bluuebunny/crossref_metadata_2025 huggingface dataset:
Capparis danielii (Capparaceae), a new species from the Gulf of Mannar Biosphere Reserve, India

Authors: MURUGAN C. , MANIKANDAN R. , NITHYA S.P. , KARTHIK B. , ARISDASON W.
Published: November 2020

A new species, Capparis danielii (Capparaceae), is described from the Gulf of Mannar Biosphere Reserve, Tamil Nadu, India. This new species was found in the coastal dry evergreen scrubs, and only three individuals were recorded from the type locality. It is very closely allied to C. brevispina and C. divaricata but can easily be distinguished from them by its glaucous branchlets, ovate-obovate leaves, short gynophore, oblong, 4-angular, pubescent ovary and usually longitudinally 4-ribbed, or rarely 6-ribbed berry. Detailed description, illustration, colour photographs, flowering and fruiting period and habitat ecology of the new species are provided.
Two new synonyms of Clematis hastata (Ranunculaceae), a species from the Daba mountains region in central China

Authors: YUAN QIONG , YANG QIN-ER
Published: November 2020

Based on the examination of herbarium specimens (including type material), we demonstrate that Clematis glabrifolia and C. hastata var. micrantha (Ranunculaceae) are identical with C. hastata, a species from the Daba mountains region in central China. We therefore place C. hastata var. micrantha and C. glabrifolia in synonymy with C. hastata herein.
Sexual Dimorphism of New Zealand Puppet Beetles (Aderidae, Coleoptera, Tenebrionoidea): Systematic Revision, Description of Three New Genera, and Phylogeny for Zenascus, gen. n.
Authors: GRZYMALA TRACI L. , LESCHEN RICHARD A.B.
Published: November 2020

The Aderidae (Coleoptera: Tenebrionoidea) of New Zeland are revised to include four genera and fourteen species. Three genera are described as new: one distributed throughout the Australasian region (Zenascus gen. n.) one endemic to the north and south islands of New Zealand (Transrenus gen. n.), and one that is endemic to the south island of New Zealand (Pseudozena gen. n.). Six species are also newly described (Pseudozena denticulata sp. n., Transrenus thulater sp. n., Zenascus roberti sp. n., Z. incensum sp. n., Z. elenae sp. n., Z. aurum sp. n.). All previously described New Zealand species of aderids contained in the preoccupied genus Xylophilus are transferred to the newly erected genus Zenascus, resulting in six new combinations (Z. antennalis (Broun), comb. n.; Z. coloratus (Broun), comb. n.; Z. luniger (Champion), comb. n.; Z. nitidus (Broun), comb. n.; Z. obscurus (Broun), comb. n.; Z. xenarthrus (Broun, 1910: 54), comb. n.). Holotype and lectotype designations are made or verified for all previously described species. The New Zealand species Xylophilus pictipes Broun is synonymized with Zenascus obscurus, syn. n. and Scraptogetus nigricans is synonymized with Scraptogetus anthracinus, syn. n. The Australian genus Pseudananca Blackburn 1893 is synonymized with the New Zealand genus Scraptogetus Broun, syn. n. Keys to the genera and species are included. Phenotypic characters previously employed in the higher classification of the Aderidae, including secondary sexually dimorphic characters, are discussed and a phylogenetic analysis for the ten New Zealand species of Zenascus is performed to reconstruct trait evolution in males, which display extreme dimorphic antennomere modifications.
Subthermocline Eddies in the Kuroshio Extension Region Observed by Mooring Arrays
Authors: Zhu Ruichen , Chen Zhaohui , Zhang Zhiwei , Yang Haiyuan , Wu Lixin
Published: November 2020

Subthermocline eddies (STEs), also termed intrathermocline eddies or submesoscale coherent vortices, are lens-shaped eddies with anomalous water properties located in or below the thermocline. Although STEs have been discovered in many parts of the World Ocean, most of them were observed accidentally in hydrographic profiles, and direct velocity measurements are very rare. In this study, dynamic features of STEs in the Kuroshio Extension (KE) region are examined in detail using concurrent temperature/salinity and velocity measurements from mooring arrays. During the moored observation periods of 2004–06 and 2015–19, 11 single-core STEs, including 8 with warm/salty cores and 3 with cold/fresh cores, were captured. The thermohaline properties in their cores suggest that these STEs may originate from the subarctic front and the upstream Kuroshio south of Japan. The estimated radius of these STEs varied from 8 to 66 km with the mean value of ~30 km. The warm/salty STEs seemed to be larger and rotate faster than the cold/fresh ones. In addition to single-core STEs, a dual-core STE was observed in the KE recirculation region, which showed that the upper cold/fresh cores stacked vertically over the lower warm/salty cores. Based on the observed parameters of the STEs, their Rossby number and Burger number were further estimated, with values up to 0.5 and 1, respectively. Furthermore, a low Richardson number O (0.25) was found at the periphery of these STEs, suggesting that shear instability-induced turbulent mixing may be an erosion route for the STEs.
Career and College Readiness for Underserved Youth: Educator and Youth Perspectives
Authors: Lindstrom Lauren , Lind John , Beno Carolynne , Gee Kevin A. , Hirano Kara
Published: November 2020

