bluuebunny/crossref_metadata_2025 huggingface dataset:
Non-Operative Management of Symptomatic Hallux Limitus: A Novel Approach of Foot Core Stabilization and Extracorporeal Shockwave Therapy
Authors: Reilly Tom , Wasserman Lindsay , Tenforde Adam S.
Published: July 2022

Background:

This video presents assessment and management of hallux limitus using intrinsic foot strengthening and joint mobilization techniques with combination of extracorporeal shockwave therapy (ESWT).

Indications:

Clinical history includes pain with walking, running, jumping, or loaded plantarflexion localized to the first metatarsophalangeal (MTP) joint. Indications for our treatment approach of hallux limitus include pain localized to the first MTP joint, corresponding lack of active range of motion/passive range of motion, and reduced foot/ankle strength often with joint space narrowing on imaging.

Technique Description:

Our program uses the principle of foot core exercises that enhance intrinsic muscles of the foot to assist in medial longitudinal arch stabilization and hallux strengthening. Progression of these exercises can be done in weight-bearing and impact activities specific to patient goals. In addition to these foot intrinsic exercises, calf raises should be incorporated to strengthen the gastroc-soleus complex to both improve plantar foot strength and facilitate extension of the first MTP joint. Manual therapy techniques reduce the rigidity of the first MTP joint and restore appropriate medial-lateral and plantar-dorsal balance. With severe limitations in mobility or pain limitations, ESWT can be incorporated to treat the joint and surrounding soft tissue restrictions.

Results:

Increased first MTP extension is observed. Reduced symptoms of first MTP joint pain with activity allow patients to return to walking and other physical activities with improved comfort. Complications are rare. Pain over the first MTP joint is expected during ESWT. Rarely, irritation of the plantar components of the first MTP joint, including the tibial and fibular sesamoid bones, may occur.

Discussion/Conclusion:

Non-surgical management of hallux limitus may improve using the described technique of intrinsic foot strengthening with focus on stabilization of the medial longitudinal arch and strategies of improved mobility of the first MTP joint. Adding ESWT may address joint limitations and facilitate gains in exercise and mobility.
Ibrutinib improves survival compared with chemotherapy in mantle cell lymphoma with central nervous system relapse
Authors: Rusconi Chiara , Cheah Chan Y. , Eyre Toby A. , Tucker David , Klener Pavel , Giné Eva , Crucitti Lara , Muzi Cristina , Iadecola Sara , Infante Gabriele , Bernard Sophie , Auer Rebecca L. , Pagani Chiara , Duglosz-Danecka Monika , Mocikova Heidi , van Meerten Tom , Cencini Emanuele , Marin-Niebla Ana , Williams Michael E. , Angelillo Piera , Nicoli Paolo , Arcari Annalisa , Morello Lucia , Mannina Donato , Vitagliano Orsola , Sartori Roberto , Chiappella Annalisa , Sciarra Roberta , Stefani Piero M. , Dreyling Martin , Seymour John F. , Visco Carlo
Published: July 2022

Central nervous system (CNS) relapse of mantle cell lymphoma (MCL) is a rare phenomenon with dismal prognosis, where no standard therapy exists. Since the covalent Bruton tyrosine kinase (BTK) inhibitor ibrutinib is effective in relapsed/refractory MCL and penetrates the blood–brain barrier (BBB), on behalf of Fondazione Italiana Linfomi and European Mantle Cell Lymphoma Network we performed a multicenter retrospective international study to investigate the outcomes of patients treated with ibrutinib or chemoimmunotherapy. In this observational study, we recruited patients with MCL with CNS involvement at relapse who received CNS-directed therapy between 2000 and 2019. The primary objective was to compare the overall survival (OS) of patients treated with ibrutinib or BBB crossing chemotherapy. A propensity score based on a multivariable binary regression model was applied to balance treatment cohorts. Eighty-eight patients were included. The median age at study entry was 65 years (range, 39-87), 76% were males, and the median time from lymphoma diagnosis to CNS relapse was 16 months (range, 1-122). Patients were treated with ibrutinib (n = 29, ibrutinib cohort), BBB crossing chemotherapy (ie, high-dose methotrexate ± cytarabine; n = 29, BBB cohort), or miscellaneous treatments (n = 30, other therapy cohort). Both median OS (16.8 vs 4.4 months; P = .007) and median progression-free survival (PFS) (13.1 vs 3.0 months; P = .009) were superior in the ibrutinib cohort compared with the BBB cohort. Multivariable Cox regression model revealed that ibrutinib therapeutic choice was the strongest independent favorable predictive factor for both OS (hazard ratio [HR], 6.8; 95% confidence interval [CI], 2.2-21.3; P < .001) and PFS (HR, 4.6; 95% CI, 1.7-12.5; P = .002), followed by CNS progression of disease (POD) >24 months from first MCL diagnosis (HR for death, 2.4; 95% CI, 1.1-5.3; P = .026; HR for death or progression, 2.3; 95% CI, 1.1-4.6; P = .023). The addition of intrathecal (IT) chemotherapy to systemic CNS-directed therapy was not associated with superior OS (P = .502) as the morphological variant (classical vs others, P = .118). Ibrutinib was associated with superior survival compared with BBB-penetrating chemotherapy in patients with CNS relapse of MCL and should be considered as a therapeutic option.
International consensus statement on the management of cardiovascular risk of Bruton’s tyrosine kinase inhibitors in CLL
Authors: Awan Farrukh T. , Addison Daniel , Alfraih Feras , Baratta Sergio J. , Campos Rodrigo Noronha , Cugliari María Silvana , Goh Yeow Tee , Ionin Valery Alexandrovich , Mundnich Stefanie , Sverdlov Aaron L. , Tam Constantine , Ysebaert Loïc
Published: July 2022

