bluuebunny/crossref_metadata_2025 huggingface dataset:
In vivo MRI detection of intraplaque macrophages with biocompatible silica-coated iron oxide nanoparticles in murine atherosclerosis
Authors: Kim Chan Woo , Hwang Byung-Hee , Moon Hyeyoung , Kang Jongeun , Park Eun-Hye , Ihm Sang-Hyun , Chang Kiyuk , Hong Kwan Soo
Published: September 2021

Identification of a vulnerable atherosclerotic plaque before rupture is an unmet clinical need. Integrating nanomedicine with multimodal imaging has the potential to precisely detect biological processes in atherosclerosis. We synthesized silica-coated iron oxide nanoparticles (SIONs) coated with rhodamine B isothiocyanate and polyethylene glycol and investigated their feasibility in the detection of macrophages in inflamed atherosclerotic plaques of apolipoprotein E-deficient (ApoE−/−) mice via magnetic resonance (MR) and fluorescence reflectance (FR) imaging. In vitro cellular uptake of SIONs was assessed in macrophages using confocal laser scanning microscopy (CLSM). In vivo MR imaging was performed 24 h after SION injection via the tail vein in 26-week-old ApoE−/− mice fed a high-cholesterol diet (HCD). We also performed FR imaging of the extracted aortas from four different mice: two normal-diet-fed C57BL/6 mice injected with saline or 10 mg/kg SIONs and two HCD-fed ApoE−/− mice injected with 5 or 10 mg/kg SIONs. The harvested aortas were cryosectioned and stained with immunohistochemical staining. The CLSM images at 24 h after incubation showed efficient uptake of SIONs by macrophages, with no evidence of cytotoxicity. The in vivo and ex vivo MR and FR images demonstrated SION deposition in the atheroma. Upon immunohistochemical staining of the aorta, CLSM images revealed colocalization of macrophages and SIONs in the atherosclerotic plaque. These results demonstrate that polyethylene glycosylated SIONs could be a highly effective method to identify macrophage activity in atherosclerotic plaques as a multimodal imaging agent.
Characteristics and clinical potential of a cellularly modified gelatin sponge
Authors: Ye Danyan , Wu Sixun , Zhang Bingna , Hong Chuzhu , Yang Lujun
Published: September 2021

Background:

Human umbilical cord mesenchymal stem cells (HuMSCs) injected directly have been proven effective for improving chronic wounds. However, HuMSCs largely die within 14 days. The aim of study is to establish a cellularly modified gelatin sponge and investigate its characteristics and clinical potential.

Methods:

HuMSCs were isolated, expanded and seeded in a poly-L-lysine (PLL)-coated gelatin sponge. Fabricated gelatin sponges were estimated through observation of morphological surface and ultrastructure, following confirmed by histology method. Supernatants were collected at different times for enzyme-linked immunosorbent assays (ELISAs) to measure growth factors. The cell embedded gelatin sponges were implanted subcutaneously on the backs of mice and the samples were harvested and studied histologically.

Results:

HuMSCs gradually modified the gelatin sponge by depositing collagen and hyaluronic acid, and degrading the structure of gelatin, resulting in a dense, and elastic structure. Compared with cells cultured in monolayer, the levels of growth factors increased remarkably when HuMSCs were cultivated in the gelatin sponge. Upon subcutaneous implantation in the backs of mice, the cellularized gelatin sponges persisted for up to 2 months and eventually integrated into the host tissue, while blank gelatin sponges degraded completely by the end of the second month.

Conclusion:

Gelatin sponge is a clinically accessible scaffold for HuMSCs implantation to maintain short-term survival of the cells and high-level production of growth factors, which demonstrates good clinical potential for enhancing wound healing.
Contributions of the Third and Fourth Digits and the Second and Fifth Digits of the Flexor Digitorum Superficialis Muscle to Elbow Valgus Stability
Authors: Matsuzawa Kanta , Edama Mutsuaki , Ikezu Masahiro , Otsuki Tomofumi , Maruyama Sae , Sato Noboru
Published: September 2021

Background:

Thiel cadavers have been reported to have lifelike flexibility and mechanical properties, but whether they are useful for measurement of the ulnohumeral joint space (JS) is unclear. The contributions of the third and fourth digits and the second and fifth digits of the flexor digitorum superficialis (FDS) to elbow valgus stability are also unknown.

Purpose:

To (1) clarify whether Thiel cadavers can be used for JS measurement on ultrasound and (2) identify the contributions to valgus stability of the third and fourth digits and the second and fifth digits of the FDS.

Study Design:

Descriptive laboratory study.

Methods:

In experiment 1 (12 elbows from human volunteers and 12 elbows from Thiel cadavers), valgus stress was increased gradually from 0 to 30 to 60 N, and the JS was compared on ultrasound between groups at each load. In experiment 2 (13 elbows from Thiel cadavers), specimens were divided into 2 groups, and the JS was measured for group 1 with the FDS intact, with tendinous insertions of the third and fourth digits cut (3/4-cut state), and with tendinous insertions of all fingers cut (all-cut state); and for group 2 at intact FDS, with tendinous insertions of the second and fifth digits cut (2/5-cut state), and at all-cut.

