bluuebunny/crossref_metadata_2025 huggingface dataset:
Design of patient specific bone stiffness mimicking scaffold
Authors: Rana Masud , Chaudhuri Abhik , Biswas Jayanta Kumar , Karim Sk Imran , Datta Pallab , Karmakar Santanu Kumar , Roychowdhury Amit
Published: July 2021

The difference in stiffness of a patient’s bone and bone implant causes stress shielding. Thus, implants which match the stiffness of bone of the patient result in better bone growth and osseointegration. Variation in porosity is one of the methods to obtain implants with different stiffness values. This study proposes a novel method to design biomimetic bone graft implant based on computed tomography (CT) scan data, that creates similar pre- and post-implant mechanical environment on peri-implant bone. The design methodology is demonstrated by taking three different sections of human femur bone, greater trochanter, diaphysis and epicondyle, with two different implant materials, Ti-6Al-4V and Ti-Mg. Bones from these three sections were replaced with porous implants of effective stiffness of replaced bone, as would have been required after a resection surgery. Models were simulated with physiological loading condition using finite element (FE) method. Variation of maximum von Mises stress and average strain on peri-prosthetic bone were found to be in the range of −6% to 10.7% and −7% to −17.9% for porous implants and 26% to 50% and −36% to −59% for solid implant respectively compared to natural bone. The results revealed that the porous implants, which have been designed based on CT scan data, can effectively produce mechanical response at peri-implant bone, which is very close to pre-implanted condition. Following this methodology, more osseointegration friendly mechanical environment can be achieved at peri-implant bone for any anatomical location independent of implant materials.
Edward S Perkins, MD, PhD (1919–2015): In the vanguard of ophthalmic physician–scientists
Authors: Blodi Christopher F
Published: July 2021

British-American ophthalmologist Edward Perkins, MD, PhD (1919–2015) held wide-ranging research interests during his career at the Institute of Ophthalmology in London, the University of Iowa, and as a military doctor stationed in Kenya. With his PhD and a medical degree, Perkins was in the vanguard of clinician–scientists who possessed such dual credentials, enabling him to perform noteworthy experimental and clinical research. Perkins’ glaucoma research included early work on acetazolamide and prostaglandins, laser iridotomy, and large-scale glaucoma surveys such as the Bedford Glaucoma Survey. In 1957, Perkins earned a PhD with a thesis on cranial nerve influences on rabbit intraocular pressure. Perkins also invented a handheld applanation tonometer; wrote an entire volume on uveitis for Duke-Elder's system of Ophthalmology; co-founded the Association for Eye Research (the European Association for Vision and Eye Research forerunner); and was a charter member of the Glaucoma Research Society. In 1961, Perkins became the first Professor of Experimental Ophthalmology at the Institute of Ophthalmology in London. In 1979, Perkins and his family emigrated to the United States, where he became a Professor of Ophthalmology at the University of Iowa. Perkins’ understated personality masked a legacy of extensive contributions to the field of ophthalmology.
Centering Matrices of Domination: Steps Toward a More Intersectional Vocational Psychology
Authors: Brewster Melanie Elyse , Molina David Alejandro López
Published: July 2021

The present paper responds to calls to integrate a more explicitly intersectional framework and agenda to vocational psychology. We elucidate how several matrices of domination (i.e., interlocking systems of oppression) may shape the working lives of Americans. Although vocational psychology has made limited progress in exploring two such matrices—the impact of White supremacy and Patriarchy—and expanding research, theory, and clinical work to increasingly diverse populations, we argue that other oppressive systemic forces have been largely overlooked. In response to this gap, a close analysis of how our economic system (i.e., late-stage capitalism, neoliberalism) and Christian hegemony (i.e., protestant work ethic, the prosperity gospel) have impacted the workforce is provided. Finally, to center intersectional perspectives on change, we argue that vocational psychology must pivot to a more activist stance and provide recommendations for research, training, and clinical work.
Implementation of a clinical pharmacist-led service to optimize management of refractory chemotherapy-induced nausea and vomiting in adult hematology/oncology clinic
Authors: Quinn Caroline S , Bergsbaken Jason J , Blessinger Emily J , Piccolo Jennifer K
Published: July 2021

Objective

Chemotherapy-induced nausea and vomiting (CINV) is a common and potentially debilitating adverse effect of chemotherapy. Refractory CINV can be particularly difficult to control. This report provides details on the implementation and evaluation of a pharmacist-led program for the management of refractory CINV in hematology and oncology clinics.

Methods

A pharmacist-led program open to adult outpatients with refractory CINV was implemented at University of Wisconsin. Pharmacists conducted baseline and follow-up assessments, provided patient education, and started, discontinued, and/or adjusted antiemetics as clinically necessary for all enrolled patients. Retrospective chart review was used to describe the proportion of patients whose CINV improved through pharmacist intervention, effect of the program on antiemetic adherence, categorization of pharmacist interventions, and duration of patient enrollment.

Results

Forty-six patients were enrolled between February 2019 and January 2020. Forty-one patients (89.1%) had an overall reduction in their nausea and vomiting from baseline. Eleven patients (23.9%) met criteria for nonadherence to prescribed antiemetics at baseline; all patients were adherent at unenrollment. A total of 111 pharmacist interventions were made. The most common intervention was addition of new breakthrough antiemetic. The least common intervention was dose escalation of a previously prescribed antiemetic. The average number of interventions made per patient was 2.5. On average, patients were enrolled in the program for 16.6 days and met with a pharmacist three times.

