bluuebunny/crossref_metadata_2025 huggingface dataset:
Effectiveness and safety of non-vitamin K antagonist oral anticoagulants and warfarin in atrial fibrillation: a Scandinavian population-based cohort study
Authors: Halvorsen Sigrun , Johnsen Søren P , Madsen Morten , Linder Marie , Sulo Gerhard , Ghanima Waleed , Gislason Gunnar , Hohnloser Stefan H , Jenkins Aaron , Al-Khalili Faris , Tell Grethe S , Ehrenstein Vera
Published: July 2021

Aims

Using Scandinavian population-based registries, we assessed risk of stroke/systemic embolism (SE) and bleeding with non-vitamin K antagonist oral anticoagulants compared with warfarin in anticoagulation-naïve patients with atrial fibrillation (AF).

Methods and results

This historical cohort study included 219 545 AF patients [median age 74 years; 43% women; mean CHA2DS2-VASc (congestive heart failure, hypertension, age ≥75 years, diabetes mellitus, stroke or transient ischaemic attack, vascular disease, age 65–74 years, sex category) score 3.3] initiating apixaban, dabigatran, rivaroxaban, or warfarin in Denmark, Norway, and Sweden (1 January 2013 to 31 December 2016). The primary endpoints were stroke/SE and major bleeding. The median follow-up times were 9.7 (3.9–21.5) months for stroke/SE and 9.6 (3.8–21.3) months for bleeding. Apixaban and warfarin initiators were older and had higher CHA2DS2-VASc scores compared with dabigatran and rivaroxaban initiators. After 1:1 propensity score matching, three cohorts were created: apixaban–warfarin (n = 111 162), dabigatran–warfarin (n = 56 856), and rivaroxaban–warfarin (n = 61 198). Adjusted hazard ratios (HRs) were estimated using a Cox regression. For stroke/SE, adjusted HRs against warfarin were 0.96 [95% confidence interval (CI): 0.87–1.06] for apixaban, 0.89 (95% CI: 0.80–1.00) for dabigatran, and 1.03 (95% CI: 0.92–1.14) for rivaroxaban. For major bleeding, the HRs against warfarin were 0.73 (95% CI: 0.67–0.78) for apixaban, 0.89 (95% CI: 0.82–0.97) for dabigatran, and 1.15 (95% CI: 1.07–1.25) for rivaroxaban. The results in the dabigatran cohort did not hold in all dose-defined subgroups.

Conclusion

In this large Scandinavian study among AF patients initiating oral anticoagulation, those initiating dabigatran, apixaban, and rivaroxaban had similar rates of stroke/SE to patients initiating warfarin. Rates of major bleeding were lower with apixaban and dabigatran and higher with rivaroxaban, each compared with warfarin.
Late Life in the Living Room: Room Décor, Functional Limitations, and Personality
Authors: Fingerman Karen L , Kim Yijung K , Zhang Shiyang , Ng Yee To , Birditt Kira S
Published: July 2021

Background and Objectives

Environmental gerontology and environmental psychology theories address adaptations of living space for disability and individual preferences. This study combines these perspectives to examine how room décor (i.e., furnishings, design, decoration) corresponds with functional limitations and personality in late life.

Research Design and Methods

Older adults aged 65 and older (N = 286) completed interviews regarding living arrangements, functional limitations, personality, and depressive symptoms. Participants provided 3–4 photographs of the room where they spend the most time. Raters coded photographs for physical adaptations for functional limitations and 19 features of décor (e.g., crowding, color), fitting 3 categories: (a) newness, (b) comfort, and (c) cheerfulness. We estimated linear regression models to examine how functional limitations or personality are associated with room décor, and whether living arrangement moderates these links. We also assessed whether room décor moderates functional limitations or personality predicting depressive symptoms.

Results

Functional limitations were associated with greater clutter and less brightness. Extraversion was associated with newness and cheerfulness (but not comfort), and conscientiousness with newness and comfort (but not cheerfulness). Openness was associated with more newness and cheerfulness for those who live alone. Moderation models revealed functional limitations were associated with fewer depressive symptoms if the room was more cluttered. Conscientiousness was negatively associated with depressive symptoms when the room was higher on newness or comfort.

Discussion and Implications

Findings generally supported environmental psychology and environmental gerontology perspectives and suggest “goodness of fit” between functional abilities, personal desires, and room characteristics may contribute to benefits of aging in place.
Industrial policy against pandemics
Authors: Cherif Reda , Hasanov Fuad
Published: July 2021

The coronavirus disease 2019 (COVID-19) pandemic illustrated the inability of the market to meet the needed production scale and speed of essential medical products. The state should adopt a risk-based approach, allowing for experimentation with various technological solutions such as vaccines and tests, while ramping up their production. The intervention should resolve uncertainty, combine resources, coordinate technological choices, lift barriers to entry, ensure knowledge sharing, and support the value chain. The cost of this strategy is dwarfed by the economic fallout of a pandemic. Universal testing, an overlooked solution, is a key component of an infrastructure against future pandemics.
Female reproductive output and potential recruitment of three fished southern king crab stocks from the Southern Atlantic Ocean
Authors: Di Salvatore Pablo , Sacristán Hernán J , Florentín Olga , Varisco Martín , Lovrich Gustavo A
Published: July 2021

