bluuebunny/crossref_metadata_2025 huggingface dataset:
An Investigation into North Korea’s ‘Real’ Nuclear Strategy: A Comparison with Pakistan’s Case
Authors: Park Hwee-rhak
Published: June 2022

The purpose of this article is to ascertain North Korea’s ‘real’ nuclear strategy. This article uses the ‘Strategy = Ends + Ways + Means’ construct for the ascertainment, and it makes comparisons to Pakistan’s nuclear strategy. This article found that North Korea’s goal of its nuclear armament was as ideological and aggressive as Pakistan’s, and that its nuclear strategy is closer to the ‘minimal deterrence strategy’ than Pakistan’s. North Korea seems more desperate than Pakistan because of its dire economic situation and the uncertain future of the Kim family dynasty. It could, therefore, try to achieve its goal, the reunification of South Korea, as soon as it has sufficient capabilities for the strategy. The United States and South Korea should be prepared for the worst-case scenario, which is North Korea’s reunification war against South Korea under the threat of nuclear attack on the US mainland and South Korea.
Role Conception of the Asia-Pacific Middle Powers: Comparative Analysis of Indonesia, South Korea, Australia and Vietnam
Authors: Karim Moch Faisal , Nabila Rona
Published: June 2022

This article examines the variety of roles enacted by Asia-Pacific middle powers in response to the rise of China. This article identifies two factors determining such variety, especially in the security realm: alignment pattern and geopolitical constraints. We argue that the differences in level of alignment with the United States and the risk of geopolitical tension with China affect the role conception taken by the middle powers. We assert that the combination of a high-level of alignment and high geopolitical risk tends to cause them to take a bridging role, a low-level of alignment and low geopolitical risk drive them to take the role of regional leader, a high-level of alignment and low geopolitical risk allow them to become faithful allies, and a low-level of alignment and high geopolitical risk enable them to take an active independent role. We illustrate this framework through the comparative analysis of Indonesia, South Korea, Australia and Vietnam.
Authoritarian Rule and the Weaponisation of Natural Disasters: The Case of Myanmar from Cyclone Nargis to the COVID-19 Pandemic (2008–2021)
Authors: Passeri Andrea
Published: June 2022

Myanmar’s 2021 military coup paved the way for a ruthless weaponisation of the COVID-19 pandemic, aimed at crushing opposition groups and ethnic minorities who opposed the army’s power grab. The manipulation of natural disasters for political purposes, however, is nothing new for Burmese praetorian regimes, which employed a similar strategy in the aftermath of the 2008 Cyclone Nargis in order to further marginalise and subjugate their internal enemies. To a large extent, such a callous decision stems from the powerful political implications brought about by natural disasters, which are perceived by authoritarian leaders as exogenous shocks capable of triggering a process of heightened popular contestation and regime change. In the case of Myanmar, this specific fear thus persuaded military rulers to weaponise the impact of natural calamities and health crises as part of a longstanding counterinsurgency playbook, centred on the so-called ‘four cuts’ doctrine. As a result, those who do not conform with the Bamar-Buddhist image of Myanmar professed by the army—or dare to criticise its dominant position in Burmese politics—have been deliberately excluded from post-disaster relief efforts, in what appears as a further testament of the junta’s unwavering resolve in retaining the reins of power. Building upon the existing literature on the political implications of natural hazards in authoritarian settings, the following article sheds light on the drivers and rationale that persuaded Myanmar’s Generals to weaponise humanitarian crisis against ethnic minorities and opposition forces, by looking at the two case-studies provided by Cyclone Nargis and the COVID-19 pandemic.
The genetic landscape of germlineDDX41variants predisposing to myeloid neoplasms
Authors: Li Peng , Brown Sara , Williams Margaret , White Thomas , Xie Wei , Cui Wei , Peker Deniz , Lei Li , Kunder Christian A. , Wang Huan-You , Murray Sarah S. , Vagher Jennie , Kovacsovics Tibor , Patel Jay L.
Published: June 2022

