bluuebunny/crossref_metadata_2025 huggingface dataset:
Economic evaluation of regular transfusions for cerebral infarct recurrence in the Silent Cerebral Infarct Transfusion Trial
Authors: Hsu Peter , Gay James C. , Lin Chyongchiou J. , Rodeghier Mark , DeBaun Michael R. , Cronin Robert M.
Published: October 2021

In 2020, the American Society of Hematology published evidence-based guidelines for cerebrovascular disease in individuals with sickle cell anemia (SCA). Although the guidelines were based on National Institutes of Health–sponsored randomized controlled trials, no cost-effectiveness analysis was completed for children with SCA and silent cerebral infarcts. We conducted a cost-effectiveness analysis comparing regular blood transfusion vs standard care using SIT (Silent Cerebral Infarct Transfusion) Trial participants. This analysis included a modified societal perspective with direct costs (hospitalization, emergency department visit, transfusion, outpatient care, and iron chelation) and indirect costs (special education). Direct medical costs were estimated from hospitalizations from SIT hospitals and unlinked aggregated hospital and outpatient costs from SIT sites by using the Pediatric Health Information System. Indirect costs were estimated from published literature. Effectiveness was prevention of infarct recurrence. An incremental cost-effectiveness ratio using a 3-year time horizon (mean SIT Trial participant follow-up) compared transfusion vs standard care. A total of 196 participants received transfusions (n = 90) or standard care (n = 106), with a mean age of 10.0 years. Annual hospitalization costs were reduced by 54% for transfusions vs standard care ($4929 vs $10 802), but transfusion group outpatient costs added $22 454 to $137 022 per year. Special education cost savings were $2634 over 3 years for every infarct prevented. Transfusion therapy had an incremental cost-effectiveness ratio of $22 025 per infarct prevented. Children with preexisting silent cerebral infarcts receiving blood transfusions had lower hospitalization costs but higher outpatient costs, primarily associated with the oral iron chelator deferasirox. Regular blood transfusion therapy is cost-effective for infarct recurrence in children with SCA. This trial is registered at www.clinicaltrials.gov as #NCT00072761.
Bistable auto-aggregation phenotype in Lactiplantibacillus plantarum emerges after cultivation in in vitro colonic microbiota
Authors: Isenring Julia , Geirnaert Annelies , Lacroix Christophe , Stevens Marc J. A.
Published: October 2021

Background

Auto-aggregation is a desired property for probiotic strains because it is suggested to promote colonization of the human intestine, to prevent pathogen infections and to modulate the colonic mucosa. We recently reported the generation of adapted mutants of Lactiplantibacillus plantarum NZ3400, a derivative of the model strain WCFS1, for colonization under adult colonic conditions of PolyFermS continuous intestinal fermentation models. Here we describe and characterize the emerge of an auto-aggregating phenotype in L. plantarum NZ3400 derivatives recovered from the modelled gut microbiota.

Results

L. plantarum isolates were recovered from reactor effluent of four different adult microbiota and from spontaneously formed reactor biofilms. Auto-aggregation was observed in L. plantarum recovered from all microbiota and at higher percentage when recovered from biofilm than from effluent. Further, auto-aggregation percentage increased over time of cultivation in the microbiota. Starvation of the gut microbiota by interrupting the inflow of nutritive medium enhanced auto-aggregation, suggesting a link to nutrient availability. Auto-aggregation was lost under standard cultivation conditions for lactobacilli in MRS medium. However, it was reestablished during growth on sucrose and maltose and in a medium that simulates the abiotic gut environment. Remarkably, none of these conditions resulted in an auto-aggregation phenotype in the wild type strain NZ3400 nor other non-aggregating L. plantarum, indicating that auto-aggregation depends on the strain history. Whole genome sequencing analysis did not reveal any mutation responsible for the auto-aggregation phenotype. Transcriptome analysis showed highly significant upregulation of LP_RS05225 (msa) at 4.1–4.4 log2-fold-change and LP_RS05230 (marR) at 4.5–5.4 log2-fold-change in all auto-aggregating strains compared to non-aggregating. These co-expressed genes encode a mannose-specific adhesin protein and transcriptional regulator, respectively. Mapping of the RNA-sequence reads to the promoter region of the msa-marR operon reveled a DNA inversion in this region that is predominant in auto-aggregating but not in non-aggregating strains. This strongly suggests a role of this inversion in the auto-aggregation phenotype.

Conclusions

L. plantarum NZ3400 adapts to the in vitro colonic environment by developing an auto-aggregation phenotype. Similar aggregation phenotypes may promote gut colonization and efficacy of other probiotics and should be further investigated by using validated continuous models of gut fermentation such as PolyFermS.
A novel 4.25 kb heterozygous deletion in PAX6 in a Chinese Han family with congenital aniridia combined with cataract and nystagmus
Authors: Qian Tianwei , Chen Chong , Li Caihua , Gong Qiaoyun , Liu Kun , Wang Gao , Schrauwen Isabelle , Xu Xun
Published: October 2021

Background

The aim of this study is to identify the genetic defect in a Chinese family with congenital aniridia combined with cataract and nystagmus.