Results:

In experiment 1, the rate of change of the JS increased significantly with elbow valgus stress in both humans and Thiel cadavers, with no significant difference between groups. In experiment 2, the JS was significantly greater in the 3/4- and 2/5-cut states compared with the intact state at both 30 N (Δ3/4-cut vs intact = 0.23 mm [ P = .01]; Δ2/5-cut vs intact = 0.32 mm [ P = .02]) and 60 N (Δ3/4-cut vs intact = 0.33 mm [ P = .002]; Δ2/5-cut vs intact = 0.37 mm [ P = .04]). There was no significant difference in JS measurements between the 3/4- and 2/5-cut states at any load.

Conclusion:

Thiel cadavers showed JS changes similar to those of humans when valgus stress was applied. The third and fourth digits and the second and fifth digits of the FDS were involved in valgus stability, and there was no difference in their respective contributions.

Clinical Relevance:

This study may help in identifying function of the FDS based on structure.
Anterior Cruciate Ligament Reconstruction With Concomitant Meniscal Repair: Is Graft Choice Predictive of Meniscal Repair Success?
Authors: Salem Hytham S. , Huston Laura J. , Zajichek Alexander , McCarty Eric C. , Vidal Armando F. , Bravman Jonathan T. , Spindler Kurt P. , Frank Rachel M. ,   MOON Knee Group, Amendola Annunziato , Andrish Jack T. , Brophy Robert H. , Jones Morgan H. , Kaeding Christopher C. , Marx Robert G. , Matava Matthew J. , Parker Richard D. , Wolcott Michelle L. , Wolf Brian R. , Wright Rick W.
Published: September 2021

Background:

When meniscal repair is performed during anterior cruciate ligament (ACL) reconstruction (ACLR), the effect of ACL graft type on meniscal repair outcomes is unclear.

Hypothesis:

The authors hypothesized that meniscal repairs would fail at the lowest rate when concomitant ACLR was performed with bone--patellar tendon--bone (BTB) autograft.

Study Design:

Cohort study; Level of evidence, 3.

Methods:

Patients who underwent meniscal repair at primary ACLR were identified from a longitudinal, prospective cohort. Meniscal repair failures, defined as any subsequent surgical procedure addressing the meniscus, were identified. A logistic regression model was built to assess the association of graft type, patient-specific factors, baseline Marx activity rating score, and meniscal repair location (medial or lateral) with repair failure at 6-year follow-up.

Results:

A total of 646 patients were included. Grafts used included BTB autograft (55.7%), soft tissue autograft (33.9%), and various allografts (10.4%). We identified 101 patients (15.6%) with a documented meniscal repair failure. Failure occurred in 74 of 420 (17.6%) isolated medial meniscal repairs, 15 of 187 (8%) isolated lateral meniscal repairs, and 12 of 39 (30.7%) of combined medial and lateral meniscal repairs. Meniscal repair failure occurred in 13.9% of patients with BTB autografts, 17.4% of patients with soft tissue autografts, and 19.4% of patients with allografts. The odds of failure within 6 years of index surgery were increased more than 2-fold with allograft versus BTB autograft (odds ratio = 2.34 [95% confidence interval, 1.12-4.92]; P = .02). There was a trend toward increased meniscal repair failures with soft tissue versus BTB autografts (odds ratio = 1.41 [95% confidence interval, 0.87-2.30]; P = .17). The odds of failure were 68% higher with medial versus lateral repairs ( P < .001). There was a significant relationship between baseline Marx activity level and the risk of subsequent meniscal repair failure; patients with either very low (0-1 points) or very high (15-16 points) baseline activity levels were at the highest risk ( P = .004).

Conclusion:

Meniscal repair location (medial vs lateral) and baseline activity level were the main drivers of meniscal repair outcomes. Graft type was ranked third, demonstrating that meniscal repairs performed with allograft were 2.3 times more likely to fail compared with BTB autograft. There was no significant difference in failure rates between BTB versus soft tissue autografts.

Registration:

NCT00463099 (ClinicalTrials.gov identifier).
Qualitative and Quantitative Anatomy of the Human Quadriceps Tendon in Young Cadaveric Specimens
Authors: Strauss Marc , Kennedy Mitchell L. , Brady Alex , Moatshe Gilbert , Chahla Jorge , LaPrade Robert F. , Lind Martin , Engebretsen Lars
Published: September 2021

Background:

A detailed understanding of the anatomy of the quadriceps tendon (QT) is clinically relevant, owing to its increased use as a graft in anterior cruciate ligament reconstruction.

Purpose:

To qualitatively and quantitatively describe the anatomy of the QT in younger adult specimens.

Study Design:

Descriptive laboratory study.

Methods:

A total of 18 nonpaired cadaveric knees with a mean age of 30.1 years (range, 18-38 years) were utilized for this study. A 3-dimensional coordinate measuring system was used to assess the structural relationships between the different layers of the QT and their attachments to the patella, and QT thickness was measured medially, centrally, and laterally at 2-cm intervals from the patellar eminence line (PEL; defined as a straight line between the medial and lateral patellar eminences) and proximally.

