bluuebunny/crossref_metadata_2025 huggingface dataset:
Going toe-to-toe with a rare case of a complex regional pain syndrome limited to the hallux
Authors: Wetzel-Weaver Audrey , Revaz Sylvie , Konzelmann Michel , Luthi Francois
Published: August 2021

We report the first case of a complex regional pain syndrome (CRPS) limited to the hallux using the Budapest criteria. Limited forms of CRPS are scarce in the literature and probably overlooked. There is currently no consensus to define these forms. Due to the particular metameric topography, common to the hand and the foot, we suggest the term ‘metameric’ CRPS to describe them. A uniform nomenclature would promote future research to study its prevalence and specific treatment in more detail.
Isolated torsion of a fallopian tube: an uncommon cause of abdominal pain in an 11-year-old
Authors: de Matos Victória Leones , Pessanha Inês , David Daniela Agostinho , Gante Inês
Published: August 2021

This report describes a rare case of isolated fallopian tube torsion (IFTT) in a premenarchal 11-year-old girl. The patient presented with subacute abdominal pain, associated with nausea and vomiting. Sonographic findings revealed left tube enlargement with free intraperitoneal fluid. Doppler mapping was not unequivocal. During exploratory laparoscopy, a large pelvic necrotic mass was found to be a twisted left fallopian tube. After detorsion, salpingectomy was performed and the patient recovered promptly, showing no complications 3 months post operation. IFTT should be considered as a differential diagnosis of lower abdominal pain in adolescent girls with normal-appearing ovaries on ultrasound. Conservative management for fertility preservation is the ideal approach. Therefore, avoiding delay in laparoscopy is crucial.
Staged hybrid single lumen reconstruction (TIGER) with bilateral subclavian transposition coupled with thoracic endovascular aneurysm repair in the management of acute symptomatic complex type B aortic dissection in a patient with arteria lusoria
Authors: Sultan Sherif , Acharya Yogesh , Salahat Hiba , Hynes Niamh
Published: August 2021

We present a 54-year-old Caucasian woman, who presented with acute symptomatic type B aortic dissection with deteriorating renal function. She was a known smoker with a 2-year history of dysphagia. CT angiography documented the artery of lusoria arising from the mid-thoracic aorta, aneurysmal dilation of her descending aorta, and kinetic and static flaps around her visceral ostia. The patient was managed by staged hybrid single lumenreconstruction and bilateral subclavian to carotid transpositions. During follow-up, there was no aortic rupture or retrograde type A dissection. There were no renal, visceral, cardiac, pulmonary or spinal complications. The patient went off her antihypertensive medication with a normal estimated glomerular filtration rate and accelerated aortic modulation.
Uterine leiomyosarcoma: a rare clinical entity
Authors: Dunphy Louise , Sheridan Gemma
Published: August 2021

Leiomyosarcoma is a rare aggressive malignant mesenchymal tumour, accounting for 1% of all uterine malignancies. It spreads rapidly through the intraperitoneal and haematogenous pathways. It is often diagnosed postoperatively following myomectomy, hysterectomy or supracervical hysterectomy for presumed benign disease. It has a predilection for perimenopausal women with a median age of 50 years. Individuals may describe symptoms of vaginal or abdominal pressure. Physical examination may reveal a large palpable pelvic mass, which may haemorrhage. Surgery remains the mainstay of treatment. Hysterectomy and a bilateral salpingo-oophorectomy may be considered, depending on the individual’s menopausal status. Ovarian preservation can be considered in young patients. Adjuvant systemic treatment and radiotherapy are of no benefit. Gemcitabine/docetaxel and doxorubicin have shown benefit in the treatment of advanced or recurrent disease. The authors present the case of a 44-year-old woman with lower abdominal pain, vaginal bleeding and a uterine fibroid. Laboratory investigations confirmed a leucocytosis, neutrophilia and a thrombocythaemia. Further investigation with an MRI pelvis showed a very large, heterogeneous, malignant appearing pelvic mass compressing the right ureter and it appeared uterine in nature. Her staging CT showed multiple lung metastases. The diagnosis of uterine leiomyosarcoma was subsequently established. Due to the aggressive behaviour of this sarcoma subtype, novel early detection strategies and targeted therapies are required.
High-titre convalescent plasma therapy for an immunocompromised patient with systemic lupus erythematosus with protracted SARS-CoV-2 infection
Authors: Moutinho-Pereira Sara , Calisto Raquel , Sabio Federico , Guerreiro Luísa
Published: August 2021

A 39-year-old woman with systemic lupus erythematosus treated with anti-CD20 monoclonal antibody rituximab was admitted to our hospital with COVID-19 pneumonia. Despite receiving dexamethasone, she developed hypoxaemia and persistent lung opacities. As bronchoalveolar lavage was suggestive of cryptogenic organising pneumonia, high-dose corticosteroid was administered, and she received antimicrobial therapy for opportunistic infections without improvement. Reverse transcription PCR was repeatedly positive for SARS-CoV-2, and virus replication was confirmed in cell cultures. As no anti-SARS-CoV-2 antibodies were detected more than 100 days after symptom onset, she was treated with convalescent plasma with fast clinical improvement, returning home days later. Our case shows that persistent SARS-CoV-2 infection in an immunocompromised patient may be overturned with the appropriate treatment.
Haemophilus parainfluenzaeendocarditis presenting with symptoms of COVID-19
Authors: Finch Laurie C , Gerdzhikov Spiro , Buttery Robert
Published: August 2021