Conclusion

Implementation of this program standardized and streamlined pharmacist involvement with refractory CINV. Enrollment resulted in a measurable reduction in nausea and/or vomiting for patients with refractory CINV.
Acute gout flare of bilateral first metatarsophalangeal joints due to ibrutinib use in chronic lymphocytic leukemia
Authors: Kaur Jaspreet , Tuler Shahaf , Dasanu Constantin A
Published: July 2021

Introduction

Bruton tyrosine kinase inhibitors represent important tools in the therapeutic armamentarium against chronic lymphocytic leukemia (CLL) and other B-lymphoproliferative disorders.

Case Report

We describe herein a unique 65-year-old patient who presented with bilateral foot pain four months after starting treatment with ibrutinib for CLL. Of note, the patient had previously been diagnosed with gout, and was taking allopurinol prophylactically at the time of the event. Compliance with allopurinol was in excess of 99%. Yet, he was diagnosed with acute gout flare of bilateral first metatarsophalangeal (MTP) joints. Management & Outcome: Ibrutinib dose was reduced by one third, and the patient’s gout flare up was treated with ibuprofen as needed. After symptoms abated, ibrutinib was continued at 2/3rds of the dose, with an excellent CLL control. The patient tolerated this dose without any further adverse effects. Discussion/Conclusions: We have reported a unique side effect of acute bilateral first MTP joint gout flare likely triggered by ibrutinib use for CLL while the patient was taking a xanthine oxidase inhibitor. The mechanism by which ibrutinib caused this phenomenon remains to be elucidated.
Analysis of bi-directional functionally graded sandwich plates via higher-order shear deformation theory and finite element method
Authors: Vinh Pham Van
Published: July 2021

This paper introduces a comprehensive investigation of bi-directional functionally graded sandwich plates using higher-order shear deformation theory and finite element method for the first time. A special procedure incorporating with a bi-linear four-node quadrilateral element is used to treat the free condition of shear stresses on two surfaces of the sandwich plates. Four types of the bi-directional functionally graded sandwich plates with several thickness ratios of layers are considered, in which the material properties of the layers are assumed to vary in both the thickness and the in-plane directions. The present results are compared with published data in some special cases to demonstrate the convergence and accuracy of the present algorithm. The investigations show that the variation of the material ingredients and properties, the boundary conditions, the thickness ratio of layers play significant roles on the bending, free vibration and buckling behaviors of bi-directional functionally graded sandwich plates.
The Impact of Adherence to Disease-Modifying Therapies on Functional Outcomes in Veterans with Multiple Sclerosis
Authors: Rabadi Meheroz H , Just Kimberly , Xu Chao
Published: July 2021

Background:

Patients who adhere to their DMTs have lower rate of MS-related relapses and disability.

Objective:

We sought to determine the adherence rate to disease-modifying therapies (DMTs) and its impact on functional outcome(s) in veterans with multiple sclerosis (MS).

Method:

We reviewed the electronic records of 279 veterans with MS who were periodically followed in our MS clinic. We compared 3 groups of patients, defined according to their adherence to DMTs (non-adherent; poorly adherent; adherent) on their effect on disability progression and time to sustained EDSS score of 6.

Results:

There were 148 (53%) veterans with MS who were non-adherent to any DMT medication(s) while of the 131 (47%) veterans who were taking medications, 118 (42%) had a good- and 13 (5%) had poor-adherence. The mean age at MS onset was 36.6 (± 11.2) and mean duration of MS for the sample was 24 ± 13.5 years. The mean initial EDSS and TFIM scores were 4.09 ± 2.9 SD and 104 ± 25.7 for the study sample. The change in MMSE, TFIM scores, and time to sustained EDSS score of 6 significantly favored the good- compared to the non-adherence group ( P < .01).

Conclusion:

This study suggests that veterans with MS who adhered to their DMTs had less decline in their MS-related cognition, disease severity and disability compared to non- and poorly-adherent groups even after adjusting for age, gender, MS duration, and type. Time to EDSS score of 6 was significantly prolonged in the good-adherence group.
Inequality and penality: The hidden side of a complex relationship
Authors: Vanneste Charlotte
Published: July 2021

This article focuses on the close association between inequality and punishment observed over recent decades at a macro level, at least in some regions of the world. A review of the empirical literature first provides an overview of the different types of variables mobilized to try to understand this complex relationship. The aim of the empirical part is to explore the potential role of attitudes towards inequality in this relationship, on the basis of country-level data available for West European countries. The results do not support the idea that a more meritocratic ethos at the country level would create the connection between inequality and punishment. On the contrary, they suggest the persistence of a systemic link independently of attitudinal variables. However, by showing that, the greater the inequality, the more the population calls for redistributive intervention by the state, and the more it also calls for punitive intervention, the findings could suggest another pattern. This moves away from a rather deterministic perspective to highlight the room for manoeuvre for social change.
The burden of chronic respiratory diseases in adults in Nepal: A systematic review
Authors: Ekezie Winifred , Jenkins Alex Robert , Hall Ian Philip , Evans Catrin , Koju Rajendra , Kurmi Om Prakash , Bolton Charlotte Emma
Published: July 2021

