bluuebunny/crossref_metadata_2025 huggingface dataset:
Increased sensitivity to SMAC mimetic LCL161 identified by longitudinal ex vivo pharmacogenomics of recurrent, KRAS mutated rectal cancer liver metastases
Authors: Kryeziu Kushtrim , Moosavi Seyed H. , Bergsland Christian H. , Guren Marianne G. , Eide Peter W. , Totland Max Z. , Lassen Kristoffer , Abildgaard Andreas , Nesbakken Arild , Sveen Anita , Lothe Ragnhild A.
Published: September 2021

Tumor heterogeneity is a primary cause of treatment failure. However, changes in drug sensitivity over time are not well mapped in cancer. Patient-derived organoids (PDOs) may predict clinical drug responses ex vivo and offer an opportunity to evaluate novel treatment strategies in a personalized fashion. Here we have evaluated spatio-temporal functional and molecular dynamics of five PDO models established after hepatic re-resections and neoadjuvant combination chemotherapies in a patient with microsatellite stable and KRAS mutated metastatic rectal cancer. Histopathological differentiation phenotypes of the PDOs corresponded with the liver metastases, and ex vivo drug sensitivities generally reflected clinical responses and selection pressure, assessed in comparison to a reference data set of PDOs from metastatic colorectal cancers. PDOs from the initial versus the two recurrent metastatic settings showed heterogeneous cell morphologies, protein marker expression, and drug sensitivities. Exploratory analyses of a drug screen library of 33 investigational anticancer agents showed the strongest ex vivo sensitivity to the SMAC mimetic LCL161 in PDOs of recurrent disease compared to those of the initial metastasis. Functional analyses confirmed target inhibition and apoptosis induction in the LCL161 sensitive PDOs from the recurrent metastases. Gene expression analyses indicated an association between LCL161 sensitivity and tumor necrosis factor alpha signaling and RIPK1 gene expression. In conclusion, LCL161 was identified as a possible experimental therapy of a metastatic rectal cancer that relapsed after hepatic resection and standard systemic treatment.
Clinicians’ perceptions of a potential wearable device for capturing upper limb activity post-stroke: a qualitative focus group study
Authors: Simpson Lisa A. , Menon Carlo , Hodgson Antony J. , Ben Mortenson W. , Eng Janice J.
Published: September 2021

Background

There is growing interest in the use of wearable devices that track upper limb activity after stroke to help determine and motivate the optimal dose of upper limb practice. The purpose of this study was to explore clinicians’ perceptions of a prospective wearable device that captures upper limb activity to assist in the design of devices for use in rehabilitation practice.

Methods

Four focus groups with 18 clinicians (occupational and physical therapists with stroke practice experience from a hospital or private practice setting) were conducted. Data were analyzed thematically.

Results

Our analysis revealed three themes: (1) “Quantity and quality is ideal” emphasized how an ideal device would capture both quantity and quality of movement; (2) “Most useful outside therapy sessions” described how therapists foresaw using the device outside of therapy sessions to monitor homework adherence, provide self-monitoring of use, motivate greater use and provide biofeedback on movement quality; (3) “User-friendly please” advocated for the creation of a device that was easy to use and customizable, which reflected the client-centered nature of their treatment.

Conclusions

Findings from this study suggest that clinicians support the development of wearable devices that capture upper limb activity outside of therapy for individuals with some reach to grasp ability. Devices that are easy to use and capture both quality and quantity may result in greater uptake in the clinical setting. Future studies examining acceptability of wearable devices for tracking upper limb activity from the perspective of individuals with stroke are needed.
Pulmonary delivery of the broad-spectrum matrix metalloproteinase inhibitor marimastat diminishes multiwalled carbon nanotube-induced circulating bioactivity without reducing pulmonary inflammation
Authors: Young Tamara L. , Mostovenko Ekaterina , Denson Jesse L. , Begay Jessica G. , Lucas Selita N. , Herbert Guy , Zychowski Katherine , Hunter Russell , Salazar Raul , Wang Ting , Fraser Kelly , Erdely Aaron , Ottens Andrew K. , Campen Matthew J.
Published: September 2021

Background

Multiwalled carbon nanotubes (MWCNT) are an increasingly utilized engineered nanomaterial that pose the potential for significant risk of exposure-related health outcomes. The mechanism(s) underlying MWCNT-induced toxicity to extrapulmonary sites are still being defined. MWCNT-induced serum-borne bioactivity appears to dysregulate systemic endothelial cell function. The serum compositional changes after MWCNT exposure have been identified as a surge of fragmented endogenous peptides, likely derived from matrix metalloproteinase (MMP) activity. In the present study, we utilize a broad-spectrum MMP inhibitor, Marimastat, along with a previously described oropharyngeal aspiration model of MWCNT administration to investigate the role of MMPs in MWCNT-derived serum peptide generation and endothelial bioactivity.

Results

C57BL/6 mice were treated with Marimastat or vehicle by oropharyngeal aspiration 1 h prior to MWCNT treatment. Pulmonary neutrophil infiltration and total bronchoalveolar lavage fluid protein increased independent of MMP blockade. The lung cytokine profile similarly increased following MWCNT exposure for major inflammatory markers (IL-1β, IL-6, and TNF-α), with minimal impact from MMP inhibition. However, serum peptidomic analysis revealed differential peptide compositional profiles, with MMP blockade abrogating MWCNT-derived serum peptide fragments. The serum, in turn, exhibited differential potency in terms of inflammatory bioactivity when incubated with primary murine cerebrovascular endothelial cells. Serum from MWCNT-treated mice led to inflammatory responses in endothelial cells that were significantly blunted with serum from Marimastat-treated mice.

