bluuebunny/crossref_metadata_2025 huggingface dataset:
Effect of commercial wearables and digital behaviour change resources on the physical activity of adolescents attending schools in socio-economically disadvantaged areas: the RAW-PA cluster-randomised controlled trial
Authors: Ridgers Nicola D. , Timperio Anna , Ball Kylie , Lai Samuel K. , Brown Helen , Macfarlane Susie , Salmon Jo
Published: April 2021

Background

There has been increasing interest in using wearable activity trackers to promote physical activity in youth. This study examined the short- and longer-term effects of a wearable activity tracker combined with digital behaviour change resources on the physical activity of adolescents attending schools in socio-economically disadvantaged areas.

Methods

The Raising Awareness of Physical Activity (RAW-PA) Study was a 12-week, multicomponent intervention that combined a Fitbit Flex (and accompanying app), and online digital behaviour change resources and weekly challenges delivered via Facebook. RAW-PA was evaluated using a cluster-randomised controlled trial with 275 adolescents (50.2% female; 13.7 ± 0.4 years) from 18 Melbourne secondary schools (intervention n = 9; wait-list control group n = 9). The primary outcome was moderate- to vigorous-intensity physical activity (MVPA), measured using hip-worn ActiGraph accelerometers. The secondary outcome was self-reported physical activity. Data were collected at baseline, 12-weeks (immediately post-intervention), and 6-months post-intervention (follow-up). Multilevel models were used to determine the effects of the intervention on daily MVPA over time, adjusting for covariates.

Results

No significant differences were observed between intervention and wait-list control adolescents’ device-assessed MVPA immediately post-intervention. At 6-months post-intervention, adolescents in the intervention group engaged in 5 min (95% CI: − 9.1 to − 1.0) less MVPA per day than those in the wait-list control group. Males in the intervention group engaged in 11 min (95% CI: − 17.6 to − 4.5) less MVPA than males in the wait-list control group at 6-months post-intervention. No significant differences were observed for females at either time point. For self-reported physical activity, no significant effects were found at 12-weeks and 6-months post-intervention.

Conclusions

Combining a wearable activity tracker with digital behaviour change resources and weekly challenges did not increase inactive adolescents’ accelerometer-derived and self-reported physical activity levels immediately post-intervention. This contrasts previous research that has suggested wearable activity tracker may increase youth physical activity levels in the short-term. Lower engagement in MVPA 6-months post-intervention was observed for males but not for females, though it is unclear why this finding was observed. The results suggest wearable activity trackers, in combination with supporting materials, may not be effective for increasing physical activity levels in adolescents.

Trial registration

ACTRN12616000899448. Australian and New Zealand Clinical Trials Registry. Registered 7 July 2016.
Correction to: Testosterone induces renal tubular epithelial cell death through the HIF-1α/BNIP3 pathway
Authors: Peng Yonghan , Fang Ziyu , Liu Min , Wang Zeyu , Li Ling , Ming Shaoxiong , Lu Chaoyue , Dong Hao , Zhang Wenhui , Wang Qi , Shen Rong , Xie Fei , Zhang Weitao , Yang Cheng , Gao Xiaofeng , Sun Yinghao
Published: April 2021

An amendment to this paper has been published and can be accessed via the original article.
Heterogeneity of post-COVID impairment: interim analysis of a prospective study from Czechia
Authors: Skala Mikulas , Svoboda Michal , Kopecky Michal , Kocova Eva , Hyrsl Martin , Homolac Michal , Chrobok Viktor , Bostik Pavel , Fajfr Miroslav , Prasil Petr , Plisek Stanislav , Sleha Radek , Koblizek Vladimir
Published: April 2021

We stratified post-COVID patients into four newly established clinical groups based on the presence or absence of at least one subjective respiratory symptom and at least one objective sign of pulmonary involvement. Nearly half of outpatients and one third of hospitalized post-COVID patients had objective signs of pulmonary involvement without accompanying subjective respiratory symptoms three months after diagnosis.
External stenting of vein grafts in coronary artery bypass grafting: interim results from a two centers prospective study
Authors: Weltert Luca Paolo , Audisio Katia , Bellisaro Alessandro , Bardi Gianluca , Flocco Roberto , De Paulis Ruggero , Centofanti Paolo
Published: April 2021

Background

previous studies evaluating external stents for saphenous vein grafts (SVG) in CABG were limited to on-pump isolated CABG and single grafting technique with one external stent per patient. The objective of this prospective study was to evaluate the safety and the short-term performance of external stents in a heterogeneous group of patients who underwent on- and off-pump CABG, single and sequential grafting.

Methods

102 patients undergoing CABG were enrolled in two centers. All patients received internal mammary artery to the left anterior descending artery and additional arterial and/or venous grafts. In each patient, at least one SVG was supported with an external stent. Grafts’ patency and SVG lumen uniformity were assessed using CT angiography at a pre-defined time window of 6–12 months post procedure. All patients were prospectively followed-up via phone call and/or visit every 6 months for Major Adverse Cardiac and Cerebrovascular Events.

Results

51 patients (50%) underwent off-pump CABG and 23 patients (23%) were grafted with bilateral internal mammary arteries. Each patient received one or more SVG grafted in a sequential technique (44%) or as a single graft (56%). All SVG were externally stented in 84% of patients and in 16% (n = 16) one SVG was stented and one remained unsupported. At 6–12 months, patency rates of LIMA, RIMA, externally stented SVG and none-stented SVG were 100, 100, 98 and 87.5% respectively. 90% of the externally stented SVG had uniform lumen compared to 37% of the non-stented SVG. Clinical follow-up was completed for all patients with a mean duration of 20 months (range 6–54 months). During follow up period, one patient experienced myocardial infarction due to occlusion of the LIMA-LAD graft and one patient experienced a transient ischemic attack.

