bluuebunny/crossref_metadata_2025 huggingface dataset:
Radio frequency identification based smart parking system using Internet of Things
Authors: Atiqur Rahman
Published: March 2021

The ideas of shrewd urban communities have consistently been a fantasy. There have been headways produced using the recent years to make a shrewd city dream to reality with the advancement of innovation, smart gadgets are getting increasingly normal in regular daily existence. In this paper a radio frequency identification (RFID) based smart parking system using Internet of Things (IoT) innovation is actualized. The ultrasonic sensors are set before the parking spots and speaker is utilized for sign. On the off chance that the parking space is vacant, at that point light emitting diode (LED) will squint and the parking opening is full LED will be OFF. At the point when vehicle is left the RFID will peruse the data and cut the particular sum and by utilizing IoT location will be sent through short message service (SMS) to proprietor using global system for mobile communications (GSM) and global positioning system (GPS) advancements.
Design and implementation of automatic painting mobile robot
Authors: Muneer Amgad , Dairabayev Zhan
Published: March 2021

Wall painting is a repetitive, stressful, and hazardous process that makes it an ideal automation case. In the automotive industry, painting had been automated but not yet for the construction industry. However, there is a strong need for a mobile robot that can move to paint residential interior walls. In this study, we aim to design and implement an automatic painting mobile robot. The conceptual design of the proposed wall painting robot consisting paint mechanism with a spray gun and ultrasonic sensor. The spray gun is attached to a pulley mechanism that has linear motion. The ultrasonic sensor is used to detect the spray gun when it reached a certain limit. The DC motor rotates clockwise and counterclockwise based on the ultrasonic sensor condition made. The experimental results indicate that the robot was able to paint the walls smoothly vertically, and horizontally. The spraying gun structure's speed is at a tolerable speed of 0.07 m/s, which could be increased, but to provide high-quality painting without any gaps, the current speed was selected as the most suitable, without any harm to the working process.
Early Changes in Rat Heart After High‐Dose Irradiation: Implications for Antiarrhythmic Effects of Cardiac Radioablation
Authors: Cha Myung‐Jin , Seo Jeong‐Wook , Kim Hak Jae , Kim Moo‐kang , Yoon Hye‐sun , Jo Seong Won , Oh Seil , Chang Ji Hyun
Published: March 2021

Background

Noninvasive cardiac radioablation is employed to treat ventricular arrhythmia. However, myocardial changes leading to early‐period antiarrhythmic effects induced by high‐dose irradiation are unknown. This study investigated dose‐responsive histologic, ultrastructural, and functional changes within 1 month after irradiation in rat heart.

Methods and Results

Whole hearts of wild‐type Lewis rats (N=95) were irradiated with single fraction 20, 25, 30, 40, or 50 Gy and explanted at 1 day or 1, 2, 3, or 4 weeks’ postirradiation. Microscopic pathologic changes of cardiac structures by light microscope with immunohistopathologic staining, ultrastructure by electron microscopy, and functional evaluation by ECG and echocardiography were studied. Despite high‐dose irradiation, no myocardial necrosis and apoptosis were observed. Intercalated discs were widened and disrupted, forming uneven and twisted junctions between adjacent myocytes. Diffuse vacuolization peaked at 3 weeks, suggesting irradiation dose‐responsiveness, which was correlated with interstitial and intracellular edema. CD68 immunostaining accompanying vacuolization suggested mononuclear cell infiltration. These changes were prominent in working myocardium but not cardiac conduction tissue. Intracardiac conduction represented by PR and QTc intervals on ECG was delayed compared with baseline measurements. ST segment was initially depressed and gradually elevated. Ventricular chamber dimensions and function remained intact without pericardial effusion.

Conclusions

Mononuclear cell–related intracellular and extracellular edema with diffuse vacuolization and intercalated disc widening were observed within 1 month after high‐dose irradiation. ECG indicated intracardiac conduction delay with prominent ST‐segment changes. These observations suggest that early antiarrhythmic effects after cardiac radioablation result from conduction disturbances and membrane potential alterations without necrosis.
Stroke Risk Factor Status and Use of Stroke Prevention Medications Among Hispanic/Latino Adults in HCHS/SOL
Authors: Bai Fang , Chen Jingsong , Pandey Dilip , Durazo-Arvizu Ramon , Talavera Gregory A. , Allison Matthew A. , Perreira Krista M. , Schneiderman Neil , Sutherland Melanie W. , Cai Jianwen , Daviglus Martha L. , Testai Fernando D.
Published: March 2021

Background and Purpose:

We investigated the prevalence, awareness, and control of vascular risk factors (VRFs) and the use of antithrombotic and statin agents in HCHS (Hispanic Community Health Study)/SOL (Study of Latinos) participants with self-reported history of stroke or transient ischemic attack.

Methods:

Sociodemographic characteristics, medications, and prevalence of different VRFs were recorded. VRF diagnoses and goals were based on the recommendations of professional organizations. Factors associated with optimal VRF control and use of antithrombotic and statin agents were investigated using multivariate logistic regression.

Results:

The analysis included 404 participants (39% men). The prevalences of hypertension, dyslipidemia, and diabetes were 59%, 65%, and 39%, respectively. Among those who met the diagnostic criteria for these diagnoses, the frequencies of awareness were 90%, 75%, and 83%, respectively. In participants who were aware of their VRFs, the prevalences of controlled hypertension, dyslipidemia, and diabetes were 46%, 32%, and 54%. Approximately 46% of the participants were on antithrombotics, 39% on statins, and 26% on both. Only 38% of those with atrial fibrillation received anticoagulation. In multivariate analyses adjusted for baseline sociodemographic characteristics, older age was associated with uncontrolled hypertension and diabetes. Residing in the United States for ≥10 years and born in the United States were associated with uncontrolled diabetes, female sex with uncontrolled dyslipidemia, and lack of health insurance with decreased use of statins and hyperlipidemia.

