bluuebunny/crossref_metadata_2025 huggingface dataset:
Suicidality In Individuals With Prader-Willi Syndrome: A Review of Registry Survey Data
Authors: Peleggi Analise , Bohonowych Jessica , Strong Theresa , Schwartz Lauren , Kim Soo-Jeong
Published: August 2021

BACKGROUND: Prader–Willi syndrome (PWS) is a rare, genetic, neurodevelopmental syndrome associated with hyperphagia and early onset obesity, growth and sex hormone insufficiencies, mild-to-moderate intellectual disability, and behavioral challenges such as compulsivity, anxiety, skin picking, social skills deficits and temper outbursts. Given high rates of psychiatric comorbidity and potential risk factors for suicide in PWS, this study sought a first estimate of the prevalence of suicidal ideation (SI) and attempts (SA) in the PWS population and any characteristics associated with suicidality in this population. METHODS: Using the Global Prader-Willi Syndrome Registry, we included all participants who had answered a question about SI. We examined the most recent data from the surveys about social, economic, and demographic factors, genetic subtype, and psychiatric symptoms and treatments. A chi-square analysis was used to compare registry participants who reported SI to those without reported SI. RESULTS: From 750 included survey respondents, 94 (12.5%) endorsed some history of SI. Of these, 25 (26.6%) also reported a history of SA, with an average age of 16.25 years at their first attempt. Those with a history of SI were predominantly male and adult age, and had higher rates of aggression and psychiatric comorbidities, therapies, and medications. CONCLUSIONS: This study indicates that the rate of SI and SA in PWS is comparable to the general population, and that suicide attempts in PWS typically begin in middle-teenage years. Despite unique challenges, individuals with PWS and their caregivers should be included in screens and psychoeducation for suicide and mental health concerns.
Evaluating Sewage Sludge Contribution During Co-Composting Using Cause-Evidence-Impact Analysis Based on Morphological Characterization
Authors: Balaganesh Pandiyan , MANGOTTIRI VASUDEVAN , Natarajan Narayanan
Published: August 2021

The methods of compost preparation from sewage sludge and their modes of application to the agricultural fields have profound impacts on the soil ecology and environment. Besides their chemical conditioning effect on soil organic matter, they also impart physical attributes to the soil texture and structure. Though it is expected that compost addition improves water holding capacity and nutrient sequestration, there is lack of clarity in correlating the outcomes with conditions of excess nutrient storage/leaching despite the benefits on crop yield. In this study, we present a systematic cause-evidence-impact relationship on the feedstock, processing and applications of co-composted organic matter. Various analytical tools were compared to elucidate the unique characteristics of co-composted sewage sludge to get a realistic understanding of the complex soil-compost interactions. Results from the spectroscopic characterization reveal the implications of selection of bulking agents and sludge pre-treatment in determination of the final quality of the compost. The results attribute significant parent material influence to the formation of well-defined porous structures. The impacts of compost quality on the soil and crop can be proactively determined in terms of elemental composition, functional groups and stability indices. Thus the present approach provides good scope for customizing compost preparations and applications to get the preferred field outputs.
Association between Conventional Oxygen Therapy and Characteristics and Outcomes of Adult Patients in a Surgical Intensive Care Unit
Authors: Stroh Lubov , Nurjadi Dennis , Uhle Florian , Bruckner Thomas , Weigand Markus A. , Fiedler Mascha O.
Published: August 2021

Background: Oxygen therapy is often used in emergency departments and intensive care units. The prevention of hypoxia with associated complications remains the main target, but a high-concentrated usual oxygen therapy seems not to be the best strategy. We hypothesize that physiological pressure of arterial oxygen (paO2) reduces mortality, onset of new infections and organ dysfunctions in critically ill patients compared with supraphysiological paO2.Methods: In this retrospective exploratory cohort study we included 112 critically ill adult patients treated in a surgical critical care unit. All patients were assigned to two groups defined a priori based on paO2 mean values measured in the first 24 hours of mechanical ventilation: first group paO2 75-100 mmHg (n=43), second group patients with paO2 > 100mmHg (n=69). Primary outcome was the cumulative survival, defined from the day of admission in the intensive care unit (ICU) until death or end of the hospital stay. Secondary outcome was the incidence of infections and new organ dysfunctions in both groups. Results: The baseline characteristics like age, body mass index (BMI), lactate and severity of disease scores were similar in both groups. A total of 27 of 69 patients (39,1%) in the group paO2 > 100mmHg and 12 of 43 patients (27,9%) in the group paO2 75-100mmHg died during their ICU stay or further hospital stay (p=0.54). There were no statistically significant differences in the incidence of new infections and new organ dysfunctions between the two groups. Positive end expiratory pressure (PEEP) and fraction of inspired oxygen (FiO2) were in the group of patients with paO2 > 100mmHg significantly lower 8,4 mbar vs. 9,5 mbar (p=0.03).Conclusions: There was no significant increase in overall mortality or new onset of infections and organ dysfunctions in critically ill adult ICU patients requiring oxygen therapy with supraphysiological paO2 (> 100 mmHg) compared to patients with physiological paO2 (75-100 mmHg). Further studies are needed to define the optimal paO2 parameter.
Preoperative Chemoradiation With Image-guided IMRT in Patients With Locally Advanced Gastric Cancer
Authors: SHEN Jing , LIAN Xin , GUAN Qiu , PANG Tingtian , HE Lei , DONG Tingting , SHEN Jie , ZHANG Fuquan
Published: August 2021

