bluuebunny/crossref_metadata_2025 huggingface dataset:
An evaluation framework for research platforms to advance cochlear implant/hearing aid technology: A case study with CCi-MOBILE
Authors: Shekar Ram C. M. C. , Hansen John H. L.
Published: January 2021

Cochlear implants (CIs) and hearing aids (HAs) are advanced assistive hearing devices that perform sound processing to achieve acoustic to acoustic/electrical stimulation, thus enabling the prospects for hearing restoration and rehabilitation. Since commercial CIs/HAs are typically constrained by manufacturer design/production constraints, it is necessary for researchers to use research platforms (RPs) to advance algorithms and conduct investigational studies with CI/HA subjects. While previous CI/HA research platforms exist, no study has explored establishing a formal evaluation protocol for the operational safety and reliability of RPs. This study proposes a two-phase analysis and evaluation paradigm for RPs. In the acoustic phase 1 step, a signal processing acoustic space is explored in order to present a sampled set of audio input content to explore the safety of the resulting output electric/acoustic stimulation. In the parameter phase 2 step, the configurable space for realizable electrical stimulation pulses is determined, and overall stimulation reliability and safety are evaluated. The proposed protocol is applied and demonstrated using Costakis Cochlear Implant Mobile. Assessment protocol observations, results, and additional best practices for subsampling of the acoustic and parameter test spaces are discussed. The proposed analysis-evaluation protocol establishes a viable framework for assessing RP operational safety and reliability. Guidelines for adapting the proposed protocol to address variability in RP configuration due to experimental factors such as custom algorithms, stimulation techniques, and/or individualization are also considered.
Scattering by thin shells in fluids: Fast solver and experimental validation
Authors: Chernokozhin Evgeny , Tsinovoy Anatoli , Boag Amir
Published: January 2021

A numerical model facilitating fast analysis of acoustic scattering by thin shells immersed in fluids is presented. The shell is simulated by an effective boundary condition, in which the inertial properties of the shell are taken into account while the elastic ones are neglected. The problem reduces to a hypersingular surface integral equation, which is solved using the boundary element method accelerated by the multilevel nonuniform grid approach. The validity of the numerical method and the adopted physical approximations were tested by comparison with a water tank experiment on acoustic scattering from cylindrical metallic shells filled with water.
Acoustic radiation force and torque on spheroidal particles in an ideal cylindrical chamber
Authors: Leão-Neto José P. , Hoyos Mauricio , Aider Jean-Luc , Silva Glauber T.
Published: January 2021

In this article, the acoustic radiation force and torque exerted on a small spheroidal particle immersed in a nonviscous fluid inside an ideal cylindrical chamber is theoretically investigated. The ideal chamber comprises a hard top and bottom (rigid boundary condition) and a soft or hard lateral wall. By assuming that the particle is much smaller than the acoustic wavelength, analytical expressions of the radiation force and torque caused by an acoustic wave of arbitrary shape are presented. Unlike previous results, these expressions are given relative to a fixed laboratory frame. The model is showcased for analyzing the behavior of an elongated metallic microspheroid (with a 10:1 aspect ratio) in a half-wavelength acoustofluidic chamber with a diameter of a few millimeters. The results show that the radiation torque aligns the microspheroid along the nodal plane, and the radiation force causes a translational motion with a speed of up to one body length per second. Finally, the implications of this study on propelled nanorods by ultrasound are discussed.
Engineering three-dimensional labyrinthine fractal acoustic metamaterials with low-frequency multi-band sound suppression
Authors: Man Xianfeng , Xia Baizhan , Luo Zhen , Liu Jian , Li Kun , Nie Yonghong
Published: January 2021

Acoustic metamaterials are a class of artificially periodic structures with extraordinary elastic properties that cannot be easily found in naturally occurring materials and can be applied to regulate the sound propagation behavior. The fractal configuration can be widely found in the acoustic system, like characterizing the broadband or multi-band sound propagation. This work will engineer three-dimensional (3D) labyrinthine fractal acoustic metamaterials (LFAMs) to regulate the sound propagation on subwavelength scales. The dispersion relations of LFAMs are systematically analyzed by the Bloch theory and the finite element method (FEM). The multi-bands, acoustic modes, and isotropic properties characterize their acoustic wave properties in the low-frequency regime. The effective bulk modulus and mass density of the LFAMs are numerically calculated to explain the low-frequency bandgap behaviors in specific frequencies. The transmissions and pressure field distributions of 3D LFAMs have been used to measure the ability for sound suppression. Furthermore, when considering the thermo-viscous loss on the transmission properties, the high absorptions occur within the multi-band range for low-frequency sound. Hence, this research contributes to potential applications on 3D LFAMs for multi-bands blocking and/or absorption on deep-subwavelength scales.
Detection mechanisms for processing delays in simulated vented hearing devices
Authors: Denk Florian , Ohlmann Kristin , Kollmeier Birger
Published: January 2021