Results:

In all specimens, 3 distinct layers formed the QT. The first (superficial) layer was formed by the rectus femoris, which was fused to the second layer with an unclearly defined direct attachment to the patella. The median length of the QT was 86.9 mm (range, 68.4-98.9 mm). The second (middle) layer consisted of the vastus medialis and vastus lateralis and was found to have fibers running in an oblique direction that attached on the patella. A “fuse point,” where the proximal part of the rectus femoris started to merge to the second layer, was identified at a median of 48.7 mm (range, 27.9-62.6 mm) from the PEL. The third (deep) layer consisted of the vastus intermedius. The median thickness of the graft centrally at 20, 40, 60, 80, and 100 mm from the PEL was 8.5, 7.2, 7.5, 6.5, and 5.4 mm, respectively.

Conclusion:

Overall, 3 different layers of the QT were consistently found in all specimens. The first layer was fused with the second layer, and the direction of the fibers of the second layer or the vastus medialis and vastus lateralis was oblique. The median length of the QT was 86.9 mm, and the thickness of the tendon diminished proximally.

Clinical Relevance:

This study allows for a better understanding of QT anatomy when harvesting the tendon as a graft for ligamentous reconstruction.
Comparison Between Early and Late Retensioning of an Adjustable-Loop Cortical Suspension Device During Hamstring ACL Reconstruction
Authors: Choi Nam-Hong , Yang Bong-Seok , Kang Hang-Ki , Kim Kyu-Wan , Kim Han-Bit , Victoroff Brian N.
Published: September 2021

Background:

Biomechanical studies have demonstrated significant loosening of the adjustable-loop device as compared with the fixed-loop device used in anterior cruciate ligament reconstruction. Retensioning of the adjustable loop has been recommended; however, the timing of the retensioning is unknown.

Hypothesis:

Early (ER) and late retensioning (LR) will show similar gapping between the femoral tunnel and graft on follow-up magnetic resonance imaging (MRI) and similar clinical outcomes.

Study Design:

Cohort study; Level of evidence, 3.

Methods:

This study included 101 patients who underwent hamstring anterior cruciate ligament reconstruction using the adjustable-loop device for femoral fixation between June 2016 and January 2018. All patients a had follow-up MRI on postoperative day 1. Patients with revision surgery and those with reinjury after reconstruction were excluded. In the ER group, retensioning and knot tying of the initially tightened adjustable loop were performed after the flip of the button and before the graft was fixed at the tibia. In the LR group, retensioning and knot tying were performed after initial tightening of the adjustable loop and graft fixation at the tibial side. The tunnel-graft gap measured on multiplanar reformatted images of MRI scans was compared between the groups, as were clinical outcomes.

Results:

The mean age of the patients at the time of surgery was 30.3 years (range, 14-61 years). ER and knot tying were performed in 56 patients and LR and knot tying in 45. Preoperative characteristics of the 2 groups showed no significant differences. The mean ± SD tunnel-graft gap was 1.5 ± 2.0 mm in the ER group and 5.4 ± 4.0 mm in the LR group ( P < .001). There were no significant differences in clinical outcomes between the groups.

Conclusion:

ER and knot tying demonstrated less tunnel-graft gap than that of LR. However, there were no differences in clinical outcomes according to the timing of retensioning.
Explaining Indonesia’s Under-balancing: The Case of the Modernisation of the Air Force and the Navy
Authors: Gindarsah Iis , Priamarizki Adhi
Published: September 2021

The current maritime challenges that Indonesia faced had not led to the development of the navy and air force. While theories of neoclassical realism highlighted the importance of domestic factors when determining responses at the strategic level, inefficiencies within the state bureaucracy had often been the bane of prudent policies. Our article attempts to engage with the neorealist concept of under-balancing to look at the reasons why there is stagnation in Indonesia’s naval and air force development. The proponents of under-balancing blamed inefficient bureaucracy as the cause of the issue. Our study on Indonesia’s naval and air force development indicated that inefficient bureaucracy was not the only driver of under-balancing. Looking at the agenda of naval and air force modernisation, this research argues the lack of commitment from the government, limited economic sources and the different modernisation priorities at the military unit level that had greatly contributed to the mismatch between systemic pressure and the response, in this case through naval and air force development, against it.
Experiences of Patients on Natural Herbal Treatments for Diabetes Mellitus at the Diabetes Clinic in Base Hospital - Matara, Sri Lanka
Authors: Edussuriya A.S.J. , Subhashini S.Y.S. , Amarasinghe K.D.S. , Kumari G.S.D. , Perera K.M.O.N. , Munidasa K.G.P.K.
Published: September 2021

The prevalence of diabetes mellitus has become a global public health issue. Natural herbal treatments for type 2 diabetes mellitus have been widely used in traditional societies but has recently become popular among western societies as well. The aim of this study was to explore the experience of type 2 patients with diabetes mellitus who are currently on natural herbal treatment. A qualitative, phenomenological design has been used. Twelve participants from both males and females, aged between 25 and 75 years, who were on medical treatment, were selected for sampling. In-depth interviews were conducted at the diabetes clinic in a selected hospital in southern Sri Lanka. The athematic analysis was conducted, and 6 themes were derived. The majority of participants (75%) were motivated to use natural herbal treatments other than oral glycemic therapy. Experiences have been identified as the most influential factors in the use of natural herbal treatments. The need for educational interventions on natural herbal treatments and to propose the integration of herbal medicine into current medical systems is recommended.
Palliative and End-of-Life Care in the Home in Regional/Rural Victoria, Australia: The Role and Lived Experience of Primary Carers
Authors: Miller Elizabeth M. , Porter Joanne E. , Peel Rebecca
Published: September 2021

Introduction

Palliative support services (generalist or specialist) can provide much-needed assistance to carers who are providing palliative and end-of-life care in their homes, but access to such services in regional and rural areas of Australia is poorly understood.