This study solicited perspectives of underserved youth and educators who serve them regarding college and career readiness. We defined underserved youth as adolescents who experience inequitable access to educational resources. Purposeful sampling was used to select 84 focus group participants including educators and students (9–12th grade). Utilizing grounded theory analysis, focus group data revealed findings in three key categories. First, student and educator participants defined readiness as specific career knowledge and skills to develop concrete postschool plans. Second, both educators and students perceived limited availability of career preparation experiences as a barrier, while educators also provided examples of challenging life circumstances which deter youth from fully realizing their college and career potential. Third, educators and students reported that providing a broad array of career related learning activities, coupled with the presence of trusted adults who serve as mentors and guides, can create capacity for young people to expand career options.
Pulmonary mucormycosis: a case of pulmonary arterial hypertension, Westermark sign, and bronchopleural fistula
Authors: Shao Weipeng , Zhang Zhenrong , Feng Hongxiang , Liang Chaoyang , Liu Deruo
Published: November 2020

We herein describe a patient with pulmonary mucormycosis and acute myelogenous leukemia. Computed tomography showed a widened pulmonary artery, a bronchopleural fistula, and the Westermark sign. Despite worsening hemoptysis, the operation was delayed for 6 months. The operation was very complicated and difficult. A thorough preoperative examination, adequate preoperative preparation, appropriate surgical timing, and rich clinical and surgical experience were the keys to successful surgery in this case.
Bilio-pancreatic diversion: report of a case involving bone metabolism complications
Authors: Santarpia Lidia , Speranza Enza , Santopaolo Maria Laura , Marra Maurizio , Pasanisi Fabrizio
Published: November 2020

Prolonged vitamin D deficiency may result in lower calcium absorption and osteoporosis, leading to pathologic fractures. We report the case of a young woman with severe, complicated osteoporosis, which developed several years after biliopancreatic diversion that was performed to treat morbid obesity. Chronic low vitamin D levels provided a continuous stimulus for parathormone secretion, which resulted in parathyroid hyperplasia/adenoma and autonomous production of the hormone.
Time-Dependent Effect of Platelet-Rich Plasma in Reducing Donor-Site Pain After Anterior Cruciate Ligament Reconstruction
Authors: de Andrade André Luís Lugnani , Sardeli Amanda Veiga , Garcia Thiago Alves , Livani Bruno , Belangero William Dias
Published: November 2020

Background:

Anterior cruciate ligament reconstruction (ACLR) has a high incidence among sports players, and one important side effect of the surgery is graft donor site morbidity. Although some evidence suggests that application of platelet-rich plasma (PRP) during ACLR reduces pain and improves knee function, it is not a universal finding.

Purpose:

To perform a meta-analysis of previous studies testing the effects of PRP on donor site morbidity after ACLR.

Study Design:

Systematic review and meta-analysis.

Methods:

We reviewed PubMed (Medline), Web of Science, Embase, Scopus, and Cochrane databases to find studies testing the effects of PRP on the donor site of ACLR autograft. After identifying 4 studies, we conducted 2 meta-analyses, 1 for the effects of PRP on pain, assessed by visual analog scale (VAS), and the other for the functional knee scores. We also tested the ability of time after ACLR to predict the PRP-related reduction of pain.

Results:

In the 4 studies identified, 157 patients were analyzed. Although the VAS score was lower with PRP at 6 months (raw mean difference [RMD], –0.97 [95% CI, −1.59 to −0.36]; P = .001) and 12 months (RMD, −0.61 [95% CI,−1.02 to −0.21]; P = .003), the effects of PRP disappeared at 24 months (RMD, −0.08 [95% CI,−0.38 to 0.22]; P = .586). A univariate regression analysis reinforced the ability of time after ACLR to predict the PRP-related reduction of VAS pain score ( r2 = 0.98). However, knee function after ACLR was not improved by the use of PRP (standardized mean difference, 0.71 [95% CI,−0.17 to 1.60]; P = .114).

Conclusion:

PRP applied to a bone–patellar tendon–bone donor site could reduce knee pain within a year, and this reduction had a correlation with time, meaning that the effect of PRP decreased with time after surgery. However, pain reduction did not reach clinical relevance and did not lead to better functional knee scores.
A highly efficient multi-step methodology for the quantification of micro-(bio)plastics in sludge
Authors: Ruggero Federica , Porter Alexandra E. , Voulvoulis Nikolaos , Carretti Emiliano , Lotti Tommaso , Lubello Claudio , Gori Riccardo
Published: November 2020

The present study develops a multi-step methodology for identification and quantification of microplastics and micro-bioplastics (together called in the current work micro-(bio)plastics) in sludge. In previous studies, different methods for the extraction of microplastics were devised for traditional plastics, while the current research tested the methodology on starch-based micro-bioplastics of 0.1–2 mm size. Compostable bioplastics are expected to enter the anaerobic or aerobic biological treatments that lead to end-products applicable in agriculture; some critical conditions of treatments (e.g. low temperature and moisture) can slow down the degradation process and be responsible for the presence of microplastics in the end-product. The methodology consists of an initial oxidation step, with hydrogen peroxide 35% concentrated to clear the sludge and remove the organic fraction, followed by a combination of flotation with sodium chloride and observation of the residues under a fluorescence microscope using a green filter. The workflow revealed an efficacy of removal from 94% to 100% and from 92% to 96% for plastic fragments, 0.5–2 mm and 0.1–0.5 mm size, respectively. The methodology was then applied to samples of food waste pulp harvested after a shredding pre-treatment in an anaerobic digestion (AD) plant in Italy, where polyethylene, starch-based Mater-Bi® and cellophane microplastics were recovered in amounts of 9 ± 1.3/10 g <2 mm and 4.8 ± 1.2/10 g ⩾2 mm. The study highlights the need to lower the threshold size for the quantification of plastics in organic fertilizers, which is currently set by legislations at 2 mm, by improving the background knowledge about the fate of the micro-(bio)plastics in biological treatments for the organic waste.
Revamping squid gladii to biodegradable composites: In situ grafting of polyaniline to β-chitin and their antibacterial activity
Authors: Balitaan Jolleen Natalie I , Martin Gloricel Anne V , Santiago Karen S
Published: November 2020

