bluuebunny/crossref_metadata_2025 huggingface dataset:
Comparison of three treatment protocols with intra-articular low or intermediate molecular weight hyaluronic acid in early symptomatic knee osteoarthritis
Authors: Galluccio Felice , D’Angela Daniela , Polistena Barbara , Porta Francesco , Barskova Tatiana , Tofani Lorenzo , Spandonaro Federico , Matucci-Cerinic Marco
Published: April 2021

Introduction:

Viscosupplementation with hyaluronic acid (HA) is indicated for non-responders to non-pharmacological therapy, to analgesics or when non-steroidal anti-inflammatory drugs (NSAIDs) are contraindicated. The aim of this study is to compare the efficacy, safety and costs of three different HA treatments ( Sinovial® Forte, sinovial one and hyalgan).

Patients and methods:

Ninety patients with grade I/II Kellgren–Lawrence knee osteoarthritis were included in three groups, the first was treated with hyalgan (weekly for 5 weeks), the second with Sinovial® Forte (weekly for 3 weeks) and the third group with a single injection of sinovial one.

Results:

All three treatments were effective, with an average reduction in the Western Ontario and McMaster Universities osteoarthritis index (WOMAC) score of 18.9 points for hyalgan, 18.04 points for Sinovial® Forte and 17.92 points for sinovial one. The comparison of the three groups did not show any statistical difference in terms of efficacy. National health system (NHS) and social costs are, respectively, €419.12 and €853.43 for hyalgan, €338.64 and €599.22 for Sinovial® Forte, €221.56 and €308.42 for sinovial one.

Conclusion:

All three treatments were equally effective with no statistically significant differences; thus, the treatment with sinovial one may be considered as clinically effective as the other two regimens, but with a very efficient cost profile in early symptomatic knee osteoarthritis.
Retrospective Quality Improvement Study of Insulin-Induced Hypoglycemia and Implementation of Hospital-Wide Initiatives
Authors: Shelton Carter , Demidowich Andrew P. , Motevalli Mahsa , Sokolinsky Sam , MacKay Periwinkle , Tucker Cynthia , Abundo Cora , Peters Eileen , Gooding Roliette , Hackett Margaret , Wedler Joyce , Alexander Lee Ann , Barry Luvenia , Flynn Mary , Rios Patricia , Fulda Constance Lulu , Young Michelle F. , Kahl Barbara , Pummer Eileen , Mathioudakis Nestoras N. , Sidhaye Aniket , Howell Eric E. , Rotello Leo , Zilbermint Mihail
Published: April 2021

Background:

Hospitalized patients who are receiving antihyperglycemic agents are at increased risk for hypoglycemia. Inpatient hypoglycemia may lead to increased risk for morbidity, mortality, prolonged hospitalization, and readmission within 30 days of discharge, which in turn may lead to increased costs. Hospital-wide initiatives targeting hypoglycemia are known to be beneficial; however, their impact on patient care and economic measures in community nonteaching hospitals are unknown.

Methods:

This retrospective quality improvement study examined the effects of hospital-wide hypoglycemia initiatives on the rates of insulin-induced hypoglycemia in a community hospital setting from January 1, 2016, until September 30, 2019. The potential cost of care savings has been calculated.

Results:

Among 49 315 total patient days, 2682 days had an instance of hypoglycemia (5.4%). Mean ± SD hypoglycemic patient days/month was 59.6 ± 16.0. The frequency of hypoglycemia significantly decreased from 7.5% in January 2016 to 3.9% in September 2019 ( P = .001). Patients with type 2 diabetes demonstrated a significant decrease in the frequency of hypoglycemia (7.4%-3.8%; P < .0001), while among patients with type 1 diabetes the frequency trended downwards but did not reach statistical significance (18.5%-18.0%; P = 0.08). Based on the reduction of hypoglycemia rates, the hospital had an estimated cost of care savings of $98 635 during the study period.

Conclusions:

In a community hospital setting, implementation of hospital-wide initiatives targeting hypoglycemia resulted in a significant and sustainable decrease in the rate of insulin-induced hypoglycemia. These high-leverage risk reduction strategies may be translated into considerable cost savings and could be implemented at other community hospitals.
Fit for Purpose? Exploring the Role of Freedom of Information Laws and Their Application for Watchdog Journalism
Authors: Žuffová Mária
Published: April 2021

Despite great volume of research into press–state relations, we know little about how journalists use information that has been generated through independent bureaucratic processes. The present study addresses this gap by investigating the role of freedom of information (FOI) laws in journalism practice. By surveying journalists ( n = 164), interviewing activists and civil servants ( n = 7) and submitting FOI requests to twenty-one ministerial departments in the United Kingdom, this study explores press-state interactions and the limits of Freedom of Information Act (FOIA) application to advance the media’s monitorial function. The results show that journalists perceive FOIA as an essential tool for their work. However, they often described their experience as negative. They reported refusals lacking legal ground, delays, not responding at all or differential treatment. In response to gating access, journalists might also adopt tactics that use loopholes in the law. The press-state interactions, already marked by suspicion, thus, continue to perpetuate distrust. These findings might have implications for journalism practices, FOIAs’ potential for government oversight and democracy. In particular, the differential treatment of requests undermines equality under the law, one of the fundamental democratic principles. The study concludes with several policy recommendations for FOIA reform to meet journalists’ needs better.
Unusual cause of heart failure in the young, the intracardiac mass: Diagnostic dilemmas solved by echocardiography
Authors: Siew Kelvin Shenq Woei , Ng Kim Fong , Othman Norliza , Lee Chuey Yan
Published: April 2021

