bluuebunny/crossref_metadata_2025 huggingface dataset:
Acute exacerbation of fibrotic hypersensitivity pneumonitis: incidence and outcomes
Authors: Kang Jieun , Kim Yeon Joo , Choe Jooae , Chae Eun Jin , Song Jin Woo
Published: May 2021

Background

Patients with fibrotic hypersensitivity pneumonitis (HP) show variable clinical courses, and some experience rapid deterioration (RD), including acute exacerbation (AE). However, little is known about AE in fibrotic HP. Here, we retrospectively examined the incidence, risk factors, and outcomes of AE in fibrotic HP.

Methods

The incidence rates of AE were calculated in 101 patients with biopsy-proven HP. AE was defined as the worsening of dyspnoea within 30 days, with new bilateral lung infiltration and no evidence of infection or other causes of dyspnoea.

Results

During follow-up (median: 30 months), 18 (17.8%) patients experienced AE. The 1, 3, and 5 year incidence rates of AE were 6.0, 13.6, and 22.8%, respectively. Lower diffusing capacity of the lung for carbon monoxide (DLCO) and a radiologic usual interstitial pneumonia (UIP)-like pattern were risk factors for AE. In-hospital mortality after AE was 44.4%. Median survival from diagnosis was significantly shorter in patients with AE (26.0 months) than in those with no-AE RD (55.0 months; p = 0.008) or no RD (not reached; p < 0.001). AE remained a significant predictor of all-cause mortality (hazard ratio, 8.641; 95% confidence interval, 3.388–22.040; p < 0.001) after adjustment for age, body mass index, lung function, lymphocyte levels in bronchoalveolar lavage fluid, and the presence of a UIP-like pattern.

Conclusions

AE was not uncommon among patients with fibrotic HP and significantly affected prognosis. A lower DLCO value and radiologic UIP-like pattern at diagnosis were associated with the development AE in patients with fibrotic HP.
Alteration of payload in extracellular vesicles by crosstalk with mesenchymal stem cells from different origin
Authors: Park Dong Jun , Park Jeong-Eun , Kong Tae Hoon , Seo Young Joon
Published: May 2021

Background

The application of extracellular vesicles (EVs) derived from mesenchymal stem cells (MSCs) requires customized materials to target disease or cell damage. We hypothesized that EVs exert different inflammatory effects on one recipient cell, although stem cells of different origins in humans have similar payloads.

Results

Here, the payload of EVs released by crosstalk between MSCs and human middle ear epithelial cells (HMEECs) extracted from adipose tissue, bone marrow and tonsils significantly increased the level of anti-inflammatory factors. EVs derived from the co-culture medium decreased TNF-α, COX-2, IL-1β, and IL-6 levels to approximately zero within 3 h in HMEECs. Expression of miR-638 and amyloid-β A4 precursor protein-binding family A member 2 was analyzed using microarrays and gene ontology analysis, respectively.

Conclusions

In conclusion, stem cells of different origins have different payloads through crosstalk with recipient-specific cells. Inducing specific factors in EVs by co-culture with MSCs could be valuable in regenerative medicine.

Graphical abstract
The socio-spatial determinants of COVID-19 diffusion: the impact of globalisation, settlement characteristics and population
Authors: Sigler Thomas , Mahmuda Sirat , Kimpton Anthony , Loginova Julia , Wohland Pia , Charles-Edwards Elin , Corcoran Jonathan
Published: May 2021

Background

COVID-19 is an emergent infectious disease that has spread geographically to become a global pandemic. While much research focuses on the epidemiological and virological aspects of COVID-19 transmission, there remains an important gap in knowledge regarding the drivers of geographical diffusion between places, in particular at the global scale. Here, we use quantile regression to model the roles of globalisation, human settlement and population characteristics as socio-spatial determinants of reported COVID-19 diffusion over a six-week period in March and April 2020. Our exploratory analysis is based on reported COVID-19 data published by Johns Hopkins University which, despite its limitations, serves as the best repository of reported COVID-19 cases across nations.

Results

The quantile regression model suggests that globalisation, settlement, and population characteristics related to high human mobility and interaction predict reported disease diffusion. Human development level (HDI) and total population predict COVID-19 diffusion in countries with a high number of total reported cases (per million) whereas larger household size, older populations, and globalisation tied to human interaction predict COVID-19 diffusion in countries with a low number of total reported cases (per million). Population density, and population characteristics such as total population, older populations, and household size are strong predictors in early weeks but have a muted impact over time on reported COVID-19 diffusion. In contrast, the impacts of interpersonal and trade globalisation are enhanced over time, indicating that human mobility may best explain sustained disease diffusion.

Conclusions

Model results confirm that globalisation, settlement and population characteristics, and variables tied to high human mobility lead to greater reported disease diffusion. These outcomes serve to inform suppression strategies, particularly as they are related to anticipated relocation diffusion from more- to less-developed countries and regions, and hierarchical diffusion from countries with higher population and density. It is likely that many of these processes are replicated at smaller geographical scales both within countries and within regions. Epidemiological strategies must therefore be tailored according to human mobility patterns, as well as countries’ settlement and population characteristics. We suggest that limiting human mobility to the greatest extent practical will best restrain COVID-19 diffusion, which in the absence of widespread vaccination may be one of the best lines of epidemiological defense.
Heterogeneity in design and analysis of ICU delirium randomized trials: a systematic review
Authors: Colantuoni Elizabeth , Koneru Mounica , Akhlaghi Narjes , Li Ximin , Hashem Mohamed D. , Dinglas Victor D. , Neufeld Karin J. , Harhay Michael O. , Needham Dale M.
Published: May 2021

Background

There is a growing number of randomized controlled trials (RCTs) evaluating interventions to prevent or treat delirium in the intensive care unit (ICU). Efforts to improve the conduct of delirium RCTs are underway, but none address issues related to statistical analysis. The purpose of this review is to evaluate heterogeneity in the design and analysis of delirium outcomes and advance methodological recommendations for delirium RCTs in the ICU.