A young man presented early in the UK’s second COVID-19 pandemic surge with a twelve-day history of fever, dry cough, breathlessness, myalgia and loss of smell and taste. His chest X-ray showed bilateral ground-glass opacities. He was treated for COVID-19 pneumonitis but covered for bacterial infection with antibiotics. He developed shock and respiratory failure, requiring vasopressors and continuous positive airway pressure. He improved but experienced transient visual disturbances and headache. Nasopharyngeal swabs and antibody tests for COVID-19 were negative. Blood cultures grewHaemophilus parainfluenzae. A new murmur prompted an echocardiogram. This confirmed a large, mobile mitral valve vegetation. An MRI of the brain showed bilateral embolic infarcts. He underwent urgent mitral valve repair and made an excellent recovery. Whether COVID-19 caused his presenting symptoms or facilitated the bacteraemia remains unclear. It seems more likely that infective endocarditis masqueraded as COVID-19. Clinicians should be aware of how context of the pandemic can bias diagnostic reasoning.
Fatty liver index and progression to type 2 diabetes: a 5-year longitudinal study in Spanish workers with pre-diabetes
Authors: Busquets-Cortés Carla , Bennasar-Veny Miquel , López-González Angel-Arturo , Fresneda Sergio , Aguiló Antoni , Yanez Aina
Published: August 2021

Objective

The main aim of the study was to evaluate the association between non-alcoholic fatty liver disease (NAFLD), estimated by fatty liver index (FLI), and the development of type 2 diabetes (T2D) in a large cohort of adult workers with pre-diabetes.

Design

Prospective cohort study.

Setting

Occupational health services from Spain.

Participants

16 648 adult workers (aged 20–65 years) with pre-diabetes (fasting plasma glucose (FPG) of 100–125 mg/dL).

Outcome and measures

FLI was calculated based on measurements of triglycerides, body mass index, waist circumference and γ-glutamyltransferase. The population was classified into three categories: FLI<30 (no hepatic steatosis), FLI 30–60 (intermediate status) and FLI>60 (hepatic steatosis). Sociodemographic, anthropometric, dietary habits, physical activity and clinical data were collected from all subjects. The incidence rate of T2D was determined after 5 years of follow-up.

Results

After 5 years of follow-up, 3706 of the 16 648 participants (22.2%) were diagnosed with T2D, corresponding to an annual rate of progression of 4.5%. FLI was strongly associated with T2D conversion. The incidence rates of T2D in the FLI<30, FLI 30–60 and FLI>60 groups were significantly different after 5 years of follow-up were 19/6,421 (0.3%), 338/4,318 (7.8%) and 3,349/5,909 (56.7%), respectively. This association remained significant for FLI>60 after adjustment for, age, diet, physical activity, FPG, blood pressure, social class and smoking habits (adjusted HR=6.879; 95% CI 5.873 to 8.057 for men, and HR=5.806; 95% CI 4.863 to 6.932 for women).

Conclusion

NAFLD assessed by FLI independently predicted the risk of conversion to T2D among people with pre-diabetes. FLI may be an easily determined and valuable early predictor for T2D in people with pre-diabetes. FLI-based assessment of NAFLD in subjects with pre-diabetes in routine clinical practice could allow the adoption of effective measures to prevent and reduce their progression to T2D.
Development and validation of a life expectancy estimator for multimorbid older adults: a cohort study protocol
Authors: Gastens Viktoria , Del Giovane Cinzia , Anker Daniela , Feller Martin , Syrogiannouli Lamprini , Schwab Nathalie , Bauer Douglas C , Rodondi Nicolas , Chiolero Arnaud
Published: August 2021

Background

Older multimorbid adults have a high risk of mortality and a short life expectancy (LE). Providing high-value care and avoiding care overuse, including of preventive care, is a serious challenge among multimorbid patients. While guidelines recommend to tailor preventive care according to the estimated LE, there is no tool to estimate LE in this specific population. Our objective is therefore to develop an LE estimator for older multimorbid adults by transforming a mortality prognostic index, which will be developed and internally validated in a prospective cohort.

Methods and analysis

We will analyse data of the Optimising Therapy to Prevent Avoidable Hospital Admissions in Multimorbid Older People cohort study in Bern, Switzerland. 822 participants were included at hospitalisation with age of 70 years or older, multimorbidity (three or more chronic medical conditions) and polypharmacy (use of five drugs or more for>30 days). All-cause mortality will be assessed during 3 years of follow-up. We will apply a flexible parametric survival model with backward stepwise selection to identify the mortality risk predictors. The model will be internally validated using bootstrapping techniques. We will derive a point-based risk score from the regression coefficients. We will transform the 3-year mortality prognostic index into an LE estimator using the Gompertz survival function. We will perform a qualitative assessment of the clinical usability of the LE estimator and its application. We will conduct the development and validation of the mortality prognostic index following the Prognosis Research Strategy (PROGRESS) framework and report it following the Transparent Reporting of a Multivariable Prediction Model for Individual Prognosis or Diagnosis (TRIPOD) statement.