PurposeTo evaluate the efficacy and toxicity of preoperative chemoradiation with image-guided IMRT in locally advanced resectable gastric cancer patients.Patients and methodsPatients with locally advanced (T3/T4 or N+) gastric cancer treated with neoadjuvant chemoradiotherapy followed by surgery between Jan 2013 and June 2019 in PUMCH were retrospectively analyzed. Radiotherapy(IMRT 45Gy/25#/5weeks) were delivered with megavolt computed tomography performed before every delivery to ensure the accuracy repeatability of gastric filling during treatment, with concurrent chemoctherapy(Capecitabine alone or XELOX*2 cycles). ResultsA total of 95 patients were included in the study with 93 patients (97.9%) had stage cT3/T4, 85 patients (89.5%) had stage N+.The location of the tumors was in the upper 1/3 in 85 patients (89.5%). Alltogether 93/95(97.9%) patients finished the neoadjuvant chemoradiation, 80 patients (84.2%) underwent gastric resection(58 D2 and 22 D1 gastrectomy). Pathology downstaging was observed in 68 patients (85.0%), including 66 patients (82.5%) with T downstaging and 56 patients (70.0%) with N downstaging. 11 patients (13.75%) obtained pathological complete response (pCR). The median follow-up was 44.7 months (19-96 months). Compared with the clinical efficacy of neoadjuvant chemotherapy in the previous literature, the clinical efficacy of image-guided IMRT combined with concurrent chemotherapy in patients with locally advanced resectable gastric cancer was improved, the 5-year OS, LRFS, and DMFS rates of patients were 46.98% (95% CI: 38.60%-55.36%), 86.55% (95% CI: 79.11%-93.99%), and 60.71% (95% CI: 51.49%-69.93%), respectively.Grades 3-4 leukopenia, anemia,and thrombocytopenia were observed in 13 (13.68%) patients, 9 (9.47%) patients, and 5 (5.26%) patients, respectively. Multivariate analysis demonstrated that pCR was significant prognostic factor for OS (HR =11.211, 95% CI: 1.500–83.813, P = 0.024).ConclusionCompared with the previous literature results of preoperative neoadjuvant chemotherapy for patients with gastric cancer, the application of image-guided IMRT(45Gy/25#/5weeks) combined with chemotherapy in preoperative neoadjuvant therapy for patients with locally advanced gastric cancer can achieve improved clinical efficacy, with higher rates of OS, LRFS, and DMFS, good tolerance of concurrent chemoradiotherapy with acceptable side effects.
Impact of Delayed Initiation of Non-Invasive Ventilation for Respiratory Distress in Outborn Late-Preterm and Term Neonates
Authors: Choi Eui Kyung , Park Kyu Hee , Choi Byung Min
Published: August 2021

The frequency of non-invasive ventilation (NIV) use increased in neonates of all gestational ages with respiratory distress (RD). However, the impact of delayed initiation of NIV support in outborn neonates remains poor understood. The aim of the present study was to identify the impact of delayed initiation of NIV in outborn late-preterm and term neonates. The medical records of 277 infants (gestational age of ≥ 35 weeks) who were received NIV as primary respiratory therapy <24 h of age between 2016 and 2020 were retrospectively reviewed. Among the 190 outborn neonates, the factors associated with respiratory adverse outcomes were investigated. Infants with RD divided into two groups, mild (FiO2 ≤0.3) and moderate-to-severe RD group (FiO2 >0.3), depending on initial oxygen requirement under NIV support. Median time to start of NIV support at tertiary center was 3.5 (2.2–5.0) h. Male sex (odds ratio [OR], 2.9; 95% CI, 1.1–7.7), high oxygen requirement (FiO2 >0.3) (OR, 4.8; 95% CI, 1.5–15.3), and respiratory distress syndrome (OR, 10.4; 95% CI, 3.9–27.8) were the significant factors associated with adverse outcomes. Subgroup analysis revealed that in the moderate-to-severe RD group, delayed initiation of NIV (≥3 h) was significantly associated with pulmonary air leakage (p=0.033).Conclusions: Our study shows that outborn neonates with moderate-to-severe RD who were treated with delayed NIV were associated with an increased likelihood of pulmonary air leakage. Additional prospective studies are needed to establish the optimal timing and methods of NIV support for outborn late-preterm and term infants.
A feasibility Randomised Controlled Trial of a Fibromyalgia Self-management Programme in a community setting with a nested qualitative study (FALCON)
Authors: Pearson Jennifer , Coggins Jessica , Derham Sandi , Russell Julie , Walsh Nicola , Lenguerrand Erik , Palmer Shea , Cramp Fiona
Published: August 2021

