bluuebunny/crossref_metadata_2025 huggingface dataset:
Retinal arterial macroaneurysm rupture by Valsalva maneuver: a case report and literature review
Authors: Meng Yang , Xu Yishuang , Li Lu , He Lu , Yi Zuohuizi , Chen Changzheng
Published: November 2022

Background

Retinal artery macroaneurysms (RAMs) are focal dilations of the large retinal arteries. Most RAMs are asymptomatic, however, when hemorrhage or exudation caused by a RAM involves the macula, patients can experience marked vision loss. This article reported a rare case of a ruptured RAM due to the Valsalva maneuver in an elderly female with constipation and offered a review of the relevant literature.

Case presentation

A 78-year-old woman with several risk factors presented with multi-level retinal hemorrhages following a Valsalva maneuver during constipation. Due to the poor coagulation and heavy bleeding in this case, the blood broke through the internal limiting membrane and drained "on its own" into the vitreous cavity. First, we observed the patient and controlled for her risk factors. After the blood was completely drained into the vitreous cavity, the root cause of the bleeding was found to be a RAM rupture. After laser photocoagulation, the patient's vision recovered significantly and remained stable for a long time despite the presence of an epiretinal membrane and a lamellar macular hole.

Conclusions

This is the first reported case of a RAM rupture by Valsalva maneuver during constipation. For multi-level hemorrhages caused by RAM, measures should be taken to drain out the sub-internal limiting membrane hemorrhage and simultaneously control for risk factors. After the RAM is exposed, laser photocoagulation can be performed.
Assessment of neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio in patients with high myopia
Authors: Wang Xin , He Qing , Zhao Xiaoyu , Li Haoru , Liu Lin , Wu Di , Wei Ruihua
Published: November 2022

Background

Previous reports have suggested that inflammation levels play a crucial role in the pathogenesis of high myopia (HM). This study aimed to investigate the relationship between HM and systemic inflammation using the neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR).

Methods

Overall, 100 age- and sex-matched participants were recruited for the study, including 50 participants each in the non-HM (NHM) and HM groups. Ocular examinations and blood tests were performed. The NLR and PLR values were calculated from complete blood counts. Receiver operating characteristic (ROC) curves and optimal cut-off values were used to determine the optimal values of the NLR and PLR to distinguish between the HM and NHM groups.

Results

The values of NLR and PLR were significantly elevated in the HM group compared with those in the NHM group (P < 0.001 and P = 0.010, respectively). Axial length (AL) was significantly correlated with the NLR (r = 0.367, P < 0.001) and PLR (r = 0.262, P = 0.009). In the ROC analysis, the NLR value to distinguish between the HM and NHM groups was 0.728; the best cut-off value was 2.68, with 76% sensitivity and 62% specificity. The PLR value to distinguish between the HM and NHM groups was 0.650; the best cut-off value was 139.69, with 52% sensitivity and 76% specificity.

Conclusion

The findings of this study indicate that the development of HM may be associated with systemic inflammation measured using the NLR and PLR.

Trial registration

The study was registered on December 28, 2021 (http://www.chictr.org.cn; ChiCTR2100054834).
Exploring the acceptability and feasibility of a whole school approach to physical activity in UK primary schools: a qualitative approach
Authors: Jones Gareth , Longbon Kim , Williams Sarah
Published: November 2022

Background

UK Children generally fail to meet physical activity (PA) recommendations. Whole school approaches (WSA) have the potential to impact large numbers of children due to their ubiquitous nature for school wide implementation, however there is limited knowledge regarding primary school PA WSA implementation in the UK. This study aimed to investigate the acceptability and feasibility of a PA WSA in the UK. 

Methods

Semi structured interviews explored research aims with participants. A qualitative description approach was adopted and data were analysed using thematic analysis to draw codes and themes from the data.

Results

Thirteen primary school senior leadership team (SLT) and Physical Education (PE) leads were interviewed. A PA WSA was found acceptable by all participants. Implementation, however, was questioned when other significant mechanisms were not in place. A PA WSA aided prioritisation and planning of PA provision, providing a holistic overview of all key areas of PE, school-sport and PA (PESSPA). Due to the high acceptability but dependent feasibility of a PA WSA, it is recommended that PA WSAs align with whole-school health policy and improvement plans to advance implementation. Future research, however, is needed to explore how this method is best implemented as additional interventions may also be required to promote the prioritisation of the PA agenda due to the importance of SLT backing for implementation being paramount, as results highlight.

Conclusions

PA WSAs aid awareness, understanding and planning of school wide PESSPA provision, however their implementation in complex. Having SLT support and an appropriately resourced PE lead maximised the impact and utility of a PA WSA.
Technique and clinical results of a new intramedullary support nail and plate system for fixation of 3- or 4- part proximal humeral fractures in older adults
Authors: Bai Xuedong , Zhu Zhengguo , Chang Zuhao , Sun Lijun , Tang Peifu , Chen Hua
Published: November 2022

Background

Internal fixation of complex proximal humeral fractures (PHF) with osteoporosis is associated with a high incidence of complications. This study introduces the technique and clinical results of a novel intramedullary support nail and plate system (ISNPs) for the internal fixation of 3- or 4- part PHF in older adults. The ISNPs combines the concept of intramedullary support and dynamic fixation into a locking plate fixation system that can be applied using a minimally invasive surgical approach.

