bluuebunny/crossref_metadata_2025 huggingface dataset:
Differential diagnosis of coronavirus disease 2019 from community-acquired-pneumonia by computed tomography scan and follow-up
Authors: Liu Kai-Cai , Xu Ping , Lv Wei-Fu , Chen Lei , Qiu Xiao-Hui , Yao Jin-Long , Gu Jin-Feng , Hu Bo , Wei Wei
Published: August 2020

Objective

Coronavirus disease 2019 (COVID-19) is currently the most serious infectious disease in the world. An accurate diagnosis of this disease in the clinic is very important. This study aims to improve the differential ability of computed tomography (CT) to diagnose COVID-19 and other community-acquired pneumonias (CAPs) and evaluate the short-term prognosis of these patients.

Methods

The clinical and imaging data of 165 COVID-19 and 118 CAP patients diagnosed in seven hospitals in Anhui Province, China from January 21 to February 28, 2020 were retrospectively analysed. The CT manifestations of the two groups were recorded and compared. A correlation analysis was used to examine the relationship between COVID-19 and age, size of lung lesions, number of involved lobes, and CT findings of patients. The factors that were helpful in diagnosing the two groups of patients were identified based on specificity and sensitivity.

Results

The typical CT findings of COVID-19 are simple ground-glass opacities (GGO), GGO with consolidation or grid-like changes. The sensitivity and specificity of the combination of age, white blood cell count, and ground-glass opacity in the diagnosis of COVID-19 were 92.7 and 66.1%, respectively. Pulmonary consolidation, fibrous cords, and bronchial wall thickening were used as indicators to exclude COVID-19. The sensitivity and specificity of the combination of these findings were 78.0 and 63.6%, respectively. The follow-up results showed that 67.8% (112/165) of COVID-19 patients had abnormal changes in their lung parameters, and the severity of the pulmonary sequelae of patients over 60 years of age worsened with age.

Conclusions

Age, white blood cell count and ground-glass opacity have high accuracy in the early diagnosis of COVID-19 and the differential diagnosis from CAP. Patients aged over 60 years with COVID-19 have a poor prognosis. This result provides certain significant guidance for the diagnosis and treatment of new coronavirus pneumonia.
Nup133 and ERα mediate the differential effects of hyperoxia-induced damage in male and female OPCs
Authors: Sunny Donna Elizabeth , Hammer Elke , Strempel Sebastian , Joseph Christy , Manchanda Himanshu , Ittermann Till , Hübner Stephanie , Weiss Frank Ulrich , Völker Uwe , Heckmann Matthias
Published: August 2020

Background

Hyperoxia is a well-known cause of cerebral white matter injury in preterm infants with male sex being an independent and critical risk factor for poor neurodevelopmental outcome. Sex is therefore being widely considered as one of the major decisive factors for prognosis and treatment of these infants. But unfortunately, we still lack a clear view of the molecular mechanisms that lead to such a profound difference. Hence, using mouse-derived primary oligodendrocyte progenitor cells (OPCs), we investigated the molecular factors and underlying mechanisms behind the differential response of male and female cells towards oxidative stress.

Results

We demonstrate that oxidative stress severely affects cellular functions related to energy metabolism, stress response, and maturation in the male-derived OPCs, whereas the female cells remain largely unaffected. CNPase protein level was found to decline following hyperoxia in male but not in female cells. This impairment of maturation was accompanied by the downregulation of nucleoporin and nuclear lamina proteins in the male cells. We identify Nup133 as a novel target protein affected by hyperoxia, whose inverse regulation may mediate this differential response in the male and female cells. Nup133 protein level declined following hyperoxia in male but not in female cells. We show that nuclear respiratory factor 1 (Nrf1) is a direct downstream target of Nup133 and that Nrf1 mRNA declines following hyperoxia in male but not in female cells. The female cells may be rendered resistant due to synergistic protection via the estrogen receptor alpha (ERα) which was upregulated following hyperoxia in female but not in male cells. Both Nup133 and ERα regulate mitochondrial function and oxidative stress response by transcriptional regulation of Nrf1.

Conclusions

These findings from a basic cell culture model establish prominent sex-based differences and suggest a novel mechanism involved in the differential response of OPCs towards oxidative stress. It conveys a strong message supporting the need to study how complex cellular processes are regulated differently in male and female brains during development and for a better understanding of how the brain copes up with different forms of stress after preterm birth.
Resistance to PD-1/PD-L1 blockade cancer immunotherapy: mechanisms, predictive factors, and future perspectives
Authors: Sun Jin-Yu , Zhang Dengke , Wu Songquan , Xu Min , Zhou Xiao , Lu Xiao-Jie , Ji Jiansong
Published: August 2020

