bluuebunny/crossref_metadata_2025 huggingface dataset:
Expression of Wnt signaling agonists and antagonists in periodontitis and healthy subjects, before and after non‐surgical periodontal treatment: A systematic review
Authors: Chatzopoulos Georgios S. , Koidou Vasiliki P. , Wolff Larry F.
Published: June 2022

Periodontitis is a preventable and treatable multifactorial chronic inflammatory disease that can lead to irreversible periodontal destruction and tooth loss. Wnt signaling and its regulators play an important role in periodontal inflammation, destruction, regeneration, and reconstruction. This systematic review aimed at investigating the involvement of Wnt signaling agonists and antagonists in periodontitis and healthy subjects, before and after periodontal treatment. Electronic searches were carried out using MEDLINE/PubMed, EMBASE, and Cochrane Library databases in addition to hand searches. Studies having different designs assessing the levels of Wnt signaling antagonist and agonist levels in gingival crevicular fluid, serum, and tissue in patients diagnosed with periodontitis or gingivitis, compared with healthy individuals were included. In addition, studies compared these levels in periodontitis patients before and after non‐surgical periodontal therapy were also eligible. Sixteen studies met the eligibility criteria. Sclerostin (SOST) has been mainly investigated in the literature (8 publications). Sclerostin (5 studies), Wnt‐5a (2 studies), secreted frizzled‐related protein 1 (SFRP1) (3 studies), and β‐catenin (3 studies) show increased levels in periodontitis compared with periodontal health. Strong correlations between marker levels and periodontal clinical parameters were identified for SOST (5 studies), SFRP1 (2 studies), and β‐catenin (2 studies). SOST (3 studies) and SFRP1 (1 study) levels significantly decrease following non‐surgical periodontal treatment. The present systematic review demonstrated an association between Wnt signaling agonist and antagonist levels and periodontitis. Wnt agonists and antagonists may serve as valuable diagnostic and prognostic markers for periodontitis onset and progression. Further case–control and longitudinal studies should be conducted for different Wnt signaling agonists and antagonists.
Effect of extrusion processing on techno‐functional, textural and bioactive properties of whole‐grain corn flour‐based breakfast cereals sweetened with honey
Authors: Bobade Hanuman , Singh Arashdeep , Sharma Savita , Gupta Antima , Singh Baljit
Published: June 2022

The present study investigated the effect of honey and extrusion processing parameters on techno‐functional and bioactive properties of whole‐grain corn flour breakfast cereals. The central composite rotatable design (CCRD) was used to plan the experiments using feed moisture (FM), extrusion temperature (ET), and honey level as process variables and sectional expansion ratio (SER), bulk density (BD), water absorption index (WAI), water solubility index (WSI), and textural hardness as response variables. The feed containing honey and whole‐grain corn flour was extruded through a twin‐screw extruder according to CCRD. The data were fit to the appropriate regression models based on model significance and insignificant lack of fit. The selected experiments from CCRD were considered for studying the bioactive properties, and the effect of ET and honey level on bioactive properties was determined. The results of the study indicated that FM and honey adversely affected the SER, BD, and textural hardness, while ET augmented these properties of breakfast cereals. The WAI decreased with an increase in honey level and ET during extrusion. The incremental addition of honey in the mix as well extrusion at elevated temperature led to higher WSI. The whole‐grain corn flour added with 10.22% honey and extruded at 16.06% FM, and 138.07°C ET produced optimum quality breakfast cereals with 0.70 desirability. The total phenolic content of breakfast cereals decreased, and antioxidant activity and hydroxymethylfurfural content increased upon extrusion at the higher temperatures. Honey addition lowers the loss of phenolic content during extrusion and improves the antioxidant activity of breakfast cereals.
Drivers of change in weight‐for‐height among children under 5 years of age in Ethiopia: Risk factors and data gaps to identify risk factors
Authors: Girma Meron , Hussein Alemayehu , Baye Kaleab , Samuel Aregash , van Zyl Cornelia , Tessema Masresha , Chitekwe Stanley , Laillou Arnaud
Published: June 2022

The prevention of wasting should be a public health priority as the global burden of acute malnutrition is still high. Gaps still exist in our understanding of context‐specific risk factors and interventions that can be implemented to prevent acute malnutrition. We used data from the four rounds of the Ethiopia Demographic and Health Survey (2000–2016) to identify risk factors that have contributed to the change in weight‐for‐height z‐score (WHZ) among children under 5 years of age. We performed a pooled linear regression analysis followed by a decomposition analysis to identify relevant risk factors and their relative contribution to the change in WHZ. Modest improvements in WHZ were seen between 2000 and 2016. The sharpest decrease in mean WHZ occurred from birth to 6 months of age. Perceived low weight at birth and recent diarrhoea predicted a decline in WHZ among children aged 0–5, 6–23 and 23–59 months. Less than 50% of the change in WHZ was accounted for by the change in risk factors included in our regression decomposition analysis. This finding highlights data gaps to identify context‐specific wasting risk factors. The decline in the prevalence of recent diarrhoea (15% of the improvement), decline in low birth size (7%–9%), and an increase in wealth (15%–30%) were the main risk factors that accounted for the explained change in WHZ. Our findings emphasize the importance of interventions to reduce low birthweight, diarrhoea and interventions that address income inequities to prevent acute malnutrition.
Potential distributions of the parasite Trypanosoma cruzi and its vector Dipetalogaster maxima highlight areas at risk of Chagas disease transmission in Baja California Sur, Mexico, under climate change
Authors: Flores‐López Carlos A. , Moo‐Llanes David A. , Romero‐Figueroa Guillermo , Guevara‐Carrizales Aldo , López‐Ordoñez Teresa , Casas‐Martínez Mauricio , Samy Abdallah M.
Published: June 2022