Methods

Complete ophthalmic examinations, including slit-lamp biomicroscopy, dilated indirect ophthalmoscopy, anterior segment photography, and anterior segment optical coherence tomography (OCT) were performed. Blood samples were collected from all family members and genomic DNA was extracted. Genome sequencing was performed in all family members and Sanger sequencing was used to verify variant breakpoints.

Results

All the thirteen members in this Chinese family, including seven patients and six normal people, were recruited in this study. The ophthalmic examination of affected patients in this family was consistent with congenital aniridia combined with cataract and nystagmus. A novel heterozygous deletion (NC_000011.10:g.31802307_31806556del) containing the 5′ region of PAX6 gene was detected that segregated with the disease.

Conclusion

We detected a novel deletion in PAX6 responsible for congenital aniridia in the affected individuals of this Chinese family. The novel 4.25 kb deletion in PAX6 gene of our study would further broaden the genetic defects of PAX6 associated with congenital aniridia.
Validation of screening tools for common mental health disorders in the methadone maintenance population in Hanoi, Vietnam
Authors: Mughal Anisa Y. , Stockton Melissa A. , Bui Quynh , Go Vivian , Ha Tran Viet , Pence Brian W. , Gaynes Bradley N.
Published: October 2021

Background

Common mental health disorders (CMDs), including depression, anxiety and post-traumatic stress disorder (PTSD) may worsen both HIV and drug use outcomes, yet feasible tools to accurately identify CMDs have received limited study in this population. We aimed to validate the Patient Health Questionnaire (PHQ-9), Generalized Anxiety Disorder screen (GAD-7) and Primary Care PTSD screen for DSM-5 (PC-PTSD-5) in a methadone maintenance therapy (MMT) patient population in Hanoi, Vietnam.

Methods

We conducted a cross-sectional survey. The PHQ-9, GAD-7, and PC-PTSD-5 were administered to MMT patients. A blinded interviewer administered the Mini-International Neuropsychiatric Interview (MINI) as the reference gold standard. Total scores of each tool were compared with the MINI diagnoses using a receiver operating characteristic curves, and we identified the optimal respective cut-off scores using the Youden’s Index.

Results

We enrolled 400 MMT patients. Approximately 99.3% were male (n = 397) and 21.8% (n = 87) were HIV positive. The prevalence of major depressive disorder, generalized anxiety disorder and PTSD, respectively, was 10.5, 4 and 2%. Optimal cut-off scores for the PHQ-9, GAD-7 and PC-PTSD were ≥ 5, ≥3, and ≥ 4 with a sensitivity/specificity of 95.2%/91.9, 93.8%/87.5, and 62.5%/95.2%.

Conclusions

The prevalence of CMDs in the MMT population was lower than expected. A lower cut-off score may be considered when screening for CMDs in this population. Further research should investigate the validity of somatic symptom-based screening tools among other drug-using or MMT populations.
Variants of the cry 1 gene may influence the effect of fat intake on resting metabolic rate in women with overweight of obesity: a cross-sectional study
Authors: Mirzababaei Atieh , Daneshzad Elnaz , Shiraseb Farideh , Pourreza Sanaz , Setayesh Leila , Clark Cain C. T. , Tangestani Hadith , Abaj Faezeh , Yarizadeh Habib , Mirzaei Khadijeh
Published: October 2021

Background

Previous studies have shown that the minor allele (C allele) for Cry 1 rs2287161, may be associated with increased risk of cardiovascular diseases (CVDs). Low resting metabolic rate (RMR) caused by the diet has been shown to have, potentially, unfavorable effects on obesity. This study sought to investigate the interactions between the Cry 1 Gene and fat intake on RMR in women with overweight of obesity.

Methods

This comparative cross-sectional study was conducted on 377 Iranian women with overweight of obesity. A food frequency questionnaire (FFQ), with 147 items, was used to assess dietary intake. Individuals were categorized into two groups based on the rs2287161 genotype. Body composition, dietary intake, and RMR were assessed for all participants.

Results

There was a significant difference between genotypes for fasting blood sugar (FBS) (P = 0.04), fat free mass (FFM) (P = 0.0009), RMR per FFM (P = 0.05), RMR per body mass index (BMI) (P = 0.02), and RMR deviation (P = 0.01). Our findings also showed significant interactions between total fat and C allele carrier group on RMR per kg body weight, RMR per body surface area (BSA), RMR per FFM, and RMR deviation (P for interaction < 0.1), in addition to a significant interaction between CC + CG group genotype and polyunsaturated fatty acids (PUFA) intake on RMR per BMI (P for interaction =0.00) and RMR per kg (P for interaction = 0.02) and RMR per BSA (P = 0.07), compared to the GG group, after control for confounder factors.

Conclusion

These results highlight that dietary compositions, gene variants, and their interaction, should be acutely considered in lower RMR.
Patient-public engagement strategies for health system improvement in sub-Saharan Africa: a systematic scoping review
Authors: Ankomah Samuel Egyakwa , Fusheini Adam , Ballard Christy , Kumah Emmanuel , Gurung Gagan , Derrett Sarah
Published: October 2021

Background

Actively involving patients and communities in health decisions can improve both peoples’ health and the health system. One key strategy is Patient-Public Engagement (PPE). This scoping review aims to identify and describe PPE research in Sub-Saharan Africa; systematically map research to theories of PPE; and identify knowledge gaps to inform future research and PPE development.

