bluuebunny/crossref_metadata_2025 huggingface dataset:
Risk factors for stillbirth and early neonatal death: a case-control study in tertiary hospitals in Addis Ababa, Ethiopia
Authors: Kebede Eskinder , Kekulawala Melani
Published: September 2021

Background

Ethiopia is a Sub-Saharan country that has made significant improvements in maternal mortality and under-five mortality over the past 15 years. However, the nation continues to have one of the highest rates of perinatal mortality in the entire world with current estimates at 33 deaths per 1000 live births.

Methods

This case-control study was conducted between October 2016 and May 2017 at Tikur Anbessa Hospital and Gandhi Memorial Hospital. All women who had a stillbirth or early neonatal death (i.e. death within 7 days) during this period willing to participate were included as cases. A systematic random sample of women delivering at the hospital were approached for recruitment as controls to generate a 2:1 ratio of controls to cases. Data on risk factors were retrieved from medical records including delivery records, and treatment charts. Statistical differences in background and social characteristics of cases and controls were determined by t-test and chi-squared (or fisher’s exact test) for quantitative and categorical variables respectively. Binary logistic regression analysis was completed to determine any associations between risk factors and stillbirth/early neonatal death.

Results

During the study period, 366 women delivering at the hospitals were enrolled as cases and 711 women delivering at the hospitals were enrolled as controls. Records from both hospitals indicated that the estimated stillbirth and neonatal mortality rates were 30.7 per 1000. Neonatal causes (43.4%) were the most common, followed by antepartum (32.5%) and intrapartum (24.5%). Risk factors for stillbirths and early neonatal death were low maternal education (aOR 1.747, 95%CI 1.098–2.780), previous stillbirth (aOR 9.447, 95%CI 6.245–14.289), previous preterm birth (aOR 3.620, 95%CI 2.363–5.546), and previous child with congenital abnormality (aOR 2.190, 95% 1.228–3.905), and antepartum hemorrhage during pregnancy (aOR 3.273, 95% 1.523–7.031).

Conclusion

Antepartum hemorrhaging is the only risk factor in our study amenable for direct intervention. Efforts should be maximized to improve patient education and antenatal and obstetric services. Moreover, the most significant cause of mortality was asphyxia-related causes. It is imperative that obstetric capacity in rehabilitation services are strengthened and for further studies to investigate the high burden of asphyxia at these tertiary hospitals to better tailor interventions.
Social support, anxiety symptoms, and depression symptoms among residents in standardized residency training programs: the mediating effects of emotional exhaustion
Authors: Zhang Hui , Cui Nianqi , Chen Dandan , Zou Ping , Shao Jing , Wang Xiyi , Zhang Yichi , Du Jiao , Du Chunxue , Zheng Deyi
Published: September 2021

Background

Although studies indicate that social support is related to emotional exhaustion, depression symptoms, and anxiety symptoms, the underlying mechanism between those variables remains unknown.

Methods

Based on a sample of 254 residents in standardized residency training programs, two mediation models were tested in which emotional exhaustion served as a mediator in the relationship between social support and anxiety symptoms/depression symptoms. We used the following self-reported questionnaires as instruments to collect data: zung self-rating depression scale, zung self-rating anxiety scale, social support rating scale, and emotional exhaustion scale.

Results

In the final study sample, the mean age of the residents was 25.92 years old (SD =1.88), and a total of 41.3% were male, and 58.7% were female. This current study suggested that social support was proven to be a relevant factor affecting anxiety symptoms and depression symptoms. Particularly, the results also indicated that emotional exhaustion partially mediated the impact of social support on anxiety symptoms and depression symptoms among Chinese residents in the standardized residency training program.

Conclusions

Our study signifies that enhancements in social support and reduction of emotional exhaustion can directly or indirectly affect anxiety symptoms and depression symptoms among Chinese residents in the standardized residency training program. These findings will offer insight for health-sector managers to develop programs aimed at social support and adopt individual-level interventions and organization-level interventions to reduce emotional exhaustion.
Exploring the relationships between wasting and stunting among a cohort of children under two years of age in Niger
Authors: Kohlmann Kristin , Sudfeld Christopher R. , Garba Souna , Guindo Ousmane , Grais Rebecca F. , Isanaka Sheila
Published: September 2021

Background

Wasting and stunting, physical growth manifestations of child undernutrition, have historically been considered separately with distinct interventions at the program, policy, and financing levels despite similar risk factors, overlapping burdens and multiplicative risk of death when the conditions are concurrent. The aim of this study was to elucidate shared risk factors and the temporal relationship between wasting and stunting among children under 2 years of age in rural Niger.

Methods

From August 2014 to December 2019, anthropometric data were collected every 4 weeks from 6 to 8 weeks to 24 months of age for 6567 children comprising 139,529 visits in Madarounfa, Niger. Children were defined as wasted if they had a weight-for-length Z-score < − 2 and stunted if they had a length-for-age Z-score < − 2 using the 2006 World Health Organization child growth standards. Parental, child, and socioeconomic risk factors for wasting and stunting at 6 and 24 months of age and the relationship between episodes of wasting, stunting and concurrent wasting-stunting were assessed using general estimating equations.

