bluuebunny/crossref_metadata_2025 huggingface dataset:
Nicotine Delivery and User Ratings of IQOS Heated Tobacco System Compared With Cigarettes, Juul, and Refillable E-Cigarettes
Authors: Phillips-Waller Anna , Przulj Dunja , Pesola Francesca , Smith Katie Myers , Hajek Peter
Published: May 2021

Introduction

Reduced-risk nicotine products are more likely to replace smoking if they match cigarettes in nicotine delivery and user satisfaction.

Aims and Methods

We examined the nicotine delivery profile and user ratings of IQOS heated tobacco system and compared it with own brand cigarettes (OBC), Juul, and refillable e-cigarettes (EC).Participants (N = 22) who were daily vapers smoking <1 cigarette per day on average, attended after overnight abstinence from smoking and vaping, to test at separate sessions OBC, IQOS, and Juul. Eight participants also tested two refillable EC using e-liquid with 20 mg/mL nicotine. At each session, a baseline blood sample was taken before participants used the product ad libitum for 5 minutes. Further samples were taken at 2, 4, 6, 8, 10, and 30 minutes. Maximum nicotine concentration (Cmax), time to Cmax (Tmax), and nicotine delivered over 30 minutes (AUC0–>30) were calculated. Participants rated their urge to smoke and product characteristics.

Results

IQOS delivered less nicotine than OBC (AUC0–>30: z = −2.73, p = .006), and than Juul (AUC0–>30: z = −3.08, p = .002; Cmax: z = −2.65, p = .008), and received less favorable ratings than Juul (effect on urges to smoke: z = −3.23, p = .001; speed of urge relief: z = −2.75, p = .006; recommendation to friends: z = −2.45, p = .014). Compared with refillable EC, IQOS delivered nicotine faster (Tmax: z = −2.37, p = .018), but received less favorable overall ratings (recommended to friends: z = −2.32, p = .021).

Conclusions

IQOS’ pharmacokinetic profile suggests that it may be less effective than Juul for smoking cessation, but at least as effective as refillable EC; although participants, who were experienced vapers rather than IQOS users, preferred refillable EC.

Implications

Because IQOS provided less efficient nicotine delivery than cigarettes and Juul in this sample, and also had a weaker effect on urges to smoke than Juul, it could be less helpful than Juul in assisting such dual users, and possibly smokers generally, to switch to an alternative product. IQOS, however, provided nicotine faster than refillable EC products, although participants preferred EC.
Streptococcus pyogenes Infective Endocarditis—Association With Injection Drug Use: Case Series and Review of the Literature
Authors: Rebechi Melanie T , Heil Emily L , Luethy Paul M , Schmalzle Sarah A
Published: May 2021

Background

Streptococcus pyogenes, or Group A Streptococcus (GAS), is not considered a typical cause of infective endocarditis (IE), but has anecdotally been observed in unexpectedly high rates in people who inject drugs (PWID) at our institution.

Methods

All cases of possible or definite GAS IE per Modified Duke Criteria in adults at an academic hospital between 11/15/2015 and 11/15/2020 were identified. Medical records were reviewed for demographics, comorbidities, treatment, and outcomes related to GAS IE. The literature on cases of GAS IE was reviewed.

Results

Eighteen cases of probable (11) or definite (7) GAS IE were identified; the mean age was 38 years, and the population was predominantly female (56%) and Caucasian (67%), which is inconsistent with local population demographics. Sixteen cases were in people who inject drugs (PWID; 89%); 14 were also homeless, 6 also had HIV (33%), and 2 were also pregnant. Antibiotic regimens were variable due to polymicrobial bacteremia (39%). One patient underwent surgical valve replacement. Four patients (22%) died due to complications of infection. The literature review revealed 42 adult cases of GAS IE, only 17 of which were in PWID (24%).

Conclusions

The 16 cases of possible and definite GAS IE in PWID over a 5-year period in a single institution reported nearly doubles the number of cases in PWID from all previous reports. This suggests a potential increase in GAS IE particularly in PWID and PWH, which warrants further epidemiologic investigation.
Latent Tuberculosis Infection Status of Pregnant Women in Uganda Determined Using QuantiFERON TB Gold-Plus
Authors: Bongomin Felix , Ssekamatte Phillip , Nattabi Gloria , Olum Ronald , Ninsiima Sandra , Kyazze Andrew Peter , Nabakka Winnie , Kukunda Rebecca , Cose Stephen , Kibirige Davis , Batte Charles , Kaddumukasa Mark , Kirenga Bruce J , Nakimuli Annettee , Baluku Joseph Baruch , Andia-Biraro Irene
Published: May 2021

Background

The risk of progression of latent tuberculosis infection (LTBI) to active disease increases with pregnancy. This study determined the prevalence and risk factors associated with LTBI among pregnant women in Uganda.

Methods

We enrolled 261 pregnant women, irrespective of gestational age. Participants who had known or suspected active tuberculosis (TB) on the basis of clinical evaluation or who had recently received treatment for TB were excluded. LTBI was defined as an interferon-γ concentration ≥0.35 IU/mL (calculated as either TB1 [eliciting CD4+ T-cell responses] or TB2 [eliciting CD8+ T-cell responses] antigen minus nil) using QuantiFERON TB Gold-Plus (QFT-plus) assay.

