bluuebunny/crossref_metadata_2025 huggingface dataset:
RObotic-Assisted Rehabilitation for balance and gait in Stroke patients (ROAR-S): study protocol for a preliminary randomized controlled trial
Authors: Giovannini Silvia , Iacovelli Chiara , Brau Fabrizio , Loreti Claudia , Fusco Augusto , Caliandro Pietro , Biscotti Lorenzo , Padua Luca , Bernabei Roberto , Castelli Letizia
Published: October 2022

Background

Stroke, the incidence of which increases with age, has a negative impact on motor and cognitive performance, quality of life, and the independence of the person and his or her family, leading to a number of direct and indirect costs. Motor recovery is essential, especially in elderly patients, to enable the patient to be independent in activities of daily living and to prevent falls. Several studies have shown how robotic training associated with physical therapy influenced functional and motor outcomes of walking after stroke by improving endurance and walking strategies.

Considering data from previous studies and patients’ needs in gait and balance control, we hypothesized that robot-assisted balance treatment associated with physical therapy may be more effective than usual therapy performed by a physical therapist in terms of improving static, dynamic balance and gait, on fatigue and cognitive performance.

Methods

This is an interventional, single-blinded, preliminary randomized control trial. Twenty-four patients of both sexes will be recruited, evaluated, and treated at the UOC Rehabilitation and Physical Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS in Rome from January to December 2022. Patients will be randomized into two groups: the experimental group will perform specific rehabilitation for balance disorder using the Hunova® robotic platform (Movendo Technology srl, Genoa, IT) for 3 times a week, for 4 weeks (12 total sessions), and for 45 min of treatment, in addition to conventional treatment, while the conventional group (GC) will perform only conventional treatment as per daily routine. All patients will undergo clinical and instrumental evaluation at the beginning and end of the 4 weeks of treatment.

Conclusions

The study aims to evaluate the improvement in balance, fatigue, quality of life, and motor and cognitive performance after combined conventional and robotic balance treatment with Hunova® (Movendo Technology srl, Genoa, IT) compared with conventional therapy alone. Robotic assessment to identify the most appropriate and individualized rehabilitation treatment may allow reducing disability and improving quality of life in the frail population. This would reduce direct and indirect social costs of care and treatment for the National Health Service and caregivers.

Trial registration

ClinicalTrials.gov NCT05280587. Registered on March 15, 2022.
Effects of structured exercises on selected psychological domains in individuals with type 2 diabetes mellitus in Southern Ethiopia institution-based study
Authors: Gebeyehu Muluken , Legesse Kessatie , Mondal Soumitra , Abdulkadir Mahmud , Bekelle Zeru , Molla Alemayehu
Published: October 2022

Background

Psychological disorders are common among individuals with type 2 diabetes mellitus. The effect of exercise training on psychological disorders like anxiety and depression has not been well studied in Ethiopia. The objective of this study was to assess the effect of structured aerobic and resistance exercises on psychological domains among people with type 2 diabetes mellitus in southern Ethiopia.

Method

We began by approaching 97 type 2 diabetic patients who regularly attend follow-up clinics. The 24 study participants were randomly assigned to one of four groups: aerobic exercise (n = 6), resistance exercise (n = 6), combined aerobic and resistance exercise (n = 6), and control group (n = 6). For each arm, the interventions were a structured workout package that was completed without interrupting usual clinical follow-up. The control groups, on the other hand, were kept as follow-up clinical cases with daily routine work. A paired t-test was performed to compare the means and mean differences of each exercise group’s pretest and posttest. A Tukey’s post hoc test was performed to compare mean differences between groups. The significance level was set at P < 0.05.

Result

A more significant change was obtained in the combined aerobic and resistance exercise on anxiety and depression (p = 0.006), social dysfunction (p = 0.009), loss of confidence (p = 0.012) in particular, and psychological wellbeing (p = 0.010) in general. Resistance exercise alone had a significant impact on social dysfunction (p = 0.010), anxiety and depression (p = 0.017), and psychological well-being (p = 0.012) in general. Changes in social dysfunction (p = 0.010), anxiety and depression (p = 0.030), and psychological well-being (p = 0.018) were also influenced by aerobic exercise. The study found no significant change in depression and anxiety among control groups.

Conclusion

As a result, the combined effect of aerobic and resistance exercise had a greater influence on improving anxiety and depression, social dysfunction, loss of confidence in particular, and psychological well-being in general among patients with type 2 diabetes. In other words, the present evidence proves the betterment of combined aerobic and resistance exercises alone followed by resistance exercise alone and aerobic exercise alone compared with non-exercise groups seems to upgrade psychological wellbeing by setting up three main benefits named as: (1) anti-anxiety and depression effects; (2) anti-social dysfunction effects; and (3) anti-loss of confidence effects. This suggests that patients with diabetes who exercise regularly enhance their psychological well-being.
High-dose intravenous glucocorticoid induces hyperamylasemia: a case series
Authors: Yang Di , Li Ming-hui
Published: October 2022

Background

Glucocorticoids have many side effects, and high-dose intravenous application may cause rare adverse reactions such as hyperamylasemia. The aim of this study is to explore the clinical characteristics, treatment, and prognosis of hyperamylasemia induced by high-dose intravenous glucocorticoids.