Results

Half of children (50%) were female, and 8.3% were born low birthweight (< 2500 g). Overall, at 24 months of age, 14% of children were wasted, 80% were stunted and 12% were concurrently wasted-stunted. We found that maternal short stature, male sex, and low birthweight were risk factors for wasting and stunting at 6 and 24 months, whereas higher maternal body mass index and household wealth were protective factors. Wasting at 6 and 24 months was predicted by a prior episodes of wasting, stunting, and concurrent wasting-stunting. Stunting at 6 and 24 months was similarly predicted by prior episodes of stunting and concurrent wasting-stunting at any prior age but only by prior episodes of wasting after 6 months of age.

Conclusions

These data support a complex and dynamic bi-directional relationship between wasting and stunting in young children in rural Niger and an important burden of concurrent wasting-stunting in this setting. Further research to better understand the inter-relationships and mechanisms between these two conditions is needed in order to develop and target interventions to promote child growth.

Trial registration

ClinicalTrials.gov Identifier: NCT02145000.
COVID-19, body mass index and cholesterol: an ecological study using global data
Authors: Sarmadi Mohammad , Ahmadi-Soleimani S. Mohammad , Fararouei Mohammad , Dianatinasab Mostafa
Published: September 2021

Background

Coronavirus disease 2019 (COVID-19) is now globally considered a serious economic, social and health threat. A wide range of health related factors including Body Mass Index (BMI) is reported to be associated with the disease. In the present study, we analyzed global databases to assess the correlation of BMI and cholesterol with the risk of COVID-19.

Methods

In this ecological study, we used age-standardized BMI and cholesterol levels as well as the incidence and mortality ratio of COVID-19 at the national-levels obtained from the publicly available databases such as the World Health Organization (WHO) and NCD Risk Factor Collaboration (NCD-RisC). Bivariate correlation analysis was applied to assess the correlations between the study variables. Mean differences (standard deviation: SD) of BMI and cholesterol levels of different groups were tested using independent sample t-test or Mann–Whitney rank test as appropriate. Multivariable linear regression analysis was performed to identify variables affecting the incidence and mortality ratio of COVID-19.

Results

Incidence and mortality ratio of COVID-19 were significantly higher in developed (29,639.85 ± 20,210.79 for cases and 503.24 ± 414.65 for deaths) rather than developing (8153.76 ± 11,626.36 for cases and 169.95 ± 265.78 for deaths) countries (P < 0.01). Results indicated that the correlations of BMI and cholesterol level with COVID-19 are stronger in countries with younger population. In general, the BMI and cholesterol level were positively correlated with COVID-19 incidence ratio (β = 2396.81 and β = 30,932.80, p < 0.01,‌ respectively) and mortality ratio (β = 38.18 and β = 417.52, p < 0.05,‌ respectively) after adjusting for socioeconomic and demographic factors.

Conclusion

Countries with higher BMI or cholesterol at aggregate levels had a higher ratios of COVID-19 incidence and mortality. The aggregated level of cholesterol and BMI are important risk factors for COVID-19 major outcomes, especially in developing countries with younger populations. We recommend monitoring and promotion of health indicices to better prevent morbidity and mortality of COVID-19.
Analyzing disparities in COVID-19 testing trends according to risk for COVID-19 severity across New York City
Authors: Lieberman-Cribbin Wil , Alpert Naomi , Flores Raja , Taioli Emanuela
Published: September 2021

Background

Given the interplay between race and comorbidities on COVID-19 morbidity and mortality, it is vital that testing be performed in areas of greatest need, where more severe cases are expected. The goal of this analysis is to evaluate COVID-19 testing data in NYC relative to risk factors for COVID-19 disease severity and demographic characteristics of NYC neighborhoods.

Methods

COVID-19 testing and the racial/ethnic composition of NYC Zip Code Tabulation Areas (ZCTA) were obtained from the NYC Coronavirus data repository and the American Community Survey, respectively. The prevalence of neighborhood-level risk factors for COVID-19 severity according to the Centers for Disease Control and Prevention criteria for risk of severe illness and complications from COVID-19 were used to create a ZCTA-level risk index. Poisson regressions were performed to study the ratio of total tests relative to the total ZCTA population and the proportion of positive tests relative to the total tests performed over time.

Results

From March 2nd-April 6th, the total tests/population (%) was positively associated with the proportion of white residents (IRRadj: 1.0003, 95% CI: 1.0003–1.0004) and the COVID risk index (IRRadj: 1.038, 95% CI: 1.029–1.046). The risk index (IRRadj: 1.017, 95% CI: 0.939–1.101) was not associated with total tests performed from April 6th-May 12th, and inversely associated from May 12th-July 6th (IRRadj: 0.862, 95% CI: 0.814–0.913). From March 2nd-April 6th the COVID risk index was not statistically associated (IRRadj: 1.010, 95% CI: 0.987–1.034) with positive tests/total tests. From April 6th-May 12th, the COVID risk index was positively associated (IRRadj: 1.031, 95% CI: 1.002–1.060), while from May 12th-July 6th, the risk index was inversely associated (IRRadj: 1.135, 95% CI: 1.042–1.237) with positivity.

