bluuebunny/crossref_metadata_2025 huggingface dataset:
Optimization of the synthesis process of β‐galactosidase/carboxymethylchitosan‐silica biocatalyst powders, stabilized with lyoprotectants for potential dietary applications
Authors: Franco Yuly Nataly , Tobón Ana Cecilia , Mesa Monica
Published: July 2023

β‐galactosidase dosing and transport powders offer benefits for people with specific digestive deficiencies. They can be produced by immobilization in solid materials by sol–gel methods. The challenge is to maintain enzyme activity under processing conditions. The objective here is to design and optimize the calcium chloride and carboxymethylchitosan concentrations at 25°C and 7.3 pH for preparing active β‐galactosidase powders. This optimization was performed using a Response Surface Methodology with Central Composite Design, selecting lyoprotectants for preserving activity during the lyophilization. Glucose, galactose, maltose, sucrose, and β‐cyclodextrin lyoprotectants were assayed in different weight proportions. The optimal conditions to obtain a biocatalyst with maximum expressed activity were 473 mM CaCl2 and 402 ppm carboxymethylchitosan, obtaining a biocatalyst with 57.8% ± .7% recovered activity and 92.3% ± 2.1% immobilization yield. The galactose, maltose, and sucrose in a 1:5 ratio increased 1.2 times the expressed activity of this biocatalyst, protecting the active site during lyophilization due to favorable interactions with the enzyme as shown by docking analysis.

Practical applications

This work shows the implementation of production methodologies of mixed enzyme‐mineral biocatalysts, based on the experimental, statistical, and docking studies of β‐galactosidase interactions with mono‐, di‐ and polysaccharides under ionic and thermal stress. The obtained powders could be candidates as dietary supplements of calcium, silicon minerals, and β‐galactosidase.
Empathic nurses with sufficient job resources are work‐engaged professionals who deliver more individualized care
Authors: Scheepers R. A. , Vollmann M. , Cramm J. M. , Nieboer A. P.
Published: July 2023

Aims

This study examined whether nurse work engagement mediated the associations of job resources (collegial support and autonomy) and a personal resource (empathy) with individualized care delivery, in both hospital and long‐term care settings. We also explored potential setting‐specific differences in how strongly the resources were associated with work engagement and individualized care delivery among nurses.

Design

We conducted a cross‐sectional study in three hospitals and two long‐term care facilities.

Methods

In total, 454 nurses completed a web‐based survey including validated measures on resources (collegial support, autonomy, empathy), work engagement and individualized care delivery. Data were analysed using mediation and moderated mediation analyses.

Results

In both settings, all resources were indirectly associated with individualized care delivery via work engagement. Empathy was also directly associated with individualized care delivery, and a stronger association was found in the long‐term care setting than in the hospital setting.

Conclusion

The present study showed work engagement to mediate the associations of job resources and empathy with individualized care delivery in both hospital and long‐term care settings. Individualized care delivery was furthermore directly facilitated by high levels of empathy, especially among nurses working in long‐term care settings.

Implications for the profession and/or patient care

Patients may benefit from better individualized care delivery by empathic nurses who are more work‐engaged in the face of sufficient job resources in their practice environment.

Impact

Nurses are better able to deliver individualized care when provided with sufficient job resources (collegial support and autonomy) that support their being work‐engaged professionals. Furthermore, empathic nurses also reported being able to better support patient individuality. These findings can be translated to policies of hospitals and long‐term care facilities, to optimize job resources and enhance empathy and thus facilitate the support of patient individuality by nurses.

Reporting method

This study adhered to the STROBE guidelines.

Patient or public contribution

Nurses were involved in the design and data collection of the study.
Severe eczema in Wiskott–Aldrich syndrome‐related disorder successfully treated with dupilumab
Authors: Alzahrani Fatmah , Miller Holly K. , Sacco Keith , Dupuy Elizabeth
Published: July 2023

Treatment of severe eczema in patients with primary immunodeficiencies can be particularly challenging as there are no guidelines with regards to these conditions. Dupilumab is an interleukin (IL)‐4Rα antagonist that inhibits both IL‐4 and IL‐13 and is approved for the treatment of atopic dermatitis in pediatric patients. In this report, we describe a patient with a case of severe eczema in the context of Wiskott–Aldrich syndrome‐related disorder, who was successfully treated with dupilumab.
Reference intervals for reticulocyte indices, immature reticulocyte fraction, and the percentage of hypochromic red blood cells in adult large breed dogs using the ADVIA 2120 hematology analyzer
Authors: Moloney Conor , Stavroulaki Evangelia M. , Augusto Monica
Published: July 2023

Reticulocyte indices are used to characterize anemia, including the identification of regeneration. In people, the immature reticulocyte fraction (IRF), percentage of hypochromic red blood cells (%HYPO‐RBC), and other reticulocyte indices have been used as earlier indicators of erythropoiesis and as valuable monitoring tools in the assessment of various therapies. The reference intervals (RI) of the IRF and %HYPO‐RBC have not been reported in dogs. The objective of this study was to establish RIs for novel variables (IRF, %HYPO‐RBC, and CH‐delta) and assess RIs for more commonly reported reticulocyte indices in healthy dogs. RIs were calculated from blood results retrospectively collected from 106 client‐owned healthy dogs at the time of induction into a blood donor program using the ADVIA 2120 hematology analyzer (Siemens Healthcare Diagnostics). For the calculation of RIs, appropriate tests were applied for outlier detection and normality assessment. For variables normally distributed, RIs and their respective 90% confidence intervals (CIs) were calculated using parametric methods, while for variables not normally distributed, robust methods were used and bootstrapping for calculating the 90% CIs. The following RIs were established: reticulocyte hemoglobin content (CHr) 24.5‐28 pg, mean reticulocyte volume (MCVr) 85.9‐99.3 fL, mean corpuscular hemoglobin concentration of reticulocytes (CHCMr) 271.0‐306.3 g/L, IRF 10.4%‐43.5%, CH‐delta 0.5‐4.3 pg, and percentage of hypochromic red blood cells (%HYPO‐RBC) 0.10%‐0.80%. The results of this study provide RIs for novel reticulocyte variables. Further studies are required to determine the clinical utility of IRF, %HYPO‐RBC, and CH delta as early indicators of erythropoietic activity in canine patients.
We are not doing enough for children with neuro-disabilities
Authors: Gibbs Anita
Published: July 2023

