bluuebunny/crossref_metadata_2025 huggingface dataset:
Systemic Lupus Erythematosus triggered by SARS-CoV-2 Infection: A Systematic Review Based on a Case Report
Authors: Gracia-Ramos Abraham Edgar , Saavedra-Salinas Miguel Angel
Published: November 2020

Systemic lupus erythematosus (SLE) is an autoimmune and multisystemic chronic inflammatory disease that can affect various organs, including skin, joints, kidneys, lungs and the nervous system. Infectious agents have long been implicated in the pathogenesis of SLE. The new viral infection caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has shown that, in genetically predisposed patients, could trigger the presentation or exacerbation of autoimmune disease. We herein report a case of a 45-year-old man who presented respiratory symptoms, bilateral pleural effusion, ascites, splenomegaly, severe thrombocytopenia and renal failure with proteinuria and hematuria. SARS-CoV-2 PCR confirmed the COVID-19 diagnosis. We diagnosed the patient with SLE based on the clinical manifestations and positive immunological markers (2019 European League Against Rheumatism/American College of Rheumatology score of 18). Glucocorticoid pulses were administered to the patient with improvement in renal function. However, thrombocytopenia was also refractory to IV immunoglobulin and rituximab, so the patient underwent splenectomy. Through a systematic search of the medical literature, we retrieved 2 cases with SLE new onset and 5 cases with previous SLE diagnosis that shown activity of disease due SARS-CoV-2 infection. We herein present a systemic review of these cases and discuss the clinical manifestations that could help to the diagnosis of this clinical condition.
Quantification of Arterial, Venous, and Cerebrospinal Fluid Flow Dynamics by Magnetic Resonance Imaging Under Simulated Micro-Gravity Conditions
Authors: Zahid Arslan , Martin Bryn , Collins Stephanie , Oshinski John N. , Ethier Christopher Ross
Published: November 2020

Background: Astronauts undergoing long-duration spaceflight are exposed to numerous health risks, including Spaceflight-Associated Neuro-Ocular Syndrome (SANS), a spectrum of ophthalmic changes that can result in permanent loss of visual acuity. The etiology of SANS is not well understood but is thought to involve changes in cerebrovascular flow dynamics in response to microgravity. There is a paucity of knowledge in this area; in particular, cerebrospinal fluid (CSF) flow dynamics have not been well characterized under microgravity conditions. Our study was designed to determine the effect of simulated microgravity (head-down tilt [HDT]) on cerebrovascular flow dynamics. We hypothesized that microgravity conditions simulated by HDT would result in increased intracranial pressure (ICP) reflected by increases in CSF pulsatile flow.Methods: In a prospective cohort study, we measured flow in major cerebral arteries, veins, and CSF spaces in fifteen healthy volunteers using phase contrast magnetic resonance (PCMR) before and during 15° HDT.Results: We found a decrease in all CSF flow variables [systolic peak flow (p=0.009), and peak-to-peak pulse amplitude (p=0.001)]. Cerebral arterial average flow (p=0.04), systolic peak flow (p=0.04), and peak-to-peak pulse amplitude (p=0.02) all also significantly decreased. We additionally found a decrease in average cerebral arterial flow (p=0.040). Finally, a significant increase in cerebral venous cross-sectional area with HDT (p=0.005) was also observed.Conclusions: These results collectively demonstrate that acute application of 15° HDT caused a reduction in CSF flow variables (systolic peak flow and peak-to-peak pulse amplitude) which, when coupled with a decrease in average cerebral arterial flow, systolic peak flow, and peak-to-peak pulse amplitude, is consistent with a decrease in cardiac-related pulsatile CSF flow. These results suggest that decreases in cerebral arterial inflow were the principal drivers of decreases in CSF pulsatile flow.
Novel mutation in the TGFBI gene in a Moroccan family with atypical corneal dystrophy: a case report
Authors: BENBOUCHTA Yahya , JAOUAD Imane CHERKAOUI , TAZI Habiba , ELORCH Hamza , OUHENACH Mouna , ZRHIDRI Abdelali , SADKI Khalid , SEFIANI Abdelaziz , LYAHYAI Jaber , BERRAHO Amina
Published: November 2020

Background: Corneal dystrophies (CDs) are a heterogeneous group of bilateral, genetically determined, non-inflammatory bilateral corneal diseases which are usually limited to the cornea. CD is characterized by a large variability in the age of onset, evolution and visual impact and the accumulation of insoluble deposits at different depths of the cornea. Clinical symptoms revealed bilaterally multiple superficial, epithelial, and stromal anterior granular opacities, in different stages of severity among three patients of this family. 99 genes are involved in CDs.The aim of this study is to identify pathogenic variant caused atypical corneal dystrophy in a large Moroccan family and to describe the clinical phenotype with their severe different stages of evolution.Case presentation: In this study, we report a large Moroccan family with CD. Whole Exome Sequencing (WES) was performed in the three affected members who shared a phenotype of a corneal dystrophy in different stages of severity. The variant validation and familial segregation were done by Sanger sequencing in affected sister and mothers and in two unaffected brothers. Whole exome sequencing showed a novel heterozygous mutation (c.1772C>A; p.Ser591Tyr) in TGFBI gene. Clinical examinations demonstrated bilaterally multiple superficial, epithelial and stromal anterior granular opacities; in different stages of severity among three patients of this family. Conclusions: This report presents a novel mutation in TGFBI gene, found in three family members affected with different phenotypic aspects. This mutation is associated with Thiel-Behnke corneal dystrophy and therefore, it could be considered as a novel phenotype genotype correlation, which will help in genetic counseling for this family
Modeling Count Data for Healthcare Utilization: an Empirical Study of Outpatient Visits Among Vietnamese Older People
Authors: Le Dung Duc , Leon-Gonzalez Roberto , Matola Joseph Upile
Published: November 2020