Case presentation

Four Asian female patients, aged between 26 and 71 years, were diagnosed with hyperamylasemia after intravenous administration of high-dose glucocorticoid. Amylase levels were elevated to varying degrees in all patients, but the peaks were below three times the upper limit of normal, and imaging showed no significant pancreatic abnormalities. Two patients developed abdominal pain, which was resolved by inhibition of pancreatic secretion, while the other patients were asymptomatic. Two patients were discharged after a significant decrease in amylase levels, while the other two were discharged after improvement of the primary disease.

Conclusion

High-dose intravenous glucocorticoid can cause hyperamylasemia, which should be given enough attention by clinicians. Etiological differentiation of hyperamylasemia should be emphasized in clinical practice, especially when the diagnosis of acute pancreatitis is not clear.
Identification of adenoid subtype characterized with immune-escaped phenotype in lung squamous carcinoma based on transcriptomics
Authors: Mei Jie , Cai Yun , Mussafi Ofek , Zheng Mingfeng , Xu Yongrui , Chen Ruo , Jiang Guanyu , Mao Wenjun , Xia Wei , Wan Yuan
Published: October 2022

Non-small cell lung cancer (NSCLC) is a heterogeneous disease, and its demarcation contributes to various therapeutic outcomes. However, a small subset of tumors shows different molecular features that are in contradiction with pathological classification. Unsupervised clustering was performed to subtype NSCLC using the transcriptome data from the TCGA database. Next, immune microenvironment features of lung adenocarcinoma (LUAD), lung squamous carcinoma (LUSC), and lung adenoid squamous carcinoma (LASC) were characterized. In addition, diagnostic biomarkers to demarcate LASC among LUSC were screened using weighted gene co-expression network analysis (WGCNA) and validated by the in-house cohort. LASC was identified as a novel subtype with adenoid transcriptomic features in LUSC, which exhibited the most immuno-escaped phenotype among all NSCLC subtypes. In addition, FOLR1 was identified as a biomarker for LASC discrimination using the WGCNA analysis, and its diagnostic value was validated by the in-house cohort. Moreover, FOLR1 was related to immuno-escaped tumors in LUSC but not in LUAD. Overall, we proposed a novel typing strategy in NSCLC and identified FOLR1 as a biomarker for LASC discrimination.
Scaffold-mediated switching of lymphoma metabolism in culture
Authors: Bhatt Rachana , Ravi Dashnamoorthy , Evens Andrew M. , Parekkadan Biju
Published: October 2022

Background

Diffuse large B cell lymphoma (DLBCL) is an aggressive subtype of non-Hodgkin lymphoma (NHL) and accounts for about a third of all NHL cases. A significant proportion (~40%) of treated DLBCL patients develop refractory or relapsed disease due to drug resistance which can be attributed to metabolomic and genetic variations amongst diverse DLBCL subtypes. An assay platform that reproduces metabolic patterns of DLBCL in vivo could serve as a useful model for DLBCL.

Methods

This report investigated metabolic functions in 2D and 3D cell cultures using parental and drug-resistant DLBCL cell lines as compared to patient biopsy tissue.

Results

A 3D culture model controlled the proliferation of parental and drug-resistant DLBCL cell lines, SUDHL-10, SUDHL-10 RR (rituximab resistant), and SUDHL-10 OR (obinutuzumab resistant), as well as retained differential sensitivity to CHOP. The results from metabolic profiling and isotope tracer studies with d-glucose-13C6 indicated metabolic switching in 3D culture when compared with a 2D environment. Analysis of DLBCL patient tumor tissue revealed that the metabolic changes in 3D grown cells were shifted towards that of clinical specimens.

Conclusion

3D culture restrained DLBCL cell line growth and modulated metabolic pathways that trend towards the biological characteristics of patient tumors. Counter-intuitively, this research thereby contends that 3D matrices can be a tool to control tumor function towards a slower growing and metabolically dormant state that better reflects in vivo tumor physiology.
Data-driven identification of plasma metabolite clusters and metabolites of interest for potential detection of early-stage non-small cell lung cancer cases versus cancer-free controls
Authors: Kim Julian O. , Balshaw Robert , Trevena Connel , Banerji Shantanu , Murphy Leigh , Dawe David , Tan Lawrence , Srinathan Sadeesh , Buduhan Gordon , Kidane Biniam , Qing Gefei , Domaratzki Michael , Aliani Michel
Published: October 2022

Background

Metabolomics is a potential means for biofluid-based lung cancer detection. We conducted a non-targeted, data-driven assessment of plasma from early-stage non-small cell lung cancer (ES-NSCLC) cases versus cancer-free controls (CFC) to explore and identify the classes of metabolites for further targeted metabolomics biomarker development.

Methods

Plasma from 250 ES-NSCLC cases and 250 CFCs underwent ultra-high-performance liquid chromatography/quadrupole time-of-flight mass spectrometry (UHPLC-QTOF-MS) in positive and negative electrospray ionization (ESI) modes. Molecular feature extraction, formula generation, and find-by-ion tools annotated metabolic entities. Analysis was restricted to endogenous metabolites present in ≥ 80% of samples. Unsupervised hierarchical cluster analysis identified clusters of metabolites. The metabolites with the strongest correlation with the principal component of each cluster were included in logistic regression modeling to assess discriminatory performance with and without adjustment for clinical covariates.

