bluuebunny/crossref_metadata_2025 huggingface dataset:
Outcomes of endovascular treatment of patients with intermittent claudication due to femoropopliteal disease
Authors: Naiem Ahmed A , Doonan Robert James , Steinmetz Oren K , MacKenzie Kent S , Girsowicz Elie , Bayne Jason P , Obrand Daniel I , Gill Heather L
Published: August 2021

Objective

Our objective was to evaluate the outcomes of endovascular treatment in patients with moderate and severe claudication due to femoropopliteal disease, that is, disease of the superficial femoral and popliteal arteries.

Methods

A retrospective review of all patients with moderate and severe claudication (Rutherford 2 and 3) undergoing endovascular treatment for FP disease between January 2012 and December 2017 at two university-affiliated hospitals was performed. All procedures were performed by vascular surgeons. Primary outcomes were mortality, freedom from reintervention, major adverse limb events defined as major amputations, open surgical revascularization, or progression to chronic limb-threatening ischemia (CLTI) at 30 days, 1 year, 2 years, and last follow-up. Unadjusted odds ratios were calculated to identify variables associated with adverse outcomes, and Kaplan–Meier survival curves were used to determine mortality and freedom from reintervention.

Results

Eighty-five limbs in 74 patients were identified on review. Mean age was 69.6 ± 9.8 years and 74.3% were males. At a median follow-up of 49.0 ± 25.5 months, all-cause mortality rate was 8.1% (6 patients) with 16.7% being due to cardiovascular causes. Reintervention rates were 1.2%, 16.5%, and 21.2% at 30 days, 1 year, and 2 years, respectively. Major adverse limb events occurred in 3 patients and rates were 0%, 1.2%, and 2.4% at 30 days, 1 year, and 2 years, respectively. Progression to CLTI was 0%, 1.2%, and 1.2% at 30 days, 1 year, and 2 years, respectively. Claudication had improved or resolved in 55.6% ( n = 34 patients), stable in 38.9% ( n = 21 patients), and worse in 5.6% ( n = 3 patients) Age ≥ 70 years (OR = 4.09 (1.14–14.66), p = 0.027), TASCII A lesion (OR = 4.67 (1.14–19.17), p = 0.025), and presence of 3-vessel runoff (OR = 3.70 (1.18–11.59), p = 0.022) predicted symptoms’ improvement. TASCII A lesions were less likely to require reintervention (OR = 0.23 (0.06–0.86), p = 0.020). Reintervention within 1 year (OR = 11.67 (0.98–138.94), p = 0.017), reintervention with a stent (OR = 14.40 (1.19–173.67), p = 0.008) and more than one reintervention (OR = 39.00 (2.89–526.28), p < 0.001) predicted major adverse limb events.

Conclusions

Careful patient selection is important when planning endovascular treatment in patients with intermittent claudication and FP disease. This could result in symptomatic improvement in more than half of the patients. Adverse outcomes such as major adverse limb events, progression to CLTI, and amputations occur at low rates.
Disrupting conventional conceptions of parental engagement: Insights from international schools
Authors: McIntosh Shona , Hayden Mary
Published: August 2021

Recently, increases in numbers of international schools have been fuelled by a growth in numbers of aspirational families selecting them. The perception that international education affords children access to social advantages has been established in the school choice literature, but there has yet to be an examination of this trend in relation to parental engagement in international schools. Views of parents on this growing trend will be sought in a separate study, but in this paper we approach the problem through international school staff perceptions of issues relating to parents. These emerged during interviews with those responsible for implementing one part of the International Baccalaureate Diploma Programme: Creativity, Activity, Service. A communities of educational practice framework, adapted for parental engagement, indicated previously unidentified tensions in the international school/parent relationship. Conditions in international education markets create conditions that tip the balance of power, conventionally with the school, towards already-privileged international school parents, raising important questions about the relationship between international schools and social inequalities perpetuated by education.
Knowledge, attitude, and practice on screening toward cervical cancer among health professionals in India—A review
Authors: Chawla Bhavika , Taneja Neha , Awasthi Aanchal Anant , Kaur Karuna Nidhi , Janardhanan Rajiv
Published: August 2021

Background:

Globally, 570,000 cases of cervical cancer and 311,000 deaths from the disease occurred in 2018. Cervical cancer is the fourth most common cancer in women. About 96,922 new cervical cancer cases are diagnosed annually in India.

Objective:

To summarize the knowledge, attitude, and practice toward screening of cervical cancer among health professionals in India.

Materials and methods:

Health sciences electronic databases PubMed and Google Scholar were searched for studies published between 2012 and March 2020. Keywords used for the search were (“CERVICAL CANCER”), (“SCREENING”), (“KNOWLEDGE”), (“ATTITUDE”), (“PRACTICE”), (“HEALTH PROFESSIONALS”), AND (“INDIA”). A total of 22 articles were included in the review based on the eligibility criteria. Statistical software SPSS-V.23 was used for the statistical application.

Results:

A total of 22 studies met the inclusion criteria with total of 6811 health professionals. The age of the study participants ranged from 18 to 60 years. The overall knowledge of cervical cancer among health professionals was 75.15%. The knowledge toward signs and symptoms and risk factors was adequate among health professionals. The knowledge, attitude, and practice toward screening was 86.20%, 85.47%, and 12.70%, respectively.

