bluuebunny/crossref_metadata_2025 huggingface dataset:
A Significant Pericardial Effusion Leading to Bronchial Compression: A Case Report
Authors: Rao Suman , Olatunde Oluwateniola , Sunkara Akhila , Vyas Vrinda , Weinberg Andrew
Published: March 2021

Commonly, pericardial effusions can cause suboptimal heart contractility. Larger pericardial effusions can lead to compression of structures that surround in the heart in the mediastinum. Our patient presented with dyspnea that required mechanical ventilation. Bronchoscopy revealed compression of the bronchus from an external source. Echocardiogram showed a large circumferential pericardial effusion, which compressed the left main stem bronchus causing left lung atelectasis and persistent respiratory failure. A subxiphoid pericardial window was performed, which led to an improvement in her oxygen requirements. This case portrays the importance of including pericardial effusions in patients who present with respiratory failure refractory to antibiotic treatment and intervention with bronchoscopy. Although our patient passed away, recognition and earlier appropriate management with a pericardial window or pericardiocentesis could have prevented this adverse event.
Self-Tensioning Feature of Knotless Suture Anchor Provides Reproducible Knotless Fixation Independent of Initial Tension
Authors: Athiviraham Aravind , Lee Cody S. , Smith Patrick A. , Piepenbrink Marina , Mackin Alexander P. , Wijdicks Coen A.
Published: March 2021

Background:

Anterior cruciate ligament (ACL) reconstruction with suture tape reinforcement has been shown to biomechanically reduce elongation and increase ultimate strength. However, the amount and consistency of the achieved tension after primary fixation using knotless suture anchors remains unclear.

Purpose:

To determine whether initial tensioning of suture tape before fixation with a knotless suture anchor significantly affects final tension of the suture tape.

Study Design:

Controlled laboratory study.

Methods:

We secured 15 pairs of Sawbones blocks with predrilled tunnels to a tensile testing machine. Suture tape was inserted through a suspensory fixation button on the representative femoral block and threaded top-down through the base of the tibial block over an attachable button system. The suture tape was attached with a knotless suture anchor in a predrilled and tapped hole on the tibial block under the following pretensioning conditions: (1) slight tension of 5 N, (2) no tension, and (3) initial slack. The suture anchor was inserted as the load-time data were recorded. After initial block testing, a porcine model of 24 tibias was used to test the same pretensioning conditions. The initial loads during anchor insertion and screw-in were measured, as well as final tension.

Results:

During block testing, no difference in final tensioning was found when comparing the slight-tension, no-tension, and slack groups (42.3 ± 5.3, 37.7 ± 6.4, and 40.2 ± 7.0 N, respectively; P = .528). Similar to block testing, no difference in final tensioning was found when comparing the slight-tension, no-tension, and slack groups using the porcine model (43.64 ± 6.69, 48.09 ± 13.93, and 44.52 ± 6.84 N, respectively; P = .633).

Conclusion:

The final tension of the suture tape construct appears to be reproducible and consistent, independent of the initial tension introduced with suture anchor placement within the tested parameters.

Clinical Relevance:

The results of the current study can help optimize the placement technique of independent suture tape reinforcement for ACL reconstruction, which is a promising strategy to help prevent ACL rerupture, particularly in the early phases of postoperative rehabilitation.
The Role of Deadlifts in Distal Biceps Brachii Tendon Ruptures: An Alternative Mechanism Described With YouTube Videos
Authors: Kapicioglu Mehmet , Bilgin Emre , Guven Necip , Pulatkan Anil , Bilsel Kerem
Published: March 2021

Background:

The classic injury mechanism of a distal biceps brachii tendon rupture (DBBTR) is eccentric loading to the flexed elbow when the forearm is supinated.

Purpose:

To determine alternative mechanisms of a DBBTR in powerlifting sports, particularly in deadlift competitions, with the use of YouTube videos.

Study Design:

Descriptive epidemiology study.

Methods:

A search on YouTube was performed using the search terms “distal biceps tendon rupture” and “distal biceps tendon injury” combined with “competition,” “deadlift,” and “powerlifting.” The videos underwent an evaluation for accuracy by 3 surgeons according to predetermined criteria. Type of sports activity, participant sex, side of the injury, and arm positions at the time of the injury were recorded.

Results:

Among the videos reviewed, 35 injuries were found appropriate for an evaluation. All participants were male. The majority of the injuries (n = 25) were observed during the deadlift. Only in 1 deadlift injury were both forearms in supination. In the remaining deadlift injuries (n = 24), all elbows were in extension, with 1 forearm in supination and the other in pronation. Among the deadlift injuries in the mixed-grip position, all ruptures occurred in a supinated extremity: 25% (n = 6) of ruptures occurred on the right side, and 75% (n = 18) of ruptures occurred on the left side; this was a significant difference ( P = .014).