Background Fibromyalgia is a condition associated with widespread musculoskeletal pain, fatigue and sleep problems. Fibroymyaglia treatment guidelines recommend non-pharmacological interventions and the development of self-management skills. The Fibromyalgia Self-management Programme (FSMP) consists of one 2.5-hour weekly session over six successive weeks and includes education about fibromyalgia, goal setting, pacing, sleep hygiene and nutritional advice. The FSMP is currently provided in a secondary care hospital setting and co-delivered by a multidisciplinary team. Delivery in a primary care setting has the potential to improve the accessibility of the programme to people with fibromyalgia. Therefore, this feasibility study aimed to determine the practicality and acceptability of conducting a future definitive randomised controlled trial of the FMSP in a community setting.MethodAn exploratory, parallel-arm, one-to-one, randomised controlled trial. Participants were recruited from general practices across South West England, and the FSMP was co-delivered by physiotherapists and occupational therapists across two community sites. To determine the outcome measures for a future definitive trial several were tested. All clinical outcome measures were patient-reported and collected at baseline, six weeks and six months. Semi-structured interviews were conducted with patient participants, occupational therapists and physiotherapists to explore the acceptability and feasibility of delivering the FMSP in a community setting.Results A total of 74 participants were randomised to the FSMP intervention (n=38) or control arm (n=36). Attrition from the trial was 42% (31/74) at six months. A large proportion of those randomised to the intervention arm (34%, 13/38) failed to attend any sessions with six of the 13 withdrawing before the intervention commenced. The proportion of missing values was small for each of the outcome measures. Three overarching themes were derived from the interview data; (1) barriers and facilitators to attending the FSMP; (2) FSMP content, delivery and supporting documentation; and (3) trial processes.Conclusion Findings indicate that it is feasible to recruit people with fibromyalgia from primary care to participate in a randomised controlled trial testing the clinical and cost-effectiveness of the FSMP delivered in a community setting. However, improvement in trial attrition and engagement with the intervention is needed. Trial registration: The trial is registered with ISRCTN registry and was assigned on 29/04/2019. The registration number is ISRCTN10824225.
Detecting potential reference list manipulation within a citation network
Authors: Wren Jonathan , Georgescu Constantin
Published: August 2021

Although citations are used as a quantifiable, objective metric of academic influence, references could be added to a paper to inflate the perceived influence of a body of research. This reference list manipulation (RLM) could take place during the peer-review process, or prior to it. Surveys have estimated how many people may have been affected by coercive RLM at one time or another, but it is not known how many authors engage in RLM, nor to what degree. By examining a subset of active, highly published authors (n = 20,803) in PubMed, we find the frequency of non-self citations (NSC) to one author coming from one paper approximates Zipf’s law, permitting the task to be approached statistically. Framed as an anomaly detection problem, higher confidence is gained the more outlier status is correlated across dimensions relative to non-outliers. We find the NSC Gini Index correlates highly with anomalous patterns across multiple RLM-related distributions. Between 81 (FDR < 0.05) and 231 (FDR < 0.10) authors are outliers on the curve, suggestive of chronic, repeated RLM. Approximately 16% of all authors may have engaged in RLM to some degree. Authors who use 18% or more of their references for self-citation are significantly more likely to have NSC Gini distortions, suggesting a potential willingness to coerce others to cite them.
Case Report: Post SARS-CoV2 Infection Erythema Nodosum
Authors: Sarvestani Aida Askari , Ghotbabadi Shabnam Hajiani
Published: August 2021

Background: Although, preliminary reports of Post SARS-CoV2 Infection Erythema Nodosum suggest it may be due to dysregulated immune response caused by coronavirus.Case presentation: The patient was a 9-year-old boy who referred to the pediatric Rheumatology clinic of Shiraz University of Medical Sciences due to bilateral painful erythematous nodules on his bilateral calves. He reported a history of fever from 4 days before his referral which was followed by erythema, warmth, stiffness, and swelling of his calves. The patient’s father had afflicted COVID-19 two months prior to the incidence. In his course of admission, COVID-19 serology tests were performed for him which was positive for SARS-CoV-2 IgG and negative for SARS-CoV-2 IgM.Conclusion: Another etiologic factor for EN might be coronaviruses such as SARS-CoV-2 which is important to be taken into consideration during the COVID-19 pandemic.
Treating PTSD With Imagery Rescripting During An Underweight State In Eating Disorder Patients. A Multiple Baseline Case Series Study
Authors: Napel Marieke ten , Vroling Maartje , Mares Suzanne HW , Arntz Arnoud
Published: August 2021

Background; Eating disorder patients with a posttraumatic stress disorder have worse treatment results regarding their eating disorder than patients without a posttraumatic stress disorder. Many underweight eating disorder patients with co-morbid posttraumatic stress disorder symptoms are not treated for their posttraumatic stress disorder symptoms during underweight. We pose that posttraumatic stress disorder treatment in underweight eating disorder is possible, and tested whether posttraumatic stress disorder symptoms decrease with Imagery Rescripting, and secondary whether the treatment of trauma has an effect on the process of weight gain and on eating disorder pathology in general.Method; Ten patients in clinical treatment (BMI 14-16.5) participated. A multiple baseline design was used, with baseline varying from six to 10 weeks, a six-week treatment phase, a three-week follow-up period and a three month follow-up measurement. Data were analyzed with mixed regression. Results; Evidence was found for strong effects of treating posttraumatic stress disorder symptoms with imagery rescripting without interfering with the eating disorder treatment. Positive effects were also found on a range of emotional and cognitive secondary measures.Conclusion;Imagery rescripting of traumatic memories at times of underweight was possible, safe and had positive clinical effects. Trial registrationNetherlands trial register (NTR) Trial NL5906 (NTR6094). Date of registration 09/23/2016. https://www.trialregister.nl/trial/5906
Integrated Data Reveal The Flavonoid Biosynthesis Metabolic Pathway In Semen Ziziphi Spinosae Using Transcriptomic And Metabolomic
Authors: Jiang Tao , Liu Lingdi , Wen Chunxiu , Xie Xiaoliang , Wen Saiqun , Tian Wei
Published: August 2021

