bluuebunny/crossref_metadata_2025 huggingface dataset:
asean and the Rakhine Crisis: Balancing Non-interference, Accountability, and Strategic Interests in Responding to Atrocities in Myanmar
Authors: Morada Noel M.
Published: April 2021

asean has not collectively responded to the Rakhine crisis since 2017 from the perspective of the Responsibility to Protect (R2P) principle and has failed to put a stop to the atrocities against the Rohingyas in Myanmar. This article argues that there is less support in the region for invoking the non-interference principle in dealing with Myanmar on the Rohingya issue even as some members have called for its relaxation and use of constructive engagement instead. As international pressure in pursuit of justice and accountability increased, so did calls from within the region for asean to do more beyond just providing humanitarian assistance to affected communities in Rakhine. Even so, asean consciously avoids pressing too hard on the issue of accountability as this could force the government and the military in Myanmar to totally disengage with asean and the international community on the Rakhine crisis, as well as push Nay Pyi Daw further into China’s embrace and thus undermine asean’s strategic interests in the region.
“World without End”
Authors: Meganck Erik
Published: April 2021

In this article, I want to make the following points, none of which are totally new, but their constellation here is meant to be challenging. First, world is not a (Cartesian) thing but an event, the event of sense. This event is opening and meaning – verbal tense. God may be a philosophical name of this event. This is recognized by late-modern religious atheist thought. This thought differs from modern scientific rationalism in that the latter’s so-called areligious atheism is actually a hyperreligious theism. On the way, the alleged opposition between philosophy and theology, between thought and faith is seen to erode. The core matter of this philosophy of religion will be the absolute reference, the system of objectivity and the holiness of the name. All this because of a prefix a- that has its sense turned inside out by the death of God.
Gender Matters in Tsai Ing-wen’s First Term: The First Woman President, the Cabinet Appointments, and Same-Sex Marriage in Taiwan
Authors: Lee Young-Im
Published: April 2021

Tsai Ing-wen was elected as the first woman president of Taiwan in 2016 and re-elected in 2020. Did the prospect of “the first woman president” shape the expectations of the changes she may bring about regarding women and lesbian, gay, bisexual, trans, and queer (LGBTQ) rights? Analyzing 35 in-depth elite interviews, this paper demonstrates Tsai’s campaign did not benefit much from “the first woman” slogan, her cabinet included fewer women than her predecessors’, and she could not proactively push for marriage equality after the elections. Tsai’s case illuminates the constraints women leaders face in promoting representation for marginalized groups.
REEEC-AGENT: human driver cognition and emotions-inspired rear-end collision avoidance method for autonomous vehicles
Authors: Butt Muhammad A , Riaz Faisal , Mehmood Yasir , Akram Somyyia
Published: April 2021

Rear-end collision detection and avoidance is one of the most crucial driving tasks of self-driving vehicles. Mathematical models and fuzzy logic-based methods have recently been proposed to improve the effectiveness of the rear-end collision detection and avoidance systems in autonomous vehicles (AVs). However, these methodologies do not tackle real-time object detection and response problems in dense/dynamic road traffic conditions due to their complex computation and decision-making structures. In our previous work, we presented an affective computing-inspired Enhanced Emotion Enabled Cognitive Agent (EEEC_Agent), which is capable of rear-end collision avoidance using artificial human driver emotions. However, the architecture of the EEEC_Agent is based on an ultrasonic sensory system which follows three-state driving strategies without considering the neighbor vehicles types. To address these issues, in this paper we propose an extended version of the EEEC_Agent which contains human driver-inspired dynamic driving mode controls for autonomous vehicles. In addition, a novel end-to-end learning-based motion planner has been devised to perceive the surrounding environment and regulate driving tasks accordingly. The real-time in-field experiments performed using a prototype AV demonstrate the effectiveness of this proposed rear-end collision avoidance system.
A Psychological Process of Bureaucratic Whistleblowing: Applying the Theory of Planned Behavior
Authors: Lee Hongseok , Kang Minsung Michael , Kim Sun Young
Published: April 2021

Whistleblowing is a psychological process that involves the calculation of risks and benefits. While there exists a broad range of research on whistleblowing in the public sector, previous studies have not examined its entire process due to the limited focus on either whistleblowing intention or whistleblowing behavior. This study aims to fill this gap by applying the theory of planned behavior (TPB) to the whistleblowing context. Specifically, we examine how individual beliefs about the likely consequences of whistleblowing (attitude toward whistleblowing), others’ expectations about whistleblowing (subjective norm), and the capability of blowing the whistle (perceived behavioral control) influence public employees’ actual whistleblowing by way of their intention to report wrongdoings. A series of structural equation models are tested using data from the 2010 Merit Principles Survey. The findings show that the more the employees perceive that the consequences of whistleblowing are important, the more the key referents support whistleblowing, and the more the protections for whistleblowers are available, the more likely are their intentions to disclose wrongdoings and then actually engage in whistleblowing behavior. We conduct additional analyses for internal and external whistleblowers separately and find that there are both meaningful similarities and differences between the two groups. This study provides support for the validity of TPB as a theoretical framework for better understanding and explicating the psychological process of bureaucratic whistleblowing.
Towards a ‘third space’ community practice school-aged-care: A learning community and ‘the new neighbourhood’
Authors: Westoby Peter , Cox Laura , Cartmel Jennifer , Roland Brett , Treasure Leonie , Blane Amy , Morgan Justin
Published: April 2021