Results

LTBI prevalence was 37.9% (n = 99) (95% confidence interval [CI], 32.3–44.0). However, 24 (9.2%) subjects had indeterminate QFT-plus results. Among participants with LTBI, TB1 and TB2 alone were positive in 11 (11.1%) and 18 (18.2%) participants, respectively. In multivariable analysis, human immunodeficiency virus (HIV) infection (adjusted odds ratio [aOR], 4.4 [95% confidence interval {CI}, 1.1–18.0]; P = .04) and age 30–39 years (aOR, 4.0 [95% CI, 1.2–12.7]; P = .02) were independently associated with LTBI. Meanwhile, smoking status, alcohol use, nature of residence, crowding index, and TB contact were not associated with LTBI.

Conclusions

Our findings are in keeping with the evidence that HIV infection and advancing age are important risk factors for LTBI in pregnancy. In our setting, we recommend routine screening for LTBI and TB preventive therapy among eligible pregnant women.
The emerging role of group 3 innate lymphoid cells in the neonate: interaction with the maternal and neonatal microbiome
Authors: Mirpuri Julie
Published: May 2021

Innate lymphoid cells (ILCs) are critical for host defense and are notably important in the context of the newborn when adaptive immunity is immature. There is an increasing evidence that development and function of group 3 ILCs (ILC3) can be modulated by the maternal and neonatal microbiome and is involved in neonatal disease pathogenesis. In this review, we explore the evidence that supports a critical role for ILC3 in resistance to infection and disease pathogenesis in the newborn, with a focus on microbial factors that modulate ILC3 function. We then briefly explore opportunities for research that are focused on the fetus and newborn.
ACONITASE 3 is part of theANAC017 transcription factor-dependent mitochondrial dysfunction response
Authors: Pascual Jesús , Rahikainen Moona , Angeleri Martina , Alegre Sara , Gossens Richard , Shapiguzov Alexey , Heinonen Arttu , Trotta Andrea , Durian Guido , Winter Zsófia , Sinkkonen Jari , Kangasjärvi Jaakko , Whelan James , Kangasjärvi Saijaliisa
Published: May 2021

Mitochondria are tightly embedded within metabolic and regulatory networks that optimize plant performance in response to environmental challenges. The best-known mitochondrial retrograde signaling pathway involves stress-induced activation of the transcription factor NAC DOMAIN CONTAINING PROTEIN 17 (ANAC017), which initiates protective responses to stress-induced mitochondrial dysfunction in Arabidopsis (Arabidopsis thaliana). Posttranslational control of the elicited responses, however, remains poorly understood. Previous studies linked protein phosphatase 2A subunit PP2A-B’γ, a key negative regulator of stress responses, with reversible phosphorylation of ACONITASE 3 (ACO3). Here we report on ACO3 and its phosphorylation at Ser91 as key components of stress regulation that are induced by mitochondrial dysfunction. Targeted mass spectrometry-based proteomics revealed that the abundance and phosphorylation of ACO3 increased under stress, which required signaling through ANAC017. Phosphomimetic mutation at ACO3-Ser91 and accumulation of ACO3S91D-YFP promoted the expression of genes related to mitochondrial dysfunction. Furthermore, ACO3 contributed to plant tolerance against ultraviolet B (UV-B) or antimycin A-induced mitochondrial dysfunction. These findings demonstrate that ACO3 is both a target and mediator of mitochondrial dysfunction signaling, and critical for achieving stress tolerance in Arabidopsis leaves.
Alexithymia and somatization in agenesis of the corpus callosum
Authors: Paul Lynn K , Pazienza Shawneen R , Brown Warren S
Published: May 2021

Deficient communication between the cerebral hemispheres is one of several prevailing neurobiological explanations for alexithymia and has been strongly supported by research on patients with commissurotomy. We examined self-reported symptoms of alexithymia in adults with agenesis of the corpus callosum (AgCC), a condition characterized by more subtle reductions in interhemispheric transfer than in commissurotomy. Sixteen adults with AgCC and full-scale intelligence quotient >80 were compared with 15 neurotypical controls group-matched for age and intelligence score. The AgCC group endorsed greater difficulty identifying and describing feelings and more vague physical symptoms than controls but similar levels of emotional experience and emotional coping. This finding of impaired emotional interpretation with intact emotional experience is consistent with findings in callosotomy patients, implicating the critical role of the corpus callosum in cognitive dimensions of emotion processing. Further study of alexithymia in AgCC using task-based measures may help clarify the nature of this relationship.
Timely N-Acetyl-Cysteine and Environmental Enrichment Rescue Oxidative Stress-Induced Parvalbumin Interneuron Impairments via MMP9/RAGE Pathway: A Translational Approach for Early Intervention in Psychosis
Authors: Dwir Daniella , Cabungcal Jan-Harry , Xin Lijing , Giangreco Basilio , Parietti Enea , Cleusix Martine , Jenni Raoul , Klauser Paul , Conus Philippe , Cuénod Michel , Steullet Pascal , Do Kim Q
Published: May 2021

