bluuebunny/crossref_metadata_2025 huggingface dataset:
Asthma management in low and middle income countries: case for change
Authors: Mortimer Kevin , Reddel Helen K. , Pitrez Paulo M. , Bateman Eric D.
Published: February 2022

Asthma is the most common noncommunicable disease in children, and among the most common in adults. The great majority of people with asthma live in low and middle income countries (LMICs), which have disproportionately high asthma-related morbidity and mortality. Essential inhaled medications, particularly those containing inhaled corticosteroids (ICS), are often unavailable or unaffordable, and this explains much of the global burden of preventable asthma morbidity and mortality. Guidelines developed for LMICs are generally based on the outdated assumption that patients with asthma symptoms <1–3 times per week do not need (or benefit from) ICS. Even when ICS are prescribed, many patients manage their asthma with oral or inhaled short-acting β2-agonists (SABA) alone, owing to issues of availability and affordability. A single ICS–formoterol inhaler-based approach to asthma management for all severities of asthma, from mild to severe, starting at diagnosis, might overcome SABA overuse/over-reliance and reduce the burden of symptoms and severe exacerbations. However, ICS–formoterol inhalers are currently very poorly available or unaffordable in LMICs. There is a pressing need for pragmatic clinical trial evidence of the feasibility and cost-effectiveness of this and other strategies to improve asthma care in these countries. The global health inequality in asthma care that deprives so many children, adolescents and adults of healthy lives and puts them at increased risk of death, despite the availability of highly effective therapeutic approaches, is unacceptable. A World Health Assembly Resolution on universal access to affordable and effective asthma care is needed to focus attention and investment on addressing this need.
Characterisation of lung function trajectories and associated early-life predictors in an Australian birth cohort study
Authors: Sanna Francesca , Locatelli Francesca , Sly Peter D. , White Elisha , Blake David , Heyworth Jane , Hall Graham L. , Foong Rachel E.
Published: February 2022

Background

There is growing evidence that lung function in early-life predicts later lung function. Adverse events over the lifespan might influence an individual's lung function trajectory, resulting in poor respiratory health. The aim of this study is to identify early-life risk factors and their impact on lung function trajectories to prevent long-term lung impairments.

Methods

Our study included participants from the Raine Study, a prospective pregnancy cohort, with at least two spirometry measurements. Lung function trajectories from the 6- to 22-year follow-ups were characterised using finite mixture modelling. Multinomial logistic regression analyses were used to evaluate the association between early-life predictors and lung function trajectories.

Main results

A total of 1512 participants (768 males, 744 females), representing 53% of the whole cohort, were included in this analysis. Four lung function trajectories of forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC) and FEV1/FVC (z-scores) were identified. FEV1and FVC trajectories were categorised as: “very low”, “low”, “average” and “above average”, respectively. Based on their shape, lung function trajectories of FEV1/FVC were categorised as “very low”, “low–average”, “average–low” and “average”. Asthma and maternal smoking were identified as risk factors for low lung function trajectories in this cohort, as well as early-life exposure to PM2.5Absorbance.

Conclusions

Early-life risk factors may influence lung function trajectories over time. Nonetheless, identifying children with a high risk of having low lung function trajectories should be prioritised to prevent deficits in later life.
New domiciliary supplemental oxygen therapy after hospitalisation for COVID-19 in metropolitan Chicago
Authors: Kaul Malvika , Gupta Preeti , Kalra Salil , Gardner Jessica , Gordon Howard S. , Rubinstein Israel
Published: February 2022

Background

A knowledge gap exists in understanding the beneficial use and duration of domiciliary supplemental oxygen (DSO) therapy among survivors of coronavirus disease 2019 (COVID-19) hospitalisations with persistent hypoxaemia upon discharge. The purpose of this single centre study was to begin to address this issue.

Methods

In this retrospective study we report features of US military veterans residing in metropolitan Chicago with no prior DSO therapy who survived COVID-19 hospitalisation, were discharged on DSO and were followed for 6 months.

Results

We found that the majority of the 65 elderly patients (median age, 70 years), predominantly obese Black males, who survived COVID-19 hospitalisations at the Jesse Brown VA Medical Center and were discharged on DSO did not undergo a formal 6-min walk test (6MWT) to re-assess ongoing ambulatory supplemental oxygen requirements (46 patients or 71%). Nonetheless, DSO therapy was discontinued in most patients predominantly within 8 weeks of hospital discharge (34 patients, 52%). In addition, a large proportion of patients, obese Black people in particular, who survived COVID-19 hospitalisations and were treated with DSO for at least 8 weeks thereafter developed post-acute sequelae of COVID-19 infection (PASC) (30 patients, 46%).

Conclusions

Given these findings, we recommend that healthcare providers be appraised about proper monitoring and evaluation, including timely performance of 6MWT, of patients who survived COVID-19 hospitalisations and were treated with DSO for persistent hypoxaemia upon discharge. Whether obese Black males who survived COVID-19 hospitalisations and are treated with DSO thereafter have an elevated risk in developing PASC remains to be determined in larger, prospective studies.
Childhood lung function following perinatal HIV infection and early antiretroviral therapy initiation: a cross-sectional study
Authors: Gie Andre , Morrison Julie , Maree David , Laughton Barbara , Browne Sara H. , Cotton Mark F. , Goussard Pierre , Innes Steve
Published: February 2022

Despite the introduction of antiretroviral therapy (ART), HIV-associated pulmonary complications remain prevalent in children following perinatal HIV infection. In the post-ART era the incidence of opportunistic infections has decreased; however, non-infectious complications including diminished lung function are common. It is unclear whether early initiation of ART influences lung function later in life.