Methods

The review followed guidelines for conducting and reporting scoping reviews. A systematic search of peer-reviewed English language literature published between January 1999 and December 2019 was conducted on Scopus, Medline (Ovid), CINAHL and Embase databases. Independent full text screening by three reviewers followed title and abstract screening. Using a thematic framework synthesis, eligible studies were mapped onto an engagement continuum and health system level matrix to assess the current focus of PPE in Sub-Saharan Africa.

Results

Initially 1948 articles were identified, but 18 from 10 Sub-Saharan African countries were eligible for the final synthesis. Five PPE strategies implemented were: 1) traditional leadership support, 2) community advisory boards, 3) community education and sensitisation, 4) community health volunteers/workers, and 5) embedding PPE within existing community structures. PPE initiatives were located at either the ‘involvement’ or ‘consultation’ stages of the engagement continuum, rather than higher-level engagement. Most PPE studies were at the ‘service design’ level of the health system or were focused on engagement in health research. No identified studies reported investigating PPE at the ‘individual treatment’ or ‘macro policy/strategic’ level.

Conclusion

This review has successfully identified and evaluated key PPE strategies and their focus on improving health systems in Sub-Saharan Africa. PPE in Sub-Saharan Africa was characterised by tokenism rather than participation. PPE implementation activities are currently concentrated at the ‘service design’ or health research levels. Investigation of PPE at all the health system levels is required, including prioritising patient/community preferences for health system improvement.
Validation of a derived version of the IPF-specific Saint George’s Respiratory Questionnaire
Authors: Prior Thomas Skovhus , Hoyer Nils , Shaker Saher Burhan , Davidsen Jesper Rømhild , Hilberg Ole , Patel Haridarshan , Bendstrup Elisabeth
Published: October 2021

Background

Health-related quality of life (HRQL) is impaired in patients with idiopathic pulmonary fibrosis (IPF). HRQL is often measured using the St. George’s Respiratory Questionnaire (SGRQ) despite the development of an IPF-specific version (SGRQ-I). Using data from a real-world cohort of patients with IPF, we aimed to transform SGRQ into a derived version of SGRQ-I, SGRQ-Ider, to examine the cross-sectional and longitudinal validity of SGRQ-Ider and to compare SGRQ-Ider to SGRQ-I.

Methods

Based on results from SGRQ, SGRQ-Ider was derived applying the algorithm used to develop SGRQ-I. Of the 50 items in SGRQ, 34 items were retained in SGRQ-Ider. Response options for seven items were collapsed and minor adjustments were made to the weights of two items after correspondence with the developers of SGRQ-I. Cross-sectional validation, responsiveness and minimal clinically important difference (MCID) were assessed by comparison to other HRQL instruments, pulmonary function tests and 6-min walk test performed at baseline, 6 and 12 months. Furthermore, the association between SGRQ-Ider scores and mortality was examined.

Results

A total of 150 IPF patients participated and 124 completed follow-up at 12 months. SGRQ-Ider performed comparably to SGRQ-I with a high concurrent validity, good test–retest reliability and high known-groups validity. SGRQ-Ider was responsive to change in HRQL and physiological anchors. MCID of SGRQ-Ider for improvement and deterioration was 3.5 and 5.7, respectively. SGRQ-Ider scores were associated with mortality in both univariate (HR 1.82, 95% CI 1.42–2.34 per 20-point increase) and multivariate analyses (HR 1.57, 95% CI 1.20–2.05 per 20-point increase).

Conclusions

The SGRQ-Ider is a valid, reliable and responsive HRQL instrument in patients with IPF and has psychometric properties comparable to SGRQ-I. Thus, SGRQ results can reliably be transformed into the SGRQ-Ider. The MCID estimates were calculated for improvement and deterioration separately. Increasing SGRQ-Ider score was associated with increased mortality.
Renal cell carcinoma with unusual metachronous metastasis up to 22 years after nephrectomy: two case reports
Authors: Bruckschen F. , Gerharz C. D. , Sagir A.
Published: October 2021

Introduction

Renal cell carcinoma is the third most common malignant tumor in the urogenital tract. An estimated 25% of renal cell carcinomas are in stage IV when diagnosed. The 5-year-survival with stage IV is about 20%. Late metastases are found after an extended disease-free interval up to 20 years after primary nephrectomy.

Case presentation

Here, we present two cases with late-onset metastasis of renal cell carcinoma with different clinical presentations. The first patient, an 88-year-old Caucasian man, presented with bleeding of the upper gastrointestinal tract. Biopsies taken from the duodenal bulb showed a tumor compatible with a solitary metastasis from renal cell carcinoma 22 years ago. The second patient, a 79-year-old Caucasian man, consulted our gastroenterological department with results of an outpatient computed tomography scan with multiple suspected tumor areas in the liver, omentum, thyroid, and mediastinum. A computed tomography-guided liver biopsy was performed that showed a clear-cell tumor consistent with a metastasis of the renal cell carcinoma 17 years ago.