I recently made a submission to the Abuse in Care: Royal Commission of Inquiry on behalf of a young whānau-member survivor who is autistic and lives with Foetal Alcohol Spectrum Disorder (FASD), Attention Deficit Hyperactivity Disorder (ADHD) and mental health issues. I made that submission also because I am a social worker and a staunch advocate for those who live with neuro- disabilities; many of them have experienced early removal from birth families, as well as lifelong rejection and misunderstanding by systems of education, health, care and justice. In my submission, I discussed how today’s current care and justice systems cause as much harm to children and whānau as historic ones. In my recent Reimagining Social Work blog (Gibbs, 2022), I highlighted the harm to children caused specifically by current, residence-based interventions in youth justice, but in this piece, I also want to highlight how multiple aspects of both current care and protection, and youth justice provision harm our children with neuro-disabilities. In a future, research-based article, I will highlight specific findings on best practices for working in the justice space for youth living with FASD (in preparation).
Supplemental Material: Temporal evolution of the early–late Neoarchean granitoid magmatism in the eastern North China Craton: Transition of geodynamic regime from mantle plume to continental marginal arc system
Authors: Shan Houxiang , et al.
Published: July 2023

Text S1: Analytical methods. Figure S1: Covariation diagrams of selected elements vs. Zr for whole-rock samples of the granitoids formed during the early and late Neoarchean in the Southern Jilin Province. Table S1: LA-ICP-MS zircon U-Pb analytical data for the different types of granitoids formed during the early and late Neoarchean in the Southern Jilin Province. Table S2: Zircon trace elemental abundances (ppm) for the different types of granitoids formed during the early and late Neoarchean in the Southern Jilin Province. Table S3: Bulk-rock major (wt%) elemental data for the different types of granitoids formed during the early and late Neoarchean in the Southern Jilin Province. Table S4: Bulk-rock trace (ppm) elemental data for the different types of granitoids formed during the early and late Neoarchean in the Southern Jilin Province. Table S5: Zircon Lu-Hf isotopic compositions for the different types of granitoids formed during the early and late Neoarchean in the Southern Jilin Province. Table S6: Whole oxygen isotopes for the different types of granitoids formed during the early and late Neoarchean in the Southern Jilin Province. 
Retracing loss of momentum for primary health care: can renewed political interest in the context of COVID-19 be a turning point?
Authors: Mhazo Alison T , Maponga Charles Chiedza
Published: July 2023

The COVID-19 pandemic has revealed major weaknesses in primary health care (PHC), and how such weaknesses pose a catastrophic threat to humanity. As a result, strengthening PHC has re-emerged as a global health priority and will take centre stage at the 2023 United Nations High Level Meeting (UNHLM) on Universal Health Coverage (UHC). In this analysis, we examine why, despite its fundamental importance and incredible promise, the momentum for PHC has been lost over the years. The portrayal of PHC itself (policy image) and the dominance of global interests has undermined the attractiveness of intended PHC reforms, leading to legacy historical policy choices (critical junctures) that have become extremely difficult to dismantle, even when it is clear that such choices were a mistake. PHC has been a subject of several political declarations, but post-declarative action has been weak. The COVID-19 provides a momentous opportunity under which the image of PHC has been reconstructed in the context of health security, breaking away from the dominant social justice paradigms. However, we posit that effective PHC investments are those that are done under calm conditions, particularly through political choices that prioritise the needs of the poor who continue to face a crisis even in non-pandemic situations. In the aftermath of the 2023 UNHLM on UHC, country commitment should be evaluated based on the technical and financial resources allocated to PHC and tangible deliverables as opposed to the formulation of documents or convening of a gathering that simply (re) endorses the concept.
Association between birth location and short-term outcomes for babies with gastroschisis, congenital diaphragmatic hernia and oesophageal fistula: a systematic review
Authors: Nezafat Maldonado Behrouz , Singhal Graciaa , Chow LiYan , Hargreaves Dougal , Gale Chris , Battersby Cheryl
Published: July 2023

Background

Neonatal care is commonly regionalised, meaning specialist services are only available at certain units. Consequently, infants with surgical conditions needing specialist care who are born in non-surgical centres require postnatal transfer. Best practice models advocate for colocated maternity and surgical services as the place of birth for infants with antenatally diagnosed congenital conditions to avoid postnatal transfers. We conducted a systematic review to explore the association between location of birth and short-term outcomes of babies with gastroschisis, congenital diaphragmatic hernia (CDH) and oesophageal atresia with or without tracheo-oesophageal fistula (TOF/OA).