This article explores how an organisation – Jabiru – integrates a learning ‘community’ philosophy into its work with children, particularly within what is understood within Australia as School-aged Care (SAC). Distinguished from other organisations, Jabiru understands community is an intentional practice that provides what we find to be a unique third space, one with links to what is sometimes understood as the new neighbourhood. Research observations and interviews in two SAC sites, guided by the conceptual framework of loving, having and being, led to key findings about the intentional approach to community that supports learning, and the significance of educator wisdom.
A Baptismal Theology of Accountability
Authors: Torrance Andrew
Published: April 2021

This article addresses the question of what it means to be accountable to God based on a baptismal theology that we find in the New Testament. It argues that various passages in the New Testament lead us to the view that we are accountable to God in Christ. Such a view is not straightforward, and so much of this article will be spent unpacking what this could mean. To do so, I elaborate on what it means for God to create humanity to find fulfilment in and through Christ. This leads me to argue that humans experience fulfilment in and through the body of Christ into which baptism initiates a person. It is by participating and finding belonging in the life of the Church that humans can begin to discover what it means to be accountable to God in Christ, and, in so doing, form the virtue of accountability.
Accountability, Autism and Friendship with God
Authors: Leidenhag Joanna
Published: April 2021

David Shoemaker has argued that autistic persons cannot be held accountable and are not members of the moral community. Arguing against this conclusion, this article both corrects the view of autism contained in Shoemaker’s paper and resituates his theory of accountability within a Christian virtue ethic based on the gift of friendship. The call to be accountable to God for one’s life contains within it the gift of God’s friendship and does not require the capacity for empathy ( contra Shoemaker) or joint attention ( contra Pinsent) as a prerequisite. Instead, the inclusion of autistic people within the moral community created by the call of God highlights that accountability is a grace given for the flourishing of all persons.
The Gratifications of Ephemeral Marketing Content, the Use of Snapchat by the Millennial Generation and Their Impact on Purchase Motivation
Authors: Lopez Evelyn , Flecha-Ortiz Jose A. , Santos-Corrada Maria , Dones Virgin
Published: April 2021

Ephemeral content has become a vital marketing resource for companies, but its effects have rarely been addressed in academic literature. Through the theory of uses and gratifications (U&G), we explore ephemeral content, the impact of Snapchat use, and their impact on millennials’ purchase motivation. Through an electronic survey of 454 millennial-generation participants, analysed through SMART-PLS, theoretical contributions are presented in identifying modality-based gratifications and interactivity-based gratifications as two additional sources of gratification that generate the modality of Snapchat’s ephemeral content. The study theoretically reflects how much interaction and identification with the medium generates a positive involvement in the audience’s needs, thus explaining its reasons for use.
Understanding Patients’ Decisions to Obtain Unplanned, High-Resource Health Care After Colorectal Surgery
Authors: Lumpkin Stephanie T. , Harvey Eileen , Mihas Paul , Carey Timothy , Fichera Alessandro , Stitzenberg Karyn
Published: April 2021

Readmissions and emergency department (ED) visits after colorectal surgery (CRS) are common, burdensome, and costly. Effective strategies to reduce these unplanned postdischarge health care visits require a nuanced understanding of how and why patients make the decision to seek care. We used a purposefully stratified sample of 18 interview participants from a prospective cohort of adult CRS patients. Thirteen (72%) participants had an unplanned postdischarge health care visit. Participant decision-making was classified by methodology (algorithmic, guided, or impulsive), preexisting rationale, and emotional response to perceived health care needs. Participants voiced clear mental algorithms about when to visit an ED. In addition, participants identified facilitators and barriers to optimal health care use. They also identified tangible targets for health care utilization reduction efforts, such as improved care coordination with streamlined discharge instructions and improved communication with the surgical team. Efforts should be directed at improving postdischarge communication and care coordination to reduce CRS patients’ high-resource health care utilization.
Umbrella Review on Non-Statin Lipid-Lowering Therapy
Authors: Beshir Semira Abdi , Hussain Nadia , Elnor Asim Ahmed , Said Amira S. A.
Published: April 2021

Dyslipidemia, particularly increased low-density lipoprotein cholesterol (LDL-C) levels, are associated with an increased risk of atherosclerotic cardiovascular disease (ASCVD) events. There is an unmet need for ASCVD risk reduction even with the optimal use of statin therapy, which has led to an ongoing search for novel targets for cholesterol reduction to decrease ASCVD events.

Objectives:

The main aim of this review was to summarize current evidence on approved and emerging non-statin lipid-lowering therapies.

Methods and Materials:

Recent literature on U.S. FDA approved non-statin lipid-lowering therapies and evolving lipid-lowering drugs currently under development was reviewed.

