bluuebunny/crossref_metadata_2025 huggingface dataset:
Digital Storytelling for Bereaved Individuals in a Virtual Setting
Authors: Rolbiecki Abigail J. , Washington Karla T. , Bitsicas Katina C. , Lero Christine M. , Spinner Eileen , Akard Terrah Foster
Published: December 2021

An emerging body literature exists highlighting the use of Digital Storytelling as an educational, and/or therapeutic intervention. Authors of this manuscript have studied Digital Storytelling as a narrative bereavement intervention designed to help individuals make meaning of adverse life events, like the death of a family member. Until recently, Digital Storytelling is typically delivered in person. The purpose of this article is to describe the steps to implementing Digital Storytelling as a bereavement intervention in a completely virtual setting, using Zoom technology. Best practices and lessons learned for the virtual delivery of Digital Storytelling are provided.
Predictors of Future Walking Speed: A 12-Month Monitoring Program
Authors: Dunsky Ayelet , Zeev Aviva , Netz Yael
Published: December 2021

The purpose of the current study was to identify significant predictors of walking speed (WS) among community-dwelling older adults, as it is one of the most representative measures of functioning in their daily lives. Seventy-seven (24 adult men, 26 adult women, and 27 older-adult women) community-dwelling older adults (73.7 ± 4.9 years) performed two assessments, over a 12-month period. Several physical, cognitive, and psychological tests were performed, as well as assessing the preferred WS. Multiple linear regression, stratified by gender, was used to identify significant predictors of future WS. For the adult men, walking and functional performances at the first assessment predicted 71.9%; for adult women, reaction time, walking, and balance performance predicted 64.4%; and, for the older-adult women, fast walking and reaction time predicted 48.2% of the variance of future WS. Clinicians should consider including different exercises for each group of older adults to evaluate and preserve functional abilities.
The mid-term outcome of interventricular septal hematoma after ventricular septal defect closure
Authors: Aoki Masaya , Ikeno Yuki , Ibuki Keijiro , Ozawa Sayaka , Hirono Keiichi , Yoshimura Naoki
Published: December 2021

We present the case report of a patient who developed interventricular septal hematoma as a complication during perimembranous ventricular septal defect closure. Although cardiopulmonary bypass was re-established and the hematoma was aspirated, postoperative echocardiography revealed that the hematoma reaccumulated in the interventricular septum. She suffered from low-cardiac-output syndrome for 1 week requiring a large amount of inotropic agents. Postoperative echocardiography revealed that the interventricular septal hematoma gradually disappeared. At 1 year follow-up, 99mTc-tetrofosmin myocardial single-photon emission computed tomographic revealed myocardial ischemia in the inferior and septal walls. At 4 years follow-up, her cardiac function has gradually improved. She has no symptoms of heart failure with angiotensin-converting enzyme inhibitor and beta-blocker.
Efficacy of ultrasound assisted catheter-directed thrombolysis compared to catheter-directed thrombolysis in vitro
Authors: Nadjiri Jonathan , Kierse Anna , Sendlbeck Melanie , Janssen Agnes , Geith Tobias , Waggershauser Tobias , Paprottka Philipp M
Published: December 2021

Background

Catheter-directed thrombolysis (CDT) is an effective and safe endovascular method used in critical limb ischemia and many other thromboembolic events. Ultrasound-assisted catheter-directed thrombolysis (US-CDT) is an emerging technique considered to accelerate thrombolysis and therefore is supposed to improve outcome.

Purpose

To evaluate the efficacy of US-CDT in comparison to standard CDT in vitro.

Material and Methods

A total of 69 sets of human venous blood were evaluated, each comprising a tube just treated with CDT, a tube treated with US-CDT, and a control tube. All tubes were kept under physiological conditions. Except for the controls, in all tubes 5 mg of tissue-type plasminogen activator was administered over the predetermined treatment interval. Thrombus mass was weighted at the end of the lysis intervals at 6 h or 24 h, respectively.

Results

CDT led to a mean thrombus reduction of 32% and ultrasound-assisted lysis led to a mean thrombus reduction of 41% ( P < 0.001 for both). Thrombus reduction was significantly higher after US-CDT compared to CDT ( P = 0.001). The better efficacy of US-CDT was mostly already apparent at early phases during thrombolysis and did further mildly increase over time (r = 0.24; P = 0.047).

Conclusion

In vitro US-CDT is significantly superior to standard CDT; this effect is apparent at an early timepoint of lysis and slightly further increases over time.
More-than-human economies of writing
Authors: Waight Emma
Published: December 2021

In this article, and based on the theme of economies of writing, I explore writing as a more-than-human or posthuman practice. In particular, I consider the way in which academics curate writing places and spaces and the role of matter (things, natures and technologies) in these assemblages of writing by drawing on a Baradian take on posthumanism. The article utilises empirical data from a qualitative, photovoice study with doctoral students. The aim of the article is to encourage reflection on the way we, as academics, experience and teach writing practice in a more-than-human world, and how these experiences relate to productivity and wellbeing.
The Role of Optimism on the Relationship Between Activity Limitations and Life Satisfaction Among Middle-Aged and Older Adults in the United States: A Growth Curve Model of Changes Over Time
Authors: Cheng Kent Jason Go , McMaughan Darcy Jones (DJ) , Smith Matthew Lee
Published: December 2021

