bluuebunny/crossref_metadata_2025 huggingface dataset:
Incidence of dural sac puncture during neuraxial anesthesia in cats: an observational, retrospective study
Authors: Rondelli Vincenzo , Otero Pablo E , Romano Francesca , Verdier Natali , Bettschart-Wolfensberger Regula , Portela Diego A
Published: June 2021

Objectives

The aim of this study was to determine the occurrence of dural puncture, indicated by cerebrospinal fluid (CSF) outflow, in cats receiving neuraxial anesthesia through a lumbosacral injection guided by a pop sensation method.

Methods

This was an observational, retrospective study. Cats that were scheduled for lumbosacral neuraxial anesthesia were included. Medical records were analyzed to investigate: (1) demographic data; (2) neuraxial anesthesia performed (epidural/spinal); (3) type of needle used, including gauge and length; (4) presence of CSF (yes/no) and/or blood (yes/no) in the hub of the needle; and (5) flicking of the tail during needle advancement (yes/no).

Results

A total of 94 medical records were analyzed. A 22 G 50 mm Tuohy needle was used in all cats scheduled for an epidural injection (n = 60), whereas a 22 G 40 mm Quincke needle was used in all cats scheduled for an intrathecal injection (n = 34). CSF outflow was detected in 55/60 (91.7%) cats in which a Tuohy needle was used, and 34/34 (100%) of the cats in which a Quincke needle was used ( P = 0.15). Flicking of the tail was detected in 41/60 (68.3%) and in 24/34 (70.6%) injections with Tuohy and Quincke needles, respectively ( P >0.99). Traces of blood, but not active blood outflow, were detected via staining of the first drops of CSF in 2/34 cats in which Quincke needles were used and in none of the cats in which Tuohy needles were used ( P = 0.12).

Conclusions and relevance

This study shows that the lumbosacral approach for neuraxial anesthesia in cats may result in a dural sac puncture when 22 G Quincke or Tuohy needles are used. The pop sensation method should be deemed effective in predicting intrathecal but not epidural needle placement.
Peripheral central catheter insertion in low eGFR patients: Retrospective single institution study
Authors: Othman Khalid , Abdulrahman Shaima , Salman Refaat , Al Harbi Asma , Al Malik Wafa , Arabi Mohammad
Published: June 2021

Purpose:

To identify the rate of Peripherally Inserted Central Catheter (PICC) placement in patients with chronic kidney disease (CKD), stage 3B or higher (glomerular filtration rate (eGFR) <45 mL/min/1.73 m2).

Material and methods:

A retrospective study of 2825 adult patients (male 51.2%, female 48.8%) who had a PICC insertion from January 2017 to December 2019. The data collected includes gender, eGFR value at the date of insertion, accessed vein and side, ongoing or subsequent dialysis within 1 year, and death within 1 year of the insertion date. The study excluded pediatric patients, patients with missing eGFR values prior to the procedure and follow-up information.

Result:

PICC insertion was done in patients with eGFR⩽45 mL/min/1.73 m2 in 26.7% (724/2709) of the sample. Ongoing dialysis was documented in 10.2% (198/1946) and subsequent dialysis in 6.5% of the patients within the year after insertion. The overall death rate for the year post PICC insertion was 38.7% (1094/2825), which was significantly higher in low eGFR patients (413/724, 57%) compared to patients with eGFR>45 mL/min/1.73 m2 (632/1985, 31.8%) ( p-value < 0.0001, odds ratio 2.84 (95% confidence interval 2.38–3.38)). The rate of dialysis initiated in the year post PICC insertion was 5.9% (98/1657). This was significantly higher in patients with a low eGFR and not previously dialyzed (59/310, 19%) compared to patients with eGFR>45 who required dialysis in the year post insertion (39/1347, 2.9%) ( p < 0.0001, odds ratio 7.88 (95% confidence interval 5.14–12.07)).

Conclusion:

PICC insertion in patients with CKD is practiced frequently. Rigorous strategies should be implemented to improve adherence to clinical practice guidelines and reduce unnecessary insertions and preserve veins for when an AVF may be required.
Transposition of the superficial femoral artery combined with ultrasound-guided returning-venous cannulation as a last resort for vascular access in a multi-complicated hemodialysis patient
Authors: Matsuda Hiroaki , Oka Yoshinari , Otaka Nozomu , Sakurama Kazufumi , Takatsu Shigeko , Miyazaki Masashi
Published: June 2021