Conclusions

Thus, MWCNT exposure induced pulmonary inflammation that was largely independent of MMP activity but generated circulating bioactive peptides through predominantly MMP-dependent pathways. This MWCNT-induced lung-derived bioactivity caused pathological consequences of endothelial inflammation and barrier disruption.
Depression and anxiety symptoms in young adults before and during the COVID-19 pandemic: evidence from a Canadian population-based cohort
Authors: Watkins-Martin Kia , Orri Massimiliano , Pennestri Marie-Hélène , Castellanos-Ryan Natalie , Larose Simon , Gouin Jean-Philippe , Ouellet-Morin Isabelle , Chadi Nicholas , Philippe Frederick , Boivin Michel , Tremblay Richard E. , Côté Sylvana , Geoffroy Marie-Claude
Published: September 2021

Background

Concerns have been raised that the COVID-19 pandemic could increase risk for adverse mental health outcomes, especially in young adults, a vulnerable age group. We investigated changes in depression and anxiety symptoms (overall and severe) from before to during the pandemic, as well as whether these changes are linked to COVID-19-related stressors and pre-existing vulnerabilities in young adults followed in the context of a population-based cohort.

Method

Participants (n = 1039) from the Quebec Longitudinal Study of Child Development reported on their depression (Centre for Epidemiological Studies Depression Scale, short form) and anxiety (General Anxiety Disorder-7 Scale) symptoms and completed a COVID-19 questionnaire during the first wave of the COVID-19 pandemic in the summer of 2020 (age 22 years). Assessments at age 20 (2018) were used to estimate pre-pandemic depression and anxiety symptom severity.

Results

While mean levels of depression and anxiety symptoms did not change from before to during the first wave of the COVID-19 pandemic (e.g., the mean of depressive symptoms was 9.30 in 2018 and 9.59 in 2020), we observed a slight increase in rates of severe depression (scores ≥ 21) from before (6.1%) to during (8.2%) the pandemic. Most COVID-19-related variables (e.g., loss of education/occupation, frequent news-seeking) – except living alone – and most pre-existing vulnerabilities (e.g., low SES, low social support) were not associated with changes in depression or anxiety symptoms. However, results varied as a function of pre-pandemic levels of depression and anxiety: depression and anxiety symptoms increased among adults with the lowest levels of symptoms before the pandemic, while they decreased among those with the highest levels of symptoms, possibly reflecting a regression to the mean.

Conclusions

Depression and anxiety symptoms in young adults from Québec in Summer 2020 were mostly comparable to symptoms reported in 2018. Most COVID-19-related stressors and pre-existing vulnerabilities were not associated with changes in symptoms, except living alone and pre-existing symptoms of depression and anxiety. However, the increased rate of severe depression warrants further investigation.
In situ conservation of traditional vegetable diversity in Wa homegardens in southwestern Yunnan, China
Authors: Shao Hua , Hill Rosemary , Xue Dayuan , Yang Jingbiao
Published: September 2021

Background

Homegardens are in situ conservation sources of germplasm diversity for overcoming homogenous germplasm problems in industrial agricultural systems. The Wa people constitute a long-dwelling ethnic group mainly in southwestern Yunnan with a unique culture and rich knowledge of traditional vegetables. We hypothesized that traditional vegetable varieties are well conserved in Wa homegardens because Wa culture promotes the preservation of traditional vegetables. We surveyed vegetable varieties and the practices that are involved in the conservation of traditional vegetables in Wa homegardens, which could form the basis for in situ conservation.

Methods

The methods were used including questionnaires and semi-structured interviews. Sixty homegardens were surveyed through purposive sampling in 6 Wa villages. We documented ethnobotanical information about vegetables in homegardens. Plant species were identified according to the Flora of China. And thematic analyses were conducted for in-depth interviews to identify the conservation factors for traditional vegetables.

Results

Fifty-two vegetable species belonging to 16 families and 41 genera were recorded from 60 Wa homegardens. Fifty-five traditional vegetable varieties and thirty-six hybrids were recorded. Among all the villages, 23 ± 6 (average ± SD) traditional vegetable varieties per homegarden and 9 ± 3 (average ± SD) introduced varieties per homegarden were recorded. Local seeds were stored in 78% of households, with an additional 9% of households’ seed supplies coming from neighbors and relatives; the other 13% of households purchased local seeds from markets. In 83% of families, the female head was mainly responsible for the decision-making concerning traditional vegetables in homegardens; in 10% of families, the male head was responsible for decision-making, and a small percentage (2%) was determined by elderly people. Five percent of families made decisions jointly between male and female household heads.