Results and Discussion:

In the past 20 years, the emergence of non-statin cholesterol-lowering drugs has changed the landscape of dyslipidemia management. Food and Drug Administration approval of non-statin lipid-lowering therapies such as ezetimibe, proprotein convertase subtilisin/Kexin type 9 (PCSK9) inhibitors (evolocumab, alirocumab), bempedoic acid and combination of bempedoic acid and ezetimibe, evinacumab and other triglyceride-lowering agents (eg, icosapent ethyl) has emerged. The European Commission has also recently approved inclisiran for treatment of hypercholesterolemia and mixed hypercholesterolemia even though FDA has put the approval of this drug on hold. Recent guidelines have incorporated PCSK9 inhibitors to treat patients with primary hyperlipidemia and patients with very high-risk ASCVD, who could not achieve adequate lipid-lowering with combination therapy of maximally tolerated statin and ezetimibe. Icosapent ethyl use as an adjunct therapy to statins is also recommended to reduce the risk of ASCVD in patients with hypertriglyceridemia.

Conclusion:

Despite cost limitations, the uptake of PCSK9 inhibitors is increasing. Approval of bempedoic acid alone or in combination with ezetimibe has provided additional oral lipid-lowering drug alternatives to ezetimibe. Various lipid-lowering drug targets are under investigation.
Difficulty in articulation following left progressive blurred vision
Authors: Lee An-Ting , Chen Wei-Dar , Lai Chien-Hsiung
Published: April 2021

Purpose:

To report a case of Paracentral acute middle maculopathy (PAMM) caused by severe internal carotid artery (ICA) stenosis and discuss the correlation between PAMM and ICA stenosis.

Case description:

A 67-year-old male patient presented with left acute blurred vision for 1 week. The best-corrected visual acuity of the left eye was 0.01. Funduscopic examination showed multiple grayish patches around the left macula. Optical coherence tomography (OCT) demonstrated train-track hyperreflective lesions over the inner nuclear layer of the left eye. Afterwards, he experienced sudden slurred speech with fair comprehension. Magnetic resonance imaging and angiography of the brain demonstrated left lacunar infarction with severe left ICA stenosis. After anticoagulant therapy, his dysarthria and left visual acuity were improved significantly.

Conclusions:

To our knowledge, PAMM in coincidence with lacunar infarction induced by ICA stenosis is firstly described in the literature. PAMM could be a critical warning of ICA stenosis, and this case can alert ophthalmologists to survey ICA stenosis in patients with PAMM.
Clinical predictors of recurrent cephalic arch stenosis and impact of the access flow reduction on the patency rate
Authors: Kim Yaeni , Kim Hyung Duk , Chung Byung Ha , Park Cheol Whee , Yang Chul Woo , Kim Yong-Soo
Published: April 2021

Objective:

Despite the widespread use of conventional percutaneous transluminal angioplasty (PTA), recurrence of cephalic arch stenosis (CAS), and low patency rate after PTA remain challenging problem. We aimed to identify the clinical predictors of recurrence of CAS and evaluate the effect of the access flow reduction on the fistula patency rate in patients with recurrent CAS.

Methods:

In 1118 angiographies of 220 patients with CAS, access circuit patency rates after PTA and potential clinical predictors of recurrence of CAS were assessed. The effect of the banding procedure was evaluated in terms of post-interventional primary patency rate, and the number of interventions per access-year.

Results:

At 3, 6, and 12 months after the first PTA on CAS, the post-interventional access circuit primary patency rates were 68.8%, 40.5%, and 25.1%, respectively. High CV to CA ratio (the ratio of the maximal diameter of the distal cephalic vein to the diameter of the cephalic arch) (Hazard ratio (HR), 1.437; 95% confidence interval (CI), 1.036–1.992) and involvement of the proximal segment of cephalic arch (HR, 1.828; 95% CI, 1.194–2.801) were significant predictors of recurrent CAS. For those with recurrent CAS (>3 times/year) and an access flow rate >1.5 L/minute, endovascular banding procedure was performed. The banding procedure significantly reduced the number of interventions per access-year ( t = 3.299, p = 0.005 and t = 2.989, p = 0.007, respectively). Post-interventional access circuit primary patency rate after banding was significantly higher than that before banding ( p = 0.01).

Conclusions:

High CV to CA ratio and involvement of the proximal segment of the cephalic arch are independent clinical predictors of recurrent CAS. Endovascular banding might delay recurrence of CAS in patients with high CV to CA ratio and high access flow.
Definitive Radiotherapy for Penoscrotal Extramammary Paget’s Disease: A Case Report with Long-Term Follow-Up
Authors: Suzuki Gen , Machida Kazutaka , Asato Akito , Seri Sho , Ikemoto Chika , Yamazaki Hideya , Yamada Kei , Katsumori Tetsuya
Published: April 2021

