bluuebunny/crossref_metadata_2025 huggingface dataset:
Validation of an artificial intelligence-driven large vessel occlusion detection algorithm for acute ischemic stroke patients
Authors: Rava Ryan A , Peterson Blake A , Seymour Samantha E , Snyder Kenneth V , Mokin Maxim , Waqas Muhammad , Hoi Yiemeng , Davies Jason M , Levy Elad I , Siddiqui Adnan H , Ionita Ciprian N
Published: March 2021

Rapid and accurate diagnosis of large vessel occlusions (LVOs) in acute ischemic stroke (AIS) patients using automated software could improve clinical workflow in determining thrombectomy in eligible patients. Artificial intelligence-based methods could accomplish this; however, their performance in various clinical scenarios, relative to clinical experts, must be thoroughly investigated. We aimed to assess the ability of Canon’s AUTOStroke Solution LVO application in properly detecting and locating LVOs in AIS patients. Data from 202 LVO and 101 non-LVO AIS patients who presented with stroke-like symptoms between March 2019 and February 2020 were collected retrospectively. LVO patients had either an internal carotid artery (ICA) ( n = 59), M1 middle cerebral artery (MCA) ( n = 82) or M2 MCA ( n = 61) occlusion. Computed tomography angiography (CTA) scans from each patient were pushed to the automation platform and analyzed. The algorithm’s ability to detect LVOs was assessed using accuracy, sensitivity and Matthews correlation coefficients (MCCs) for each occlusion type. The following results were calculated for each occlusion type in the study (accuracy, sensitivity, MCC): ICA = (0.95, 0.90, 0.89), M1 MCA = (0.89, 0.77, 0.78) and M2 MCA = (0.80, 0.51, 0.59). For the non-LVO cohort, 98% (99/101) of cases were correctly predicted as LVO negative. Processing time for each case was 69.8 ± 1.1 seconds (95% confidence interval). Canon’s AUTOStroke Solution LVO application was able to accurately identify ICA and M1 MCA occlusions in addition to almost perfectly assessing when an LVO was not present. M2 MCA occlusion detection needs further improvement based on the sensitivity results displayed by the LVO detection algorithm.
Cytomegalovirus prophylaxis using low-dose valganciclovir in patients with acute leukemia undergoing allogeneic hematopoietic stem-cell transplantation
Authors: Li Po-Hsien , Lin Cheng-Hsien , Lin Yu-Hui , Chen Tsung-Chih , Hsu Chiann-Yi , Teng Chieh-Lin Jerry
Published: March 2021

Background:

Letermovir prophylaxis is currently the standard of care for the prevention of cytomegalovirus (CMV) infections in allogeneic hematopoietic stem-cell transplantation (allo-HSCT). However, drug–drug interactions between letermovir and azoles or calcineurin inhibitors and the high financial burden of letermovir remain problematic, especially in resource-limited countries. It has not been clarified whether a lower dose of valganciclovir would constitute an effective strategy for CMV prevention in patients with acute leukemia undergoing allo-HSCT.

Methods:

We retrospectively assessed 84 consecutive adult patients with acute leukemia who underwent allo-HSCT. These 84 patients were stratified into a valganciclovir prophylaxis group ( n = 20) and a non-valganciclovir prophylaxis group ( n = 64).

Results:

Patients in the valganciclovir prophylaxis group had a lower possibility of CMV DNAemia at week 14 after allo-HSCT than those in the non-valganciclovir prophylaxis group (15.0% versus 50.0%; p = 0.012). The cumulative incidence of CMV DNAemia at week 14 was also lower in patients with valganciclovir CMV prophylaxis than in those without (15.0% versus 50.4%; p = 0.006). Multivariate analysis validated these data, showing that a low dose of valganciclovir significantly reduced the risk of CMV DNAemia at week 14 by 88% (hazard ratio: 0.12; 95% confidence interval: 0.04–0.42; p = 0.001). However, these two groups had similar overall survival rates at week 48 (75.0% versus 76.6%; p = 0.805). Four of 20 (20%) patients discontinued valganciclovir prophylaxis because of adverse events.

Conclusion:

Low-dose valganciclovir prophylaxis could be an alternative to letermovir to prevent CMV infection in allo-HSCT, especially in resource-limited countries.
Urban form, traffic volume, and air quality: A spatiotemporal stratified approach
Authors: Tian Ye , Yao Xiaobai
Published: March 2021

Understanding the interplay between urban form, traffic volume, and air quality is significant for urban planning and environmental sustainability. However, limited progress has been made in bringing effective urban planning strategies to help control traffic demand and resulting air pollutants. Therefore, this study aims to investigate the interrelation between urban form, traffic volume, and air quality with a spatiotemporal stratified method. The method extracts and preprocesses traffic volume data in spatial (polluted and unpolluted zones) and temporal (periods in holidays and workdays) dimensions. Three decision tree models (random forest, random tree, M5 model tree) and two comparison models (multiple linear regression, artificial neural network) are used to examine the relationships. The final results show that the spatiotemporal stratification approach effectively reveals the interrelations, and the random forest model outperforms the other models. Specifically, highly aggregated roads and industrial areas are more associated with traffic volume in polluted zones. The dominance of waterway and vegetation shows a strong association with traffic volume in unpolluted zones. The degree of association also varies significantly between workdays and holidays. Our spatiotemporal stratified approach reveals heterogeneous relationships between urban form, traffic volume, and air quality and provides insightful references on sustainable urban development.
Minimally Invasive Dorsal Cheilectomy and Hallux Metatarsal Phalangeal Joint Arthroscopy for the Treatment of Hallux Rigidus
Authors: Glenn Rachel L. , Gonzalez Tyler A. , Peterson Alexander B. , Kaplan Jonathan
Published: March 2021