Methods

A total of 46 consecutive patients diagnosed with 3- or 4-part PHF that met the criteria were included in this study, including 18 in the ISNPs group and 28 in the conventional locking plate (LP) group. Clinical results, including operative time, intraoperative bleeding, reduction quality, subjective outcome ratings, and complications, were compared between the two groups. Functional outcomes were evaluated using the Constant score and disability of the arm, shoulder, and hand (DASH) questionnaire at 1-year follow-up.

Results

There were no significant differences in age, sex, local bone quality, Neer-fracture type, and follow-up time between the ISNPs and LP groups. For clinical analysis, there were no significant differences in intraoperative bleeding and operation time between the ISNPs and LP groups. Significant differences were observed in the percentage of the malreduced cases, Constant and DASH score analysis, and the patients’ subjective evaluation (‘excellent’ and ‘good’ %) between the two groups.

Conclusion

The ISNPs technique proposed in this study provides a novel hybrid internal fixation model for complex PHF with osteoporosis. The clinical results at 1-year follow-up confirmed the advantage of applying it to 3- or 4- part PHF in older patients. Further studies are required to optimize its design and explore its optimal indications.
The germline mutational landscape of genitourinary cancers and its indication for prognosis and risk
Authors: Yang Yong , Zhang Guoying , Hu Chen , Luo Wei , Jiang Haiyang , Liu Shaoyou , Yang Hong
Published: November 2022

Background

Germline mutations represent a high risk of hereditary cancers in population. The landscape and characteristics of germline mutations in genitourinary cancer are largely unknown, and their correlation with patient prognosis has not been defined.

Methods

Variant data and relevant clinical data of 10,389 cancer patients in The Cancer Genome Atlas (TCGA) database was downloaded. The subset of data of 206 genitourinary cancer patients containing bladder urothelial carcinoma (BLCA), kidney chromophobe carcinoma (KICH), kidney renal clear cell carcinoma (KIRC), kidney renal papillary cell carcinoma (KIRP) and prostate adenocarcinoma (PRAD) cancer with germline mutation information was filtered for further analysis. Variants were classified into pathogenic, likely pathogenic and non-pathogenic categories based on American College of Medical Genetics and Genomics (ACMG) guidelines. Genome Aggregation Database (gnomAD) database was used to assist risk analysis.

Results

There were 48, 7, 44, 45 and 62 patients with germline mutations identified in BLCA, KICH, KIRC, KIRP and PRAD, respectively. Pathogenic germline mutations from 26 genes and likely pathogenic mutations from 33 genes were revealed. GJB2, MET, MUTYH and VHL mutations ranked top in kidney cancers, and ATM and CHEK2 mutations ranked top for bladder cancer, while ATM and BRCA1 mutations ranked top for prostate cancer. Frameshift, stop gained and missense mutations were the predominant mutation types. BLCA exhibited the highest ratio of stop gained mutations (22/48 = 45.8%). No difference in patient age was found among pathogenic, likely pathogenic and non-pathogenic groups for all cancer types. The number of male patients far overweight female patients whether PRAD was included (P = 0) or excluded (P < 0.001). Patients with pathogenic or likely pathogenic germline mutations exhibited significantly worse overall survival rate than the non-pathogenic group for all genitourinary cancers. More important, analyses assisted by gnomAD database revealed that pathogenic or likely pathogenic germline mutations significantly increased the risk for genitourinary cancer in population, with the odds ratio at 14.88 (95%CI 11.80–18.77) and 33.18 (95%CI 24.90–44.20), respectively.

Conclusions

The germline mutational status for genitourinary cancers has been comprehensively characterized. Pathogenic and likely pathogenic germline mutations increased the risk and indicated poor prognosis of genitourinary cancers.
The perceived value and impact of virtual simulation-based education on students’ learning: a mixed methods study
Authors: Edgar Amanda K. , Macfarlane Susie , Kiddell Elissa J. , Armitage James A. , Wood-Bradley Ryan J.
Published: November 2022

Background

Virtual simulations are used throughout healthcare training programs to enable development of clinical skills, however the potential for virtual simulation to enhance cognitive and affective skills is less well understood. This study explored pre-clinical optometry students’ perceptions of the impact of virtual simulation on the development of core competency skills including patient-centred care, communication, scientific literacy, and evidence-based practice.

Methods

A mixed methods study was conducted using pre-existing anonymized data from an electronic survey distributed to pre-clinical optometry students enrolled in the double degree Bachelor of Vision Science/Master of Optometry at Deakin University, Australia. The data were interpreted using descriptive statistics and qualitative analysis using constant comparison for thematic analysis.

Results

A total of 51 responses were analyzed. Students reported that virtual simulation motivated them to become an optometrist (93%) and to learn beyond the course material (77%). Students reported that after participating in the virtual simulation, their core competency skills improved: patient-centered care (100%) evidence-based practice (93%) and clinical reasoning (93%). The themes identified through qualitative analysis were: enablers to cognitive experience in virtual simulation in optometry education, realism of the virtual simulation design, dimensions of fidelity in virtual simulations design replicated the complexity of the optometric environment, virtual simulation as an enabler for learning and assessment in optometry education, a place to develop cognitive and affective skills and application of learning in the virtual simulation developed an appreciation of future roles and professional identity.