Penoscrotal extramammary Paget’s disease (EMPD) is a rare intraepithelial adenocarcinoma in older male patients, and no effective nonsurgical treatment strategies are currently available. The aim of this study was to report the usefulness of external radiotherapy (RT) for penoscrotal EMPD in an inoperable elderly patient. This report presents the treatment of an 89-year-old man with widespread penoscrotal EMPD. A multidisciplinary treatment team decided on radical RT. The patient received a radiation dose of 61.8 Gy in 30 fractions through electron and photon beams. His treatment tolerance was good, and no severe toxicity had been observed up the last follow-up. At 6.5 years after the RT, the patient showed no evidence of recurrence. Definitive RT resulted in excellent disease control and minimal toxicity; thus, it could be a promising nonsurgical therapeutic option for penoscrotal EMPD, even in extremely elderly individuals.
The code-mixing of the Senegalese migrants in Italy
Authors: Tramutoli Laura
Published: April 2021

Aims and objectives/purpose/research questions:

This paper describes and analyses the speech from the Senegalese migrant community in the city of Pescara (Italy) from a contact-linguistics perspective. The focus is on the phenomena of code-mixing found when the Italian language, that of the host community, is added to the complex repertoire of Wolof/French multilingual speakers.

Design/methodology/approach:

The patterns of code-mixing and the composition of trilingual speech are presented and discussed following the Muysken grammatical model for classifying features of language-contact discourse.

Data and analysis:

Primary data have been collected recording spontaneous interactions among a group of first-generation migrants that have lived in Italy for about 10 years and are all speakers of a fluent learner-variety of Italian.

Findings/conclusions:

It will be shown that insertional and alternational code-mixing patterns are present in both the bilingual (French/Wolof) and the trilingual (Italian/French/Wolof) speech, but with different degrees of variation and distribution.

Originality:

Besides documenting the trilingual speech framed in a specific yet new migration contact setting, the author considers the role that the two languages of prestige, French and Italian, play within the structural composition of both types of code-mixing, especially with regards to their relationship with Wolof.

Significance/implications:

The results achieved contribute to the general theory of the grammatical model by reaffirming the properties of the patterns of insertion and alternation, but also by revealing other ambiguous forms of code-mixing that might suggest a future revision of the model.
Promoting healthy futures in a rural refugee resettlement location: A community-based participatory research intervention
Authors: Nunn Caitlin , Wilding Raelene , McKinnon Katharine , Ku Htoo Gay , Myint Gai Porh Soe La , Taveesupmai Posao (Nido) , O’Keefe Megan , Graves Kaye
Published: April 2021

The resettlement of refugees in rural areas is presenting new challenges for healthcare. This article reports on a community-based participatory research project that explored understandings of health and care across the life course in a refugee-background community in regional south-east Australia. Participants identified key challenges, including lack of access to local services that address their complex needs and problems created by communicating across languages, cultures, and ontologies. Clear opportunities were identified for improving local health services to meet the needs of refugee-background communities. Building on participant recommendations, we argue that appropriate, high-quality healthcare requires the cultivation of dialogue and respect across different understandings of health and care. We suggest that approaches grounded in an ethos of collaboration, power-sharing and dialogue provide a way forward, not just for research, but for embedding practices of cultural safety in rural and regional resettlement.
Exploiting structural similarity in network reliability analysis using graph learning
Authors: Zhang Ping , Xie Min , Zhu Xiaoyan
Published: April 2021

Considering the large-scale networks that can represent construction of components in a unit, a transportation system, a supply chain, a social network system, and so on, some nodes have similar topological structures and thus play similar roles in the network and system analysis, usually complicating the analysis and resulting in considerable duplicated computations. In this paper, we present a graph learning approach to define and identify structural similarity between the nodes in a network or the components in a network system. Based on the structural similarity, we investigate component clustering at various significance levels that represent different extents of similarity. We further specify a spectral-graph-wavelet based graph learning method to measure the structural similarity and present its application in easing computation load of evaluating system survival signature and system reliability. The numerical examples and the application show the insights of structural similarity and effectiveness of the graph learning approach. Finally, we discuss potential applications of the graph-learning based structural similarity and conclude that the proposed structural similarity, component clustering, and graph learning approach are effective in simplifying the complexity of the network systems and reducing the computational cost for complex network analysis.
The Defensive Golden Index: A novel method to rank football player defensive performance for Fútbol Club Barcelona
Authors: Ferreira Rui , Pereira Sara , Ribeiro João , Garganta Júlio , Barreira Daniel
Published: April 2021

This study sought to create a formula called the Defensive Golden Index (DGI) that assigns an index to each player according to his individual and collective defensive performance. This method helps identify the best-ranked players in defending play, designated as Defensive Golden Players. The study was organized in two main phases: (1) selection, definition, and validation, including weighting assignment, of a set of variables associated with players’ defensive performance by applying statistical techniques to standardize variable values that compose the DGI formula; and (2) applicability of the DGI formula to rank players’ performance of Fútbol Club Barcelona (FCB) according to the opponents’ level in 38 games of La Liga 2018–2019. A set of variables (e.g. tackles, anticipation, successful interception, successful 1 × 1 defensive) were included in a questionnaire and (re)conceptualized based on previous literature and author’s experience as coaches and match analysts. The survey was reviewed by 11 football experts to ascertain the importance of variables, as well as validate and determine the weight of each variable. Each defensive variable was divided by the time played. Then the individual values were subtracted from the mean and divided by the standard deviation of the variable. The results of the DGI formula were obtained by multiplying the weights from the experts for each of the 12 standardized defensive variables by the sum of each variable. In general, the best-ranked FCB players (Defensive Golden Players) were Gerard Piqué, Clement Lenglet, and Sergio Busquets. Moreover, considering the opponents’ levels, the same players were best-ranked, however, with different order in the top three positions. The DGI formula is a valuable method for capturing individual and collective performance of football players in defending play.
Endourological approach in patients with anatomical urinary tract challenges
Authors: Fonseca Rita , Santos José C , Lopes Filipe A , Peyroteo Inês , Silva Andreia , Gaspar Frederico P , Mota Renato L
Published: April 2021

