bluuebunny/crossref_metadata_2025 huggingface dataset:
Unexpected difficult extubation of double lumen bronchial intubation: a case report
Authors: Zhang Xingcai , Tang Shumiao , Lu Zihui , Chen Yijun
Published: December 2021

Background

The anesthetist and other members of the perioperative team need to be extremely cautious for successful completion of any surgery. If the final step of any general anesthetic-extubation is not sufficiently well planned, it can lead to critical airway incidents during the extubation and hinder transportation of the patient to the post-anesthesia care unit.

Case presentation

A 48-year-old female underwent video-assisted thoracoscopic surgery (VATS) combined with left lower lobectomy. The distal end of the left branch of the tracheal tube was lodged by surgical sutures. In this case, the respiratory physician burned the sutures using an argon electrode, after discussion with the thoracic surgery experts.

Conclusions

Teamwork is essential when caring for a patient with a shared airway. The anesthetist and surgeon must communicate well with each other to achieve optimal surgical outcomes. Importantly, testing the patency of the ETT prior to extubation should be a regular procedure, which is practical significance to guide safe extubation.
Is measurement of central venous pressure required to estimate systemic vascular resistance? A retrospective cohort study
Authors: Oh Chahyun , Noh Chan , Hong Boohwi , Shin Suyeon , Jeong Kuhee , Lim Chaeseong , Kim Yoon-Hee , Lee Soomin , Lee Sun Yeul
Published: December 2021

Background

The clinical range of central venous pressure (CVP) (typically 5 to 15 mmHg) is much less than the range of mean arterial blood pressure (60 to 120 mmHg), suggesting that CVP may have little impact on estimation of systemic vascular resistance (SVR). The accuracy and feasibility of using an arbitrary CVP rather than actual CVP for the estimation of SVR during intraoperative period is not known.

Methods

Using vital records obtained from patients who underwent neurological and cardiac surgery, the present study retrospectively calculated SVR using fixed values of CVP (0, 5, 10, 15, and 20 mmHg) and randomly changing values of CVP (5 to 15 mmHg) and compared these calculated SVRs with actual SVR, calculated using actual CVP. Differences between actual SVR and SVRs based on fixed and random CVPs were quantified as root mean square error (RMSE) and mean absolute percentage error (MAPE). Bland-Altman analysis and four-quadrant plot analysis were performed.

Results

A total of 34 patients are included, including 18 who underwent neurosurgery and 16 who underwent cardiac surgery; 501,380 s (139.3 h) of data was analyzed. The SVR derived from a fixed CVP of 10 mmHg (SVRf10) showed the highest accuracy (RMSE: 115 and 104 [dynes/sec/cm− 5] and MAPE: 6.3 and 5.7% in neurological and cardiac surgery, respectively). The 95% limits of agreement between SVRf10 and actual SVR were − 208.5 (95% confidence interval [CI], − 306.3 to − 148.1) and 242.2 (95% CI, 181.8 to 340.0) dynes/sec/cm− 5 in neurosurgery and − 268.1 (95% CI, − 367.5 to − 207.7) and 163.2 (95% CI, 102.9 to 262.6) dynes/sec/cm− 5 in cardiac surgery. All the SVRs derived from the fixed CVPs (regardless of its absolute value) showed excellent trending ability (concordance rate > 0.99).

Conclusions

SVR can be estimated from a fixed value of CVP without causing significant deviation or a loss of trending ability. However, caution is needed when using point estimates of SVR when the actual CVP is expected to be out of the typical clinical range.

Trial registration

This study was registered Clinical Research Information Service, a clinical trial registry in South Korea (KCT0006187).
The effects of erector spinae plane block on perioperative opioid consumption and rehabilitation in video assisted thoracic surgery
Authors: Zhang Sen , Han Xiaodan , Zhou Di , Sun Minli , Cang Jing , Miao Changhong , Liang Chao
Published: December 2021

Background

This study aimed to determine whether ultrasound-guided continuous erector spinae plane block (ESPB) had an effect on opioid consumption and postoperative rehabilitation in patients undergoing video-assisted thoracic surgery (VATS).

Methods

In this prospective study, 120 patients aged 20–70 years who underwent elective VATS were randomly allocated to one of three groups: group C (general anesthesia with patient-controlled intravenous analgesia [PCIA]), group T (general anesthesia with patient-controlled epidural analgesia [PCEA]), or group E (general anesthesia with continuous ESPB and PCIA). Perioperative opioid consumption, visual analog scale (VAS) scores, preoperative and postoperative Quality of Recovery-15 scores, and postoperative opioid-related adverse events were all assessed.

Results

Intraoperative sufentanil consumption in groups T and E was significantly lower than that in group C (both P < 0.001), and the postoperative sufentanil consumption in group E was also significantly lower than that in group C (P = 0.001). Compared with group C, the VAS scores at rest or during coughing immediately out of the post-anesthesia care unit at 6 h, 12 h, and 24 h postoperatively were significantly lower in group T (P < 0.05). However, the VAS scores at rest at 6 h and 12 h postoperatively in group E were lower than those of group C (P < 0.05), but were significantly higher than those of group T at all study times (P < 0.05).

Conclusion

Ultrasound-guided continuous ESPB significantly reduced perioperative opioid consumption during VATS and improved postoperative rehabilitation. However, these effects were inferior to those of thoracic epidural anesthesia.