Conclusion:

We described an alternative mechanism for a DBBTR, namely, eccentric loading to an extended elbow when the forearm is supinated during the deadlift. As all the ruptures occurred in a supinated extremity, holding the bar with both forearms in pronation may prevent or decrease the risk of ruptures during the deadlift.
Individuals in Default or the System? Race and Ethnicity, Stratification Views on Legal Debt, and Desire for Escalating Punishment
Authors: Henricks Kasey , Ortiz Ruben
Published: March 2021

How do members of racial and ethnic groups explain the origins of unpaid legal debt from monetary sanctions, and how do such attributions undergird group differences in support for policy responses that escalate punishment? Using data from the Chicago Area Finances Survey, 2019, we apply an attributional typology of stratification beliefs to account for why legal debt from fines, fees, and tickets goes unpaid. We find differences in attribution types along key measures of socio-demographics and political values, and we identify racial differences in these attributions when other measures are held constant. How people understand why legal debt goes unpaid shapes their policy preferences as well, and they explain a small but significant fraction of racial and ethnic differences in the desire for punitive recourse.
Nurses’ Attitude Toward Caring for Dying Patients in a Nigerian Teaching Hospital
Authors: Faronbi Joel Olayiwola , Akinyoola Oladele , Faronbi Grace Oluwatoyin , Bello Cecilia Bukola , Kuteyi Florence , Olabisi Isaiah Oluwaseyi
Published: March 2021

Introduction

Death and the dying experience are common phenomena in all clinical settings. Death and the dying presents physical and emotional strain on the dying patient, his relations and professional caregivers.

Objective

The study therefore assessed the sociodemographic determinants of nurses’ attitudes towards death and caring for dying patient.

Method

A cross–sectional design was used to study 213 randomly selected nurses, working in one of the tier one teaching hospital in Nigeria. Attitude towards death and the dying was collected with Frommelt Attitude Care of the Dying and Death Attitude Profit–Revised questionnaire. The data collected was analysed with SPSS version 20 and inferential analyses were considered statistically significant at p < 0.05.

Results

The study revealed that most of the nurses had negative attitudes toward the concept of death (76.5%) and caring for dying patient (68%). Furthermore, a chi-square test revealed significant associations between the nurses’ years of working experience (χ2 = 24.57, p <.00) and current unit of practice (χ2 = 21.464; p = .002) and their attitude towards caring for the dying patient. Also, nurses’ age (χ2 = 13.77, p = .032), professional qualifications (χ2 = 13.774, p = .008), and current ward of practice (χ2 = 16.505, p = .011) were significantly associated with their attitudes to death. Furthermore, the study observed a significant association between nurses’ attitudes to death and caring for the dying patient (χ2 = 11.26, p < 0.01).

Conclusion

This study concluded that nurses had negative attitudes towards death and dying and therefore prescribes, as part of continuing professional development strategy, the need for requisite positive value – laden, ethnoreligious specific education regarding end of life care.
Dental Caries Severity and Nutritional Status of Nigerian Preschool Children
Authors: Olatosi O.O. , Alade A.A. , Naicker T. , Busch T. , Oyapero A. , Li M. , Pape J. , Olotu J. , Awotoye W. , Hassan M. , Adeleke C. , Adeyemo W.L. , Shaffer J. , Marazita M.L. , Butali A.
Published: March 2021

Introduction:

Malnutrition in children is one of the most prevalent global health challenges, and malnourished children have a higher risk of death from childhood diseases. Early childhood caries (ECC) is the most common chronic disease of childhood. Complications from ECC such as pain, loss of tooth/teeth, and infection can undermine a child’s nutrition and growth.

Aim:

This study aims to evaluate the severity of decay, missing, and filled tooth (dmft) by nutritional status using the z scores of the anthropometric measurements: height for age (HFA), weight for age (WFA), weight for height (WFH), and body mass index for age (BMIA) among children with ECC in Nigeria.

Study Design:

This is a cross-sectional study conducted in 5 local government areas (LGAs) in Lagos State, Nigeria. A multistage sampling technique was used.

Results:

A total of 273 cases of ECC were included in the analyses (mean age 4.19 ± 0.96 y). Overall, the mean dmft was 3.04 ± 2.28, and most (96%) were accounted for by untreated decay. The distribution of dmft within the different z score categories of BMIA (<–3 = severely wasted, –2 to –3 = wasted, –2 to +2 = normal, +2 to +3 = overweight and >+3 = obese) showed the highest dmft scores among the combined severely wasted and wasted groups, lowest among children with normal z scores, and intermediate in the overweight and obese groups. There was a significant negative correlation between BMIA z score, WFH z score, and dmft ( r = −0.181, P < 0.05 and r = −0.143, P < 0.05, respectively). However, the correlations between HFA z score, WFA z score, and dmft were positive but not significant ( r = 0.048, P = 0.44 and r = 0.022, P = 0.77, respectively).

Conclusion:

Our study showed an increased severity of dental caries among severely wasted or wasted children with ECC compared to those of normal or overweight.

Knowledge Transfer Statement:

The results from this study will raise awareness among clinicians and policy makers on the need for a primary prevention program for early childhood caries in countries with high burden of malnutrition and limited resources. Also, it will help draw the attention of clinicians to the caries status of malnourished children that can be managed to improve the nutritional outcomes.
From towers to walls: Trump’s border wall as entrepreneurial performance
Authors: Kolås Åshild , Oztig Lacin ldil
Published: March 2021