The female reproductive output and potential recruitment (PR) were studied in three Argentinean southern king crab (Lithodes santolla and Lithodes confundens) stocks: in the Beagle Channel (BC), under an artisanal fishery pressure since 1930; in the San Jorge Gulf (SJG), under 10-years industrial fishing exploitation; and off the Atlantic coast of Isla Grande de Tierra del Fuego (TDF), under current exploratory regime. After evaluating their reproductive parameters, we suggest that these fisheries pass through at least two detectable phases. The first phase, in the SJG stock, is sperm limitation evidenced by a high proportion of ovigerous females but a decreased female fecundity. A second phase, in the BC stock, shows a sustained low proportion of ovigerous females which were the largest females of this stock, along with a decreased relative abundance, which in lithodids are indicators of recruitment overfishing. Contrastingly, the TDF stock showed healthy population parameters before the opening of the exploratory fishery. The extremely low value of PR (2.6%) in the bc stock further reinforces that this stock is experiencing or has experienced recruitment overfishing, as a small proportion of the offspring would reach sexual maturity or achieve legal sizes.
Firm Size, Employment and Value Added in African Manufacturing Firms: Why Ghana Needs Its 1%
Authors: Teal Francis
Published: July 2021

In this paper, we use manufacturing firm census data to examine the size distribution of firms in Ghana for 1962, 1987 and 2003 and the distribution of employment and value added across the size distribution for 2003. We make four contributions to the literature on firm size in Africa. First, we compare the Tybout procedure, of matching employment shares to that implied by a Paretian distribution, to obtain the shape parameter from the Paretian distribution with a direct estimate from the firm size distribution. We show they differ. Our second contribution is to follow up on Tybout’s suggestion that a policy undistorted environment would produce a Paretian distribution and show that such a distribution can describe firm size, for both the 1987 and 2003 censuses, for firms with more than nine employees. The implication we draw is that processes of firm growth are quite different for firms above and below the nine employees’ threshold. Rather than there being a ‘missing middle’ of mid-sized firms, the data are better described as a ravine at nine employees, whereby the density of the distribution of firm size collapses at this point. Our third contribution is to show that the increasing dominance of the small, which has characterised firm growth in Ghana over this period, implies an increasing proportion of employment in the low productivity part of the size spectrum. Finally, we show that in 2003 while 95% of firms have less than ten employees, they produce only 14% of value added. At the other end of the size spectrum, less than 1% of the firms produced nearly 80% of value added.
Seeing Is Believing: Is Video Modality More Powerful in Spreading Fake News via Online Messaging Apps?
Authors: Sundar S Shyam , Molina Maria D , Cho Eugene
Published: July 2021

False rumors on WhatsApp, the world’s largest messaging app, have led to mob lynching in India and other countries. Doctored videos sent over the platform have elicited visceral responses among users, resulting in the wrongful death of innocent people. Would the responses have been so strong if the false news were circulated in text or audio? Is video modality the reason for such powerful effects? We explored this question by comparing reactions to three false stories prepared in either text-only, audio-only, or video formats, among rural and urban users in India. Our findings reveal that video is processed more superficially, and therefore users believe in it more readily and share it with others. Aside from advancing our theoretical understanding of modality effects in the context of mobile media, our findings also hold practical implications for design of modality-based flagging of fake news, and literacy campaigns to inoculate users against misinformation.
Substrate availability regulates the suppressive effects of Canada goldenrod invasion on soil respiration
Authors: Hu Zhiyuan , Zhang Jiaqi , Du Yizhou , Shi Kangwei , Ren Guangqian , Iqbal Babar , Dai Zhicong , Li Jian , Li Guanlin , Du Daolin
Published: July 2021

Invasive alien plants not only decrease riparian vegetation diversity but also alter wetland ecosystem carbon processes, especially when they displace the original vegetation. Invasive Canada goldenrod (Solidago canadensis L.) has colonized large areas of disturbed and undisturbed land in southeastern China, yet little is known regarding how it affects soil carbon cycling. To explore the response patterns of soil respiration following S. canadensis invasion and their driving mechanisms, an observational field study and a greenhouse experiment simulating invasion were performed. In the field study, soil respiration was measured weekly from 21th July 2018 to 15th December 2018. In the greenhouse experiment, soil, autotrophic and heterotrophic respiration were measured every 1st and 15th of the month from 15th July 2019 to 15th December 2019. Soil, autotrophic and heterotrophic respiration were measured using a closed-chamber system with the deep gauze collar root exclusion method. Solidago canadensis invasion appeared to decrease the total soil CO2 emissions in both the field study and the greenhouse experiment. The suppressive effects on soil respiration may be attributed to S. canadensis invasion-induced alterations in the quality and quantity of available soil substrate, suggesting that S. canadensis invasion may impact soil carbon cycling via plant-released substrates and by competing for the soil available substrate with native plant and/or soil microbes. These results have substantial implications for estimations of the effects of invasive plants on belowground carbon dynamics and their contribution to the warming world.
Testing for Phases of Dropout Attrition Using Change-Point Hazard Models
Authors: Hochheimer Camille J , Sabo Roy T
Published: July 2021

While web-based surveys are a convenient research tool, the ease of dropping out in the online setting has become a growing issue in ensuring data quality. One theory is that dropout, or attrition, occurs in phases that can be generalized to phases of high dropout and phases of stable use. In order to detect these phases, survey dropout is considered as a time-to-event outcome and tests within change-point hazard models are introduced. Here, we apply the multiple change-point exponential model and extend the single change-point Weibull model to account for multiple change-points. We also introduce a likelihood ratio test to aid in determining the number of distinct phases, using Monte Carlo simulations of the null hypothesis of no attrition phases or change-points against the alternative hypothesis that distinct attrition phases exist (at least one change-point). The performances of these change-point hazard models are compared using both a simulation study and also with application to survey data on patient cancer screening preferences, as well as compared to previous work with discrete models.
Towards a computer-assisted aesthetics of user response
Authors: Armaselu Florentina
Published: July 2021