Conclusion:

The health professionals have optimum level of knowledge of cervical cancer and knowledge of screening of cervical cancer with appropriate attitude toward screening with low uptake of practice toward screening.
Is there a role for referral of high-risk patients seen in preoperative medical consultation for postoperative inpatient follow-up?
Authors: Evans Jessica , Chan James , Saraqini Delvina H , Mallick Ranjeeta
Published: August 2021

The potential benefit of referring select high-risk surgical patients who are seen during a preoperative medical consultation for postoperative inpatient medical follow-up is uncertain. Over a seven-year period, our internal medicine perioperative clinic referred 5% of 4642 preoperative consults for postoperative follow-up. A retrospective chart review found that although reasons for referral were heterogeneous, those assessed by the medical consult team postoperatively were more comorbid, had more adverse medical complications and had longer hospital admissions compared to those not referred. Physicians were best able to predict adverse cardiac and diabetes-related complications. Half of the patients who were referred for postoperative assessment were lost to follow-up, and there was a trend towards increased hospital readmissions in this group. Further research is required to identify the subset of patients who might benefit from postoperative inpatient medical assessment.
“White” Self-Identification: A Source of Uniqueness Threat
Authors: Rios Kimberly , Mackey Cameron D.
Published: August 2021

The present research introduces the possibility that Whiteness can threaten majority group members’ sense of uniqueness and reduce their support for multiculturalism, an ideology that emphasizes recognition of distinctive cultural identities and is seen as primarily relevant to racial/ethnic minorities. Across three studies, being induced to self-identify as “White” (vs. “European American”) led majority group members high, but not low, in need for uniqueness (measured in Study 1, manipulated in Studies 2 and 3) to express less positivity toward multiculturalism. Further, the effect of uniqueness motives on reduced support for multiculturalism among participants self-identifying as “White” was mediated by reduced personal feelings of diversity (Study 3). Implications for optimal distinctiveness theory and the functions of White identity are discussed.
Robotics for neuroendovascular intervention: Background and primer
Authors: Narsinh Kazim H , Paez Ricardo , Mueller Kerstin , Caton M Travis , Baker Amanda , Higashida Randall T , Halbach Van V , Dowd Christopher F , Amans Matthew R , Hetts Steven W , Norbash Alexander M , Cooke Daniel L
Published: August 2021

The simultaneous growth of robotic-assisted surgery and telemedicine in recent years has only been accelerated by the recent coronavirus disease 2019 pandemic. Robotic assistance for neurovascular intervention has garnered significant interest due to opportunities for tele-stroke models of care for remote underserved areas. Lessons learned from medical robots in interventional cardiology and neurosurgery have contributed to incremental but vital advances in medical robotics despite important limitations. In this article, we discuss robot types and their clinical justification and ethics, as well as a general overview on available robots in thoracic/abdominal surgery, neurosurgery, and cardiac electrophysiology. We conclude with current clinical research in neuroendovascular intervention and a perspective on future directions.
Critical positions: Situating critical perspectives in work and organizational psychology
Authors: Islam Gazi , Sanderson Zoe
Published: August 2021

This paper argues that critical perspectives have constituted a marginal yet continued presence in work and organizational (W-O) psychology and calls for a reflexive taking stock of these perspectives to ground a critical research agenda. We argue that critical W-O psychology has been positioned between a psychology literature with limited development of critical perspectives, and an emergent critical management literature that has allowed their selective development. This in-between position has allowed critical W-O psychology to persist, albeit in a fragmented form, while limiting its potential for theoretical and applied impact. We use this diagnosis to reflect on how critical perspectives can best develop from within W-O psychology. We end with a call for developing a critical movement unique to the current historical moment, drawing upon without repeating the experiences of its home disciplines, in a future oriented and reflexive psychology research agenda.
Robotic-assisted radical cystectomy with complete intracorporal diversion: Initial experience in a tertiary teaching hospital
Authors: He Yilu , Shanmugasundaram Ramesh , Hana Bishoy , McCombie Steve P , Bhoopathy Varun , Myint Michael , Arianayagam Mohan , Canagasingham Betram , Ferguson Richard , Goolam Ahmed S , Jeffery Nicola , Khadra Mohamed , Ko Raymond , Varol Celi , Winter Matthew
Published: August 2021

Objective:

The aim of this study was to report the outcomes from robotic-assisted radical cystectomy (RARC) at an Australian public teaching hospital since the introduction of this technique in 2012.

Methods:

A retrospective analysis was conducted on perioperative and pathological outcomes from a consecutive series of 43 patients who underwent RARC for bladder cancer between 2012 and 2020 at Nepean Public Hospital.

Results:

Median operative time was 352 minutes for 32 (74.4%) patients undergoing construction of an ileal conduit, 499 minutes for nine (20.9%) patients undergoing construction of a neo-bladder and 239 minutes for two (4.7%) patients undergoing percutaneous urostomy. Median estimated blood loss was 500 mL, and median length of stay was 12 days. Complications within 60 days of any grade occurred in 63.4% of patients, and major complications (Clavien–Dindo ⩾Grade III) occurred in 20.9% of patients. The median number of lymph nodes removed was 17. Positive surgical margins occurred in 11.6% of patients overall, all in patients with T3 and above disease. Neo-adjuvant chemotherapy was utilised in 34.9% of patients overall and in 71.4% of patients with muscle-invasive urothelial cancer.