The global health concern on wound care is becoming more challenging with the emerging prevalence of inexorable antibiotic resistance. Amidst this crisis, various material innovations have been made to combat this dilemma. Herein, squid pens, which are regarded as discards in the seafood industry, were biorefined into β-chitin-graft-polyaniline (β-chitin-g-PANI) composites for possible wound dressing development. β-chitin was first chemically extracted from gladii, and was then grafted with PANI via in situ chemical oxidative polymerization of various concentrations of aniline, to produce the β-chitin-g-PANI composites. Supporting data from FTIR, UV-Vis, SEM, TGA, and DSC suggest that β-chitin was successfully grafted with PANI. Moreover, improved conductivity and in vitro degradation of the composites were observed as compared to β-chitin and PANI alone, respectively. Zones of inhibition observed from agar diffusion method suggest that the synthesized composites have antibacterial activity against E. coli and S. aureus. The resulting physicochemical and biological properties of integrating conducting PANI to β-chitin substantiated and rendered the β-chitin-g-PANI composites desirable candidates for the development wound care products.
Theorising gendered childhoods and girls’ schooling: Poverty, patriarchy and girls’ education in urban India
Authors: Yunus Reva
Published: November 2020

This paper offers gendered accounts of girls’ schooling and childhood from urban India. It challenges global ‘girl effect’ narratives by grappling with the interplay of poverty and caste patriarchy and how it shapes families’ struggles and concerns and girls’ (re)productive labour, (un)freedoms and classroom experiences. Moving beyond the notion of ‘multiple childhoods’ it develops a conceptual framework that accounts for the way the state, the market, economic inequalities and local patriarchies inscribe poor girls’ schooling and work. Drawing upon ethnographic work with Class VIII students in a state school it also unpacks girls’ negotiation of classed and casted patriarchies.
Pre-mortem risk factors for mortality in kittens less than 8 weeks old at a dedicated kitten nursery
Authors: Dolan Emily D , Doyle Erin , Tran Huyanh Ralph , Slater Margaret R
Published: November 2020

Objectives

Kittens have unique requirements for care in a shelter setting given their higher susceptibility to infectious disease and socialization needs. Significant time and resources are necessary to care for this vulnerable population and dedicated kitten nurseries are one way to meet the requirements of kittens too young for neutering and rehoming. However, young kittens remain at a higher risk of dying relative to adult cats, even in specialized settings. Efforts to investigate kitten mortality have focused on post-mortem findings and little is known about pre-mortem clinical signs that may be associated with death. The purpose of this study was to elucidate predictors of mortality in underage kittens.

Methods

The medical records of kittens aged <8 weeks reared in a kitten nursery in New York City during 2017 were examined. The data collected included signalment (estimated age and weight at intake, sex), physical findings (body condition score [BCS]), clinical signs (weight loss, anorexia, diarrhea, upper respiratory tract infection [URI]), diagnoses (panleukopenia, trauma), how early in the feline breeding season the kitten entered (April–November), and whether the kitten had died or was euthanized. The data were analyzed using Cox proportional hazard modeling with 1353 kittens to identify factors associated with any death or euthanasia.

Results

Elevated risk of dying was found for kittens in the lightest weight group (13 times greater), diagnosed with panleukopenia (13 times greater), exhibiting weight loss (>9 times greater), diagnosed with URI (almost four times greater), exhibiting anorexia (three times greater), identified with a low BCS at intake (two times greater) and experiencing diarrhea (almost two times greater).

Conclusions and relevance

These findings identify clinical signs and diagnoses that can serve as prognostic indicators for underage kitten survival in a shelter/rescue setting and can aid in enhancing protocols for monitoring, intervention and euthanasia decision-making.
Re-imagining play spaces in early childhood education: Supporting girls’ motive orientation to STEM in times of COVID-19
Authors: Fleer Marilyn
Published: November 2020

In unprecedented times, the global community is calling for greater knowledge and engagement in science, technology, engineering and mathematics (STEM) to support the decision making and practices of the general community. COVID-19 has highlighted this pressing need and inviting a ‘new normal’. But STEM is not the core business of early childhood. What role can the early childhood education research community take? This paper reports on a cultural-historical study that investigated how a Conceptual PlayWorld changed the traditional Froebelian play areas to support girls’ play and motives in STEM. The question guiding that study was how could a Conceptual PlayWorld overcome the problems previously identified in the literature on girls’ inclusion in STEM activities in preschools. In our educational experiment we implemented a Conceptual PlayWorld over 12 weeks (123 hour of digital video observations), with a focus on role-playing ‘as if’ engineers and scientists (five 4-year-olds and eight 5-year-olds). The outcomes show how a Conceptual PlayWorld created new kinds of 21century learning areas. Spaces traditionally difficult for girls to enter, were transformed and afforded completely new ways of playing, shown to be inclusive of girls, and disrupted gendered interactions and divergence.
Analysis of the Microstructure and Mechanical Properties during Inertia Friction Welding of the Near-α TA19 Titanium Alloy
Authors: Wu Yanquan , Zhang Chunbo , Zhou Jun , Liang Wu , Li Yunlei
Published: November 2020