Processing delays are a disturbing factor in hearing devices, especially with vented or open fits. While the disturbance due to delays is well characterized, neither have the perception thresholds of delays been systematically assessed, nor are the perceptual detection mechanisms clear. This study presents experiments determining the delay detection thresholds in simulated linear vented hearing devices in normal-hearing listeners, where spectral effects of delays were either compensated or not. Furthermore, the psychometric function for the detection of delays was determined for an example condition and linked to model predictions, showing that delay detection can be well predicted from spectral artefacts.
Experimental study of vocal–ventricular fold oscillations in voice production
Authors: Matsumoto Takuma , Kanaya Mayuka , Ishimura Kazuyoshi , Tokuda Isao T.
Published: January 2021

Ventricular folds are located in the supraglottal region above the vocal folds. Although the ventricular folds do not vibrate under normal vocalizations, they vibrate under certain conditions, e.g., throat singing or ventricular fold dysphonia. In throat singing, the ventricular folds vibrate at the same frequency as (or at integer ratios of) the vocal fold vibration frequency. In ventricular fold dysphonia, on the other hand, the ventricular folds interfere with the vocal folds, giving rise to a hoarse voice. In the present study, the synthetic larynx model was utilized to examine the vocal–ventricular fold oscillations. Our experiments revealed that the vocal and ventricular folds can co-oscillate at the same frequency with an out-of-phase relation. Compared to the control condition, under which no ventricular folds exist, the phonation threshold pressure was increased in the presence of the ventricular folds. Acoustic analysis indicated that jitter was reduced and vocal efficiency was increased by the ventricular folds. Distance between the vocal and ventricular folds did not alter these oscillation properties. A computational model was further simulated to elucidate the mechanism underlying the observed vocal–ventricular fold oscillations. It has been suggested that out-of-phase oscillations of the vocal and ventricular folds are important for sustaining periodic laryngeal vibrations.
Eating Disorders in Male Athletes: Factors Associated With Onset and Maintenance
Authors: Freedman Julie , Hage Sally , Quatromoni Paula A.
Published: January 2021

Male athletes are underrepresented in eating disorders research. This phenomenological study investigated the experiences of male athletes who self-identified as having an eating disorder, disordered eating, or compulsive exercise behaviors. Eight male collegiate athletes were interviewed, and qualitative analysis identified factors associated with the onset and maintenance of disordered behaviors. Among the novel findings was the salient influence of social media as a driver of body dissatisfaction and disordered behaviors. The participants described a perceived sense of control and feeling of pride associated with the use of behaviors, cultural norms in a male sport environment that sustained these behaviors, and a shared belief that, until they experienced a loss of control over their use of behaviors, they would not likely ask for help or seek treatment. These findings have implications for additional research, as well as individual and systems-level strategies for the prevention, screening, and treatment of eating and exercise disorders in male sport.
Mental Toughness, Sport-Related Well-Being, and Mental Health Stigma Among National Collegiate Athletic Association Division I Student-Athletes
Authors: Bird Matthew D. , Simons Eadie E. , Jackman Patricia C.
Published: January 2021

Mental toughness has been associated with factors related to psychological well-being, but little is known about its relationship with stigma toward mental health and mental health help-seeking. This study investigated the relationship between mental toughness, sport-related well-being, and personal stigma toward mental health in a sample of 154 National Collegiate Athletic Association Division I student-athletes. The moderating effect of mental toughness on the relationship between public stigma and self-stigma toward mental health help-seeking was also explored. Mental toughness was significantly and positively associated with sport-related well-being, but not significantly related to personal stigma toward mental health. Moderation analysis indicated that mental toughness was not a significant moderator of the relationship between public stigma and self-stigma, but higher levels of mental toughness were significantly associated with lower levels of stigma toward mental health help-seeking. Building mental toughness may be a way to increase well-being and to reduce stigma toward help-seeking in student-athletes.
Effectiveness of Aerobic Exercise on Smoking Cessation in Adults: A Systematic Review and Meta-Analysis
Authors: Santos Caroline Pereira , Proença Mahara , Gouveia Tamara dos Santos , Soares de Oliveira Crystian Bitencourt , Tacao Guilherme Yassuki , Trevisan Iara Buriola , Ramos Ercy Mara Cipulo , Ramos Dionei
Published: January 2021

Background: The specific benefits of aerobic exercises in smoking cessation are unclear, as they have different characteristics, intensities, and durations. The purpose of this systematic review with meta-analysis was to evaluate the effects of aerobic exercise, with or without co-interventions, compared with a control group of cognitive behavior treatment on smoking cessation. Methods: This review was prospectively registered on PROSPERO, and the searches were performed from 2016 to 2018. Randomized controlled trials evaluating the effects of aerobic exercise, with or without nicotine therapy replacement, compared with usual care were included. The primary outcome was smoking cessation defined as the prevalence of those who quit or continuous abstinence. Meta-analysis was calculated using random effects model in the comprehensive meta-analysis software. Results: The authors identified 18 trials reporting data for a total of 2815 participants. There was moderate-quality evidence that aerobic exercise was better than usual care in promoting smoking cessation at short term (11 trials, risk ratio 0.79; 95% confidence interval, 0.66–0.94). However, there were no differences between aerobic exercises and usual care at medium- or long-term follow-ups. Conclusions: According to review, aerobic exercise may be effective in promoting smoking cessation at short-term, but not at medium- and long-term follow-ups.
Dual-Task Cost and Related Clinical Features in Patients With Multiple Sclerosis
Authors: Ozkul Cagla , Guclu-Gunduz Arzu , Eldemir Kader , Apaydin Yasemin , Gulsen Cagri , Yazici Gokhan , Soke Fatih , Irkec Ceyla
Published: January 2021

