bluuebunny/crossref_metadata_2025 huggingface dataset:
A Modified Method to Isolate Circulating Tumor Cells and Identify by a Panel of Gene Mutations in Lung Cancer
Authors: Wang Helin , Wu Jieqing , Zhang Qi , Hao Jianqing , Wang Ying , Li Zhuoran , Niu Hongrui , Zhang Hongtao , Zhang Shucai
Published: May 2021

The CellSearch system is the only FDA approved and successful used detection technology for circulating tumor cells(CTCs). However, the process for identification of CTCs by CellSearch appear to damage the cells, which may adversely affects subsequent molecular biology assays. We aimed to explore and establish a membrane-preserving method for immunofluorescence identification of CTCs that keeping the isolated cells intact. 98 patients with lung cancer were enrolled, and the efficacy of clinical detection of CTCs was examined. Based on the CellSearch principle, we optimized an anti-EpCAM antibody and improved cell membrane rupture. A 5 ml peripheral blood sample was used to enrich CTCs with EpCAM immunomagnetic beads. Fluorescence signals were amplified with secondary antibodies against anti-EpCAM antibody attached on immunomagnetic beads. After identifying CTCs, single CTCs were isolated by micromanipulation. To confirm CTCs, genomic DNA was extracted and amplified at the single cell level to sequence 72 target genes of lung cancer and analyze the mutation copy number variations (CNVs) and gene mutations. A goat anti-mouse polyclonal antibody conjugated with Dylight 488 was selected to stain tumor cells. We identified CTCs based on EpCAM+ and CD45+ cells to exclude white blood cells. In the 98 lung cancer patients, the detection rate of CTCs (≥1 CTC) per 5 ml blood was 87.76%, the number of detections was 1–36, and the median was 2. By sequencing 72 lung cancer-associated genes, we found a high level of CNVs and gene mutations characteristic of tumor cells. We established a new CTCs staining scheme that significantly improves the detection rate and allows further analysis of CTCs characteristics at the genetic level.
Sensemaking Through Metaphors: The Role of Imaginative Metaphor Elicitation in Constructing New Understandings
Authors: Nardon Luciara , Hari Amrita
Published: May 2021

Drawing on in-depth interviews with exchange and international students during the COVID-19 pandemic, we elaborate on the role of Imaginative Metaphor Elicitation (IME) to generate knowledge about participants’ experiences while helping them make sense of and cope with a difficult situation. Imaginative metaphors allow participants to explore feelings, assumptions, and behaviors in non-threatening ways and facilitate introspection and self-awareness. We propose that imaginative metaphors help participants make their experience tangible and accessible, identify problematic assumptions, behaviors, as well as resources available to them. Some reported gaining a renewed sense of empowerment. Simultaneously, IME provides an opportunity to collect rich data while co-creating solutions for and with participants. We contribute to calls for embedding social impact in the research design by highlighting the value of IME in gaining deeper access to participants’ experiences while supporting them in taking an active role in their situations.
Cervical pap smears and pandemics: The effect of COVID-19 on screening uptake & opportunities to improve
Authors: Masson Hannah
Published: May 2021

Background:

The Coronavirus disease 2019 (COVID-19) pandemic has led to an unprecedented upheaval within global healthcare systems and resulted in the temporary pausing of the National Health Service (NHS) Scotland Cervical Screening Programme. With several months of backlogs in appointments, there has not only been a reduction in primary samples being taken for human papilloma virus (HPV) testing but there have also been fewer women referred to colposcopy for investigation and treatment of precancerous or cancerous changes as a result. Encouraging uptake for cervical screening was always a priority before the pandemic, but it is even more important now, considering that the fears and barriers to screening that women may have are now exacerbated by COVID-19.

Objectives:

This article explores the impact of the pandemic on the uptake of cervical screening within NHS Ayrshire & Arran and evaluates potential strategies to improve uptake now and in future such as self-sampling and telemedicine.

Methods:

This article presents evidence-based literature and local health board data relating to cervical screening during the pandemic.