Ethics and dissemination

Written informed consent by patients themselves or, in the case of cognitive impairment, by a legal representative, was required before enrolment. The local ethics committee (Kantonale Ethikkommission Bern) has approved the study. We plan to publish the results in peer-reviewed journals and present them at national and international conferences.
eHBB: a randomised controlled trial of virtual reality or video for neonatal resuscitation refresher training in healthcare workers in resource-scarce settings
Authors: Umoren Rachel , Bucher Sherri , Hippe Daniel S , Ezenwa Beatrice Nkolika , Fajolu Iretiola Bamikeolu , Okwako Felicitas M , Feltner John , Nafula Mary , Musale Annet , Olawuyi Olubukola A , Adeboboye Christianah O , Asangansi Ime , Paton Chris , Purkayastha Saptarshi , Ezeaka Chinyere Veronica , Esamai Fabian
Published: August 2021

Objective

To assess the impact of mobile virtual reality (VR) simulations using electronic Helping Babies Breathe (eHBB) or video for the maintenance of neonatal resuscitation skills in healthcare workers in resource-scarce settings.

Design

Randomised controlled trial with 6-month follow-up (2018–2020).

Setting

Secondary and tertiary healthcare facilities.

Participants

274 nurses and midwives assigned to labour and delivery, operating room and newborn care units were recruited from 20 healthcare facilities in Nigeria and Kenya and randomised to one of three groups: VR (eHBB+digital guide), video (video+digital guide) or control (digital guide only) groups before an in-person HBB course.

Intervention(s)

eHBB VR simulation or neonatal resuscitation video.

Main outcome(s)

Healthcare worker neonatal resuscitation skills using standardised checklists in a simulated setting at 1 month, 3 months and 6 months.

Results

Neonatal resuscitation skills pass rates were similar among the groups at 6-month follow-up for bag-and-mask ventilation (BMV) skills check (VR 28%, video 25%, control 22%, p=0.71), objective structured clinical examination (OSCE) A (VR 76%, video 76%, control 72%, p=0.78) and OSCE B (VR 62%, video 60%, control 49%, p=0.18). Relative to the immediate postcourse assessments, there was greater retention of BMV skills at 6 months in the VR group (−15% VR, p=0.10; −21% video, p<0.01, –27% control, p=0.001). OSCE B pass rates in the VR group were numerically higher at 3 months (+4%, p=0.64) and 6 months (+3%, p=0.74) and lower in the video (−21% at 3 months, p<0.001; −14% at 6 months, p=0.066) and control groups (−7% at 3 months, p=0.43; −14% at 6 months, p=0.10). On follow-up survey, 95% (n=65) of respondents in the VR group and 98% (n=82) in the video group would use their assigned intervention again.

Conclusion

eHBB VR training was highly acceptable to healthcare workers in low-income to middle-income countries and may provide additional support for neonatal resuscitation skills retention compared with other digital interventions.
Analysis of high-intensity care in intensive care units and its cost at the end of life among older people in South Korea between 2016 and 2019: a cross-sectional study of the health insurance review and assessment service national patient sample database
Authors: Lee Yunji , Jo Minjeong , Kim Taehwa , Yun Kyoungsun
Published: August 2021

Objectives

To provide useful information for clinicians and policy makers to prepare guidelines for adequate use of medical resources during end-of-life period by analysing the intensive care use and related costs at the end of life in South Korea.

Design

Cross-sectional, retrospective, observational study.

Setting

Tertiary hospitals in South Korea.

Participants

We analysed claim data and patient information from the Health Insurance Review and Assessment Service national dataset. This dataset included 19 119 older adults aged 65 years or above who received high-intensity care at least once and died in the intensive care unit in South Korea between 2016 and 2019. High-intensity care was defined as one of the following treatments or procedures: cardiopulmonary resuscitation, mechanical ventilation, extra-corporeal membrane oxygenation, haemodialysis, transfusion, chemotherapy and vasopressors.

Primary and secondary outcome measures

Usage and cost of high-intensity care.

Results

The most commonly used high-intensity care was transfusion (68.9%), mechanical ventilation (50.6%) and haemodialysis (35.7%) during the study period. The annual cost of high-intensity care at the end of life increased steadily from 2016 to 2019. There existed differences by age, gender, length of hospital stays and primary cause of death in use of high-intensity care and associated costs.

Conclusion

Findings indicate that invasive and device-dependent high-intensity care is frequently provided at the end of life among older adults, which could potentially place an economic burden on patients and their families. In Korea’s ageing society, increased rates of chronic illness are expected to significantly burden those who lack the financial resources to provide end-of-life care. Therefore, guidelines for the use of high-intensity care are required to ensure affordable end-of-life care.
Factors influencing the effectiveness of remote patient monitoring interventions: a realist review
Authors: Thomas Emma E , Taylor Monica L , Banbury Annie , Snoswell Centaine L , Haydon Helen M , Gallegos Rejas Victor M , Smith Anthony C , Caffery Liam J
Published: August 2021

Objectives

Our recent systematic review determined that remote patient monitoring (RPM) interventions can reduce acute care use. However, effectiveness varied within and between populations. Clinicians, researchers, and policymakers require more than evidence of effect; they need guidance on how best to design and implement RPM interventions. Therefore, this study aimed to explore these results further to (1) identify factors of RPM interventions that relate to increased and decreased acute care use and (2) develop recommendations for future RPM interventions.

Design

Realist review—a qualitative systematic review method which aims to identify and explain why intervention results vary in different situations. We analysed secondarily 91 studies included in our previous systematic review that reported on RPM interventions and the impact on acute care use. Online databases PubMed, EMBASE and CINAHL were searched in October 2020. Included studies were published in English during 2015–2020 and used RPM to monitor an individual’s biometric data (eg, heart rate, blood pressure) from a distance.