Conclusions

This study demonstrated that rich traditional germplasm diversity is harbored in Wa homegardens because of the unique culture and traditional knowledge of Wa communities, which are practiced daily with homegrown food plants. Local vegetable seed conservation and sharing systems help maintain germplasm diversity in the Wa community homegardens. Wa homegardens constitute a practical solution for protecting traditional germplasm diversity and maintaining traditional lifestyles.
Subtotal cholecystectomy for difficult acute cholecystitis: how to finalize safely by laparoscopy—a systematic review
Authors: Toro Adriana , Teodoro Michele , Khan Mansoor , Schembari Elena , Di Saverio Salomone , Catena Fausto , Di Carlo Isidoro
Published: September 2021

Background

Aim of this study was to clarify the best laparoscopic subtotal cholecystectomy (LSTC) technique for finalizing a difficult cholecystectomy.

Patients and methods

A review was performed (1987–2021) searching "difficulty cholecystectomy" AND/OR "subtotal cholecystectomy". The LSTC techniques considered were as follows: type A, leaving posterior wall attached to the liver and the remainder of the gallbladder stump open; type B, like type A but with the stump closed; type C, resection of both the anterior and posterior gallbladder walls and the stump closed; type D, like type C but with the stump open. Morbidity (including mortality) was analysed with Dindo–Clavien classification.

Results

Nineteen articles were included. Of the 13,340 patients screened, 678 (8.2%) had cholecystectomy finalized by LSTC: 346 patients (51.0%) had type A LSTC, 134 patients (19.8%) had type B LSTC, 198 patients (29.2%) had type C LSTC, and 198 patients (0%) had type D LSTC. Bile leakage was found in 83 patients (12.2%), and recorded in 58 patients (69.9%) treated by type A. Twenty-three patients (3.4%) developed a subhepatic collection, 19 of whom (82.6%) were treated by type A. Other complications were reported in 72 patients (10.6%). The Dindo–Clavien classification was four for grade I, 27 for grade II, 126 for grade IIIa, 18 for grade IIIb, zero for grade IV and three for grade V.

Conclusion

In the case of LSTC, closure of the gallbladder stump represents the best method to avoid complications. Careful exploration of the gallbladder stump is mandatory, washing the abdominal cavity and leaving drainage.
Trampoline-related fractures of the proximal tibia in children
Authors: Jeong Changhoon , Lee Sang Uk , Kim Hyun Gyun , Joo Sun Young
Published: September 2021

Background

Trampoline-related fractures of the proximal tibial metaphysis are common in children and have been linked to subsequent valgus deformity of the tibia. The purpose of this study was to investigate the characteristics of trampoline-related proximal tibial fractures in young children.

Methods

We evaluated 40 patients with proximal tibial fracture after trampolining between 2013 and 2019. The median duration of follow-up was 18 months. Standing long leg radiographs were obtained at the last follow-up to evaluate angular deformity and limb length inequality in the patients. The measurements recorded include the lower limb length, mechanical lateral distal femoral angle (mLDFA), medial proximal tibial angle (MPTA), mechanical axis deviation (MAD), and anatomical tibio-femoral angle (aTFA). The anterior tilt angle (ATA) was measured using a lateral radiograph of the tibia.

Results

The median age at injury was 40.0 months. Using trampoline with a heavier person was the most common mechanism of injury. aTFA and MAD were found to be increased towards the valgus at the last follow-up in our patient; however, the increase was not statistically significant (p = 0.692 and p = 0.973, respectively). The anterior tilt angle was increased in the injured leg at the last follow-up. But the change was not statistically significant (p = 0.09).

Conclusions

Using trampoline with a heavier person carries the risk of trampoline-related proximal tibial fracture in young children. We did not find a significant change in limb alignment at a minimum of one year of follow-up.
Aortic valve replacement in pediatric patients: 30 years single center experience
Authors: Schlein Johanna , Simon Paul , Wollenek Gregor , Base Eva , Laufer Günther , Zimpfer Daniel
Published: September 2021

Background

The choice of aortic valve replacement needs to be decided in an interdisciplinary approach and together with the patients and their families regarding the need for re-operation and risks accompanying anticoagulation. We report long-term outcomes after different AVR options.

Methods

A chart review of patients aged < 18 years at time of surgery, who had undergone AVR from May 1985 until April 2020 was conducted. Contraindications for Ross procedure, which is performed since 1991 at the center were reviewed in the observed non-Ross AVR cohort. The study endpoints were compared between the mechanical AVR and the biological AVR cohort.

Results

From May 1985 to April 2020 fifty-five patients received sixty AVRs: 33 mechanical AVRs and 27 biological AVRs. In over half of the fifty-three AVRs performed after 1991 (58.5%; 31/53) a contraindication for Ross procedure was present. Early mortality was 5% (3/60). All early deaths occurred in patients aged < 1 year at time of surgery. Two late deaths occurred and survival was 94.5% ± 3.1% at 10 years and 86.4% ± 6.2% at 30 years. Freedom from aortic valve re-operation was higher (p < 0.001) in the mechanical AVR than in the biological AVR cohort with 95.2% ± 4.6% and 33.6% ± 13.4% freedom from re-operation at 10 years respectively.

Conclusions

Re-operation was less frequent in the mechanical AVR cohort than in the biological AVR cohort. For mechanical AVR, the risk for thromboembolic and bleeding events was considerable with a composite linearized event rate per valve-year of 3.2%.
Effects of seasonal and climate variations on in-hospital mortality and length of stay in patients with type A aortic dissection
Authors: Luo Zeng-Rong , Lin Zhi-Qin , Chen Liang-wan , Qiu Han-Fan
Published: September 2021

Objective

To investigate the effects of seasonal and climatic changes on postoperative in-hospital mortality and length of stay (LOS) in patients with type A acute aortic dissection (AAD).