Background:

Hallux rigidus (HR) is a common source of forefoot pain and disability. For those who fail nonoperative treatment, minimally invasive dorsal cheilectomy (MIDC) is an increasingly popular alternative to the open approach with early positive results. Early failures may be due to lose bone debris from the MIDC as well as other intra-articular pathology that cannot be addressed with MIDC alone. Metatarsophalangeal (MTP) arthroscopy can be used in addition to MIDC to assess the joint after MIDC and address any intra-articular pathology while still maintaining the benefits of minimally invasive surgery. We report our clinical outcomes following MIDC combined with MTP arthroscopy.

Methods:

From November 2017 to July 2020, a retrospective analysis of all MIDC cheilectomies with MTP arthroscopy performed by the 2 senior authors was done. Wound complications, infections, revision rates, need for future surgery, conversion to fusion rates, pre- and postoperative range of motion, visual analog scale (VAS) scores, time to return to normal shoe, intraoperative arthroscopic findings, and operative time were collected. Follow-up average was 16.5 months (range 3-33 months).

Results:

A total of 20 patients were included with an average follow-up of 16.5 months. The average VAS score improved from 7.05 preoperatively to 0.75 postoperatively ( P < .05). Average range of motion in dorsiflexion increased from 32 to 48 degrees ( P < .05) and plantarflexion increased from 15 to 19 degrees plantarflexion ( P < .05). All patients were weightbearing as tolerated immediately after surgery in a postoperative shoe and transitioned to a regular shoe at average of 2.1 weeks. We had no wound infections, wound complications, revision surgeries, tendon injuries or nerve damage. One patient required conversion to a fusion 3 years after the index procedure. Average tourniquet time was 30.39 minutes (range 17-60 minutes) and total average operating room time was 59.7 minutes (range 40-87 minutes). On arthroscopic evaluation of the MTP joint after MIDC, 100% of patients had bone debris, 100% had synovitis, 10% had loose bodies, and 30% had large cartilage flaps within the joint.

Conclusion:

MIDC and first MTP joint arthroscopy for treatment of hallux rigidus provide improved pain relief with minimal complications while still maintaining the benefits touted for minimally invasive operative procedures. Additionally, we have shown a high rate of intra-articular debris along with intra-articular pathology such as synovitis, loose chondral flaps, and loose bodies that exist after MIDC. This combined procedure has the potential for improving patient outcomes and may minimize risk of future revision surgeries compared with MIDC alone.

Level of Evidence:

Level IV, case series study.
Identification of cutaneous fungi and mites in adult atopic dermatitis: analysis by targeted 18S rRNA amplicon sequencing
Authors: Edslev Sofie Marie , Andersen Paal Skytt , Agner Tove , Saunte Ditte Marie Lindhardt , Ingham Anna Cäcilia , Johannesen Thor Bech , Clausen Maja-Lisa
Published: March 2021

Background

Atopic dermatitis (AD) patients have an altered skin bacterial community, with an abundance of Staphylococcus aureus associated with flares, highlighting that microbial organisms may be important for disease exacerbation. Despite strong evidence of association between bacterial skin colonisation and AD, very limited knowledge regarding the eukaryotic microbial community, including fungi and ectoparasites, in AD exists. In this study, we compared the skin and nasal eukaryotic microbial community between adult AD patients (n = 55) and non-AD healthy controls (n = 45) using targeted 18S rRNA amplicon sequencing. Analysis was based on the presence or absence of eukaryotic microorganisms.

Results

The cutaneous composition of the eukaryotic microbial community and the alpha-diversity differed significantly between AD patients and non-AD individuals, with increased species richness on AD skin. Alpha-diversity and beta-diversity were similar on lesional and non-lesional skin of patients. The ectoparasite Demodex folliculorum and the yeast Geotrichum candidum were significantly more prevalent on the skin of AD patients. The prevalence of D. folliculorum on lesional skin was greater among patients recently treated with topical corticosteroid. Malassezia was one of the most frequently detected genera at all sites, with M. globosa and M. restricta being the most prevalent. M. restricta was under represented in the anterior nares of AD patients as compared to the non-AD control population.

Conclusion

Significant differences in the eukaryotic microbial communities were found between AD patients and non-AD individuals, with the most striking finding being the significantly overrepresentation of D. folliculorum on AD skin. Whether D. folliculorum can contribute to skin inflammation in AD needs further investigation.
General versus regional anaesthesia for caesarean section indicated for acute foetal distress: a retrospective cohort study
Authors: Metogo Junette Arlette Mbengono , Nana Theophile Njamen , Ngongheh Brian Ajong , Nyuydzefon Emelinda Berinyuy , Adjahoung Christoph Akazong , Tochie Joel Noutakdie , Minkande Jacqueline Ze
Published: March 2021

Background

Acute foetal distress (AFD) is a life-threatening foetal condition complicating 2% of all pregnancies and accounting for 8.9% of caesarean sections (CS) especially in developing nations. Despite the severity of the problem, no evidence exists as to the safest anaesthetic technique for the mother and foetus couple undergoing CS for AFD. We aimed to compare general anaesthesia (GA) versus regional (spinal and epidural) anaesthesia in terms of their perioperative maternal and foetal outcomes.