PD-1/PD-L1 blockade therapy is a promising cancer treatment strategy, which has revolutionized the treatment landscape of malignancies. Over the last decade, PD-1/PD-L1 blockade therapy has been trialed in a broad range of malignancies and achieved clinical success. Despite the potentially cure-like survival benefit, only a minority of patients are estimated to experience a positive response to PD-1/PD-L1 blockade therapy, and the primary or acquired resistance might eventually lead to cancer progression in patients with clinical responses. Accordingly, the resistance to PD-1/PD-L1 blockade remains a significant challenge hindering its further application. To overcome the limitation in therapy resistance, substantial effort has been made to improve or develop novel anti-PD-1/PD-L1 based immunotherapy strategies with better clinical response and reduced immune-mediated toxicity. In this review, we provide an overview on the resistance to PD-1/PD-L1 blockade and briefly introduce the mechanisms underlying therapy resistance. Moreover, we summarize potential predictive factors for the resistance to PD-1/PD-L1 blockade. Furthermore, we give an insight into the possible solutions to improve efficacy and clinical response. In the following research, combined efforts of basic researchers and clinicians are required to address the limitation of therapy resistance.
Acute brain injuries trigger microglia as an additional source of the proteoglycan NG2
Authors: Huang Wenhui , Bai Xianshu , Meyer Erika , Scheller Anja
Published: August 2020

NG2 is a type I transmembrane glycoprotein known as chondroitin sulfate proteoglycan 4 (CSPG4). In the healthy central nervous system, NG2 is exclusively expressed by oligodendrocyte progenitor cells and by vasculature pericytes. A large body of immunohistochemical studies showed that under pathological conditions such as acute brain injuries and experimental autoimmune encephalomyelitis (EAE), a number of activated microglia were NG2 immuno-positive, suggesting NG2 expression in these cells. Alternative explanations for the microglial NG2 labeling consider the biochemical properties of NG2 or the phagocytic activity of activated microglia. Reportedly, the transmembrane NG2 proteoglycan can be cleaved by a variety of proteases to deposit the NG2 ectodomain into the extracellular matrix. The ectodomain, however, could also stick to the microglial surface. Since microglia are phagocytic cells engulfing debris of dying cells, it is difficult to identify a genuine expression of NG2. Recent studies showing (1) pericytes giving rise to microglial after stroke, and (2) immune cells of NG2-EYFP knock-in mice lacking NG2 expression in an EAE model generated doubts for the de novo expression of NG2 in microglia after acute brain injuries. In the current study, we took advantage of three knock-in mouse lines (NG2-CreERT2, CX3CR1-EGFP and NG2-EYFP) to study NG2 expression indicated by transgenic fluorescent proteins in microglia after tMCAO (transient middle cerebral artery occlusion) or cortical stab wound injury (SWI). We provide strong evidence that NG2-expressing cells, including OPCs and pericytes, did not differentiate into microglia after acute brain injuries, whereas activated microglia did express NG2 in a disease-dependent manner. A subset of microglia continuously activated the NG2 gene at least within the first week after tMCAO, whereas within 3 days after SWI a limited number of microglia at the lesion site transiently expressed NG2. Immunohistochemical studies demonstrated that these microglia with NG2 gene activity also synthesized the NG2 protein, suggesting activated microglia as an additional source of the NG2 proteoglycan after acute brain injuries.
Combining phytate treatment and nanocellulose stabilization for mitigating iron gall ink damage in historic papers
Authors: Völkel L. , Prohaska T. , Potthast A.
Published: August 2020

Because of its acidic and oxidative nature, iron gall ink promotes the endogenous degradation of paper manuscripts. Mechanical damage in areas of concentrated ink application or along mechanically stressed edges or folds results in problems during storage and handling. So far, such strongly degraded areas have usually been stabilized locally with thin Japanese paper and adhesives. A new and innovative material—nanocellulose—is being evaluated as a stabilizer for manuscripts that have been degraded by iron gall ink. The aim of this study is to integrate the nanocellulose application into a multi-stage calcium phytate/calcium hydrogencarbonate treatment to combine deacidification and stabilization, thus avoiding an additional stabilization and drying step. Two different types of fibrillated nanocelluloses were applied on manuscripts damaged by iron gall inks in different treatment steps. The newly formed, interlinked network of nanocellulose and paper was characterised before and after accelerated degradation in closed vials. The effects on the paper cellulose were studied by size exclusion chromatography and light scattering with carbonyl group profiling to follow cellulose hydrolysis and oxidation pathways. In addition, the migration behavior of iron ions was examined by laser ablation coupled with metal analysis (ICP-MS). This paper discusses the applicability and stability of nanocellulose on paper damaged by iron gall ink with regard to its long-term performance. Advantages and limitations are covered in detail.
The impact of sanction and healthcare system reform on the healthcare performance and pharmaceutical market in Iran; 2001-2016
Authors: Zartab Saman , Koopaei Nasrin Nassiri , Abbasian Hadi , Koopaei Mansur Nassiri , Koopaei Nasser Nassiri
Published: August 2020

Background

Iranian government has introduced multiple healthcare system reforms during the last 30 years aiming at improving accessibility and affordability of care. Pharmaceutical products are one of the major sources of financial burden on the healthcare system. The healthcare system and pharmaceutical sector have been balanced out by the partially counteracting effects of the HSEP (Health sector evolution plan) and the imposed sanctions.

Methods

This research investigates the healthcare system performance as well as the pharmaceutical market trend mostly based on the financial criteria from 2001. The correlation between the two change patterns was studied to understand the underlying driving market forces.