Dipetalogaster maxima is a primary vector of Chagas disease in the Cape region of Baja California Sur, Mexico. The geographic distribution of D. maxima is limited to this small region of the Baja California Peninsula in Mexico. Our study aimed to construct the ecological niche models (ENMs) of this understudied vector species and the parasite responsible for Chagas disease (Trypanosoma cruzi). We modelled the ecological niches of both species under current and future climate change projections in 2050 using four Representative Concentration Pathways (RCPs): RCP 2.6, RCP 4.5, RCP 6.0, and RCP 8.5. We also assessed the human population at risk of exposure to D. maxima bites, the hypothesis of ecological niche equivalency and similarity between D. maxima and T. cruzi, and finally the abundance centroid hypothesis. The ENM predicted a higher overlap between both species in the Western and Southern coastal regions of the Baja California Peninsula. The climate change scenarios predicted a Northern shift in the ecological niche of both species. Our findings suggested that the highly tourist destination of Los Cabos is a high‐risk zone for Chagas disease circulation. Overall, the study provides valuable data to vector surveillance and control programs.
Antifungal drug price increases in the United States, 2000–2019
Authors: Thomas Christine M. , Shae Whitney , Koestler Devin , DeFor Terese , Bahr Nathan C. , Alpern Jonathan D.
Published: June 2022

Background

Antifungal drugs treat a variety of conditions, ranging from localised dermatologic disease to life‐threatening systemic infections. Some common antifungal drugs experienced large price increases in recent years, however, factors contributing to these price increases are poorly understood. We sought to examine trends in antifungal drug prices and determine underlying drivers of price changes.

Methods

Antifungal drug products in the United States were identified using the Food and Drug Administration (FDA) Label database. For each product, we determined the wholesale acquisition cost per unit over time between 2000 and 2019, adjusting for inflation, and examined variables that could impact price: route of administration, number of FDA indications, the quantity of professional guideline recommendations, use for prophylaxis, number of FDA‐approved manufacturers, and whether it was compounded. Price trajectories were clustered into four groups: (1) stable, 2) moderate, (3) high, and (4) extreme price increases.

Results

Of 139 identified drug products, one outlier was removed due to exorbitant price increases. Cluster 1 (n = 31) demonstrated the most stable prices with a 25% mean price increase. Clusters 2 (n = 97), 3 (n = 7), and 4 (n = 3) demonstrated moderate, high, and extreme price increases with 52%, 318%, and 900% mean price increases, respectively. Atypical routes of administration and compounding were over‐represented in clusters 3 and 4. There was no correlation between the number of manufacturers and price changes.

Conclusions

Antifungal drugs exhibited large, inflation‐adjusted price increases. Atypical routes of administration and compounding were over‐represented within clusters exhibiting extraordinary price increases. Our data support policies aiming to curb large price increases for medically important drugs.
Pediatric fibromyxoid tumor with PLAG1 fusion: An emerging entity with a novel intracranial location
Authors: Santisukwongchote Sakun , Thorner Paul Scott , Desudchit Tayard , Techavichit Piti , Jittapiromsak Nutchawan , Amornfa Jiraporn , Shuangshoti Somruetai , Shuangshoti Shanop , Teerapakpinyo Chinachote
Published: June 2022

Translocations involving PLAG1 occur in several tumors, most commonly pleomorphic adenoma and lipoblastoma. Recently, a distinctive soft tissue tumor with a PLAG1 fusion has been reported in the pediatric age group. These are low grade tumors with a fibroblastic or mixed fibroblastic and myxoid morphology but no other lines of differentiation. They are typically immunopositive for desmin and CD34. The partner genes for these tumors have included YWHAZ, EEF1A1, ZFHX4l, CHCHD7, and PCMTD1. We report another case of this fibromyxoid tumor with a PLAG1 fusion, this time with COL3A1 as the partner gene. The fusion placed expression of a full‐length PLAG1 protein under the control of the constitutively active COL3A1 promoter. Overexpression of PLAG1 was confirmed by diffusely positive immunostaining for PLAG1. The most novel aspect of this tumor is the intracranial location. Opinion has been divided over whether these tumors are a specific entity, or related to lipoblastoma, since that tumor also typically occurs in soft tissue in the pediatric age group and shows many of the same gene fusions. However, lipoblastoma has never been reported in an intracranial location and, thus, our case provides compelling evidence that this fibromyxoid tumor is indeed a distinct entity.
Mitogen‐activated protein kinase TaMPK3 suppresses ABA response by destabilising TaPYL4 receptor in wheat
Authors: Liu Ying , Yu Tai‐Fei , Li Yi‐Tong , Zheng Lei , Lu Zhi‐Wei , Zhou Yong‐Bin , Chen Jun , Chen Ming , Zhang Jin‐Peng , Sun Guo‐Zhong , Cao Xin‐You , Liu Yong‐Wei , Ma You‐Zhi , Xu Zhao‐Shi
Published: June 2022

Abscisic acid (ABA) receptors are considered as the targeted manipulation of ABA sensitivity and water productivity in plants. Regulation of their stability or activity will directly affect ABA signalling. Mitogen‐activated protein kinase (MAPK) cascades link multiple environmental and plant developmental cues. However, the molecular mechanism of ABA signalling and MAPK cascade interaction remains largely elusive.