Conclusions

External stenting of SVG is feasible and safe in CABG setting which includes off pump CABG and sequential SVG grafting and associated with acceptable early patency rates.

Trial registration

Study was registered at ClinicalTrials.gov. NCT01860274 (initial release 20.05.2013).
Treatable inherited metabolic disorders causing intellectual disability: 2021 review and digital app
Authors: Hoytema van Konijnenburg Eva M. M. , Wortmann Saskia B. , Koelewijn Marina J. , Tseng Laura A. , Houben Roderick , Stöckler-Ipsiroglu Sylvia , Ferreira Carlos R. , van Karnebeek Clara D. M.
Published: April 2021

Background

The Treatable ID App was created in 2012 as digital tool to improve early recognition and intervention for treatable inherited metabolic disorders (IMDs) presenting with global developmental delay and intellectual disability (collectively ‘treatable IDs’). Our aim is to update the 2012 review on treatable IDs and App to capture the advances made in the identification of new IMDs along with increased pathophysiological insights catalyzing therapeutic development and implementation.

Methods

Two independent reviewers queried PubMed, OMIM and Orphanet databases to reassess all previously included disorders and therapies and to identify all reports on Treatable IDs published between 2012 and 2021. These were included if listed in the International Classification of IMDs (ICIMD) and presenting with ID as a major feature, and if published evidence for a therapeutic intervention improving ID primary and/or secondary outcomes is available. Data on clinical symptoms, diagnostic testing, treatment strategies, effects on outcomes, and evidence levels were extracted and evaluated by the reviewers and external experts. The generated knowledge was translated into a diagnostic algorithm and updated version of the App with novel features.

Results

Our review identified 116 treatable IDs (139 genes), of which 44 newly identified, belonging to 17 ICIMD categories. The most frequent therapeutic interventions were nutritional, pharmacological and vitamin and trace element supplementation. Evidence level varied from 1 to 3 (trials, cohort studies, case–control studies) for 19% and 4–5 (case-report, expert opinion) for 81% of treatments. Reported effects included improvement of clinical deterioration in 62%, neurological manifestations in 47% and development in 37%.

Conclusion

The number of treatable IDs identified by our literature review increased by more than one-third in eight years. Although there has been much attention to gene-based and enzyme replacement therapy, the majority of effective treatments are nutritional, which are relatively affordable, widely available and (often) surprisingly effective. We present a diagnostic algorithm (adjustable to local resources and expertise) and the updated App to facilitate a swift and accurate workup, prioritizing treatable IDs. Our digital tool is freely available as Native and Web App (www.treatable-id.org) with several novel features. Our Treatable ID endeavor contributes to the Treatabolome and International Rare Diseases Research Consortium goals, enabling clinicians to deliver rapid evidence-based interventions to our rare disease patients.
Escaping the past and living in the present: a qualitative exploration of substance use among Syrian male refugees in Germany
Authors: Lindert Jutta , Neuendorf Ulrike , Natan Marta , Schäfer Ingo
Published: April 2021

Background

Syrians have been the largest group of refugees in Germany since 2014. Little is known about Syrian refugees` perspectives on substance use. The aim of this study is to investigate the perspective of male refugees from Syria and to foster specific knowledge and understanding of substance use.

Methods

We applied a qualitative study design. Five semi-structured focus group discussions with a total of 19 refugees were conducted in 2019 among the difficult to reach population of Syrian refugees. Audio recordings were translated and transcribed. We used a hybrid approach by integrating inductive and deductive thematic frameworks.

Results

We identified common themes. Firstly, refugees perceived that substances are widely available and accepted in Germany. Secondly, refugees perceived that rules and norms in Germany differ from rules and norms in the home country and favor availability of substances. Thirdly, substance use is related to the intention to escape the past. Fourthly, substance use is related to living in the present through connecting with others and being part of the community. Finally, mental health professional treatment for substance use is associated with shame.

Conclusions

Findings support Syrian refugees` perspectives of substance use as a way of both escaping the past and coping with psychosocial difficulties in the present in a socio-ecological understanding. Understanding the explanatory model of Syrian refugees can inform future interventions to prevent substance abuse and design tailored interventions. Further studies with Syrian refugees in more countries are needed to better understand resettled refugees` perspectives on substance use.
Two novel mouse models mimicking minor deletions in 22q11.2 deletion syndrome revealed the contribution of each deleted region to psychiatric disorders
Authors: Saito Ryo , Miyoshi Chika , Koebis Michinori , Kushima Itaru , Nakao Kazuki , Mori Daisuke , Ozaki Norio , Funato Hiromasa , Yanagisawa Masashi , Aiba Atsu
Published: April 2021