Objective:

This article reports our experience managing neoplasms, stenosis and urolithiasis in patients with anatomical variations of the urinary system, using an endourological approach, either with an antegrade access or with combined access.

Patients and methods:

A retrospective review was performed using medical records of all patients who underwent percutaneous endourological treatment at our institution between 2014 and 2019. Those with such urinary anatomical variations were selected.

Results:

Out of 185 patients, 10 were identified. The study group included patients with urinary diversion, renal transplantation and congenital anomalies. Patients were divided into two sets, A and B, based on the presence or absence of urolithiasis, respectively. In set A, the median operative time was 213 minutes (standard deviation ( SD)=65.91 minutes). Only one patient had lithiasis in the first postoperative evaluation. Two patients had postoperative complications graded ⩾II in the Clavien–Dindo classification. Regarding set B, the median operation time was 75 minutes ( SD=66.89 minutes). Two patients had postoperative complications graded ⩾II in the Clavien–Dindo classification.

Conclusions:

Patients with anatomical tract challenges currently have a longer life expectancy and are therefore prone to urological complications in their unusual structures. Treatment of urological complications is essential, and minimal invasive procedures should be considered to resolve them and to reduce morbidity.

Level of evidence:

Not applicable.
Lupus Cerebritis Refractory to Guideline-Directed Therapy: A Case Report
Authors: Rao Suman , Sunkara Akhila , Ashwath Ashwini , Srivastava Nimisha , Albert Emily
Published: April 2021

Systemic lupus erythematosus is an autoimmune disease that affects multiple organs and organ systems, subsequently requiring an elaborate regimen for management. We present the case of a 63-year-old female who developed unrelenting symptoms of drug-induced lupus, which persisted even after the offending agent was withdrawn, unmasking her underlying systemic lupus erythematosus. She continued to develop neuropsychiatric symptoms, including mania and hallucinations, which complicated the management of her disease. After exhausting the bank of anti-inflammatory and immunomodulators recommended by current guidelines, we found that a combination of rituximab infusions with thiothixene, an antipsychotic agent, significantly improved our patient’s neuropsychiatric symptoms. Further research should be conducted to determine the efficacy of rituximab in the treatment of resistant lupus cerebritis, and to validate the use of thiothixene in the management of neuropsychiatric symptoms secondary to lupus.
First comprehensive analysis of lysine succinylation in paper mulberry (Broussonetia papyrifera)
Authors: Dong Yibo , Li Ping , Li Ping , Chen Chao
Published: April 2021

Background

Lysine succinylation is a naturally occurring post-translational modification (PTM) that is ubiquitous in organisms. Lysine succinylation plays important roles in regulating protein structure and function as well as cellular metabolism. Global lysine succinylation at the proteomic level has been identified in a variety of species; however, limited information on lysine succinylation in plant species, especially paper mulberry, is available. Paper mulberry is not only an important plant in traditional Chinese medicine, but it is also a tree species with significant economic value. Paper mulberry is found in the temperate and tropical zones of China. The present study analyzed the effects of lysine succinylation on the growth, development, and physiology of paper mulberry.

Results

A total of 2097 lysine succinylation sites were identified in 935 proteins associated with the citric acid cycle (TCA cycle), glyoxylic acid and dicarboxylic acid metabolism, ribosomes and oxidative phosphorylation; these pathways play a role in carbon fixation in photosynthetic organisms and may be regulated by lysine succinylation. The modified proteins were distributed in multiple subcellular compartments and were involved in a wide variety of biological processes, such as photosynthesis and the Calvin-Benson cycle.

Conclusion

Lysine-succinylated proteins may play key regulatory roles in metabolism, primarily in photosynthesis and oxidative phosphorylation, as well as in many other cellular processes. In addition to the large number of succinylated proteins associated with photosynthesis and oxidative phosphorylation, some proteins associated with the TCA cycle are succinylated. Our study can serve as a reference for further proteomics studies of the downstream effects of succinylation on the physiology and biochemistry of paper mulberry.
Aging features of the migratory locust at physiological and transcriptional levels
Authors: Guo Siyuan , Yang Pengcheng , Liang Bo , Zhou Feng , Hou Li , Kang Le , Wang Xianhui
Published: April 2021

Background

Non-Drosophila insects provide diverse aging types and important complementary systems for studies of aging biology. However, little attention has been paid to the special roles of non-Drosophila insects in aging research. Here, the aging-related features of the migratory locust, Locusta migratoria, were determined at the physiological, cellular, and transcriptional levels.