Results

During 2001 to 2013, total health expenditure has grown 25.6% in average. THE (Total health expenditure) share of the GDP remains between 6-7%, while the out of pocket payment has dropped to 37% in 2015 from 57% in 2001, and most health services been directed to the inpatient facilities. Iranian pharmaceutical market has grown rapidly in recent years and grew 28.38% per year and drug consumption per capita reached 34.43$ from 2.28$. However, the import drove most of the market expansion. Noteworthy, the share of pharmaceuticals from THE has also increased.

Conclusions

It is concluded that the sanctions and HSEP have enforced partially counteracting forces on the pharmaceutical market to maintain its consistent growing trend.
Evaluation of aerosol iron solubility over Australian coastal regions based on inverse modeling: implications of bushfires on bioaccessible iron concentrations in the Southern Hemisphere
Authors: Ito Akinori , Perron Morgane M. G. , Proemse Bernadette C. , Strzelec Michal , Gault-Ringold Melanie , Boyd Philip W. , Bowie Andrew R.
Published: August 2020

Mineral dust is the major source of external micro-nutrients such as iron (Fe) to the open ocean. However, large uncertainties in model estimates of Fe emissions and aerosol-bearing Fe solubility (i.e., the ratio of labile Fe (LFe) to total Fe (TFe)) in the Southern Hemisphere (SH) hampered accurate estimates of atmospheric delivery of bioavailable Fe to the Southern Ocean. This study applied an inverse modeling technique to a global aerosol chemistry transport model (IMPACT) in order to optimize predictions of mineral aerosol Fe concentrations based on recent observational data over Australian coastal regions (110°E–160°E and 10°S–41°S). The optimized (a posteriori) model did not only better capture aerosol TFe concentrations downwind from Australian dust outbreak but also successfully reproduced enhanced Fe solubility (7.8 ± 8.4%) and resulted in much better agreement of LFe concentrations with the field measurements (1.4 ± 1.5 vs. 1.4 ± 2.3 ng Fe m–3). The a posteriori model estimates suggested that bushfires contributed a large fraction of LFe concentrations in aerosols, although substantial contribution from missing sources (e.g., coal mining activities, volcanic eruption, and secondary formation) was still inferred. These findings may have important implications for the projection of future micro-nutrient supply to the oceans as increasing frequency and intensity of open biomass burning are projected in the SH.
The Influence of Exercise-Induced Fatigue on Inter-Limb Asymmetries: a Systematic Review
Authors: Heil Jessica , Loffing Florian , Büsch Dirk
Published: August 2020

Background

Non-contact injuries such as anterior cruciate ligament ruptures often occur during physical load toward the end of a match. This is ascribed to emerging processes due to exercise-induced fatigue. Moreover, non-contact injuries often occur during dynamic actions such as landing or cutting movements. Inter-limb asymmetries are suggested as one possible cause for those injuries based on findings indicating that asymmetries between limbs are associated with a higher injury risk. Hence, assessing inter-limb asymmetry during physical load in the condition of exercise-induced fatigue is warranted to identify potentially relevant precursors for non-contact injuries.

Objective

The objective of this study was to overview the current state of evidence concerning the influence of exercise-induced fatigue on inter-limb asymmetries through a systematic review.

Methods

A systematic literature search was conducted using the databases Web of Science, Scopus, PubMed, SURF, and SPONET to identify studies that assessed inter-limb asymmetries of healthy people, calculated with an asymmetry equation, before and after, or during a loading protocol.

Results

Thirteen studies were included in the systematic review. The loading protocols involved running, race walking, jumping, squatting, soccer, rowing, and combinations of different exercises. Moreover, different tasks/procedures were used to assess inter-limb asymmetries, e.g., squats, single-leg countermovement jumps, gait analysis, or isokinetic strength testing. The results seem to depend on the implemented loading protocol, the tasks/procedures, and the measured parameters.

Conclusions

Future research needs more systematization and consistency, assessing the effect of exercise-induced fatigue on inter-limb asymmetries. Moreover, the emergence of inter-limb asymmetries should be regarded in the context of sport-specific movements/tasks. Testing before, after, and during a physical loading protocol is advisable to consider the influence of exercise-induced fatigue on sport-specific tasks and to identify the possible mechanisms underlying load-dependent inter-limb asymmetries with regard to risk of non-contact injury.
Microvascular reconstruction for maxillofacial defects: a retrospective analysis of outcomes and complications in 121 consecutive cases
Authors: Kim SeongRyoung , Lee Dong-Hun , Ahn Kang-Min
Published: August 2020

Background

Microvascular reconstruction is the treatment of choice after oral cancer ablation surgery. There are few published studies of free flap survival among Korean populations. This study aimed to determine the survival rate after 121 consecutive cases of maxillofacial microvascular reconstruction and to analyze the complications associated with microsurgery.

Methods

This study included consecutive patients who underwent microsurgical reconstruction with free flaps, from January 2006 through September 2019, performed by a single surgeon at the oral and maxillofacial surgery department of a tertiary medical center. A total of 121 cases were reviewed retrospectively. The flap survival rate, flap type, radiotherapy history, complications, and treatment results were analyzed.

Results

Four different flap types were used for microvascular reconstruction: radial forearm (n = 65), fibula (n = 34), latissimus dorsi (n = 21), and serratus anterior muscle with rib bone free flap (n = 1). Total necrosis of the flap was found in four cases (two latissimus dorsi flaps and two fibular flaps). The free flap survival rate was 97.5%. Nineteen patients received radiotherapy before surgery, and none of them experienced flap failure. The mean operation time was 334 ± 83.1 min, and the mean ischemic time was 48.9 ± 12.7 min.