Primary cardiac tumor remains exceedingly rare, accounting for 0.5 cases per million of the population annually. We report a case of cardiac tumor, which was initially misdiagnosed as heart failure secondary to acute coronary syndrome. The diagnosis was revised later after routine echocardiography in the ward. A 39-year-old gentleman who presented to the emergency department with cardiac failure and ischemic changes on the electrocardiogram was initially worked-up for acute coronary syndrome. However, echocardiography was performed later in the ward to evaluate the cardiac ejection fraction, revealing a massive left atrial mass measuring 6 cm × 4 cm. Severe mitral regurgitation was noted through the echocardiogram owing to the mass prolapse into the mitral annulus. The initial presentation of cardiac tumors can be ambiguous. Studies have shown that echocardiography as the noninvasive cardiac imaging approach remains the gold standard of diagnostic tool. Hence, echocardiography should be performed as a routine assessment of cardiac failure. Meanwhile, the incorporation of point of care ultrasound in the available center may assist the physician to diagnose accurately in the emergency department setting by excluding other potential differential diagnoses. Delay in diagnosis and initiation of treatment may result in progression to chronic heart failure and dangerous complication, i.e. hemodynamic sequelae and systemic embolism of the clot. In our experience, we managed to reach an accurate diagnosis, timely referral and appropriate intervention despite the lack of point of care ultrasound.
Crisis history and hindsight: A stakeholder perspective on the case of Boeing 737-Max
Authors: Jong Wouter , Broekman Paula
Published: April 2021

This study assesses the so-called effect of crisis history, based on two crashes with the new Boeing 737-Max. While Boeing’s responsibility was not clear cut after the first crash, the developments in the second crash led to a reinterpretation of initial responsibility for the first crash. This reinterpretation intensified the threat on Boeing’s reputation, and raised doubts on the appropriateness of the initial response. This case study illustrates the importance for organizations to be wary and to anticipate developments when selecting and creating a crisis response. Otherwise, statements can backfire when new information comes to light as similar events occur.
A case of spontaneous pneumomediastinum in a patient with severe SARS-CoV-2 and a review of the literature
Authors: Hua Duong T , Shah Farah , Perez-Corral Cherlyn
Published: April 2021

Spontaneous pneumomediastinum is defined as having an etiology that is not related to surgery, trauma, or mechanical ventilation. Precipitating causes of spontaneous pneumomediastinum include coughing, exercise, vomiting, infection, underlying lung diseases such as asthma, and illicit drugs. Symptoms include chest pain, shortness of breath, and dysphagia. A 54-year-old man presented with 2 weeks of shortness of breath, cough, and fever. He was admitted for severe SARS-CoV-2 pneumonia and acute hypoxic respiratory failure requiring non-rebreather mask. Chest imaging on admission showed bilateral peripheral consolidations and pneumomediastinum with subcutaneous emphysema. No precipitating event was identified. He did not require initiation of positive pressure ventilation throughout his admission. On hospital day 7, chest imaging showed resolution of pneumomediastinum and subcutaneous emphysema, and he was successfully discharged on oxygen therapy. Spontaneous pneumomediastinum is a rare complication of severe acute respiratory syndrome coronavirus 2 infection. Spontaneous pneumomediastinum is typically benign and self-limiting, requiring only supportive treatment.
The Semantics of ἐν ᾧ in 1 Peter
Authors: Atkinson Jordan
Published: April 2021

The prepositional phrase ἐν ᾧ occurs repeatedly in 1 Peter, and scholars debate its function in each occurrence. To determine the most likely functions of the phrase, this article analyzes each instance in the book. Based on the context of each occurrence, ἐν ᾧ is likely causal in 1 Pet 1.6 and 3.16, where it should be translated as “because of this” or “because of which.” In 1 Pet 2.12, ἐν ᾧ is both causal and concessive. In 1 Pet 3.19, however, it is likely a dative of reference, so should be translated as “in which.” Finally, in 1 Pet 4.4, ἐν ᾧ again functions causally.
Roles and Functions of the Korean Bible Society’s Journal of Biblical Text Research in Bible Translation Projects
Authors: Cho Ji-Youn
Published: April 2021

This article reviews various works in progress relating to the Journal of Biblical Text Research ( JBTR), which is published biannually by the Institute for Biblical Text Research (IBTR) of the Korean Bible Society (KBS), and proposes possible future roles and functions of JBTR in Bible translation projects. Since 1997, fifty volumes including three supplementary volumes have been published by JBTR, comprising a total of 611 articles. In reviewing these publications, this article specifically focuses on: (1) the initial roles and functions of JBTR; (2) the Korean Translation Workshops (KTW) 2003–2009 and the publications of JBTR; (3) JBTR for Korean Bible translation projects; (4) the influence of The Bible Translator ( TBT) on JBTR; and (5) the future roles and functions of JBTR in Bible translation projects. The article demonstrates how journals have contributed and can continue to contribute to Bible translation projects in Bible societies in cooperation with the United Bible Societies fellowship. In addition, further possible projects that the journal can meaningfully undertake in order to broaden its ministry and contribution will be discussed.
An Evaluation of the Supposed Hebraism in Mark 8.12
Authors: Michael McKay J.
Published: April 2021