Primary and secondary outcome measures

Contextual factors and potential mechanisms that led to variation in acute care use (hospitalisations, length of stay or emergency department presentations).

Results

Across a range of RPM interventions 31 factors emerged that impact the effectiveness of RPM innovations on acute care use. These were synthesised into six theories of intervention success: (1) targeting populations at high risk; (2) accurately detecting a decline in health; (3) providing responsive and timely care; (4) personalising care; (5) enhancing self-management, and (6) ensuring collaborative and coordinated care.

Conclusion

While RPM interventions are complex, if they are designed with patients, providers and the implementation setting in mind and incorporate the key variables identified within this review, it is more likely that they will be effective at reducing acute hospital events.

PROSPERO registration number

CRD42020142523.
Study on acupuncture in the treatment of painful diabetic peripheral neuropathy based on rs-fMRI: a protocol for systematic review and meta-analysis
Authors: Li Mengyuan , Yao Lin , Huang Haipeng , Zheng Haizhu , Cao Jiazhen , Wang Guan , Liu Yanze , Wang Hongfeng
Published: August 2021

Introduction

Studies have shown that acupuncture has significant therapeutic effects on painful diabetic peripheral neuropathy (PDPN) yet the precise mechanism of action underpinning these effects remains controversial. Resting-state functional MRI (rs-fMRI) is an advanced imaging technique that can be used to monitor changes in the activity of the brain, particularly in PDPN. However, the data from several studies remain inconclusive and there is currently no systematic review and meta-analysis for the use of rs-fMRI in PDPN.

Methods and analysis

In this study, we will select all eligible studies published on or before 30 June 2021. Four English and four Chinese databases will be searched, specifically, PubMed, Embase, Web of Science, Cochrane Library, China National Knowledge Infrastructure, WanFang database, China Science Technology Journal Database (VIP) and China Doctor/Master Dissertations Full-text Database. Only clinical trials and the first cycle of a cross-over trial linked to acupuncture for PDPN will be included in the analysis. The main outcomes include the amplitude of low-frequency fluctuation, regional homogeneity, functional connectivity of the brain, bilateral superficial peroneal nerve sensory nerve conduction velocity, bilateral dorsal current perception threshold values and the degree of subjective pain. The secondary outcomes include biochemical indicators, the degree of depression and anxiety and changes in efficiency. The study selection, data extraction and risk of bias assessment will be performed by two investigators. For statistical analyses, Review Manager V.5.4 software will be used. If necessary, heterogeneity testing, data synthesis, and subgroup analysis will be performed.

Ethics and dissemination

Our systematic review and meta-analysis will be based on published literature for data extraction and will not include the use of individual patient data and so no ethical approval required.

PROSPERO registration number

CRD42021211644.
Improving physician compliance with mammography screening by implementing a breast cancer screening guideline at a hospital in Bahrain
Authors: Abou leila Rabih Mustapha , Shannon Michael , El-Nigoumi Sarah El-Nassir
Published: August 2021

Background

From a health and safety perspective, it is critical to use adequate, evidence-based breast screening guidelines. The aim of this quality improvement project was to improve physicians’ compliance with breast cancer screening guidelines to enhance the mammography screening rate among eligible women; this was achieved through the implementation of multifaceted changes to the hospital’s processes and the improvement of physicians’ attitudes towards the guidelines.

Methods

The project used the Plan-Do-Study-Act method to implement the changes. This was a pre-post evaluation study. The data were collected from patients’ charts. The primary outcome of interest was the rate of physician compliance with mammography screening guidelines before and after the implementation of the process changes. A literature review was conducted to determine which women should be identified as eligible for mammography screening.

Intervention

The interventions targeted physician knowledge and hospital processes. Improving doctors’ expertise was achieved by implementing the US Preventive Service Task Force recommendation for mammography screening every 2 years for women aged 50–74 years. The process modifications included the establishment of a system that would be effective in identifying at-risk patients and reminding physicians at the point of care.

Results

Over the course of this study, 825 patients met the criteria for breast cancer screening. The rate of physician compliance with the breast cancer screening guideline increased from 2% to 69% after 23 weeks, and the control charts demonstrated a reliable process.

Conclusion

This project examined the relationship between different interventions (identification of the eligible patient, reminder alerts and physician knowledge) and physician compliance with mammography screening guidelines. The results suggest a positive link between the study variables and physicians’ compliance with mammography screening guidelines.
Impact evaluation of immunisation service integration to nutrition programmes and paediatric outpatient departments of primary healthcare centres in Rumbek East and Rumbek Centre counties of South Sudan
Authors: Idris Israel Oluwaseyidayo , Obwoya Justin Geno , Tapkigen Janet , Lamidi Serifu Ayobami , Ochagu Victor A , Abbas Kaja
Published: August 2021

Objective

To evaluate the impact of immunisation service integration to nutrition programmes and under 5-year-old paediatric outpatient departments of primary healthcare centres in Rumbek East and Rumbek Centre counties of South Sudan.

Design

Retrospective intervention study.

Setting

Three primary healthcare centres in Rumbek East county and three primary healthcare centres in Rumbek Centre county of Lakes state in South Sudan.