Bruton’s tyrosine kinase inhibitors (BTKis) have altered the treatment landscape for chronic lymphocytic leukemia (CLL) by offering effective and well-tolerated therapeutic options. However, since the approval of ibrutinib, concern has risen regarding the risk of cardiovascular (CV) adverse events, including atrial fibrillation (AF), hypertension, and heart failure. Newer BTKis appear to have lower CV risks, but data are limited. It is important to understand the risks posed by BTKis and how those risks interact with individual patients, and we convened a panel of physicians with expertise in CLL and CV toxicities in oncology to develop evidence-based consensus recommendations for community hematologists and oncologists. Care providers should thoroughly assess a patient’s CV risk level before treatment initiation, including established CV diseases and risk factors, and perform investigations dependent on preexisting diseases and risk factors, including an electrocardiogram (ECG). For patients with high CV risk, BTKi treatment is often appropriate in consultation with a multidisciplinary team (MDT), and more selective BTKis, including acalabrutinib and zanubrutinib, are preferred. BTKi treatment should generally be avoided in patients with a history of heart failure. Ibrutinib should be avoided in patients with a history of ventricular arrhythmias, but the risk of newer drugs is not yet known. Finally, an MDT is crucial to help manage emerging toxicities with the goal of maintaining BTKi therapy, if possible. Optimizing heart failure, arrhythmia, and hypertension control will likely improve tolerance and maintenance of BTKi therapy. However, additional studies are needed to identify the most optimal strategy for these drugs.
Green nanopriming: responses of alfalfa (Medicago sativa L.) seedlings to alfalfa extracts capped and light-induced silver nanoparticles
Authors: Song Kexiao , Zhao Donghao , Sun Haoyang , Gao Jinzhu , Li Shuo , Hu Tianming , He Xueqing
Published: July 2022

The application of nanotechnology in agriculture can remarkably improve the cultivation and growth of crop plants. Many studies showed that nanoparticles (NPs) made plants grow more vigorously. Light can make NPs aggregated, leading to the reduction of the NPs toxicity. In addition, treatment with NPs had a “hormesis effect” on plants. In this study, light-induced silver nanoparticles (AgNPs) were synthesized by using the alfalfa (Medicago sativa L.) extracts, and then the optimal synthetic condition was determined. Light-induced AgNPs were aggregated, spherical and pink, and they were coated with esters, phenols, acids, terpenes, amino acids and sugars, which were the compositions of alfalfa extracts. The concentration of free Ag+ was less than 2 % of the AgNPs concentration. Through nanopriming, Ag+ got into the seedlings and caused the impact of AgNPs on alfalfa. Compared with the control group, low concentration of light-induced AgNPs had a positive effect on the photosynthesis. It was also harmless to the leaf cells, and there was no elongation effect on shoots. Although high concentration of AgNPs was especially beneficial to root elongation, it had a slight toxic effect on seedlings due to the accumulation of silver. With the increase of AgNPs concentration, the content of silver in the seedlings increased and the silver enriched in plants was at the mg/kg level. Just as available research reported the toxicity of NPs can be reduced by using suitable synthesis and application methods, the present light induction, active material encapsulation and nanopriming minimized the toxicity of AgNPs to plants, enhancing the antioxidant enzyme system.

Graphical Abstract
Microbial amelioration of salinity stress in endangered accessions of Iranian licorice (Glycyrrhiza glabra L.)
Authors: Mousavi Seyyed Sasan , Karami Akbar , Saharkhiz Mohammad Jamal , Etemadi Mohammad , Ravanbakhsh Mohammadhossein
Published: July 2022

Background

Glycyrrhiza glabra L. is a medicinal and industrial plant that has gone extinct due to different abiotic stress caused by climate change. To understand how the plant-associated microorganism can support this plant under salinity, we collected sixteen Iranian accessions of G. glabra L., inoculated their rhizomes with Azotobacter sp. (two levels, bacterial treatments, and no-bacterial treatments, and grown them under salinity stress (NaCl levels; 0, and 200 mM).

Results

Two accessions of Bardsir and Bajgah significantly showed higher resistant to salinity, for example by increasing crown diameter (11.05 and 11 cm, respectively) compared to an average diameter of 9.5 in other accessions. Azotobacter inoculation caused a significant increase in plant height and crown diameter. Among studied accessions, Kashmar (46.21%) and Ilam (44.95%) had the highest rate of membrane stability index (MSI). Evaluation of enzyme activity represented that bacterial application under salinity, increased polyphenol oxidase (PPO) (0.21 U mg−1 protein), peroxidase (POD) (3.09 U mg−1 protein U mg−1 protein), and phenylalanine ammonia-lyase (PAL) (17.85 U mg−1 protein) activity. Darab accession showed the highest increase (6.45%) in antioxidant potential compared with all studied accessions under Azotobacter inoculation. According to principal component analysis (PCA), it was found that the accession of Meshkinshahr showed a more remarkable ability to activate its enzymatic defense system under salt stress. Also, three accessions of Meshkinshahr, Eghlid, and Ilam were categorized in separated clusters than other accessions regarding various studied treatments.