A superficialized artery as a blood-drawing route could be an option for vascular access (VA) in hemodialysis patients with cardiac failure, vessel damage, steal syndrome, and venous hypertension, and it could be a secondary VA option in those with repetitive vascular access troubles, routinely requiring a blood-returning venous route. The brachial artery is preferably used for superficialization due to the benefit of its appropriate diameter for cannulation, procedural ease of surgery under local anesthesia, and usable subcutaneous vein for blood-returning route in the upper limb. The superficial femoral artery (SFA) has also been reported as a candidate for arterial transposition; however, its subcutaneous transposition could have difficulties in requiring general anesthesia and securing blood-inflow-venous routes. We experienced a multi-complicated hemodialysis patient who had intractable tunneled-cuffed catheter-related bacteremia and right atrial thrombosis, low cardiac function with bilateral proximal bifurcation of the brachial artery at the axilla, and damaged cutaneous veins in the upper limb. Herein, we report a case of successful superficialization of the SFA under ultrasound-guided regional anesthesia combined with local anesthesia and intravenous sedation, which could be feasible as a blood-drawing route with ultrasound-guided ipsilateral greater saphenous vein cannulation during chronic hemodialysis. Assisted by ultrasound-guided venous cannulation in the ipsilateral lower limb, cutaneous repositioning of the SFA could be a viable and acceptable option for VA in hemodialysis patients with a multitude of complications, wherein the possibilities of VAs of arteriovenous access, arterial superficialization using vessels in the upper extremity, or artificial devices should be eliminated.
Adherence to National Consensus Guidelines and Association with Clinical Outcomes in Patients with Candidemia
Authors: Junco Shauna Jacobson , Chehab Sarah , Giancarelli Amanda , Bowman Mary Catherine , Turner R Brigg
Published: June 2021

Background:

National consensus guidelines outline recommendations for best practices in treating patients with candidemia. This study evaluated the impact of receiving care adherent to the best practice recommendations on clinical outcomes in patients with candidemia.

Methods:

This retrospective, multicenter study included patients with candidemia from 2010 to 2015 at 9 hospitals. The primary outcome was the composite of 30-day in-hospital mortality and 90-day candidemia recurrence. Outcomes were compared between those receiving and not receiving care adherent to the guideline recommendations. Inverse probability weights with regression adjustment were utilized to determine the average treatment effect of adherent care on the composite outcome

Results:

295 patients were included with 14.2% meeting criteria for the composite outcome (11.9% mortality and 2.4% recurrence). The average treatment effect of adherent care was not significant ( P = .75). However, receiving appropriate initial antifungal treatment and central venous catheter removal were both associated with the composite (average treatment effect of −17.5%, P = .011 and −8.8%, P = .013, respectively). In patients with a source of infection other than the central line, central venous catheter removal was not associated with the composite ( P = .95). The most common reason for failure to receive appropriate initial antifungal treatment was omission of the loading dose.

Conclusions:

Central venous catheter removal and appropriate initial antifungal treatment were associated with a lower incidence of the composite of mortality and recurrence. Additional studies are needed to determine the optimal duration of therapy following candidemia clearance.
Protecting livelihoods in the COVID-19 crisis: A comparative analysis of European labour market and social policies
Authors: Seemann Anika , Becker Ulrich , He Linxin , Maria Hohnerlein Eva , Wilman Nikola
Published: June 2021

This article provides a comparative study of the labour market and social policy measures introduced in light of the COVID-19 crisis in Denmark, France, Germany, Italy and the United Kingdom between March 2020 and January 2021. Its main aim is to understand whether the crisis response has changed the structures of the welfare states concerned. Focusing in particular on the differences regarding the crisis measures taken for individuals in ‘standard employment’ and ‘non-standard workers’ in each country, it argues that, although extensive temporary protection instruments were introduced for both groups during the crisis, these did not lead to an immediate convergence as regards these groups’ social protection. Rather than changing the underlying structures of welfare systems, many of the measures in fact highlighted the specific vulnerabilities of large segments of Europe’s labour markets. States have, however, granted social compensation at unprecedented levels, which could result in improved infrastructures and a clearer understanding of the responsibility of the welfare state in future emergencies.
Quantile regression for longitudinal data via the multivariate generalized hyperbolic distribution
Authors: Flórez Alvaro J. , Van Keilegom Ingrid , Molenberghs Geert , Verhasselt Anneleen
Published: June 2021

While extensive research has been devoted to univariate quantile regression, this is considerably less the case for the multivariate (longitudinal) version, even though there are many potential applications, such as the joint examination of growth curves for two or more growth characteristics, such as body weight and length in infants. Quantile functions are easier to interpret for a population of curves than mean functions. While the connection between multivariate quantiles and the multivariate asymmetric Laplace distribution is known, it is less well known that its use for maximum likelihood estimation poses mathematical as well as computational challenges. Therefore, we study a broader family of multivariate generalized hyperbolic distributions, of which the multivariate asymmetric Laplace distribution is a limiting case. We offer an asymptotic treatment. Simulations and a data example supplement the modelling and theoretical considerations.
From real to virtual mobility: Erasmus students’ transition to online learning amid the COVID-19 crisis
Authors: Koris Rita , Mato-Díaz Francisco Javier , Hernández-Nanclares Núria
Published: June 2021

This study explores international students’ perceptions of the transition to the online learning environment while they were studying on an Erasmus+ Study Mobility Programme at host universities in Europe during the COVID-19 pandemic in spring 2020. Applying the theoretical framework based on the affective, behavioural and cognitive aspects of adaptation in the case of international students, this study reveals what adaptive responses and decisions sojourners made, and how their study experience and learning capabilities were challenged by the restrictive measures introduced at host universities due to the state of emergency declared in the host countries. Fourteen semi-structured interviews with both incoming and outgoing international students were conducted. Results reveal that studying online with reduced social interaction was a real challenge to Erasmus students. They were lacking cultural knowledge of the destination country as well as the insights typically arising from face-to-face teaching and social interactions. However, findings also expose students’ satisfaction with their academic accomplishments. In this regard, specific proposals are made for universities that consider virtual mobility programmes for international students in the future.
COVID-19, IP and access: Will the current system of medical innovation and access to medicines meet global expectations?
Authors: Gurgula Olga , Lee Wen H
Published: June 2021