Participant

We extracted the data for the uptake of pentavalent vaccine (first, second and third dose) given to children aged between 6 weeks and 23 months from immunisation records for January–June 2019 before immunisation service integration and July–December 2019 after immunisation service integration from the District Health Information System 2 website to estimate the immunisation uptake ratios and drop-out rates.

Results

The uptake of the first dose of the pentavalent vaccine improved from 61% to 96% (p<0.001) after immunisation service integration into the nutrition programmes of the primary healthcare centres in Rumbek Centre county. The uptake of the second pentavalent dose improved from 37% to 69% (p<0.001) and for the third pentavalent dose from 36% to 62% (p<0.001), while the drop-out rate reduced from 57% to 40% (p<0.001). While in Rumbek East county, the uptake of the first dose of the pentavalent vaccine improved from 55% to 77% (p<0.001) after immunisation service integration into the under 5-year-old paediatric outpatient departments. The uptake of the second dose improved from 36% to 62% (p<0.001) and for the third dose from 44% to 63% (p<0.001), while the drop-out rate reduced from 40% to 28% (p<0.001). Children were 23% more likely (RR 1.23, 95% CI 1.12 to 1.36, p<0.001) to be immunised with the first dose of the pentavalent vaccine on immunisation service integration into the nutrition programmes of primary healthcare centres of Rumbek Centre county in comparison to integration into under 5-year-old outpatient departments of Rumbek East county.

Conclusion

Integration of immunisation service delivery to nutrition sites and children’s outpatient departments improved the immunisation coverage and decreased drop-out rates in the Rumbek East and Rumbek Centre counties of South Sudan. This evidence of positive impact should encourage the stakeholders of the Expanded Programme on Immunisation to focus on the sustainability and scale-up of this intervention to other counties in South Sudan, as logistically as possible.
NK cells enhance CAR-T cell antitumor efficacy by enhancing immune/tumor cells cluster formation and improving CAR-T cell fitness
Authors: Bachiller Mireia , Perez-Amill Lorena , Battram Anthony Matthew , Carné Sebastian Ciro , Najjar Amer , Verhoeyen Els , Juan Manel , Urbano-Ispizua Alvaro , Martin-Antonio Beatriz
Published: August 2021

Background

Chimeric antigen receptor (CAR)-T cell immunotherapy has modified the concept of treatment in hematological malignancies. In comparison with pediatric patients, where responses are maintained over many years, older patients, such as those with non-Hodgkin’s lymphoma (NHL) and multiple myeloma (MM), present lower persistence of CAR-T cells that might be due to decreased fitness of T cells acquired with aging. Moreover, cord blood derived-NK cells (CB-NKs) and CAR-NK cells derived from CB-NK can be used ‘off-the-shelf’ as immune cells with antitumor properties for the treatment of cancer patients. However, to date, clinical studies have only demonstrated the safety of these therapies but not optimal efficacy. To confront the shortcomings of each therapy, we devised a novel approach consisting of simultaneous (CAR-)NK cell and CAR-T cell administration. In this setting, NK cells demonstrate an important immunoregulation of T cells that could be exploited to enhance the efficacy of CAR-T cells.

Methods

A combinatorial treatment based on either CAR-T and CAR-NK cells or CB-NK and CAR-T cells in two models of NHL and MM was performed. Antitumor efficacy was analyzed in vitro and in vivo, and parameters related to early activation, exhaustion and senescence of T cells were analyzed.

Results

We show that CAR-NK cells derived from CB-NK are only effective at high doses (high E:T ratio) and that their activity rapidly decreases over time in comparison with CAR-T cells. In comparison and to exploit the potential of ‘off-the-shelf’ CB-NK, we demonstrate that a low number of CB-NK in the CAR-T cell product promotes an early activation of CAR-T cells and their migration to MM cells leading to enhanced anti-MM efficacy. Moreover, cytokines related to CRS development were not increased, and importantly, CB-NK enhanced the fitness of both CARposand CARnegT cells, promoting lower levels of exhaustion and senescence.

Conclusion

This study demonstrates a relevant immunoregulatory role of CB-NK collaborating with CAR-T cells to enhance their antitumor activity. A novel and different approach to consider in CAR-T cell immunotherapy studies is presented here with the goal to enhance the efficacy of the treatment.
Comorbidity and healthcare utilisation in persons with incident systemic lupus erythematosus followed for 3 years after diagnosis: analysis of a claims data cohort
Authors: Albrecht Katinka , Redeker Imke , Aringer Martin , Marschall Ursula , Strangfeld Anja , Callhoff Johanna
Published: August 2021

Objective

To analyse comorbidity and healthcare utilisation in individuals with SLE.

Methods

A cohort of individuals with incident SLE diagnosis in 2016 were investigated using claims data from a German statutory health insurance fund. Concomitant diagnoses, medical prescriptions, hospitalisation and sick leave were analysed in the year prior to diagnosis and during a 3-year follow-up in comparison with age-matched and sex-matched controls (1) without autoimmune diseases and (2) with incident diabetes mellitus. Sensitivity analyses were performed excluding cases with additional autoimmune diagnoses and without prescription of antimalarials.