Background Vietnam is undergoing a fast aging process that poses potential critical issues for older people and central among those is demand for healthcare utilization. However, healthcare utilization, here measured as count data, creates challenges for modeling because such data typically has distributions that are skewed with a large mass at zero. This study compares empirical econometric strategies for the modeling of healthcare utilization (measured as the number of outpatient visits in the last 12 months), and identifies the determinants of healthcare utilization among Vietnamese older people based on the best-fitting model identified. Methods Using the Vietnam Household Living Standard Survey in 2006 (N=2426), nine econometric regression models for count data were examined to identify the best-fitting one. We used model selection criteria; statistical tests; and goodness-of-fit for in-sample model selection. In addition, we conducted 10-fold cross-validation checks to examine reliability of in-sample model selection. Finally, we utilized marginal effects to identify the factors associated with the number of outpatient visits among Vietnamese older people based on the best-fitting model identified. Results We found strong evidence in favor of hurdle negative binomial model 2 (HNB2) for both in-sample selection and 10-fold cross-validation checks. The marginal effect results of the HNB2 showed that ethnicity, region, household size, health insurance, smoking status, non-communicable diseases, and disability were significantly associated with the number of outpatient visits. The predicted probabilities for each count event showed the distinct trends of healthcare utilization among specific groups: at low count events, women and people in the younger age group used more healthcare utilization than did men and their counterparts in older age groups, but a reversed trend was found at higher count events. Conclusions Data come in all shapes and sizes, this study highlights the importance of model specification checks and model selection criteria to avoid potential biased estimates as a result of model misspecifications. This study’s findings lay the groundwork for future research on the modeling of healthcare utilization in developing countries and those findings could be used to forecast on healthcare demand and making provisions for healthcare costs.
Ion channel profiling of the Lymnaea stagnalis ganglia via transcriptome analysis
Authors: Dong Nan , Bandura Julia , Zhang Zhaolei , Wang Yan , Labadie Karine , Noel Benjamin , Davison Angus , Koene Joris M , Sun Hong-Shuo , Coutellec Marie-Agnes , Feng Zhong-Ping
Published: November 2020

Background. The pond snail Lymnaea stagnalis (L. stagnalis) has been widely used as a model organism in neurobiology, ecotoxicology, and parasitology due to the relative simplicity of its central nervous system (CNS). However, its usefulness is restricted by a limited availability of transcriptome data. While sequence information for the L. stagnalis CNS transcripts has been obtained from EST library and a de novo RNA-seq assembly, the quality of these assemblies is limited by a combination of low coverage of EST libraries, the fragmented nature of de novo assemblies, and lack of reference genome. Results. In this study, taking advantage of the recent availability of a preliminary L. stagnalis genome, we generated an RNA-seq library from the adult L. stagnalis CNS, using a combination of genome-guided and de novo assembly programs to identify 17,832 protein-coding L. stagnalis transcripts. We combined our library with existing resources to produce a transcript set with greater sequence length, completeness, and diversity than previously available ones. Using our assembly and functional domain analysis, we profiled L. stagnalis CNS transcripts encoding ion channels and ionotropic receptors, which are key proteins for CNS function, and compared their sequences to other vertebrate and invertebrate model organisms. Interestingly, L. stagnalis transcripts encoding numerous putative Ca2+ channels showed the most sequence similarity to those of Mus musculus, Danio rerio, Xenopus tropicalis, Drosophila melanogaster, and Caenorhabditis elegans, suggesting that many calcium channel-related signaling pathways may be evolutionarily conserved. Conclusions. Our study provides the most thorough characterization to date of the L. stagnalis transcriptome and provides insights into differences between vertebrates and invertebrates in CNS transcript diversity, according to function and protein class. Furthermore, this study provides a complete characterization of the ion channels of Lymnaea stagnalis, opening new avenues for future research on fundamental neurobiological processes in this model system.
The Effectiveness Of Prolotherapy For Recalcitrant Medial Tibial Stress Syndrome: A Prospective Case Series
Authors: Padhiar Nat , Curtin Mark , Aweid Osama , Awied Bashaar , Morrissey Dylan , Chan Otto , Malliaras Peter , Crisp Tom
Published: November 2020