The pledge to build a “great”, “beautiful” southern border wall was a cornerstone of Donald J. Trump’s 2016 presidential election campaign. This paper analyzes Trump’s border wall project as an example of performative statecraft, suggesting that the wall works better rhetorically, than as a barrier against unauthorized cross-border movement. Identifying Trump’s performative statecraft as “entrepreneurial”, we argue that his border wall discourse differs from that of earlier presidents in the way Trump meshes the performance of the border wall as a protective device with his own performance as an entrepreneur and developer. Trump’s border wall discourse accentuates his personal skills as an entrepreneur, and makes these skills relevant to his key campaign promises: to “Make America Great Again”, and defend the nation against transnational crime. Despite Trump’s radical reformulation of US asylum policy, enhanced pursuit of unauthorized immigrants, termination of Obama-era programs like Deferred Action for Childhood Arrivals (DACA), and disturbing but short-lived family separation and ‘Zero-Tolerance’ detention scheme, the border security policies of President Trump are not as novel as his promotional campaigns would have us believe. In fact, Trump’s border control strategies have continued many of the measures introduced by earlier presidents. The novelty of the Trump presidency lies in the strong focus on the new US–Mexico border wall, and fervent attention to the physical attributes and instrumental functions of the wall. Much more than a fence, Trump’s proposed border wall is a grand, awe-inspiring monument to national security, and to Trump’s entrepreneurial statecraft. It also works as a visual aide for Trump’s plan to “Make America Great Again”. Border walls stand as testimony to the power of the state, and the determination of those who defend it. Trump’s border wall would be no exception.
A Recent Achievement in the Discovery and Development of Vaccines and Therapeutic Agents in the Race for COVID-19 Protection and Treatment
Authors: Kifle Zemene Demelash , Enyew Engidaw Fentahun , Mekuria Abebe Basazn
Published: March 2021

Currently, the coronavirus disease 2019 (COVID-19) is a big challenge to the healthcare systems in the world. Several researchers in the world have immediately carried out clinical investigations for the discovery of vaccines and drugs. Different studies have shown that antiviral measures including small bioactive compounds targeting multifaceted molecular communications take in COVID-19 infection. The drug development archived in this review emphasizes mainly on drugs that are effective for the Management of MERS-CoV, SARS-CoV, and other RNA viruses. The investigation of therapeutic agents for COVID-19 includes anti-inflammatory agents, antibodies, and nucleic acid-based treatments targeting virus gene expression as well as different sorts of vaccines. Numerous patents revealed techniques of these biologics with the potential for treating and preventing coronavirus infections, which may apply to COVID-19. Phase 3 clinical trials such as Sputnik V, AZD1222, mRNA-1273, BNT162b2, Ad5-nCoV, Anti-COVID antibodies, Kevzara; Actemra, Jakafi; Baricitinib, and some others were undergoing in the race for Covid-19 treatment. However, there’s still a lack of a review on vaccines and drugs for COVID-19 management. Therefore, this review summarizes different studies that are ongoing in the race for Covid-19 protection and treatment.
COVID-19 and conjunctivitis: a meta-analysis
Authors: Al-Namaeh Mashael
Published: March 2021

COVID-19 is a disease first identified in Wuhan City, Hubei Province, China, in December 2019, causes by a SARS-COV-2 virus infection. By 27 October 2020, 43,921,473 confirmed cases were reported worldwide, with 1,166,389 COVID-19 deaths. Conjunctivitis has been reported in adults and pediatric patients with COVID-19.

Objective:

The aim of this meta-analysis is to estimate the odd Ratio (ORs) of conjunctivitis in patients with COVID-19.

Methods:

A systematic review and meta-analysis have been performed using the PubMed and Google Scholar literature search. The ORs of conjunctivitis in adults and pediatric patients is the outcome of this meta-analysis.

Results:

There have been 1041 articles published since the outbreak in December 2019, according to the latest literature. For the meta-analysis, 20 studies with a total of 3383 participants were included. The odds ratio (ORs) of conjunctivitis was 0.01 (95% confidence interval [CI]: 0.00–0.02). No bias has been reported.

Conclusion:

Conjunctivitis is the most common ocular manifestations reported in adults. This comprehensive meta-analysis quantifies the existing evidence linking conjunctivitis with COVID-19 and highlights the high percentage of heterogeneity that is shown in the current studies. Finally, it offers a single review article which includes all the current articles available for COVID-19 and conjunctivitis in adults and children.
Fertility-Related Problems and Ways of Coping of Couples With Primary Infertility in Urban India
Authors: De Devika , Mukhopadhyy Pritha , Roy Prasanta Kumar
Published: March 2021

Objective:

To study the impact of infertility in terms of fertility-related problems and ways of coping among male organic factor, female organic factor, and unexplained factor infertility groups suffering from primary infertility. Infertility is defined as an inability to become pregnant after 1 year of regular sexual relations without use of contraceptives. This study compared coping strategies and specific fertility problems among the 3 infertile groups.

Methods:

This was a clinic-based cross-sectional comparative study based on consecutive sampling method. Sixty couples were taken, of which 10 couples were from the male factor, 10 from the female factor, and 10 from the unexplained factor group. Fertility Problem Inventory and Ways of Coping Questionnaire were the tools that were administered.

Results:

The female factor group had greater social and relationship concern and need for parenthood. Seeking social support was used more by the unexplained factor group, whereas positive reappraisal coping style was used more by the female factor group. The male factor group used confrontative and self-controlling strategy to deal with the infertility problem.