Objectives

This study aimed to explore the role and lived experience of primary carers who are providing palliative and end-of-life care in the home in regional/rural Victoria, Australia.

Methods

Nine female participants, of whom six were bereaved between 7 and 20 months were interviewed using a semistructured interview technique. Each interview was audio-recorded, transcribed verbatim, and analyzed thematically.

Results

Two themes emerged: “ Negotiating healthcare systems” which described the needs for multidisciplinary supports and “ The caring experience” which discussed daily tasks, relationships, mental and physical exhaustion, respite, isolation, medication management, and grief and loss. Findings show that regional/rural carers have an added burden of travel stress as well as feeling overwhelmed, isolated, and physically and emotionally exhausted. Carers would benefit from greater flexibility for short-term respite care. The engagement of specialist palliative care services assisted the participants to navigate the health care system. Some participants did not understand the value of palliative care, highlighting the need for general practitioners to conduct early conversations about this with their patients. Education is needed to build capacity within the primary palliative care workforce, confirming the importance of timely referrals to a specialist palliative care practitioner if pain or symptom control is not effectively managed.

Conclusion

Providing palliative and end-of-life care in the home is an exhausting and emotionally draining role for unpaid, primary carers. Multiple supports are needed to sustain primary carers, as they play an essential role in the primary health care system.
Nursing Students' Eating Habits, Subjective, and Mediterranean Nutrition Knowledge During the COVID-19 Pandemic
Authors: Green Gizell
Published: September 2021

Background

Mediterranean nutrition knowledge, healthy eating habits, and subjective nutritional knowledge are crucially important to nursing students’ health. The study strives to examine, during the COVID-19 pandemic period: (a) nursing students' eating habits and their subjective nutritional knowledge according to three groups: novice, advanced, and senior; and (b) subjective knowledge and its role as a mediator between Mediterranean nutritional knowledge and nursing students’ eating habits.

Methods

A cross-sectional study design with a convenience sample consisting of 212 university nursing students. Participants volunteered to complete a questionnaire that examined their eating habits, subjective nutritional knowledge, and Mediterranean diet knowledge. The university's institutional review board provided permission to conduct the current study.

Results

Nursing students from the novice group had better eating habits than the advanced and senior groups, and no significant differences were found between the advanced and senior groups regarding eating habits. Additionally, Mediterranean nutritional knowledge had a positive indirect effect on eating habits through subjective nutritional knowledge. Therefore, subjective nutritional knowledge partially mediated the relationship between Mediterranean nutritional knowledge and eating habits.

Conclusion

First, especially for the advanced and senior groups, it is important to create opportunities for learning via seminars, symposia, and webinars. Interprofessional teams, such as clinical nutritionists or a registered certified dietitian and nursing student, can engage with important, authentic information. Second, since subjective nutritional knowledge was found to be a partial mediator, it may be assumed that there are other mediating variables that we did not examine in this study. Therefore, it is necessary to conduct further research to examine other factors that can serve as mediators for eating habits, in addition to subjective knowledge, especially during COVID-19 times.
Community/Public Health Nurses’ Awareness of Residential High-Rise Fire Safety issues
Authors: Glauberman Gary , Qureshi Kristine
Published: September 2021

High-rise (HR) building fires remain a tragic cause of preventable injury and death in the United States. Recent incidences of HR building fires have served as high-profile reminders of the persistent threat that HR fires pose to public health. Fire safety is an important aspect of household emergency preparedness addressed by community/public health nurses (C/PHNs). This study aimed to address a gap in the literature regarding C/PHNs’ awareness of fire safety for people and families who reside in HR buildings. A descriptive qualitative study using key-informant and focus group interviews was conducted involving C/PHNs ( n  =  19) in Honolulu, Hawaii. Qualitative data analysis revealed three main themes related to this issue: (1) C/PHN awareness of HR fire safety issues, (2) C/PHN perceived barriers for HR building occupant fire safety, and (3) C/PHN suggested strategies to address HR fire safety for occupants. Findings highlight how more needs to be done to assure that C/PHNs are adequately prepared to work with occupants of residential HR buildings on matters related to fire safety.
The Aesthetics and Politics of the Abstract Line in Bhimayana: Experiences of Untouchability
Authors: Rajendran Punnya
Published: September 2021