Trial registration

The present study was prospectively registered at http://www.chictr.org/cn /(registration number: ChiCTR1900023050); registration date: May 82,019.
Parkinson’s disease with a typical clinical course of 17 years overlapped by Creutzfeldt–Jakob disease: an autopsy case report
Authors: Kubo Shin-ichiro , Matsubara Tomoyasu , Taguchi Takeshi , Sengoku Renpei , Takeuchi Atsuko , Saito Yuko
Published: December 2021

Background

Late-stage Parkinson’s disease (PD) often presents with neuropsychiatric symptoms such as dementia, psychosis, excessive daytime sleepiness, apathy, depression, and anxiety. However, neuropsychiatric symptoms are the cardinal features of Creutzfeldt–Jakob disease (CJD), raising the possibility that CJD may be an overlooked condition when it accompanies late-stage PD.

Case presentation

We describe a female autopsy case of PD with a typical clinical course of 17 years, in which CJD overlapped with PD during the final year of the patient’s life. The patient died aged 85 years. Neuropathological features included widespread Lewy body-related α-synucleinopathy predominantly in the brainstem and limbic system, as well as the typical pathology of methionine/methionine type 1 CJD in the brain.

Conclusions

Our case demonstrates the clinicopathological co-occurrence of PD and CJD in a sporadic patient. The possibility of mixed pathology, including prion pathology, should be taken into account when neuropsychiatric symptoms are noted during the disease course of PD.
Selective termination of the fetus in multiple pregnancies using ultrasound-guided radiofrequency ablation
Authors: Li Nan , Sun Jimei , Wang Jiayan , Jian Wei , Lu Jing , Miao Yonghui , Li Yufan , Chen Fei , Chen Dunjin , Ye Xiaoqing , Chen Min
Published: December 2021

Background

To evaluate the perinatal outcomes in women with selective termination using ultrasound-guided radiofrequency ablation (RFA).

Methods

Complicated monochorionic (MC) twin pregnancies and multiple pregnancies with an indication for selective termination by ultrasound-guided coagulation of the umbilical cord with RFA under local anesthesia between July 2013 and Jan 2020 were reviewed. We analyzed the indications, gestational age at the time of the procedure, cycles of RFA, duration of the procedure, and perinatal outcome.

Results

Three hundred and thirteen patients were treated during this period. Seven of whom were lost of follow-up. The remaining 306 cases, including 266 pairs of monochorionic diamniotic (MCDA) twins (86.93%), two pairs of monoamniotic twins (0.65%), 30 dichorionic triamniotic (DCTA) triplets (1%), and three monochorionic triamniotic (MCTA) triplets (0.98%), were analyzed. Indications included twin-to-twin transfusion syndrome (TTTS) (n = 91), selective fetal growth restriction (sFGR) (n = 83), severe discordant structural malformation (n = 78), multifetal pregnancy reduction (MFPR) (n = 78), twin reverse arterial perfusion sequence (TRAPS) (n = 19), and twin anemia-polycythemia sequence (TAPS) (n = 3). Upon comparison of RFA performed before and after 20 weeks, the co-twin loss rate (20.9% vs. 21.5%), the incidence of preterm premature rupture of membranes (PPROM) within 24 h (1.5% vs. 1.2%), and the median gestational age at delivery [35.93 (28–38) weeks vs. 36 (28.54–38.14) weeks] were similar (p > 0.05).

Conclusions

RFA is a reasonable option when indicated in multiple pregnancies and complicated monochorionic pregnancies. In our experience, the overall survival rate was 78.76% with RFA in selective feticide, and early treatment increases the likelihood of survival for the remaining fetus because the fetal loss rate is similar before and after 20 weeks.
Red flags of poor prognosis in pediatric cases of COVID-19: the first 6610 hospitalized children in Iran
Authors: Madani Sedigheh , Shahin Sarvenaz , Yoosefi Moein , Ahmadi Naser , Ghasemi Erfan , Koolaji Sogol , Mohammadi Esmaeil , Mohammadi Fateh Sahar , Hajebi Amirali , Kazemi Ameneh , Pakatchian Erfan , Rezaei Negar , Jamshidi Hamidreza , Larijani Bagher , Farzadfar Farshad
Published: December 2021

Introduction

COVID-19 clinical course, effective therapeutic regimen, and poor prognosis risk factors in pediatric cases are still under investigation and no approved vaccinehas been introduced for them.

Methods

This cross-sectional study evaluated different aspect of COVID-19 infection in hospitalized COVID-19 positive children (≺18 years oldwith laboratory confirmed COVID-19 infection, using the national COVID-19 registry for all admitted COVID-19 positive cases from February 19 until November 13,2020, in Iran.

Results

We evaluated 6610 hospitalized children. Fifty-four percent (3268) were male and one third of them were infants younger than 1 year. Mortality rate in total hospitalized children was 5.3% and in children with underlying co-morbidities (14.4%) was significantly higher (OR: 3.6 [2.7-4.7]). Chronic kidney disease (OR: 3.42 [1.75-6.67]), Cardiovascular diseases (OR: 3.2 [2.09-5.11]), chronic pulmonary diseases (OR: 3.21 [1.59-6.47]), and diabetes mellitus (OR: 2.5 [1.38-4.55]), resulted in higher mortality rates in hospitalized COVID-19 children. Fever (41%), cough (36%), and dyspnea (27%) were the most frequent symptoms in hospitalized children and dyspnea was associated with near three times higher mortality rate among children with COVID-19 infection (OR: 2.65 [2.13-3.29]).

