bluuebunny/crossref_metadata_2025 huggingface dataset:
Immunophenotypic switch in cutaneous T‐cell lymphoma: A series of three cases and review of the literature
Authors: Bitar Carole , Hile Grace , Brown Noah A. , Fullen Douglas R. , Lowe Lori , Tejasvi Trilokraj , Wilcox Ryan A. , Harms Paul W. , Chan May P. , Bresler Scott C. , Hristov Alexandra C.
Published: April 2021

Primary cutaneous T‐cell lymphoma (CTCL) comprises a heterogeneous group of neoplasms with variable clinical behavior. Immunophenotypic switch (IS) is a phenomenon that occurs during lymphoma progression and is defined by an alteration in the immunophenotypic expression of a tumor with retention of its genotypic signature. This has been well‐recognized in hematopoietic neoplasms; however, it has been rarely reported in CTCL and its clinical implications are not well understood. We present the clinical, histopathologic, immunophenotypic, and genetic findings of three cases of CTCL that demonstrated IS post treatment with variable outcomes. We add our cases to the small number previously reported to increase awareness of this phenomenon and its diagnostic challenge.
Plant‐caterpillar food web: Integrating leaf stoichiometry and phylogeny
Authors: Zhu Chunchao , Zhang Minhua , Chen Yongfa , Yin Deyi , He Dong , Fang Suqin , Ellwood M. D. Farnon , Chu Chengjin
Published: April 2021

1. Trophic interactions and plant‐herbivore network structure may be regulated by ecological and evolutionary factors. The allocation of resources to physical and chemical traits may influence plant nutritional values and defence against insect herbivores. However, the elemental consistency of plant leaves is rarely considered a functional trait, despite leaf chemical traits being critical for understanding trophic interactions and network modularity.

2. We constructed a high‐resolution network of a plant‐caterpillar food web in a subtropical forest in southern China using DNA barcoding. We analysed whether abundance, phylogeny, and functional traits (including leaf chemical elements) significantly differed among modules and conducted linear regressions to explore how these traits could explain the intensity and likelihood of trophic interactions between plants and caterpillars.

3. Caterpillar feeding intensity increased with increasing specific leaf area and leaf nitrogen to phosphorus (N:P) ratio. The intensity and likelihood of feeding decreased with increasing calcium and magnesium levels. Leaf dry matter content and leaf concentrations of potassium, magnesium, copper, and manganese varied among modules. Caterpillar feeding likelihood and intensity were constrained by plant and caterpillar phylogenies, and module phylogenetic clustering was apparent. Species abundance of plants and caterpillars constrained the feeding intensity but not the likelihood of feeding and network module composition.

4. We highlighted the combined roles of functional traits and phylogeny in shaping trophic interactions and modularity in plant‐insect herbivore networks and illustrated the importance of leaf stoichiometry in establishing dietary associations.
Interictal dysphoric disorder in people with and without epilepsy
Authors: Zinchuk Mikhail , Kustov Georgii , Pashnin Evgenii , Pochigaeva Ksenia , Rider Flora , Yakovlev Alexander , Hesdorffer Dale , Hauser W. Allen , Guekht Alla
Published: April 2021

Objective

Interictal dysphoric disorder (IDD) has been regarded as an affective disorder occurring only in people with epilepsy (PWE). Data showing similar characteristics and similar prevalence of IDD in patients with migraine and with psychogenic nonepileptic seizures question the epilepsy‐specific nature of IDD. The aim of the study was to investigate the nature of IDD in people with prevalent epilepsy with mood disorders and people with mood disorders who are free of neurological disease.

Methods

This is a case–control study, with 142 patients with a confirmed diagnosis of epilepsy and major depressive disorder (MDD; cases) and 222 patients with MDD only (controls). MDD diagnosis was confirmed by a structured clinical interview for Diagnostic and Statistical Manual of Mental Disorders, 4th edition (SCID‐I‐RV). We used the Beck Depression Inventory and the Beck Anxiety Inventory to estimate anxiety and depression levels and the Interictal Dysphoric Disorder Inventory (IDDI) to confirm the presence of IDD. Mann–Whitney U test, Pearson chi‐squared, Spearman correlation, and logistic regression were used.

Results

No differences were found in the prevalence of IDD between PWE with MDD and people with MDD alone (88.73% vs. 85.13%, χ2 = .96, p = .32). There were no differences between the groups overall or for any IDDI subscales (all p > .05). In both groups, IDD symptoms were grouped with the same incidence and had the same duration and periodicity. IDD was not associated with epilepsy (odds ratio = .84, 95% confidence interval = .40–1.98, p = .72). No significant correlation was found between epilepsy, demographic characteristics, and all IDDI subscales (all p > .05). Notably, patients with IDD suffered from affective disorders longer (6.68 ± 6.82 years vs. 3.7 ± 3.97 years, p = .001) and also received higher scores on all psychometric scales (all p < .05).