The article focuses on the analysis of the user as an aesthetic category and proposes a methodology for evaluating user response within a framework that combines theoretical background from different areas, the theory of aesthetic response, psycholinguistics, appraisal theory, dialogism, and affective stylistics, with the application of digital tools for corpus linguistics and sentiment analysis. Four user types were derived from the corpus linguistics analysis referred to as immersed, distant, sceptical, and enthusiastic users. Each type may encompass a certain degree of intentionality and convey an attitude, implying features such as commitment and honesty, objectivity and engagement with the audience, critical reflection and circumspection, openness to technological novelty, and enjoyment. This assumes that the users involved in usability testing are not neutral or undifferentiated informational entities placed in an experimental context but individuals that respond to the same stimuli and express themselves differently in light of psycholinguistic factors and rules of social interaction. On the other hand, the results of sentiment analysis showed that an experiential analysis, centred not only on the artefact but also on the response and the experience it generates, may enable understanding the user as involved in a hermeneutic process of interpretation during his/her interaction with the studied artefact. Given the small scale of the analysed data, the study does not intend to provide evidence for general or definitive statements but formulates and illustrates a set of interpretative hypotheses and methodological directions for further enquiry aiming at developing an ‘aesthetics’ of user response.
The RGG domain in the C-terminus of the DEAD box helicases Dbp2 and Ded1 is necessary for G-quadruplex destabilization
Authors: Yan Kevin Kok-Phen , Obi Ikenna , Sabouri Nasim
Published: July 2021

The identification of G-quadruplex (G4) binding proteins and insights into their mechanism of action are important for understanding the regulatory functions of G4 structures. Here, we performed an unbiased affinity-purification assay coupled with mass spectrometry and identified 30 putative G4 binding proteins from the fission yeast Schizosaccharomyces pombe. Gene ontology analysis of the molecular functions enriched in this pull-down assay included mRNA binding, RNA helicase activity, and translation regulator activity. We focused this study on three of the identified proteins that possessed putative arginine-glycine-glycine (RGG) domains, namely the Stm1 homolog Oga1 and the DEAD box RNA helicases Dbp2 and Ded1. We found that Oga1, Dbp2, and Ded1 bound to both DNA and RNA G4s in vitro. Both Dbp2 and Ded1 bound to G4 structures through the RGG domain located in the C-terminal region of the helicases, and point mutations in this domain weakened the G4 binding properties of the helicases. Dbp2 and Ded1 destabilized less thermostable G4 RNA and DNA structures, and this ability was independent of ATP but dependent on the RGG domain. Our study provides the first evidence that the RGG motifs in DEAD box helicases are necessary for both G4 binding and G4 destabilization.
Intermediate luminosity type Iax supernova 2019muj with narrow absorption lines: Long-lasting radiation associated with a possible bound remnant predicted by the weak deflagration model
Authors: Kawabata Miho , Maeda Keiichi , Yamanaka Masayuki , Nakaoka Tatsuya , Kawabata Koji S , Aoki Kentaro , Anupama G C , Burgaz Umut , Dutta Anirban , Isogai Keisuke , Kino Masaru , Kojiguchi Naoto , Kota Iida , Kumar Brajesh , Kuroda Daisuke , Maehara Hiroyuki , Matsubayashi Kazuya , Morihana Kumiko , Murata Katsuhiro L , Ohshima Tomohito , Otsuka Masaaki , Sahu Devendra K , Singh Avinash , Sugitani Koji , Takahashi Jun , Takagi Kengo
Published: July 2021

We present comprehensive spectroscopic and photometric analyses of the intermediate luminosity type Iax supernova (SN Iax) 2019muj based on multi-band datasets observed through the framework of the OISTER target-of-opportunity program. SN 2019muj exhibits almost identical characteristics to the subluminous SNe Iax 2008ha and 2010ae in terms of the observed spectral features and the light curve evolution at the early phase, except for the peak luminosity. The long-term observations unveil late-time flattening light curves as seen in luminous SN Iax 2014dt. This can be explained by the existence of an inner dense and optically thick component possibly associated with a bound white dwarf remnant left behind after the explosion. We demonstrate that the weak deflagration model with a wide range of explosion parameters can reproduce the late-phase light curves of other SNe Iax. Therefore, we conclude that a common explosion mechanism operates for different subclass SNe Iax.
AUXIN RESPONSE FACTORS 6 and 17 control the flag leaf angle in rice by regulating secondary cell wall biosynthesis of lamina joints
Authors: Huang Guoqiang , Hu Heng , van de Meene Allison , Zhang Jiao , Dong Le , Zheng Shuai , Zhang Fengli , Betts Natalie S. , Liang Wanqi , Bennett Malcolm J. , Persson Staffan , Zhang Dabing
Published: July 2021