Conclusions

Testing in NYC has suffered from the lack of availability in high-risk populations, and was initially limited as a diagnostic tool for those with severe symptoms, which were mostly concentrated in areas where vulnerable residents live. Subsequent time periods of testing were not targeted in areas according to COVID-19 disease risk, as these areas still experience more positive tests.
The Mediterranean diet and dietary approach to stop hypertension (DASH)-style diet are differently associated with lipid profile in a large sample of Iranian adults: a cross-sectional study of Shahedieh cohort
Authors: Panbehkar-Jouybari Monireh , Mollahosseini Mehdi , Salehi-Abargouei Amin , Fallahzadeh Hossein , Mirzaei Masoud , Hosseinzadeh Mahdieh
Published: September 2021

Background

The association between the Mediterranean diet (MED) or dietary approach to stop hypertension (DASH) and cardiovascular disease (CVD) risk factors is well-documented. Nevertheless, a consistent relationship with the Middle East population has yet to be known. Thus, we aimed to investigate the association between DASH/MED and blood lipids in Iranian adults.

Methods

Four thousand seven hundred forty participants, aged 35–70 years (mean: 50.0) participated in the Shahedieh cohort study in Yazd, Iran, were followed from 2016 until now. Participants provided dietary and blood lipid data through a validated semi-quantitative food frequency questionnaire, and blood samples were taken after a fasted state. We used binary logistic regression to examine the association between DASH/MED scores and blood lipids.

Results

In the participants who ingested a DASH-like diet the third vs. the first tertile of total cholesterol (TC), triglyceride (TG), low-density lipoprotein (LDL) levels, and LDL/HDL (high-density lipoprotein) ratio reduced significantly (P < 0.01). While in the participants who ingested the MED-like diet the HDL level increased significantly( 52.8 ± 12. 3 vs. 51.6 ± 11.6, P < 0.01). In Binary logistic regression, higher adherence to the DASH diet showed 19 % lower odds of high TC level (OR: 0.81; 95 %CI: 0.69–0.95) and 18 % lower odds of high LDL/HDL ratio (OR: 0.82; 95 %CI: 0.70–0.96). Besides, high adherence to the MED diet was associated with lower odds of LDL/HDL ratio (OR: 0.85; 95 %CI: 0.72–0.99).

Conclusions

Our findings suggest that TC, TG, LDL, LDL/HDL ratio, and HDL improved in participants who ingested a DASH-like diet and the LDL/HDL ratio improved in participants who ingested MED-like diet and, subsequently they might have a protective effect on CVDs risk. Further epidemiological studies are needed to confirm our findings.
Improvement of three-dimensional motion sickness using a virtual reality simulator for robot-assisted surgery in undergraduate medical students: A prospective observational study
Authors: Takata Ryo , Kanehira Mitsugu , Kato Yoichiro , Matsuura Tomohiko , Kato Renpei , Maekawa Shigekatsu , Obara Wataru
Published: September 2021

Background

A virtual reality (VR) simulator is utilized as an inexpensive tool for gaining basic technical competence in robotic-assisted surgery (RAS). We evaluated operator 3D motion sickness while using a VR simulator and assessed whether it can be reduced by repeating the training.

Methods

This prospective observational study was conducted at the Department of Urology, Iwate Medical University, a tertiary training hospital in an urban setting. A total of 30 undergraduate medical students participated in the study. We compared whether the VR simulator improved the students’ skills in operating the da Vinci robot. Fifteen students underwent training with a VR simulator for 4 h a day for 5 days. Then, motion sickness was determined using the Visual Analog Scale and Simulator Sickness Questionnaire (SSQ) before and after the training.

Results

Manipulation time significantly improved after training compared to before training (293.9 ± 72.4 versus 143.6 ± 18.4 s;p < 0.001). Although motion sickness worsened after each training session, it gradually improved with continuous practice with the VR simulator. SSQ subscores showed that the VR simulator induced nausea, disorientation, and oculomotor strain, and oculomotor strain was significantly improved with repeated training.

Conclusions

In undergraduate students, practice with the VR simulator improved RAS skills and operator 3D motion sickness caused by 3D manipulation of the da Vinci robot.
Attitude towards COVID 19 vaccines and vaccine hesitancy in urban and rural communities in Tamil Nadu, India – a community based survey
Authors: Danabal Kenneth Grace Mascarenhas , Magesh Shiva Shankar , Saravanan Siddharth , Gopichandran Vijayaprasad
Published: September 2021

Background

Effective and safe COVID 19 vaccines have been approved for emergency use since the end of 2020 and countries are actively vaccinating their people. Nevertheless, hesitancy towards the vaccines exist globally.

Objectives

We conducted this study to understand the attitudes towards COVID 19 vaccines and hesitancy to accept it among urban and rural communities in Tamil Nadu, India.

Methods

We conducted a community based cross sectional study in urban and rural communities among 564 persons who had not been vaccinated yet, selected through multistage random sampling. The vaccine attitude scale (VAX) was used to measure attitudes towards the vaccines and their acceptance of the vaccine was captured by responses to a direct question.

Results

More than 50% of the respondents had positive attitudes towards the COVID 19 vaccines. Based on their attitudes, they were segmented into four clusters, first with preference for natural immunity compared to vaccines and low concern regarding adverse effects. Second with high level of trust in vaccines and low mistrust. The third cluster members had high level of concern regarding the adverse effects and low levels of mistrust in vaccines and the fourth had high trust in vaccines and low preference for natural immunity. Older individuals with higher education and occupation were more likely to belong to cluster four with high trust in the vaccines. Younger individuals, women, rural residents, belonging to low income labourer class were highly mistrusting of the vaccines. The prevalence of vaccine hesitancy was 40.7% (95% CI – 36.67 - 44.73%), while 19.5% (95% CI = 16.23 - 22.77%) of the respondents were vaccine deniers. While vaccine acceptance was greatest in cluster 1, it was least in cluster 3.