22q11.2 deletion syndrome (22q11.2DS) is a disorder caused by the segmental deletion of human chromosome 22. This chromosomal deletion is known as high genetic risk factors for various psychiatric disorders. The different deletion types are identified in 22q11.2DS patients, including the most common 3.0-Mb deletion, and the less-frequent 1.5-Mb and 1.4-Mb deletions. In previous animal studies of psychiatric disorders associated with 22q11.2DS mainly focused on the 1.5-Mb deletion and model mice mimicking the human 1.5-Mb deletion have been established with diverse genetic backgrounds, which resulted in the contradictory phenotypes. On the other hand, the contribution of the genes in 1.4-Mb region to psychiatric disorders is poorly understood. In this study, we generated two mouse lines that reproduced the 1.4-Mb and 1.5-Mb deletions of 22q11.2DS [Del(1.4 Mb)/+ andDel(1.5 Mb)/+] on the pure C57BL/6N genetic background. These mutant mice were analyzed comprehensively by behavioral tests, such as measurement of locomotor activity, sociability, prepulse inhibition and fear-conditioning memory.Del(1.4 Mb)/+ mice displayed decreased locomotor activity, but no abnormalities were observed in all other behavioral tests.Del(1.5 Mb)/+ mice showed reduction of prepulse inhibition and impairment of contextual- and cued-dependent fear memory, which is consistent with previous reports. Furthermore, apparently intact social recognition inDel(1.4 Mb)/+ andDel(1.5 Mb)/+ mice suggests that the impaired social recognition observed inDel(3.0 Mb)/+ mice mimicking the human 3.0-Mb deletion requires mutations both in 1.4-Mb and 1.5 Mb regions. Our previous study has shown thatDel(3.0 Mb)/+ mice presented disturbance of behavioral circadian rhythm. Therefore, we further evaluated sleep/wakefulness cycles inDel(3.0 Mb)/+ mice by electroencephalogram (EEG) and electromyogram (EMG) recording. EEG/EMG analysis revealed the disturbed wakefulness and non-rapid eye moving sleep (NREMS) cycles inDel(3.0 Mb)/+ mice, suggesting thatDel(3.0 Mb)/+ mice may be unable to maintain their wakefulness. Together, our mouse models deepen our understanding of genetic contributions to schizophrenic phenotypes related to 22q11.2DS.
Adding a smartphone app to global postural re-education to improve neck pain, posture, quality of life, and endurance in people with nonspecific neck pain: a randomized controlled trial
Authors: Abadiyan Fatemeh , Hadadnezhad Malihe , Khosrokiani Zohre , Letafatkar Amir , Akhshik Haniyeh
Published: April 2021

Background

In this study, the effect of adding a smartphone app to an 8-week global postural reeducation (GPR) on neck pain, endurance, quality of life, and forward head posture (FHP) in patients with chronic neck pain and FHP was evaluated.

Methods

Sixty male and female office workers (38.5 ± 9.1 years) with chronic neck pain were randomly assigned into three groups: group 1 (GPR+ a smartphone app, n = 20), group 2 (GPR alone, n = 20), and group 3 (the control group, n = 20). The primary outcome was pain and the secondary outcomes were disability, quality of life, endurance, and posture. Pain, disability, endurance, quality of life, and posture were evaluated using the visual analog scale (VAS), neck disability index (NDI), progressive iso-inertial lifting evaluation (PILE) test, quality of life questionnaire (SF-36), and photogrammetry, respectively, at pre-and post-8-week interventions. A one-way analysis of covariance (ANCOVA) has been conducted to statistically analyze the data.

Results

The GPR+ a smartphone app had statistically significant improvements versus GPR alone in pain (mean difference, − 2.05 ± 0.65, ES (95% CI) − 0.50 (− 1.04 to − 0.01), P = 0.04), disability (difference = 11.5 ± 1.2, ES (95% CI) = 0.31 (0.22 to 0.97), p = 0.033), FHP (difference = 1.6 ± 0.2, ES (95% CI) = 0.31 (0.09 to 0.92), p = 0.047), and endurance (difference = 2 ± 3.3, ES (95% CI) = 0.51 (0.02 to 1.03), p = 0.039). Both of the GPR+ a smartphone app and GPR alone groups had statistically significant differences versus the control group in all outcomes.

Conclusion

When a workplace assessment and management could not be as part of any intervention, adding a smartphone app to GPR for NP may be an appropriate tool to administer a home and work exercise program resulting in elevating pain and disability, as well as improving FHP and endurance.

Trial registration

Current Controlled Trials using the UMIN-RCT website UMIN000039720. Retrospectively registered on January 9, 2020.
Functional interpretation of ATAD3A variants in neuro-mitochondrial phenotypes
Authors: Yap Zheng Yie , Park Yo Han , Wortmann Saskia B. , Gunning Adam C. , Ezer Shlomit , Lee Sukyeong , Duraine Lita , Wilichowski Ekkehard , Wilson Kate , Mayr Johannes A. , Wagner Matias , Li Hong , Kini Usha , Black Emily Davis , Monaghan Kristin G. , Lupski James R. , Ellard Sian , Westphal Dominik S. , Harel Tamar , Yoon Wan Hee
Published: April 2021

Background

ATPase family AAA-domain containing protein 3A (ATAD3A) is a nuclear-encoded mitochondrial membrane-anchored protein involved in diverse processes including mitochondrial dynamics, mitochondrial DNA organization, and cholesterol metabolism. Biallelic deletions (null), recessive missense variants (hypomorph), and heterozygous missense variants or duplications (antimorph) inATAD3Alead to neurological syndromes in humans.

Methods

To expand the mutational spectrum ofATAD3Avariants and to provide functional interpretation of missense alleles in trans to deletion alleles, we performed exome sequencing for identification of single nucleotide variants (SNVs) and copy number variants (CNVs) inATAD3Ain individuals with neurological and mitochondrial phenotypes. ADrosophila Atad3a Gal4knockin-null allele was generated using CRISPR-Cas9 genome editing technology to aid the interpretation of variants.