Germline DDX41 variants are the most common mutations predisposing to acute myeloid leukemia (AML)/myelodysplastic syndrome (MDS) in adults, but the causal variant (CV) landscape and clinical spectrum of hematologic malignancies (HMs) remain unexplored. Here, we analyzed the genomic profiles of 176 patients with HM carrying 82 distinct presumably germline DDX41 variants among a group of 9821 unrelated patients. Using our proposed DDX41-specific variant classification, we identified features distinguishing 116 patients with HM with CV from 60 patients with HM with variant of uncertain significance (VUS): an older age (median 69 years), male predominance (74% in CV vs 60% in VUS, P = .03), frequent concurrent somatic DDX41 variants (79% in CV vs 5% in VUS, P < .0001), a lower somatic mutation burden (1.4 ± 0.1 in CV vs 2.9 ± 0.04 in VUS, P = .012), near exclusion of canonical recurrent genetic abnormalities including mutations in NPM1, CEBPA, and FLT3 in AML, and favorable overall survival (OS) in patients with AML/MDS. This superior OS was determined independent of blast count, abnormal karyotypes, and concurrent variants, including TP53 in patients with AML/MDS, regardless of patient’s sex, age, or specific germline CV, suggesting that germline DDX41 variants define a distinct clinical entity. Furthermore, unrelated patients with myeloproliferative neoplasm and B-cell lymphoma were linked by DDX41 CV, thus expanding the known disease spectrum. This study outlines the CV landscape, expands the phenotypic spectrum in unrelated DDX41-mutated patients, and underscores the urgent need for gene-specific diagnostic and clinical management guidelines.
Outcomes following treatment for ADA-deficient severe combined immunodeficiency: a report from the PIDTC
Authors: Cuvelier Geoffrey D. E. , Logan Brent R. , Prockop Susan E. , Buckley Rebecca H. , Kuo Caroline Y. , Griffith Linda M. , Liu Xuerong , Yip Alison , Hershfield Michael S. , Ayoub Paul G. , Moore Theodore B. , Dorsey Morna J. , O’Reilly Richard J. , Kapoor Neena , Pai Sung-Yun , Kapadia Malika , Ebens Christen L. , Forbes Satter Lisa R. , Burroughs Lauri M. , Petrovic Aleksandra , Chellapandian Deepak , Heimall Jennifer , Shyr David C. , Rayes Ahmad , Bednarski Jeffrey J. , Chandra Sharat , Chandrakasan Shanmuganathan , Gillio Alfred P. , Madden Lisa , Quigg Troy C. , Caywood Emi H. , Dávila Saldaña Blachy J. , DeSantes Kenneth , Eissa Hesham , Goldman Frederick D. , Rozmus Jacob , Shah Ami J. , Vander Lugt Mark T. , Thakar Monica S. , Parrott Roberta E. , Martinez Caridad , Leiding Jennifer W. , Torgerson Troy R. , Pulsipher Michael A. , Notarangelo Luigi D. , Cowan Morton J. , Dvorak Christopher C. , Haddad Elie , Puck Jennifer M. , Kohn Donald B.
Published: June 2022

Adenosine deaminase (ADA) deficiency causes ∼13% of cases of severe combined immune deficiency (SCID). Treatments include enzyme replacement therapy (ERT), hematopoietic cell transplant (HCT), and gene therapy (GT). We evaluated 131 patients with ADA-SCID diagnosed between 1982 and 2017 who were enrolled in the Primary Immune Deficiency Treatment Consortium SCID studies. Baseline clinical, immunologic, genetic characteristics, and treatment outcomes were analyzed. First definitive cellular therapy (FDCT) included 56 receiving HCT without preceding ERT (HCT); 31 HCT preceded by ERT (ERT-HCT); and 33 GT preceded by ERT (ERT-GT). Five-year event-free survival (EFS, alive, no need for further ERT or cellular therapy) was 49.5% (HCT), 73% (ERT-HCT), and 75.3% (ERT-GT; P < .01). Overall survival (OS) at 5 years after FDCT was 72.5% (HCT), 79.6% (ERT-HCT), and 100% (ERT-GT; P = .01). Five-year OS was superior for patients undergoing HCT at <3.5 months of age (91.6% vs 68% if ≥3.5 months, P = .02). Active infection at the time of HCT (regardless of ERT) decreased 5-year EFS (33.1% vs 68.2%, P < .01) and OS (64.7% vs 82.3%, P = .02). Five-year EFS (90.5%) and OS (100%) were best for matched sibling and matched family donors (MSD/MFD). For patients treated after the year 2000 and without active infection at the time of FDCT, no difference in 5-year EFS or OS was found between HCT using a variety of transplant approaches and ERT-GT. This suggests alternative donor HCT may be considered when MSD/MFD HCT and GT are not available, particularly when newborn screening identifies patients with ADA-SCID soon after birth and before the onset of infections. This trial was registered at www.clinicaltrials.gov as #NCT01186913 and #NCT01346150.
Evaluation of elastic stiffness in bolted timber joints for applying turn-of-nut method
Authors: Matsubara Doppo , Teranishi Masaki
Published: June 2022

The mechanical performance of bolt joints in wooden structures is known to vary significantly with the initial tightening force (axial force) of the bolts during the construction work. When a joining method that considers axial force is applied to a structure, the control of the axial force is important. This study attempts to evaluate the elastic stiffness of bolted timber joints during tightening for the purpose of applying the turn-of-nut tightening method, one of the methods for controlling axial force. Considering the elastic stiffness of joints during tightening as a series spring model using the spring constant of the bolt and the embedment spring constant of the washer, elastic stiffness is calculated using the washer embedment spring constant obtained through a washer embedment test. This result is compared with the elastic stiffness obtained through the tightening test using four species of timber. It was found that while the washer embedment spring constant varies greatly with timber species, the calculated values agreed well with the test results.
Evolution education in light of religious science teachers’ and scientists’ conceptions of evolution and religion
Authors: Stahi-Hitin Reut , Yarden Anat
Published: June 2022

Background

The presumed conflict between religion and evolution is considered one of the main causes of rejection of evolution worldwide. However, there is a unique group of religious people who accept, study, and teach evolution. The aim of this study was to gain a better understanding of these individuals’ conception of the relationship between evolution and religion, and the factors that influenced this conception. Religious biology teachers (n = 10) and scientists (n = 10) were surveyed and interviewed about their conception of evolution and religion and the factors that influenced it.

Results

The study population demonstrated that reconciling science and religion was possible for them. The interpretation of the bible as moral guidance, and not as a science book, was found to be a main idea in the participants’ conception. Most participants said that their conception of evolution was influenced by their parents’ and teachers’ approach to science. Participants who had rejected evolution in the past emphasized that exposure to scientific knowledge alone was not enough to counter this rejection, whereas exposure to the possible compatibility between religion and evolution promoted their acceptance.