This article focuses on the final six words in the Greek text of Mark 8.12: εἰ δοθήσεται τῇ γενεᾷ ταύτῃ σημεῖον. This partial conditional statement is typically translated as an emphatic negative oath based on the belief that a Hebraism is in use. For example, NRSV translates this part of the verse as, “no sign will be given to this generation,” instead of formally as a straightforward conditional. The thesis of this article is that Mark 8.12 should not be translated as an emphatic negative oath because no Hebraism is in use; instead, Jesus’ words should be translated according to the figure of speech known as aposiopesis: “if a sign will be given to this generation . . .”
The Emphatic Hypernegation That Was(n’t): Revisiting οὐ μὴ and New Testament Translation in Light of Research and Contemporary Linguistics
Authors: Andreas Hübner Jamin
Published: April 2021

The pleonastic hypernegation οὐ μὴ is widely recognized as conveying an emphatic “no.” However, all major English translations fail to render it consistently with such emphasis. This article explores the nature of this disparity by locating οὐ μὴ linguistically, semantically, and lexically within New Testament literature and contemporary research. It concludes that, despite theoretical exceptions and the erroneous trend of translations, οὐ μὴ should, in the New Testament, always be rendered with some explicit emphasis.
The Translation of יהוה‎ in Dholuo: Overview and History
Authors: Mercy Kobimbo Mary
Published: April 2021

The rendering of the divine name יהוה‎ is one of the most debated issues in Bible translation. This is also the case in translation of the Bible into the Dholuo language of Kenya and Tanzania. Different solutions have been proffered in different Dholuo versions, but without a clear rationale. This raises important questions. To what extent do versions used as sources influence translation choice? Should traditional religion and culture provide guidance in the search for a solution? This study analyses renderings of יהוה‎ in existing Dholuo versions against the background of the history of church and mission in the Dholuo context.
Celiac disease: Understandings in diagnostic, nutritional, and medicinal aspects
Authors: Ben Houmich Taoufik , Admou Brahim
Published: April 2021

Celiac disease (CD) is characterized by clinical polymorphism, with classic, asymptomatic or oligosymptomatic, and extra-intestinal forms, which may lead to diagnostic delay and exposure to serious complications. CD is a multidisciplinary health concern involving general medicine, pediatric, and adult gastroenterology, among other disciplines. Immunology and pathology laboratories have a fundamental role in diagnosing and monitoring CD. The diagnosis consists of serological testing based on IgA anti-transglutaminase (TG2) antibodies combined with IgA quantification to rule out IgA deficiency, a potential misleading factor of CD diagnosis. Positive TG2 serology should be corroborated by anti-endomysium antibody testing before considering an intestinal biopsy. Owing to multiple differential diagnoses, celiac disease cannot be confirmed based on serological positivity alone, nor on isolated villous atrophy. In children with classical signs or even when asymptomatic, with high levels of CD-linked markers and positive HLA DQ2 and/or DQ8 molecules, the current trend is to confirm the diagnosis on basis of the non-systematic use of the biopsy, which remains obligatory in adults. The main challenge in managing CD is the implementation and compliance with a gluten-free diet (GFD). This explains the key role of the dietitian and the active participation of patients and their families throughout the disease-management process. The presence of the gluten in several forms of medicine requires the sensitization of physicians when prescribing, and particularly when dispensing gluten-containing formulations by pharmacists. This underlines the importance of the contribution of the pharmacist in the care of patients with CD within the framework of close collaboration with physicians and nutritionists.
A Multidisciplinary NHS COVID-19 Service to Manage Post-COVID-19 Syndrome in the Community
Authors: Parkin Amy , Davison Jennifer , Tarrant Rachel , Ross Denise , Halpin Stephen , Simms Alex , Salman Rashad , Sivan Manoj
Published: April 2021

The National Institute for Health and Care Excellence (NICE) describe “ post COVID-19 syndrome” or “Long COVID” as a set of persistent physical, cognitive and/or psychological symptoms that continue for more than 12 weeks after illness and which are not explained by an alternative diagnosis. These symptoms are experienced not only by patients discharged from hospital but also those in the community who did not require inpatient care. To support the recovery of this group of people, a unique integrated rehabilitation pathway was developed following extensive service evaluations by Leeds Primary Care Services, Leeds Community Healthcare NHS Trust and Leeds Teaching Hospital NHS Trust. The pathway aligns itself to the NHS England “Five-point plan” to embed post-COVID-19 syndrome assessment clinics across England, supporting the comprehensive medical assessment and rehabilitation intervention for patients in the community. The pathway was first of its kind to be set up in the UK and comprises of a three-tier service model (level 1: specialist MDT service, level 2: community therapy teams and level 3: self-management). The MDT service brings together various disciplines with specialist skill sets to provide targeted individualized interventions using a specific core set of outcome measures including C19-YRS (Yorkshire Rehabilitation Scale). Community and primary care teams worldwide need such an integrated multidisciplinary comprehensive model of care to deal with the growing number of cases of post-COVID-19 syndrome effectively and in a timely manner.
Clinical Validity of 3 Different Grading Systems for Facet Joint Violation: A Retrospective Study and In-Depth Review
Authors: Zhao Yiwei , Yuan Suomao , Liu Wubo , Tian Yonghao , Liu Xinyu
Published: April 2021

Study Design:

Retrospective.