This study aimed to investigate the dual-task cost of both motor and cognitive performances in patients with multiple sclerosis (PwMS) and in healthy controls and to determine their relationships with clinical features in PwMS. The participants performed motor tasks (postural stability, walking, and manual dexterity) and cognitive tasks (mental tracking and verbal fluency) under single- and dual-task conditions. The results showed that postural stability under dual-task conditions did not change, whereas walking and manual dexterity deteriorated, regardless of the concurrent cognitive task, in PwMS (median Expanded Disability Status Scale score: 1) and the healthy controls. Verbal fluency decreased during postural stability, whereas it increased during walking, and it was maintained during manual dexterity in both groups. Mental tracking did not change during walking; it declined during manual dexterity in both groups. Mental tracking during postural stability deteriorated in PwMS, while it did not change in the healthy controls. In general, dual-task costs were associated with baseline performances of tasks rather than clinical features. Therefore, baseline performances of both tasks should be increased for improving dual-task performance in PwMS.
Structure-guided multivalent nanobodies block SARS-CoV-2 infection and suppress mutational escape
Authors: Koenig Paul-Albert , Das Hrishikesh , Liu Hejun , Kümmerer Beate M. , Gohr Florian N. , Jenster Lea-Marie , Schiffelers Lisa D. J. , Tesfamariam Yonas M. , Uchima Miki , Wuerth Jennifer D. , Gatterdam Karl , Ruetalo Natalia , Christensen Maria H. , Fandrey Caroline I. , Normann Sabine , Tödtmann Jan M. P. , Pritzl Steffen , Hanke Leo , Boos Jannik , Yuan Meng , Zhu Xueyong , Schmid-Burgk Jonathan L. , Kato Hiroki , Schindler Michael , Wilson Ian A. , Geyer Matthias , Ludwig Kerstin U. , Hällberg B. Martin , Wu Nicholas C. , Schmidt Florian I.
Published: January 2021

A double punch against SARS-CoV-2

Monoclonal antibodies are an important weapon in the battle against COVID-19. However, these large proteins are difficult to produce in the needed quantities and at low cost. Attention has turned to nanobodies, which are aptly named, single-domain antibodies that are easier to produce and have the potential to be administered by inhalation. Koenig
et al.
describe four nanobodies that bind to the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) spike protein and prevent infection of cells (see the Perspective by Saelens and Schepens). Structures show that the nanobodies target two distinct epitopes on the SARS-CoV-2 spike protein. Multivalent nanobodies neutralize virus much more potently than single nanobodies, and multivalent nanobodies that bind two epitopes prevent the emergence of viral escape mutants.

Science
, this issue p.
eabe6230
; see also p.
681
Short linear motif candidates in the cell entry system used by SARS-CoV-2 and their potential therapeutic implications
Authors: Mészáros Bálint , Sámano-Sánchez Hugo , Alvarado-Valverde Jesús , Čalyševa Jelena , Martínez-Pérez Elizabeth , Alves Renato , Shields Denis C. , Kumar Manjeet , Rippmann Friedrich , Chemes Lucía B. , Gibson Toby J.
Published: January 2021

Cytosolic tail motifs in host cell surface receptors predict modes of SARS-CoV-2 entry and propagation.
Evaluation of Synergistic Activity of Isavuconazole or Voriconazole plus Anidulafungin and the Occurrence and Genetic Characterization of Candida auris Detected in a Surveillance Program
Authors: Pfaller Michael A. , Messer Shawn A. , Deshpande Lalitagauri M. , Rhomberg Paul R. , Utt Eric A. , Castanheira Mariana
Published: January 2021

A total of 15
Candida auris
isolates from the SENTRY antimicrobial surveillance program between 2006 and 2019 were combined with 21 isolates from other collections for the evaluation of antifungal susceptibility and synergy against anidulafungin plus voriconazole or isavuconazole using the checkerboard method. Surveillance isolates were analyzed for genetic relatedness and resistance mechanisms.
Analysis of Multidrug Resistance in Staphylococcus aureus with a Machine Learning-Generated Antibiogram
Authors: Cazer Casey L. , Westblade Lars F. , Simon Matthew S. , Magleby Reed , Castanheira Mariana , Booth James G. , Jenkins Stephen G. , Gröhn Yrjö T.
Published: January 2021

Multidrug resistance (MDR) surveillance consists of reporting MDR prevalence and MDR phenotypes. Detailed knowledge of the specific associations underlying MDR patterns can allow antimicrobial stewardship programs to accurately identify clinically relevant resistance patterns.
Activity of Cefepime in Combination with the Novel β-Lactamase Inhibitor Taniborbactam (VNRX-5133) against Extended-Spectrum-β-Lactamase-Producing Isolates in
In Vitro
Checkerboard Assays
Authors: Kloezen Wendy , Melchers Ria J. , Georgiou Panagiota-Christina , Mouton Johan W. , Meletiadis Joseph
Published: January 2021