While chronic lung disease causes substantial global morbidity and mortality, global estimates have primarily been based on broad assumptions. Specific country data from low-income countries such as Nepal are limited. This review assessed primary evidence on chronic respiratory disease burden among adults in Nepal. A systematic search was performed in June 2019 (updated May 2020) for studies through nine databases. High levels of heterogeneity deemed a narrative synthesis appropriate. Among 27 eligible studies identified, most were low-moderate quality with cross-sectional and retrospective study design. Chronic lung diseases identified were chronic obstructive pulmonary disease (COPD), asthma, bronchiectasis and restrictive lung diseases. Studies were categorised as: (i) community-based, (ii) hospital-based and (iii) comorbidity-related and disease burden. Reported disease prevalence varied widely (COPD, 1.67–14.3%; asthma, 4.2–8.9%). The prevalence of airflow obstruction was higher among rural dwellers (15.8%) and those exposed to household air pollution from domestic biomass burning as opposed to liquid petroleum gas users (Odds Ratio: 2.06). Several comorbidities, including hypertension and diabetes mellitus added to the disease burden. The review shows limited literature on lung disease burden in Nepal. Publications varied in terms of overall quality. Good quality research studies with prospective cohorts related to respiratory conditions are required.
Optimisation of cutting parameters and surface deformation during thin steel sheets plasma processing using Taguchi approach
Authors: Gani Adel , Ion William , Yang Erfu
Published: July 2021

Plasma machining was investigated for suitability to cut thin sheets and the quality obtained was assessed. The aim of this research was to analyse the impact of the heat generated from plasma cutting on thin sheet surface deformation and heat affected zones. Plasma cutting was assumed to be noneffective for processing thin material, this technology was known primely for cutting medium to thick plates. Tremendous work was performed previously to improve the quality. However, there are no scientific publications assessed the effect of the plasma heat on thin material under 1 mm and optimised optimise the process to reduce the phenomena resulted to their minimal. The traditional cutting methods were found to be limited and time consuming. This research can be beneficial for vehicle convertors such as wheelchair accessible vehicles or similar industries where conventional cutting methods are still predominant. Therefore, an automated plasma cutter if properly optimised would be an effective solution. CNC Plasma cutter with an automated torch height adjustment was used for this experiment to process a 0.6 mm thick deep drawing cold rolled DCO1 steel grade material. Tests were carried out varying the plasma parameters speed, pressure and intensity, the quality obtained was assessed. Three-dimensional Triplescan Atos model was used to measure the maximum surface deformation. Samples were sectioned, mounted, polished, mirrored and etched with 5% Nital acid to expose the material grains. Results were gathered on a tables, then Taguchi method and Analysis of Variance were used to optimise and analyse the parameters. Results showed an effective cut for thin materials. The optimal values obtained were 8000 mm/min, pressure 70 psi and Intensity 25 A for sheet deformation whereas heat affected zones was cutting speed 8500 mm/min, pressure 80 psi and Intensity 30 A. Cutting speed and intensity had the highest impact on deformation however heat affected zones was influenced mainly by the cutting speed. The study suggested also that a mathematical model can be constructed to predict the response for both phenomena and assess the relationship strength, the method used was least square error, the tests showed that the models fit adequately and can be trusted to predict new values. Lastly, a vehicle chassis was used for the test, the results showed an effective cutting on painted material, no second processing was required. Sealant under the material required removal on plasma pathway to avoid excess smoke or fire generation. An estimation was made for the underbody chassis cut out processing time and it was found that automated plasma can reduce the cycle time to just above 40 min.
Aerosol Generation in Ear Canal and Air‐Fluid Interface Suction
Authors: Bahgat Mohammed , Lindsey Leon , Lindsey Paul , Knight Andrew
Published: July 2021

Objective

The identification of aerosol‐generating procedures (AGPs) is important during the current SARS‐CoV‐2 pandemic due to aerosol‐mediated virus transmission. Aerosol measurement during clinical procedures using particle counting may be confounded by variable natural background aerosol levels or limited by partial volume sampling. The study objective was to quantify any significant aerosol generated from simulated suction clearance procedures.

Study Design

Prospective quantification of aerosol generation during clinical suction simulation.

Setting

Clean chamber.

Methods

We created a clean environment for particle counting in a transparent neutralized polypropylene chamber. Air was passed through a HEPA 14 class filter to maintain a constant chamber inlet pressure. An optical particle counter was connected in line to the chamber exhaust vent to measure all of the vented particles. The chamber background count was 1 particle ≥0.3 µm per 15 minutes at a flow rate of 1 chamber air change per minute. We used this system to quantify very low aerosol counts generated from suction clearance of a silicone ear canal and at an open air‐fluid interface.

Results

No clinically significant aerosol generation was found by particle counting of the whole chamber air volume during simulated suction procedures.