Conclusion

Optometry students perceived virtual simulation in optometric education as a valuable training and assessment strategy enabled by qualities that generate contextual, cognitive, functional, task and psychological fidelity. The data provide insight to inform how optometry educators can incorporate simulation into the curriculum.
Development of an acute medical unit to optimize patient flow and early discharges in a tertiary care hospital in the United Arab Emirates
Authors: Harhara Thana , Ibrahim Halah , Gaba Waqar H. , Kamour Ashraf M.
Published: November 2022

Background

Hospitals worldwide are seeing an increased number of acute admissions, with resultant emergency department (ED) crowding and increased length of stay (LOS). Acute Medical Units (AMUs) have developed throughout the United Kingdom and other Western countries to reduce the burden on EDs and improve patient flow. Limited information is available on AMUs in the Middle East. The purpose of this study is to describe the development of the first AMU in the United Arab Emirates (UAE) for general medical patients and its impact on LOS, early discharges, ED boarders, and readmission rates.

Methods

We established a consultant-led AMU in a tertiary hospital in the UAE. A retrospective comparative review of all general medical admissions to the AMU between August 1, 2020 and December 31, 2020 and all admissions to the traditional medical wards between August 1, 2019 and December 31, 2019 was conducted.

Results

The average LOS reduced from 10 to 5 days (95% CI [4.14–6.25], p < 0.001) after the introduction of AMU. Early discharges increased by 22%. The number of outliers and number of patients boarding in ED reduced significantly (111 in 2019 vs. 60 in 2020, p < 0.05; 938 in 2019 vs. 104 in 2020, p < 0.001 respectively), with a decrease in ED waiting time from 394 min to 134 min (95% CI [229.25–290.75], p < 0.001). There was no increase in 30-day readmission rates.

Conclusion

Restructuring the system of care can reduce LOS, overcome discharge barriers and improve patient flow. Similar units can be developed in hospitals throughout the UAE and the region to reduce LOS and improve patient flow through acute care units.
Socioeconomic disparities in using rehabilitation services among Iranian adults with disabilities: a decomposition analysis
Authors: Soltani Shahin , Moghadam Marzieh Mohammadi , Amani Shiva , Akbari Shahram , Shiani Amir , Soofi Moslem
Published: November 2022

Background

Persons with disabilities (PWD) generally experience various barriers in using health care compared to the general population, and these problems are more worsened for those with disabilities in lower socioeconomic status. The study aimed to estimate socioeconomic inequality in using rehabilitation services (URS) in adults with disabilities in Iran.

Methods

This cross-sectional study was conducted at a national level in Iran. 786 PWD (aged 18 years and older) participated in the study between September and December 2020. Socioeconomic-related inequality in URS was estimated by the Concentration Index (C). The C was decomposed to identify factors explaining the variability within the socioeconomic inequality in URS.

Results

In the present study 8.10% (N = 61) of the study population used rehabilitation services during the past three months. In this study, the value of the C was estimated 0.25 (p-value = 0.025) that shows URS was unequally distributed, and concentrated among the higher SES groups. The results of decomposition analysis indicated that the wealth index was the largest contributor (94.22%) to the observed socioeconomic inequalities in URS among PWD. Following the wealth index, Age and marital status were the major contributors to the unequal distribution of URS among the study population.

Conclusions

Our findings revealed that socioeconomic inequality in using rehabilitation services was concentrated among well-off PWD. Accordingly, rehabilitation financing through appropriate mechanisms for individuals with low SES is suggested.
Positional transversal release is effective as stretching on range of movement, performance and balance: a cross-over study
Authors: Thomas Ewan , Ficarra Salvatore , Scardina Antonino , Bellafiore Marianna , Palma Antonio , Maksimovic Nemanja , Drid Patrik , Bianco Antonino
Published: November 2022

Background

The aim of this study was to compare the positional transversal release (PTR) technique to stretching and evaluate the acute effects on range of movement (ROM), performance and balance.

Methods

Thirty-two healthy individuals (25.3 ± 5.6 years; 68.8 ± 12.5 kg; 172.0 ± 8.8 cm) were tested on four occasions 1 week apart. ROM through a passive straight leg raise, jumping performance through a standing long jump (SLJ) and balance through the Y-balance test were measured. Each measure was assessed before (T0), immediately after (T1) and after 15 min (T2) of the provided intervention. On the first occasion, no intervention was administered (CG). The intervention order was randomized across participants and comprised static stretching (SS), proprioceptive neuromuscular facilitation (PNF) and the PTR technique. A repeated measure analysis of variance was used for comparisons.

Results

No differences across the T0 of the four testing sessions were observed. No differences between T0, T1 and T2 were present for the CG session. A significant time × group interaction for ROM in both legs from T0 to T1 (mean increase of 5.4° and 4.9° for right and left leg, respectively) was observed for SS, PNF and the PTR. No differences for all groups were present between T1 and T2. No differences in the SLJ and in measures of balance were observed across interventions.

Conclusions

The PTR is equally effective as SS and PNF in acutely increasing ROM of the lower limbs. However, the PTR results less time-consuming than SS and PNF. Performance and balance were unaffected by all the proposed interventions.
Tobacco cessation among smokers under substance use treatment for alcohol and/or cannabis: study protocol and pilot study
Authors: Feliu Ariadna , Fernández Esteve , Castellano Yolanda , Enríquez Marta , Saura Judith , Cabezas Carmen , Colom Joan , Suelves Josep M. , Pla Margarida , Parejo Mar , Mondon Sílvia , Barrio Pablo , Andreu Magalí , Raich Antonia , Bernabeu Jordi , Vilaplana Jordi , Roca Xavier , Bautista Pablo , Guydish Joseph , Martínez Cristina ,   group of clinicians involved in the recruitment of the study, Miquel Laia , Bruguera Pol , Nadal Karen , Anduaga Monika , Martínez Silvia , Pallejà Beth , Reyes Rosanna , Surribas Enrique , Fonseca Francina , Caterina Clara , Aranega Diego , Cabezón Nuria , Martí Víctor , Gual Amalia , Franco Carolina , Parellada Delia , Masferrer Laura , Batllori Esther
Published: November 2022

Background

Approximately 80% of people with a substance use disorder (SUD) are smokers. Starting SUD treatment offers the opportunity to also quit smoking. The ACT-ATAC project aims to identify the predictors associated with smoking cessation among persons treated for alcohol and/or cannabis use disorder in Barcelona. This manuscript reports its methodology and the experience of carrying it out during the COVID-19 pandemic.