Background: Medial tibial stress syndrome (MTSS) is one of the most common lower leg injuries in sporting populations. It accounts for between 6%-16% of all running injuries, and up to 53% of lower leg injuries in military recruits. Various treatment modalities are available with varying degree of success. In recalcitrant cases, surgery is often the only option.Objective: To evaluate whether ultrasound-guided injection of 15% dextrose for treatment of recalcitrant Medial Tibial Stress Syndrome decreases pain and facilitates a return to desired activity levels for those who may otherwise be considering surgery or giving up sport.Design: Prospective case seriesSetting: Private specialist CentrePatients: Eighteen patients: fifteen male and three female; (mean age=31.2 years) with MTSS were referred from sports injury clinics across the UK, having failed all available conservative treatment.Intervention: An ultrasound-guided sub-periosteal injection of 15% dextrose was administered by the same clinician (NP) along the length of the symptomatic area. Typically, 1 mL of solution was injected per cm of symptomatic area. Main Outcome Measures: Pain was assessed using a 10-cm visual analogue scale (VAS) at baseline, short-term, medium-term (mean 18 weeks) and long-term (mean one year) follow-up. Symptom resolution and return to activity were measured using a Likert scale at medium and long-term follow-up. Results: Patients reported a significant (p<0.01) reduction in median VAS pain score at medium and long-term follow-up compared to baseline. Median improvement per patient was 4.5/10. Patients rated their condition as ‘much improved’ at medium-term follow-up and median return to sport score was ‘returned to desired but not pre-injury level’ at medium-term and long-term follow-up. No adverse events were reported.Conclusions: Ultrasound-guided 15% dextrose prolotherapy injection has a significant medium-term effect on pain in MTSS. This benefit may be maintained long-term. More robust trials are required to validate these findings.Clinical Relevance: Clinicians should consider the use of ultrasound-guided injection of 15% dextrose as a viable treatment option to reduce pain and aid return to activity for patients with recalcitrant Medial Tibial Stress Syndrome.
The local concentration of Ca2+ correlates with BMP7 expression and osseointegration in patients with total hip arthroplasty
Authors: Fu Xiaodong , Wang Weili , Li Xiaomiao , Gao Yingjian , Li Hao , Shen Yi
Published: November 2020

Background: A successful osseointegration of total hip arthroplasty (THA) relies on the interplay of implant surface and bone marrow microenvironment. This study was undertaken to investigate the impact of perioperative biochemical molecules (Ca2+, Mg2+, Zn2+, VD, PTH) on the bone marrow osteogenetic factors (BMP2, BMP7, Stro-1+ cells) in the metaphyseal region of the femoral head, and further on the bone mineral density (BMD) of Gruen R3. Methods: Bone marrow aspirates were obtained from the discarded metaphysis region of the femoral head in 51 patients with THA. Flow cytometry was used to measure the Stro-1+ expressing cells. ELISA was used to measure the concentrations of bone morphologic proteins (BMP2 and BMP7) and the content of TRACP5b in serum. TRAP staining was used to detect the osteoclast activity in the hip joint. The perioperative concentrations of the biochemical molecules above were measured by radioimmunoassay. The BMD of Gruen zone R3 was examined at 6 months after THA, using dual-energy X-ray absorptiometry (DEXA).Results: Our data demonstrated that the concentration of Ca2+ was positively correlated with BMP7 expression, and with the postoperative BMD of Gruen zone R3. However, the concentration of Mg2+ had little impact on the R3 BMD, although it was negatively correlated with the expression of BMP7. Osteoclast activity in hip joint tissue of patients with femoral neck fractures was increased. Compared with the patients before THA, the levels of TRACP5b in serum of patients after THA were decreased. The data also suggested that the other biochemical molecules, such as Zn2+, VD, and PTH, were not significantly correlated with any bone marrow osteogenetic factors (BMP2, BMP7, Stro-1+ cells). The postoperative R3 BMD of patients of different gender and age had no significant difference.Conclusions: These results indicate the local concentration of Ca2+ may be an indicator for the prognosis of THA patients.
Mortality is not increased with Diabetes in Hospitalised Very Old Adults - A multi-site review.
Authors: Smerdely Peter
Published: November 2020

Objective: Few data exist regarding hospital outcomes in people with diabetes aged beyond 75 years. This study aimed to explore the association of diabetes with hospital outcome in the very old patient.Design: A retrospective review was conducted of all presentations of patients aged 65 years or more admitted to three Sydney teaching hospitals over six years (2012-2018), exploring primarily the outcomes of in-hospital mortality, and secondarily the outcomes of length of stay, the development of hospital-acquired adverse events and unplanned re-admission to hospital within 28 days of discharge. Demographic and outcome data, the presence of diabetes and comorbidities were determined from ICD10 coding within the hospital's electronic medical record. Logistic and negative binomial regression models were used to assess the association of diabetes with outcome.Results: A total of 139130 separations (mean age 80 years, range 65 to 107 years; 51% female) were included, with 49% having documented comorbidities and 26.1% a diagnosis of diabetes. When compared to people without diabetes, diabetes was not associated with increased odds of mortality (OR: 0.89 SE (0.02), p<0.001). Further, because of a significant interaction with age, diabetes was associated with decreased odds of mortality beyond 80 years of age. While people with diabetes overall had longer lengths of stay (10.2 days SD (13.4) v 9.4 days SD (12.3), p<0.001), increasing age was associated with shorter lengths of stay in people aged more than 90 years. Diabetes was associated with increased odds of hospital-acquired adverse events (OR: 1.09 SE (0.02), p<0.001) and but not 28-day re-admission (OR: 0.88 SE (0.18), p=0.523).Conclusion: Diabetes has not been shown to have a negative impact on mortality or length of stay in hospitalised very old adults from data derived from hospital administrative records. This may allow a more measured application of diabetic guidelines in the very old hospitalised patient.
Effectiveness of a Breastfeeding Program for Mothers Returning to Work in Japan: a quasi-experiment study
Authors: Nakada Kaori
Published: November 2020