Conclusion:

The perioperative and pathological outcomes from RARC at our institution are comparable to the international literature.

Level of evidence

Level 4.
Phenotyping as disciplinary practice: Data infrastructure and the interprofessional conflict over drug use in California
Authors: Hussain Mustafa I , Bowker Geoffrey C
Published: August 2021

The narrative of the digital phenotype as a transformative vector in healthcare is nearly identical to the concept of “data drivenness” in other fields such as law enforcement. We examine the role of a prescription drug monitoring program in California—a computerized law enforcement surveillance program enabled by a landmark Supreme Court case that upheld “broad police powers”—in the interprofessional conflict between physicians and law enforcement over the jurisdiction of drug use. We bring together interview passages, clinical artifacts, and academic and gray literature to investigate the power relations between police, physicians, and patients to show that prescribing data appear to the physician as evidence of problematic patient behavior by the patients, and to law enforcement as evidence of physician misconduct. In turn, physicians have adopted a disciplinary approach to patients, using quasi-legalistic documents to litigate patient behavior. We conclude that police powers have been used to pave data infrastructure through a contested jurisdiction, and law enforcement have used that infrastructure to enroll physicians into the work of disciplining patients.
Insulin amyloid fibrils interact directly with the NLRP3, resulting in inflammasome activation and pyroptotic cell death
Authors: Mori Wakako , Kaneko Naoe , Nakanishi Ayaka , Zako Tamotsu , Masumoto Junya
Published: August 2021

Introduction

Nucleotide-binding oligomerization domain-like receptor family, pyrin domain containing 3 (NLRP3), an intracellular pattern recognition receptor, recognizes various pathogen-associated molecular pattern and/or damage-associated molecular pattern molecules to constitute inflammasome that act as an interleukin (IL)-1β processing platform. Injected insulin is reported to induce focal amyloidosis and the formation of subcutaneous lumps called insulin balls, but the formation of subcutaneous lumps and the underlying cytotoxic mechanism has not been elucidated.

Methods

Amyloid formation was evaluated by thioflavin T spectroscopic assay and scanning electron microscopy. Binding between insulin amyloid fibrils and NLRP3 was evaluated by immunoprecipitation followed by native polyacrylamide gel electrophoresis. Inflammasome activation was evaluated by immunofluorescence speck formation called “ASC speck” and Western blotting. IL-1β secretion in culture supernatants of peripheral blood mononuclear cells was evaluated by enzyme-linked immunosorbent assay. Cytotoxicity was measured by lactate dehydrogenase release assay.

Results

Insulin amyloid fibrils interact directly with NLRP3, resulting in NLRP3 inflammasome activation and pyroptotic cell death.

Conclusion

Insulin ball formation and cytotoxicity may be associated with NLRP3 inflammasome activation followed by pyroptotic cell death.
Muscle Degeneration Induced by Sequential Release and Denervation of the Rotator Cuff Tendon in Sheep
Authors: Wieser Karl , Grubhofer Florian , Hasler Anita , Götschi Tobias , Beeler Silvan , Meyer Dominik , Rechenberg Brigitte von , Gerber Christian
Published: August 2021

Background:

In a sheep rotator cuff model, tenotomy predominantly induces fatty infiltration, and denervation induces mostly muscle atrophy. In clinical practice, myotendinous retraction after tendon tear or lateralization after tendon repair tear may lead to traction injury of the nerve.

Purpose/Hypothesis:

To analyze whether an additional nerve lesion during rotator cuff repair leads to further degeneration of the rotator cuff muscle in the clinical setting. We hypothesized that neurectomy after tendon tear would increase atrophy as well as fatty infiltration and that muscle paralysis after neurectomy would prevent myotendinous retraction after secondary tendon release.

Study Design:

Controlled laboratory study.

Methods:

Twelve Swiss alpine sheep were used for this study. For the 6 sheep in the tenotomy/neurectomy (T/N) group, the infraspinatus tendon was released; 8 weeks later, the suprascapular nerve was transected. For the 6 sheep in the neurectomy/tenotomy (N/T) group, neurectomy was performed, and the infraspinatus was tenotomized 8 weeks later. All sheep were sacrificed after 16 weeks. Magnetic resonance imaging (MRI) was performed before the first surgery (baseline) and then after 8 and 16 weeks. The MRI data were used to assess muscle volume, fat fraction, musculotendinous retraction, pennation angle, and muscle fiber length of the infraspinatus muscle.

Results:

Three sheep (2 in the T/N and 1 in the N/T group) had to be excluded because the neurectomy was incomplete. After 8 weeks, muscle volume decreased significantly less in the T/N group (73% ± 2% of initial volume vs 52% ± 7% in the N/T group; P < .001). After 16 weeks, the mean intramuscular fat increase was higher in the T/N group (36% ± 9%) than in the N/T group (23% ± 6%), without reaching significance ( P = .060). After 16 weeks, the muscle volumes of the N/T (52% ± 8%) and T/N (49% ± 3%) groups were the same ( P = .732).

Conclusion:

Secondary neurectomy after tenotomy of a musculotendinous unit increases muscle atrophy. Tenotomy of a denervated muscle is associated with substantial myotendinous retraction but not with an increase of fatty infiltration to the level of the tenotomy first group.

