bluuebunny/crossref_metadata_2025 huggingface dataset:
The effectiveness of a modified Gui Zhi Fu Ling Wan formulation (Gynoclear™) for the treatment of endometriosis: a study protocol for a placebo-controlled, double-blind, randomised controlled trial
Authors: Armour Mike , Al-Dabbas Mahmoud A. , Ee Carolyn , Smith Caroline A. , Ussher Jane , Arentz Susan , Lawson Kenny , Abbott Jason
Published: April 2021

Background

Endometriosis is the presence of tissue similar to that of the endometrium outside the uterine cavity and is the most common cause of chronic pelvic pain. Current non-surgical treatments such as non-steroidal anti-inflammatories, oral contraceptive pills and hormonal treatments have limited effectiveness, and the side effect profile is bothersome. This study will evaluate the efficacy of Gynoclear™ by change in endometriosis-related pain based on the Endometriosis Pain Daily Diary (EPPD) scores.

Methods

This randomised, double-blind, placebo-controlled trial will recruit a minimum of 90 adult participants across Australia who have a laparoscopic visualisation/confirmation of endometriosis in the last 5 years and have current moderate or greater pelvic pain. Participants will be randomly allocated in a 1:1 ratio to receive either Gynoclear™ (active) or placebo. Gyncolear’s active ingredients are Carthamus tinctorius (Safflower), Cinnamomum cassia (Chinese cinnamon), Poria cocos (Hoelen), Paeonia suffriticosa (Tree peony), Paeonia lactiflora (Peony) and Salvia miltiorrhiza (Red sage). Participants are asked to complete a total of 5 months’ worth of pain diary entries via the EPDD v3, including 1-month screening, 2-month treatment period and 1-month post-treatment follow-up. The primary outcome variable is change in endometriosis-related pain based on the EPDD v3 scores. Secondary outcomes include change in health-related quality of life via the Endometriosis Health Profile (EHP-30), SF-12 and EQ-5D scores as well as changes in rescue analgesic usage, dyspareunia and fatigue via the EPDD.

Discussion

This study will determine the safety and efficacy of Gynoclear™ to reduce the severity and duration of non-cyclical pelvic pain, dysmenorrhoea, dyspareunia and other symptoms of endometriosis. Study outcomes will be of interest to health professionals and members of the public who suffer from endometriosis.

Trial registration

Australia and New Zealand Clinical Trials Registry ACTRN12619000807156. Registered on 3 June 2019.
Regulation of osteoclastogenesis by mast cell in rheumatoid arthritis
Authors: Kim Kyoung-Woon , Kim Bo-Mi , Won Ji-Yeon , Min Hong-Ki , Lee Kyung-Ann , Lee Sang-Heon , Kim Hae-Rim
Published: April 2021

Background

In the pathogenesis of rheumatoid arthritis (RA), the role of mast cells has not been revealed clearly. We aimed to define the inflammatory and tissue-destructive roles of mast cells in rheumatoid arthritis (RA).

Methods

Serum and synovial fluid (SF) concentration levels of tryptase, chymase, and histamine were quantified using ELISA. After activating mast cells using IL-33, the production of TNF-α, IL-1β, IL-6, IL-17, RANKL, and MMPs was determined using real-time PCR and ELISA. Osteoclastogenesis was assessed in CD14+ monocytes from peripheral blood and SF, which were cultured with IL-33-activated mast cells, by counting TRAP-positive multinucleated cells.

Results

The concentration levels of serum tryptase, chymase, and histamine and SF histamine were higher in patients with RA than in controls. FcεR1 and c-kit-positive mast cells were higher in RA synovium than in osteoarthritic (OA) synovium. Stimulation of mast cells by IL-33 increased the number of trypatse+chymase− and tryptase+chymase+ mast cells. IL-33 stimulation also increased the gene expression levels of TNF-α, IL-1β, IL-6, IL-17, RANKL, and MMP-9 in mast cells. Furthermore, IL-33 stimulated human CD14+ monocytes to differentiate into TRAP+ multinucleated osteoclasts. When CD14+ monocytes were co-cultured with mast cells, osteoclast differentiation was increased. Additionally, IL-33-activated mast cells stimulated osteoclast differentiation. The inhibition of intercellular contact between mast cells and monocytes using inserts reduced osteoclast differentiation.

Conclusions

IL-33 increased inflammatory and tissue-destructive cytokines by activation of mast cells. Mast cells stimulated osteoclast differentiation in monocytes. Mast cells could stimulate osteoclastogenesis indirectly through production of tissue-destructive cytokines and directly through stimulation of osteoclast precursors.
Survival time among patients who were diagnosed with tuberculosis, the precocious deaths and associated factors in southern Brazil
Authors: dos Santos Danielle Talita , Arroyo Luiz Henrique , Alves Yan Mathias , Alves Luana Seles , Berra Thais Zamboni , Crispim Juliane de Almeida , Alves Josilene Dália , Ramos Denisse Andrea Cartagena , Alonso Jonas Bodini , de Assis Ivaneliza Simionato , Ramos Antônio Vieira , Dessunti Elma Mathias , Carvalho Pinto Ione , Palha Pedro Fredemir , Arcêncio Ricardo Alexandre , Nunes Carla
Published: April 2021

Background

A diagnosis of tuberculosis (TB) does not mean that the disease will be treated successfully, since death may occur even among those who are known to the health services. Here, we aimed to analyze patient survival time from the diagnosis of TB to death, precocious deaths, and associated factors in southern Brazil.