Conclusions:

Hispanic/Latino adults in the United States have high prevalence and awareness of VRFs but low adherence to secondary stroke prevention strategies. Older adults, women, and uninsured people are vulnerable groups that may benefit from targeted interventions.

Registration:

URL:
https://www.clinicaltrials.gov
; Unique identifier: NCT02060344.
CCM2L (Cerebral Cavernous Malformation 2 Like) Deletion Aggravates Cerebral Cavernous Malformation Through Map3k3-KLF Signaling Pathway
Authors: Choi Jaesung P. , Yang Xi , He Shuang , Song Renhua , Xu Zi-Ran , Foley Matthew , Wong Justin J.-L. , Xu Cheng-Ran , Zheng Xiangjian
Published: March 2021

Background and Purpose:

Cerebral cavernous malformation (CCM) is a common cerebrovascular disease. CCMs are major causes of stroke, cerebral hemorrhage, and neurological deficits in young individuals. Loss-of-function mutations in
CCM1
,
CCM2
, and
CCM3
have been identified to cause CCM in humans.
Ccm2-like
(
Ccm2l
) is a paralog of
Ccm2
and is predominantly expressed in endothelial cells (ECs). CCM2L (CCM2-like) competes with CCM2 for binding to CCM1 and has been shown to have an antagonistic function to that of CCM2 during vascular development. The role of CCM2L in CCM pathogenesis is unknown.

Methods:

We isolated brain ECs from the inducible-CCM mouse models for gene expression analysis. Micro-computed tomography imaging was used to analyze CCM lesion burden from the genetic cross of
Ccm2l
knockout mice (
Ccm2l
−/−
) with
Ccm1
or
Ccm2
-deficient mice to determine the role of
Ccm2l
in CCM pathogenesis. Genetic crosses with
Map3k3

fl/fl

mice were used to determine the role of
Map3k3
in
Ccm2l
-facilitated CCM formation.

Results:

We demonstrated increased
Ccm2l
expression in brain ECs of
Ccm2
-deficient mice. Analysis of RNA-seq data from CCM patient samples revealed a trend of increased
CCM2L
expression and its positive correlation with Kruppel-like factor 2/4
(KLF2/4
) expression. Micro-computed tomography revealed that the deletion of
Ccm2l
in
Ccm2
-deficient mice increased CCM lesion volume compared with that of controls but had no effect on lesion numbers. Correlating to the increased lesion burden,
Klf2/4
mRNA expressions in brain ECs were significantly increased in double knockouts (
Ccm2
- and
Ccm2l
-deficient mice) compared with that of controls (
Ccm2
deficient). Hemizygous deletion of
Map3k3
in ECs relieved CCM lesion burden in the double knockouts. These results suggest that CCM2L regulates the Map3k3-KLF signaling pathway in CCM pathogenesis.

Conclusions:

Loss of CCM2L aggravates CCM lesion formation in the
Ccm2
-deficient mouse model through increased Map3k3-KLF signaling. Our data suggest that increased
Ccm2l
expression is a compensatory mechanism in CCM pathogenesis.
Intraluminal Thrombus and Outcomes of Patients With Acute Large Vessel Occlusive Stroke Undergoing Endovascular Treatment
Authors: Ding Yarong , Leng Xinyi , Nie Ximing , Pan Yuesong , Li JieJie , Liu Dacheng , Yan Hongyi , Pu Yuehua , Wei Yufei , Cai Yuan , Lu Qixuan , Zhang Zhe , Duan Wanying , Gu Weibin , Hou Xinyi , Yang Zhonghua , Wen Miao , Ma Ning , Miao Zhongrong , Wang Yongjun , Liu Liping ,   on behalf of the RESCUE-RE Study Group
Published: March 2021

Background and Purpose:

Intraluminal thrombus (ILT) is an emerging imaging marker in acute ischemic stroke. We aimed to investigate the association of ILT with outcomes of acute large vessel occlusion (LVO) patients receiving endovascular treatment.

Methods:

Acute LVO stroke patients who underwent endovascular treatment within 24 hours, in a prospective, nationwide registry were enrolled. Pretreatment digital subtraction angiography was reviewed for the presence of ILT. The primary outcome was 90-day functional dependence (modified Rankin Scale scores, 3–6). Secondary outcomes included 24-hour LVO, 90-day death, and symptomatic intracranial hemorrhage.

Results:

Among 711 patients enrolled, 75 (10.5%) with ILT were less likely to have 90-day functional dependence compared with those without ILT (adjusted odds ratio, 0.53 [95% CI, 0.31–0.90];
P
=0.021). The same trend was found among those with successful reperfusion (modified Thrombolysis in Cerebral Infarction 2b–3;
P
=0.008) but not in those without successful reperfusion (
P
=0.107). Presence of ILT was also independently associated with a lower rate of 24-hour LVO (adjusted odds ratio 0.34 [95% CI, 0.13–0.89];
P
=0.028). However, those with or without ILT had similar risks of symptomatic intracranial hemorrhage and 90-day death.