Conclusion

Simulated ear suction clearance and air‐fluid interface suction does not generate any significant aerosol. It appears likely that any aerosol potentially generated at the suction tube tip is entrained by incoming air flow. This is the first study to quantify aerosols generated by suction in a controlled environment; further research is required to determine its clinical implications.
Overexpressed XRCC2 as an independent risk factor for poor prognosis in glioma patients
Authors: Liu Zhendong , Zhang Wang , Cheng Xingbo , Wang Hongbo , Bian Lu , Wang Jialin , Han Zhibin , Wang Yanbiao , Lian Xiaoyu , Liu Binfeng , Ren Zhishuai , Zhang Bo , Jiang Zhenfeng , Lin Zhiguo , Gao Yanzheng
Published: July 2021

Background

XRCC2, a homologous recombination-related gene, has been reported to be associated with a variety of cancers. However, its role in glioma has not been reported. This study aimed to find out the role of XRCC2 in glioma and reveal in which glioma-specific biological processes is XRCC2 involved based on thousands of glioma samples, thereby, providing a new perspective in the treatment and prognostic evaluation of glioma.

Methods

The expression characteristics of XRCC2 in thousands of glioma samples from CGGA and TCGA databases were comprehensively analyzed. Wilcox or Kruskal test was used to analyze the expression pattern of XRCC2 in gliomas with different clinical and molecular features. The effect of XRCC2 on the prognosis of glioma patients was explored by Kaplan–Meier and Cox regression. Gene set enrichment analysis (GSEA) revealed the possible cellular mechanisms involved in XRCC2 in glioma. Connectivity map (CMap) was used to screen small molecule drugs targeting XRCC2 and the expression levels of XRCC2 were verified in glioma cells and tissues by RT-qPCR and immunohistochemical staining.

Results

We found the overexpression of XRCC2 in glioma. Moreover, the overexpressed XRCC2 was associated with a variety of clinical features related to prognosis. Cox and meta-analyses showed that XRCC2 is an independent risk factor for the poor prognosis of glioma. Furthermore, the results of GSEA indicated that overexpressed XRCC2 could promote malignant progression through involved signaling pathways, such as in the cell cycle. Finally, doxazosin, quinostatin, canavanine, and chrysin were identified to exert anti-glioma effects by targeting XRCC2.

Conclusions

This study analyzed the expression pattern of XRCC2 in gliomas and its relationship with prognosis using multiple datasets. This is the first study to show that XRCC2, a novel oncogene, is significantly overexpressed in glioma and can lead to poor prognosis in glioma patients. XRCC2 could serve as a new biomarker for glioma diagnosis, treatment, and prognosis evaluation, thus bringing new insight into the management of glioma.
Hypoxia-induced preadipocyte factor 1 expression in human lung fibroblasts through ERK/PEA3/c-Jun pathway
Authors: Cheng Wun-Hao , Chen Chia-Ling , Chen Jing-Yun , Lin Chien-Huang , Chen Bing-Chang
Published: July 2021

Background

Several studies have reported that hypoxia plays a pathological role in severe asthma and tissue fibrosis. Our previous study showed that hypoxia induces A disintegrin and metalloproteinase 17 (ADAM17) expression in human lung fibroblasts. Moreover, preadipocyte factor 1 (Pref-1) is cleaved by ADAM17, which participates in adipocyte differentiation. Furthermore, Pref­1 overexpression is involved in tissue fibrosis including liver and heart. Extracellular signal-regulated kinase (ERK) could active downstram gene expression through polyoma enhancer activator 3 (PEA3) phosphorylation. Studies have demonstrated that PEA3 and activator protein 1 (AP-1) play crucial roles in lung fibrosis, and the Pref-1 promoter region contains PEA3 and AP-1 binding sites as predicted. However, the roles of ERK, PEA3, and AP-1 in hypoxia-stimulated Pref-1 expression in human lung fibroblasts remain unknown.

Methods

The protein expression in ovalbumin (OVA)-induced asthmatic mice was performed by immunohistochemistry and immunofluorescence. The protein expression or the mRNA level in human lung fibroblasts (WI-38) was detected by western blot or quantitative PCR. Small interfering (si) RNA was used to knockdown gene expression. The collaboration with PEA3 and c-Jun were determined by coimmunoprecipitation. Translocation of PEA3 from the cytosol to the nucleus was observed by immunocytochemistry. The binding ability of PEA3 and AP-1 to Pref-1 promoter was assessed by chromatin immunoprecipitation.

Results

Pref-1 and hypoxia-inducible factor 1α (HIF-1α) were expressed in the lung sections of OVA-treated mice. Colocalization of PEA3 and Fibronectin was detected in lung sections from OVA-treated mice. Futhermore, Hypoxia induced Pref­1 protein upregulation and mRNA expression in human lung fibroblasts (WI­38 cells). In 60 confluent WI-38 cells, hypoxia up-regulated HIF-1α and Pref-1 protein expression. Moreover, PEA3 small interfering (si) RNA decreased the expression of hypoxia-induced Pref­1 in WI­38 cells. Hypoxia induced PEA3 phosphorylation, translocation of PEA3 from the cytosol to the nucleus, PEA3 recruitment and AP-1 binding to the Pref­1 promoter region, and PEA3-luciferase activity. Additionally, hypoxia induced c-Jun-PEA3 complex formation. U0126 (an ERK inhibitor), curcumin (an AP­1 inhibitor) or c-Jun siRNA downregulated hypoxia-induced Pref-1 expression.