Methods

We conducted a longitudinal study with patients who were diagnosed with TB and who died due to the disease between 2008 and 2015 in southern Brazil. The starting point for measuring survival time was the patient’s diagnosis date. Techniques for survival analysis were employed, including the Kaplan-Meier test and Cox’s regression. A mixed-effect model was applied for identifying the associated factors to precocious deaths. Hazard ratio (HR) and odds ratio (OR) with 95% confidence intervals (95% CI) were estimated. We defined p value <0.05 as statistically significant for all statistics applied.

Results

One hundred forty-six patients were included in the survival analysis, observing a median survival time of 23.5 days. We observed that alcoholism (HR=1.55, 95% CI=1.04-2.30) and being male (HR=6.49, 95% CI=1.03-2.68) were associated with death. The chance of precocious death within 60 days was 10.48 times greater than the chance of early death within 30 days.

Conclusion

Most of the deaths occurred within 2 months after the diagnosis, during the intensive phase of the treatment. The use of alcohol and gender were associated with death, revealing inequality between men and women. This study advanced knowledge regarding the vulnerability associated with mortality. These findings must be addressed to fill a gap in the care cascades for active TB and ensure equity in health.
LncRNA LPAL2/miR-1287-5p/EGFR Axis Modulates TED-Derived Orbital Fibroblast Activation Through Cell Adhesion Factors
Authors: Wang Nuo , Hou Shi-ying , Qi Xin , Deng Mi , Cao Jia-min , Tong Bo-Ding , Xiong Wei
Published: April 2021

Context

The activation of orbital fibroblasts, the prime targets in thyroid eye disease (TED), is central to its underlying pathogenesis.

Objective

We aimed to investigate the mechanism of TED orbital fibroblast activation from the perspective of noncoding RNA regulation.

Methods

Immunofluorescence (IF) staining was applied to evaluate the fibrotic changes in target cells. Cell proliferation was evaluated by 5-ethoxy 2-deoxyuridine and colony-formation assays. Collagen I concentration was determined by enzyme-linked immunosorbent assay. Human microarray analysis was performed on 3 TED and 3 healthy control orbital tissue samples.

Results

Bioinformatics analysis showed that cell adhesion signaling factors were differentially expressed in TED tissues, including intercellular adhesion molecule (ICAM)-1, ICAM-4, vascular cell adhesion molecule, and CD44, which were all upregulated in diseased orbital tissues. Long noncoding RNA LPAL2 level was also upregulated in orbital tissues and positively correlated with ICAM-1 and ICAM-4 expression. Stimulation of the TED orbital fibroblasts by transforming growth factor-β1 (TGF-β1) significantly increased the expression of ICAM-1, ICAM-4, and LPAL2. Knockdown of LPAL2 in orbital fibroblasts inhibited TGF-β1–induced increases in cell adhesion factor levels and orbital fibroblast activation. Microarray profiling was performed on TED and normal orbital tissues to identify differentially expressed microRNAs, and miR-1287-5p was remarkably reduced within diseased orbital samples. miR-1287-5p was directly bound to the epidermal growth factor receptor (EGFR) 3′ untranslated region and LPAL2, and LPAL2 modulated EGFR/protein kinase B (AKT) signaling through targeting miR-1287-5p.

Conclusion

The LPAL2/miR-1287-5p axis modulated TGF-β1–induced increases in cell adhesion factor levels and TED orbital fibroblast activation through EGFR/AKT signaling.
Thyroid Immune-related Adverse Events Following Immune Checkpoint Inhibitor Treatment
Authors: Muir Christopher A , Clifton-Bligh Roderick J , Long Georgina V , Scolyer Richard A , Lo Serigne N , Carlino Matteo S , Tsang Venessa H M , Menzies Alexander M
Published: April 2021

Context

Thyroid dysfunction occurs commonly following immune checkpoint inhibition. The etiology of thyroid immune-related adverse events (irAEs) remains unclear and clinical presentation can be variable.

Objective

This study sought to define thyroid irAEs following immune checkpoint inhibitor (ICI) treatment and describe their clinical and biochemical associations.

Methods

We performed a retrospective cohort study of thyroid dysfunction in patients with melanoma undergoing cytotoxic T-lymphocyte antigen-4 (CTLA-4) and/or programmed cell death protein-1 (PD-1) based ICI treatment from November 1, 2009, to December 31, 2019. Thyroid function was measured at baseline and at regular intervals following the start of ICI treatment. Clinical and biochemical features were evaluated for associations with ICI-associated thyroid irAEs. The prevalence of thyroid autoantibodies and the effect of thyroid irAEs on survival were analyzed.