Results

In physiological assessments, the flight performance and sperm state of locusts displayed clear aging-related decline in male adults. Transcriptional analyses demonstrated locusts have similar aging-related genes with model species. However, different from those of Drosophila and mammals, the organ-specific aging transcriptional features of locusts were characterized by intensive expression changes in flight muscle and fat body and little transcriptional changes in brain. The predominant transcriptional characteristics of flight muscle and fat body aging were changes in expression of mitochondrion-related genes and detoxification and phagocytosis genes, respectively. Cellular assessments revealed the incidence of mitochondrial abnormalities significantly increased in aged flight muscle, and apoptotic signals and nuclear abnormalities were enhanced in aged fat body but not in brain. In addition, some well-known aging genes and locust aging-related genes (i.e., IAP1, PGRP-SA, and LIPT1), whose roles in aging regulation were rarely reported, were demonstrated to affect lifespan, metabolism, and flight ability of locusts after RNAi.

Conclusion

This study revealed multi-level aging signatures of locust, thus laying a foundation for further investigation of aging mechanisms in this famous insect in the future.
Prevalence and associated factors of hypertension among adults with diabetes mellitus in northern Sudan: a cross-sectional study
Authors: Abdelbagi Omer , Musa Imad R. , Musa Shaza M. , ALtigani Salim A. , Adam Ishag
Published: April 2021

Background

Hypertension and diabetes mellitus (DM), are highly prevalent worldwide health non-communicable diseases, and are associated with chronic complications. The co-existence of both conditions accelerates the related complications and increases morbidities and mortalities. A cross-sectional study was conducted in Nahr an Nil State (River Nile State) in Sudan between May and August 2018 to identify the prevalence of hypertension and risk factors among patients with DM in that region.

Results

The median (interquartile) age of the 1,973 enrolled patients was 58.0 (50.0‒65.0) years, and 818 (45.6%) were males. The median (interquartile) duration of diabetes was 5.0 (3.0‒9.0) years. Of the 1,973 enrolled participants, 21.7%, 1.3%, 37.1%, and 39.9% were normal weight, underweight, overweight, and obese, respectively. Of 1,973 854 (47.6%) patients also had hypertension. Logistic regression analyses showed that elderly patients (adjusted odds ratio [AOR] = 1.03, 95%; confidence interval [CI] = 1.02‒1.04), males (AOR = 2.96, 95%; CI = 2.15‒4.07), employed patients (AOR = 1.92, 95%; CI = 1.38‒2.70), obese patients (AOR = 1.59, 95%; CI = 1.21‒2.08), and patients with diabetic foot (DF) (AOR = 2.45, 95%; CI = 1.72‒3.47) were at higher risk for hypertension. Conversely, patients with Type 2 DM (T2DM) (AOR = 0.63, 95%; CI = 0.50‒0.80) were at lower risk for hypertension. There was no significant association between overweight, uncontrolled DM, and hypertension.

Conclusion

This study showed a high prevalence of hypertension among patients with DM. Notably, older age, male gender, employment, duration of DM, DF, underweight, and obesity were significant predictors of hypertension among patients with DM.
PET/MR imaging for the evaluation of cervical cancer during pregnancy
Authors: Ishiguro Tatsuya , Nishikawa Nobumichi , Ishii Shiro , Yoshihara Kosuke , Haino Kazufumi , Yamaguchi Masayuki , Adachi Sosuke , Watanabe Takafumi , Soeda Shu , Enomoto Takayuki
Published: April 2021

Background

Malignancy during pregnancy is increasing, and the most common type of malignancy is uterine cervical cancer. When planning the treatment of cervical cancer, it is important to look for signs of metastasis before surgery, especially metastasis to the lymph nodes. In this report, we assessed the diagnostic value of positron emission tomography/magnetic resonance imaging (PET/MRI) for evaluating cervical cancer propagation before surgery, with a focus on pregnant women.

Case presentation

18F Fluorodeoxyglucose (FDG)-PET/MRI was performed in seven pregnant cervical cancer patients (28–34 years old) at 9–18 gestational weeks. In case #5, a second PET/MRI was performed at 24 gestational weeks. Of seven FDG-PET/MRI examination series in six cases (cases #1–6), FDG-PET/MR imaging could detect cervical tumors with abnormal FDG accumulation; these tumors were confirmed with a standardized uptake value max (SUV max) titer of 4.5–16. A second PET/MRI examination in case #5 revealed the same SUV max titer as the first examination. In these six imaging series (cases #1–5), there were no signs of cancer metastasis to the parametrium and lymph nodes. However, in case #6, abnormal FDG accumulation in the left parametrial lymph nodes was also detectable. Pathological examination showed lymph node metastasis in case #6. In case #7, PET/MRI could not detect any abnormal FDG accumulation in the cervix and other sites. Cone biopsy demonstrated only micro-invasive squamous cell carcinoma. After treatment for cervical cancer, all seven patients have had no recurrence of disease within the follow-up period (2.8–5.6 years), and their children have developed appropriately.