Results

We report 13 individuals from 8 unrelated families with biallelicATAD3Avariants. The variants included four missense variants inherited in trans to loss-of-function alleles (p.(Leu77Val), p.(Phe50Leu), p.(Arg170Trp), p.(Gly236Val)), a homozygous missense variant p.(Arg327Pro), and a heterozygous non-frameshift indel p.(Lys568del). Affected individuals exhibited findings previously associated withATAD3Apathogenic variation, including developmental delay, hypotonia, congenital cataracts, hypertrophic cardiomyopathy, and cerebellar atrophy.Drosophilastudies indicated that Phe50Leu, Gly236Val, Arg327Pro, and Lys568del are severe loss-of-function alleles leading to early developmental lethality. Further, we showed that Phe50Leu, Gly236Val, and Arg327Pro cause neurogenesis defects. On the contrary, Leu77Val and Arg170Trp are partial loss-of-function alleles that cause progressive locomotion defects and whose expression leads to an increase in autophagy and mitophagy in adult muscles.

Conclusion

Our findings expand the allelic spectrum ofATAD3Avariants and exemplify the use of a functional assay inDrosophilato aid variant interpretation.
Potential capacity of interferon-α to eliminate covalently closed circular DNA (cccDNA) in hepatocytes infected with hepatitis B virus
Authors: Wang Gang , Guan Jun , Khan Nazif U. , Li Guojun , Shao Junwei , Zhou Qihui , Xu Lichen , Huang Chunhong , Deng Jingwen , Zhu Haihong , Chen Zhi
Published: April 2021

Interferon-alpha (IFN-α) and nucleot(s)ide analogs (NAs) are first-line drugs for the treatment of chronic hepatitis B virus (HBV) infections. Generally, NAs target the reverse transcription of HBV pregenomic RNA, but they cannot eliminate covalently-closed-circular DNA (cccDNA). Although effective treatment with NAs can dramatically decrease HBV proteins and DNA loads, and even promote serological conversion, cccDNA persists in the nucleus of hepatocytes due to the lack of effective anti-cccDNA drugs. Of the medications currently available, only IFN-α can potentially target cccDNA. However, the clinical effects of eradicating cccDNA using IFN-α in the hepatocytes of patients with HBV are not proficient as well as expected and are not well understood. Herein, we review the anti-HBV mechanisms of IFN-α involving cccDNA modification as the most promising approaches to cure HBV infection. We expect to find indications of promising areas of research that require further study to eliminate cccDNA of HBV in patients.
Double ipsilateral parathyroid adenomas, with one supernumerary and ectopic at the same time: a case report
Authors: Tzikos Georgios , Polyzonis Michael , Milias Konstantinos , Milias Stefanos , Passos Ioannis , Ioannidis Konstantinos , Doutsini Nektaria-Dimitra , Chatzoulis Georgios , Spyridopoulos Panagiotis
Published: April 2021

Background

Double adenomas (DA) represents a distinct clinical entity of primary hyperparathyroidism (PHPT). DA may follow various embryologic distribution patterns and could be supernumerary and/or ectopic.

Case presentation

We describe the first case of PHPT which comes as a result of double ipsilateral adenoma, of which one was both ectopic and supernumerary. A 45 year-old Greek male patient with diagnosed PHPT due to a single lower right parathyroid adenoma was admitted to our department for surgical treatment. The preoperative tests (neck US, Sestamibi scan) were conclusive for single gland disease. The patient underwent focused parathyroidectomy. The frozen section revealed a parathyroid adenoma with a slight possibility for parathyroid carcinoma. Ten minutes after the excision, intact PTH (iPTH) dropped >50% related to preoperative values and was within normal range. Right hemithyroidectomy with additional ipsilateral central neck dissection was performed, because of the possibility for parathyroid carcinoma. The final pathology report showed that the first excised tissue proved to be a parathyroid adenoma, while a second subcapsular one and a normal right upper parathyroid gland were also found.

Conclusions

Preoperative localization of DA using routine imaging tests and the utility of intraoperative parathyroid hormone assay are still unreliable in detecting multiple adenomas. Furthermore, a slight possibility of a second and simultaneously supernumerary and ectopic adenoma maybe present. Therefore, it would be advisable to establish the use of more advanced imaging tests (such as 4D-CT, 4D-MRI) or other diagnostic tools when DA are suspected.
Sheep scab transmission: a spatially explicit dynamic metapopulation model
Authors: Nixon Emily , Brooks-Pollock Ellen , Wall Richard
Published: April 2021

Psoroptic mange (sheep scab), caused by the parasitic mite,Psoroptes ovis, is an important disease of sheep worldwide. It causes chronic animal welfare issues and economic losses. Eradication of scab has proved impossible in many sheep-rearing areas and recent reports of resistance to macrocyclic lactones, a key class of parasiticide, highlight the importance of improving approaches to scab management. To allow this, the current study aimed to develop a stochastic spatial metapopulation model for sheep scab transmission which can be adapted for use in any geographical region, exhibited here using data for Great Britain. The model uses agricultural survey and sheep movement data to geo-reference farms and capture realistic movement patterns. Reported data on sheep scab outbreaks from 1973 to 1991 were used for model fitting with Sequential Monte Carlo Approximate Bayesian Computation methods. The outbreak incidence predicted by the model was from the same statistical distribution as the reported outbreak data ($${\chi }^{2}$$χ2= 115.3,p = 1) and the spatial location of sheep scab outbreaks predicted was positively correlated with the observed outbreak data by county ($$\tau$$τ= 0.55,p < 0.001), confirming that the model developed is able to accurately capture the number of farms infected in a year, the seasonality of scab incidence and the spatial patterns seen in the data. This model gives insight into the transmission dynamics of sheep scab and will allow the exploration of more effective control strategies.
The effect of systemic lidocaine on post-operative opioid consumption in ambulatory surgical patients: a meta-analysis of randomized controlled trials
Authors: Lovett-Carter Danielle , Kendall Mark C. , Park James , Ibrahim-Hamdan Anas , Crepet Susannah , De Oliveira Gildasio
Published: April 2021