The current research of titanium alloy on friction welding process in the field of aero-engines mainly focuses on the linear friction welding. Compared to the linear friction welding, inertial friction welding of titanium alloy still has important application position in the welding of aero-engine rotating assembly. However, up to now, few reports on inertial friction welding of titanium alloy are found. In this paper, the near-alpha TA19 titanium alloy welded joint was successfully obtained by inertial friction welding (IFW) process. The microstructures and mechanical properties were investigated systematically. Results showed that the refined grains within 15‒20 μm and weak texture were found in the weld zone due to dynamic recrystallization caused by high temperature and plastic deformation. The weld zone consisted of acicular α′ martensite phase, αp phase and metastable β phase. Most lath-shaped αs and β phase in base metal were transformed into acicular martensite α′ phase and metastable β phase in thermo-mechanically affected zone and heat affected zone. As a result, the microhardness of welded joint gradually decreased from the weld zone to the base metal. Tensile specimens in room temperature and high temperature of 480 °C were all fractured in base metal illustrating that the inertia friction welded TA19 titanium alloy joint owned higher tensile strength compared to the base metal.
Learning process of ultrasound-guided Ilio-fascial compartment block on a simulator: a feasibility study
Authors: Celi Julien , Fehlmann Christophe A. , Rutschmann Olivier T. , Pelieu-Lamps Iris , Fournier Roxane , Nendaz Mathieu , Sarasin François , Rouyer Frédéric
Published: November 2020

Background

Ultrasound-guided fascia iliaca compartment block (US-FICB) is not part of the learning curriculum of the emergency physicians (EP) and is usually performed by anesthesiologists. However, several studies promote EP to use this procedure.

The goal of this study was to assess the feasibility of a training concept for non-anesthesiologists for the US-FICB on a simulator based on a validating learning path.

Method

This was a feasibility study. Emergency physicians and medical students received a 1-day training with a learning phase (theoretical and practical skills), followed by an assessment phase.

The primary outcome at the assessment phase was the number of attempts before successfully completing the procedure. The secondary outcomes were the success rate at first attempt, the length of procedure (LOP), and the stability of the probe, corresponding to the visualization of the needle tip (and its tracking) throughout the procedure, evaluated on a Likert scale.

Results

A total of 25 participants were included. The median number of attempts was 2.0 for emergency physicians and 2.5 for medical students, and this difference was not significant (p = 0.140). Seven participants (28%) succeeded at the first attempt of the procedure; the difference between emergency physicians and medical students was not significant (37% versus 21%; p = 0.409). The average LOP was 19.7 min with a significant difference between emergency physicians and medical students (p = 0.001). There was no significant difference regarding the stability of the probe between the two groups.

Conclusion

Our 1-day training for non-anesthesiologists with or without previous skills in ultrasound seems to be feasible for learning the US-FICB procedure on a simulator.
Isabl Platform, a digital biobank for processing multimodal patient data
Authors: Medina-Martínez Juan S. , Arango-Ossa Juan E. , Levine Max F. , Zhou Yangyu , Gundem Gunes , Kung Andrew L. , Papaemmanuil Elli
Published: November 2020

Background

The widespread adoption of high throughput technologies has democratized data generation. However, data processing in accordance with best practices remains challenging and the data capital often becomes siloed. This presents an opportunity to consolidate data assets into digital biobanks—ecosystems of readily accessible, structured, and annotated datasets that can be dynamically queried and analysed.

Results

We present Isabl, a customizable plug-and-play platform for the processing of multimodal patient-centric data. Isabl's architecture consists of a relational database (Isabl DB), a command line client (Isabl CLI), a RESTful API (Isabl API) and a frontend web application (Isabl Web). Isabl supports automated deployment of user-validated pipelines across the entire data capital. A full audit trail is maintained to secure data provenance, governance and ensuring reproducibility of findings.

Conclusions

As a digital biobank, Isabl supports continuous data utilization and automated meta analyses at scale, and serves as a catalyst for research innovation, new discoveries, and clinical translation.
Differential gene expression analysis reveals pathways important in early post-traumatic osteoarthritis in an equine model
Authors: McCoy Annette M. , Kemper Ann M. , Boyce Mary K. , Brown Murray P. , Trumble Troy N.
Published: November 2020

Background

Post-traumatic osteoarthritis (PTOA) is a common and significant problem in equine athletes. It is a disease of the entire joint, with the synovium thought to be a key player in disease onset and progression due to its role in inflammation. The development of effective tools for early diagnosis and treatment of PTOA remains an elusive goal. Altered gene expression represents the earliest discernable disease-related change, and can provide valuable information about disease pathogenesis and identify potential therapeutic targets. However, there is limited work examining global gene expression changes in early disease. In this study, we quantified gene expression changes in the synovium of osteoarthritis-affected joints using an equine metacarpophalangeal joint (MCPJ) chip model of early PTOA. Synovial samples were collected arthroscopically from the MCPJ of 11 adult horses before (preOA) and after (OA) surgical induction of osteoarthritis and from sham-operated joints. After sequencing synovial RNA, Salmon was used to quasi-map reads and quantify transcript abundances. Differential expression analysis with the limma-trend method used a fold-change cutoff of log2(1.1). Functional annotation was performed with PANTHER at FDR < 0.05. Pathway and network analyses were performed in Reactome and STRING, respectively.