Methods

Relevant databases, including PubMed and Embase, were searched with no restrictions on language or publication date; the search was conducted on July 8, 2019. RCTs conducted on adult ICU patients with delirium as the primary outcome were included where trial results were available. Data on frequency and duration of delirium assessments, delirium outcome definitions, and statistical methods were independently extracted in duplicate. The review was registered with PROSPERO (CRD42020141204).

Results

Among 65 eligible RCTs, 44 (68%) targeted the prevention of delirium. The duration of follow-up varied, with 31 (48%) RCTs having ≤7 days of follow-up, and only 24 (37%) conducting delirium assessments after ICU discharge. The incidence of delirium was the most common outcome (50 RCTs, 77%) for which 8 unique statistical methods were applied. The most common method, applied to 51 of 56 (91%) delirium incidence outcomes, was the two-sample test comparing the proportion of patients who ever experienced delirium. In the presence of censoring of patients at ICU discharge or death, this test may be misleading. The impact of censoring was also not considered in most analyses of the duration of delirium, as evaluated in 24 RCTs, with 21 (88%) delirium duration outcomes analyzed using a non-parametric test or two-sample t test. Composite outcomes (e.g., rank-based delirium- and coma-free days), used in 11 (17%) RCTs, seldom explicitly defined how ICU discharge, and death were incorporated into the definition and were analyzed using non-parametric tests (11 of 13 (85%) composite outcomes).

Conclusions

To improve delirium RCTs, outcomes should be explicitly defined. To account for censoring due to ICU discharge or death, survival analysis methods should be considered for delirium incidence and duration outcomes; non-parametric tests are recommended for rank-based delirium composite outcomes.

Trial registration

PROSPERO CRD42020141204. Registration date: 7/3/2019.
The Drinkers’ Intervention to Prevent Tuberculosis (DIPT) trial among heavy drinkers living with HIV in Uganda: study protocol of a 2×2 factorial trial
Authors: Lodi Sara , Emenyonu Nneka I. , Marson Kara , Kwarisiima Dalsone , Fatch Robin , McDonell Michael G. , Cheng Debbie M. , Thirumurthy Harsha , Gandhi Monica , Camlin Carol S. , Muyindike Winnie R. , Hahn Judith A. , Chamie Gabriel
Published: May 2021

Background

The risk of tuberculosis (TB) is high among people with HIV (PWH). Heavy alcohol drinking independently increases TB risk and approximately 25% of PWH globally engage in heavy drinking. While isoniazid (INH) preventive therapy decreases TB incidence and mortality among PWH, heavy drinking during INH is associated with liver toxicity and poor adherence. Interventions are, therefore, urgently needed to decrease alcohol use and improve adherence to INH in this population in settings with high prevalence of HIV and TB like Uganda.

Methods

The Drinkers’ Intervention to Prevent TB (DIPT) study is a 2×2 factorial randomized controlled trial among HIV/TB co-infected adults (≥18 years) who engage in heavy alcohol drinking and live in Uganda. The trial will allocate 680 participants with a 1:1:1:1 individual randomization to receive 6 months of INH and one of the following interventions: (1) no incentives (control), (2) financial incentives contingent on low alcohol use, (3) financial incentives contingent on high adherence to INH, and (4) escalating financial incentives for both decreasing alcohol use and increasing adherence to INH. Incentives will be in the form of escalating lottery-based monetary rewards. Participants will attend monthly visits to refill isoniazid medications, undergo liver toxicity monitoring, and, except for controls, determine eligibility for prizes. We will estimate (a) the effect of incentives contingent on low alcohol use on reduction in heavy drinking, measured via a long-term objective and self-reported metric of alcohol use, at 3- and 6-month study visits, and (b) the effect of incentives contingent on high adherence to INH, measured as >90% pill-taking days by medication event monitoring system cap opening. We will use qualitative methods to explore the mechanisms of any influence of financial incentives on HIV virologic suppression.

Discussion

This study will provide new information on low-cost strategies to both reduce alcohol use and increase INH adherence among people with HIV and TB infection who engage in heavy drinking in low-income countries with high HIV and TB prevalence.