Results

A total of 1246 patients were included with a median follow-up of 11.3 months. Five hundred and eighteen (42%) patients developed an ICI-associated thyroid irAE. Subclinical thyrotoxicosis (n = 234) was the most common thyroid irAE, followed by overt thyrotoxicosis (n = 154), subclinical hypothyroidism (n = 61), and overt hypothyroidism (n = 39). Onset of overt thyrotoxicosis occurred a median of 5 weeks (interquartile range [IQR] 2-8) after receipt of a first dose of ICI. Combination immunotherapy was strongly associated with development of overt thyrotoxicosis (odds ratio [OR] 10.8, 95% CI 4.51-25.6 vs CTLA-4 monotherapy; P < .001), as was female sex (OR 2.02, 95% CI 1.37-2.95; P < .001) and younger age (OR 0.83 per 10 years, 95% CI 0.72-0.95; P = .007). By comparison, median onset of overt hypothyroidism was 14 weeks (IQR 8-25). The frequency of overt hypothyroidism did not differ between different ICI types. The strongest associations for hypothyroidism were higher baseline thyroid-stimulating hormone (OR 2.33 per mIU/L, 95% CI 1.61-3.33; P < .001) and female sex (OR 3.31, 95% CI 1.67-6.56; P = .01). Overt thyrotoxicosis was associated with longer progression free survival (hazard ratio [HR] 0.68, 95% CI 0.49-0.94; P = .02) and overall survival (HR 0.57, 95% CI 0.39-0.84; P = .005). There was no association between hypothyroidism and cancer outcomes.

Conclusion

Thyroid irAEs are common and there are multiple distinct phenotypes. Different thyroid irAE subtypes have unique clinical and biochemical associations, suggesting potentially distinct etiologies for thyrotoxicosis and hypothyroidism arising in this context.
Endocrine Influence on Cardiac Metabolism in Development and Regeneration
Authors: Graham Niall , Huang Guo N
Published: April 2021

Mammalian cardiomyocytes mostly utilize oxidation of fatty acids to generate ATP. The fetal heart, in stark contrast, mostly uses anaerobic glycolysis. During perinatal development, thyroid hormone drives extensive metabolic remodeling in the heart for adaptation to extrauterine life. These changes coincide with critical functional maturation and exit of the cell cycle, making the heart a post-mitotic organ. Here, we review the current understanding on the perinatal shift in metabolism, hormonal status, and proliferative potential in cardiomyocytes. Thyroid hormone and glucocorticoids have roles in adult cardiac metabolism, and both pathways have been implicated as regulators of myocardial regeneration. We discuss the evidence that suggests these processes could be interrelated and how this can help explain variation in cardiac regeneration across ontogeny and phylogeny, and we note what breakthroughs are still to be made.
Advances in Type 1 Diabetes Prediction Using Islet Autoantibodies: Beyond a Simple Count
Authors: So Michelle , Speake Cate , Steck Andrea K , Lundgren Markus , Colman Peter G , Palmer Jerry P , Herold Kevan C , Greenbaum Carla J
Published: April 2021

Islet autoantibodies are key markers for the diagnosis of type 1 diabetes. Since their discovery, they have also been recognized for their potential to identify at-risk individuals prior to symptoms. To date, risk prediction using autoantibodies has been based on autoantibody number; it has been robustly shown that nearly all multiple-autoantibody-positive individuals will progress to clinical disease. However, longitudinal studies have demonstrated that the rate of progression among multiple-autoantibody-positive individuals is highly heterogenous. Accurate prediction of the most rapidly progressing individuals is crucial for efficient and informative clinical trials and for identification of candidates most likely to benefit from disease modification. This is increasingly relevant with the recent success in delaying clinical disease in presymptomatic subjects using immunotherapy, and as the field moves toward population-based screening. There have been many studies investigating islet autoantibody characteristics for their predictive potential, beyond a simple categorical count. Predictive features that have emerged include molecular specifics, such as epitope targets and affinity; longitudinal patterns, such as changes in titer and autoantibody reversion; and sequence-dependent risk profiles specific to the autoantibody and the subject’s age. These insights are the outworking of decades of prospective cohort studies and international assay standardization efforts and will contribute to the granularity needed for more sensitive and specific preclinical staging. The aim of this review is to identify the dynamic and nuanced manifestations of autoantibodies in type 1 diabetes, and to highlight how these autoantibody features have the potential to improve study design of trials aiming to predict and prevent disease.
Trends in Mothers' Parenting Time by Education and Work From 2003 to 2017
Authors: Prickett Kate C. , Augustine Jennifer March
Published: April 2021

Scholars have been increasingly concerned about the rise in “intensive mothering” and its implications for the well-being of children and women and for inequality more broadly. These concerns, however, reflect a key assumption: that socioeconomic disparities in mothers' parenting time observed in earlier eras have continued to grow. Using the American Time Use Survey (ATUS) from 2003–2005 and 2015–2017 (n = 13,755), we test this assumption by examining whether maternal education gaps in active time spent with children have persisted across the 2000s. We pay particular attention to the continued socioeconomic bifurcation in women's access to full-time stable work, assessing whether changes in the education-related time gap are due to changes in who works and how much. We find that the gap in active childcare time between mothers with a college degree and those without has closed dramatically. Although some of this narrowing was driven by declines in time among college-educated mothers, most was driven by increases among mothers with less education. These trends, however, are observed only among mothers who were not employed full-time. Blinder-Oaxaca decomposition analyses further reveal that although most of the increase in active care time among nonworking mothers with less education was attributable to behavioral change, 58% of the decline among nonworking, college-educated mothers was a result of sociodemographic compositional changes. These findings illuminate population-level trends in mothers' active parenting time, provide insights into the driving factors, and help update theories, qualitative findings, and policy considerations related to mothers' and children's well-being.
Socioeconomic Segregation, Campus Social Context, and Disparities in Bachelor's Degree Attainment
Authors: Gelbgiser Dafna
Published: April 2021