Clinical Relevance:

Substantial retraction, which is associated with hitherto irrecoverable fatty infiltration, should be prevented, and additional neurogenic injury during repair should be avoided to limit the development of further atrophy.
A simplified and versatile element model for elastomeric seismic isolation bearings
Authors: Miranda Sebastián , Miranda Eduardo , de la Llera Juan Carlos
Published: August 2021

A novel approach for two-dimensional modeling of elastomeric bearings using three springs in parallel is presented. This simplified element model considers as follows: (1) an elastoplastic spring with a smooth transition between branches; (2) a linear elastic spring; and (3) a non-linear elastic spring, and is fully defined by only six parameters. The main advantages of the simplified model are twofold: (1) versatility, as a single model is capable of accurately reproducing the main characteristics of the hysteretic behavior of different types of rubber-based seismic isolators, including low damping rubber bearings (LDRBs), high damping rubber bearings (HDRBs), and lead-core rubber bearings (LRBs) and (2) simplicity, as it requires fewer parameters and it is easier to calibrate from experimental cyclic test results than most currently available models. Model parameters’ identification is illustrated using quasi-static cyclic and earthquake simulator tests of HDRBs and LRBs, demonstrating that the model shows a good agreement between the test-measured and model-predicted hysteretic behavior. Different objective functions are evaluated in the optimization procedure, and their effect on the identified parameters is studied and discussed. This practitioner-oriented model is particularly amenable for implementation in general-purpose structural analysis software. Its usage is strongly recommended as an initial-stage design tool to select the optimal isolation system for a specific project.
Surgical management in retroperitoneal fibrosis: beyond ureterolysis
Authors: Venkatachalapathy Vigneswara Srinivasan Sockkalingam , Palathullil Datson George , Sam Dempsey Mohan , Abraham George Palathullil
Published: August 2021

Background

Retroperitoneal fibrosis can be associated with bilateral dense and extensive periureteral adhesions. When ureterolysis could not be successfully performed due to disease extent and severity, elaborate ureteral reconstructive procedures will be required.

Case presentation

A young male with retroperitoneal fibrosis presented with bilateral hydroureteronephrosis. The ureteral involvement was extensive and adhesions were dense. He was managed by laparoscopic boari flap ureteroneocystostomy on one renal unit and laparoscopic nephrectomy with renal autotransplantation on the other renal unit.

Conclusions

Ureterolysis is not feasible in all cases of retroperitoneal fibrosis. Extensive bilateral ureteral reconstruction without using intestinal segments is feasible. Minimally invasive surgical reconstructive procedures can be successfully employed in such scenarios also.
Large-scale transcriptome sequencing in broiler chickens to identify candidate genes for breast muscle weight and intramuscular fat content
Authors: Kang Huimin , Zhao Di , Xiang Hai , Li Jing , Zhao Guiping , Li Hua
Published: August 2021

Background

In broiler production, breast muscle weight and intramuscular fat (IMF) content are important economic traits. Understanding the genetic mechanisms that underlie these traits is essential to implement effective genetic improvement programs. To date, genome-wide association studies (GWAS) and gene expression analyses have been performed to identify candidate genes for these traits. However, GWAS mainly detect associations at the DNA level, while differential expression analyses usually have low power because they are typically based on small sample sizes. To detect candidate genes for breast muscle weight and IMF contents (intramuscular fat percentage and relative content of triglycerides, cholesterol, and phospholipids), we performed association analyses based on breast muscle transcriptomic data on approximately 400 Tiannong partridge chickens at slaughter age.

Results

First, by performing an extensive simulation study, we evaluated the statistical properties of association analyses of gene expression levels and traits based on the linear mixed model (LMM) and three regularized linear regression models, i.e., least absolute shrinkage and selection operator (LASSO), ridge regression (RR), and elastic net (EN). The results show that LMM, LASSO and EN with tuning parameters that are determined based on the one standard error rule exhibited the lowest type I error rates. Using results from all three models, we detected 43 candidate genes with expression levels that were associated with breast muscle weight. In addition, candidate genes were detected for intramuscular fat percentage (1), triglyceride content (2), cholesterol content (1), and phospholipid content (1). Many of the identified genes have been demonstrated to play roles in the development and metabolism of skeletal muscle or adipocyte. Moreover, weighted gene co-expression network analyses revealed that many candidate genes were harbored by gene co-expression modules, which were also significantly correlated with the traits of interest. The results of Gene Ontology and Kyoto Encyclopedia of Genes and Genomes enrichment analyses indicated that these modules are involved in muscle development and contraction, and in lipid metabolism.

Conclusions

Our study provides valuable insight into the transcriptomic bases of breast muscle weight and IMF contents in Chinese indigenous yellow broilers. Our findings could be useful for the genetic improvement of these traits in broiler chickens.
Experimental Babesia rossi infection induces hemolytic, metabolic, and viral response pathways in the canine host
Authors: Smith Rachel L. , Goddard Amelia , Boddapati Arun , Brooks Steven , Schoeman Johan P. , Lack Justin , Leisewitz Andrew , Ackerman Hans
Published: August 2021

Background

Babesia rossiis a leading cause of morbidity and mortality among the canine population of sub-Saharan Africa, but pathogenesis remains poorly understood. Previous studies ofB. rossiinfection were derived from clinical cases, in which neither the onset of infection nor the infectious inoculum was known. Here, we performed controlledB. rossiinoculations in canines and evaluated disease progression through clinical tests and whole blood transcriptomic profiling.