Conclusions

These findings suggest the importance of exposing teachers to different approaches to the relationship between evolution and religion. Implementation of the study conclusions in professional development programs may help teachers promote religiously affiliated students’ better learning of evolution and a meaningful learning of science in general.
ACO:lossless quality score compression based on adaptive coding order
Authors: Niu Yi , Ma Mingming , Li Fu , Liu Xianming , Shi Guangming
Published: June 2022

Background

With the rapid development of high-throughput sequencing technology, the cost of whole genome sequencing drops rapidly, which leads to an exponential growth of genome data. How to efficiently compress the DNA data generated by large-scale genome projects has become an important factor restricting the further development of the DNA sequencing industry. Although the compression of DNA bases has achieved significant improvement in recent years, the compression of quality score is still challenging.

Results

In this paper, by reinvestigating the inherent correlations between the quality score and the sequencing process, we propose a novel lossless quality score compressor based on adaptive coding order (ACO). The main objective of ACO is to traverse the quality score adaptively in the most correlative trajectory according to the sequencing process. By cooperating with the adaptive arithmetic coding and an improved in-context strategy, ACO achieves the state-of-the-art quality score compression performances with moderate complexity for the next-generation sequencing (NGS) data.

Conclusions

The competence enables ACO to serve as a candidate tool for quality score compression, ACO has been employed by AVS(Audio Video coding Standard Workgroup of China) and is freely available at https://github.com/Yoniming/ACO.
Transient J wave-like ST-segment elevation in intracerebral hemorrhage: a case report
Authors: Du Xing , Zhang Yongjun
Published: June 2022

Background

Certain cerebrovascular events can induce electrocardiography (ECG) abnormalities and cardiac dysfunction. The most frequent patterns reported are nonspecific ST-T change, inverted or broad T wave, prolongation of QT interval as well as ST-segment depression or elevation. Here we present a case of intracerebral hemorrhage (ICH) with transient J wave-like ST-segment elevation accompanied by myocardial lesion.

Case presentation

A 58-year-old woman was admitted to our hospital and diagnosed with right basal ganglia region cerebral hemorrhage. The ECG recorded on the second hospital day showed transient J wave-like ST-segment elevation accompanied by increased myocardial troponin I and myocardial enzyme.

Conclusions

The J wave-like ST-segment elevation may be not a specific ECG signs for primary ischemic heart diseases as it also could be found in ICH patients. We believe that the follow-up ECGs can be used in conjunction with repeated myocardial enzyme analysis and echocardiography to differentiate ICH-ralated J wave-like ST-segment elevation from acute myocardial infarction (AMI), thus avoiding unnecessary cardiac catheterization.
Clinicopathological characteristics of pancreatic acinar cell metaplasia associated with Helicobacter pylori infection
Authors: Fuchino Takafumi , Wada Yasuhiro , Kodama Masaaki , Mukaisho Ken-ichi , Mizukami Kazuhiro , Okimoto Tadayoshi , Kushima Ryoji , Murakami Kazunari
Published: June 2022

Background

Pancreatic acinar cell metaplasia (PACM) has been rarely reported in the gastric mucosa. In the present study, we aimed to elucidate the clinical and pathological characteristics of PACM associated with Helicobacter pylori (H. pylori).

Method

5930 patients who underwent five- or two-point gastric biopsy according to the updated Sydney system (USS) by upper gastrointestinal endoscopy were enrolled. The patients were categorized into current H. pylori infection (CHI), post-H. pylori eradication (PHE), and non-H. pylori infection (NHI) groups according to the H. pylori infection status, and the frequency and location of PACM were compared. Additionally, a case–control study was performed to compare the USS scores between patients with CHI and PACM and those with CHI but not PACM.

Result

The frequencies of PACM were 0.49% (10/2039), 0.75% (25/3332), and 0% (0/559) in the CHI, PHE, and NHI groups, respectively. PACM was found in the greater curvature of the antrum in 33 of the 35 patients with PACM. Among the patients with CHI, the inflammation scores in the greater curvature of the antrum and the greater curvature of the corpus were lower in patients with PACM than in those without PACM.

Conclusion

Although rarely reported in the gastric mucosa, PACM was closely related to H. pylori infection, especially in the antrum, and was associated with relatively mild inflammation.
Physical activity measured by accelerometry in paediatric and young adult patients with inflammatory bowel disease
Authors: Lund Ken , Larsen Michael Due , Knudsen Torben , Kjeldsen Jens , Nielsen Rasmus Gaardskær , Brage Søren , Nørgård Bente Mertz
Published: June 2022

Objectives

Physical activity in paediatric and young adult patients suffering from inflammatory bowel disease (IBD) may play an important role in the overall health status. However, physical activity in these patients has not been reported using objective methods. We aimed to describe accelerometry-measured physical activity levels in paediatric and young adult IBD patients with either ulcerative colitis (UC) or Crohn’s disease (CD).

Methods

We recruited Danish patients with IBD aged 10–20 years in clinical remission and with a faecal calprotectin below 200 µg/mg. Physical activity was assessed using tri-axial wrist accelerometry over seven days and quantified using the activity-related acceleration derived as the conventional Euclidian Norm Minus One (ENMO) metric expressed in milli-gravity units (mg). Time spent in Moderate-to-Vigorous Physical Activity (MVPA) was classified as ENMO > 210 mg in 5 s epoch resolution (unbouted).