It is well established that students from different socioeconomic backgrounds attend different colleges, net of their academic preparation. An unintended consequence of these disparities is that in the aggregate, they enhance socioeconomic segregation across institutions of higher education, cultivating separate and distinct social environments that can influence students' outcomes. Using information on the academic careers of a nationally representative sample of U.S. high school students who entered college in the mid-2000s, matched with external information on the social context of each college, this study evaluates the extent of socioeconomic segregation by social context in higher education and its implications for socioeconomic inequality in bachelor's degree attainment. Results confirm that social context is highly consequential for inequality in student outcomes. First, disparities in social context are extensive, even after differences in demographics, skills, attitudes, and college characteristics are accounted for. Second, the social context of campus, as shaped by segregation, is a robust predictor of students' likelihood of obtaining a bachelor's degree. Finally, the degree attainment rates of all students are positively associated with higher concentrations of economic advantages on campus. Combined, these results imply that socioeconomic segregation across colleges exacerbates disparities in degree attainment by placing disadvantaged students in social environments that are least conducive to their academic success.
Inorganic Carbon Acquisition by The Hydrothermal Vent Tubeworm Riftia Pachyptila Depends Upon High External And Upon Proton-Equivalent Ion Transport by The Worm
Authors: Goffredi Shana K. , Childress James J. , Desaulniers Nicole T. , Lee Raymond W. , Lallier Francois H. , Hammond Doug
Published: April 2021

Riftia pachyptila is the most conspicuous organism living at deep sea hydrothermal vents along the East Pacific Rise. To support its large size and high growth rates, this invertebrate relies exclusively upon internal chemosynthetic bacterial symbionts. The animal must supply inorganic carbon at high rates to the bacteria, which are far removed from the external medium. We found substantial differences in body fluid total inorganic carbon (ΣCO2) both within and between vent sites when comparing freshly captured worms from a variety of places. However, the primary influence on body fluid ΣCO2 was the chemical characteristics of the site from which the worms were collected. Studies on tubeworms, both freshly captured and maintained in captivity, demonstrate that the acquisition of inorganic carbon is apparently limited by the availability of CO2, as opposed to bicarbonate, and thus appears to be accomplished via diffusion of CO2 into the plume, rather than by mediated transport of bicarbonate. The greatly elevated measured at the vent sites (up to 12.6 kPa around the tubeworms), which is a result of low environmental pH (as low as 5.6 around the tubeworms), and elevated ΣCO2 (as high as 7.1 mmol l−1 around the tubes) speeds this diffusion. Moreover, despite large and variable amounts of internal ΣCO2, these worms maintain their extracellular fluid pH stable, and alkaline, in comparison with the environment. The maintenance of this alkaline pH acts to concentrate inorganic carbon into extracellular fluids. Exposure to N-ethylmaleimide, a non-specific H+-ATPase inhibitor, appeared to stop this process, resulting in a decline in extracellular pH and ΣCO2. We hypothesize that the worms maintain their extracellular pH by active proton-equivalent ion transport via high concentrations of H+-ATPases. Thus, Riftia pachyptila is able to support its symbionts’ large demand for inorganic carbon owing to the elevated in the vent environment and because of its ability to control its extracellular pH in the presence of large inward CO2 fluxes.
The evolution of computer-based analysis of high-resolution CT of the chest in patients with IPF
Authors: Calandriello Lucio , Walsh Simon LF
Published: April 2021

In patients with idiopathic pulmonary fibrosis (IPF), there is an urgent need of biomarkers which can predict disease behaviour or response to treatment. Most published studies report results based on continuous data which can be difficult to apply to individual patients in clinical practice. Having antifibrotic therapies makes it even more important that we can accurately diagnose and prognosticate in IPF patients. Advances in computer technology over the past decade have provided computer-based methods for objectively quantifying fibrotic lung disease on high-resolution CT of the chest with greater strength than visual CT analysis scores. These computer-based methods and, more recently, the arrival of deep learning-based image analysis might provide a response to these unsolved problems. The purpose of this commentary is to provide insights into the problems associated with visual interpretation of HRCT, describe of the current technologies used to provide quantification of disease on HRCT and prognostication in IPF patients, discuss challenges to the implementation of this technology and future directions.
Informed consent in interventional radiology – are we doing enough?
Authors: Prashar Akash , Butt Saqib , Castiglione Davide Giuseppe , Shaida Nadeem
Published: April 2021

Objectives:

Obtaining informed consent is a mandatory part of modern clinical practice. The aim of this study was to identify how often complications relating to Interventional Radiology (IR) procedures were discussed with the patient prior to the procedure.

Methods:

A retrospective analysis of 100 patients who experienced a complication related to an IR procedure was performed. The patient’s procedure consent form was examined to identify whether the complication they experienced had been discussed as a possible risk. Other parts of the consent form relating to need for blood transfusion and the need for further procedures were also examined.

Results:

39% of patients who experienced a complication did not have the complication documented as a potential risk on the consent form. 14% of patients required a blood transfusion but were not consented for this. 42% of patients required a further procedure or operation but were not warned of this.

Conclusion:

The model of gaining informed consent on the day of procedure is no longer valid. Better education and the use of clinics, patient information sheets and other resources is essential.