Methods

We carried out a retrospective cohort study by reviewing the medical records of all women who underwent CS indicated for AFD between 2015 to 2018 at the Douala General Hospital, Cameroon. Medical records of neonates were also reviewed. We sought to investigate the association between GA, and regional anaesthesia administered during CS for AFD and foetal and maternal outcomes. The threshold of statistical significance was set at 0.05.

Results

We enrolled the medical records of 117 pregnant women who underwent CS indicated for AFD. Their mean age and mean gestational age were 30.5 ± 4.8 years and 40 weeks respectively. Eighty-three (70.9%), 29 (24.8%) and 05 (4.3%) pregnant women underwent CS under SA, GA and EA respectively. Neonates delivered by CS under GA were more likely to have a significantly low APGAR score at both the 1st (RR = 1.93, p = 0.014) and third-minute (RR = 2.52, p = 0.012) and to be resuscitated at birth (RR = 2.15, p = 0.015). Past CS, FHR pattern on CTG didn’t affect these results in multivariate analysis. Adverse maternal outcomes are shown to be higher following SA when compared to GA.

Conclusion

The study infers an association between CS performed for AFD under GA and foetal morbidity. This, however, failed to translate into a difference in perinatal mortality when comparing GA vs RA. This finding does not discount the role of GA, but we emphasize the need for specific precautions like adequate anticipation for neonatal resuscitation to reduce neonatal complications associated with CS performed for AFD under GA.
Reasons for poor blood pressure control in Eastern Sub-Saharan Africa: looking into 4P’s (primary care, professional, patient, and public health policy) for improving blood pressure control: a scoping review
Authors: Sorato Mende Mensa , Davari Majid , Kebriaeezadeh Abbas , Sarrafzadegan Nizal , Shibru Tamiru , Fatemi Behzad
Published: March 2021

Aim

Hypertension control in Sub-Saharan Africa (SSA) is the worst (less than one out of ten) when compared to the rest of the world. Therefore, this scoping review was conducted to identify and describe the possible reasons for poor blood pressure (BP) control based on 4Ps’ (patient, professional, primary healthcare system, and public health policy) factors.

Methods

PRISMA extension for scoping review protocol was used. We systematically searched articles written in the English language from January 2000 to May 2020 from the following databases: PubMed/Medline, Embase, Scopus, Web of Science, and Google scholar.

Results

Sixty-eight articles were included in this scoping review. The mean prevalence of hypertension, BP control, and patient adherence to prescribed medicines were 20.95%, 11.5%, and 60%, respectively. Only Kenya, Malawi, and Zambia out of ten countries started annual screening of the high-risk population for hypertension. Reasons for nonadherence to prescribed medicines were lack of awareness, lack of access to medicines and health services, professional inertia to intensify drugs, lack of knowledge on evidence-based guidelines, insufficient government commitment, and specific health behaviors related laws. Lack of screening for high-risk patients, non-treatment adherence, weak political commitment, poverty, maternal and child malnutrition were reasons for the worst BP control.

Conclusion

In conclusion, the rate of BP treatment, control, and medication adherence was low in Eastern SSA. Screening for high-risk populations was inadequate. Therefore, it is crucial to improve government commitment, patient awareness, and access to medicines, design country-specific annual screening programs, and empower clinicians to follow individualized treatment and conduct medication adherence research using more robust tools.
Aggressive primary gastric lymphoma (PGL) masquerading as hepatocellular cancer (HCC) in alcoholic cirrhosis
Authors: Ahmed Moiz , Al-Khazraji Ahmed , Syed Umer , Seen Tasur , Walfish Aaron
Published: March 2021

Background

The gastrointestinal tract is sa well-known site for extranodal Non-Hodgkin lymphomas, with the stomach is known to be the most common site on lymphoma, primary gastric lymphoma (PGL). The lymphoproliferative disorder rarely occurs in patients with cirrhosis. We report a unique case of metastatic PGL in a patient with cirrhosis.

Case presentation

A middle-aged male with decompensated alcoholic cirrhosis presented with two weeks of epigastric abdominal pain, abdominal distension, and jaundice. Abdominal triple-phase CT scan was consistent with cirrhosis, ascites, and multiple new hypodense liver lesions classified as an intermediate probability for HCC based on the LI-RADS classification system (LI RADS 3). Due to the CT findings in the setting of cirrhosis, a provisional diagnosis of HCC was made. Upper endoscopy revealed new multiple umbilicated submucosal nodules in the gastric body. Biopsy and immunostaining consistent with high-grade B-cell lymphoma. Targeted liver biopsy with similar morphology and immunostaining profile consistent with metastatic primary gastric DLBCL.

Conclusions

The case highlights the importance of recognizing metastatic PGL in patients with underlying cirrhosis to differentiate lymphoma from hepatocellular cancer. Targeted liver biopsies with lymphoma immunostaining are required to make a diagnosis.
Breastfeeding competency scale (BCS); development and validation of an evaluation instrument on breastfeeding competency in third trimester pregnancy
Authors: Wu Yu , Wang Ying , Hu Jiazhen , Dang Yan , Zhang Yuanyuan , Qi Xiumei , Tian Qingxiu , Wang Aihua , Li Yunfeng
Published: March 2021

Background

Breastfeeding plays an important role in the early stages of humans and throughout the development process. Breastfeeding competency is a self-assessment of pregnant women’s overall competency to breastfeeding which could predict the breastfeeding behaviours of pregnant women. However, a valid and reliable scale for assessing breastfeeding competency has not yet been developed and validated. This study was conducted to develop and validate an assessment scale designed to assess pregnant women’s breastfeeding competency in the third trimester: the Breastfeeding Competency Scale (BCS).