Conclusions

These results implied that ERK, PEA3, and AP­1 participate in hypoxia­induced Pref­1 expression in human lung fibroblasts.
Particle Size Effect of Lanthanum-Modified Bismuth Titanate Ceramics on Ferroelectric Effect for Energy Harvesting
Authors: Kim Sangmo , Nguyen Thi My Huyen , He Rui , Bark Chung Wung
Published: July 2021

Piezoelectric nanogenerators (PNGs) have been studied as renewable energy sources. PNGs consisting of organic piezoelectric materials such as poly(vinylidene fluoride) (PVDF) containing oxide complex powder have attracted much attention for their stretchable and high-performance energy conversion. In this study, we prepared a PNG combined with PVDF and lanthanum-modified bismuth titanate (Bi4−XLaXTi3O12, BLT) ceramics as representative ferroelectric materials. The inserted BLT powder was treated by high-speed ball milling and its particle size reduced to the nanoscale. We also investigated the effect of particle size on the energy-harvesting performance of PNG without polling. As a result, nano-sized powder has a much larger surface area than micro-sized powder and is uniformly distributed inside the PNG. Moreover, nano-sized powder-mixed PNG generated higher power energy (> 4 times) than the PNG inserted micro-sized powder.
The vicious cycle: a history of obesity and COVID-19
Authors: Bil Jacek , Możeńska Olga
Published: July 2021

Recently, we face a surge in the fast-forward Coronavirus Disease 2019 (COVID-19) pandemic with nearly 170 million confirmed cases and almost 3.5 million confirmed deaths at the end of May 2021. Obesity, also known as the pandemic of the 21st century, has been evolving as an adverse prognostic marker. Obesity is associated with a higher risk of being SARS-CoV-2-positive (46%), as well as hospitalization (113%) and death (48%) due to COVID-19. It is especially true for subjects with morbid obesity. Also, observational studies suggest that in the case of COVID-19, no favorable “obesity paradox” is observed. Therefore, it is postulated to introduce a new entity, i.e., coronavirus disease-related cardiometabolic syndrome (CIRCS). In theory, it applies to all stages of COVID-19, i.e., prevention, acute proceedings (from COVID-19 diagnosis to resolution or three months), and long-term outcomes. Consequently, lifestyle changes, glycemic control, and regulation of the renin-angiotensin-aldosterone pathway have crucial implications for preventing and managing subjects with COVID-19. Finally, it is crucial to use cardioprotective drugs such as angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers and statins. Nevertheless, there is the need to conduct prospective studies and registries better to evaluate the issue of obesity in COVID-19 patients.
Validity of ultrasonography-derived predictions for estimating skeletal muscle volume: a systematic literature review
Authors: Liegnell Rasmus , Wessman Fredrik , Shalabi Adel , Harringe Marita
Published: July 2021

Background

The amount of muscle volume (MV) varies between individuals and is important for health, well-being and performance. Therefore, the monitoring of MV using different imaging modalities is important. Magnetic resonance imaging (MRI) is considered the gold standard, but is not always easily accessible, and the examinations are expensive. Ultrasonography (US) is a much less expensive imaging method widely used to measure changes in muscle thickness (MT). Whether MT may translate into MV needs further investigation.

Purpose

The aim of this review is to clarify whether US-derived equations based on MT predict MV based on MRI.

Methods

A systematic literature review was conducted according to the PRISMA statement, searching the electronic databases PubMed, CINAHL and Web of Science, for currently published equations to estimate MV with US.

Results

The literature search resulted in 363 citations. Twelve articles met the eligibility criteria. Ten articles scored eight out of eleven on QUADAS and two scored nine. Thirty-six prediction equations were identified. R values ranged between 0.53 and 0.961 and the standard error of the estimate (SEE) ranged between 6 and 12% for healthy adult populations, and up to 25.6% for children with cerebral palsy. Eight studies evaluated the results with a Bland–Altman plot and found no systematic errors. The overall strength and quality of the evidence was rated “low quality” as defined by the GRADE system.

Conclusions

The validity of US-derived equations based on MT is specific to the populations from which it is developed. The agreement with MV based on MRI is moderate with the SEE ranging between 6 and 12% in healthy adult populations. Suggestions for future research include investigations as to whether testing positions or increasing the number of measuring sites could improve the validity for prediction equations.
Haemochromatosis in a kidney transplant recipient: a case report
Authors: Zakrocka Izabela , Baranowicz-Gąszczyk Iwona , Załuska Wojciech
Published: July 2021

Background

Iron overload is inevitably related to chronic kidney disease (CKD) treatment. Haemochromatosis leads to multiorgan damage and is associated with increased mortality. Primary haemochromatosis is the most common autosomal recessive disease in white populations. In most cases, the classic form of hereditary haemochromatosis is caused by mutations, mainly C282Y and H63D, in the haemochromatosis gene (HFE). Secondary haemochromatosis can be triggered by iron administration and blood transfusions. Haemochromatosis is rarely reported in kidney transplant recipients. Atypical factors may evoke haemochromatosis in patients without HFE mutations or other standard risk factors.