Advances in knowledge:

The paper highlights the inadequacies of the current model in gaining consent for IR procedures. A more comprehensive consent process making use of all available resources is essential.
Clinical use, challenges, and barriers to implementation of deformable image registration in radiotherapy – the need for guidance and QA tools
Authors: Hussein Mohammad , Akintonde Adeyemi , McClelland Jamie , Speight Richard , Clark Catharine H
Published: April 2021

Objective:

The aim of this study was to evaluate the current status of the clinical use of deformable image registration (DIR) in radiotherapy and to gain an understanding of the challenges faced by centres in clinical implementation of DIR, including commissioning and quality assurance (QA), and to determine the barriers faced. The goal was to inform whether additional guidance and QA tools were needed.

Methods:

A survey focussed on clinical use, metrics used, how centres would like to use DIR in the future and challenges faced, was designed and sent to 71 radiotherapy centres in the UK. Data were gathered specifically on which centres we using DIR clinically, which applications were being used, what commissioning and QA tests were performed, and what barriers were preventing the integration of DIR into the clinical workflow. Centres that did not use DIR clinically were encouraged to fill in the survey and were asked if they have any future plans and in what timescale.

Results:

51 out of 71 (70%) radiotherapy centres responded. 47 centres reported access to a commercial software that could perform DIR. 20 centres already used DIR clinically, and 22 centres had plans to implement an application of DIR within 3 years of the survey. The most common clinical application of DIR was to propagate contours from one scan to another (19 centres). In each of the applications, the types of commissioning and QA tests performed varied depending on the type of application and between centres. Some of the key barriers were determining when a DIR was satisfactory including which metrics to use, and lack of resources.

Conclusion:

The survey results highlighted that there is a need for additional guidelines, training, better tools for commissioning DIR software and for the QA of registration results, which should include developing or recommending which quantitative metrics to use.

Advances in knowledge:

This survey has given a useful picture of the clinical use and lack of use of DIR in UK radiotherapy centres. The survey provided useful insight into how centres commission and QA DIR applications, especially the variability among centres. It was also possible to highlight key barriers to implementation and determine factors that may help overcome this which include the need for additional guidance specific to different applications, better tools and metrics.
Kommerell’s diverticulum with right-sided aortic arch and anomalous origin of neck vessels: Uncommon imaging finding in neonate with cyanosis
Authors: Kanwal Darakhshan , Khalil Safaa , Attia Khaled , Fam Maged , Arakkal Mohammad
Published: April 2021

Kommerell diverticulum is a rare developmental anomaly of aortic arch. It is most frequently seen with right-sided aortic arch and aberrant left subclavian artery or ligamentum arteriosum, which have a significant role in completing a vascular ring. However, aberrant origin of neck vessels along with it is not commonly seen. The signs and symptoms vary depending on the severity. The paediatric patients usually present early due to compression of mediastinal structures such as trachea or oesophagus.
Computer tomographic differential diagnosis of ameloblastoma and odontogenic keratocyst: classification using a convolutional neural network
Authors: Bispo Mayara Simões , Pierre Júnior Mário Lúcio Gomes de Queiroz , Apolinário Jr Antônio Lopes , dos Santos Jean Nunes , Junior Braulio Carneiro , Neves Frederico Sampaio , Crusoé-Rebello Iêda
Published: April 2021

Objective:

To analyse the automatic classification performance of a convolutional neural network (CNN), Google Inception v3, using tomographic images of odontogenic keratocysts (OKCs) and ameloblastomas (AMs).

Methods:

For construction of the database, we selected axial multidetector CT images from patients with confirmed AM (n = 22) and OKC (n = 18) based on a conclusive histopathological report. The images (n = 350) were segmented manually and data augmentation algorithms were applied, totalling 2500 images. The k-fold × five cross-validation method (k = 2) was used to estimate the accuracy of the CNN model.

Results:

The accuracy and standard deviation (%) of cross-validation for the five iterations performed were 90.16 ± 0.95, 91.37 ± 0.57, 91.62 ± 0.19, 92.48 ± 0.16 and 91.21 ± 0.87, respectively. A higher error rate was observed for the classification of AM images.

Conclusion:

This study demonstrated a high classification accuracy of Google Inception v3 for tomographic images of OKCs and AMs. However, AMs images presented the higher error rate.
The value of serum procalcitonin in the anti-infection therapy of acute stroke patients
Authors: Wang Hui-ling , Li Ying-lei , Li Xiao-fang , Wang Zhi-zun
Published: April 2021

Objectives: To investigate the value of dynamic monitoring of serum procalcitonin (PCT) in anti-infective therapy of patients with acute stroke.

Methods: This is a case control retrospective study of acute stroke patients conducted from July 2016 to October 2018, in the Department of Neurology, Affiliated Hospital of Hebei University, who who reached within twenty four hours. They, were selected as the study subjects who were divided into infection group and non-infection group according to the inclusion and exclusion criteria. The serum PCT and CRP levels were compared between the two groups at 24 hours, 48 hours and 72 hours. In order to judge the changes of PCT level and the infection of stroke patients, different kinds of antibiotics were used for corresponding treatment. Retrospective analysis of the cases that did not monitor PCT anti infective treatment before July 2016 were compared with the cases that monitored PCT to guide anti infective treatment after July 2016, and compared the efficacy of antibiotics.