Objectives:

To study the violation rate of 3 different types of facet joint violation (FJV) grading systems (Babu, Shah, and Park), and to evaluate the accuracy, reliability, and association with clinical outcomes of the above 3 grading systems.

Methods:

152 patients of lumbar spinal stenosis treated with percutaneous pedicle screw placement were enrolled in our study. FJV was evaluated on 3-dimensional lumbar CT reconstruction. Three types of grading systems were used to evaluate FJV: Babu’s system (grading by the severity of violation), Shah’s system (grading by side of violation), and modified Park’s system (grading by different components to cause violation). The violation rate and observer consistency of the 3 grading systems were analyzed. Clinical outcomes were evaluated by visual analog score (VAS), Oswestry disability index (ODI) score.

Results:

Kappa coefficients of interobserver consistency on Babu, Shah, and Park grading systems were 0.726,0.849,0.692, respectively. The violation rate of Babu, Shah, and Park grading systems were comparable, which were 34.54%, 32.57%, 33.55%, respectively. In all 3 grading systems, the postoperative VAS low-back pain and ODI scores in non-FJV groups were lower than those in FJV groups ( P < .05), and there were no significant differences between 2 groups in VAS leg pain( P >.05).

Conclusions:

Babu, Shah and modified Park grading system are reliable grading systems, and it reported comparable violation rate. The self-reported clinical outcomes of patients with FJV were worse at 2-year follow-up. For clinical application, it is recommended to use 2 or even 3 different grading systems together to evaluate the FJV.
New Grading System for Cervical Paraspinal Soft Tissue Damage After Traumatic Cervical Spinal Cord Injury Without Major Fracture Based on the Short-T1 Inversion Recovery Mid-Sagittal MRI for Prediction of Neurological Improvements: The STIR-MRI Grade
Authors: Aburakawa Kotaro , Yokoyama Toru , Takeuchi Kazunari , Numasawa Takuya , Wada Kanichiro , Kumagai Gentaro , Tanaka Sunao , Asari Toru , Otsuka Hironori , Ishibashi Yasuyuki
Published: April 2021

Study Design:

Retrospective cohort study.

Objective:

To develop a grading method for cervical paraspinal soft tissue damage after cervical spinal cord injury (CSCI) without major fracture based on the short T1 inversion recovery (STIR) mid-sagittal magnetic resonance image (MRI) for prediction of neurological improvements.

Methods:

This study included 34 patients with CSCI without major fracture, treated conservatively for at least 1 year and graded using the STIR-MRI Grade. This system consists of anterior grades; A0: no high-intensity area (HIA), A1: linear HIA, and A2: fusiform HIA, and posterior grades; P0: no HIA, P1: HIA not exceeding the nuchal ligament, and P2: HIA exceeding the nuchal ligament, within 24 hours postinjury. The American Spinal Injury Association impairment scale (AIS) and the Japanese Orthopedic Association (JOA) scores were examined.

Results:

Anterior grades were not significantly correlated with the AIS and JOA score. At both injury and final follow-up, the AIS in P2 patients was significantly more severe ( P = 0.007, P = 0.015, respectively) than that in P0 patients. At the injury, the AIS in P2 patients was significantly more severe ( P = 0.008) than that in P1 patients. Among P2 patients only, the JOA score at the injury (1.4 points) did not improve by the final follow-up (3.9 points). The final follow-up JOA score (3.9 points) in P2 patients was significantly lower than that (13.6 points) in P0 patients ( P = 0.016).

Conclusions:

Grade P2 led to poor neurological outcomes. The STIR-MRI Grade is a prognostic indicator for neurological improvements past-CSCI.
Post-pandemic Higher Education: Perspectives from University Leaders and Educational Experts in the United Arab Emirates
Authors: Ashour Sanaa , El-Refae Ghaleb A. , Zaitoun Eman A.
Published: April 2021

The COVID-19 pandemic has presented an opportunity to rethink higher education. This study focused on analysing experiences from three higher education institutions (HEIs) in the United Arab Emirates (UAE) since the onset of the crisis and explored how university leaders and professors in these institutions imagine post-COVID-19 higher education. The study aimed to find out whether the pandemic has been a factor that has helped to legitimize online teaching and learning as a universal mode of delivery across different fields of studies, or if the Zoom fatigue has shown its limitations. In addition, the research investigated what transformations university experts predict and their vision for the future of higher education. The study found that many lessons learnt during the period of forced adoption of distance education will be used by universities to enhance and expand online learning provisions. This shift will be driven by the investments the universities have made in distance education and the increased familiarity of the students, staff and institutions with e-learning. The study participants foresee that more sophisticated forms of hybrid campuses will be a more appropriate model for the future, if face-to-face (F2F) classrooms do not return.
Analyzing the dynamics of urbanization in Delhi National Capital Region in India using satellite image time-series analysis
Authors: Chaudhuri Gargi , Mainali Kumar P. , Mishra Niti B.
Published: April 2021