Methods

We searched MEDLINE, CINAHL, Web of Science and SCOPUS databases for studies from high income countries comparing outcomes for infants with gastroschisis, CDH or TOF/OA based on their place of delivery. Outcomes of interest included mortality, length of stay, age at first feed, comorbidities and duration of parenteral nutrition. We assessed study quality using the Newcastle-Ottawa Scale. We present a narrative synthesis of our findings.

Results

Nineteen cohort studies compared outcomes of babies with one of gastroschisis, CDH or TOF/OA. Heterogeneity across the studies precluded meta-analysis. Eight studies carried out case-mix adjustments. Overall, we found conflicting evidence. There is limited evidence to suggest that birth in a maternity unit with a colocated surgical centre was associated with a reduction in mortality for CDH and decreased length of stay for gastroschisis.

Conclusions

There is little evidence to suggest that delivery in colocated maternity-surgical services may be associated with shortened length of stay and reduced mortality. Our findings are limited by significant heterogeneity, potential for bias and paucity of strong evidence. This supports the need for further research to investigate the impact of birth location on outcomes for babies with congenital surgical conditions and inform future design of neonatal care systems.

PROSPERO registration number

CRD42022329090.
It takes two to tango: the recruiter’s role in accepting or refusing to participate in group antenatal care among pregnant women—an exploration through in-depth interviews
Authors: Talrich Florence , Van Damme Astrid , Bastiaens Hilde , Rijnders Marlies , Bergs Jochen , Beeckman Katrien
Published: July 2023

Objective

The purpose of this study was to explore how women are recruited for group antenatal care (GANC) in primary care organisations (PCOs), what elements influence the behaviour of the recruiter, and what strategies recruiters use to encourage women to participate.

Method

Using a qualitative research design, we conducted 10 in-depth interviews with GANC facilitators working in PCOs. Selected constructs of the domains of the Consolidated Framework for Implementation Research and the Theoretical Domains Framework helped to develop interview questions and raise awareness of important elements during interviews and thematic analyses. GANC facilitators working in multidisciplinary PCOs located in Brussels and Flanders (Belgium) were invited to participate in an interview. We purposively selected participants because of their role as GANC facilitators and recruiters. We recruited GANC facilitators up until data saturation and no new elements emerged.

Result

We identified that the recruitment process consists of four phases or actions: identification of needs and potential obstacles for participation; selection of potential participants; recruitment for GANC and reaction to response. Depending on the phase, determinants at the level of the woman, recruiter, organisation or environment have an influence on the recruitment behaviour.

Conclusion

Our study concludes that it takes two to tango for successful recruitment for GANC. Potential participants’ needs and wishes are of importance, but the care providers’ behaviour should not be underestimated. Therefore, successful recruitment may be improved when introducing a multidisciplinary recruitment plan consisting of specific strategies, as we suggest.
An introduction to L∞-algebras and their homotopy theory for the working mathematician
Authors: Kraft Andreas , Schnitzer Jonas
Published: July 2023

In this paper, we give a detailed introduction to the theory of (curved) [Formula: see text]-algebras and [Formula: see text]-morphisms, avoiding the concept of operads and providing explicit formulas. In particular, we recall the notion of (curved) Maurer–Cartan elements, their equivalence classes and the twisting procedure. The main focus is then the study of the homotopy theory of [Formula: see text]-algebras and [Formula: see text]-modules. In particular, one can interpret [Formula: see text]-morphisms and morphisms of [Formula: see text]-modules as Maurer–Cartan elements in certain [Formula: see text]-algebras, and we show that twisting the morphisms with equivalent Maurer–Cartan elements yields homotopic morphisms. We hope that these notes provide an accessible entry point to the theory of [Formula: see text]-algebras.
Decoupled Edge Guidance Network for Automatic Checkout
Authors: You Rongbiao , He Fuxiong , Lin Weiming
Published: July 2023

Automatic checkout (ACO) aims at correctly generating complete shopping lists from checkout images. However, the domain gap between the single product in training data and multiple products in checkout images endows ACO tasks with a major difficulty. Despite remarkable advancements in recent years, resolving the significant domain gap remains challenging. It is possibly because networks trained solely on synthesized images may struggle to generalize well to realistic checkout scenarios. To this end, we propose a decoupled edge guidance network (DEGNet), which integrates synthesized and checkout images via a supervised domain adaptation approach and further learns common domain representations using a domain adapter. Specifically, an edge embedding module is designed for generating edge embedding images to introduce edge information. On this basis, we develop a decoupled feature extractor that takes original images and edge embedding images as input to jointly utilize image information and edge information. Furthermore, a novel proposal divide-and-conquer strategy (PDS) is proposed for the purpose of augmenting high-quality samples. Through experimental evaluation, DEGNet achieves state-of-the-art performance on the retail product checkout (RPC) dataset, with checkout accuracy (cAcc) results of 93.47% and 95.25% in the average mode of faster RCNN and cascade RCNN frameworks, respectively. Codes are available at https://github.com/yourbikun/DEGNet.
New microscopic analysis for 15N(d,p)16N neutron transfer reaction at 15 MeV
Authors: Alharbi Wedad , Ibraheem Awad A. , Hamada Sh.
Published: July 2023