Trial registration

ClinicalTrials.gov NCT03492216. Registered on April 10, 2018
Letter to the Editor in response to the Position statement and best practice recommendations on the imaging use of ultrasound from the European Society of Radiology ultrasound subcommittee
Authors: Kalinka Chris , Dickson Jeanette , Evans Richard , Morris Edward , Parker Pamela , Walton Gill , Ramsden William , Harrison Gill
Published: May 2021

This letter to the editor is in response to the consensus statement from the Ultrasound Subcommittee of the European Society of Radiology, the European Union of Medical Specialists (UEMS) Section of Radiology, and the European Federation of Societies for Ultrasound in Medicine and Biology. It highlights the role of the non-medical sonographer in the UK and the evidence underpinning this safe and effective practice.
Strontium ranelate promotes chondrogenesis through inhibition of the Wnt/β-catenin pathway
Authors: Yu Hao , Liu Yan , Yang Xiangwen , He Jiajing , Zhang Fan , Zhong Qun , Guo Xiaojing
Published: May 2021

Background

Cartilage regeneration is a key step in functional reconstruction for temporomandibular joint osteoarthritis (TMJ-OA) but is a difficult issue to address. Strontium ranelate (SrR) is an antiosteoporosis drug that has been proven to affect OA in recent years, but its effect on chondrogenesis and the underlying mechanism are still unclear.

Methods

Bone mesenchymal stem cells (BMSCs) from Sprague–Dawley (SD) rats were induced in chondrogenic differentiation medium with or without SrR, XAV-939, and LiCl. CCK-8 assays were used to examine cell proliferation, and alcian blue staining, toluidine blue staining, immunofluorescence, and PCR analysis were performed. Western blot (WB) analyses were used to assess chondrogenic differentiation of the cells. For an in vivo study, 30 male SD rats with cartilage defects on both femoral condyles were used. The defect sites were not filled, filled with silica nanosphere plus gelatine-methacryloyl (GelMA), or filled with SrR-loaded silica nanosphere plus GelMA. After 3 months of healing, paraffin sections were made, and toluidine blue staining, safranin O/fast green staining, and immunofluorescent or immunohistochemical staining were performed for histological evaluation. The data were analyzed by SPSS 26.0 software.

Results

Low concentrations of SrR did not inhibit cell proliferation, and the cells treated with SrR (0.25 mmol/L) showed stronger chondrogenesis than the control. XAV-939, an inhibitor of β-catenin, significantly promoted chondrogenesis, and SrR did not suppress this effect, while LiCl, an agonist of β-catenin, strongly suppressed chondrogenesis, and SrR reversed this inhibitory effect. In vivo study showed a significantly better cartilage regeneration and a lower activation level of β-catenin by SrR-loaded GelMA than the other treatments.

Conclusion

SrR could promote BMSCs chondrogenic differentiation by inhibiting the Wnt/β-catenin signaling pathway and accelerate cartilage regeneration in rat femoral condyle defects.
Mean square cross error: performance analysis and applications in non-Gaussian signal processing
Authors: Zhang Yunxiang , Zhao Yuyang , Wang Gang , Xue Rui
Published: May 2021

Most of the cost functions of adaptive filtering algorithms include the square error, which depends on the current error signal. When the additive noise is impulsive, we can expect that the square error will be very large. By contrast, the cross error, which is the correlation of the error signal and its delay, may be very small. Based on this fact, we propose a new cost function called the mean square cross error for adaptive filters, and provide the mean value and mean square performance analysis in detail. Furthermore, we present a two-stage method to estimate the closed-form solutions for the proposed method, and generalize the two-stage method to estimate the closed-form solution of the information theoretic learning methods, including least mean fourth, maximum correntropy criterion, generalized maximum correntropy criterion, and minimum kernel risk-sensitive loss. The simulations of the adaptive solutions and closed-form solution show the effectivity of the new method.
Some inequalities involving two generalized beta functions in n variables
Authors: Raïssouli Mustapha , El-Soubhy Salma I.
Published: May 2021

The beta and gamma functions have recently seen several developments and various extensions because of their nice properties and interesting applications. The contribution of this paper falls within this framework. After introducing a generalized gamma function and two generalized beta functions in several variables, we investigate some inequalities involving these generalized functions.
Sorption behavior of phosphate by fly ash discharged from biomass thermal power plant
Authors: Park Jong-Hwan , Hwang Se-Wook , Lee Su-Lim , Lee Jae-Hoon , Seo Dong-Cheol
Published: May 2021

This study evaluated the characteristics and mechanism of phosphate adsorption by fly ash discharged from a biomass thermal power plant (BTP-FA) under various environmental conditions in order to increase the recyclability of BTP-FA. The phosphate adsorption properties of BTP-FA and fly ash derived from coal thermal power plant (CTP-FA) were better matched by those predicted by the Langmuir isothermal model and the pseudo-second-order model, and their maximum adsorption capacities were 62.1 and 4.1 mg/g, respectively. It was found that the adsorption of phosphate by BTP-FA was predominantly influenced by the outer boundary layer rather than the inner diffusion in the pores. The phosphate adsorption process by BTP-FA was greatly influenced by the initial pH and the BTP-FA dose. Therefore, to effectively treat phosphate using BTP-FA, the concentration and flow rate of phosphate in the incoming wastewater must be considered. The concentration of dissolved calcium from BTP-FA decreased sharply during the phosphate adsorption process compared to that in the phosphate-free solution. This was thought to be due to surface adsorption/reaction between calcium and phosphate. The SEM–EDS and FTIR results also supported the surface adsorption/precipitation reaction of Ca-P. Recycling fly ash discharged from biomass power plants as phosphate adsorbents is expected to contribute not only to waste reduction, but also to wastewater purification.
Genetic susceptibility of COVID-19: a systematic review of current evidence
Authors: SeyedAlinaghi SeyedAhmad , Mehrtak Mohammad , MohsseniPour Mehrzad , Mirzapour Pegah , Barzegary Alireza , Habibi Pedram , Moradmand-Badie Banafsheh , Afsahi Amir Masoud , Karimi Amirali , Heydari Mohammad , Mehraeen Esmaeil , Dadras Omid , Sabatier Jean-Marc , Voltarelli Fabricio
Published: May 2021