Methods

Mixed methods project with three substudies. Substudy 1 (S1) comprises heterogeneous discussion groups among clinicians. S2 has two prospective cohorts composed of smokers under treatment for alcohol and/or cannabis use disorder and the clinicians in charge of these patients. Participating smokers will be followed for 12 months and interviewed about their substance use and the tobacco cessation services received using the Spanish version of the users’ Knowledge, Attitudes, and Services (S-KAS) scale. The clinicians will be asked about their self-reported practices in smoking cessation using the Knowledge, Attitudes, and Practices (S-KAP) scale. S3 comprises heterogeneous discussion groups with smokers. Data will be triangulated using qualitative and quantitative analyses. To facilitate the recruitment process, the researchers have introduced several strategies (design clear protocols, set monthly online meetings, extend the project, provide gift cards, etc.).

Discussion

The results of S1 were used to develop the questionnaires. S2 required some adjustments due to the COVID-19 pandemic, particularly the follow-up interviews being conducted by phone instead of face-to-face, and the recruitment rhythm was lower than expected. Recruitment will last until reaching at least 200–250 users. The fieldwork could not have been possible without the collaboration of the ACT-ATAC team and the introduction of several strategies.

Trial registration The ACT-ATAC project has been successfully registered at Clinicaltrials.gov [NCT04841655].
The effect of biceps tenotomy on humeral migration and clinical outcomes in arthroscopic rotator cuff repair
Authors: Çakar Burak , Güney Ahmet , Güney Betül , Uzun Erdal , Sekban Hazım
Published: November 2022

Purpose

To evaluate the effect of biceps tenotomy on humeral migration and clinical outcomes in patients who underwent arthroscopic rotator cuff (RC) repair.

Methods

This is a retrospective study of 60 patients who underwent arthroscopic RC repair. Patients were divided into two groups, whether they underwent concomitant biceps tenotomy or not. The group underwent concomitant biceps tenotomy, tenotomy ( +), or not, tenotomy (-). Clinical and functional outcomes were performed using the American Shoulder and Elbow Surgeons (ASES), the University of California-Los Angeles (UCLA) scoring system.

Radiological evaluation was performed in X-rays and magnetic resonance imaging (MRI), measuring the acromiohumeral distance (AHD), humeral migration (HM) and upper migration index (UMI).

Results

There was no significant difference between the groups in terms of patient characteristics. The follow-up period was 30.9 ± 8.7 months in the tenotomy ( +) group and 34.9 ± 8.2 months in the tenotomy (-) group with no significant difference. Postoperative ASES score improved significantly in the tenotomy ( +) group compared to the tenotomy (-) group (91.2 ± 4.7, 80.8 ± 18.7, respectively, p = 0.005). There was a significant difference in postoperative AHD, HM and UMI values (MRI; p = 0.003, p = 0.017, p = 0.025; X-ray; p = 0.049, p = 0.002, p = 0.010, respectively). The post–pre difference increase of AHD [MRI for tenotomy( +): 0.14 ± 0.86 and tenotomy(-): 0.91 ± 0.85, p = 0.001; X-ray for tenotomy( +): 0.61 ± 0.43 and tenotomy(-): 1.12 ± 0.7, p = 0.001] and UMI [MRI for tenotomy( +): 0.005 ± 0.05 and tenotomy(-): 0.04 ± 0.06, p = 0.006; X-ray for tenotomy( +): 0.01 ± .064 and tenotomy(-): 0.12 ± 0.37, p = 0.110] values were higher in the tenotomy (-) group compared to the tenotomy ( +) group while HM values decreased more in the tenotomy (-) group. [MRI for tenotomy ( +): -0.19 ± 1.07 and tenotomy (-): -0.79 ± 1.52, p = 0.079; X-ray for tenotomy ( +): -0.27 ± 0.54 and tenotomy (-): -1.006 ± 1.83, p = 0.040].

Conclusion

After short-term follow-up, the humeral head was positioned higher in patients who underwent LHBT tenotomy compared to patients without tenotomy. However, it seems to affect clinical outcomes during this period positively.

Level of Evidence

Level 3
Strongyloides colitis, a rare but important mimic of Crohn’s disease, resulting in coma and multi-organ failure: a case report
Authors: Saqib Sabah Uddin , Sood Sumit , Wong Ling , Patel Abhilasha
Published: November 2022

Background

Strongyloides colitis is a severe form of strongyloidiasis that carries a high mortality rate if untreated. There is an overlapping clinical presentation between Strongyloides colitis and Crohn’s disease. Here, we present a case of a patient who was diagnosed with Crohn’s disease and was treated with immunosuppressant therapy which resulted in a poor outcome.