Methods

The BCS was developed and validated over three phases between September 2018 and September 2019, and these phases included item statistical analysis, exploratory factor analysis (EFA), content validation, internal consistency assessment, split-half reliability assessment and confirmatory factor analysis (CFA).

Results

The item statistical analysis and EFA resulted in 38 items and 4 factors that explained 66.489% of the total variance. The Cronbach’s α coefficients for the total scale and the 4 factors were 0.970, 0.960, 0.940, 0.822 and 0.931. The split-half reliability of the BCS was 0.894 and 0.890. CFA model showed that the 4-factor model fits the data well.

Conclusions

The BCS is a new valid and reliable instrument for assessing the breastfeeding competency of pregnant women in the third trimester.
Emotional states of different obesity phenotypes: a sex-specific study in a west-Asian population
Authors: Mehrabi Fahimeh , Amiri Parisa , Cheraghi Leila , Kheradmand Ali , Hosseinpanah Farhad , Azizi Fereidoun
Published: March 2021

Background

The present study aimed to investigate the associations of obesity phenotypes with depression, anxiety, and stress symptoms among adults in the Tehran Lipid and Glucose Study (TLGS).

Methods

Depression, anxiety, and stress levels of participants from the TLGS were examined among different obesity phenotypes in this cross-sectional study.

Obesity was defined as body mass index (BMI) ≥30 kg/m2, and metabolically unhealthy status based on having metabolic syndrome (MetS) or type 2 diabetes. Four obesity phenotypes were defined: 1) Metabolically Healthy Non-Obese (MHNO), 2) Metabolically Healthy Obese (MHO) 3) Metabolically Unhealthy Non-Obese (MUNO), and 4) Metabolically Unhealthy Obese (MUO). Emotional states of different obesity phenotypes were assessed by the Persian version of depression, anxiety, and stress scale-21 items (DASS-21). Ordinal logistic regression analysis was used to compare sex-specific odds ratios of depression, anxiety, and stress in different obesity phenotypes.

Results

The mean age of 2469 men and women was 46.2 ± 15.9 and 45.6 ± 14.7, respectively. In total, women were more likely to experience higher levels of depression (30.5%), anxiety (44.2%), and stress (43.5%) symptoms compared to men. After adjusting for potential confounders, compared to MHNO men, the odds of experiencing higher anxiety levels were significantly greater in metabolically unhealthy men whether they were obese (OR: 1.78, 95% CI: 1.25–2.54;P = < 0.001) or non-obese (OR: 1.61, 95% CI: 1.17–2.21;P = < 0.001), and also in MUO women (OR: 1.73, 95% CI: 1.28–2.34;P = < 0.001) compared to MHNO women. Moreover, the odds of experiencing higher stress levels were significantly greater in MUNO men (OR: 1.40, 95% CI: 1.02–1.90;P = 0.04) compared to MHNO men and in MUO women (OR: 1.45, 95% CI: 1.07–1.96;P = 0.02) compared to MHNO women. No difference in depression levels was observed in either sex.

Conclusions

Our results showed that men and women with various obesity phenotypes experienced different anxiety and stress levels. While MUO women and all metabolically unhealthy men experienced more anxiety and stress levels than MHNO individuals, none of the obesity phenotypes were associated with depression. These findings provide insight into recognizing the psychological consequences of different phenotypes of obesity in both sexes and utilizing future health promotion planning.
An unusual case of reactivated latent pulmonary cryptococcal infection in a patient after short‐term steroid and azathioprine therapy: a case report
Authors: Pan Wei-Gang , Chen Bao-Chung , Li Yao-Feng , Wu Rui-Xin , Wang Ching-Hsun
Published: March 2021

Background

Cryptococcus is one of the major fungal pathogens infecting the lungs. Pulmonary cryptococcal infection is generally considered a community-acquired condition caused by inhalation of dust contaminated with fungal cells from the environment. Here, we report a case developing pulmonary cryptococcosis 3 months after hospital admission, which has rarely been reported before.

Case presentation

A 73-year-old female patient who was previously immunocompetent experienced persistent dry cough for 2 weeks, 3 months after admission. Chest computed tomography (CT) showed a new solitary pulmonary nodule developed in the upper lobe of the left lung. Staining and culture of expectorated sputum smears were negative for bacteria, acid-fast bacilli, or fungus. The patient then underwent biopsy of the lesion. Histopathology findings and a positive serum cryptococcal antigen titer (1:8) indicated pulmonary cryptococcosis. Daily intravenous 400 mg fluconazole was administered initially followed by oral fluconazole therapy. Follow-up chest CT after 3 months of antifungal therapy showed complete disappearance of the pulmonary nodule. Respiratory symptoms of the patient also resolved. A complete investigation excluded the possibility of a patient-to-patient transmission or primarily acquiring the infection from the hospital environment. Based on the patient’s history of exposure to pigeons before admission and recent steroid and azathioprine use after admission for the treatment of myasthenic crisis, reactivation of a latent pulmonary cryptococcal infection acquired before admission, in this case, is impressed.