Conclusion

Both cases show that patients with a history of renal cell carcinoma should be followed up for a longer time than patients with other malignant tumors.
EFL teachers’ perceptions and practices of their language assessment knowledge
Authors: Farhady Hossein , Tavassoli Kobra
Published: October 2021

Research on language assessment knowledge (LAK) of teachers has focused on two major topics: identifying the LAK needs of teachers and developing appropriate LAK tests. Although the prior research findings significantly contributed to our understanding of the parameters of LAK, they were mostly quantitative and did not provide much information about EFL teachers’ perceptions and applications of their LAK in a direct and face-to-face situation. Therefore, this qualitative study was designed to shed light on some key issues related to teachers’ LAK using semi-structured interviews. The issues included EFL teachers’ perception of their LAK and their utilization of LAK in their teaching. The participants were 11 teachers with a high level of LAK and 10 teachers with a low level of LAK determined by their performance on a LAK test. The interviews were recorded, transcribed, and content analyzed. The findings did not reveal significant differences in the responses provided by the two groups of teachers. Further, to investigate the extent of teachers’ application of LAK in classroom contexts, some of the tests made by the participating teachers were collected and content analyzed. The results showed that teachers with high LAK wrote longer tests with more varied sections and tasks. Finally, no meaningful relationship was found between the teachers’ level of LAK and their students’ performance on classroom achievement tests. The findings imply that the language assessment field needs more research on multiple dimensions of LAK.
Comparative analysis of information tendency and application features for projection mapping technologies at cultural heritage sites
Authors: Li Hengyi , Ito Hiromu
Published: October 2021

With the rapid development of interactive technologies using projection mapping (PJM), these digital technologies have introduced new interpretative possibilities for the presentation of cultural heritage sites. PJM attracts more visitors with greater expectations to cultural heritage sites through its excellent visual effects and guidance capabilities. In the past decade, especially after 2015, design events have frequently introduced digital projections to cultural heritage sightseeing spots worldwide. However, this trend has also led to the emergence of many digital projection events that merely exhibit beautiful projection effects on buildings and neglect to show the history and value of the cultural heritage site. Based on this phenomenon, this study compiled and analyzed 45 related cases of PJM applications at cultural heritage sites around the world from the past 5 years. These 45 examples were studied by disassembling the projection content, analyzing the information characteristics exhibited in each projection video, and arranging the obtained data on a timeline chart for analysis. According to the data, two information characteristics of PJM at cultural heritage sites can be observed: “the relationship between projection content and heritage” and “information tendency.” The advantages and limitations of these characteristics were distinguished and suggestions for the application of PJM on cultural heritage sites were derived. These results can be used as a reference for other research studies on visitors to cultural heritage sites and improving digital interpretation and presentation designs.
Current perspective on production and applications of microbial cellulases: a review
Authors: Bhardwaj Nisha , Kumar Bikash , Agrawal Komal , Verma Pradeep
Published: October 2021

The potential of cellulolytic enzymes has been widely studied and explored for bioconversion processes and plays a key role in various industrial applications. Cellulase, a key enzyme for cellulose-rich waste feedstock-based biorefinery, has increasing demand in various industries, e.g., paper and pulp, juice clarification, etc. Also, there has been constant progress in developing new strategies to enhance its production, such as the application of waste feedstock as the substrate for the production of individual or enzyme cocktails, process parameters control, and genetic manipulations for enzyme production with enhanced yield, efficiency, and specificity. Further, an insight into immobilization techniques has also been presented for improved reusability of cellulase, a critical factor that controls the cost of the enzyme at an industrial scale. In addition, the review also gives an insight into the status of the significant application of cellulase in the industrial sector, with its techno-economic analysis for future applications. The present review gives a complete overview of current perspectives on the production of microbial cellulases as a promising tool to develop a sustainable and greener concept for industrial applications.
Application of near-infrared spectroscopy technology in the complex fermentation system to achieve high-efficiency production
Authors: Yang Chen , Lingli Chen , Meijin Guo , Xu Li , jinsong Liu , Xiaofeng Liu , Zhongbing Chen , Xiaojun Tian , Haoyue Zheng , Xiwei Tian , Ju Chu , Yingping Zhuang
Published: October 2021

The fermentation process is dynamically changing, and the metabolic status can be grasped through real-time monitoring of environmental parameters. In this study, a real-time and on-line monitoring experiment platform for substrates and products detection was developed based on non-contact type near-infrared (NIR) spectroscopy technology. The prediction models for monitoring the fermentation process of lactic acid, sophorolipids (SLs) and sodium gluconate (SG) were established based on partial least-squares regression and internal cross-validation methods. Through fermentation verification, the accuracy and precision of the NIR model for the complex fermentation environments, different rheological properties (uniform system and multi-phase inhomogeneous system) and different parameter types (substrate, product and nutrients) have good applicability, and R2 was greater than 0.98, exhibiting a good linear relationship. The root mean square error of prediction shows that the model has high credibility. Through the control of appropriate glucose concentration in SG fermentation as well as glucose and oil concentrations SLs fermentation by NIR model, the titers of SG and SLs were increased to 11.8% and 26.8%, respectively. Although high cost of NIR spectrometer is a key issue for its wide application in an industrial scale. This work provides a basis for the application of NIR spectroscopy in complex fermentation systems.
Adults have more male-biased sex ratios than first-winter juveniles in wintering duck populations
Authors: Wood Kevin A. , Brides Kane , Durham Maurice E. , Hearn Richard D.
Published: October 2021

Background

The long-term monitoring of demographic changes in waterbird populations remains limited, but such information can be valuable for conservationists and waterbird managers. Biased sex ratios can indicate differences in survival rates between sexes. In particular, differences in the sex ratios of fledged juveniles and adults can provide insight into the development of male bias among populations.