The COVID-19 pandemic has exposed the fundamental flaws in the current system of medical innovation and access to medicines, which require urgent attention from the global community. This is prompted by the experience of the past decades, which has proven that this system was ineffective in securing adequate access to medicines for all. The understanding of the deficiencies of the existing system is crucial today, as it may help to design effective approaches for improving access. This article will also consider mechanisms that may be implemented by governments for the protection of public health. These include short-term mechanisms, such as compulsory licensing and government use, as well as the long-term design of a new innovation model, including state-coordinated research of medicines and open innovation. The current system should be reconsidered to ensure the prompt development of COVID-19 therapy accessible to everyone and full preparedness for the pandemics of the future.
Hysterectomy in India: Spatial and multilevel analysis
Authors: Singh Angad , Govil Dipti
Published: June 2021

Objective:

Using the unit-level data of women aged 15–49 years from National Family Health Survey-IV (2015–2016), the article maps the prevalence of hysterectomy across districts in India and examines its determinants.

Methods:

Descriptive statistics, multivariate techniques, Moran’s Index and Local indicators of Spatial Association were used to understand the objectives. The data were analysed in STATA 14.2, Geo-Da and Arc-GIS.

Results:

In India, the prevalence of hysterectomy operation was 3.2%, the highest in Andhra Pradesh (8.9%) and the lowest in Assam (0.9%). Rural India had higher a prevalence than urban India. The majority of women underwent the operation in private hospitals. Hysterectomy prevalence ranged between 3% and 5% in 126 districts, 5% and 7% in 47 districts and more than 7% in 26 districts. Moran’s Index (0.58) indicated the positive autocorrelation for the prevalence of hysterectomy among districts; a total of 202 districts had significant neighbourhood association. Variation in the prevalence of hysterectomy was attributed to the factors at the primary sampling unit, district and state level. Age, parity, wealth and insurance were positively associated with the prevalence of hysterectomy, whereas education and sterilization was negatively associated.

Conclusion:

Hysterectomy operation in India presented the geographical, socio-economic, demographic and medical phenomenon. The high prevalence of hysterectomy in many parts of the country suggested conducting in-depth studies, considering the life cycle approach and providing counselling and education to women about their reproductive rights and informed choice. Surveillance and medical audits and promoting the judicial use of health insurance can be of great help.
Usefulness of black-blood magnetic resonance angiography generated from vessel wall imaging after the stent-assisted treatment of intracranial arterial diseases
Authors: Gomyo Miho , Tsuchiya Kazuhiro , Goto Shun , Hosoi Shinsuke , Tahara Takahiro , Yokoyama Kenichi
Published: June 2021

Purpose

After stent-assisted treatment for intracranial diseases, three-dimensional time-of-flight magnetic resonance angiography is a noninvasive follow-up method, but susceptibility artifacts prevent accurate evaluations of stented arteries. Sampling perfection with application-optimized contrast using different flip angle evolution (SPACE) sequence often used for vessel wall imaging is less susceptible to susceptibility artifacts, since it is a spin-echo sequence. Hence, we evaluated the feasibility of black-blood magnetic resonance angiography generated from vessel wall imaging data obtained using the SPACE sequence in the depiction of stented arteries by comparing with three-dimensional time-of-flight magnetic resonance angiography and digital subtraction angiography.

Methods

Our study group comprised 11 consecutive patients. For both three-dimensional time-of-flight magnetic resonance angiography and black-blood magnetic resonance angiography, the contrast ratio obtained from the stented artery and the normal artery proximal to the stent were calculated. And the depiction of stented arteries was visually evaluated. Additionally, the relative diameter index obtained from the stented artery and the normal artery proximal to the stent were calculated for three-dimensional time-of-flight magnetic resonance angiography, black-blood magnetic resonance angiography and digital subtraction angiography.

Results

The contrast ratio of the stented artery was significantly lower than that of the normal artery on three-dimensional time-of-flight magnetic resonance angiography, but no significant difference was seen using black-blood magnetic resonance angiography. Regarding both the diameter index and the visual assessment score, black-blood magnetic resonance angiography was significantly better than three-dimensional time-of-flight magnetic resonance angiography. On black-blood magnetic resonance angiography, the diameter index was equal to that of digital subtraction angiography, and the flow signal was homogeneous and continuous in most the cases.
Technical Features of Biventricular Repair for Unbalanced Transitional AVSD With LVOTO
Authors: Kiraly Laszlo , Shah Nishant Ch , Duke Christopher
Published: June 2021

Surgical management of left ventricle outflow tract obstruction in infants with right-dominant unbalanced transitional atrioventricular septal defect poses difficulties. A two-month-old infant with transitional atrioventricular septal defect and complex left ventricle outflow tract obstruction presented in cardiogenic shock. The patient underwent successful biventricular repair. The operative procedure included detachment of the anterior bridging leaflet and resection of its chordal attachments. Septal myectomy was performed with creation of an interventricular communication, followed by patch augmentation of the left ventricular outflow tract and anterior bridging leaflet. The zone of apposition between anterior and posterior bridging leaflets was closed. The repair resulted in effective augmentation of the left ventricular inflow and outflow tracts.
Validity and Reliability of the Korean version of the Wong and Law Emotional Intelligence Scale for Nurses
Authors: Park Hye-Ja , Yu Soyoung
Published: June 2021