Semen Ziziphi Spinosae (SZS) is used to treat neurasthenia, insomnia, and anxiety in China. The extract from SZS contains many bioactive components, such as flavonoids, alkaloids, and terpenoids. Among these, the flavonoids are the main bioactive compounds that have been proven to be responsible for the sedative effects. In this study, a total of 13232 differentially expressed genes and 83 flavonoid metabolites were identified at three different growth and development stages (T1, T2, and T3) of SZS using transcriptomic and metabolomic. The main flavonoid metabolic components of SZS were catechin, L-epicatechin, (-)-epigallocatechin, (+)-gallocatechin, spinosin and its derivatives. A total of 53 unigenes encoding 15 enzymes were identified as candidate genes involved in flavonoid biosynthesis in SZS. Among, PAL, C4H, 4CL, CHS, CHI, FLS, FNS, ANS, ANR, LAR, and UFGT genes were all downregulated in T3 than in T1. The expression levels of these genes influence the accumulation of flavonoids in SZS. Our results should provide valuable information for flavonoid metabolites and candidate genes involved in flavonoid biosynthesis on SZS.
Chrysin Alleviates DNA Damage to Improve Disturbed Immuno-Homeostasis and Pro-Angiogenic Environment in Laser-Induced Choroidal Neovascularization
Authors: Wang Jing , Bo Qiyu , Zhou Minwen , Wang Hong , Zhu Hong , Wang Fenghua , Jiang Mei , Sun Xiaodong
Published: August 2021

Background: Choroidal neovascularization (CNV) is a devastating pathology of numerous ocular diseases, such as wet age-related macular degeneration (wAMD), which causes irreversible vision loss. Although anti-VEGF therapy has been widely used, poor response or no response exits in some patients, suggesting that some other important angiogenic components play roles. Therefore, the underlined mechanism need to be clarified and new target of anti-angiogenic therapy is urgently needed. Damaged retinal pigment epithelium (RPE) cells have been demonstrated to activate inflammasome, drive a degenerative tissue environment and an enhanced pro-angiogenic response, which emphasizes the dysfunction of RPE, may be the hallmark of the pathogenesis.Methods: C57BL/6J male mice aged between 6 and 8 weeks were subjected to laser-induced CNV models. Chrysin was administered intragastrically at 25 mg/kg daily for 3 days or one week after laser-treated. Then to observe the CNV areas and CNV thickness, immunofluorescence staining of choroidal flatmount, SD-OCT and fluorescein angiograghy were performed, respectively. To further confirm the effect of chrysin on stress-induced DNA damage in RPE cells, RPE cells were administered with A2E and western-blot, cell viability assay, immunofluorescence chromosome PNA-FISH and SA-β-gal staining were performed. To elucidate the underlying mechanism, we performed RNA-seq and bioinformatics analyses.Results: In this study, we demonstrated that chrysin could successfully alleviated choroidal neovascularization. We show that DNA damage of RPE cells is remarkable in laser-induced choroidal neovascularization, resulting in inflammation response, which can be ameliorated by chrysin through inactivation of STAT3. Also, we identify that chrysin can reduce DNA damage, especially telomere erosion, simultaneously compromise the dysfunction of RPE and the secretion of SASP factor in vitro. Mechanistically, KEGG pathway analyzes show that chrsyin improves inflammatory imbalance mainly through down-regulation of IL17 pathway in the laser- induced CNV development.Conclusions: Our results indicate the interplay between DNA damage, perturbed RPE homeostasis, inflammatory imbalance and angiogenesis in laser-induced choroidal neovascularization. Importantly, chrysin may be an effective therapeutic supplement for CNV.
QTL Mapping of a Brazilian Bioethanol Strain Unravels the Cell Wall Protein-Encoding Gene GAS1 as a Major Contributor to Low Ph Tolerance in S. Cerevisiae
Authors: Coradini Alessandro L V , de Mello Fellipe da Silveira Bezerra , Furlan Monique , Maneira Carla , Carazzolle Marcello Falsarella , Pereira Goncalo Amarante Guimarães , Teixeira Gleidson Silva
Published: August 2021

BACKGROUNDSaccharomyces cerevisiae is largely applied in many biotechnological processes, from traditional food and beverage industries to modern biofuel and biochemicals factories. During the fermentation process, yeast cells are usually challenged in different harsh conditions, which often impact productivity. Regarding bioethanol production, cell exposure to acidic environments is related to productivity loss on both first and second generation ethanol. In this scenario, indigenous strains traditionally used in fermentation stand out as a source of complex genetic architecture, mainly due to their highly robust background - including low pH tolerance. RESULTSIn this work, we pioneer the use of QTL mapping to uncover the genetic basis that endow industrial strain Pedra-2 (PE-2) with outstanding acid resistance. First, we developed a fluorescence-based high-throughput approach to collect a large number of haploid cells using flow cytometry. Then, we were able to apply a bulk segregant analysis to solve the genetic basis of low pH resistance in PE-2, which uncovered a region in chromosome XIII as the major QTL associated with the evaluated phenotype. A reciprocal hemizygosity analysis revealed allele GAS1, encoding a β-1,3-glucanosyltransferase, as the major contributor to this phenotype. The GAS1 sequence alignment of 48 S. cerevisiae strains pointed out a non-synonymous mutation (T211A) prevalence in wild type isolates, which is absent in laboratory strains. We further showcase that GAS1 allele swap between PE-2 and a low pH-susceptible strain can improve cell viability on the latter of up to 12% after a sulfuric acid wash process.CONCLUSIONThis work revealed GAS1 as the major causative gene associated with low pH resistance in PE-2, harboring a non-synonymous mutation persistent in industrial strains. We also showcase how GAS1PE-2 can improve acid resistance of a susceptible strain, suggesting that these findings can be a powerful foundation for the development of more robust and acid-tolerant strains for the industrial production of economically-relevant goods. Our results collectively show the importance of tailored industrial isolated strains in the discovery of the genetic architecture of relevant traits and its implications over productivity.
Very Early Onset of Leber’s Mitochondrial Optic Neuropathy in Pediatric Females: Case Report and Review of the Literature
Authors: Tagliani Sara , Malaventura Cristina , Ceccato Chiara , Parmeggiani Francesco , Suppiej Agnese
Published: August 2021