Background: Maternal employment has been described as a barrier to breastfeeding in many countries. In Japan, many mothers quit breastfeeding after returning to work because they do not know how to continue breastfeeding. The primary objective of this study was to investigate the effectiveness of a breastfeeding support program for mothers. The secondary objective was to explore the effectiveness of a pamphlet for mothers returning to work.
Methods: This was a quasi-experimental design study with a program group (n=48), pamphlet group (n=46) and comparison group (n=47) that took place from February 2017 to August 2018. Participants in the program and pamphlet groups were women who planned to return to work within 4–12 months after giving birth, while the comparison group included women who had been back at work for at least 3 months. The program involved a 90-min breastfeeding class, a pamphlet, a newsletter, and email consultation. The pamphlet group was sent only the pamphlet, while the control group received no intervention. The outcome was breastfeeding continuation rate at 3 months after returning to work.
Results: The breastfeeding continuation rate 3 months after returning to work was significantly higher in the program group than in the comparison group (79.2% vs. 51.1%, p=0.004). After adjusting for background factors, the program intervention had an effect on breastfeeding rates (adjusted odds ratio=4.68, 95% confidence interval: 1.57, 13.96; p=0.006). However, comparison of the pamphlet and comparison groups revealed no significant differences in breastfeeding continuation rates at 3 months after returning to work (69.6% vs. 51.1%, p=0.07).
Conclusions: Program intervention resulted in a significant increase in breastfeeding continuation rates 3 months after returning to work. Randomized controlled trials are needed to make this program applicable in practice. Pamphlet intervention resulted in no significant difference. Further study is necessary after examining the contents of the pamphlet.
Digital learning designs in physiotherapy education: A systematic review and meta-analysis.
Authors: Ødegaard Nina Bjerketveit , Myrhaug Hilde Tinderholt , Dahl-Michelsen Tone , Røe Yngve
Published: November 2020

Background: Digital learning designs have the ability to support teaching and learning within higher education. However, the research on digital learning designs within physiotherapy education is limited. This study aims to identify and investigate the effectiveness of digital learning designs in physiotherapy education.Methods: The study was designed as a systematic review and meta-analysis of randomized and non-randomized trials. A search of eight databases on digital learning designs and technology was conducted. Study selection, methodology and quality assessment were performed independently by three reviewers. The included studies were mapped according to the types of digital interventions and studies. For similar interventions, the learning effects were calculated using meta-analyses.Results: Altogether, 22 studies were included in the review (17 randomized controlled trials and five cohort studies). A blended learning design was used in 21 studies, a flipped classroom model in five and a distance learning design in one. Altogether, 10 of the 22 articles were included in meta-analyses, which showed statistically significant effects for flipped classrooms on knowledge acquisition (standardized mean difference [SMD]: 0.41; 95% confidence interval [CI]: 0.20, 0.62) and for interactive websites or applications (apps) on practical skills (SMD: 1.07; 95% CI: 0.71,1.43). The meta-analysis of different interactive websites/apps on knowledge acquisition favoured traditional teaching (SMD: 0.51; 95% CI:-0.80,1.82), but this was not statistically significant. Overall, the effects indicated that blended learning designs are equally as or more effective than traditional classroom teaching to achieve learning outcomes. Distance learning showed no significant differences compared to traditional classroom teaching.Conclusions: The results indicate that digital learning designs in the form of blended learning and distance learning were equally or more effective compared to traditional teaching in physiotherapy education. The meta-analysis revealed a significant effect on student learning in favour of flipped classrooms and interactive websites/apps. However, these results must be confirmed in larger controlled trials. Further, research should investigate how digital learning designs can facilitate students’ learning of practical skills and behaviour, learning retention and approaches to studying as well as references for teaching and learning in digital learning environments.
Genome-wide identification and characterization of long non-coding RNAs conferring resistance to Colletotrichum gloeosporioides in walnut (Juglans regia)
Authors: Feng Shan , Fang Hongcheng , Liu Xia , Dong Yuhui , Wang Qingpeng , Yang Ke Qiang
Published: November 2020

Background: Walnut anthracnose caused by Colletotrichum gloeosporioides (Penz.) Penz. and Sacc. is an important walnut production problem in China. Although the long non-coding RNAs (lncRNAs) are important for plant disease resistance , the molecular mechanisms underlying resistance to C. gloeosporioides in walnut remain poorly understood.Results: The anthracnose-resistant F26 fruits from the B26 clone and the anthracnose-susceptible F423 fruits from the 4-23 clone of walnut were used as the test materials. Specifically, we performed a comparative transcriptome analysis of F26 and F423 fruit bracts to identify differentially expressed LncRNAs (DELs) at five time-points (tissues at 0 hpi, pathological tissues at 24 hpi, 48 hpi, 72 hpi, and distal uninoculated tissues at 120 hpi). Compared with F423, a total of 14525 DELs were identified, including 10645 upregulated lncRNAs and 3846 downregulated lncRNAs in F26. The number of upregulated lncRNAs in F26 compared to in F423 was significantly higher at the early stages of C. gloeosporioides infection. A total of 5 modules related to disease resistance were screened by WGCNA and the target genes of lncRNAs were obtained. Bioinformatic analysis showed that the target genes of upregulated lncRNAs were enriched in immune-related processes during the infection of C. gloeosporioides, such as activation of innate immune response, defense response to bacterium, incompatible interaction and immune system process, and enriched in plant hormone signal transduction, phenylpropanoid biosynthesis and other pathways. And 124 known target genes for 96 hub lncRNAs were predicted, including 10 known resistance genes. The expression of 5 lncRNAs and 5 target genes was confirmed by qPCR, which was consistent with the RNA-seq data.Conclusions: The results of this study provide the basis for future functional characterizations of lncRNAs regarding the C. gloeosporioides resistance of walnut fruit bracts.
Gene expression patterns of red sea urchins (Mesocentrotus franciscanus) exposed to different combinations of temperature and pCO2 during early development
Authors: Wong Juliet M. , Hofmann Gretchen E.
Published: November 2020

