bluuebunny/crossref_metadata_2025 huggingface dataset:
Comparison of metabolic states using genome-scale metabolic models
Authors: Sarathy Chaitra , Breuer Marian , Kutmon Martina , Adriaens Michiel E. , Evelo Chris T. , Arts Ilja C. W.
Published: November 2021

Genome-scale metabolic models (GEMs) are comprehensive knowledge bases of cellular metabolism and serve as mathematical tools for studying biological phenotypes and metabolic states or conditions in various organisms and cell types. Given the sheer size and complexity of human metabolism, selecting parameters for existing analysis methods such as metabolic objective functions and model constraints is not straightforward in human GEMs. In particular, comparing several conditions in large GEMs to identify condition- or disease-specific metabolic features is challenging. In this study, we showcase a scalable, model-driven approach for an in-depth investigation and comparison of metabolic states in large GEMs which enables identifying the underlying functional differences. Using a combination of flux space sampling and network analysis, our approach enables extraction and visualisation of metabolically distinct network modules. Importantly, it does not rely on known or assumed objective functions. We apply this novel approach to extract the biochemical differences in adipocytes arising due to unlimited vs blocked uptake of branched-chain amino acids (BCAAs, considered as biomarkers in obesity) using a human adipocyte GEM (iAdipocytes1809). The biological significance of our approach is corroborated by literature reports confirming our identified metabolic processes (TCA cycle and Fatty acid metabolism) to be functionally related to BCAA metabolism. Additionally, our analysis predicts a specific altered uptake and secretion profile indicating a compensation for the unavailability of BCAAs. Taken together, our approach facilitates determining functional differences between any metabolic conditions of interest by offering a versatile platform for analysing and comparing flux spaces of large metabolic networks.
More pests but less pesticide applications: Ambivalent effect of landscape complexity on conservation biological control
Authors: Zamberletti Patrizia , Sabir Khadija , Opitz Thomas , Bonnefon Olivier , Gabriel Edith , Papaïx Julien
Published: November 2021

In agricultural landscapes, the amount and organization of crops and semi-natural habitats (SNH) have the potential to promote a bundle of ecosystem services due to their influence on ecological community at multiple spatio-temporal scales. SNH are relatively undisturbed and are often source of complementary resources and refuges, therefore supporting more diverse and abundant natural pest enemies. However, the nexus of SNH proportion and organization with pest suppression is not trivial. It is thus crucial to understand how the behavior of pest and natural enemy species, the underlying landscape structure, and their interaction, may influence conservation biological control (CBC). Here, we develop a generative stochastic landscape model to simulate realistic agricultural landscape compositions and configurations of fields and linear elements. Generated landscapes are used as spatial support over which we simulate a spatially explicit predator-prey dynamic model. We find that increased SNH presence boosts predator populations by sustaining high predator density that regulates and keeps pest density below the pesticide application threshold. However, predator presence over all the landscape helps to stabilize the pest population by keeping it under this threshold, which tends to increase pest density at the landscape scale. In addition, the joint effect of SNH presence and predator dispersal ability among hedge and field interface results in a stronger pest regulation, which also limits pest growth. Considering properties of both fields and linear elements, such as local structure and geometric features, provides deeper insights for pest regulation; for example, hedge presence at crop field boundaries clearly strengthens CBC. Our results highlight that the integration of species behaviors and traits with landscape structure at multiple scales is necessary to provide useful insights for CBC.
The expression of FOXP3 in lesions of several forms of leprosy in patients co-infected with HIV
Authors: Xavier Marília Brasil , Pires Carla Andréa Avelar , Gomes Cláudia Maria de Castro , Rodrigues Gabriela Fernandes , Xavier Débora Pinheiro , Brito João Augusto Gomes de Souza Monteiro de , Corbett Carlos Eduardo Pereira
Published: November 2021

Background

Brazil remains endemic for infection by the human immunodeficiency virus (HIV) and leprosy, having a major impact on public health and the life quality of affected patients. Although the relevance of this co-infection is recognized, several aspects, such as the immune response, are not yet fully understood. The objective of this study was to investigate the expression of FOXP3+ Treg cells in leprosy skin lesions and to correlate their clinical forms, laboratory characteristics (CD4, CD8, and CV), and the immune reconstitution syndrome in HIV-leprosy co-infection.

Methodology/Principal findings

An observational, cross-sectional, and analytical study was carried out comparing four groups of patients: those with concomitant diagnosis of leprosy and HIV infection without a leprosy reaction, those with leprosy and HIV co-infection patients with a reverse reaction (RR), those with leprosy without HIV and without reaction, and those with leprosywithout HIV and with RR. The patients were diagnosed at a dermatology outpatient clinic located in Belém, Pará, Brazil, from 2003 to 2017. In the sample studied, there was a positive correlation between FOXP3+ cell density and viral load, negative correlation with blood CD4+ (not statistically significant), significant positive correlation in CD8 count in patients with leprosy reaction, and positive relationship in patients with IRIS. The density of cells expressing FOXP3 was higher in the BL/LL forms in patients without HIV, although the difference was not statistically significant. However, the cell mean was higher in the TT/BT forms in patients co-infected with leprosy and HIV, showing contradictory results.