Significance

This study does not confirm the specificity of IDD for epilepsy. The presence of IDD symptoms may be associated with a more severe course of MDD and significant anxiety distress.
5‐Aminolaevulinic acid photodynamic therapy amplifies intense inflammatory response in the treatment of acne vulgaris via CXCL8
Authors: Zhang Linglin , Yang Jiayi , Liu Xiaojing , Xu Detian , Shi Lei , Liu Jia , Zeng Qingyu , Wang Xiuli
Published: April 2021

Acne vulgaris is a chronic inflammatory cutaneous disease. 5‐Aminolaevulinic acid photodynamic therapy (ALA‐PDT) is a novel and effective approach for severe acne vulgaris treatment. However, its specific treatment mechanism still remains unclear. In the present study, we investigated the potential mechanism of how ALA‐PDT regulated intense inflammatory response in acne vulgaris. It appeared that ALA‐PDT suppresses proliferation and lipid secretion of primary human sebocytes. Besides, ALA‐PDT could up‐regulate the expression of CXCL8 in vivo and in vitro, amplifying the inflammatory response by recruiting T cells, B cells, neutrophils and macrophages. We also found that ALA‐PDT elevated the expression of CXCL8 via p38 pathway. SB203580, a p38 pathway inhibitor, decreased the expression of CXCL8 in sebocytes after ALA‐PDT. These findings indicate that ALA‐PDT amplifies the intense inflammatory response in the treatment of acne vulgaris via CXCL8. Our data decipher the mechanism of intense inflammatory response after ALA‐PDT for acne vulgaris.
Tracking industrial fishing activities in African waters from space
Authors: Li Mi‐Ling , Ota Yoshitaka , Underwood Philip J. , Reygondeau Gabriel , Seto Katherine , Lam Vicky W. Y. , Kroodsma David , Cheung William W. L.
Published: April 2021

Marine fisheries in African waters contribute substantially to food security and local economies in African coastal nations. Recently, there are growing concerns about the sustainability of living marine resources in these countries’ exclusive economic zones (EEZs) due to increased risks from climate change, pollution and potential over‐exploitation of fisheries resources by non‐African (foreign) countries. To effectively manage fishing activities and sustain marine resources in African waters, we need useful tools for characterizing the fishing activities in African waters. Here, we assess the utility of the Automatic Identification System (AIS) derived data for describing the spatial characteristics of African and foreign industrial fishing activities within the EEZs of African coastal nations. The results show that the AIS‐derived spatial pattern of industrial fishing activities in African waters is consistent with that of industrial catches derived from the Sea Around Us database. Across African EEZs, the spatial correlations between primary productivity and fishing effort highly vary by gear types, which emphasizes the importance of investigating specific fishing strategies when studying the effects of bottom‐up drivers on fishing effort. We find an EEZ‐specific spatial pattern for fishing efforts across African waters and identify some socioeconomic, political and geographic factors that likely affect the decision of fleets to fish in specific African EEZs. We conclude that AIS‐derived fishing data can be a useful complementary tool for characterizing the spatial pattern of industrial fishing efforts in African waters.
Emerging role of lncRNA ELDR in development and cancer
Authors: Sur Subhayan , Ray Ratna B.
Published: April 2021

Whole‐genome sequencing and transcriptome analysis revealed more than 90% of the human genome transcribes noncoding RNAs including lncRNAs. From the beginning of the 21st century, lncRNAs have gained widespread attention as a new layer of regulation in biological processes. lncRNAs are > 200 nucleotides in size, transcribed by RNA polymerase II, and share many similarities with mRNAs. lncRNA interacts with DNA, RNA, protein, and miRNAs, thereby regulating many biological processes. In this review, we have focused mainly on LINC01156 [also known as the EGFR long non‐coding downstream RNA (ELDR) or Fabl] and its biological importance. ELDR is a newly identified lncRNA and first reported in a mouse model, but it has a human homolog. The human ELDR gene is closely localized downstream of epidermal growth factor receptor (EGFR) gene at chromosome 7 on the opposite strand. ELDR is highly expressed in neuronal stem cells and associated with neuronal differentiation and mouse brain development. ELDR is upregulated in head and neck cancer, suggesting its role as an oncogene and its importance in prognosis and therapy. Publicly available RNA‐seq data further support its oncogenic potential in different cancers. Here, we summarize all the aspects of ELDR in development and cancer, highlighting its future perspectives in the context of mechanism.
Geographies of cultural industries across the global urban system
Authors: Yin Miao , Derudder Ben
Published: April 2021

This paper reviews the research literature analysing the uneven geographical distribution of cultural industries across the global urban system. We begin by discussing the two major conceptual links between cultural industries and urban economies: (1) production processes becoming more flexible and specialised, and (2) the symbolic‐oriented and place‐rooted identities of cultural products. This has provided the backcloth for a wide‐ranging urban‐geographical research agenda exploring cultural industries, and here the focus is on how these industries are unevenly distributed, implemented and shaped across the global urban system. Cultural industries' dependence on a large pool of creative labour, extensive local networks of suppliers, access to tacit knowledge, and synergies based on spatial proximity all strengthen their agglomeration in a limited number of major metropolitan areas. However, the cultural economy also increasingly thrives in a range of smaller and remote cities as these have succeeded integrating into global cultural production networks and/or carved out a niche in increasingly differentiated consumer markets. In addition, because the economic importance of cultural production is expanding rapidly across the globe, we are seeing an increasingly polycentric urban geography with new global cultural centres emerging on the map.
Black British female managers—The silent catastrophe
Authors: Miller Denise A.
Published: April 2021