When Bhimayana: Experiences of Untouchability, a graphic biography of the life of B. R. Ambedkar, was first published in 2011, it was welcomed as an enunciation of Dalit identity and as a uniquely Indian counterpart to the Western sequential art of comics in its use of Pardhan Gond artistic practices. My argument for moving beyond the twin poles of ‘Dalit identity’ and ‘tribal art’ is threefold. First, a close reading of Bhimayana reveals that the narrative emphasis is not so much on caste as identity as it is a critique of the processes involved in that very identity. Second, the visual style of Bhimayana does not merely mirror the political concerns of the text; the images are an aesthetic response to the ‘problem’ of identity as enunciated in the linear narrative. Third, in order to identify how exactly the images form such a response, we need to arm ourselves with an alternative methodology. The question is therefore how to read, how to look—what is the ideal spectatorial position for the pages of Bhimayana such that it critically intersects with the question of identity? The analysis of the visual object at a ‘subrepresentative’ realm, therefore, becomes the key to breaking out of old habits of looking at the image as a site of representation towards the possibility that the politics of image-making lies instead in its aesthetic intensities.
Blood–brain barrier permeability in survivors of immune-mediated thrombotic thrombocytopenic purpura: a pilot study
Authors: Huang Shih-Han Susan , Pavenski Katerina , Lee Ting-Yim , Jurkiewicz Michael T. , Bharatha Aditya , Thiessen Jonathan Dale , St. Lawrence Keith , Théberge Jean , Mandzia Jennifer , Barth David , Licht Christoph , Patriquin Christopher Jordan
Published: September 2021

Immune-mediated thrombotic thrombocytopenic purpura (iTTP) is a rare, life-threatening disorder of systemic microthrombosis and organ ischemia. The etiology of chronic cerebrovascular outcomes in iTTP survivors is largely unknown. In this pilot study, we measured blood–brain barrier (BBB) permeability in patients with iTTP at the start of remission and 6 months later. This prospective pilot study included 7 adult patients with incident iTTP. Eligibility criteria included ADAMTS13 activity < 10% and detectable inhibitor at diagnosis. Patients were recruited from London Health Sciences Centre in Canada (2017-2019) within 3 days of hospital admission and followed for 6 months after remission (defined as normalization of platelet count and lactate dehydrogenase with no clinical signs or symptoms of microvascular injury for more than 30 days after the last plasma exchange). All patients had cerebral computed tomography perfusion scans with BBB permeability surface product measurements. Patients (5 women, 2 men) had a mean age of 48 years (range, 21-77 years). At diagnosis, patients had a mean platelet count of 22 (standard deviation [SD], 25) × 109/L. At the start of remission, mean BBB permeability surface product was 0.91 (0.30) mL/min/100 g. Six months later, the mean permeability surface product was 0.56 (0.22) mL/min/100 g, with a mean difference of −0.312 mL/min/100 g (95% confidence interval: −0.4729 to −0.1510; P = .0032). In this pilot study of patients with iTTP, pathologically increased BBB permeability was evident, and although there was some improvement, this persisted 6 months after remission. Future work will explore the chronicity of these findings and their clinical implications.
Optimization on the Crosswind Stability of Trains Using Neural Network Surrogate Model
Authors: Zhang Le , Li Tian , Zhang Jiye , Piao Ronghuan
Published: September 2021

Under the influence of crosswinds, the running safety of trains will decrease sharply, so it is necessary to optimize the suspension parameters of trains. This paper studies the dynamic performance of high-speed trains under crosswind conditions, and optimizes the running safety of train. A computational fluid dynamics simulation was used to determine the aerodynamic loads and moments experienced by a train. A series of dynamic models of a train, with different dynamic parameters were constructed, and analyzed, with safety metrics for these being determined. Finally, a surrogate model was built and an optimization algorithm was used upon this surrogate model, to find the minimum possible values for: derailment coefficient, vertical wheel-rail contact force, wheel load reduction ratio, wheel lateral force and overturning coefficient. There were 9 design variables, all associated with the dynamic parameters of the bogie. When the train was running with the speed of 350 km/h, under a crosswind speed of 15 m/s, the benchmark dynamic model performed poorly. The derailment coefficient was 1.31. The vertical wheel-rail contact force was 133.30 kN. The wheel load reduction rate was 0.643. The wheel lateral force was 85.67 kN, and the overturning coefficient was 0.425. After optimization, under the same running conditions, the metrics of the train were 0.268, 100.44 kN, 0.474, 34.36 kN, and 0.421, respectively. This paper show that by combining train aerodynamics, vehicle system dynamics and many-objective optimization theory, a train’s stability can be more comprehensively analyzed, with more safety metrics being considered.
PathFams: statistical detection of pathogen-associated protein domains
Authors: Lobb Briallen , Tremblay Benjamin Jean-Marie , Moreno-Hagelsieb Gabriel , Doxey Andrew C.
Published: September 2021

Background

A substantial fraction of genes identified within bacterial genomes encode proteins of unknown function. Identifying which of these proteins represent potential virulence factors, and mapping their key virulence determinants, is a challenging but important goal.

Results

To facilitate virulence factor discovery, we performed a comprehensive analysis of 17,929 protein domain families within the Pfam database, and scored them based on their overrepresentation in pathogenic versus non-pathogenic species, taxonomic distribution, relative abundance in metagenomic datasets, and other factors.