Conclusion

Iran has relatively high COVID-19 mortality in hospitalized children. Pediatricians should consider children presenting with dyspnea, infants≺ 1 year and children with underlying co-morbidities, as high-risk groups for hospitalization, ICU admission, and death.
Community-based interventions to reduce dental caries among 24-month old children: a pilot study of a field trial
Authors: Deghatipour Marzie , Ghorbani Zahra , Mokhlesi Amir Hossein , Ghanbari Shahla , Namdari Mahshid
Published: December 2021

Background

Early childhood caries (ECC) is the most common dental disease among children worldwide, leading to many difficulties on child’s growth. As WHO mentioned, educational interventions in addition to interprofessional collaboration are needed to achieve proper ECC prevention. In present study we’ve aimed to evaluate the effectiveness of some oral health promotion interventions to reduce dental caries among 24-month old children.

Methods

A field trial study was conducted amongst 439 mothers from pregnancy up to 24 months after delivery in Public Health Centers in Varamin, Tehran, Iran. Participants were allocated to intervention (n = 239) and control groups (n = 200). Demographic, socioeconomic status and dental care behavior data were collected using a questionnaire. The content of our study intervention consisted of nutritional and behavioral oral health-related messages. Mothers received messages via either of four methods (A: comprehensive method including all other methods together (n = 74), B: group discussion by dentists (n = 59), C: face to face education by primary health care providers (n = 53), and D: social network (n = 53). The control group received routine maternal and oral health care. To assess the effectiveness of interventions on promoting children’s oral health, the oral health-related behaviors data, the number of decayed teeth (d), and being caries free at the age of two were considered.

Results

Among the 436 examined children, with a mean age of 23.7 months, 48.2% were male. The frequency of using finger toothbrush increased from 53.4% to 89.8% in all intervention groups. The mean (SD) of decayed teeth at 24 months in intervention and control group were 0.36 (0.93) and 1.61 (2.61), respectively. All the four intervention groups, except social network, had more chance of being caries free compared to control group (P value < 0.05). Analysis showed that children in comprehensive intervention group had a higher chance of being caries free compared to all other groups, after adjustment for covariates.

Conclusions

Performing oral health interventions could help the prevention of dental caries in newborn children. Also, using a combination of different methods of sending messages can have the best results in promoting oral health.
Qualitative assessment of the intention of Chinese community health workers to implement advance care planning using theory of planned behavior
Authors: Xing Bingyu , Liang Guanmian , Zhang Jing , Zhang Jinsheng , Jiang Zhizhi , Miao Qunfang
Published: December 2021

Background

The aging population coupled with progressive medical technology has increased the demand for improved quality of end-of-life in China. However, implementation of an advance care planning (ACP) program in mainland China is still in its infancy owing to the significant influence of filial piety in Chinese culture. Research on implementation of ACP program among community health workers (CHWs) is limited. The current study sought to explore the willingness of CHWs to implement ACP based on the theory of planned behavior (TPB) and provide a reference for promotion of ACP in Chinese communities.

Methods

Phenomenological qualitative study using semi-structured face-to-face interviews. Interviews were audio-recorded. Colaizzi’s method was used for data analysis. The study received ethical approval and all participants provided written consent.

Results

Thirteen CHWs from 3 community health service centers (CHSCs) in Hangzhou, Zhejiang Province, China were interviewed. Through the analysis of the interview content, we determined that most CHWs have a supportive attitude towards the implementation of ACP, the reasons for which are as follows: relieve suffering of patients and respect their medical autonomy; relieve economic and psychological burden on family members; promote development of community palliative care. However, some CHWs believe that the implementation of ACP will lead to doctor-patient disputes and medical risks. CHWs reported that the support of patients and their families, community lawyers, psychosocial professionals, and CHSCs senior managers helped them to implement ACP. In addition, they indicated that the improvement of doctor-patient communication ability, the improvement of community medical environment, the support of government policy, and the training of CHWs were the promoting factors influencing their implementation of ACP. The hindrance factors include insufficient allocation of community health human resources, imperfect ACP legislation in China, and deep-rooted traditional culture.

Conclusion

Findings demonstrated that Chinese CHWs tend to support the implementation of ACP, but their willingness to implement is affected by different factors. CHSCs should actively organize standardized ACP training and comprehensively consider community medical environment, organizational norms, and human resources in implementation of ACP.
Lifestyle correlates of eight breast cancer-related metabolites: a cross-sectional study within the EPIC cohort
Authors: His Mathilde , Viallon Vivian , Dossus Laure , Schmidt Julie A. , Travis Ruth C. , Gunter Marc J. , Overvad Kim , Kyrø Cecilie , Tjønneland Anne , Lécuyer Lucie , Rothwell Joseph A. , Severi Gianluca , Johnson Theron , Katzke Verena , Schulze Matthias B. , Masala Giovanna , Sieri Sabina , Panico Salvatore , Tumino Rosario , Macciotta Alessandra , Boer Jolanda M. A. , Monninkhof Evelyn M. , Olsen Karina Standahl , Nøst Therese H. , Sandanger Torkjel M. , Agudo Antonio , Sánchez Maria-Jose , Amiano Pilar , Colorado-Yohar Sandra M. , Ardanaz Eva , Vidman Linda , Winkvist Anna , Heath Alicia K. , Weiderpass Elisabete , Huybrechts Inge , Rinaldi Sabina
Published: December 2021

Background

Metabolomics is a promising molecular tool for identifying novel etiological pathways leading to cancer. In an earlier prospective study among pre- and postmenopausal women not using exogenous hormones, we observed a higher risk of breast cancer associated with higher blood concentrations of one metabolite (acetylcarnitine) and a lower risk associated with higher blood concentrations of seven others (arginine, asparagine, phosphatidylcholines (PCs) aa C36:3, ae C34:2, ae C36:2, ae C36:3, and ae C38:2).