We performed a cross-sectional study examining pulmonary function tests (PFT) (spirometry, plethysmography, carbon monoxide diffusing capacity) in HIV-unexposed (HU), HIV-exposed-uninfected (HEU) and perinatally HIV-infected children on early ART (HIV+) recruited from the Cape Town arms of the CHER and IMPAACT 1060 trials. PFT was performed once children could participate (October 2013 to January 2020). Global Lung Initiative reference software was used for Z-standardisation of lung function by sex, age and height.

In total 394 children (HU n=90, HEU n=162, HIV+n=142) underwent PFT, median age 8.7 (IQR 7.7–9.8) years. HIV+had ART initiated at a median age of 17.6 (8.0–36.7) weeks. Forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC) and FEV1/FVC Z-scores were similar in all groups. Plethysmography demonstrated air-trapping with increased total lung capacity (TLC), functional residual capacity, residual volume (RV) and RV/TLC Z-scores in HIV+. There were no differences in alveolar volume; however, diffusing capacity was increased in HIV+.

Our findings indicate that following perinatal HIV infection, early ART may attenuate HIV-associated lung disease and is associated with normal childhood spirometry. However plethysmography demonstrates that small airway dysfunction is more pronounced in HIV+. Longitudinal follow-up is required to assess if these children are at risk of obstructive airway disease later in life.
CFTR modulator use and risk of nontuberculous mycobacteria positivity in cystic fibrosis, 2011–2018
Authors: Ricotta Emily E. , Prevots D. Rebecca , Olivier Kenneth N.
Published: February 2022

Background

People with cystic fibrosis are at increased risk of pulmonary nontuberculous mycobacteria (NTM) disease. Cystic fibrosis transmembrane conductance regulator (CFTR) modulators are associated with reduced lung infection with pathogens likePseudomonas aeruginosaandStaphylococcus aureus. This association has not been studied with NTM.

Methods

Using encounter-level data from the US Cystic Fibrosis Foundation Patient Registry from 2011 to 2018, we identified individuals aged >12 years with one or more NTM-negative sputum culture and information on receipt of ivacaftor therapy. We used a Cox proportional hazards model to assess the relationship between CFTR modulator usage (any and monotherapyversuscombination therapy) and NTM sputum culture positivity, controlling for sex, least severe class of CFTR mutation, receipt of chronic macrolides, age, body mass index and percentage predicted forced expiratory volume.

Results

Out of 25 987 unique individuals, 17 403 individuals met inclusion criteria. During follow-up, 42% of individuals received CFTR modulator therapy, and 23% had incident NTM. The median (interquartile range) time to event was 6.1 (4.0–7.3) years for those ever receiving CFTR modulators compared to 4.0 (1.6–6.5) years in those never receiving CFTR modulators. CFTR modulator use was associated with a significantly reduced hazard of NTM culture positivity (hazard ratio (HR) 0.88, 95% CI 0.79–0.97); there was no significant difference in the hazard between those receiving ivacaftor monotherapyversuscombination therapy (combination HR 1.01, 95% CI 0.79–1.23).

Conclusions

CFTR modulator therapy is associated with a decreased risk of NTM positivity in individuals with cystic fibrosis.
HIV outcomes within the context of orphans and vulnerable children programing: the 4Children project in South Sudan
Authors: Coard Emily , Oliver Daniel , Monday Felix
Published: February 2022

Background

Poor antiretroviral therapy (ART) adherence is a challenge to containing the spread of HIV. This is an especially difficult challenge in conflict and post-conflict settings. This study investigates the relationship between attendance in an Orphan and Vulnerable Children program in South Sudan and HIV-related outcomes, including clinic appointment attendance, frequency of viral load testing and viral load suppression rates.

Methods

Patient records (n = 295) were selected from project-supported clinics in Juba, South Sudan, and analyzed to measure the association between enrollment status and select health outcomes. Data were collected at multiple time points between 2018 and 2019, to measure the strength of relationship between select treatment variables (e.g., viral load, retention in care, etc.). Given the structure of the data, non-parametric tests were applied to answer the research questions.

Results

Analysis revealed three important trends: (1) enrollment in the 4Children project was associated with a statistically significant increase in the frequency of viral load testing; (2) there was an increase in median appointment attendance after program enrollment; and (3) there was improved management of viral load and CD4 count, albeit small, during the time period before and after enrollment.

Conclusions

Data from South Sudan suggests that caregivers and children receiving project services saw improvement in treatment-related indicators. After enrolling in the project, overall amount of viral load testing increased from previous counts before enrollment. This suggests that after providing additional services with psychosocial and financial support to patients at the two hospitals in Juba, there was potential that similar interventions can support improved HIV outcomes.
Clinical outcomes of a beveled tip, ultra-high speed, 25-gauge pars plana vitrectomy system
Authors: Uy Harvey S. , Cabahug Vicente Lorenzo O. , Artiaga Jose Carlo M. , Chan Pik Sha , Famadico Jordan T.
Published: February 2022

Objective

To report the clinical outcomes of a 25-gauge, beveled-tip, 10,000 cuts-per-minute (cpm) microincisional vitrectomy surgery (MIVS) system.