Conclusion:

Men and women had different fertility-related concerns and used different coping methods to address these issues. Mental health professionals can address these concerns with specifically devised psychotherapy module.
YBX1 is required for maintaining myeloid leukemia cell survival by regulating BCL2 stability in an m6A-dependent manner
Authors: Feng Mengdie , Xie Xueqin , Han Guoqiang , Zhang Tiantian , Li Yashu , Li Yicun , Yin Rong , Wang Qifan , Zhang Tong , Wang Peipei , Hu Jin , Cheng Ying , Gao Zhuying , Wang Jing , Chang Jiwei , Cui Manman , Gao Kexin , Chai Jihua , Liu Weidong , Guo Chengli , Li Shaoguang , Liu Lingbo , Zhou Fuling , Chen Jianjun , Zhang Haojian
Published: March 2021

RNA-binding proteins (RBPs) are critical regulators of transcription and translation that are often dysregulated in cancer. Although RBPs are increasingly recognized as being important for normal hematopoiesis and for hematologic malignancies as oncogenes or tumor suppressors, RBPs that are essential for the maintenance and survival of leukemia remain elusive. Here we show that YBX1 is specifically required for maintaining myeloid leukemia cell survival in an N6-methyladenosine (m6A)-dependent manner. We found that expression of YBX1 is significantly upregulated in myeloid leukemia cells, and deletion of YBX1 dramatically induces apoptosis and promotes differentiation coupled with reduced proliferation and impaired leukemic capacity of primary human and mouse acute myeloid leukemia cells in vitro and in vivo. Loss of YBX1 has no obvious effect on normal hematopoiesis. Mechanistically, YBX1 interacts with insulin-like growth factor 2 messenger RNA (mRNA)-binding proteins (IGF2BPs) and stabilizes m6A-tagged RNA. Moreover, YBX1 deficiency dysregulates the expression of apoptosis-related genes and promotes mRNA decay of MYC and BCL2 in an m6A-dependent manner, which contributes to the defective survival that results from deletion of YBX1. Thus, our findings have uncovered a selective and critical role of YBX1 in maintaining myeloid leukemia survival, which might provide a rationale for the therapeutic targeting of YBX1 in myeloid leukemia.
Active case-finding of tuberculosis in general populations and at-risk groups: a systematic review and meta-analysis
Authors: Bohlbro Anders Solitander , Hvingelby Victor Schwartz , Rudolf Frauke , Wejse Christian , Patsche Cecilie Blenstrup
Published: March 2021

Background

The World Health Organization (WHO) recommends active case-finding (ACF) of tuberculosis (TB) in certain high-risk groups; however, more evidence is needed to elucidate the scope of ACF beyond the current recommendations. In this study we aimed to systematically review yields (the prevalence of active TB) of studies on ACF in general populations and at-risk groups.

Methods

A literature search in PubMed, Embase and the Cochrane Central Library (CENTRAL) was performed for studies concluded after 31 December 1999 and published before 1 September 2020. Screening yields were estimated and yield/prevalence ratios (ratio between yield of study and WHO estimated prevalence of TB) were calculated to assess which groups might especially benefit from ACF. Finally, risk of bias was assessed and heterogeneity was investigated using meta-regression and sensitivity analyses.

Results

We included 197 studies, with a total of 12 372 530 screened and 53 158 cases found. Yields were high among drug users, close contacts, the poor and marginalised, people living with HIV, and prison inmates across incidence strata, and estimated yield/prevalence ratios in screenings of general populations tended to be >1 with an overall ratio of 1.4 and ranging between 1.0 and 1.5. Sensitivity analyses suggested that inclusion of studies at high risk of bias contributed to underestimation of yields.

Conclusion

Despite many studies using insensitive screening methods, these results suggest that more at-risk groups should be considered for inclusion in future screening recommendations and that screening of general populations may outperform current case-finding practices, providing evidence for extending ACF beyond the current recommendations.
Multi-omics links IL-6 trans-signalling with neutrophil extracellular trap formation andHaemophilusinfection in COPD
Authors: Winslow Sofia , Odqvist Lina , Diver Sarah , Riise Rebecca , Abdillahi Suado , Wingren Cecilia , Lindmark Helena , Wellner Annika , Lundin Sofia , Yrlid Linda , Ax Elisabeth , Djukanovic Ratko , Sridhar Sriram , Higham Andrew , Singh Dave , Southworth Thomas , Brightling Christopher E. , Olsson Henric K. , Jevnikar Zala
Published: March 2021

Background:

Interleukin (IL)-6 trans-signalling (IL-6TS) is emerging as a pathogenic mechanism in chronic respiratory diseases; however, the drivers of IL-6TS in the airways and the phenotypic characteristic of patients with increased IL-6TS pathway activation remain poorly understood.

Objective:

Our aim was to identify and characterise COPD patients with increased airway IL-6TS and to elucidate the biological drivers of IL-6TS pathway activation.

Methods:

We used an IL-6TS-specific sputum biomarker profile (soluble IL-6 receptor (sIL-6R), IL-6, IL-1β, IL-8, macrophage inflammatory protein-1β) to stratify sputum data from patients with COPD (n=74; Biomarkers to Target Antibiotic and Systemic Corticosteroid Therapy in COPD Exacerbation (BEAT-COPD)) by hierarchical clustering. The IL-6TS signature was related to clinical characteristics and sputum microbiome profiles. The induction of neutrophil extracellular trap formation (NETosis) and IL-6TS byHaemophilus influenzaewere studied in human neutrophils.

Results:

Hierarchical clustering revealed an IL-6TS-high subset (n=24) of COPD patients, who shared phenotypic traits with an IL-6TS-high subset previously identified in asthma. The subset was characterised by increased sputum cell counts (p=0.0001), persistent sputum neutrophilia (p=0.0004), reduced quality of life (Chronic Respiratory Questionnaire total score; p=0.008), and increased levels of pro-inflammatory mediators and matrix metalloproteinases in sputum. IL-6TS-high COPD patients showed an increase in Proteobacteria, withHaemophilusas the dominating genus. NETosis induced byH. influenzaewas identified as a potential mechanism for increased sIL-6R levels. This was supported by a significant positive correlation between sIL-6R and NETosis markers in bronchoalveolar lavage fluid from COPD patients.