Background

Ambulatory surgical procedures continue to grow in relevance to perioperative medicine. Clinical studies have examined the use of systemic lidocaine as a component of multimodal analgesia in various surgeries with mixed results. A quantitative review of the opioid-sparing effects of systemic lidocaine in ambulatory surgery has not been investigated. The primary objective of this study was to systematically review the effectiveness of systemic lidocaine on postoperative analgesic outcomes in patients undergoing ambulatory surgery.

Methods

We performed a quantitative systematic review of randomized controlled trials in electronic databases (Cochrane Library, Embase, PubMed, and Google Scholar) from their inception through February 2019. Included trials investigated the effects of intraoperative systemic lidocaine on postoperative analgesic outcomes, time to hospital discharge, and adverse events. Methodological quality was evaluated using Cochrane Collaboration’s tool and the level of evidence was assessed using GRADE criteria. Data was combined in a meta-analysis using random-effects models.

Results

Five trials evaluating 297 patients were included in the analysis. The pooled effect of systemic lidocaine on postoperative opioid consumption at post-anesthesia care unit revealed a significant effect, weighted mean difference (95% CI) of − 4.23 (− 7.3 to 1.2, P = 0.007), and, at 24 h, weighted mean difference (95% CI) of − 1.91 (− 3.80 to − 0.03, P = 0.04) mg intravenous morphine equivalents. Postoperative pain control during both time intervals, postoperative nausea and vomiting reported at post anesthesia care unit, and time to hospital discharge were not different between groups. The incidence rate of self-limiting adverse events of the included studies is 0.007 (2/297).

Conclusion

Our results suggest that intraoperative systemic lidocaine as treatment for postoperative pain has a moderate opioid-sparing effect in post anesthesia care unit with limited effect at 24 h after ambulatory surgery. Moreover, the opioid-sparing effect did not impact the analgesia or the presence of nausea and vomiting immediately or 24 h after surgery. Clinical trials with larger sample sizes are necessary to further confirm the short-term analgesic benefit of systemic lidocaine following ambulatory surgery.

Trial registration

PROSPERO (CRD42019142229)
Integrated management is effective in the prevention and control of COVID-19 in the blood purification center: joint efforts from multiple departments
Authors: Yin Jinmei , Yin Jun , Tian Zhiwu , Li Peiqiu , Chen Xiaoqiu
Published: April 2021

Background

During the outbreak of new coronavirus pneumonia, many hospitals in China became the designated hospitals for the treatment of new coronavirus pneumonia. The goal was to develop rapid and effective prevention and control methods for blood purification centers.

Research design and methods

The medical department, hospital department, nursing department, and blood purification center jointly set up a multi-department integrated COVID-19 prevention and control management team to manage the blood purification center. The efforts included the establishment of the continuous renal replacement therapy (CRRT) team for COVID-19, the integrated training and assessment of medical personnel, the integrated education of patients and their families, and the integrated management of the workflow of the hemodialysis room.

Results

No infected persons, including medical staff, patients, and their families, have been found in the dialysis center. After multi-departmental integrated training, the theoretical performance of medical staff in our dialysis center has increased from 82.36 ± 8.10 to 95.29 ± 4.95 (p < 0.05), and the unqualified rate dropped from 23.21 to 1.78% (p < 0.05). In addition, the three operational skills evaluation scores have also been significantly improved, from 86.00 ± 4.02, 88.01 ± 6.20, 92.01 ± 2.46 to 95.90 ± 0.30, 97.21 ± 0.87, 96.00 ± 1.00 (p < 0.01), and the passing rate from 80.36 to 100% (p < 0.05).

Conclusion

Medical staff’s knowledge of novel coronavirus pneumonia prevention and control can be improved by multi-sectoral integrated management, and CRRT treatment of COVID-19 patients is effective.
Assessing quality of life in pediatric fibrous dysplasia and McCune Albright syndrome: PEDS-QL and HADS data from the Fibrous Dysplasia Foundation Patient Registry
Authors: Konradi Amanda
Published: April 2021

Purpose

The International FD/MAS Consortium recently encouraged using the Pediatric Quality of Life Inventory (PEDS-QL) and the Hospital Anxiety and Depression scales (HADS) in clinical care. This study examines scores on these measures among pediatric fibrous dysplasia and McCune Albright (FD/MAS) patients to initiate consideration of their use in clinical treatment.

Methods

This is a retrospective analysis of pediatric data from 39 minors, ages 2–17, entered in the Fibrous Dysplasia Foundation Patient Registry from July 2016 to December 2018. Sample means and score distributions are compared to general population and chronic disease benchmarks. Associations with medical and demographic variables are also explored.