Conclusions:

Among acute LVO patients receiving endovascular treatment, pretreatment ILT-positive patients may have a better 90-day functional outcome (versus ILT-negative) but similar risk of death and symptomatic intracranial hemorrhage. The possibly favorable effect of ILT patients remained in those with successful reperfusion.

Registration:

URL:
http://www.chictr.org.cn
; Unique identifier: ChiCTR1900022154.
Revision and phylogenetic analysis of the genus Acanthischium Amyot & Serville, 1843 (Hemiptera: Reduviidae: Harpactorinae)
Authors: Castro-Huertas Valentina , Forero Dimitri
Published: March 2021

The Neotropical harpactorine assassin bug genus Acanthischium Amyot & Serville, 1843 (Hemiptera: Reduviidae: Harpactorini) includes four valid species: Acanthischium maculatum Amyot & Serville, 1843 (with ten color varieties proposed by Stål [1872]), Acanthischium haglundi Stål, 1866, Acanthischium superbum Haviland, 1931, and Acanthischium invium Elkins, 1961. A taxonomic revision and a morphological phylogenetic analysis were carried out to test species limits and to propose a hypothesis of evolutionary relationships. As a result of the phylogenetic analysis, Acanthischium is characterized on its external morphology by the elongate postocular region, posterior margin of the pronotum with spines, ventral surface of protrochanter with apical and basal protuberances, profemur wider than mesofemur, and protibia strongly curved. After the taxonomic revision we propose nine valid species, taking into consideration characters of external morphology, male and female genitalia, and color patterns: Acanthischium dimidiatum Stål, 1859 stat. rev.; Acanthischium flaviceps Stål, 1872 stat. rev.; Acanthischium haglundi Stål, 1866; Acanthischium kuna sp. nov. from Panama and Colombia; Acanthischium maculatum Amyot & Serville, 1843; Acanthischium meloae sp. nov. from Suriname; Acanthischium nigrum Stål, 1872 stat. rev.; Acanthischium semiflavum Stål,1872 stat. rev.; and Acanthischium superbum Haviland, 1931. We further synonymize A. invium Elkins, 1961 with A. superbum. All but one of the species ‒ A. flaviceps ‒ were included in the phylogenetic analysis, in which Acanthischium was found to be monophyletic, with the following set of relationships: (A. haglundi + (A. nigrum +(A. dimidiatum (A. maculatum, A. semiflavum, A. kuna, A. meloae, A. superbum)))). The resulting phylogenetic pattern indicate a body color transition from drab to more vivid ones, such as orange or red. The species exhibiting red and orange colorations are found in a clade, suggesting an underlying biological phenomenon, such as wasp mimetism.
Lectotypification of Corypha taliera Roxburgh and Orania nicobarica Kurz (Arecaceae)
Authors: MANE ROHIT N. , LEKHAK MANOJ M.
Published: March 2021

Lectotypes are designated for Corypha taliera and Orania nicobarica.
A Comparison of Government Communication of Climate Change in Hong Kong and United Kingdom
Authors: Ferranti Emma J. S. , Yan Wong Joanna Ho , Dhesi Surindar
Published: March 2021

As leaders of civil society, governments have a prime responsibility to communicate climate change information in order to motivate their citizens to mitigate and adapt. This study compares the approaches of the U.K. and Hong Kong governments. Although different in size and population, the United Kingdom and Hong Kong have similar climate change agendas to communicate to similarly educated and prosperous populations. The study finds that while both governments use similar means: policy, education, campaigns, internet, and social media, these have different characteristics, with different emphases in their climate change message. The United Kingdom’s top-down approach is more prominent in its legally binding policy and well-defined programs for adaptation and risk assessment. Hong Kong has more effectively embedded climate change education across the school curricula and has a more centralized and consistently branded campaign, with widespread use of visual language to connect the public to the problem. Hong Kong frames climate change as a science–society problem and has a greater focus on self-responsibility and bottom-up behavioral change. Thus, the U.K. and Hong Kong governments have polarized approaches to motivating their citizens into climate action. Moving forward, both governments should consider best practice elements of the other to develop their communication of climate change.
Current Challenges When Using Numbers in Patient Decision Aids: Advanced Concepts
Authors: Trevena Lyndal J. , Bonner Carissa , Okan Yasmina , Peters Ellen , Gaissmaier Wolfgang , Han Paul K. J. , Ozanne Elissa , Timmermans Danielle , Zikmund-Fisher Brian J.
Published: March 2021

Background

Decision aid developers have to convey complex task-specific numeric information in a way that minimizes bias and promotes understanding of the options available within a particular decision. Whereas our companion paper summarizes fundamental issues, this article focuses on more complex, task-specific aspects of presenting numeric information in patient decision aids.

Methods

As part of the International Patient Decision Aids Standards third evidence update, we gathered an expert panel of 9 international experts who revised and expanded the topics covered in the 2013 review working in groups of 2 to 3 to update the evidence, based on their expertise and targeted searches of the literature. The full panel then reviewed and provided additional revisions, reaching consensus on the final version.

Results

Five of the 10 topics addressed more complex task-specific issues. We found strong evidence for using independent event rates and/or incremental absolute risk differences for the effect size of test and screening outcomes. Simple visual formats can help to reduce common judgment biases and enhance comprehension but can be misleading if not well designed. Graph literacy can moderate the effectiveness of visual formats and hence should be considered in tool design. There is less evidence supporting the inclusion of personalized and interactive risk estimates.