Conclusion:

IL-6TS pathway activation due to chronic colonisation withHaemophilusmay be an important disease driver in a subset of COPD patients.
Clustering based approach for population level identification of condition-associated T-cell receptor β-chain CDR3 sequences
Authors: Yohannes Dawit A. , Kaukinen Katri , Kurppa Kalle , Saavalainen Päivi , Greco Dario
Published: March 2021

Background

Deep immune receptor sequencing, RepSeq, provides unprecedented opportunities for identifying and studying condition-associated T-cell clonotypes, represented by T-cell receptor (TCR) CDR3 sequences. However, due to the immense diversity of the immune repertoire, identification of condition relevant TCR CDR3s from total repertoires has mostly been limited to either “public” CDR3 sequences or to comparisons of CDR3 frequencies observed in a single individual. A methodology for the identification of condition-associated TCR CDR3s by direct population level comparison of RepSeq samples is currently lacking.

Results

We present a method for direct population level comparison of RepSeq samples using immune repertoire sub-units (or sub-repertoires) that are shared across individuals. The method first performs unsupervised clustering of CDR3s within each sample. It then finds matching clusters across samples, called immune sub-repertoires, and performs statistical differential abundance testing at the level of the identified sub-repertoires. It finally ranks CDR3s in differentially abundant sub-repertoires for relevance to the condition. We applied the method on total TCR CDR3β RepSeq datasets of celiac disease patients, as well as on public datasets of yellow fever vaccination. The method successfully identified celiac disease associated CDR3β sequences, as evidenced by considerable agreement of TRBV-gene and positional amino acid usage patterns in the detected CDR3β sequences with previously known CDR3βs specific to gluten in celiac disease. It also successfully recovered significantly high numbers of previously known CDR3β sequences relevant to each condition than would be expected by chance.

Conclusion

We conclude that immune sub-repertoires of similar immuno-genomic features shared across unrelated individuals can serve as viable units of immune repertoire comparison, serving as proxy for identification of condition-associated CDR3s.
Lipopolysaccharide- TLR-4 Axis regulates Osteoclastogenesis independent of RANKL/RANK signaling
Authors: AlQranei Mohammed S. , Senbanjo Linda T. , Aljohani Hanan , Hamza Therwa , Chellaiah Meenakshi A.
Published: March 2021

Background

Lipopolysaccharide (LPS) is an endotoxin and a vital component of gram-negative bacteria’s outer membrane. During gram-negative bacterial sepsis, LPS regulates osteoclast differentiation and activity, in addition to increasing inflammation. This study aimed to investigate how LPS regulates osteoclast differentiation of RAW 264.7 cells in vitro.

Results

Herein, we revealed that RAW cells failed to differentiate into mature osteoclasts in vitro in the presence of LPS. However, differentiation occurred in cells primed with receptor activator of nuclear factor-kappa-Β ligand (RANKL) for 24 h and then treated with LPS for 48 h (henceforth, denoted as LPS-treated cells). In cells treated with either RANKL or LPS, an increase in membrane levels of toll-like receptor 4 (TLR4) receptor was observed. Mechanistically, an inhibitor of TLR4 (TAK-242) reduced the number of osteoclasts as well as the secretion of tumor necrosis factor (TNF)-α in LPS-treated cells. RANKL-induced RAW cells secreted a very basal level TNF-α. TAK-242 did not affect RANKL-induced osteoclastogenesis. Increased osteoclast differentiation in LPS-treated osteoclasts was not associated with the RANKL/RANK/OPG axis but connected with the LPS/TLR4/TNF-α tumor necrosis factor receptor (TNFR)-2 axis. We postulate that this is because TAK-242 and a TNF-α antibody suppress osteoclast differentiation. Furthermore, an antibody against TNF-α reduced membrane levels of TNFR-2. Secreted TNF-α appears to function as an autocrine/ paracrine factor in the induction of osteoclastogenesis independent of RANKL.

Conclusion

TNF-α secreted via LPS/TLR4 signaling regulates osteoclastogenesis in macrophages primed with RANKL and then treated with LPS. Our findings suggest that TLR4/TNF-α might be a potential target to suppress bone loss associated with inflammatory bone diseases, including periodontitis, rheumatoid arthritis, and osteoporosis.
Vaccinomic approach for novel multi epitopes vaccine against severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2)
Authors: Almofti Yassir A. , Abd-elrahman Khoubieb Ali , Eltilib Elsideeq E. M.
Published: March 2021

Background

The spread of a novel coronavirus termed severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) in China and other countries is of great concern worldwide with no effective vaccine. This study aimed to design a novel vaccine construct against SARS-CoV-2 from the spike S protein and orf1ab polyprotein using immunoinformatics tools. The vaccine was designed from conserved epitopes interacted against B and T lymphocytes by the combination of highly immunogenic epitopes with suitable adjuvant and linkers.