Results

A total of 1900 UHPLC-QTOF-MS assessments identified 1667 and 2032 endogenous metabolites in the ESI-positive and ESI-negative modes, respectively. After data filtration, 676 metabolites remained, and 12 clusters of metabolites were identified from each ESI mode. Multivariable logistic regression using the representative metabolite from each cluster revealed effective classification of cases from controls with overall diagnostic accuracy of 91% (ESI positive) and 94% (ESI negative). Metabolites of interest identified for further targeted analysis include the following: 1b, 3a, 12a-trihydroxy-5b-cholanoic acid, pyridoxamine 5′-phosphate, sphinganine 1-phosphate, gamma-CEHC, 20-carboxy-leukotriene B4, isodesmosine, and 18-hydroxycortisol.

Conclusions

Plasma-based metabolomic detection of early-stage NSCLC appears feasible. Further metabolomics studies targeting phospholipid, steroid, and fatty acid metabolism are warranted to further develop noninvasive metabolomics-based detection of early-stage NSCLC.
The Wnt/β-catenin signalling pathway in Haematological Neoplasms
Authors: Yu Siwei , Han Ruyue , Gan Runliang
Published: October 2022

Leukaemia and lymphoma are common malignancies. The Wnt pathway is a complex network of proteins regulating cell proliferation and differentiation, as well as cancer development, and is divided into the Wnt/β-catenin signalling pathway (the canonical Wnt signalling pathway) and the noncanonical Wnt signalling pathway. The Wnt/β-catenin signalling pathway is highly conserved evolutionarily, and activation or inhibition of either of the pathways may lead to cancer development and progression. The aim of this review is to analyse the mechanisms of action of related molecules in the Wnt/β-catenin pathway in haematologic malignancies and their feasibility as therapeutic targets.
Prediction of soil erosion and sediment transport in a mountainous basin of Taiwan
Authors: Liou Yuei-An , Nguyen Quang-Viet , Hoang Duc-Vinh , Tran Duy-Phien
Published: October 2022

Soil erosion substantially implicates global nutrient and carbon cycling of the land surface. Its monitoring is crucial for assessing and managing global land productivity and socio-economy. The Zhuoshui River Basin, the largest catchment, in Taiwan is highly susceptible to soil erosion by water due to extremely high rainfall, rugged terrain, easily eroded soil, and intensively agricultural cultivation over the steep land. Hence, this study examines the annual soil erosion rate for 2005, 2011, and 2019 and the average long-term soil erosion and sediment yield (SY) during 2005–2019. Coupling of the Revised Universal Soil Loss Equation (RUSLE) and sediment delivery ratio (SDR) models is implemented using remote sensing and GIS techniques. The soil erosion rate is classified into five classes, namely mild (0–10 t ha−1 year−1), moderate (10–50 t ha−1 year−1), moderately severe (50–100 t ha−1 year−1), severe (100–150 t ha−1 year−1), and very severe (> 150 t ha−1 year−1). Over one half of the total area is categorized as moderate and moderately severe classes, and one-third of the whole basin as severe and very severe classes. Recently, mild and moderate classes increase, while moderately severe, severe, and very severe decrease. During 2005–2019, the annual soil loss rate ranges from 0.00 to 6,881.88 t ha−1 year−1 with an average rate of 122.94 t ha−1 year−1. Among the SDR models, the RUSLE combined with the SDR model with the length and slope gradient of mainstream shows satisfactory sediment yield estimation. Predictably, the downstream receives a massive sediment delivery from all upper streams (246.06 × 106 t year−1), and the percent bias values for all sub-basins are below ± 39.0%. The study provides a rapid approach to investigate soil erosion and sediment yield, and it can be applied to the other basins in Taiwan. More importantly, information about spatial patterns of soil erosion and SY is critical to establish suitable measures to achieve effective watershed planning and optimize the regional productivity and socio-economy. The proposed approach is potentially to identify risk areas, conduct scenario estimation for management, and perform spatiotemporal comparison of soil erosion, while adjustment in the empirical formulas of the proposed approach may be needed when it is applied to the other regions, especially outside Taiwan.
Interlink Between Physiological and Biomechanical Changes in the Swim-to-Cycle Transition in Triathlon Events: A Narrative Review
Authors: Ambrosini Luca , Presta Valentina , Galli Daniela , Mirandola Prisco , Vitale Marco , Gobbi Giuliana , Condello Giancarlo
Published: October 2022

Triathlon is a multisport composed of swim, cycle, and run segments and two transition periods. The swim-to-cycle transition is considered a critical period for the change in body position and the modifications in physiological (heart rate, VO2, lactate) and biomechanical parameters (cycling power and cadence, swimming stroke rate). Therefore, the aim of this review was to summarize the current evidence regarding the physiological and biomechanical changes and their interlink during the swim-to-cycle transition hinting at practical recommendations for coaches and athletes. The influence of the swim segment on cycle one is more evident for short-distance events. Greater modifications occur in athletes of lower level. The modulation of intensity during the swim segment affects the changes in the physiological parameters (heart rate, blood lactate, core temperature), with a concomitant influence on cycling gross efficiency. However, gross efficiency could be preserved by wearing a wetsuit or by swimming in a drafting position. A higher swim leg frequency during the last meters of the segment induces a higher cadence during the cycle segment. Training should be directed to the maintenance of a swimming intensity around 80–90% of a previous maximal swim test and with the use of a positive pacing strategy. When athletes are intended to train consecutively only swim and cycle segments, for an optimal muscle activation during cycling, triathletes could adopt a lower cadence (about 60–70% of their typical cadence), although an optimal pedaling cadence depends on the level and type of athlete. Future research should be focused on the combined measurements of physiological and biomechanical parameters using an intervention study design to evaluate training adaptations on swim kick rate and their effects on cycling performance. Coaches and athletes could benefit from the understanding of the physiological and biomechanical changes occurring during the swim-to-cycle transition to optimize the overall triathlon performance.
Our problems and observations in 3D facial implant planning
Authors: Saponaro Gianmarco , Paolantonio Chiara , Barbera Giorgio , Foresta Enrico , Gasparini Giulio , Moro Alessandro
Published: October 2022