Conclusions

The success rate was reliable and comparable with previous studies. The success rate was not affected by radiation therapy. Free flaps can be safely used even after radiation treatment.
Novel genetic alteration in congenital melanocytic nevus: MAP2K1 germline mutation with BRAF somatic mutation
Authors: Zou Yun , Sun Yi , Zeng Xiaojing , Liu Yun , Cen Qingqing , Gu Hao , Lin Xiaoxi , Cai Ren , Chen Hui
Published: August 2020

Congenital melanocytic nevus (CMN) represent a benign proliferative skin disease in the epidermis and dermis. CMN are historically known to be associated with activating NRAS or BRAF mutations. Melanoma frequently harbors the BRAF p.Val600Glu mutation, which is also commonly found in benign nevi. A recent study reported mutation of MAP2K1, a downstream effector of the RAS-RAF-MEK pathway, in melanoma with an overall frequency of 8%. Later, in 2019, Jansen P detected one activating MAP2K1 mutation in acral nevi. However, it is unknown whether MAP2K1 mutations are common in CMN, and how MAP2K1 contributes to the pathogenesis of CMN remains to be determined.

In this study, we report one patient clinically and histologically diagnosed with CMN, with the MAP2K1 germline mutation and a BRAF p.Val600Glu somatic hit in the lesion. To the best of our knowledge, this is the first report of the coexistence of mutated BRAF and MAP2K1 in CMN, which may suggest that MAP2K1 mutations contribute to the occurrence and development of nevus expanding our knowledge of the genetics of CMN.
How does moulage contribute to medical students’ perceived engagement in simulation? A mixed-methods pilot study
Authors: Stokes-Parish Jessica B. , Duvivier Robbert , Jolly Brian
Published: August 2020

Introduction

Moulage is used frequently in simulation, with emerging evidence for its use in fields such as paramedicine, radiography and dermatology. It is argued that moulage adds to realism in simulation, although recent work highlighted the ambiguity of moulage practice in simulation. In the absence of knowledge, this study sought to explore the impact of highly authentic moulage on engagement in simulation.

Methods

We conducted a randomised mixed-methods study exploring undergraduate medical students’ perception of engagement in relation to the authenticity moulage. Participants were randomised to one of three groups: control (no moulage, narrative only), low authenticity (LowAuth) or high authenticity (HighAuth). Measures included self-report of engagement, the Immersion Scale Reporting Instrument (ISRI), omission of treatment actions, time-to-treat and self-report of authenticity. In combination with these objective measures, we utilised the Stimulated Recall (SR) technique to conduct interviews immediately following the simulation.

Results

A total of 33 medical students participated in the study. There was no statistically significant difference between groups on the overall ISRI score. There were statistically significant results between groups on the self-reported engagement measure, and on the treatment actions, time-to-treat measures and the rating of authenticity. Four primary themes ((1) the rules of simulation, (2) believability, (3) consistency of presentation, (4) personal knowledge ) were extracted from the interview analysis, with a further 9 subthemes identified ((1) awareness of simulating, (2) making sense of the context (3) hidden agendas, (4) between two places, (5) dismissing, (6) person centredness, (7) missing information (8) level of training (9) previous experiences).

Conclusions

Students rate moulage authenticity highly in simulations. The use of high-authenticity moulage impacts on their prioritisation and task completion. Although the slower performance in the HighAuth group did not have impact on simulated treatment outcomes, highly authentic moulage may be a stronger predictor of performance. Highly authentic moulage is preferable on the basis of optimising learning conditions.
Can corrections spread misinformation to new audiences? Testing for the elusive familiarity backfire effect
Authors: Ecker Ullrich K. H. , Lewandowsky Stephan , Chadwick Matthew
Published: August 2020

Misinformation often continues to influence inferential reasoning after clear and credible corrections are provided; this effect is known as the continued influence effect. It has been theorized that this effect is partly driven by misinformation familiarity. Some researchers have even argued that a correction should avoid repeating the misinformation, as the correction itself could serve to inadvertently enhance misinformation familiarity and may thus backfire, ironically strengthening the very misconception that it aims to correct. While previous research has found little evidence of such familiarity backfire effects, there remains one situation where they may yet arise: when correcting entirely novel misinformation, where corrections could serve to spread misinformation to new audiences who had never heard of it before. This article presents three experiments (total N = 1718) investigating the possibility of familiarity backfire within the context of correcting novel misinformation claims and after a 1-week study-test delay. While there was variation across experiments, overall there was substantial evidence against familiarity backfire. Corrections that exposed participants to novel misinformation did not lead to stronger misconceptions compared to a control group never exposed to the false claims or corrections. This suggests that it is safe to repeat misinformation when correcting it, even when the audience might be unfamiliar with the misinformation.
High frequency of methotrexate intolerance in longstanding rheumatoid arthritis: using the methotrexate intolerance severity score (MISS)
Authors: Amaral Jéssica Martins , Brito Maria José Menezes , Kakehasi Adriana Maria
Published: August 2020

Background

Methotrexate (MTX) intolerance is frequent, and its early identification may impact treatment, leading to timely changes in medication that may promote patient compliance and better control of rheumatoid arthritis (RA). The objective of this study was to identify the frequency of, and risk factors for, MTX intolerance using the Brazilian Portuguese version of the Methotrexate Intolerance Severity Score (MISS) questionnaire in patients with RA.