Results

Among 571 individuals with SLE, hypertension (48%), depression (30%), hyperlipidaemia (25%), osteoarthritis (25%) and osteoporosis (20%) were the most frequent comorbidities in 2016. Cerebrovascular disease was documented in 9.6%. The number of drugs (mean 9.6, ∆+6.2), hospitalisation (40%, ∆+27%) and days on sick leave (median 46 days, ∆+27 days) increased significantly in the first year with SLE diagnosis. Individuals with SLE were more frequently hospitalised and had more medications compared with both control groups (all p<0.001). The increase in comorbidity diagnoses was low in controls without autoimmune diseases, while controls with diabetes showed a more pronounced increase in cardiovascular risk factors, but less in osteoporosis and cerebrovascular disease. Sensitivity analyses showed comparable results.

Conclusion

Comorbidities are frequently detected at the time of diagnosis of SLE. High numbers of drug prescriptions and hospitalisation following SLE diagnosis reflect the comprehensive disease burden. The comparison with incident diabetes shows that differences with controls without autoimmune disease are overestimated by detection bias.
Complexity of virtual multistrings
Authors: Freund David
Published: August 2021

A virtual [Formula: see text]-string [Formula: see text] consists of a closed, oriented surface [Formula: see text] and a collection [Formula: see text] of [Formula: see text] oriented, closed curves immersed in [Formula: see text]. We consider virtual [Formula: see text]-strings up to virtual homotopy, i.e. stabilizations, destabilizations, stable homeomorphism, and homotopy.

Recently, Cahn proved that any virtual [Formula: see text]-string can be virtually homotoped to a minimally filling and crossing-minimal representative by monotonically decreasing both genus and the number of self-intersections. We generalize her result to the case of non-parallel virtual [Formula: see text]-strings.

Cahn also proved that any two crossing-irreducible representatives of a virtual [Formula: see text]-string are related by isotopy, Type 3 moves, stabilizations, destabilizations, and stable homeomorphism. Kadokami claimed that this held for virtual [Formula: see text]-strings in general, but Gibson found a counterexample for [Formula: see text]-strings. We show that Kadokami’s statement holds for non-parallel [Formula: see text]-strings and exhibit a counterexample for general virtual [Formula: see text]-strings.
Mathematical analysis and optimal control for Chikungunya virus with two routes of infection with nonlinear incidence rate
Authors: El Hajji Miled , Zaghdani Abdelhamid , Sayari Sayed
Published: August 2021

Chikungunya fever, caused by Chikungunya virus (CHIKV) and transmitted to humans by infected Aedes mosquitoes, has posed a global threat in several countries. In this paper, we investigated a modified within-host Chikungunya virus (CHIKV) infection model with antibodies where two routes of infection are considered. In a first step, the basic reproduction number [Formula: see text] was calculated and the local and global stability analysis of the steady states is carried out using the local linearization and the Lyapunov method. It is proven that the CHIKV-free steady-state [Formula: see text] is globally asymptotically stable when [Formula: see text], and the infected steady-state [Formula: see text] is globally asymptotically stable when [Formula: see text]. In a second step, we applied an optimal strategy in order to optimize the infected compartment and to maximize the uninfected one. For this, we formulated a nonlinear optimal control problem. Existence of the optimal solution was discussed and characterized using some adjoint variables. Thus, an algorithm based on competitive Gauss–Seidel-like implicit difference method was applied in order to resolve the optimality system. The theoretical results are confirmed by some numerical simulations.
Nutrition as Fuel for Human Spaceflight
Authors: Smith Scott M. , Zwart Sara R.
Published: August 2021

History books are rife with examples of the role of nutrition in determining either the success or the failure of human exploration on Earth. With planetary exploration in our future, it is imperative that we understand the role of nutrition in optimizing health before humans can safely take the next giant leaps in space exploration.
Inhibiting PP2Acα Promotes the Malignant Phenotype of Gastric Cancer Cells through the ATM/METTL3 Axis
Authors: Cheng Zhaoxiang , Gao Shan , Liang Xiaojie , Lian Chao , Chen Jianquan , Fang Chao
Published: August 2021

This article is aimed at exploring the relationship between the phosphatase 2A catalytic subunit Cα (PP2Acα, encoded by PPP2CA) and methyltransferase‐like 3 (METTL3) in the malignant progression of gastric cancer (GC). Through analyzing the bioinformatics database and clinical tissue immunohistochemistry results, we found that abnormal PP2Acα and METTL3 levels were closely related to the malignant progression of GC. To explore the internal connection between PP2Acα and METTL3 in the progression of GC, we carried out cellular and molecular experiments and finally proved that PP2Acα inhibition can upregulate METTL3 levels by activating ATM activity, thereby promoting the malignant progression of GC.
A Case of Torsion in an Otherwise-Normal Ovary with a Giant Hematosalpinx Larger than Enlarged Ovary: Utilization of Diagnostic Laparoscopy for the Accurate Diagnosis
Authors: Yu Sae , Yamanoi Koji , Sunada Masumi , Kitamura Sachiko , Horikawa Naoki , Chigusa Yoshitsugu , Yamaguchi Ken , Horie Akihito , Hamanishi Junzo , Kondoh Eiji , Mandai Masaki
Published: August 2021