Results:

Human papilloma virus self-sampling carried out by the woman in her home has been shown to improve uptake, especially in non-attenders, whilst maintaining a high sensitivity and, crucially, reducing the need for face-to-face contact. Increased education is key to overcoming barriers women have to screening and telemedicine can strengthen engagement with women during this time.

Conclusion:

There are lessons to be learned from the pandemic, and we must use this opportunity to improve cervical screening uptake for the future.
Serum neurofilament levels reflect outer retinal layer changes in multiple sclerosis
Authors: Seitz Caspar B. , Steffen Falk , Muthuraman Muthuraman , Uphaus Timo , Krämer Julia , Meuth Sven G. , Albrecht Philipp , Groppa Sergiu , Zipp Frauke , Bittner Stefan , Fleischer Vinzenz
Published: May 2021

Background:

Serum neurofilament light chain (sNfL) and distinct intra-retinal layers are both promising biomarkers of neuro-axonal injury in multiple sclerosis (MS). We aimed to unravel the association of both markers in early MS, having identified that neurofilament has a distinct immunohistochemical expression pattern among intra-retinal layers.

Methods:

Three-dimensional (3D) spectral domain macular optical coherence tomography scans and sNfL levels were investigated in 156 early MS patients (female/male: 109/47, mean age: 33.3 ± 9.5 years, mean disease duration: 2.0 ± 3.3 years). Out of the whole cohort, 110 patients had no history of optic neuritis (NHON) and 46 patients had a previous history of optic neuritis (HON). In addition, a subgroup of patients ( n = 38) was studied longitudinally over 2 years. Support vector machine analysis was applied to test a regression model for significant changes.

Results:

In our cohort, HON patients had a thinner outer plexiform layer (OPL) volume compared to NHON patients ( B = −0.016, SE = 0.006, p = 0.013). Higher sNfL levels were significantly associated with thinner OPL volumes in HON patients ( B = −6.734, SE = 2.514, p = 0.011). This finding was corroborated in the longitudinal subanalysis by the association of higher sNfL levels with OPL atrophy ( B = 5.974, SE = 2.420, p = 0.019). sNfL levels were 75.7% accurate at predicting OPL volume in the supervised machine learning.

Conclusions:

In summary, sNfL levels were a good predictor of future outer retinal thinning in MS. Changes within the neurofilament-rich OPL could be considered as an additional retinal marker linked to MS neurodegeneration.
Leading with Curricular Co-Design: An Exploration of Teacher Leadership Through the Co-Design Process
Authors: Scornavacco Karla , Kelly Mary Rose , Boardman Alison
Published: May 2021

This study bridges teacher leadership research with principles of co-design in an effort to understand teachers’ experiences with co-design as a process of teacher leadership and its implications for strengthening teacher leadership development efforts. Using qualitative data from a multi-year co-design research project aimed at developing curricular materials, we explore how co-design aligns with and promotes multiple dimensions of teacher leadership. Findings revealed that teachers not only engaged in a process that shaped how they saw themselves as leaders, but also that critical elements of co-design promoted teacher leadership enactment.
Epidemiology and clinicopathological features of lung cancer in patients with prior history of breast cancer
Authors: Wang Kevin Y , Newman James , Lee Chung-Shien , Seetharamu Nagashree
Published: May 2021

Breast cancer is the most common malignancy in women, and lung cancer, the leading cause of cancer-related mortality in the United States, is the most common subsequent primary cancer among breast cancer survivors. In this review, we examine the risk factors that cause subsequent primary lung cancer after breast cancer (referred to herein as BCLC patients) as well as the prognostic factors that may affect survival. Notable clinicopathological features include patient characteristics such as age, smoking history, and the presence of EGFR or BRCA mutations, as well as factors related to the treatment of breast cancer such as radiation, surgery, chemotherapy, stage, anti-estrogen therapy, and ER/PR/HER2 status.
A Review of Racial and Ethnic Disparities in Immunizations for Elderly Adults
Authors: Elekwachi Oluchi , Wingate La’Marcus T. , Clarke Tasker Veronica , Aboagye Lorraine , Dubale Tadesse , Betru Dagmawit , Algatan Razan
Published: May 2021