Conclusion

Analysis indicated that five accessions of Meshkinshahr, Rabt, Piranshahr, Bardsir, and Kermanshah from the perspective of induced systematic resistance are the accessions that showed a greater morphophysiological and biochemical outcome under salinity. This study suggested that, inoculation of with Azotobacter on selected accession can relieve salt stress and support industrial mass production under abiotic condition.
Preconception vitamin D intake and obstetric outcomes in women using assisted reproductive technology: the Japan Environment and Children’s Study
Authors: Kyozuka Hyo , Murata Tsuyoshi , Fukuda Toma , Imaizumi Karin , Yamaguchi Akiko , Yasuda Shun , Suzuki Daisuke , Sato Akiko , Ogata Yuka , Hosoya Mitsuaki , Yasumura Seiji , Hashimoto Koichi , Nishigori Hidekazu , Fujimori Keiya ,   the Japan Environment, Children’s Study (JECS) Group, Kamijima Michihiro , Yamazaki Shin , Ohya Yukihiro , Kishi Reiko , Yaegashi Nobuo , Hashimoto Koichi , Mori Chisato , Ito Shuichi , Yamagata Zentaro , Inadera Hidekuni , Nakayama Takeo , Iso Hiroyasu , Shima Masayuki , Kurozawa Youichi , Suganuma Narufumi , Kusuhara Koichi , Katoh Takahiko
Published: July 2022

Background

In reproductive medicine, vitamin D (VitD) is of particular interest because its deficiency has been linked to various infertility issues. Thus, preconception care, including appropriate VitD supplementation, is essential, especially in women using assisted reproductive technology (ART). Despite the therapeutic benefits of VitD, adverse events due to a high daily intake may influence obstetric outcomes. However, the effects of either low or high preconception VitD intake on obstetric outcomes, including the outcomes in women who used ART, remain unclear. Therefore, the aim of this study was to examine the association between pre-pregnancy daily VitD intake and obstetric outcomes in Japanese women, including those who conceived through ART.

Methods

Data were obtained from the Japan Environment and Children’s study database comprising 92,571 women recruited between January 2011 and March 2014 in Japan. Participants were categorized into five quintiles according to pre-pregnancy VitD intake (Q1 and Q5 had the lowest and highest VitD intake, respectively) and stratified according to the use of ART. Multiple logistic regression was performed to identify the effects of pre-pregnancy VitD intake on preterm birth (PTB), low-birth weight infant (LBW), and small for gestational age (SGA).

Results

Using Q3 (middle VitD intake) as a reference, our analysis revealed that Q5 (highest VitD intake) showed an increased risk of LBW < 1500 g (adjusted odds ratio [aOR]: 1.09, 95% confidence interval [CI]: 1.00–1.18) and SGA (aOR: 1.26, 95% CI: 1.14–1.39) among women who conceived without ART. Among women who conceived with ART, we found that Q5 (highest VitD intake) showed an increased risk of PTB at < 37 weeks (aOR: 2.05, 95% CI: 1.27–3.31).

Conclusion

The present study revealed that higher VitD intake before pregnancy may affect perinatal outcomes, particularly in women using ART. Our findings may facilitate personalized preconceptional counseling regarding VitD intake based on the method of conception, especially among women using ART.
Neighbourhood and family correlates of immigrant children’s mental health: a population-based cross-sectional study in Canada
Authors: Sim Amanda , Georgiades Katholiki
Published: July 2022

Background

Immigrant children exhibit significant variation in their mental health outcomes despite disproportionate exposure to socio-economic adversity compared to their non-immigrant peers. Identifying aspects of neighbourhood and family contexts that are most salient for immigrant children’s mental health can help to inform and target interventions to prevent mental disorder and promote mental well-being among this population.

Methods

The study analyzed multi-informant data from 943 first- and second-generation immigrant caregiver and child dyads from the Hamilton Youth Study, a representative sample of immigrant and non-immigrant families in Hamilton, Ontario. Multivariate multilevel regression models examined associations between neighbourhood and family characteristics and processes, and parent and child self reports of internalizing and externalizing problems.

Results

Positive and negative parenting behaviours were significantly associated with internalizing and externalizing problems, with negative parenting demonstrating associations with externalizing problems across both parent and child reports (b = 0.26–1.27). Neighbourhood social disorder and parental trauma exposure were associated with greater internalizing and externalizing problems, and neighbourhood immigrant concentration was associated with fewer externalizing problems for parent reports only. Adding parental distress and parenting behaviour to the models reduced the coefficients for parental trauma exposure by 37.2% for internalizing problems and 32.5% for externalizing problems and rendered the association with neighbourhood social disorder non-significant. Besides the parenting variables, there were no other significant correlates of child-reported internalizing and externalizing problems.

Conclusions

Results highlight the importance of parenting behaviour and parental experiences of trauma and distress for immigrant children’s mental health. While not unique to immigrants, the primacy of these processes for immigrant children and families warrants particular attention given the heightened risk of exposure to migration-related adverse experiences that threaten parental and family well-being. To prevent or mitigate downstream effects on child mental health, it is imperative to invest in developing and testing trauma-informed and culturally responsive mental health and parenting interventions for immigrant families.
Persistent Aspergillus fumigatus infection in cystic fibrosis: impact on lung function and role of treatment of asymptomatic colonization—a registry-based case–control study
Authors: Blomquist Axel , Inghammar Malin , Al Shakirchi Mahasin , Ericson Petrea , Krantz Christina , Svedberg Marcus , Lindblad Anders , Påhlman Lisa I.
Published: July 2022

Background

Aspergillus fumigatus is the most common filamentous fungus isolated from the airways of people with cystic fibrosis (CF). The aim of this study was to investigate how chronic A. fumigatus colonization affects lung function in people with CF, to identify risk factors for colonization, and to evaluate antifungal treatment of asymptomatic Aspergillus colonization.