Results: The serum PCT level of patients in the infection group was significantly higher than that of patients in the noninfection group (P<0.001). For the patients whose PCT<0.5 ng/ml within 72 hour, anti-infective therapy was not administered. However, for those patients whose PCT<0.5 ng/ml and CRP rose significantly, WBC, body temperature and chest CT were closely monitored. For the patients whose PCT increased slightly (0.5 ng/ml<PCT<2.0 ng/ml), first-generation and second-generation cephalosporin or semisynthetic penicillin, such as mezlocillin, were administered. For the patients whose PCT increased moderately (5 ng/ml>PCT>2 ng/ml), mezlocillin/ sulbactam or ceftriaxone/ tazobactam was administered. For patients whose PCT increased significantly (PCT>5 ng/ml), carbapenem antibiotic or a combination of two antibiotics was administered.

Conclusion: Dynamic detection of serum PCT concentration can make accurate judgment on the severity of bacterial infection in patients with acute stroke and guide the rational application of antibiotics.

doi: https://doi.org/10.12669/pjms.37.4.3932

How to cite this:Wang H, Li Y, Li X, Wang Z. The value of serum procalcitonin in the anti-infection therapy of acute stroke patients. Pak J Med Sci. 2021;37(4):1155-1160. doi: https://doi.org/10.12669/pjms.37.4.3932

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Risk of Covid-19 infection during endoscopy: Efficacy of personal protective equipment (PPE) in protecting health professionals
Authors: Dilshad Muhammad Akif , Sarwar Shahid , Aslam Farheen , Shabbir Adnan , Rasool Shafqat , Tayyab Ghias un-Nabi
Published: April 2021

Objectives: To correlate compliance to personal protective equipment (PPE) protocols and risk of exposure to SARS-COV-2 infection in endoscopy staff.

Methods: We included 85 endoscopic procedures performed at Lahore General Hospital from May to July 2020. Standard operating procedures (SOPs) were implemented for patient selection, risk stratification and personal protective equipment (PPE) use for endoscopy staff. Patient and endoscopy staff were followed for Covid-19 infection. PPE scores for staff and Covid-19 positivity on follow-up were correlated using student’s t test.

Results: Following 85 procedures included, 2 (2.3%) patients became Covid-19 positive. PPE score was <9 in 5 (5.8%) procedures for endoscopist and Covid-19 developed in 2 (2.3%) of them, PPE score was <9 during 19 (22.3%) procedures in 1st assistant and 9 (10.5%) developed infection and for 2nd assistant PPE score was <9 in 19(22.3%) endoscopies and 5 (5.9%) tested positive for covid-19. Infectivity of endoscopy staff was 6.2%. Association between PPE score and risk of Covid-19 was not significant. (p value 0.51 for endoscopist, 0.10 for 1st assistant and 0.09 for 2nd assistant).

Conclusion: Compliance of SOPs for infection control reduces risk of acquiring Covid-19 infection during endoscopy. Proper use of PPE is effective for safety of endoscopy staff.

doi: https://doi.org/10.12669/pjms.37.4.4057

How to cite this:Dilshad MA, Sarwar S, Aslam F, Shabbir A, Rasool S, Tayyab GN. Risk of Covid-19 infection during endoscopy: Efficacy of personal protective equipment (PPE) in protecting health professionals. Pak J Med Sci. 2021;37(4):1093-1098.   doi: https://doi.org/10.12669/pjms.37.4.4057

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Technologies for an inclusive robotics education
Authors: ALIMISIS Dimitris
Published: April 2021

The H2020 project “INBOTS: Inclusive Robotics for a Better Society” (2018­–21) has worked in different disciplines involved in the acceptance and uptake of interactive robotics, including the promotion of accessible and multidisciplinary education programs. In INBOTS, educational robotics is considered as a learning tool that can bring robotics into school classrooms and benefit all children regardless of their future educational or professional orientation. Aiming to make robotics education inclusive, INBOTS has introduced a paradigm shift inspired by sound pedagogies (Papert’s constructionism) and emerging educational trends (the maker movement) and focused on creativity and other 21st-century skills. However, the realisation of this new paradigm requires appropriate curricula and technologies at both hardware and software levels. This paper addresses several questions and dilemmas related to the technologies currently in use in robotics education and the kind of technologies that can best support the proposed paradigm. This discussion results in specific criteria that robotics technologies must fulfil to foster the new paradigm. Based on these criteria, we review some representative technologies in both hardware and software. Then, we identify and discuss some technological solutions that exemplify the kind of technologies that can best support inclusive robotics education and make the proposed paradigm feasible. Finally, we show how some of these technologies can be combined to design a creative and inclusive project consistent with the criteria set in this paper.
Primeiro registro de Bucephalogonia xanthophis (Berg) (Hemiptera: Cicadellidae) em Eranthemum pulchellum Andr. (Lamiales: Acanthaceae)
Authors: Da-Silva Elidiomar Ribeiro , Boa Nova Ribeiro Silva Tainá , Coelho Luci Boa Nova
Published: April 2021