TaMPK3 overexpression decreases drought tolerance and wheat sensitivity to ABA, significantly weakening ABA's inhibitory effects on growth. Under drought stress, overexpression lines show lower survival rates, shoot fresh weight and proline content, but higher malondialdehyde levels at seedling stage, as well as decreased grain width and 1000 grain weight in both glasshouse and field conditions at the adult stage. TaMPK3‐RNAi increases drought tolerance.

TaMPK3 interaction with TaPYL4 leads to decreased TaPYL4 levels by promoting its ubiquitin‐mediated degradation, whereas ABA treatment diminishes TaMPK3–TaPYL interactions. In addition, the expression of ABA signalling proteins is impaired in TaMPK3‐overexpressing wheat plants under ABA treatment. The MPK3‐PYL interaction module was found to be conserved across monocots and dicots.

Our results suggest that the MPK3‐PYL module could serve as a negative regulatory mechanism for balancing appropriate drought stress response with normal plant growth signalling in wheat.
Squeeze the beat: Enhancing cardiac vagal activity during resonance breathing via coherent pelvic floor recruitment
Authors: Tatschl Josef Martin , Schwerdtfeger Andreas Richard
Published: June 2022

Resonance breathing (RB) has been shown to benefit health and performance within clinical and non‐clinical populations. This is attributed to its baroreflex stimulating effect and the concomitant increase in cardiac vagal activity (CVA). Hence, developing methods that strengthen the CVA boosting effect of RB could improve its clinical effectiveness. Therefore, we assessed whether supplementing RB with coherent pelvic floor activation (PRB), which has been shown to entrain the baroreflex, yields stronger CVA than standard RB. N = 32 participants performed 5‐min of RB and PRB, which requires to recruit the pelvic floor during the complete inspiratory phase and release it at the initiation of the expiration. CVA was indexed via heart rate variability using RMSSD and LF‐HRV. PRB induced significantly larger RMSSD (d = 1.04) and LF‐HRV (d = 0.75, ps < .001) as compared to RB. Results indicate that PRB induced an additional boost in CVA relative to RB in healthy individuals. However, subsequent studies are warranted to evaluate whether these first findings can be replicated in individuals with compromised health, including a more comprehensive psychophysiological assessment to potentially elucidate the origin of the observed effects. Importantly, longitudinal studies need to address whether PRB translates to better treatment outcomes.
Justifying the Imperfect: Differentiated Integration and the Problem of the Second Best
Authors: Eriksen Erik O.
Published: June 2022

This article deals with the problem of the second best in a politically differentiated Europe. Drawing on Kant’s category of permissive law of public right, it establishes the missing link between ideal and nonideal theory and then an indirect legitimation theorem. This theorem provides tools to contain damages and unlock practices and dynamics that obstruct reforms and lead to counterproductive outcomes. The theorem, which is equipped with a time and knowledge index, awaits the formation of favourable circumstances of integration. It establishes the conditions under which differentiated integration would be nonregressive. The theorem rules out backsliding solutions, which undermine the European integration process.
Trading offshore: evidence on banks’ tax avoidance*
Authors: Langenmayr Dominika , Reiter Franz
Published: June 2022

Little is known about how banks shift profits to low‐tax countries. Because of their specific business model, banks use other profit‐shifting channels than non‐financial firms. We propose a novel and bank‐specific method of profit shifting: the strategic relocation of proprietary trading to low‐tax jurisdictions. Using regulatory data from the German central bank, we show that a 1 percentage point lower corporate tax rate increases banks’ fixed‐income trading assets by 3–4 percent and trading derivatives by 9 percent. Suggestively, this increase does not arise from a relocation of real activities (i.e., traders); instead, it stems from the relocation of book profits.
Is the US Phillips curve stable? Evidence from Bayesian vector autoregressions*
Authors: Karlsson Sune , Österholm Pär
Published: June 2022

It has been claimed that the fall in US inflation during the Great Recession was surprisingly small. One possible explanation for this is that the Phillips curve is unstable and that its slope was lower around the Great Recession. We investigate the importance of time‐varying parameters using Bayesian vector autoregressions for inflation and unemployment. We find support for time variation in the inflation equation and an unstable Phillips curve that was somewhat flatter between 2005 and 2013. However, conditional forecasts mostly suggest that inflation was not unexpectedly high around the Great Recession, which puts the claim of a “missing disinflation” into question.
The current state of research into linguistic epicentres
Authors: Peters Pam , Bernaisch Tobias
Published: June 2022