Results

RNA was sequenced from 28 samples (6 preOA, 11 OA, 11 sham). “Sham” and “preOA” were not different and were grouped. Three hundred ninety-seven genes were upregulated and 365 downregulated in OA synovium compared to unaffected. Gene ontology (GO) terms related to extracellular matrix (ECM) organization, angiogenesis, and cell signaling were overrepresented. There were 17 enriched pathways, involved in ECM turnover, protein metabolism, and growth factor signaling. Network analysis revealed clusters of differentially expressed genes involved in ECM organization, endothelial regulation, and cellular metabolism.

Conclusions

Enriched pathways and overrepresented GO terms reflected a state of high metabolic activity and tissue turnover in OA-affected tissue, suggesting that the synovium may retain the capacity to support healing and homeostasis in early disease. Limitations of this study include small sample size and capture of one point post-injury. Differentially expressed genes within key pathways may represent potential diagnostic markers or therapeutic targets for PTOA. Mechanistic validation of these findings is an important next step.
The factors of adaptation to nursing homes in mainland China: a cross-sectional study
Authors: Sun Changxian , Yu Yiting , Li Xuxu , Cui Yan , Ding Yaping , Zhu Shuqin , Li Xianwen , Chen Shen , Zhou Rong
Published: November 2020

Background

China is one of the most rapidly ageing countries and has the largest ageing population in the world. The demand for long-term care is increasing. Nursing home placement is one of the most stressful events in a person’s life. Although research on relocation adjustment has been conducted in many countries, few studies have been related to the predictors of nursing home adjustment in mainland China. This study aimed to identify the predictors of nursing home adjustment in the context of filial piety in mainland China.

Methods

This was a descriptive study that employed a cross-sectional survey. A total of 303 residents from 22 nursing homes in Nanjing, China, were recruited. A structured questionnaire about residents’ characteristics, activities of daily living, social support, resilience, and nursing home adjustment was administered. Multiple linear regression was used to identify the predictors of adaptation to nursing homes.

Results

The predictors of nursing home adjustment were the satisfaction with services(β = .158, P < .01), number of diseases(β = −.091, P < .05), length of stay(β = .088, P < .05), knowledge of the purpose of admission (β = .092, P < .05), resilience(β = .483, P < .001) and social support(β = .186, P < .001). The total explained variance for this model was 61.6%.

Conclusion

Nursing staff members should assess the characteristics of residents to promote their better adjustment. Resilience had the most significant influence on the level of adaptation, which has been the primary focus of interventions to improve adjustment. The management of disease comorbidities in nursing homes should be standardized and supervised by the government. More volunteers from universities and communities should be encouraged to provide social support to residents. Moreover, a caring culture needs to be emphasized, and the value of filial piety should be advocated in nursing homes of East Asian countries.
Case report: progressive familial intrahepatic cholestasis type 3 with compound heterozygous ABCB4 variants diagnosed 15 years after liver transplantation
Authors: Goubran Mariam , Aderibigbe Ayodeji , Jacquemin Emmanuel , Guettier Catherine , Girgis Safwat , Bain Vincent , Mason Andrew L.
Published: November 2020

Background

Progressive familial intrahepatic cholestasis (PFIC) type 3 is an autosomal recessive disorder arising from mutations in the ATP-binding cassette subfamily B member 4 (ABCB4) gene. This gene encodes multidrug resistance protein-3 (MDR3) that acts as a hepatocanalicular floppase that transports phosphatidylcholine from the inner to the outer canalicular membrane. In the absence of phosphatidylcholine, the detergent activity of bile salts is amplified and this leads to cholangiopathy, bile duct loss and biliary cirrhosis. Patients usually present in infancy or childhood and often progress to end-stage liver disease before adulthood.

Case presentation

We report a 32-year-old female who required cadaveric liver transplantation at the age of 17 for cryptogenic cirrhosis. When the patient developed chronic ductopenia in the allograft 15 years later, we hypothesized that the patient’s original disease was due to a deficiency of a biliary transport protein and the ductopenia could be explained by an autoimmune response to neoantigen that was not previously encountered by the immune system. We therefore performed genetic analyses and immunohistochemistry of the native liver, which led to a diagnosis of PFIC3. However, there was no evidence of humoral immune response to the MDR3 and therefore, we assumed that the ductopenia observed in the allograft was likely due to chronic rejection rather than autoimmune disease in the allograft.

Conclusions

Teenage patients referred for liver transplantation with cryptogenic liver disease should undergo work up for PFIC3. An accurate diagnosis of PFIC 3 is key for optimal management, therapeutic intervention, and avoidance of complications before the onset of end-stage liver disease.
Randomized clinical trial to compare efficacy and safety of repeated courses of rituximab to single-course rituximab followed by maintenance mycophenolate-mofetil in children with steroid dependent nephrotic syndrome
Authors: Basu Biswanath , Preussler Stella , Sander Anja , Mahapatra T. K. S. , Schaefer Franz
Published: November 2020

Background

Approximately 30% of children with idiopathic nephrotic syndrome develop a complicated course with frequent relapses or steroid dependency. Rituximab, a B cell depleting monoclonal antibody, is a safe and effective alternative to steroids or other immunosuppressants for achieving and maintaining remission in this population at short term. Despite the good initial response relapses inevitably occur after regeneration of B lymphocytes, necessitating either repeat courses of rituximab or addition of another steroid-sparing immunosuppressant.