Background: The red sea urchin Mesocentrotus franciscanus is an ecologically important kelp forest herbivore and an economically valuable wild fishery species. To examine of how M. franciscanus responds to its environment on a molecular level, differences in gene expression patterns were observed in embryos raised under combinations of two temperatures (13 °C or 17 °C) and two pCO2 levels (475 matm or 1050 matm). These combinations mimic various present-day conditions measured during and between upwelling events in the highly dynamic California Current System with the exception of the 17 °C and 1050 matm combination, which does not currently occur. However, as ocean warming and acidification continues, warmer temperatures and higher pCO2 conditions are expected to increase in frequency and to occur simultaneously. The transcriptomic responses of the embryos were assessed at two developmental stages (gastrula and prism) in light of previously described plasticity in body size and thermotolerance under these temperature and pCO2 treatments.Results: Although transcriptomic patterns primarily varied by developmental stage, there were pronounced differences in gene expression as a result of the treatment conditions. Temperature and pCO2 treatments led to the differential expression of genes related to the cellular stress response, transmembrane transport, metabolic processes, and the regulation of gene expression. At each developmental stage, temperature contributed significantly to the observed variance in gene expression, which was also correlated to the phenotypic attributes of the embryos. On the other hand, the transcriptomic response to pCO2 was relatively muted, particularly at the prism stage.Conclusions: M. franciscanus exhibited transcriptomic plasticity under different temperatures, indicating their capacity for a molecular-level response that may facilitate red sea urchins facing ocean warming as climate change continues. In contrast, the lack of a robust transcriptomic response, in combination with observations of decreased body size, under elevated pCO2 levels suggest that this species may be negatively affected by ocean acidification. High present-day pCO2 conditions that occur due to coastal upwelling may already be influencing populations of M. franciscanus.
Resilience as a predictor of Quality of Life in participants with borderline personality disorder before and after treatment.
Authors: Guillén Verónica , Tormo Mireia Esplugues , Fonseca-Baeza Sara , Botella Cristina , Baños Rosa , García-Palacios Azucena , Marco Jose Heliodoro
Published: November 2020

Background: Studies have suggested that psychotherapy improves the Quality of Life (QoL) of participants with Borderline Personality Disorder (BPD). However, there are no studies on the differential efficacy of treatments on the QoL of participants with BPD. Moreover, the relationship between QoL and resilience has rarely been studied in participants with BPD. Objectives: a) to examine whether people with BPD have worse QoL than the non-clinical population; b) to examine whether there are statistically significant differences between Dialectical Behavioural Therapy (DBT), Systems Training for Emotional Predictability and Problem Solving (STEPPS), or Cognitive Behavioural Therapy-Treatment at Usual (CBT-TAU) in the improvement of QoL; c) to examine whether participants show clinically significant improvements in QoL after treatment; d) to analyse whether resilience is associated with QoL before and after the BPD treatment; e) to analyse whether resilience is a predictor of QoL at pre-treatment and posttreatment. Method: The sample comprised 403 participants (n = 202 participants diagnosed with BPD and n = 201 non-clinical). Participants filled out the Quality of Life Index, Resilience Scale, and Beck Depression Inventory. The clinical participants received one of these possible treatments, DBT, STEPPS, or CBT-TAU. MANOVA and regression analyses were performed. Results: a) participants diagnosed with BPD had statistically significant lower resilience than the non-clinical population; b) all three forms of psychotherapy statistically improved QoL, but there were no statistically significant differences between DBT, STEPPS, and CBT-TAU in the improvement of QoL; c) participants did not show clinically significant improvements in QoL after treatment; d) resilience was associated with QoL before and after treatment; and e) resilience was a predictor of QoL before and after treatment. Conclusion: It is necessary to assess QoL and Resilience in studies on psychotherapy with BPD patients.
The microbiologic spectrum of dacryocystitis
Authors: Luo Ban , Li Mu , Xiang Nan , Hu Weikun , Liu Rong , Yan Xiaoqin
Published: November 2020