Methods

Prospective case series of eyes undergoing primary pars plana vitrectomy (PPV) for common vitreoretinal indications. Main outcome measures were: rate of achieving surgical objectives, operative times, number of surgical steps, use of ancillary instruments, corrected distance visual acuity (CDVA), and adverse events (AE).

Results

The surgical objectives were achieved in all eyes. Mean total operative time (TOT), core, shave and total vitrectomy times were 1891 ± 890, 204 ± 120, 330 ± 320, 534 ± 389 s, respectively. Mean number of surgical steps was 4.3 ± 1.5. Mean number of ancillary instruments used was 4.5 ± 1.9. Mean CDVA improved by 0.53 ± 0.56 logMAR units (P < 0.001) 3 months postoperatively. AE included elevated IOP (8%), hypotony (6%), and re-detachment (2%). Majority (82%) had no postoperative discomfort. The number of surgical steps demonstrated a positive correlation with TOT (p < 0.05), number of ancillary instruments used (p < 0.05), and postoperative Day 1 IOP (p < 0.05). The number of times ancillary instrumentation was used demonstrated a positive correlation with TOT (p < 0.05).

Conclusion

Beveled-tip, 10,000 cpm MIVS system effectively and safely performs common VR procedures of varying complexity and may reduce operative times and use of ancillary instrumentation.
Aberrant functional connectivity in insular subregions in somatic depression: a resting-state fMRI study
Authors: Yan Rui , Geng Ji Ting , Huang Ying Hong , Zou Hao Wen , Wang Xu Miao , Xia Yi , Zhao Shuai , Chen Zhi Lu , Zhou Hongliang , Chen Yu , Yao Zhi Jian , Shi Jia Bo , Lu Qing
Published: February 2022

Background

Somatic depression (SD) is different from non-somatic depression (NSD), and insular subregions have been associated with somatic symptoms. However, the pattern of damage in the insular subregions in SD remains unclear. The aim of this study was to use functional connectivity (FC) analyses to explore the bilateral ventral anterior insula (vAI), bilateral dorsal anterior insula (dAI), and bilateral posterior insula (PI) brain circuits in SD patients.

Methods

The study included 28 SD patients, 30 NSD patients, and 30 matched healthy control (HC) subjects. All participants underwent 3.0 T resting state functional magnetic resonance imaging. FC analyses were used to explore synchronization between insular subregions and the whole brain in the context of depression with somatic symptoms. Pearson correlation analyses were performed to assess relationships between FC values in brain regions showing significant differences and the total and factor scores on the 17-item Hamilton Rating Scale for Depression (HAMD17).

Results

Compared with the NSD group, the SD group showed significantly decreased FC between the left vAI and the right rectus gyrus, right fusiform gyrus, and right angular gyrus; between the right vAI and the right middle cingulate cortex, right precuneus, and right superior frontal gyrus; between the left dAI and the left fusiform gyrus; and between the right dAI and the left postcentral gyrus. Relative to the NSD group, the SD group exhibited increased FC between the left dAI and the left fusiform gyrus. There were no differences in FC between bilateral PI and any brain regions among the SD, NSD, and HC groups. Within the SD group, FC values between the left vAI and right rectus gyrus were positively correlated with cognitive impairment scores on the HAMD17; FC values between the right vAI and right superior frontal gyrus were positively related to the total scores and cognitive impairment scores on the HAMD17(p < 0.05, uncorrected).

Conclusions

Aberrant FC between the anterior insula and the frontal and limbic cortices may be one possible mechanism underlying SD.
Twin epidemics: the effects of HIV and systolic blood pressure on mortality risk in rural South Africa, 2010-2019
Authors: Houle Brian , Kabudula Chodziwadziwa W , Tilstra Andrea M , Mojola Sanyu A , Schatz Enid , Clark Samuel J , Angotti Nicole , Gómez-Olivé F Xavier , Menken Jane
Published: February 2022

Background

Sub-Saharan African settings are experiencing dual epidemics of HIV and hypertension. We investigate effects of each condition on mortality and examine whether HIV and hypertension interact in determining mortality.

Methods

Data come from the 2010 Ha Nakekela population-based survey of individuals ages 40 and older (1,802 women; 1,107 men) nested in the Agincourt Health and socio-Demographic Surveillance System in rural South Africa, which provides mortality follow-up from population surveillance until mid-2019. Using discrete-time event history models stratified by sex, we assessed differential mortality risks according to baseline measures of HIV infection, HIV-1 RNA viral load, and systolic blood pressure.

Results

During the 8-year follow-up period, mortality was high (477 deaths). Survey weighted estimates are that 37% of men (mortality rate 987.53/100,000, 95% CI: 986.26 to 988.79) and 25% of women (mortality rate 937.28/100,000, 95% CI: 899.7 to 974.88) died. Over a quarter of participants were living with HIV (PLWH) at baseline, over 50% of whom had unsuppressed viral loads. The share of the population with a systolic blood pressure of 140mm Hg or higher increased from 24% at ages 40-59 to 50% at ages 75-plus and was generally higher for those not living with HIV compared to PLWH. Men and women with unsuppressed viral load had elevated mortality risks (men: adjusted odds ratio (aOR) 3.23, 95% CI: 2.21 to 4.71, women: aOR 2.05, 95% CI: 1.27 to 3.30). There was a weak, non-linear relationship between systolic blood pressure and higher mortality risk. We found no significant interaction between systolic blood pressure and HIV status for either men or women (p>0.05).