Extended-spectrum-β-lactamase (ESBL)-producing strains are increasing worldwide, limiting therapeutic options. Taniborbactam (VNRX-5133) is a newly developed β-lactamase inhibitor with a wide spectrum of activity covering both serine and metallo enzymes.
Extracellular Metabolism Sets the Table for Microbial Cross-Feeding
Authors: Fritts Ryan K. , McCully Alexandra L. , McKinlay James B.
Published: January 2021

The transfer of nutrients between cells, or cross-feeding, is a ubiquitous feature of microbial communities with emergent properties that influence our health and orchestrate global biogeochemical cycles. Cross-feeding inevitably involves the externalization of molecules.
Phosphorylation of the Canonical Histone H2A Marks Foci of Damaged DNA in Malaria Parasites
Authors: Goyal Manish , Heinberg Adina , Mitesser Vera , Kandelis-Shalev Sofiya , Singh Brajesh Kumar , Dzikowski Ron
Published: January 2021

Plasmodium falciparum
is the deadliest human parasite that causes malaria when it reaches the bloodstream and begins proliferating inside red blood cells, where the parasites are particularly prone to DNA damage. The molecular mechanisms that allow these pathogens to maintain their genome integrity under such conditions are also the driving force for acquiring genome plasticity that enables them to create antigenic variation and become resistant to essentially all available drugs.
Analysis of Apoptosis-Related Genes Reveals that Apoptosis Functions in Conidiation and Pathogenesis of
Fusarium pseudograminearum
Authors: Chen Linlin , Ma Yuming , Peng Mengya , Chen Wenbo , Xia Huiqing , Zhao Jingya , Zhang Yake , Fan Zhuo , Xing Xiaoping , Li Honglian
Published: January 2021

The plant-pathogenic fungus
F. pseudograminearum
is the causal agent of
Fusarium
crown rot (FCR) in wheat and barley, resulting in substantial yield losses worldwide. Particularly, in the Huanghuai wheat-growing region of China,
F. pseudograminearum
was reported as the dominant
Fusarium
species in FCR infections.
Elucidating the anatomy of a rare communicating bronchopulmonary foregut malformation (CBPFM) in a preschool child
Authors: Shama Niveditha , Mathai John , Rai Ekta , Kodiatte Thomas Alex
Published: January 2021

Communicating bronchopulmonary foregut malformations (CBPFMs) are complex and rare anomalies. Their characteristic feature is an anomalous communication between the respiratory system (trachea, lung or bronchus) on one side and the gastrointestinal tract (oesophagus or stomach) on the other. Though acquired CBPFMs are known, the large majority of them are congenital and single. CBPFMs often go undetected even at surgery and require more than one operation before they are successfully addressed. This is because the symptomatology of CBPFM resembles the more common oesophageal atresia (OA) with tracheoesophageal fistula, wherein it may coexist. We report a patient with OA who had a rare form of CBPFM where the upper lobe of the right lung communicated with the upper oesophagus. This account highlights a novel method of working out the uncertain anatomy, in such cases. There may be associated anomalies of the lung parenchyma and vasculature usually involving the pulmonary arterial supply to the affected lung. Clinical, radiological, endoscopic and pathological characterisation permit precise diagnosis in most instances, with an occasional case that defies definition.
Identification of a pathogenicCARD14mutation in a 70-year-old woman with pityriasis rubra pilaris: when genetic diagnosis influences choice of treatment strategy
Authors: Nielsen Rikke Maria , Gram Stine Bjørn , Bygum Anette
Published: January 2021

Pityriasis rubra pilaris (PRP) is a rare dermatosis characterised by hyperkeratotic follicular papules, orange-red scaly plaques and palmoplantar keratoderma. The aetiology of the disease is in most cases unclear and treatment can be challenging. Familial cases of PRP may result from pathogenic variants in the caspase recruitment domain family member 14 (CARD14). We present a case of lifelong PRP in a 70-year-old woman, where genetic testing revealed a heterozygote missense variant c.412G>A, p.(Glu138Lys) in CARD14. Therapy with ustekinumab was initiated with remarkable effect, which improved the patient’s quality of life significantly.
Over-the-counter antacids linked to severe hypokalaemia in the context of threatened preterm labour
Authors: Lattey Katherine , Quinn Sarah , O'Brien Katherine
Published: January 2021

A healthy multiparous woman presented at 35 weeks and 4 days’ gestation with threatened preterm labour on multiple occasions. An incidental finding of severe hypokalaemia (2.4 mmol/L) was detected on routine blood tests. The cause of this hypokalaemia was not initially obvious. It was eventually linked to overuse of over-the-counter antacids for pregnancy-associated heartburn. The patient was managed with parenteral and then oral electrolyte replacement which corrected a pH of 7.55, bicarbonate of 36.7 mEq/L and a base excess 13.1. In this case report we consider whether hypokalaemia could be linked to uterine irritability and threatened preterm labour, whether antacids were being abused in the context of an eating disorder and the importance of taking a full drug history.
Rare case of perforated appendicitis presenting as persistent perineal discharge following laparoscopic abdominoperinal excision of rectum (APER)
Authors: Mukherjee Tanmoy , Kudchadkar Shantata Jayant , Sagar Jayesh , Gurjar Shashank
Published: January 2021