Discussion

More complex numeric information. such as the size of the benefits and harms for decision options, can be better understood by using incremental absolute risk differences alongside well-designed visual formats that consider the graph literacy of the intended audience. More research is needed into when and how to use personalized and/or interactive risk estimates because their complexity and accessibility may affect their feasibility in clinical practice.
New fourth-order convergent algorithm for analysis of trusses with material and geometric nonlinearities
Authors: Souza Luiz Antonio Farani de , Santos Douglas Fernandes dos , Kawamoto Rodrigo Yukio Mizote , Vanalli Leandro
Published: March 2021

This paper presents a new algorithm to solve the system of nonlinear equations that describes the static equilibrium of trusses with material and geometric nonlinearities, adapting a three-step method with fourth-order convergence found in the literature. The co-rotational formulation of the Finite Element Method is used in the discretization of structures. The nonlinear behavior of the material is characterized by an elastoplastic constitutive model. The equilibrium paths with limit points of load and displacement are obtained using the linearized Arc-Length path-following technique. The numerical results obtained with the free program Scilab show that the new algorithm converges faster than standard procedures and modified Newton-Raphson, since the approximate solution of the problem is obtained with a smaller number of accumulated iterations and less CPU time. The equilibrium paths show that the structures exhibit a completely different behavior when the material nonlinearity is considered in the analysis with large displacements.
eConsult Specialist Quality of Response (eSQUARE): A novel tool to measure specialist correspondence via electronic consultation
Authors: Tran Christopher , Archibald Douglas , Humphrey-Murto Susan , Wood Timothy J , Dudek Nancy , Liddy Clare , Keely Erin
Published: March 2021

High-quality correspondence between healthcare providers is critical for effective patient care. We developed an assessment tool to measure the quality of specialist correspondence to primary care providers (PCPs) via electronic consultation (eConsult), where specialists provide advice without specialist-patient interactions. We incorporated fourteen previously described features of high-quality eConsult correspondence into an assessment tool named the eConsult Specialist Quality of Response (eSQUARE). Six PCPs and two specialists applied the 10-item eSQUARE tool to 30 eConsults of varying quality as informed by PCP survey data. Content, response process, and internal structure validity evidence was gathered. Psychometric properties were calculated using descriptive statistics and generalizability analyses. Mean total score for low-quality eConsults (M = 24 ± 5.6) was significantly lower than moderate-quality eConsults (M = 38 ± 4.7; p<0.001) which was significantly lower than high-quality eConsults (M = 46 ± 3.0; p = 0.002). Reliability measures were high, including generalizability coefficient (0.96), inter-item (≥0.55) and item-total correlations (≥0.68). A decision study demonstrated that a single rater was adequate to achieve a reliability measure of ≥0.70. This study demonstrates initial validity evidence including multiple reliability measures for the eSQUARE. A single rater is adequate to achieve reliability measures for formative feedback. Future studies can apply the eSQUARE when planning educational initiatives aiming to improve specialist-to-PCP correspondence via eConsult.
Exploring COVID-19 Related Factors Influencing Antenatal Care Services Uptake: A Qualitative Study among Women in a Rural Community in Southwest Ethiopia
Authors: Hailemariam Shewangizaw , Agegnehu Wubetu , Derese Misganaw
Published: March 2021

Introduction:

Evidences suggest a significant decline in maternal health service uptake following the coronavirus disease 2019 (COVID-19) pandemic in Ethiopia. However, COVID-19 related factors impacting the service uptake are not sufficiently addressed. Hence, the current study was intended to explore COVID-19 related factors influencing antenatal care service uptake in rural Ethiopia.

Methods:

A community-based qualitative study was conducted from September 25/2020 to November 25/2020 among selected pregnant women residing in rural districts of Bench-Sheko Zone, and healthcare providers working in the local health care facilities. Six focus group discussions and 9 in-depth interviews were made between pregnant women, and health care providers, respectively. Data was collected by health education and behavioral science professionals who also have experience in qualitative data collection procedure. Data were transcribed, translated, and analyzed thematically using Open Code 4.0 software.

Result:

The study revealed several COVID-19 related factors influencing the uptake of antenatal care service during the pandemic. Health facility related barriers, perceived poor quality of care during the pandemic, government measures against COVID-19, anxiety related to the pandemic, and risk minimization were the identified factors possibly influencing the current antenatal care service uptake among women in rural Bench-Sheko Zone.

Conclusion:

COVID-19 preventive measures, and health facility related factors and individual factors were responsible for the current decline in antenatal care service uptake. Preserving essential health care service is critical to prevent avoidable losses of maternal and child lives during the pandemic period. Hence, programs and strategies designed to maintain maternal health services particularly, antenatal care service have better take the above determinants into consideration.
Clinical manifestations of, diagnostic approach to, and treatment of neurolymphomatosis in the rituximab era
Authors: Khurana Arushi , Novo Mattia , Nowakowski Grzegorz S. , Ristow Kay M. , Spinner Robert J. , Hunt Christopher H. , King Rebecca L. , Lachance Daniel H. , Habermann Thomas M. , Micallef Ivana N. , Johnston Patrick B.
Published: March 2021