Conclusions

Our results indicate that HIV and elevated blood pressure are acting as separate, non-interacting epidemics affecting high proportions of the older adult population.

PLWH with unsuppressed viral load were at higher mortality risk compared to those uninfected. Systolic blood pressure was a mortality risk factor independent of HIV status. As antiretroviral therapy becomes more widespread, further longitudinal follow-up is needed to understand how the dynamics of increased longevity and multimorbidity among people living with both HIV and high blood pressure, as well as the emergence of COVID-19, may alter these patterns.
Radius distraction during volar plating of distal radius fractures may improve distal radioulnar joint stability at minimum 3-year follow-up: a retrospective case series study
Authors: Yin Cheng-Yu , Huang Hui-Kuang , Fufa Duretti , Wang Jung-Pan
Published: February 2022

Background

The surgical technique of radius distraction for stabilization of distal radioulnar joint (DRUJ) if intraoperative DRUJ instability was found after the fixation of distal radius fracture has been previously described, but this surgical technique lacks clinical and radiographic effect in minimal 3 years follow-up. We therefore evaluated the clinical outcome and radiographic results of radius distraction in minimal 3 years follow-up as long-term evaluation.

Methods

We reviewed the case series of distal radius fracture with concomitant DRUJ instability receiving radius distraction from the senior author over a 5-year period (January 1st, 2013, to June 30th, 2017) retrospectively. Radius distraction during volar plating was performed by moving the volar plate distally via compression screw loosening/fastening to achieve firm endpoint on the dorsopalmar stress test. The evaluations of radiographic, including bone union time and ulnar variance, and clinical outcomes, including grading of DRUJ instability, NRS of wrist pain, DASH score, MMWS score, and range of motion of operated wrist at final follow-up, were performed at clinic as minimum 3-year follow-up; a total 34 patients had been evaluated.

Results

At minimal post-operative 36 months follow-up, all cases demonstrated acceptable wrist range of motion with stable DRUJs, low NRS of wrist pain (0.6, SD 0.7), and satisfactory DASH score (mean 9.1, SD 6.2) and MMWS score (mean 87, SD 10). There were no cases suffering from nonunion of distal radius. The mean ulnar variance of injured wrist and uninjured wrist were -1.2 mm and 0.2 mm, respectively (SD 1.0 and 0.6) with significant statistical difference.

Conclusions

Radius distraction during volar fixation of distal radius fracture should be considered if DRUJ instability was found by the dorsopalmar stress test intraoperatively, and the long-term DRUJ stability could be achieved by maintenance of normal-to-negative ulnar variance, with decreased wrist pain and satisfactory function outcome.

Level of Evidence

Therapeutic Level IV
User fee removal for the poor: a qualitative study to explore policies for social health assistance in Iran
Authors: Etemadi Manal , Hajizadeh Mohammad
Published: February 2022

Introduction

Removal of user fee for vulnerable people reduces the financial barriers associated with healthcare payments, which, in turn, improves health outcomes and promotes health equity. This study sought to provide policy strategies to reduce user fee at the point of service delivery for the poor in Iran.

Methods

This is a qualitative study carried out in 2018. The purposive sampling method was applied, and 33 experts with relevant and valuable experiences and maximum variation to obtain representativeness and rich data were interviewed. Trustworthiness criteria were used to assure the quality of the results. The data were analyzed based on thematic analysis using the MAXQDA10 software.

Results

The most important issue regarding financial protection against user fee for the poor in Iran is policy integration and cohesion. Differences in access to financial support for user fee coverage among different groups of the poor have led to inequalities in access and financial protection among the poor. The suggested protection policies against the user fee at the point of service delivery in Iran can be categorized into three main categories: 1) basic health social insurance instruments, 2) free health services to the poor outside of the health insurance system, and 3) complementary insurance mechanisms.

Conclusion

Implementing a cohesive social assistance policy for all disadvantaged groups is needed to address inequalities in financial protection against user fee payment among the poor in Iran. Reducing user fee through mechanisms such as deductible cap, stop-loss, variable user fee and sliding fee scale can improve financial protection and enhance healthcare utilization among the poor. A user fee exemption is not enough to remove barriers to access to service for the poor, as other costs such as transportation expenditures and informal payments also put financial pressure on them. Therefore, financial support for the poor should be designed in a comprehensive protection package to reduce out-of-pocket payments for healthcare services, and indirect costs associated with healthcare utilization.
Comparison of computer-assisted navigated technology and conventional technology in unicompartmental knee arthroplasty: a meta-analysis
Authors: Xu Keteng , Chen Qun , Yan Qing , Wang Qin , Sun Jun
Published: February 2022

Background

Though unicompartmental knee arthroplasty (UKA) is a useful procedure to treat knee osteoarthritis, it remains a great controversial point as to if navigated systems are able to achieve better accuracy of limb alignment and greater clinic results. Current meta-analysis was conducted to explore if better clinical outcomes and radiographic outcomes could be acquired in the navigated system when compared with conventional procedures.