Emotional intelligence is a social ability that enables one to control one’s emotions and understand and empathize with others, which is an essential skill for medical professionals, including nurses. However, no valid and reliable instrument exists to assess the emotional intelligence of nurses in Korea. Thus, the aim of this study was to evaluate the validity and reliability of the Korean version of the Wong and Law Emotional Intelligence Scale. To do this, the existing English version of the scale was translated into Korean and its content, construct, and convergent validity were evaluated. Participants ( N = 210 nurses) were recruited from two hospitals in South Korea. The final scale showed a content validity index of .90, had adequate construct validity, and had a Cronbach’s α of .91 for the overall scale. Thus, this scale is a valid, reliable, and suitable measure of Korean hospital nurses’ emotional intelligence.
Rasch Analysis of Lebanese Nurses’ Responses to the Copenhagen Burnout Inventory Alternative to the Maslach Burnout Inventory
Authors: Clinton Michael , Shehadeh, MSN, RN Roula
Published: June 2021

Introduction

Lebanon struggled with political and economic crises before it was affected by the COVID-19 pandemic. Executive nurses and hospital administrations need reliable open-source measures to monitor burnout and prioritize nurses for intervention as Lebanon struggles with the multiple crises compounded by rising numbers of COVID-19 cases and deaths.

Objectives

The study aimed to determine whether the Copenhagen Burnout Inventory scales are suitable for settings experiencing multiple crises. Its objectives were to investigate the CBI scales' measurement properties, identify burnout levels in a sample of nurses experiencing compound stressors, assess whether the scales' three-dimensional burnout model is plausible, and establish norms for using the scales in work settings subject to compound external stressors.

Methods

The study is a psychometric analysis of the anonymous survey data of 142 registered nurses working in acute hospitals in Lebanon. We fitted the data to unidimensional and multidimensional Rasch rating scale models. Item fit, person separation and reliability, targeting, differential item functioning, and scale norms were estimated.

Results

Nurses in the sample had a high level of burnout. The Copenhagen Burnout Inventory scales have excellent reliability. The personal burnout and work-related scales were highly correlated and moderately correlated with the client-related burnout scale. Possible differential functioning in the work-related burnout scale requires further investigation.

Conclusion

More extensive and diverse studies in workplaces subjected to compound stressors are required to confirm the study results. Meanwhile, executive nurses and hospital administrations can use the norms reported to prioritize nurses for burnout prevention and intervention programs. In Lebanon, our reported CBI scale values can be used as baseline standards for studies tracking how the COVID-19 pandemic is impacting the nursing workforce.
A procedure to develop a backbone ground-motion model: A case study for its implementation
Authors: Akkar Sinan , Kale Özkan , Sandıkkaya M Abdullah , Yenier Emrah
Published: June 2021

The backbone modeling in ground-motion characterization (GMC) is a useful methodology to describe the epistemic uncertainty in median ground-motion predictions. The approach uses a backbone ground-motion model (GMM) and populates the GMC logic tree with the scaled and/or adjusted versions of the backbone GMM to capture the epistemic uncertainty in median ground motions. The scaling and/or adjustment should represent the specific features and uncertainties involved in source, path, and site effects at the target site. The identification of the backbone model requires different considerations specific to the nature of the ground-motion hazard problem. In this article, we present a scaled backbone modeling approach that considers the magnitude- and distance-scaling predictors as well as their correlation to address the epistemic uncertainty in median ground-motion predictions. This approach results in a trivariate normal distribution to fully define a range of epistemic uncertainty in a model sample space. The simultaneous consideration of magnitude and distance scaling while defining the epistemic uncertainty and the methodology followed for the simplified representation of trivariate normal distribution in ground-motion logic tree are the two important features in our procedure. We first present the proposed approach that is followed by a case study for Central and Eastern North America (CENA) stable continental region. The case study discusses the underlying assumptions and limitations of the proposed approach.
Incidental Thyroid Nodules Found During Acute Stroke Angiography: Prevalence, Outcomes, and Suggested Management Guidelines
Authors: Lin Diana M. , Arevalo Yurany A. , Lin Chen
Published: June 2021

Objective:

In stroke patients, extensive interventions for incidental thyroid nodules can be burdensome and costly. It appears that the risk of malignancy has not been reported in angiographically detected nodules and outcomes have not yet been described in patients, receiving acute stroke work-up.

Materials and Methods:

Incidental thyroid nodules were found on neck computerized tomography angiography or magnetic resonance angiography performed during inpatient stroke workup (January 2017 to September 2019). These patient cases were reviewed based on sonography reports, diagnosis, and follow-up care.

Results:

Of the 13 563 patients, 192 had incidental thyroid nodules (prevalence 1.4%). Twenty-six died from comorbidities and 22 received thyroid sonography. Twelve nodules from 10 patients had sonographic characteristics for biopsy: 10 benign, 1 indeterminate, and 1 papillary thyroid cancer (risk of malignancy: 8%). The cancer patient underwent hemithyroidectomy and is disease-free. Follow-up of the remaining patients showed no worsening or suspicious nodules. The American College of Radiology (ACR) guidelines would have prevented 8 unnecessary sonograms and 1 biopsy without missing malignancy.