Background: To investigate the microbiologic spectrum of dacryocystitis in adult and pediatric groups, specifically the microbiologic differences between chronic dacryocystitis with nasolacrimal duct obstruction (NLDO) and acute dacryocystitis in pediatric group.Methods: This retrospective study was reviewed for demographic and microbiologic profile of dacryocystitis. The culture results were reported. Results: Sixty-four adults and one hundred and five pediatrics with dacryocystitis were included in this study. Of all adults, only chronic dacryocystitis with NLDO was observed. Of all pediatric patients, 89 had chronic dacryocystitis with NLDO and 16 had acute dacryocystitis. Gram positive and negative isolates were numerically equal in adult group (both 36(48.65%)), while gram positive isolates were the major organism in pediatric group (71(58.68%)). Streptococcus pneumonia was the most common isolate in both adult (11(14.86%)) and pediatric (30(24.79%)) dacryocystitis. For both pediatric subgroups, gram positive isolates were the major organism (59(57.84%) for chronic dacryocystitis with NLDO and 12 (63.16%) for acute dacryocystitis). However, the leading isolates in those two subgroups were distinct, with Streptococcus pneumonia (29(28.43%)) being most common in chronic dacryocystitis with NLDO and Staphylococcus aureus (8(42.11%)) being most common in acute dacryocystitis. Conclusions: In adult group, gram negative isolates were more common in dacryocystitis than before. In pediatric group, gram positive isolates were still the major infection pathogen. Moreover, the more virulent organisms were more common in acute dacryocystitis than chronic dacryocystitis with NLDO.
Musculo-skeletal phenotype of Costello syndrome and cardio-facio-cutaneous syndrome: insights on the functional assessment status
Authors: Leoni Chiara , Romeo Domenico M , Michele Pelliccioni , Mariangela Di Già , Roberta Onesimo , Valentina Giorgio , Elisabetta Flex , Tedesco Marta , Tartaglia Marco , Rigante Donato , Valassina Antonio , Zampino Giuseppe
Published: November 2020

BackgroundCostello syndrome (CS) and cardio-facio-cutaneous syndrome (CFCS) belong to the RASopathies, a group of neurodevelopmental disorders with skeletal anomalies. Due to their rarity, the characterization of the musculo-skeletal phenotype in both disorders has been poorly characterized. Patients and methodsHerein we reported data on orthopedic findings and functional status of a large sample of CS and CFCS patients. Thirty-four patients (CS=17 and CFCS=17) were recruited. Functional and disability evaluations were performed by assessing the 6-minute walking test (6MWT) and Pediatric Outcomes Data Collection Instrument (PODCI). Genotype/phenotype correlations was also provided. ResultsOrthopedic manifestations are highly prevalent in CS and CFCS, and do overlap in the two disorders. Overall, patients with CS harboring the recurrent HRAS Gly12Ser substitution show a more severe skeletal phenotype compared to patients carrying the Gly12Ala and Gly13Cys variants. Among CFCS patients, those with MAP2K1/2 pathogenic variant show different skeletal characteristics compared to BRAF variants, with a higher prevalence of orthopedic abnormalities. Functional assessment demonstrates that patients with CS and CFCS reach lower values compared to the general population with CFCS patients showing the lowest scores.ConclusionsOrthopedic manifestations appear universal features of CS and CFCS and they can evolve along patients’ life. Longitudinal assessment of disability status by using 6MWT and PODCI could be useful to evaluate the functional impact of orthopedic manifestations on patients’ outcome, and help planning a tailored treatment of these comorbidities.
The Dual Amylin and Calcitonin Receptor Agonist KBP-089 and the GLP-1 receptor agonist liraglutide act complimentarily on body weight reduction and metabolic profile 
Authors: Larsen Anna Thorsø , Gydesen Sofie , Sonne Nina , Karsdal Morten Asser , Henriksen Kim
Published: November 2020

Background: Weight loss therapy is becoming more and more important, and two classes of molecules, namely amylin receptor and GLP-1 receptor agonists, have shown promise in this regard. Interestingly, these molecules have several overlapping pharmacological effects, such as suppression of gastric emptying, reduction of glucagon secretion and weight loss in common; however, they also have distinct effects on prandial insulin secretion. Hence, a combination of these two mechanisms is of significant interest. Methods: In this study, we investigated the add-on potential of the dual amylin and calcitonin receptor agonist (DACRA) KBP-089 in combination with the GLP-1 receptor agonist liraglutide as obesity treatment in high-fat diet (HFD) fed rats. Results: Increasing doses of KBP-089 and liraglutide alone and in combination were studied with respect to their effects on body weight, food intake and glucose metabolism during a 9-week intervention study conducted in HFD rats. Further, the gastric emptying rate during an oral glucose tolerance was assessed. Treatment with KBP-089 and liraglutide dose-dependently lowered body weight 15% (at 2.5 µg/kg/day) and 7% (at 400 µg/kg/day) in HFD rats, respectively, while the combination resulted in a 21% body weight reduction, which was mirrored by reduction in fat depot sizes. Gastric emptying and glucose metabolism were improved, primarily by KBP-089, although liraglutide led to a reduction in fasting plasma glucagon. Conclusion: DACRAs complement GLP-1 on food intake, body weight, and glucose tolerance indicating the potential for an add-on therapy.
Nomogram-derived prediction of pathologic complete response (pCR) in breast cancer patients treated with neoadjuvant chemotherapy (NCT)
Authors: pu shengyu , wang ke , liu yang , liao xiaoqin , chen heyan , he jianjun , zhang jian
Published: November 2020