Results

Two subjects were administered a low inoculum (104parasites) while three received a high (108parasites). Subjects were monitored for 8 consecutive days; anti-parasite treatment with diminazene aceturate was administered on day 4. Blood was drawn prior to inoculation as well as every experimental day for assessment of clinical parameters and transcriptomic profiles. The model recapitulated natural disease manifestations including anemia, acidosis, inflammation and behavioral changes. Rate of disease onset and clinical severity were proportional to the inoculum. To analyze the temporal dynamics of the transcriptomic host response, we sequenced mRNA extracted from whole blood drawn on days 0, 1, 3, 4, 6, and 8. Differential gene expression, hierarchical clustering, and pathway enrichment analyses identified genes and pathways involved in response to hemolysis, metabolic changes, and several arms of the immune response including innate immunity, adaptive immunity, and response to viral infection.

Conclusions

This work comprehensively characterizes the clinical and transcriptomic progression ofB. rossiinfection in canines, thus establishing a large mammalian model of severe hemoprotozoal disease to facilitate the study of host-parasite biology and in which to test novel anti-disease therapeutics. The knowledge gained from the study ofB. rossiin canines will not only improve our understanding of this emerging infectious disease threat in domestic dogs, but also provide insight into the pathobiology of human diseases caused byBabesiaandPlasmodiumspecies.
Transcriptomic analysis to elucidate the effects of high stocking density on grass carp (Ctenopharyngodon idella)
Authors: He Yan , Yu Hongyan , Zhao Honggang , Zhu Hua , Zhang Qingjing , Wang Anqi , Shen Yubang , Xu Xiaoyan , Li Jiale
Published: August 2021

Background

Grass carp (Ctenopharyngodon idella) is one of the most widely cultivated fishes in China. High stocking density can reportedly affect fish growth and immunity. Herein we performed PacBio long-read single-molecule real-time (SMRT) sequencing and Illumina RNA sequencing to evaluate the effects of high stocking density on grass carp transcriptome.

Results

SMRT sequencing led to the identification of 33,773 genes (14,946 known and 18,827 new genes). From the structure analysis, 8,009 genes were detected with alternative splicing events, 10,219 genes showed alternative polyadenylation sites and 15,521 long noncoding RNAs. Further, 1,235, 962, and 213 differentially expressed genes (DEGs) were identified in the intestine, muscle, and brain tissues, respectively. We performed functional enrichment analyses of DEGs, and they were identified to be significantly enriched in nutrient metabolism and immune function. The expression levels of several genes encoding apolipoproteins and activities of enzymes involved in carbohydrate enzymolysis were found to be upregulated in the high stocking density group, indicating that lipid metabolism and carbohydrate decomposition were accelerated. Besides, four isoforms of grass carp major histocompatibility complex class II antigen alpha and beta chains in the aforementioned three tissue was showed at least a 4-fold decrease.

Conclusions

The results suggesting that fish farmed at high stocking densities face issues associated with the metabolism and immune system. To conclude, our results emphasize the importance of maintaining reasonable density in grass carp aquaculture.
Scattered migrating colony formation in the filamentous cyanobacterium, Pseudanabaena sp. NIES-4403
Authors: Yamamoto Hiroki , Fukasawa Yuki , Shoji Yu , Hisamoto Shumpei , Kikuchi Tomohiro , Takamatsu Atsuko , Iwasaki Hideo
Published: August 2021

Background

Bacteria have been reported to exhibit complicated morphological colony patterns on solid media, depending on intracellular, and extracellular factors such as motility, cell propagation, and cell-cell interaction. We isolated the filamentous cyanobacterium,Pseudanabaenasp. NIES-4403 (Pseudanabaena, hereafter), that forms scattered (discrete) migrating colonies on solid media. While the scattered colony pattern has been observed in some bacterial species, the mechanism underlying such a pattern still remains obscure.

Results

We studied the morphology ofPseudanabaenamigrating collectively and found that this species forms randomly scattered clusters varying in size and further consists of a mixture of comet-like wandering clusters and disk-like rotating clusters. Quantitative analysis of the formation of these wandering and rotating clusters showed that bacterial filaments tend to follow trajectories of previously migrating filaments at velocities that are dependent on filament length. Collisions between filaments occurred without crossing paths, which enhanced their nematic alignments, giving rise to bundle-like colonies. As cells increased and bundles aggregated, comet-like wandering clusters developed. The direction and velocity of the movement of cells in comet-like wandering clusters were highly coordinated. When the wandering clusters entered into a circular orbit, they turned into rotating clusters, maintaining a more stable location. Disk-like rotating clusters may rotate for days, and the speed of cells within a rotating cluster increases from the center to the outmost part of the cluster. Using a mathematical modeling with simplified assumption we reproduced some features of the scattered pattern including migrating clusters.

Conclusion

Based on these observations, we propose thatPseudanabaenaforms scattered migrating colonies that undergo a series of transitions involving several morphological patterns. A simplified model is able to reproduce some features of the observed migrating clusters.
Emergence agitation after intraoperative neurolytic celiac plexus block with alcohol: a case report
Authors: Zhou Huixuan , Pan Yinbing , Liu Cunming , Sun Xiaodi
Published: August 2021

Background

Emergence agitation after general anesthesia may cause several undesirable events in the clinic during patient anesthesia recovery, and acute alcohol intoxication, while rare in surgery, is one of the risk factors.

