birth weight 3528 g (668 g). There were 950 heart rate notations from each device, but heart rate was absent from the reference monitor in 14 of these data points, leaving 936 data pairs to compare. The mean (SD) difference when comparing NeoBeat to the reference monitor was -0.25 (9.91) beats per minute (bpm) (p = 0.44). There was a deviation of more than 10 bpm in 7.4% of the data pairs, which primarily (78%) was attributed to ECG signal disturbance, and secondly (22%) due to algorithm differences between the devices. Excluding these outliers, the correlation was equally consistent (r2 = 0.96) in the full range of heart rate captured measurements with a mean difference of − 0.16 (3.09) bpm. The mean difference was less than 1 bpm regardless of whether outliers were included or not.
Recurrent bilateral chorioretinitis with positive Lyme serology: a case report
Authors: Issa Reda , DeSouza Stephen A. M.
Published: May 2021

Background

It has been disputed whether Lyme is a true causative agent in posterior uveitis or an incidental finding.

Case presentation

This report presents a case of a 33-year-old Caucasian female with a remote history of Lyme disease who presented with blurry vision in the right eye. Exam and imaging revealed a right active chorioretinitis and positive Lyme serology. The patient was systemically treated with prednisone and antibiotics. Symptoms initially improved, but she later developed a localized choriocapillaritis in the left eye. Steroids and antibiotics were restarted many times with fluctuating course of the disease. The patient was then started on chronic steroid-sparing immunosuppression, which has controlled the condition without recurrence.

Conclusions

The current report presents a unique case of recurrent bilateral chorioretinitis with positive Lyme serology and raises the question of the existence of true Lyme-associated uveitis.
Potassium wasting nephropathy in the setting of tizanidine overdose: a case report
Authors: Brucculeri Michael J. , Garcia Juan
Published: May 2021

Background

Hypokalemia has been rarely attributed to tizanidine, although the precise mechanism is unclear. Severe hypokalemia is a well-established cause of abnormalities involving cardiac conduction. Given this agent’s well-known cardiac arrhythmogenic potential, awareness of potential concomitant electrolyte abnormalities is important.

Case presentation

Electrolyte disorders, including hypokalemia, are rare complications of the antispasmodic medicine tizanidine when taken in doses as outlined by the manufacturer’s prescribing instructions. Although cases of severe hypokalemia have also been described in the literature in association with this agent, such reports are few. We report a Caucasian case of an intentional overdose involving a very large ingestion of tizanidine. In addition to the characteristic abnormalities on the electrocardiogram, our patient developed electrolyte derangements as well as self-limited acute kidney injury. These biochemical abnormalities included profound hypokalemia that was refractory to aggressive replacement over the ensuing several days, before eventually dissipating. A thorough assessment of the etiology of this hypokalemia was consistent with a defect in renal potassium handling.

Conclusion

In our patient with intentional tizanidine overdose, severe and refractory hypokalemia appears to have been due to a transient potassium wasting nephropathy.
A novel stop codon mutation in exon 5 (c.639G>A) of the cadherin-1 gene in a Vietnamese man with hereditary diffuse gastric cancer: a case report
Authors: Dang Dzung Ngoc Thi , Nguyen Huong Thanh Thi , Ngo Hoa Dieu , Tran Bac Manh , Vu Anh Duc , Dang Huy Quang , Ta Van Thanh
Published: May 2021

Background

Germline pathogenic variants in the cadherin-1 (CDH1) gene cause a predisposition to hereditary diffuse gastric cancer (HDGC). We report an HDGC case in Vietnam and identify a novel mutation in the CDH1 gene.

Case presentation

A 28-year-old Vietnamese man was diagnosed with HDGC and a novel mutation at c.639G>A. All exons of CDH1 were sequenced in his pedigree, which revealed the c.639G>A mutation in the proband, his father, and uncle. The patient refused treatment and died 4 months after diagnosis. Endoscopic surveillance of the father and the uncle showed structural abnormalities in the father.

Conclusion

In cases of HDGC, identification of the CDH1 gene mutation is very important for better counseling and more effective strategies to prevent the development of diseases, such as prophylactic gastrectomy for family members with genetic mutations.
Food allergy safety: a descriptive report of changing policy in a single large medical center
Authors: Harari Rivki , Toren Orly , Tal Yuval , Ben-Porat Tair
Published: May 2021

Background

Food allergy can result in life-threatening anaphylaxis and is considered an increasing public health burden. Hospitalized patients are dependent on the hospital menu to meet their nutritional needs; thus, errors in the meals provided can have a substantial impact on patients’ health outcomes. In Israel, no specific policy protocol exists to ensure food allergy safety in the setting of a hospital foodservice system.