Results

The proposed vaccine composed of 526 amino acids and was shown to be antigenic in Vaxigen server (0.6194) and nonallergenic in Allertop server. The physiochemical properties of the vaccine showed isoelectric point of 10.19. The instability index (II) was 31.25 classifying the vaccine as stable. Aliphatic index was 84.39 and the grand average of hydropathicity (GRAVY) was − 0.049 classifying the vaccine as hydrophilic. Vaccine tertiary structure was predicted, refined and validated to assess the stability of the vaccine via Ramachandran plot and ProSA-web servers. Moreover, solubility of the vaccine construct was greater than the average solubility provided by protein sol and SOLpro servers indicating the solubility of the vaccine construct. Disulfide engineering was performed to reduce the high mobile regions in the vaccine to enhance stability. Docking of the vaccine construct with TLR4 demonstrated efficient binding energy with attractive binding energy of − 338.68 kcal/mol and − 346.89 kcal/mol for TLR4 chain A and chain B respectively. Immune simulation significantly provided high levels of immunoglobulins, T-helper cells, T-cytotoxic cells and INF-γ. Upon cloning, the vaccine protein was reverse transcribed into DNA sequence and cloned into pET28a(+) vector to ensure translational potency and microbial expression.

Conclusion

A unique vaccine construct from spike S protein and orf1ab polyprotein against B and T lymphocytes was generated with potential protection against the pandemic. The present study might assist in developing a suitable therapeutics protocol to combat SARSCoV-2 infection.
Association between the vertebrobasilar artery geometry and basilar artery plaques determined by high-resolution magnetic resonance imaging
Authors: Zheng Jinmei , Sun Bin , Lin Ruolan , Teng Yongqi , Zhao Xihai , Xue Yunjing
Published: March 2021

Background

Atherosclerotic plaques are often present in regions of arteries with complicated flow patterns. Vascular morphology plays important role in hemodynamics. In this study, we investigated the relationship between the geometry of the vertebrobasilar artery system and presence of basilar artery (BA) plaque.

Methods

We enrolled 290 patients with posterior circulation ischemic stroke. We distinguished four configurations of the vertebrobasilar artery: Walking, Tuning Fork, Lambda, and No Confluence. Patients were divided into multi-bending (≥ 3 bends) and oligo-bending (< 3 bends) VA groups. The diameter of the vertebral artery (VA) and the number of bends in the intracranial VA segment were assessed using three-dimensional time-of-flight magnetic resonance angiography. High-resolution magnetic resonance imaging was used to evaluate BA plaques. Logistic regression models were used to determine the relationship between the geometry type and BA plaque prevalence.

Results

After adjusting for sex, age, body mass index ≥ 28, hypertension, and diabetes mellitus, the Walking, Lambda, and No Confluence geometries were associated with the presence of BA plaque (all p < 0.05). Patients with multi-bending VAs in both the Walking (20/28, 71.43% vs. 6/21, 28.57%, p = 0.003) and Lambda group (19/47, 40.43% vs. 21/97, 21.65%, p = 0.018) had more plaques compared to patients with oligo-bending VAs in these groups. In the Lambda group, the difference in diameter of bilateral VAs was larger in patients with BA plaques than that in patients without BA plaques (1.4 mm [IQR: 0.9–1.6 mm] vs. 0.9 mm [IQR: 0.6–1.3 mm], p < 0.001).

Conclusions

The Walking, Lambda, and No Confluence geometry, ≥ 3 bends in the VAs, and a large diameter difference between bilateral VAs are associated with the presence of BA plaque.
Distinguishing cardiac myxomas from cardiac thrombi by a radiomics signature based on cardiovascular contrast-enhanced computed tomography images
Authors: Qian Wen-lei , Jiang Yu , Liu Xi , Guo Ying-kun , Li Yuan , Tang Xin , Yang Zhi-gang
Published: March 2021

Background

Cardiac myxomas (CMs) and thrombi are associated with high morbidity and mortality. These two conditions need totally different treatments. However, they are difficult to distinguish using naked eye. In clinical, misdiagnoses occur now and then. This study aimed to compare the characteristics of CMs and cardiac thrombi and investigate the value of a radiomics signature in distinguishing CMs from cardiac thrombi, based on cardiovascular contrast-enhanced computed tomography (CECT) images.

Methods

A total of 109 patients who had CMs (n = 59) and cardiac thrombi (n = 50) were enrolled in this retrospective study from 2009 to 2019. First, the lesion characteristics of cardiovascular CECT images were documented and compared by two radiologists. Then all patients were randomly allotted to either a primary group or a validation group according to a 7:3 ratio. Univariate analysis and the least absolute shrinkage and selection operator were used to select robust features. The best radiomics signature was constructed and validated using multivariate logistic regression. An independent clinical model was created for comparison.

Results

The best radiomics signature was developed using eight selected radiomics. The classification accuracies of the radiomics signature were 90.8% and 90.9%, and the area under the receiver operating characteristic curves were 0.969 and 0.926 in the training and testing cohorts, respectively. Cardiovascular CECT images showed that the two diseases had significant differences in location, surface, Hydrothorax, pericardial effusion and heart enlargement. The naked eye findings were used to create the clinical model. All metrics of the radiomics signature were higher than those of clinical model.

Conclusions

Compared with clinical model, the radiomics signature based on cardiovascular CECT performed better in differentiating CMs and thrombi, suggesting that it could help improving the diagnostic efficiency.
Economic burden of non-alcoholic steatohepatitis with significant fibrosis in Thailand
Authors: Phisalprapa Pochamana , Prasitwarachot Ratthanon , Kositamongkol Chayanis , Hengswat Pranaidej , Srivanichakorn Weerachai , Washirasaksiri Chaiwat , Treeprasertsuk Sombat , Charatcharoenwitthaya Phunchai , Chaiyakunapruk Nathorn
Published: March 2021

Background

Non-alcoholic steatohepatitis (NASH) has been recognised as a significant form of chronic liver disease and a common cause of cirrhosis and hepatocellular carcinoma, resulting in a considerable financial burden on healthcare resources. Currently, there is no information regarding the economic burden of NASH in low- and middle-income countries (LMICs). The aim of this study was to estimate the economic burden of NASH in Thailand as a lesson learned for LMICs.