Conclusion

PET/MRI is an effective imaging tool to evaluate cervical cancer progression in pregnancy.
Mesenchymal stem cells accelerated growth and metastasis of neuroblastoma and preferentially homed towards both primary and metastatic loci in orthotopic neuroblastoma model
Authors: Yu Jiao-Le , Chan Shing , Fung Marcus Kwong-Lam , Chan Godfrey Chi-Fung
Published: April 2021

Background

Majority of neuroblastoma patients develop metastatic disease at diagnosis and their prognosis is poor with current therapeutic approach. Major challenges are how to tackle the mechanisms responsible for tumorigenesis and metastasis. Human mesenchymal stem cells (hMSCs) may be actively involved in the constitution of cancer microenvironment.

Methods

An orthotopic neuroblastoma murine model was utilized to mimic the clinical scenario. Human neuroblastoma cell line SK-N-LP was transfected with luciferase gene, which were inoculated with/without hMSCs into the adrenal area of SCID-beige mice. The growth and metastasis of neuroblastoma was observed by using Xenogen IVIS 100 in vivo imaging and evaluating gross tumors ex vivo. The homing of hMSCs towards tumor was analyzed by tracing fluorescence signal tagged on hMSCs using CRI Maestro™ imaging system.

Results

hMSCs mixed with neuroblastoma cells significantly accelerated tumor growth and apparently enhanced metastasis of neuroblastoma in vivo. hMSCs could be recruited by primary tumor and also become part of the tumor microenvironment in the metastatic lesion. The metastatic potential was consistently reduced in lung and tumor when hMSCs were pre-treated with stromal cell derived factor-1 (SDF-1) blocker, AMD3100, suggesting that the SDF-1/CXCR4 axis was one of the prime movers in the metastatic process.

Conclusions

hMSCs accelerated and facilitated tumor formation, growth and metastasis. Furthermore, the homing propensity of hMSCs towards both primary tumor and metastatic loci can also provide new therapeutic insights in utilizing bio-engineered hMSCs as vehicles for targeted anti-cancer therapy.
Barriers and coping mechanisms to accessing healthcare during the COVID-19 lockdown: a cross-sectional survey among patients with chronic diseases in rural Rwanda
Authors: Nshimyiryo Alphonse , Barnhart Dale A. , Cubaka Vincent K. , Dusengimana Jean Marie Vianney , Dusabeyezu Symaque , Ndagijimana Deogratias , Umutesi Grace , Shyirambere Cyprien , Karema Nadine , Mubiligi Joel M. , Kateera Fredrick
Published: April 2021

Background

Large scale physical distancing measures and movement restrictions imposed to contain COVID-19, often referred to as ‘lockdowns’, abruptly and ubiquitously restricted access to routine healthcare services. This study describes reported barriers and coping mechanisms to accessing healthcare among chronic care patients during the nationwide COVID-19 lockdown in Rwanda.

Methods

This cross-sectional study was conducted among chronic care patients enrolled in pediatric development, HIV/AIDS, non-communicable diseases, mental health, and oncology programs at 3 rural Rwandan districts. Active patients with an appointment scheduled between March–June 2020 and a phone number recorded in the electronic medical record system were eligible. Data were collected by telephone interviews between 23rd April and 11th May 2020, with proxy reporting by caregivers for children and critically ill-patients. Fisher’s exact tests were used to measure associations. Logistic regression analysis was also used to assess factors associated with reporting at least one barrier to accessing healthcare during the lockdown.

Results

Of 220 patient respondents, 44% reported at least one barrier to accessing healthcare. Barriers included lack of access to emergency care (n = 50; 22.7%), lack of access to medication (n = 44; 20.0%) and skipping clinical appointments (n = 37; 16.8%). Experiencing barriers was associated with the clinical program (p < 0.001), with oncology patients being highly affected (64.5%), and with increasing distance from home to the health facility (p = 0.031). In the adjusted logistic regression model, reporting at least one barrier to accessing healthcare was associated with the patient's clinical program and district of residence. Forty (18.2%) patients identified positive coping mechanisms to ensure continuation of care, such as walking long distances during suspension of public transport (n = 21; 9.6%), contacting clinicians via telephone for guidance or rescheduling appointments (n = 15; 6.8%), and delegating someone else for medication pick-up (n = 6; 2.7%). Of 124 patients who reported no barriers to accessing healthcare, 9% used positive coping mechanisms.

Conclusion

A large proportion of chronic care patients experienced barriers to accessing healthcare during the COVID-19 lockdown. However, many patients also independently identified positive coping mechanisms to ensure continuation of care - strategies that could be formally adopted by healthcare systems in Rwanda and similar settings to mitigate effects of future lockdowns on patients.
Do acute inflammatory cytokines affect 3- and 12-month postoperative functional outcomes–a prospective cohort study of 12 patients with proximal tibia fractures
Authors: Iversen Imran Jamal , Pham That Minh , Schmal Hagen
Published: April 2021

Background

Patients with intra-articular fractures tend to develop post-traumatic osteoarthritis (PTOA). The initial inflammatory response with elevation of inflammatory cytokines following joint trauma might be responsible for triggering cartilage catabolism and degradation. We aimed to identify and quantify cytokine levels in fractured and healthy knee joints and the correlation of these cytokines with clinical outcomes.