Activity limitations can diminish life satisfaction. This study explored the role of optimism on the relationship between changes in activities of daily living and instrumental activities of daily living (ADL/IADL) limitations and life satisfaction over time among middle-aged and older adults. Growth curve modeling accounting for intra- and inter-individual changes in life satisfaction was applied to the 2008–2018 waves of the Health and Retirement Study Leave Behind Survey subsample ( n = 39,122 person-years). After controlling for sociodemographic factors, physical functioning decline adversely affected life satisfaction ( βADL = −0.12, βIADL = −0.13, p < 0.001), but the negative consequences reduced slightly through optimism ( βADL = −0.11, βIADL = −0.12, βoptimism = 0.47, p < 0.001). Increasing optimism could reduce the negative consequences of ADL/IADL limitations on life satisfaction among middle-aged to older adults.
Novel application of mapping method from small displacement torsor to tolerance: Error optimization design of assembly parts
Authors: Mu Xiaokai , Yuan Bo , Wang Yunlong , Sun Wei , Liu Chong , Sun Qingchao
Published: December 2021

The manufacturing/assembly error of machine parts is a key factor that influences the performance and economy of mechanical systems. To achieve high assembly precision and performance on the basis of low manufacturing accuracy and cost, this study primarily optimizes the assembly error of machine parts. First, the small displacement torsor is used to characterize the small deformation between the mating surfaces of parts. Subsequently, to realize the combination of small displacement torsor and tolerance, the small displacement torsor with manufacturing error and assembly deformation is mapped to the tolerance domain. Second, based on the relationship between small displacement torsor and tolerance, an assembly error optimization model is established on the basis of the conventional tolerance-cost model, considering the emergence of manufacturing error and assembly deformation. Third, aiming at the high-pressure rotor for aeroengines, the error optimization design of assembly is carried out developed with the assembly accuracy requirement as the constraint condition, and the total costs of the manufacturing and assembly processes as the objective. The optimization results indicate that the manufacturing error range of each mating surface after optimization changes, from small to large, under the premise of ensuring the product’s performance, which verifies that the difficulty in processing parts is reduced, and that the efficiency of parts processing is also improved. Meanwhile, the relative manufacturing cost after optimization is reduced by 6.79%, which reflects the economic requirements to a certain extent. The content of this article provides the necessary design basis and reference for the realization of high assembly accuracy of mechanical systems, under low cost requirements from the design perspective.
Multi-objective optimization in incremental sheet forming of Ti-6Al-4V alloy using grey relational analysis method
Authors: Ajay C Veera , Elangovan S , Pratheesh Kumar S , Manisekar K
Published: December 2021

Incremental sheet forming is a novel approach and advanced manufacturing process in industries, where it is capable of producing complex geometrical components with high accuracy. In this study, Ti-6Al-4V material used in aircraft, naval ships, spacecraft, armour plating and missiles was considered to determine the formability in the incremental sheet forming process. A 20 set of experiments were conducted considering three process variables such as tool rotational speed, step depth and feed rate on the response variables such as formed wall thickness, surface roughness, thrust force and wall angle. The process parameters are optimized using the grey relational analysis method to achieve a better quality of products. By execution multi-objective optimization using grey relational analysis, it is observed that 200 r/min tool rotational speed, 0.1 mm step depth and 2000 mm/min feed rate are optimum parameter settings.
Endometrial Stromal Expression of ER, PR, and B-Catenin Toward Differentiating Hyperplasia Diagnoses
Authors: Chatzipantelis Paschalis , Koukourakis Michail , Balaska Konstantina , Giatromanolaki Alexandra
Published: December 2021

Background. The interpretation of histopathological changes of endometrial hyperplasia with or without atypia can be challenging. We aim to investigate the role of specific immunohistochemical markers in the endometrial stroma to classify endometrial hyperplasia in difficult cases. Methods and Results. We retrospectively reviewed and reclassified (WHO 2014): 47 specimens with endometrial hyperplasia without atypia, 33 with atypical hyperplasia (AH), and 13 endometrioid adenocarcinomas. We performed IHC for B-catenin, E-cadherin, p16, estrogen receptors and progesterone receptors, and B-cell lymphoma 2 (BCL2). Percentage of positive stromal cells was calculated. B-catenin was equally expressed in the stroma of both hyperplasia and AH (mean 60%, 50%; P = .17) and was absent from adenocarcinoma (0%, hyperplasia vs adenocarcinoma; P < .0001, AH vs adenocarcinoma; P < .0001). E-cadherin was not expressed in the stroma of any lesion, while p16 expression levels were not statistically different (hyperplasia vs AH; P = .46, hyperplasia vs adenocarcinoma; P = .22, AH vs adenocarcinoma; P = .48). Estrogen and progesterone were highly identified in stromal cells of hyperplasia (80%) and diminished in AH (respectively, at 30% and 60%, hyperplasia vs AH; P < .0001), and in adenocarcinoma (0% and 40%, respectively). Finally, BCL2 was not differentially expressed (hyperplasia vs AH; P = .33, hyperplasia vs adenocarcinoma; P = .17, AH vs adenocarcinoma; P = .36). Conclusion. Estrogen and progesterone were strongly expressed in stroma exclusively of hyperplasia, while B-catenin was particularly expressed in hyperplasia and AH. Use of these markers can be useful in the differential diagnosis of hyperplasia from AH, and AH from adenocarcinoma in challenging cases.
Remembering Dr Li-Ching Lee, a pioneer of global autism research
Authors: Rubenstein Eric , Rice Catherine , Hollingue Calliope , Tsai Peng-Chou , Stewart Lydia , Daniele Fallin M
Published: December 2021