The researcher examined the experiences of Black British female managers (BBFM) who worked for Children and Young People's Services (CYPS) operating in the UK. The following research questions guided this study: How do Black British female managers experience racial microaggressions and how do they cope with it? Purposive and theoretical sampling were used to recruit 10 BBFM who worked for CYPS and who had similar demographic characteristics (i.e., racial/ethnic background and managerial experience). Interview transcripts were analyzed using constructivist grounded theory (Charmaz, 2006a). Over 200 codes were identified and extracted from individual interview transcripts. Organizing the codes into categories resulted in five themes that highlighted the challenging practices that BBFM perceived thwarted their careers (i.e., The Organizational Culture, On the Outside Looking In, Stereotype Threat, Prejudice, and Discrimination and Institutional Racism and Espoused Practice vs. Reality), and one theme that described their coping strategies (i.e., The Silent Catastrophe). Although the study is centered on a multisectorial sample, two main conclusions can be drawn from this study. First, gendered racism curtails the career development of BBFM in ways that are not experienced by their White counterparts. Second, BBFM perceive that their experiences in CYPS was fundamentally negatively disproportionate and aversive. The implication is that CYPS leaders must give racial and gender equality, diversity and inclusion greater priority.
UV‐irradiation influence on free radical formation and radical scavenging ability of caffeic acid—EPR, UV‐Vis, and colorimetric examination
Authors: Bogacz Adam , Stec Małgorzata , Ramos Paweł , Pilawa Barbara
Published: April 2021

Electron paramagnetic resonance (EPR) spectroscopy, UV‐Vis spectrophotometry, and colorimetric analysis, were used to examine nonirradiated and UV‐irradiated caffeic acid. In this work free radical formation during UV‐irradiation of caffeic acid and the effect of UV‐irradiation on its radical scavenging ability, were studied. The influence of time of UV‐irradiation on these problems was evaluated. EPR spectra of free radicals in caffeic acid and 1,1‐diphenyl‐2‐picrylo‐hydrazyl (DPPH) were measured. DPPH was used as the model free radical reference to test antioxidative properties of caffeic acid. Amplitudes, linewidths, integral intensities, and g‐factors were analyzed. Free radical concentrations were determined by comparing of the EPR spectra of caffeic acid and ultramarine—the paramagnetic reference. Free radicals were found (~1018 spin/g) in all the UV‐irradiated samples independent on irradiation time. Free radical concentrations in caffeic acid increased with increasing of irradiation time. Analysis of spectral shape for different microwave powers pointed out that free radicals system in UV‐irradiated caffeic acid was complex. Nonirradiated and UV‐irradiated caffeic acid as antioxidants strongly interacted with free radicals and EPR signals of DPPH were highly quenched. UV‐irradiation increased interactions of caffeic acid with free radicals, and this effect increased with increasing of irradiation time.

Practical Application

The performed studies indications that caffeic acid should not be storage exposed to UV. UV‐irradiation formed free radicals in caffeic acid and changed its antioxidative properties as radical scavenging ability. Free radical concentrations in caffeic acid increased with increased UV irradiation time. UV‐irradiation causes a change of color in caffeic acid. The change of color and formation of free radicals in caffeic acid during UV‐irradiation can indicate the destruction of the chemical structure of tested samples.
A comparison of intestinal parasite infections and activity budgets in three free‐ranging vs. enclosure‐housed lemur species (Lemur catta,Varecia rubra, andEulemur mongoz)
Authors: Achorn Angela , Winking Jeffrey
Published: April 2021

This study examines how range size affects intestinal parasite infections, and how such infections affect activity budgets in captive lemurs. There were no differences in parasite richness or intensity attributable to habitat type. However, there was a strong suggestion that parasite loads reduce activity levels.
When seed becomes capital: Commercialization of Bt cotton in Pakistan
Authors: Rana Muhammad Ahsan
Published: April 2021

The multinational Monsanto effectively used a (non‐existent) patent in Pakistan to block approval of locally developed genetically modified (GM) cotton seeds during 2002–2010, despite their immense popularity with farmers. Monsanto also (unsuccessfully) tried to negotiate an arrangement with the Pakistani government that would create the conditions under which Monsanto could operate without subjecting itself to market vicissitudes. The Pakistani government denied biosafety approval to local GM seeds, but biosafety concerns were just a mask to cover government's reluctance to infringe Monsanto's patent. Thus, farmers could now purchase new seeds only from the informal market where quality assurance was lacking. They were dispossessed of their right to legally buy, use, and save new seeds. Farmers' dispossession was a prerequisite to their purchase of Monsanto's seed. The seed had to become capital, so that its use was possible only within capitalist relations of production. This paper provides empirical evidence of a continuing process of dispossession through a combination of state power and market institutions.
« I am not a French woman, you know »
Authors: Jaques Amélie
Published: April 2021