Case presentation

In the current study, we present a patient who started to have haemochromatosis symptoms after kidney transplantation. A 37-year-old man after kidney transplantation from a deceased donor was admitted to the hospital due to high serum ferritin levels and impaired graft function. The patient’s past medical history included arterial hypertension, embolization of both renal arteries and necrosis of the left femoral head. Glomerulonephritis was suspected as a cause of CKD; however, severe kidney failure was diagnosed, kidney biopsy was not performed, and the patient started intermittent haemodialysis. While on dialysis to treat anaemia, the patient had received erythropoietin and iron intravenously, and the maximal serum ferritin level was 2115 ng/ml. After kidney transplantation, ferritin levels started to increase rapidly, with a maximum level of 9468 ng/ml one and a half years after surgery. His genetic study showed HFE C282Y heterozygosity. Symptoms of haemochromatosis, such as skin hyperpigmentation, elevated activity of aminotransferases, impaired glucose tolerance and heart failure, were observed. Therapeutic phlebotomy was started, and 36 procedures were performed. After treatment, graft function significantly improved, most haemochromatosis symptoms resolved, and the serum ferritin level significantly decreased.

Conclusions

Haemochromatosis can occur in heterozygotic HFE patients after kidney transplantation. Iron administration, infections, type of immunosuppression and liver dysfunction should be considered potential triggers of haemochromatosis in this group of patients.
Comparison of the curative effect and prognosis of stereotactic drainage and conservative treatment for moderate and small basal ganglia haemorrhage
Authors: Huang Xin , Jiang Lai , Chen Shaojun , Li Gang , Pan Wanxi , Peng Lei , Yan Ziwei
Published: July 2021

Background

Minimally invasive surgery has achieved good results in the treatment of cerebral haemorrhage.However, no large-scale clinical study has demonstrated that surgical treatment of cerebral haemorrhages less than 30 ml can improve the curative effect. Our study explored the efficacy and complication of stereotactic drainage based on the amount of cerebral hemorrhage (15-30 ml) in hypertensive basal ganglia.

Method

Sixty patients with hypertensive basal ganglia haemorrhages were divided into a control group and an experimental group with 30 patients in each group. Patients in the control group were treated conservatively. In contrast, those in the experimental group received stereotactic drainage, and urokinase was injected into the haematoma cavity after the operation. The haematoma volume at admission and 1, 3, 7 and 30 days after treatment and National Institute of Health stroke scale(NIHSS) score data were recorded. Complications after treatment in the two groups of data were compared and analysed.

Result

No significant differences in age, sex, time of treatment after onset, admission blood pressure, admission haematoma volume or admission NIHSS score were noted between these two groups (P > 0.05). After treatment, significant differences in haematoma volume were noted between the two groups on the 1st, 3rd, 7th and 30th days after treatment (P < 0.05). The amount of hematoma of patients in the experimental group was significantly reduced compared with that in the control group, and the NIHSS scores were significantly different on the 3rd, 7th and 30th days after treatment. The neurological deficit scores of patients in the experimental group were significantly reduced compared with those in the control group, and the incidence of pulmonary infection and venous thrombosis in the lower limbs of patients in the experimental group were significantly reduced (P < 0.05). ROC curve analysis showed that stereotactic drainage affected the early neurological function of patients with small and medium basal ganglia haemorrhages.

Conclusion

For patients with small and medium basal ganglia haemorrhages, stereotactic drainage can be used due to the faster drainage speed of haematomas after operation, which is beneficial to the recovery of neurological function and reduce complications.
A case report of atypical hemiplegic migraine with nonheadache onset in a Chinese child
Authors: Chen Hui , Sun Xiaolan , Wang Ruiyan , Yi Zhaoshi , Huang Zhixin , Xie Jihua , Yu Xiongying , Chen Yong , Zhong Jianmin
Published: July 2021

Background

Hemiplegic migraine (HM) is an uncommon subtype of migraine with aura including motor weakness. The core symptoms of HM are headache and motor weakness. However, we report a rare case of atypical HM with nonheadache onset in a Chinese child who was misdiagnosed several times.

Case presentation

We report a Chinese boy whose onset was sudden when he was 3 years old. He presented with a variety of phenotypes, including fever, vomiting, alternating hemiplegia, and drowsiness, but no headache in the initial stages. Magnetic resonance imaging (MRI) demonstrated unilateral cerebral oedema during the initial episode of hemiplegia. These symptoms recurred many times. As the disease progressed, the patient developed episodic headache. The patient was misdiagnosed several times with encephalitis, alternating hemiplegia of childhood (AHC) and mitochondrial encephalopathy. Whole-exome next-generation sequencing revealed a de novo heterozygous missense mutation in the ATP1A2 gene(p.Gly715Arg) classified as pathogenic and eventually led to a diagnosis of HM when he was 11 years old. Flunarizine was subsequently administered, and no recurrence was found during follow-up.

Conclusions

HM in children may be atypical in the initial stage of the disease, which could manifest as fever, alternating hemiplegia and drowsiness but no headache at the onset. This could easily lead to misdiagnosis. With age, it may eventually manifest as typical HM. Therefore, attention should be given to differentiation in clinical practice.When similar clinical cases appear, gene detection is particularly important, which is conducive to early diagnosis and treatment.
Factors influencing the nutritional behavior of Syrian migrants in Germany — results of a qualitative study
Authors: Sauter Alexandra , Kikhia Salma , von Sommoggy Julia , Loss Julika
Published: July 2021

Background

Syrian migrants represent the third-largest group of foreigners in Germany and are therefore potential users of health promotion initiatives, including nutrition programs. It is little known how (healthy) nutrition is understood and implemented by this group and which factors influence their experiences related to food and eating in the host country. Thus, this study aimed to explore the importance of (healthy) nutrition, facilitators, and barriers of a preferred diet; nutritional changes in relation to the country of origin; and how nutrition may change with increasing length of stay.