Conclusions

Although rarely reported, pulmonary cryptococcal infection should be included in the differential diagnosis of hospitalized patients with respiratory symptoms, especially in those with predisposing risk factors. Chest image studies and further surgical biopsy are needed for confirmation.
Nomogram to predict the risk of acute kidney injury in patients with diabetic ketoacidosis: an analysis of the MIMIC-III database
Authors: Fan Tingting , Wang Haosheng , Wang Jiaxin , Wang Wenrui , Guan Haifei , Zhang Chuan
Published: March 2021

Background

This study aimed to develop and validate a nomogram for predicting acute kidney injury (AKI) during the Intensive Care Unit (ICU) stay of patients with diabetic ketoacidosis (DKA).

Methods

A total of 760 patients diagnosed with DKA from the Medical Information Mart for Intensive Care III (MIMIC-III) database were included and randomly divided into a training set (70%,n = 532) and a validation set (30%,n = 228). Clinical characteristics of the data set were utilized to establish a nomogram for the prediction of AKI during ICU stay. The least absolute shrinkage and selection operator (LASSO) regression was utilized to identified candidate predictors. Meanwhile, a multivariate logistic regression analysis was performed based on variables derived from LASSO regression, in which variables withP < 0.1 were included in the final model. Then, a nomogram was constructed applying these significant risk predictors based on a multivariate logistic regression model. The discriminatory ability of the model was determined by illustrating a receiver operating curve (ROC) and calculating the area under the curve (AUC). Moreover, the calibration plot and Hosmer-Lemeshow goodness-of-fit test (HL test) were conducted to evaluate the performance of our newly bullied nomogram. Decision curve analysis (DCA) was performed to evaluate the clinical net benefit.

Results

A multivariable model that included type 2 diabetes mellitus (T2DM), microangiopathy, history of congestive heart failure (CHF), history of hypertension, diastolic blood pressure (DBP), urine output, Glasgow coma scale (GCS), and respiratory rate (RR) was represented as the nomogram. The predictive model demonstrated satisfied discrimination with an AUC of 0.747 (95% CI, 0.706–0.789) in the training dataset, and 0.712 (95% CI, 0.642–0.782) in the validation set. The nomogram showed well-calibrated according to the calibration plot and HL test (P > 0.05). DCA showed that our model was clinically useful.

Conclusion

The nomogram predicted model for predicting AKI in patients with DKA was constructed. This predicted model can help clinical physicians to identify the patients with high risk earlier and prevent the occurrence of AKI and intervene timely to improve prognosis.
Incidence of microcarcinoma and non‐microcarcinoma in ultrasound‐found thyroid nodules
Authors: Chen Zhi , Mosha Singla Sethiel , Zhang Tong , Xu Ming , Li Yanli , Hu Zhuoqing , Liang Weiqiang , Deng Xiaoyi , Ou Tingting , Li Ling , Li Wangen
Published: March 2021

Backgrounds

The incidence of thyroid nodules is increasing year by year around the world. However, ultrasound is not recommended as a screening test for the general population or patients with a normal thyroid on palpation by the American Association of Clinical Endocrinologists (AACE). In practice, some individuals with normal thyroid palpation have nodules that can just be found out by ultrasound. No studies have directly described the risk of nodules found by ultrasound or by palpation up to now. More evidence is needed to carry out for helping us balance the over diagnosis and missed diagnosis of malignant lesions. Therefore, we carried out a retrospective study to investigate the incidence of malignant lesions in ultrasound-found nodules in a large cohort.

Methods

We conducted a retrospective analysis involving 2957 patients who underwent thyroid ultrasound evaluation and fine-needle aspiration (FNA) between Jan 2013 and Dec 2019. The cytologic examinations were analyzed based on the Bethesda system. For nodules suspected to be follicular neoplasm or other malignant tumors by cytological tests, patients were recommended for surgery and histopathology examinations.

Results

Compared with palpation-found nodules, ultrasound-found nodules were presenting less as purely cystic nodules (10.1 % vs. 39.9 %, x2 = 355.69, p = 0.000), smaller size (17.5 ± 9.9 mm vs. 28.0 ± 12.5 mm, t = 23.876 p = 0.000), and higher TI-RADS score (5.5 ± 2.9 vs. 3.4 ± 3.3, t = 18.084, p = 0.000), respectively. More ultrasound-found nodules were diagnosed as carcinoma by histology examinations [136 (11.2 %) nodules found by ultrasound vs. 68 (3.9 %) by palpation, x2 = 59.737, p = 0.000], and 88 (64.7 %) nodules found by ultrasound were non-microcarcinoma. Among the malignant nodules confirmed by histopathology, a higher proportion of microcarcinoma was detected in ultrasound-found nodules [35.3 % (48/136) vs. 16.2 % (11/68), x2 = 8.183, p = 0.004].

Conclusions

In view of the results observed in our research, malignant nodules were more common in nodules screened out by ultrasound, and nearly two thirds of them were non-microcarcinoma. We suggest the recommendation against screening thyroid nodules by ultrasound needs to be re-evaluated.
A dietary pattern rich in fruits and dairy products is inversely associated to gestational diabetes: a case-control study in Iran
Authors: Roustazadeh Abazar , Mir Hamed , Jafarirad Sima , Mogharab Farideh , Hosseini Seyed Ahmad , Abdoli Amir , Erfanian Saiedeh
Published: March 2021

Background

Gestational diabetes mellitus (GDM) causes many problems for mother and her neonate. A healthy diet plays an important role in preventing GDM. This study aimed to investigate the relationship between major dietary patterns and the GDM.