The field of global autism research lost a pioneer, champion, and innovator with the passing of Dr Li-Ching Lee in May 2021. Dr Lee served as the editor for a special issue in Autism on global autism research (2017, Volume 21, Issue 5) and her substantial impact on autism research and autistic individuals and their families in low- and middle-income countries warrants a place in this special issue. While a giant in the professional arena, her large impact on science is minor compared to the compassion, kindness, and love she brought to her family, friends, and her professional communities at Johns Hopkins, across institutions, her native Taiwan, and the areas in which she conducted her research. Dr Lee was immensely humble and intensely focused on harnessing epidemiology to positively impact the lives of people with autism and developmental disabilities. Her humility and professional dedication was coupled with a desire to keep her own challenges and triumphs private including her courageous efforts to stave off cancer while accomplishing so much in support of others.
Doctors’ knowledge regarding decision-making capacity: A survey of anesthesiologists
Authors: Moodley Alastair , Dhai Ames
Published: December 2021

Informed consent for anesthesia is an ethical and legal requirement. A patient must have adequate decision-making capacity (DMC) as a prerequisite to informed consent. In determining whether a patient has sufficient DMC, anesthesiologists must draw on their knowledge of DMC. Knowledge gaps regarding DMC may result in incorrect assessments of patients’ capacity. This could translate to an informed consent process that is ethically and legally unsound. This study examined the DMC-related knowledge of anesthesiologists in a group of four university-affiliated hospitals. The findings suggest that anesthesiologists have several areas of knowledge deficiency regarding DMC and DMC assessment. These findings could inform the development of undergraduate and postgraduate curricula.
An effective, low-cost method to improve the movement velocity measurement of a smartphone app during the bench press exercise
Authors: Külkamp Wladymir , Rosa-Junior Jairo L , Ache-Dias Jonathan , Carminatti Lorival J
Published: December 2021

Some studies have reported considerable errors in the movement velocity measurement when using the My Lift app. This study aimed to investigate whether these errors may be related to the use of a range of movement (ROM) statically measured prior to the movement (ROMMYLIFT) instead of ROM dynamically monitored. Ten young adults performed two repetitions of the bench press exercise on a Smith machine with loads that allowed two velocity conditions (above and below 0.6 m s−1). The exercises were monitored by the My Lift app, a magnet and a rotary encoder. After, 15 older adults performed the same exercise at different percentages of 1RM, monitored by the My Lift app and a magnet. The results revealed that ROM dynamically obtained by encoder (reference method) with the mean velocity above (0.497 ± 0.069 m) and below (0.450 ± 0.056 m) 0.6 m s−1 were quite different ( p < 0.05; large effect) from the ROMMYLIFT (0.385 ± 0.040 m). These errors provided highly biased and heteroscedastic mean velocity measurements (mean errors approximately 22%). The errors observed in adults were also observed in the older participants, except for loads equal to 85% of 1RM. The magnet method proved to be valid, presenting measurements very close to the encoder (mean errors approximately 1.7%; r > 0.99). In conclusion, the use of ROMMYLIFT is inadequate, as the higher the movement velocity, the higher the errors, both for young and older adults. Thus, to improve the measurement of the My Lift app, it is recommended that the magnet method be used in conjunction with the app to more accurately determine the ROM.
Impact of high-risk cytogenetics on outcomes for children and young adults receiving CD19-directed CAR T-cell therapy
Authors: Leahy Allison Barz , Devine Kaitlin J. , Li Yimei , Liu Hongyan , Myers Regina , DiNofia Amanda , Wray Lisa , Rheingold Susan R. , Callahan Colleen , Baniewicz Diane , Patino Maria , Newman Haley , Hunger Stephen P. , Grupp Stephan A. , Barrett David M. , Maude Shannon L.
Published: December 2021

Chimeric antigen receptor (CAR) T-cell therapy can induce durable remissions of relapsed/refractory B-acute lymphoblastic leukemia (ALL). However, case reports suggested differential outcomes mediated by leukemia cytogenetics. We identified children and young adults with relapsed/refractory CD19+ ALL/lymphoblastic lymphoma treated on 5 CD19-directed CAR T-cell (CTL019 or humanized CART19) clinical trials or with commercial tisagenlecleucel from April 2012 to April 2019. Patients were hierarchically categorized according to leukemia cytogenetics: High-risk lesions were defined as KMT2A (MLL) rearrangements, Philadelphia chromosome (Ph+), Ph-like, hypodiploidy, or TCF3/HLF; favorable as hyperdiploidy or ETV6/RUNX1; and intermediate as iAMP21, IKZF1 deletion, or TCF3/PBX1. Of 231 patients aged 1 to 29, 74 (32%) were categorized as high risk, 28 (12%) as intermediate, 43 (19%) as favorable, and 86 (37%) as uninformative. Overall complete remission rate was 94%, with no difference between strata. There was no difference in relapse-free survival (RFS; P = .8112), with 2-year RFS for the high-risk group of 63% (95% confidence interval [CI], 52-77). There was similarly no difference seen in overall survival (OS) (P = .5488), with 2-year OS for the high-risk group of 70% (95% CI, 60-82). For patients with KMT2A-rearranged infant ALL (n = 13), 2-year RFS was 67% (95% CI, 45-99), and OS was 62% (95% CI, 40-95), with multivariable analysis demonstrating no increased risk of relapse (hazard ratio, 0.70; 95% CI, 0.21-2.90; P = .7040) but a higher proportion of relapses associated with myeloid lineage switch and a 3.6-fold increased risk of all-cause death (95% CI, 1.04-12.75; P = .0434). CTL019/huCART19/tisagenlecleucel are effective at achieving durable remissions across cytogenetic categories. Relapsed/refractory patients with high-risk cytogenetics, including KMT2A-rearranged infant ALL, demonstrated high RFS and OS probabilities at 2 years.
Intestinal IL-33 promotes platelet activity for neutrophil recruitment during acute inflammation
Authors: Chen Zuojia , Luo Jialie , Li Jian , Kim Girak , Stewart Andy , Huang Yuefeng , Wu Chuan
Published: December 2021