Conclusions

We identify pathogen-associated domain families, candidate virulence factors in the human gut, and eukaryotic-like mimicry domains with likely roles in virulence. Furthermore, we provide an interactive database called PathFams to allow users to explore pathogen-associated domains as well as identify pathogen-associated domains and domain architectures in user-uploaded sequences of interest. PathFams is freely available at https://pathfams.uwaterloo.ca.
Diazepam induced sleep spindle increase correlates with cognitive recovery in a child with epileptic encephalopathy
Authors: Stoyell S. M. , Baxter B. S. , McLaren J. , Kwon H. , Chinappen D. M. , Ostrowski L. , Zhu L. , Grieco J. A. , Kramer M. A. , Morgan A. K. , Emerton B. C. , Manoach D. S. , Chu C. J.
Published: September 2021

Background

Continuous spike and wave of sleep with encephalopathy (CSWS) is a rare and severe developmental electroclinical epileptic encephalopathy characterized by seizures, abundant sleep activated interictal epileptiform discharges, and cognitive regression or deceleration of expected cognitive growth. The cause of the cognitive symptoms is unknown, and efforts to link epileptiform activity to cognitive function have been unrevealing. Converging lines of evidence implicate thalamocortical circuits in these disorders. Sleep spindles are generated and propagated by the same thalamocortical circuits that can generate spikes and, in healthy sleep, support memory consolidation. As such, sleep spindle deficits may provide a physiologically relevant mechanistic biomarker for cognitive dysfunction in epileptic encephalopathies.

Case presentation

We describe the longitudinal course of a child with CSWS with initial cognitive regression followed by dramatic cognitive improvement after treatment. Using validated automated detection algorithms, we analyzed electroencephalograms for epileptiform discharges and sleep spindles alongside contemporaneous neuropsychological evaluations over the course of the patient’s disease. We found that sleep spindles increased dramatically with high-dose diazepam treatment, corresponding with marked improvements in cognitive performance. We also found that the sleep spindle rate was anticorrelated to spike rate, consistent with a competitively shared underlying thalamocortical circuitry.

Conclusions

Epileptic encephalopathies are challenging electroclinical syndromes characterized by combined seizures and a deceleration or regression in cognitive skills over childhood. This report identifies thalamocortical circuit dysfunction in a case of epileptic encephalopathy and motivates future investigations of sleep spindles as a biomarker of cognitive function and a potential therapeutic target in this challenging disease.
Cross-talk and clinical value of m[superscript 6]A regulatory gene in bladder cancer
Authors: Zhou Ben-zheng , Luo Qin , Zhang Ye
Published: September 2021

Background

RNA modification is a regulation at the post-transcriptional level. RNA methylation modification accounts for more than 60% of all RNA modifications, and m[superscript 6]A(6-methyladenine) is the most common type of RNA methylation modification on mRNA of higher organisms. The modification level of transcription m[superscript 6]A is dynamically regulated by methyltransferase (reader), binding protein (writer) and demethylase (eraser). Furthermore, m[superscript 6]A methylation has been found to have an impact on tumor initiation and progression through various mechanisms.

Methods

13 genes related m[superscript 6]A from all the gene expressions in The Cancer Genome Atlas (TCGA) were screened. Gene Ontology (GO) and KEGG analysis were applied to explore the functions of genes identified in study. We clustered the related regulators of m[superscript 6]A into three subgroups with “ConsensusClusterPlus”. 13 genes were used for univariate Cox analysis to find genes associated with prognosis, and the risk model was constructed based on lasso regression. According to the median risk score of each patient, the patients were divided into high and low risk groups for survival analysis. The ROC curve evaluates the model. Then the risk group and clinical characteristics were analyzed.

Results

The three subgroups had different clinical characteristics. Our tumor clusters were related to grade, survival status. Moreover, we observed a significantly longer overall survival (OS) in the cluster 1 than the cluster 2 and cluster 3. Three m[superscript 6]A-related genes related to prognosis were used to construct a prognostic risk model. We found age are independent prognostic marker. What’s more, risk score can also be an independent prognostic factor.

Conclusion

Revealing the regulation and functional mechanism of cross-talk among m[superscript 6]A writers, erasers, and readers, and determine its role in bladder cancer may help in developing novel and efficient strategies for the diagnosis, prognosis and treatment of bladder cancer.
Associations of early childhood caries with salivary beta defensin-3 and childhood anemia: a case–control study
Authors: Faheem Sanam , Maqsood Shahida , Hasan Arshad , Imtiaz Fouzia , Shaikh Faheem , Farooqui Waqas Ahmed
Published: September 2021

Background

Human beta defensin-3 (HβD-3) is an antimicrobial peptide present in saliva that protects tooth surfaces from microbial attack. These peptides are part of innate immunity so levels may be affected by different systemic diseases like anemia. Therefore, anemia may predispose an affected child to an increased risk of dental caries. The objectives of this study were to determine the association of early childhood caries (ECC) with HβD-3 levels and observe the association of HβD-3 levels with childhood anemia.

Methods

A total of 80 children admitted in a pediatric medical ward, age 48–71 months, of either sex were included in the study. The included children were categorized as cases (children with ECC n = 40) and controls (children without ECC n = 40). Children were further segregated into the anemic and non-anemic sub-groups based on the hospital record of hemoglobin level. The salivary concentration of HβD-3 was measured by Enzyme-Linked Immuno-sorbent assay (ELISA). IBM SPSS version 20 software was used for statistical analysis. Two sample t-test and one-way ANOVA were used to compare mean values while spearman was used for correlations at p < 0.05.