Conclusions

Vaccine hesitancy was high in urban and rural Tamil Nadu. The population could be effectively segmented into groups based on their attitudes and this understanding can be used to develop targeted behaviour change communication campaigns.
Decentralized facility financing versus performance-based payments in primary health care: a large-scale randomized controlled trial in Nigeria
Authors: Khanna Madhulika , Loevinsohn Benjamin , Pradhan Elina , Fadeyibi Opeyemi , McGee Kevin , Odutolu Oluwole , Fritsche Gyorgy Bela , Meribole Emmanuel , Vermeersch Christel M. J. , Kandpal Eeshani
Published: September 2021

Background

Health system financing presents a challenge in many developing countries. We assessed two reform packages, performance-based financing (PBF) and direct facility financing (DFF), against each other and business-as-usual for maternal and child healthcare (MCH) provision in Nigeria.

Methods

We sampled 571 facilities (269 in PBF; 302 in DFF) in 52 districts randomly assigned to PBF or DFF, and 215 facilities in 25 observable-matched control districts. PBF facilities received $2 ($1 for operating grants plus $1 for bonuses) for every $1 received by DFF facilities (operating grants alone). Both received autonomy, supervision, and enhanced community engagement, isolating the impact of additional performance-linked facility and health worker payments. Facilities and households with recent pregnancies in facility catchments were surveyed at baseline (2014) and endline (2017). Outcomes were Penta3 immunization, institutional deliveries, modern contraceptive prevalence rate (mCPR), four-plus antenatal care (ANC) visits, insecticide-treated mosquito net (ITN) use by under-fives, and directly observed quality of care (QOC). We estimated difference-in-differences with state fixed effects and clustered standard errors.

Results

PBF increased institutional deliveries by 10% points over DFF and 7% over business-as-usual (p<0.01). PBF and DFF were more effective than business-as-usual for Penta3 (p<0.05 and p<0.01, respectively); PBF also for mCPR (p<0.05). Twenty-one of 26 QOC indicators improved in both PBF and DFF relative to business-as-usual (p<0.05). However, except for deliveries, PBF was as or less effective than DFF: Penta3 immunization and ITN use were each 6% less than DFF (p<0.1 for both) and QOC gains were also comparable. Utilization gains come from the middle of the rural wealth distribution (p<0.05).

Conclusions

Our findings show that both PBF and DFF represent significant improvements over business-as-usual for service provision and quality of care. However, except for institutional delivery, PBF and DFF do not differ from each other despite PBF disbursing $2 for every dollar disbursed by DFF. These findings highlight the importance of direct facility financing and decentralization in improving PHC and suggest potential complementarities between the two approaches in strengthening MCH service delivery.

Trial registration

ClinicalTrials.gov NCT03890653; May 8, 2017. Retrospectively registered.
IL-1β and HMGB1 are anti-neurogenic to endogenous neural stem cells in the sclerotic epileptic human hippocampus
Authors: Zaben Malik , Haan Niels , Sharouf Feras , Ahmed Aminul , Sundstrom Lars E. , Gray William P.
Published: September 2021

Background

The dentate gyrus exhibits life-long neurogenesis of granule-cell neurons, supporting hippocampal dependent learning and memory. Both temporal lobe epilepsy patients and animal models frequently have hippocampal-dependent learning and memory difficulties and show evidence of reduced neurogenesis. Animal and human temporal lobe epilepsy studies have also shown strong innate immune system activation, which in animal models reduces hippocampal neurogenesis. We sought to determine if and how neuroinflammation signals reduced neurogenesis in the epileptic human hippocampus and its potential reversibility.

Methods

We isolated endogenous neural stem cells from surgically resected hippocampal tissue in 15 patients with unilateral hippocampal sclerosis. We examined resultant neurogenesis after growing them either as neurospheres in an ideal environment, in 3D cultures which preserved the inflammatory microenvironment and/or in 2D cultures which mimicked it.

Results

3D human hippocampal cultures largely replicated the cellular composition and inflammatory environment of the epileptic hippocampus. The microenvironment of sclerotic human epileptic hippocampal tissue is strongly anti-neurogenic, with sustained release of the proinflammatory proteins HMGB1 and IL-1β. IL-1β and HMGB1 significantly reduce human hippocampal neurogenesis and blockade of their IL-1R and TLR 2/4 receptors by IL1Ra and Box-A respectively, significantly restores neurogenesis in 2D and 3D culture.

Conclusion

Our results demonstrate a HMGB1 and IL-1β-mediated environmental anti-neurogenic effect in human TLE, identifying both the IL-1R and TLR 2/4 receptors as potential drug targets for restoring human hippocampal neurogenesis in temporal lobe epilepsy.
UPLC-MS/MS method for simultaneously determining nucleosides and methyl-nucleosides in liver mRNA of Epimedin C-induced liver injury mouse model
Authors: Song Zhizhen , Li Zeyun , Wen Xueqian , Liu Ruijuan , Tian Xin
Published: September 2021

Background

Epimedin C, one of the main active ingredients of Epimedium, has been reported to have potential hepatotoxicity. However, the mechanism of Epimedin C-induced liver injury has not been studied. mRNA methylation, mainly includingN6-methyladenosine andN5-methylcytidine, is implicated in the regulation of many biological processes and diseases. The study of quantifying mRNA methylation alterations in Epimedin C-induced liver injury mice may contribute to clarify the mechanism of its hepatotoxicity. Therefore, an analysis method needs to be established to determine nucleoside and methyl-nucleoside levels in liver mRNA.