Conclusions/Significance

These findings support that higher activity of the HIV may stimulate or result in a higher expression of FOXP3-Tregs and that they may be involved in active immunosuppression observed at the infection site at the tissue level. This supports the need to expand studies on FOXP3+ Treg cells in co-infected patients.
Cost-effectiveness of point-of-care C-Reactive Protein test compared to current clinical practice as an intervention to improve antibiotic prescription in malaria-negative patients in Afghanistan
Authors: Dickinson Simon , Yi Chong Huey , Leslie Toby , Rowland Mark , Schultz Hansen Kristian , Boyers Dwayne
Published: November 2021

Background

Antimicrobial resistance (AMR) is a global health problem requiring a reduction in inappropriate antibiotic prescribing. Point-of-Care C-Reactive Protein (POCCRP) tests could distinguish between bacterial and non-bacterial causes of fever in malaria-negative patients and thus reduce inappropriate antibiotic prescribing. However, the cost-effectiveness of POCCRP testing is unclear in low-income settings.

Methods

A decision tree model was used to estimate cost-effectiveness of POCCRP versus current clinical practice at primary healthcare facilities in Afghanistan. Data were analysed from healthcare delivery and societal perspectives. Costs were reported in 2019 USD. Effectiveness was measured as correctly treated febrile malaria-negative patient. Cost, effectiveness and diagnostic accuracy parameters were obtained from primary data from a cost-effectiveness study on malaria rapid diagnostic tests in Afghanistan and supplemented with POCCRP-specific data sourced from the literature. Incremental cost-effectiveness ratios (ICERs) reported the additional cost per additional correctly treated febrile malaria-negative patient over a 28-day time horizon. Univariate and probabilistic sensitivity analyses examined the impact of uncertainty of parameter inputs. Scenario analysis included economic cost of AMR per antibiotic prescription.

Results

The model predicts that POCCRP intervention would result in 137 fewer antibiotic prescriptions (6%) with a 12% reduction (279 prescriptions) in inappropriate prescriptions compared to current clinical practice. ICERs were $14.33 (healthcare delivery), $11.40 (societal), and $9.78 (scenario analysis) per additional correctly treated case.

Conclusions

POCCRP tests could improve antibiotic prescribing among malaria-negative patients in Afghanistan. Cost-effectiveness depends in part on willingness to pay for reductions in inappropriate antibiotic prescribing that will only have modest impact on immediate clinical outcomes but may have long-term benefits in reducing overuse of antibiotics. A reduction in the overuse of antibiotics is needed and POCCRP tests may add to other interventions in achieving this aim. Assessment of willingness to pay among policy makers and donors and undertaking operational trials will help determine cost-effectiveness and assist decision making.
Items analysis of the Frailty Index (FI-35): Insight in the contribution of each item to the level of frailty
Authors: Zhang Xiaohong , Van Der Schans C. P. , Liu Yanhui , Krijnen W. , Hobbelen J. S. M.
Published: November 2021

Background

The FI-35 is a valid multidimensional Chinese frailty assessment instrument. Like other scales, functional measures rely on the information the total score provides. Our research aimed to analyze the contribution of each item.

Methods

Descriptive statistics were used to summarize the sample characteristics. The expected item score (EIS) was used to determine how the items contribute to the generic measure of frailty.

Results

This study showed that most of the EIS curves increased across the entire range of frailty levels, and most of the items discriminate relatively well over the entire frailty range. Items differentially contributed to the total frailty score and differentially discriminated between frailty levels.

Conclusions

Although nearly all items monotonically increased with frailty levels, there were large differences between items in their ability to differentiate between persons being either weakly, moderately or highly frail.
Evidence for hybrid breakdown in production of red carotenoids in the marine invertebrate Tigriopus californicus
Authors: Powers Matthew J. , Martz Lucas D. , Burton Ronald S. , Hill Geoffrey E. , Weaver Ryan J.
Published: November 2021

The marine copepod, Tigriopus californicus, produces the red carotenoid pigment astaxanthin from yellow dietary precursors. This ‘bioconversion’ of yellow carotenoids to red is hypothesized to be linked to individual condition, possibly through shared metabolic pathways with mitochondrial oxidative phosphorylation. Experimental inter-population crosses of lab-reared T. californicus typically produces low-fitness hybrids is due in large part to the disruption of coadapted sets nuclear and mitochondrial genes within the parental populations. These hybrid incompatibilities can increase variability in life history traits and energy production among hybrid lines. Here, we tested if production of astaxanthin was compromised in hybrid copepods and if it was linked to mitochondrial metabolism and offspring development. We observed no clear mitonuclear dysfunction in hybrids fed a limited, carotenoid-deficient diet of nutritional yeast. However, when yellow carotenoids were restored to their diet, hybrid lines produced less astaxanthin than parental lines. We observed that lines fed a yeast diet produced less ATP and had slower offspring development compared to lines fed a more complete diet of algae, suggesting the yeast-only diet may have obscured effects of mitonuclear dysfunction. Astaxanthin production was not significantly associated with development among lines fed a yeast diet but was negatively related to development in early generation hybrids fed an algal diet. In lines fed yeast, astaxanthin was negatively related to ATP synthesis, but in lines fed algae, the relationship was reversed. Although the effects of the yeast diet may have obscured evidence of hybrid dysfunction, these results suggest that astaxanthin bioconversion may still be related to mitochondrial performance and reproductive success.
A short comparative study on modified Duckworth-Lewis methods
Authors: Asif Muhammad , Ahmadian Ali , Azeem Muhammad , Pansera Bruno Antonio
Published: November 2021