Inspired by the prevalent [Formula: see text] cluster structure of deuterons, which appears at an excitation energy of 2.225[Formula: see text]MeV, the recently measured angular distributions (ADs) for [Formula: see text]N([Formula: see text],[Formula: see text]N and [Formula: see text]N([Formula: see text],[Formula: see text]N systems at an energy of 15[Formula: see text]MeV X. Y. Li et al., [Phys. Rev. C 106, (2022) 025807] are microscopically analyzed using the continuum discretized coupled channel (CDCC) method. The extracted [Formula: see text] potential, considered as the coherent sum of cluster folding and dynamical polarization potentials, both derived from the CDCC computations, was then employed to investigate the [Formula: see text]N([Formula: see text],[Formula: see text]N neutron transfer reaction leading to the (2−, 0.0[Formula: see text]MeV), (0−, 0.12[Formula: see text]MeV), (3−, 0.298[Formula: see text]MeV), and (1−, 0.397[Formula: see text]MeV) [Formula: see text]N states. Since extracting reliable information on spectroscopic factors (SFs) is highly dependent on the interaction potential, the extracted [Formula: see text] was employed to get such information. The investigation gives evidence for the applicability of the [Formula: see text] in describing the elastic scattering and the neutron transfer ADs data. The extracted SFs for the [Formula: see text]N states under consideration are consistent with those that have been reported before.
FIRST-PRINCIPLES STUDY OF THE LATTICE THERMAL CONDUCTIVITY OF MoSi2P4 AND WSi2P4 MONOLAYERS
Authors: WANG YUHANG , DING WEI , TAO YIFENG
Published: July 2023

Recently, the 2D van der Waals (vdW) layered MA2Z4 series has attracted a lot of attention. Among these 2D materials, MoSi2P4 and WSi2P4 monolayers each demonstrate strong environmental stability, a moderate band gap, and considerable carrier mobility. The lattice thermal transport properties in MoSi2P4 and WSi2P4 monolayer structures have been investigated using first-principles calculations. Due to the gap present in the phonon energy band structure of the WSi2P4 monolayer within the middle frequency range, the specific heat capacity, phonon group velocity, and phonon relaxation time of the WSi2P4 monolayer structure are smaller than those of the MoSi2P4 monolayer structure. This makes the lattice thermal conductivity of the WSi2P4 monolayer lower than that of the MoSi2P4 monolayer. The MoSi2P4 structure has a lattice thermal conductivity of 28 W/mK at 300 K. The WSi2P4 structure has a lattice thermal conductivity of 14.5 W/mK in the [Formula: see text] -direction and 15 W/mK in the [Formula: see text]-direction. The results suggest that the MoSi2P4 and WSi2P4 monolayers can be potentially used as nanoelectronics devices for thermal transport applications.
The Impact of the 2019 Australian Bushfire: Financial Markets, Air Pollution, and Economic Effects
Authors: Yang Minhua , Gerth Florian , Ramiah Vikash , Muschert Glenn W.
Published: July 2023

Our study investigates the consequences of the 2019 Australian bushfire regarding its financial, economic, and environmental effects. Using an augmented version of the event study methodology, we show that depressed investors’ mood leads to a countrywide financial impact, which tends to be long-lasting. On the other hand, regional effects are self-correcting, bringing financial valuations back to their fundamental values. We observe that polluting firms experience an increase in their stock market returns during bushfire seasons– consistent with the theory of increased risk premiums in times of uncertainty. Regarding economic activity, we confirm that the countrywide tourism sector, which employs a significant fraction of Australia’s labor force, continues to be severely impaired by regional fires. Unlike previous studies in finance, we demonstrate that bushfires have a substantial and harmful impact on Australia’s air quality. The battery of robustness tests (range of event windows, controlling for information leakage, and changing macroeconomic conditions) validates our findings.
Compact relativistic sphere with charged anisotropic matter in f(R,G) gravity
Authors: Ilyas M. , Iqbal Rohna
Published: July 2023

The main purpose of this research is to examine a number of interior configurations of stable anisotropic objects formed in the shape of spherical charged stars within the gravity region described by [Formula: see text], where [Formula: see text] represents the Gauss–Bonnet invariant and [Formula: see text] defines the Ricci Scalar in this scenario. The formation of these charged stars is investigated using the solutions found by Karori and Barua, among several feasible models within the theory of [Formula: see text] gravity. The study explores the behavior of these realistically charged compact stars, analyzing various physical components through the use of graphs. Furthermore, the feasibility of our model is assessed by evaluating it against different energy conditions. Additionally, topics such as density modification, stress evolution, various forces, star stability, anisotropy measurement, state parameter equations, and charge distribution are discussed.
Investigation of Structural, Magnetic, and Elastic Properties of a New Full-Heusler Alloy Ir2FeAl
Authors: Mebrek Moued , Medjahed Baghdad , Zemouli Mostefa , Benyamina Benabdellah , Berber Mohamed , Benziadi Djillali , Amrani Samir
Published: July 2023

In this paper, we studied the magnetic stability, structural, elastic and electronic properties of Ir2FeAl full Heusler compound in the regular phase (Cu2MnAl, prototype L2[Formula: see text], by using the first principle of density functional theory, with the generalized approximation of the GGA gradient. We found that the ferromagnetic state of Ir2FeAl is more stable than the nonmagnetic configuration at their lattice parameters equilibrium. This result was confirmed by the calculation of the cohesive energy. The stability is asserted by the elastic constants and the conditions of the mechanical stability criterion. The band structure and the calculated densities of states (DOS) of this alloy show a semi-metallic behavior. The ferromagnetic performance of Ir2FeAl is confirmed by the total magnetic moment of 4.28 [Formula: see text], where its major contribution comes from Fe atoms. We estimated the Debye temperature of Ir2FeAl from the average speed of sound. This is the first quantitative theoretical prediction of the elastic properties of the Ir2FeAl compound, and it still awaits experimental confirmation.
Co-Creating a Nature-Based Social Prescription Intervention in Urban Socioeconomically Deprived Neighbourhoods: A Case Study from RECETAS Project in Barcelona, Spain
Authors: Santos-Tapia Celia , Hidalgo Laura , Jimenez-Arenas Pol , Casajuana Cristina , Domènech Sara , Ballester-Lledó Aida , Litt Jill , Sachs Ashby , Garcia Gabriela , Blancafort-Alias Sergi
Published: July 2023