Methods

To identify determinants of these breast cancer-related metabolites, we conducted a cross-sectional analysis to identify their lifestyle and anthropometric correlates in 2358 women, who were previously included as controls in case-control studies nested within the European Prospective Investigation into Cancer and Nutrition cohort and not using exogenous hormones at blood collection. Associations of each metabolite concentration with 42 variables were assessed using linear regression models in a discovery set of 1572 participants. Significant associations were evaluated in a validation set (n = 786).

Results

For the metabolites previously associated with a lower risk of breast cancer, concentrations of PCs ae C34:2, C36:2, C36:3, and C38:2 were negatively associated with adiposity and positively associated with total and saturated fat intakes. PC ae C36:2 was also negatively associated with alcohol consumption and positively associated with two scores reflecting adherence to a healthy lifestyle. Asparagine concentration was negatively associated with adiposity. Arginine and PC aa C36:3 concentrations were not associated to any of the factors examined. For the metabolite previously associated with a higher risk of breast cancer, acetylcarnitine, a positive association with age was observed.

Conclusions

These associations may indicate possible mechanisms underlying associations between lifestyle and anthropometric factors, and risk of breast cancer. Further research is needed to identify potential non-lifestyle correlates of the metabolites investigated.
Lead exposure and serum metabolite profiles in pregnant women in Mexico City
Authors: Niedzwiecki Megan M. , Eggers Shoshannah , Joshi Anu , Dolios Georgia , Cantoral Alejandra , Lamadrid-Figueroa Héctor , Amarasiriwardena Chitra , Téllez-Rojo Martha M. , Wright Robert O. , Petrick Lauren
Published: December 2021

Background

Lead (Pb) exposure is a global health hazard causing a wide range of adverse health outcomes. Yet, the mechanisms of Pb toxicology remain incompletely understood, especially during pregnancy. To uncover biological pathways impacted by Pb exposure, this study investigated serum metabolomic profiles during the third trimester of pregnancy that are associated with blood Pb and bone Pb.

Methods

We used data and specimens from 99 women enrolled in the Programming Research in Obesity, Growth, Environment, and Social Stressors birth cohort in Mexico City. Maternal Pb exposure was measured in whole blood samples from the third trimester of pregnancy and in the tibia and patella bones at 1 month postpartum. Third-trimester serum samples underwent metabolomic analysis; metabolites were identified based on matching to an in-house analytical standard library. A metabolome-wide association study was performed using multiple linear regression models. Class- and pathway-based enrichment analyses were also conducted.

Results

The median (interquartile range) blood Pb concentration was 2.9 (2.6) µg/dL. Median bone Pb, measured in the tibia and patella, were 2.5 (7.3) µg/g and 3.6 (9.5) µg/g, respectively. Of 215 total metabolites identified in serum, 31 were associated with blood Pb (p < 0.05). Class enrichment analysis identified significant overrepresentation of metabolites classified as fatty acids and conjugates, amino acids and peptides, and purines. Tibia and patella Pb were associated with 14 and 8 metabolites, respectively (p < 0.05). Comparing results from bone and blood Pb, glycochenodeoxycholic acid, glycocholic acid, and 1-arachidonoylglycerol were positively associated with blood Pb and tibia Pb, and 7-methylguanine was negatively associated with blood Pb and patella Pb. One metabolite, 5-aminopentanoic acid, was negatively associated with all three Pb measures.

Conclusions

This study identified serum metabolites in pregnant women associated with Pb measured in blood and bone. These findings provide insights on the metabolic profile around Pb exposure in pregnancy and information to guide mechanistic studies of toxicological effects for mothers and children.
Identification of the minimal active soluble TREM2 sequence for modulating microglial phenotypes and amyloid pathology
Authors: Sheng Xuan , Yao Yunling , Huang Ruizhi , Xu Ying , Zhu Yifei , Chen Linting , Zhang Lianshuai , Wang Wanbing , Zhuo Rengong , Can Dan , Chang Che-Feng , Zhang Yun-wu , Xu Huaxi , Bu Guojun , Zhong Li , Chen Xiao-Fen
Published: December 2021

Background

TREM2 is a microglial receptor genetically linked to the risk for Alzheimer’s disease (AD). The cerebrospinal fluid (CSF) levels of soluble TREM2 (sTREM2) have emerged as a valuable biomarker for the disease progression in AD and higher CSF levels of sTREM2 are linked to slower cognitive decline. Increasing sTREM2 in mouse models of amyloidosis reduces amyloid-related pathology through modulating microglial functions, suggesting a beneficial role of sTREM2 in microglia biology and AD pathology.

Methods

In the current study, we performed serial C- and N-terminal truncations of sTREM2 protein to define the minimal sequence requirement for sTREM2 function. We initially assessed the impacts of sTREM2 mutants on microglial functions by measuring cell viability and inflammatory responses. The binding of the sTREM2 mutants to oligomeric Aβ was determined by solid-phase protein binding assay and dot blot assay. We further evaluated the impacts of sTREM2 mutants on amyloid-related pathology by direct stereotaxic injection of sTREM2 proteins into the brain of 5xFAD mice.