Understanding urban land-use changes and accurately quantifying urban land transitions is essential to global land-change research. The present study aimed to capture non-linear land transitions within urban areas using an automated change detection technique in a satellite image time series. Traditional land-use and cover maps used to map and monitor urban areas assume land change is a linear process and that urbanization is the last stage of land transition. In reality, however, most land transitions are non-linear. The present study focused on Delhi National Capital Territory, in India, and its adjacent major cities. A popular time-series analysis method was applied on MODIS NDVI time-series (2000–2017) data to detect change within the impervious surface area of the region. Overall validation and analysis of the results showed that the method was able to capture the direction and timing of the changes very well within all levels of urban density (except very high-density areas with more than 98% built-up density). The majority of urban areas in the region experienced interrupted, abrupt, and gradual greening. The results show different examples of non-linear land transitions detected from satellite images. Until recently, these land transitions could only be observed via long-term field surveys and/or local knowledge. The results reveal that the land-change trajectories can be different based on the level of built-up density, size of the urban area, physical proximity, and accessibility to relatively bigger urban areas. Knowledge gained from this study can be useful in better understanding the micro-climatic patterns and environmental quality within a city.
Lenalidomide triggers T-cell effector functions in vivo in patients with follicular lymphoma
Authors: Ménard Cédric , Rossille Delphine , Dulong Joelle , Nguyen Tien-Tuan , Papa Ilenia , Latour Maelle , Bescher Nadège , Bezier Isabelle , Chouteau Myriam , Fest Thierry , Houot Roch , Morschhauser Franck , Tarte Karin
Published: April 2021

The immunomodulatory drug lenalidomide is used in patients with follicular lymphoma (FL) with the aim of stimulating T-cell antitumor immune response. However, little is known about the effects of lenalidomide on T-cell biology in vivo in patients with FL. We thus undertook an extensive longitudinal immunologic study, including phenotypic, transcriptomic, and functional analyses, on 44 first-line and 27 relapsed/refractory patients enrolled in the GALEN trial (Obinutuzumab Combined With Lenalidomide for Relapsed or Refractory Follicular B-Cell Lymphoma) to test the efficacy of lenalidomide and obinutuzumab combination in patients with FL. Lenalidomide rapidly and transiently induced an activated T-cell phenotype, including HLA-DR, Tim-3, CD137, and programmed cell death protein 1 (PD-1) upregulation. Furthermore, sequential RNA-sequencing of sorted PD-1+ and PD-1– T-cell subsets revealed that lenalidomide triggered a strong enrichment for several gene signatures related to effector memory T-cell features, including proliferation, antigen receptor signaling, and immune synapse restoration; all were validated at the phenotypic level and with ex vivo functional assays. Correlative analyses pinpointed a negative clinical impact of high effector T-cell and regulatory T-cell percentages before and during treatment. Our findings bring new insight in lenalidomide mechanisms of action at work in vivo and will fuel a new rationale for the design of combination therapies.
Molecular Dynamics Simulation on Cutting Mechanism in the Hybrid Machining Process of Single-Crystal Silicon
Authors: Liu Changlin , He Wenbin , Chu Jianning , Zhang Jianguo , Chen Xiao , Xiao Junfeng , Xu Jianfeng
Published: April 2021

In this paper, molecular dynamics simulations are carried out to investigate the cutting mechanism during the hybrid machining process combined the thermal and vibration assistants. A modified cutting model is applied to study the material removal behavior and subsurface damage formation in one vibration cycle. The results indicate that during the hybrid machining process, the dominant material removal mechanism could transform from extrusion to shearing in a single vibration cycle. With an increase of the cutting temperature, the generation and propagation of cracks are effectively suppressed while the swelling appears when the dominant material removal mechanism becomes shearing. The formation mechanism of the subsurface damage in one vibration cycle can be distinct according to the stress distribution. Moreover, the generation of the vacancies in workpiece becomes apparent with increasing temperature, which is an important phenomenon in hybrid machining process.
Fulminant hepatic failure in a patient testing re-positive for SARS-CoV-2: a case report
Authors: Aldossary Bader , Hassan Ali , Moussa Mohamed , Alsaif Hind S. , Alfaraj Dunya
Published: April 2021

Background

Infection by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) may not elicit lifelong protective immunity and reinfection could occur. Liver function impairment is a common manifestation of coronavirus disease 2019 (COVID-19). However, acute hepatic failure in the setting of COVID-19 is very rare.

Case presentation

We report the case of a 47-year-old woman who presented with acute abdominal pain and vomiting. Abdominal examination revealed a soft and lax abdomen with mild tenderness in the right upper quadrant. The patient recovered from COVID-19 2 months previously with negative results on reverse transcription-polymerase chain reaction (RT-PCR). Laboratory investigations revealed markedly elevated transaminases with normal results on viral hepatitis serology panel and undetectable blood paracetamol level. Prior to admission, the patient underwent RT-PCR for SARS-CoV-2, which revealed a positive result. The patient experienced rapid deterioration in the neurological status with a remarkable increase in the liver enzyme levels. Despite aggressive resuscitation, the patient suffered irreversible cardiac arrest and died.

Conclusion

Fulminant hepatic failure is a rare manifestation in patients with re-positive RT-PCR tests for SARS-CoV-2. Clinicians should maintain a high index of suspicion for hepatic injury with active monitoring of liver enzymes.
Association of vitamin D pathway genes polymorphisms with pulmonary tuberculosis susceptibility in a Chinese population
Authors: Zhang Tian-Ping , Chen Shuang-Shuang , Zhang Gen-You , Shi Si-Jiu , Wei Li , Li Hong-Miao
Published: April 2021

Objective

This study aimed to evaluate the association of single nucleotide polymorphisms (SNPs) of vitamin D metabolic pathway genes with susceptibility to pulmonary tuberculosis (PTB).