Flag leaf angle impacts the photosynthetic capacity of densely grown plants and is thus an important agronomic breeding trait for crop architecture and yield. The hormone auxin plays a key role in regulating this trait, yet the underlying molecular and cellular mechanisms remain unclear. Here, we report that two rice (Oryza sativa) auxin response factors (ARFs), OsARF6 and OsARF17, which are highly expressed in lamina joint tissues, control flag leaf angle in response to auxin. Loss-of-function double osarf6 osarf17 mutants displayed reduced secondary cell wall levels of lamina joint sclerenchymatous cells (Scs), resulting in an exaggerated flag leaf angle and decreased grain yield under dense planting conditions. Mechanical measurements indicated that the mutant lamina joint tissues were too weak to support the weight of the flag leaf blade, resembling the phenotype of the rice increased leaf angle1 (ila1) mutant. We demonstrate that OsARF6 and OsARF17 directly bind to the ILA1 promoter independently and synergistically to activate its expression. In addition, auxin-induced ILA1 expression was dependent on OsARF6 and OsARF17. Collectively, our study reveals a mechanism that integrates auxin signaling with the secondary cell wall composition to determine flag leaf angle, providing breeding targets in rice, and potentially other cereals, for this key trait.
ASSESSMENT OF MEASUREMENT UNCERTAINTY FOR THE MEASUREMENT OF THE QUANTITY PERSONAL DOSE EQUIVALENT HP (10) IN PHOTON FIELDS USING THE GUM FRAMEWORK AND THE MONTE CARLO METHODS: APPLICATION TO GABON RESULTS OBTAINED DURING THE 2018 IAEA REGIONAL INTERCOMPARISON EXERCISE
Authors: Meye P Ondo , Mouandza S Y Loemba , Dallou G B , Omon Y , Bazoma J , Chaley C , Schandorf C , Ben-Bolie G H
Published: July 2021

This paper describes the essential of the “Guide to the expression of Uncertainty in Measurement” Framework (GUMF) Method and Monte Carlo Method (MCM) for propagating uncertainties, with an application to Gabon results obtained during the 2018 International Atomic Energy Agency (IAEA) regional intercomparison exercise. The work has shown that the output quantity Hp (10) follows a lognormal distribution. The study has also shown that although the normal distribution does not best approximate the distribution of the output quantity Hp (10), it has been observed that its estimate, the associated standard uncertainty and the coverage interval determined by GUMF and MCM were close, meaning that the application of the GUMF could still be seen as valid. Finally, the results obtained by the two methods are in agreement with International Commission on Radiological Protection and IAEA requirements for overall accuracy.
Prenatal immune stimulation alters the postnatal acute phase and metabolic responses to an endotoxin challenge in weaned beef heifers,
Authors: Carroll Jeffery A , Burdick Sanchez Nicole C , Broadway Paul R , Silva Gleise M , Ranches Juliana , Warren Julie , Arthington John D , Lancaster Phillip A , Moriel Philipe
Published: July 2021

This study evaluated whether administration of lipopolysaccharide (LPS) at each trimester of gestation would alter the acute phase (APR) and metabolic responses to a postnatal LPS challenge in weaned heifers. Pregnant crossbred multiparous cows (n = 50) were randomized into prenatal immune stimulation (PIS; n = 24; administered 0.1 µg/kg BW LPS subcutaneously at 71 ± 2, 170 ± 2 and 234 ± 2 d of gestation) and saline (CON; n = 26) groups. From these treatment groups, heifer calves (n = 12 PIS and 11 CON) were identified at weaning (244 ± 3 d of age) to receive an LPS challenge. On d 0, heifers were fitted with vaginal temperature (VT) devices, jugular catheters, and moved into individual stalls. On d 1, heifers were challenged i.v. with LPS (0.5 µg/kg BW) at 0 h. Blood samples were collected and sickness behavior scores (SBS) recorded at 0.5 h intervals from −2 to 8 h and at 24 h relative to LPS challenge. Serum was analyzed for cortisol, cytokines, glucose, non-esterified fatty acids (NEFA), and serum urea nitrogen (SUN) concentrations. Baseline VT was lesser in PIS heifers from −11 to −5 h pre-LPS (treatment × time: P < 0.01) compared to the CON; however, the post-LPS VT response did not differ between treatments (P = 0.89). There was a treatment × time interaction (P < 0.01) for SBS with PIS heifers having lesser SBS from 0.5 to 2 h post-LPS compared to CON. There was a treatment × time interaction (P = 0.03) for cortisol with PIS heifers having greater cortisol at 0.5, 3, 3.5, 5.5 and 6.5 h post-LPS compared to CON. There were treatment × time interactions for the post-LPS cytokine responses (P ≤ 0.05). Specifically, PIS heifers had greater TNF-α from 1.5 to 2 h, yet less TNF-α at 3 h than CON (P < 0.01), and PIS heifers had greater IFN-γ from 3.5 to 5.5 h post-LPS than CON (P < 0.01). In contrast, IL-6 was less in PIS than CON heifers from 1.5 to 8 h post-LPS (P < 0.001). Glucose concentrations were greater in PIS heifers at −1 h, but less at 2, 3 and 5.5 h compared to CON (treatment × time: P < 0.01). Serum NEFA concentrations were greater (P = 0.04) in PIS than CON heifers. There was a treatment × time interaction (P < 0.01) for SUN with PIS heifers having greater SUN concentrations at −2, −1.5, 2, 3, 6.5 and 24 h than CON. These data demonstrate that in utero exposure to multiple low doses of endotoxin has lasting physiological and immunological effects when the offspring encounter a similar postnatal immunological insult.
A qualitative exploration of the feasibility of incorporating depression apps into integrated primary care clinics
Authors: Dinkel Danae , Harsh Caspari Jennifer , Fok Louis , Notice Maxine , Johnson David J , Watanabe-Galloway Shinobu , Emerson Margaret
Published: July 2021