Methods

Patients undergoing implantation of the modified triple-branched stent graft to replace the descending aorta in addition to aortic root reconstruction for type A AAD in our hospital from January 2016 to December 2019 were included. Relevant data were retrospectively collected and analyzed.

Results

A total of 404 patients were included in our analyses. The multivariate unconditional logistic regression analysis showed that patients admitted in autumn (OR 4.027, 95% CI 1.023–17.301, P = 0.039) or with coronary heart disease (OR 8.938, 95% CI 1.991–29.560, P = 0.049) were independently associated with an increased risk of postoperative in-hospital mortality. Furthermore, patients admitted in autumn (OR 5.956, 95% CI 2.719–7.921, P = 0.041) or with hypertension (OR 3.486, 95% CI 1.192–5.106, P = 0.035) were independently associated with an increased risk of longer LOS.

Conclusion

Patients admitted in autumn or with coronary heart disease are at higher risk of in-hospital mortality following surgery for type A AAD. Also, patients admitted in autumn or with hypertension have a longer hospital LOS. In the autumn of the temperature transition, we may need to strengthen the management of medical quality after surgery for type A AAD.
In the VEST trial: are we missed to address the pathology incurred by the external stent?
Authors: Palanisamy Vijayanand , Kurian Valikapthalil Mathew , sethuratnam Rajan
Published: September 2021

In the VEST IV trial, the author concluded that external stenting of saphenous vein graft mitigates its remodeling and also significantly reduces the diffuse intimal hyperplasia and development of lumen irregularities at 4.5 years after coronary artery bypass grafting surgery. We also have valuable a suggestion in addition to external stenting that might nullify the pathology caused by the stent and might enhances graft patency.
The effects of the COVID-19 pandemic on patients with lysosomal storage disorders in Israel
Authors: Kristal Eyal , Pode-Shakked Ben , Hazan Guy , Banne Ehud , Ling Galina , David Odeya , Shany Eilon , Raas-Rothschild Annick , Anikster Yair , Kneller Katya , Hershkovitz Eli , Landau Yuval E. , Spiegel Ronen , Zehavi Yoav , Staretz-Chacham Orna
Published: September 2021

Background

Severe acute respiratory syndrome coronavirus 2 (SARS CoV-2) is the causative agent of the current COVID-19 pandemic. Lysosomal storage disorders (LSD) comprise of 70 inherited inborn errors of metabolism. Affected individuals suffer from multi-systemic involvement with variable severity and rate of disease progression between different diseases. Some of the LSDs have established treatments, whether parenteral or oral therapies. The full impact of the COVID-19 pandemic together with the lockdown on the wellbeing and medical management of patients with rare diseases, such as LSDs, is widely unknown. Herein, we describe the effects of the COVID-19 pandemic and its associated mandatory home lockdown on patients with LSDs in Israel.

Results

We present a prospective multi-center questionnaire study including 48 LSD patients from four medical centers in Israel. The study objective was to assess the impact of the COVID-19 pandemic restrictions on individuals with LSDs in Israel, as reported by their caregivers. Secondary objectives were to assess the morbidity from SARS CoV-2 in LSD patients and the impact of changes in mood and behavior on compliance to treatment and to assess the relationship between changes in mood to changes in cognition and behavior. Thirty one of 38 patients (82%) who received any kind of regular treatment did not miss treatments. Among patients receiving enzyme replacement therapy (ERT) in the in-hospital setting, 5 patients (20%) experienced treatment disruptions. Four patients had tested positive for SARS-Cov-2 virus infection by PCR. Seven out of the 48 patients (14%) described mood changes with cognitive and motor deterioration during the home quarantine.

Conclusions

We observed high rates of treatment adherence and low morbidity through the COVID-19 pandemic in patients with LSDs in Israel. LSDs patients can be a model for patients with complex chronic diseases requiring routine treatments and surveillance during a pandemic or other disruption of daily routine.
Functional organization of the midbrain periaqueductal gray for regulating aversive memory formation
Authors: Yeh Li-Feng , Ozawa Takaaki , Johansen Joshua P.
Published: September 2021

Innately aversive experiences produce rapid defensive responses and powerful emotional memories. The midbrain periaqueductal gray (PAG) drives defensive behaviors through projections to brainstem motor control centers, but the PAG has also been implicated in aversive learning, receives information from aversive-signaling sensory systems and sends ascending projections to the thalamus as well as other forebrain structures which could control learning and memory. Here we sought to identify PAG subregions and cell types which instruct memory formation in response to aversive events. We found that optogenetic inhibition of neurons in the dorsolateral subregion of the PAG (dlPAG), but not the ventrolateral PAG (vlPAG), during an aversive event reduced memory formation. Furthermore, inhibition of a specific population of thalamus projecting dlPAG neurons projecting to the anterior paraventricular thalamus (aPVT) reduced aversive learning, but had no effect on the expression of previously learned defensive behaviors. By contrast, inactivation of dlPAG neurons which project to the posterior PVT (pPVT) or centromedial intralaminar thalamic nucleus (CM) had no effect on learning. These results reveal specific subregions and cell types within PAG responsible for its learning related functions.
Modulating tumor infiltrating myeloid cells to enhance bispecific antibody-driven T cell infiltration and anti-tumor response
Authors: Park Jeong A. , Wang Linlin , Cheung Nai-Kong V.
Published: September 2021

Background

Tumor microenvironment (TME) is a dynamic cellular milieu to promote tumor angiogenesis, growth, proliferation, and metastasis, while derailing the host anti-tumor response. TME impedes bispecific antibody (BsAb) or chimeric antigen receptor (CAR)-driven T cells infiltration, survival, and cytotoxic efficacy. Modulating tumor infiltrating myeloid cells (TIMs) could potentially improve the efficacy of BsAb.