Introduction

While COVID-19 pandemic continues to spread worldwide, researchers have linked patterns of traits to poor disease outcomes. Risk factors for COVID-19 include asthma, elderly age, being pregnant, having any underlying diseases such as cardiovascular disease, diabetes, obesity, and experiencing lifelong systemic racism. Recently, connections to certain genes have also been found, although the susceptibility has not yet been established. We aimed to investigate the available evidence for the genetic susceptibility to COVID-19.

Methods

This study was a systematic review of current evidence to investigate the genetic susceptibility of COVID-19. By systematic search and utilizing the keywords in the online databases including Scopus, PubMed, Web of Science, and Science Direct, we retrieved all the related papers and reports published in English from December 2019 to September 2020.

Results

According to the findings, COVID-19 uses the angiotensin-converting enzyme 2 (ACE2) receptor for cell entry. Previous studies have shown that people with ACE2 polymorphism who have type 2 transmembrane serine proteases (TMPRSS2) are at high risk of SARS-CoV-2 infection. Also, two studies have shown that males are more likely to become infected with SARS-CoV-2 than females. Besides, research has also shown that patients possessing HLA-B*15:03 genotype may become immune to the infection.

Conclusion

Combing through the genome, several genes related to immune system’s response were related to the severity and susceptibility to the COVID-19. In conclusion, a correlation was found between the ACE2 levels and the susceptibility to SARS-CoV-2 infection.
Urban wastewater bacterial communities assemble into seasonal steady states
Authors: LaMartina Emily Lou , Mohaimani Aurash A. , Newton Ryan J.
Published: May 2021

Background

Microorganisms in urban sanitary sewers exhibit community properties that suggest sewers are a novel ecosystem. Sewer microorganisms present both an opportunity as a control point for wastewater treatment and a risk to human health. If treatment processes are to be improved and health risks quantified, then it is necessary to understand microbial distributions and dynamics within this community. Here, we use 16S rRNA gene sequencing to characterize raw influent wastewater bacterial communities in a 5-year time series from two wastewater treatment plants in Milwaukee, WI; influent wastewater from 77 treatment plants across the USA; and wastewater in 12 Milwaukee residential sewers.

Results

In Milwaukee, we find that in transit from residences to treatment plants, the human bacterial component of wastewater decreases in proportion and exhibits stochastic temporal variation. In contrast, the resident sewer community increases in abundance during transit and cycles seasonally according to changes in wastewater temperature. The result is a bacterial community that assembles into two distinct community states each year according to the extremes in wastewater temperature. Wastewater bacterial communities from other northern US cities follow temporal trends that mirror those in Milwaukee, but southern US cities have distinct community compositions and differ in their seasonal patterns.

Conclusions

Our findings provide evidence that environmental conditions associated with seasonal change and climatic differences related to geography predictably structure the bacterial communities residing in below-ground sewer pipes.
The impact of cross-kingdom molecular forensics on genetic privacy
Authors: Elhaik Eran , Ahsanuddin Sofia , Robinson Jake M. , Foster Emily M. , Mason Christopher E.
Published: May 2021

Recent advances in metagenomic technology and computational prediction may inadvertently weaken an individual’s reasonable expectation of privacy. Through cross-kingdom genetic and metagenomic forensics, we can already predict at least a dozen human phenotypes with varying degrees of accuracy. There is also growing potential to detect a “molecular echo” of an individual’s microbiome from cells deposited on public surfaces. At present, host genetic data from somatic or germ cells provide more reliable information than microbiome samples. However, the emerging ability to infer personal details from different microscopic biological materials left behind on surfaces requires in-depth ethical and legal scrutiny. There is potential to identify and track individuals, along with new, surreptitious means of genetic discrimination. This commentary underscores the need to update legal and policy frameworks for genetic privacy with additional considerations for the information that could be acquired from microbiome-derived data. The article also aims to stimulate ubiquitous discourse to ensure the protection of genetic rights and liberties in the post-genomic era.
Cursor movement detection in brain-computer-interface systems using the K-means clustering method and LSVM
Authors: Mohammadi Leila , Einalou Zahra , Hosseinzadeh Hamidreza , Dadgostar Mehrdad
Published: May 2021

In this study, we present the detection of the up-downward as well as the right- leftward motion of cursor based on feature extraction. In this algorithm, the K-means clustering method is used to recognize the available hidden patterns in each of the four modes (up, down, left, and right). The identification of these patterns can raise the accuracy of classification. The membership degree of each feature vector in the proposed new patterns is considered as a new feature vector corresponding to the previous feature vector and then, the cursor motion is detected using the linear SVM classifier. Applying the proposed method for data based on the hold-up cross validation causes the accuracy of the classifier in the up-downward and left- rightward movements in each person to increase by 2–10 %.
A novel risk score for the prediction of airway management in patients with deep neck space abscess: a multicenter retrospective cohort study
Authors: Lin Yu , Gao Wenxiang , Yue Huijun , Chen Weixiong , Liu Tianrun , Ye Jin , Cai Qian , Ye Fei , He Long , Xie Xingqiang , Xiong Guoping , Wang Bin , Pang Feng , Li Pei , Wu Jianhui , Wang Bin , Huang Junru , Wen Weiping , Lei Wenbin
Published: May 2021

Background

Airway management, including noninvasive endotracheal intubation or invasive tracheostomy, is an essential treatment strategy for patients with deep neck space abscess (DNSA) to reverse acute hypoxia, which aids in avoiding acute cerebral hypoxia and cardiac arrest. This study aimed to develop and validate a novel risk score to predict the need for airway management in patients with DNSA.