Methods

This is a prospective, single-center, open-label, two-parallel-arm randomized controlled phase III study among children with steroid dependent nephrotic syndrome who are maintained in remission with oral steroids. One hundred children will be randomized to either Rituximab and maintenance Mycophenolate mofetil (A) or repeated courses of prophylactic Rituximab only (B). In arm A, mycophenolate mofetil (1200 mg/m2per day) will be started 3 months after Rituximab administration. In arm B, Rituximab infusions will be administered at 0, 8 and 16 months if B cell count normalize at the given time points. Prednisolone will be discontinued in both groups 2 weeks following first course of rituximab. Primary aim is to evaluate the difference in 24-month relapse-free survival. Main secondary endpoints are cumulative prednisolone dose, frequency of relapses and changes in anthropometry. Circulating B lymphocyte populations will be studied as biomarkers or predictors of rituximab responsiveness and adverse events will be analysed.

Discussion

The study will provide evidence as to the comparative safety and efficacy of two alternative steroid-sparing therapeutic options in children suffering from steroid dependent nephrotic syndrome. The two-year study design will address the long-term results obtained with the alternative treatment protocols.

Trial registration

This trial was prospectively registered to theClinicaltrial.gov(NCT03899103dated 02/04/2019;https://clinicaltrials.gov/) and Clinical Trials Registry of India (CTRI/2019/04/018517dated 09/04/2019).
Effect of manual aspiration thrombectomy using large-bore aspiration catheter for acute basilar artery occlusion: comparison with a stent retriever system
Authors: Choi Jin Wook , Han Miran , Park Jung Hyun , Jung Woo Sang
Published: November 2020

Background

A large-bore aspiration catheter can be employed for recanalization of acute basilar artery occlusion. Here we compare the results of mechanical thrombectomy using a stent retriever (SR) and manual aspiration thrombectomy (MAT) using a large-bore aspiration catheter system as a first-line recanalization method in acute basilar artery occlusion (BAO).

Methods

The records of 50 patients with acute BAO who underwent mechanical thrombectomy were retrospectively reviewed. Patients were assigned to one of two groups based on the first-line recanalization method. The treatment and clinical outcomes were compared.

Results

Sixteen (32%) patients were treated with MAT with a large-bore aspiration catheter and 34 (68%) with a SR as the first-line treatment method. The MAT group had a shorter procedure time (28 vs. 65 min; p = 0.001), higher rate of first-pass recanalization (68.8% vs. 38.2%, p = 0.044), and lower median number of passes (1 vs 2; p = 0.008) when compared with the SR group. There was no significant difference in the incidence of any hemorrhagic complication (6.3% vs. 8.8%; p = 0.754) between the groups. However, there were four cases of procedure-related subarachnoid hemorrhage (SAH) in the SR group and one death occurred due to massive hemorrhage.

Conclusions

Selection of MAT using a large-bore aspiration catheter for acute BAO may be a safe and effective first-line treatment method with higher first-pass recanalization rate and shorter procedure time than SR.
Three-dimensional (3D) magnetic resonance volume assessment and loco-regional failure in anal cancer: early evaluation case-control study
Authors: Sekhar Hema , Kochhar Rohit , Carrington Bernadette , Kaye Thomas , Tolan Damian , Saunders Mark P. , Sperrin Matthew , Sebag-Montefiore David , van Herk Marcel , Renehan Andrew G.
Published: November 2020

Background

The primary aim was to test the hypothesis that deriving pre-treatment 3D magnetic resonance tumour volume (mrTV) quantification improves performance characteristics for the prediction of loco-regional failure compared with standard maximal tumour diameter (1D) assessment in patients with squamous cell carcinoma of the anus undergoing chemoradiotherapy.

Methods

We performed an early evaluation case-control study at two UK centres (2007–2014) in 39 patients with loco-regional failure (cases), and 41 patients disease-free at 3 years (controls). mrTV was determined using the summation of areas method (Volsum). Reproducibility was assessed using intraclass concordance correlation (ICC) and Bland-Altman limits of agreements. We derived receiver operating curves using logistic regression models and expressed accuracy as area under the curve (ROCAUC).

Results

The median time per patient for Volsum quantification was 7.00 (inter-quartile range, IQR: 0.57–12.48) minutes. Intra and inter-observer reproducibilities were generally good (ICCs from 0.79 to 0.89) but with wide limits of agreement (intra-observer: − 28 to 31%; inter-observer: − 28 to 46%). Median mrTVs were greater for cases (32.6 IQR: 21.5–53.1 cm3) than controls (9.9 IQR: 5.7–18.1 cm3, p < 0.0001). The ROCAUC for mrT-size predicting loco-regional failure was 0.74 (95% CI: 0.63–0.85) improving to 0.82 (95% CI: 0.72–0.92) when replaced with mrTV (test for ROC differences, p = 0.024).

Conclusion

Preliminary results suggest that the replacement of mrTV for mrT-size improves prediction of loco-regional failure after chemoradiotherapy for squamous cell carcinoma of the anus. However, mrTV calculation is time consuming and variation in its reproducibility are drawbacks with the current technology.
The association of leptin and adiponectin with hepatocellular carcinoma risk and prognosis: a combination of traditional, survival, and dose-response meta-analysis
Authors: Zhang Lilong , Yuan Qihang , Li Man , Chai Dongqi , Deng Wenhong , Wang Weixing
Published: November 2020

Background

An increasing number of studies have focused on the association between leptin, adiponectin levels and the risk as well as the prognosis of hepatocellular carcinoma. However, the reported results are conflicting.