Methods

Nine hundred seventy-nine patients (490 PTB cases and 489 healthy controls) were included in this study. Seventeen SNPs of vitamin D metabolic pathway genes, including CYP24A1, CYP27A1, CYP27B1, CYP2R1, GC, and DHCR7, were genotyped with improved multiple ligase detection reaction (iMLDR).

Results

The GC rs3733359 GA, rs16847024 CT genotypes were significantly associated with the reduced risk of PTB, and the rs3733359 A, rs16847024 T alleles were also associated with the decreased PTB susceptibility. The GT genotype of GC rs4588 variant was significantly higher in patients with PTB when compared to controls. Moreover, the increased risk of rs3733359 and rs16847024 variants, and a decreased risk of rs4588, were found under the dominant mode among the PTB patients. However, there was no significant relationship of CYP24A1, CYP27A1, CYP27B1, CYP2R1, and DHCR7 polymorphisms with the risk of PTB. In CYP27A1, the rs17470271 T and rs933994 T alleles were significantly associated with leukopenia, drug resistance in the PTB patients, respectively. In GC gene, the rs7041 and rs3733359 variants were found to be associated with pulmonary infection, fever in the PTB patients, respectively. The increased frequency of rs16847024 TT genotype was found in the PTB patients with fever and drug-induced liver damage. DHCR7 rs12785878 TT genotype, and T allele frequencies were both significantly associated with pulmonary infection in the PTB patients. The haplotype analysis showed that CYP24A1 TACT, CYP2R1 GGCT, GGAT, GC AATG haplotypes were related to PTB susceptibility.

Conclusion

Our study suggested that GC SNPs were associated with the genetic background of PTB. CYP27A1, GC, and DHCR7 genetic variations might contribute to several clinical phenotypes of PTB in Chinese.
Dynamics of rumen gene expression, microbiome colonization, and their interplay in goats
Authors: Pan Xiangyu , Li Zongjun , Li Bibo , Zhao Chen , Wang Yu , Chen Yulin , Jiang Yu
Published: April 2021

Background

Preweaned rumen development is vital for animal health and efficient fermentation. In this study, we integrated ruminal transcriptomic and metagenomic data to explore the dynamics of rumen functions, microbial colonization, and their functional interactions during the first 8 weeks of life in goats.

Results

The dynamic rumen transcriptomic and microbial profiles both exhibited two distinct phases during early rumen development. The differentially expressed genes of the rumen transcriptome between the two phases showed that the immune-related response was enriched in the first phase and nutrient-related metabolism was enriched in the second phase, whereas the differentially expressed genes of the rumen microbiome were enriched in bacteriocin biosynthesis and glycolysis/gluconeogenesis activities. The developmental shift in the rumen transcriptome (at d 21) was earlier than the feed stimulus (at d 25) and the shift in the rumen microbiome (at d 42). Additionally, 15 temporal dynamic rumen gene modules and 20 microbial modules were revealed by coexpression network analysis. Functional correlations between the rumen and its microbiome were primarily involved in rumen pH homeostasis, nitrogen metabolism and the immune response. Rumen gene modules associated with the microbial alpha diversity index were also enriched in the immune response process.

Conclusions

The present study touched the critical developmental process of rumen functions, microbial colonization and their functional interactions during preweaned development. Taken together, these results demonstrated that rumen development at the first phase is more likely a programmed process rather than stimulation from feed and the microbiome, while the shift of rumen metagenomes was likely regulated by both the diet and host. The intensive functional correlations between rumen genes and the microbiome demonstrated that synergistic processes occurred between them during early rumen development.
Genetic variability in multidrug-resistant Mycobacterium tuberculosis isolates from patients with pulmonary tuberculosis in North India
Authors: Singh Ajay Vir , Singh Suman , Yadav Anjali , Kushwah Shweta , Yadav Rajbala , Sai Davuluri Kushma , Chauhan Devendra Singh
Published: April 2021

Background

Information on the genetic variability of drug resistant isolates of Mycobacterium tuberculosis is of paramount importance to understand transmission dynamics of disease and to improve TB control strategies. Despite of largest number of multidrug-resistant (MDR) tuberculosis cases (1, 30,000; 27% of the global burden), strains responsible for the expansion or development of drug-resistant Mycobacterium tuberculosis infections have been poorly characterized in India. Present study was aimed to investigate the genetic diversity in MDR isolates of Mycobacterium tuberculosis in North India.

Results

Spacer oligonucleotide typing (spoligotyping) was performed on 293 clinical MDR isolates of Mycobacterium tuberculosis recovered from cases of pulmonary tuberculosis from North India. Spoligotyping identified 74 distinct spoligotype patterns. Comparison with an international spoligotype database (spoldb4 database) showed that 240 (81.91%) and 32 (10.92%) strains displayed known and shared type patterns, while 21 (7.16%) strains displayed unique spoligotype patterns. Among the phylogeographic lineages, lineage 3 (East African-Indian) was found most predominant lineage (n = 159, 66.25%), followed by lineage 2 (East Asian; n = 34, 14.16%), lineage 1 (Indo-Oceanic; n = 30, 12.50%) and lineage 4 (Euro American; n = 17, 7.08%). Overall, CAS1_DEL (60.41%; SITs 2585, 26, 2694, 309, 381, 428, 1401, 141, 25, 1327) was found most pre-dominant spoligotype pattern followed by Beijing (14.16%; SITs255, 260, 1941, 269) and EAI3_IND (5.00%; SITs 298, 338, 11). The demographic and clinical characteristics were not found significantly associated with genotypic lineages of MDR-M.tuberculosis isolates recovered from pulmonary TB patients of North India.