Methods

Patients with DNSA admitted to 9 hospitals in Guangdong Province between January 1, 2015, and December 31, 2020, were included. The cohort was divided into the training and validation cohorts. The risk score was developed using the least absolute shrinkage and selection operator (LASSO) and logistic regression models in the training cohort. The external validity and diagnostic ability were assessed in the validation cohort.

Results

A total of 440 DNSA patients were included, of which 363 (60 required airway management) entered into the training cohort and 77 (13 required airway management) entered into the validation cohort. The risk score included 7 independent predictors (p < 0.05): multispace involvement (odd ratio [OR] 6.42, 95% confidence interval [CI] 1.79–23.07, p < 0.001), gas formation (OR 4.95, 95% CI 2.04–12.00, p < 0.001), dyspnea (OR 10.35, 95% CI 3.47–30.89, p < 0.001), primary region of infection, neutrophil percentage (OR 1.10, 95% CI 1.02–1.18, p = 0.015), platelet count to lymphocyte count ratio (OR 1.01, 95% CI 1.00–1.01, p = 0.010), and albumin level (OR 0.86, 95% CI 0.80–0.92, p < 0.001). Internal validation showed good discrimination, with an area under the curve (AUC) of 0.951 (95% CI 0.924–0.971), and good calibration (Hosmer–Lemeshow [HL] test, p = 0.821). Application of the clinical risk score in the validation cohort also revealed good discrimination (AUC 0.947, 95% CI 0.871–0.985) and calibration (HL test, p = 0.618). Decision curve analyses in both cohorts demonstrated that patients could benefit from this risk score. The score has been transformed into an online calculator that is freely available to the public.

Conclusions

The risk score may help predict a patient’s risk of requiring airway management, thus advancing patient safety and supporting appropriate treatment.
Innovative procedure for measuring left ventricular ejection fraction from 18F-FDG first-pass ultra-sensitive digital PET/CT images: evaluation with an anthropomorphic heart phantom
Authors: Verrecchia-Ramos Emilie , Morel Olivier , Retif Paul , Ben Mahmoud Sinan
Published: May 2021

Background

Left ventricular ejection fraction (LVEF) is usually measured by cine-cardiac magnetic resonance imaging (MRI), planar and single-photon emission-computerized tomography (SPECT) equilibrium radionuclide angiocardiography (ERNA), and echocardiography. It would be clinically useful to measure LVEF from first-pass positron-emission tomography/computed tomography (PET/CT) radionuclide angiography, but this approach has been limited by fast radiotracer diffusion. Ultra-sensitive digital PET systems can produce high-quality images within 3-s acquisition times. This study determined whether digital PET/CT accurately measured LVEF in an anthropomorphic heart phantom under conditions mimicking radiotracer first-pass into the cardiac cavities.

Methods

Heart phantoms in end-diastole and end-systole were 3D-printed from a patient’s MRI dataset. Reference left ventricle end-diastole volume (EDV), end-systole volume (ESV), and LVEF were determined by phantom weights before/after water filling. PET/CT (3-s acquisitions), MRI, and planar and SPECT ERNA were performed. EDV, ESV, and/or LVEF were measured by manual and automated cardiac cavity delineation, using clinical segmentation softwares. LVEF was also measured from PET images converted to 2D “pseudo-planar” images along the short axis and horizontal long axis. LVEF was also calculated for planar ERNA images. All LVEF, ESV and EDV values were compared to the reference values assessed by weighing.

Results

Manually calculated 3D-PET-CT-based EDV, ESV, and LVEF were close to MRI and reference values. Automated calculations on the 3D-PET-CT dataset were unreliable, suggesting that the SPECT-based tool used for this calculation is not well adapted for PET acquisitions. Manual and automated LVEF estimations from “pseudo-planar” PET images were very close/identical to MRI and reference values.

Conclusions

First-pass “pseudo-planar” PET may be a promising method for estimating LVEF, easy to use in clinical practice. Processing 3D PET images is also a valid method but to date suffers from a lack of well-suited software for automated LV segmentation.
Anesthetic management of a patient with severe aortic regurgitation undergoing reoperation for ascending aorta false aneurysm using hypothermia: prevention of ventricular fibrillation by nifekalant
Authors: Tomita Akiko , Fujimoto Tomoko , Takada Shoko , Hayashi Yukio
Published: May 2021

Background

To prevent cardiac collapse and to protect cerebral function, hypothermic cardiopulmonary bypass is established before resternotomy. However, ventricular fibrillation under hypothermia facilitates left ventricular distension, which causes irreversible myocardial damage when the patient has aortic regurgitation. We report a case of successful management in preventing ventricular fibrillation under hypothermia by using nifekalant.