Methods

In this prospective cohort study, synovial fluid and plasma were collected from 12 patients with proximal intra-articular tibia fractures before surgery. The concentration of sixteen inflammatory cytokines, two cartilage degradation products and four metabolic mediators where measured, comparing the acute injured knee with the healthy contralateral knee. Patients were evaluated 3- and 12-months after surgery with clinical parameters and radiographical scanning. Non-parametrical Wilcoxon rank-sum and Spearman tests were used for statistical analysis, and a P-value below 0.05 was considered significant.

Results

We found an elevation of the pro-inflammatory cytokines IL-1β, IL-2, IL-6, IL-8, IL-12p70, TNF-α, IFN-y, MMP-1, MMP-3, and MMP-9 and a simultaneous elevation of the anti-inflammatory cytokines IL-1RA, IL-4, IL-10, and IL-13 in the injured knee. Several pro- and anti-inflammatory cytokines and metabolic mediators were correlated with clinical outcomes 12 months after surgery, especially with pain perception.

Conclusions

Our results support that an inflammatory process occurs after intra-articular knee fractures, which is characterized by the elevation of both pro- and anti-inflammatory cytokines. There was no sign of cartilage damage within the timeframe from injury to operation. We found a correlation between the initial inflammatory reaction with clinical outcomes 12 months after surgery.
Measurement of salivary testosterone in adolescents and young men with Duchenne muscular dystrophy
Authors: Sahun Yolanda Alins , Cheetham Tim , Boot Christopher , Straub Volker , Wood Claire L.
Published: April 2021

Background

Many young adults with Duchenne Muscular Dystrophy (DMD) receive long-term glucocorticoids (GC). GC can cause hypogonadotrophic hypogonadism and adolescents may therefore be candidates for pubertal induction. It is unclear whether men with DMD on or off GC have age-appropriate endogenous testosterone production.

Methods

We undertook a quality improvement project to assess the feasibility of measuring salivary testosterone (SalT) levels in men with DMD at home. A Sal-T sampling kit was sent by post to all patients with DMD, aged 17 and older, registered at the John Walton Muscular Centre in Newcastle (n = 75). Submitted Sal-T samples were collected and submitted for analysis.

Results

Twenty-eight out of seventy-five patients returned samples (age range: 17–34 years). 6/28 samples were unsuitable for analysis. Overall Sal-T levels (n = 22) were significantly lower than in the healthy population (178 ± 107 v 287 ± 109 pmol/l, p = 0.0001). Sal-T was lower in those on GC compared to those off GC (144 ± 81 versus 218 ± 125 pmol/l, p = 0.05). Three patients were unable to collect a sample due to ventilator dependence.

Conclusion

Sal T can provide information about androgen status in DMD patients at home, overcoming barriers such as mobility difficulties and challenging venepuncture. However we only obtained samples in a minority of patients suggesting that Sal-T measurement may not be appropriate or acceptable to everyone. There needs to be a more detailed exploration of the barriers to sample submission.
COVID-19 in adults with dementia: clinical features and risk factors of mortality—a clinical cohort study on 125 patients
Authors: Vrillon Agathe , Mhanna Elsa , Aveneau Clément , Lebozec Manon , Grosset Lina , Nankam Diane , Albuquerque Fernanda , Razou Feroldi Raphaelle , Maakaroun Barbara , Pissareva Iana , Cherni Gherissi Dalenda , Azuar Julien , François Véronique , Hourrègue Claire , Dumurgier Julien , Volpe-Gillot Lisette , Paquet Claire
Published: April 2021

Background

There is limited evidence on the characteristics and outcome of patients with dementia hospitalised for novel coronavirus infection (COVID-19).

Method

We conducted a prospective study in 2 gerontologic COVID units in Paris, France, from March 14, 2020, to May 7, 2020. Patients with dementia hospitalised for confirmed COVID-19 infection were systematically enrolled. A binary logistic regression analysis was performed to identify factors associated with mortality at 21 days.

Results

We included 125 patients. Median age was 86 (IQI 82–90); 59.4% were female. Most common causes of dementia were Alzheimer’s disease, mixed dementia and vascular dementia. 67.2% had ≥ 2 comorbidities; 40.2% lived in a long-term care facility. The most common symptoms at COVID-19 onset were confusion and delirium (82.4%), asthenia (76.8%) and fever (72.8%) before polypnea (51.2%) and desaturation (50.4%). Falls were frequent at the initial phase of the disease (35.2%). The fatality rate at 21 days was 22.4%. Chronic kidney disease and CRP at admission were independent factors of death. Persisting confusion, mood and behavioural disorders were observed in survivors (19.2%).

Conclusion

COVID-19 in demented individuals is associated with severe outcome in SARS-CoV-2 infection and is characterised by specific clinical features and complications, with confusion and delirium at the forefront. COVID-19 testing should be considered in front of any significant change from baseline.