Methods

We evaluated the effects of TIM modulation on BsAb-driven T cell infiltration into tumors, their persistence, and in vivo anti-tumor response. Anti-GD2 BsAb and anti-HER2 BsAb built on IgG-[L]-scFv platform were tested against human cancer xenografts in BALB-Rag2−/−IL-2R-γc-KO (BRG) mice. Depleting antibodies specific for polymorphonuclear myeloid-derived suppressor cell (PMN-MDSC), monocytic MDSC (M-MDSC), and tumor associated macrophage (TAM) were used to study the role of each TIM component. Dexamethasone, an established anti-inflammatory agent, was tested for its effect on TIMs.

Results

BsAb-driven T cells recruited myeloid cells into human tumor xenografts. Each TIM targeting therapy depleted cells of interest in blood and in tumors. Depletion of PMN-MDSCs, M-MDSCs, and particularly TAMs was associated with enhanced T cell infiltration into tumors, significantly improving tumor control and survival in multiple cancer xenograft models. Dexamethasone premedication depleted monocytes in circulation and TAMs in tumors, enhanced BsAb-driven T cell infiltration, and anti-tumor response with survival benefit.

Conclusion

Reducing TIMs markedly enhanced anti-tumor effects of BsAb-based T cell immunotherapy by improving intratumoral T cell infiltration and persistence. TAM depletion was more effective than PMN- or M-MDSCs depletion at boosting the anti-tumor response of T cell engaging BsAb.
Perceptions and satisfaction of a mandatory continuing professional development programme amongst Aotearoa New Zealand podiatrists
Authors: Carroll Matthew , Brenton‐Rule Angela , Jepson Hannah , Molyneux Prue
Published: September 2021

Background

Aotearoa New Zealand (NZ) registered podiatrists are required to participate in a mandatory continuing professional development (CPD) programme. This study investigated podiatrist's perceptions and satisfaction surrounding mandatory CPD requirements following the implementation of a new 2‐year CPD programme.

Methods

A cross‐sectional study of NZ registered podiatrists was conducted between October 9th and December 9th, 2020. Data was collected using a web‐based survey. The 39‐item survey included questions to elicit participant characteristics, perceptions of CPD, difficulties undertaking CPD, and satisfaction with the new CPD programme. The survey findings were reported using descriptive statistics and conventional content analysis.

Results

One hundred and thirty‐four podiatrists completed the survey. Most respondents worked in private practice (n = 107, 80 %), were in full‐time employment (n = 83, 62 %), and had greater than 16 years of work experience (n = 73, 54 %). Respondents agreed it was important to engage in CPD (n = 126, 94 %) and reported that knowledge gained from CPD contributed to their daily work (n = 78, 58 %). 44 % (n = 58) reported difficulties keeping up to date with CPD. The main barriers to CPD participation reported were workload (n = 90, 67 %) and lack of time (n = 84, 63 %). Three categories (understanding the CPD programme; access to CPD; and time to complete CPD) were identified from the qualitative analysis to describe why it was difficult to meet CPD requirements.

Conclusions

NZ podiatrists value CPD and are satisfied with most aspects of the mandatory CPD programme apart from the hours attributed to compulsory activities. The current approach to cultural safety CPD requires revision, with a move away from a time‐based approach to a system that promotes an understanding and relevance to practice. Lack of time, practice workload, financial barriers, geographical location, and employment context were factors that influenced a practitioner's ability to engage in CPD. Facilitation of CPD activities that are flexible to ensure relevance to the practitioner's specific work within their scope of practice, and that can occur in the workplace environment, may address barriers and increase engagement with to CPD activities.
The use of head helmets to deliver noninvasive ventilatory support: a comprehensive review of technical aspects and clinical findings
Authors: Coppadoro Andrea , Zago Elisabetta , Pavan Fabio , Foti Giuseppe , Bellani Giacomo
Published: September 2021

A helmet, comprising a transparent hood and a soft collar, surrounding the patient’s head can be used to deliver noninvasive ventilatory support, both as continuous positive airway pressure and noninvasive positive pressure ventilation (NPPV), the latter providing active support for inspiration. In this review, we summarize the technical aspects relevant to this device, particularly how to prevent CO2rebreathing and improve patient–ventilator synchrony during NPPV. Clinical studies describe the application of helmets in cardiogenic pulmonary oedema, pneumonia, COVID-19, postextubation and immune suppression. A section is dedicated to paediatric use. In summary, helmet therapy can be used safely and effectively to provide NIV during hypoxemic respiratory failure, improving oxygenation and possibly leading to better patient-centred outcomes than other interfaces.
Machine-learning-based COVID-19 mortality prediction model and identification of patients at low and high risk of dying
Authors: Banoei Mohammad M. , Dinparastisaleh Roshan , Zadeh Ali Vaeli , Mirsaeidi Mehdi
Published: September 2021

Background

The coronavirus disease 2019 (COVID-19) pandemic caused by the SARS-Cov2 virus has become the greatest health and controversial issue for worldwide nations. It is associated with different clinical manifestations and a high mortality rate. Predicting mortality and identifying outcome predictors are crucial for COVID patients who are critically ill. Multivariate and machine learning methods may be used for developing prediction models and reduce the complexity of clinical phenotypes.