Abdominoperineal excision of rectum (APER) is one of the widely used surgical procedures to treat low rectal cancer, benign conditions like Crohn’s proctitis with anal involvement and as a salvage procedure for anal cancer. Perineal wound infection is a well-recognised complication following such major surgery. Occurrence of appendicitis in a few weeks’ time following such a major surgery is uncommon. However, here we present a rare case report of perforated appendicitis presenting as persistent perineal discharge in an elderly man, following laparoscopic APER for a low rectal tumour. To our knowledge, this is the first time such a rare clinical presentation of appendicitis is reported in the history of medical literature. Through this case report, we aim to highlight the importance of considering such an uncommon presentation in patients with perineal discharge, following APER.
Skull base osteomyelitis with secondary cavernous sinus thrombosis: a rare presentation of an animate foreign body in the ear
Authors: Alex Anu , Philip Ajay , Paulose Antony Abraham , Mammen Manju Deena , Lepcha Anjali
Published: January 2021

A 42-year-old woman presented with fever, left ear pain, restricted mouth opening, difficulty in swallowing and inability to open her left eyelid for a period of 10 days. She was treated with antibiotics for the same at a local medical facility; however, a sudden decrease in her left eye vision prompted her to visit our tertiary centre. Her history was insignificant except for having multiple left ear syringing for an insect removal 10 days before onset of her current symptoms. On examination, she had ptosis of the left eye with chemosis, dilated pupil with only perception of light and restricted ocular mobility. Oral examination revealed trismus and bulge in the left peritonsillar region. Left ear examination revealed a large central perforation with mucopurulent discharge. CT of the neck with contrast demonstrated a collection in the left peritonsillar space with left internal carotid artery thrombosis. MRI of the brain with gadolinium revealed left cavernous sinus thrombosis with acute infarcts in the left frontal lobe. An emergency incision and drainage of the left peritonsillar abscess was performed. Culture grew broad aseptate fungal hyphae. Despite starting on antifungal therapy, she succumbed to her illness.
Left ventricular perforation from a dislodged needle migrating via a pulmonary artery branch in an intravenous drug user
Authors: Waidyanatha Sawan , Sekhsaria Sachin
Published: January 2021

Embolised needles causing injury to the right heart and cardiac tamponade has been reported before in intravenous drug users, but to our knowledge, this is the first reported case of a needle migrating via the pulmonary arterial system to cause perforation of theleftventricle. Appropriate utilisation of imaging modalities such as plain X-ray and point-of-care focused cardiac ultrasound can be vital and life-saving in the emergency setting, and the value of gated multidetector CT as a powerful tool for imaging moving structures is highlighted.
Rare case of tubercular parotid abscess
Authors: Ramesh Bhat Yellanthoor , Kini Sandesh , Prakashini Koteshwara
Published: January 2021

Acute parotitis progressing to parotid abscess is rare in children.Staphylococcus aureusis the usual pathogen in parotid abscess. Granulomatous parotid abscess due to tubercular aetiology is extremely rare. Authors report a case of chronic parotid abscess in a child who received multiple courses of antibiotics without any cure. The ultrasonography and CT scan of the parotid gland confirmed the extent of parotid abscess and the changes in the parotid lymph nodes. The surgical drainage and the biopsy of the lymph nodes lead to the diagnosis of granulomatous abscess. The antitubercular therapy finally cured the disease without further recurrence.
Kickboxing a cardiomyopathy: mitochondrial sequencing provides answer for young athlete and her family
Authors: Dineen Elizabeth H , Torkamani Ali , Muse Evan D
Published: January 2021

Mitochondrial diseases are rare, often go undiagnosed and can lead to devastating cascades of multisystem organ dysfunction. This report of a young woman with hearing loss and gestational diabetes illustrates a novel presentation of a cardiomyopathy caused by a previously described mutation in a mitochondrial gene, MT-TL1. She initially had biventricular heart dysfunction and ventricular arrhythmia that ultimately recovered with beta blockade and time. She continues to participate in sport without decline. It is important to keep mitochondrial diseases in the differential diagnosis and understand the testing and management strategies in order to provide the best patient care.
Abdominal pain with intra-adrenal bleeding as an initial presentation of pheochromocytoma
Authors: Lambrecht Astrid , Inglis Joshua M , Young Robert
Published: January 2021

A 55-year-old man presented with severe right upper quadrant abdominal pain and hypertension up to 231/171 mm Hg on a background of a known adrenal mass, intravenous drug use and recurrent anxiety attacks. CT showed heterogenous lesion of the right adrenal gland but the sudden severe pain remained unexplained. After correction of the blood pressure with analgesia and antihypertensives, the patient developed a type 2 non-ST-elevation myocardial infarction that was treated with aspirin and therapeutic enoxaparin. This resulted in worsening pain and a repeat CT angiogram showed a haemoretroperitoneum around the right adrenal lesion. On review, an occult intra-adrenal haemorrhage was identified on the initial CT scan. Presumably this concealed haemorrhage caused the initial pain crisis and later decompressed into the retroperitoneal space. Raised metanephrine levels confirmed the diagnosis of pheochromocytoma and after preoperative optimisation with phenoxybenzamine, an open right adrenalectomy was performed.
Complete recovery from COVID-19 of a kidney-pancreas transplant recipient: potential benefit from everolimus?
Authors: Heron Vanessa C , Bach Cindy-Anne T , Holmes Natasha E , Whitlam John B
Published: January 2021