BackgroundLeber’s hereditary optic neuropathy is a rare mitochondrial disease that usually begins in the second/third decade of life and affects generally young adult males. The information is scarce on the female phenotype particularly when onset is at a very young age and the diagnosis is challenged by other more frequent conditions. Aim of this study is to highlight the pediatric female phenotype by a literature review and by adding a new case.MethodsThe literature search was conducted on Pubmed in the period September 2020-February 2021 using “Child”, “Leber Hereditary Optic Neuropathy”, “females” “girls” keywords. We add a three years old girl with genetically confirmed Leber’s hereditary optic neuropathy.Results55 of 968 articles reported pediatric in girls accounting for 226 cases, male to female ratio 1,8:1. Mean age at onset was 11 years. The onset at the age of 3 years was described in only 3 girls, including our case. Acute bilateral mild visual impairment was the most common clinical presentation, associated to papilledema in 14% of the cases who underwent fundus oculi examination. Partial visual recovery occurred in 50% (30/60). Idebenone treatment was administered in 5/30. ConclusionLHON is extremely rare in very young females and represents a diagnostic challenge for the pediatrician. It should be considered even in young girls with acute-subacute visual loss, bilateral pseudo-papilledema, VEP changes non responding to steroid therapy.
Efficient Degradation of Alginate And Preparation of Unsaturated Monosaccharides By A Novel Alginate Lyase And Effects of Domain Truncation On Biochemical Characteristics, Degradation Patterns
Authors: Li Qian , Cao Shengsheng , Zheng Ling , Zhu Benwei
Published: August 2021

BackgroundBrown algae are considered promising crops for the production of sustainable biofuels. However, its commercial application has been limited by lack of efficient methods for converting alginate into fermentable sugars. Recently, exo-type alginate lyases have received extensive attention due to their excellent ability of conversion of alginate into 4-deoxy-L-erythro-5-hexoseulose uronate (DEH), a promising material for bioethanol production and biorefinery systems.ResultsHerein, we cloned and characterized a novel alginate lyase AlyPL17 from Pedobacter hainanensis NJ-02. It possessed outstanding catalytic efficiency towards polymannuronic acid (polyM), polyguluronic acid (polyG) and alginate sodium, with kcat of 39.42 + 1.9 s-1, 32.53 + 0.88 s-1, and 38.30 + 2.12 s-1, respectively. In addition, AlyPL17 adopts a unique hybrid action mode to degrade alginate by the synergistic effect of two domains. Furthermore, the combination of AlyPL17 and AlyPL6 exhibited apparently synergistic effect for the preparation of unsaturated monosaccharides. ConclusionOverall, the results show that AlyPL17 is a PL17 exo-type alginate lyase with high activity and a high conversion rate at low/moderate temperatures, which provides a useful enzymatic tool for the conversion of brown algae into biofuels and enhance our understanding of the function of modular domain of alginate lyase.
Evaluation of Antioxidant Activity of Caffeine Extracted From Kolanut (Cola Nitida)
Authors: Onyeyilim Ebuka Leonard , Ugwu Ezinne Evelyn , Onugwu Adaeze Linda , Uzoewulu Chiamaka Peace , Otunomo Idowu Iyabo
Published: August 2021

Crude caffeine was isolated from kola nut, by treating the filtrate obtained from powdered kola nut with lead (II) acetate to precipitate acids and albumins, along with HCl to precipitate lead ions, and to make some insoluble tannins to be soluble, then Na2CO3 solution was added to neutralise the acidic HCl solution. Dichloromethane is added to the filtrate to extract the caffeine from the aqueous layer and then distilled to obtain the crude caffeine. The extracted crude caffeine is recrystallized with activated charcoal and tested for its antioxidant capacity, using the DPPH assay, which screens the antioxidant activity of plant extracts. The DPPH (2, 2-diphenyl-1-picrylhydrazyl) in methanol helps to facilitate the extraction of the antioxidant compounds from the sample. Ascorbic acid (Vitamin C) is used as the standard for this assay, due to its appreciable antioxidant activity. The IC50 value was calculated from the graph of % inhibition against concentration, and the extracted caffeine from kola nut was found out to have a high antioxidant activity comparable to that of the standard, ascorbic acid.
Association of Sonographic Features of Unifocal Papillary Thyroid Carcinoma With Cervical Lymph Node Metastasis
Authors: Zhou Liuhua , Zhu Qiaodan , Yao Jincao , Yang Chen , Xu Dong
Published: August 2021