Methods

Data from 2014–2018 was collected from the Swedish CF registry and medical records. Baseline data before the start of A. fumigatus colonization was compared with the two succeeding years to evaluate how colonization and treatment affected lung function and other clinical aspects.

Results

A total of 437 patients were included, of which 64 (14.6%) became colonized with A. fumigatus during the study period. Inhaled antibiotics was associated with A. fumigatus colonization (adjusted OR 3.1, 95% CI 1.6–5.9, p < 0.05). Fungal colonization was not associated with a more rapid lung function decline or increased use of IV-antibiotics compared to the non-colonized group, but patients with A. fumigatus had more hospital days, a higher increase of total IgE, and higher eosinophil counts. In the Aspergillus group, 42 patients were considered to be asymptomatic. Of these, 19 patients received antifungal treatment. Over the follow up period, the treated group had a more pronounced decrease in percent predicted Forced Expiratory Volume in one second (ppFEV1) compared to untreated patients (− 8.7 vs − 1.4 percentage points, p < 0.05).

Conclusion

Inhaled antibiotics was associated with A. fumigatus colonization, but no association was found between persistent A. fumigatus and subsequent lung function decline. No obvious benefits of treating asymptomatic A. fumigatus colonization were demonstrated.
Putting measurement on a diet: development of a core set of indicators for quality improvement in the ICU using a Delphi method
Authors: Zegers Marieke , Verhage Rutger , Hesselink Gijs , van der Hoeven Johannes G.
Published: July 2022

Background

The number and efficacy of indicators used to monitor and improve the quality of care in Intensive Care Units (ICU) is debatable. This study aimed to select a consensus-based core set of indicators for effective quality improvement in the ICU.

Methods

A Delphi study with a panel of intensivists, ICU nurses, and former ICU patients or relatives (n = 34) from general, teaching, and academic hospitals. Panelists completed a questionnaire in which they scored 69 preselected quality indicators on relevance using a nine-point Likert scale. Indicators were categorized using the rated relevance score into: ‘accepted, ‘equivocal’ and ‘excluded’. Questionnaire results were discussed in focus groups to reach consensus on the final set.

Results

Response rates for the questionnaire and focus groups were 100 and 68%, respectively. Consensus was reached on a final set of 17 quality indicators including patient reported outcome measures (PROMs) and patient reported experience measures (PREMs). Other quality indicators relate to the organization and outcome of ICU care, including safety culture, ICU standardized mortality ratio, and the process indicator ‘learning from and improving after serious incidents’.

Conclusions

ICU clinicians and former patients and relatives developed a consensus-based core set of ICU quality indicators that is relatively short but comprehensive and particularly tailored to end-users needs.
Identification of genes and key pathways underlying the pathophysiological association between nonalcoholic fatty liver disease and atrial fibrillation
Authors: Chu Yanan , Yu Fangcong , Wu Yakui , Yang Jinxiu , Shi Jiaran , Ye Tianxin , Han Deheng , Wang Xingxiang
Published: July 2022

Background

Atrial fibrillation (AF) is one of the most prevalent sustained cardiac arrhythmias. The latest studies have revealed a tight correlation between nonalcoholic fatty liver disease (NAFLD) and AF. However, the exact molecular mechanisms underlying the association between NAFLD and AF remain unclear. The current research aimed to expound the genes and signaling pathways that are related to the mechanisms underlying the association between these two diseases.

Materials and methods

NAFLD- and AF- related differentially expressed genes (DEGs) were identified via bioinformatic analysis of the Gene Expression Omnibus (GEO) datasets GSE63067 and GSE79768, respectively. Further enrichment analysis of Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG), the construction of a protein–protein interaction (PPI) network, the identification of significant hub genes, and receiver operator characteristic curve analysis were conducted. The gene-disease interactions were analyzed using the Comparative Toxicogenomics Database. In addition, the hub genes were validated by quantitative Real-Time PCR (qRT-PCR) in NAFLD cell model.

Results

A total of 45 co-expressed differentially expressed genes (co-DEGs) were identified between the NAFLD/AF and healthy control individuals. GO and KEGG pathway analyses revealed that the co-DEGs were mostly enriched in neutrophil activation involved in the immune response and cytokine-cytokine receptor interactions. Moreover, eight hub genes were selected owing to their high degree of connectivity and upregulation in both the NAFLD and AF datasets. These genes included CCR2, PTPRC, CXCR2, MNDA, S100A9, NCF2, S100A12, and S100A8.

Conclusions

In summary, we conducted the gene differential expression analysis, functional enrichment analysis, and PPI analysis of DEGs in AF and NAFLD, which provides novel insights into the identification of potential biomarkers and valuable therapeutic leads for AF and NAFLD.
GRB10 is a novel oncogene associated with cell proliferation and prognosis in glioma
Authors: Chen Yuanbing , Tang Miao , Xiong Jianbing , Gao Qiongjue , Cao Wuyang , Huang Jun
Published: July 2022

Background

Glioma is the most common malignant tumor of the central nervous system and is associated with a poor prognosis. This study aimed to explore the function of growth factor receptor-bound protein 10(GRB 10) in glioma.

Methods

The expression of GRB10 in glioma was determined based on the glioma transcriptome profile downloaded from The Cancer Genome Atlas (TCGA), Chinese Glioma Genome Atlas (CGGA), and Gene Expression Omnibus (GEO) databases. RT-qPCR was performed to detect the expression of GRB10 in tissue samples obtained from 68 glioma patients. The patients were followed up via telephone or in-person outpatient visits to determine survival. Kaplan-Meier survival analyses were used to evaluate the effect of GRB10 on the prognosis of glioma patients. Further, we constructed GRB10 knockdown cell lines were constructed to investigate the effect of GRB10 on glioma. The cell growth, colony formation, cell cycle assay, EdU assay, and tumor formation in xenograft were performed.