Background Previous research results on the predictive factors of neoadjuvant chemotherapy (NCT) efficacy in breast cancer are inconsistent, suggesting that the ability of a single factor to predict efficacy is insufficient. Combining multiple potential efficacy-related factors to build a model may improve the accuracy of prediction. This study intends to explore the clinical and biological factors in breast cancer patients receiving NCT and to establish a nomogram that can predict the pathologic complete response (pCR) rate of NCT.Methods We selected 165 breast cancer patients receiving NCT from July 2017 to May 2019. Using pretreatment biopsy materials, immunohistochemical studies to assess estrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor receptor 2 (HER-2), and Ki-67 expression. The correlation between biological markers and pCR was analyzed. These predictors were used to develop a binary logistic regression model with cross-validation and to show the established predictive model with a nomogram.Results The nomogram for pCR based on lymphovascular invasion, anemia (hemoglobin≤120 g/L), ER, Ki67 expression levels and NCT regimen had good discrimination performance (area under the curve [AUC], 0.758; 95% confidence interval [CI], 0.675-0.841) and calibration coordination. According to the Hosmer-Lemeshow test, the calibration chart showed satisfactory agreement between the predicted and observed probabilities. The final prediction accuracy of cross-validation was 76%.Conclusions We developed a nomogram based on multiple clinical and biological covariations that can provide an early prediction of NCT response and can help to quickly assess the individual benefits of NCT.
Multivariate analysis of factors for failed continuous bladder irrigation in hemorrhagic cystitis patients after hematopoietic stem cell transplantation
Authors: Yang Wenbo , Du Yiqing , Qu Zhan , Bai Wenjun , Yu Luping , Zhang Xiaopeng , Wang Qi , Zhang Xiaowei , Li Qing , Xu Tao
Published: November 2020

Background: Continuous bladder irrigation (CBI) and proper adjustment of saline irrigation speed are important to avoid CBI failure in hemorrhagic cystitis (HC) patients after allogeneic hematopoietic stem cell transplantation (HSCT). Nevertheless, too fast irrigation speed could take away the patient's much heat, contribute to blood coagulopathy, and increase the nursing workload. Evaluation of risk for CBI failure remains an unmet clinical need.Methods: The general information, clinical characteristics, and consultation records of HC patients in 1380 patients with hematopoietic stem cell transplantation in our center from 2017 to 2019 were analyzed retrospectively. The receiver operating characteristic (ROC) curve was used to calculate the cutoff point of the continuous variable, and multivariate logistic regression was used to analyze the risk factors affecting CBI failure in HC patients.Results: The incidence of HC after HSCT was 23%. A total of 227 patients with HC above grade 2 were included. Univariate analysis showed that CRP, age, platelet counts, onset time after transplantation, albumin, and hemoglobin were associated with CBI failure in the short-term (P < 0.05). ROC curve and multivariate logistic regression analysis showed that CRP > 8.89 ng/ml (RR = 7.828, 95% CI 2.885-21.244), age < 14.5 years (RR = 9.940, 95% CI 3.219-30.697), and onset time of HC＞37d after transplantation (RR = 7.021, 95% CI 2.204-22.364), were independent risk factors for failure of CBI (P < 0.05).Conclusions: The study identified CRP > 8.89 ng/ml, age < 14.5 years, and onset time of HC after HSCT > 37d are independent factors for failure of CBI, which could be combined to allow stratification of HC after HSCT patients into low-, intermediate- and high-risk subgroups of CBI failure.
Recommendations to Improve Physical Activity Prescription for the Cystic Fibrosis Population: An Irish Perspective
Authors: Hurley Nicola , Kehoe Bróna , McCaffrey Noel , Redmond Karen , Cullen Lydia , Moyna Niall M.
Published: November 2020

Background: Physical activity (PA) is a well-established therapeutic modality for the maintenance and improvement of long-term health in cystic fibrosis (CF). Healthcare professionals (HCP) are considered credible and well-placed messengers for the delivery of PA advice. Limited research exists investigating the extent of PA prescription within CF care. This study aimed to identify Irish HCP i) knowledge and practice of, and ii) motivators and barriers to PA prescription, and iii) proposed strategies to optimize PA promotion and prescription in CF populations.Methods: HCP from six designated CF centres in Ireland and members of the national physiotherapy CF clinical interest group were invited to participate. Following an expression of interest, each HCP (n=81) received an email containing the plain language statement and link to the online survey. 48 HCP (physiotherapists n=24, other n=24) completed the 30-item investigator-developed survey, which included multiple choice single answer, matrix style and open-ended questions.Results: Most HCP (81%) acknowledged that discussing PA with CF patients was part of their professional role. Almost all physiotherapists (95%) reported having sufficient knowledge regarding PA prescription, compared to 17% of other HCP. All physiotherapists reported discussing PA at every patient interaction, with 81% employing the current consensus guidelines, compared to 33% and 5% of other HCP, respectively. Among the most common barriers reported by HCP to recommending PA to their CF patients were; lack of motivation and compliance among patients to adhere to PA advice, limited availability of PA programmes to refer their patients to, limited time with patients during clinic visits and a lack of knowledge regarding PA prescription for CF care. Three-quarters of HCP reported a need to improve PA services for CF patients in Ireland.Conclusion: As people with CF are living longer, it is imperative that HCP are expanding their scope of practice to include discussions around PA at every patient visit. Formal educational opportunities in the form of continuing professional development programmes are warranted for CF HCP to optimize long-term patient management and outcomes. There is also a need to develop patient-centered and evidence-based PA programmes underpinned by theories of behaviour change to enhance motivation and compliance among CF patients.
Adapting evidence-based clinical practice guidelines for people with attention deficit hyperactivity disorder in Saudi Arabia: process and outputs of a national initiative
Authors: Bashiri Fahad A. , Albatti Turki H. , Hamad Muddathir H. , Al-Joudi Haya F. , Daghash Hadeel F. , Al-Salehi Saleh M. , Varnham Jeremy L. , Alhaider Fatimah , Almodayfer Omar , Alhossein Abdulkarim , Aldhalaan Hesham , Ad-Dab'bagh Yasser , Backer Nouf Al , Altwaijri Waleed , Alburikan Khalid , Buraik Maysaa , Ghaziuddin Mohammad , Nester Michael J. , Wahabi Hayfaa , Alhabib Samia , Jamal Amr A. , Amer Yasser Sami
Published: November 2020