This special issue focuses on key issues in epicentral research. Against the background of a brief discussion of the epicentre metaphor in the world Englishes paradigm, the various regional constellations in Africa, America, Asia and Australasia relevant to the concept of linguistic epicentres are highlighted and the temporal framing of epicentral influence is discussed with regard to often‐assumed evolutionary prerequisites of potential linguistic epicentres. More fine‐grained methodological perspectives on linguistic epicentres are subsequently provided with regard to: (1) linguistic variables studied; (2) data sources available; and (3) statistical approaches. Before short summaries of the papers featured in this special issue are presented, the role of linguistic epicentres as a component in modelling world Englishes is scrutinised.
A Conservation-Based Transitional Boundary Layer Model
Authors: Brewster M. Q.
Published: June 2022

A simple, flow-physics-based model of flat-plate, transitional boundary layer skin friction and heat transfer is presented. The model is based on the assumption of negligible time-, spanwise-, and streamwise-average wall-normal velocity at the top of the boundary layer. This results in a threefold increase in boundary layer thickness over the transition region. This simple velocity assumption and its boundary-layer growth implications seem to be reasonably consistent with more sophisticated (direct numerical simulation (DNS)) modeling simulations. Only two modeling parameters need to be assumed, the Reynolds numbers at the onset and at the completion of transition, for which there is guidance based on freestream turbulence intensity for smooth plates. Several experimental datasets for air are modeled. New criteria are proposed to help define the onset and completion of transition: zero net vertical (wall-normal) velocity or mass flux (integrated in time and space, spanwise and streamwise) at the top of the boundary layer, and tripling of boundary layer thickness. Also presented is a minor improvement to a previously published unheated starting length factor for flat-plate laminar boundary layers with uniform wall heat flux.
Data-Driven Self-Optimizing Control With Parametric Programing Based Constraint Handling
Authors: Zhao Zhongfan , Li Yaoyu , Salsbury Timothy I. , House John M.
Published: June 2022

Self-optimizing control (SOC) aims to achieve near-optimal operation regardless of variation in disturbances. For constrained operation, the model-based SOC has been solved as an explicit model predictive control (MPC) problem, where the changes in active constraint sets under large variations in disturbance inputs can be determined via parametric programing. For constrained SOC design with historical data only, this paper presents an extended work for a data-driven method that Zhao et al. proposed (2022 “Global Self-Optimizing Control With Data-Driven Optimal Selection of Controlled Variables With Application to Chiller Plant”, ASME J. Dyn. Sys., Meas., Control., 144(2), p. 021008.) for obtaining global SOC solution. While this work remains to adopt the Koopman subspace model that has been used, the SOC-associated constrained optimization problem is solved by applying the multiparameter quadratic programing technique. The solutions consist of piecewise-affine control laws and active constraint sets that are determined via partitions of the disturbance space. The proposed approach is illustrated with a Modelica simulation model of a chilled-water plant, where minimizing the total power consumption is the economic objective. The results show that the proposed method yields the total power very close to that by an offline genetic algorithm-based global optimization procedure, and substantially better than a best-practice rule-based control strategy. The degree of constraint violations under high cooling load is also smaller with the solution of constrained SOC.
Turbine Vane Endwall Film Cooling and Pressure Side Phantom Cooling Performances With Upstream Coolant Flow at Various Injection Angles
Authors: Bai Bo , Li Zhigang , Li Jun , Mao Shuo , Ng Wing F.
Published: June 2022

In this paper, the endwall film cooling and vane pressure side surface phantom cooling performances of a first nozzle guide vane (NGV) with endwall contouring, similar to an industry gas turbine, were experimentally and numerically evaluated at the simulated realistic gas turbine operating conditions (high inlet freestream turbulence level of 16%, exit Mach number of 0.85, and exit Reynolds number of 1.7 × 106). A novel numerical method for the predictions of adiabatic wall film cooling effectiveness was proposed based on a double coolant temperature model. The credibility and accuracy of this numerical method were validated by comparing the predicted results with experimental data. Results indicate that the present numerical method can accurately predict endwall film cooling performance and vane surface phantom cooling performance for both the ideal low density ratio (DR = 1.2) and the typical high density ratio (DR = 2.0) conditions. The endwall film cooling effectiveness, vane surface phantom cooling effectiveness, and secondary flow field were compared and analyzed for the axisymmetric convergent contoured endwall at three coolant injection angles (small injection angle of θ = 40 deg, design injection angle of θ = 50 deg, large injection angle of θ = 60 deg), two density ratios (low density ratio of DR = 1.2 and typical high density ratio of DR = 2.0), and the design blowing ratio (M = 2.5), based on the commercial CFD solver ansys fluent. An analysis method of the coolant momentum flux φ (decomposed into the axial component φx and vertical component φz) was proposed to describe and explain the migration and mixing mechanisms of coolant flow. Results indicate that the proposed analysis method of the coolant momentum flux φ can accurately and reliably describe and explain the coolant flow physics, including the coolant lift-off, the interaction between the coolant and the mainstream, and the coolant migration in the vane passage. The increased coolant injection angles result in a deterioration of the endwall film cooling performance and vane pressure surface side phantom cooling performance. Nevertheless, the sensitivity of endwall film cooling effectiveness and phantom cooling effectiveness to coolant injection angles is variable, and is significantly affected by density ratio. This suggests that the coupling effects of the coolant injection angles and density ratio should be taken into account for the prediction of endwall film cooling and phantom cooling performances. It is very necessary for the optimized design of the coolant injection angles and the predictions of film cooling performance at the realistic density ratio.
Cyclometallated Ruthenium Complex with 3,3',5,5'-Tetramethyl-1,1'-biphenyl-4,4'-bipyrazole and 2,2'-Dicarboxybipyridine: Synthesis, Optical Properties, and Quantum Chemical Modeling
Authors: Lavrova M. A. , Lunev A. M. , Goncharenko V. E. , Taidakov I. V. , Dolzhenko V. D. , Belousov Yu. A.
Published: June 2022