Results

We found that both sTREM2 fragments 41–81 and 51–81 enhance cell viability and inflammatory responses in primary microglia. However, the fragment 51–81 exhibited impaired affinity to oligomeric Aβ. When administrated to the 5xFAD mice brain, the sTREM2 fragment 41–81, but not 51–81, increased the number of plaque-associated microglia and reduced the plaque deposition. Interestingly, the fragment 41–81 was more efficient than the physiological form of sTREM2 in ameliorating Aβ-related pathology.

Conclusions

Our results indicate that the interaction of sTREM2 truncated variants with Aβ is essential for enhancing microglial recruitment to the vicinity of an amyloid plaque and reducing the plaque load. Importantly, we identified a 41-amino acid sequence of sTREM2 that is sufficient for modulating microglial functions and more potent than the full-length sTREM2 in reducing the plaque load and the plaque-associated neurotoxicity. Taken together, our data provide more insights into the mechanisms underlying sTREM2 function and the minimal active sTREM2 sequence represents a promising candidate for AD therapy.
MicroRNA-155-5p promotes neuroinflammation and central sensitization via inhibiting SIRT1 in a nitroglycerin-induced chronic migraine mouse model
Authors: Wen Qianwen , Wang Yunfeng , Pan Qi , Tian Ruimin , Zhang Dunke , Qin Guangcheng , Zhou Jiying , Chen Lixue
Published: December 2021

Background

Previous studies have confirmed that the microglial activation and subsequent inflammatory responses in the trigeminal nucleus caudalis (TNC) are involved in the central sensitization of chronic migraine (CM). MicroRNA-155-5p has been shown to modulate the polarization of microglia and participate in inflammatory processes in a variety of neurological diseases. However, its role in CM remains unclear. The purpose of this study was to determine the precise role of miR-155-5p in CM.

Methods

A model of CM in C57BL/6 mice was established by recurrent intraperitoneal injection of nitroglycerin (NTG). Mechanical and thermal hyperalgesia were evaluated by Von Frey filaments and radiant heat. The expression of miR-155-5p was examined by qRT-PCR, and the mRNA and protein levels of silent information regulator 1(SIRT1) were measured by qRT-PCR, Western blotting (WB) and immunofluorescence (IF) analysis. The miR-155-5p antagomir, miR-155-5p agomir, SRT1720 (a SIRT1 activator) and EX527 (a SIRT1 inhibitor) were administered to confirm the effects of miR-155-5p and SIRT1 on neuroinflammation and the central sensitization of CM. ELISA, WB and IF assays were applied to evaluate the expression of TNF-α, myeloperoxidase (MPO), IL-10, p-ERK, p-CREB, calcitonin gene-related peptide (CGRP), c-Fos and microglial activation. The cellular localization of SIRT1 was illustrated by IF.

Results

After the NTG-induced mouse model of CM was established, the expression of miR-155-5p was increased. The level of SIRT1 was decreased, and partly colocalized with Iba1 in the TNC. The miR-155-5p antagomir and SRT1720 downregulated the expression of p-ERK, p-CREB, CGRP, and c-Fos, alleviating microglial activation and decreasing inflammatory substances (TNF-α, MPO). The administration of miR-155-5p agomir or EX527 exacerbated neuroinflammation and central sensitization. Importantly, the miR-155-5p agomir elevated CGRP and c-Fos expression and microglial activation, which could subsequently be alleviated by SRT1720.

Conclusions

These data demonstrate that upregulated miR-155-5p in the TNC participates in the central sensitization of CM. Inhibiting miR-155-5p alleviates neuroinflammation by activating SIRT1 in the TNC of CM mice.
Microbial co-occurrence complicates associations of gut microbiome with US immigration, dietary intake and obesity
Authors: Wang Zheng , Usyk Mykhaylo , Vázquez-Baeza Yoshiki , Chen Guo-Chong , Isasi Carmen R. , Williams-Nguyen Jessica S. , Hua Simin , McDonald Daniel , Thyagarajan Bharat , Daviglus Martha L. , Cai Jianwen , North Kari E. , Wang Tao , Knight Rob , Burk Robert D. , Kaplan Robert C. , Qi Qibin
Published: December 2021

Background

Obesity and related comorbidities are major health concerns among many US immigrant populations. Emerging evidence suggests a potential involvement of the gut microbiome. Here, we evaluated gut microbiome features and their associations with immigration, dietary intake, and obesity in 2640 individuals from a population-based study of US Hispanics/Latinos.

Results

The fecal shotgun metagenomics data indicate that greater US exposure is associated with reduced ɑ-diversity, reduced functions of fiber degradation, and alterations in individual taxa, potentially related to a westernized diet. However, a majority of gut bacterial genera show paradoxical associations, being reduced with US exposure and increased with fiber intake, but increased with obesity. The observed paradoxical associations are not explained by host characteristics or variation in bacterial species but might be related to potential microbial co-occurrence, as seen by positive correlations among Roseburia, Prevotella, Dorea, and Coprococcus. In the conditional analysis with mutual adjustment, including all genera associated with both obesity and US exposure in the same model, the positive associations of Roseburia and Prevotella with obesity did not persist, suggesting that their positive associations with obesity might be due to their co-occurrence and correlations with obesity-related taxa, such as Dorea and Coprococcus.