Peripheral serotonin (5-HT) is mainly generated from the gastrointestinal tract and taken up and stored by platelets in the circulation. Although the gut is recognized as a major immune organ, how intestinal local immune responses control whole-body physiology via 5-HT remains unclear. Here, we show that intestinal inflammation enhances systemic platelet activation and blood coagulation. Intestinal epithelium damage induces elevated levels of the alarm cytokine interleukin-33 (IL-33), leading to platelet activation via promotion of gut-derived 5-HT release. More importantly, we found that loss of intestinal epithelial-derived IL-33 lowers peripheral 5-HT levels, resulting in compromised platelet activation and hemostasis. Functionally, intestinal IL-33 contributes to the recruitment of neutrophils to sites of acute inflammation by enhancing platelet activities. Genetic deletion of intestinal IL-33 or neutralization of peripheral IL-33 protects animals from lipopolysaccharide endotoxic shock through attenuated neutrophil extravasation. Therefore, our data establish a distinct role of intestinal IL-33 in activating platelets by promoting 5-HT release for systemic physiology and inflammation.
Factors associated with prolonged duration of viral clearance in non-severe SARS-CoV-2 patients in Osaka, Japan
Authors: Hoffman Emma Nakagawa , Kawachi Haruna , Hirayama Atsushi , Zhang Jingwen , Murayama Ayumi , Masui Jun , Fujita Satomi , Mori Yasushi , Hirayama Takanori , Ohara Toshitake , Asada Rumiko , Iso Hiroyasu
Published: December 2021

Background

We investigated factors associated with prolonged viral clearance of SARS-CoV-2 among non-severe adult patients in Osaka, Japan. A total of 706 laboratory-confirmed COVID-19 patients were enrolled in this longitudinal observational study between 29 January 2020 and 31 May 2020, across 62 hospitals and three non-hospital recuperation facilities.

Methods

Logistic regression analysis was performed to investigate the factors associated with prolonged (29 days: upper 25% in duration) viral clearance of SARS-CoV-2. Linear regression analysis was conducted to assess these factors 14 days after symptom onset.

Results

The median duration of viral clearance was 22 days from symptom onset. After adjustment for sex, age, symptoms, comorbidity, and location of recuperation, comorbidities were associated with prolonged duration: (OR, 1.77 [95% CI, 1.11–2.82]) for one, (OR, 2.47 [95% CI, 1.32–4.61]) for two or more comorbidities. Viral clearance 14 days after symptom onset was 3 days longer for one comorbidity and 4 days longer for two or more comorbidities compared to clearance when there was no comorbidity.

Conclusion

The presence of comorbidity was a robust factor associated with a longer duration of viral clearance, extending by 3 to 4 days compared to patients with no comorbidity.
Hospitalizations related to meningococcal infection in Spain from 1997 to 2018
Authors: Walter Stefan , Gil-Prieto Ruth , Gil-Conesa Mario , Rodriguez-Caravaca Gil , San Román Jesús , Gil de Miguel Angel
Published: December 2021

Background

Baseline hospitalization, mortality, and in-hospital fatality rates for meningococcal infection are required to evaluate preventive interventions, such as the inclusion of the conjugated quadrivalent meningococcal vaccine and serogroup B based protein vaccines.

Methods

All meningococcal infection–related hospitalizations in any diagnostic position in Spain from 1st January 1997 through 31st December 2018 were analysed. The annual hospitalization rate, mortality rate and case-fatality rate were calculated.

Results

The average hospitalization rate for meningococcal infection was 1.64 (95% CI 1.61 to 1.66) hospitalizations per 100,000 inhabitants during the study period and significantly decreased from 1997 to 2018. Hospitalizations for meningococcal infection decreased significantly with age and were concentrated in children under 5 years of age (46%). The hospitalization rates reached 29 per 100,000 and 24 per 100,000 children under 1 and 2 years of age, respectively. The in-hospital case-fatality rate was 7.45% (95% CI 7.03 to 7.86). Thirty percent of the deaths occurred in children under 5 years of age, and more than half occurred in adults. The case fatality rate increased significantly with age (p < 0.001).

Conclusion

It is necessary to maintain epidemiological surveillance of meningococcal infection to determine the main circulating serogroups involved, track their evolution, and evaluate preventive measures whose effectiveness must be assessed in all age groups.
Effectiveness and safety of pegylated liposomal doxorubicin versus epirubicin as neoadjuvant or adjuvant chemotherapy for breast cancer: a real-world study
Authors: Zhang Jin , Jiang Hongchuan , Zhang Jian , Bao Guoqiang , Zhang Guoqiang , Wang Haibo , Wang Xi
Published: December 2021

Background

Pegylated liposomal doxorubicin (PLD) is an improved formulation of doxorubicin with comparable effectiveness but significantly lower cardiotoxicity than conventional anthracycline. This study aimed to evaluate the real-world effectiveness and safety of PLD versus epirubicin as neoadjuvant or adjuvant treatment for breast cancer.