Research in schizophrenia (SZ) emphasizes the need for new therapeutic approaches based on antioxidant/anti-inflammatory compounds and psycho-social therapy. A hallmark of SZ is a dysfunction of parvalbumin-expressing fast-spiking interneurons (PVI), which are essential for neuronal synchrony during sensory/cognitive processing. Oxidative stress and inflammation during early brain development, as observed in SZ, affect PVI maturation. We compared the efficacy of N-acetyl-cysteine (NAC) and/or environmental enrichment (EE) provided during juvenile and/or adolescent periods in rescuing PVI impairments induced by an additional oxidative insult during childhood in a transgenic mouse model with gluthation deficit (Gclm KO), relevant for SZ. We tested whether this rescue was promoted by the inhibition of MMP9/RAGE mechanism, both in the mouse model and in early psychosis (EP) patients, enrolled in a double-blind, randomized, placebo-controlled clinical trial of NAC supplementation for 6 months. We show that a sequential combination of NAC+EE applied after an early-life oxidative insult recovers integrity and function of PVI network in adult Gclm KO, via the inhibition of MMP9/RAGE. Six-month NAC treatment in EP patients reduces plasma sRAGE in association with increased prefrontal GABA, improvement of cognition and clinical symptoms, suggesting similar neuroprotective mechanisms. The sequential combination of NAC+EE reverses long-lasting effects of an early oxidative insult on PVI/perineuronal net (PNN) through the inhibition of MMP9/RAGE mechanism. In analogy, patients vulnerable to early-life insults could benefit from a combined pharmacological and psycho-social therapy.
The modulatory impacts of Glycyrrhiza glabra extract against methotrexate-induced testicular dysfunction and oxidative stress
Authors: Aldhahrani Adil , Soliman Mohamed Mohamed , Althobaiti Fayez , Alkhedaide Adel , Nassan Mohamed Abdo , Mohamed Wafaa Abdou , Youssef Gehan B A , Said Alshaimaa Mohammed
Published: May 2021

Glycyrrhiza glabra root (licorice) is a widely used herb for its beneficial effects on health. This study explored the protective effects of licorice extract against oxidative stress and testicular dysfunction caused by methotrexate (MTX). Mice were allocated into (i) negative control group that received saline; (ii) licorice extract group, orally administered with 200 mg/kg body weight (bw) licorice extract for 12 days; (iii) positive MTX-intoxicated group, injected with a single intraperitoneal dose of MTX (20 mg/kg bw) on day 7; and (iv) a protective group that received licorice extract for 12 days and then MTX on day 7 as in groups 2 and 3. Total proteins, albumin, globulins, malondialdehyde, glutathione peroxidase, reduced glutathione, IL-1, and IL-6 were measured in blood and testis samples collected from all groups. Testicular oxidative stress, serum reproductive hormones, and spermogram were examined. The expression of steroidogenesis-associated genes (translocator protein; and P450scc) was examined by quantitative real-time PCR. Bcl-2-associated X protein and cyclogenase-2 genes were examined by immunohistochemical analysis. The bioactive contents of licorice extract were confirmed by gas chromatography–mass spectrometry analysis. Pretreatment with licorice extract ameliorated the toxic effects of MTX on total proteins, albumin, and globulins and oxidative stress biomarkers and reversed the effect of MTX on examined serum and tissue antioxidants. Besides, MTX down-regulated mRNA expression of translocator protein and P450scc genes. Licorice extract averted the decrease in serum testosterone and the increase in IL-1β and IL-6 levels induced by MTX. Moreover, MTX increased sperm abnormalities and percentage of dead sperms and reduced sperm motility. These changes were absent in the licorice preadministered group. Licorice prevented the increase in immunoreactivity of testis for Bcl-2-associated X protein and cyclogenase-2 that were overexpressed in MTX-injected mice. Licorice extracts positively regulated the expression of steroidogenesis genes suppressed by MTX, increased antioxidant enzymes (glutathione peroxidase, reduced glutathione, and catalase) and reduced biomarker of oxidative stress (testicular malondialdehyde) and inflammatory cytokines (IL-1 and -6). Moreover, reduction in testicular tissue immunoreactivity to Bcl-2-associated X protein and cyclogenase-2. In conclusion, licorice extract mitigated the toxic effects of MTX-induced testicular dysfunction at biochemical, molecular, and cellular levels.
Proteomic insights into the photosynthetic divergence between bark and leaf chloroplasts in Salix matsudana
Authors: Liu Junxiang , Sun Chao , Zhai Fei-Fei , Li Zhenjian , Qian Yongqiang , Gu Lin , Sun Zhenyuan
Published: May 2021

Bark chloroplasts play important roles in carbon balancing by recycling internal stem CO2 into assimilated carbon. The photosynthetic response of bark chloroplasts to interior stem environments has been studied recently in woody plants. However, the molecular regulatory mechanisms underlying specific characteristics of bark photosynthesis remain unclear. To address this knowledge gap, differences in the structure, photosynthetic activity and protein expression profiles between bark and leaf chloroplasts were investigated in Salix matsudana in this study. Bark chloroplasts exhibited broader and lower grana stacks and higher levels of starch relative to leaf chloroplasts. Concomitantly, decreased oxygen evolution rates and decreased saturated radiation point were observed in bark chloroplasts. Furthermore, a total of 293 differentially expressed proteins (DEPs) were identified in bark and leaf chloroplast profile comparisons. These DEPs were significantly enriched in photosynthesis-related biological processes or Kyoto Encyclopedia of Genes and Genomes (KEGG) pathways associated with photosynthesis. All 116 DEPs within the KEGG pathways associated with photosynthesis light reactions were downregulated in bark chloroplasts, including key proteins responsible for chlorophyll synthesis, light energy harvesting, nonphotochemical quenching, linear electron transport and photophosphorylation. Interestingly, seven upregulated proteins involved in dark reactions were identified in bark chloroplasts that comprised two kinds of malic enzymes typical of C4-type photosynthesis. These results provide comprehensive proteomic evidence to understand the low photochemical capability of bark chloroplasts and suggest that bark chloroplasts might fix CO2 derived from malate decarboxylation.
Subcutaneous mycoses in Ethiopia: a retrospective study in a single dermatology center
Authors: Abate Dagim A , Ayele Mesfin H , Mohammed Amel B
Published: May 2021

Background

The magnitude of various types of subcutaneous mycoses in Ethiopia is unknown.