Conclusion:

Although a small risk of malignancy was noted, 95% of patients undergoing additional diagnostic thyroid testing had clinically insignificant results. The ACR guidelines can prevent unnecessary interventions. Given the 14% mortality rate in the study cohort, it is proposed that a clinical evaluation of patients is important before undergoing further diagnostics, as comorbidities may be worse than a thyroid cancer.
Impact of the COVID-19 pandemic on migraine in Japan: a multicentre cross-sectional study
Authors: Suzuki Keisuke , Takeshima Takao , Igarashi Hisaka , Imai Noboru , Danno Daisuke , Yamamoto Toshimasa , Nagata Eiichiro , Haruyama Yasuo , Mitsufuji Takashi , Suzuki Shiho , Ito Yasuo , Shibata Mamoru , Kowa Hisanori , Kikui Shoji , Shiina Tomohiko , Okamura Madoka , Tatsumoto Muneto , Hirata Koichi
Published: June 2021

Objectives

To assess the impacts of social situation changes due to the coronavirus disease 2019 (COVID-19) pandemic on headache-related disability and other symptoms in patients with migraine in Japan.

Methods

We conducted a multicentre, cross-sectional study including 659 outpatients with migraine diagnosed by headache specialists. The participants were asked about the impacts of the first wave of the COVID-19 pandemic on headache-related disability, headache days, headache intensity, stress, physical activity, hospital access and their work and home lives. For headache-related disability, the total Migraine Disability Assessment (MIDAS) score and part A and B scores were analysed. Multivariate stepwise linear regression analysis was performed to identify the clinical predictors of changes in the total MIDAS score before and during the COVID-19 pandemic. Logistic regression analysis was performed to determine the factors related to new-onset headache during the COVID-19 pandemic.

Results

Finally, 606 migraine patients (73 M/533 F; age, 45.2 ± 12.0 years) were included in the study, excluding those with incomplete data. Increased stress, substantial concern about COVID-19 and negative impacts of the first wave of the COVID-19 pandemic on daily life were reported in 56.8 %, 55.1 and 45.0 % of the participants, respectively. The total MIDAS and A and B scores did not significantly change after the first wave of the COVID-19 pandemic. New-onset headache, which was observed in 95 patients (15.7 %), was associated with younger age and worsened mood and sleep in the logistic regression analysis. The multivariate stepwise linear regression analysis of changes in the total MIDAS score before and during the first wave of COVID-19 pandemic identified worsened sleep, increased acute medication use, increased stress, medication shortages, comorbidities, the absence of an aura and new-onset headache were determinants of an increased total MIDAS score during the first wave of the COVID-19 pandemic.

Conclusions

In this multicentre study, clinical factors relevant to headache-related disability, such as new-onset headache, stress and sleep disturbances, were identified, highlighting the importance of symptom management in migraine patients during the first wave of the COVID-19 pandemic.
Lipid polymeric nanoparticles modified with tight junction-modulating peptides promote afatinib delivery across a blood–brain barrier model
Authors: Lo Yu-Li , Lin Hua-Ching , Hong Shu-Ting , Chang Chih-Hsien , Wang Chen-Shen , Lin Anya Maan-Yuh
Published: June 2021

Background

Brain metastases from non-small cell lung cancer (NSCLC) remain one of the most challenging malignancies. Afatinib (Afa) is an orally administered irreversible ErbB family blocker approved for epidermal growth factor receptor (EGFR)-mutated NSCLC. However, the incidence of brain metastases in patients with NSCLC and EGFR mutation is high. One of the major obstacles in the treatment of brain metastases is to transport drugs across the blood–brain barrier (BBB). A lipid polymeric nanoparticle (LPN) modified with a tight junction-modulating peptide is a potential formulation to deliver therapeutics across the BBB. FD7 and CCD are short peptides that perturb the tight junctions (TJs) of the BBB. In this study, the use of LPN modified with FD7 or CCD as a delivery platform was explored to enhance Afa delivery across the BBB model of mouse brain-derived endothelial bEnd.3 cells.

Results

Our findings revealed that Afa/LPN-FD7 and Afa/LPN-CCD exhibited a homogeneous shape, a uniform nano-scaled particle size, and a sustained-release profile. FD7, CCD, Afa/LPN-FD7, and Afa/LPN-CCD did not cause a significant cytotoxic effect on bEnd.3 cells. Afa/LPN-FD7 and Afa/LPN-CCD across the bEnd.3 cells enhanced the cytotoxicity of Afa on human lung adenocarcinoma PC9 cells. FD7 and CCD-modulated TJ proteins, such as claudin 5 and ZO-1, reduced transendothelial electrical resistance, and increased the permeability of paracellular markers across the bEnd.3 cells. Afa/LPN-FD7 and Afa/LPN-CCD were also partially transported through clathrin- and caveolae-mediated transcytosis, revealing the effective activation of paracellular and transcellular pathways to facilitate Afa delivery across the BBB and cytotoxicity of Afa on PC9 cells.