Methods

An ultra-high performance liquid chromatography-tandem mass spectrometry (UPLC-MS/MS) method was developed and validated to simultaneously determine six nucleosides (adenosine, uridine, cytidine, guanosine,N6-methyladenosine andN5-methylcytidine) in liver mRNA. Besides, the Epimedin C-induced liver injury mouse model was studied by intragastrical administration Epimedin C at a daily dose of 10 or 40 mg/kg for 4 weeks. The nucleoside samples of the mice liver mRNA were prepared and separated on an UPLC column using 0.1% formic acid water and methanol after enzymatic digestion. Then the sample was detected by a Qtrap 6500 mass spectrometer.

Results

In this method, calibration curves of the six nucleosides showed good linearity over their concentration ranges. The linear ranges were 40–20,000 pg/mL for adenosine, cytidine,N6-methyladenosine andN5-methylcytidine, 0.2–100 ng/mL for guanosine, and 2–1000 ng/mL for uridine. Epimedin C-induced liver injury mouse model was successfully established,which could be proved by the elevation of serum aminotransferase levels, and the increased inflammatory cell infiltration as well as vacuolar degeneration in liver. TheN6-methyladenosine andN5-methylcytidine levels, and the ratios ofN6-methyladenosine to adenosine andN5-methylcytidine to cytidine of the mice liver mRNA were all significantly increased after Epimedin C treatment.

Conclusion

The established method was successfully applied to the determination of six nucleosides levels in liver mRNA of the Epimedin C-induced liver injury mice model and the control group. The results indicated that mRNA methylation might be associated with Epimedin C-induced liver injury. This study will facilitate the mechanism research on the hepatotoxicity of Epimedin C.
Transcranial direct current stimulation (tDCS) in addition to walking training on walking, mobility, and reduction of falls in Parkinson’s disease: study protocol for a randomized clinical trial
Authors: Nascimento Lucas Rodrigues , Nakamura-Palacios Ester Miyuki , Boening Augusto , Cordeiro Bárbara Naeme Lima , Cabral Daniel Lyrio , Swarowsky Alessandra , Arêas Guilherme Peixoto Tinoco , Paiva Wellingson Silva , da Silva Arêas Fernando Zanela
Published: September 2021

Background

Transcranial direct current stimulation (tDCS) has the potential to modulate cortical excitability and enhance the effects of walking training in people with Parkinson’s disease. This study will examine the efficacy of the addition of tDCS to a task-specific walking training to improve walking and mobility and to reduce falls in people with Parkinson’s disease.

Methods

This is a two-arm, prospectively registered, randomized trial with concealed allocation, blinded assessors, participants and therapists, and intention-to-treat analysis. Twenty-four individuals with Parkinson’s disease, categorized as slow or intermediate walkers (walking speeds ≤ 1.0 m/s), will be recruited. The experimental group will undertake a 30-min walking training associated with tDCS, for 4 weeks. The control group will undertake the same walking training, but with sham-tDCS. The primary outcome will be comfortable walking speed. Secondary outcomes will include walking step length, walking cadence, walking confidence, mobility, freezing of gait, fear of falling, and falls. Outcomes will be collected by a researcher blinded to group allocation at baseline (week 0), after intervention (week 4), and 1 month beyond intervention (week 8).

Discussion

tDCS associated with walking training may help improve walking of slow and intermediate walkers with Parkinson’s disease. If walking is enhanced, the benefits may be accompanied by better mobility and reduced fear of falling, and individuals may experience greater free-living physical activity at home and in the community.

Trial registration

Brazilian Registry of Clinical Trials (ReBEC) RBR-6bvnx6. Registered on September 23, 2019
Unilateral Urrets-Zavalia syndrome after Implantable Collamer Lens implantation: a case report and review of the literature
Authors: Niruthisard Duangratn , Kasetsuwan Ngamjit
Published: September 2021

Background

Fixed dilated pupil after ophthalmic surgery or Urrets-Zavalia syndrome occurs after anterior segment surgery and usually relates to postoperative elevation of intraocular pressure. Urrets-Zavalia syndrome results in complaints of glare, halo, and photophobia. Retention of the viscoelastic agent during Implantable Collamer Lens implantation can result in postoperative elevation of intraocular pressure and Urrets-Zavalia syndrome. However, reversibility of pupillary dilatation is possible in some cases.

Case presentation

A 20-year-old Thai man with myopic astigmatism in both eyes underwent Implantable Collamer Lens implantation in the right eye. The preoperative slit-lamp examination of both eyes was normal, and no ectatic changes were detected from corneal tomography. One hour after the uncomplicated surgery of the right eye, intraocular pressure increased to 48 mmHg and was immediately controlled with antiglaucoma medications. Postoperative pupillary dilatation was detected, presumably due to effect of preoperative application of mydriatic drops. At postoperative day 1, the right pupil remained dilated but still reactive to light and pilocarpine 2% eye drops. Two weeks later, the left eye underwent the Implantable Collamer Lens implantation and showed neither postoperative increase in intraocular pressure nor postoperative pupillary dilatation. Two months after surgery, the dilatation of the right pupil partially reversed.