Results

We included 61 patients with a median age of 17 years [Inter Quartile Range, IQR 14–19]. The total volume of activity expressed as average acceleration (ENMO) per day was 31.5 mg (95% CI 29.1–33.9). Time spent in unbouted MVPA was 32 min per day (95% CI 26–37). There was no significant difference in activity volume between patients with UC to patients with CD, the adjusted linear regression coefficient was − 1.7 mg (95% CI –6.2–2.7). Activity volume was higher for males (36.2 mg, 95% CI 31.9–40.5) than for females (27.8 mg, 95% CI 25.6–30.0), and younger patients were more active than older patients; Activity volume in 10–13 year olds was 37.2 mg (95% CI 28.6–45.7), whereas it was 28.5 mg (95% CI 25.2–31.7) for those aged 18–20 years.

Conclusions

We collected tri-axial accelerometry in young patients with IBD in clinical remission, and described their level of physical activity by the conventional ENMO measure. We found no statistically significant difference in patients with UC compared to patients with CD. The volume of physical activity was higher in males compared to females, and inversely associated with age.
Association of body mass index and waist circumference with type 2 diabetes mellitus in older adults: a cross-sectional study
Authors: Bai Kaizhi , Chen Xuejiao , Song Rui , Shi Wenlong , Shi Songhe
Published: June 2022

Background

The prevalence of obesity and diabetes is rising. The aim of this study was to determine the association of body mass index (BMI) and waist circumference (WC) with type 2 diabetes mellitus (T2DM) in the elderly and to compare the discriminatory abilities of BMI, WC and other anthropometric indicators, including waist-to-height ratio (WHtR), body adiposity estimator (BAE) and body roundness index (BRI) for T2DM.

Methods

This cross-sectional study included 69,388 subjects aged ≥ 60 years living in Xinzheng, Henan Province, from January to December 2020. The data came from the residents’ electronic health records of the Xinzheng Hospital Information System. Logistic regression was used to examine the relationships. Fully adjusted models adjusted for age, sex, place of residence, alcohol consumption, smoking, physical exercise, SBP and RHR. The area under the receiver operating characteristic curve (AUC) was used to compare the discriminatory ability of different anthropometric indicators for T2DM under the influence of potential risk factors.

Results

After adjusting for multiple covariates, compared with the first BMI quintile, the odds ratios (ORs) and 95% confidence intervals (CIs) from the second to fifth quintile for T2DM were 1.416 (1.335–1.502), 1.664 (1.570–1.764), 1.879 (1.774–1.990) and 2.156 (2.037–2.283), respectively. Compared with the first WC quintile, the ORs and 95% CIs from the second to fifth quintiles for T2DM were 1.322 (1.244–1.404), 1.549 (1.459–1.643), 1.705 (1.609–1.807) and 2.169 (2.048–2.297), respectively. Among men, compared with other anthropometric indicators (BMI, WHtR, BAE and BRI), WC showed the highest AUC (AUC: 0.629; 95% CI: 0.622–0.636). Among women, the AUCs of BMI (AUC: 0.600; 95% CI: 0.594–0.606), WC (AUC: 0.600; 95% CI: 0.593–0.606) and BAE (AUC: 0.600; 95% CI: 0.594–0.607) were similar, and the AUCs of BMI, WC and BAE were higher than WHtR, BRI.

Conclusions

All anthropometric indicators were positively associated with T2DM. In men, WC with the strongest positive association with T2DM was the best predictor of T2DM. In women, BMI was most strongly associated with T2DM, and the predictive powers of BMI, WC and BAE were similar. After adjusting the potential confounding factors including age, sex, place of residence, alcohol consumption, smoking, physical exercise, SBP and RHR, the effect of these factors was eliminated, the findings were independent of the covariates considered.
Factors influencing the stages of frailty among Korean older adults focusing on objective and subjective social isolation
Authors: Han Song Yi , Jang Hye Young , Ko Young
Published: June 2022

Background

Although many studies have investigated the factors influencing frailty, few studies have confirmed the influence of social factors on the stages of frailty. This study was conducted to identify factors influencing the stages of frailty in Korean older adults, focusing on objective and subjective social isolation.

Methods

This study analyzed the data of 10,041 older adults from the 2017 National Survey of Older Koreans. Two multiple logistic regression analyses were performed to identify the factors influencing the frailty stages. Frailty was calculated using the FRAIL scale with the five domains: fatigue, resistance, ambulation, illness, and loss of weight.

Results

Among Korean older adults, 51.5% were in the robust stage, 42.5% in the pre-frail stage and 6.0% in the frail stage. As a multiple logistic regression analysis, participants with an intimate relationship (Odds ratio (OR) 0.93, 95% Confidential interval (CI) = 0.91–0.95) or objective social non-isolated participants were more likely to be in the robust group than the pre-frail group. Objective social-isolated participants were more likely to belong to the frail group than the pre-frail group: isolation from family member only (OR 1.57, 95% CI = 1.04–2.39), isolation from non-family member only (OR 1.75, 95% CI = 1.39–2.19), and isolation from both family and non-family member (OR 2.56, 95% CI = 1.67–3.92).