We present a kidney-pancreas transplant recipient who achieved complete recovery from COVID-19. A 45-year-old patient with T3 paraplegia underwent kidney-pancreas transplantation 18 years ago, followed by a subsequent kidney transplant 9 years ago, and presented with fever, hypoxia and hypotension after exposure to two confirmed cases of COVID-19. History of solid organ transplant, pre-existing renal impairment, asthma and an elevated D-dimer were identified as established risk factors for severe COVID-19. Supportive management was provided, baseline immunosuppression with everolimus was continued, and oral prednisolone was increased. A complete recovery was observed. Given the favourable outcome despite risk factors for severe COVID-19, we identify and review the potential mitigating roles of immunosuppression and mammalian target of rapamycin (mTOR) inhibitors in this disease. Further investigation is required to establish whether mTOR inhibitors could be used as therapeutic agents to treat COVID-19, or as alternative immunosuppression implemented early in the COVID-19 disease course.
Recurrent calcifying aponeurotic fibroma of the hand: managing a rare hand tumour in an evolving healthcare landscape
Authors: Gallagher Michael , Cooper Lilli , Ibanez Mata Javier
Published: January 2021

Calcifying aponeurotic fibroma (CAF) is a rare benign tumour originating from the aponeuroses of tendons and their bony insertions. A 15-year-old student presented to his general practitioner with a 1-year history of a progressively enlarging painless finger swelling. The lesion was excised by the local paediatric orthopaedic service and recurred over the course of the following 4 months. Histology confirmed a diagnosis of CAF. He was referred to our specialist hand surgery service and the lesion was excised along with the ulnar lateral band and the overlying skin. At 9 months, there was no clinical evidence of recurrence. We are the first group to report the potential benefit of including of the overlying skin in the histological specimen to reduce the residual disease burden. Our case illustrates the technical challenges and considerations of removing a large, recurrent CAF of the hand and highlights the importance of centralised specialist care.
Safely replacing a percutaneous endoscopic gastrostomy tube using a portable X-ray system at a patient’s home
Authors: Eguchi Hitoshi , Katsuki Naoko E , Yamamoto Ken-ichi , Tago Masaki
Published: January 2021

An 81-year-old woman who underwent percutaneous endoscopic gastrostomy (PEG) a year before, after cerebral infarction was receiving home medical care. The first accidental PEG tube removal occurred after clinic hours, and the home-care doctor visited her home to quickly reinsert the tube. After the narrowed fistula was dilated, the tube was reinserted with a guide wire. An X-ray taken with a CALNEO Xair, which is an easily portable X-ray system launched in 2018, confirmed that the tip of the PEG tube was successfully placed in the stomach. A similar accidental removal occurred 2 months later, and we managed it in the same way. Both events were resolved with a single radiograph without significant difficulty. With in-home medical care, PEG tube replacement can be performed easily and safely with a handy portable X-ray system.
Recurrent macroglossia requiring tracheostomy after haemorrhagic basal ganglia stroke
Authors: Osoba Muyinat Y , Schneider Alexander L , Alexiev Borislav , Matsuoka Akihiro J
Published: January 2021

A 50-year-old African American woman with hypertension, congestive heart failure, chronic kidney disease and prior cerebral vascular accident was transferred from an outside hospital after being found unresponsive and subsequently intubated for severe orolingual swelling. Imaging showed left thalamic haemorrhagic stroke, and the lingual swelling was clinically concerning for angio-oedema, with which a lingual biopsy was consistent. Work-up was negative for hereditary or acquired angio-oedema, and imaging was negative for structural causes. Of note, the patient had an episode of severe orolingual swelling 3 months prior to this presentation after suffering left thalamic haemorrhage which self-resolved after approximately 2 months. In both episodes lingual swelling predated receipt of tissue plasminogen activator and she had discontinued ACE inhibitor therapy since her first episode of tongue swelling. Despite medical and supportive management, tongue swelling progressed during admission and the decision was made to allow the patient’s tongue swelling to self-resolve.
Prolonged postictal hemianopsia after a focal extraoccipital onset seizure
Authors: Wasade Vibhangini S , Logan Jennifer L
Published: January 2021

We report a case of a prolonged postictal hemianopsia occurring after a focal extraoccipital seizure. A 55-year-old man with a history of neurosyphilis, treated with penicillin, presented to our epilepsy monitoring unit (EMU) for diagnostic evaluation of his spells occurring for 2 years. The spell semiology was stereotypical, described as oral and manual automatisms, speech difficulty and unresponsiveness. During the EMU stay, after his typical seizure was recorded, he experienced right hemianopsia lasting for 2 hours. Electrographically, the ictal pattern was prominent over the left temporal derivation and propagated to the left occipital derivation as the seizure progressed. Interictal epileptiform activity was over the left temporal derivations. We support the view that postictal phenomenon may represent merely a seizure termination zone and not be necessarily localising to the seizure onset zone. Furthermore, prolonged isolated postictal symptom of hemianopsia could also be noted in rare situations.
Neonatal thyroid storm: the importance of an accurate antenatal history
Authors: Tamgumus Sean , Lauesen Elisabeth , Boyle Michael A
Published: January 2021