The use of mobile applications or “apps” is beginning to be identified as a potential cost-effective tool for treating depression. While the use of mobile apps for health management appears promising, little is known on how to incorporate these tools into integrated primary care settings—especially from the viewpoints of patients and the clinic personnel. The purpose of this study was to explore patient- and clinic-level perceptions of the use of depression self-management apps within an integrated primary care setting. Patients (n = 17), healthcare providers, and staff (n = 15) completed focus groups or semi-structured interviews in-person or via Zoom between January and July 2020. Participants were asked about barriers and facilitators to app use, how to best integrate it into care, and reviewed pre-selected mental health apps. Data were analyzed using a directed content analysis approach. From a patient perspective, features within the app such as notifications, the provision of information, easy navigation, and a chat/support function as well as an ability to share data with their doctor were desirable. Providers and staff identified integration of app data into electronic health records to be able to share data with patients and the healthcare team as well as clear evidence of effectiveness as factors that could facilitate implementation. All participants who reviewed apps identified at least one of them they would be interested in continuing to use. Overall, patients, healthcare providers, and staff believed depression apps could be beneficial for both patients and the clinic.
Proof of Concept for Shoot Blight and Fire Blight Canker Management with Postinfection Spray Applications of Prohexadione-Calcium and Acibenzolar-S-Methyl in Apple
Authors: Aćimović Srđan G. , Meredith Christopher L. , Santander Ricardo Delgado , Khodadadi Fatemeh
Published: July 2021

To reduce the severity of shoot blight and prevent the resulting development of cankers on perennial apple wood, we evaluated eight fire blight postinfection spray programs of prohexadione-calcium (PCA) alone or with acibenzolar-S-methyl (ASM) over 2 years. On mature trees of cultivar Royal Court, a single application of the high PCA rate (247 mg/liter) at 2 to 3 days after inoculation resulted in 89.5 and 69.5% reduction of shoot blight severity after inoculation. Two applications of PCA 247 mg/liter 12 or 14 days apart, with the first one applied 2 to 3 days after inoculation, resulted in 78.8 and 74.5% reduction of shoot blight severity in both years. A 100% control of canker incidence on perennial wood from infected shoots in both years was achieved with a single application of PCA (247 mg/liter) applied at 2 or 3 days after the inoculation, and three applications of PCA (125 mg/liter) + ASM (25 mg/liter) 12 to 16 days apart reduced canker incidence by 83.5 and 69% in the 2 years. The other programs with lower PCA rates and frequencies of application reduced shoot blight severity 50.8 and 51.8% (PCA) and 62.6 to 72% and 59.3% (PCA + ASM) over 2 years, respectively. Reduction of canker incidence on wood by the other programs was 66.5% and 69 to 90.4% in the two years, respectively. As fire blight cankers lead to death of dwarf apple trees and serve as primary sources of inoculum, our effective PCA and PCA + ASM programs could serve as viable postinfection management options. These treatments can reduce or prevent canker development and thus significantly abate tree losses in high-density apple orchards after fire blight epidemics occur.
Ultrasound-guided regional anesthesia in COVID-19 and future pandemics: infection control
Authors: Murata Hiroaki , Vanegas Cristina , Ogami-Takamura Keiko
Published: July 2021

Purpose of review

Infection control is inherent in ultrasound-guided regional anesthesia practice, because ultrasound transducer and coupling gel can be vectors for pathogen transmission. We reviewed the current standards and recommendations of ultrasound transducer cleaning, disinfection, and safe handling of ultrasound equipment. Based on the available data, we propose a set of practical recommendations applicable to coronavirus disease 2019 (COVID-19) pandemic and future epidemics.

Recent findings

Regional anesthesia is often preferred over general anesthesia for COVID-19 patients. Avoidance of general anesthesia reduces the need for aerosol generating procedures. Administration of ultrasound-guided regional anesthesia and surgery under regional anesthesia in COVID-19 patients requires careful infectious precautions to prevent the viral spread through the use equipment.

Ultrasound machine, transducer and coupling gel can serve as a vector for transmission of pathogens. In the era of COVID-19 pandemic, standardized strategies are recommended to minimize the risk of spread of COVID-19 to both patients and the healthcare providers.
Coexistence of a secondary STRN–ALK, EML4–ALK double-fusion variant in a lung adenocarcinoma patient with EGFR mutation: a case report
Authors: Zeng Qian , Gao Han , Zhang Longdan , Qin Shouming , Gu Yongyao , Chen Quanfang
Published: July 2021

ALK-positive disease is characterized by the presence of ALK gene rearrangements that encode driver fusion oncoproteins. EML4–ALK fusion is regarded as the most common type in advanced nonsmall cell lung cancers. STRN–ALK is a novel ALK fusion partner in NSCLC and is considered sensitive to targeted therapy. However, there was no study regarding effective therapy for EML4–ALK and STRN–ALK double fusion variants in EGFR-resistant mutant lung cancer. TP53, RB1, and EGFR exon 21 L858R were found in tumor tissues and plasma from patients with capture-based NGS. After 3 months of gefitinib treatment, an NGS of plasma circulating tumor DNA showed that all variants disappeared significantly, and the tumor mass regressed on CT. However, after 10 months, the patient developed drug resistance and the disease progressed with the appearance of new metastatic lesions in the liver and bones. A repeated NGS test revealed EGFR exon20 T790M and the appearance of a novel double-fusion EML4–ALK and STRN–ALK. A combined therapeutic regimen of crizotinib plus osimertinib showed a promising prognosis confirmed with lung CT scans showing stable lesions without any new metastasis. Moreover, a subsequent genotype by NGS also showed the disappearance of STRN–ALK and EGFR exon20 T790M. The therapeutic efficacy of crizotinib plus osimertinib on EML4–ALK and STRN–ALK double-fusion variant in patients with EGFR-resistant mutant lung cancer may provide a supportive reference for the patients with such genetic alteration.
Chemoimmunotherapy after progression on single-agent pembrolizumab for metastatic urothelial carcinoma: a case series
Authors: Childs Daniel S. , Quevedo J. Fernando , Costello Brian A. , Pagliaro Lance C.
Published: July 2021