Results

The mean Salivary HβD-3 level in cases (8.87 ± 4.30) was significantly higher (p = 0.042) as compared to controls (7.23 ± 2.57). Salivary HβD-3 level in patients with caries and without anemia was highest (10.80 ± 4.50) whereas salivary HβD-3 level in the presence of caries and anemia was lowest (6.94 ± 3.13) amongst all groups. This difference was statistically significant (p = 0.001). Salivary HβD-3 level was found to be moderately correlated with cases (p = 0.002). An inverse correlation was found between salivary HβD-3 level and anemia (r = -0.479, p = 0.002).

Conclusion

Anemia may affect the innate immunity of children, and may result in a decreased level of salivary HβD3, thus increasing vulnerability to decay.
Addressing challenges in information-provision: a qualitative study among oncologists and women with advanced breast cancer
Authors: van Vliet Liesbeth M. , Meijers Maartje C. , van Dulmen Sandra , van der Wall Elsken , Plum Nicole , Stouthard Jacqueline , Francke Anneke L.
Published: September 2021

Background

There is a need for more insight into how to address challenges of information-provision for women with advanced breast cancer. We aimed to explore oncologists’ and patients’ views on (i) the challenges of information-provision, and (ii) possible strategies to address these challenges, meanwhile (iii) exploring the possible facilitating role of positive expectations and empathy.

Methods

Semi-structured interviews were held with oncologists (n = 10) and women with advanced breast cancer (n = 14). Principles of Thematic Analysis were followed, with two researchers analyzing transcribed data, supported by Atlas.ti software.

Results

Taken together the data from oncologists and patients, we found that when communicating with patients with advanced cancer, oncologists face challenges, including handling patients’ unrealistic disease (status) beliefs, and choosing approaches for discussing available treatment options and their side effects. Possible strategies to address these challenges include balancing information with acceptance of denial, and using medical expertise to guide treatment discussions. A sensitive issue is whether to discuss the option of no anti-cancer treatment. Meanwhile, approaches and preferences for discussions of side effects vary. Positive expectations and empathy can facilitate information-provision by creating space and helping patients to open up more.

Conclusions

Integrating oncologists’ and patients’ views, oncologists can provide realistic information while also, temporarily, accepting denial, and can use their medical expertise to address challenges around unrealistic beliefs and discussion of treatment options. Finding ways to tailor discussions of no anti-cancer treatment and side-effect information are needed. Positive expectations and empathy might facilitate – tailored – information-provision, leading ultimately to patient-centered care lying at the heart of medicine.
Home care workers’ experiences of work conditions related to their occupational health: a qualitative study
Authors: Grasmo Sunniva Grønoset , Liaset Ingeborg Frostad , Redzovic Skender Elez
Published: September 2021

Background

The need for home care workers (HCWs) is rapidly growing in Norway due to the increasingly growing elderly population. HCWs are exposed to a number of occupational hazards and physically demanding work tasks. Musculoskeletal disorders, stress, exhaustion, high sick leave rates and a high probability of being granted a disability pension are common challenges. This qualitative study explored the views of HCWs on how working conditions affect their safety, health, and wellbeing.

Methods

A descriptive and explorative design was utilised using semi-structured individual interviews with eight HCWs from three home care units in a middle-sized Norwegian city. Interviews were conducted in the Norwegian language, audio-recorded, and transcribed verbatim. The data was analysed by systematic text condensation. Key data quotes were translated into English by the authors.

Results

HCWs reported that meaningful work-related interactions and relationships contributed to their improved wellbeing. Challenging interactions, such as verbal violence by consumers, were deemed stressful. The unpredictable work conditions HCWs encounter in users’ homes contributed to their exposure to environmental hazards and unhealthy physical workloads. This was the case, although the employer promoted ergonomic work practices such as ergonomic body mechanics when mobilising and handling of clients, using safe patient handling equipment. HCWs perceived high level of individual responsibility for complying with company safety policies and practices, representing a health barrier for some. Organisational frameworks created unhealthy work conditions by shift work, time pressure and staffing challenges. Performing tasks in accordance with HCWs professional skills and identity was perceived as health-promoting.

Conclusions

This study suggests that unpredictable working conditions at users’ home can adversely affect the safety, health, and wellbeing of HCWs. The interaction between the unpredictable environment at users’ homes, HCWs’ perceived high level of individual responsibility for complying with company safety policies and practices, and staffing challenges due to sickness-related absences upon the workplace creates tense work conditions with a negative influence on HCWs health.
Factors to improve quality for older patients in the emergency department: a qualitative study of patient trajectory
Authors: De Brauwer Isabelle , Cornette Pascale , D’Hoore William , Lorant Vincent , Verschuren Franck , Thys Frédéric , Aujoulat Isabelle
Published: September 2021

Background

Managing older people in the emergency department remains a challenge. We aimed to identify the factors influencing the care quality of older patients in the emergency department, to fine-tune future interventions for older people, considering the naturalistic context of the ED.