Conclusions

The findings of the right eye suggested diagnosis of Urrets-Zavalia syndrome. Compared with former reports, we noted an association between immediate control of elevation of postoperative intraocular pressure, light reactivity of the dilated pupil, and reactivity to pilocarpine 2% eye drops as potential predictors for reversibility of Urrets-Zavalia syndrome.
Comparative analysis of genetic characterization of β-lactam-resistant Escherichia coli from bulk tank milk in Korea
Authors: Jung Hye-Ri , Kim Koeun , Lee Young Ju
Published: September 2021

Background

This study was conducted to analyze the genetic characteristics of 41 β-lactam-resistant Escherichia coli isolates, which are one of the common causes of environmental mastitis, isolated from the bulk tank milk of 290 dairy farms in five factories operated by three dairy companies in Korea.

Results

Analysis of the phenotypic and genotypic characteristics of β-lactam-resistant E. coli isolates revealed differences between factories even within the same company. Isolates from factory A1 and C1 showed high resistance to cephalothin (76.9 and 100%, respectively), which is a first-generation cephalosporins, whereas resistance to tetracycline was showed by only the isolates from factories B1 (60.0%), C2 (66.7%), and C3 (100%). Although all the 41 β-lactam-resistant E. coli isolates were positive for blaOXA-1, blaTEM-1 was highly prevalent in isolates from factories C2 (100%) and C3 (100%). Among 17 isolates resistant to both β-lactams and aminoglycosides, the most common multilocus sequence type was ST399 (13isolates, 76.5%). Furthermore, 2 (11.8%) and 12 (70.6%) isolates belonged to the phylogenetic groups B2 and D, respectively, which are invasive strains that cause intestinal infections, respectively. The predominant serogroup was O15 (70.6%), which is a globally distributed extraintestinal pathogen. Interestingly, one isolate from factory A1 belonged to O157 and carried six virulence genes, simultaneously.

Conclusions

Although E. coli isolates were isolated from bulk tank milk, and not the clinical mastitis samples, the presence of the phylogenetic groups B2 and D, and the serogroups O15 and O157, which harbor antimicrobial resistance genes and virulence factors, can pose a threat to public health.
Establishing the effectiveness of technology-enabled dementia education for health and social care practitioners: a systematic review
Authors: Muirhead Kevin , Macaden Leah , Smyth Keith , Chandler Colin , Clarke Charlotte , Polson Rob , O’Malley Chris
Published: September 2021

Background

Dementia prevalence is increasing globally and yet evidence suggest that gaps exist in dementia-specific knowledge among health and social care practitioners. Technological modes of educational delivery may be as effective as traditional education and can provide practitioners with increased accessibility to dementia training. Benefits of digitally based dementia education have been established including pedagogical strategies that influence dementia knowledge and care attitudes. This review aimed to appraise and synthesise contemporary experimental evidence that evaluated technology-enabled dementia education for health and social care practitioners. Outcomes based on Kirkpatrick’s Model were learner satisfaction; knowledge, skills, and attitudes; behaviours; and results.

Methods

MEDLINE, CINAHL, and Web of Science were among 8 bibliographic databases searched from January 2005 until February 2020. Keywords included dementia and education (and terms for technological modes of education, learning, or training). We included experimental and quasi-experimental studies. Medical Education Research Study Quality Instrument established the overall quality of included studies and pragmatic application of Mixed Methods Appraisal Tool established individual study quality and highlighted methodological features of educational research. Narrative synthesis was conducted as heterogeneous outcome data precluded meta-analysis.

Results

We identified 21 relevant studies: 16 evaluated online dementia education and 5 evaluated computer-based approaches. Most studies used before-after designs and study quality was moderate overall. Most studies reported knowledge-based outcomes with statistically significant findings favouring the training interventions. Positive effects were also observed in studies measuring skills and attitudinal change. Fewer studies reported significant findings for behavioural change and results due to training. Case-based instruction was a frequently described instructional strategy in online dementia education and videos were common information delivery modes. CD-ROM training and simulation activities were described in computer-based dementia education.

Discussion

Future emphasis must be placed on teaching and learning methods within technology-enabled dementia education which should be role relevant and incorporate active and interactive learning strategies. Future evaluations will require contextually relevant research methodologies with capacity to address challenges presented by these complex educational programmes and multi-component characteristics.