O camarão-azul (Eranthemum pulchellum) é um arbusto perene que atinge cerca de 1,8 m de altura e se desenvolve bem em clima Equatorial, Tropical e Subtropical. Tem abundantes flores azuis, conferindo à planta interessante aspecto ornamental. Na Ilha do Fundão, câmpus da Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, conjuntos do camarão-azul formam a bordadura da cerca de um estacionamento. Com poucos registros de entomofauna associada, a espécie parece ser pouco atacada por insetos fitófagos. O presente trabalho constitui o primeiro registro formal da ocorrência de cigarrinhas Bucephalogonia xanthophis (Cicadellinae: Cicadellini) em arbustos de camarão-azul. As cigarrinhas estão depositadas na Coleção Entomológica José Alfredo Pinheiro Dutra, Instituto de Biologia, UFRJ, e exsicatas da planta hospedeira estão depositadas no Herbário Prof. Jorge Pedro Pereira Carauta (HUNI), Instituto de Biociências, Universidade Federal do Estado do Rio de Janeiro (UNIRIO). Tal espécie de cigarrinha é polífaga, estando registrada em plantas de importância econômica como Citrus sinensis (Rutaceae) e Coffea arabica (Rubiaceae), transmitindo a bactéria Xylella fastidiosa (Xanthomonadaceae).
The Preciseness of Nutrition Recommendation and Information Published in Twitter Accounts.
Authors: Alqahtani Nasser
Published: April 2021

False nutrition-related information poses a significant threat to public health. The increasing use of social media platforms as sources of knowledge introduces the need to investigate their preciseness. To investigate the proportion of incorrect nutrition-related online information posted in Arabic by the most followed Twitter accounts. A specific search strategy was conducted on Twitter to locate the most relevant sources of nutritional knowledge. Tweets were collected over one month and classified according to their subjects, popularity, and specialty, as well as the nationality of tweeters. Subsequently, the tweets were reviewed by a nutrition consultant and labeled as “true” or “false” based on their content. A total of 509 tweets posted by 33 different accounts were identified (38.3% of unknown specialty, 44.8% Saudi, and 24.8% with 100,000–200,000 followers). Of these, 183 tweets (36.0%) were false. Tweets published by accounts with a greater number of followers (less than 100,000) were significantly more precise than those with fewer followers (P = 0.001). Saudi and medical tweeters as well as those of unknown identities posted significantly higher proportions of correct tweets than other nationalities and nutritionist tweeters (P = 0.002 and P = 0.001, respectively). Tweets about allergy, anemia, maternal health, and diabetes were more accurate that those about orthopedics and obesity (P = 0.011). About one-third of posted tweets were incorrect and the role of dietitians was negligible. Targeted intervention programs with the aid of personal and institutional nutrition accounts are warranted on all social media platforms to protect individuals/patients.
Are patient-reported outcomes the same following second-side surgery in primary hip and knee arthroplasty?
Authors: Tucker Adam , Warnock Jonathan M. , Cassidy Roslyn , Napier Richard J. , Beverland David
Published: April 2021

Aims

Up to one in five patients undergoing primary total hip (THA) and knee arthroplasty (TKA) require contralateral surgery. This is frequently performed as a staged procedure. This study aimed to determine if outcomes, as determined by the Oxford Hip Score (OHS) and Knee Score (OKS) differed following second-side surgery.

Methods

Over a five-year period all patients who underwent staged bilateral primary THA or TKA utilizing the same type of implants were studied. Eligible patients had both preoperative and one year Oxford scores and had their second procedure completed within a mean (2 SDs) of the primary surgery. Patient demographics, radiographs, and OHS and OKS were analyzed.

Results

A total of 236 patients met the inclusion criteria, of which 122 were THAs and 114 TKAs. The mean age was 66.5 years (SD 9.4), with a 2:1 female:male ratio. THAs showed similar significant improvements in outcomes following first- and second-side surgery, regardless of sex. In contrast for TKAs, although male patients demonstrated the same pattern as the THAs, female TKAs displayed significantly less improvement in both OKS and its pain component following second-side surgery.

Conclusion

Female patients undergoing second-side TKA showed less improvement in Oxford and pain scores compared to the first-side. This difference in outcome following second-side surgery did not apply to male patients undergoing TKA, or to either sex undergoing THA. Cite this article: Bone Jt Open 2021;2(4):243–254.
Assessment and identification of three types of difficult soils
Authors: Ayadat Tahar
Published: April 2021

The soil engineer needs to be able to readily identify difficult or problematic soils and to determine the amount of settlement that may occur. This paper deals with the assessment and identification of three types of difficult soils: collapsible soils, swelling soils, and liquefiable soils. In the first instance, the study investigates the effect of some soil properties on wetting-induced collapse strain and the swelling potential of soils. Also, two new methods for predicting soil collapse and swelling potential are developed. The proposed relationships correlate between collapse strain and swelling potential and some soil parameters which are believed to govern soil collapse and swelling. Validation of these two relationships with some data reported in literature is also examined. Furthermore, the paper describes the different steps suggested in a new procedure for soil liquefaction assessment. The procedure was presented in the form of an evaluation guide. In addition, a relationship was suggested for computing the potential for liquefaction. An application of the proposed procedure to a practical case is included in order to validate and illustrate the different steps to be followed in the suggested evaluation procedure.
Evaluation of COVID-19 vaccination strategies with a delayed second dose
Authors: Moghadas Seyed M. , Vilches Thomas N. , Zhang Kevin , Nourbakhsh Shokoofeh , Sah Pratha , Fitzpatrick Meagan C. , Galvani Alison P.
Published: April 2021