Methods

This is a qualitative study of some 450 h of observations performed in three emergency departments selected for their diverse contexts. We performed seventy observations of older patient trajectories admitted to the emergency department. Themes were extracted from the material using an inductive reasoning approach, to highlight factors positively or negatively influencing management of patient’s trajectories, in particular those presenting with typically geriatric syndromes.

Results

Four themes were developed: no geriatric flow routine; risk of discontinuity of care; unmet basic needs and patient-centered care; complex older patients are unwelcome in EDs.

Conclusions

The overall process of care was based on an organ- and flow-centered paradigm, which ignored older people’s specific needs and exposed them to discontinuity of care. Their basic needs were neglected and, when their management slowed the emergency department flow, older people were perceived as unwelcome. Findings of our study can inform the development of interventions about the influence of context and organizational factors.
Multimorbidity and achievement of treatment goals among patients with type 2 diabetes: a primary care, real-world study
Authors: Heikkala Eveliina , Mikkola Ilona , Jokelainen Jari , Timonen Markku , Hagnäs Maria
Published: September 2021

Background

Type 2 diabetes (T2D), with its prevalence and disability-causing nature, is a challenge for primary health care. Most patients with T2D are multimorbid, i.e. have one or more long-term diseases in addition to T2D. Multimorbidity may play a role in the achievement of T2D treatment targets, but is still not fully understood. The aims of the present cross-sectional, register-based study were to evaluate the prevalence and the most common patterns of multimorbidity among patients with T2D; and to study the potential associations between multimorbidity and treatment goal achievement, including measurements of glycosylated haemoglobin A1c (HbA1c), low-density lipoprotein (LDL) and systolic blood pressure (sBP).

Methods

The study population consisted of 4545 primary care patients who received a T2D diagnosis between January 2011 and July 2019 in Rovaniemi Health Centre, Finland. Data on seven long-term concordant (T2D-related) diseases, eight long-term discordant (non-T2D-related) diseases, potential confounders (age, sex, body mass index, prescribed medication), and the outcomes studied were collected from patients’ records. Logistic regression models with odds ratios (ORs) and 95 % confidence intervals (CIs) were assessed to determine the associations between multimorbidity and the achievement of treatment targets.

Results

Altogether, 93 % of the patients had one or more diseases in addition to T2D, i.e. were considered multimorbid. Furthermore, 21 % had only concordant disease(s) (Concordant subgroup), 8 % had only discordant disease(s) (Discordant subgroup) and 64 % had both (Concordant and discordant subgroup). As either single diseases or in combination with others, hypertension, musculoskeletal (MS) disease and hyperlipidaemia were the most prevalent multimorbidity patterns. Being multimorbid in general (OR 1.32, CI 1.01–1.70) and belonging to the Concordant (OR 1.45, CI 1.08–1.95) and Concordant and discordant (OR 1.31, CI 1.00–1.72) subgroups was associated with achievement of the HbA1c treatment target. Belonging to the Concordant and discordant subgroup was related to meeting the LDL treatment target (OR 1.31, CI 1.00–1.72).

Conclusions

Multimorbidity, including cardiovascular risk and the musculoskeletal disease burden, was extremely prevalent among the T2D patients who consulted primary health care. Primary care clinicians should survey the possible co-existence of long-term diseases among T2D patients to help maintain adequate treatment of T2D.
Body weight changes in patients with type 2 diabetes and a recent acute coronary syndrome: an analysis from the EXAMINE trial
Authors: Ferreira João Pedro , Rossignol Patrick , Bakris George , Mehta Cyrus , White William B. , Zannad Faiez
Published: September 2021

Background

Patients with type 2 diabetes (T2D) may experience frequent body weight changes over time. The prognostic impact of these weight changes (gains or losses) requires further study.

Aims

To study the associations between changes in body weight (intentional or unintentional) with subsequent outcomes.

Methods

The EXAMINE trial included 5380 patients with T2D and a recent acute coronary syndrome, who were randomized to alogliptin or placebo. Time-updated Cox models and mixed effects models were used to test the associations between changes in body weight and subsequent outcomes over a median follow-up of 1.6 (1.0–2.1) years.

Results

During the post-randomization follow-up period, 1044 patients (19.4%) experienced a weight loss ≥ 5% of baseline weight, 2677 (49.8%) had a stable weight, and 1659 (30.8%) had a ≥ 5 % weight gain. Patients with weight loss were more frequently women and had more co-morbid conditions. In contrast, patients who gained ≥ 5% weight were more frequently men with less co-morbid conditions. A weight loss ≥ 5% was independently associated with a higher risk of subsequent adverse outcomes, including all-cause mortality: adjusted HR (95% CI) = 1.79 (1.33–2.42), P < 0.001. Similar associations were found for cardiovascular mortality, the composite of cardiovascular mortality or heart failure hospitalization, and the primary outcome. A weight gain ≥ 5% was independently associated with an increase in the risk of subsequent cardiovascular mortality or heart failure hospitalization only: adjusted HR (95% CI) = 1.34 (1.02–1.76), P = 0.033.

Conclusions

In patients with T2D who had a recent ACS/MI, a ≥ 5% loss of body weight was associated with a higher risk of subsequent cardiovascular events and mortality.