A near-term infant became unwell immediately after birth with cardiorespiratory compromise—persistent tachycardia, pulmonary hypertension and reduced cardiac function. There had been no concerns during the pregnancy and the obstetrical and maternal medical history was unremarkable apart from hypothyroidism. A thyroid function test on admission revealed a significantly elevated free T4 and a diagnosis of a thyroid storm was made. On questioning it became apparent that she had Graves’ disease after her last pregnancy and was rendered hypothyroid post surgery, she was not aware of the relevance of this at her booking visit. This case highlights the importance of monitoring of women who have a history of a diagnosis of Graves’ disease, regardless of thyroid function status, to allow for appropriate antenatal monitoring, preparedness of the NICU (neonatal intensive care unit) team and correct follow-up of the neonate. It also demonstrates the importance of ensuring a patient is properly educated about their condition.
Rare case of right ventricular dilatation associated with anomalous pulmonary venous drainage, sinus venosus atrial septal defect and persistent left superior vena cava
Authors: Rees Stephanie , Tahir Muhammad , Ahmad Syed Jawad , Subkovas Eduardas
Published: January 2021

A 34-year-old woman was seen in the emergency department for shortness of breath and chest pain. During a pandemic, it is easy to ‘think horses and not zebras’, and with a patient presenting with the classic coronavirus symptoms it would have been easy to jump to that as her diagnosis. After a careful history and examination, it became clear that there was another underlying diagnosis. Chest X-ray, echocardiogram and CT scan revealed marked right ventricular dilatation and pulmonary hypertension, alongside a persistent left superior vena cava (PLSVC). Further investigation with cardiac MRI and coronary angiography at a tertiary centre demonstrated that she not only have a PLSVC but also a partial anomalous pulmonary venous drainage and sinus venosus atrial septal defect. This case highlights the importance of considering all differentials and approaching investigations in a logical manner.
Clinical management of acute low back pain in elite and subelite rowers: a Delphi study of experienced and expert clinicians
Authors: Wilkie Kellie , Thornton Jane S , Vinther Anders , Trease Larissa , McDonnell Sarah-Jane , Wilson Fiona
Published: January 2021

Objectives

Rowing-related low back pain (LBP) is common but published management research is lacking. This study aims to establish assessment and management behaviours and beliefs of experienced and expert clinicians when elite and subelite rowers present with an acute episode of LBP; second, to investigate how management differs for developing and masters rowers. This original research is intended to be used to develop rowing-related LBP management guidelines.

Methods

A three-round Delphi survey was used. Experienced clinicians participated in an internet-based survey (round 1), answering open-ended questions about assessment and management of rowing-related LBP. Statements were generated from the survey for expert clinicians to rate (round 2) and rerate (round 3). Consensus was gained when agreement reached a mean of 7 out of 10 and disagreement was 2 SD or less.

Results

Thirty-one experienced clinicians participated in round 1. Thirteen of 20 invited expert clinicians responded to round 2 (response rate 65%) and 12 of the 13 participated in round 3 (response rate 92%).

One hundred and fifty-three of 215 statements (71%) relating to the management of LBP in elite and subelite rowers acquired consensus status. Four of six statements (67%) concerning developing rowers and two of four (50%) concerning masters rowers gained consensus.

Conclusion

In the absence of established evidence, these consensus-derived statements are imperative to inform the development of guidelines for the assessment and management of rowing-related LBP. Findings broadly reflect adult LBP guidelines with specific differences. Future research is needed to strengthen specific recommendations and develop best practice guidelines in this athletic population.
Increased stress, weight gain and less exercise in relation to glycemic control in people with type 1 and type 2 diabetes during the COVID-19 pandemic
Authors: Ruissen Merel M , Regeer Hannah , Landstra Cyril P , Schroijen Marielle , Jazet Ingrid , Nijhoff Michiel F , Pijl Hanno , Ballieux Bart E P B , Dekkers Olaf , Huisman Sasja D , de Koning Eelco J P
Published: January 2021

Introduction

Lockdown measures have a profound effect on many aspects of daily life relevant for diabetes self-management. We assessed whether lockdown measures, in the context of the COVID-19 pandemic, differentially affect perceived stress, body weight, exercise and related this to glycemic control in people with type 1 and type 2 diabetes.

Research design and methods

We performed a short-term observational cohort study at the Leiden University Medical Center. People with type 1 and type 2 diabetes ≥18 years were eligible to participate. Participants filled out online questionnaires, sent in blood for hemoglobin A1c (HbA1c) analysis and shared data of their flash or continuous glucose sensors. HbA1c during the lockdown was compared with the last known HbA1c before the lockdown.