Case presentation

A 56-year-old male, who had been performed a David operation, was scheduled for a Bentall operation for a pseudo aortic aneurysm with severe aortic regurgitation. After inducing anesthesia, we administered intravenous nifekalant and a vent tube was inserted into the left ventricle under one-lung ventilation. Extracorporeal circulation was established and resternotomy started after cooling to 27 °C. Although severe bradycardia and QT prolongation were observed, ventricular fibrillation did not occur until aortic cross-clamping.

Conclusion

Combining maintaining cerebral perfusion and avoiding left ventricle distension during hypothermia was successfully managed with nifekalant in our redo cardiac patient with aortic regurgitation.
Implementation and utilization of gynecological teaching associate and male urogenital teaching associate programs: a scoping review
Authors: Hopkins Holly , Weaks Chelsea , Napier Elise
Published: May 2021

Background

Gynecological Teaching Associates (GTAs) and Male Urogenital Teaching Associates (MUTAs) are individuals trained to instruct health professional learners with their own body to conduct accurate, patient-centered breast, pelvic, urogenital, rectal, and/or prostate examinations. Evidence indicates that this results in improvements in technical competence and communication skills, but there is wide variability to how such programs are implemented and engaged within the curriculum. In this scoping review, we mapped evidence regarding (1) how GTA/MUTA programs are utilized with health professional learners, (2) how GTA/MUTA programs are implemented using the Association of Standardized Patient Educators (ASPE) Standards of Best Practice (SOBP) as a framework, and (3) what broad outcomes are addressed in publications.

Methods

PubMed, ERIC, PsychINFO, CINAHL, and Sociological Abstracts were searched for all publications addressing instruction of physical examinations with a GTA/MUTA and/or administration of GTA/MUTA programs. Studies were charted in tandem until consensus was identified and then charted individually, using an iterative process. The scoping review protocol was registered prospectively.

Results

One hundred and one articles were identified, and nearly all highlighted positive results regarding GTA/MUTA programs. Most studies addressed medical students within the USA and Europe. During instructional sessions, three (SD=1.4) learners worked with each GTA/MUTA and an average of 32 min (SD=17) was allocated per learner. GTAs/MUTA instructed both independently (n=33) and in pairs (n=51). Thirty-eight articles provided detailed information consistent with one or more of the Domains of the ASPE SOBP, with six providing specific information regarding safe work environments.

Conclusions

While studies demonstrate consistently positive outcomes for learners, there is wide variability in implementation patterns. This variability may impact learning outcomes and impact both physical and psychological safety for GTAs/MUTAs and learners. Terminology used to refer to GTAs/MUTAs is inconsistent and may obscure relevant publications. Additional research is indicated to explore the pedagogical variables that result in positive learning outcomes and examine methods to ensure physical and psychological safety of GTAs/MUTAs and learners.

Trial registration

https://osf.io/x9w2u/.
Purines for Rapid Identification of Stroke Mimics (PRISM): study protocol for a diagnostic accuracy study
Authors: Shaw Lisa , Graziadio Sara , Lendrem Clare , Dale Nicholas , Ford Gary A. , Roffe Christine , Smith Craig J. , White Philip M. , Price Christopher I.
Published: May 2021

Background

Rapid treatment of stroke improves outcomes, but accurate early recognition can be challenging. Between 20 and 40% of patients suspected to have stroke by ambulance and emergency department staff later receive a non-stroke ‘mimic’ diagnosis after stroke specialist investigation. This early diagnostic uncertainty results in displacement of mimic patients from more appropriate services, inappropriate demands on stroke specialist resources and delayed access to specialist therapies for stroke patients. Blood purine concentrations rise rapidly during hypoxic tissue injury, which is a key mechanism of damage during acute stroke but is not typical in mimic conditions. A portable point of care fingerprick test has been developed to measure blood purine concentration which could be used to triage patients experiencing suspected stroke symptoms into those likely to have a non-stroke mimic condition and those likely to have true stroke. This study is evaluating test performance for identification of stroke mimic conditions.

Methods

Design: prospective observational cohort study

Setting: regional UK ambulance and acute stroke services

Participants: a convenience series of two populations will be tested: adults with a label of suspected stroke assigned (and tested) by attending ambulance personnel and adults with a label of suspected stroke assigned at hospital (who have not been tested by ambulance staff).

Index test: SMARTChip Purine assay

Reference standard tests: expert clinician opinion informed by brain imaging and/or other investigations will assign the following diagnoses which constitute the suspected stroke population: ischaemic stroke, haemorrhagic stroke, TIA and stroke mimic conditions.

Sample size: ambulance population (powered for mimic sensitivity) 935 participants; hospital population (powered for mimic specificity) 377 participants.

Analyses: area under the receiver operating curve (ROC) and optimal sensitivity, specificity, and negative and positive predictive values for identification of mimic conditions. Optimal threshold for the ambulance population will maximise sensitivity, minimum 80%, and aim to keep specificity above 70%. Optimal threshold for the hospital population will maximise specificity, minimum 80%, and aim to keep sensitivity above 70%.

Discussion

The results from this study will determine how accurately the SMARTChip purine assay test can identify stroke mimic conditions within the suspected stroke population. If acceptable performance is confirmed, deployment of the test in ambulances or emergency departments could enable more appropriate direction of patients to stroke or non-stroke services.