Methods

We identified studies in the online databases, including Medline, Embase, the Cochrane Library and Web of Science before May 2021. The PRISMA guidelines in this report were strictly followed. Our research was completed via Review Manager 5.4 software.

Results

Fourteen articles were included, involving 852 knees. The present meta-analysis displayed that the navigated system had remarkably improved outcomes in inliers of mechanical axis (MA) (P < 0.01), MA in the Kennedy's central zone (Zone C) (P = 0.04), inliers of the coronal femoral component (P < 0.01), inliers of the coronal tibial component (P = 0.005), inliers of the sagittal femoral component (P = 0.03), inliers of the sagittal tibial component (P = 0.002) and Range Of Motion (ROM) (P = 0.04). No significant differences were observed in Oxford Knee Score (OKS) (P = 0.15), American Knee Society Knee Score (KSS score) (P = 0.61) and postoperative complications (P = 0.73) between these 2 groups. Regarding operating time, the navigated group was 10.63 min longer in contrast to the traditional group.

Conclusion

Based on our research, the navigated system provided better radiographic outcomes and no significant difference in the risk of complications with longer surgical time than the conventional techniques. But no significant differences were found in functional outcomes. Because the included studies were small samples and short-term follow-up, high-quality RCTs with large patients and sufficient follow-up are required to identify the long-term effect of the navigated system.
The application of selenium nanoparticles for enhancing the efficacy of photodynamic inactivation of planktonic communities and the biofilm of Streptococcus mutans
Authors: Shahmoradi Samane , Shariati Aref , Amini Seyed Mohammad , Zargar Nazanin , Yadegari Zahra , Darban-Sarokhalil Davood
Published: February 2022

Objective

Streptococcus mutans is one of the principal causative agents of dental caries (tooth decay) found in the oral cavity. Therefore, this study investigates whether selenium nanoparticles (SeNPs) enhance the efficacy of photodynamic therapy (PDT) against both planktonic communities and the one-day-old biofilm of S. mutans. In this study, the planktonic and 24-h biofilm of S. mutans have been prepared in 96-cell microplates. These forms were treated by methylene blue (MB) and SeNPs and then were exposed to light-emitting diode (LED) lighting. Finally, the results have been reported as CFU/ml.

Results

The outcomes demonstrated that MB-induced PDT and SeNPs significantly reduced the number of planktonic bacteria (P-value < 0.001). The comparison between the treated and untreated groups showed that combining therapy with SeNPs and PDT remarkably decreased colony-forming units of one-day-old S. mutans biofilm (P-value < 0.05). The findings revealed that PDT modified by SeNPs had a high potential to destroy S. mutans biofilm. This combination therapy showed promising results to overcome oral infection in dental science.
Change the preprocedural fasting policy for contrast-enhanced CT: results of 127,200 cases
Authors: Liu Heng , Zhao Li , Liu Junling , Lan Fang , Cai Li , Fang Jingqin , Li Xue
Published: February 2022

Objectives

To analyze the relationship between the dietary preparation status prior to contrast-enhanced CT (CECT) and adverse drug reactions (ADR) and emetic complications.

Methods

Non-emergency adult patients who underwent routine CECT in our hospital from January 2019 to December 2020 were retrospectively analyzed. Stratified dietary preparation regimens were implemented for different clinical scenarios. The relationship between actual dietary preparation status and ADR and emetic complications was analyzed.

Results

A total of 127,200 cases were enrolled, including 49,676 cases in the fasting group (57 years ± 13, 56.79% men) and 77,524 cases in the non-fasting group (60 years ± 13, 54.55% men). No statistical difference was found in the overall incidence of ADR (0.211% vs. 0.254%, p = 0.126) or emetic complications (0.030% vs. 0.046%, p = 0.158) between the two groups, and no aspiration pneumonia or death occurred. For patients with an ICM-ADR history, the ADR incidence in non-fasting group was significantly lower than fasting group (2.424% vs. 12.371%, p = 0.002). For patients with hypertension, injection dose ≥ 100 mL, injection rate ≥ 5 mL/s, and Iopromide 370 usage, non-fasting was associated with higher ADR incidence (p < 0.05). 36.67% of the patients experienced unnecessary excessive fasting in practice. Excessive fasting (≥ 10 h) and more water ingestion (≥ 500 mL) within 1 h prior to CECT were associated with higher ADR incidence (p < 0.05).

Conclusion

Unrestricted food ingestion would not increase the overall risk of ADR and emetic complications. For some special patient subgroups, non-fasting, excessive fasting, and more water ingestion were associated with higher ADR incidence.
KeyPIn – mitigating the free rider problem in the distributed cloud based on Key, Participation, and Incentive
Authors: Pal Doyel , Khethavath Praveen , Thomas Johnson P. , Mangla Utpal
Published: February 2022