Background

Three-dimensional renderings of two-dimensional computed tomography data have allowed for more precise analysis in the craniofacial field. Design, engineering, architecture, and other industries have paved the way for the manipulation and printing of three-dimensional objects.

The usual planning is only carried out based on the bony structures, often without taking into consideration the presence of soft tissues and soft structures. During our practice, we have found ourselves facing the challenge posed by these structures; the aim of this article is to discuss our experience in designing implants presenting our tips and tricks for a better planning leading to an easy and reliable positioning.

Case presentation

We have retrieved all patients in 5 years among those who underwent computer-aided design/computer-aided manufacturing implant placement in the last 5 years in order to review the eventual problems and the solutions found.

A total number of 25 patients were retrieved and, among them, 10 patients were selected, in which planning inaccuracy caused difficulties during implant placement and which then led to induced changes during the planning of similar cases or in which the problems were noted before or during the planning which led to changes in the plan to address those problems.

Six of the selected cases were polyetheretherketone facial implants for the correction of residual deformities in malformed or deformed patients.

One case was a delayed orbital reconstruction with a titanium implant.

Two cases were titanium functional and anatomical reconstruction of the mandible in patients with failed post-oncological reconstructions.

There was 1 case with a mandibular ramus complex and hard-to-treat fracture.

Conclusions

The planning of the implant mostly relies on hard tissue three-dimensional reconstruction, but it should not be limited at what is immediately evident. A surgeon’s clinical experience should always guide the process, with knowledge of the patient’s anatomy and evaluation of the quality and of the soft tissue response being taken into consideration. The implant should always be tailored not only based on the bone defect and evaluations but also using the patient’s previewed and actual anatomy, evaluating eventual interferences and pitfalls.
Evaluation of the additive effect of interferon α 2b with monthly intravitreal injection of bevacizumab in refractory diabetic macular edema
Authors: Faghihi Hooshang , Inanloo Bahman , Mirzaee Arash , Fadakar Kaveh , Mirshahi Ahmad , Ebrahimiadib Nazanin , Ghassemi Fariba , Bazvand Fatemeh , Amini Abdulrahman , Mirghorbani Masoud , Faghihi Shahin , Khalili Pour Elias , Riazi-Esfahani Hamid
Published: October 2022

Background

To evaluate the additive effect of topical or sub-tenon injection of interferon (IFN)-α 2b in the treatment of refractory diabetic macular edema.

Methods

In this prospective study patients with center-involved DME who were unresponsive to 3 monthly consecutive IVB injections were recruited. Patients were divided into three groups: group1, received IFN- α 2b topical drop at a dose of 1mIU/ml four times a day for 3 months. Group 2, received a single sub-tenon injection of 1mIU/ml IFN- α 2b at the enrollment. Group 3 received artificial tears four times a day for 3 months (control group). All groups received three consecutive monthly IVB injections and were evaluated monthly up to 1 month following the last IVB injection.

Results

In this study, 59 eyes of 35 patients with refractory DME were assessed. The final follow-up showed that although CMT decreased in all groups, only patients in Group 2 had statistically significant lower CMT compared to their baseline values (change in CMT: − 117 ± 213 µm; p-value = 0.025). Comparison of CMT changes between three groups showed no statistically significant difference, although it was higher in group 2 (change in CMT: − 117 ± 213 µm (Group2) vs. − 49 ± 173 (Group 1) vs. − 36 ± 86 (Group 3); p-value = 0.085). Considering eyes with baseline CMT > 400 µm, sub-tenon injection of IFN α2b led to a significant reduction of CMT at the first month and final follow-up visit (CMT change: − 166 ± 210, − 145 ± 231 µm; p-value = 0.018 and 0.035, respectively). In this subgroup, eyes in Group 2 had lower CMT at the first month following treatment in comparison with the control group (CMT: 444 ± 123 µm vs. 544 ± 96 µm, p-value = 0.042). Alterations of CDVA were not statistically significant among groups, although patients in Group 1 had a significant improvement in vision at second and last follow up (CDVA change: − 0.23 ± 0.39, − 0.20 ± 0.43 logMAR; p-value = 0.030 and 0.010, respectively).

Conclusions

In short term, Sub-tenon injection of IFN might have an additive anatomical effect in eyes with refractory DME. Validation of this observation requires further prospective controlled studies.
Cervical selective nerve root injection alleviates chronic refractory pain after brachial plexus avulsion: a case report
Authors: Chikama Yoji , Maeda Aiko , Tanaka Ryudo , Tominaga Masachika , Shirozu Kazuhiro , Yamaura Ken
Published: October 2022

Background

Intractable chronic pain, as well as motor, sensory, and autonomic neuropathy, significantly reduces the quality of life of brachial plexus avulsion (BPA) patients. We report the successful application of cervical selective nerve root injection (CSNRI) in a patient with BPA.