New complex [RuL(Dmdcbp)2]PF6 (I) is synthesized by the consecutive reactions of [Ru-p-cymene]2Cl4 with 3,3',5,5'-tetramethyl-1,1'-biphenyl-4,4'-bipyrazole (L) and 4,4'-dicarboxy-2,2'-bipyridine in a methanol–chloroform medium. The composition of complex I is confirmed by NMR and elemental analysis, and the optical and luminescence properties of the complex are studied. Ligand L is characterized for the first time by X-ray diffraction (CIF file CCDC no. 2118676). Quantum chemical calculations in terms of the density functional theory are performed for the interpretation of the absorption and emission spectra. Complex I is promising for using as a photosensitizer.
Interaction of 5-[4′-(N-Methyl-1,3-benzimidazol-2-yl)phenyl]-10,15,20-tri-(N-methyl-3′-pyridyl)porphyrin Triiodide with SARS-CoV-2 Spike Protein
Authors: Syrbu S. A. , Kiselev A. N. , Lebedev M. A. , Gubarev Yu. A. , Yurina E. S. , Lebedeva N. Sh.
Published: June 2022

The results of experimental studies of the interaction of the S-protein with a monohetaryl-substituted porphyrin containing a benzimidazole residue are presented. It has been revealed that the S-protein forms high-affinity complexes with the specified porphyrin. The porphyrin binding by the SARS-CoV-2 S-protein has proceeded stepwise; at the first stage, the driving force of the complexation is electrostatic interaction between the surface negatively charged regions of the protein and cationic substituents of the porphyrin. At the second stage, the target complex of the S-protein with the porphyrin is formed. It has been established that the introduction of 5-[4′-(N-methyl-1,3-benzimidazol-2-yl)phenyl]-10,15,20-tri-(N-methyl-3′-pyridyl)porphyrin triiodide into a solution of the S-protein complex with the angiotensin-converting enzyme leads to the replacement of the latter with the porphyrin. Displacement of the angiotensin-converting enzyme from the complex with the S-protein under the action of 5-[4′-(N-methyl-1,3-benzimidazol-2-yl)phenyl]-10,15,20-tri-(N-methyl-3′-pyridyl)porphyrin triiodide is the experimental evidence for the porphyrin binding at the receptor-binding domain of the S-protein.
Celebration of a century of insulin therapy in children with type 1 diabetes
Authors: Rogol Alan D , Laffel Lori M , Bode Bruce , Sperling Mark A
Published: June 2022

Insulin is the key anabolic hormone of metabolism, with clear effects on glycaemia. Near-complete insulin deficiency occurs in type 1 diabetes (T1D), the predominant form affecting children, and uniformly fatal until the discovery of insulin. By the early 20th century, it was known that T1D was caused by the lack of a factor from pancreatic islets, but isolation of this substance proved elusive. In 1921, an unusual team in Toronto comprising a surgeon, a medical student, a physiologist and a biochemist successfully isolated a glucose-lowering pancreatic endocrine secretion. They treated an emaciated 14-year-old boy in 1922, restoring his health and allowing him to live for another 13 years. Thus began an era of remarkable progress and partnership between academia and the pharmaceutical industry to produce drugs that benefit sick people. The Toronto team received the 1923 Nobel Prize, and more Nobel Prizes for work with insulin followed: for elucidation of its amino acid sequence and crystalline structure, and for its role in the development of radioimmunoassays to measure circulating hormone concentrations. Human insulin was the first hormone synthesised by recombinant methods, permitting modifications to enable improved absorption rates and alterations in duration of action. Coupled with delivery via insulin pens, programmable pumps and continuous glucose monitors, metabolic control and quality of life vastly improved and T1D in children was converted from uniformly fatal to a manageable chronic condition. We describe this remarkable ongoing story as insulin remains a paradigm for human ingenuity to heal nature’s maladies.
Hyperostosis in orbital rhabdomyosarcoma
Authors: Rogelio Paolo Nico Aseron , Ranche Felice Katrina Trio , Pe-Yan Mary Rose
Published: June 2022