Methods

Multivariate predictive analysis was applied to 108 out of 250 clinical features, comorbidities, and blood markers captured at the admission time from a hospitalized cohort of patients (N = 250) with COVID-19. Inspired modification of partial least square (SIMPLS)-based model was developed to predict hospital mortality. Prediction accuracy was randomly assigned to training and validation sets. Predictive partition analysis was performed to obtain cutting value for either continuous or categorical variables. Latent class analysis (LCA) was carried to cluster the patients with COVID-19 to identify low- and high-risk patients. Principal component analysis and LCA were used to find a subgroup of survivors that tends to die.

Results

SIMPLS-based model was able to predict hospital mortality in patients with COVID-19 with moderate predictive power (Q2 = 0.24) and high accuracy (AUC > 0.85) through separating non-survivors from survivors developed using training and validation sets. This model was obtained by the 18 clinical and comorbidities predictors and 3 blood biochemical markers. Coronary artery disease, diabetes, Altered Mental Status, age > 65, and dementia were the topmost differentiating mortality predictors. CRP, prothrombin, and lactate were the most differentiating biochemical markers in the mortality prediction model. Clustering analysis identified high- and low-risk patients among COVID-19 survivors.

Conclusions

An accurate COVID-19 mortality prediction model among hospitalized patients based on the clinical features and comorbidities may play a beneficial role in the clinical setting to better management of patients with COVID-19. The current study revealed the application of machine-learning-based approaches to predict hospital mortality in patients with COVID-19 and identification of most important predictors from clinical, comorbidities and blood biochemical variables as well as recognizing high- and low-risk COVID-19 survivors.
Efficacy and safety of electroacupuncture combined with Suanzaoren decoction for insomnia following stroke: study protocol for a randomized controlled trial
Authors: Huang Hui-lian , Yang Song-bai , Mei Zhi-gang , Huang Ya-guang , Chen Mao-hua , Mei Qun-li , Lei Hua-ping , Mei Qing-xian , Chen Jian-hua
Published: September 2021

Background

Insomnia is a common but frequently overlooked sleep disorder after stroke, and there are limited effective therapies for insomnia following stroke. Traditional Chinese medicine (TCM), including acupuncture and the Chinese herbal medication (CHM) Suanzaoren decoction (SZRD), has been reported as an alternative option for insomnia relief after stroke in China for thousands of years. Here, this study aims to investigate the efficacy and safety of electroacupuncture (EA) in combination with SZRD in the treatment of insomnia following stroke.

Methods

A total of 240 patients with post-stroke insomnia will be included and randomized into four groups: the EA group, SZRD group, EA & SZRD group, and sham group. The same acupoints (GV20, GV24, HT7, and SP6) will be used in the EA group, EA & SZRD group, and sham group, and these patients will receive the EA treatment or sham manipulation every other day for 4 consecutive weeks. SZRD treatments will be given to participants in the SZRD group and EA & SZRD group twice a day for 4 consecutive weeks. The primary outcome measures include Pittsburgh Sleep Quality Index scores and polysomnography. Secondary outcome measures include the Insomnia Severity Index, the National Institutes of Health Stroke Scale, the Hospital Anxiety and Depression Scale, brain magnetic resonance imaging, functional magnetic resonance imaging, and nocturnal melatonin concentrations. The primary and secondary outcomes will be assessed at baseline (before treatment), during the 2nd and 4th weeks of the intervention, and at the 8th and 12th weeks of follow-up. Safety assessments will be evaluated at baseline and during the 4th week of the intervention.

Discussion

This study will contribute to assessing whether the combination of these two therapies is more beneficial for post-stroke insomnia than their independent use, and the results of this clinical trial will improve our understanding of the possible mechanisms underlying the effects of combination therapies.

Trial registration

Chinese Clinical Trials Register ChiCTR2000031413. Registered on March 30, 2020
Operative treatment of cervical radiculopathy: anterior cervical decompression and fusion compared with posterior foraminotomy: study protocol for a randomized controlled trial
Authors: Holy Marek , MacDowall Anna , Sigmundsson Freyr Gauti , Olerud Claes
Published: September 2021

Background

Cervical radiculopathy is the most common disease in the cervical spine, affecting patients around 50–55 year of age. An operative treatment is common clinical praxis when non-operative treatment fails. The controversy is in the choice of operative treatment, conducting either anterior cervical decompression and fusion or posterior foraminotomy. The study objective is to evaluate short- and long-term outcome of anterior cervical decompression and fusion (ACDF) and posterior foraminotomy (PF)

Methods

A multicenter prospective randomized controlled trial with 1:1 randomization, ACDF vs. PF including 110 patients. The primary aim is to evaluate if PF is non-inferior to ACDF using a non-inferiority design with ACDF as “active control.” The neck disability index (NDI) is the primary outcome measure, and duration of follow-up is 2 years.