Active citizen participation in research is important to generate societal impact of outcomes. Even so, many times, the community input in these processes is limited or non-existent, and co-creation processes are often not documented. This paper describes a structured and systematised protocol to co-create a nature-based social prescribing intervention addressed to face loneliness in urban deprived neighbourhoods. As a result, a nature-based social prescription menu was co-developed with stakeholders from health, social prescription, nature, associative, and research sectors. The menu consists of open spaces and nature activities and will be offered to the participants of a randomised controlled trial to test actions for social prescribing in natural spaces.
The Risk of Lymphoproliferative Disorders and Skin Cancers in Patients with Psoriasis and Inflammatory Bowel Disease Administered Biologics
Authors: Jung Joon Min , Kim Ye-Jee , Chang Sung Eun , Lee Mi Woo , Won Chong Hyun , Lee Woo Jin
Published: July 2023

Few large population‐based studies have investigated the effects of biologic agents on the risks of lymphoproliferative disorders (LPDs) and skin cancers in patients with psoriasis and inflammatory bowel disease (IBD). The objective of this study is to determine the effects of biologic agents on the risk of LPDs and skin cancers in South Korean patients with psoriasis and IBD. The Korean Health Insurance Review and Assessment Service database was reviewed, and patients newly diagnosed with psoriasis or IBD between 2008 and 2019 were included. The effects of exposure to biologics on the risk of cancer were assessed using multivariable Cox regression models. The study included 191,678 patients with psoriasis, 23,640 with Crohn’s disease (CD), and 66,730 with ulcerative colitis (UC). The tumor necrosis factor (TNF)‐α inhibitor was associated with increased risks of overall lymphoma (adjusted hazard ratio (aHR), 2.93; 95% confidence interval (CI), 1.01–8.50), non‐Hodgkin lymphoma (NHL) (aHR, 2.98; 95% CI, 1.02–8.69), and cutaneous lymphoma (aHR, 3.46; 95% CI, 1.07–11.21) in patients with psoriasis. TNF‐α inhibitor exposure was associated with increased risks of overall lymphoma (aHR, 3.70; 95% CI, 1.81–7.55) and NHL (aHR, 3.72; 95% CI, 1.81–7.62) in patients with CD, whereas it did not increase the risks of cancer in patients with UC. In conclusion, treatment with TNF‐α inhibitors can increase the risks of LPDs in patients with psoriasis or CD.
Reflectance Confocal Microscopy of Skin after the Sting of the Jellyfish Pelagia noctiluca
Authors: Paolino Giovanni , Di Nicola Matteo Riccardo , Pampena Riccardo , Bianchi Vittoria Giulia , Mercuri Santo Raffaele
Published: July 2023

Jellyfish are aquatic animals of the phylum Cnidaria found in seas all over the world. They are characterized by the presence of cnidocytes, cells that contain a secretory organelle, the cnidocyst, mainly used for predation and defense purposes. An adult female patient presented to our Unit of Dermatology, for a 10 days-old history of macular-erythematous lesions in her right upper limb, due to a sting by a mauve stinger Pelagia noctiluca. Dermoscopy showed a general pinkish background surmounted by numerous brown dots and lines, distributed along the surface of the skin. Reflectance confocal microscopy (RCM) showed the presence of multiple partially hyperreflective, highly coiled, hollow, and harpoonlike structures through the epidermis but without the barbed tubes found in a previous RCM report, likely due to a greater time elapsed between the sting and the dermatological visit. This case highlights how dermoscopy and RCM may help clinicians for the diagnosis of jellyfish stings.
Immediate Response to Brentuximab Vedotin in a Patient with Localized MF-LCT
Authors: Giza Agnieszka , Miklusiak Karol , Hałubiec Przemysław , Jaworek Andrzej , Zimowska-Curyło Dagmara , Dyduch Grzegorz , Sacha Tomasz
Published: July 2023

The large cell transformation of mycosis fungoides (MF-LCT) is a phenomenon observed in the advanced stages of mycosis fungoides (MF), which is the most common primary cutaneous lymphoma. The diagnostic criteria of MF-LCT are a minimum of 25% of large cells or a formation of microscopic nodules of them in the histological examination of skin samples. The clinical outcomes for MF-LCT are poor, as less than 20% of patients survive 5 years after diagnosis, but the expression of the CD30 antigen is generally considered to be associated with a better prognosis. We present a case of a patient with the diagnosis of MF with LCT, with an ulcerated tumor lesion approximately 30 × 20 cm in size on the right lateral abdominal wall. Brentuximab vedotin (BV) treatment was started due to the presence of the CD30 antigen, with a quick and impressive regression of the cutaneous lesion and tumor mass and good treatment tolerance. After follow-up of 20 months, patient remains in complete remission. A schedule of treatment for MF-LCT is directed mainly by the clinical stage of the disease and the comorbidities; the more severe clinical course of the disease requires systemic treatment. If at least 5% of the cells found in the skin lesions biopsy sample express the CD30 antigen, a beneficial effect of BV treatment could be expected. It may seem that the use of BV is one of the optimal therapeutic options in patients with advanced MF-LCT showing expression of CD30.
Reduced Growth Hormone Predicts Worsening Adipose Tissue Insulin Resistance in Adults with Obesity
Authors: Li Xiaohui , Zhou Biao , Yao Yuan , Wang Guang , Meng Hua
Published: July 2023