Case presentation

A middle-aged, native African male presented with diarrhea, abdominal pain, and weight loss. Colonoscopy showed some patchy inflammation in the caecum, which on biopsy was suggestive of Crohn’s disease. He had a short course of steroids before being admitted to an emergency with abdominal pain, diarrhea, malnutrition, and severe weight loss. Initial conservative treatment failed, and he became acutely unwell and septic with peritonitis. Laparotomy was carried out, which showed mild inflammation in the terminal ileum, which was not resected. Postoperatively, the patient became comatose and went into multi-organ dysfunction. He failed to progress, and a further laparotomy and subtotal colectomy were performed on the 12th postoperative day. His multi-organ failure progressed, and he succumbed to death 4 days later.

Discussion

Strongyloides stercoralis is a parasite causing an enteric infection in animals and humans. Strongyloidiasis in immunocompetent individuals is usually an indolent disease. However, in immunocompromised individuals, it can cause hyperinfective syndrome. Patients with strongyloid colitis should undergo colonoscopy and biopsy where acute inflammation with eosinophilic infiltrates indicates parasitic infiltration of the colonic wall. Surgery is generally not indicated, and any surgical intervention with misdiagnosis of a flare-up of IBD can be very detrimental to the patient.

Conclusion

Strongyloid colitis can very harmfully mimic Crohn’s colitis, and the use of steroids and immunosuppressants can disseminate parasitic infection. Hyperinfection syndrome can lead to sepsis, organ dysfunction, and comma. Disseminated infection carries a high mortality.
Who stop telemonitoring disease activity and who adhere: a prospective cohort study of patients with inflammatory arthritis
Authors: Wiegel J. , Seppen B. F. , Nurmohamed M. T. , Bos W. H. , ter Wee M. M.
Published: November 2022

Background

The use of frequent electronic patient reported outcome measures (ePRO’s) enables monitoring disease activity at a distance (telemonitoring) in patients with inflammatory arthritis. However, telemonitoring studies report declining long-term adherence to reporting ePRO’s, which may oppose the benefits of telemonitoring. Therefore, the objective was to investigate what factors are associated with (non-)adherence to telemonitoring with a weekly ePRO in patients with inflammatory arthritis (IA).

Methods

We performed a prospective cohort study in patients with rheumatoid arthritis (RA), psoriatic arthritis (PsA) and ankylosing spondylitis (AS) at Reade Amsterdam, The Netherlands. Patients telemonitored their disease activity weekly for 6 months with a modified Multidimensional Health Assessment Questionnaire completed in a smartphone application. The primary outcome was time to dropout, defined as ≥ 4 weeks of consecutively nonresponse. Based on literature and through expert meetings, a predefined set of 13 baseline factors were selected to assess the association with time to dropout through a multivariable Cox-regression analysis.

Results

A total of 220 consecutive patients were included (mean age 54, SD 12; 55% females; 99 RA, 81 PsA, and 40 AS). A total of 141 patients (64%) dropped out, with a median time to dropout of 17 weeks (IQR 9–26). Women had a significant higher chance to dropout over 6 months compared to men (HR 1.58, 95% CI 1.06–2.36).

Conclusion

In the set of investigated factors, women stopped reporting the weekly ePRO sooner than men. Future focus group discussions will be performed to investigate the reasons for dropout, and in specific why women dropped out sooner.

Trial registration This trials was prospectively registered at www.trialregister.nl (NL8414).
Polysaccharide composition during cotton seed fibre development: temporal differences between species and in different seasons
Authors: Pettolino Filomena A. , Yulia Dina , Bacic Antony , Llewellyn Danny J.
Published: November 2022

Background

Cotton seed fibres are long single-celled epidermal trichomes that first appear on the surface of the ovule at anthesis and then elongate rapidly over a period of 15–25 days until a secondary cell wall (SCW) begins to develop through a rapid increase in the deposition of microfibrillar cellulose between the plasma membrane and the primary cell wall that eventually terminates elongation. Quantitative measurements of the different polysaccharide components in both wall types over time and how they influence fibre quality can direct studies involved in enhancing fibre properties for yarn quality through cell wall manipulation or molecular breeding.

Results

A detailed chemical analysis of cell wall composition by differential solvent fractionation was used to identify the range of polysaccharides present in mature cotton fibres and used to validate a simpler total cell wall monosaccharide linkage analysis protocol for wall compositional analysis. Analysis of fibres from 5 days post-anthesis through maturity for three cultivated species,Gossypium hirsutum,G. barbadense, andG. arboreum, showed the dynamic nature of cell wall polysaccharide composition through fibre development and that it progressed differently for each species. Plants grown in the glasshouse during either autumn to winter or spring to summer and within each species had fibre qualities and temporal aspects of cell wall development that were different for each season. Notably, the timing of the deposition of the SCW was delayed in winter grown plants and appeared to influence key fibre quality properties.

Conclusions

These results suggest that the temporal aspects of cell wall polysaccharide biogenesis during fibre development influence final fibre quality, and this timing is determined by both genetic and environmental factors. The onset of SCW synthesis appears to be a critical factor coinciding with termination of fibre elongation and specifying the duration of wall thickening that then affects fibre length and other wall-associated quality parameters that ultimately determine yarn quality.
Computed tomographic features of pulmonary pure ground-glass nodule: a comparison between neoplastic and non-neoplastic nodules
Authors: Hafez Mona Ahmed Fouad , Elgaml Arwa Mohammed Abdulbaset Emam , Khairy Mostafa Ahmed , El Hinnawy Yasmine Hamdy , Abd-Elmageed Mohammed Raafat
Published: November 2022

Background

Ground-glass nodules (GGNs) are detected more frequently nowadays with the increase in MDCT resolution and applications. On CT GGN is a well circumscribed nodule with mild increase attenuation and not obscuring bronchial and vascular markings. This study aimed to discriminate neoplastic from non-neoplastic pure ground-glass nodules (pGGNs) by performing comparative quantitative and qualitative assessment of main features in computed tomography (CT) chest imaging. This prospective study involved 72 patients, who were referred to perform multidetector computed tomography of the chest in the radiology department. Cases with ground-glass pulmonary nodules were included in the study, and each nodule was assessed and followed for 2 years by a radiomics software for density and histogram analysis and then classified to neoplastic and non-neoplastic nodules. Neoplastic and non-neoplastic nodules morphology and radiomics were compared, and statistical analysis was done.