Results

Mean PEDS-QL scores for children 2–7 were inconclusive in determining at risk status for impaired quality of life (QOL). Individual score distributions suggested up to half experienced extensive physical or social impairment. Means and individual score distributions for the physical and psychosocial components of the PEDS-QL for children 8–17 suggested many were at risk of impaired QOL. Over half of 13–17 year-olds met the clinical benchmark for anxiety. Older males scored better than females on the PEDS-QL and HADS. Pain frequency was associated with physical function for older children.

Conclusions

Older children with FD/MAS may be more compromised in terms of psychosocial QOL than previously reported. Clinicians should be attentive to the influence of gender on QOL in older children. Online patient registries associated with rare diseases have the potential to serve as efficient and cost-effective mechanisms to jumpstart examination of new measures in consideration for clinical use.
Bilateral antrochoanal polyps: a case report
Authors: cherrabi Kaoutar , Touihem Nabil , Nakkabi Ismail , Nadour Karim
Published: April 2021

Background

Antrochoanal or Killian polyp is a rare polyp of the maxillary sinus in adults. It is generally unilateral, implanted on the lateral wall of the maxillary sinus upon the uncinate process. Bilateral cases are very rare; only 14 cases have been cited from 1980 to 2020.

Case presentation

Our patient presented with a complete bilateral nasal obstruction, this symptom persisted for more than 10 years, with a perceived prolapse in his throat in the last 4 months. Anterior rhinoscopy showed a polyp that took up the totality of his nasal vestibule. Posterior rhinoscopy showed a polyp bulging behind the uvula.

The challenge in this case is related to diagnosis decision; conditions with the same clinical presentation are several.

Diagnosis was established through the clinical, radiological, and endoscopic aspects, and confirmed by histological findings. Management was obtained through functional endoscopic sinus surgery; no recurrence was noted in the 12-month follow-up, and clinical signs had completely subsided.

Conclusion

Diagnosis in bilateral forms of Killian polyp is perplexing; however, its management is generally simple, with excellent outcome. We report the case of the 15th patient along with a systematic literature review discussing bilateral Killian polyps, illustrated by a rare case of enormous bilateral antrochoanal polyps.
Pembrolizumab in Patients With Metastatic Breast Cancer With High Tumor Mutational Burden: Results From the Targeted Agent and Profiling Utilization Registry (TAPUR) Study
Authors: Alva Ajjai S. , Mangat Pam K. , Garrett-Mayer Elizabeth , Halabi Susan , Hansra Damien , Calfa Carmen J. , Khalil Maged F. , Ahn Eugene R. , Cannon Timothy L. , Crilley Pamela , Fisher Julie G. , Haslem Derrick S. , Shrestha Sagun , Antonelli Kaitlyn R. , Butler Nicole L. , Warren Sasha L. , Rygiel Andrew L. , Ranasinghe Shamika , Bruinooge Suanna S. , Schilsky Richard L.
Published: April 2021

PURPOSE

The TAPUR Study is a phase II basket trial that aims to identify signals of antitumor activity of commercially available targeted agents in patients with advanced cancers harboring genomic alterations known to be drug targets. Results in a cohort of patients with metastatic breast cancer (mBC) with high tumor mutational burden (HTMB) treated with pembrolizumab are reported.

METHODS

Patients with advanced mBC received standard doses of either 2 mg/kg or 200 mg infusions of pembrolizumab every 3 weeks. Simon's two-stage design was used with a primary study end point of disease control (DC) defined as objective response or stable disease of at least 16 weeks duration. If two or more patients in stage I achieved DC, the cohort would enroll 18 additional patients in stage II. Secondary end points include progression-free survival (PFS), overall survival, and safety.

RESULTS

Twenty-eight patients were enrolled from October 2016 to July 2018. All patients' tumors had HTMB ranging from 9 to 37 mutations/megabase. DC and objective response were noted in 37% (95% CI, 21 to 50) and 21% of patients (95% CI, 8 to 41), respectively. Median PFS was 10.6 weeks (95% CI, 7.7 to 21.1); median overall survival was 30.6 weeks (95% CI, 18.3 to 103.3). No relationship was observed between PFS and tumor mutational burden. Five patients experienced ≥ 1 serious adverse event or grade 3 adverse event at least possibly related to pembrolizumab consistent with the product label.

CONCLUSION

Pembrolizumab monotherapy has antitumor activity in heavily pretreated patients with mBC characterized by HTMB. Our findings support the recent US Food and Drug Administration approval of pembrolizumab for treatment of patients with unresectable or metastatic solid tumors with HTMB without alternative treatment options.
Cigarette consumption in adult dual users of cigarettes and e-cigarettes: a review of the evidence, including new results from the PATH study
Authors: Lee Peter N. , Fry John S. , Forey Barbara A. , Coombs Katharine J. , Thornton Alison J.
Published: April 2021

Background:  Modelling disease risk from e-cigarette use requires knowing how much e-cigarette uptake affects a smoker’s cigarette consumption.  From Waves 1-3 of the US PATH study and other evidence, we sought answers to three questions: (Q1) Does consumption differ between dual users and exclusive smokers?  (Q2) Does initiating e-cigarettes affect cigarette consumption?  (Q3) Is baseline consumption related to later initiation of e-cigarettes?

Methods:  Consumption data from PATH were corrected for clear recording errors, with e-cigarette use classified as established or every day, and adjustment made for demographics, use of alcohol, drugs and other tobacco products, and age of starting smoking.  Searches identified other studies published since 2008, with Q1 answered from cross-sectional studies, and Q2 and Q3 also from prospective studies. 