Case presentation

A 40-year-old man had been diagnosed with complete left BPA due to a motorcycle accident and underwent intercostal nerve transplantation at the age of 18 years and had been experiencing pain ever since. His pain increased after fracture of the left humerus, and he was referred to our pain management clinic. As his exacerbated pain was suspected to be due to peripheral nerve hypersensitivity, we performed repetitive ultrasound-guided CSNRI (3 mL of 1% mepivacaine of each) targeted C5 and 6 intervertebral foramina, and his symptoms gradually improved.

Conclusions

Repetitive CSNRI may help diagnose and treat BPA-associated peripheral neuropathic pain, even in patients diagnosed with BPA.
Novel viral and microbial species in a translocated Toutouwai (Petroica longipes) population from Aotearoa/New Zealand
Authors: French Rebecca K. , Stone Zoë L. , Parker Kevin A. , Holmes Edward C.
Published: October 2022

Background

Translocation is a common tool in wildlife management and its implementation has resulted in many conservation successes. During translocations, any associated infectious agents are moved with their wildlife hosts. Accordingly, translocations can present a risk of infectious disease emergence, although they also provide an opportunity to restore natural infectious communities (‘infectome’) and mitigate the long-term risks of reduced natural resistance.

Methods

We used metatranscriptomic sequencing to characterise the cloacal infectome of 41 toutouwai (North Island robin, Petroica longipes) that were translocated to establish a new population within the North Island of New Zealand. We also screened for pathogenic bacteria, fungi and parasites.

Results

Although we did not detect any known avian diseases, which is a positive outcome for the translocated toutouwai population, we identified a number of novel viruses of interest, including a novel avian hepatovirus, as well as a divergent calici-like virus and four hepe-like viruses of which the host species is unknown. We also revealed a novel spirochete bacterium and a coccidian eukaryotic parasite.

Conclusions

The presumably non-pathogenic viruses and microbial species identified here support the idea that most microorganisms likely do not cause disease in their hosts, and that translocations could serve to help restore and maintain native infectious communities. We advise greater surveillance of infectious communities of both native and non-native wildlife before and after translocations to better understand the impact, positive or negative, that such movements may have on both host and infectome ecology.
Ho‘ouna Pono implementation: applying concept mapping to a culturally grounded substance use prevention curriculum in rural Hawai‘i schools
Authors: Okamura Kelsie H. , Okamoto Scott K. , Marshall Sarah Momilani , Chin Steven Keone , Garcia Pamela M. , Powell Byron J. , Stern Kelly A. , Becker Sara J. , Mandell David S.
Published: October 2022

Background

Despite their potential to ameliorate health disparities and address youth substance use, prevention programs have been poorly disseminated and implemented across Hawai‘i, which begs the question: Why are effective prevention programs not being used in communities most in need of them? Implementing and sustaining culturally grounded prevention programs is critical to address equitable healthcare and minimize health disparities in communities. The field of implementation science provides frameworks, theories, and methods to examine factors associated with community adoption of these programs.

Method

Our project applies concept mapping methods to a culturally grounded youth drug prevention program with state level educational leadership in rural Hawai‘i schools. The goal is to integrate barrier and facilitator salience collected through teacher and school staff surveys and specific implementation strategies to regionally tailored implementation plans on Hawai‘i island. This protocol paper describes the concept mapping steps and how they will be applied in public and public-charter schools.

Discussion

Improving prevention program implementation in rural schools can result in sustained support for populations that need it most. The project will integrate implementation science and culturally grounded methods in rural Hawai‘i, where most youth are of Native Hawaiian and Pacific Islander descent. This project addresses health disparities among Native Hawaiian and Pacific Islander youth and provides actionable plans for rural Hawai‘i communities to implement effective prevention programming.
The potential therapeutic effect of platelet-rich plasma in the treatment of post-COVID-19 parosmia
Authors: Abo El Naga Heba A. , El Zaiat Reham S. , Hamdan Ahmad M.
Published: October 2022

Background

COVID-19-related olfactory dysfunction is an emerging problem with a significant impact on the quality of life of affected individuals. Different lines of treatment have been used with varying results. This study aimed to assess the potential therapeutic effect of PRP in the treatment of post-COVID olfactory dysfunction. This work aimed to assess the potential therapeutic effect of platelet-rich plasma (PRP) in treating post-COVID-19 parosmia. A pilot study was conducted on 60 patients with post-COVID parosmia without responding to a 3-month course of olfactory training, topical corticosteroids, omega-three, vitamin B12, and zinc supplementation. The patients were distributed randomly and equally among 2 groups. The case group was subjected to three PRP injections in the olfactory cleft at 3 weeks intervals. The control group continued the pre-study treatment protocol for 6 weeks. The degree of parosmia was assessed before and after treatment subjectively using a visual analog scale (VAS) from 0 to 10. Reaching 0–1 on the visual analog scale was a complete improvement. The primary outcome was assessing the post-treatment score for parosmia 1 month after the third injection in the case group. The second outcome was the comparison between both groups regarding the degree of improvement 1 month after cessation of treatment.

Results

There was a highly significant improvement in VAS for parosmia (p < 0.00001) in the case group and a significant improvement in VAS for parosmia in the control group (p = P = 0.00148). There was a significant difference between both groups regarding the degree of improvement favoring the case group (p = 0.002).