Discussion

Due to absence of high level of evidence, the authors believe that a RCT will improve the evidence for using the different surgical treatments for cervical radiculopathy and strengthen current surgical treatment recommendation.

Trial registration

ClinicalTrials.gov NCT04177849. Registered on November 26, 2019
Voice production model based on phonation biophysics
Authors: Rocha Raissa Bezerra , José Lira de Queiroz Wamberto , Sampaio de Alencar Marcelo
Published: September 2021

This paper presents a proposal to a source-filter theory of voice production, more precisely related to voiced sounds. It is a proposal of a model to generate signal using linear and time-invariant systems and takes into account the phonation biophysics and the cyclostationary characteristics of the voice signal, related to the vibrational behavior of the vocal cords. The model suggests that the oscillation frequency of the vocal cords is a function of its mass and length, but controlled by the longitudinal tension applied to them. The mathematical description of the model of glottal excitation is presented, along with a mathematical closed expression for the power spectral density of the signal that excites the glottis. The voice signal, whose parameters can be adjusted for detection and classification of glottis pathologies, is also present. As a result, the output of each block diagram that represents the proposed model is analysed, including a power spectral density comparison between emulated voice, original voice, and classic source-filter model. The Log Spectral Distortion is computed, providing values below 1.40 dB, indicating an acceptable distortion for all cases.
Exact solutions involving special functions for unsteady convective flow of magnetohydrodynamic second grade fluid with ramped conditions
Authors: Riaz Muhammad Bilal , Abro Kashif Ali , Abualnaja Khadijah M. , Akgül Ali , Rehman Aziz Ur , Abbas Muhammad , Hamed Y. S.
Published: September 2021

A number of mathematical methods have been developed to determine the complex rheological behavior of fluid’s models. Such mathematical models are investigated using statistical, empirical, analytical, and iterative (numerical) methods. Due to this fact, this manuscript proposes an analytical analysis and comparison between Sumudu and Laplace transforms for the prediction of unsteady convective flow of magnetized second grade fluid. The mathematical model, say, unsteady convective flow of magnetized second grade fluid, is based on nonfractional approach consisting of ramped conditions. In order to investigate the heat transfer and velocity field profile, we invoked Sumudu and Laplace transforms for finding the hidden aspects of unsteady convective flow of magnetized second grade fluid. For the sake of the comparative analysis, the graphical illustration is depicted that reflects effective results for the first time in the open literature. In short, the obtained profiles of temperature and velocity fields with Laplace and Sumudu transforms are in good agreement on the basis of numerical simulations.
Effect of Waste Tire Rubber Particles on Concrete Abrasion Resistance Under High-Speed Water Flow
Authors: Feng Ling-Yun , Chen Ai-Jiu , Liu Han-Dong
Published: September 2021

Rubberized concrete is an environmentally friendly building material that mixes rubber particles from old automobile tires into normal concrete in place of fine aggregate. The addition of rubber particles can improve the abrasion resistance of normal concrete observably. It has a good application prospect in hydraulic engineering, especially in the concrete building parts with high abrasion resistance. However, there are few experimental studies on the abrasion resistance of rubberized concrete, and the influence law and mechanism of rubber particles on the abrasion resistance of concrete are not understood. In this paper, the abrasion resistance of rubberized concrete is studied using the underwater-steel-ball method. The results show that rubber particles increase the slump of concrete mixtures. The abrasion resistance of rubberized concrete increases significantly with increasing rubber particle content, whereas the compressive strength decreases linearly. For the same rubber particle size and content, the abrasion resistance of rubberized concrete positively correlates with compressive strength and larger rubber particles significantly improve the abrasion resistance. Rubber particle content is the factor that most strongly affects abrasion resistance of rubberized concrete, followed by the compressive strength. Rubber particle pretreatment methods of NaOH + KH570 can significantly improve the abrasion resistance of rubberized concrete.
Assessing the potential of biochar aged by humic substances to enhance plant growth and soil biological activity
Authors: Hammerschmiedt Tereza , Holatko Jiri , Pecina Vaclav , Huska Dalibor , Latal Oldrich , Kintl Antonin , Radziemska Maja , Muhammad Sadiq , Gusiatin Zygmunt M. , Kolackova Martina , Nasir Muhammad , Baltazar Tivadar , Ahmed Niaz , Brtnicky Martin
Published: September 2021

Background

Soil carbon-rich organic amendments (biochar, humic substances) may improve the quality and fertility of arable soil. Their co-application can additively enhance the beneficial effect on soil. Hypothetically, the pre-treatment of biochar, by aging via soaking in a solution of commercially available humic substances, could result in synergism, which may exceed the benefit from simple co-application of both amendments to the soil. Therefore, the aim of this study was to investigate the impact of biochar, humic substances, the combination of both, and the impact of biochar aged by humic substances solution on soil microbial activities and plant growth in a short-term pot experiment with lettuce.