Those with metastatic urothelial carcinoma generally respond more poorly to chemotherapy after they have progression on a checkpoint inhibitor (CPI). There is interest in combining CPIs with conventional cytotoxic chemotherapies as a strategy to exploit the efficacy and immunomodulatory effects of chemotherapy. We conducted a single institution, retrospective analysis including all patients treated between May 2018 and May 2020 with carboplatin and paclitaxel, concurrently or sequential with pembrolizumab, after having progression on a CPI alone. Clinical characteristics, response by RECIST 1.1, progression-free survival, and safety/tolerance of the treatment are reported. Median age was 80 years (64–85). Five patients (100%) had visceral metastases when starting carboplatin and paclitaxel. Chemotherapy was given with concurrent pembrolizumab (four patients) or following pembrolizumab (one patient) and continued until maximum response, significant toxicity, or progression. Two patients subsequently remained on maintenance pembrolizumab. There were four partial responses and one patient with stable disease. All patients on follow-up have progressed with median time to progression of 47 weeks (18–75). Two patients died from disease progression. This case series suggests that the combination of carboplatin, paclitaxel, and pembrolizumab leads to durable freedom from progression in some with metastatic urothelial cancer, who have progressed on a CPI alone. Larger studies of chemoimmunotherapy for metastatic urothelial carcinoma are warranted.
Real-world efficacy and safety of lorlatinib in treating advanced ALK-positive non–small cell lung cancer patients
Authors: Lee Po-Hsin , Chen Kun-Chieh , Hsu Kuo-Hsuan , Huang Yen-Hsiang , Tseng Jeng-Sen , Yang Tsung-Ying , Chang Gee-Chen
Published: July 2021

Anaplastic lymphoma kinase (ALK) translocation is a rare driver mutation in lung cancer. This study was aimed to report on the efficacy of lorlatinib in real-world practice and to evaluate the impact of prior ALK inhibitor treatments. We retrospectively evaluated patients with ALK-positive non–small cell lung cancer (NSCLC) treated with lorlatinib regarding its efficacy, the impact of prior ALK inhibitor treatments and the adverse events, in particular dyslipidemia. A total of 22 ALK-positive patients were analyzed. All patients had received at least one second-generation ALK inhibitor(s), while 12 patients had a history of crizotinib treatment. For lorlatinib, the objective response rate was 35.7%, and disease control rate was 64.3%. Their progression-free survival (PFS) was 6.2 months. With prior therapies, patients receiving only second-generation ALK inhibitor(s) treatment showed PFS longer than those with both crizotinib and second-generation ALK inhibitor(s) treatments (15.2 vs. 6.2 months). Moreover, patients who showed benefits from prior ALK inhibitor(s) also had a PFS longer than those who did not (6.5 vs. 3.5 months). Regarding adverse events, 94.7% of patients had dyslipidemia and 21.1% of them were in grade 3 or 4. None of these patients discontinued the treatment due to dyslipidemia. No acute complication occurred with dyslipidemia. The real-world efficacy of lorlatinib and adverse events were similar to those reported in clinical trials. Interestingly, the history and responses of prior ALK inhibitor treatments may influence the efficacy of subsequent lorlatinib treatment.
Central neurotoxicity induced by trastuzumab emtansine (T-DM1): a case report
Authors: Papageorgiou Georgios I. , Symeonidis David G. , Tsakatikas Sergios A. , Liatsos Alexandros D. , Douglas Konstantinos A. A. , Douglas Vivian P. , Moschos Marilita M. , Kosmas Christos
Published: July 2021

Trastuzumab emtansine (T-DM1) is a human epidermal growth factor receptor 2 (Her2) – targeted antibody-drug conjugate that is approved for patients previously treated with trastuzumab and a taxane for Her2-positive advanced breast cancer and those who have progressed within 6 months of completion of adjuvant chemotherapy, as well as for patients with residual invasive Her2-positive disease after the completion of adjuvant chemotherapy. Peripheral neuropathy is a common adverse event; however, ocular events have also been described. With the current report we present the case of a 67-year old woman who developed transient grade 2–3 blurred vision after the first T-DM1 infusion, which was complicated with grade 2 diplopia causing vertigo after the second infusion. After extended investigation, this symptomatology was attributed to central neurotoxicity, and gradually resolved after T-DM1 discontinuation.
Metastatic small cell lung cancer – an aggressive disease: a case report and literature review
Authors: Shalata Walid , Massalha Ismaell , Rouvinov Keren , Oscar Elron , Toker Margarita , A-J Ashraf , Dudnik Yulia , Yakobson Alexander
Published: July 2021