Neurolymphomatosis (NL) is a rare manifestation of lymphoma, with limited evidence for optimal management. The largest patient series, 50 cases of lymphoma and leukemia, was published in 2010 with limited rituximab exposure. This study aims to evaluate the clinical presentation, diagnostic testing, and outcomes of NL in the rituximab era. Forty biopsy-proven cases of NL, in association with non-Hodgkin lymphoma (NHL), at the Mayo Clinic were retrospectively evaluated. B-cell NHL was associated with 97% of NL cases, of which diffuse large B-cell lymphoma (DLBCL) was the most common (68%). Primary NL, defined as neural involvement present at the time of diagnosis of lymphoma, was noted in 52% cases. Seventy percent of patients presented with sensorimotor weakness and neuropathic pain. Magnetic resonance imaging (MRI) was positive in 100% patients. Overall survival (OS) was significantly better for primary NL and NL associated with indolent lymphomas. Relapses were seen in 60% (24/40) of patients; 75% involved the peripheral or central nervous system at relapse. The use of rituximab in the frontline setting significantly impacted progression-free survival (PFS). Transplant consolidation was noted to be associated with improved OS. This study adds to the available literature on NL in the rituximab era. The overall outcomes have improved in recent years. In our experience, MRI and positron emission tomography/computed tomography may be required for accurate assessment of the extent of disease involvement and identification of an optimal biopsy site. The use of rituximab was associated with improvement in PFS, and autologous stem cell transplant was associated with OS.
MetAP2 inhibition modifies hemoglobin S to delay polymerization and improves blood flow in sickle cell disease
Authors: Demers Melanie , Sturtevant Sarah , Guertin Kevin R. , Gupta Dipti , Desai Kunal , Vieira Benjamin F. , Li Wenjing , Hicks Alexandra , Ismail Ayman , Gonçalves Bronner P. , Di Caprio Giuseppe , Schonbrun Ethan , Hansen Scott , Musayev Faik N. , Safo Martin K. , Wood David K. , Higgins John M. , Light David R.
Published: March 2021

Sickle cell disease (SCD) is associated with hemolysis, vascular inflammation, and organ damage. Affected patients experience chronic painful vaso-occlusive events requiring hospitalization. Hypoxia-induced polymerization of sickle hemoglobin S (HbS) contributes to sickling of red blood cells (RBCs) and disease pathophysiology. Dilution of HbS with nonsickling hemoglobin or hemoglobin with increased oxygen affinity, such as fetal hemoglobin or HbS bound to aromatic aldehydes, is clinically beneficial in decreasing polymerization. We investigated a novel alternate approach to modify HbS and decrease polymerization by inhibiting methionine aminopeptidase 2 (MetAP2), which cleaves the initiator methionine (iMet) from Val1 of α-globin and βS-globin. Kinetic studies with MetAP2 show that βS-globin is a fivefold better substrate than α-globin. Knockdown of MetAP2 in human umbilical cord blood–derived erythroid progenitor 2 cells shows more extensive modification of α-globin than β-globin, consistent with kinetic data. Treatment of human erythroid cells in vitro or Townes SCD mice in vivo with selective MetAP2 inhibitors extensively modifies both globins with N-terminal iMet and acetylated iMet. HbS modification by MetAP2 inhibition increases oxygen affinity, as measured by decreased oxygen tension at which hemoglobin is 50% saturated. Acetyl-iMet modification on βS-globin delays HbS polymerization under hypoxia. MetAP2 inhibitor–treated Townes mice reach 50% total HbS modification, significantly increasing the affinity of RBCs for oxygen, increasing whole blood single-cell RBC oxygen saturation, and decreasing fractional flow velocity losses in blood rheology under decreased oxygen pressures. Crystal structures of modified HbS variants show stabilization of the nonpolymerizing high O2–affinity R2 state, explaining modified HbS antisickling activity. Further study of MetAP2 inhibition as a potential therapeutic target for SCD is warranted.
Cost-effectiveness of magnetic resonance imaging for diagnosing recurrent ipsilateral deep vein thrombosis
Authors: van Dam Lisette F. , van den Hout Wilbert B. , Gautam Gargi , Dronkers Charlotte E. A. , Ghanima Waleed , Gleditsch Jostein , von Heijne Anders , Hofstee Herman M. A. , Hovens Marcel M. C. , Huisman Menno V. , Kolman Stan , Mairuhu Albert T. A. , Nijkeuter Mathilde , van de Ree Marcel A. , van Rooden Cornelis J. , Westerbeek Robin E. , Westerink Jan , Westerlund Eli , Kroft Lucia J. M. , Klok Frederikus A.
Published: March 2021

The diagnostic workup of recurrent ipsilateral deep vein thrombosis (DVT) using compression ultrasonography (CUS) can be complicated by persistent intravascular abnormalities after a previous DVT. We showed that magnetic resonance direct thrombus imaging (MRDTI) can exclude recurrent ipsilateral DVT. However, it is unknown whether the application of MRDTI in daily clinical practice is cost effective. The aim of this study was to evaluate the cost effectiveness of MRDTI-based diagnosis for suspected recurrent ipsilateral DVT during first year of treatment and follow-up in the Dutch health care setting. Patient-level data of the Theia study (NCT02262052) were analyzed in 10 diagnostic scenarios, including a clinical decision rule and D-dimer test and imaging with CUS and/or MRDTI. The total costs of diagnostic tests and treatment during 1-year follow-up, including costs of false-positive and false-negative diagnoses, were compared and related to the associated mortality. The 1-year health care costs with MRDTI (range, €1219-1296) were generally lower than strategies without MRDTI (range, €1278-1529). This was because of superior specificity, despite higher initial diagnostic costs. Diagnostic strategies including CUS alone and CUS followed by MRDTI in case of an inconclusive CUS were potential optimal cost-effective strategies, with estimated average costs of €1529 and €1263 per patient and predicted mortality of 1 per 737 patients and 1 per 609 patients, respectively. Our model shows that diagnostic strategies with MRDTI for suspected recurrent ipsilateral DVT have generally lower 1-year health care costs than strategies without MRDTI. Therefore, compared with CUS alone, applying MRDTI did not increase health care costs.
Treatment burden and ability to work
Authors: Trakoli Anna
Published: March 2021

Treatment burden can adversely affect patient functioning and wellbeing, including their ability work. Workers with multimorbidity, such as ageing, are disproportionately affected and their number is set to rise as the workforce ages. Complex treatment regimens and their sequalae can be a barrier to a successful return to work or even incompatible with work demands. Enlightened employers will seek to accommodate the burden of treatment by implementing reasonable adjustments. However, where the employer is unable or unwilling to accommodate such adjustments, the result may be loss of employment, with often devastating consequences to the worker's physical and emotional health and wellbeing.