Conclusions

This cross-sectional study showed that social isolation was associated with the stage of frailty. Therefore, researchers need to consider issues of social isolation of older adults in the development of frailty prevention and management intervention.
Predicting the onset of freezing of gait in Parkinson’s disease
Authors: Wang Fengting , Pan Yixin , Zhang Miao , Hu Kejia
Published: June 2022

Background

Freezing of gait is a debilitating symptom of Parkinson’s disease associated with high risks of falls and poor quality of life. While productive therapy for FoG is still underway, early prediction of FoG could help high-risk PD patients to take preventive measures. In this study, we predicted the onset of FoG inde novoPD patients using a battery of risk factors from patients enrolled in PPMI cohort.

Methods

Baseline characteristics were compared between subjects who developed FoG (68 patients, 37.2%, pre-FoG group) during the five-year follow up and subjects who did not (115 patients, 62.8%, non-FoG group). A multivariate logistic regression model was built based on backward stepwise selection of factors that were associated with FoG onset in the univariate analysis. ROC curves were used to assess sensitivity and specificity of the predictive model.

Results

At baseline, age, PIGD score, cognitive functions, autonomic functions, sleep behavior, fatigue and striatal DAT uptake were significantly different in the pre-FoG group relative to the non-FoG group. However, there was no difference in genetic characteristics between the two patient sets. Univariate analysis showed several motor and non-motor factors that correlated with FoG, including PIGD score, MDS-UPDRS part II score, SDMT score, HVLT Immediate/Total Recall, MOCA, Epworth Sleepiness Scale, fatigue, SCOPA-AUT gastrointestinal score, SCOPA-AUT urinary score and CSF biomarker Abeta42. Multivariate logistic analysis stressed that high PIGD score, fatigue, worse SDMT performance and low levels of Abeta42were independent risk factors for FoG onset in PD patients.

Conclusions

Combining motor and non-motor features including PIGD score, poor cognitive functions and CSF Abeta can identify PD patients with high risk of FoG onset.
Inactivated COVID-19 vaccine induced acute stroke-like focal neurologic symptoms: a case series
Authors: Roongpiboonsopit Duangnapa , Nithisathienchai Chichaya , Akarathanawat Wasan , Lertutsahakul Krittanon , Tantivattana Jarturon , Viswanathan Anand , Suwanwela Nijasri Charnnarong
Published: June 2022

Background

A subgroup of individuals experienced stroke-like symptoms after receiving an inactivated COVID-19 vaccine. We present clinical characteristics, neuroimaging, and outcome of these patients.

Methods

Medical personals who had neurological symptoms after receiving inactivated COVID-19 vaccine were enrolled. Clinical, laboratory investigation and neuroimaging were collected. Subjects were prospectively followed-up on clinical and neuroimaging to detect brain parenchymal or cerebrovascular abnormality.

Results

Nineteen out of 385 subjects (4.9%) developed neurological symptoms after vaccination. There was a female predominance (89.5%) with mean age of 34 ± 7.5 years. Majority of patients (52.6%) had symptoms within 60 min after vaccination. The most common neurological symptoms were numbness (94.7%) followed by headache (52.6%) and weakness (47.4%). The most common neurological signs were sensory deficit (79%) followed by motor weakness (52.6%) and tongue deviation (26.3%). Recurrent headache was observed in most patients (89.5%) during followed up. Serial brain imaging was done in all patients with median follow-up interval of 18 days. There was no evidence of acute brain infarction in any of the patients, 84.2% had no vascular abnormality, 15.8% had transient focal narrowing of cerebral vessels. Outcome was favorable, modified ranking scale 0–1 for all patients at 4 weeks after vaccination.

Conclusions

Transient focal neurological symptoms and deficits can be found after COVID-19 vaccination. However, benefit to stop COVID-19 pandemic by vaccination is outweighed by these seemingly reversible side effects. The pathophysiology underlined these phenomena should be further investigated.
Cesarean section in Uruguay from 2008 to 2018: country analysis based on the Robson classification. An observational study
Authors: Colomar Mercedes , Colistro Valentina , Sosa Claudio , de Francisco Luis Andres , Betrán Ana Pilar , Serruya Suzanne , De Mucio Bremen
Published: June 2022

Background

The use of caesarean section has steadily increased, with Latin America being the region with the highest rates. Multiple factors account for that increase and the Robson classification is appropriate to compare determinants at the clinical level for caesarean section rates over time. The purpose of this study is to describe the evolution of caesarean section rates by Robson groups in Uruguay from 2008 to 2018 using a country level database.

Methods

We included the records of all women giving birth in Uruguay (pregnancies ≥22 weeks and weights ≥500 g) with valid data in the mode of childbirth recorded in the Perinatal Information System database between 2008 and 2018. Caesarean section rates were calculated by Robson groups for each of the years included, disaggregated by care sector (public/private) and by geographical area (Capital City/Non-Capital), with time trends and their significance analyzed using linear regression models.

Results

Of the total 485,263 births included in this research, the overall caesarean section rate was 43,1%. In 2018, among the groups at lower risk of caesarean section (1 to 4), the highest rates were seen in women in group 2B (98,8%), followed by those in group 4B (97,9%). A significant increase in the number of caesarean sections was seen in groups 2B (97,9 to 98,8%), 3 (8,36 to 11,1%) and 4 (A (22,7 to 26,9%) and B (95,4 to 97,9%) Significant growth was also observed in groups 5 (74,3 to 78,1%), 8 (90,6 to 95,5%), and 10 (39,1 to 46,7%). The private sector had higher rates of caesarean section for all groups throughout the period, except for women in group 9. The private sector in Montevideo presented the highest rates in the groups with the lowest risk of caesarean section (1, 2A, 3 and 4A), followed by the private sector outside of the capital.