Case presentation

A 66-year-old male patient was found to have pancreatic tail neoplasm upon computed tomography (CT) examination. The surgeon planned to resect the pancreatic tail under general anesthesia. However, the surgeon found extensive tumor metastasis in the abdominal cavity, and thus performed a neurolytic celiac plexus block (NCPB) with 40 ml 95% ethyl alcohol and finished the surgery in approximately 1 h. Twenty minutes later, the patient was extubated and developed significant emergence agitation in the postoperative care unit, characterized by restlessness, uncontrollable movements, confusion and disorientation. The patient was flushed and febrile with an alcohol smell in his breath and was unable to follow commands. Patient symptoms were suspected to be due to acute alcohol intoxication. Thus, the patient was given 40 mg of propofol intravenously. Following treatment, the patient recovered with less confusion and disorientation after approximately 10 min. After treatment with propofol twice more, he regained consciousness, was calm and cooperative, had no pain, and could obey instructions approximately 1 h and 40 min following the last treatment. Following this treatment, the patient was transferred to the inpatient ward and felt well.

Conclusions

It is paramount to correctly identify the underlying cause of emergence agitation in order to successfully manage patient symptoms, since treatment plans vary between different etiological causes. Emergence agitation may be due to acute alcohol intoxication after intraoperative use of alcohol.
Creating efficiencies in the extraction of data from randomized trials: a prospective evaluation of a machine learning and text mining tool
Authors: Gates Allison , Gates Michelle , Sim Shannon , Elliott Sarah A. , Pillay Jennifer , Hartling Lisa
Published: August 2021

Background

Machine learning tools that semi-automate data extraction may create efficiencies in systematic review production. We evaluated a machine learning and text mining tool’s ability to (a) automatically extract data elements from randomized trials, and (b) save time compared with manual extraction and verification.

Methods

For 75 randomized trials, we manually extracted and verified data for 21 data elements. We uploaded the randomized trials to an online machine learning and text mining tool, and quantified performance by evaluating its ability to identify the reporting of data elements (reported or not reported), and the relevance of the extracted sentences, fragments, and overall solutions. For each randomized trial, we measured the time to complete manual extraction and verification, and to review and amend the data extracted by the tool. We calculated the median (interquartile range [IQR]) time for manual and semi-automated data extraction, and overall time savings.

Results

The tool identified the reporting (reported or not reported) of data elements with median (IQR) 91% (75% to 99%) accuracy. Among the top five sentences for each data element at least one sentence was relevant in a median (IQR) 88% (83% to 99%) of cases. Among a median (IQR) 90% (86% to 97%) of relevant sentences, pertinent fragments had been highlighted by the tool; exact matches were unreliable (median (IQR) 52% [33% to 73%]). A median 48% of solutions were fully correct, but performance varied greatly across data elements (IQR 21% to 71%). Using ExaCT to assist the first reviewer resulted in a modest time savings compared with manual extraction by a single reviewer (17.9 vs. 21.6 h total extraction time across 75 randomized trials).

Conclusions

Using ExaCT to assist with data extraction resulted in modest gains in efficiency compared with manual extraction. The tool was reliable for identifying the reporting of most data elements. The tool’s ability to identify at least one relevant sentence and highlight pertinent fragments was generally good, but changes to sentence selection and/or highlighting were often required.

Protocol

https://doi.org/10.7939/DVN/RQPJKS
Do assisted living facilities that offer a dementia care program differ from those that do not? A population-level cross-sectional study in Ontario, Canada
Authors: Manis Derek R. , Rahim Ahmad , Poss Jeffrey W. , Bielska Iwona A. , Bronskill Susan E. , Tarride Jean-Éric , Abelson Julia , Costa Andrew P.
Published: August 2021

Background

Many residents of assisted living facilities live with dementia, but little is known about the characteristics of assisted living facilities that provide specialized care for older adults who live with dementia. In this study, we identify the characteristics of assisted living facilities that offer a dementia care program, compared to those that do not offer such a program.

Methods

We conducted a population-level cross-sectional study on all licensed assisted living facilities in Ontario, Canada in 2018 (n = 738). Facility-level characteristics (e.g., resident and suite capacities, etc.) and the provision of the other 12 provincially regulated care services (e.g., pharmacist and medical services, skin and wound care, etc.) attributed to assisted living facilities were examined. Multivariable Poisson regression with robust standard errors was used to model the characteristics of assisted living facilities associated with the provision of a dementia care program.

Results

There were 123 assisted living facilities that offered a dementia care program (16.7% versus 83.3% no dementia care). Nearly half of these facilities had a resident capacity exceeding 140 older adults (44.7% versus 21.6% no dementia care) and more than 115 suites (46.3% versus 20.8% no dementia care). All assisted living facilities that offered a dementia care program also offered nursing services, meals, assistance with bathing and hygiene, and administered medications. After adjustment for facility characteristics and other provincially regulated care services, the prevalence of a dementia care program was nearly three times greater in assisted living facilities that offered assistance with feeding (Prevalence Ratio [PR] 2.91, 95% Confidence Interval [CI] 1.98 to 4.29), and almost twice as great among assisted living facilities that offered medical services (PR 1.78, 95% CI 1.00 to 3.17), compared to those that did not.