Methods

This cross-sectional study was performed between April 2018 and April 2019 and enrolled patients with RA in regular use of oral or subcutaneous MTX for at least 3 months. Patients were invited to answer the Brazilian Portuguese version of the MISS questionnaire, and MTX intolerance was defined by a score ≥ 6 points. Age, sex, disease duration, time of MTX use, dose, route of administration, concomitant medications, comorbidities, smoking, and Disease Activity Score for 28joint (DAS28) data were collected from institutional medical records.

Results

Among 120 patients, 103 (85.8%) were female, the mean age was 61 (±12.5) years, the mean duration of disease was 16 (±10.3) years, and the average duration of MTX use was 7 (±5.5) years. The frequency of MTX intolerance was 21.6%. The most frequent symptoms reported after the use of MTX were nausea (92.3%), abdominal pain (46.1%), and vomiting (30.7%). Behavioral symptoms occurred in 96.1% of patients with MTX intolerance, the most frequent being restlessness and irritability. Patients who used corticosteroids were more likely to develop MTX intolerance than those not using corticosteroids (odds ratio = 2.73; 95% confidence interval, 1.06 to 7.06; p = 0.038). Conversely, increasing age showed marginally significant association with decreased risk of MTX intolerance (p = 0.059).

Conclusions

The use of the MISS questionnaire disclosed high frequencies of anticipatory, associative, and behavioral symptoms in MTX-intolerant patients, and the use of corticosteroid increases the risk of MTX intolerance. We suggest that the MISS questionnaire be used routinely in clinical practice.
Developing cheese tourism: a local-based perspective from Valle de Roncal (Navarra, Spain)
Authors: Fusté-Forné Francesc
Published: August 2020

This paper aims to investigate the opinions of local cheese producers with regard to the relationships between cheese and tourism in rural areas. Based on a case study approach, data was collected through semi-structured interviews with cheesemakers and visits to cheesemaking facilities in Valle de Roncal (Roncal valley), a mountain region in northern Spain. Results of this research show that cheese producers in rural areas award tourism value to cheese by appreciating its historical linkages to land and landscapes, the rural lifestyle, and a regional communication of cheese. The originality of this paper lies on the approach to a niche tourism which is drawn from the understanding of cheese as both a local product and a tourist attraction, from the perspective of local producers in peripheries. This research informs rural tourism planners in the design of (food) tourist experiences that rely on a local-based storytelling.
Comparative analysis of restraint stress-induced depressive-like phenotypes in C57BL/6N mice derived from three different sources
Authors: Hwang Dong-Joo , Kwon Ki-Chun , Hwang Dae-Youn , Seo Min-Soo , Kim Kil-Soo , Jung Young-Suk , Cho Joon-Yong
Published: August 2020

C57BL/6NKorl mice are a novel mouse stock recently developed by the National Institute of Food and Drug Safety Evaluation in Korea. Extensive research into the nature of C57BL/6NKorl mice is being conducted. However, there is no scientific evidence for the phenotypic response to restraint stress (RST), a stress paradigm for modeling depressive disorders, in rodents. In this study, we investigated the repeated RST-induced depressive-like phenotypes in C57BL/6 N mouse substrains (viz., C57BL/6NKorl mice from Korea, C57BL/6NA mice from the United States, and C57BL/6NB mice from Japan) obtained from different sources. The results showed that C57BL/6 N mice derived from various sources exposed to repeated RST resulted in depressive-like phenotypes reflected by a similar degree of behavioral modification and susceptibility to oxidative stress in a duration-dependent manner, except for the distinctive features (increased body weight (BW) and tolerance to the suppression of BW gain by exposure to repeated RST) in C57BL/6NKorl mice. Taken together, the duration-dependent alteration in depressive-like phenotypes by repeated exposure to RST observed in this study may provide valuable insights into the nature of C57BL/6NKorl mice as an alternative animal resource for better understanding of the etiology of depressive disorders and the mechanisms of antidepressant actions.
Congenital peritoneal encapsulation presented with small bowel obstruction
Authors: Mohamed Abdallah A. A. , Al Shuraiqi Fatma Mohammmed , Al Sarhani Salwa , Al Busaidi Sultan Ali Salim , Joodi Amer Ameen
Published: August 2020

Background

Congenital peritoneal encapsulation is an extremely rare condition with an etiology based on abnormal embryonic gastrointestinal development. It is characterized by congenital development of an accessory peritoneal layer partially or entirely encapsulating the small bowel. The condition is poorly understood and often discovered incidentally, either intra-operatively or during autopsy. The majority of cases are asymptomatic and rarely complicated by small bowel obstruction. The preoperative diagnosis may be impossible by plain radiographs, which are often normal or may show signs of small bowel obstruction. Computed tomography (CT) may be helpful in preoperative diagnosis of congenital peritoneal encapsulation in a patient with obstruction.

Case presentation

We report a case of a 46-year-old male patient, who presented with features of intestinal obstruction; surprisingly, CT accurately suggested the diagnosis of peritoneal encapsulation which was confirmed at surgery.