Conclusion

Uruguay is no exception to the increasing caesarean section trend, even in groups of women who have lower risk of requiring caesarean section. The implementation of interventions aimed at reducing caesarean section in the groups with lower obstetric risk in Uruguay is warranted.
Closed isolated anterolateral calcaneal dislocation: a case report
Authors: Vosoughi Amir Reza , Akbarzadeh Armin , Zakaee Alireza
Published: June 2022

Background

Complete isolated calcaneal dislocation, defined as dislocation of talocalcaneal and calcaneocuboid joints with intact talonavicular joint without significant fracture, is an exceedingly rare injury.

Case presentation

A 49-year-old man, after a motor vehicle collision, presented with a closed isolated anterolateral dislocation of the calcaneus associated with fracture of the sustentaculum tali, cuboid, lateral process of the talus, and avulsion fracture of superior peroneal retinaculum. Urgent successful closed reduction was immediately performed in the emergency room under sedation. Two days later, through sinus tarsi approach extended proximally to posterior of the lateral malleolus and distally to the calcaneocuboid joint, peroneal tendons were reduced in the retromalleolar groove and avulsion fracture of the superior peroneal retinaculum was reduced and fixed by a suture anchor. A chondral lesion (6 × 8 mm) was seen in the posterior facet of the calcaneus for that chondroplasty and microfracture were performed. Also, small bony fragments from the cuboid were excised. The reduced calcaneocuboid joint was fixed by two Kirschner wires. In the second stage, 10 days later, through medial approach to the talocalcaneal joint, multiple free bony fragments were excised. Then sustentaculum tali was reduced and fixed using a lag screw. Postoperatively, a non-weight bearing short leg cast was applied for six weeks. The patient had permission to start partial weight bearing 6 weeks after removal of K-wires. Finally, at the 10th postoperative week, he had full weight-bearing without any aid instrument. He was able to return to his regular activities about 6 months after the injury. At 34 months, the American Orthopaedic Foot and Ankle Society ankle-hindfoot scale was 92 from 100. The foot function index percentile was 7% and the visual analogue score for pain was 1.9. The last radiographs revealed normal configuration of talocalcaneal, calcaneocuboid, and talonavicular joints with a little joint space narrowing in posterior part of the subtalar joint.

Conclusion

Patients with isolated anterolateral calcaneal dislocations, even with multiple associated fractures, can have acceptable outcomes, if it is urgently diagnosed and properly managed.
Ultrasound-guided needle release of A1 pulley combined with corticosteroid injection is more effective than ultrasound-guided needle release alone in the treatment of trigger finger
Authors: Wu Yan-Yan , Chen Kai , He Fan-Ding , Quan Jie-Rong , Guo Xuan-Yan
Published: June 2022

Background

The purpose of the present study was to evaluate the clinical effectiveness of ultrasonography-guided needle release of A1 pulley combined with corticosteroid injection by comparing it with ultrasound-guided needle release of the A1 pulley alone.

Methods

A total of 49 patients (55 fingers, thumb) with trigger fingers were included in this retrospective study. Twenty-seven fingers were treated with ultrasound-guided needle release of the A1 pulley alone (monotherapy group), and 28 fingers were treated with needle release of the A1 pulley combined with corticosteroid injection (combination group). Visual analog scale (VAS), Froimson scale, postoperative recurrence rate, and thickness of A1 pulley at baseline, Week-2, Week-12, and Month-6 were recorded.

Results

Higher clinical cure rates were observed in the combination group at Week-2 after treatment among patients with the Froimson scale Grade III and IV (p < 0.05). Among Froimson scale Grade IV patients, the combination group had a significantly thinner thickness of A1 pulley and better articular pain relief at Week-2 (all p < 0.05). No significant differences were found in the clinical cure rate, the thickness of the A1 pulley, articular pain relief, and recurrence rate between the two groups at Week-12 and Month-6 (all p > 0.05).

Conclusions

Ultrasonography-guided needle release of A1 pulley plus corticosteroid injection was superior to ultrasonography-guided A1 pulley needle release alone during early-stage treatment of severe patients with trigger fingers. Moreover, ultrasonography-guided A1 pulley needle release combined with corticosteroid injection narrows the thickness of the A1 pulley. It is necessary to carry out preoperative evaluation and individualized treatment for patients of various severities.
Transumbilical single-site two incision laparoscopic pyloromyotomy for pediatric hypertrophic pyloric stenosis
Authors: Ji Yi , Lai Xiaoqin , Xu Zhicheng
Published: June 2022

Purpose

A new novel technique for the treatment of pediatric hypertrophic pyloric stenosis (HPS), transumbilical single-site laparoscopic pyloromyotomy with a single instrument (TUSSLP), was introduced. TUSSLP was compared with the transabdominal three-site laparoscopic pyloromyotomy (TATSLP) procedure.

Methods

Patients with HPS who underwent TUSSLP and TATSLP between January 2016 and September 2020 were assigned to group A and group B, respectively. The descriptive variables, perioperative clinical characteristics and postoperative follow-up results were retrospectively analyzed and compared between the 2 groups. The primary outcome of this study was the rate of switching to conventional pyloromyotomy.