Objectives: Adipose tissue distribution and glucose metabolism differ from adults with normal weight to adults with obesity. Growth hormone (GH) is closely related to obesity. Few studies have investigated the role of GH in adipose tissue insulin resistance (Adipo-IR). Herein, we investigated GH level and Adipo-IR in adults ranging from normal weight to obesity and the potential association between GH and Adipo-IR. Methods: A total of 1,017 participants had their body mass index (BMI), GH, and Adipo-IR evaluated. Based on the BMI, participants were assigned to five groups from normal weight to class 3 obesity; based on the GH level tertiles, participants were divided into low-, medium-, and high-GH groups. Results: In total, the GH level was negatively correlated with the BMI and Adipo-IR index (r = −0.32 and −0.22, respectively; both p < 0.001). The GH level gradually decreased, and Adipo-IR progressively increased from normal weight to class 3 obesity (all p < 0.001). Compared with the low-GH group, the reductions in the BMI, homeostasis model assessment of insulin resistance index, and homeostasis model assessment of β-cell function were more significant in both medium-GH and high-GH groups (all p < 0.05). Additionally, the Adipo-IR index in the high-GH group was significantly lower than that in the low-GH group (p < 0.001). For the multivariate regression analysis, serum GH concentration was an independent protective factor against Adipo-IR (β = −0.013, 95% CI: −0.025 to −0.001, p = 0.028). Conclusions: A marked suppression of GH level occurs in the adults with severe obesity. GH might be an important metabolic regulator associated with Adipo-IR.
Early Recurrence of Immunoglobulin A Nephropathy after Kidney Transplantation in a Patient with Down Syndrome
Authors: Ohki Yutaro , Kawabe Mayuko , Yamamoto Izumi , Kobayashi Akimitsu , Kanzaki Go , Koike Kentaro , Ueda Hiroyuki , Tanno Yudo , Urabe Fumihiko , Miki Jun , Yamada Hiroki , Kimura Takahiro , Ohkido Ichiro , Tsuboi Nobuo , Yamamoto Hiroyasu , Yokoo Takashi
Published: July 2023

A 39-year-old male kidney transplant recipient with Down syndrome (DS) was admitted to our hospital for biopsy. He had proteinuria at age 9, was diagnosed with immunoglobulin A nephropathy (IgAN) at age 22, had a tonsillectomy at age 35, and underwent ABO-compatible kidney transplantation (from his mother) at age 36. His serum creatinine was stable at 2.21 mg/dL 3 months after the kidney transplant, and his urine protein was 0.11 g/day. A protocol biopsy was performed 7 months after the kidney transplant, and there was suspicion of early recurrence of IgAN. One year after the transplant, urine erythrocytes were elevated and proteinuria was 0.41 g/day; at 3 years and 5 months after the kidney transplant, hematuria was evident along with proteinuria (0.74 g/day). Therefore, an episode biopsy was performed. A total of 23 glomeruli were obtained, four of which exhibited global sclerosis; three others showed intra- and extracapillary proliferative glomerulonephritis compatible with IgAN recurrence. Here, we report a rare case of early recurrence of IgAN with disease progression despite tonsillectomy in a patient with DS.
A Case of Multicystic Dysplastic Kidney Presenting as a Single Midline Pelvic Cyst
Authors: Ebert Kristin M. , Ching Christina B.
Published: July 2023

We present an unusual case of a female neonate presenting with a single midline pelvic cyst. Prenatal imaging was suggestive of multicystic dysplastic kidney (MCDK), but postnatal imaging was atypical for this diagnosis given the location and singular cyst noted. The patient ultimately underwent surgical exploration and was diagnosed with an ectopic MCDK. Ectopic MCDK should be considered in the differential diagnosis of unilocular cystic pelvic lesions identified in the perinatal period.
Rural versus Urban Residence in Adulthood and Incident Cognitive Impairment
Authors: Harris Matthew L. , Bennion Erica , Magnusson Kristine R. , Howard Virginia J. , Wadley Virginia G. , McClure Leslie A. , Levine Deborah A. , Manly Jennifer J. , Avila Justina F. , Glymour Maria M. , Wisco Jonathan J. , Thacker Evan L.
Published: July 2023