Conclusions

The presence of physical signs such as asymmetrical and fixed abdominal distension can help the clinician to raise the suspicion of peritoneal encapsulation; however, CT in the right settings can confirm the diagnosis.
Predicting short-term suicide risk: allowing for ongoing variation in severity of intent
Authors: Morgan Gethin
Published: August 2020

This article considers the role that assessment of suicidal ideation may have in short-term prediction of suicide. Suicide risk assessment is a multifactorial process and it is assumed that assessment of suicidal ideation is one component. Denial that suicidal ideation has any useful role in risk assessment fails to allow for the marked ongoing short-term variability in severity of intent, which is a common feature of the suicidal state of mind. It is concluded that the assessment of suicidal ideation, provided it is carried out correctly and applied appropriately, should continue to be regarded as a central component of the overall prediction process. A ‘two-take’ approach to short-term risk assessment and mitigation is proposed that takes variability in severity of intent into account and includes anticipatory treatment planning for any problems that may occur in the near future.
Addressing psychiatric care in conflict zones: recommendations for the Arab region
Authors: El-Khoury Joseph , Barkil-Oteo Andres , Adam Lynn
Published: August 2020

The Arab world has struggled with conflict and political turmoil for several decades, rendering its already underdeveloped mental healthcare system unable to serve the psychiatric needs of victims of violence and trauma, with consequences that extend far beyond the cessation of hostilities. This role has become incumbent on international relief agencies, which have expanded mental health programmes in countries of conflict and refuge. Although their intervention has overall been positive, their mission is usually short term, leaving countries unable to maintain these advantages when the funding ends. The authors advocate for a sustainable framework that emphasises a larger role for regional and local actors. Expertise that is culturally and socially grounded could take the initiative in research, training and deployment in collaboration with non-governmental organisations, allowing for comprehensive development of the mental health sector.
Psychological impact of COVID-19 in the Swedish population: Depression, anxiety, and insomnia and their associations to risk and vulnerability factors
Authors: McCracken Lance M. , Badinlou Farzaneh , Buhrman Monica , Brocki Karin C.
Published: August 2020

Background:

The 2019 coronavirus disease (COVID-19) pandemic, with its associated restrictions on daily life, is like a perfect storm for poor mental health and wellbeing. The purpose of this study was therefore to examine the impacts of COVID-19 on mental health and wellbeing during the ongoing pandemic in Sweden.

Method:

Standardized measures of depression, anxiety, and insomnia as well as measures of risk and vulnerability factors known to be associated with poor mental health outcomes were administered through a national, online, cross-sectional survey (n = 1,212; mean age 36.1 years; 73% women).

Result:

Our findings show significant levels of depression, anxiety, and insomnia in Sweden, at rates of 30%, 24.2%, and 38%, respectively. The strongest predictors of these outcomes included poor self-rated overall health and a history of mental health problems. The presence of COVID-19 symptoms and specific health and financial worries related to the pandemic also appeared important.

Conclusions:

The impacts of COVID-19 on mental health in Sweden are comparable to impacts shown in previous studies in Italy and China. Importantly, the pandemic seems to impose most on the mental health of those already burdened with the impacts of mental health problems. These results provide a basis for providing more support for vulnerable groups, and for developing psychological interventions suited to the ongoing pandemic and for similar events in the future.
The molecular and cellular features of 2-cell-like cells: a reference guide
Authors: Genet Marion , Torres-Padilla Maria-Elena
Published: August 2020

Currently, two main cell culture models predominate pluripotent stem cell research: embryonic stem cells (ESCs) and induced pluripotent stem cells (iPSCs). Thanks to their ability to contribute to and form all tissues within the body, ESCs and iPSCs have proven invaluable in understanding pluripotent states, early embryonic development and cell differentiation, as well as in devising strategies for regenerative medicine. Comparatively little is known about totipotency – a cellular state with greater developmental potential. In mice, only the zygote and the blastomeres of the 2-cell-stage embryo are truly totipotent, as they alone can develop to form the embryo and all of its supportive extra-embryonic tissues. However, the discovery of a rare subpopulation of cells in murine ESC cultures, possessing features of 2-cell embryo blastomeres and expanded cell fate potential, has provided a biochemically tractable model to enable the in vitro study of totipotency. Here, we summarize current known features of these 2-cell-like cells (2CLCs) in an effort to provide a reference for the community, and to clarify what we know about their identity so far.
From pluripotency to totipotency: an experimentalist's guide to cellular potency
Authors: Riveiro Alba Redó , Brickman Joshua Mark
Published: August 2020

Embryonic stem cells (ESCs) are derived from the pre-implantation mammalian blastocyst. At this point in time, the newly formed embryo is concerned with the generation and expansion of both the embryonic lineages required to build the embryo and the extra-embryonic lineages that support development. When used in grafting experiments, embryonic cells from early developmental stages can contribute to both embryonic and extra-embryonic lineages, but it is generally accepted that ESCs can give rise to only embryonic lineages. As a result, they are referred to as pluripotent, rather than totipotent. Here, we consider the experimental potential of various ESC populations and a number of recently identified in vitro culture systems producing states beyond pluripotency and reminiscent of those observed during pre-implantation development. We also consider the nature of totipotency and the extent to which cell populations in these culture systems exhibit this property.
Multiparametric prostate MRI-based intensity-modulated radiation therapy guided by prostatic calcifications
Authors: Kao Johnny , Karwowski Pawel , Pettit Jeffrey , Barney Austin Kevin , Atalla Christopher
Published: August 2020

Objectives:

The optimal technique to administer image-guided radiation therapy for prostate cancer remains poorly defined. This study assessed outcomes after multiparametric prostate MRI-based planning was delivered with image-guided radiation therapy using prostatic calculi observed on cone beam CT (CBCT).