Conclusion

TJ-modulating peptide-modified LPN could be a prospective platform for the delivery of chemotherapeutics across the BBB to the brain for the potential treatment of the BM of NSCLC.
Evolutionary ecology of the visual opsin gene sequence and its expression in turbot (Scophthalmus maximus)
Authors: Wang Yunong , Zhou Li , Wu Lele , Song Changbin , Ma Xiaona , Xu Shihong , Du Tengfei , Li Xian , Li Jun
Published: June 2021

Background

As flatfish, turbot undergo metamorphosis as part of their life cycle. In the larval stage, turbot live at the ocean surface, but after metamorphosis they move to deeper water and turn to benthic life. Thus, the light environment differs greatly between life stages. The visual system plays a great role in organic evolution, but reports of the relationship between the visual system and benthic life are rare. In this study, we reported the molecular and evolutionary analysis of opsin genes in turbot, and the heterochronic shifts in opsin expression during development.

Results

Our gene synteny analysis showed that subtypeRH2Cwas not on the same gene cluster as the other four green-sensitive opsin genes (RH2) in turbot. It was translocated to chromosome 8 from chromosome 6. Based on branch-site test and spectral tuning sites analyses, E122Q and M207L substitutions inRH2C, which were found to be under positive selection, are closely related to the blue shift of optimum light sensitivities. And real-time PCR results indicated the dominant opsin gene shifted from red-sensitive (LWS) toRH2B1during turbot development, which may lead to spectral sensitivity shifts to shorter wavelengths.

Conclusions

This is the first report thatRH2Cmay be an important subtype of green opsin gene that was retained by turbot and possibly other flatfish species during evolution. Moreover, E122Q and M207L substitutions inRH2Cmay contribute to the survival of turbot in the bluish colored ocean. And heterochronic shifts in opsin expression may be an important strategy for turbot to adapt to benthic life.
Genome-wide identification of the Capsicum bHLH transcription factor family: discovery of a candidate regulator involved in the regulation of species-specific bioactive metabolites
Authors: Liu Renjian , Song Jiali , Liu Shaoqun , Chen Changming , Zhang Shuanglin , Wang Juntao , Xiao Yanhui , Cao Bihao , Lei Jianjun , Zhu Zhangsheng
Published: June 2021

Background

The basic helix–loop–helix (bHLH) transcription factors (TFs) serve crucial roles in regulating plant growth and development and typically participate in biological processes by interacting with other TFs. Capsorubin and capsaicinoids are found only in Capsicum, which has high nutritional and economic value. However, whether bHLH family genes regulate capsorubin and capsaicinoid biosynthesis and participate in these processes by interacting with other TFs remains unknown.

Results

In this study, a total of 107 CabHLHs were identified from the Capsicum annuum genome. Phylogenetic tree analysis revealed that these CabHLH proteins were classified into 15 groups by comparing the CabHLH proteins with Arabidopsis thaliana bHLH proteins. The analysis showed that the expression profiles of CabHLH009, CabHLH032, CabHLH048, CabHLH095 and CabHLH100 found in clusters C1, C2, and C3 were similar to the profile of carotenoid biosynthesis in pericarp, including zeaxanthin, lutein and capsorubin, whereas the expression profiles of CabHLH007, CabHLH009, CabHLH026, CabHLH063 and CabHLH086 found in clusters L5, L6 and L9 were consistent with the profile of capsaicinoid accumulation in the placenta. Moreover, CabHLH007, CabHLH009, CabHLH026 and CabHLH086 also might be involved in temperature-mediated capsaicinoid biosynthesis. Yeast two-hybrid (Y2H) assays demonstrated that CabHLH007, CabHLH009, CabHLH026, CabHLH063 and CabHLH086 could interact with MYB31, a master regulator of capsaicinoid biosynthesis.

Conclusions

The comprehensive and systematic analysis of CabHLH TFs provides useful information that contributes to further investigation of CabHLHs in carotenoid and capsaicinoid biosynthesis.
Screening and identification of genes affecting grain quality and spikelet fertility during high-temperature treatment in grain filling stage of rice
Authors: Park Jae-Ryoung , Kim Eun-Gyeong , Jang Yoon-Hee , Kim Kyung-Min
Published: June 2021

Background

Recent temperature increases due to rapid climate change have negatively affected rice yield and grain quality. Particularly, high temperatures during right after the flowering stage reduce spikelet fertility, while interfering with sugar energy transport, and cause severe damage to grain quality by forming chalkiness grains. The effect of high-temperature on spikelet fertility and grain quality during grain filling stage was evaluated using a double haploid line derived from another culture of F1 by crossing Cheongcheong and Nagdong cultivars. Quantitative trait locus (QTL) mapping identifies candidate genes significantly associated with spikelet fertility and grain quality at high temperatures.

Results

Our analysis screened OsSFq3 that contributes to spikelet fertility and grain quality at high-temperature. OsSFq3 was fine-mapped in the region RM15749-RM15689 on chromosome 3, wherein four candidate genes related to the synthesis and decomposition of amylose, a starch component, were predicted. Four major candidate genes, including OsSFq3, and 10 different genes involved in the synthesis and decomposition of amylose and amylopectin, which are starch constituents, together with relative expression levels were analyzed. OsSFq3 was highly expressed during the initial stage of high-temperature treatment. It exhibited high homology with FLOURY ENDOSPERM 6 in Gramineae plants and is therefore expected to function similarly.