Dans le domaine des études de genre, l’articulation entre multilinguisme et transculturalité au siècle des Lumières reste peu étudiée. Certes, des études récentes ont démontré que de nombreuses écrivaines, traductrices et éditrices éclairées se sont construit une vie à la croisée des langues et des littératures. Or, ces études ont surtout illustré la contribution active des femmes aux circuits de transferts culturels. Inversement, l’apport particulier du multilinguisme à l’auto‐façonnement intellectuel des femmes, et notamment à la construction de leur rôle de médiatrice, n’a pas encore été étudié en profondeur. Sur cet arrière‐fond, le présent article offre une micro‐lecture des correspondances de Marie‐Jeanne Riccoboni, écrivaine et traductrice active dans la seconde moitié du dix‐huitième siècle, qui s’engageait dans les rapports anglo‐français. La lecture des lettres adressées à David Hume et à David Garrick met en lumière l’apport stratégique du métissage langagier, d’une part, et des références aux pratiques multilingues, d’autre part, à la construction de ses rôles de romancière et de traductrice. Dans le cadre d’une recherche plus large sur les formes et les fonctions du multilinguisme dans les récits personnels de quelques médiatrices éclairées, cette lecture ouvre la voie à une analyse plus approfondie des pratiques multilingues au siècle des Lumières.
India's RCEP Dilemma with China: Beyond the Legal Texts*
Authors: Wang Chao , Sharma Vinay
Published: April 2021

The ASEAN‐inaugurated Regional Comprehensive Economic Partnership (RCEP) was eventually concluded on 15 November 2020 after 8 years of tough negotiations. India was counted as an important member of the RCEP, but it chose to back out when other members were finalizing the RCEP legal text. This article critically analyzes the relevant legal provisions leading to India's withdrawal from this significant mega trade deal, the reasons behind India's refusal of those provisions, the possibility of isolationism India might face, and geopolitical changes in Sino–India relations post stand‐off on the Galwan Valley as well as the COVID‐19 pandemic. It argues that unbalanced economic relations, India's self‐reliant ideology, as well as China's growing hegemony in the Asia‐Pacific region are among the principle factors for India to back out from the RCEP. However, the door to participate in the future remains open for India.
Thoracoabdominal asynchrony associates with exercise intolerance in fibrotic interstitial lung diseases
Authors: Santana Pauliane Vieira , Cardenas Leticia Zumpano , Ferreira Jeferson George , de Carvalho Carlos Roberto Ribeiro , de Albuquerque André Luis Pereira , Caruso Pedro
Published: April 2021

Background and objective

The precise coordination of respiratory muscles during exercise minimizes work of breathing and avoids exercise intolerance. Fibrotic interstitial lung disease (f‐ILD) patients are exercise‐intolerant. We assessed whether respiratory muscle incoordination and thoracoabdominal asynchrony (TAA) occur in f‐ILD during exercise, and their relationship with pulmonary function and exercise performance.

Methods

We compared breathing pattern, respiratory mechanics, TAA and respiratory muscle recruitment in 31 f‐ILD patients and 31 healthy subjects at rest and during incremental cycle exercise. TAA was defined as phase angle (PhAng) >20°.

Results

During exercise, when compared with controls, f‐ILD patients presented increased and early recruitment of inspiratory rib cage muscle (p < 0.05), and an increase in PhAng, indicating TAA. TAA was more frequent in f‐ILD patients than in controls, both at 50% of the maximum workload (42.3% vs. 10.7%, p = 0.01) and at the peak (53.8% vs. 23%, p = 0.02). Compared with f‐ILD patients without TAA, f‐ILD patients with TAA had lower lung volumes (forced vital capacity, p < 0.01), greater dyspnoea (Medical Research Council > 2 in 64.3%, p = 0.02), worse exercise performance (lower maximal work rate % predicted, p = 0.03; lower tidal volume, p = 0.03; greater desaturation and dyspnoea, p < 0.01) and presented higher oesophageal inspiratory pressures with lower gastric inspiratory pressures and higher recruitment of scalene (p < 0.05).

Conclusion

Exercise induces TAA and higher recruitment of inspiratory accessory muscle in ILD patients. TAA during exercise occurred in more severely restricted ILD patients and was associated with exertional dyspnoea, desaturation and limited exercise performance.
Import competition and industry location in a small‐country model of productivity growth
Authors: Davis Colin , Hashimoto Ken‐ichi
Published: April 2021

We study how import competition affects the regional concentration of industry location in a small open economy with two regions. Industry concentration is linked with firm‐level investment in process innovation through an import competition effect that is increasing in the market share of imported goods and the productivity differential of domestic firms with the rest of the world. We show that increased import competition, through a larger number of imported goods or a faster international rate of productivity growth, leads to greater regional industry concentration by reducing domestic market entry and decreasing the relative productivity of domestic firms.
Introduction to the Special Issue on Reframing Confederate Monuments: Memory, Power, and Identity
Authors: Evans Jocelyn J. , Lees William B.
Published: April 2021

Objective

This article highlights the contours of the Confederate monument debate, frames the contributions to the special issue, and underscores important emergent themes from the collection as a whole.

Method

By way of introduction, we articulate and examine the issue of Confederate monument contestation in terms of three concurrent debates and then provide theoretical synthesis across the various scholarly contributions presented in this special issue.

Results

Several themes emerge. Memorials are rhetorical and evocative by design, articulating messages of memory, identity, and power. They are part of a broader living narrative giving cultural shape to the city and its inhabitants. Contesting them is part of a transitional justice process required of a society moving from racial oppression and marginalization toward racial equality and social justice.