Rhabdomyosarcoma is the most common soft-tissue sarcoma in paediatric patients and may arise as a primary orbital neoplasm. Imaging studies show a unilateral solitary orbital lesion. With larger tumours, erosion of the adjacent orbital walls is a common accompanying bony change. We present an unusual case of rhabdomyosarcoma in a preschool girl with proptosis and temporal bossing. Imaging studies showed a homogeneous, well-delineated, extraconal mass of the right orbit with hyperostosis of the adjacent sphenoid bone. After excision of the mass and debulking of the sphenoid bone, histopathology showed embryonal rhabdomyosarcoma with no malignant infiltration of the adjacent bone. This is the first reported case of hyperostosis associated with rhabdomyosarcoma. Periosteal reaction is the proposed underlying mechanism.
Rare case of spindle cell haemangioma of oral cavity
Authors: Jot Kiran , Manchanda Smita , Roychoudhury Ajoy , Mishra Deepika
Published: June 2022

Spindle cell haemangioma (SCH) is a slow growing, benign vascular lesion with a preference for the distal extremities. Its occurrence in the oral cavity is rare. Clinically, it presents as solitary or multiple subcutaneous nodules, therefore, it could be considered in the differential diagnosis of benign soft tissue tumours. Microscopically it mimics some malignant vascular tumours and it is necessary to differentiate it from other malignant vascular lesions. We report a case of SCH in anterior mandibular region of a young male in his 20s. Although it is a benign lesion, the reported case displayed extensive areas of muscle infiltration and necrosis. After studying the radiographic findings and considering the absence of cellular atypia, a final diagnosis of SCH was made. Literature survey suggests that this is the eleventh case of SCH reported in oral cavity.
Study design and protocol of a low to high intensity computer-based cognitive training at home in supplement to standard care in patients with AD
Authors: Dimachki Samar , Tarpin-Bernard Franck , Croisile Bernard , Chainay Hanna
Published: June 2022

Introduction

Recent studies on cognitive training in patients with Alzheimer’s disease (AD) showed positive long-term effects on cognition and daily living, suggesting remote computer-based programmes to increase training sessions while reducing patient’s travelling. The aim of this study is to examine short-term and long-term benefits of computer-based cognitive training at home in patients with mild to moderate AD, as a complement to the training in speech and language therapists’ (SLT) offices. The secondary purpose is to study training frequency required to obtain noticeable effects.

Methods and analyses

This is a national multicentre study, conducted in SLT offices. The patients follow training in one of three conditions: once a week in SLT office only (regular condition) and once a week in SLT office plus one or three times per week at home. The trainings’ content in SLT office and at home is identical. For all three groups near and far transfer will be compared with evaluate training frequency’s effect. Our primary outcome is executive and working memory scores in experimental tasks, and the secondary is neuropsychological tests and questionnaires’ scores. Linear models’ analyses are considered for all measures with a random intercept for patients and another for per practice. The fixed effects will be: three modality groups and time, repeated measures, (T0—pretraining, T1—post-training, T2—long-term follow-up) and the interaction pairs.

Ethics and dissemination

The study got ethics approval of the national ethical committee CPP Sud Méditerranée III (No 2019-A00458-49) and of the National Commission for Information Technology and Liberties (No 919217). Informed consent is obtained from each participant. Results will be disseminated in oral communications or posters in international conferences and published in scientific journals.

Trial registration number

NCT04010175.
Anaesthesia provision, infrastructure and resources in the Heilongjiang Province, China: a cross-sectional observational study
Authors: Zheng Xiaoyu , Zhao Jingshun , Zhang Jian , Yao Dandan , Jiang Ge , Yang Wanchao , Ma Xuesong , Wang Hui , Lu Xiaodi , Zhu Xidong , Chen Meijun , Zhang Mingyue , Zhang Xi , Wang Guonian , Han Fei
Published: June 2022

Objective

The aim of this study was to explore the current status of the anaesthesia provision, infrastructure and resources in the Heilongjiang Province, China.

Design

A cross-sectional observational study of hospitals, anaesthesiologists, assistant anaesthesiologists and anaesthetic nurses in the Heilongjiang Province.

Setting

All hospitals in the Heilongjiang Province.

Participants

The hospitals, anaesthesiologists (attending physicians, associate chief physicians and chief physicians), assistant anaesthesiologists (licenced assistant physicians, resident physicians and other trainees) and anaesthetic nurses.

Main outcome measures

Standard descriptive statistics (percentages and numbers) were used to summarise the data.

Results

The investigation involved 1123 hospitals, 405 of these hospitals had anaesthesiology departments (36.06%). There were 2406 anaesthesiologists, 175 assistant anaesthesiologists and 409 anaesthetic nurses. The proportion of anaesthesiologists was 56.60% in tertiary hospitals, 40.15% in secondary hospitals and 3.25% in primary hospitals and ungraded hospitals, respectively. Anaesthesiologists were present in 91.20% of public hospitals and 8.80% of private hospitals. Anaesthesiologists were present in 83.55% general hospitals and 16.45% of specialised hospitals. The Heilongjiang Province has a total of 2041 operating rooms and 543 beds in recovery rooms. The number of anaesthesia cases per capita per year was 326.86. The percentages of anaesthesiologists’ age ≥46, 36–45, 25–35 and <25 are 24.03%, 41.80%, 33.91% and 0.27%, respectively. The proportions of resident physicians and attending physicians were 60.87%, and the proportions of associate chief physicians and chief physicians were 39.13%. The proportions of anaesthesiologists working >12 hours, 10 hours≤time≤12 hours, 8 hours≤time<10 hours and <8 hours were 0.55%, 22.04%, 64.30% and 13.11%, respectively.