Methods

Clinical data of invasive breast cancer patients who received neoadjuvant or adjuvant chemotherapy with PLD or epirubicin were retrospectively collected. Propensity score matching (PSM) was performed to reduce the risk of selection bias. The molecular typing of these patients included Luminal A, Luminal B, HER2-positive, and basal-like/triple-negative. The primary outcome was pathological complete response (pCR) rate for neoadjuvant chemotherapy and 3-year disease-free survival (DFS) rate for adjuvant chemotherapy. Noninferiority was suggested if the lower limit of the 95% CI for the 3-year DFS rate difference was greater than − 10%. The secondary outcome was adverse reactions.

Results

A total of 1213 patients were included (neoadjuvant, n = 274; adjuvant, n = 939). pCR (ypT0/Tis ypN0) rates of patients who received neoadjuvant chemotherapy were 11.6% for the PLD group and 7.0% for the epirubicin group, but the difference was not statistically significant (P = 0.4578). The 3-year DFS rate of patients who received adjuvant chemotherapy was 94.9% [95%CI, 91.1–98.6%] for the PLD group and 95.4% [95%CI, 93.0–97.9%] for the epirubicin group (P = 0.5684). Rate difference between the two groups and its 95% CI was - 0.55 [− 5.02, 3.92]. The lower limit of the 95% CI was − 5.0% > − 10.0%, suggesting that PLD is not be inferior to epirubicin in adjuvant chemotherapy for breast cancer. The incidences of myelosuppression, decreased appetite, alopecia, gastrointestinal reactions, and cardiotoxicity were lower in the PLD group than in the epirubicin group, while the incidence of nausea was higher in the PLD group.

Conclusions

In the neoadjuvant and adjuvant treatment of breast cancer, effectiveness is similar but toxicities are different between the PLD-containing regimen and epirubicin-containing regimen. Therefore, further study is warranted to explore PLD-based neoadjuvant and adjuvant chemotherapy for breast cancer.
Characteristics of inhomogeneous lower extremity growth and development in early childhood: a cross-sectional study
Authors: Apibantaweesakul Sudarat , Omura Shiho , Qi Weihuang , Shiotani Hiroto , Evangelidis Pavlos E. , Sado Natsuki , Tanaka Fumiko , Kawakami Yasuo
Published: December 2021

Background

Early childhood is a transferring stage between the two accelerated growth periods (infant and adolescent). Body dimensions are related to physical growth and development. The purpose of this study was to investigate physical growth in terms of anthropometry, muscle growth of the lower extremity, and functional development over early childhood.

Methods

A cross-sectional study was carried out on 29 preschool children (PS: 3–5 years), 21 school children (SC: 6–8 years), and 22 adults (AD: 20–35 years). Lower extremity characteristics (segmental dimensions, muscle and adipose tissue thicknesses of the thigh and lower leg), and voluntary joint torque (knee and ankle) were measured. Correlations between parameters and group comparisons were performed.

Results

All the parameters except for body mass index (BMI) and subcutaneous adipose tissue thickness were correlated with age for PS and SC combined (r = 0.479–0.920,p < 0.01). Relative thigh and shank lengths to body height were greatest in AD and smallest in PS (p < 0.05) but the relative foot dimensions were significantly larger in PS and SC than in AD (p < 0.05). Relative subcutaneous adipose tissue thickness was largest in PS and lowest in AD. Muscle thickness and the muscle volume measure (estimated from muscle thickness and limb length) were significantly larger in older age groups (p < 0.05). All groups showed comparable muscle thickness when normalized to limb length. Joint torque normalized to estimated muscle volume was greatest for AD, followed by SC and PS (p < 0.05).

Conclusions

Relative lower extremity lengths increase with age, except for the foot dimensions. Muscle size increases with age in proportion to the limb length, while relative adiposity decreases. Torque-producing capacity is highly variable in children and rapidly develops toward adulthood. This cross-sectional study suggests that children are not a small scale version of adults, neither morphologically nor functionally.
Demographic, clinical, and socioeconomic factors associated with delayed diagnosis and management of pediatric testicular torsion in West China: a retrospective study of 301 cases in a single tertiary children’s hospital
Authors: Yu Chengjun , Zhao Jie , Lu Jiandong , Wei Yi , Jiang Li , Zhao Tianxin , Lin Tao , He Dawei , Wen Sheng , Wu Shengde , Wei Guanghui
Published: December 2021

Background

To investigate the association between geographic, clinical, socioeconomic factors and delayed management of pediatric testicular torsion (TT) in West China.

Methods

A retrospective study was conducted on TT at Children’s Hospital of Chongqing Medical University in West China from November 2004 to December 2020. Univariate analysis and logistic regression analysis were conducted to determine the association between these factors and delayed management of TT.

Results

A total of 301 cases were included in this study. The misdiagnosis rate of TT in primary, secondary healthcare units and tertiary hospitals was 93.8, 71.1, and 8.9%, respectively. Approximately 26.9% of TT boys received timely surgical management (within 12 h from symptoms inset to surgery). Logistic regression analyses suggested the following factors were associated with delayed repair of TT:

age less than 6 years (P = 0.001), with a history of symptoms progress (P = 0.001) or former treatment (P <0.001), absence of other diagnosis (P = 0.011) and those boys living far away from the main city zones (P <0.001).