Methods

386 healthy and 306 GDM pregnant women (total 693) completed this case-control study. Basic information and anthropometric indices were recorded, and a food frequency questionnaire was completed. For extracting major dietary patterns, the principal component analysis was performed. Multivariable logistic regression models were used to examine whether specific dietary patterns are associated to the GDM.

Results

Four dietary patterns were identified: “fruits and dairy products”, “red meat and plant-based foods”, “snacks and high-fat foods” and “carbohydrate-rich foods”. Among these major extracted dietary patterns, “fruits and dairy products” showed an inverse association to the GDM (odds ratio adjusted for confounders: 0.50, confidence interval: 0.284–0.882, p-trend = 0.019, for highest vs. lowest quartile).

Conclusions

It seems using a healthy dietary pattern such as “fruits and dairy products” may decrease GDM risk.

Graphical abstract
Association between dental fear and eating disorders and Body Mass Index among Finnish university students: a national survey
Authors: Sharifian Mohammad Jalil , Pohjola Vesa , Kunttu Kristina , Virtanen Jorma I.
Published: March 2021

Background

Little is known about the association between eating disorders (ED) and dental fear. This study investigated the association between dental fear and EDs through body mass index (BMI), and SCOFF (sick, control, one stone, fat, food) questionnaire among Finnish university students. We hypothesised that dental fear is associated with EDs and BMI.

Methods

We used the latest data from the Finnish University Student Health Survey 2016. This survey targeted undergraduate Finnish students (n = 10,000) of academic universities and universities of applied sciences. We enquired about e.g. age, gender, height, weight, educational sector and perceived mental well-being. We used the SCOFF questionnaire to assess those at risk for developing EDs. The question ‘Do you feel scared about dental care?’ enquired about dental fear. We used the chi-square test and gender-specific logistic regression to analyse the associations between dental fear, EDs and BMI controlling for age, educational sector and mental well-being.

Results

In total, 3110 students participated in the study. Overall 7.2% of the students reported high dental fear and 9.2% scored SCOFF positive; more women than men reported high dental fear (11.2% vs. 3.8%, p < 0.001) and scored positive on SCOFF (14.2% vs. 3.6%, p < 0.001). Gender modified the association between dental fear and EDs and BMI. Among females, when controlling for educational sector and BMI, those with positive SCOFF score were more likely to have high dental fear than those with negative SCOFF score (OR = 1.6; CI = 1.0–2.4). After adding perceived mental well-being to the gender-specific regression analyses, overweight and obese males, BMI ≥ 25 (OR = 2.4; CI 1.3–4.4) and females with poor to moderate mental well-being (OR = 2.1; CI 1.4–2.9) were more likely than their counterparts to have high dental fear.

Conclusions

Among the Finnish university students BMI in males and problems of mental well-being in females were positively associated with high dental fear. The results of this study support possible common vulnerability factors that dental fear and other psychological disorders may share.
Quantitative analysis on the wear of monolithic zirconia crowns on antagonist teeth
Authors: Tang Zhenyu , Zhao Xinyi , Wang Hui
Published: March 2021

Background

The present study aimed to quantitate the wear of the highly transparent Yttria-stabilized tetragonal zirconia polycrystals (Y-TZP) ceramic monolithic zirconia crown on the enamel in vivo and discuss the prone position of the wear and the underlying mechanism.

Methods

A total of 43 patients with 43 posterior teeth were selected for full zirconia crown restoration and examined immediately, at 6 months, and at 1 year after restoration. During the follow-up visit, the fine impression of the patients’ monolithic zirconia crowns, the antagonist teeth, the corresponding contralateral natural teeth, the super plaster cast, and epoxy resin model was ontained. The model of epoxy resin was observed under a stereo microscope, and the microstructure parts were observed under a scanning electron microscope.

Results

After 1 year, the mean depth and volume of wearing of the monolithic zirconia crown were the smallest (all P < 0.01), while those of the antagonist teeth were significantly larger than those of the natural teeth (P < 0.0001), and no significant difference was found among the natural teeth (P = 0.3473, P = 0.6996). The amount of wear after one year was remarkably higher than that at 6 months (P < 0.0001). The microscopic observation revealed the tendency of wearing of the monolithic zirconia crown on the antagonist teeth at the protruding early contact points. Electron micrographs of tooth scars showed that the wearing mechanism of the monolithic zirconia crown on natural teeth was mainly abrasive and fatigue wear.

Conclusions

Although the self-wearing is insignificant, the monolithic zirconia crown can cause wear of the antagonist teeth via occlusal or early contact significantly; the amount of wearing is higher than that of natural teeth and increases over time. The wearing mechanism is mainly abrasive and fatigue wear.
Exploring the differences between men’s and women’s perceptions of gender-based violence in rural Tajikistan: a qualitative study
Authors: Wood Elizabeth A. , Wilson Karina E. , Jacobs K. D.
Published: March 2021

Background

Most women living in rural provinces of Tajikistan, specifically Khatlon, experience little to no opportunities for education and economic growth, making them vulnerable to gender-based violence (GBV). Unfortunately due to social norms that are bolstered by a patriarchal society, GBV has become tolerated and even normalized in rural areas. This study looks to investigate the differences in perceptions of violence as it relates to empowerment among men and women in rural Tajikistan.