Conclusions

The present study demonstrated for the first time that the proportion of anaesthesiologists in the Heilongjiang Province, China, is still insufficient. The structure of anaesthesiologists needs to be optimised.
Alpha-2-adrenergic receptor agonists for the prevention of delirium and cognitive decline after open heart surgery (ALPHA2PREVENT): protocol for a multicentre randomised controlled trial
Authors: Neerland Bjørn Erik , Busund Rolf , Haaverstad Rune , Helbostad Jorunn L , Landsverk Svein Aslak , Martinaityte Ieva , Norum Hilde Margrethe , Ræder Johan , Selbaek Geir , Simpson Melanie R , Skaar Elisabeth , Skjærvold Nils Kristian , Skovlund Eva , Slooter Arjen JC , Svendsen Øyvind Sverre , Tønnessen Theis , Wahba Alexander , Zetterberg Henrik , Wyller Torgeir Bruun
Published: June 2022

Introduction

Postoperative delirium is common in older cardiac surgery patients and associated with negative short-term and long-term outcomes. The alpha-2-adrenergic receptor agonist dexmedetomidine shows promise as prophylaxis and treatment for delirium in intensive care units (ICU) and postoperative settings. Clonidine has similar pharmacological properties and can be administered both parenterally and orally. We aim to study whether repurposing of clonidine can represent a novel treatment option for delirium, and the possible effects of dexmedetomidine and clonidine on long-term cognitive trajectories, motor activity patterns and biomarkers of neuronal injury, and whether these effects are associated with frailty status.

Methods and analysis

This five-centre, double-blind randomised controlled trial will include 900 cardiac surgery patients aged 70+ years. Participants will be randomised 1:1:1 to dexmedetomidine or clonidine or placebo. The study drug will be given as a continuous intravenous infusion from the start of cardiopulmonary bypass, at a rate of 0.4 µg/kg/hour. The infusion rate will be decreased to 0.2 µg/kg/hour postoperatively and be continued until discharge from the ICU or 24 hours postoperatively, whichever happens first.

Primary end point is the 7-day cumulative incidence of postoperative delirium (Diagnostic and Statistical Manual of Mental Disorders, fifth edition). Secondary end points include the composite end point of coma, delirium or death, in addition to delirium severity and motor activity patterns, levels of circulating biomarkers of neuronal injury, cognitive function and frailty status 1 and 6 months after surgery.

Ethics and dissemination

This trial is approved by the Regional Committee for Ethics in Medical Research in Norway (South-East Norway) and by the Norwegian Medicines Agency. Dissemination plans include publication in peer-reviewed medical journals and presentation at scientific meetings.

Trial registration number

NCT05029050.
Factors associated with hospital length of stay in patients admitted with suspected malaria in Kenya: secondary analysis of a cross-sectional survey
Authors: Machini Beatrice , Achia Thomas N O , Kipruto Hillary , Amboko Beatrice , Chesang Jacqueline
Published: June 2022

Objectives

To investigate factors associated with hospital length of stay (LOS) in patients admitted with suspected malaria using a competing risk approach.

Setting

County government referrals and major faith-based hospitals in Kenya in 2018.

Design

Secondary analysis of a cross-sectional survey data.

Participants

Data were extracted from 2396 medical records of patients admitted with suspected malaria at 90 hospitals.

Outcome measures

LOS, defined as time to discharge, was the primary event of interest, and time to death was the competing event against patient factors assessed during admission and hospitalisation.

Results

Among the patients analysed, 2283 were discharged, 49 died and 64 were censored. The median LOS was 4 days (IQR: 3–6 days). The cumulative incidence of discharge significantly decreased (p<0.05) by 12.7% (subdistribution-HR (SDHR): 0.873; 95% CI 0.789 to 0.967) when the respiratory rate was assessed, by 14.1% (SDHR 0.859; 95% CI 0.754 to 0.978) when oxygen saturation was monitored, by 23.1% (SDHR 0.769; 95% CI 0.709 to 0.833) and 23.4% (SDHR 0.766; 95% CI 0.704 to 0.833) when haemoglobin/haematocrit and glucose/random blood sugar were performed, respectively, and by 30.4% (SDHR 0.696; 95% CI 0.626 to 0.774) when patients had at least one clinical feature of severe malaria. Conversely, patients with confirmed severe malaria and those treated with injectable artesunate had a significantly increased cumulative incidence of discharge by 21.4% (SDHR 1.214; 95% CI 1.082 to 1.362) and 33.9% (SDHR 1.339; 95% CI 1.184 to 1.515), respectively.

Conclusions

Factors of inpatient clinical processes that influence hospital LOS were identified. These can be targeted during quality improvement interventions to enhance health service delivery in Kenya. Early recognition and appropriate management of the signs of malaria severity could greatly affect beneficial outcomes. Strengthening clinical practices and nursing care according to national case management guidelines should be a priority for malaria control managers in Kenya.
Clinical application of oral Chinese Patent Medicines in ophthalmology: a scoping review protocol
Authors: Xu Kai , Liao Xing , Liang Lina , Li Yamin , Huang Ziyang , Li Xiaoyu , Zhou Wei , Zuo Qianqian
Published: June 2022

Introduction

The prevalence of eye diseases has been increasing worldwide. In China, in addition to conventional medicine, Traditional Chinese Medicine (TCM) plays an important role in maintaining people’s vision health. Although less flexible and targeted than TCM decoction, Chinese Patent Medicines (CPMs) are stable and well used. In recent years, CPMs have been increasingly used in ophthalmology clinics by TCM practitioners and by Western doctors in general hospitals. However, comprehensive evidence for using CPMs in ophthalmology is lacking.