Results

Sixty-four patients were enrolled in this study. Of these patients, 29 (22 males, 7 females, 54.4 ± 22.6 days) who received TUSSLP were assigned to group A. The remaining 35 (28 males, 7 females, 54.5 ± 27.6 days) who received TATSLP were assigned to group B. The data of preoperative patient variables were comparable between the 2 groups (P > 0.05). The mean operative time (ORT) was 28.1 ± 5.6 min in group A, which was not significantly different from 25.8 ± 3.1 min in group B (P = 0.25). The other perioperative features were not significantly different between the 2 groups (P > 0.05). During follow-up (39.1 ± 14.7 m in group A and 35.4 ± 16.1 m in group B, P = 0.51), no significant difference was observed in the overall incidence of vomiting between the 2 groups (P = 0.26).

Conclusions

TUSSLP is a feasible and reliable minimally invasive method for HPS. It has the advantages of an improved cosmetic appearance. The postoperative follow-up results of TUSSLP are comparable with those of TATSLP.
Experiences of family caregivers of children with cancer while receiving home-based pediatric palliative care in Indonesia: a qualitative study
Authors: Effendy Christantie , Uligraff Deby Kristiani , Sari Selvia Harum , Angraini Fany , Chandra Lynna
Published: June 2022

Background

Caring for children living with life-threatening and life-limiting illnesses can be challenging. Parents’ roles as the main caregivers can be complex with extensive responsibilities. The experiences of family caregivers can provide key insights into the provision of home-based Pediatric Palliative Care (PPC) for seriously ill children. This study is aimed at exploring the experiences of family caregivers of children diagnosed with cancer while receiving home-based PPC.

Methods

This was a qualitative study. This study used semi-structured interviews which were audio-recorded with family caregivers of twelve children diagnosed with cancer who had received home-based PPC. The interviews were transcribed verbatim. The data were analyzed using qualitative content analysis. The reporting of the study was based on the Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist.

Results

Three main themes emerged: (1) The implementation of home-based PPC; (2) The benefits of home-based PPC; and (3) The family caregivers’ hopes of the home-based PPC service and their impressions of home-based PPC. The implementation of home-based PPC described the experiences of family caregivers in receiving home-based PPC provided by nurses with particular attention to the bio-psychosocial-spiritual aspects. Family caregivers experienced several benefits from the home-based PCC service, where holistic care was provided for both the patient and the family. Family caregivers shared their hopes prior to receiving support from competent health care professionals to care for their sick child at home and improve the child's quality of life. They confirmed that these hopes were fulfilled through the home-based PPC service delivered by Rachel House.

Conclusions

Home-based PPC provides several benefits with a positive impact for both the children diagnosed with cancer as well as their families. Nurses involved in the home-based PPC service provide holistic care with a family-centered approach. We believe that children with terminal illnesses and their families need and deserve home-based PPC during difficult times.
Exploring the comorbidity mechanisms between asthma and idiopathic pulmonary fibrosis and the pharmacological mechanisms of Bu-Shen-Yi-Qi decoction therapy via network pharmacology
Authors: Zhong Yuanyuan , Hu Lingli , Chen Wenjing , Wang Bin , Sun Jing , Dong Jingcheng
Published: June 2022

Backgrounds

Asthma and idiopathic pulmonary fibrosis (IPF) are common chronic diseases of the respiratory system in clinical practice. However, the relationship and molecular links remain unclear, and the current treatment’s efficacy is disappointing. Bu-Shen-Yi-Qi (BSYQ) decoction has proven effective in treating various chronic airway inflammatory diseases, including asthma and IPF. But the underlying pharmacological mechanisms are still to be elucidated.

Methods

This study searched the proteins related to asthma and IPF via TTD, CTD, and DisGeNET databases and then submitted to the STRING to establish the protein–protein interaction (PPI) network. The co-bioinformatics analysis was conducted by Metascape. The active ingredients of BSYQ decoction were screened from TCMSP, ETCM, BATMAN-TCM databases, and HPLC/MS experiment. The corresponding targets were predicted based on TCMSP, ETCM, and BATMAN-TCM databases. The shared targets for asthma and IPF treatment were recognized, and further GO and KEGG analyses were conducted with the DAVID platform. Finally, molecule docking via Autodock Vina was employed to predict the potential binding mode between core potential compounds and targets.

Results

Finally, 1333 asthma-related targets and 404 IPF-related proteins were retrieved, 120 were overlapped between them, and many of the asthma-related proteins fall into the same statistically significant GO terms with IPF. Moreover, 116 active ingredients of BSYQ decoction were acquired, and 1535 corresponding targets were retrieved. Eighty-three potential compounds and 56 potential targets were recognized for both asthma and IPF treatment. GO and KEGG analysis indicated that the inflammation response, cytokine production, leukocyte differentiation, oxygen level response, etc., were the common pathological processes in asthma and IPF, which were regulated by BSYQ decoction. Molecule docking further predicted the potential binding modes between the core potential compounds and targets.

Conclusion

The current study successfully clarified the complex molecule links between asthma and IPF and found the potential common targets. Then we demonstrated the efficacy of BSYQ decoction for asthma and IPF treatment from the angle of network pharmacology, which may provide valuable references for further studies and clinical use.
Optimizing simulated interviews and feedback to maximize medical students’ self-efficacy in real time
Authors: Aoki Shuntaro , Shikama Yayoi , Yasui Kiyotaka , Moroi Yoko , Sakamoto Nobuo , Suenaga Hiroki , Tang Zunyi , Yasuda Megumi , Chiba Yasuko , Stanyon Maham , Otani Koji
Published: June 2022

Background

Self-efficacy is crucial in improving medical students’ communication skills. This study aims to clarify where medical students’ self-efficacy is greatest following an interview with a simulated patient and subsequent feedback.