Conclusions

The contemporary debate over Confederate monuments holds deep theoretical implications for scholars across the disciplines of the arts, social sciences, and humanities. Consequently, the academy is significantly positioned to speak to this debate through its various avenues of community engagement.
Effectiveness of hepatitis B vaccination in chronic HCV patients after successful generic direct acting antiviral therapy: significance of isolated hepatitis B core antibodies
Authors: Abd El‐Wahab Ekram W. , Metwally Mohammed , Lotfy Nesma
Published: April 2021

Objective

Previous reports show conflicting results regarding hepatitis B virus (HBV) vaccine efficacy in Hepatitis C virus (HCV) infected individuals and in those with isolated hepatitis B core antibodies (HBcAb). We aimed to evaluate the effectiveness of HBV vaccine and identify possible factors that may contribute to hyporesponsivness in HCV‐treated patients, including those with isolated HBcAb.

Methods

We conducted a prospective study with 118 enrolled chronic HCV patients who followed a 12‐week regimen of direct acting antivirals (DAAs) and were evaluated for HBV serological markers. Eventually, 98 received appropriate HBV vaccination and were assessed for response.

Results

A total of 57.1% were vaccine responders although only 5.1% achieved a seroprotective level of HBsAb titre. The response rate was significantly lower among treated HCV patients with isolated HBcAb [2 (5.6%) vs. 40 (64.5%) respectively]. On multivariate analysis, advanced age [OR (95% CI) = 1.09 (1.02–1.17)] and presence of isolated HbcAb [OR (95% CI) = 39.59 (7.98–196.63)] were predictors of vaccine non‐response. In our cost‐effectiveness models, the cost of HBV serological screening was less than the nationally adopted non‐screening approach. A model ratifying reinforced vaccination in non‐responder HBcAb seropositive HCV patients would incur extra cost.

Conclusion

Hyporesponsiveness to the HBV vaccination is frequent in chronic HCV patients even after achieving SVR following DAAs. Although there is no consensus on the clinical management of patients with isolated HBcAb, our cost‐effectiveness options may support decision‐making for better clinical benefit and proper health investments.
Mild Jugular Compression Reduces White Matter Alterations in High School-Aged Males Playing Collision Sports
Authors: Nye Megan , Cacolice Paul A.
Published: April 2021

Clinical question: Do mild jugular compression (MJC) devices reduce white matter alterations in high school-aged males playing collision sports? Clinical bottom line: There is moderate evidence at Strength of Recommendation B to support that MJC reduces WMAs in high school-aged males playing collision sports.
The illustration of dinosaur tracks through time
Authors: Goldstein Donald H. , Getty Patrick
Published: April 2021

Dinosaur tracks have been illustrated since they were first found. The earliest illustrations depicted dinosaur tracks as the work of mythical beings. With the advent of scientific inquiry into dinosaur tracks in the nineteenth century, natural explanations were sought for the fossil tracks. Illustrations of the period were relatively realistic but were influenced by then-current beliefs and were constrained by the artists’ skills and by what scientists considered salient. In the mid-nineteenth century, the first photographs were used for the scientific study of fossil tracks. Photography eliminated some limitations of artistic talent and showed complete specimens, not just aspects that were deemed salient. The ability to compare and name similar tracks from disparate authors and places became easier. Advances in photography, laser scanning, optical scanning and lidar, and the ability to manipulate images with computers, have enabled the modern synthesis of illustrating dinosaur tracks, which combines many types of images. With each advance and the adoption of newer technologies, the older methods have not been retired. Rather, we have continued to see new uses for old methods and an integration of illustrative styles.

For Patrick. Your friendship and your vision will be so deeply missed.
A Unified Approach to Disjoining Pressure in Liquid and Vapor Interlayer within the Framework of the Density Functional Theory
Authors: Shchekin A. K. , Gosteva L. A. , Lebedeva T. S. , Tat’yanenko D. V.
Published: April 2021

The classical density functional theory makes it possible to explicitly calculate the local density profiles, the components of the pressure tensor, and the thicknesses of thin interlayers between a lyophilic or lyophobic solid surface and, accordingly, gas or liquid phases at different values of the chemical potentials of the phases. Within the framework of a unified approach based on the gradient approximation of the classical density functional theory, it has been shown that, at certain values of parameters characterizing the wettability or nonwettability of a solid, equilibrium liquid films or vapor layers of a uniform thickness are formed around a spherical particle, if its surface is lyophilic or lyophobic, respectively. Mechanical and thermodynamic definitions have been given for the disjoining pressure in the spherical liquid or vapor interlayer around a solid particle, and the agreement between the definitions has been proven by calculations at different interlayer thicknesses and particle radii. It has been shown that the disjoining pressure in a vapor interlayer around a nanosized lyophobic particle decreases with an increase in particle radius, with this phenomenon being opposite to the situation with liquid films.
Colocutaneous fistula followingClostridioides difficileinfection managed as an ‘autocolostomy’: a novel approach to a recognised complication
Authors: Ahmed Marriam , Randhawa Kiran , Kawesha Anthony , Akingboye Akinfemi Ayobami
Published: April 2021

Colocutaneous fistula is a rare entity in colorectal disease. We present a case of colocutaneous fistula in a patient whose postoperative course following a laparoscopic anterior resection for sigmoid cancer was complicated byClostridioides difficilecolitis. During the follow-up period, it was found that his bowel contents were preferentially discharging through this fistula which had taken up the role of an ‘autocolostomy’. Given the physiological impact of an additional surgical procedure, a definitive repair of the fistula was deferred and instead the patient was taught to manage it in keeping with general principles of stoma care. Over the subsequent follow-up period, he has now developed a large parastomal hernia and is being considered for definitive repair.
Haematuria without diagnosis? Think about the rare causes…
Authors: Esteireiro Ana Sofia , Santos Pedro , Bicho Anabela
Published: April 2021