Conclusions

Among US Hispanics/Latinos, US exposure is associated with unfavorable gut microbiome profiles for obesity risk, potentially related to westernized diet during acculturation. Microbial co-occurrence could be an important factor to consider in future studies relating individual gut microbiome taxa to environmental factors and host health and disease.
Oncologic Treatment of HIV-Associated Kaposi Sarcoma 40 Years on
Authors: Ramaswami Ramya , Lurain Kathryn , Yarchoan Robert
Published: December 2021

The observation in 1981 of the emergence of Kaposi sarcoma (KS) among young men who had sex with men was one of the first harbingers of the HIV epidemic. With advances in HIV care, the incidence of HIV-associated KS (HIV+KS) has decreased over time in the United States. However, it remains a persistent malignancy among some HIV-infected populations and is one of the most common tumors in sub-Saharan Africa. Because of the relapsing and remitting nature of this cancer, patients with HIV+KS can experience significant, long-term, morbidity. Patients with severe HIV+KS may also have concurrent lymphoproliferative syndromes, malignancies, and/or infections that can contribute to mortality. Several chemotherapy agents were explored in clinical trials for HIV+KS during the early stage of the epidemic. As HIV+KS emerges with CD4 lymphopenia and immunodysregulation, T-cell–sparing options are important to consider. Here, we explore the pathogenesis of HIV+KS and the current evidence for immunotherapy and therapies that potentially target KS pathogenesis. This review provides the current landscape of therapies for HIV+KS and highlights management issues for patients with HIV and cancer.
New Therapies for Primary Hyperlipidemia
Authors: Aguilar-Salinas Carlos A , Gómez-Díaz Rita A , Corral Pablo
Published: December 2021

Primary hyperlipidemias include a heterogeneous set of monogenic and polygenic conditions characterized by a strong family aggregation, severe forms of hypercholesterolemia and/or hypertriglyceridemia, appearance early on life, and a high risk of cardiovascular events and/or recurrent pancreatitis. In real life, a small proportion of the primary hyperlipidemia cases is recognized and treated properly. Our goal is to present an update of current and upcoming therapies for patients with primary hyperlipidemia. Recently, new lipid-lowering medications have obtained authorization from the U.S. Food and Drug Administration and the European Medicines Agency. These drugs target metabolic pathways, including (adenosine 5′-triphosphates)-citrate lyase (bempedoic acid), proprotein convertase subtilisin/kexin 9 (inclisiran), apolipoprotein CIII (volanesorsen), and angiopoietin-like 3 (volanesorsen), that have additive effects with the actions of the currently available therapies (i.e., statins, ezetimibe or fibrates). We discuss the potential clinical indications for the novel medications. To conclude, the addition of these new medications to the therapeutic options for primary hyperlipidemia patients may increase the likelihood of achieving the treatment targets. Also, it could be a safer alternative for patients with side effects for the currently available drugs.
Unmasking Fracture Risk in Type 2 Diabetes: The Association of Longitudinal Glycemic Hemoglobin Level and Medications
Authors: Wang Bowen , Wang Zehai , Poundarik Atharva A , Zaki Mohammed J , Bockman Richard S , Glicksberg Benjamin S , Nadkarni Girish N , Vashishth Deepak
Published: December 2021

Context

Fracture risk is underestimated in people with type 2 diabetes (T2D).

Objective

To investigate the longitudinal relationship of glycated hemoglobin (HbA1c) and common medications on fracture risk in people with T2D.

Methods

This retrospective population-based cohort study was conducted using de-identified claims and electronic health record data obtained from the OptumLabs Data Warehouse for the period January 1, 2007, to September 30, 2015. For each individual, the study was conducted within a 2-year HbA1c observation period and a 2-year fracture follow-up period. A cohort of 157 439 individuals with T2D [age ≥ 55 years with mean HbA1c value ≥ 6%] were selected from 4 018 250 US Medicare Advantage/Commercial enrollees with a T2D diagnosis. All fractures and fragility fractures were measured.

Results

With covariates adjusted, poor glycemic control in T2D individuals was associated with an 29% increase of all fracture risk, compared with T2D individuals who had adequate glycemic control (HR: 1.29; 95% CI, 1.22-1.36). Treatment with metformin (HR: 0.88; 95% CI, 0.85-0.92) and DPP4 inhibitors (HR: 0.93; 95% CI, 0.88-0.98) was associated with a reduced all fracture risk, while insulin (HR: 1.26; 95% CI, 1.21-1.32), thiazolidinediones (HR: 1.23; 95% CI, 1.18-1.29), and meglitinides (HR: 1.12; 95% CI, 1.00-1.26) were associated with an increased all fracture risk (All P value < 0.05). Bisphosphonates were associated similarly with increased fracture risk in the T2D and nondiabetic groups.

Conclusion

Longitudinal 2-year HbA1c is independently associated with elevated all fracture risk in T2D individuals during a 2-year follow-up period. Metformin and DPP4 inhibitors can be used for management of T2D fracture risk.
Artificial intelligence in functional imaging of the lung
Authors: San José Estépar Raúl
Published: December 2021

Artificial intelligence (AI) is transforming the way we perform advanced imaging. From high-resolution image reconstruction to predicting functional response from clinically acquired data, AI is promising to revolutionize clinical evaluation of lung performance, pushing the boundary in pulmonary functional imaging for patients suffering from respiratory conditions. In this review, we overview the current developments and expound on some of the encouraging new frontiers. We focus on the recent advances in machine learning and deep learning that enable reconstructing images, quantitating, and predicting functional responses of the lung. Finally, we shed light on the potential opportunities and challenges ahead in adopting AI for functional lung imaging in clinical settings.
Analysis of the Economic Security of the Power Grid Complex in Russia Based on an Assessment of the Likelihood of Bankruptcy of Enterprises
Authors: Bulatenko Mariya , Romanov Ya.
Published: December 2021