Conclusions

Delayed surgical management for TT was more likely for boys with age less than 6 years, the absence of other diagnosis, with a history of former treatment or symptoms progress, and those living far away from the main city zone. To maximize the possibility of timely surgical management for TT, it is vital to strengthen the public awareness of TT and conduct continuously re-education and update physicians working at primary and secondary healthcare units.
Patients’ views of shared decision making in inflammatory bowel disease: a survey in China
Authors: Xu Dingting , Zhang Hanyun , Chen Yan
Published: December 2021

Background

Recently, decision-making process has become increasingly complex. But there is limited information on Chinese patients’ views of shared decision making (SDM) in inflammatory bowel disease (IBD). This questionnaire investigation aimed to understand Chinese patients’ perspectives and expectations of SDM in IBD and analyze the possible factors that influence their views.

Methods

An online survey was conducted from July 19th to 24th, 2020. A total of 1118 patients completed the survey.

Results

One-third of patients were dissatisfied with the current decision-making model, and the satisfaction of inpatients was lower than that of outpatients. 84% of patients preferred to participate in SDM, who were young and had a high education level, high income, commercial insurance, strong learning ability and knowledge of SDM. Most of those who did not want to participate (72%) were worried about the cost. The kind of medicine (948, 84.8%), surgical indications (505, 45.2%) and operation methods (482, 43.1%) were the topics that patients thought most require SDM. Side effects of medicine (837, 74.9%), costs of therapy (675, 60.4%), and surgical risks (563, 50.4%) were considered to be the most influential factors for SDM. 52.7% of all patients hoped experts in different disciplines would participate in SDM. The most desirable amount of time for discussion was 30 to 60 min (562/1118, 50.3%), that were associated with the cost of SDM.

Conclusion

We can meet the needs of patients by reducing costs and strengthening online patient education and exploring a model suitable for Chinese IBD patients.
Self-referral to inpatient treatment program in a community mental health Centre in Central Norway: investigating the implementation, professionals’ experiences and costs
Authors: Moljord Inger Elise Opheim , Stensvåg Kine Gabrielsen , Halsteinli Vidar , Rise Marit By
Published: December 2021

Background

Self-referral to inpatient treatment (SRIT) is built on user participation and patient autonomy. SRIT was conducted for patients with severe mental disorders in a Norwegian Community Mental Health Centre. The aims of the present study were to describe the implementation of SRIT, explore the professionals’ experiences of SRIT and assess the costs entailed.

Methods

Qualitative document analysis, interviews with professionals and quantitative analysis of register data from a randomized controlled trial were used.

Results

SRIT seemed to be implemented as intended. According to the professionals, SRIT allowed the patients to cope, be empowered, more active and responsible. Some professionals experienced increased responsibility for patients’ medication and for assessing health and suicide risks. SRIT did not reduce hospital costs. The professionals were satisfied with nurse-led SRIT treatment.

Conclusions

SRIT appears to be a high-quality mental health service that empowers and activates patients. Nurse-led treatment may entail more efficient use of professional resources.

In future implementations of SRIT, the efficient use of service resources and the administration of beds should be investigated. More flexible availability should be considered in line with the intentions behind SRIT, as well as ensuring adequate professional training in assessing health and suicide risk.
Nocturnal dexmedetomidine alleviates post–intensive care syndrome following cardiac surgery: a prospective randomized controlled clinical trial
Authors: Dong Chun-hui , Gao Chao-nan , An Xiao-hua , Li Na , Yang Le , Li De-cai , Tan Qi
Published: December 2021

Background

Dexmedetomidine is a sedative agent that may have the potential to reduce the risk of post-intensive care syndrome (PICS). This study aimed to establish whether prophylactic nocturnal dexmedetomidine safely reduces postoperative PICS incidence and to develop an easy-to-use model for predicting the risk of PICS following cardiac surgery.

Methods

This was a single-center, double-blind, randomized, prospective, placebo-controlled trial. Patients undergoing cardiac surgery were randomly assigned (1:1) to dexmedetomidine or placebo (normal saline) groups between January 2019 and July 2020. Dexmedetomidine or a similar volume of saline was administered, with an infusion rate up to 1.2 μg/kg/h until the RASS remained between − 1 and 0. The primary study endpoint was PICS incidence at 6 months follow-up, as defined by cognitive, physical, or psychological impairments.

Results

We assessed 703 individuals for eligibility, of whom 508 were enrolled. Of these, there were 251 in the dexmedetomidine group and 257 in the placebo group that received the trial agent, forming a modified intention-to-treat population. PICS incidence at 6-month follow-up was significantly decreased in the dexmedetomidine group (54/251, 21.5%) relative to the placebo group (80/257, 31.1%) (odds ratio [OR] 0.793, 95% CI 0.665–0.945; p = 0.014). Psychological impairment was significantly reduced in the dexmedetomidine group relative to the placebo group (18.7% vs. 26.8%, OR 0.806, CI 0.672–0.967, p = 0.029). However, dexmedetomidine treatment was associated with a higher rate of hypotension. A nomogram revealed that age, education, a medical history of diabetes and smoking, dexmedetomidine treatment, postoperative atrial fibrillation, and sequential organ failure assessment scores at 8 h post-surgery were independent predictors of PICS.

Conclusions

Prophylactic nocturnal dexmedetomidine administration significantly reduced PICS incidence by a marked reduction in psychological impairment within a 6-month follow-up period.