Trial registration

Registered with ISRCTN (identifier: ISRCTN22323981) on 13/02/2019 http://www.isrctn.com/ISRCTN22323981
Reducing the risk of bleeding after myomectomy: is preemptive embolization a valuable tool?
Authors: Abrahami Ylann , Najid Sophia , Petit Arthur , Sauvanet Eric , Novelli Luigi
Published: May 2021

Purpose

Abdominal myomectomy can be a challenging procedure, with elevated intraoperative blood loss and post-operative complications such as the need for blood transfusion and hemostasis with sometimes hysterectomy. Previous studies suggested that preemptive uterine artery embolization (PUAE) might reduce intraoperative blood loss.

Materials and methods

We reviewed all cases of abdominal myomectomy in our institution between January 2016 and June 2018. Out of 119 cases, 16 patients had PUAE and 103 did not. The objective of our study was to determine whereas PUAE reduced blood loss and post-operative complication rate.

Results

In our study, there was no difference between the two groups in regard to average blood loss (128 vs 192 mL, OR 1,00 [0.99;1,01], p = 0,73), difference between pre- and post-operative hemoglobin level (− 1,15 g/dL vs − 1,32 g/dL, OR 0,91 [0.47;1,73], p = 0,79), and post-operative complications (need for transfusion, surgical revision, post-operative embolization, hysterectomy).

Conclusion

Our findings could not conclude that PUAE is effective in reducing intraoperative blood loss during abdominal myomectomy, but it should still be considered an option for patients with large or multiple myomas, with a specific situation or previously operated, who wish to preserve their uterus.
Enhancement of drought tolerance in Triticum aestivum L. seedlings using Azospirillum brasilense NO40 and Stenotrophomonas maltophilia B11
Authors: Kasim Wedad A. , Osman Mohamed E. H. , Omar Mohamed N. , Salama Samar
Published: May 2021

Background

The effectiveness of two PGPB; Azospirillum brasilense NO40 and Stenotrophomonas maltophilia B11 was investigated in enhancing the drought tolerance of wheat (Triticum aestivum L.) seedlings cultivar Gemiza9. The inoculated or uninoculated grains were sown in unsterilized sandy soil and watered normally untill the 8th day. Drought stress was initiated by completely withholding water for 7 days (until wilting). Samples were collected after 15 days from sowing to evaluate some growth criteria, damage and defense indicators and to analyze the roots’ protein pattern.

Results

The results showed that inoculating wheat seedlings with these strains significantly diminished the inhibitory effects of drought stress on the relative water content of roots, shoots and leaves; area of leaves; contents of pigments (chlorophyll a and b) and ascorbic acid; and on the protein patterns of roots. Moreover, the bacterial inoculation notably reduced the drought-induced damage indicated by lower leakage of electrolytes and less accumulation of Malondialdehyde and hydrogen peroxide, surprisingly with less enhanced production of proline and activities of catalase and peroxidase than their uninoculated counterparts. Under normal conditions, inoculating wheat plants with these PGPB resulted in significantly promoted growth and elevated contents of pigments and altered protein patterns of roots.

Conclusion

Overall, we can say that both Azospirillum brasilense NO40 and Stenotrophomonas maltophilia B11 were able to deactivate the growth inhibition in wheat seedlings to some extent, while maintaining a certain level of efficient protection against damage under drought stress.
An association study between FokI, BsmI, miR-146a, and miR-155 and Behcet’s disease in the Egyptian population
Authors: Emara Mohamed M. , Mahmoud Maiada M. , Saad Mohamed N. , Mabrouk Mai S. , Hamed Mohamed , Shaker Olfat G.
Published: May 2021

Background

Behcet’s disease (BD) is a systemic inflammatory disease of the blood vessels and affects various body parts. This study aimed to determine the association of four single-nucleotide polymorphisms (SNPs) and BD in the Egyptian population using multiple statistical models and show the resulting associations along with previous studies of different populations. Four SNPs were examined for their association with BD: two SNPs from vitamin D receptor gene (FokI and BsmI) were selected and the other two were selected from miR-146a and miR-155. These four SNPs were selected for their association and role with BD in different populations and in the immune system. A marker check was conducted using the Hardy-Weinberg equilibrium and minor allele frequency. The associations were tested using four different statistical models: multiplicative, dominant, recessive, and codominant models. All statistical models used the odd’s ratio (OR) with confidence interval (CI) of 95% to evaluate the association of each SNP.

Results

BsmI showed association using the four models, while FokI did not show any association through any model. miR-155 showed association using the multiplicative and recessive models. miR-146a showed association using the multiplicative model only.

Conclusions

As a result, BsmI, miR-155, and miR-146a SNPs could have a role in the development of BD in the Egyptian population, while FokI could have a weak role, if any, in the development of BD in the Egyptian population.
A mixed methods evaluation of the large-scale implementation of a school- and community-based parenting program to reduce violence against children in Tanzania: a study protocol
Authors: Martin Mackenzie , Lachman Jamie , Wamoyi Joyce , Shenderovich Yulia , Wambura Mwita , Mgunga Samwel , Ndyetabura Esther , Ally Amal , Barankena Asheri , Exavery Amon , Manjengenja Nyasha
Published: May 2021

Background

Despite the rapid dissemination of parenting programs aiming to reduce and prevent violence against children (VAC) worldwide, there is limited knowledge about and evidence of the implementation of these programs at scale. This study addresses this gap by assessing the quality of delivery and impact of an evidence-based parenting program for parents/caregivers and their adolescent girls aged 9 to 14—Parenting for Lifelong Health Teens (PLH-Teens), known locally as Furaha Teens—on reducing VAC at scale in Tanzania. The study will explore participating family and staff perspectives on program implementation and examine factors associated with implementation and how implementation quality is associated with intervention outcomes when the program is delivered to approximately 50,000 parent-child dyads (N = 100,000) in schools and community centers across eight districts of Tanzania.