Methods

We performed a 5-y retrospective review of confirmed cases at ALERT hospital dermatology clinics.

Result

Confirmed cases of subcutaneous mycoses included chromoblastomycosis (n=12) and mycetoma (n=8). The patients originated from four regions: Oromia (n=10), Amhara (n=6), Addis Ababa (n=3) and South (n=1). Males were affected in 75% of cases (15/20). Ages ranged from 19 to 66 y with a median age of 44 y. Duration of disease ranged from 1 to 25 y. Extremities were affected in all cases, with lower limb involvement in 85% (17/20).

Conclusion

Chromoblastomycosis was the most frequent subcutaneous mycosis followed by mycetoma.
The evolution of anteriorly directed molar occlusion in mammals
Authors: Grossnickle David M , Weaver Lucas N , Jäger Kai R K , Schultz Julia A
Published: May 2021

In non-mammalian synapsids and early mammals, evolutionary transformations in the feeding and hearing apparatuses are posited to have been prerequisites for the radiation of extant mammals. Unlike most vertebrates, including many early synapsids, mammals have precise dental occlusion, a lower jaw composed of one bone, and middle ear ossicles derived from ancestral jaw bones. We illuminate a related functional transition: therian mammals (eutherians and metatherians) evolved anteriorly directed chewing strokes, which are absent in other synapsid lineages. Anteriorly directed jaw movement during occlusion necessitates anteriorly directed muscle force vectors, and we posit that a shift in muscle orientation is reflected in the fossil record by the evolutionary appearance of a posteriorly positioned angular process in cladotherians (therians and their close kin). Anteriorly directed occlusion might have been absent in earlier synapsids because of the presence of attached middle ear elements in the posterior region of the jaw that prohibited the posterior insertion of jaw musculature. These changes to the masticatory apparatus in cladotherians are likely to have permitted the evolution of novel masticatory movements, including grinding in both the anterior and medial directions (e.g. rodents and ungulates, respectively). Thus, this evolutionary transition might have been a crucial prerequisite for the dietary diversification of therians.
ATP-Dependent Protease ClpP and Its Subunits ClpA, ClpB, and ClpX Involved in the Field Bismerthiazol Resistance in Xanthomonas oryzae pv. oryzae
Authors: Ni Yuan , Hou Yiping , Kang Jinbo , Zhou Mingguo
Published: May 2021

Resistance of Xanthomonas oryzae pv. oryzae, which causes rice bacterial leaf blight, to bismerthiazol has been detected in China since the 1990s. The strains resistant to bismerthiazol on rice plants were more sensitive to bismerthiazol than wild-type (WT) strains in vitro. Here, quantitative PCR was applied to detect the fold expression of adenosine triphosphate–dependent proteases, ClpP and its subunits, which withstand stresses including bactericides in bismerthiazol-resistant strains and their parental susceptible WT strain (ZJ173). Results showed that the expression of ClpP and its subunits was higher in bismerthiazol-resistant strains than in ZJ173. They were upregulated during the early growth phase and downregulated during the middle growth phase in ZJ173 treated with bismerthiazol but did not change in the resistant strains. ClpP and its subunits were overexpressed in X. oryzae pv. oryzae in this study; the higher expression of these genes increased sensitivity in vitro and increased resistance in vivo to bismerthiazol. Bismerthiazol inhibition of exopolysaccharide (EPS) production, biofilm production, and motility was also lower in ClpP and its subunits’ overexpression mutants of X. oryzae pv. oryzae. The deletion mutants of ClpP and its subunits in ZJ173 decreased pathogenicity, biofilm production, swimming ability, EPS production, and growth in low-nutrient environments. Moreover, ClpP and its subunits may act downstream of the histidine utilization pathway, which could be inhibited by bismerthiazol in X. oryzae pv. oryzae. Taken together, our results indicated that ClpP and its subunits of X. oryzae pv. oryzae influenced resistance to bismerthiazol.
The Role of the Family in Preventing Addiction
Authors: Naeim Mahdi , Rezaeisharif Ali
Published: May 2021

The family is the first place to form and direct the individual’s personality, but because of educational poverty of family members, they play a major role in the tendency of adolescents and young people to take new drugs. According to available statistics, the majority of new drug users are young people, and Iran has one of the youngest populations in the world. The risk of drug addiction begins in adolescence. In this developmental period, a person experiences the most sensitive period of his life and may use drugs. We aimed to investigate the impact of the family environment on the prevention of youth drug addiction. This article is written in a library-style and cites several books and articles. As a result of this research, although prevention can be considered the most effective strategy to deal with substance abuse, choosing the best method of prevention is not so easy and clear, because the causes of addiction are related and multidimensional. Therefore, there is no doubt that different societies have to adapt various preventive measures to their specific conditions.
Power-assisted Pedicle Screw Technique Protects Against Risk of Surgeon Overuse Injury
Authors: Claeson Amy A. , Schwab Frank J. , Gandhi Anup A. , Skaggs David L.
Published: May 2021

Study Design.