Methods

A meta-analysis was performed to assess the correlation between leptin, adiponectin levels and risk and prognosis of hepatocellular carcinoma (CRD42020195882). Through June 14, 2020, PubMed, Cochrane Library and EMBASE databases were searched, including references of qualifying articles. Titles, abstracts, and main texts were reviewed by at least 2 independent readers. Stata 16.0 was used to calculate statistical data.

Results

Thirty studies were included in this meta-analysis and results showed that hepatocellular carcinoma group had significantly higher leptin levels than the cancer-free control group (SMD = 1.83, 95% CI (1.09, 2.58),P = 0.000), the healthy control group (SMD = 4.32, 95% CI (2.41, 6.24),P = 0.000) and the cirrhosis group (SMD = 1.85, 95% CI (0.70, 3.01),P = 0.002). Hepatocellular carcinoma group had significantly higher adiponectin levels than the healthy control group (SMD = 1.57, 95% CI (0.37, 2.76),P = 0.010), but no statistical difference compared with the cancer-free control group (SMD = 0.24, 95% CI (− 0.35, 0.82),P = 0.430) and the cirrhosis group (SMD = − 0.51, 95% CI (− 1.30, 0.29),P = 0.213). The leptin rs7799039 polymorphism was associated with increased risk of hepatocellular carcinoma (G vs A: OR = 1.28, 95% CI (1.10, 1.48),P = 0.002). There were linear relationships between adiponectin levels and the risk of hepatocellular carcinoma (OR = 1.066, 95% CI (1.03, 1.11),P = 0.001). In addition, the results showed that high/positive expression of adiponectin was significantly related to lower overall survival in hepatocellular carcinoma patients (HR = 1.70, 95% CI (1.22, 2.37),P = 0.002); however, there was no significantly association between the leptin levels and overall survival (HR = 0.92, 95% CI (0.53, 1.59),P = 0.766).

Conclusion

The study shows that high leptin levels were associated with a higher risk of hepatocellular carcinoma. Adiponectin levels were proportional to hepatocellular carcinoma risk, and were related to the poor prognosis.
A prospective follow-up study of the relationship between high-sensitivity C-reactive protein and primary liver cancer
Authors: Siyin Sarah Tan , Liu Tong , Li Wenqiang , Yao Nan , Xu Guoshuai , Qu Jun , Chen Yajun
Published: November 2020

Background

Competing risk method has not been used in a large-scale prospective study to investigate whether increased levels of high-sensitivity C-reactive protein (hs-CRP) elevate the risk of primary liver cancer (PLC). Our study aims to prospectively investigate the relationship between hs-CRP and new-onset PLC.

Methods and results

Ninety-five thousand seven hundred fifty-nine participants without the diagnosis of PLC, and who had their demographic characteristics and biochemical parameters recorded, were analyzed from the Kailuan Cohort study. Cox proportional hazards regression models and competing risk regression models were used to evaluate the hazard ratios (HRs) and 95% confidence intervals (95% CIs) of PLC. During a median follow-up of 11.07 years, 357 incidental PLC cases were identified over a total of 1,035,039 person-years. The multivariable HRs (95%CI) for the association of hs-CRP of 1–3 mg/L group and hs-CRP>3 mg/L with PLC were 1.07(0.82 ~ 1.38), 1.51(1.15 ~ 1.98) in a Cox proportional hazard regression analysis adjusted for other potential confounders. In the cause-specific hazard model, the multivariable HRs (95%CI) for the association of hs-CRP of 1–3 mg/L group and hs-CRP>3 mg/L with PLC were 1.06(0.81 ~ 1.40), 1.50(1.14 ~ 1.99). Similar results were also observed in the sub-distribution hazard function model with corresponding multivariate HRs (95%CI) of 1.05(0.80 ~ 1.40), 1.49(1.13 ~ 1.98) in hs-CRP of 1–3 mg/L group and hs-CRP>3 mg/L group, respectively.

Conclusions

This prospective study found a significant association of higher levels of hs-CRP with new-onset PLC. The main clinical implications would be an increased awareness of hs-CRP and its correlation to the risk of PLC. This study should be a steppingstone to further research on chronic inflammation and PLC.

Trial registration

Registration number:ChiCTR–TNRC–11001489.
The safety and efficacy of transcranial direct current stimulation as add-on therapy to fluoxetine in obsessive-compulsive disorder: a randomized, double-blind, sham-controlled, clinical trial
Authors: Yoosefee Sadegh , Amanat Man , Salehi Mona , Mousavi Seyed Vahid , Behzadmanesh Jamshid , Safary Victoria , Yoonesi Ali , Salehi Bahman
Published: November 2020

Background

Obsessive-compulsive disorder (OCD) is an anxiety disorder that causes impairment in daily activities. This study aimed to assess the safety and efficacy of transcranial direct current stimulation (tDCS) as adjunctive therapy with fluoxetine in individuals diagnosed with moderate to severe OCD.