Results

In total, 435 people were included (type 1 diabetes n=280, type 2 diabetes n=155). An increase in perceived stress and anxiety, weight gain and less exercise was observed in both groups. There was improvement in glycemic control in the group with the highest HbA1c tertile (type 1 diabetes: −0.39% (−4.3 mmol/mol) (p<0.0001 and type 2 diabetes: −0.62% (−6.8 mmol/mol) (p=0.0036). Perceived stress was associated with difficulty with glycemic control (p<0.0001).

Conclusions

An increase in perceived stress and anxiety, weight gain and less exercise but no deterioration of glycemic control occurs in both people with relatively well-controlled type 1 and type 2 diabetes during short-term lockdown measures. As perceived stress showed to be associated with glycemic control, this provides opportunities for healthcare professionals to put more emphasis on psychological aspects during diabetes care consultations.
Protocol for a young adult mental health (Uspace) cohort: personalising multidimensional care in young people admitted to hospital
Authors: Tickell Ashleigh M , Rohleder Cathrin , Garland Alexandra , Song Yun Ju Christine , Carpenter Joanne Sarah , Harel Kate , Parker Lisa , Hickie Ian B , Scott Elizabeth
Published: January 2021

Introduction

Currently, the literature on personalised and measurement-based mental healthcare is inadequate with major gaps in the development and evaluation of 21st century service models. Clinical presentations of mental ill health in young people are heterogeneous, and clinical and functional outcomes are often suboptimal. Thus, treatments provided in a person-centred and responsive fashion are critical to meet the unique needs of young people and improve individual outcomes. Personalised care also requires concurrent assessment of factors relating to outcomes and underlying neurobiology. This study builds on a completed feasibility study and will be the first to incorporate clinical, cognitive, circadian, metabolic and hormonal profiling with personalised and measurement-based care in a cohort of young people admitted to hospital.

Methods and analysis

This prospective, transdiagnostic, observational study will be offered to all young people between the ages of 16 and 30 years admitted to the inpatient unit of the participating centre. In total, 400 participants will be recruited. On admission to hospital, young people will undergo clinical and diagnostic assessment, cognitive testing, self-report questionnaires, metabolic and hormonal data collection, and anthropomorphic measurements. Participants will wear an actigraphy watch for at least 1 week during admission to measure circadian patterns and sleep-wake cycles. A feedback session between clinician and participant will occur after clinical and other laboratory assessments to tailor individual treatment plans, explain the ongoing process of measurement-based care, and provide participant and family education. Associations between cognitive impairments, disturbed sleep-wake behaviours, circadian rhythms, clinical symptoms and functional impairments will be evaluated to improve the understanding of parameters affecting clinical outcomes.

Ethics and dissemination

This study protocol was approved by the Human Research Ethics Committees of the University of Sydney (HREC USYD 2015/867) and St Vincent’s Hospital (HREC SVH 17/045). This study will be published on completion in a peer-reviewed journal.
Effects of family history of diabetes on pancreatic β-cell function and diabetic ketoacidosis in newly diagnosed patients with type 2 diabetes: a cross-sectional study in China
Authors: Xiong Xiaofen , Wei Ling , Xiao Ying , Han Yachun , Yang Jinfei , Zhao Hao , Yang Ming , Sun Lin
Published: January 2021

Objective

To investigate the association between a parental and/or sibling history of diabetes and clinical characteristics.

Design

A cross-sectional study.

Setting

The data were collected from the endocrinology department of The Second Xiangya Hospital of Central South University from June 2017 to October 2019.

Participants

A total of 894 newly diagnosed patients with type 2 diabetes were recruited. Data on clinical characteristics were collected from patient medical records. Pancreatic β-cell function and insulin resistance were calculated with the homeostatic model assessment. SPSS V.25.0 was used to perform the analysis.

Results

The percentages of patients with parental and sibling histories of diabetes were 14.8% and 9.8%, respectively. The prevalence of diabetic ketoacidosis (DKA) was 3.9%. Compared with those with no parental history of diabetes, patients with a parental history of diabetes were characterised by early-onset disease (41.70±10.88 vs 51.17±14.09 years), poor glycaemic control of fasting blood glucose (10.84±5.21 vs 8.91±4.38 mmol/L) and a high prevalence of DKA (7.6% vs 3.3%). The patients with a sibling history of diabetes had later disease onset (56.05±9.86 vs 49.09±14.29 years) and lower BMI (24.49±3.48 vs 25.69±3.86 kg/m2) than those with no sibling history of diabetes. Univariate regression suggested that both parental history (p=0.037) and sibling history (p=0.011) of diabetes were associated with β-cell function; however, multiple regression analysis showed that only a sibling history of diabetes was associated with β-cell function (p=0.038). Univariate regression revealed a positive correlation between parental history of diabetes (p=0.023, OR=2.416, 95% CI 1.132 to 5.156) and DKA. Unfortunately, this correlation was not statistically significant for either patients with a parental history (p=0.234, OR=1.646, 95% CI 0.724 to 3.743) or those with a sibling history (p=0.104, OR=2.319, 95% CI 0.841 to 6.389) after adjustments for confounders.

Conclusion

A sibling history of diabetes was associated with poor β-cell function, and a parental history of diabetes was associated with poor glycaemic control and a high prevalence of DKA.