Cadaveric.

Objective.

The aim of this study was to quantify the amplitude and duration of surgeons’ muscle exertion from pedicle cannulation to screw placement using both manual and power-assisted tools in a simulated surgical environment using surface electromyography (EMG).

Summary of Background Data.

A survey of Scoliosis Research Society members reported rates of neck pain, rotator cuff disease, lateral epicondylitis, and cervical radiculopathy at 3 ×, 5 ×, 10 ×, and 100 × greater than the general population. The use of power-assisted tools in spine surgery to facilitate pedicle cannulation through screw placement during open posterior fixation surgery may reduce torque on the upper limb and risk of overuse injury.

Methods.

Pedicle preparation and screw placement was performed from T4-L5 in four cadavers by two board-certified spine surgeons using both manual and power-assisted techniques. EMG recorded muscle activity from the flexor carpi radialis, extensor carpi radialis, biceps, triceps, deltoid, upper trapezius, and neck extensors. Muscle activity was reported as a percentage of the maximum voluntary exertion of each muscle group (%MVE) and muscle exertion was linked to low- (0–20% MVE), moderate- (20%–45% MVE), high- (45%–70% MVE) and highest- (70%–100% MVE) risk of overuse injury based on literature.

Results.

Use of power-assisted tools for pedicle cannulation through screw placement maintains average muscle exertion at low risk for overuse injury for every muscle group. Conversely with manual technique, the extensor carpi radialis, biceps, upper trapezius and neck extensors operate at levels of exertion that risk overuse injury for 50% to 92% of procedure time. Powerassisted tools reduce average muscle exertion of the biceps, triceps, and deltoid by upwards of 80%.

Conclusion.

Power-assisted technique protects against risk of overuse injury. Elevated muscle exertion of the extensor carpi radialis, biceps, upper trapezius, and neck extensors during manual technique directly correlate with surgeons’ self-reported diagnoses of lateral epicondylitis, rotator cuff disease, and cervical myelopathy.

Level of Evidence: N/A
Multifidus Muscle Fiber Type Distribution is Changed in Mouse Models of Chronic Intervertebral Disc Degeneration, but is not Attenuated by Whole Body Physical Activity
Authors: James Gregory , Millecamps Magali , Stone Laura S. , Hodges Paul W.
Published: May 2021

Study Design.

Case-controlled animal study.

Objective.

The aim of this study was to investigate whether multifidus muscle fiber type distribution changes in models of interverbal disc (IVD) degeneration and whether this is resolved by physical activity (PA).

Summary of Background Data.

The loss of slow type I muscle fibers in the multifidus muscle in people with low back pain is contentious. Data from animal models of IVD degeneration suggest some discrepancies in human studies might be explained by the dependence of slow muscle fiber changes and their underlying mechanisms, on the time since injury and progression of IVD degeneration. It is not yet resolved what changes are apparent once the chronic phase is established. It is also not known whether muscle fiber changes can be resolved by whole body PA. This study aimed to examine slow fiber distribution in the multifidus muscle in models of IVD injury or spontaneous degeneration in animals with or without exposure to PA.

Methods.

Two models of IVD degeneration were used. The first model used a genetically modified mouse (SPARC-null) that spontaneously develops IVD degeneration. The second model involved a surgically induced IVD lesion to induce degeneration. Mice in each study were allocated to housing with or without a running wheel for PA. At 12 months of age, the multifidus muscle was harvested. Slow muscle fiber distribution and the mRNA expression of genes associated with muscle fiber type transformation were examined.

Results.

The proportion and cross-sectional area of slow muscle fibers were reduced in both models of IVD degeneration compared to controls, without evidence of ongoing fiber transformation. Whole-body PA did not attenuate these alterations.

Conclusion.

Results confirmed slow muscle fiber loss in the multifidus in the chronic phase of IVD degeneration induced spontaneously and by injury. Whole-body PA did not attenuate changes to muscle fiber distribution. More specific approaches to muscle activation might be required to achieve more complete reversal of muscle fiber changes, with potential implications for therapy in humans.

Level of Evidence: N/A
Perioperative care capacity in East Africa: results of an Ethiopian national cross-sectional survey
Authors: Kifle Fitsum , Belihu Kokeb D. , Beljege Bezaye Z. , Dhufera Hailu T. , Keno Frezer B. , Taye Desalegn B. , Teklehaimanot Masresha G. , Weldesenbet Ermiyas B. , Gemechu Tirunesh B. , Moore Jolene
Published: May 2021

Background:

Provision of safe surgery has gained focus recently. In 2015, the World Health Organization (WHO) called for the strengthening of surgical and anesthesia services as a universal health coverage component. The same year, the Ethiopian Ministry of Health (MOH) launched the “Saving Lives through Safe Surgery” initiative to prioritize and scale-up surgical services. This study provides an updated overview of perioperative facilities’ status to facilitate the identification of future focus areas.

Methods:

An online national cross-sectional survey was conducted in September–November 2020, incorporating elements from recognized surgical and anesthesia facility assessment tools to assess infrastructure, workforce, and availability of resources across Ethiopian government facilities.