Collaborative action in three key settings: the healthcare system, the workplace and the state can help reduce barriers, thereby enabling working-age people with chronic health conditions or disabilities remain in, and benefit from, employment.

Educational aims

To raise awareness on how treatment burden can adversely affect health, work and societal outcomes in working age people.

To promote good practice in relation to managing treatment burden in healthcare and work settings, so that working age people with chronic health conditions or disabilities can remain in and benefit from work.
TGF-β-induced α-SMA expression is mediated by C/EBPβ acetylation in human alveolar epithelial cells
Authors: Ding Hui , Chen Jinjun , Qin Jingping , Chen Ruhua , Yi Zili
Published: March 2021

Background

Although the morbidity and mortality rates associated with idiopathic pulmonary fibrosis (IPF) are high, there is still lack of powerful and precise therapeutic options for IPF.

Object

Through in vitro model, this study sought to determine whether binding of acetylated CCAAT/enhancer binding protein β (C/EBPβ) to alpha-smooth muscle actin (α-SMA) promoter could affect the activity of the latter as well as assess if it is essential for epithelial-to-mesenchymal transition (EMT) and extracellular matrix deposition in IPF.

Methods

The expression of EMT and C/EBPβ in A549 cells treated with transforming growth factor-beta (TGF-β) as pulmonary fibrotic model was detected by western blotting and qPCR. Collagen-I expression using ELISA was performed. The luciferase activity was used to examine the activity of C/EBPβ. Knockdown of C/EBPβ was performed by siRNA. We also investigated the effect of deacetylation of C/EBPβ on EMT using sirtuin 1 (SIRT1). The binding ability of C/EBPβ with α-SMA promoter was affirmed via chromatin immunoprecipitation (ChIP) and electrophoresis mobility shift assay (EMSA). The relationship between α-SMA and acetylated C/EBPβ was determined with co-immunoprecipitation (Co-IP). SiRNA-mediated knockdown of C/EBPβ in A549 cells attenuated TGF-β1-induced myofibroblast differentiation and ECM deposition. The extent of association between acetylated C/EBPβ and α-SMA promoter was dynamically monitored.

Results

It was confirmed that deacetylation of C/EBPβ in A549 cells successfully ameliorated TGF-β1-induced EMT, as shown by reduction in α-SMA expression and excessive collagen-I accumulation.

Conclusion

The EMT and fibrotic effect of TGF-β1 is dependent on acetylated C/EBPβ-mediated regulation of α-SMA gene activity. Thus, C/EBPβ acetylation may play a central role in pulmonary fibrosis.
Composition and diversity of bacterial communities in the rhizosphere of the Chinese medicinal herb Dendrobium
Authors: Zuo Jiajia , Zu Mengting , Liu Lei , Song Xiaomei , Yuan Yingdan
Published: March 2021

Background

Dendrobiumis a precious herbal that belongs to Orchidaceae and is widely used as health care traditional Chinese medicine in Asia. Although orchids are mycorrhizal plants, most research still focuses on endophytes, and there is still large amount unknown about rhizosphere microorganisms. To investigate the rhizosphere microbial community of differentDendrobiumspecies during the maturity stage, we used high-throughput sequencing to analyze microbial community in rhizosphere soil during the maturity stage of three kinds ofDendrobiumspecies.

Results

In our study, a total of 240,320 sequences and 11,179 OTUs were obtained from these threeDendrobiumspecies. According to the analysis of OTU annotation results, differentDendrobiumrhizosphere soil bacteria include 2 kingdoms, 63 phyla, 72 classes, 159 orders, 309 families, 850 genera and 663 species. Among all sequences, the dominant bacterial phyla (relative abundance > 1%) were Proteobacteria, Actinobacteria, Bacteroidetes, Acidobacteria, Firmicutes, Verrucomicrobia, Planctomycetes, Chloroflexi, and Gemmatimonadetes. And through WGCNA analysis, we found the hub flora was also belong to Acidobacteria, Actinobacteria and Proteobacteria.

Conclusions

We found that the rhizosphere bacterial communities of the three kinds ofDendrobiumhave significant differences, and that the main species of rhizosphere microorganisms ofDendrobiumare concentrated in the Proteobacteria, Actinobacteria, and Bacteroidetes. Moreover, the smaller the bacterial level, the greater the difference amongDendrobiumspecies. These results fill knowledge gaps in the rhizosphere microbial community ofDendrobiumand provide a theoretical basis for the subsequent mining of microbial functions and the study of biological fertilizers.
Delayed diagnosis of dilated thyrotoxic cardiomyopathy with coexistent multifocal atrial tachycardia: a case report
Authors: Yamamoto Hiroyuki , Monno Satoshi , Ohta-Ogo Keiko , Ishibashi-Ueda Hatsue , Hashimoto Toru
Published: March 2021

Background

Thyroid storm (TS) is a rare but potentially life-threatening sequelae of untreated or undertreated hyperthyroidism. While TS frequently causes high-output heart failure, low-output heart failure related to dilated cardiomyopathy (DCM) is extremely rare. Tachycardia is a common clinical presentation of TS, and β1-selective blockers are the first-line agents for treating TS-associated tachycardia. However, given that β-blockers have negative chronotropic and negative inotropic effects, amiodarone may be safe and effective for the treatment of TS-induced tachyarrhythmia in patients with moderate to severe heart failure. While long-term amiodarone administration causes hypothyroidism, or less frequently, hyperthyroidism, little is known about the effects of short-term amiodarone administration on thyroid function.