Conclusion

The QTL, major candidate genes, and OsSFq3 identified herein could be effectively used in breeding rice varieties to improve grain quality, while tolerating high temperatures, to cope with climate changes. Furthermore, linked markers can aid in marker-assisted selection of high-quality and -yield rice varieties tolerant to high temperatures.
Information meetings on end-of-life care for older people by the general practitioner to stimulate advance care planning: a pre-post evaluation study
Authors: van der Plas Annicka G. M. , Pasman H. Roeline W. , Kox Roosmarijne M. K. , Ponstein Marianne , Dame Bea , Onwuteaka-Philipsen Bregje D.
Published: June 2021

Background

To increase knowledge about options people have concerning end-of-life-care issues, General Practitioners (GPs) can organise meetings to inform their older patients. We evaluated these meetings, using the following research questions: How did the attendees experience the information meeting? Was there a rise in Advance Care Planning (ACP) behaviour after the information meeting? Was there a change in trust people have that physicians will provide good care at the end of life and that they will follow their end-of-life wishes after the information meetings?

Methods

Four GPs invited all patients of 75 years and older registered in their GP practices to the meeting via a written letter. Four meetings of 2 h took place in 2016. Meetings started with a presentation on end-of-life topics and ACP by the GP followed by time for questions.

A pre-post evaluation study was done using written questionnaires distributed and filled in at the start of the meeting (T0) at the end of the meeting (T1) and 6 months after the meeting (T2).

Results

In total 225 older people attended a meeting of which 154 (68%) filled in the questionnaire at T0 and 145 (64%) filled in the questionnaire at T1. After six months, 90 of the 121 people who approved of being sent another questionnaire at T2, returned it (40%). The average age of the respondents was 80 years (T0). The meetings were evaluated positively by the attendees (T1). ACP issues (appointing a proxy, resuscitation, hospitalisation, euthanasia, treatment preferences under certain circumstances, preferred place of care and nursing home admittance) were discussed with a physician, a relative or both more often in the 6 months after having attended the meeting (T2), compared to before (T0). Compared to before the meeting (T0), trust in the GP providing good end-of-life care and following end-of-life wishes was higher immediately after the meeting (T1), but not after 6 months (T2).

Conclusion

Information meetings on end-of-life care by GPs have a positive influence on the occurrence of ACP, both with the physician and others. Although, this method especially reaches the older people that are already interested in the subject, this seems a relatively easy way to stimulate ACP.
Frailty increases the risk for developing urinary tract infection among 79,887 patients with diabetic mellitus and chronic kidney disease
Authors: Chao Chia-Ter , Lee Szu-Ying , Wang Jui , Chien Kuo-Liong , Huang Jenq-Wen
Published: June 2021

Background

Patients with diabetic mellitus (DM) and chronic kidney disease (CKD) are at an increased risk of urinary tract infection (UTI) due to their altered immunological integrity. These patients are similarly prone to developing frailty, a state of cumulative health deficits involving multiple domains and leading to adverse outcomes. Whether frailty predisposes affected individuals to UTI among patients with DM and CKD remains unclear.

Methods

A population-based cohort of patients with DM and CKD (n = 79,887) were assembled from the Longitudinal Cohort of Diabetes Patients, with their baseline frailty status measured by a  modified FRAIL scale. We analyzed their risk of developing UTI depending on their severity of frailty, after accounting demographic profiles, lifestyle factors, comorbidities, concurrent medications, and major interventions. A secondary analysis focused on the risk of urosepsis related to frailty.

Results

Among all participants, 36.1 %, 50.3 %, 12.8 %, and 0.8 % did not have or had 1, 2, and ≥ 3 FRAIL items, respectively, at baseline. After 3.51 years, 11,175 UTI events occurred. Kaplan-Meier analysis showed that participants with DM, CKD and an increasing number of FRAIL items had successively higher incidence of UTI than those without any FRAIL items (log rank p < 0.001). Cox proportional hazard modeling revealed that after accounting for all confounders, those with more severe frailty exhibited a significantly higher risk of incident UTI (for groups of 1, 2, and ≥ 3 FRAIL items, hazard ratio 1.19, 1.24, and 1.43, respectively; all p < 0.001) than those without. An 11 % risk elevation for UTI could be observed for every FRAIL item increase. Participants with more severe frailty exhibited a trend of having higher risk of urosepsis as well.

Conclusions

Having frailty predicted a higher risk of developing UTI in the future in patients with DM and CKD. It would be prudent to screen for frailty in these patients and provide optimal frailty-directed management to attenuate their risk of UTI and improve their outcomes.
Observation of retinal neovascularization using optical coherence tomography angiography after panretinal photocoagulation for proliferative diabetic retinopathy
Authors: Feng H. E. , Weihong Y. U. , Dong Fangtian
Published: June 2021

Background

To describe the longitudinal changes in retinal neovascularization elsewhere (NVE) as observed on optical coherence tomography angiography (OCTA) in proliferative diabetic retinopathy (PDR) treated by panretinal photocoagulation (PRP).