Results:

Responses were received from 81/289 (28%) facilities, conducting a mean of 6.9 (range: 1–37) surgeries per day. All regions were represented. There were shortages in specialty surgical, obstetric, and anesthesiology workforce, functioning anesthesia machines, airway equipment, recommended monitoring devices, and capnography. Shortages of analgesia, anesthesia, and emergency medications were reported. Sixty-eight (84%) facilities had a postanesthetic care unit with a mean of 3.1 (range: 1–15) beds. The presence of trained nurses, oxygen, monitoring devices, equipment, medications, and postoperative care guidelines was minimal.

Conclusions:

This study provides an updated overview of surgical capacity in Ethiopia. Despite the expansion of surgical access, there are ongoing resource deficits. Expansion of surgical capacity should be accompanied by a similar expansion in the provision of adequately equipped and staffed postanesthetic care units and a focus on postoperative care.
Women's knowledge and awareness on menopause symptoms and its treatment options remains inadequate: a report from the United Arab Emirates
Authors: Shahzad Dania , Thakur Asiya Aqeel , Kidwai Samreen , Shaikh Habiba Omer , AlSuwaidi Alia Obaid , AlOtaibi Afra Fahad , Carrick Frederick Robert , Abdulrahman Mahera
Published: May 2021

Objectives:

We aimed to evaluate the awareness, knowledge, and perception of middle-aged women regarding menopause and hormone therapy (HT).

Methods:

This observational study was conducted on pre-, peri-, post-, and surgically menopausal women (n = 591) from January 2020 until June 2020 in Dubai. A structured questionnaire was developed based on previous literature to assess participants’ knowledge and awareness of menopause and HT. The questionnaire was implemented by face-to-face interview. Factors associated with the degree of menopausal knowledge were identified.

Results:

Majority (498, 82%) of participant women had fair to poor overall knowledge on menopause, did not know whom HT is used for (404, 48%), and for whom it is contradicted (455, 77%). Knowledge on menopause and HT was highly associated with better attitudes (P < 0.001 and P < 0.001, respectively).

Furthermore, the greater the knowledge on menopause, the better the knowledge of HT (P < 0.001). Education was the primary factor that played a significant role in having better knowledge or attitudes. Nationality showed an association with better attitudes on menopause, with non-Arabs having better attitudes than Arabs and UAE nationals.

Conclusions:

Community medicine educators and primary healthcare providers need to prepare tailored premenopausal and postmenopausal educational interventional programs for further educating women and preparing them for this phase of their lives.
PURTSCHER-LIKE RETINOPATHY IN A PATIENT WITH MILK-ALKALI SYNDROME AND PANCREATITIS
Authors: Alsberge Joseph B. , Chen Judy J. , McDonald H. Richard
Published: May 2021

Purpose:

To report a case of Purtscher-like retinopathy in a patient with milk-alkali syndrome and pancreatitis.

Methods:

Case report and review of the literature.

Results:

A 46-year-old woman presented with decreased vision following discharge from the intensive care unit, where she had been admitted for milk-alkali syndrome secondary to long-term calcium supplementation and over-the-counter antacid use, and pancreatitis. Dilated examination showed ischemic retinal whitening and retinal hemorrhages in the posterior pole bilaterally consistent with Purtscher-like retinopathy. Over three months, the retinopathy resolved and her vision improved.

Conclusion:

Milk-alkali syndrome is the clinical triad of hypercalcemia, renal failure, and metabolic alkalosis and occurs secondary to the consumption of large amounts of calcium and alkali. The hypercalcemia associated with milk-alkali syndrome may cause pancreatitis, which can lead to Purtscher-like retinopathy.
Work and Non-Work Sickness Presenteeism
Authors: Probst Tahira M. , Lee Hyun Jung , Bazzoli Andrea , Jenkins Melissa R. , Bettac Erica L.
Published: May 2021

Objective:

To test the role of workplace coronavirus disease (COVID-19) climate in shaping employee attitudes toward the CDC prevention guidelines and subsequent levels of work and non-work sickness presenteeism.

Methods:

Three waves of anonymous survey data were collected in October and December 2020 and February 2021. Participants were 304 employed adults in the U.S., of whom half were working onsite.

Results:

Time 1 workplace COVID-19 climate was positively associated with Time 2 employee attitudes toward the CDC prevention guidelines, which in turn predicted Time 3 levels of non-work and work sickness presenteeism.

Conclusions:

The workplace can shape employee attitudes toward the CDC COVID-19 prevention guidelines and their work and non-work sickness presenteeism, thus highlighting the important role companies have in reducing community spread of the novel coronavirus in work and non-work settings.
Clinical Features and Management of Drop Attacks in Menière's Disease. Special Emphasis on the Possible Occurrence of Vertigo After the Drop Attacks
Authors: Lelonge Yann , Karkas Alexandre , Peyron Roland , Reynard Pierre , Convers Philippe , Bertholon Pierre
Published: May 2021

Introduction:

Tumarkin first described drop attacks (DA) in patients with a peripheral vestibular syndrome and speculated the role of a mechanical deformation of the otolith organs. We emphasized on the possible occurrence of vertigo/dizziness after a DA. In the light of the oculomotor examination of one patient right after the DA, we discussed on the mechanisms. We also described the management of DA.

Material and Method:

This study included patients with definite Meni�re's disease (MD) and at least one DA without associated neurological symptoms. Patients with vertigo/dizziness after the fall were not excluded.