Vaccine preventable diseases are responsible for a substantial degree of morbidity in the United States as over 18 million annual cases of vaccine preventable disease occur in the U.S. annually. The morbidity due to vaccine preventable disease is disproportionately borne by adults as over 99% of the deaths due to vaccine preventable diseases occur within adults, and national data indicates that there racial disparities in the receipt of vaccines intended for elderly adults. A literature review was conducted by using the PubMed database to identify research articles that contained information on the vaccination rates among minority populations for selected vaccines intended for use in elderly populations including those for herpes zoster, tetanus, diphtheria, pertussis, hepatitis A, and hepatitis B. A total of 22 articles were identified, 8 of which focused on tetanus related vaccines, 2 of which focused on hepatitis related vaccines, and 12 of which focused on herpes zoster. The findings indicate that magnitude of the disparity for the receipt of tetanus and herpes related vaccines is not decreasing over time. Elderly patients having a low awareness of vaccines and suboptimal knowledge for when or if they should receive specific vaccines remains a key contributor to suboptimal vaccination rates. There is an urgent need for more intervention-based studies to enhance the uptake of vaccines within elderly populations, particularly among ethnic minorities where culturally sensitive and tailored messages may be of use.
Challenges Faced by Female Out-of-School Adolescents in Accessing and Utilizing Sexual and Reproductive Health Service: A Qualitative Exploratory Study in Southwest, Ethiopia
Authors: Hailemariam Shewangizaw , Gutema Lidiya , Agegnehu Wubetu , Derese Msganaw
Published: May 2021

Introduction

Due to the limited access to sexual and reproductive health service, out-of-school-adolescents become at a higher risk for early marriage, early pregnancy early parenthood, and poor health outcomes over their life course. Hence, the aim of this study was to explore the challenges faced by female out-of-school adolescents in accessing sexual and reproductive health service in Bench-Sheko zone.

Methods

A community-based qualitative exploratory study was carried out from November 01/2020 to December 01/2020 among selected out-of-school adolescents residing in rural and urban districts of Bench-Sheko Zone, and healthcare professionals working in the local health centers. FGD participants and healthcare providers were purposely selected for this study. Eight focus group discussions and 8 in-depth interviews were conducted among female out-of-school adolescents, and health care professionals, respectively.

Result

The study revealed that out-of-school adolescents encounter several challenges in accessing sexual reproductive health service which includes socio-cultural barriers, health system barriers, perceived legal barrier, inadequate information regarding sexual reproductive health service, and low parent-adolescent communication.

Conclusion

The finding suggests the need to engage community influencers (religious leaders, community leaders, and elders) in overcoming the socio-cultural barriers. Program planners and policy makers have better make an effort to create adolescent friendly environments in SRH service areas. Furthermore, implementing community-based awareness raising programs, parental involvement in sexual reproductive health programs, and encouraging parent-adolescent communication on sexual reproductive health issues could improve sexual reproductive health service utilization by out-of-school adolescents in the study area.
House Officers’ Choice of Family Medicine Specialty amid the Implementation of the New Universal Health Insurance Law
Authors: Ahmed Marwa Mostafa , Fares Samar , Sayed Asmaa Ahmed , ElSayed Inas Talat , Soliman Saeed S. A.
Published: May 2021

Background

The new Egyptian Universal Health Insurance Law is introduced through family-oriented primary health care. Increasing the number of recent graduates who specialized in family medicine is considered a national need to overcome family physicians’ shortage.

Aim

To explore the factors affecting the house officers’ choice of Family Medicine as a future career amid the implementation of the new Universal Health Insurance Law in Egypt.

Methods

This is a cross-sectional study conducted on house officers during their training in Cairo university hospitals from the first of March 2020 to February 2021. The researchers offered an anonymous self-administered questionnaire to all house officers at the beginning of their 2-week family medicine training (1170 house officers).