Methods

Thirty semi-structured qualitative interviews with Syrian migrants (male = 16, female = 14, 18–35 years, length of stay 10–68 months) were conducted in 2018. Seventeen migrants could be followed-up after 12 months and were interviewed in 2019 again and were asked for changes in their nutritional behavior. Interviews were conducted in German, English, or Arabic, transcribed and translated into English if necessary. For analysis, an abbreviated version of the Grounded Theory was used.

Results

We identified six overarching themes that described influencing factors on a favored diet in Germany over the course of stay: (1) managing everyday life; (2) intercultural contact with local residents; (3) social context of cooking and eating; (4) ambiguity toward Arabic food; (5) mistrust toward certain types of food; and (6) influence of postmigration stressors. In general, the importance of nutrition is high among Syrian migrants. However, daily stressors, the lack of practical knowledge of how to cook favored dishes, and food insecurity in the new food environment make it difficult to obtain a preferred diet. With increasing stay, many developed a higher awareness of healthy eating, mainly due to a new independence or influences from the social environment in Germany.

Conclusion

Results highlight the need for health promotion interventions to be more responsive to the specific needs of Syrian migrants, including nutrition. Syrian migrants differ in their capabilities, needs, and aims, and they should be addressed differently by health professionals, social services or migrant specific services. Future research should continue to focus on the living conditions of Syrian migrants and its influence on nutrition.
Health system factors that influence diagnostic and treatment intervals in women with breast cancer in sub-Saharan Africa: a systematic review
Authors: Gbenonsi Gloria , Boucham Mouna , Belrhiti Zakaria , Nejjari Chakib , Huybrechts Inge , Khalis Mohamed
Published: July 2021

Background

Breast cancer patients in sub-Saharan Africa experience long time intervals between their first presentation to a health care facility and the start of cancer treatment. The role of the health system in the increasing treatment time intervals has not been widely investigated. This review aimed to identify existing information on health system factors that influence diagnostic and treatment intervals in women with breast cancer in sub-Saharan Africa to contribute to the reorientation of health policies in the region.

Methods

PubMed, ScienceDirect, African Journals Online, Mendeley, ResearchGate and Google Scholar were searched to identify relevant studies published between 2010 and July 2020. We performed a qualitative synthesis in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Related health system factors were extracted and classified according to the World Health Organization’s six health system building blocks. The quality of qualitative and quantitative studies was assessed by using the Critical Appraisal Skills Program Quality-Assessment Tool and the National Institute of Health Quality Assessment Tool, respectively. In addition, we used the Confidence in the Evidence from Reviews of Qualitative Research tool to assess the evidence for each qualitative finding.

Results

From 14,184 identified studies, this systematic review included 28 articles. We identified a total of 36 barriers and 8 facilitators that may influence diagnostic and treatment intervals in women with breast cancer. The principal health system factors identified were mainly related to human resources and service delivery, particularly difficulty accessing health care, diagnostic errors, poor management, and treatment cost.

Conclusion

The present review shows that diagnostic and treatment intervals among women with breast cancer in sub-Saharan Africa are influenced by many related health system factors. Policy makers in sub-Saharan Africa need to tackle the financial accessibility to breast cancer treatment by adequate universal health coverage policies and reinforce the clinical competencies for health workers to ensure timely diagnosis and appropriate care for women with breast cancer in this region.
Different patterns and characteristics of Talar injuries at two main orthopedic trauma centers in Shiraz, south of Iran
Authors: Vosoughi Amir Reza , Fereidooni Reza , Shirzadi Saeedreza , Zomorodian Seyed Alireza , Hoveidaei Amir Human
Published: July 2021

Background

Categorizing different injury patterns of the talus, describing demographic data, mechanisms of injury and associated fractures are important issues in orthopedic trauma surgeries. Injuries of the talus require careful attention with appropriate treatment approaches in order to reduce possible complications.

Methods

In a cross-sectional study, the demographic characteristics, mechanism of injury, fracture type, and associated fractures were compiled from all patients’ files and operation notes with diagnosis of talar injuries from January 2014 to December 2019.

Results

Among 367 patients, 317 (86.4%) males and 50 (13.6%) females with mean age of 31.8 ± 11.6 years were identified. There were three (0.8%) patients with bilateral talar fractures. The most common mechanism of injury was motor vehicle accident (MVA) (46.1%), followed by falls (43.3%), direct trauma (6.2%) and sport injuries (4.4%). About half of the patients injured in MVAs were motorcyclists. Isolated talar body fractures (21.9%) were more common than isolated talar neck (19.2%) or combined body & neck fractures (14.6%). Isolated lateral process fracture is the most frequent fractured process of the talus (14.3%). Hawkin type IIA (39.2%) was the most common type of talar neck, followed by Hawkin type III (22.3%), type I (21.5%), type IIB (14.6%) and type IV (2.3%). Medial malleolus, fibula and calcaneus were the most common associated fractures, respectively.