Background Papillary thyroid carcinoma (PTC) is the most common pathological type of thyroid carcinoma. We aim to evaluate the association of sonographic features of PTC and cervical lymph node metastasis (CLNM) at the initial surgery.Methods Clinical information, ultrasonographic measurements and features for 1335 patients were acquired in data collection. Univariate analysis was performed to test CLNM by 7 independent variables. Receiver operating characteristic (ROC) curve was created to evaluate the diagnostic performance.Results Univariate analysis showed that gland, location, aspect ratio, margin and echogenic foci were independently associated with CLNM metastatic status (P < 0.05). Binary linear regression analysis showed that sex, age, tumour maximum diameter and volume, location, margin and echogenic foci were independent correlative factors. The ROC curves were established based on the relevant factors, the AUC of tumour maximum diameter, tumour volume and margin were 0.74, 0.73, and 0.71, respectively. The multiple-variable linear regression model was constructed with AUC of 0.81, specificity of 72.8%, and sensitivity of 75.0%. ANOVA variance analysis for sub-positive groups, tumour maximum diameter, tumour volume, margin and echogenic foci had statistical significance (P < 0.05).Conclusion Younger age, male, larger tumour, margin, and echogenic foci were high risk factors for CLNM in PTC. Cross-sectional aspect ratio with value ≥ 1 had higher predictive value for CLNM in PTC patients excluding papillary thyroid microcarcinoma (PTMC).
Disordered Climate Threatens Short-Distance Migrants
Authors: Yang Haile , Yu Luxian , Qi Hongfang , Fu Shengyun , Wang Yang , Yang Jianxin , Du Hao
Published: August 2021

In the global warming world, the migratory and breeding behaviors of many species have changed, and short-distance migrants may benefit from climate change. With climate change leading to an increasingly disordered climate, we show here that a disordered spring climate disturbs the migration and breeding of a short-distance anadromous fish. In 2020, on the Qinghai-Tibetan Plateau, an abnormally low temperature in April delayed the migration rhythm of Gymnocypris przewalskii by nearly 10 days, while the gonadal development rhythm of the breeding population was almost normal. The phenology mismatch decreased the migrating populations by 30–70%, reducing the larval flux by nearly 80%. This case reveals that for short-distance migrants, different phenologies within the same species respond to disordered climates differently, which leads to phenology mismatches and then threatens the species. Along with increasing local abnormal climate events, short-distance migrants need more attention and conservation actions.
Time To Complete hepatitis C Cascade of Care Among Patients Identified During Mass Screening Campaigns in Rural Rwanda: A Retrospective Cohort Study
Authors: Kamali Innocent , Shumbusho Fabienne , Barnhart Dale A , Nyirahabihirwe Françoise , Gakuru Jean de la Paix , Dusingizimana Wellars , Nizeyumuremyi Esdras , Habinshuti Placide , Walker Stephen , Makuza Jean Damascene , Serumondo Janvier , Rwibasira Gallican Nshogoza , Ndahimana Jean d'Amour
Published: August 2021

Background

Since the discovery of direct-acting antivirals, treatment for hepatitis C virus (HCV) is increasingly accessible in low-resource settings, but quality of care in these settings is not known. We described progression through the cascade of care among individuals who screened positive for HCV antibodies during a mass screening campaign in Kirehe and Kayonza, two rural Rwandan districts, in September 2019.
Methods

This retrospective cohort study used routine clinical data to assess proportions of participants completing each stage of the cascade of care, including: a) screening positive on rapid diagnostic test; b) return of initial viral load results; c) detectable viral load; d) treatment assessment; e) treatment initiation; f) return of sustained virological response (SVR12) results; and g) achieving SVR12. We proposed three indicators to assess timely care provision and used medians and interquartile ranges (IQR) to describe the time to complete the cascade of care.
Results

Overall, 666 participants screened HCV positive, among them, 452 (68.1%) were female and median age was 61 years (IQR: 47, 70). Viral load results were returned for 537 (80.6%) participants of whom 448 (83.4%) had detectable viral loads. Of these, 398 (88.8%) were assessed for treatment, 394 (99%) were initiated, but only 222 (56.3%) had results returned for SVR12. Among those with SVR12 results, 208 (93.7%) achieved SVR12. When assessing timely care provision, we found 65.9% (95% CI: 62.0, 69.7) of initial viral load results were returned ≤ 30 days of screening; 45% (95% CI: 40.1, 49.8) of people with detectable viral load completed treatment assessment ≤ 90 days of initial viral load results; and 12.5% (95% CI: 9.2,16.3) of SVR12 results were returned ≤ 210 days of treatment initiation among those who initiated treatment. The overall median time from screening to SVR12 assessment was 437 days.
Conclusion

Despite high rates of SVR12 among those who completed all stages of the cascade of care, we identified gaps and delays in the treatment cascade. Improving communication between viral load testing hubs and health facilities could reduce the turn-around time for viral load testing, and actively monitor timeliness of care provision could improve quality of HCV care.
Efficacy of Non-Invasive and Invasive Respiratory Managements in Adult Patients with Acute Hypoxaemic Respiratory Failure: A Systematic Review and Network Meta-Analysis
Authors: Sakuraya Masaaki , Okano Hiromu , Masuyama Tomoyuki , Kimata Shunsuke , Hokari Satoshi
Published: August 2021