Methods

This is a randomized, double-blind sham-controlled trial. Individuals with OCD who had baseline Yale-Brown obsessive-compulsive scale (Y-BOCS) of > 15 were enrolled. Eligible cases were randomly assigned in 1:1 ratio to receive either 20-min-period of stimulation with tDCS and fluoxetine (experimental arm) or fluoxetine only (sham control arm). The anodal electrode of tDCS was placed over the left dorsolateral prefrontal cortex (Fp3) and the cathodal electrode was placed over the right orbitofrontal cortex (F8). Two mA electrical stimulation with the tDCS was used for 20 min in individuals of experimental group. In the control group, electrodes were placed and stimulation was administered for 30 s to induce the same skin sensation as in experimental group. This procedure was performed three times per week for 8 weeks. Y-BOCS test was assessed at baseline, week 4 (after 12th stimulation), week 8 (after 24th stimulation), and 1 month after the last stimulation. The primary endpoints were the mean changes in Y-BOCS total score from baseline to the last visit. The secondary endpoints were the mean changes in obsession and compulsion sub-scores from baseline to the last visit. Adverse events were also assessed. Mixed design repeated measures analysis of variance assessed the endpoints.

Results

Sixty individuals (30 in each group) were participated. All individuals in control group and 28 cases in experimental arm completed the trial. The mean Y-BOCS (F(1.85) = 30.83; P < 0.001), OCD obsession (F(2.23) = 25.01; P < 0.001), and compulsion (F(2.06) = 10.81; P < 0.001) scores decreased significantly during the study. No statistical differences were, however, detected between experimental and control groups (P > 0.05). The tDCS was well tolerated and no major adverse events were reported.

Conclusion

This study showed that among individuals with moderate to severe OCD, there was no significant difference regarding OC symptoms between cases used tDCS as adjunctive therapy with fluoxetine and individuals used fluoxetine only.

Trial registration

IRCT2017030632904N1. Registered 14 July 2017, http://irct.ir/user/trial/44193/view
Suicidal behaviours among adolescents in Liberia
Authors: Quarshie Emmanuel Nii-Boye , Onyeaka Henry K. , Oppong Asante Kwaku
Published: November 2020

Background

Whereas suicide remains in the top 12 leading causes of death among young people aged 10–24 in sub-Saharan Africa, little is known about suicidal behaviours among adolescents in Liberia. We aimed to estimate the 12-month prevalence and describe some of the correlates of suicide behaviours (ideation, planning, and attempt) among school-going adolescents in Liberia.

Methods

We analysed data from the 2017 Liberia Global School-based Student Health Survey conducted nationwide among secondary school students. We performed bivariate and multivariable analyses to assess the correlates of suicidal ideation, planning, and attempt in the previous 12 months.

Results

Of the 2744 students, 26.8% reported suicidal ideation, 36.5% made a specific plan to attempt suicide and 33.7% attempted suicide during the 12 months preceding the survey. In the final adjusted logistic models, bullying victimisation and food insecurity were associated with increased odds of ideation, planning, and attempt. Whereas no factor was uniquely associated with suicidal ideation, having many close friends, and parental monitoring were associated with the increased odds of suicidal planning only. Leisure-time sedentary behaviour was associated with increased odds of suicidal planning and attempt. Cannabis use, alcohol drunkenness, being physically attacked, and parental supervision were uniquely associated with increased odds of suicidal attempt, while parental understanding and having a smaller number of close friends were uniquely associated with reduced odds of suicidal attempt.

Conclusions

The relatively high prevalence estimates of suicide behaviours and the multi-contextual nature of the associated factors warrant the need for the design and implementation of universal and multi-level, collaborative targeted intervention efforts towards the prevention of the onset of ideation, planning, and attempt, and the possible transition to deaths by suicide among school-going adolescents in Liberia.
Social determinants of male partner attendance in women’s prevention-of mother-to-child transmission program in Malawi
Authors: Triulzi Isotta , Keiser Olivia , Somerville Claire , Salimu Sangwani , Ciccacci Fausto , Palla Ilaria , Sagno Jean Baptiste , Gondwe Jane , Marazzi Cristina , Orlando Stefano , Palombi Leonardo , Turchetti Giuseppe
Published: November 2020

Background

Male partners are rarely present during PMTCT (Prevention-Mother-To-Child-Transmission) services in Sub-Saharan Africa (SSA). Male involvement is increasingly recognised as an important element of women’s access to care. This study aims to identify the socio-demographic characteristics, HIV-Knowledge, Attitude and Practice (KAP) among women accompanied and not accompanied by their male partners.

Methods

We included pregnant women enrolled in PMTCT programme between August 2018 and November 2019 in the Southern Region of Malawi. Eligible women were aged 18 years or older, living with a male partner, enrolled for the first time in one of the four selected facilities. We provided a KAP survey to women and their partners attending the facilities. Our primary objective was to assess and analyse the proportion of women who were accompanied by their partner at least once. We applied descriptive statistics and logistic regressions to study the association between being accompanied and explanatory variables.

Results

We enrolled 128 HIV-positive women: 82 (64.1%) were accompanied by their male partners and 46 (35.9%) were alone. In the multivariable model, women’s unemployment and owning a means of transport are negatively associated with male attendance (respectively adjusted OR 0.32 [95% CI, 0.11–0.82] and 0.23 [95% CI, 0.07–0.77]), whereas, in the univariable model, high women’s level of knowledge of HIV is positively associated with male attendance (OR 2.17 [95% CI, 1.03–4.58]). Level of attitude and practice toward HIV were not significantly associated to our study variable.

Conclusions

Our study shows a high male attendance in Malawi compared to other studies performed in SSA. This study highlights that women’s level of knowledge on HIV and their economic condition (employment and owning a means of transport) affects male attendance. Moreover, the study points out that gender power relationships and stringent gender norms play a crucial role thus they should be considered to enhance male involvement.