Results

The expression level of GRB10 was positively correlated to the histological grades of gliomas. In addition, Kaplan-Meier survival curves revealed that glioma patients with lower expression of GRB10 had more prolonged survival. The knockdown of GRB10 was shown to inhibit cell proliferation, colony formation, and tumor formation in the xenograft models. Cell cycle assay revealed that the knockdown of GRB10 can inhibit the cells entering the G2/M phase from the S phase. The analysis of GSEA suggests that the expression of GRB10 was positively correlated with the hypoxia and EMT signaling pathway.

Conclusions

Our data revealed that GRB10 regulated tumorigenesis in glioma and played a vital role in promoting the glioma progression, which indicated that GRB10 could be used as a potential prognostic marker.
Effects of altitude and slope on the climate–radial growth relationships of Larix olgensis A. Henry in the southern Lesser Khingan Mountains, Northeast China
Authors: Qiao Jingjing , Sun Yujun
Published: July 2022

Background

The relationship between climate and radial growth of trees exhibits spatial variation due to environmental changes. Therefore, elucidation of how the growth–climate responses of trees vary in space is essential for understanding forest growth dynamics to facilitate scientific management with the ongoing global climate warming. To explore the altitudinal and slope variations of these interactions, tree-ring width chronologies of Larix olgensis A. Henry were analyzed in the southern Lesser Khingan Mountains, Northeast China.

Results

The radial growth of L. olgensis exhibited significant 5- to 10-year periodic changes at three altitudes and two slopes, and the frequency change occurred mainly during the early growth stage and after 2000. The radial growth of L. olgensis was significantly negatively correlated with September precipitation only at low altitudes, but also with the mean temperature in July–August and the mean maximum temperature in June–August at high altitudes. The radial growth of L. olgensis at low and middle altitudes as well as on the sunny slope led to a higher demand for moisture, while temperature was the key limiting factor at high altitudes and on the shady slope.

Conclusions

The climate–radial growth relationship of L. olgensis exhibits altitudinal and slope variability. This study quantitatively describes the spatially varying growth–climate responses of L. olgensis in the southern Lesser Khingan Mountains, which provides basic data for the management of L. olgensis forests and the prediction of future climate impacts on forest ecosystems.
Forage offering and seasonal intake comparisons to evaluate European rabbit threat in Nothofagus forests of southern Patagonia
Authors: Huertas Herrera Alejandro , Toro-Manríquez Mónica , Borrelli Laura , Lencinas María Vanessa , Martínez Pastur Guillermo
Published: July 2022

Background

The European rabbit (Oryctolagus cuniculusL. 1758) was introduced into different regions of the world, generating significant trade-offs that critically impacted native vegetation. Here, we evaluate the rabbit's forage intakes in three vegetation types (forests, shrublands, and grasslands) along the four seasons in a temperate forest landscape in Southern Patagonia and discuss the potential threats over native vegetation. We formulated the following questions: (i) what is the forage offer at each vegetation type? (ii) what is the rabbit's forage intake and how it varied across the seasons along the year? and (iii) which vegetation types and plant life forms were more used according to the rabbit's forage intakes?

Methods

We censused understory vegetation to characterize the forage offer at each vegetation type and determined seasonal dietary intakes using microhistological analysis of pellets. The plant species identified in the field were grouped according to life form classes (tree regeneration, shrubs, forbs, graminoids, orchids, ferns, bryophytes, and hemiparasites). Data were analysed through uni- and multi-variate analyses, determining relationships between forage offer and the rabbit's forage intakes.

Results

Forage intakes revealed changes in plant life form consumption across vegetation types, where intake pressure was considerably different for tree regeneration (p = 0.001), graminoids (p = 0.001), and hemiparasites (p = 0.001). Besides, significant changes in consumption among seasons were detected for shrubs (p = 0.001), ferns (p = 0.030), and hemiparasites (p = 0.002). Although many species play an important role in the rabbit's forage intake networks (e.g.,Chiliotrichum diffusum,Holcus lanatus), the strongest intake linkages were found in exotic grasses (e.g.,Poa pratensisandFestucasp.), native hemiparasites (e.g.,Misodendrumsp.), native shrubs (e.g.,Empetrum rubrum), and native trees (e.g.,Nothofagussp.). The summer and autumn seasons presented higher intake compared to the winter and spring seasons. Furthermore, hemiparasites intake (e.g.,Misodendrumsp.) suggests that rabbits utilize different forage sources depending on the vegetation types.

Conclusions

Rabbits regularly inhabit the forest, even though it is not their preferred vegetation type to live. Rabbit management entails isolating regions that are more favourable to intake and emphasizing the year's season for rabbit control efforts.
A phase II pilot randomized controlled trial to assess the feasibility of the “supra-marginal” surgical resection of malignant glioma (G-SUMIT: Glioma supra marginal incision trial) study protocol
Authors: Mansouri Alireza , Lai Carolyn , Scales Damon , Pirouzmand Farhad
Published: July 2022

Background

High-grade gliomas are the most common primary malignant brain tumor in adults having a median survival of only 13–16 months. This is despite the current standard of maximal safe surgical resection followed by fractionated radiotherapy and chemotherapy. Extending the tumor resection limit beyond the gadolinium (GAD)-enhancing margin (i.e., supra-marginal resection) could in principle provide an added survival benefit as it has been shown that > 80% of post-operative tumor recurrence is within a 2-cm region surrounding the original GAD-enhancing margin. However, this must be weighed against the risk of potential damage to functional brain tissue.