Natural monopolies are one of the most profitable sectors of the economy. However, due to the lack of competition, the government has to regulate prices through rigid tariffs, thereby limiting the amount of revenue. This trend plays a huge role for the end consumer, as prices are fixed by the public sector. This negatively affects the economic security of the monopolist enterprise. Improper management of an enterprise in conditions of government regulation, limited investment resources, high consumer requirements for the quality of electricity can lead to the bankruptcy of the power grid company.To identify the risk of bankruptcy in the article, calculations were performed using multiple discriminant analysis models (MDA models: Altman's two-factor model and Fedotova's two-factor model) and logistic models (Logit models: Gruzchinsky's model (2003) and Lin-Piesse's model (2004)) of the annual financial reports of enterprises of the electric grid complex of Russia (subsidiaries of PJSC Rosseti, such as: OJSC IDGC of Urals, PJSC IDGC of Center and Volga Region, PJSC Rosseti Volga, PJSC Rosseti Kuban, PJSC TRK) for the last five years (2016-2020, this period characterizes the financial situation of enterprises before and during the Covid-19 pandemic).
Consultation and clinical assessment of the genitourinary system for advanced clinical practitioners
Authors: Powell Karen
Published: December 2021

Assessment of symptoms affecting the genitourinary system is in high demand as they can significantly impact on quality of life. Nurses with advanced skills in communication, consultation and specialist knowledge play a key role in improving the experience for patients presenting with genitourinary symptoms.
Quality of life of ostomates at a teaching and referral hospital in Kenya
Authors: Mungai Margaret Wanjiru , Abere Mercy Nyanchama , Avula Edward Kilamonda
Published: December 2021

Background:

Ostomy surgery is performed to maintain gastrointestinal function. However, there is a lack of knowledge and experience about ostomies among patients and clinicians in public hospitals in Kenya. The issue is compounded by the social isolation and stigma ostomates face in the wards and in the community after discharge. Although it is not easy to identify the exact number of ostomates in Kenya and other African countries, there is need to shift the focus from curing symptoms in ostomates to maximising patients’ quality of life (QoL) and integrating services for ostomates in mainstream public hospitals.

Aim:

To understand the effects of ostomies on patients’ QoL, with a focus on nutrition, psychosocial aspects and challenges around sexuality after ostomy creation.

Method:

A descriptive study was undertaken using an interviewer-administered QoL questionnaire with 81 patients.

Results:

Most patients were male (54%); the largest age group was 35–44 years (24.7%). Colorectal carcinoma, intestinal obstruction and traumatic injuries were the main indications for ostomy. Ostomates resumed sexual activity, but did not find it fulfilling (P=0.002). Most reported feeling depressed, with suicidal attempts that negatively correlated with QoL. Ostomates adjusted their diets regardless of whether their level of QoL was poor, fair, good or excellent after ostomy creation (P=0.564).

Conclusion:

Ostomates experience low QoL. Patients’ lives can be improved by focusing on providing individualised ostomy care services after discharge. Enhancing stoma therapy training for nurses and running ostomy clinics alongside mainstream services, as well as support for ostomates towards enrolment into the country’s National Hospital Insurance Fund, will also improve patients’ QoL.
Electronic prescribing
Authors: Robertson Deborah
Published: December 2021

Deborah Robertson provides an overview of recently published articles that may be of interest to non-medical prescribers. Should you wish to look at any of the papers in more detail, a full reference is provided
Research on Sugarcane Seed-Bud Location Based on Anisotropic Scaling Transformation
Authors: Wang Fukuan , Liu Qi , Huang Meizhang , Qiao Xi , Huang Yiqi
Published: December 2021

Highlights

A method of locating sugarcane seed bud based on anisotropy transformation is proposed.

Using computer binocular vision technology, the location of the sugarcane seed bud was determined by edge feature matching of the sugarcane seed bud.

There are few methods to study the automatic location of sugarcane seed buds, and our research provides a new research idea.

Abstract. Sugarcane is a major economic crop in China, but the degree of mechanization in sugarcane cultivation is low. To improve the economic benefit of sugarcane planting, promoting the use of mechanization in sugarcane planting is necessary. Currently, the sugarcane planted using mechanization has a low survival rate and the mechanization efficiency is low because the existing sugarcane precutting machine fails to address the problem of damaging seed buds. This study proposed a sugarcane bud localization method based on computer binocular vision technology. The sugarcane stem segment positions can be determined by the grayscale horizontal projection after preprocessing the sugarcane image based on color and grayscale features. Then, the bud area can be intercepted according to the positional relationship between the seed bud and the stem node, and the planar position of the seed bud will be determined by using the color space conversion and the gray vertical projection. Finally, the anisotropic scaling transformation is used to match the seed-bud area and restore the spatial coordinates of the seed bud, and the spatial position of the seed bud can be determined. The image pyramid acceleration matching process is adopted, which can make the method more suitable for real-time applications. The experimental results show that the accuracy of seed-bud matching based on the anisotropic scaling transformation is 98%, which provides a basis for research on the anti-injury germ system in the automatic planting process of sugarcane. Keywords: Anisotropic scaling, Binocular vision, Image pyramid, Mechanization planting of sugarcane, Seed bud location.
Development of a Seeding Control Method Based on Seed Height in the Hopper of a Precision Wheat Drill
Authors: Hu Jianping , Zhao Xingsheng , Liu Wei , Yao Mengjiao , Zhao Jun
Published: December 2021

Highlights

Seed height in the hopper has an important influence on seeding accuracy.

Through experiments, the relationship between the seed height and seeding quantity discharged per rotation of the flute roller is obtained.