In the present case study, we describe a 53-year-old male with an aggressive small cell lung cancer (SCLC) that was diagnosed in January 2019. Our patient was treated as first line of systemic chemotherapy consisting of cisplatin and etoposide followed by mediastinal prophylactic radiotherapy with good response later he received for his metastatic disease (M-SCLC) a rechallenge of systemic chemotherapy consisting of carboplatin, etoposide and dulvalumab with stable disease and after progression his disease he was treated with lurbinectedin and after four cycles he reached a complete radiologic response. To the best of our knowledge, this is the first case to be reported of M-SCLC patient treated with prior of two types of platinum combination with immunotherapy and reaching a complete radiologic response.
Antibodies targeting Prostate-Specific Membrane Antigen positive prostate cancer: from diagnostic imaging to theranostics
Authors: Roumeguère Thierry , Aoun Fouad , Albisinni Simone , Mjaess Georges
Published: July 2021

Purpose of review

Targeting Prostate-Specific Membrane Antigen (PSMA) has paved the way for personalized medicine in prostate cancer (PCa) patients. This review aims to highlight the role of PSMA targeting antibodies in PCa, for diagnostic and therapeutic purposes.

Recent findings

PSMA Positron Emission Tomography/Computed Tomography has been a game changer in the diagnosis of PCa in the recent decade. Two anti-PSMA monoclonal antibodies have been studied in PCa: 7E11-C35 (limited use) and J591. J591 antibody was used for diagnostic purposes coupled with different radionuclides. Most importantly, it was combined to numerous therapeutic radionuclides such as Lutetium-177 (177Lu), Yttrium-90 (90Y), Indium-111 (111In), and Actinium-225 (225Ac). It was also conjugated to drugs forming antibody-drug conjugates (e.g. MLN2704 and PSMA-ADC). These compounds were tested in recent phase I/II clinical trials.

PSMA targeting antibodies are very promising for further clinical investigation and continue to be a momentous research area, for both imaging and therapeutic settings. Although some clinical trials resulted in unfavorably safety profiles for some antibodies, they validated PSMA as a crucial immunoconjugate target.
Psychometric Comparison of the English and Spanish Western-Hemisphere Versions of the Modified Checklist for Autism in Toddlers—Revised
Authors: DuBay Michaela , Watson Linda R. , Méndez Lucía I. , Rojevic Carolina
Published: July 2021

Objectives:

Parent-report screening tools for autism spectrum disorder (ASD) are widely used to promote early identification of children with or at risk for ASD. Most screening tools have been developed in English in the United States or United Kingdom; thus, translated versions are needed for use with culturally and linguistically diverse populations. Traditional translation methods include a forward translation, back translation, and review. However, when used in new cultural and linguistic contexts, this “forward-back” approach may have limitations, including differing psychometric properties compared with original instruments. This study presents a psychometric analysis of the forward-back translation methodology of an ASD screening tool.

Methods:

A retrospective chart review design was used to examine Modified Checklist for Autism in Toddlers—Revised (M-CHAT-R; Robins et al.) records from 2974 toddlers. Data were compared between caregivers who completed the original English M-CHAT-R and caregivers who completed its forward-back “Spanish-Western Hemisphere” translation to compare select psychometric properties of the 2 instruments.

Results:

Significant differences were observed between the 2 versions, including a higher overall risk score, higher initial screen-positive rate, and increased likelihood of leaving items blank among Spanish-speaking respondents.

Conclusion:

Traditional translation methods seemed to affect select psychometric properties between translations of the M-CHAT-R. A more rigorous cultural adaptation approach may be necessary to maintain equivalence with the original instrument. Until new rigorous translations are available, it is recommended that language-specific screening tools continue to be used, along with recommended follow-up interviews, to avoid exacerbating existing health disparities.
Resveratrol Confers Protection Against Ischemia/Reperfusion Injury by Increase of Angiotensin (1-7) Expression in a Rat Model of Myocardial Hypertrophy
Authors: Soltan Fahimeh , Esmaili Dahej Mansour , Yadegari Maryam , Moradi Ali , Hafizi Barjin Zeinab , Safari Fatemeh
Published: July 2021

Left ventricular hypertrophy (LVH) makes the heart vulnerable to ischemia/reperfusion (IR) injury. Angiotensin (Ang) (1-7) is recognized as a cardioprotective peptide. We investigated the effect of polyphenol resveratrol on myocardial IR injury after hypertrophy and examined cardiac content of Ang (1-7) and transcription of its receptor (MasR). Rats were divided into sham-operated, LVH, IR, LVH + IR, and resveratrol + LVH + IR groups. Myocardial hypertrophy and IR models were created by abdominal aortic banding and left coronary artery occlusion, respectively. To evaluate the electrocardiogram parameters and incidence of arrhythmias, electrocardiogram was recorded by subcutaneous leads (lead II). Blood pressure was measured through the left carotid artery. Infarct size was determined by the triphenyl tetrazolium chloride staining. The Ang (1-7) level was evaluated by immunohistochemistry. The Mas receptor mRNA level was assessed by the real-time real time reverse transcription polymerase chain reaction technique. QT-interval duration, infarct size, and incidence of ischemia-induced arrhythmia were significantly higher in the LVH + IR group. However, in the resveratrol-treated group, these parameters were decreased significantly. The cardiac level of Ang (1-7) was decreased in untreated hypertrophied hearts (LVH and LVH + IR groups). Pretreatment with resveratrol normalized the cardiac level of Ang (1-7). The mRNA level of Mas receptor was increased in all of hypertrophied hearts in the presence or absence of resveratrol. Resveratrol can decrease IR injury in rats with LVH. The anti-ischemic effect of resveratrol may be related to the enhancement of Ang (1-7)/MasR axis.
Dual Role of Mitophagy in Cardiovascular Diseases
Authors: Li Yibo , Meng Weizheng , Hou Yaxin , Li Dongxu , Wang Xiulong , Wu Kai , Sun Siyu , Liu Huibing , Li Xuefang , Lin Fei , Zhao Guoan
Published: July 2021