Systematic review registration

This systematic review is based on a protocol registered with PROSPERO (CRD42018115378).
The time lag between deformation process and seismic activity in El Hierro Island during the eruptive process (2011–2014): a functional phased approach
Authors: Pérez-Plaza Sonia , Berrocoso Manuel , Rosado Belén , Prates Gonçalo , Fernández-Palacín Fernando
Published: September 2021

On 10 October 2011, a submarine eruption occurred in El Hierro island. Thus, the eruptive process in the Canary islands was reactivated after 40 years of inactivity. The main objective of this work is to evaluate, using Functional Data Analysis, how the surface deformation phenomenon explains the seismic–volcanic activity in the island. The GNSS-GPS data are from the FRON (GRAFCAN) station, located in Frontera. These data measure, each 4 h, the distance between the FRON station and the reference station LPAL (La Palma island) from August, 2010 to December, 2013. In this study a functional correlation measure is employed to establish the relation between the deformation curve and the curve of cumulative energy released. The period of time analysed has been divided into four phases to avoid the mix of phenomena. For each phase, the correlation measure and the time lag between deformation curve and the curve of cumulative energy released have been estimated. These values show a strong relation between these curves. With respect to time lag period, the only significant lag, of about 1 month, occurred in Phase 1, which was after a long period without seismic activity. The later phases had very short, insignificant, lags. After a long period without seismic and volcanic activity in El Hierro island, the time lag between the deformation process and the beginning of the seismic activity takes approximately 1 month. In a similar situation a method to predict in real time the beginning of the seismic activity is proposed. This method, based on the changes produced in the derivative curves when there is a rapid descent in the deformation curve, could activate a warning system approximately 13 days before the beginning of seismicity.
Left paraduodenal hernia treated by single-incision laparoscopic surgery: a case report
Authors: Hasegawa Noboru , Takeyama Hiroshi , Suzuki Yozo , Noura Shingo , Odagiri Kazuki , Yanagimoto Yoshitomo , Yamashita Masafumi , Shimizu Junzo , Kawase Tomono , Imamura Hiroshi , Iwazawa Takashi , Tomita Naohiro , Dono Keizo
Published: September 2021

Background

Paraduodenal hernia is a rare internal hernia which accounts for only 1% of all intestinal hernias. There have been limited reported cases of paraduodenal hernia treated by laparoscopic surgery. We report a case of left paraduodenal hernia that was successfully treated by single-incision laparoscopic surgery (SILS).

Case presentation

A 17-year-old woman presented with left upper abdominal pain. An abdominal enhanced multi-detector computed tomography demonstrated encapsulated cluster of small bowel loops in the left upper quadrant which passed through the dorsal side of the inferior mesenteric vein, and showed that blood flow of the prolapsed small bowel was preserved. We preoperatively diagnosed left paraduodenal hernia without ischemia or necrosis. We performed elective SILS because she was a young actress training school student and cosmetic benefit was thought to be important. We pulled out the protruded small bowel and closed a defect with a running suture by SILS. The patient was discharged 3 days after the surgery with no complications.

Conclusions

We reported the case of left paraduodenal hernia successfully diagnosed and treated by SILS.
Combined laparoscopic and thoracoscopic surgical repair of Bochdalek hernia in an adult: a case report
Authors: Nambara Sho , Sakaguchi Yoshihisa , Shoji Fumihiro , Tsuda Yasuo , Kudou Kensuke , Kusumoto Eiji , Hashimoto Kenkichi , Kusumoto Tetsuya , Ikejiri Koji
Published: September 2021

Background

Bochdalek hernia is a rare disease in adults. Diaphragmatic hernia in adults has been repaired using minimally invasive surgery through laparoscopy or thoracoscopy. However, the literature regarding the combined use of laparoscopy and thoracoscopy for the repair of Bochdalek hernia is limited.

Case presentation

A 26-year-old man diagnosed with Bochdalek hernia was managed through combined abdominal and thoracic endoscopic surgery. On laparoscopy, the omentum prolapsed into the left thoracic cavity through the posterolateral area of the left diaphragm. On thoracoscopy, no adhesions of the omentum were seen in the thoracic cavity. The omentum was drawn back to the abdominal cavity, and a 4 × 3-cm hernial orifice was identified. The hernia orifice was repaired through simple closure with sutures laparoscopically. The patient’s postoperative course was uneventful with no recurrences within the first year post-surgery.

Conclusion

Combined laparoscopic and thoracoscopic surgery is a safe and effective method for Bochdalek hernial repair in adults.
Association between PON1 rs662 gene polymorphism and serum paraoxonase1 level in coronary artery disease patients in Northern India
Authors: Kumar Rohit , Saini Vandana , Kaur Charanjeet , Isser H. S. , Tyagi Nitin , Sahoo Subhra
Published: September 2021

Background

Coronary artery disease (CAD) is a leading cause of morbidity and mortality, with a shifting trend towards the younger population. Paraoxonase1 (PON1) is a glycoprotein enzyme associated with high-density lipoprotein (HDL) particles in the blood. It has the ability to protect against lipid oxidation, thereby reducing the risk of atherogenesis. PON1 rs662 gene polymorphism may affect serum PON1 levels as well as its activity and may have a significant role in the pathogenesis of CAD. The present study was conducted to identify the association of PON1 rs662 gene polymorphism with serum PON1 levels in CAD patients in the North Indian population. This case–control study included 71 angiography-proven CAD patients (with > 50% luminal stenosis in one or more coronary arteries) and 71 controls (with < 50% luminal obstruction in angiography). PON1 rs662 gene polymorphism was studied using PCR and RFLP under the standardized protocol. Serum PON1 levels were estimated by ELISA.

Results

The serum PON1 level was significantly lower in the CAD group than in the controls (7.79 ± 3.16 vs. 10.79 ± 3.19 ng/mL; p < 0.0001). Logistic regression analysis showed that homozygous GG genotype of PON1 rs662 SNP has ninefold increased risk of developing CAD in an Indian population (OR = 9.0, 95%CI 2.79–29.06, p = 0.0002). A significantly higher frequency of G allele was also observed in CAD patients than in controls (OR 2.64, 95%CI 1.61–4.33, p = 0.001).