Background: Although non-invasive respiratory managements are preformed to avoid intubation, patients with de novo acute hypoxaemic respiratory failure (AHRF) are high risk for treatment failure. Choosing the most effective primary respiratory management for adults with de novo AHRF is a complex problem. In the previous meta-analyses, the effect of non-invasive ventilation was not sufficiently evaluated according to ventilation modes in patients with AHRF. Furthermore, no meta-analyses comparing non-invasive respiratory managements with invasive mechanical ventilation (IMV) have been reported. We performed a network meta-analysis to compare the efficacy of non-invasive ventilation according to ventilation modes with high-flow nasal oxygen (HFNO), standard oxygen therapy (SOT), and IMV in adult patients with AHRF.Methods: The Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, and Ichushi databases were searched. Studies including adults with AHRF and randomised controlled trials comparing two different respiratory managements (continuous positive airway pressure [CPAP], pressure support ventilation [PSV], HFNO, SOT, or IMV) were reviewed. A network meta-analysis was performed via a frequentist approach with a multivariate random-effects meta-analysis. The certainty of evidence was assessed based on the Grades of Recommendation, Assessment, Development and Evaluation Working Group approach. The primary outcome was short-term mortality.Results: Using SOT as the reference, CPAP (risk ratio [RR], 0.55; 95% confidence interval [CI], 0.31–0.95; very low certainty) was significantly associated with a lower risk of mortality. Compared with SOT, PSV (RR, 0.81; 95% CI, 0.62–1.06; low certainty) and HFNO (RR, 0.90; 95% CI, 0.65–1.25; very low certainty) were not associated with a significantly lower risk of mortality. Compared with IMV, no non-invasive respiratory management was associated with a significantly lower risk of mortality, although all certainties of evidence were very low. The probability of being best in reducing short-term mortality among all possible interventions was higher for CPAP, followed by PSV and HFNO; IMV and SOT were tied for the worst.Conclusions: Our findings imply that CPAP may be the most effective strategy as the primary non-invasive respiratory management for AHRF to avoid unnecessary pressure support. Trial registration: protocols.io (Protocol integer ID 49375, April 23, 2021). dx.doi.org/10.17504/protocols.io.buf7ntrn.
Nursing Qualifications needed in Municipal Emergency Inpatient Units. A qualitative study
Authors: Landstad Bodil J. , Hole Torstein , Strand Aasta Marie Sveino , Kvangarsnes Marit
Published: August 2021

Background: Providing care to older individuals with complex needs and patients with chronic illness is a concern worldwide. In Norway, this situation led to the transfer of responsibility for care and treatment to the districts. Providing emergency care at the municipal level – thereby reducing the need for emergency hospital admissions – is part of the Coordination Reform in Norway. This reform from 2012 warrants a reconsideration of which nursing qualifications are needed in the municipalities.The aim of the study is to explore which professional qualifications nurses need to provide emergency care in municipal emergency inpatient units. A qualitative design with a hermeneutic approach was employed. Interviewing physicians about nursing qualifications may be considered inappropriate. We believe that this is important for developing knowledge that can strengthen interprofessional cooperation in emergency situations. Three focus groups were conducted. Physicians with experience in municipal emergency inpatient units were interviewed.Results: The physicians highlighted broad medical knowledge, clinical judgement, skills in treatment management and communication, a holistic understanding, and continuous learning as relevant professional qualifications for nurses in municipal emergency inpatient units. Taking a holistic approach requires ethical judgement and teamwork. Interpersonal skills and adopting a family perspective were considered important in facilitating care in municipal emergency inpatient units.Conclusions: Nurses have a considerable responsibility to work independently and safely in a setting where both the patient and the patient’s family play important roles. Nurses should adopt a family perspective when managing patients in municipal emergency inpatient units. Nursing education should prepare students to treat patients with complex needs and chronic illnesses. This requires an emphasis on broad medical knowledge, clinical judgement, and skills in communication, treatment management and continuous learning.
Treatment of Unstable Intertrochanteric Fractures in Elderly Patients Using a New Technique of Wire Tension Band Ventral Compression Wiring Combined With Artificial Femoral Head Replacement
Authors: Ye Jiajing , Zhu Zhong , Jiang Lingjun , Wu Haizhao , Wang Shouli , Pan Qiaohong , Chen Zhongyi
Published: August 2021

Background: This study evaluates the effects of wire tension band ventral compression wiring technology paired with artificial femoral head replacement according to the different types of intertrochanteric fractures of the greater trochanter in elderly patients. Methods: Thirty-eight patients with unstable intertrochanteric fractures of the femur treated with artificial femoral head replacement between January 2015 and August 2019 were included. According to the fracture line of the greater trochanter, a new classification system was proposed. Type A fractures include transverse fractures from the greater trochanter tip to the base (2 patients). Type B fractures include oblique fractures from the greater trochanter tip to the base (according to the fracture line direction, type B was further divided into types B1 [4 patients], and B2 [24 patients]). the fracture line of type C fractures runs from the greater trochanter to near the femur end (8 patients). Different wire tension belt ventral compression wiring technologies were used for each fracture type. The Harris hip function score, Parker activity score, and hip pain were evaluated during the follow-up period. Fracture healing and prosthesis positioning, loosening, and dislocation were evaluated using radiographs. Results: The average follow-up period was 28.6 ± 5.8 months. Deep vein embolism was noted in one patient, heterotopic ossification in another, and steel wire fractures in another. All patients had satisfactory fracture healing and femoral prosthesis positioning and no chronic pain. The mean Harris hip function score was 7.21 ± 2.58 preoperatively and 84.74 ± 3.82 at the final follow-up (F = -48.13, P < 0.001).Conclusion: The use of different wire tension band ventral compression wiring technology based on different types of femoral rotation fractures combined with artificial femoral head replacement in elderly patients with unstable intertrochanteric fractures results in favorable clinical outcomes.
Measuring Digital Competence: An Exploratory Study Mapping Digital
Competence Profiles of Sri Lankan English Language Teachers
Authors: Karunaweera A. Sajani , Lee Kean Wah
Published: August 2021