In this paper, the Duckworth-Lewis-Stern (DLS) and Duckworth-Lewis-McHale-Asif (DLMA) methods of revising targets for a team batting in second innings in an interrupted Limited Overs International Cricket (LOI), are examined for fairness. The work discusses four significant points: flexibility, intuition, simplicity, and goodness-of-fit of the two mentioned methods. The research findings have shown that the DLMA method is better in every aspect than the DLS method. Further, the data of 1764 ODI matches played during 2004–2021 to investigate the compatibility of the DLMA for high run-scoring One-Day International matches. The results show that DLMA is compatible to the situation of the well-above run-scoring situation.
Artificial intelligence applications in social media for depression screening: A systematic review protocol for content validity processes
Authors: Owusu Priscilla N. , Reininghaus Ulrich , Koppe Georgia , Dankwa-Mullan Irene , Bärnighausen Till
Published: November 2021

Background

The popularization of social media has led to the coalescing of user groups around mental health conditions; in particular, depression. Social media offers a rich environment for contextualizing and predicting users’ self-reported burden of depression. Modern artificial intelligence (AI) methods are commonly employed in analyzing user-generated sentiment on social media. In the forthcoming systematic review, we will examine the content validity of these computer-based health surveillance models with respect to standard diagnostic frameworks. Drawing from a clinical perspective, we will attempt to establish a normative judgment about the strengths of these modern AI applications in the detection of depression.

Methods

We will perform a systematic review of English and German language publications from 2010 to 2020 in PubMed, APA PsychInfo, Science Direct, EMBASE Psych, Google Scholar, and Web of Science. The inclusion criteria span cohort, case-control, cross-sectional studies, randomized controlled studies, in addition to reports on conference proceedings. The systematic review will exclude some gray source materials, specifically editorials, newspaper articles, and blog posts. Our primary outcome is self-reported depression, as expressed on social media. Secondary outcomes will be the types of AI methods used for social media depression screen, and the clinical validation procedures accompanying these methods. In a second step, we will utilize the evidence-strengthening Population, Intervention, Comparison, Outcomes, Study type (PICOS) tool to refine our inclusion and exclusion criteria. Following the independent assessment of the evidence sources by two authors for the risk of bias, the data extraction process will culminate in a thematic synthesis of reviewed studies.

Discussion

We present the protocol for a systematic review which will consider all existing literature from peer reviewed publication sources relevant to the primary and secondary outcomes. The completed review will discuss depression as a self-reported health outcome in social media material. We will examine the computational methods, including AI and machine learning techniques which are commonly used for online depression surveillance. Furthermore, we will focus on standard clinical assessments, as indicating content validity, in the design of the algorithms. The methodological quality of the clinical construct of the algorithms will be evaluated with the COnsensus-based Standards for the selection of health status Measurement Instruments (COSMIN) framework. We conclude the study with a normative judgment about the current application of AI to screen for depression on social media.

Systematic review registration

International Prospective Register of Systematic Reviews PROSPERO (registration number CRD42020187874).
Reasons for nonadherence to vaccination for influenza among older people in Brazil
Authors: Gomes de Macedo Bacurau Aldiane , Sato Ana Paula Sayuri , Francisco Priscila Maria Stolses Bergamo
Published: November 2021

This study aimed to estimate the prevalence of non-vaccination and the reasons for nonadherence to the influenza vaccine among older Brazilians according to sociodemographic characteristics. A cross-sectional study was conducted with data from older people (≥ 60 years of age; n = 23,815) who participated in the 2013 National Health Survey. Frequencies of non-vaccination and the main reasons for nonadherence were calculated with respective 95% confidence intervals. The prevalence of non-vaccination was 26.9% (approximately 7,106,730 older people). The reason rarely gets the flu was the most cited among the men (28.2%), the 60-to-69-year-old age group (29.6%), individuals with higher education (41.9%), and those with health insurance (32.3%). Fear of a reaction was the most cited reason in the northeastern region (25.4%), among women (29.3%), longer-lived individuals (≥70 years; 28.7%), and those who did not know how to read/write (26.7%). A total of 12.1% reported not believing in the vaccine’s protection, and 5.5% did not know that it was necessary to take vaccine. The proportions of the main reasons for non-vaccination varied by sociodemographic characteristics. This study’s findings highlight the need to increase older people’s knowledge regarding influenza and influenza vaccines. Healthcare providers should be encouraged to counsel older people–especially those in subgroups with lower adherence, such as residents in the Northeast region, those aged 60–69 years, those who do not know how to read/write, those without a spouse/companion, and those without health insurance–regarding the different aspects of the vaccine and formally indicate it for groups at risk.
Technology intensity and Indian manufacturing industries
Authors: Kaur Kawaljeet , Mehta Swati
Published: November 2021