Results

A total of 1052 completed the questionnaire (response rate 90%). Family medicine as a specialty was considered by 53.6% (n = 564) of participants, while only 23.4% (n = 246) of participants had an obvious intention to choose family medicine. Multivariate (adjusted) logistic regression model revealed that factors significantly associated with intention to choose family medicine were marital status, knowledge about governmental advantages for family medicine offered to the specialized recent graduates, and previously encountered with family practice as customers.

Conclusions

The choice of family medicine specialty is increasing among house officers. This could be attributed to the growing interest in family medicine in Egypt, especially after implementing the new insurance law’s first phase in several Egyptian governorates.
Challenges in the Treatment of Restless Legs Syndrome: A Case Report
Authors: Umbreit Audrey , Sinha Shirshendu , Kolla Bhanu Prakash , Mansukhani Meghna P.
Published: May 2021

Treatment resistant restless legs syndrome (RLS) in the setting of psychiatric comorbidities can be difficult to manage. Our patient is a 69-year-old Caucasian gentleman with bipolar disorder type I, unspecified anxiety disorder, obstructive sleep apnea (OSA), and treatment-refractory RLS. At initial presentation, the patient’s prescribed medication regimen included fluoxetine 40 mg daily, gabapentin 800 mg in the morning and 3200 mg at bedtime, pramipexole 0.375 mg daily, lamotrigine 200 mg daily, trazodone 200 mg at bedtime, and temazepam 15 to 30 mg as needed for insomnia and RLS. Over the course of nearly 4 years, treatment interventions for this patient’s RLS included: cognitive behavioral therapy for insomnia, discontinuation of exacerbating medications, switching dopamine agonists, use of pregabalin and iron supplement. This report demonstrates a challenging case of RLS in the setting of psychiatric comorbidities, development of augmentation, and polypharmacy.
Global Financial Crisis, Working Capital Management, and Firm Performance: Evidence From an Islamic Market Index
Authors: Akbar Minhas , Akbar Ahsan , Draz Muhammad Umar
Published: May 2021

This research investigates the impact of working capital management (WCM) on the profitability and market performance of firms that constitute an Islamic market index (Karachi Meezan Index [KMI-30]) in Pakistan during 2002–2013. The data have been divided into three parts, that is, preglobal (2002–2007), during (2007–2008), and postglobal financial crisis period (2008–2013), to examine the proposed relationship in different macroeconomic settings. Net trade cycle (NTC) and its components are used to measure the WCM efficiency, while NTC square is used to proxy the impact of excessive holdings of working capital on corporate performance. The econometric models are calculated in a generalized method of moments (GMMs)-based regression environment to ensure the robustness of empirical outcome. The results reveal that, as opposed to conventional businesses, KMI-30 firms are more ethical in their short-term financial management. Besides, such firms adopted a conservative WCM policy during the global financial crisis of 2007–2008. Furthermore, we confirm the presence of a concave relationship between working capital levels and firm performance as NTC is positively, whereas NTC square is negatively, related to firm performance. This article makes a significant contribution to the extant literature as it evaluates the impact of WCM on the profitability and market performance of Islamic market indexed firms under varying macroeconomic conditions.
Using Production-Oriented Approach in Business English Courses: Perceptions of China’s English-Major and Non-English-Major Undergraduates
Authors: Xie Qing
Published: May 2021