Case presentation

A 31-year-old healthy woman presented with worsening dyspnoea. She was tachycardic with multifocal atrial tachycardia (MAT) of 184 beats/min, confirmed by electrocardiogram. Echocardiographic findings were consistent with DCM, with an ejection fraction of 20%. Thus, she was initially diagnosed with acute heart failure due to DCM with coexistent MAT. Tachycardia persisted despite cardioversion attempts and treatment with multiple anti-arrhythmic drugs. Consequently, she rapidly progressed to cardiogenic shock and respiratory decompensation, which required intubation and an intra-aortic balloon pump support. Moreover, the undiagnosed Graves' disease, lack of suspicion, and postponed analysis of thyroid function tests led to a delayed diagnosis of TS. Amiodarone, which was initiated for MAT, unexpectedly ameliorated thyrotoxicosis, resulting in a euthyroid state and the patient’s significantly improved condition and cardiac function. She was discharged on day 40. Finally, she underwent total thyroidectomy; thyroid pathology was consisting with Graves' disease. Her postoperative course was uneventful.

Conclusions

Herein, we describe a case of delayed diagnosis of dilated thyrotoxic cardiomyopathy with coexistent MAT. The patient required intensive care due to the catastrophic sequelae and was successfully treated with amiodarone. This is the first case report of TS-associated MAT and highlights the clinical importance of high suspicion of TS in de novo heart failure with any tachyarrhythmia or DCM of unknown etiology and the potential effects of short-term amiodarone administration in the treatment of TS.
Vagus nerve stimulation ameliorates L-NAME-induced preeclampsia-like symptoms in rats through inhibition of the inflammatory response
Authors: Zheng Linmei , Tang Rong , Shi Lei , Zhong Mei , Zhou Zhongyi
Published: March 2021

Background

Preeclampsia is characterized by an excessive inflammatory response. Recent studies have shown that vagus nerve stimulation (VNS) has anti-inflammatory properties in vivo. This study aims to investigate whether VNS is safe for use during pregnancy and to explore the therapeutic potential and underlying mechanisms of VNS in PE.

Methods

Pregnant Sprague-Dawley rats were randomly chosen to receive N-nitro-L-arginine methyl ester (L-NAME)-containing water (preeclampsia-like mouse model) or saline (normal pregnancy control) daily at gestational days 14.5–20.5. VNS and the α7nAChR antagonist methyllycaconitine citrate (MLA, 1 mg/kg/d) were given daily at the same time.

Results

VNS decreased the high systolic blood pressure and urinary protein observed in the PE rats. In addition, VNS mitigated abnormal pregnancy outcomes. Moreover, VNS alleviated the inflammatory response by decreasing the levels of inflammatory cytokines. VNS significantly increased the expression of α7nAChR and attenuated the activation of NF-κB p65 in the placenta.

Discussion

Our findings indicate that maternal VNS treatment is safe during pregnancy and has a protective effect in a pregnant rat model of preeclampsia induced by L-NAME.
Comparative outcome analysis of bleb needling of fibrotic blebs in the clinic versus the operating room: a retrospective case series
Authors: Ponnusamy Vikram , Nguyen Van , An Jella A.
Published: March 2021

Background

To compare 6 month outcomes of bleb needling performed in the clinic vs. the operating room (OR) in adult glaucoma patients with failed bleb.

Methods

A retrospective case series of 47 eyes from 41 glaucoma patients who received needling with mitomycin C (MMC) of scarred bleb from prior bleb-forming procedures in clinic (32 eyes) vs. the OR (15 eyes), including trabeculectomy (14 eyes), ExPress shunt (16 eyes), and ab-interno XEN gel stent (17 eyes). The primary outcome was needling success, defined as IOP ≤ 18 mmHg on 0 glaucoma medications without requiring an additional IOP lowering procedure within 6 months after needling.

Results

At 6 months, bleb needling success rate was similar when performed in the clinic vs. in the OR (28% vs. 20%, P = 0.54). Success rate was not statistically different in patients with prior trabeculectomy, ExPress shunt, and XEN gel stent (29% vs. 38% vs. 12%, P = 0.26). When comparing clinic vs. the OR needling procedures at 6 months, there was no difference in mean IOP (14.2 vs. 14.9 mmHg, P = 0.73), mean glaucoma medications (1.4 vs. 1.7, P = 0.69), additional IOP-lowering procedure rate (16% vs. 27%, P = 0.37), or complication rate (0% vs. 7%, P = 0.32).