The significance of technology-intensive industries for the growth and competitiveness of the manufacturing sector has been well documented. Many studies have attempted to define and classify the industries based on their technology intensity. However, very few attempts have been made in this respect from the vantage point of developing counties. In an attempt to fill this gap in the empirical literature, this article examines the technology intensity of organized manufacturing industries in India. A composite index of technology intensity of industries is calculated using the method of principal component analysis. The results of our analysis reveal poor performance of industries in terms of their technology intensity. It was found that only four industries in the Indian organized manufacturing sector spend more than 1 per cent of their sales on R&D. The highest score of ‘composite technology intensity index’ (2.63) is for the industry manufacturing electronic components. This score is, however, found to be far below the level prescribed by OECD for an industry to be categorized as ‘high-tech’. The results of our empirical analysis, therefore, suggest the need for increasing technology intensity for the Indian organized manufacturing industries to achieve competitiveness in the global market.
ACTIVITIES OF DAILY LIVING MEASURED BY THE HARVARD AUTOMATED PHONE TASK TRACK WITH COGNITIVE DECLINE OVER TIME IN NON-DEMENTED ELDERLY
Authors: Marshall G.A. , Aghjayan S.L. , Dekhtyar M. , Locascio J.J. , Jethwani K. , Amariglio R.E. , Johnson K.A. , Sperling R.A. , Rentz D.M.
Published: November 2021

Background: Impairment in activities of daily living is a major burden to both patients and caregivers. Mild impairment in instrumental activities of daily living is often seen at the stage of mild cognitive impairment. The field of Alzheimer’s disease is moving toward earlier diagnosis and intervention and more sensitive and ecologically valid assessments of instrumental or complex activities of daily living are needed. The Harvard Automated Phone Task, a novel performance-based activities of daily living instrument, has the potential to fill this gap. Objective: To further validate the Harvard Automated Phone Task by assessing its longitudinal relationship to global cognition and specific cognitive domains in clinically normal elderly and individuals with mild cognitive impairment. Design: In a longitudinal study, the Harvard Automated Phone Task was associated with cognitive measures using mixed effects models. The Harvard Automated Phone Task’s ability to discriminate across diagnostic groups at baseline was also assessed. Setting: Academic clinical research center. Participants: Two hundred and seven participants (45 young normal, 141 clinically normal elderly, and 21 mild cognitive impairment) were recruited from the community and the memory disorders clinics at Brigham and Women’s Hospital and Massachusetts General Hospital. Measurements: Participants performed the three tasks of the Harvard Automated Phone Task, which consist of navigating an interactive voice response system to refill a prescription (APT-Script), select a new primary care physician (APT-PCP), and make a bank account transfer and payment (APT-Bank). The 3 tasks were scored based on time, errors, repetitions, and correct completion of the task. The primary outcome measure used for each of the tasks was total time adjusted for correct completion. Results: The Harvard Automated Phone Task discriminated well between young normal, clinically normal elderly, and mild cognitive impairment participants (APT-Script: p<0.001; APT-PCP: p<0.001; APT-Bank: p=0.04). Worse baseline Harvard Automated Phone Task performance or worsening Harvard Automated Phone Task performance over time tracked with overall worse performance or worsening performance over time in global cognition, processing speed, executive function, and episodic memory. Conclusions: Prior cross-sectional and current longitudinal analyses have demonstrated the utility of the Harvard Automated Phone Task, a new performance-based activities of daily living instrument, in the assessment of early changes in complex activities of daily living in non-demented elderly at risk for Alzheimer’s disease. Future studies will focus on cross-validation with other sensitive activities of daily living tests and Alzheimer’s disease biomarkers.
On reducing CO2 concentration in buildings by using plants
Authors: Franek Ondřej , Jarský Čeněk
Published: November 2021

The article deals with the implementation of plants in the indoor environment of buildings to reduce the concentration of CO2. Based on a specified model representing the internal environment of an office space, it was studied whether the requirement for the total amount of ventilated air could be reduced by using plants, thereby achieving savings of operating costs in the building ventilation sector. The present research describes the effect of plant implementation according to different levels of CO2 concentration of the supply air, specifically with values of 410 ppm corresponding to the year 2020, 550 ppm to the year 2050 and 670 ppm to the year 2100, as well as according to different levels of CO2 concentration in the indoor environment, namely 1000 ppm and 1500 ppm, the illumination of plants in the indoor environment is constant in the model, PPFD equals to 200 μmolm−2 s−1. Based on the computational model, it was found that the implemented plants can positively influence the requirement for the total amount of ventilated air, the most significant effect is in the case of a low indoor environment quality, with the CO2 concentration of 1500 ppm, and a high supply air quality 410 p˙pm. The simulation also showed that compared to 2020, by the year 2100, it will be necessary to increase the ventilation of the indoor environment by 25.1% to ensure the same quality of the indoorenvironment.
Supporting Autistic Culture in Defining Autistic Identity
Authors: Beaulieu Gerald
Published: November 2021