Two of the Coronavirus Disease 2019 (COVID-19) vaccines currently approved in the United States require 2 doses, administered 3 to 4 weeks apart. Constraints in vaccine supply and distribution capacity, together with a deadly wave of COVID-19 from November 2020 to January 2021 and the emergence of highly contagious Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) variants, sparked a policy debate on whether to vaccinate more individuals with the first dose of available vaccines and delay the second dose or to continue with the recommended 2-dose series as tested in clinical trials. We developed an agent-based model of COVID-19 transmission to compare the impact of these 2 vaccination strategies, while varying the temporal waning of vaccine efficacy following the first dose and the level of preexisting immunity in the population. Our results show that for Moderna vaccines, a delay of at least 9 weeks could maximize vaccination program effectiveness and avert at least an additional 17.3 (95% credible interval [CrI]: 7.8–29.7) infections, 0.69 (95% CrI: 0.52–0.97) hospitalizations, and 0.34 (95% CrI: 0.25–0.44) deaths per 10,000 population compared to the recommended 4-week interval between the 2 doses. Pfizer-BioNTech vaccines also averted an additional 0.60 (95% CrI: 0.37–0.89) hospitalizations and 0.32 (95% CrI: 0.23–0.45) deaths per 10,000 population in a 9-week delayed second dose (DSD) strategy compared to the 3-week recommended schedule between doses. However, there was no clear advantage of delaying the second dose with Pfizer-BioNTech vaccines in reducing infections, unless the efficacy of the first dose did not wane over time. Our findings underscore the importance of quantifying the characteristics and durability of vaccine-induced protection after the first dose in order to determine the optimal time interval between the 2 doses.
Effects of realistic e-learning cases on students’ learning motivation during COVID-19
Authors: Rahm Ann-Kathrin , Töllner Maximilian , Hubert Max Ole , Klein Katrin , Wehling Cyrill , Sauer Tim , Hennemann Hannah Mai , Hein Selina , Kender Zoltan , Günther Janine , Wagenlechner Petra , Bugaj Till Johannes , Boldt Sophia , Nikendei Christoph , Schultz Jobst-Hendrik
Published: April 2021

Background

Keeping up motivation to learn when socially isolated during a pandemic can be challenging. In medical schools, the COVID-19 pandemic required a complete switch to e-learning without any direct patient contact despite early reports showing that medical students preferred face-to-face teaching in clinical setting. We designed close to real-life patient e-learning modules to transmit competency-based learning contents to medical students and evaluated their responses about their experience.

Methods

Weekly e-learning cases covering a 10-week leading symptom-based curriculum were designed by a team of medical students and physicians. The internal medicine curriculum (HeiCuMed) at the Heidelberg University Medical School is a mandatory part of clinical medical education in the 6thor 7thsemester. Case-design was based on routine patient encounters and covered different clinical settings: preclinical emergency medicine, in-patient and out-patient care and follow-up. Individual cases were evaluated online immediately after finishing the respective case. The whole module was assessed at the end of the semester. Free-text answers were analyzed with MaxQDa following Mayring`s principles of qualitative content analyses.

Results

N = 198 students (57.6% female, 42.4% male) participated and 1252 individual case evaluations (between 49.5% and 82.5% per case) and 51 end-of-term evaluations (25.8% of students) were collected. Students highly appreciated the offer to apply their clinical knowledge in presented patient cases. Aspects of clinical context, interactivity, game-like interface and embedded learning opportunities of the cases motivated students to engage with the asynchronously presented learning materials and work through the cases.

Conclusions

Solving and interpreting e-learning cases close to real-life settings promoted students’ motivation during the COVID-19 pandemic and may partially have compensated for missing bedside teaching opportunities.
Intimate partner violence is a barrier to antiretroviral therapy adherence among HIV-positive women: Evidence from government facilities in Kenya
Authors: Biomndo Bornice C. , Bergmann Alexander , Lahmann Nils , Atwoli Lukoye
Published: April 2021

Introduction

Intimate Partner Violence (IPV) is linked to low engagement with HIV management services and adverse clinical outcomes, including poor ART adherence. In sub-Saharan Africa, studies on pregnant/postpartum women and transactional sex workers have produced divergent evidence regarding IPV’s association with poor ART adherence. We investigate this association among a broad group of women.

Methods

We sampled 408 HIV-positive women receiving free ART from different types of HIV clinics at government health facilities, assessing for IPV exposure by a current partner, ART adherence rate, and other factors that affect ART adherence (e.g. education, disclosure). ART adherence rates were measured using the Visual Analogue Scale (VAS); responses were dichotomised at a ≥95% cut-off. Multiple logistic regression models assessed the association between the independent variables and ART adherence.

Results

The participants’ mean age was 38.6 (range: 18–69 years). The majority had ever attended school (94%, n = 382), were in monogamous marriages (70%, n = 282), and had disclosed status to partners (94%, n = 380). Overall, 60% (n = 242) reported optimal ART adherence (≥ 95%) in the previous 30 days. The prevalence of IPV by the current partner was 76% (CI95 = 72–80%). Experiencing physical IPV (AOR 0.57, CI95: 0.34–0.94, p = .028), sexual IPV (AOR 0.50, CI95: 0.31–0.82, p = .005), or controlling behaviour (AOR 0.56, CI95: 0.34–0.94, p = .027) reduced the odds of achieving optimal adherence, while a higher education level and having an HIV-positive partner increased the odds.

Conclusion

IPV is common and is associated with suboptimal ART adherence rates among a broad group of HIV-positive women. ART programs could consider incorporating basic IPV interventions into regular clinic services to identify, monitor and support exposed women, as they might be at risk of poor ART adherence. Still, there is need for more research on how IPV affects ART adherence.