Conclusions

The reduced serum PON1 level is associated with CAD. PON1 rs662 gene polymorphism is significantly associated with CAD susceptibility in the North Indian population.
Hepatocellular carcinoma with uncommon sites of metastasis: a rare case report
Authors: Targe Mangala , Yasam Venkata Ramesh , Nagarkar Raj
Published: September 2021

Background

Hepatocellular carcinoma (HCC) is a highly malignant tumor, causing both intrahepatic and extrahepatic metastases. The extrahepatic metastasis occurs in one-third of patients with HCC and it is associated with a poor prognosis. The most common sites of extrahepatic metastasis are lung, regional lymph nodes, bone, adrenal glands, and peritoneum/omentum. Detection of such extrahepatic metastasis plays a vital role in the staging and treatment planning of HCC.

Case presentation

A 60-year-old man was presented to our centre with loss of apetite, generalised weakness, and weight loss. Abdominal examination revealed a firm lump in the right hypochondrium. CT findings revealed a large well-defined hypodense mass in almost entire right lobe of the liver. A well-defined oval, heterogeneously enhancing soft tissue mass lesions were also noted in both adrenal glands and psoas muscles. For histopathological diagnosis, percutaneous ultrasound-guided truecut biopsy was done from right lobe liver mass confirming well differentiated HCC.

Conclusions

In the present case report, we present an extremely rare and unique case of HCC with disseminated skeletal muscle metastasis with concomitant bilateral axillary lymph node metastasis. It is crucial for radiologists to detect such extrahepatic sites of metastasis initially at the time of diagnosis for accurate staging and treatment planning for a better prognosis.
Phyllotaxis-inspired nanosieves with multiplexed orbital angular momentum
Authors: Jin Zhongwei , Janoschka David , Deng Junhong , Ge Lin , Dreher Pascal , Frank Bettina , Hu Guangwei , Ni Jincheng , Yang Yuanjie , Li Jing , Yu Changyuan , Lei Dangyuan , Li Guixin , Xiao Shumin , Mei Shengtao , Giessen Harald , zu Heringdorf Frank Meyer , Qiu Cheng-Wei
Published: September 2021

Nanophotonic platforms such as metasurfaces, achieving arbitrary phase profiles within ultrathin thickness, emerge as miniaturized, ultracompact and kaleidoscopic optical vortex generators. However, it is often required to segment or interleave independent sub-array metasurfaces to multiplex optical vortices in a single nano-device, which in turn affects the device’s compactness and channel capacity. Here, inspired by phyllotaxis patterns in pine cones and sunflowers, we theoretically prove and experimentally report that multiple optical vortices can be produced in a single compact phyllotaxis nanosieve, both in free space and on a chip, where one meta-atom may contribute to many vortices simultaneously. The time-resolved dynamics of on-chip interference wavefronts between multiple plasmonic vortices was revealed by ultrafast time-resolved photoemission electron microscopy. Our nature-inspired optical vortex generator would facilitate various vortex-related optical applications, including structured wavefront shaping, free-space and plasmonic vortices, and high-capacity information metaphotonics.
To Cope or Not to Cope? Characterizing Biology Graduate Teaching Assistant (GTA) Coping with Teaching and Research Anxieties
Authors: Musgrove Miranda M. Chen , Cooley Alyssa , Feiten Olivia , Petrie Kate , Schussler Elisabeth E.
Published: September 2021

Biology graduate teaching assistants (GTAs) often used adaptive coping strategies to manage teaching and research anxieties. Notably, GTAs tended to use strategies such as support seeking, self-reliance, accommodation, and distraction more often to manage research anxieties compared with teaching anxieties. Over time, GTAs narrowed their adaptive coping to certain strategies.
Emotional abuse and neglect in a clinical setting: challenges for mental health professionals
Authors: DeJong Margaret , Wilkinson Simon , Apostu Carmen , Glaser Danya
Published: September 2021

This article addresses some of the common uncertainties and dilemmas encountered by both adult and child mental health workers in the course of their clinical practice when dealing with cases of suspected emotional abuse or neglect (EAN) of children. We suggest ways of dealing with these according to current best practice guidelines and our own clinical experience working in the field of child maltreatment.
Assessment of age-at-onset criterion for adult attention-deficit hyperactivity disorder
Authors: Riglin Lucy , Blakey Rachel , Langley Kate , Thapar Ajay K. , Agha Sharifah Shameem , Davey Smith George , Stergiakouli Evie , Thapar Anita
Published: September 2021

To investigate the accuracy of the age-at-onset criterion in those who meet other DSM-5 criteria for attention-deficit hyperactivity disorder, using a prospective population cohort we compared four different approaches to asking those aged 25 years (n = 138) when their symptoms started. Receiver operating characteristic curves showed variation between the approaches (χ(3) = 8.99, P = 0.03); all four showed low discrimination against symptoms that had been assessed when they were children (area under the curve: 0.57–0.68). Asking adults to recall specific symptoms may be preferable to recalling at what age symptoms started. However, limitations to retrospective recall add to debate on the validity of ADHD age-at-onset assessment.