Results

After histopathology, positron emission tomography and computed tomography, or close follow-up, pGGNs were classified to neoplastic and non-neoplastic nodules. There was statistically significant difference regarding the mean size, where in cases of neoplastic nodules it was 6.66 mm and the mean size of benign nodules was 11.25 mm. Moreover, irregularity index and histogram peak frequency had a significant correlation with a P value of 0.007 and 0.022, respectively. The cutoff level for peak frequency percentage was 20.5% with 56.3% sensitivity and 79.2% specificity.

Conclusions

Radiomics had a growing role in pulmonary nodule assessment. Radiomics along with morphologic features assessment improved the detection efficiency of neoplastic versus non-neoplastic ground-glass nodules with histogram peak frequency, nodule size, and irregularity index as the main differentiating factors in this study.
Insulinoma Presenting With Postprandial Hypoglycemia in a Pregnant Woman With MEN-1
Authors: Wood Anna J , Kasireddy Vidya , Chitturi Sridhar , Walsh John P
Published: November 2022

Insulinomas are rare insulin-secreting tumors of pancreatic origin that cause hypoglycemia and can be associated with multiple endocrine neoplasia type 1 (MEN1). While rare, they are the most common cause of hypoglycemia related to endogenous hyperinsulinism. A 28-year-old woman with known MEN1 presented with postprandial hypoglycemia in the second trimester of pregnancy. Prior to her presentation she was known to have several pancreatic neuroendocrine tumors that had been stable on serial imaging, but no history of hypoglycemia. She was managed with dietary intervention during pregnancy and gave birth to a healthy baby at 37 weeks’ gestation. After pregnancy, hypoglycemia initially resolved, but then recurred at 8 months post partum. Magnetic resonance imaging showed several pancreatic neoplasms with the largest lesion measuring 29 mm in the pancreatic tail, unchanged from previous imaging. After localization with a selective arterial calcium stimulation test, the patient underwent successful distal pancreatectomy with resolution of symptoms. This case is unusual in that her initial presentation was during pregnancy, she had predominantly postprandial rather than fasting hypoglycemia, and her symptoms remitted for several months after delivery. Key learning points are to have a low index of suspicion for an insulinoma when there is a history of MEN1 and the need for a pragmatic approach to diagnosis and treatment during pregnancy.
Isomorphic (Koebner) Phenomenon Induced by Insulin Analogue Injections in Psoriasis
Authors: Thijs Saartje , Balti Eric , Degraeve Corinne , Coremans Peter
Published: November 2022

Koebner phenomenon is an uncommon skin-related complication of subcutaneous insulin injection in patients with diabetes mellitus. This reaction, also referred as isomorphic phenomenon, has previously been described in various conditions including vitiligo, lichen planus, and psoriasis. We report a 56-year-old woman insulin-treated patient with type 2 diabetes mellitus who developed new-onset, sharply well-demarcated erythematous scaly plaques at the insulin injection sites consistent with Koebner phenomenon. These lesions occurred after withdrawal of methotrexate initiated for the treatment of psoriasis. The lesions responded well to guselkumab, an interleukin-23 targeting agent but not ciclosporin. Of note, unlike previously reported cases, our patient developed isomorphic response under treatment with insulin analogues and during psoriasis flare-up. This case highlights the paramount role of thorough and cautious examination of injection and insertion sites in patients at risk undergoing subcutaneous continuous glucose monitoring or treated with continuous transdermal/subcutaneous insulin injections.
Shanzhai: Creative Imitation of China in Highland Myanmar
Authors: Steinmüller Hans
Published: November 2022

The Wa State of Myanmar is often called “shanzhai China,” that is, a lesser imitation of China. This essay unpacks the material and symbolic implications of creative imitation at the Chinese periphery, embodied in shanzhai 山寨 practices. Literally “mountain fortress,” shanzhai refers to the provenience of cheap brand imitations, made by mountain dwellers who cannot afford the original. The term is commonly used to describe creative and ironic brand imitation in the People's Republic of China today. Until the 1950s, the inhabitants of the Wa hills did indeed live in mountain fortresses—both a pragmatic necessity as well as a miniature repetition of Chinese imperial rule. The pragmatic limitations and creative potential of imitating China are shown for the cases of Maoism, authoritarian capitalism, and contemporary nationhood. Rather than an essentialized feature of Chinese cultural practice, the practices of shanzhai reveal that material and symbolic recombination are essential to creative imitation.
Enhancement of the activity of the antimicrobial peptides HNP1 and LL-37 by bovine pancreatic ribonuclease A
Authors: Ericksen Bryan
Published: November 2022

Background: HNP1, LL-37, and HBD1 are antimicrobial against Escherichia coli ATCC 25922 at the standard inoculum but less active at higher inocula.  