Methods

In this phase II pilot randomized control trial (RCT), we aim to assess the feasibility of “supra-marginal” resection extending 1 cm beyond the enhancing tumor in adults with radiographic evidence of GAD-enhancing intra-axial tumor consistent with high-grade glioma in a safe anatomical location and a Karnofsky Performance Score > 60. With six academic institutions with established neurosurgical oncology practices in participation, we aim to enroll 72 patients over 2 years. Primary outcomes include evaluating the feasibility of performing a large-scale trial with regard to recruitment, allocation, and outcome documentation as well as safety data. Secondary outcomes include determining if there is an increased survival benefit with supra-marginal resection and impact on quality of life (Modified Rankin Scale (mRS), EuroQol-5D (ED-5D), 30-day all-cause mortality).

Discussion

Recent studies have revealed survival advantages comparing supra-marginal resection to standard attempt at gross total resection (GTR) with no additional perioperative surgical risk; however, the current quality of evidence is low and under-powered. Therefore, there are no current practice guidelines, and the philosophy of surgical resection is guided by individual surgeon preferences on an individual patient basis. This creates additional uncertainty and is potentially detrimental to our patients. This clinical equipoise supports the need for an adequately powered RCT to determine whether a supra-marginal resection can have a positive impact on survival for patients with HGGs. Our pilot RCT will test the feasibility of comparing the standard gross total resection of GAD-enhancing tumors and supra-marginal resection to prepare for a larger definitive multicenter RCT.

Trial registration

ClinicalTrials.gov, NCT04737577. Registered on February 4, 2021
Temporary hypotension and ventilation difficulty during endoscopic injection sclerotherapy for esophageal varices in a child with Fontan circulation: a case report
Authors: Yasutomi Nanako , Shimizu Tatsuhiko , Kanazawa Tomoyuki , Shimizu Kazuyoshi , Iwasaki Tatsuo , Morimatsu Hiroshi
Published: July 2022

Background

Endoscopic procedures are rarely performed in children with congenital heart disease (CHD); therefore, the associated complications are unknown. We report an abrupt change in circulatory and respiratory condition during endoscopic injection sclerotherapy for esophageal varices.

Case presentation

A 9-year-old boy with a history of total anomalous pulmonary venous connection (TAPVC) repair and Fontan procedure for asplenia and a single ventricle with TAPVC underwent endoscopic injection sclerotherapy under general anesthesia for esophageal varices. Systolic blood pressure decreased from 70 to 50 mmHg following a sclerosant injection; a second injection reduced his peripheral oxygen saturation from 93 to 79% secondary to ventilation difficulty. Although we suspected anaphylaxis intraoperatively, postoperative imaging suggested that balloon dilation performed to prevent sclerosing agent leakage caused compression of the pulmonary venous chamber and trachea owing to the anomalous intrathoracic organ anatomy.

Conclusion

Thorough understanding of the complex anatomy is important before performing endoscopic procedures in children with CHD to preoperatively anticipate possible intraoperative complications and select the optimal therapeutic approach and anesthesia management.
Experimental measurement of the exclusion-diffusion potential in sandstone and shaly sand samples at full and partial water saturation
Authors: Alarouj Mutlaq , Jackson Matthew David
Published: July 2022

The exclusion-diffusion potential (EDP) arises in response to concentration gradients and is one of the key components of the self-potential (SP) observed in subsurface environments. However, few data are available to characterize the EDP in reservoir rocks saturated with complex natural brines and at partial brine saturation. We report experimental measurements of the EDP across fully and partially brine-saturated sandstone samples and fully brine-saturated shaly sand samples, using natural saline brine (2.2 Mol/L), seawater (0.5 Mol/L), and natural crude oil. When fully saturated, the EDP across the samples is diffusion-dominated, with the shaly samples exhibiting a small contribution from charge exclusion. The contribution of charge exclusion to the measured EDP increases as permeability decreases. At the residual oil saturation, the measured EDP is diffusion-dominated, consistent with our findings at full saturation. However, the EDP is more exclusive at the irreducible water saturation, and the polarity of the excluded ions depends on the polarity of the charged oil-brine interface. A charge exclusion is more significant at lower irreducible water saturation. Our results support recent studies suggesting that the oil-brine interface can be positively charged in contact with natural brines. The EDP trends reported have not been observed previously and have broad implications for geophysical monitoring of subsurface flow and transport, such as transport of nonaqueous phase contaminants in aquifers and water flow during hydrocarbon production.
Triglyceride Metabolism Modifies Lipoprotein(a) Plasma Concentration
Authors: Ramos-Cáceres Maria , Lamiquiz-Moneo Itziar , Cenarro Ana , Calmarza Pilar , Marco-Benedí Victoria , Bea Ana M , Mateo-Gallego Rocio , Puzo Jose , Ordovas Jose M , Civeira Fernando , Laclaustra Martin
Published: July 2022

Background

Lipoprotein(a) (Lp(a)) is a significant cardiovascular risk factor. Knowing the mechanisms that regulate its concentration can facilitate the development of Lp(a)-lowering drugs. This study analyzes the relationship between triglycerides (TGs) and Lp(a) concentrations, cross-sectionally and longitudinally, and the influence of the number and composition of TG-rich lipoproteins, and the APOE genotype.