Results: (Q1) In PATH, consumption in current every day e-cigarette users was 2-3 cigarettes per day lower in dual users, with no difference seen in established users.  From 31 published studies, consumption was no lower in dual users for current or ever e-cigarette users.  (Q2) In PATH study consistent decreases in consumption occurred in those becoming every day dual users with increases seen in those reverting to exclusive smoking.  Thirteen published studies consistently showed reduced consumption in those becoming dual users.  (Q3) Three studies consistently showed greater consumption in smokers subsequently initiating e-cigarettes, but no significant difference was seen for PATH. 

Conclusions:  Assessment is complicated by the few every day e-cigarette users in PATH, and between-study variability in quantifying e-cigarette use and presentation of results. As taking up e-cigarettes is associated with reducing consumption, finding no clear cross-sectional difference between dual users and exclusive smokers suggests smokers taking up e-cigarettes had higher consumption initially, limited evidence supporting this.  Given the much lower disease risk of e-cigarettes vs. cigarettes, smokers becoming dual users should somewhat reduce their disease risk.
A new analysis approach for single nephron GFR in intravital microscopy of mice
Authors: Kessel Friederike , Kröger Hannah , Gerlach Michael , Sradnick Jan , Gembardt Florian , Todorov Vladimir , Hugo Christian
Published: April 2021

Background: Intravital microscopy is an emerging technique in life science with applications in kidney research. Longitudinal observation of (patho-)physiological processes in living mice is possible in the smallest functional unit of the kidney, a single nephron (sn). In particular, effects on glomerular filtration rate (GFR) - a key parameter of renal function - can be assessed.

Methods: After intravenous injection of a freely filtered, non-resorbable, fluorescent dye in C57BL/6 mice, a time series was captured by multiphoton microsopy. Filtration was observed from the glomerular capillaries to the proximal tubule (PT) and the tubular signal intensity shift was analyzed to calculate the snGFR.

Results: Previously described methods for snGFR analysis relied on two manually defined measurement points in the PT and the tubular volume was merely estimated in 2D images. We present an extended image processing workflow by adding continuous measurement of intensity along the PT in every frame of the time series using ImageJ. Automatic modelling of actual PT volume in a 3D dataset replaced 2D volume estimation. Subsequent data analysis in R, with a calculation of intensity shifts in every frame and normalization against tubular volume, allowed exact assessment of snGFR by linear regression. Repeated analysis of image data obtained in healthy mice showed a striking increase of reproducibility by reduction of user interaction.

Conclusions: These improvements in image processing and data analysis maximize the reliability of a sophisticated intravital microscopy technique for the precise assessment of snGFR, a highly relevant predictor of kidney function.
On extension of classical Baer results to Poisson algebras
Authors:   Oles Honchar Dnipro National University, Kurdachenko L. A. , Pypka A. A. ,   Oles Honchar Dnipro National University, Subbotin I. Ya. ,   National University
Published: April 2021

In this paper we prove that if P is a Poisson algebra and the n-th hypercenter (center) of P has a finite codimension, then P includes a finite-dimensional ideal K such that P/K is nilpotent (abelian). As a corollary, we show that if the nth hypercenter of a Poisson algebra P (over some specific field) has a finite codimension and P does not contain zero divisors, then P is an abelian algebra.
Should adult ventilated patients on the intensive care unit be fasted preoperatively?
Authors: Pandya Shivani J , Spiro Michael
Published: April 2021

In the absence of separate guidelines for critically unwell ventilated patients in the intensive care unit who are undergoing surgery, questions arise about whether patients in intensive care should be starved preoperatively, despite already having a protected airway.
Perioperative risk prediction
Authors: Davis Edward
Published: April 2021

Predicting outcomes for surgical patients accurately can be challenging preoperatively. Fortunately, there is an array of evidence-based scoring systems which can guide perioperative decision making and discussions of risk with patients.
Peripatetic teaching: what can medical education learn from ancient Greece?
Authors: Murphy John , Mannion Christopher J
Published: April 2021

Background/Aims

Peripatetic teaching originated in the Aristotelian school of ancient Greece and refers to the action of walking, discussion and deep learning. A pilot study was carried out to evaluate the educational impact of peripatetic teaching in clinical medical education. There has been no previous evaluation of this form of teaching within medical education.

Methods

A pilot study was carried out to evaluate small group clinical sessions encompassing peripatetic teaching.

Results

A total of 56 post teaching questionnaires were completed and evaluated (return rate ~95%). High levels of satisfaction (n~4.7/5) were reported from this method of teaching. On average, a total of 1420 steps were taken during each teaching session, identifying additional exercise benefits for all.

Conclusions

This article identifies educational and health benefits to peripatetic teaching. The authors present a simple framework to structure each teaching session using the mnemonic FIRM – Feedback, dIscussion, Reflection and Mentorship. From this pilot study, the authors conclude that there are perceived benefits for teacher and learner from this teaching method.
Risk factors associated with delayed and aseptic nonunion following tibial diaphyseal fractures managed with intramedullary nailing
Authors: Makaram Navnit S. , Leow Jun Min , Clement Nicholas D. , Oliver William M. , Ng Zhan H. , Simpson Cameron , Keating John F.
Published: April 2021

Aims

The primary aim of this study was to identify independent predictors associated with nonunion and delayed union of tibial diaphyseal fractures treated with intramedullary nailing. The secondary aim was to assess the Radiological Union Scale for Tibial fractures (RUST) score as an early predictor of tibial fracture nonunion.