Conclusion

Bleb needling with MMC in clinic may be a safe and effective way to revise failed bleb after trabeculectomy, ExPress shunt, and XEN gel stent procedures when compared to needling in the OR.
Clinical utility of procalcitonin in febrile infants younger than 3 months of age visiting a pediatric emergency room: a retrospective single-center study
Authors: Park Jun-Sung , Byun Young-Hoon , Lee Jeong-Yong , Lee Jong Seung , Ryu Jeong-Min , Choi Seung Jun
Published: March 2021

Background

Fever in infants under 90 days of age is highly likely to be caused by a severe bacterial infection (SBI) and it accounts for a large number of patients visiting the pediatric emergency room. In order to predict the bacterial infection and reduce unnecessary treatment, the classic classification system is based on white blood cell (WBC) count, urinalysis, and x-ray, and it is modified and applied at each center by incorporating recently studied biomarkers such as c-reactive protein (CRP) or procalcitonin (PCT). This study analyzed the usefulness of PCT in predicting SBI when applied along with the existing classification system, including CRP, among infants less than 90 days old who visited with a fever at a single institution pediatric emergency center.

Methods

We retrospectively reviewed the medical records of patients younger than 3 months of age who presented with fever at the Seoul Asan Medical Center pediatric emergency room between July 2017 and October 2018.

Results

A total of 317 patients were analyzed, and 61 were diagnosed with SBI, among which urinary tract infection (UTI) accounted for the largest proportion (55/61, 90.2%). There were differences in WBC, neutrophil proportion, CRP, and PCT between the SBI group and the non-SBI group, and the AUC values of WBC, CRP, and PCT were 0.651, 0.804, and 0.746, respectively. When using the cut-off values of CRP and PCTs as 2.0 mg/dL and 0.3 ng/mL, respectively, the sensitivity and specificity for SBI were 49.2/89.5, and 54.1/87.5, respectively. WBC, CRP, and PCT were statistically significant for predicting SBI in multivariate analysis (odds ratios 1.066, 1.377, and 1.291, respectively). When the subjects were classified using the existing classification criteria, WBC and CRP, the positive predictive value (PPV) and negative predictive value (NPV) were 29.3 and 88.7%, respectively, and when PCT was added, the PPV and NPV were 30.7 and 92%, respectively, both increased.

Conclusion

PCT is useful for predicting SBI in children aged 3 months or less who visit the emergency room with a fever. It is useful as a single biomarker, and when used in conjunction with classic biomarkers, its diagnostic accuracy is further increased.
Escape and absconding among offenders with schizophrenia spectrum disorder – an explorative analysis of characteristics
Authors: Kirchebner Johannes , Lau Steffen , Sonnweber Martina
Published: March 2021

Background

Escape and absconding, especially in forensic settings, can have serious consequences for patients, staff and institutions. Several characteristics of affected patients could be identified so far, albeit based on heterogeneous patient populations, a limited number of possible factors and basal statistical analyses. The aim of this study was to determine the most important characteristics among a large number of possible variables and to describe the best statistical model using machine learning in a homogeneous group of offender patients with schizophrenia spectrum disorder.

Methods

A database of 370 offender patients suffering from schizophrenia spectrum disorder and 507 possible predictor variables was explored by machine learning. To counteract overfitting, the database was divided into training and validation set and a nested validation procedure was used on the training set. The best model was tested on the validation set and the most important variables were extracted.

Results

The final model resulted in a balanced accuracy of 71.1% (95% CI = [58.5, 83.1]) and an AUC of 0.75 (95% CI = [0.63, 0.87]). The variables identified as relevant and related to absconding/ escape listed from most important to least important were: more frequent forbidden intake of drugs during current hospitalization, more index offences, higher neuroleptic medication, more frequent rule breaking behavior during current hospitalization, higher PANSS Score at discharge, lower age at admission, more frequent dissocial behavior during current hospitalization, shorter time spent in current hospitalization and higher PANSS Score at admission.

Conclusions

For the first time a detailed statistical model could be built for this topic. The results indicate the presence of a particularly problematic subgroup within the group of offenders with schizophrenic spectrum disorder who also tend to escape or abscond. Early identification and tailored treatment of these patients could be of clinical benefit.
A feasibility study evaluating a reservoir storage system for continuous oxygen delivery for children with hypoxemia in Kenya
Authors: Otiangala Dickson , Agai Nicholas O. , Olayo Bernard , Adudans Steve , Ng Chin Hei , Calderon Ryan , Forgie Ella , Bachman Christine , Lieberman Daniel , Bell David , Hawkes Michael , Somoskovi Akos
Published: March 2021

Background

Supplemental oxygen is an essential treatment for childhood pneumonia but is often unavailable in low-resource settings or unreliable due to frequent and long-lasting power outages. We present a novel medium pressure reservoir (MPR) which delivers continuous oxygen to pediatric patients through power outages.

Methods

An observational case series pilot study assessing the capacity, efficacy and user appraisal of a novel MPR device for use in low-resource pediatric wards. We designed and tested a MPR in a controlled preclinical setting, established feasibility of the device in two rural Kenyan hospitals, and sought user feedback and satisfaction using a standardized questionnaire.

Results

Preclinical data showed that the MPR was capable of bridging power outages and delivering a continuous flow of oxygen to a simulated patient. The MPR was then deployed for clinical testing in nine pediatric patients at Ahero and Suba Hospitals. Power was unavailable for 2% of the total time observed due to 11 power outages (median 4.6 min, IQR 3.6–13.0 min) that occurred during treatment with the MPR. Oxygen flowrates remained constant across all 11 power outages. Feedback on the MPR was uniformly positive; all respondents indicated that the MPR was easy to use and provided clinically significant help to their patients.

Conclusion

We present a MPR oxygen delivery device that has the potential to mitigate power insecurity and improve the standard of care for hypoxemic pediatric patients in resource-limited settings.