A compensation algorithm for rotational speed is built, which greatly improves the seeding accuracy.

Abstract. The aim of this study was to develop a control method for precise seeding that is able to keep the seed discharged quantity per flute roller rotation stable when the seed volume in the hopper is insufficient. The designed experimental equipment consists of an embedded controller, ultrasonic sensor, square hopper, stepper motor, stepper motor driver, flute roller, and pressure sensor. Seed height in the hopper was measured by an ultrasonic sensor, whose installation location was determined by the distribution of seeds in the hopper. Then, the rotational speed of the flute roller was adjusted based on seed height. A pressure sensor was used to monitor the quantity of seeds discharged per flute roller rotation. Moreover, laboratory experiments were conducted to compare the seeding control method based on seed height and the traditional seeding control method. The average seeding accuracy of the seeding control method based on seed height was 4.07% higher than the traditional seeding control method, and the seeding coefficient of variation was 3.56% less than that. The testing results show that the control method that used a compensation algorithm for rotational speed effectively improves the seeding accuracy, especially when the seed volume is insufficient. Keywords: Compensation algorithm, Precise seeding, Seed distribution, Seed height, Ultrasonic sensor.
An Empirical V-notch Weir Equation and Standard Procedure to Accurately Estimate Drainage Discharge
Authors: Shokrana Md Sami Bin , Ghane Ehsan
Published: December 2021

Highlights

An empirical flow equation was developed for a metal-edge sharp-crest V-notch weir.

A top-down approach was used to determine the height of the V-notch apex.

A combination of the weighing method and a flow meter was used to develop the stage-discharge equation.

A standard procedure was presented to accurately estimate the flow rate.

Abstract. A reliable empirical flow equation for V-notch weirs will provide flow estimates that can be used to calculate nutrient loads leaving fields with subsurface drainage. The objective of this study was to develop such an equation for an AgriDrain metal-edge sharp-crest 45° V-notch weir. In this undertaking, we measured flow rate with a combination of the weighing method for low flow and a turbine flow meter for high flow. The head of water (H) was measured inside a 25-cm AgriDrain control structure with a three-step method. First, we measured the water level (a) and height of the control structure (b). Second, we measured the height of the V-notch apex (c). Third, we calculated head using this equation: H= (b-a) – (b-c). Based on the flow meter readings (Q) and H measurements, we developed the following stage-discharge equation: Q = 0.749H 2.25, with Q in liters per minute and H in centimeters. This equation is valid for an H less than the height of the V-notch (i.e., flow through the V-notch) with unsubmerged flow. Based on field experience, we provide a standard procedure for accurate estimation of drainage discharge. In conclusion, the stage-discharge equation developed in this study can provide reliable flow estimates for subsurface drainage studies. Keywords: Flow rate, Metal-edge weir, Sharp-crest weir, Subsurface drainage, Tile drainage, Weir placement.
4G to 6G: disruptions and drivers for optical access [Invited]
Authors: Ranaweera Chathurika , Kua Jonathan , Dias Imali , Wong Elaine , Lim Christina , Nirmalathas Ampalavanapillai
Published: December 2021

The exponential growth of diverse smart mobile applications such as smart monitoring, holograms, and autonomous vehicles are driving mobile technologies toward a more intelligent and software-defined communication system. This growing demand has led to the next giant leap in next-generation wireless communication technology, i.e., sixth-generation (6G) mobile technology, which anticipates providing 1 Tbps data rates and ultralow latency over ubiquitous 3D coverage areas. However, the transport network, which connects hundreds of thousands of cell sites and the network core to enable intelligence, virtualization, and other key features of 6G, has not advanced enough to cater the dense cell deployment expected in future 6G networks. Because many aspects of 6G remain undefined, this provides us with the opportunity to take optical transport networks into design consideration to realize the benefits that 6G has to offer. To this end, in this paper, we present a comprehensive view on the role of optical access networks in supporting fourth-generation (4G), fifth-generation (5G), and beyond wireless technologies. In particular, we discuss design and deployment strategies and their challenges when using optical access as a transport solution during the evolution of wireless access technologies. For this purpose, we first identify how an optical access network is used to support high-capacity transport networks in 4G, followed by the challenges that 5G brought into optical transport networks and its diverse solutions. We conclude the paper by providing insights into how an optical transport network can be designed to support 6G.
Coherent generation of arbitrary first-order Poincaré sphere beams on an Si chip
Authors: Pi Hailong , Yu Wangke , Yan Jize , Fang Xu
Published: December 2021

Generalized vector vortex light beams possess spatially variant polarization states, and higher-order Poincaré spheres represent a powerful analytical tool for analyzing these intriguing and complicated optical fields. For the generation of these vortex beams, a range of different methods have been explored, with an increasing emphasis placed on compact, integrated devices. Here, we demonstrate via numerical simulation, for the first time, an on-chip light emitter that allows for the controllable generation of all points on a first-order Poincaré sphere (FOPS). The FOPS beam generator consists of a waveguide-coupled, nanostructured Si microring resonator that converts two guided, coherent light waves into freely propagating output light. By matching their whispering gallery modes with the nanostructures, the fundamental TE (transverse electric) and TM (transverse magnetic) input modes produce radial and azimuthal polarizations, respectively. These two linear polarizations can form a pair of eigenstates for the FOPS. Consequently, tuning the phase contrast and the intensity ratio of these two coherent inputs allows for the generation of an arbitrary point on the FOPS. This result indicates a new way for on-chip vector vortex beam generation, which may be applied for integrated optical tweezers and high-capacity optical communications.