Conclusions

Present study reveals high genetic diversity among the Mycobacterium tuberculosis isolates and highlights that SIT141/CAS1_Del followed by SIT26/ Beijing lineage is the most common spoligotype responsible for the development and transmission of MDR-TB in North India. The high presence of shared type and unique spoligotype patterns of MDR strains indicates epidemiological significance of locally evolved strains in ongoing transmission of MDR-TB within this community which needs to be further monitored using robust molecular tools with high discriminatory power.
Clonal diversity and genomic characterization of Panton-valentine Leukocidin (PVL)-positive Staphylococcus aureus in Tehran, Iran
Authors: Najafi olya Zahra , Najar-Peerayeh Shahin , Yadegar Abbas , Bakhshi Bita
Published: April 2021

Background

Some Staphylococcus aureus strains produce Panton-Valentine leukocidin (PVL), a bi-component pore-forming toxin, which causes leukocyte lysis and tissue necrosis. Currently, there is very limited information on the molecular epidemiology of PVL-encoding S. aureus strains in Iran. This study aimed to determine the molecular epidemiology and genetic background of PVL-positive S. aureus clinical strains isolated from Iranian patients.

Methods

A total of 28 PVL-positive S. aureus strains were detected from 600 S. aureus isolates between February 2015 and March 2018 from different hospitals in Tehran, Iran. Antimicrobial susceptibility testing was performed according to the Clinical and Laboratory Standards Institute (CLSI) guidelines. Molecular genotyping was performed using SCCmec and accessory gene regulator (agr) typing, PVL haplotyping, multilocus sequence typing (MLST), and pulsed-field gel electrophoresis (PFGE).

Results

The highest antibiotic resistance rate was found to be against erythromycin (57.1%), followed by ciprofloxacin (42.8%) and clindamycin (35.7%). Moreover, 19 (67.9%) out of 28 S. aureus isolates were identified as MRSA, including CA-MRSA (14/19, 73.7%) and HA-MRSA (5/19, 26.3%). SCCmec type IVa was detected as the predominant type (10/19, 52.6%), followed by type III (5/19, 26.3%) and type V (4/19, 21.1%). The agr type I was identified as the most common type (14/28, 50%), and H and R haplotype groups were observed at frequencies of 67.9 and 32.1%, respectively. Among H variants, the predominant variant was H2 (78/9%). The isolates encompassed 21 different sequence types (STs), including 16 new STs (ST5147 to ST5162). Based on eBURST analysis, the isolates were clustered into five CCs, including CC30, CC22, CC1, CC8, and CC5 (ST5160), and nine singletons. PFGE typing showed that 24 isolates were clustered into A (4 pulsotypes), B (9 pulsotypes), and C (11 pulsotypes) clusters.

Conclusions

A high prevalence of PVL-positive CA-MRSA strains was detected in Iran. The majority of PVL-positive isolates were of H (mostly H2) variant, while R variant was harbored by 100% of PVL-positive MRSA strains. Also, CC8, CC22, and CC30 were identified as the dominant clones among PVL-encoding S. aureus strains. This study promotes a better understanding of the molecular epidemiology and evolution of PVL-positive S. aureus strains in Iran.
A composite biomarker of neutrophil-lymphocyte ratio and hemoglobin level correlates with clinical response to PD-1 and PD-L1 inhibitors in advanced non-small cell lung cancers
Authors: Ayers Kristin L. , Ma Meng , Debussche Gaspard , Corrigan David , McCafferty Jonathan , Lee Kyeryoung , Newman Scott , Zhou Xiang , Hirsch Fred R. , Mack Philip C. , Liu Jane J. , Schadt Eric E. , Chen Rong , Li Shuyu D.
Published: April 2021

Background

Immune checkpoint inhibitors (ICIs) have been incorporated into various clinical oncology guidelines for systemic treatment of advanced non-small cell lung cancers (aNSCLC). However, less than 50% (and 20%) of the patients responded to the therapy as a first (or second) line of therapy. PD-L1 immunohistochemistry (IHC) is an extensively studied biomarker of response to ICI, but results from this test have equivocal predictive power. In order to identify other biomarkers that support clinical decision-making around whether to treat with ICIs or not, we performed a retrospective study of patients with aNSCLC who underwent ICI-based therapy in the Mount Sinai Health System between 2014 and 2019.

Methods

We analyzed data from standard laboratory tests performed in patients as a part of the routine clinical workup during treatment, including complete blood counts (CBC) and a comprehensive metabolic panel (CMP), to correlate test results with clinical response and survival.