Conclusions

A dementia care program was more prevalent in assisted living facilities that housed many older adults, had many suites, and offered at least five of the other 12 regulated care services. Our findings deepen the understanding of specialized care for dementia in assisted living facilities.
Estimating case fatality risk of severe Yellow Fever cases: systematic literature review and meta-analysis
Authors: Servadio Joseph L. , Muñoz-Zanzi Claudia , Convertino Matteo
Published: August 2021

Background

Case fatality risk (CFR), commonly referred to as a case fatality ratio or rate, represents the probability of a disease case being fatal. It is often estimated for various diseases through analysis of surveillance data, case reports, or record examinations. Reported CFR values for Yellow Fever vary, offering wide ranges. Estimates have not been found through systematic literature review, which has been used to estimate CFR of other diseases. This study aims to estimate the case fatality risk of severe Yellow Fever cases through a systematic literature review and meta-analysis.

Methods

A search strategy was implemented in PubMed and Ovid Medline in June 2019 and updated in March 2021, seeking reported severe case counts, defined by fever and either jaundice or hemorrhaging, and the number of those that were fatal. The searches yielded 1,133 studies, and title/abstract review followed by full text review produced 14 articles reporting 32 proportions of fatal cases, 26 of which were suitable for meta-analysis. Four studies with one proportion each were added to include clinical case data from the recent outbreak in Brazil. Data were analyzed through an intercept-only logistic meta-regression with random effects for study. Values of the I2 statistic measured heterogeneity across studies.

Results

The estimated CFR was 39 % (95 % CI: 31 %, 47 %). Stratifying by continent showed that South America observed a higher CFR than Africa, though fewer studies reported estimates for South America. No difference was seen between studies reporting surveillance data and studies investigating outbreaks, and no difference was seen among different symptom definitions. High heterogeneity was observed across studies.

Conclusions

Approximately 39 % of severe Yellow Fever cases are estimated to be fatal. This study provides the first systematic literature review to estimate the CFR of Yellow Fever, which can provide insight into outbreak preparedness and estimating underreporting.
Adherence to Mediterranean diet impacts gastrointestinal microbial diversity throughout pregnancy
Authors: Miller Corrie B. , Benny Paula , Riel Jonathan , Boushey Carol , Perez Rafael , Khadka Vedbar , Qin Yujia , Maunakea Alika K. , Lee Men-Jean
Published: August 2021

Background

Consumption of a diet with high adherence to a Mediterranean diet pattern (MDP) has been associated with a favorable gastrointestinal tract (GIT) microbiome. A healthy GIT microbiome in pregnancy, as defined by increased alpha diversity, is associated with lower chance of adverse perinatal outcomes. This study aimed to evaluate the impact of adherence to an MDP on GIT microbial diversity longitudinally throughout pregnancy.

Methods

Adherence to MDP was scored by the Alternate Mediterranean (aMED) Diet Quality Score, after being applied to a validated Food Frequency Questionnaire. Association of aMED Scores with GIT alpha diversity profiles were compared linearly and across time using a linear mixed model, including covariates of age, body mass index (BMI), ethnicity, and parity.

Results

Forty-one participants of Filipino, Japanese, Native Hawaiian, and Non-Hispanic White descent provided dietary information and microbiome samples during each trimester of pregnancy. Alpha diversity profiles changed over gestation, with decreased microbial diversity in the third trimester. aMED scores positively correlated with Chao1 Index and Observed Species Number (r = 0.244, p = 0.017, and r = 0.233, p = 0.023, respectively). The strongest association was detected in the third trimester (Chao 1: r = 0.43, p = 0.020, Observed Species Number: r = 0.41, p = 0.026). Participants with higher aMED scores had higher relative abundance of Acidaminoacaeae at the family level (p = 0.0169), as well as higher abundance of several species known to increase production of short chain fatty acids within the GIT.

Conclusions

Adherence to MDP pattern is associated with increased maternal GIT microbial diversity, and promotes the abundance of bacteria that produce short chain fatty acids. Increased consumption of fruits, vegetables and legumes with low red meat consumption were key components driving this association. The effect of nutrition however, was less of an effect than pregnancy itself. Further studies are needed to determine if adherence to a Mediterranean diet translates not only into microbial health, but also into reduced risk of adverse pregnancy outcomes.
Pre-existing interstitial lung disease is associated with onset of nivolumab-induced pneumonitis in patients with solid tumors: a retrospective analysis
Authors: Yamaguchi Teppei , Shimizu Junichi , Hasegawa Takaaki , Horio Yoshitsugu , Inaba Yoshitaka , Hanai Nobuhiro , Muro Kei , Hida Toyoaki
Published: August 2021

Background

Nivolumab, an anti-programmed death 1 (PD-1) monoclonal antibody, has shown survival benefit in clinical trials of various malignant tumors. Nivolumab-induced pneumonitis is major immune-related adverse event (irAE) that is occasionally serious and life-threatening. The aim of this study was to examine the association between pre-existing interstitial lung disease (ILD) on chest computed tomography (CT) and nivolumab-induced pneumonitis among different types of solid tumors.

Methods

We retrospectively collected the clinical data of 311 patients who were diagnosed with non-small cell lung cancer (NSCLC), head and neck cancer (HNC), or gastric cancer (GC), and treated with nivolumab monotherapy. Patients who underwent chest CT immediately before starting nivolumab without previous thoracic radiotherapy or other immune checkpoint inhibitors were eligible. We collected baseline patient characteristics and assessed pre-existing ILD on baseline chest CT.