Methods

Data from Aragon Workers Health Study (AWHS) (n = 5467), National Health and Nutrition Examination Survey III phase 2 (n = 3860), and Hospital Universitario Miguel Servet (HUMS) (n = 2079) were used for cross-sectional TG and Lp(a) relationship. Lp(a) intrasubject variation was studied in AWHS participants and HUMS patients with repeated measurements. TG-rich lipoproteins were quantified by nuclear magnetic resonance in a subsample from AWHS. Apolipoproteins B and E were quantified by Luminex in very low-density lipoprotein (VLDL) isolated by ultracentrifugation, from HUMS samples. APOE genotyping was carried in AWHS and HUMS participants. Regression models adjusted for age and sex were used to study the association.

Results

The 3 studies showed an inverse relationship between TG and Lp(a). Increased VLDL number, size, and TG content were associated with significantly lower Lp(a). There was an inverse association between the apoE concentration in VLDL and Lp(a). No significant association was observed for apolipoprotein (apo)B. Subjects carrying the apoE2/E2 genotype had significantly lower levels of Lp(a).

Conclusion

Our results show an inverse relationship Lp(a)-TG. Subjects with larger VLDL size have lower Lp(a), and lower values of Lp(a) were present in patients with apoE-rich VLDL and apoE2/E2 subjects. Our results suggest that bigger VLDLs and VLDLs enriched in apoE are inversely involved in Lp(a) plasma concentration.
Cathepsin K Mutation—A Subtle Clinical Presentation
Authors: Nandipati Venkata Sandeep , Chapla Aaron , Jebasingh Felix K , Charlu Arun Paul , Jepegnanam Thilak Samuel , Cherian Kripa Elizabeth , Paul Thomas V , Thomas Nihal
Published: July 2022

Context

Pyknodysostosis is an uncommon inherited disorder associated with consanguinity, often presenting with sclerotic bone disease, short stature, dysmorphic features, and recurrent fragility fractures at an early age.

Case

A 34-year-old woman was evaluated for the cause of recurrent fragility fractures. She was born of a third-degree consanguineous marriage and had a twin brother who was of short stature. The index patient had a height of 141 cm, dysmorphic features including frontoparietal bossing, blue sclera with short stubby fingers and toes. Radiological evaluation revealed diffuse osteosclerosis with acro-osteolysis exclusively in the toes, apart from mid-facial hypoplasia, lack of pneumatization of the paranasal sinuses, dental abnormalities, and scoliosis. Dual-energy x-ray absorptiometry revealed increased bone mineral density. Based on the clinical features, the patient was tested for cathepsin K gene variants using next-generation sequencing and was found to be positive for a novel homozygous c.224T>C, p.Met75Thr likely pathogenic missense variant.

Discussion

This patient presented at a later age than expected with recurrent fragility fractures and the diagnosis was not suspected till adulthood, owing to the subtle clinical features. Confirmation with genetic testing helped in establishing the diagnosis.

Conclusion

Pyknodysostosis, although uncommon, is one of the differential diagnoses for diffuse osteosclerosis presenting with recurrent fragility fractures. Next-generation sequencing in an appropriate setting may confirm the diagnosis.
Examining the Gradient of All-Cause Mortality Risk in Women across the Cardiorespiratory Fitness Continuum
Authors: FARRELL STEPHEN W. , LEONARD DAVID , BARLOW CAROLYN E. , SHUVAL KEREM , PAVLOVIC ANDJELKA , DEFINA LAURA F.
Published: July 2022

Purpose

Although cardiorespiratory fitness (CRF) is inversely associated with all-cause mortality in women, less is known regarding the gradient of mortality risk in women, particularly at the lower end of the CRF continuum.

Methods

A total of 17,901 healthy women (mean age, 45.9 yr) completed a baseline clinical examination, including a maximal treadmill exercise test at the Cooper Clinic in Dallas, TX, between 1971 and 2016. Participants were placed into CRF quintiles based on age and treadmill time.

Results

After a mean follow-up period of 17.9 yr, 1198 all-cause deaths occurred. More favorable cardiometabolic risk factors, smoking status, and physical activity levels were observed across ordered CRF quintiles (P < 0.001 for all). Adjusted all-cause mortality hazard ratios with 95% confidence intervals were 1.71 (1.40–2.09), 1.55 (1.29–1.87), 1.25 (1.03–1.51), 1.16 (0.97–1.38), and 1.0 (referent), respectively, across CRF quintiles (P trend ≤ 0.001). When utilizing CRF as a continuous variable in a spline analysis and using 4.5 METs as the referent, we estimate a 10% reduction in mortality risk per 1-MET increment in CRF (P < 0.001) until a threshold of approximately 11 METs. Mortality risk was approximately 50% lower at the 11-MET threshold when compared with the referent. No further significant reduction in mortality risk was observed beyond the 11-MET threshold. In addition, age-adjusted hemodynamic variables including resting and maximal double product, heart rate reserve, double-product reserve, and 1-min recovery heart rate were more favorable across CRF quintiles (P < 0.001 for all).