Methods

A total of 162 medical students (109 men, 53 women) in their fourth or fifth year at a university in Japan participated in this study. The degree of self-efficacy in medical interviewing was measured before and after a medical interview with a simulated patient, and after the subsequent feedback session.

Results

ANOVA analysis revealed that self-efficacy for medical interviews was higher after both the interview and the feedback session than before the interview. Among all three time points, self-efficacy was highest after the feedback session.

Conclusions

Feedback following a simulated interview with a simulated patient is important to improve the self-efficacy of medical students when learning medical interviewing skills.
A recombinant Bifidobacterium bifidum BGN4 strain expressing the streptococcal superoxide dismutase gene ameliorates inflammatory bowel disease
Authors: Kang Sini , Lin Zhaoyan , Xu Yang , Park Minju , Ji Geun Eog , Johnston Tony V. , Ku Seockmo , Park Myeong Soo
Published: June 2022

Background

Inflammatory bowel disease (IBD) is a gastrointestinal disease characterized by diarrhea, rectal bleeding, abdominal pain, and weight loss. Recombinant probiotics producing specific proteins with IBD therapeutic potential are currently considered novel drug substitutes. In this study, aBifidobacterium bifidumBGN4-SK strain was designed to produce the antioxidant enzymes streptococcal superoxide dismutase (SOD) and lactobacillus catalase (CAT), and aB. bifidumBGN4-pBESIL10 strain was proposed to generate an anti-inflammatory cytokine, human interleukin (IL)-10. In vitro and in vivo efficacy of these genetically modifiedBifidobacteriumstrains were evaluated for colitis amelioration.

Results

In a lipopolysaccharide (LPS)-stimulated HT-29 cell model, tumor necrosis factor (TNF)-α and IL-8 production was significantly suppressed in theB. bifidumBGN4-SK treatment, followed byB. bifidumBGN4-pBESIL10 treatment, when compared to the LPS-treated control. Synergistic effects on TNF-α suppression were also observed. In a dextran sodium sulphate (DSS)-induced colitis mouse model,B. bifidumBGN4-SK treatment significantly enhanced levels of antioxidant enzymes SOD, glutathione peroxidase (GSH-Px) and CAT, compared to the DSS-only group.B. bifidumBGN4-SK significantly ameliorated the symptoms of DSS-induced colitis, increased the expression of tight junction genes (claudin and ZO-1), and decreased pro-inflammatory cytokines IL-6, IL-1β and TNF-α.

Conclusions

These findings suggest thatB. bifidumBGN4-SK ameliorated DSS-induced colitis by generating antioxidant enzymes, maintaining the epithelial barrier, and decreasing the production of pro-inflammatory cytokines. AlthoughB. bifidumBGN4-pBESIL10 exerted anti-inflammatory effects in vitro, the enhancement of IL-10 production and alleviation of colitis were very limited.
Surveillance to achieve malaria elimination in eastern Myanmar: a 7-year observational study
Authors: Rae Jade D. , Nosten Suphak , Kajeechiwa Ladda , Wiladphaingern Jacher , Parker Daniel M. , Landier Jordi , Thu Aung Myint , Dah Hsa , Be Aye , Cho Win Cho , Paw K.’Nyaw , Paw Eh Shee , Shee Paw Bway , Poe Christ , Nu Chit , Nyaw Baw , Simpson Julie A. , Devine Angela , Maude Richard J. , Moo Ku Ler , Min Myo Chit , Thwin May Myo , Tun Saw Win , Nosten François H.
Published: June 2022

Background

The collection and utilization of surveillance data is essential in monitoring progress towards achieving malaria elimination, in the timely response to increases in malaria case numbers and in the assessment of programme functioning. This paper describes the surveillance activities used by the malaria elimination task force (METF) programme which operates in eastern Myanmar, and provides an analysis of data collected from weekly surveillance, case investigations, and monitoring and evaluation of programme performance.

Methods

This retrospective analysis was conducted using data collected from a network of 1250 malaria posts operational between 2014 and 2021. To investigate changes in data completeness, malaria post performance, malaria case numbers, and the demographic details of malaria cases, summary statistics were used to compare data collected over space and time.

Results

In the first 3 years of the METF programme, improvements in data transmission routes resulted in a 18.9% reduction in late reporting, allowing for near real-time analysis of data collected at the malaria posts. In 2020, travel restrictions were in place across Karen State in response to COVID-19, and from February 2021 the military coup in Myanmar resulted in widescale population displacement. However, over that period there has been no decline in malaria post attendance, and the majority of consultations continue to occur within 48 h of fever onset. Case investigations found that 43.8% of cases travelled away from their resident village in the 3 weeks prior to diagnosis and 36.3% reported never using a bed net whilst sleeping in their resident village, which increased to 72.2% when sleeping away from their resident village. Malaria post assessments performed in 82.3% of the METF malaria posts found malaria posts generally performed to a high standard.

Conclusions

Surveillance data collected by the METF programme demonstrate that despite significant changes in the context in which the programme operates, malaria posts have remained accessible and continue to provide early diagnosis and treatment contributing to an 89.3% decrease in Plasmodium falciparum incidence between 2014 and 2021.