Methods

Data collection was done through participatory workshops and semi-structured interviews (SSI) that were led by Extension Home Economists, which lectured on gender, violence, and empowerment. Community Empowerment Drawings is a novel tool that has been used to further gather sensitive information that was not previously discussed. During this process, participant groups were asked to draw their perception of empowered versus disempowered women, later explaining the different characteristics and traits of both. Random participants across both genders were later contacted for a SSI to triangulate the data from the participatory workshops. This qualitative study implemented qualitative content analysis to explore the data inductively. Analysis of the drawings and transcripts from the workshops and SSIs included two researchers coding through an iterative process. Themes were stratified by men’s and women’s perceptions and codebooks were compared to ensure consensus.

Results

Men and women from 12 villages participated in the Community Empowerment Drawings within each workshop, with 234 participants total. Results were stratified into two categories which were later broken down into notable themes: education, employment, decision-making, marital status, relationship wellness and respect, violence, mental health, and substance abuse. Major findings illustrated how disempowered women were perceived to have more exposure to men who experience alcohol abuse. This study found that differences in perceptions of empowerment between men and women remain—with men still holding onto the traditional power structure within a household and women challenging gender roles and mobility.

Conclusion

Future studies may find engaging communities through drawings will yield more information regarding sensitive topics rather than traditional instruments. More support and advocacy are needed in areas of mental, neurological, and substance abuse disorders throughout rural Tajikistan.
Thymoquinone inhibited vasculogenic capacity and promoted mesenchymal-epithelial transition of human breast cancer stem cells
Authors: Haiaty Sanya , Rashidi Mohammad-Reza , Akbarzadeh Maryam , Bazmani Ahad , Mostafazadeh Mostafa , Nikanfar Saba , Zibaei Zohre , Rahbarghazi Reza , Nouri Mohammad
Published: March 2021

Background

Vasculogenic mimicry (VM) is characterized by the formation of tubular structure inside the tumor stroma. It has been shown that a small fraction of cancer cells, namely cancer stem cells (CSCs), could stimulate the development of vascular units in the tumor niche, leading to enhanced metastasis to the remote sites. This study aimed to study the inhibitory effect of phytocompound, Thymoquinone (TQ), on human breast MDA-MB-231 cell line via monitoring Wnt/PI3K signaling pathway.

Methods

MDA-MB-231 CSCs were incubated with different concentrations of TQ for 48 h. The viability of CSCs was determined using the MTT assay. The combination of TQ and PI3K and Wnt3a inhibitors was examined in CSCs. By using the Matrigel assay, we measured the tubulogenesis capacity. The percent of CD24− CSCs and Rhodamine 123 efflux capacity was studied using flow cytometry analysis. Protein levels of Akt, p-Akt, Wnt3a, vascular endothelial-cadherin (VE-cadherin), and matrix metalloproteinases-2 and -9 (MMP-2 and -9) were detected by western blotting.

Results

TQ decreased the viability of CSCs in a dose-dependent manner. The combination of TQ with PI3K and Wnt3a inhibitors reduced significantly the survival rate compared to the control group (p < 0.05). TQ could blunt the stimulatory effect of vascular endothelial growth factor (VEGF), epidermal growth factor (EGF), fibroblast growth factor (FGF) on CSCs (p < 0.05). The vasculogenic capacity of CSCs was reduced after being-exposed to TQ (p < 0.05). Western blotting revealed the decrease of CSCs metastasis by suppressing MMP-2 and -9. The protein level of VE-cadherin was also diminished in TQ-treated CSCs as compared to the control cell (p < 0.05), indicating inhibition of mesenchymal-endothelial transition (MendT). TQ could suppress Wnt3a and PI3K, which coincided with the reduction of the p-Akt/Akt ratio. TQ had the potential to decrease the number of CD24− CSCs and Rhodamine 123 efflux capacity after 48 h.

Conclusion

TQ could alter the vasculogenic capacity and mesenchymal-epithelial transition of human breast CSCs in vitro. Thus TQ together with anti-angiogenic therapies may be a novel therapeutic agent in the suppression of VM in breast cancer.
Québec health care professionals’ perspectives on organ donation after medical assistance in dying
Authors: Allard Julie , Ballesteros Fabian , Fortin Marie-Chantal
Published: March 2021

Background

Medical assistance in dying (MAID) has been legal in Québec since December 2015 and in the rest of Canada since July 2016. Since then, more than 60 people have donated their organs after MAID. Such donations raise ethical issues about respect of patients’ autonomy, potential pressure to choose MAID, the information given to potential donors, the acceptability of directed donations in such a context and the possibility of death by donation. The objective of this study was to explore Québec professionals’ perspectives on the ethical issues related to organ donation after MAID.

Methods

We conducted semi-directed interviews with 21 health care professionals involved in organ donation such as intensivists and intensive care nurses, operating room nurses, organ donation nurses and coordinators.

Results

The participants were all favourable to organ donation after MAID in order to respect patients’ autonomy. They also favoured informing all potential donors of the possibility of donating organs. They highlighted the importance of assessing donors’ reasons for requesting MAID during the assessment. They were divided on directed donation, living donation before MAID and death by donation.