The overall vision for 21st century learning has incorporated digitalisation as a key focus in teaching and learning practices. In Sri Lanka, however, despite major initiatives taken to improve digital competency of teachers, only minor improvement was noted. Using the DigCompEdu assessment tool, this study investigates to what extent Sri Lankan English language teachers are digitally competent. The results aim to inform national initiatives to facilitate the shift towards a bottom-up process, informed by actual realities based on skills and competences. The DigCompEdu 22-item quantitative survey was used to sample 40 English language teachers working within the public education system. Overall, the study finds that not even 50% of the sample is at one competency band. It is recommended that for substantial changes to occur, a more varied and individualised teacher-training is recommended, using the DigCompEdu as a diagnostic guide.
The Patency Rate of the Primary and Exchanged Femoral Haemodialysis Catheters
Authors: Cheraghali Roozbeh , Farshidmehr Pezhman
Published: August 2021

Background: This prospective cohort study aims to evaluate the primary and exchanged femoral catheter patency rates, as well as mortality rates and determine the probable risk factors affecting femoral catheter survival.
Methods: All 79 tunneled femoral catheters created in our hospital from 2017 to 2020 were included in this study. Patients having no other means for dialysis access other than the femoral catheter was recruited in this study. Data collected included patient age, sex, comorbidities (diabetes and hypertension), transplant history, dialysis duration, catheter complications, femoral access history, and primary and exchanged femoral patency rates. Patients were followed for 4–36 months.
Results: The median catheter primary patency was 7 months (95% confidence interval [CI]: 5.77, 8.22) and the primary patency rates at 2, 4 and 6 months were 79%, 68% and 48%, respectively. The median exchanged catheter survival was 8 months (95% CI: 0.83, 15.17) and the exchanged patency rates at 1, 3 and 8 months were 72%, 64% and 32%, respectively. Of the patients (n = 62), 8% (5 patients) died because they had no other option for dialysis access.
Conclusion: Tunneled femoral catheters have a low patency rate and should be the last option for haemodialysis patients when other probable accesses are not available.
The Utility of N-Terminal Pro-Brain Natriuretic Peptide as an Adjunct Diagnostic Tool for Acute Heart Failure in Acute Dyspneic Patients Coming to the Emergency Department: A Retrospective Review of Our Early Experience
Authors: Rajah Rathika , Kuan Yee Lim , Boon Hau Ng , Chun Ian Soo
Published: August 2021

Acute dyspnea is one of the prevalent reasons for admission to the emergency department. The use of N-terminal pro-B-type natriuretic peptide (NT-proBNP) as an adjunct for assessing acute dyspnea is not a common practice in many public hospitals in Malaysia. This retrospective review is part of our clinical audit to determine the utility of NT-proBNP as an adjunct to non- standardised clinical evaluation in identifying acute heart failure (HF) in patients with persistent dyspnea (24 h) post-admission. In this cohort of 30 patients with acute dyspnea, NT-proBNP was positive in 20 patients (87%) with acute HF. Three patients (13%) who were treated for septic shock recorded a NT-proBNP false-positive. NT-proBNP demonstrated an overall sensitivity of 90%, a specificity of 70%, a positive predictive value of 85.7% and a negative predictive value of 77.8% in identifying acute HF. These results reinforce that age-stratified NT-proBNP cut-off values are useful for ruling-in or -out acute HF. Thus, NT-proBNP should be considered a crucial point of care, testing to decifer the conundrum of acute dyspneic patients.
AN OVERVIEW OF LESS KNOWN JACOBSEN SYNDROMEAN OVERVIEW OF LESS KNOWN JACOBSEN SYNDROME
Authors:   Nursing Tutor, Shri Mata Vaishno Devi College of Nursing, Kakryal, Katra, Jammu, India., Kumari Sushma , Hedleen Hanna ,   Nursing Tutor, Shri Mata Vaishno Devi College of Nursing, Kakryal, Katra, Jammu, India.
Published: August 2021

Jacobsen syndrome is catastrophic in 1 out of every 5 cases, with children usually dying within the first 2 years of life due to heart complications. Jacobsen syndrome is a contiguous gene syndrome caused by partial deletion of the long arm of chromosome 11. The prevalence has been estimated at 1/100,000 births, with a female/male ratio 2:1. The most common clinical features include pre- and postnatal physical growth retardation, psychomotor retardation, and characteristic facial dysmorphism (skull deformities, hypertelorism, ptosis, coloboma, downslanting palpebral fissures, epicanthal folds, broad nasal bridge, short nose, v-shaped mouth, small ears, low set posteriorly rotated ears). Abnormal platelet function, thrombocytopenia or pancytopenia are usually present at birth. Patients commonly have malformations of the heart, kidney, gastrointestinal tract, genitalia, central nervous system and skeleton. Ocular, hearing, immunological and hormonal problems may be also present. The deletion size ranges from 07 to 20 Mb, with the proximal breakpoint within or telomeric to subband 11q 23.3 and the deletion extending usually to the telomere. The deletion is de novo in 85% of reported cases, and in 15% of cases it results from an unbalanced segregation of a familial balanced translocation or from other chromosome rearrangements. Diagnosis is based on clinical findings (intellectual deficit, facial dysmorphic features and thrombocytopenia) and confirmed by cytogenetics analysis.