Methods

To estimate the healthcare costs and prevalence of NASH with significant fibrosis (fibrosis stage ≥ 2) in the general Thai population, an eleven-state lifetime horizon Markov model with 1-year cycle length was performed. The model comprised Thai population aged 18 years and older. The cohort size was based on Thailand Official Statistic Registration Systems. The incidence of NASH, transitional probabilities, and costs-of-illness were based on previously published literature, including systematic reviews and meta-analyses. The age-specific prevalence of NASH was based on Thai NASH registry data. Costs were expressed in 2019 US Dollars ($). As we undertook analysis from the payer perspective, only direct medical costs were included. All future costs were discounted at an annual rate of 3%. A series of sensitivity analyses were performed.

Results

The estimated total number of patients with significant NASH was 2.9 million cases in 2019, based on a NASH prevalence of 5.74%. The total lifetime cost of significant NASH was $15.2 billion ($5,147 per case), representing approximately 3% of the 2019 GDP of Thailand. The probabilistic sensitivity analysis showed that the lifetime costs of significant NASH varied from $11.4 billion to $18.2 billion.

Conclusions

The economic burden associated with NASH is substantial in Thailand. This prompts clinicians and policy makers to consider strategies for NASH prevention and management.
Willingness and preparedness to provide care: interviews with individuals of different ages and with different caregiving experiences
Authors: de Jong Lea , Stahmeyer Jona Theodor , Eberhard Sveja , Zeidler Jan , Damm Kathrin
Published: March 2021

Background

At present, the provision of informal care to older relatives is an essential pillar of the long-term care system in Germany. However, the impact of demographic and social changes on informal caregiving remains unclear.

Methods

Thirty-three semi-structured interviews were conducted with care consultants, informal caregivers and people without any caregiving experience to explore if people are willing to provide older adult care and how prepared these are with regard to the possibility of becoming care dependent themselves.

Results

In total, three main categories (willingness to provide care, willingness to receive care and information as preparation) with several sub-categories were identified during the content analysis. While almost all interviewees were willing to provide care for close family members, most were hesitant to receive informal care. Other factors such as the available housing space, flexible working hours and the proximity of relatives were essential indicators of a person’s preparedness to provide informal care. It is, however, unclear if care preferences change over time and generations. Six out of 12 informal caregivers and nine out of 14 care consultants also reported an information gap. Because they do not possess adequate information, informal caregivers do not seek help until it is too late and they experience high physical and mental strain. Despite the increased efforts of care consultants in recent years, trying to inform caregivers earlier was seen as almost impossible.

Conclusions

The very negative perception of caregiving as a burden was a reoccurring theme throughout all interviews and influenced people’s willingness to receive care as well as seeking timely information. Despite recent political efforts to strengthen home-based care in Germany, it remains unclear whether political efforts will be effective in changing individuals’ perceptions of informal caregiving and their willingness to be better prepared for the highly likely scenario of having to care for a close relative or becoming care dependent at a later stage in life.
‘Long COVID’: persistent COVID-19 symptoms in survivors managed in Lagos State, Nigeria
Authors: Osikomaiya Bodunrin , Erinoso Olufemi , Wright Kikelomo Ololade , Odusola Aina Olufemi , Thomas Babafemi , Adeyemi Oluwatosin , Bowale Abimbola , Adejumo Olusola , Falana Ayodeji , Abdus-salam Ismail , Ogboye Olusegun , Osibogun Akin , Abayomi Akin
Published: March 2021

Background

Coronavirus disease once thought to be a respiratory infection is now recognised as a multi-system disease affecting the respiratory, cardiovascular, gastrointestinal, neurological, immune, and hematopoietic systems. An emerging body of evidence suggests the persistence of COVID-19 symptoms of varying patterns among some survivors. This study aimed to describe persistent symptoms in COVID-19 survivors and investigate possible risk factors for these persistent symptoms.

Methods

The study used a retrospective study design. The study population comprised of discharged COVID-19 patients. Demographic information, days since discharge, comorbidities, and persistent COVID-19 like symptoms were assessed in patients attending the COVID-19 outpatient clinic in Lagos State. Statistical analysis was done using STATA 15.0 software (StataCorp Texas) with significance placed at p-value < 0.05.

Results

A total of 274 patients were enrolled in the study. A majority were within the age group > 35 to ≤49 years (38.3%), and male (66.1%). More than one-third (40.9%) had persistent COVID-19 symptoms after discharge, and 19.7% had more than three persistent COVID-like symptoms. The most persistent COVID-like symptoms experienced were easy fatigability (12.8%), headaches (12.8%), and chest pain (9.8%). Symptomatic COVID-19 disease with moderate severity compared to mild severity was a predictor of persistent COVID-like symptoms after discharge (p < 0.05).

Conclusion

Findings from this study suggests that patients who recovered from COVID-19 disease may still experience COVID-19 like symptoms, particularly fatigue and headaches. Therefore, careful monitoring should be in place after discharge to help mitigate the effects of these symptoms and improve the quality of life of COVID-19 survivors.
Stillbirths including intrapartum timing: EN-BIRTH multi-country validation study
Authors:   EN-BIRTH Study Group, Peven Kimberly , Day Louise T. , Ruysen Harriet , Tahsina Tazeen , KC Ashish , Shabani Josephine , Kong Stefanie , Ameen Shafiqul , Basnet Omkar , Haider Rajib , Rahman Qazi Sadeq-ur , Blencowe Hannah , Lawn Joy E.
Published: March 2021

Background

An estimated >2 million babies stillborn around the world each year lack visibility. Low- and middle-income countries carry 84% of the burden yet have the least data. Most births are now in facilities, hence routine register-recording presents an opportunity to improve counting of stillbirths, but research is limited, particularly regarding accuracy. This paper evaluates register-recorded measurement of hospital stillbirths, classification accuracy, and barriers and enablers to routine recording.