Conclusion

Platelet-rich plasma injection in the olfactory cleft offers a therapeutic option for treating patients with post-COVID-19 olfactory parosmia who failed to respond to traditional conservative treatment.
Immunotherapy, Chemotherapy, or Both: Options for First-Line Therapy for Patients With Recurrent or Metastatic Head and Neck Squamous Cell Carcinoma
Authors: Ho Alan L.
Published: October 2022

The Oncology Grand Rounds series is designed to place original reports published in the Journal into clinical context. A case presentation is followed by a description of diagnostic and management challenges, a review of the relevant literature, and a summary of the authors’ suggested management approaches. The goal of this series is to help readers better understand how to apply the results of key studies, including those published in the Journal of Clinical Oncology , to patients seen in their own clinical practice.

The development of immune checkpoint inhibitors has revolutionized the management of recurrent or metastatic head and neck squamous cell carcinoma (R/M HNSCC). The landmark KEYNOTE-048 clinical trial established the programmed death-1 inhibitor pembrolizumab with and without chemotherapy as a new standard first-line treatment for patients with platinum-sensitive R/M HNSCC. Nonetheless, clinical decision making can be challenging when considering the significant morbidity associated with rapidly progressive disease in high-risk locations, patient fitness, and programmed death-ligand 1 expression. Both planned and unplanned subgroup analyses from KEYNOTE-048 provide valuable insights into how therapy for untreated R/M HNSCC may be optimized for individual patients. Given differences in the toxicity profile of pembrolizumab alone versus in combination with chemotherapy, prioritizing patient preference is paramount in this palliative treatment setting. Here, the case of a patient presenting with de novo metastatic HNSCC is discussed to highlight the practical application of KEYNOTE-048 data in clinical practice.
IMPACT the Brain: A Team-Based Approach to Management of Metastatic Breast Cancer With CNS Metastases
Authors: Fleege Nicole M. Grogan , Pierce-Gjeldum Donna , Swartz Leigh K. , Verbal Kait , Merajver Sofia , Friese Christopher R. , Kiyota Ayano , Heth Jason , Leung Denise , Smith Sean R. , Gabel Nicolette , Kim Michelle M. , Morikawa Aki
Published: October 2022

PURPOSE:

CNS metastases are associated with decreased survival and quality of life for patients with metastatic breast cancer (MBC). Team-based care can optimize outcomes. IMPACT the Brain is a care coordination program that aims to improve access to team-based care for patients with MBC and CNS metastases.

MATERIALS AND METHODS:

Patients with MBC and CNS metastases were eligible for enrollment in this care coordination program. A team of specialists supported a dedicated program coordinator who provided navigation, education, specialty referral, and clinical trial screening. A unique intake form developed for the program created personalized, coordinated, and expedited specialty referrals. Patient-reported outcomes and caregiver burden assessments were collected on a voluntary basis throughout enrollment. Data were analyzed using descriptive statistics.

RESULTS:

Sixty patients were referred, and 53 were enrolled (88%). The median time to program enrollment was 1 day (range, 0-11) and to first visit was 5 days (range, 0-25). On the basis of the program intake form, 47 referrals were made across six specialties, most commonly physical medicine and rehabilitation (n = 10), radiation oncology (n = 10), and neuropsychology (n = 10). Nineteen patients (36%) consented to enroll in clinical trials.

CONCLUSION:

A tailored team-based care coordination program for patients with MBC and CNS metastases is feasible. Use of a unique intake screening form by a dedicated program coordinator resulted in faster time to first patient visit, enabled access to subspecialist care, and supported enrollment in clinical trials. Future research should focus on intervention development using PRO data collected in this care coordination program.
Does violation of cosmic no-hair conjecture guarantee the existence of wormhole?
Authors: Roy Dhritimalya , Dutta Ayanendu , Chakraborty Subenoy
Published: October 2022

The present work investigates the interrelation between the validity (or violation) of the cosmic no-hair conjecture and the existence (or non-existence) of wormholes, both in Einstein’s Gravity and in modified gravity theories. It is found that the existence of wormholes implies a violation of the cosmic no-hair conjecture, and the validity of the cosmic no-hair conjecture implies the non-existence of wormholes but not the reverse way both in Einstein’s Gravity and in modified gravity theories. We will also re-visit the gravitational entropy predictions of the wormhole and show how they are connected.
Diagnosis and Treatment of Essential Tremor
Authors: Wagle Shukla Aparna
Published: October 2022

PURPOSE OF REVIEW

Essential tremor is a chronic, progressive syndrome that primarily presents with an action tremor involving the arms and hands. This article reviews the history and physical examination features pertinent for diagnosis, differential diagnoses, and treatments and approaches for optimal control of symptoms.

RECENT FINDINGS

Essential tremor is a syndrome with symptoms extending beyond tremor to involve disturbances in gait, speech, cognition, and mood. Although the new guidelines on the definition and biaxial classification scheme have provided clarity, some tremor experts have critiqued the recently coined term essential tremor plus. For treatment, new orthotic devices and peripheral stimulation devices are now available in addition to pharmacologic and surgical options.