Aim

We will apply the methodology of scoping review to systematically search and sort out the available evidence on oral CPMs for the treatment of eye diseases, identify the distribution of evidence in this field and provide a basis for clinical practice and medical decisions.

Methods

The scoping review will be implemented in the following seven steps: (1) defining the research question; (2) searching National Essential Medicines List (2018 edition), National Basic Medical Insurance, Work Injury Insurance and Maternity Insurance Drug Catalog (2020 edition) and Chinese Pharmacopoeia (2020 edition) for oral CPMs for the treatment of eye diseases; (3) searching Embase, Web of Science, PubMed, Cochrane Library, Chongqing VIP Chinese Scientific Journals Database, Chinese National Knowledge Infrastructure, Chinese Biomedical Literature Database and Wanfang Database for relevant literature published from inception to December 2021; (4) developing eligibility criteria; (5) screening the studies based on inclusion criteria; (6) extracting relevant data and lastly, (7) collating, summarising and reporting the results.

Ethics and dissemination

Since the scoping review aims at collecting data from publicly available publications, this study does not require ethical approval. The results will be published in a peer-reviewed journal and presented at scientific conferences.
COVID-19 health information needs of older adults from ethnic minority groups in the UK: a qualitative study
Authors: Paudyal Priyamvada , Skinner Emily , Majeed-Hajaj Saliha , Hughes Laura J , Magar Naresh Khapangi , Keeling Debbie Isobel , Armes Jo , Kulasabanathan Kavian , Ford Elizabeth , Sharp Rebecca , Cassell Jackie A
Published: June 2022

Objective

This study aimed to identify the COVID-19 health information needs of older adults from ethnic minority groups in the UK.

Study design

A qualitative study using semistructured interviews.

Setting and participants

Indian and Nepalese older adults (≥65 years), their families (≥18 years) and healthcare professionals (HCPs) (≥18 years) engaging with these communities. Participants were recruited between July and December 2020 from Kent, Surrey and Sussex through community organisations.

Results

24 participants took part in the study; 13 older adults, 7 family members and 4 HCPs. Thirteen participants were female, and the majority (n=17) spoke a language other than English at home. Older participants mostly lived in multigenerational households, and family and community were key for providing support and communicating about healthcare needs. Participants’ knowledge of COVID-19 varied widely; some spoke confidently about the subject, while others had limited information. Language and illiteracy were key barriers to accessing health information. Participants highlighted the need for information in multiple formats and languages, and discussed the importance of culturally appropriate avenues, such as community centres and religious sites, for information dissemination.

Conclusion

This study, undertaken during the COVID-19 pandemic, provides insight into how health information can be optimised for ethnic minority older adults in terms of content, format and cultural relevance. The study highlights that health information interventions should recognise the intersection between multigenerational living, family structure, and the health and well-being of older adults, and should promote intergenerational discussion.
Australian general practice registrars’ experiences of training, well-being and support during the COVID-19 pandemic: a qualitative study
Authors: White Isabella , Benson Jill , Elliott Taryn , Walters Lucie
Published: June 2022

Objectives

Providing well-supported general practice (GP) training is fundamental to strengthen the primary health workforce. Research into the unique needs of GP registrars during disasters is limited. Registrar burnout and insufficient support have been associated with personal and professional detrimental effects. This study aims to explore the experiences of Australian GP registrars with learning, well-being and support from their training organisation during the COVID-19 pandemic, and to guide training organisation efforts to support registrars through future disasters.

Setting

Interviews were conducted via Zoom.

Participants

Fifteen GP registrars from South Australia, Victoria and New South Wales who had experienced community-based GP training in both 2019 (prepandemic) and 2020 (early pandemic).

Outcome measures

Training, well-being and support experiences were explored. Interviews were recorded and transcribed and themes analysed.

Results

Diverse experiences were reported: changes included telehealth, online tutorials, delayed examinations and social restrictions. Social and professional connections strongly influenced experiences. Personal and training factors were also important. Additional GP training organisation support was minimally needed when strong connections were in place.

Conclusions

This study identifies aspects of support which shaped registrars’ diverse experiences of COVID-19, particularly regarding professional and social connections. Findings illustrate the importance of broad principles around supporting registrar well-being. Particularly significant aspects of support include connection to educational mentors such as supervisors and medical educators; connection and culture within practices; opportunities to share clinical experiences; and connection to personal social supports. Participation in this global disaster contributed to registrars’ developing professionalism. GP training organisations are positioned to implement monitoring and supports for registrars through disasters. Although registrars may not require significant GP training organisation intervention where powerful professional and personal connections exist, strong foundational GP training organisation supports can be established and augmented to support registrars in need before and during future disasters. These findings contribute to the global developing field of knowledge of registrar training and well-being needs during crises.