In a distributed cloud, unlike centralized resource management, users provide and share resources. However, this allows for the existence of free riders who do not provide resources to others, but at the same time use resources that others provide. In a distributed cloud, resource providers share resources in a P2P fashion. In this paper, we propose a 3-pronged solution KeyPIn—a Key-based, Participation-based, and Incentive-based scheme to mitigate the free rider problem in a distributed cloud environment. We propose an incentive-based scheme based on game theory for providers to participate in the cloud by providing resources. This participation will be low for free riders thereby limiting their access to resources. A secure time instant key is generated based on a key management scheme that enables good users’ more time to access resources as their participation is high, whereas free riders are given limited or no time as their participation is low. Simulation results show that our scheme is effective in mitigating the free rider problem in the distributed cloud.
The effectiveness of high-flow nasal cannula during sedated digestive endoscopy: a systematic review and meta-analysis
Authors: Zhang Yu-Xin , He Xing-Xiang , Chen Yu-Ping , Yang Shuai
Published: February 2022

Background

Studies evaluating the role of high-flow nasal cannula (HFNC) in sedated digestive endoscopy have reported conflicting results. This meta-analysis evaluates the effectiveness of HFNC in patients undergoing digestive endoscopy procedures under sedation.

Methods

PubMed, Medline, EMBASE, Cochrane Central Register of Controlled Trials and Web of Science, were searched from inception to 31 July 2021. Only randomized clinical trials comparing HFNC with standard nasal cannula oxygen (SNC) during sedated digestive endoscopy were included. The incidence of hypoxemia was the primary outcome, and the secondary outcome was the percentage of patients who needed airway interventions.

Results

Seven studies that enrolled 2998 patients were included. When compared to SNC, HFNC was associated with a significant reduction in hypoxemia incidence (OR 0.24, 95% CI 0.09 to 0.64) and airway intervention requirements (OR 0.15, 95% CI 0.03 to 0.69), with both high heterogeneity (I2 = 81% and 94%). In subgroup analysis, when hypoxemia was defined as pulse oxygen saturation (SpO2) < 90%, low risk of hypoxemia subjects who received HFNC were associated with a significant reduction in hypoxemia incidence (OR 0.02, 95% CI 0.00 to 0.07; heterogeneity I2 = 39%) and airway intervention requirements (OR 0.02, 95% CI 0.01 to 0.04; heterogeneity I2 = 15%). However, in the high risk of hypoxemia subjects, there were no significant differences between the two oxygen administration techniques in both primary (OR 0.81, 95% CI 0.36 to 1.78; heterogeneity I2 = 0%) and secondary outcomes (OR 0.85, 95% CI 0.46 to 1.59; heterogeneity I2 = 0%).

Conclusions

Compared to SNC, HFNC not only reduce the incidence of hypoxemia but also reduce the requirements for airway interventions during sedated digestive endoscopy procedures, especially in patients at low risk for hypoxemia. In high risk of hypoxemia patients, there were no significant differences between the two oxygen administration techniques.

Trial registration PROSPERO International prospective register of systematic reviews on 28 July 2021, registration no. CRD42021264556.
Clinicians’ perspectives on supporting individuals with severe anorexia nervosa in specialist eating disorder intensive treatment settings during the COVID-19 pandemic
Authors: Webb Hannah , Dalton Bethan , Irish Madeleine , Mercado Daniela , McCombie Catherine , Peachey Gemma , Arcelus Jon , Au Katie , Himmerich Hubertus , Johnston A. Louise , Lazarova Stanimira , Pathan Tayeem , Robinson Paul , Treasure Janet , Schmidt Ulrike , Lawrence Vanessa
Published: February 2022

Background

The COVID-19 pandemic has significantly affected intensive treatment settings (i.e., inpatient [IP] and day patient [DP]) in specialist eating disorder services. However, the impact on clinicians working in these services is largely unknown. We therefore explored the perspectives of those supporting individuals with severe anorexia nervosa (AN) in intensive treatment settings during the pandemic.

Methods

Between May 2020 and June 2021, we interviewed clinicians (n = 21) who delivered IP and/or DP treatment to patients with severe AN in four specialist eating disorder services in the United Kingdom. Data relating to experiences during COVID-19 were analysed using reflexive thematic analysis.

Results

We identified six themes: Disruptions to Routine Treatment; Introduction of Virtual Treatment; Separation from Treatment, Others and the World; Impact on Recovery; Impact on Staff; and Pressure on Referral Pathways. COVID-19 posed significant challenges to IP and DP services: forcing closures, operating with restrictions and virtual treatment, and impacting delivery of essential treatment components, referral pathways, clinician wellbeing, risk management, and patient isolation and recovery trajectories. Opportunities arose, in particular in DP services offering virtual support.

Conclusions

COVID-19 challenged the continuation of multidisciplinary treatment. The findings underline the necessity for medical, psychological, practical, and nutritional support, as well as carer involvement and fostering social connections to remain at the forefront of intensive treatment for severe AN. They also emphasise the uncertainty surrounding which intensive treatment may be best suited to which patient when, particularly within the context of virtual DP support.
Effects of uncertainty in fault parameters on deterministic tsunami hazard assessment: examples for active faults along the eastern margin of the Sea of Japan
Authors: Satake Kenji , Ishibe Takeo , Murotani Satoko , Mulia Iyan E. , Gusman Aditya Riadi
Published: February 2022