Essential tremor has a rich clinical phenomenology with many subtleties and nuances. A detailed history with open-ended questions and focused questions encompassing medical history, social history, and family history is key for establishing the diagnosis. The presence of bilateral action tremor for 3 years and absence of isolated head and voice tremor and absence of task- and position-dependent tremor are necessary for diagnosis. Dystonic tremor, Parkinson disease tremor, physiologic tremor, and drug-induced tremor are common differential diagnoses. Differentiating these tremor disorders from essential tremor based on phenomenology and physical examination alone could be challenging; thus, clinicians should seek additional clues from a detailed history. Treatment could begin with noninvasive and nonpharmacologic therapies, especially in mild cases. As the severity increases, they can advance stepwise to include pharmacotherapies and surgical interventions. With the growing recognition that essential tremor is not a monosymptomatic disorder, management should involve a multidisciplinary team. Furthermore, treatment selection should be based on shared decision making between patients and providers that gives due consideration to severity of symptoms, level of functional disability, impact on social interactions, patient preferences, and patient expectations.
The Mythic Sea in Contemporary Irish and Caribbean Poetry
Authors: Howley Ellen
Published: October 2022

Myths of the sea are some of the most enduring cultural associations with oceanic spaces. In particular, literature written from islands and coastal locations often shares an interest in these mythic narratives. With a focus on this comparative element, this article investigates how contemporary poets from Ireland and from the Anglophone Caribbean engage with the myths of the sea in their work. It examines the poetry of Lorna Goodison (Jamaica), Seamus Heaney (Northern Ireland), Eiléan Ní Chuilleanáin (Republic of Ireland), and Derek Walcott (Saint Lucia), demonstrating the ways in which a contemporary engagement with the myths of the sea transforms and translates understandings not only of the present moment but also of traditional ideas of linear time. Specific myths of the sea become a tool with which to mine the past and present as they allow these poets to reflect on beginnings, endings, and the repetition of cycles. The critiques that these poets level in their work are also considered through a gendered lens here, as the association between woman and sea, as well as the mythologization of woman is discussed. This article analyzes key poems from these writers to draw out rarely evinced transatlantic routes of correspondence between the four poets. In doing so, it also emphasizes the connective properties of the sea’s cultural, artistic, and imaginative resonances.
Optimal Cost-Effective Screening Strategy for Unruptured Intracranial Aneurysms in Female Smokers
Authors: Salih Mira , Salem Mohmed M. , Moore Justin M. , Ogilvy Christopher S.
Published: October 2022

BACKGROUND:

The prevalence of intracranial aneurysms among female cigarette smokers was shown to be high in previous studies, yet the cost-effectiveness of screening them has never been explored.

OBJECTIVE:

To explore the most cost-effective screening strategy for female smokers.

METHODS:

A decision analytical study was performed with a Markov model to compare different screening strategies with no screening and to explore the most optimal screening strategy for female smokers. Input data for the model were extracted from literature. A single screening at different ages and multiple screening every 15 years, 10 years, 5 years, and 2 years were performed for female smokers in different age ranges. Deterministic and probabilistic sensitivity analyses were performed to evaluate the robustness of the model. Finally, value of information analysis was performed to investigate the value of collecting additional data.

RESULTS:

Screening female smokers for unruptured intracranial aneurysm is cost-effective. All screening strategies yield extra quality-adjusted life years. Screening at younger age brings more health benefit at lower cost. Frequent screening strategies decrease rupture rate of aneurysms more with higher costs per quality-adjusted life year. Screening after age 70 years and frequent screening (every 2 years) after age 60 years is not optimal. Among all the parameters in the model, collecting additional data on utility of the unscreened population would be most valuable.

CONCLUSION:

Screening female smokers for intracranial aneurysms once at younger age is most optimal. However, in clinical practice, the duration and intensity of exposure to cigarettes should be taken into consideration.
Υπερηχογραφική αξιολόγηση του διαφράγματος σε ασθενείς με καρδιακή ανεπάρκεια και διατηρημένο κλάσμα εξώθησης
Authors: Ανδριοπούλου Μαρία
Published: October 2022