Late diagnosed Autistic adults who are also practicing artists are very likely to have clues about their identities expressed in their work. This gives them the opportunity to reevaluate their meaning through a more accurate lens and proper context. It also challenges viewers and audiences to do the same and to confront misconceptions. These biases are likely to extend across all forms of cultural production. This leaves Autistic and disabled artists with a very small and unrecognized footprint in our current cultural landscape. This needs to be rectified by rejecting outmoded stereotypes and establishing committed programs of engagement with Autistic culture by our public institutions.
COVID-19 pandemic and antimicrobial resistance in developing countries
Authors:   CMH Lahore Medical College and Institute of Dentistry, Abdur Rehman Road, Cantt, Lahore, Pakistan, Arshad Abdul Rehman , Ijaz Farhat ,   CMH Lahore Medical College and Institute of Dentistry, Abdur Rehman Road, Cantt, Lahore, Pakistan, Siddiqui Mishal Shan ,   Dow Medical College, Dow University of Health Sciences, Mission Road, New Labour Colony Nankwara, Karachi, Pakistan, Khalid Saad ,   Dow Medical College, Dow University of Health Sciences, Mission Road, New Labour Colony Nankwara, Karachi, Pakistan, Fatima Abeer ,   Dow Medical College, Dow University of Health Sciences, Mission Road, New Labour Colony Nankwara, Karachi, Pakistan, Aftab Rana Khurram ,   Punjab Institute of Cardiology, Lahore, Pakistan
Published: November 2021

A wide range of antimicrobial agents were touted as potential remedies during the COVID-19 pandemic. While both developed and developing countries have recorded an increase in the use of antimicrobial drugs, use and misuse have occurred to a far greater degree in developing countries. This can have deleterious consequences on antimicrobial resistance, especially when various developing countries have already reported the emergence of various drug-resistant organisms even before the pandemic. Telemedicine services, societal and cultural pressures, and bacterial co-infections can predispose to overwhelming antimicrobial prescriptions. The emergence of new multidrug resistance species is a major concern for the developing world especially since health services are already overburdened and lack the diagnostic capabilities and basic amenities for infection prevention and control. This can lead to outbreaks and the rampant spread of such microorganisms. Improper waste management and disposal from hospitals and communities establish freshwater runoffs as hubs of various microorganisms that can predispose to the rise of multidrug-resistant species. Microplastics' ability to act as vectors for antibioticresistant organisms is also particularly concerning for lower-middle-income countries. In this review, we aim to study the impact of antimicrobial use during the COVID-19 pandemic and antimicrobial resistance in lower middle-income countries, by understanding various determinants of resistance unique to the developing world and exploring solutions to combat the problem.
When “Even” Is Uneven
Authors: Keskin Burhanettin
Published: November 2021

The main objective of this article is to provide a critical view, through autoethnographic inquiry, of one of the seemingly most innocent, popular, and “inclusive” public statements (and images) for welcoming/tolerating “outcasts.” More specifically, the article aims to demonstrate the marginalizing and power-assertive nature of seemingly “inclusive” statements. It points out how good intentions to be inclusive, when done carelessly, not only fail to lessen the distance between “us” and “them” but actually widen the gap between the two. Another objective of this article is to provide others who feel marginalized a way of thinking that might be helpful in dealing with such issues.
Teaching strategies: How do teachers in remote area survive during remote learning?
Authors: Amelia Rini , Istianah Tia Nur
Published: November 2021

During the pandemic of COVID-19, remote learning has been very highlighted. This environment creates huge challenges especially to those teaching in remote areas. Drawing on them, this descriptive qualitative study aims to explore teaching strategies applied there. In collecting the data, interviews and questionnaires were given to two English teachers of a Junior High School in Aranio, Banjar Regency. The results show that they have to face some challenges such as the limitedness of internet access and low motivated students when implementing remote learning. Due to this condition, they need to survive by making some efforts such as creating and using interesting teaching modules, coordinating with the related parties, carrying out blended learning, conducting home visit and setting up offline classes because of no possibility for online learning. Through this study, other teachers are kindly informed on the applicable teaching strategies to create effective remote learning experiences in remote areas.
Teaching ESP during emergency remote learning (ERL): Best practices
Authors: Mandasari Yuyun Putri , Wulandari Eka
Published: November 2021

After a year more of living with COVID-19, the teachers’ and students’ resilience is still demanding, particularly regarding language online learning. Both parties must keep struggling to fulfill the learning requirements in times of crisis. One of the challenges in language issues is teaching English for Specific Purpose (ESP) in higher education during emergency remote learning (ERL) including teaching ESP at Poltekkes Kemenkes Malang in 2020-2021. At these times, ESP teachers have to design the materials by taking a lot of consideration regarding the students’ needs, goals, learning model, activities, tools, and feedback that met the emergency due to Coronavirus outbreak. They planned, implemented, and evaluated the learning process until they can find the best ones for the students. This study was a survey research with 23 participants of ESP lecturers. This article presented some best practices of teaching ESP in the online mode during ERL as the best experience of ESP lecturers, in the hope that it will be able to give some new insights for fellow educators to help them to provide better learning experiences for the students.
Unilateral gynecomastia as an initial presentation of hyperthyroid Graves’ disease
Authors: Sakulterdkiat Titipatima , Romphothong Kessanee , Chatchomchuan Waralee , Nakasatien Soontaree , Krittiyawong Sirinate , Thewjitcharoen Yotsapon , Himathongkam Thep
Published: November 2021