Results

Of 11,138 NSCLC patients identified, 249 had been treated with ICIs. We found associations between high neutrophil-to-lymphocyte ratio (NLR ≥ 5) and poor survival in ICI-treated NSCLC. We further observed that sustained high NLR after initiation of treatment had a more profound impact on survival than baseline NLR, regardless of PD-L1 status. Hazard ratios when comparing patients with NLR ≥ 5 vs. NLR < 5 are 1.7 (p = 0.02), 3.4 (p = 4.2 × 10− 8), and 3.9 (p = 1.4 × 10− 6) at baseline, 2–8 weeks, and 8–14 weeks after treatment start, respectively. Mild anemia, defined as hemoglobin (HGB) less than 12 g/dL was correlated with survival independently of NLR. Finally, we developed a composite NLR and HGB biomarker. Patients with pretreatment NLR ≥ 5 and HGB < 12 g/dL had a median overall survival (OS) of 8.0 months (95% CI 4.5–11.5) compared to the rest of the cohort with a median OS not reached (95% CI 15.9-NE, p = 1.8 × 10− 5), and a hazard ratio of 2.6 (95% CI 1.7–4.1, p = 3.5 × 10− 5).

Conclusions

We developed a novel composite biomarker for ICI-based therapy in NSCLC based on routine CBC tests, which may provide meaningful clinical utility to guide treatment decision. The results suggest that treatment of anemia to elevate HGB before initiation of ICI therapy may improve patient outcomes or the use of alternative non-chemotherapy containing regimens.
Gender differences in refraction prediction error of five formulas for cataract surgery
Authors: Zhang Yibing , Li Tingyang , Reddy Aparna , Nallasamy Nambi
Published: April 2021

Objectives

To evaluate gender differences in optical biometry measurements and lens power calculations.

Methods

Eight thousand four hundred thirty-one eyes of five thousand five hundred nineteen patients who underwent cataract surgery at University of Michigan’s Kellogg Eye Center were included in this retrospective study. Data including age, gender, optical biometry, postoperative refraction, implanted intraocular lens (IOL) power, and IOL formula refraction predictions were gathered and/or calculated utilizing the Sight Outcomes Research Collaborative (SOURCE) database and analyzed.

Results

There was a statistical difference between every optical biometry measure between genders. Despite lens constant optimization, mean signed prediction errors (SPEs) of modern IOL formulas differed significantly between genders, with predictions skewed more hyperopic for males and myopic for females for all 5 of the modern IOL formulas tested. Optimization of lens constants by gender significantly decreased prediction error for 2 of the 5 modern IOL formulas tested.

Conclusions

Gender was found to be an independent predictor of refraction prediction error for all 5 formulas studied. Optimization of lens constants by gender can decrease refraction prediction error for certain modern IOL formulas.
Personality traits and their clinical associations in trichotillomania and skin picking disorder
Authors: Grant Jon E. , Chamberlain Samuel R.
Published: April 2021

Background

Despite being discussed in the psychiatric literature for decades, very little is known about personality features associated with trichotillomania and skin picking disorder (known as body focused repetitive behavior disorders, BFRBs); and the contribution of personality traits to their clinical presentations.

Aim

The present study assessed personality traits in a large and well-characterized sample of adults with either trichotillomania or skin picking disorder or both.

Methods

Adults (n = 98, aged 18–65 years), with trichotillomania (n = 37), skin picking disorder (n = 32), both trichotillomania and skin picking disorder (n = 10), and controls (n = 19) were enrolled. Participants completed self-report questionnaires to quantify personality (NEO Personality Inventory), as well as extent/severity of picking/pulling symptoms, mood and anxiety, impulsive and perfectionistic tendencies, and neurocognitive functioning. Group differences were characterized and correlations with other measures were examined.

Results

In comparison to controls, BFRBs had elevated neuroticism scores (p < 0.001), lower extraversion scores (p = 0.023), and lower conscientiousness scores (p = 0.007). Neuroticism was significantly related to both hair pulling (r = 0.24, p < 0.001) and skin picking severity (r = 0.48, p < 0.001), as well as elevated perceived stress, worse anxiety and depressive symptoms, and poorer quality of life. Introversion (i.e. lower extraversion) was significantly associated with worse picking severity, higher perceived stress, and higher depression. Lack of conscientiousness was significantly associated with more depression, impulsivity, and perceived stress.

Discussion

Personality traits of neuroticism, introversion, and lack of conscientiousness are heightened in individuals with BFRBs and show strong associations with a number of clinically relevant features of illness. The holistic understanding and treatment of these disorders is likely to require consideration of dimensional traits such as these.
The association of education in a new society and social support from the education with the health of North Korean defectors: a cross-sectional study
Authors: Lee Jihyun , Park Yui , Han Dong-Hun , Yoo Ji Won , Zhou Wenlian , Kim Pearl , Shen Jay J.
Published: April 2021

Background

The number of North Korean defectors (NKDs) escaping to South Korea has increased. The health status of NKDs is an essential factor for a successful settlement into South Korean society. However, no studies have been conducted on the health status of NKDs in terms of education and social support. The aim of this study was to determine the associations of education and social support with the self-rated health status among NKDs.

Methods

This study utilized data gained from face-to-face interviews with 126 NKDs. A multivariable logistic regression and path analysis were performed to assess the effects of education in South Korea and social support on their self-rated health status and to explore the complex relationships between direct and indirect effects of the variables.

Results

NKDs who did not experience regular education in South Korea responded that they were in poor health compared to their counterpart (OR = 5.78). Although a direct association between education in South Korea and self-rated health was not shown, there was an indirect path from education in South Korea to self-rated health through social support.

Conclusions

Participation in regular education in South Korea is important for the health status of NKDs. Moreover, social support has an important role in the association between education and self-rated health. Social policies and NKD assistance programs should consider and reflect the combination of education and social support interventions relevant to the health status of NKDs.