Methods

This mixed-methods study will answer the following research questions: (1) what is the implementation quality and fidelity of PLH-Teens at scale in Tanzania; (2) what factors are associated with the quality of delivery and implementation fidelity of PLH-Teens; (3) how are implementation quality and fidelity associated with intervention outcomes; (4) what are participant and implementing staff perspectives on the acceptability, appropriateness, feasibility, benefits, and challenges of delivering PLH-Teens in their schools and communities; (5) what is the impact of PLH-Teens on VAC and participant well-being; and (6) how much does it cost to deliver PLH-Teens at scale? Qualitative and quantitative data will be collected directly from implementers, parents/caregivers, and adolescents using pre-post questionnaires, observational assessments, cost surveys, focus groups, and interviews. Qualitative data will be analyzed thematically with the aid of NVIVO software. Quantitative data will be cleaned and analyzed using methods such as correlation, regression, and structural equation models using Stata and R. COREQ and TREND guidelines will be used, where appropriate.

Discussion

Findings will provide vital insights into some of the factors related to quality implementation at scale. Lessons learned regarding the implementation of PLH-Teens at scale will be applied in Tanzania, and also in the delivery of PLH parenting programs globally.
The bucket test reinterpreted: a study on benign paroxysmal positional vertigo and Ménière’s disease patients
Authors: Castro-Urquizo Angel , Celis-Aguilar Erika , Rubio-Partida Guillermo Alejandro
Published: May 2021

Background

The bucket test is a simple and practical instrument to evaluate vestibular diseases; additionally, it could be a useful tool in the evaluation of the vertigo patient. Unfortunately, the bucket test still lacks standardization. The objective of this study was to evaluate and to interpret the subjective visual vertical (SVV) using the bucket test in benign paroxysmal positional vertigo (BPPV) and Ménière’s disease patients. We performed a cross-sectional study in a secondary care center. All patients with diagnosis of unilateral posterior canal BPPV or Ménière’s disease underwent complete neuro-otological physical examination and the bucket test. Normal bucket test was 0° to 3° according to previous study.

Results

We included seventy-eight subjects. Benign paroxysmal positional vertigo cases (n = 51) showed a mean 2.62° of SVV prior to the Epley maneuver and 1.7° of SVV after the maneuver (p = < 0.001), 57% of patients with BPPV were categorized as abnormal. Inactive Ménière’s disease patients (n = 22) had mean SVV of 2.74° and Ménière’s disease with active crisis (n = 5) had 5.06° of SVV (p = 0.002).

Conclusion

The bucket test is a simple and useful test for the evaluation of SVV, and it has a role in the evaluation of patients with active vestibular diseases such as Ménière’s disease and BPPV.
Towards estimating the economic cost of invasive alien species to African crop and livestock production
Authors: Eschen René , Beale Tim , Bonnin J. Miguel , Constantine Kate L. , Duah Solomon , Finch Elizabeth A. , Makale Fernadis , Nunda Winnie , Ogunmodede Adewale , Pratt Corin F. , Thompson Emma , Williams Frances , Witt Arne , Taylor Bryony
Published: May 2021

Background

Invasive alien species (IAS) cause significant economic losses in all parts of the world. Although IAS are widespread in Africa and cause serious negative impacts on livelihoods as a result of yield losses and increased labour costs associated with IAS management, few data on the impacts are available in the literature and the magnitude and extent of the costs are largely unknown. We estimated the cost of IAS to agriculture, the most important economic sector in Africa.

Methods

Data on the monetary costs of IAS to mainland Africa as well as information about the presence and abundance of the most important IAS were collected through literature review and an online survey among a wide variety of stakeholders. Using this and additional data from publicly available sources we estimated yield losses and management costs due to IAS in agriculture for individual countries and the entire continent. Where the data allowed, the costs for selected IAS or crops were estimated separately. The estimates were extrapolated using production and distribution data and/or matching of agro-ecological zones.

Results

The total estimated annual cost of IAS to agriculture in Africa is USD 65.58 Bn. Management costs (comprising mainly labour costs associated with weeding), crop yield losses and reductions in livestock derived income constitute the majority of the estimated cost (55.42, 44.31 and 0.26 percent, respectively). The IAS causing the highest yield losses was Spodoptera frugiperda (USD 9.4 Bn).

Conclusions

This study reveals the extent and scale of the economic impacts of IAS in the agricultural sector in one of the least studied continents. Although the cost estimate presented here is significant, IAS also cause major costs to other sectors which could not be assessed due to data deficit. The results highlight the need for pre-emptive management options, such as prevention and early detection and rapid response to reduce huge potential future costs, as well as measures that contribute to large-scale control of widely established IAS at little cost to farmers and other affected land users, to reduce losses and improve livelihoods.