We describe a case of a 17-year-old man admitted in the emergency room with a 2-month history of intermittent macroscopic haematuria and left lumbar pain. Physical examination and vital signs were normal. Investigation indicated a recurrent non-glomerular haematuria. The Doppler ultrasound revealed a compression of the left renal vein with upstream dilatation which was subsequently confirmed by CT angiography. These findings are in keeping with a case of nutcracker syndrome (NutS). Although asymptomatic in most cases, it can be a rare cause of haematuria. The teenager was referred to paediatric nephrology and was treated conservatively with spontaneous resolution of macroscopic haematuria. With this case, we would like to highlight that in children or adolescents with haematuria without an apparent cause, a high level of suspicion and appropriate imaging are necessary for the diagnosis of NutS.
De Garengeot hernia: a rare case in an elderly woman and a review of operative approaches
Authors: Zainudin Syaza , Hayati Firdaus , Arumugam Tharanrajh , Ho Kah Yee
Published: April 2021

De Garengeot hernia is a rare finding of the vermiform appendix inside a femoral hernia sac. We report this occurrence in a 73-year-old woman who presented in the acute setting. There are no standardised surgical approaches and many different techniques have been described in case reports in the literature. We conducted a literature review of and found a total of 113 cases with addition of our case 114 unique cases were included for analysis. Inguinal incision was most cited (n=89). Concomitant laparotomy was needed in 13 patients, however, the association between type of incision and additional laparotomy was not significant (p>0.05). Laparoscopic surgery alone was performed in eight patients. Nine patients had hybrid surgery. The most common hernia repair was through suture technique with non-absorbable material (n=31). Mesh repair was used in 28 cases. More laparoscopic surgeries were done when the disease was diagnosed preoperatively (7/39, p<0.05).
One man, three tick-borne illnesses
Authors: Grant Leah , Mohamedy Imran , Loertscher Laura
Published: April 2021

A 70-year-old man presented to the emergency department with fevers, ankle edema and nausea following a presumed insect bite on his ankle 1 month prior. On examination, he was febrile and had left leg pain with passive range of motion. Laboratory studies revealed anemia, thrombocytopenia, acute kidney injury and elevated aminotransaminases. Due to his recent travel to the Northeastern United States, he was suspected of having a possible tick-borne illness. Serologies were positive forBorrelia burgdorferi,Anaplasma phagocytophilumandBabesia microti, and the patient was diagnosed with Lyme disease, babesiosis and anaplasmosis. He was treated with doxycyline, atovaquone and azithromycin, leading to resolution of symptoms. While co-infection with Lyme disease is common, infection with three tickborne illnesses at one time is relatively rare.
Primary angiosarcoma of superior vena cava: an unexpected diagnosis after an oncological emergency
Authors: Rêgo Salgueiro Fábio , Vieira Inês , Gomes Inês , Petrova Maja
Published: April 2021

Angiosarcoma (AS) is a rare malignant tumour representing 1%–2% of all sarcomas. Primary AS of superior vena cava (SVC) was reported in two cases worldwide. We report a 69-year-old woman with neck discomfort, headache and dyspnoea for 3 months. CT angiography showed thrombosis in SVC and brachiocephalic veins resulting in an SVC syndrome. The patient began anticoagulant therapy and underwent balloon angioplasty with clinical improvement. Additionally, a positron emission tomography scan confirmed the presence of a mediastinal mass involving the SVC locally. The tumour was excised and a prosthesis was placed on the SVC. Histology revealed a heterogeneous tumour matrix, either myxoid and composed by fusiform cells with vimentin, homogeneous CD31 and a 30% Ki67 immunoexpression, supporting the diagnosis of an AS. Due to multiple complications, the patient never started chemotherapy, and after tumour recurrence, she died within 5 months after diagnosis.
Can synthetic data be a proxy for real clinical trial data? A validation study
Authors: Azizi Zahra , Zheng Chaoyi , Mosquera Lucy , Pilote Louise , El Emam Khaled
Published: April 2021

Objectives

There are increasing requirements to make research data, especially clinical trial data, more broadly available for secondary analyses. However, data availability remains a challenge due to complex privacy requirements. This challenge can potentially be addressed using synthetic data.

Setting

Replication of a published stage III colon cancer trial secondary analysis using synthetic data generated by a machine learning method.

Participants

There were 1543 patients in the control arm that were included in our analysis.

Primary and secondary outcome measures

Analyses from a study published on the real dataset were replicated on synthetic data to investigate the relationship between bowel obstruction and event-free survival. Information theoretic metrics were used to compare the univariate distributions between real and synthetic data. Percentage CI overlap was used to assess the similarity in the size of the bivariate relationships, and similarly for the multivariate Cox models derived from the two datasets.

Results

Analysis results were similar between the real and synthetic datasets. The univariate distributions were within 1% of difference on an information theoretic metric. All of the bivariate relationships had CI overlap on the tau statistic above 50%. The main conclusion from the published study, that lack of bowel obstruction has a strong impact on survival, was replicated directionally and the HR CI overlap between the real and synthetic data was 61% for overall survival (real data: HR 1.56, 95% CI 1.11 to 2.2; synthetic data: HR 2.03, 95% CI 1.44 to 2.87) and 86% for disease-free survival (real data: HR 1.51, 95% CI 1.18 to 1.95; synthetic data: HR 1.63, 95% CI 1.26 to 2.1).