Introduction: Rural versus urban living is a social determinant of cognitive health. We estimated the association of rural versus urban residence in the USA with incident cognitive impairment (ICI) and assessed effect heterogeneity by sociodemographic, behavioral, and clinical factors. Methods: The Reasons for Geographic and Racial Differences in Stroke Study (REGARDS) is a population-based prospective observational cohort of 30,239 adults, 57% female, 36% Black, aged 45+ years, sampled from 48 contiguous states in the USA in 2003–2007. We analyzed 20,878 participants who at baseline were cognitively intact with no history of stroke and had ICI assessed on average 9.4 years later. We classified participants’ home addresses at baseline as urban (population ≥50,000), large rural (10,000–49,999), or small rural (≤9,999) by Rural-Urban Commuting Area codes. We defined ICI as ≥1.5 SD below the mean on at least 2 of the following tests: word list learning, word list delayed recall, and animal naming. Results: Participants’ home addresses were 79.8% urban, 11.7% large rural, and 8.5% small rural. ICI occurred in 1,658 participants (7.9%). Small rural residents had higher odds of ICI than urban residents, adjusted for age, sex, race, region, and education (OR = 1.34 [95% CI: 1.10, 1.64]), and after further adjustment for income, health behaviors, and clinical characteristics (OR = 1.24 [95% CI: 1.02, 1.53]). Former smoking versus never, nondrinking versus light alcohol drinking, no exercise versus ≥4 times/week, CES-D depressive symptom score of 2 versus 0, and fair versus excellent self-rated health had stronger associations with ICI in small rural areas than in urban areas. For example, in urban areas, lack of exercise was not associated with ICI (OR = 0.90 [95% CI: 0.77, 1.06]); however, lack of exercise combined with small rural residence was associated with 1.45 times the odds of ICI compared with ≥4 bouts of exercise/week in urban areas (95% CI: 1.03, 2.03). Overall, large rural residence was not associated with ICI; however, black race, hypertension, and depressive symptoms had somewhat weaker associations with ICI, and heavy alcohol drinking a stronger association with ICI, in large rural areas than in urban areas. Conclusion: Small rural residence was associated with ICI among USA adults. Further research to better understand why rural residents are at higher risk for developing ICI and mechanisms to ameliorate that risk will support efforts to advance rural public health.
Use of Mixed Lymphocyte Reaction Assay to Evaluate Immune Tolerance before Kidney Transplantation with an Immunosuppression-Free Protocol following Hematopoietic Stem Cell Transplantation from the Same Donor
Authors: Nonoyama Sho , Hotta Kiyohiko , Iwahara Naoya , Tanabe Tatsu , Hirose Takayuki , Harada Shigeru , Junichi Sugita , Nakazawa Daigo , Shigematsu Akio , Otsuka Takuya , Shinohara Nobuo
Published: July 2023

Several cases of kidney transplantation after hematopoietic stem cell transplantation (HSCT) from the same donor for end-stage renal disease have been reported. In those cases, immunosuppressive drugs were discontinued since immune tolerance was supposed to be induced. Theoretically, the recipient’s immune system recognizes the kidney allograft as its own tissue with the same human leukocyte antigen (HLA) profile, and the kidney allograft will not be rejected, even without the use of immunosuppressive agents. However, almost all recipients receive immunosuppressants in the early stages after kidney transplantation owing to concerns of acute rejection. Here, we report a successful case of post-HSCT kidney transplantation without the use of immunosuppressive drugs, in which a mixed lymphocyte reaction (MLR) assay was used to evaluate immune tolerance before kidney transplantation. The patient was a 25-year-old woman. Five years prior, she developed acute myeloid leukemia and underwent HLA-half-matched peripheral blood stem cell transplantation. Thereafter, she was in remission of the acute myeloid leukemia, but 1 year later, she developed renal graft-versus-host disease. Subsequently, the patient’s renal function gradually deteriorated to end-stage renal failure, and she underwent kidney transplantation with the previous stem cell donor: her mother. HLA typing of donor and recipient showed a complete chimerism in the peripheral blood. The pretransplantation complement-dependent cytotoxic crossmatch and flow cytometric T-cell crossmatch results were both negative, and HLA antibody measurements were all negative. The MLR assay revealed no T-lymphocyte reaction to the donor; therefore, immunosuppressants were not used. Two years after transplantation, the patient’s serum creatinine concentration was around 0.8 mg/dL (down from 4 mg/dL before transplantation). No abnormalities were observed in a renal biopsy performed after 3 months. Our study, along with others, indicates that immune tolerance to a donor develops in post-HSCT kidney transplantation from the same donor.
Adaptation and Validation of Overall Assessment of the Speaker’s Experience of Stuttering for Adults in Kannada (OASES-A-K)
Authors: Mahesh Sangeetha , Pushpavathi Mariswamy , Seth Divya , Saravanan Sivaranjani , Yaruss J.Scott
Published: July 2023

Introduction: Psychosocial aspects of stuttering may affect the quality of life of a person who stutters (PWS). Further, the social stigma and experiences of PWS may vary globally. The WHO-ICF guidelines recommend quality of life as an essential component in the assessment of individuals who stutter. However, the availability of linguistically and culturally appropriate tools is often a challenge. Thus, the current study adapted and validated the OASES-A for Kannada-speaking adults who stutter. Method: The original English version of OASES-A was adapted to Kannada using a standard reverse translation process. The adapted version was administered on 51 Kannada-speaking adults with very mild to very severe stuttering. The data were analyzed for item characteristics, reliability, and validity assessment. Results: The results revealed floor and ceiling effects for six and two items, respectively. The mean overall impact score indicated a moderate impact of stuttering. Further, the impact score for section II was relatively higher when compared to the data from other countries. The reliability and validity analyses showed good internal consistency and test-retest reliability for OASES-A-K. Conclusion: The findings of the current research suggest that OASES-A-K is a sensitive and reliable tool to assess the impact of stuttering in Kannada-speaking PWS. The findings also highlight cross-cultural differences and the need for research in this direction.
Succinate Dehydrogenase Defects Giant Renal Cell Carcinoma
Authors: Sun Xia , Wang Guang , Huang Ziye , Li Pei , Yang Bowei , Wang Tianyun , Li Jiongming
Published: July 2023