Graves’ disease is an autoimmune condition leading to the activation of and an increase in thyroid hormone secretion. Manifestations of hyperthyroidism in Graves’ disease can vary among people. In this case, we report a 24-year-old Thai man with a rare presentation of unilateral gynecomastia along with symptoms of thyrotoxicosis. Physical examination revealed a 3 cm non-tender palpable glandular tissue beneath and around the left areola without nipple discharge and moderately diffuse thyroid enlargement with thyroid bruit. Thyroid function test showed a typical thyrotoxicosis state with elevated serum-free T4 and decreased serum TSH. His diagnosis of Graves’ disease was confirmed biochemically with a highly elevated anti-TSH receptor antibody. Early treatment with anti-thyroid medication was given first, followed by Radioiodine treatment (RAI) for definitive treatment due to high level of anti-TSH receptor antibody, enlarged thyroid and severe thyrotoxicosis presentation at a young age, which might not resolve by anti-thyroid medication alone. The patient responded well to treatment and achieved complete resolution of unilateral gynecomastia with clinically and biochemically euthyroid within 3 months after treatment. No recurrent gynecomastia was found during the 2-year follow-up.

Learning points

Characteristic of gynecomastia in hyperthyroidism is usually presented with bilateral progressive gynecomastia; however, unilateral gynecomastia is occasionally found as a presentation of hyperthyroidism.

Complete resolution of gynecomastia without recurrence can be achieved within a few months of treatment after thyrotoxicosis is resolved in patients with hyperthyroidism with the recent development of gynecomastia.

RAI for definitive treatment is recommended in young adult patients expressing very high anti-TSH antibody level with severe thyrotoxicosis.
Analysis of the physical and chemical properties of activated carbons based on hulless barley straw and plain wheat straw obtained by H3PO4 activation
Authors: Wang Bing , Li Yongang , Si Hongyu , Chen Huiyuan , Zhang Ming , Song Tao
Published: November 2021

High specific surface area activated carbon was prepared by improving the process conditions of phosphoric acid activation and hulless barley straw and plain wheat straw as raw materials. The effects of the activation time on the pore structure and specific surface area of two types of activated carbon were investigated. The results revealed that soaking straws in the high concentrations of H3PO4 for 0.5 h to ensure complete soaking and then removing the straws from H3PO4 solution to activate was beneficial to the infiltration of H3PO4 in the raw material, and there was an increase in the surface area of activated carbon. The largest specific surface area of activated carbon prepared from plain wheat straw and hulless barley straw was 1524 m2/g and 1885 m2/g, respectively. Thermogravimetric analysis and scanning electron microscopy showed that the higher cellulose content, higher hemicellulose content, and smaller fiber morphology in hulless barley straw compared with wheat straw were the main reasons for the more abundant pore structure and higher specific surface area of the activated carbon.
Modified pectin as imprinting substrate to immobilize pectinase via both adsorption and crosslinking
Authors: Xiao Jing , Li Ziyuan , Sun Jian , Yang Qinzheng
Published: November 2021

A broad-spectrum substrate-imprinted adsorption and crosslinking double immobilized pectinase (SDP) was prepared using a universal modified pectin obtained through enzymatic hydrolysis as the imprinting substrate. Its structure was characterized by infrared spectroscopy, circular dichroism, and scanning electron microscopy. The results showed that 1) cross-linking increased the Schiff base in SDP, 2) immobilization barely changed the secondary structure such as α-helix and β-sheet of SDP, and 3) adhesives were evenly distributed on the surface after immobilization. Studies on the enzymatic properties of SDP showed that the substrate imprinting significantly improved heat resistance and neutralization resistance of SDP. For example, the relative activity of SDP at 35 to 75 °C and at pH 4.4 to 6.5 was 5% and 15% more than that of the adsorption and crosslinking double immobilized pectinase (DP), respectively. In addition, after 8 cycles of use, the relative enzyme activity of SDP still reached 39.5%. Moreover, use of SDP decreased the cation demand in whitewater by 10% compared with DP. Overall, the use of a broad-spectrum substrate for imprinting to obtain SDP provides a new idea and method for using pectinase in in complex systems such as juice clarification and wastewater treatment.
Drug-Induced Intersticial Nephritis. Clinical Case
Authors: Tekoriutė Paulina , Matuliauskaitė Monika , Jonaitis Laimas Virginijus
Published: November 2021