Methods

Each patient included in this prospective clinical study was newly diagnosed with PDR and NVE confirmed by both fundus fluorescein angiography (FFA) and OCTA. They received four sessions of PRP using a multiwavelength laser. Best-corrected visual acuity (BCVA) and OCTA images of the NVE were obtained before each PRP session and at 1 month, 3 months, and 6 months after the PRP treatment. Generalized estimating equations (GEE) was used to investigate the differences between the BCVA and NVE areas before and after PRP.

Results

Thirty-two eyes of 32 patients with a mean age of 50.56 ± 7.05 years were included. We found a statistically significant reduction in the NVE area at all time points compared with the baseline except at 6 months (all P < 0.05). Further analysis demonstrated no statistically significant change in the NVE area between two adjacent timepoints except from baseline to post-1st PRP (P < 0.05). BCVA at 3 months showed a statistically significant improvement compared with baseline (P < 0.05), but no significant changes in BCVA were observed during the other visits.

Conclusions

We found an overall regression in the NVE area following PRP starting as early as 1 week after the 1st session and lasting up to 3 months. OCTA provides quantitative information on vascular changes and could be a practical method for the longitudinal evaluation of neovascularization.
Cohort study of ageing from Bagé (SIGa-Bagé), Brazil: profile and methodology
Authors: Thumé Elaine , Kessler Marciane , Machado Karla P. , Nunes Bruno P. , Volz Pamela M. , Wachs Louriele S. , Soares Mariangela U. , Saes Mirelle O. , Duro Suele M. , Dilélio Alitéia Santiago , Facchini Luiz A.
Published: June 2021

Background

The Bagé Cohort Study of Ageing is a population-based cohort study that has recently completed the first follow-up of a representative sample of older adults from Bagé, a city with more than 100,000 inhabitants located in the state of Rio Grande do Sul, Brazil. This is one of the first longitudinal studies to assess the impact of primary health care coverage on health conditions and inequalities. Our aim is to investigate the prevalence, incidence and trends of risk factors, health behaviours, social relationships, non-communicable diseases, geriatric diseases and disorders, hospitalisation, self-perceived health, and all-cause and specific-cause mortality. In addition, we aim to evaluate socioeconomic and health inequalities and the impact of primary health care on the outcomes under study.

Methods/design

The study covers participants aged 60 or over, selected by probabilistic (representative) sampling of the urban area of the city of Bagé, which is covered by Primary Health Care Services. The baseline examination included 1593 older adults and was conducted from July 2008 to November 2008. After eight to nine years (2016/2017), the first follow-up was conducted from September 2016 to August 2017. All participants underwent an extensive core assessment programme including structured interviews, questionnaires, cognitive testing (baseline and follow-up), physical examinations and anthropometric measurements (follow-up).

Results

Of the original participants, 1395 (87.6%) were located for follow-up: 757 elderly individuals (47.5%) were re-interviewed, but losses in data transfer occurred for 22. The remaining 638 (40.1%) had died. In addition, we had 81 (5.1%) refusals and 117 (7.3%) losses. Among the 1373 older adults who were followed down, there was a higher proportion of female interviewees (p=0.042) and a higher proportion of male deaths (p=0.001) in 2016/2017. There were no differences in losses and refusals according to gender (p=0.102). There was a difference in average age between the interviewees (68.8 years; SD ±6.5) and non-interviewees (73.2 years; SD ±9.0) (p<0.001). Data are available at the Department of Social Medicine in Federal University of Pelotas, Rio Grande do Sul, Brazil, for any collaboration.
Plantar load transfer in children: a descriptive study with two pathological case studies
Authors: Brierty Alexis , Carty Christopher P. , Giacomozzi Claudia , Phillips Teresa , Walsh Henry P. J. , Bade David , Horan Sean
Published: June 2021

Background

Typical gait is often considered to be highly symmetrical, with gait asymmetries typically associated with pathological gait. Whilst gait symmetry is often expressed in symmetry ratios, measures of symmetry do not provide insight into how these asymmetries affect gait variables. To fully understand changes caused by gait asymmetry, we must first develop a normative database for comparison. Therefore, the aim of this study was to describe normative reference values of regional plantar load and present comparisons with two pathological case studies.

Methods

A descriptive study of the load transfer of plantar pressures in typically developed children was conducted to develop a baseline for comparison of the effects of gait asymmetry in paediatric clinical populations. Plantar load and 3D kinematic data was collected for 17 typically developed participants with a mean age of 9.4 ± 4.0 years. Two case studies were also included; a 10-year-old male with clubfoot and an 8-year-old female with a flatfoot deformity. Data was analysed using a kinematics-pressure integration technique for anatomical masking into 5 regions of interest; medial and lateral forefoot, midfoot, and medial and lateral hindfoot.

Results

Clear differences between the two case studies and the typical dataset were seen for the load transfer phase of gait. For case study one, lateral bias was seen in the forefoot of the trailing foot across all variables, as well as increases in contact area, force and mean pressure in the lateral hindfoot of the leading foot. For case study two, the forefoot of the trailing foot produced results very similar to the typical dataset across all variables. In the hindfoot of the leading foot, medial bias presents most notably in the force and mean pressure graphs.

Conclusions

This study highlights the clinical significance of the load transfer phase of gait, providing meaningful information for intervention planning.