Succinate dehydrogenase (SDH)-deficient renal cell carcinoma (RCC) is a new subtype of RCC included in the 2016 edition of the WHO classification in RCC. SDH-defective RCC accounts for 0.05–0.2%, and preoperative diagnosis is difficult. We report a severe adherent RCC of inferior vena cava that underwent open radical nephrectomy after preoperative renal artery embolization. Postoperative histopathological examination diagnosed SDH-defective RCC; the clinicopathological stage was pT2b. After 10 months of follow-up, the patient had no evidence of disease recurrence. For patients with large RCC, interventional embolization can be selected to reduce intraoperative bleeding and blood transfusion, and it is recommended to complete interventional surgery within 3–4 h before surgery. SDH-deficient RCC is difficult to distinguish from other renal tumors in imaging, so immunohistochemical examination of SDHB is recommended for young and middle-aged patients, especially those under 45.
Head and Neck Solitary Fibrous Tumor Presenting as Salivary Gland Tumor: Two Case Reports and Review of the Literature
Authors: Suzuki Kensuke , Noda Yuri , Sakagami Tomofumi , Yagi Masao , Kusafuka Kimihide , Iwai Hiroshi
Published: July 2023

Solitary fibrous tumors (SFTs) are soft tumors (mesenchymal origin) that most likely develop from adult mesenchymal stem cells. SFTs are not common in the head and neck region, and the characteristics of tumors in this location are unclear. The present study describes the clinicopathological findings of 2 cases of SFTs arising in the parotid gland and buccal space, presenting as salivary gland tumors. The first case is a 76-year-old man presenting with a painless tumor on the right parotid gland who subsequently underwent partial superficial parotidectomy. According to the results of histopathological analysis, the tumor consisted of stellate and spindle-shaped cells proliferating on a mucous-like substrate. Immunohistochemical staining revealed that neoplastic cells were positive for CD34, vimentin, Bcl2, and STAT6. The second case is of a 64-year-old man presenting with a painless lump on his right cheek. Based on the findings of fine needle aspiration cytology, a tumor derived from myoepithelial cells of the minor salivary gland or a nonepithelial tumor was suspected. The patient underwent surgical resection via an intraoral approach. Histopathologically, the tumor consisted of spindle-shaped cells with rod-shaped or irregular nuclei. Immunohistochemical staining revealed that the neoplastic cells were positive for CD34, CD99, Bcl2, and STAT6. Briefly, SFT should be considered in the differential diagnosis of a well-marginalized lesion in the salivary gland and oral cavity. STAT6 immunohistochemistry is the most specific and sensitive method of diagnosing SFT. A thorough understanding of the morphological changes associated with SFT and their correlation with clinical, immunohistochemical, and molecular characteristics is important to avoid misdiagnosis.
Single-Dose Pharmacokinetics and Total Removal of Cyclophosphamide in a Patient with Acute Kidney Injury Undergoing Intermittent Haemodialysis and Prolonged Intermittent Kidney Replacement Therapy: A Case Report
Authors: Lück Catherina , Beutel Gernot , Kühn-Velten W. Nikolaus , Kielstein Jan T.
Published: July 2023

The largest study on cyclophosphamide pharmacokinetics in dialysis patients comprises of 6 subjects. In the 2 decades since these data were obtained, dialyser membranes, treatment intensities, and treatment duration have changed considerably making new pharmacokinetic studies desirable. We aimed to readdress the pharmacokinetics of cyclophosphamide in a 74-year-old critically ill male suffering from ANCA-associated vasculitis. Due to an acute-on-chronic kidney injury, he underwent intermittent (IHD) and prolonged intermittent kidney replacement therapy (PIKRT). IHD was started 7 h after end of a cyclophosphamide infusion with a blood/dialysate flow of 300 mL/min for 255 min, followed by PIKRT with a blood/dialysate flow of 140 mL/min for 540 min, both using a 1.3 m2 polysulphone high-flux dialyser (F60S, Fresenius Medical Care). Peak concentration of cyclophosphamide was 20.2 mg/L. Using IHD and PIKRT serum concentration of cyclophosphamide decreased to 1.2 mg/L after IHD and to <0.1 mg/L after PIKRT with dialyser-clearances of 153.0 mL/min and 84.9 mL/min, respectively. Total recovery of cyclophosphamide, calculated from the collected dialysate, was 57.5 mg (7.7% of administered dose) for IHD and was 8.3 mg (1.1% of administered dose) for PIKRT. By using IHD with a high-flux dialyser cyclophosphamide could be eliminated. Remaining cyclophosphamide should be eliminated by PIKRT. Hence, even in the absence of renal function a dose >50% of the recommended for patient with normal renal function may be applied, as complete elimination of the parent drug by modern dialysis is feasible.
Dramatic Recovery of Vision after Trastuzumab Deruxtecan Treatment of HER2-Positive Breast Cancer with Pituitary Metastasis
Authors: Matsui Chiaki , Shibata Nobuhiro , Hirai Chie , Tada Manami , Kikawa Yuichiro , Sugie Tomoharu
Published: July 2023

In recent years, both the number of patients with breast cancer and those with associated brain metastases (BMs) have increased. Human epidermal growth factor receptor 2 (HER2)-positive breast cancer has a high BM frequency. The prognosis of BM from breast cancer is poor, and establishing effective treatment for this disease is essential. We report a HER2-positive patient with multiple BM and right-eye blindness due to pituitary metastasis. She responded promptly to trastuzumab deruxtecan (T-DXd) in the 5th line of treatment, which shrunk the tumors and restored vision. Although the Graded Prognostic Assessment (GPA) predicted survival of 13 months, the patient recovered well after treatment and continued T-DXd use with no progression, including vision loss at 22 months after treatment initiation. This case demonstrates the successful action of T-DXd in the face of multiple BM and poorly predicted outcomes.