Conclusions

The population that is most affected by talar injury are active young men who are involved in motor vehicle accidents, especially motorcycle crashes, with fracture of body and/or neck of talus being the most common type.
Association between changes in hip-knee-ankle angle and hindfoot alignment after total knee arthroplasty for varus knee osteoarthritis
Authors: Diao Naicheng , Yu Fei , Yang Bo , Ma Lifeng , Yin Heyong , Guo Ai
Published: July 2021

Background

The change in hip-knee-ankle (HKA) angle after total knee arthroplasty (TKA) may cause an adjustment in hindfoot alignment (HFA). However, the relationship between the changes in HKA angle and HFA is still not well studied. This study aimed to investigate the association between HKA angle and hindfoot alignment changes after TKA for varus knee osteoarthritis.

Methods

A prospective study was carried out in which 108 patients with varus knee deformities were radiographically and clinically evaluated before and 3 months after TKA. The relationship of change in HFA with correction in HKA angle was investigated.

Results

The results showed that the HFA was adjusted significantly by 3 months after TKA (p < 0.001), along with improved American Orthopaedic Foot and Ankle Society (AOFAS) ankle hindfoot score (p < 0.001). Next, a univariate correlation and linear regression analysis showed that the change in HFA was weakly correlated with the change in HKA angle (r=-0.262, β=-0.14, 95 % CI: -0.23 to -0.04, P = 0.006). Further stratified analysis and interaction tests revealed that age has a distinct effect on the correlation between the changes in HFA and HKA angle. The correlation was dramatically greater in the group under 65 years (r=-0.474, β=-0.26, 95 % CI: -0.41 to -0.12, P = 0.001), whilst, no correlation was observed in those above 65 years old (r=-0.036, β=-0.02, 95 % CI: -0.14 to 0.11, P = 0.779).

Conclusions

Our findings indicated that correction of HKA after TKA tend to promote adjustment in the hindfoot alignment toward re-balance of the whole lower limb weight-bearing axis. However, this mechanism obviously weakens in elderly patients. Therefore, if apparent hindfoot deformity exists in these patients before TKA, more perioperative intervention is required for hindfoot adjustment, and even HKA undercorrection may be considered.
Anticancer effects of dihydromyricetin on the proliferation, migration, apoptosis and in vivo tumorigenicity of human hepatocellular carcinoma Hep3B cells
Authors: Jiang Lianggui , Ye Wen-Chu , Li Zuobiao , Yang Yongguang , Dai Wei , Li Mingyi
Published: July 2021

Background

Hepatocellular carcinoma (HCC) represents a serious public health problem worldwide and has high morbidity and mortality. Dihydromyricetin (DHM) exhibits anticancer effect on a variety of malignancies, but its anticancer function of DHM in HCC has been unclear. The aim of this study was designed to investigate the anticancer effect of DHM on cell apoptosis, proliferation, migration and invasion of hepatoma carcinoma cells.

Methods

Cultured Hep3B cells were treated with different DHM concentrations, followed by cell apoptosis, proliferation, migration and invasion were examined by CCK-8, colony formation assay, wound healing, Transwell and flow cytometry, respectively. The mRNA and protein expression of BCL-2, Cleaved-caspase 3, Cleaved-caspase 9, BAK, BAX and BAD were validated by western blot.

Results

DHM markedly suppressed proliferation, migration, invasion and facilitated apoptosis in Hep3B cells. Mechanistically, DHM significantly downregulated the Bcl-2 expression, and upregulated the mRNA and protein levels of Cleaved-Caspase 3, Cleaved- Caspase 9, Bak, Bax and Bad. Furthermore, in the nude mice tumorigenic model, DHM treatment greatly decreased the weight of the HCC cancers compared to the weights in control and NDP group.

Conclusions

DHM could suppress cell proliferation, migration, invasion, and facilitated apoptosis in Hep3B cells. These findings could provide novel insights to develop potential therapeutic strategy for the clinical treatment of HCC.
A quasi-experimental study to improve health service quality: implementing communication and self-efficacy skills training to primary healthcare workers in two counties in Iran
Authors: Shahnazi Hossein , Araban Marzieh , Karimy Mahmood , Basiri Mansooreh , Ghazvini Ali , Stein LAR
Published: July 2021

Background

Service satisfaction ratings from clients are a good indicator of service quality. The present study aimed to investigate the impact of communication skills and self-efficacy training for healthcare workers on clients’ satisfaction.

Methods

A quasi-experimental study was conducted in health centers of Saveh University of Medical Science in Iran. Primary Healthcare (PHC; N = 105) workers and service recipients (N = 364) were randomly assigned to intervention and control groups. The intervention group received four 90-min training sessions consisting of lecture, film screening, role-playing, and discussion group. Before and 3 months after the intervention, a multi-part questionnaire (including demographics, self-efficacy and communication skills in PHC workers; and satisfaction questionnaire in service recipients) was completed by participants in both intervention and control groups.

Results

PHC worker mean scores of self-efficacy and communication skills after the educational program were increased in the intervention group compared to the control group (p < 0.05). Also, mean satisfaction scores for service recipients of the intervention group (PHC workers) generally significantly increased compared to the control group (p < 0.001).

Conclusions

The educational program improved the self-efficacy, and communication skills in health workers and improved client satisfaction overall. Our results support the application of self-efficacy and communication skills training for other medical groups who wish to improve clients satisfaction as an important health services outcome.