Methods

In this study, we used data from individual birds captured over a 57-year period to assess the extent, and temporal variability in male bias in nine populations of ducks wintering in the United Kingdom: Gadwall (Mareca strepera), Northern Mallard (Anas platyrhynchos), Northern Pintail (Anas acuta), Common Pochard (Aythya ferina), Common Shelduck (Tadorna tadorna), Northern Shoveler (Spatula clypeata), Eurasian Teal (Anas crecca), Tufted Duck (Aythya fuligula), and Eurasian Wigeon (Mareca penelope).

Results

Overall, eight of these populations were significantly male-biased and adults were more male-biased than first-winter juveniles for all nine populations. The increased male bias among adults is consistent with the hypothesis that factors such as higher mortality of reproductive-age females during the breeding season is a major cause of male bias in duck populations. However, such predation cannot explain the male bias detected in first-winter juveniles in four of the populations. The temporal trends in male bias differed between adults and first-winter juveniles in Northern Mallard, Northern Pintail, Common Pochard, Common Shelduck, Eurasian Teal, Tufted Duck, and Eurasian Wigeon. Over the study period we found increased male bias among adult Northern Mallard, Northern Pintail, Common Pochard, Common Shelduck, and Tufted Duck as well as both adult and first-winter juvenile Northern Shoveler.

Conclusions

We provide evidence that among wintering duck populations, sex ratios are typically male-biased, with adults exhibiting stronger male-biased sex ratios than first-winter juveniles. Improved monitoring of sex ratios of wintering waterbirds would help to increase our understanding of changes in waterbird demography, population structure, and observed population trends; our study shows that birds caught during ringing projects can be a valuable source of such data.
EEG-based human emotion recognition using entropy as a feature extraction measure
Authors: Patel Pragati , R Raghunandan , Annavarapu Ramesh Naidu
Published: October 2021

Many studies on brain–computer interface (BCI) have sought to understand the emotional state of the user to provide a reliable link between humans and machines. Advanced neuroimaging methods like electroencephalography (EEG) have enabled us to replicate and understand a wide range of human emotions more precisely. This physiological signal, i.e., EEG-based method is in stark comparison to traditional non-physiological signal-based methods and has been shown to perform better. EEG closely measures the electrical activities of the brain (a nonlinear system) and hence entropy proves to be an efficient feature in extracting meaningful information from raw brain waves. This review aims to give a brief summary of various entropy-based methods used for emotion classification hence providing insights into EEG-based emotion recognition. This study also reviews the current and future trends and discusses how emotion identification using entropy as a measure to extract features, can accomplish enhanced identification when using EEG signal.
Equity and inclusivity in research: co-creation of a digital platform with representatives of marginalized populations to enhance the involvement in research of people with limited literacy skills
Authors: Loignon Christine , Dupéré Sophie , Leblanc Caroline , Truchon Karoline , Bouchard Amélie , Arsenault Johanne , Pinheiro Carvalho Julia , Boudreault-Fournier Alexandrine , Marcotte Sylvain Aimé
Published: October 2021

To improve health equity, as well as equity in research, community-engaged research and participatory research needs to be inclusive. Equity in health research refers to the principle that anyone affected by research or who can benefit from its outcomes should have equal opportunities to contribute to it. Many researchers advocate the importance of promoting equity in research and engage in processes that foster the research involvement of lay persons, patients, and community members who are otherwise “absent” or “silent”. Still, people with limited literacy skills who experience unwarranted structural barriers to healthcare access have little involvement in research. Low literacy is a major barrier to equity in health research. Yet there exist approaches and methods that promote the engagement in research of people with literacy challenges. Building on our previous research projects conducted with community members using participatory visual and sound methods (participatory mapping, photovoice, digital storytelling, etc.), we embarked on the co-creation of a digital platform in 2017. Our aim in this commentary is to report on this co-creation experience that was based on a social justice-oriented partnership. The development of the online platform was overseen by a steering committee made up of workers from community organizations involved with people with limited literacy skills, students, and researchers. In the development process, the co-creation steps included a literature review, informal interviews with key informants, and discussion and writing sessions about format and content. After numerous challenges raised and addressed during co-creation, the Engage digital platform for engagement in research went live in the winter of 2020. This platform presents, on an equal footing, approaches and methods from academic research as well as from the literacy education community engaged with people with limited literacy skills.
Treatment delay from aneurysmal subarachnoid hemorrhage to endovascular treatment: a high-volume hospital experience
Authors: Zhang Xiaoxi , Tang Haishuang , Zuo Qiao , Xue Gaici , Duan Guoli , Xu Yi , Hong Bo , Zhao Rui , Yang Pengfei , Liu Jianmin , Huang Qinghai
Published: October 2021

Background

Early treatment for patients with aneurysmal subarachnoid hemorrhage (aSAH) could significantly reduce the risk of re-bleeding and improve clinical outcomes. We assessed the different time intervals from the initial hemorrhage, admission, and endovascular treatment and identified the risk factors contributing to delay.