Εισαγωγή: Η ανοχή στην άσκηση των ασθενών με καρδιακή ανεπάρκεια και διατηρημένο κλάσμα εξώθησης (ΚΑΔΚΕ), η οποία εκφράζεται ποσοτικά με τη μέτρηση της κορυφαίας πρόσληψης οξυγόνου (peak VO2) κατά την δοκιμασία καρδιοαναπνευστικής κόπωσης, αποτελεί βασικό προγνωστικό παράγοντα θνησιμότητας και εξαρτάται από κεντρικούς και περιφερικούς παράγοντες όπως η μυϊκή δυσλειτουργία. Υπάρχουν ελάχιστες ενδείξεις, ωστόσο, σχετικά με την επίδραση των σκελετικών μυών και ιδίως του διαφράγματος και του τετρακέφαλου στην μειωμένη peak VO2 των ασθενών με ΚΑΔΚΕ. Συνεπώς σκοπός της παρούσας μελέτης ήταν η υπερηχογραφική διερεύνηση ύπαρξης δυσλειτουργίας του διαφράγματος και του τετρακέφαλου μυός σε ασθενείς με ΚΑΔΚΕ συγκριτικά με ομάδα ελέγχου και η συσχέτισή τους με την peak VO2. Μεθοδολογία: Σε αυτήν τη συγχρονική μελέτη συμμετείχαν 25 ασθενείς με ΚΑΔΚΕ και 25 υγιείς μάρτυρες αντίστοιχης ηλικίας και φύλου, οι οποίοι υποβλήθηκαν σε υπερηχογραφική αξιολόγηση της μετατόπισης του διαφράγματος κατά την ήρεμη (QBr) και βαθιά (DBr) αναπνοή, της εγκάρσιας διατομής του ορθού μηριαίου μυός (RFcsa) και του πάχους του τετρακέφαλου μυός (Qt) καθώς και σε καρδιοαναπνευστική δοκιμασία κόπωσης. Αποτελέσματα: Όλοι οι υπερηχογραφικοί δείκτες και η peak VO2 παρουσίασαν στατιστικά σημαντική διαφορά μεταξύ ασθενών και μαρτύρων (p<0.05). Υπήρξε σημαντική συσχέτιση της κορυφαίας πρόσληψης οξυγόνου με την Rfcsa (r=0.31, p=0.05), Qt (r=0.36, p<0.05), QBr (r=0.47, p<0.01), DBr (r=0.71, p<0.001) και τη δύσπνοια (RPD) (r=0.60, p<0.001). Η μετατόπιση του διαφράγματος κατά τη βαθιά αναπνοή είχε μεγαλύτερη βαρύτητα ως προς τη συσχέτιση με τη peak VO2 στο σύνολο του δείγματος (p<0.001) αλλά και στους ασθενείς με ΚΑΔΚΕ (p=0.019) και στην ομάδα ελέγχου (p<0.001) ξεχωριστά. Συμπέρασμα: Η υψηλή συσχέτιση της λειτουργικότητας του διαφράγματος και του τετρακέφαλου μυός με τη μειωμένη ανοχή στην άσκηση, ενισχύει τον ρόλο των σκελετικών μυών στη παθοφυσιολογία των συμπτωμάτων της ΚΑΔΚΕ. Η μετατόπιση του διαφράγματος κατά τη βαθιά αναπνοή έχει μεγαλύτερη βαρύτητα.
Feasibility of contextualizing the Informed Health Choices learning resources in Italy: A pilot study in a primary school in Florence
Authors: Alderighi Camilla , Rasoini Raffaele , Formoso Giulio , Celani Maria Grazia , Rosenbaum Sarah E.
Published: October 2022

Background

The Informed Health Choices (IHC) project team developed learning resources for primary school children to teach critical thinking about treatments claims and health choices and evaluated their effect in a randomized controlled trial of 120 schools in Uganda. Children taught with these resources showed a better ability to think critically about treatments claims and health choices than children not taught with these resources. Teams in multiple countries are contextualising the IHC resources for use in other languages and settings; in this pilot we describe contextualization for use in Italian primary school. 

Methods

After translating the IHC resources to Italian and holding an introductory workshop with participating schoolteachers, we piloted the resources with two classes of a primary school in Florence over nine lessons. Our aims were: 1) to assess the feasibility of introducing the IHC curriculum in Italian primary school; 2) to evaluate students’ ability to assess health claims and make informed health choices; to explore 3) students’ and 4) teachers’ experiences with the IHC learning resources; 5) to identify barriers and facilitators to implementation of IHC learning resources in Italian primary school. To assess these objectives, we used qualitative and quantitative methods.

Results

Both qualitative and quantitative analyses consistently showed that the IHC learning resources had a positive impact on the objectives examined. The resources integrated well into the Italian primary school curriculum. Both students and teachers considered these resources comprehensible, appealing in design and content, and stimulating for the development of a critical attitude. The only barrier teachers and students expressed was using the resources in a remote learning context. 

Conclusions

Findings from our contextualisation of IHC learning resources in Italian primary school indicate that these resources are well-suited for Italian teachers and students in a primary school context and compatible with the Italian primary school curriculum.
Effect of linear alkylbenzene sulfonate on the uptake of microcystins by Brassica oleracea and Solanum tuberosum
Authors: Pindihama Glynn , Gitari Mugera , Madala Ntakadzeni
Published: October 2022

Background

Hypereutrophic conditions in major water reservoirs used for irrigation purposes in South Africa promote the co-existence of cyanotoxins and other pollutants such as linear alkylbenzene sulfonate (LAS). LAS is known to alter the permeability of membranes and promote the uptake of other pollutants by plants. In light of the potential human health risks and prevailing hypereutrophic conditions in some catchments in South Africa, we investigated the combined effects of LAS and microcystins (MCs) when cyanobacteria infested water is used to irrigate terrestrial crops.

Methods

To understand the potential risks, pot-culture experiments were conducted to assess the effect of LAS on the accumulation of MCs in Brassica oleracea (cabbage) and Solanum tuberosum (potato) plants. The plants were watered with dam water containing 3.48 mg L-1 of the LAS (sodium dodecyl sulfate) and MCs (MC-LR: 10.47 ± 3.879; 6.158 ± 4.127 for MC-RR and 8.160 ± 2.544 for MC-YR μg L-1) for 20 days.

Results

The presence of LAS, at environmentally relevant concentrations in the irrigation water, did not enhance the uptake of MCs in the two plants, as demonstrated by statistically insignificant differences in the means of the treatments (with and without LAS). In addition, the presence of LAS, high pH, electrical conductivity (EC), and cyanotoxins in the water did not affect the total chlorophyll or the well-being of the plants. However, in some cases the levels of MCs bioaccumulated by the two plants exceeded the WHO recommended tolerable daily intake (TDI).

Conclusions

These findings imply that the tested levels of LAS and MCs did not have any synergic effects on the two plant species, but irrigating food crops with such water still poses a human health risk.