We investigated the effects of fault parameter uncertainty on the deterministic assessment of tsunami hazards for the submarine and coastal active faults in the Sea of Japan that were recently modeled by the Integrated Research Project on Seismic and Tsunami Hazards around the Sea of Japan. A key parameter in scenario-based tsunami assessment is the fault slip amount, which is usually calculated from empirical scaling relations that relate the fault size to the slip. We examined four methods to estimate the fault slip amounts and compared the coastal tsunami heights from the slip amounts obtained by two different empirical relations. The resultant coastal tsunami heights were strongly affected by the choice of scaling relation, particularly the fault aspect ratio (fault length/fault width). The geometric means of the coastal tsunami heights calculated from the two methods ranged from 0.69 to 4.30 with an average of 2.01. We also evaluated the effects of fault slip angles, which are also important parameters for controlling coastal tsunami heights, by changing the slip angles for faults in the southwestern and central parts of the Sea of Japan, where the strike-slip faults are concentrated. The effects of uncertainty of the fault slip angles (± 30° from the standard) on the coastal tsunami heights were revealed to be equal to or greater than those resulting from the choice of scaling relations; the geometric means of the coastal tsunami heights from the modified fault slip angles relative to the standard fault slip angles ranged from 0.23 to 5.88. Another important characteristic is that the locations of the maximum coastal tsunami height and the spatial pattern of the coastal tsunami heights can change with varying fault slip angles.

Graphical Abstract
Risk assessment of fungal materials
Authors: van den Brandhof Jeroen G. , Wösten Han A. B.
Published: February 2022

Sustainable fungal materials have a high potential to replace non-sustainable materials such as those used for packaging or as an alternative for leather and textile. The properties of fungal materials depend on the type of fungus and substrate, the growth conditions and post-treatment of the material. So far, fungal materials are mainly made with species from the phylum Basidiomycota, selected for the mechanical and physical properties they provide. However, for mycelium materials to be implemented in society on a large scale, selection of fungal species should also be based on a risk assessment of the potential to be pathogenic, form mycotoxins, attract insects, or become an invasive species. Moreover, production processes should be standardized to ensure reproducibility and safety of the product.
Superior mesenteric vein to the right testicular vein shunt operation for jejunal varices bleeding associated with extrahepatic portal vein obstruction after pancreaticoduodenectomy: a case report
Authors: Shiozaki Shohei , Matsugu Yasuhiro , Hamaoka Michinori , Ishimoto Tatsuro
Published: February 2022

Background

Causes of extrahepatic portal vein obstruction include abdominal surgeries such as pancreaticoduodenectomy. We improved jejunal variceal bleeding due to extrahepatic portal vein occlusion after pancreaticoduodenectomy, by shunting of the testicular vein.

Case presentation

A 72-year-old man was diagnosed with extrahepatic bile duct cancer and underwent subtotal stomach-preserving pancreaticoduodenectomy 5 years ago. No postoperative complications occurred, adjuvant chemotherapy using gemcitabine hydrochloride was performed, and the patient remained recurrence-free. One year and 6 months post-operation, extrahepatic portal vein stenosis appeared, but no recurrence was noted. However, 4 years and 6 months later, recurrent gastrointestinal bleeding occurred, and the patient was diagnosed with an extrahepatic portal vein obstruction. Double-balloon enteroscopy showed capillary dilatation and varicose veins in the hepaticojejunostomy region, and venous bleeding from collateral blood vessels was diagnosed. A superior mesenteric vein to the right testicular vein shunt operation was performed, following which the gastrointestinal bleeding disappeared, and the anemia improved. Although transient hepatic encephalopathy occurred, conservative treatment relieved it. Double-balloon enteroscopy confirmed the disappearance of abnormal blood vessels.

Conclusions

A portosystemic shunt operation using the right testicular vein effectively relieved refractory variceal bleeding around the hepaticojejunostomy site in the jejunum due to an extrahepatic portal vein obstruction after pancreaticoduodenectomy.
Surgical transversus abdominis plane block versus surgical rectus sheath block for postoperative pain control in morbid obese patients undergoing major gynaecological surgery: a prospective, randomized, blinded study
Authors: Mowafi Marwa M. , Elsenity Mohamed A. , Elbeialy Marwa A. K.
Published: February 2022

Background

Postoperative analgesia for major abdominal surgeries, especially with midline incisions, can be challenging particularly in morbid obese patients. This study aimed to compare surgical transversus abdominis plane (TAP) block and surgical rectus sheath (RS) block for postoperative analgesia in patients undergoing major gynaecological surgery regarding their efficacy and adverse effects. Sixty female patients aged 18–60 years were randomly allocated to two equal groups; (group TB,n= 30) patients received surgical TAP block, or (RB group,n= 30) patients received surgical RS block.

Results

Postoperative total morphine consumption was significantly higher among patients in the TB group than patients in the RB group (Mean ± SD; 18.2 ± 4.4 mg versus 14.3 ± 3.5 mg respectively,Pvalue < 0.001). There was no significant difference between patients in either group regarding pain scores at rest and cough except at 6-h postoperatively when patients in the RB group experienced lower pain scores (Pvalue < 0.001). The RB group showed better respiratory functions at the first hour, 6 h and 12 h postoperatively. There was no significant statistical difference between both groups regarding the incidence of postoperative complications.

Conclusions

Surgical RS block provided more favourable outcomes than surgical TAP block concerning postoperative analgesia in morbid obese patients with similar incidence of postoperative complications.