Methods

Between February 2017 and December 2019, 422 consecutive aSAH patients treated in a high-volume hospital were collected and reviewed. Risk factors contributing to admission delay and treatment delay were analyzed with univariate and multivariate analysis.

Results

One hundred twenty-two (28.9%) were admitted to the high-volume hospital at the day of symptom onset and 386 (91.5%) were treated with endovascular management at the same day of admission. The multivariate analysis found that younger age (P = 0.022, OR = 0.981, 95% CI 0.964–0.997) and good Fisher score (P = 0.002, OR = 0.420, 95% CI 0.245–0.721) were independent risk factors of admission delay. None was found to be related with treatment delay. Multivariate analysis (OR (95% CI)) showed that higher age 1.027 (1.004–1.050), poorer Fisher score 3.496 (1.993–6.135), larger aneurysmal size 1.112 (1.017–1.216), and shorter interval between onset to admission 1.845 (1.018–3.344) were independent risk factors of poorer clinical outcome.

Conclusion

Treatment delay was mainly caused by pre-hospital delay including delayed admission and delayed transfer. Our experience showed that cerebrovascular team could provide early treatment for aSAH patients. Younger age and good Fisher score were significantly related with admission delay. However, admission delay was further significantly correlated with better clinical outcome.
Beauveria bassiana: as a potential microbial biocontrol agent for tea mosquito bug, Helopeltis theivora Waterhouse (Hemiptera: Miridae) in Dooars and Darjeeling, India
Authors: Deka Bhabesh , Babu Azariah , Peter Arulmarianathan John , Pandey Abhay Kumar , Kumhar Kishor Chand , Sarkar Suman , Rajbongshi Hirakjyoti , Dey Pritam , Amalraj Emmanuel Leo Daniel , Talluri Venkateswara Rao
Published: October 2021

Background

In the present study, the efficacy of two isolates ofBeauveria bassiananamely, BKN20 and BKN1/14 was evaluated against the tea mosquito bug (TMB),Helopeltis theivora,Waterhouse (Hemiptera: Miridae) damaging harvestable shoots of tea plants in the Dooars and Darjeeling regions of West Bengal, India.

Results

Laboratory study revealed that, in both isolates, BKN20 was more pathogenic than BKN1/14, exhibiting 76% mortality of the test insect. The BKN20 isolate was formulated as an aqueous suspension (5%AS), and evaluated against TMB through micro-plot trials in tea plantations. The Micro-plot field study revealed a maximum of 72.19% reduction in the shoot damage due to TMB in plots sprayed with a 1000 ml/ha concentration of BKN20 5%AS containing 2 × 107conidia/ml, as compared to the synthetic insecticide (Thiamethoxam 25%WG), where a 63.12% reduction in the shoots was recorded. Furthermore, different concentrations of the formulated BKN20 5%AS were evaluated against the test insect at 2 locations of tea gardens in the Dooars and Darjeeling regions. The results from both locations revealed that 1000 and 1200 ml/ha concentrations of BKN20 5%AS (each concentration containing 2 × 107conidia/ml) significantly (p < 0.05) reduced the TMB population and they were more effective than Thiamethoxam 25%WG (120 g/ha). However, non-significant differences in crop yields were recorded. The formulation BKN20 5%AS was found to be non-pathogenic to non-target insects, i.e. natural enemies present in the tea ecosystem. BKN20 5%AS had no phytotoxic effect on the tea leaves, with acceptable organoleptic attributes.

Conclusion

The BKN20 isolate could be commercialized as an alternative microbial insecticide to reduce the load of chemical insecticides in the tea ecosystem.
Early administration of gonadotropin-releasing hormone antagonist versus flexible antagonist ovarian stimulation protocol in poor responders: a randomized clinical trial
Authors: Esfidani Tayebeh , Moini Ashraf , Arabipoor Arezoo , Mojtahedi Maryam Farid , Mohiti Shima , Salehi Ensieh , Kashani Ladan
Published: October 2021

Background

Determining the initiation day of antagonist administration is an important and challenging issue and different results have been reported in the previous studies. The present study was designed to compare the controlled ovarian hyperstimulation (COH) cycles outcomes of early-onset gonadotropin-releasing hormone antagonist (GnRH-ant) protocol with conventional flexible GnRH-ant protocol in patients with poor ovarian response (POR) diagnosis. This randomized clinical trial was performed on infertile women who were diagnosed as poor responders in in vitro fertilization/intra-cytoplasmic sperm injection (IVF/ICSI) cycles at Arash Women’s Hospital affiliated to Tehran University of Medical Sciences. POR was defined according to the Bologna criteria and the eligible women were randomly allocated into an experimental (early-onset GnRH-ant) and control (conventional flexible GnRH-ant) groups. The women in the experimental group received recombinant gonadotropins (150–225 IU) and GnRH-ant (0.25 mg) simultaneously on the second day of the cycle. In the control group, the starting and the dose of gonadotropins were similar but daily administration of GnRH-ant was initiated when the leading follicle diameter was ≥ 13 mm. The COH outcomes were compared between groups (n=58 in each group).