We report a case of torsion in an otherwise-normal ovary with a giant hematosalpinx. A 23-year-old woman presented with complaints of abdominal pain and nausea. At initial visit, there was few abnormal findings of imaging tests, and we made a diagnosis of ovarian hemorrhage. Three days later, she came back with increased symptoms, and we detected the mass of a complex solid cystic structure with a unilocular cyst much larger than solid component. A diagnostic laparoscopy was performed immediately, and we could make a diagnosis of torsion in an otherwise-normal ovary with a giant hematosalpinx. We performed a salpingectomy and could preserve her ovary. This is the first case of torsion in an otherwise-normal ovary with a giant hematosalpinx which enlarged to a greater extent than the ovary.
Passive Fetal Movement Signal Detection System Based on Intelligent Sensing Technology
Authors: Liang Sensong , Peng Jiansheng , Xu Yong
Published: August 2021

Fetal movement (FM) is an essential physiological parameter to determine the health status of the fetus. To address the problems of harrowing FM signal extraction and the low recognition rate of traditional machine learning classifiers in FM signal detection, this paper develops a passive FM signal detection system based on intelligent sensing technology. FM signals are obtained from the abdomen of the pregnant woman by using accelerometers. The FM signals are extracted and identified according to the clinical nature of the features hidden in the amplitude and waveform of the FM signals that fluctuate in duration. The system consists of four main stages: (i) FM signal preprocessing, (ii) maternal artifact signal preidentification, (iii) FM signal identification, and (iv) FM classification. Firstly, Kalman filtering is used to reconstruct the FM signal in a continuous low-amplitude noise background. Secondly, the maternal artifact signal is identified using an amplitude threshold algorithm. Then, an innovative dictionary learning algorithm is used to construct a dictionary of FM features, and orthogonal matching pursuit and adaptive filtering algorithms are used to identify the FM signals, respectively. Finally, mask fusion classification is performed based on the multiaxis recognition results. Experiments are conducted to evaluate the performance of the proposed FM detection system using publicly available and self-built accelerated FM datasets. The classification results showed that the orthogonal matching pursuit algorithm was more effective than the adaptive filtering algorithm in identifying FM signals, with a positive prediction value of 89.74%. The proposed FM detection system has great potential and promise for wearable FM health monitoring.
A Noninterference Model for Mobile OS Information Flow Control and Its Policy Verification
Authors: Yuan Zhanhui , Li Wenfa , Yang Zhi , Sun Lei , Du Xuehui , Zhang Hongqi
Published: August 2021

Mobile operating systems such as Android are facing serious security risk. First, they have a large number of users and store a large number of users’ private data, which have become major targets of network attack; second, their openness leads to high security risks; third, their coarse-grained static permission control mechanism leads to a large number of privacy leaks. Recent decentralized information flow control (DIFC) operating systems such as Asbestos, HiStar, and Flume dynamically adjust the label of each process. Asbestos contains inherent covert channels due to this implicit label adjustment. The others close these covert channels through the use of explicit label change, but this impedes communication and increases performance overhead. We present an enhanced implicit label change model (EILCM) for mobile operating systems that can close the known covert channel in these models with implicit label change and supports dynamic constraints on tags for separation of duty. We also formally analyze the reasons why EILCM can close the known covert channels and prove that abstract EILCM systems have the security property of noninterference with declassification by virtue of the model checker tool FDR. We also prove that the problem of EILCM policy verification is NP-complete and propose a backtrack-based search algorithm to solve the problem. Experiments are presented to show that the algorithm is effective.
Calculation and Analysis of Aircraft Pollutant Emission Based on Time Wake Separation Mode under Coastal Airport and Headwind Conditions
Authors: Wei-Jun Pan , Heng-Heng Zhang , Xiao-Lei Zhang , Tian-Yi Wu
Published: August 2021

During the final approach, the headwind leads to a reduction of landing rate, which affects the achieved capacity and the predictability of operation, time, fuel efficiency, and environmental pollution. Under headwind conditions, ground speed decrease results in increased flight time. Time-based separation (TBS) changes the separation rule of the final approach, which changes the distance separation between two aircrafts into a time separation. This paper introduces the time-based separation (TBS) based on the distance-based separation (DBS). According to the aircraft landing schedule of each airport, the ICAO (International Civil Aviation Organization) aircraft engine emission database, Boeing Fuel Flow Method 2 (BFFM2), and meteorological data of Pu-dong airport, this study uses the modified P3-T3 aviation pollutant emission model to calculate, respectively, the fuel consumption and pollutant emissions based on distance separation mode and time separation mode. According to the calculation results, TBS operation mode can save 32.52%, 19.12%, and 30.41% fuel, reduce 28.93%, 17.9%, and 29.29% CO, 31.02%, 19.36%, and 33.78% HC, 30.85%, 16.42%, and 28.67% NOx, respectively, compared with the DBS operation mode at three stages of the day. It ends that TBS has an obvious optimization effect on fuel consumption and pollutant emission compared with DBS from data.
Research on the Dependence Structure and Risk Spillover of Internet Money Funds Based on C‐Vine Copula and Time‐Varying t‐Copula
Authors: Ma Huizi , Lin Lin , Sun Han , Qu Yue
Published: August 2021

Internet money funds (IMFs) are the most widely involved products in the Internet financial products market. This research utilized the C‐vine copula model to study the risk dependence structure of IMFs and then introduces the time‐varying t‐copula model to analyze the risk spillover of diverse IMFs. The results show the following: (1) The risks of Internet‐based IMFs, bank‐based IMFs, and fund‐based IMFs have obvious dependence structure, and the degree of risk dependence among different categories of IMFs is significantly different. (2) There are risk spillover effects among diverse IMFs, and their risk dependence relationship is characterized by cyclical feature. (3) The risk spillover effect among diverse IMFs is pronounced, and dynamic risk dependence between IMFs is characterized by synchronization.
Application of Mobile Big Data and Artificial Intelligence in the Efficiency of E-Commerce Industry
Authors: Cui Hongkai , Xiao Lina , Zhang Xiaheng
Published: August 2021