Trial registration

ChiCTR, ChiCTR1800014314. Registered 5 January 2018, http://www.chictr.org.cn/index.aspx
Length of metacarpal and metatarsal bones in five Iranian sheep breeds and their associations with ungula measurements
Authors: Azarpajouh Samaneh , Munita María Pia , Calderón Díaz Julia Adriana
Published: December 2021

Background

This study aimed to measure the length of metacarpal and metatarsal bones in five Iranian sheep breeds and to correlate the length of the bones with ungula measurements. Thoracic and pelvic limbs of 2-year-old, previously untrimmed, pastured Afshari, Moghani, Kurdi, Makoui, and Lori–Bakhtiari ewes, (n = 20 ewes per breed) were collected after slaughter. The following lengths were recorded in the metacarpal and metatarsal bones: from the margo proximalis lateralis to the lateral (L1) and medial (D1) cartilago physialis; from the margo proximalis lateralis to the margo abaxialis of the lateral (L2) and medial (D2) caput; from the cartilago physialis lateralis to the margo abaxialis of the lateral caput (X1); from the cartilago physialis medialis to the margo distalis of the caput ridge (X2) and from the margo axialis of cartilago physialis to the margo axialis of the lateral caput (X3). Additionally, measurements of the ungula including pars dorsalis length, pars mobilis lateralis and medialis height, pars dorsalis height to the ground and to the solea cornea, thickness of the solea in the pars dorsalis, pars mobilis lateralis and medialis, solea cornea length and angulus dorsalis were recorded in the medial and lateral digits of the thoracic and pelvic limbs. Data on length of the metatarsal and metacarpal bones were analysed using mixed model equations while Pearson correlations were calculated between metacarpal and metatarsal bones and ungula measurements.

Results

Lori- Bakhtiari and Moghani ewes had greater L1, L2, and D1 and D2 while X1, X2 and X3 was greater in Kurdi ewes (P < 0.05). Measurements such as L1, L2, D1 and D2 were greater in the metatarsal than in metacarpal bones (P < 0.05) and the opposite was observed for X1, X2 and X3 (P < 0.05). No asymmetry was observed between the lateral and medial measurements (P > 0.05). Low to moderate correlations were observed between bone and ungula measurements (P < 0.05).

Conclusion

Under the conditions of this study, differences in metacarpal and metatarsal bone measurements were observed between breeds but no asymmetry was observed between lateral and medial bones. Results indicate an association between metacarpal and metatarsal bones ungula measurements. This could provide baseline information for the development and/or improvement of current ungula health protocols in the studied sheep breeds.
Is the suckling period and application pattern relevant for fluazuron against tick infestation in cows and their suckling calves?
Authors: Suárez Gonzalo , Robaina Diego , Muela Agustina , Tatiana Saporiti , Puigvert Florencia , Alvariza Silvana , Pareja Lucia
Published: December 2021

Background

Fluazuron is a chitin synthesis inhibitor administered as a pour-on formulation in cattle for tick control. This study analyzes under endemic tick infestation, the incidence of the pour-on application pattern on the plasma levels of fluazuron in calves and cows in the lactation period of the beef cow. Two hundred and ninety-two beef cows around parturition were treated with a commercial pour-on formulation of fluazuron at a rate of 2.5 mg/kg of body weight. A total of 4 treatments were carried out on days 0, 32, 77, and 117. At each administration time, the cows were grouped according to the pour-on administration pattern: long (~ 60 cm pour-on application surface) and short (~ 30 cm pour-on application surface). Fluazuron levels in cows and calves plasma were determined before the third and fourth application for each subgroup (n = 10) by HPLC-MS/MS. During the entire study, cow-calf pairs were maintained under field conditions and qualitatively examined for tick infestation on the day of each treatment. Both treatments (long and short) schemes were designed to prevent the annual persistence of ticks.

Results

No animals with presence of ticks were identified during the first 117 days of the study, except for three cows and one calf at the time of the third application (day 77). There were no differences after 40 days (day 77) post-treatment of the second application (30 ± 5 ppb vs. 28.5 ± 12 ppb, p > 0.05) and 45 days (day 117) after the third application (147 ± 55 ppb vs 140 ± 46 ppb, p > 0.05) between groups of cows treated with the long or short pour-on application, respectively. Plasma concentration of fluazuron at second and third application was increased (3.3 and 2.9 times, respectively) in calves under free suckling compared to cows. Nevertheless, both groups of cows and calves showed a significant increase in plasma concentration of fluazuron between times (4.9 times, p < 0.0001 and 2.8 times, p < 0.0001, respectively). In both groups, tick prevalence was 0% throughout the trial, except for day 77, which reached 1%.

Conclusions

The main conclusions of this study were the following: 1) Different administration patterns (long vs. short) did not differ in plasma levels of fluazuron.; 2) Given that only the cows were treated and lactating calves presented higher plasma levels of fluazuron than cows, passage through milk appears to be relevant and possibly due to a cumulative effect and continuous drug intake.
Tumor-antigens and immune landscapes identification for prostate adenocarcinoma mRNA vaccine
Authors: Zheng Xiaonan , Xu Hang , Yi Xianyanling , Zhang Tianyi , Wei Qiang , Li Hong , Ai Jianzhong
Published: December 2021

Prostate adenocarcinoma (PRAD) is a leading cause of death among men. Messenger ribonucleic acid (mRNA) vaccine presents an attractive approach to achieve satisfactory outcomes; however, tumor antigen screening and vaccination candidates show a bottleneck in this field. We aimed to investigate the tumor antigens for mRNA vaccine development and immune subtypes for choosing appropriate patients for vaccination. We identified eight overexpressed and mutated tumor antigens with poor prognostic value of PRAD, including KLHL17, CPT1B, IQGAP3, LIME1, YJEFN3, KIAA1529, MSH5 and CELSR3. The correlation of those genes with antigen-presenting immune cells were assessed. We further identified three immune subtypes of PRAD (PRAD immune subtype [PIS] 1–3) with distinct clinical, molecular, and cellular characteristics. PIS1 showed better survival and immune cell infiltration, nevertheless, PIS2 and PIS3 showed cold tumor features with poorer prognosis and higher tumor genomic instability. Moreover, these immune subtypes presented distinguished association with immune checkpoints, immunogenic cell death modulators, and prognostic factors of PRAD. Furthermore, immune landscape characterization unraveled the immune heterogeneity among patients with PRAD. To summarize, our study suggests KLHL17, CPT1B, IQGAP3, LIME1, YJEFN3, KIAA1529, MSH5 and CELSR3 are potential antigens for PRAD mRNA vaccine development, and patients in the PIS2 and PIS3 groups are more suitable for vaccination.
Network DEA based on DEA-ratio
Authors: Akbarian Dariush
Published: December 2021