Mitophagy is involved in the development of various cardiovascular diseases, such as atherosclerosis, heart failure, myocardial ischemia/reperfusion injury, and hypertension. Mitophagy is essential for maintaining intracellular homeostasis and physiological function in most cardiovascular origin cells, such as cardiomyocytes, endothelial cells, and vascular smooth muscle cells. Mitophagy is crucial to ensuring energy supply by selectively removing dysfunctional mitochondria, maintaining a balance in the number of mitochondria in cells, ensuring the integrity of mitochondrial structure and function, maintaining homeostasis, and promoting cell survival. Substantial research has indicated a “dual” effect of mitophagy on cardiac function, with inadequate and increased mitochondrial degradation both likely to influence the progression of cardiovascular disease. This review summarizes the main regulatory pathways of mitophagy and emphasizes that an appropriate amount of mitophagy can prevent endothelial cell injury, vascular smooth muscle cell proliferation, macrophage polarization, and cardiomyocyte apoptosis, avoiding further progression of cardiovascular diseases.
Applications of interpretability in deep learning models for ophthalmology
Authors: Hanif Adam M. , Beqiri Sara , Keane Pearse A. , Campbell J. Peter
Published: July 2021

Purpose of review

In this article, we introduce the concept of model interpretability, review its applications in deep learning models for clinical ophthalmology, and discuss its role in the integration of artificial intelligence in healthcare.

Recent findings

The advent of deep learning in medicine has introduced models with remarkable accuracy. However, the inherent complexity of these models undermines its users’ ability to understand, debug and ultimately trust them in clinical practice. Novel methods are being increasingly explored to improve models’ ’interpretability’ and draw clearer associations between their outputs and features in the input dataset. In the field of ophthalmology, interpretability methods have enabled users to make informed adjustments, identify clinically relevant imaging patterns, and predict outcomes in deep learning models.

Interpretability methods support the transparency necessary to implement, operate and modify complex deep learning models. These benefits are becoming increasingly demonstrated in models for clinical ophthalmology. As quality standards for deep learning models used in healthcare continue to evolve, interpretability methods may prove influential in their path to regulatory approval and acceptance in clinical practice.
A review of the impact of exercise on fall rates among community-dwelling older adults
Authors: Pierson Kirsten , Maloney Meghan , Bavuso Alyssa , Dowling Kathryn , Kunsang Tenzin , Wong Michelle E.
Published: July 2021

Background:

The physical decrements of aging predispose older adults to falls and fall-related injuries. Consequences of falling place financial and logistical burdens on the health care system. With an aging population, mitigation of risk and reduction of harm are important objectives. Studies show that exercise can improve balance and build muscle mass. The challenge is prescribing safe and evidence-based exercise regimens to older adults.

Objectives:

The objective of this evidence review was to determine if an exercise program can reduce fall rates and prolong functional independence among older adults living in the community.

Data sources:

This review included 14 randomized control trials and one quasi-experimental interventional study, all published between 2014 and 2020.

Conclusions:

The evidence suggests that a home- or community-based exercise program with formal instruction and health care provider involvement can be an effective fall-prevention and harm reduction strategy for community-dwelling older adults.

Implications for practice:

The evidence suggests that a home- or community-based exercise program may be an effective fall-prevention strategy for older adults living independently in the community. Health care providers should educate these patients about the benefits of exercise as a fall-prevention measure and assist patients in increasing participation in exercise programs by making referrals and promoting engagement in evidence-based exercise programs.
Perioperative omega-3 fatty acids for liver surgery
Authors: Xiao Fubin , Han Wei , Yue Qing , Ke Jianji , Jia Baoxing , Fu Xiaojuan
Published: July 2021

Introduction:

The effect of perioperative omega-3 fatty acids for liver surgery remained controversial. We conducted a systematic review and meta-analysis to explore the influence of omega-3 fatty acids versus placebo in patients undergoing liver surgery.

Methods:

We have searched PubMed, EMbase, Web of science, EBSCO, and Cochrane library databases through May 2020, and included randomized controlled trials (RCTs) assessing the effect of omega-3 fatty acids versus placebo for liver surgery. This meta-analysis was performed using the random-effect model.

Results:

Five RCTs were included in the meta-analysis. Overall, compared with control group for liver surgery, omega-3 fatty acids were associated with substantially reduced incidence of infection (odd ratio [OR]=0.56; 95% confidence interval [CI] =0.34–0.91; P = .02), but revealed no remarkable influence on complications (OR = 0.60; 95% CI = 0.29–1.24; P = .17), mortality (OR = 0.76; 95% CI = 0.06–9.37; P = .83), liver failure (OR = 0.72; 95% CI = 0.10 to 5.00; P = 0.74), biliary leakage (OR=1.24; 95% CI = 0.41 to 3.76; P = .70), bleeding (OR = 1.76; 95% CI = 0.63–4.95; P = .28), or ileus (OR = 0.39; 95% CI = 0.07–2.05; P = .27).

Conclusion:

Perioperative omega-3 fatty acids may be beneficial to reduce the incidence of infection after liver surgery.