Results:

Fifteen patients with MD complained of DA that was complicated either by severe head trauma (n = 1) or various fractures (n = 4). Seven patients complained of vertigo/dizziness after the DA. In one patient, DA occurred in the waiting room with a vertical illusion of movement immediately after the fall and a predominant down beating nystagmus that later changed direction. Follow up was favorable in all patients after oral medication alone (n = 7), chemical labyrinthectomy (n = 7) or vestibular neurotomy (n = 1).

Conclusions:

We suggest that a subset of patients with MD can complain of vertigo after a DA. We conclude on the possible occurrence of a vertical mainly down beating nystagmus in MD. Since this latter nystagmus is likely related to a semicircular canal rather than an otolith dysfunction, we discuss on the mechanisms of DA followed by vertigo/dizziness. Due to the risk of trauma in DA, chemical labyrinthectomy is a reasonable and effective option although spontaneous remission is possible.
Proteomic Imaging of Vestibular Schwannomas and Normal Nerves. Histopathologic Correlations
Authors: Karkas Alexandre , Berger François , Péoc’h Jean-Michel , Cosmo Philippe , Bouamrani Ali , Dumollard Jean-Marc
Published: May 2021

Objectives:

Proteomic analysis of vestibular schwannoma (VS), non-vestibular schwannoma (NVS), and normal nerve (NN) using mass spectrometry and imaging of matrix assisted laser desorption ionization-time of flight (MALDI-TOF).

Methods:

Retrospective, qualitative, and descriptive study on VS, NVS, and NN. Samples were provided by our Tumor Bank. They were analyzed histologically then sprayed by acid matrix. The laser beam of MALDI performed desorption-ionization of the sample. A mass spectrogram (MS) was drawn depending on time of flight of ionized peptides, and MALDI-imaging was obtained which is a summation color spectrum depending on sample's peptide content. The slice was reexamined histologically and results compared with MALDI-imaging.

Results:

Fifty schwannomas were sampled, of which 27 exploitable: 22 VS (17 Antoni type A and five type B) and five NVS (all Antoni type B). Eleven NN were analyzed. Among the 22 VS, near-total correlation between MALDI-imaging and pathology was found in two cases (9.1%), partial correlation in four (18.2%), and no correlation in 16 (72.7%); correlations were more frequent in VS of the Antoni type B. MS showed a peptide spike at 2,000 m/z in 7 (31.8%) and 5,000 m/z in 21 (95.5%). Among the five NVS, near-total correlation was found in three cases (60%), partial correlation in one (20%), and no correlation in one (20%). MS showed a peptide spike at 2,000 m/z in two (40%) and 5,000 m/z in all (100%). Among the 11 NN, near-total correlation was found in nine cases (81.8%), partial correlation in one (9.1%), and no correlation in one (9.1%). MS showed no peptide spike at 2,000 or 5,000 m/z. Behind homogeneous areas on histology, there was great heterogeneity on MALDI-imaging and MS, regarding VS and NVS, but not NN.

Conclusions:

There was a lack of correlation between MALDI-imaging and pathology in VS (except Antoni type B) as compared with NVS and NN. The lack of correlation in VS of the type A as compared with type B VS and NVS could be attributed to the overexpression of degeneration-associated proteins/peptides in VS of the type B as well as NVS that are better correlated with histologic findings. The two peptide spikes detected in schwannoma and not in NN opens up the prospect of tumor biomarkers identifiable by sequencing. The proteomic polymorphism found in VS and NVS was absent on histology which is a new morphologic characteristic of schwannoma. Further studies should be performed in the future to confirm the benefit and usefulness of the MALDI in the analysis of VS and NVS.
Management of surgery, menorrhagia and child-birth for patients with unclassified bleeding disorders: a systematic review of cohort studies
Authors: Desborough Michael J.R. , Obaji Samya , Lowe Gillian C. , Doree Carolyn , Thomas Will
Published: May 2021

Unclassified bleeding disorders account for 2.6% of all new bleeding disorder registrations in the UK. The management of the bleeding phenotype associated with these disorders is poorly described. Systematic review and meta-analysis to determine the bleeding rates associated with tranexamic acid, desmopressin, platelet transfusion, plasma transfusion and recombinant activated factor VII, for patients with unclassified bleeding disorders undergoing surgery, childbirth or with menorrhagia. We searched for randomized controlled trials in MEDLINE, Embase, The Cochrane Central Register of Controlled Trials, PubMed, ISI Web of Science and the Transfusion Evidence Library from inception to 24 February 2020. Wherever appropriate, data were pooled using the metaprop function of STATA. Two studies with 157 participants with unclassified bleeding disorders were identified. The pooled risk of minor bleeding for patients undergoing surgery treated with peri-operative tranexamic acid was 11% (95% confidence interval 3--20%; n = 52; I
2 = 0%); the risk for desmopressin and tranexamic acid in combination was 3% (95% confidence interval 0--7%; n = 71; I
2 = 0%). There were no instances of major bleeding. In one procedure, 1 of 71 (1.4%), treated with a combination of desmopressin and tranexamic acid, the patient had a line-related deep vein thrombosis. There were too few patients treated to prevent postpartum haemorrhage or for menorrhagia to draw conclusions. The GRADE quality of evidence was very low suggesting considerable uncertainty over the results. However, both tranexamic acid, and the combination of tranexamic and desmopressin have high rates of haemostatic efficacy and have few adverse events.