Background: We recently adapted the published National institute for Health and Care Excellence (NICE) Attention deficit hyperactivity disorder (ADHD) diagnosis and management guideline to the Saudi Arabian context. It has been postulated that adaptation of evidence-based clinical practice guidelines to the local healthcare context rather than de-novo development will improve their adoption and implementation without imposing a significant burden on resources. The objective of this paper is to describe the adaptation process methodology utilized for the generation of the first national guideline for management of people with ADHD in Saudi Arabia.Methods: We used the KSU-Modified-ADAPTE methodology for the guideline adaptation process. We describe the full process in detail including the three phases of set-up, adaptation, and finalization. The process was conducted by a multidisciplinary guideline adaptation group in addition to an external review for the clinical content and methodology.Results: The group adapted ten main categories of recommendations from one source CPG (NICE). The recommendations include; (i) service organisation and training, (ii) recognition, identification and referral, (iii) diagnosis, (iv) support, (v) managing ADHD, (vi) dietary advice, (vii) medication, (viii) maintenance and monitoring, (ix) adherence to treatment, and (x) review of medication and discontinuation. Several implementation tools were compiled and developed to enhance implementability including a clinical algorithm, quality measures, coding system, medication tables, translations, patient information, and online resources.Conclusions: The finalized clinical practice guideline provides healthcare providers with applicable evidence-based guidance for the management of people with ADHD in Saudi Arabia. The project also demonstrated the effectiveness of KSU-Modified-ADAPTE, and emphasized the value of a collaborative clinical and methodological expert group for adaptation of national guidelines.
Shotgun Metagenomic Analysis Reveals New Insights into Bacterial Community Profiles in Tempeh
Authors: Yulandi Adi , Suwanto Antonius , Waturangi Diana Elizabeth , Wahyudi Aris Tri
Published: November 2020

Objective: Amplicon sequencing targeting 16S ribosomal RNA (rRNA) has been widely used to profile the microbial community from fermented food samples. However, polymerase chain reaction (PCR) steps on amplicon sequencing analysis and intragenomic heterogeneity within 16S rRNA are believed to contribute to bias in estimating microbial community composition. As potential paraprobiotics sources, a comprehensive profiling study of tempeh microbial ecology could contribute to tempeh product development. This study employed a shotgun metagenomic approach, where metagenome fragments from tempeh samples were sequenced directly for taxonomic and functional profiling analysis.Results: Taxonomic profiling showed that Proteobacteria, Firmicutes, and Bacteroidetes were the dominant phyla from the shotgun metagenomic analysis in all tempeh samples. In terms of composition, this shotgun metagenomic study revealed that Proteobacteria was the most abundant phylum. Functional profiling showed that iron complex outer-membrane recepter protein (KEGG ID: K02014) was the most transcribed gene based on this metagenomic analysis. The metagenome-assembled genomes (MAGs) results from the binning pipeline could reveal almost complete whole genome sequence of Lactobacillus fermentum, Enterococcus cecorum, Escherichia coli, Klebsiella pneumoniae, and Acinetobacter baumannii.
Phlebotomus (Adlerius) simici NITZULESCU, 1931: first record in Austria and phylogenetic relationship with other Adlerius species 
Authors: Kniha Edwin , Dvorak Vit , Milchram Markus , Obwaller Adelheid , Köhsler Martina , Pöppl Wolfgang , Antoniou Maria , Chaskopoulou Alexandra , Paronyan Lusine , Stefanovski Jovana , Mooseder Gerhard , Volf Petr , Walochnik Julia
Published: November 2020

Background: Phlebotomine sand flies are the principal vectors of Leishmania spp. (Kinetoplastida: Trypanosomatidae). Sand fly findings in Central Europe are scarce and in Austria, to date only Phlebotomus mascittii has been recorded. In 2018 and 2019, entomological surveys were conducted in Austria with the aim to further clarify sand fly distribution and species composition.Results: In 2019, a Ph. simici specimen was trapped in Austria for the first time. Analyses of two commonly used marker genes, coxI and cytb, revealed high sequence identity with Ph. simici specimens from North Macedonia and Greece. Phylogenetic analyses showed high intraspecific distances within Ph. simici, thereby dividing this species into three lineages, from Europe, Turkey and Israel, respectively. Low interspecific distances between Ph. simici, Ph. brevis and a yet unidentified Adlerius sp. from Turkey and Armenia highlights that molecular identification can be challenging within the Adlerius complex, even when applying standard marker genes.Conclusion: This study provides the first finding of Ph. simici in Austria and the northernmost record so far. Moreover, it reveals valuable insights into the phylogenetic relationships of species within the Adlerius subgenus. Ph. simici is a suspected vector of Leishmania infantum and therefore of medical and veterinary importance. Potential sand fly expansion in Central Europe due to climatic change and the increasing import of Leishmania-infected dogs from endemic areas, urge the need for further studies on sand fly distribution in Austria and Central Europe in general.