Data envelopment analysis (DEA) is a technique to measure the performance of decision-making units (DMUs). Conventional DEA treats DMUs as black boxes and the internal structure of DMUs is ignored. Two-stage DEA models are special case network DEA models that explore the internal structures of DMUs. Most often, one output cannot be produced by certain input data and/or the data may be expressed as ratio output/input. In these cases, traditional two-stage DEA models can no longer be used. To deal with these situations, we applied DEA-Ratio (DEA-R) to evaluate two-stage DMUs instead of traditional DEA. To this end, we developed two novel DEA-R models, namely, range directional DEA-R (RDD-R) and (weighted) Tchebycheff norm DEA-R (TND-R). The validity and reliability of our proposed approaches are shown by some examples. The Taiwanese non-life insurance companies are revisited using these proposed approaches and the results from the proposed methods are compared with those from some other methods.
Multisystem inflammatory syndrome in Indian adolescents associated with SARS-CoV-2 infection: a case report
Authors: Bhiwgade Rahul D. , Nischitha M. C. , Shahare Bhushan , Bitey Shobhna
Published: December 2021

Background

Adolescents with coronavirus disease 2019 (COVID-19) associated multisystem inflammatory syndrome (MIS) can present with shock and myocardial injury and mimic Kawasaki disease.

Case presentation

We describe 4 previously well adolescents (age 13–14 years), presenting with clinical features of MIS in children (MIS-C). All patients had nearly similar clinical presentation. Hematological investigations revealed elevated inflammatory markers, anemia, thrombocytopenia, and decreased neutrophil:lymphocyte ratio. All patients were negative on real-time polymerase chain reaction against severe acute respiratory syndrome coronavirus 2, but had elevated immunoglobulin G titers. Two patients had atypical Kawasaki disease. Three patients had severe disease with hypotensive shock and required intensive care with fluids and inotropes. Two patients required non-invasive respiratory support for dyspnea and one patient had biventricular dysfunction. All received empiric antibiotics, low-molecular weight heparin, steroids, and intravenous immunoglobulin. One patient succumbed, while others recovered well.

Conclusions

MIS-C may be a late presentation in adolescent with COVID-19. Individualized treatment with empiric antibiotics, immunomodulation, and thromboprophylaxis can result in significantly better outcome.
Improving Familial Hypercholesterolemia Diagnosis Using an EMR-based Hybrid Diagnostic Model
Authors: Eid Wael E , Sapp Emma Hatfield , Wendt Abby , Lumpp Amity , Miller Carl
Published: December 2021

Context

Familial hypercholesterolemia (FH) confers a greatly increased risk for premature cardiovascular disease, but remains very underdiagnosed and undertreated in primary care populations.

Objective

We assessed whether using a hybrid model consisting of 2 existing FH diagnostic criteria coupled with electronic medical record (EMR) data would accurately identify patients with FH in a Midwest US metropolitan healthcare system.

Methods

We conducted a retrospective, records-based, cross-sectional study using datasets from unique EMRs of living patients. Using Structured Query Language to identify components of 2 currently approved FH diagnostic criteria, we created a hybrid model to identify individuals with FH.

Results

Of 264 264 records analyzed, between 794 and 1571 patients were identified as having FH based on the hybrid diagnostic model, with a prevalence of 1:300 to 1:160. These patients had a higher prevalence of premature coronary artery disease (CAD) (38-58%) than the general population (1.8%) and higher than those having a high CAD risk but no FH (10%). Although most patients were receiving lipid-lowering therapies (LLTs), only 50% were receiving guideline-recommended high-intensity LLT.

Conclusion

Using the hybrid model, we identified FH with a higher clinical and genetic detection rate than using standard diagnostic criteria individually. Statin and other LLT use were suboptimal and below guideline recommendations. Because FH underdiagnosis and undertreatment are due partially to the challenges of implementing existing diagnostic criteria in a primary care setting, this hybrid model potentially can improve FH diagnosis and subsequent early access to appropriate treatment.
A Critique of “Mascquerade”
Authors: Branciforte Joshua J.
Published: December 2021

This article begins by identifying the demand for “masc” in gay male digital cultures as a repressive phenomenon. Drawing on a key queer alt-right text by Jack Donovan in which “masc” is explicitly theorized, it shows that its disciplinary logic is distinct from homonormativity. The homo/hetero binary is explicitly rejected, and the perverse structure is weaponized as a repressive mechanism suited to a postnormative environment. Under these conditions, critiques of normativity and homonationalism are unable to provide an effective counter because the subjects they address have stopped caring. The article describes perverse homogenization processes as “homotribalism,” arguing that they provide an erotic basis for ethnonationalism. It then provides a detailed reading of Call Me by Your Name (2017), claiming that its striking contemporary relevance during the first year of the Trump administration followed from working through the question of homotribal desire within liberalism.