Results

Finally, 188 patients were included in the analysis: 96 patients with NSCLC, 43 patients with HNC, and 49 patients with GC. NSCLC patients had a significantly higher rate of pre-existing ILD compared with HNC/GC patients (P = 0.047). Nivolumab-induced pneumonitis occurred in 11.7% (22 of 188), including 14.6% (14 of 96) of NSCLC, and 8.7% (8 of 92) of HNC/GC. Univariate and multivariate logistic regression analyses revealed that pre-existing ILD (odds ratio, 5.92; 95% confidence interval (CI), 2.07–18.54, P = 0.0008) and male sex (odds ratio, 5.58; 95% CI, 1.01–104.40, P = 0.049) significantly increased the risk of nivolumab-induced pneumonitis.

Conclusion

Our results indicated that pre-existing ILD and male sex are risk factors for nivolumab-induced pneumonitis in solid tumors.
Associations between study questionnaire-assessed need and school doctor-evaluated benefit of routine health checks: an observational study
Authors: Nikander Kirsi , Hermanson Elina , Vahlberg Tero , Kaila Minna , Sannisto Tuire , Kosola Silja
Published: August 2021

Background

In Finland, school doctors examine all children at predetermined ages in addition to annual health checks by school nurses. This study explored the association of study questionnaire-assessed need for and school doctor-evaluated benefit of routine health checks conducted by doctors.

Methods

Between August 2017 and August 2018, we recruited a random sample of 1341 children in grades 1 and 5 (aged seven and eleven years, respectively) from 21 elementary schools in four Finnish municipalities. Children mainly studying in special education groups or whose parents needed an interpreter were excluded. School nurses performed their health check as usual. Parents, nurses, and teachers then completed study questionnaires that assessed the concerns of parents, school nurses, and teachers regarding each child’s physical, mental and social health. Doctors, blinded to the responses, routinely examined all the children. The primary outcome measures were (1) the need for a health check based on the study questionnaires and (2) the benefit/harm of the appointment as estimated by the doctors according to predetermined criteria, and (3) the patient-reported experience measures (PREMs) of benefit/harm of the appointment as estimated by the parents and children. We compared the need for a health check with the doctor-evaluated benefit using multilevel logistic regression.

Results

The participation rate was 75.5 %. According to all questionnaires, 20–25 % of the 1013 children had no need for a health check. The doctors regarded 410 (40.6 %) and the parents 812 (83.4 %) of the appointments as being beneficial. Respondents rarely reported harm. The children who were classified as needing a health check more often benefitted from the health check (assessed by the doctor) than children with no need for one (OR 3.53; 95 % CI 2.41–5.17).

Conclusions

The need for a health check is an important predictor of school-doctor evaluated benefit of the health check. This approach could allow school doctors to allocate time for the children who need them most.

Trial registration

ClinicalTrials.gov, Identifier NCT03178331, registration June 6th 2017.
Sleep problems in children with autism spectrum disorder: a multicenter survey
Authors: Chen Hongyu , Yang Ting , Chen Jie , Chen Li , Dai Ying , Zhang Jie , Li Ling , Jia Feiyong , Wu Lijie , Hao Yan , Ke Xiaoyan , Yi Mingji , Hong Qi , Chen Jinjin , Fang Shuanfeng , Wang Yichao , Wang Qi , Jin Chunhua , Li Tingyu
Published: August 2021

Background

High prevalence of sleep problems have been reported in children with Autism Spectrum Disorder (ASD). This study aims to investigate the sleep conditions of ASD children in China, and explore the relationship between the common sleep problems and core symptoms and developmental levels.

Methods

Using a cross-sectional design, we included 2 to 7-year-old children from 13 cities in China: 1310 with ASD and 1158 with typically-developing (TD) children. The neurodevelopmental level was evaluated with the revised Children Neuropsychological and Behavior Scale (CNBS-R2016). ASD were diagnosed with DSM-5 and Child Autism Rating Scale (CARS). the Social Responsiveness Scale (SRS), the Autism Behavior Checklist (ABC) and the communication warning behavior sub-scale in CNBS-R2016 valued autism behaviors. The children’ s sleep habits questionnaire (CSHQ) assessed sleep conditions.

Results

The prevalence of sleep disorders in ASD children was significantly higher than that in TD (67.4% vs. 51%,p < 0.01), and among them the four dimensions with the highest prevalence of sleep problems were bedtime resistance (25.6%), sleep anxiety (22.7%), sleep onset delay (17.9%) and daytime sleepiness (14.7%). ASD children with sleep onset delay or sleep anxiety had higher ABC, SRS scores and higher scores on communication warning behavior with sleep anxiety, with daytime sleepiness had higher ABC, SRS and CARS scores, and with bedtime resistance had higher SRS total scores. Differences in the neurodevelopmental level were not significant.

Conclusion

Children with ASD have a higher prevalence of sleep problems. Bedtime resistance, anxiety, sleep onset delay and daytime sleepiness may be related to the core symptoms, but not be related to the developmental level in ASD children. In the clinic, sleep assessment should be included in the routine of ASD visits, and during the intervention, sleep hygiene education is as important as the treatment of biological factors.

Trial registration

The study was approved by the ethics committee of the Children’s Hospital of Chongqing Medical University, Approval Number: (2018) IRB (STUDY) NO. 121, and registered in the Chinese Clinical Trial Registry (Registration number:ChiCTR2000031194).