In recent years, with the rapid development of network technology and mobile clients, the upsurge of online shopping users has been accelerated. The development of e-commerce has become a key factor affecting the economy. At the same time, in the process of online shopping, users produce a large number of user access data and transaction data, which seem messy but contain huge commercial value. E-commerce urgently needs to mine its own data information and related data so as to obtain competitive advantage. Web data mining technology has become the focus of research in universities and enterprises. This paper summarizes these two methods and explains their advantages and disadvantages, respectively. Next, based on the advantages and disadvantages of model control and logic analysis, a logic analysis method based on model control is proposed. A formal analysis method combining finite machine and logic is proposed. This new method can analyze the responsibility, fairness, and timeliness of e-commerce protocol, provide a state transition diagram describing the working principle of the protocol, and fully analyze the responsibilities of all parties when repeated attacks occur. Experiments show that the efficiency of e-commerce is improved by 30%. As mentioned above, this paper hopes to play a certain role in the development of e-commerce. This paper summarizes the time series of e-commerce data, sales changes, and the sensitivity of consumer goods, which is conducive to the prediction and evaluation of the market, seize the market trend, and provide better decision-making.
Rigidity of Complete Gradient Shrinkers with Pointwise Pinching Riemannian Curvature
Authors: Chu Yawei , Li Dehe , Zhou Jundong
Published: August 2021

Let

M

n

,
g
,
f

be a complete gradient shrinking Ricci soliton of dimension

n
≥
3

. In this paper, we study the rigidity of

M

n

,
g
,
f

with pointwise pinching curvature and obtain some rigidity results. In particular, we prove that every

n

-dimensional gradient shrinking Ricci soliton

M

n

,
g
,
f

is isometric to

ℝ

n

or a finite quotient of

S

n

under some pointwise pinching curvature condition. The arguments mainly rely on algebraic curvature estimates and several analysis tools on

M

n

,
g
,
f

, such as the property of

f

-parabolic and a Liouville type theorem.
Based on the Beers Criteria 2019 Edition Over‐the‐Counter Drugs Risk Confirmation of Elderly Chinese
Authors: Yang Yongyu , Zhang Lu , Huang Yamin , Huang Hangxing , Sun Shusen , Xiao Jian
Published: August 2021

Objective. To explore OTC (over‐the‐counter drugs) in Chinese community pharmacies often causes ADE (adverse drug event) in elderly patients. Methods. Use the drugs in the Beers Criteria 2019 potentially inappropriate medication use (PIM) list as search terms. Search for drugs registered on the National Medical Products Administration of China website before December 2019 to determine the drugs containing PIM active ingredients and, then, search the Chinese OTC selection and conversion catalog database to determine it as OTC. Two databases are considered to be the same drug if they have the same drug composition. Results. The incidence of PIM in elderly patients in our community is relatively high, and the management of OTC may be related to risk factors. Statistics found that 71 OTC contained the Beers Criteria ingredients, including 65 chemicals and six Chinese patent medicines. Varieties of compound preparations accounted for 78.9% and cold medicines accounted for 47.9%. Conclusions. The high detection rate of the Beers Criteria in Chinese OTC suggests that medical practitioners in China, especially community pharmacists, should pay attention to the rational use of OTC in the elderly.
Evaluation of Time Consumption for Debonding Brackets Using Different Techniques: A Hospital-Based Study
Authors: Bora Neelutpal , Mahanta Putul , Konwar Ranjumoni , Basumatari Bharati , Phukan Chiranjita , Kalita Deepjyoti , Gojendra Singh Senjam , Deka Sangeeta
Published: August 2021

Background and Objectives. The debonding procedures of brackets in orthodontics cause a different amount of time loss and enamel damage. The current research assesses and equates the time consumption for bracket debonding using four different techniques. Materials and Methods. A total of 80 human premolars were included in this study. The samples were first arranged following a standard protocol for bracketing and then debonded using the ultrasonic scaler (US), debonding plier (DP), ligature cutter (LC), and thermal method (TM). Depending on the technique applied for debonding, the specimens were randomly divided into four groups with 20 samples, each keeping a 1 : 1 ratio. During the debonding process, the time taken for each bracket removal was recorded using a stopwatch. To assess the difference in mean time required for debonding among the four techniques, one-way ANOVA test was applied along with Tukey’s HSD to compare the two methods. Results. The time range and the mean time required for the four techniques analyzed show that the DP method has the highest range of time needed for debonding with 0.97–2.56 seconds, while LC methods have the least time range taking 0.46 to 1.79 seconds. TM’s mean time to debond is the highest at 1.5880 seconds. LC method has the lowest mean debonding time of 0.9880 seconds. The one-way ANOVA test has shown the mean debonding time required by the four techniques to be significantly different (

p
<
0.001

). Tukey’s HSD multiple comparisons also show that the mean time to debond using the LC method is substantially less than the other three methods (

p
<
0.001

). Conclusion. The mean debonding time for the TM was substantially the highest, followed by the US and DP. Debonding with the LC technique required the least time. This study shows some limelight towards the effectiveness of the LC method as it is the least time-consuming technique.