Trial registration

We carried out this trial at Ain-Shams University Hospitals, Cairo, Egypt, between October 2018 and January 2020. The study was approved by the Research Ethics Committee at the Faculty of Medicine, Ain Shams University (code number: FMASU R55/2018), and then registered in theClinicalTrials.gov(registration no. NCT03732027)https://clinicaltrials.gov/ct2/show/NCT03732027.
Superhydrophobic micro-nanofibers from PHBV-SiO2 biopolymer composites produced by electrospinning
Authors: Rabbani Saad , Jafari Reza , Momen Gelareh
Published: February 2022

Electrospinning is a relatively simple technique for producing continuous fibers of various sizes and morphologies. In this study, an intrinsically hydrophilic poly(3-hydroxybutarate-co-3-hydroxyvalerate) (PHBV) biopolymer strain was electrospun from a solution under optimal processing conditions to produce bilayers of beadless micro-fibers and beaded nano-fibers. The fibrous mats produced from the pure PHBV solution exhibited hydrophilicity with complete wetting. Incorporation of polydimethylsiloxane (PDMS) treated silica into the electrospinning solutions resulted in a non-wetting state with increased fiber roughness and enhanced porosity; however, the fiber mats displayed high water droplet-adhesion. The SiO2–incorporated fibrous mats were then treated with stearic acid at an activation temperature of 80 °C. This treatment caused fiber surface plasticization, creating a tertiary hierarchical roughness owing to the interaction of PHBV chains with the polar carboxyl groups of the stearic acid. Scanning electron microscopy was used to assess the influence of the electrospinning process parameters and the incorporation of nanoparticles on surface morphology of the fibers; energy dispersive X-ray spectroscopy confirmed the presence of SiO2 nanoparticles. Fourier transform infrared spectroscopy was performed to study the incorporation of SiO2 and the interaction of stearic acid with PHBV at various concentrations. The chemical interaction between stearic acid and PHBV was confirmed, while SiO2 nanoparticles were successfully incorporated into the PHBV fibers at concentrations up to 4.5% by weight. The incorporation of nanoparticles and plasticization altered the thermal properties of PHBV and a decrease in crystalline fraction was observed. The stearic acid modified bilayers produced from the micro-nano-fibrous composites showed very low water droplet sticking, a roll off angle of approximately 4° and a high static contact angle of approximately 155° were achieved.

Graphical Abstract
Thellungiella halophila ST5 improves salt tolerance in cotton
Authors: NAZISH Tahmina , JAVAID Ayesha , ALI Mohsin , ZHU Yonghong , LI Jing , ZHANG Huangyang , WU Jie , XIANG Chengbin , WU Shenjie , ALFATIH Alamin
Published: February 2022

Background

Salinity is a major abiotic stress to global agriculture which hampers crop growth and development, and eventually reduces yield. Transgenic technology is an effective and efficient approach to improve crop salt tolerance but depending on the availability of effective genes. We previously isolated Salt Tolerance5 (ThST5) from the halophyte Thellungiella halophila, an ortholog of Arabidopsis SPT4-2 which encodes a transcription elongation factor. However, SPT4-2-confered salt tolerance has not been evaluated in crops yet. Here we report the evaluation of ThST5-conferred salt tolerance in cotton (Gossypium hirsutum L.).

Results

The ThST5 overexpression transgenic cotton plants displayed enhanced tolerance to salt stress during seed germination and seedling stage compared with wild type. Particularly, the transgenic plants showed improved salinity tolerance as well as yield under saline field conditions. Comparative transcriptomic analysis showed that ThST5 improved salt tolerance of transgenic cotton mainly by maintaining ion homeostasis. In addition, ThST5 also orchestrated the expression of genes encoding antioxidants and salt-responsive transcription factors.

Conclusion

Our results demonstrate that ThST5 is a promising candidate to improve salt tolerance in cotton.
Critical evaluation of socio-cultural and climatic aspects in a traditional community: a case study of Pillayarpalayam weavers' cluster, Kanchipuram
Authors: Vijayalaxmi J. , Arathy K. C. Kalam
Published: February 2022

Protecting vernacular architecture is important because it reflects a treasure-trove of local information, including climate responses, functions and the socio-cultural context. This study aimed to assess and evaluate the spatial and climate response features of the vernacular weavers’ settlement in Pillayarpalayam, Kanchipuram, Tamil Nadu. This precinct, delineated as a heritage zone under the National Heritage City Development and Augmentation Yojana scheme by the Government of India, consists of a large number of traditional weavers’ residences that have cultural and social significance. The methodology comprised primary documentation and unstructured interviews to assess the architectural and anthropological development of the settlement. The study and analysis were conducted at three levels—dwelling, cluster and street. Spatial analysis was carried out to understand the relationship between different weaving activities and their physical setting. Analysis of building materials and construction techniques was carried out to understand the climate response features. The traditional dwellings accommodated the spaces for the weavers to live, as well as functioning as a workspace. It was observed that many houses had undergone alterations to adapt to family needs while some houses had been demolished and replaced by concrete structures. The traditional craft of weaving was losing its importance and only few weavers in this cluster had retained the traditional living and working space. These vernacular dwellings need to be preserved because they represent a unique typology and are evidence of traditional knowledge and culture. Guidelines and recommendations have been proposed to conserve the intangible values such as culture, lifestyles, social factors, and production methods, in addition to conserving the vernacular built heritage and workspaces of this traditional and unique craft industry.