Methods

A consecutive series of 647 patients who underwent intramedullary nailing for tibial diaphyseal fractures were identified from a trauma database. Demographic data, comorbidities, smoking status, alcohol consumption, use of non-steroidal anti-inflammatory drugs (NSAIDs), and steroid use were documented. Details regarding mechanism of injury, fracture classification, complications, and further surgery were recorded. Nonunion was defined as the requirement for revision surgery to achieve union. Delayed union was defined as a RUST score < 10 at six months postoperatively.

Results

There were 41 nonunions (6.3%), of which 13 were infected (31.7%), and 77 delayed unions (11.9%). There were 127 open fractures (19.6%). Adjusting for confounding variables, NSAID use (odds ratio (OR) 3.50; p = 0.042), superficial infection (OR 3.00; p = 0.026), open fractures (OR 5.44; p < 0.001), and high-energy mechanism (OR 2.51; p = 0.040) were independently associated with nonunion. Smoking (OR 1.76; p = 0.034), open fracture (OR 2.82; p = 0.001), and high-energy mechanism (OR 1.81; p = 0.030) were independent predictors associated with delayed union. The RUST score at six-week follow-up was highly predictive of nonunion (sensitivity and specificity of 75%).

Conclusion

NSAID use, high-energy mechanisms, open fractures, and superficial infection were independently associated with nonunion in patients with tibial diaphyseal fractures treated with intramedullary nailing. The six-week RUST score may be useful in identifying patients at risk of nonunion. Cite this article: Bone Jt Open 2021;2(4):227–235.
Axis-Switching Behavior of Liquid Jets Issued from Non-Circular Nozzles Under Low-Intermediate Pressure
Authors: Hua Lin , Li Hong , Jiang Yue
Published: April 2021

Highlights

The flow behavior of water jets discharged from different orifices was investigated.

High-speed photography (HSP) was used to obtain surface structures and spread characteristics of water jets.

The deformation process in axis switching related to the corner vortices effect of non-circular jets was researched by numerical simulation.

The axis switching of non-circular jets enhances entrainment ability of the jet.

ABSTRACT. Low-intermediate pressure sprinkler irrigation systems are important research topics in the field of water-saving irrigation. Non-circular nozzles improve spray uniformity at lower pressures and are key components of sprinkler irrigation systems. In this article, the behavior of discharged water jets from nozzles with circular, square, and equilateral triangular orifices designed with the same flow rate was investigated. High-speed photography (HSP) was used to capture jet characteristics in the near field (z<20D). The largest spread angle was obtained for the square jet, which was on average 37% larger than that of the circular jet. In addition, numerical simulations were performed to analyze the axis-switching process using the large-eddy simulation (LES) method and the coupled level-set and volume of fluid (CLSVOF) method. The axis-switching phenomenon was observed in non-circular jets, in which surrounding air mixed with the jet and promoted the formation of thin diaphragm structures. The deformation process that occurs in axis switching is described according to the simulated vorticity and velocity fields. The research results suggest the axis-switching phenomenon is induced by corner vortex motions produced by the polygonal orifice, which accelerate the decay of the axial velocity and increase the jet entrainment rate. Thus, the effect of corner vortices should be considered in the design of polygonal nozzles. Keywords: Axis switching, High-speed photography, Liquid jet, Low-intermediate pressure sprinkler irrigation, Non-circular nozzle, Numerical simulation.
Active alignment of complex perturbed pupil-offset off-axis telescopes using the extension of nodal aberration theory
Authors: Wen Ming , Ma Hongcai , Han Chengshan
Published: April 2021

This paper presents an optical alignment strategy for complex perturbed pupil-offset off-axis reflective telescopes, based on the extension of nodal aberration theory (NAT). First, the direct expansion of the wave aberration function in the vector form for perturbed off-axis systems is given, which is especially convenient for the expansion of the corresponding higher-order terms. The inherent vector relationships between the contributions generated by the aberrations of the on-axis parent systems through pupil transformation are disclosed in detail, which is helpful to understand the aberration behavior of off-axis systems. Then, according to the inherent vector relationships, an analytical alignment model based on NAT for complex cases of perturbed off-axis telescopes is established. It can quantitatively separate the effects of misalignments and surface figure errors from the total aberration fields. The alignment model is solved by using particle swarm optimization algorithm. Then, an optical alignment example of the off-axis three-mirror anastigmatic telescope with misalignments and complex surface figure errors based on the proposed method is demonstrated. After correction, the perturbed telescope can be nearly restored to the nominal states. Finally, Monte Carlo simulations are carried out to show the effectiveness and accuracy of the proposed method.
Nearly dispersionless multicolor metasurface beam deflector for near eye display designed by a physics-driven deep neural network
Authors: Chen Wen-Qing , Zhang Da-Sen , Long Shang-Yu , Liu Zhen-Zhen , Xiao Jun-Jun
Published: April 2021

Dispersion is one of the most important issues in see-through near eye displays with waveguide technology. In particular, the nanophotonics design is challenging but demanding. In this paper, we propose a design method for a multilayer achromatic metasurface structure for near eye display application by a physics-driven generative neural network. Two in-coupling metagratings under different projector illuminations are presented and numerically verified with the absolute diffraction efficiency over 89%. A beam splitter, which provides a balance between compactness and visual comfort in a single-projector-binocular display, is also designed. Finally, we apply this method to an out-coupling metasurface with the capability of enlarging the visible region by threefold.