Objectives

This paper has two aims: 1) to provide an in-depth review of food allergy as a major public health concern and 2) to report actions taken in a single large medical center, as an ongoing project that aimed to ensure patients’ safety, and which ended in developing policy on this matter.

Results

During the years 2017–2019, we initiated several interventions with the goal of achieving food allergy safety and ensuring quality of care for patients with food allergies at Hadassah Hebrew University Medical Center. These included integrating food management safety into the computerized foodservice system, highlighting labels on patients’ food trays, introducing safety checks into the process of food delivery to hospitalized patients; and ensuring the nutritional requirements of patients with allergy restrictions. Moreover, changes were made in specialized menus for patients with various types of food allergy, and specific procedures were implemented regarding enteral feeding, to prevent accidental allergen exposure. All the procedures were incorporated into a written protocol that applies to all hospital employees, and the staff received the relevant training.

Conclusions

Our experience suggests that methods for food allergy safety should be promoted, and that an established policy and suitable set of guidelines on this matter is required. This clearly mandates collaboration between the various sectors of the hospital, including management and the computer department; and the medical, nursing, dietetics and kitchen staffs. Furthermore, routine ongoing knowledge training programs for medical teams and kitchen staff are crucial for such implementational changes. In a technological world, computerized systems delivering food to hospitalized patients must be adapted such as to create a uniformly safe food environment of healthcare systems, and developing a suitable policy should be prioritized accordingly by hospitals across Israel, with collaboration and synergy between institutions management and the departments of nutrition and patient safety and risk management.
Quantile Jensen’s inequalities
Authors: Zhao Mu , Yang Xinai , He Qi , Zhou Zunrong , Ge Xiangyu
Published: May 2021

Quantiles of random variable are crucial quantities that give more delicate information about distribution than mean and median and so on. We establish Jensen’s inequality for q-quantile ($q\geq 0.5$
q
≥
0.5
) of a random variable, which includes as a special case Merkle (Stat. Probab. Lett. 71(3):277–281, 2005) where Jensen’s inequality about median (i.e. $q= 0.5$
q
=
0.5
) was given. We also refine this inequality in the case where $q<0.5$
q
<
0.5
. An application to the confidence interval of parameters in pivotal quantity is also considered by virtue of the rigorous description on the relationship between quantiles and intervals that have required probability.
Estimates and properties of certain q-Mellin transform on generalized q-calculus theory
Authors: Al-Omari Shrideh
Published: May 2021

This paper deals with the generalized q-theory of the q-Mellin transform and its certain properties in a set of q-generalized functions. Some related q-equivalence relations, q-quotients of sequences, q-convergence definitions, and q-delta sequences are represented. Along with that, a new q-convolution theorem of the estimated operator is obtained on the generalized context of q-Boehmians. On top of that, several results and q-Mellin spaces of q-Boehmians are discussed. Furthermore, certain continuous q-embeddings and an inversion formula are also discussed.
Dynamical behavior of two predators–one prey model with generalized functional response and time-fractional derivative
Authors: Djilali Salih , Ghanbari Behzad
Published: May 2021

The behavior of any complex dynamic system is a natural result of the interaction between the components of that system. Important examples of these systems are biological models that describe the characteristics of complex interactions between certain organisms in a biological environment. The study of these systems requires the use of precise and advanced computational methods in mathematics. In this paper, we discuss a prey–predator interaction model that includes two competitive predators and one prey with a generalized interaction functional. The primary presumption in the model construction is the competition between two predators on the only prey, which gives a strong implication of the real-world situation. We successfully establish the existence and stability of the equilibria. Further, we investigate the impact of the memory measured by fractional time derivative on the temporal behavior. We test the obtained mathematical results numerically by a proper numerical scheme built using the Caputo fractional-derivative operator and the trapezoidal product-integration rule.
A cubic nonlinear population growth model for single species: theory, an explicit–implicit solution algorithm and applications
Authors: Wacker Benjamin , Schlüter Jan Christian
Published: May 2021