Methods:

Between January 2015 and December 2017, 94 consecutive patients were treated with CBCT-based image-guided radiation therapy (IGRT) without fiducial markers. MRI was routinely incorporated for target delineation and intraprostatic tumor nodules were boosted to allow reduced doses to normal appearing prostate. The primary endpoint was the prevalence of prostatic calcifications while toxicity and biochemical control were secondary endpoints.

Results:

Median follow-up was 39.7 months with 82% NCCN intermediate to very high risk. Intraprostatic calculi were noted in 68% of patients. The 3-year biochemical control, late grade ≥2 rectal toxicity and late grade ≥2 urinary toxicity rates were 96%, 3 and 7%, respectively. Biochemical control and toxicity were not significantly impacted by the presence of prostatic calculi.

Conclusion:

Prostatic calcifications can serve as natural fiducial markers to allow for non-invasive IGRT for prostate cancer with promising early disease control and toxicity outcomes.

Advances in knowledge:

Prostate calcification-guided IGRT is technically feasible.
Aspectos clínico-epidemiológicos de um cluster de febre maculosa brasileira, ocorrido no município de Americana, São Paulo, Brasil, 2018
Authors: Brasil Jardel , Soares Samara , Brites-Neto José
Published: August 2020

Objetivos: descrever os principais aspectos clínicos, laboratoriais e epidemiológicos relacionados à ocorrência de um cluster de febre maculosa brasileira (FMB) na cidade de Americana/SP, em 2018. Métodos: realizou-se uma análise descritiva baseada na revisão das informações constantes nos registros do Sistema de Informação de Agravos de Notificação – SINAN e nos relatórios de investigações epidemiológicas obtidos junto ao banco de dados da Unidade de Vigilância em Saúde Municipal. Resultados: esse cluster ocorreu em um fragmento de mata ciliar situado na confluência dos rios Atibaia e Jaguari, entre os dias 21/4/2018 e 31/5/2018. Durante esse período, ocorreram 15 casos positivos de FMB, com registro de 11 óbitos, atingindo uma taxa de letalidade de 73%. O sexo masculino representou 93% dos pacientes, e a faixa etária mais afetada foi a de indivíduos acima dos 30 anos (67%), seguindo-se o percentual de 13% para as faixas de 1 a 4 e 5 a 9 anos, e 7% para pessoas de 20 a 29 anos. Os principais sinais clínicos observados foram febre (100%); cefaléia (80%) e mialgia (73,33%). Conclusão: foi possível delinear o perfil epidemiológico dos indivíduos a serem alcançados nas campanhas de educação em saúde, com enfoque para medidas preventivas visando à redução de frequência nas áreas de risco para parasitismo humano por carrapatos vetores da FMB.
Analgesic efficacy of intravenous nefopam after spine surgery: a randomized, double-blind, placebo-controlled trial
Authors: Eiamcharoenwit Jatuporn , Chotisukarat Haruthai , Tainil Kanjana , Attanath Nalinrat , Akavipat Phuping
Published: August 2020

Background: The incidence of moderate to severe pain is high among patients undergoing spinal surgery. Nefopam can be used as an adjuvant analgesic postoperatively after spine surgery. The study aimed to assess the analgesic efficacy and side effects of nefopam on 24-hour postoperative morphine consumption after spine surgery.

Methods: The study is a randomized, double-blinded, placebo-controlled trial. A total of 96 patients were randomized into 4 treatment groups, 24 each. In group 1, patients received normal saline before surgical incision and before the end of surgery. In group 2, patients received 30 mg nefopam before surgical incision and normal saline before the end of surgery. In group 3, patients received normal saline before surgical incision and 30 mg of nefopam before the end of surgery. In group 4, patients received 30 mg of nefopam in both timings. Patient-controlled analgesia morphine was used for the postoperative period. Outcomes were to determine 24-hour morphine consumption and incidence of side effects. 

Results: Of 96 patients enrolled, 21 in placebo-placebo, 22 in nefopam-placebo, 22 in placebo-nefopam and 21 in nefopam-nefopam groups completed the study. Analysis of the Kruskal-Wallis test shows no significant difference in 24-hour postoperative morphine consumption between four groups, which were 18 [IQR 13.5-29], 20 [IQR 11-28.3], 17 [IQR 11.5-28.5], 13 [IQR 8.5-18.5] mg., respectively (p = 0.223).  Incidence of side effects, including tachycardia, sedation, sweating and nausea/ vomiting, did not differ.

Conclusions: Adding perioperative nefopam to opioid analgesic does not improve analgesic efficacy in patients who underwent spine surgery.