Conclusion

Organ donation after MAID was widely accepted among the participants, based on the principle of respect for the donor’s autonomy. The findings of this study only provide the perspectives of Québec health care professionals involved in organ donation. Future studies are needed to gather other stakeholders’ perspectives on this issue as well as patients’ and families’ experiences of organ donation after MAID.
First-line management of canine status epilepticus at home and in hospital-opportunities and limitations of the various administration routes of benzodiazepines
Authors: Charalambous Marios , Volk Holger A. , Van Ham Luc , Bhatti Sofie F. M.
Published: March 2021

Status epilepticus (SE) or prolonged epileptic seizure activity is a common neurological emergency with a high mortality rate and, if left untreated, can lead to irreversible cerebral damage and systemic complications. Fast and effective first-line management is of paramount importance, particularly in the at-home management of seizures where drug administration routes are limited. Benzodiazepines (BZDs) have been exclusively used in veterinary medicine for decades as first-line drugs based on their high potency and rapid onset of action. Various administration routes exist in dogs, such as oral, intravenous, intramuscular, rectal, and intranasal, all with different advantages and limitations. Recently, intranasal drug delivery has become more popular due to its unique and favourable characteristics, providing potential advantages over other routes of drug administration in the management of canine SE. This narrative review provides an outline of the management of SE at home and in a hospital setting, discusses considerations and challenges of the various routes of BZD administration, and evaluates the impact of intranasal drug administration (nose-brain pathway) for controlling canine SE at home and within hospital settings.
Streptozotocin induces alpha-2u globulin nephropathy in male rats during diabetic kidney disease
Authors: Kengkoom Kanchana , Angkhasirisap Wannee , Kanjanapruthipong Tapanee , Tungtrakanpoung Rongdej , Tuentam Khwanchanok , Phansom Naphatson , Ampawong Sumate
Published: March 2021

Background

Alpha-2u globulin nephropathy mainly shows toxicological pathology only in male rats induced by certain chemicals and drugs, such as levamisole (antiparasitic and anticancer drugs). Streptozotocin (STZ) is also an anticancer-antibiotic agent that has been used for decades to induce a diabetic kidney disease model in rodents. The purpose of this study is to determine if STZ causes alpha-2u globulin nephropathy in male rats during an advanced stage of diabetic kidney disease. Alpha-2u globulin nephropathy, water absorption and filtration capacities (via aquaporin [AQP]-1, − 2, − 4 and − 5) and mitochondrial function (through haloacid dehalogenase-like hydrolase domain-containing protein [HDHD]-3 and NADH-ubiquinone oxidoreductase 75 kDa subunit [NDUFS]-1 proteins) were examined in STZ-induced diabetic Wistar rat model.

Results

More than 80% of severe clinical illness rats induced by STZ injection simultaneously exhibited alpha-2u globulin nephropathy with mitochondrial degeneration and filtration apparatus especially pedicels impairment. They also showed significantly upregulated AQP-1, − 2, − 4 and − 5, HDHD-3 and NDUFS-1 compared with those of the rats without alpha-2u globulin nephropathy.

Conclusions

STZ-induced alpha-2u globulin nephropathy during diabetic kidney disease in association with deterioration of pedicels, renal tubular damage with adaptation and mitochondrial driven apoptosis.
Intracellular galectins sense cytosolically exposed glycans as danger and mediate cellular responses
Authors: Hong Ming-Hsiang , Weng I-Chun , Li Fang-Yen , Lin Wei-Han , Liu Fu-Tong
Published: March 2021

Galectins are animal lectins that recognize carbohydrates and play important roles in maintaining cellular homeostasis. Recent studies have indicated that under a variety of challenges, intracellular galectins bind to host glycans displayed on damaged endocytic vesicles and accumulate around these damaged organelles. Accumulated galectins then engage cellular proteins and subsequently control cellular responses, such as autophagy. In this review, we have summarized the stimuli that lead to the accumulation of galectins, the molecular mechanisms of galectin accumulation, and galectin-mediated cellular responses, and elaborate on the differential regulatory effects among galectins.
d-Allulose 3-epimerase of Bacillus sp. origin manifests profuse heat‐stability and noteworthy potential of d-fructose epimerization
Authors: Patel Satya Narayan , Kaushal Girija , Singh Sudhir P.
Published: March 2021

Background

d-Allulose is an ultra-low calorie sugar of multifarious health benefits, including anti-diabetic and anti-obesity potential. d-Allulose 3-epimerase family enzymes catalyze biosynthesis of d-allulose via epimerization of d-fructose.

Results

A novel d-allulose 3-epimerase (DaeB) was cloned from a plant probiotic strain, Bacillus sp. KCTC 13219, and expressed in Bacillus subtilis cells. The purified protein exhibited substantial epimerization activity in a broad pH spectrum, 6.0–11.0. DaeB was able to catalyze d-fructose to d-allulose bioconversion at the temperature range of 35 °C to 70 °C, exhibiting at least 50 % activity. It displaced excessive heat stability, with the half-life of 25 days at 50 °C, and high turnover number (kcat 367 s− 1). The coupling of DaeB treatment and yeast fermentation of 700 g L− 1d-fructose solution yielded approximately 200 g L− 1d-allulose, and 214 g L− 1 ethanol.

Conclusions

The novel d-allulose 3-epimerase of Bacillus sp. origin discerned a high magnitude of heat stability along with exorbitant epimerization ability. This biocatalyst has enormous potential for the large-scale production of d-allulose.