Results

The analysis showed that the two groups did not have statistically significant differences in terms of the ovarian stimulation duration and the total dose of used gonadotropins. The total number of metaphase II (MII) oocytes in the experimental group was significantly higher than that of in control group (P = 0.04). Moreover, clinical and ongoing pregnancy rates per embryo transfer (ET) in the experimental group were significantly higher than those in the control group (P = 0.02 and P = 0.03, respectively); however, the implantation and miscarriage rates were similar between groups.

Conclusions

The early-onset GnRH-ant protocol can improve the number of retrieved and MII oocytes and probably the pregnancy outcomes after fresh embryo transfer in POR patients. However, larger randomized clinical trials are required to compare the pregnancy outcomes after this approach with other COH protocols with considering cost-effectiveness issue.

Trial registration

IRCT20110731007165N9.

The name of the registry: Ladan Kashani.

The date of trial registration: 8.02.2020.
Impact of endometriosis on female fertility and the management options for endometriosis-related infertility in reproductive age women: a scoping review with recent evidences
Authors: Vatsa Richa , Sethi Ankita
Published: October 2021

Background

Endometriosis is a chronic inflammatory condition with varied presentation, which ultimately leads to chronic pelvic pain and infertility. It is a psychological and economic burden to the women and their families.

Main body of abstract

The literature search was performed on the following databases: MEDLINE, Google Scholar, Scopus, EMBASE, Global health, the COCHRANE library, and Web of Science. We searched the entirety of those databases for studies published until July 2020 and in English language. The literature search was conducted using the combination of the Medical Subject heading (MeSH) and any relevant keywords for “endometriosis related infertility and management” in different orders. The modalities of treatment of infertility in these patients are heterogeneous and inconclusive among the infertility experts. In this article, we tried to review the literature and look for the evidences for management of infertility caused by endometriosis. In stage I/II endometriosis, laparoscopic ablation leads to improvement in LBR. In stage III/IV, operative laparoscopy better than expectant management, to increase spontaneous pregnancy rates. Repeat surgery in stage III/IV rarely increases fecundability as it will decrease the ovarian reserve, and IVF will be better in these patients. The beneficial impact of GnRH agonist down-regulation in ART is undisputed. Dienogest is an upcoming and new alternative to GnRH agonist, with a better side effect profile. IVF + ICSI may be beneficial as compared to IVF alone. Younger patients planned for surgery due to pain or any other reason should be given the option of fertility preservation.

Short conclusion

In women with endometriosis-related infertility, clinician should individualize management, with patient-centred, multi-modal, and interdisciplinary integrated approach.
Unexplained back pain and sciatica: the added value of upright dynamic MRI of the lumbar spine in cases of clinical/radiological mismatch
Authors: Ibrahim Heba , Diab Khaled
Published: October 2021

Background

Degenerative disease of the lumbar spine is one of the most prevalent pathologies worldwide, and MRI is the gold standard imaging modality that helps to assess soft tissue and bony abnormalities and elicit causes of neural compression. It is not uncommon in the daily practice to have patients presenting with neurological symptoms during standing or walking while MRI fails to detect lesion that explains their clinical picture. The aim of this study was to detect changes that appear on dynamic weight-bearing MRI of the lumbar spine that was hidden on conventional supine MRI and to correlate them with the clinical situation.

Methodology

Ninety patients with back pain were enrolled in the study, they did conventional and dynamic MRI of the lumbar spine. We compared findings in both modalities as regard alignment, ligamentum flavum buckling, foraminal narrowing and neural compression.

Results

Dynamic MRI showed neural compression in 87% of patients in comparison to supine MRI, ligamentum flavum buckling was reported in 80%, neural foraminal narrowing was seen in 24%, exaggeration of the lumbar lordoisis in 10% and exaggeration of the already existing disc protrusion was documented in 60% of the included patients.

Conclusions

Upright dynamic MRI has added to supine MRI in problem solving cases with clinical radiological mismatch. The results indicated changes in the spine alignment, neural compression and spinal canal stenosis. Since the examination is non-invasive, it could be used in the preoperative planning of patients with degenerative lumbar spine disease.
Large Eddy simulation of the fluctuating wind environment at a bridge site in the mountainous area
Authors: Xing Longfei , Zhang Mingjin , Li Yongle , Zhang Zhijie , Yin Dianguo
Published: October 2021

To have a comprehensive understanding of the complex wind environment at a bridge site in the mountainous area, a numerical simulation study of the wind environment under the mean and the fluctuating wind flow conditions was carried out and the results were compared. First, according to the weighted amplitude wave superposition (WAWS) method, the fluctuating wind speed time history was compiled by UDF. And the wind speed time history was added to the inlet boundary of a numerical empty wind tunnel to verify the feasibility of the simulation method of the fluctuating wind. Then, with a bridge in the mountainous area in Yunnan as the engineering background, a numerical simulation study of the wind environment of the bridge site area under the mean wind flow and the fluctuating wind flow was carried out by using FLUENT. The study indicates that Large Eddy Simulation (LES) method more accurate than Reynold average method with a sufficient number of grids and a short enough time step. The average wind characteristics of the bridge site under the mean wind and the fluctuating wind are not much different. The fluctuating wind characteristics at the bridge site are mainly affected by the terrain and the pulsating component of the wind flow. There are different terrain pulsation effects at the bridge site under different incoming flow directions.
Molecular Subgroup Is the Strongest Predictor of Medulloblastoma Outcome in a Resource-Limited Country
Authors: Amayiri Nisreen , Swaidan Maisa , Ibrahimi Ahmed , Hirmas Nader , Musharbash Awni , Bouffet Eric , Al-Hussaini Maysa , Ramaswamy Vijay
Published: October 2021

PURPOSE

Medulloblastoma is composed of four clinically and prognostically distinct molecular subgroups (WNT, SHH, group 3, and group 4). However, the clinical implications of these subgroups in the context of the unique challenges of low- to middle-income countries are rarely reported.