Conclusions

The high concordance between the analytical results and conclusions from synthetic and real data suggests that synthetic data can be used as a reasonable proxy for real clinical trial datasets.

Trial registration number

NCT00079274.
Prevalence and risk factors of children’s dental anxiety in China: a longitudinal study
Authors: Gao Shuo , Lu Jiaxuan , Li Pei , Yu Dongsheng , Zhao Wei
Published: April 2021

Objectives

Dental anxiety remains widespread among children, may continue into adulthood and affect their oral health-related quality of life and clinical management. The aim of the study was to explore the trend of children’s dental anxiety over time and potential risk factors.

Design

Longitudinal study.

Methods

Children aged between 5 and 12 years were investigated with the Chinese version of face version of Children’s Fear Survey Schedule-Dental Subscale (CFSS-DS) and Frankl Behavior Rating scale from 2008 to 2017, and influential factors were explored.

Results

Clinical data were available from 1061 children, including 533 (50.2%) male participants and 528 (49.8%) female participants. The total CFSS-DS scores ranged from 16 to 66, with a mean of 24.8±10.3. The prevalence of dental anxiety is 11.59%. No significant differences in total CFSS-DS scores between girls and boys were found. According to the Frankl scale, 238 children were allocated to the uncooperative group and the remaining 823 children were allocated to the cooperative group. Scores of CFSS-DS were negatively correlated with the clinical behaviour level of Frankl. Children aged 11–12 years old had significantly decreased scores compared with other age groups, and there was a decline in the scores of the group aged 8–10 years old over time. The factor analysis divided 15 items of CFSS-DS into four factors, and the total scores of ‘less invasive oral procedures’ items belonging to factor III decreased significantly over time in the group aged 8–10 years old.

Conclusions

Age is a significant determinant for children’s dental anxiety, and dental anxiety outcomes have improved for Chinese children aged 8–10 years. This study is one of the few reports on changes of children’s dental anxiety in a new era of information, but the results may be extrapolated to other populations with caution.
COVID-19 and palliative medicine: faith-based hospitals in India
Authors: Sundararaj Jenifer Jeba , Munday Daniel , Duomai Savita , John Priya , Priscilla S Ruby Angeline , Powys Ruth , Singh Ashita , Boyd Kirsty J , Grant Liz , Murray Scott A
Published: April 2021

Objectives

Faith-based organisations (FBOs) in India provide health services particularly to marginalised communities. We studied their preparedness and delivery of palliative care during COVID-19 as part of a mixed-method study. We present the results of an online questionnaire.

Methods

All FBOs providing palliative care in India were invited to complete an online questionnaire. Descriptive analysis was undertaken.

Results

Response rate was 46/64 (72%); 44 provided palliative care; 30/44 (68%) were in rural or semiurban areas with 10–2700 beds. Fifty-two per cent (23/44) had dedicated palliative care teams and 30/44 (68%) provided it as part of general services; 17/44 (39%) provided both. 29/44 (66%) provided palliative care for cancer patients; 17/44 (34%) reported that this was more than half their workload.

The pandemic led to reduced clinical work: hospital 36/44 (82%) and community 40/44 (91%); with reduction in hospital income for 41/44 (93%). 18/44 (44%) were designated government COVID-19 centres; 11/40 (32%) had admitted between 1 and 2230 COVID-19 patients.

COVID-19 brought challenges: 14/44 (32%) lacked personal protective equipment; 21/44 (48%) had reduced hospital supplies and 19/44 (43%) lacked key medications including morphine. 29/44 (66%) reported reduction in palliative care work; 7/44 (16%) had stopped altogether. Twenty-three per cent (10/44) reported redeployment of palliative care teams to other work. For those providing, palliative care 32/37 (86%) was principally for non-COVID patients; 13/37 (35%) cared for COVID-19 patients. Service adaptations included: teleconsultation, triaged home visits, medication delivery at home and food supply.

Conclusions

FBOs in India providing palliative care had continued to do so despite multiple challenges. Services were adapted to enable ongoing patient care. Further research is exploring the effects of COVID-19 in greater depth.
Non-Surgical Animal Model of Gastroesophageal Reflux Disease by Overeating Induced in Mice
Authors: Nu-Ri IM , Kim Byoungjae , Jung Kwang-Yoon , Kim Tae Hoon , Baek Seung-Kuk
Published: April 2021

Previous animal models of gastroesophageal reflux disease (GERD) were not physiological and required a variety of surgical procedures. Therefore, the animal model developed by conditions that are similar to the pathogenesis of GERD is necessary. The aim is to establish a non-surgical animal model with GERD caused by overeating induced in mice. To induce mice to overeat, we designed dietary control protocols including repetitive fasting and feeding. The esophageal tissues were evaluated with GERD markers to prove the establishment of a GERD animal model. Mice fasted every other day (group 2) showed more pronounced overeating feature and demonstrated evident changes similar to the macroscopic and microscopic findings of GERD, the expressions of inducible nitric oxide synthase and substance P were stronger. The higher frequency of fasting and overeating could cause GERD effectively. The dietary control can make mice overeat, which elicits the change of lower esophageal mucosa similar to GERD. Thus, the overeating-induced mouse may be used as a GERD mouse model.
Diagnostic Efficacy of Serum and Urinary Netrin-1 in the Early Detection of Diabetic Nephropathy
Authors: Elkholy Rasha A , Younis Reham L , Allam Alzahraa A , Hagag Rasha Youssef , Abdel Ghafar Muhammad Tarek
Published: April 2021