Conclusions

Beginning at a referent value of 4.5 METs, a significant decreasing gradient of all-cause mortality exists across the CRF continuum, until a threshold of approximately 11 METs is reached. Although all women should be encouraged to work toward meeting public health guidelines for physical activity, it is especially important to target those at the low end of the CRF continuum.
Η θεραπευτική αντιμετώπιση των παθήσεων του ουροποιητικού συστήματος στη χρυσή εποχή της Αραβοϊσλαμικής ιατρικής (7ος-15ος αιώνας) και η απήχηση της στη σύγχρονη ουρολογία
Authors: Δρογώσης Αχιλλεύς
Published: July 2022

Στην ανατολική Μεσόγειο κατά την αρχαιότητα ήκμασαν σημαντικοί πολιτισμοί όπως της Αιγύπτου και της Ελλάδας. Η ιατρική σημείωσε πρόοδο μέσω της ανατομίας και της χειρουργικής. Τα χειρουργικά εργαλεία εξελίχθηκαν και η ιατρική κατά την περίοδο της Κλασικής Ελλάδας μετέβη από τη θεουργική στην επιστημονική της φύση. Η ουρολογία ξεκίνησε σταδιακά με την περιτομή και τα διουρητικά βότανα για να εξελιχθεί σε μεγαλύτερη ποικιλία επεμβάσεων και χρησιμοποιούμενων φυτικών σκευασμάτων. Ο Ιπποκράτης (460-377 π.Χ.) θα αφιερώσει πολλά αποσπάσματα στις παθήσεις του ουροποιητικού, όπως και ο Αέτιος (502-575) και ο Παύλος ο Αιγινήτης (625-690). Οι Ρωμαίοι υιοθέτησαν την Ελληνική ιατρική και το ίδιο έπραξαν και οι Άραβες. Διείδαν ότι μέσω των επιτευγμάτων της Ελληνορωμαϊκής ιατρικής θα μπορούσαν να εξυπηρετήσουν πρακτικές ανάγκες και να δημιουργήσουν τη δική τους επιστημονική βάση. Μετέφρασαν τα σημαντικότερα έργα, ήρθαν σε επαφή με ιατρούς άλλων εθνών και ξεκίνησαν τη δική τους σχολή. Χειρουργικές επεμβάσεις κήλης, στένωσης ουρήθρας και αφαίρεσης λίθων ξεκίνησαν να εξελίσσονται. Πολλά χειρουργικά εργαλεία και καθετήρες επινοήθηκαν και κατασκευάστηκαν προκειμένου να εξυπηρετήσουν τις ανάγκες χειρουργικών παρεμβάσεων και επεμβάσεων στο κατώτερο ουροποιητικό σύστημα. Τα βότανα χρησιμοποιήθηκαν για την αύξηση της διούρησης, την θεραπευτική αντιμετώπιση των ελκών, καθώς και για την πρόληψη και θεραπεία της λιθίασης. Ο Ραζής (864/865-925/935), ο Αβικέννας (980-1037) ο Σαμπουντζούογλου (1385-1468) και πολλοί άλλοι Άραβες της εποχής των Χαλιφών συνέβαλαν με τα επιτεύγματα τους στην εξέλιξη της Ουρολογίας. Οι θεμελιώδεις αρχές αντιμετώπισης των ουρολογικών παθήσεων, τα βασικά χειρουργικά εργαλεία, οι κυριότερες επεμβατικές τεχνικές και φυσικά ο καθετήρας ακόμη και σήμερα καταδεικνύουν τη συνεισφορά των Αράβων της εποχής εκείνης. Η Ουρολογία οφείλει στους Άραβες την διάσωση της Ελληνορωμαϊκής ιατρικής, που μαζί με την δική τους συνεισφορά πέρασε μέσω μεταφράσεων από τα Αραβικά στα Λατινικά δίνοντας ώθηση για περεταίρω εξέλιξη στις ιατρικές σχολές της Δυτικής Ευρώπης.
Module intervention to improve involvement and practices of fathers towards infant and young child feeding (IYCF) in Coastal South India - a randomized controlled trial
Authors: Mithra Prasanna , Unnikrishnan Bhaskaran , T Rekha , Kumar Nithin , Holla Ramesh , Rathi Priya
Published: July 2022

Background: Overall child health depends on nutrition and its related practices. At the family level, responsibility of child feeding lies with both parents. There is no uniform and systematic way to determine and assess the practices of fathers in infant and young child feeding (IYCF). Also, there is a paucity of evidence related to interventions for fathers in improving their practices and involvement in the feeding of their infant or young child (aged less than two years).

Methods: This was a community-based randomized control trial, conducted among 120 fathers with infants and/or young children in Dakshina Kannada District of Karnataka. Fathers with poor level of involvement and practices towards IYCF, during the initial assessment, were included as the study participants. For the intervention, a module in the flipchart format was developed. Simple randomization technique was used to allot the participants into two groups - intervention and control. Participants in the intervention group received module intervention, in addition to the care which they received routinely, and the control group received only routine care. The participants in the intervention group were paid a monthly visit to implement the module, for six months. The post-intervention assessment was done at the end of 6 months.

Results: A total of 117 participants provided post-intervention data. The mean age was 34.7 (+/- 5.48) years in the intervention group and 34.36 years (+/- 5.26) in the control group. The intervention group showed significantly higher improvement in knowledge, attitude, and practice components at 6 months (p<0.05), in both unadjusted and adjusted models.

Conclusions: The extent of increase in practice and involvement in child feeding was clearly higher among the intervention group. The module developed was successful in improving the practices of fathers in feeding their infants and young children.

Clinical Trials Registry India: CTRI/2017/06/008936 (29/06/2017)
Better pandemic preparedness does correlate with lower COVID-19 mortality
Authors: Dowell Scott F , Wang Haidong , Blazes David
Published: July 2022

Paradoxically, many countries with strong pandemic preparedness have reported high coronavirus disease 2019 (COVID-19) mortality.  After adjusting for country under-reporting by using total excess mortality estimates, and age distributions by using indirect standardization, we find the resulting comparative mortality ratios are predicted by pandemic preparedness.  Countries with higher scores on the Global Health Security Index had significantly lower COVID-19 mortality (r(192) = -.32, p<.001).  These findings can help inform and prioritize future pandemic preparedness work.