METHODS

We assembled an institutional cohort of children (3-18 years) diagnosed with medulloblastoma and treated in Jordan between 2003 and 2016. Tumors were subgrouped by NanoString and correlated with clinical and radiologic characteristics.

RESULTS

Eighty-eight patients were identified (63% male); median age was 6.9 years (interquartile range 4.8-9.2) and median symptom duration was 6 weeks (interquartile range 4-11). Radiotherapy was implemented as standard-risk in 41 patients (47%) and high-risk in 47 patients (53%). Subgrouping revealed 17 WNT (19%), 22 SHH (25%), 21 group 3 (24%), and 28 group 4 tumors (32%). Median time between craniotomy and radiotherapy was 45 days (17-155); 44% of them > 49 days. Median duration of radiotherapy was 44 days (36-74). Seventy-two patients (82%) received chemotherapy afterward. With a median follow-up of 4.6 years (0.2-14.9), 5-year progression-free survival (PFS) and overall survival were 73.5% and 69.4%, respectively, with no statistically significant survival difference between standard-risk and high-risk patients. Metastasis was significant for overall survival ( P = .011). Patients with SHH and group 4 tumors had very good PFS (83.4% and 87.0%, respectively) and those with group 3 tumors had dismal outcomes (PFS 44.9%), whereas WNT tumors had less-than expected PFS (70.5%). PFS was statistically significant in patients with nonmetastatic tumors receiving radiotherapy ≤ 49 days ( P = .011), particularly group 3 tumors.

CONCLUSION

Patients with SHH and group 4 medulloblastoma had excellent survival comparable with high-income countries. Compliance with treatment protocols and avoiding radiotherapy delays are important in achieving adequate survival in low- to middle-income country settings. Subgroup-driven treatment protocols should be considered in countries with limited resources.
Is the heart involved or not? The diagnostic value of cardiovascular magnetic resonance imaging in the assessment of non-cardiac malignancies and metastatic cardiac tumours
Authors: Stoddart Catriona , Nikolaidou Chrysovalantou , Benamore Rachel , Xie Cheng
Published: October 2021

Cardiovascular magnetic resonance (CMR) is a radiation-free, high-spatial resolution technique which provides dynamic assessment of the heart and pericardial tissue. This is particularly useful for the evaluation and characterisation of non-cardiac tumours close to the pericardium for the exclusion of cardiovascular infiltration, and also for the assessment of the extent of myocardial invasion of cardiac metastases. This information can help make key decisions on further management in oncology multidisciplinary meetings. The CMR evaluation and main types of sequences acquired are detailed in this case series to illustrate the application of CMR in the assessment of non-cardiac malignancies and its importance in guiding management.
Efficacy of mesenchymal stromal cells in preclinical models of necrotizing enterocolitis: a systematic review protocol
Authors: Maltais-Bilodeau Camille , Henckel Ewa , D. Cobey Kelly , Ahmadzai Nadera , Skidmore Becky , Ferretti Emanuela , Thébaud Bernard
Published: October 2021

Introduction: Necrotizing enterocolitis is an acute inflammatory disease of the intestine that can lead to necrosis and bowel perforation. It is a severe complication of preterm birth. It’s mortality rate is up to 50% and survival after necrotizing enterocolitis leads to long-term complications. The current treatment is supportive and includes bowel rest and decompression and antibiotics. Thus, new treatments are necessary to reduce mortality and morbidity. Mesenchymal stromal cells are known to have anti-inflammatory properties and might be a promising option for treatment. Here we present a protocol for a systematic review with the aim to explore the efficacy of cell therapies with mesenchymal stromal cells in animal models of necrotizing enterocolitis. The primary outcome is histological signs of necrotizing enterocolitis. Additional outcomes include survival, bowel perforation, gut permeability, gut motility, levels of inflammatory markers, cytokine levels and adverse events.

Methods: We will conduct a systematic search of MEDLINE, Embase, and Web of Science databases. The retrieved records will be screened individually by two investigators. We will include all preclinical in vivo animal models of experimentally induced necrotizing enterocolitis that evaluate the efficacy of mesenchymal stromal cells or other cell therapy treatments. Outcome data will be extracted from each article and risk of bias assessment performed. Funnel plots and SYRCLE’s risk of bias tool for animal studies will be used. Data will be reported as ratios, divided in predefined subgroups where relevant.

Conclusions: This systematic review aims to examine the efficacy of mesenchymal stromal cells in preclinical models of necrotizing enterocolitis and whether there is sufficient evidence to support a clinical trial of efficacy and safety of the treatment with mesenchymal stromal cells in infants with necrotizing enterocolitis.