Methods: The virtual colony count (VCC) microbiological assay was adapted for high inocula and the addition of yeast tRNA and bovine pancreatic ribonuclease A (RNase).  96-well plates were read for 12 hours in a Tecan Infinite M1000 plate reader and photographed under 10x magnification.   

Results: Adding tRNA 1:1 wt/wt to HNP1 at the standard inoculum almost completely abrogated activity.  Adding RNase 1:1 to HNP1 at the standard inoculum of 5x105 CFU/mL did not enhance activity.  Increasing the inoculum to 6.25x107 CFU/mL almost abrogated HNP1 activity.  However, adding RNase 25:1 to HNP1 enhanced activity at the highest tested concentration of HNP1.  Adding both tRNA and RNase resulted in enhanced activity, indicating that the enhancement effect of RNase overwhelms the inhibiting effect of tRNA when both are present.  HBD1 activity at the standard inoculum was almost completely abrogated by the addition of tRNA, but LL-37 activity was only slightly inhibited by tRNA.  At the high inoculum, LL-37 activity was enhanced by RNase.  HBD1 activity was not enhanced by RNase.  RNase was not antimicrobial in the absence of antimicrobial peptides.  Cell clumps were observed at the high inoculum in the presence of all three antimicrobial peptides and at the standard inoculum in the presence of HNP1+tRNA and HBD1+tRNA.   

Conclusions: Antimicrobial peptide-ribonuclease combinations have the potential to be active against high cell concentrations and biofilms, conditions where the antimicrobial agent alone is relatively ineffective.
Sexual and reproductive health and rights knowledge, perceptions, and experiences of adolescent learners from three South African townships: qualitative findings from the Girls Achieve Power (GAP Year) Trial
Authors: Pleaner Melanie , Milford Cecilia , Kutywayo Alison , Naidoo Nicolette , Mullick Saiqa
Published: November 2022

Background: Adolescence is a time of psycho-social and physiological changes, with increased associated health risks including vulnerability to pregnancy, HIV, sexually transmitted infections, and gender-based violence. Adolescent learners, from three townships in South Africa, participated in a 44 session, after-school asset-building intervention (GAP Year), over 2 years providing sexual and reproductive health (SRH) education. This paper explores adolescent learners’ SRH, sexual risk and rights knowledge; perceptions about transactional sex; and contraceptive method preferences and decision-making practices.

Methods: The intervention was conducted in 13 secondary schools across Khayelitsha, Thembisa, and Soweto, South Africa. A baseline survey collected socio-demographic data prior to the intervention. Overall, 26 focus group discussions (FGDs): 13 male and 13 female learner groups, purposively selected from schools, after completing the intervention (2 years after baseline data collection). Descriptive analyses were conducted on baseline data. Qualitative data were thematically coded, and NVivo was used for data analysis.

Results: In total, 194 learners participated in the FGDs. Mean age at baseline was 13.7 years (standard deviation 0.91). Participants acquired SRH and rights knowledge during the GAP Year intervention. Although transactional sex was viewed as risky, some relationships were deemed beneficial and necessary for material gain. Negative healthcare provider attitudes were the main barrier to healthcare service utilisation. There was awareness about the benefits of contraceptives, but some myths about method use. The injectable was the preferred contraceptive method, followed by the implant, with equal preference for condoms and oral pill.

Conclusions: An afterschool intervention at school is a viable model for the provision of SRH and rights education to learners. Recommendations include the need for risk reduction strategies in the curriculum, dealing with misconceptions, and the promotion of informed decision making. Endeavours to ensure health services are youth friendly is a priority to limit barriers to accessing these services.
Protocol for the Addressing the Social Determinants and Consequences of Tuberculosis in Nepal (ASCOT) pilot trial
Authors: Rai Bhola , Dixit Kritika , Dhital Raghu , Rishal Poonam , Gurung Suman Chandra , Paudel Puskar Raj , Mishra Gokul , Bonnett Laura , Siqueira-Filha Noemia , Khanal Mukti Nath , Lonnroth Knut , Squire S Bertel , Caws Maxine , Wingfield Tom
Published: November 2022

BACKGROUND: The World Health Organization’s End TB (tuberculosis) Strategy advocates social and economic support for TB-affected households but evidence from low-income settings is scarce. We will evaluate the feasibility and acceptability of a locally-appropriate socioeconomic support intervention for TB-affected households in Nepal.

METHODS: We will conduct a pilot randomised-controlled trial with mixed-methods process evaluation in four TB-endemic, impoverished districts of Nepal: Pyuthan, Chitwan, Mahottari, and Morang. We will recruit 128 people with TB notified to the Nepal National TB Program (NTP) and 40 multisectoral stakeholders including NTP staff, civil-society members, policy-makers, and ASCOT (Addressing the Social Determinants and Consequences of Tuberculosis) team members. People with TB will be randomised 1:1:1:1 to four study arms (n=32 each): control; social support; economic support; and combined social and economic (socioeconomic) support. Social support will be TB education and peer-led mutual-support TB Clubs providing TB education and stigma-reduction counselling. Economic support will be monthly unconditional cash transfers during TB treatment with expectations (not conditions) of meeting NTP goals. At 0, 2, and 6 months following TB treatment initiation, participants will be asked to complete a survey detailing the social determinants and consequences of TB and their feedback on ASCOT. Complementary process evaluation will use focus group discussions (FGD), key informant interviews (KII), and a workshop with multi-sectoral stakeholders to consider the challenges to ASCOT’s implementation and scale-up. A sample of ~100 people with TB is recommended to estimate TB-related costs. Information power is estimated to be reached with approximately 25 FGD and 15 KII participants.