Methods

The EN-BIRTH mixed-methods, observational study took place in five hospitals in Bangladesh, Nepal and Tanzania (2017–2018). Clinical observers collected time-stamped data on perinatal care and birth outcomes as gold standard. To assess accuracy of routine register-recorded stillbirth rates, we compared birth outcomes recorded in labour ward registers to observation data. We calculated absolute rate differences and individual-level validation metrics (sensitivity, specificity, percent agreement). We assessed misclassification of stillbirths with neonatal deaths. To examine stillbirth appearance (fresh/macerated) as a proxy for timing of death, we compared appearance to observed timing of intrauterine death based on heart rate at admission.

Results

23,072 births were observed including 550 stillbirths. Register-recorded completeness of birth outcomes was > 90%. The observed study stillbirth rate ranged from 3.8 (95%CI = 2.0,7.0) to 50.3 (95%CI = 43.6,58.0)/1000 total births and was under-estimated in routine registers by 1.1 to 7.3 /1000 total births (register: observed ratio 0.9–0.7). Specificity of register-recorded birth outcomes was > 99% and sensitivity varied between hospitals, ranging from 77.7–86.1%. Percent agreement between observer-assessed birth outcome and register-recorded birth outcome was very high across all hospitals and all modes of birth (> 98%). Fresh or macerated stillbirth appearance was a poor proxy for timing of stillbirth. While there were similar numbers of stillbirths misclassified as neonatal deaths (17/430) and neonatal deaths misclassified as stillbirths (21/36), neonatal deaths were proportionately more likely to be misclassified as stillbirths (58.3% vs 4.0%). Enablers to more accurate register-recording of birth outcome included supervision and data use.

Conclusions

Our results show these routine registers accurately recorded stillbirths. Fresh/macerated appearance was a poor proxy for intrapartum stillbirths, hence more focus on measuring fetal heart rate is crucial to classification and importantly reduction in these preventable deaths.
Virtual reality applications to assist pregnant women: a scoping review
Authors: Hajesmaeel-Gohari Sadrieh , Sarpourian Fatemeh , Shafiei Elaheh
Published: March 2021

Background

Virtual reality (VR) is a computer technology that simulates the real world to allow users to communicate with a similar but artificial environment. VR technologies can be used in pregnancy to help mothers gain a better understanding of this significant yet stressful event. The aim of this study was to find and summarize VR applications to help pregnant women during their pregnancy and delivery.

Methods

PubMed, Embase, and Web of Science databases were searched on November 11th, 2020 to access relevant studies. The following data were extracted from the collected studies: first author’s name, year of publication, country, type of study, sample size, study objective, VR components (hardware and software), data gathering method, and study outcomes. Through a descriptive summary and analysis, the results eventually presented.

Results

Nine studies were included in this study. Four studies (44.5%) had used VR technology to reduce the anxiety of pregnant women, four studies (44.5%) had applied VR for decreasing delivery pain, and one study (11%) used VR for exercise trainings. Five studies (56%) used VR headsets and three studies (33.5%) used VR glasses. Most studies showed that VR was a useful method to be used for different purposes in both pregnancy and delivery (n = 8, 89%).

Conclusion

The use of VR technology for pregnancy has been increasing in recent years. This technology has different applications in pregnancy, from reducing anxiety and pain to exercise training. However, more studies are required to reach a general common understanding about the efficacy of VR during pregnancy and delivery.
CD47 expression and CD163+ macrophages correlated with prognosis of pancreatic neuroendocrine tumor
Authors: Imam Rami , Chang Qing , Black Margaret , Yu Caroline , Cao Wenqing
Published: March 2021

Background

Recent studies have suggested the important roles of CD47 and tumor-associated macrophages in the prognosis and immunotherapy of various human malignancies. However, the clinical significance of CD47 expression and CD163+ TAMs in pancreatic neuroendocrine tumor (PanNET) remains unclear.

Methods

In this study, 47 well-differentiated PanNET resection specimens were collected. CD47 expression and CD163+ macrophages were evaluated using immunohistochemistry and correlated with clinicopathologic properties.

Results

Positive CD47 staining was seen in all PanNETs as well as adjacent normal islets. Compared to normal islets, CD47 overexpressed in PanNETs (p = 0.0015). In the cohort, lymph node metastasis (LNM), lymphovascular invasion (LVI), and perineural invasion (PNI) were found in 36.2, 59.6, and 48.9% of the cases, respectively. Interestingly, PanNETs with LNM, LVI, or PNI had significantly lower H-score of CD47 than those without LNM (p = 0.035), LVI (p = 0.0005), or PNI (p = 0.0035). PanNETs in patients with disease progression (recurrence/death) also showed a significantly lower expression of CD47 than those without progression (p = 0.022). In contrast, CD163+ macrophage counts were significantly higher in cases with LNM, LVI, and PNI.

Conclusions

Our data suggest relative low CD47 expression and high CD163+ TAMs may act as indicators for poor prognosis of PanNETs.