In this paper, we extend existing population growth models and propose a model based on a nonlinear cubic differential equation that reveals itself as a special subclass of Abel differential equations of first kind. We first summarize properties of the time-continuous problem formulation. We state the boundedness, global existence, and uniqueness of solutions for all times. Proofs of these properties are thoroughly given in the Appendix to this paper. Subsequently, we develop an explicit–implicit time-discrete numerical solution algorithm for our time-continuous population growth model and show that many properties of the time-continuous case transfer to our numerical explicit–implicit time-discrete solution scheme. We provide numerical examples to illustrate different behaviors of our proposed model. Furthermore, we compare our explicit–implicit discretization scheme to the classical Eulerian discretization. The latter violates the nonnegativity constraints on population sizes, whereas we prove and illustrate that our explicit–implicit discretization algorithm preserves this constraint. Finally, we describe a parameter estimation approach to apply our algorithm to two different real-world data sets.
Ecological implications of twentieth century reforestation programs for the urban forests of São Paulo, Brazil: a study based on litterfall and nutrient cycling
Authors: Ferreira Maurício Lamano , Barbosa Marcelo Ferreira , Gomes Eduardo Pereira Cabral , do Nascimento Ana Paula Branco , de Luca Edgar Fernando , da Silva Karina Gonçalves , França Ulisses Bezerra , de Camargo Plínio Barbosa , Lafortezza Raffaele
Published: May 2021

The focus of this study was to investigate the wide use of Eucalyptus spp., an exotic plant with high allelopathic ability, in the reforestation programs of urban parks in São Paulo City, Brazil, over the last century. To understand the implications of using Eucalyptus spp. in the city’s parks, this study aimed to compare nutrient cycling and litter decomposition between a mixed composition of litter (i.e., native and exotic species) and the litter of a single species (i.e., Eucalyptus). To accomplish this, newly deciduous leaves were collected from two native and two exotic species that are commonly used in the afforestation of São Paulo as well as from Eucalyptus spp. The mixed composition of litter yielded a higher dry mass loss and return of macro- and micronutrients to the forest floor. The decomposition constant (k) values were 0.00322 and 0.00207 g g−1 day−1 for the mixed composition and Eucalyptus spp., respectively. The time required for decomposition of 50 and 95% of deciduous material was 215 and 931 days, respectively, and for the mixed litterfall 334 and 1449 days, respectively, for Eucalyptus spp. Therefore, the mixed litter exhibited greater dry mass loss and nutrient cycling in an urban forest of São Paulo City, since dry mass losses as well as speed and amount of nutrients returned to the forest floor were relatively higher compared to Eucalyptus spp. Nutrient cycling via Eucalyptus spp. litter was less efficient than mixed composition of litter, demonstrating that reforestation programs carried out in the twentieth century using only one species may have had little success. The results of this work emphasize the fact that in urban reforestation programs the City of São Paulo must consider the environmental and biogeographic characteristics of the species employed and use high levels of biodiversity, since the city lies in a megadiverse biome.
The association between residual neuromuscular blockade (RNMB) and critical respiratory events: a prospective cohort study
Authors: Alenezi Faraj K , Alnababtah Khalid , Alqahtani Mohammed M , Olayan Lafi , Alharbi Mohammed
Published: May 2021

Background

Inadequate neuromuscular recovery might impair pulmonary function among adult patients who undergo general anaesthesia and might thus contribute to critical respiratory events in the post-anaesthesia care unit (PACU). The pilot study aims to understand the baseline incidence of residual neuromuscular blockade (RNMB) and postoperative critical respiratory events (CREs), which are described in a modified Murphy’s criteria in the PACU.

Method

This is a prospective cohort study from January to March 2017 from a tertiary hospital in Saudi Arabia with thirty adult patients over 18 years old scheduled for elective surgery under general anaesthesia with neuromuscular blocking drugs (NMBDs) who were enrolled in the study. The Mann-Whitney U tests, chi-square tests and independent-samples T tests were used. The train-of-four (TOF) ratios were measured upon arrival in the PACU by using acceleromyography with TOF-Scan. Subjects’ demographics, perioperative data and the occurrence of postoperative CREs in the PACU were recorded.

Results

Twenty-six (86.7%) patients out of thirty in the study have received rocuronium as NMBDs whilst neostigmine as a reversal drug with only 23 (76.7%). The incidence of RNMB (TOF ratio < 0.9) was in 16 patients (53.3%). The incidence of RNMB was significantly higher in female patients (p = 0.033), in patients who had not undergone quantitative neuromuscular monitoring before extubation (p = 0.046) and in patients with a shorter duration of surgery (p = 0.001). Postoperative CREs occurred in twenty patients (66.7%), and there were significantly more of these CREs among patients with RNMB (p = 0.001). In addition, a statistically significant difference was observed in the occurrence of CREs according to body mass index (p = 0.047).

Conclusion

This research showed that RNMB is a significant contributing factor to the development of critical respiratory events during PACU stay. Therefore, routine quantitative neuromuscular monitoring is recommended to reduce the incidence of RNMB.