5-Aminosalicylic acid (5-ASA) preparations are widely used in the treatment of inflammatory bowel diseases. The most commonly used medicine is mesalamine. Overall, it is a very safe drug with few side effects. A rare side effect of this medicine is interstitial nephritis (IN). With discontinuation of the drug the renal function usually restores. However, if damage has not been detected for a long time, irreversible changes may occur. In this article, we present a clinical case of mesalamine induced IN. A 56-year-old man who has had ulcerative colitis for 20 years, was admitted due to mesalamine induced acute renal failure. A year before, the patient had been diagnosed with mesalamine-induced interstitial nephritis and the treatment with mesalamine was discontinued. The symptoms of ulcerative colitis worsened, and the patient independently decided to start taking mesalamine, which resulted in worsening of his health condition and impaired renal function. Mesalamine has been discontinued, additional treatment for acute kidney failure has been administered including hemodialysis. Renal function recovered and the patient was released for further treatment of ulcerative colitis and monitoring of renal function.
Digestive Toxicities Secondary to Immune Checkpoint Inhibition Therapy – Reports of Rare Events. A Systematic Review
Authors: Radulescu Liliana , Crisan Dana , Grapa Cristiana , Radulescu Dan
Published: November 2021

Background and Aims: While immune checkpoint inhibitors therapy (ICI) is exceedingly effective, these drugs are associated with various immune-related adverse effects. As gastrointestinal, hepatic or pancreatic toxicity becomes more common, various reports of rare adverse effects have emerged, leading to a significant clinical and prognostic impact. We aimed to provide a systematic review of mainly case-reports on rare events, to help physicians to make an accurate and fast diagnosis.

Methods: We performed a systematic review of the literature, using established MeSH terms: “immune checkpoint inhibitors”, “gastrointestinal tract”, “gastrointestinal diseases”, “liver”, “pancreas”, “nivolumab”, “ipilimumab”, the subheadings “adverse effects”, “toxicity” and the supplementary concepts “pembrolizumab”, “tremelimumab”, “atezolizumab”, “avelumab”, “durvalumab”, with defined inclusion criteria.

Results: From 419 manuscripts initially selected, 74 reports of rare adverse events were included in our review. Special cases of neutrophilic gastritis, hemorrhagic gastritis, or even perforations were described at upper digestive tract. Different types of colitis were found secondary to ICI such as pseudomembranous, granulomatous, collagenous and microscopic colitis or even inflammatory bowel disease. In terms of liver toxicity, we found rare reports of cholangitis, granulomatous hepatitis, lipodystrophy and hepatic sinusoidal obstruction syndrome. Pancreas toxicity was rarely reported as severe pancreatitis, exocrine failure and diabetes mellitus.

Conclusion: Although a complete check-up of every organ at every routine visit may not be practical, focus on symptoms, targeted laboratory and imaging testing may reveal rare organ damage. Raising awareness of the uncommon toxicities related to the immunotherapy is essential, as some rare events can lead to fatal outcomes.
Less Stress, More Success
Authors: Jones Marilee , Ginsburg Kenneth R. , Jablow Martha M.
Published: November 2021

The college admissions process is an ideal time to help teens learn to manage stress...before they show up in your office with complaints of anxiety, depression, or the results of risky behavior. Is your teen stressing over college admittance? Are you? Cowritten by a former top college admissions dean and a leading pediatrician, this first-of-its-kind book delivers strategies for surviving the admissions process while strengthening parent-child relationships, managing the stress of applying to college, and building resilience to meet challenges today and in the future. Less Stress, More Success is just what parents and teens need to thrive during this important rite of passage into adulthood. For Parents: How to encourage true high achievement, rather than perfectionism, Important dos and don'ts about the admissions process and how you can most effectively help your child, Why and when some forms of "helping" undermine your teenager's self-confidence and chances of admission, How to turn deadlines into opportunities to learn time-management and organization skills, How you can encourage positive strategies for handling stress and building resilience. For Teens: How to evaluate campus culture to find the right fit for you, Ways to manage your parents and your friends, Tips for the college interview, Letting your true, authentic self come through in your admissions essay, How your body handles stress...and what you can do to feel better and stay healthy. Includes a Personalized Stress Management Plan!
Pediatric Ophthalmology for Primary Care, 3rd Ed
Authors: Wright Kenneth W.
Published: November 2021

Formatted for practical problem solving, the new 3rd edition of this clinical resource manual covers the full spectrum of eye disorders, eye examinations, vision screening, strabismus, dyslexia, ocular trauma, genetic syndromes, and all the diverse pediatric-specific eye disorders you are likely to encounter. "This book is a useful and well presented source of pediatric ophthalmology. The excellent photos are clear and crisp." Stephen Mikell, MD, Ochsner Clinic Foundation, Doody's Review, 2008.