Protocol registration

PROSPERO CRD42020169727.
Objective assessment of metabolism and guidance of ICU rehabilitation with cardiopulmonary exercise testing
Authors: Whittle John , San-Millán Iñigo
Published: May 2021

Purpose of review

Addressing the reduced quality of life that affects ICU survivors is the most pressing challenge in critical care medicine. In order to meet this challenge, we must translate lessons learnt from assessing and training athletes to the clinical population, utilizing measurable and targeted parameters obtained during cardiopulmonary exercise testing (CPET).

Recent findings

Critical illness survivors demonstrate a persistent reduction in their physical and metabolic function. This manifests in reduced aerobic exercise capacity and metabolic inflexibility. CPET-guided targeted metabolic conditioning has proved beneficial in several clinical populations, including those undergoing high-risk surgery, and could be successfully applied to the rehabilitation of ICU survivors.

CPET shows great promise in the guidance of rehabilitation in functionally limited ICU survivors. Parallels in the physiological response to exercise in athletes and clinical populations with the stress and consequences of critical illness must be investigated and ultimately applied to the burgeoning population of ICU survivors in order to treat the consequences of survival from critical illness.
Impact of cognitive behavioural play therapy on social anxiety among school children with stuttering deficit
Authors: Obiweluozo Patience Enuma , Ede Moses Onyemaechi , Onwurah Chimezie Nneka , Uzodinma Uchenna Eugenia , Dike Ibiwari Caroline , Ejiofor Juliana Ngozi
Published: May 2021

Background:

Stuttering is a speech deficit which is characterized by obstruction of speech eloquence and verbal expression in addition to involuntary flow of air during communication. School children with communication deficit often experience social anxiety in their immediate environment. Currently, reports show that a good number of children with communication deficits are prone to social maladjustment due to their being socially inept. And this has significantly affected their thought pattern, social behaviours and emotional responses. In view of this, we examined the impact of cognitive behavioural play therapy in reducing social anxiety among school children with stuttering.

Method:

This is a pretest-posttest randomized control group design. Participants were 178schoolchildren in inclusive schools in South east Nigeria. Participants in the intervention group were treated using cognitive behavioural play therapy programme (CBPT). Participants in the waitlist control group were only assessed at three points of assessment. Data analyses were completed using repeated measures ANOVA.

Results:

The results show that cognitive behavioural play therapy is beneficial in decreasing schoolchildren's social anxiety scores. The intervention equally showed the considerable impacts on the children when exposed to cognitive behavioural play programme at different times of assessment compared to waitlisted control group.

Conclusion:

It is concluded that CBPT is a long-term psychotherapeutic programme that has significant impacts in reducing social anxiety among children with stuttering. This study makes a leading contribution on the limited scholarship focusing on the impact of CBPT on social anxiety of special population with stuttering deficits in developing countries.
Xuefu Zhuyu decoction for nonalcoholic fatty liver disease
Authors: Liu Jiaxin , Dong Bo , Yang Lin , Huang Wei , Tang Songqi
Published: May 2021

Background:

Nonalcoholic fatty liver disease (NAFLD) includes nonalcoholic fatty liver (NAFL) and nonalcoholic steatohepatitis (NASH), which ranks only second to viral hepatitis and poses an increasingly serious challenge to global public health and economy. NAFLD has attracted more and more attention, but there is no drugs with exact curative effects are available. The commonly used drugs for the treatment of NAFLD in clinical practice are statins, such drugs, inevitably increase the burden on the live. Compared to statins, traditional Chinese medicines are believed to be “all natural” with fewer side effects, are associated with strong patient compliance. Accordingly, a great deal of clinical studies have shown that Xuefu Zhuyu decoction (XFZYD) can significantly improve the clinical symptoms and enhance the therapeutic effect. Meanwhile, a system review and meta-analysis are conducted by us to further clarify the effectiveness and safety of XFZYD for NAFLD.

Methods:

We will apply to database mainly range from the English literature searches Cochrane Library, PubMed, excerpt medica database, and Web of Science to the Chinese literature China national knowledge infrastructure, Chinese biomedical literature database, VIP, and Wanfang database, randomized controlled trials (RCTs) are enrolled to evaluate the effectiveness and safety of XFZYD in the treatment of NAFLD, the enrollment of RCTs is from the establishment of the database to February 01, 2021. Simultaneously we will retrieval clinical registration tests and grey literatures. The 2 researchers worked independently on literature selection, data extraction, and quality assessment. The dichotomous data is expressed in terms of relative risk, the continuous is represented by mean difference or standard mean difference, whether there is heterogeneity is the factor that determines the synthesis of data in fixed effect model or random effect model. Alanine aminotransferase (ALT) or Aspartic acid aminotransferase (AST) coupled with Glutamyltransferase (GGT) is considered as one of the main indicators of the NAFLD, while the pathology, imaging and diagnosis of metabolic syndrome are also auxiliary results. The last, meta-analysis was conducted by RevMan software version 5.3.

Results:

This study will provide evidence for treatment of NAFLD with XFZYD in terms of effectiveness and safety.

Conclusion:

This systematic review aims to confirm the efficacy and safety of XFZYD in the treatment of NAFLD.

OSF registration number:

DOI 10.17605/OSF.IO/7CWRK.