Results

The aging of biochar decreased the C:N ratio as compared to non-activated biochar. The co-application of biochar and humic substances into the soil resulted in the highest microbial biomass carbon and respiration activity. The majority of enzyme activities (β-glucosidase, arylsulfatase,N-acetyl-β-d-glucosaminidase, phosphatase) were the highest in humic substances-amended soil. The application of humic substances and biochar with humic substances seemed to stimulate microbial growth and activity followed by the competition of microflora for nutrients with plants, whereas the aged biochar behaved differently. The plants treated by aged biochar achieved the highest values of dry aboveground and root biomass of all variants. However, the assumed rapid uptake of nutrients by plants resulted in lower nutrient availability for microflora, and a decline in microbial viability.

Conclusions

Based on this study, the positive effect of co-applied humic substances and biochar on soil fertility, quality, and health can be concluded. The usability of biochar aging by humic solution requires further study.

Graphic abstract
Effects of foliar spray of agricultural grade mineral oil in springtime, in combination with potassium and calcium sulfates on the phenological and biophysical indices of clusters, and foliar nutritional levels in grapevine (Vitis vinifera L.) cv. Sultana (Id. Thompson seedless, Sultanina)
Authors: Karimi Rouhollah , Saberi Abbas , Khadivi Ali
Published: September 2021

Background

Improving the nutritional condition of grapevine in spring to regulate bloom, fruit set, and yield is among the management goals of vineyards.

Methods

In the present study, the early season spray of calcium sulfate (C; 0.00 and 2.00%), potassium sulfate (K; 0.00 and 3.00%), and agricultural grade mineral oil (V; 0.00 and 1.00%) on flower and fruit phenology, nutrient concentration, and cluster biophysical indices and yield of Sultana grapevine (Vitis viniferaL.) were investigated for two consecutive years.

Results

Based on the results, the spray of this nutrient combined with mineral oil significantly affected all the treatments except cluster length, berry length, and phosphorus concentration. The highest concentrations of potassium, calcium, and magnesium were obtained in the vines treated with V0K1C1, and the highest concentrations of zinc and iron were obtained only in the vines treated with mineral oil. In treatments containing mineral oil, especially in combination with the second level of calcium and potassium (V1K1C1), bloom time, berries pea-sized time, and harvest time were delayed by 3, 3, and 6 days compared with control vines. While in vines treated with a combination of the second level of potassium and calcium (V0K1C1), bloom time, berries pea-sized time, and harvest time were advanced by 5, 4, and 1.50 days, respectively, compared with control vines. Regarding the biophysical indices of the cluster, it was found that the vines treated with V1K1C1had higher cluster weight, berry weight, fruit, and raisins yield than other treatments. Also, the highest berry quality, including total soluble solids, titratable acidity, and total phenol content, were obtained in the vines treated with V0K1C1. However, the lowest berry quality was observed in the vines treated with mineral oil.

Conclusions

Therefore, the combination of nutrients with mineral oil can alleviate the adverse effect of mineral oil solely on some phenological indices and berry quality-related traits in vineyards.
Recurrent massive bleeding from a small intestinal arteriovenous malformation after surgery for biliary atresia in an infant: a case report and literature review
Authors: Kudo Wataru , Kouchi Katsunori , Takenouchi Ayako , Matsuoka Aki , Yabe Kiyoaki , Nakazawa Tadao , Hasegawa Atsuko
Published: September 2021

Background

Small intestinal arteriovenous malformation (AVM) can cause bleeding. Most small intestinal AVMs occur during adulthood, rarely in infancy. We report a case of an infant with hemorrhage due to small intestinal AVM early and recurrently after Kasai portoenterostomy (PE) for biliary atresia (BA).

Case presentation

A 51-day-old male infant was admitted to our institution for obstructive jaundice. Laparotomic cholangiography revealed BA (IIIb1μ), and Kasai PE was performed at 60 days of age. On postoperative day 17, he developed massive melena and severe anemia. Contrast-enhanced computed tomography (CT) revealed that the jejunum around the PE site was strongly enhanced with enhancing nodules in the arterial phase, and a wide area of the Roux limb wall was slightly enhanced in the venous phase. As melena continued, emergency laparotomy was performed. There were no abnormal macroscopic findings at the PE site except for a clot in the Roux limb 5 cm away from the PE site, and the Roux limb was resected 5 cm. On further investigation, a red spot was detected on the jejunal serosa 30 cm away from the Roux-en-Y anastomosis site. PE and wedge resection for the red spot were performed. Histopathologically, both specimens indicated AVM. He was jaundice-free 65 days after the first surgery. However, at 7 months of age, he developed massive melena again. Contrast-enhanced CT and upper gastrointestinal endoscopy revealed no bleeding lesions. Hemorrhagic scintigraphy showed a slight accumulation at the hepatic hilum prompting an emergency surgery. Intraoperative endoscopy detected a bleeding lesion at the PE site, and the Roux limb was resected (approximately 6 cm). Intraoperative frozen section analysis of the stump of the resected jejunum revealed no abnormal vessels. PE was performed, and permanent section analysis revealed an AVM in the resected jejunum. The postoperative course was uneventful without re-bleeding.

Conclusions

We experienced a case of recurrent massive bleeding from small intestinal AVM in an infant after surgery for BA. Intraoperative endoscopy and frozen section analysis helped identify the bleeding lesion and perform a complete resection of the small intestinal AVM, even after surgery, in the infant.