Clear, concise explanations and recommendations are complemented by numerous figures and photographs demonstrating eye pathology. Includes more than 200 color images; ready access to expert guidance through all the steps in effective diagnosis and intervention, including laboratory workup, etiology, differential diagnosis, preferred treatment approach, clinical course, prognosis, and indications for referral; expanded chapter on amblyopia and strabismus; new information on the importance of maintaining physiologic hypoxia; and down syndrome.
Challenging Cases in Pediatric Emergency Medicine
Authors: Yamamoto Loren , Kanegaye John T.
Published: November 2021

Developed by leading practitioners, this all-new clinical resource and learning tool brings you 77 expertly prepared reports based on actual emergency department cases. Enhance your ability to cope with both common and less frequently encountered pediatric emergencies. From patient presentation to final outcome, you'll see exactly "how it's done." The concise text steps you through assessment; differential diagnosis; evaluation; final case discussion, including management recommendations; and suggested readings. More than 150 full-color photos aid in patient evaluation and diagnostic and treatment decision-making. Case reports are grouped by topic area for quick lookup--gastrointestinal and abdominal presentations, febrile illnesses, allergies and skin reactions, injuries, central nervous system presentations, head and neck presentations, extremity presentations, genital/rectal conditions, and pulmonary presentations.
Guidelines for Air & Ground Transport
Authors:   American Academy of Pediatrics Section on Transport Medicine
Published: November 2021

The third edition includes "must-have" guidelines for health care professionals who make decisions about the emergency interfacility transport of children. The third edition of Guidelines represents the collaborative work of a diverse team of professionals involved in neonatal or pediatric transport. Of interest to hospital administrators, clinicians, communication personnel, and policy makers, updated topics include: Quality improvement, Reimbursement, Ethical considerations, Legal issues, Research, International Transport
Heading Home With Your Newborn
Authors: Jana Laura A. , Shu Jennifer
Published: November 2021

Named "one of the best guides to the first year of your baby's life" by Parents magazine! Heading Home with Your Newborn has everything new and expectant parents need to know about caring for baby in the first few months after birth. Written by two pediatricians who are also parents, this awarding-winning guide covers feeding, sleeping, changing, bathing, dressing, traveling, sickness, child care options, and much more.
New Mother’s Guide to Breastfeeding-Spanish - Nueva Guia De Lactancia Materna
Authors:   American Academy of Pediatrics
Published: November 2021

This Spanish edition of New Mother’s Guide to Breastfeeding has the same state-of-the-art information and advice found in the English edition. This comprehensive resource for Spanish speakers covers: Preparing for breastfeeding before your baby is born, Benefits to breastfeeding: including the most recent neurological, psychological, and immunological research, Father’s role and creating a postpartum support network, Establishing a nursing routine and returning to work, Solutions to common challenges, And much more.
Caring for Your Baby and Young Child: Birth to Age 5 (Spanish version) - El Cuidado De Su Hijo Pequeño
Authors:   American Academy of Pediatrics
Published: November 2021

This Spanish version of Caring for Your Baby and Young Child: Birth to Age 5 offers a wealth of parenting resources and tools for Spanish speakers: Guidelines and milestones for physical, emotional, social, and cognitive growth; A complete health encyclopedia covering injuries, illnesses, congenital diseases, and other disabilities; Guidelines for prenatal and newborn care with sections on maternal nutrition, exercise, and screening tests during pregnancy; An in-depth guide to breastfeeding, including its benefits, techniques, and challenges; A complete guide for immunizations and updated information on vaccine safety; A guide for choosing child care programs and car safety seats; Ways to reduce your child’s exposure to environmental hazards such as tobacco smoke; Winner of the "Best Health Book" award at the 2001 Latino Hall of Fame Awards.
New Mother’s Guide to Breastfeeding
Authors:   American Academy of Pediatrics, Yu Winnie
Published: November 2021

With everything new mothers need to know about breastfeeding, this fully revised and updated edition covers more than a decade's worth of the latest research! The Breastfeeding book that your doctor recommends! Nursing mothers everywhere will find this book an indispensable guide to important nutrition information that only the American Academy of Pediatrics can provide. Offering the most up-to-date information and statistics about the benefits of nursing, sage advice on how to establish a breastfeeding routine, and troubleshooting tips, the second edition of New Mother's Guide to Breastfeeding will provide new and expectant moms with everything they need to know about breastfeeding.

It takes time (and practice!) for mom and baby to adjust to the new routine. Helping to smooth the process, this book provides easy-to-understand guidance and the latest medical findings to ensure that the breastfeeding experience is a healthy and positive one. Complete with more than 50 illustrations and drawings, numerous Q&A sidebars addressing common questions and concerns, and a handy list of other breastfeeding resources, New Mother's Guide to Breastfeeding is an indispensable tool.
AM:STARs: Adolescent Gynecology, Vol 23, No. 1
Authors:   American Academy of Pediatrics
Published: November 2021

AM:STARs: Adolescent Medicine: State of the Art Reviews is the official publication of the AAP Section on Adolescent Health. Published 3 times per year, the journal offers adolescent medicine specialists and other primary care physicians who treat adolescents state of the art information on all matters relating to adolescent health and wellness. Each issue centers on a specific topic area and experts in those areas are invited to contribute review articles that cover the most up to date information available.

AM:STARs: Adolescent Medicine: State of the Art Reviews is the official publication of the AAP Section on Adolescent Health. Published 3 times per year, the journal offers adolescent medicine specialists and other primary care physicians who treat adolescents state of the art information on all matters relating to adolescent health and wellness. Each issue centers on a specific topic area and experts in those areas are invited to contribute review articles that cover the most up to date information available.