Registration: Thai Clinical Trials Registry ID TCTR20171115001; registered on 15 November 2017.
Case Report: Sudden cardiac death due to ventricular myocardial non-compaction
Authors: Mannoubi Syrine , Mesrati Med Amin , Hassen Ibn Hadj Amor , Hasnaoui Taha , Limem Hiba , Boussaid Marwa , Ben Abdejlil Nouha , Aissaoui Abir
Published: August 2020

Ventricular non-compaction (VNC) is a rare myocardium disorder, which can be both genetic and sporadic. A poor wall compaction process or an excessive trabeculae formation may be at the genesis of myocardial hypertrabeculation with multiple recesses. It is often complicated by ventricular dysfunction, arrhythmias and cardiac embolism. Herein we report a case of a 20-year-old male patient with no particular past medical history who was followed up at the cardiology department for dyspnea. Echocardiography showed reduced ejection fraction of the left ventricle with potential hypertrabeculation in the right ventricle, confirmed by cardiac MRI. The patient was not put under medication and was later lost to follow-up. He died few months later without a clear cause explaining death. A forensic autopsy was performed that attributed death to acute ventricle arrhythmia secondary to VNC, emphasizing the major role of an early and specific treatment to avoid such a fatal outcome.
Detection of antifungal drug-resistant and ERG11 gene mutations among clinical isolates of Candida species isolated from Khartoum, Sudan.
Authors: Osman Mohamed Ahmed , Suliman Mohamed Malik , Abdelrahman Hussain Mohamed , Fatahalrahman Ahmed Ibrahim
Published: August 2020

Background: Candida species are one of the most important opportunistic fungal pathogens that cause both superficial and systemic infections, especially in immunocompromised individuals. Considering the sharp increase in the rate of Candida infections, and resistance to commonly used antifungal agents in the last decades; this study was conducted to determine the rate of resistance among clinical isolates of Candida species, and to characterize some of the resistant genes among resistant isolates collected in Khartoum. 

Methods: This is a cross-sectional laboratory-based study included 100 pre-screened Candida species isolates from Khartoum state hospitals. Chromogenic media was used for Candida isolation and/or identification. The standard disc diffusion method was performed to investigate the susceptibility to fluconazole, itraconazole, and amphotericin. Following genomic DNA extraction, the entire ERG11 gene was amplified from someC. albicansresistant isolates, sequenced, and further analyzed.

Results: Out of 100 clinical isolates collected, 51% were C. albicans, followed by C. glabrata (31%), C. krusie (8%), C. tropicals (5%), andC. dupliniens (5%). Resistance rate was 23% for fluconazole, 4% for itraconazole, while there were no amphotericin resistant isolates detected.C. albicans ERG11 gene sequence reveals 15 different mutations. Among these, three (D116E, E266D, and V488I) were missense mutations; however, these substitutions do not contribute to fluconazole resistance.

Conclusion: C. albicanswas found to be the most common species. Resistance against fluconazole was observed most frequently; however, mutations inERG11are unlikely to be the reason behind fluconazole resistance among these isolates.
Are current avian influenza vaccines a solution for smallholder poultry farmers?
Authors: Guyonnet Vincent , Peters Andew R.
Published: August 2020

Vaccination against highly pathogenic avian influenza (HPAI) viruses, along with other measures, was successful in eradicating AI in very few countries where the competence of national veterinary services or the geography and bird density have contributed favorably to the outcome.  The main constraints to an effective AI vaccination are vaccine composition matching field strains, reliable cold chain and logistics to target all poultry smallholders, constraints related to the availability of sufficient financial and human resources.  When not conducted properly, vaccination can also contribute to the emergence of new field viral strains, through genetic drifts of HPAI viruses.   While new technologies have improved the possibility to produce high quality vaccines matching field strains, recurrent issues like post-vaccination field surveillance and vaccination coverage continue to limit the relevance of AI vaccination in smallholder settings. A “game-changer” vaccine targeting smallholders should be universal to protect against all field viral strains and reduce significantly, if not totally eliminate, the need for costly post-vaccination surveillance.  The ease of administration of this vaccine (eye drop or one single injection) would further contribute to its relevance in the field.  These characteristics are considered essential for the product profile of an AI vaccine that can contribute in a meaningful way to the livelihoods of poultry smallholders.
Case Article—Forward-Reserve Storage Design: A Case of Carriage Repair Workshop, Indian Railways
Authors: Singbal Vishwesh , Adil Gajendra K. , Venkitasubramony Rakesh
Published: August 2020

Case studies are useful in imparting decision-making skills to students. Warehousing is a critical part of most supply chains, but case studies based on warehousing methods and operations therein are rare. Recognizing the need to bridge this gap, a case study is designed to present a real-life scenario at the carriage repair workshop of Indian Railways. The case study facilitates the learning of students regarding operations in automated warehousing and relevant storage strategies. Additionally, the case encourages the students to explore the use of heuristics and optimization models. This case article highlights the major learning objectives of the case study and discusses the classroom teaching experience. This case can be used in various courses and the case questions can be selected based on the teaching objectives and/or the educational background of the students.
Dynamic Inventory and Price Controls Involving Unknown Demand on Discrete Nonperishable Items
Authors: Katehakis Michael N. , Yang Jian , Zhou Tingting
Published: August 2020

Data-Driven Ordering and Pricing