This study aimed to assess the diagnostic value of serum and urinary netrin-1 in patients with type 2 diabetes mellitus (T2DM) at different stages of diabetic nephropathy (DN) and to compare its efficacy of estimation in serum with that in the urine. This study was carried out on 135 patients with T2DM and 45 healthy subjects. The patients with diabetes were divided according to urinary albumin creatinine ratio (UACR) into: T2DM with normoalbuminuria, incipient DN with microalbuminuria, and overt DN with macroalbuminuria groups. Serum and urinary levels of netrin-1 were measured by ELISA. The mean levels of serum and urinary netrin-1 were significantly higher in the microalbuminuric and macroalbuminuric patients with DN than those in the normoalbuminuric patients with T2DM, with the highest values detected in macroalbuminuric patients with DN. Urinary netrin-1 level was significantly higher in the normoalbuminuric T2DM group than control group, whereas no significant difference existed regarding serum netrin-1 level. In T2DM groups, the urinary and serum netrin-1 correlated with each other and were independently related to fasting blood glucose, UACR, and estimated glomerular filtration rate. Receiver operating characteristic curve analysis showed that the area under the curve of urinary netrin-1 was 0.916 which is significantly higher than that of serum netrin-1 (0.812) for the detection of incipient DN and reached 0.938 on coestimation of both urinary and serum netrin-1. In conclusion, netrin-1 is a potential diagnostic marker for early detection of DN with its estimation in urine has higher accuracy than that of serum.
Specific imaging features of intestinal perforation on supine abdominal X-ray evaluation in infants with necrotizing enterocolitis
Authors: Zhang Han , Guo Lu , Ling Keran , Hu Xiaoyu , Li Wei , Li Luquan
Published: April 2021

Background

Necrotizing enterocolitis (NEC) is associated with high mortality and morbidity in neonates. For infants with NEC, intestinal perforation is the most serious complication, and confirming perforation and performing radical surgical treatment as early as possible may reduce mortality and sequelae. The aim of this study was to identify the specific imaging characteristics of intestinal perforation after NEC on supine abdominal X-ray for the early diagnosis of intestinal perforation.

Methods

A retrospective study was conducted at the Children’s Hospital of Chongqing Medical University. Infants admitted to the hospital from 2013 to 2020 with NEC (Bell’s stage ≥Ⅱ) were divided into perforation and non-perforation groups. All infants were examined by abdominal X-ray in the erect and supine positions. The sensitivity and specificity of specific X-ray signs were analyzed.

Results

A total of 598 infants were included, 113 of whom suffered from perforation. On the supine abdominal films, lucency over the liver shadow, the liver falciform ligament sign, the football sign, the Rigler sign, the triangle sign and more than any one of the above signs had sensitivities of 64.60%, 45.13%, 37.17%, 30.97%, 15.93% and 86.73%, respectively. None of these signs were found on erect or supine abdominal films in the non-perforation group. The total of accuracy of prediction was 46.76%, and the specificity of all the signs was 100%.

Conclusion

Specific signs on supine abdominal X-ray could be used to confirm perforation in neonates with NEC with 86.73% sensitivity and 100% specificity.
Soil Mehlich-3-extractable elements as affected by the addition of biochars to a clay soil co-amended with or without a compost
Authors: Lévesque Vicky , Gagnon Bernard , Ziadi Noura
Published: April 2021

Biochar has the potential to sequester carbon and mitigate greenhouse gas emissions, and it may also contribute nutrients for plant growth in temperate climates. Nutrient availability in biochar-amended soil was assessed in a 338 d incubation study. The clay soil prepared with 4% w/w (dry basis) compost or without compost, then amended with wood-based biochar made at different pyrolysis temperatures [maple bark (Acer saccharum) at 400 (M400), 550 (M550), and 700 °C (M700)] on a dry-rate basis of 5% (w/w). After moistening the soil mixture to 44% volumetric soil water content (equivalent to 70% water-filled pore space), soil mixtures were incubated in the dark at 22 °C. Soil was sampled at days 9, 16, 23, 44, 86, 23 170, and 338 of the incubation. Biochar amendment increased the Mehlich-3 phosphorus, potassium (K), magnesium, and copper concentrations, and reduced the Mehlich-3 aluminum and iron concentrations at each sampling date, and M400 had the most significant effect on Mehlich-3-extractable nutrient concentrations. Compost addition also increased the amounts of extractable nutrients. These results suggested that M400 and carbon-rich compost promoted microbial growth and mineralization in amended soil. In addition, soil mixed with compost and amended with biochar had more Mehlich-3-extractable K than when compost or biochar was applied alone, probably due to greater growth and activity of soil K-solubilizing microorganisms. Overall, our study indicated that co-application of wood-based biochar and compost could improve soil fertility in temperate regions by increasing the availability of most plant macronutrients and micronutrients.