CONCLUSIONS: The ASCOT pilot trial will both generate robust evidence on a locally-appropriate, socioeconomic support intervention for TB-affected households in Nepal and inform a large-scale future ASCOT trial, which will evaluate the intervention’s impact on catastrophic costs mitigation and TB outcomes.

The trial is registered with the ISRCTN (ISRCTN17025974).
The comparison of population density of Holothuria tubulosa (Gmelin, 1790) and Holothuria polii (Delle Chiaje, 1823) between exploited and non-exploited areas in the Aegean Sea coast of Türkiye
Authors: Lök Altan , Özgül Aytaç , Şensurat Genç Tuğçe , Kurtay Evrim , Lök Aynur
Published: November 2022

Increasing demand from the Asian market first led to the collapse of economically valuable sea cucumber stocks in the Indo-Pacific, and then demand shifted to lower value Mediterranean species. The effect of this change in sea cucumber stocks in Türkiye started to be seen after the 2010s. To address it, we carried out a study to compare the population density of the most caught Holothuria tubulosa and Holothuria polii species between exploited and non-exploited areas in the Aegean Sea coast of Türkiye. The study was carried out between September 2018 and March 2020 at 4 stations, two of which are in Çandarlı Bay, where sea cucumber fishing is free, and two in İzmir Bay, where it is prohibited. Samplings between 0-20 m depths were carried out with underwater transect line technique, and at depths deeper than 20 m, with beam trawling operations. A total of 6 sea cucumber species were identified, including Holothuria mammata, Holothuria sanctori, Parastichopus regalis and Holothuria forskali species, apart from the target species H. tubulosa and H. polii. Only one P. regalis individual was recorded in the samplings in waters deeper than 20 m. The mean densities of H. tubulosa and H. polii were found to be higher in İzmir Bay stations than in Çandarlı Bay (p<0.05). The results of this study clearly reveal that the population density of sea cucumber in sampling areas has decreased tens of times compared to the last 5 years.
Integrated assessment with biomarker responses and metal concentrations on some fish species from İzmir Bay: A preliminary investigation
Authors: Bilgin Mustafa , Uluturhan-Suzer Esin , Darılmaz Enis
Published: November 2022

Antioxidant related biomarkers (superoxide dismutase, catalase, malondialdehyde) were investigated to evaluate metal (Hg, Cd, Pb, Cr, Cu, Zn, and Mn) bioaccumulation in some organs of fish species (Sparus aurata, Chelon labrosus, Diplodus vulgaris) from the İzmir Bay. Samples were collected at November 2019 from Inner and Outer Bays. Metal and biomarker analyses were carried out by Atomic Absorption Spectrometer and microplate reader, respectively. For metal analyses in organs, higher metal bioaccumulations were found at liver tissues. Higher Hg and Zn concentrations were found in S. aurata, higher Cd, Cr, Cu and, Mn concentrations were detected in C. labrosus and higher Pb concentrations were determined in D. vulgaris. In biomarker results, superoxide dismutase (SOD) and catalase (CAT) activities were generally higher in gills, however, MDA contents were higher at liver. The highest biomarker results were detected at C. labrosus. Statistical analyses were demonstrated that especially MDA content were expressed strong responses for the metal bioaccumulations. Also, Mn levels were considerably correlated with all biomarkers as expected. This study revealed that combined utilization of biomarkers and metal concentrations could be a vital indicator to investigate health status of the marine ecosystems.
Estimating length-weight, length-length relationships, and condition factor of eight fish species, a case study of Bashar River, Tigris drainage (Iran)
Authors: Naserabad Saeid Shahbazi , Poorbagher Hadi , Eagderi Soheil
Published: November 2022

This study investigate investigated the length-weight, length-length relationships and condition factor of eight fish species collected from Bashar River, Tigris drainage by sampling 341 specimens of Alburnus sellal (Heckel, 1843), Barbus karunensis (Khaefi, Esmaeili, Geiger & Eagderi, 2017), Capoeta aculeate (Valenciennes, 1844), Capoeta coadi (Alwan, Zareian & Esmaeili, 2016), Chondrostoma regium (Heckel, 1843), Garra gymnothorax (Berg, 1949), Glyptothorax galaxias (Mousavi-Sabet, Eagderi, Vatandoust & Freyhof, 2021) and Turcinoemacheilus hafezi (Golzarianpour, Abdoli, Patimar & Freyhof, 2013). The results showed that the b parameter was form 2.41 (in C. aculeate) to 3.88 (in A. sellal) and condition factors ranged from 0.74 (in A. sellal and B. karunensis) to 1.35 (in C. aculeate). The coefficient of determination (r2) in the length-weight and length-length relationships was > 0.83. In conclusion, allometric growth patterns for A. sellal, B. karunensis, G. gymnothorax, and G. galaxias were positive while for C. aculata, C. regium and T. hafezi, and C. coadi presented negative patterns. This study represents the first data for G. galaxias.
Abnormal hermaphroditic shark Squalus blainville (Risso, 1826) (Chondrichthyes: Squalidae) from the Aegean Sea
Authors: Özden Uğur , Irmak Erhan
Published: November 2022

Eighty-six specimens of longnose spurdog Squalus blainville were examined for determination of some bio-ecogical features. During the study, one of the specimens was determined as a hermaphrodite with a clasper and yolk sac formation. This very rare case in elasmobranch is a report of hermaphroditism recorded from the Aegean Sea.