In light of pedagogical innovation, this study reports a two-stage survey with 172 participants from English-major and non-English-major programs on their needs of production-oriented approach and perceptions of effective implementation strategies in business English courses at a Chinese university. The results of the study suggest that while the two student groups used different learning methods, both valued communication with native speakers. While the two groups had different needs in business English reading, writing, and speaking activities, they also preferred listening to business news broadcasts. The two groups liked learning in case studies and case-based methodology. Based on the needs, a production-oriented teaching procedure is designed. For teaching activities, the students preferred simulation and role-play. As to their favorite teaching and learning materials, English-majors mentioned English news reading and videos, whereas non-English-majors liked theme-based reading materials. For curriculum adaptation and post-course practice, they suggested using communicative activities and more recent cases. The majority of the groups considered the teaching activities, materials, and activities as effective. Based on the different needs and perceptions, effective and tailored implementation strategies for a production-oriented approach in business English courses for the two student groups at this Chinese university context are suggested. Informed by production-oriented pedagogical theories, the results of the study may have significant implications for business English teaching reform and theoretical development in Chinese universities as well as other cultural and education settings in further innovating and refining the teaching and learning process.
Developing Student Teachers’ Reflexivity Toward Their Course Planning: Implementation of a Training Program Focused on Writing and Reflective Skills
Authors: Colognesi Stéphane , Deprit Agnès , Coppe Thibault , Van Nieuwenhoven Catherine , März Virginie , Hanin Vanessa
Published: May 2021

Recent literature has shown the low levels of reflexivity student teachers exhibit when doing reflective writing and the lack of a training program in their initial training to help them. A training program that was developed to support future teachers’ reflective writing was implemented and the program’s results were evaluated. The program was based on a combination of theories from the fields of teacher training and writing instruction. The training program was offered to a class of 16 future primary school teachers in French-speaking Belgium (three males and 13 females, averaging 20 years old) who were in their final year of training. They rewrote a reflective text several times and the 64 texts produced were analyzed quantitatively. The results showed that the training program enabled participants to make major progress from one draft to another and thus improve their reflective writing skills. In addition, a qualitative single case study showed how one student’s writing evolved during the training program. Among the practical implications that emerged from this study were the recommendations to include time in the training curricula dedicated to the teaching of reflective writing and to train trainers to support the writing of reflective texts.
Leg Stiffness, Joint Stiffness, and Running-Related Injury: Evidence From a Prospective Cohort Study
Authors: Davis John J. , Gruber Allison H.
Published: May 2021

Background:

The spring-like behavior of the leg and the joints of the lower body during running are thought to influence a wide range of physiologic and mechanical phenomena, including susceptibility to overuse injury. If leg and joint stiffness are associated with running-related injuries, altering joint or leg stiffness may be a useful avenue for injury rehabilitation and injury prevention programs.

Purpose:

To test the associations between running-related injury and leg stiffness, knee stiffness, and ankle stiffness in a prospective study of recreational runners.

Study Design:

Cohort study; Level of evidence, 2.

Methods:

A total of 49 healthy recreational runners took part in a year-long study. Participants completed a 3-dimensional kinematic and kinetic biomechanical assessment at baseline and reported training volume and injury status in a weekly survey during the follow-up period. Relationships between stiffness and injury were assessed at the level of individual legs (n = 98) using spline terms in Cox proportional hazards models.

Results:

During follow-up, 23 participants (29 legs) sustained injury. The median time to injury was 27 weeks (53.27 hours of training). Relative injury rate as a function of knee stiffness displayed a weak and nonsignificant U-shaped curve ( P = .187-.661); ankle and leg stiffness displayed no discernable associations with relative injury rate (leg stiffness, P = .215-.605; ankle stiffness, P = .419-.712).

Conclusion:

Leg and joint stiffness may not be important factors in the development of running-related injuries. Moderate changes in leg and joint stiffness are unlikely to substantially alter injury risk.
Fundoplication after lung transplantation in patients with systemic sclerosis–related end-stage lung disease
Authors: Leiva-Juárez Miguel M , Urso Andreacarola , Costa Joseph , Stanifer Bryan P , Sonett Joshua R , Benvenuto Luke , Aversa Megan , Robbins Hilary , Shah Lori , Arcasoy Selim , D’Ovidio Frank
Published: May 2021

Introduction:

Gastroesophageal reflux and aspiration are risk factors for chronic lung allograft dysfunction in lung transplant recipients. Patients with systemic sclerosis are at an increased risk of aspiration due to esophageal dysmotility and an ineffective lower esophageal sphincter. The aim of this study is to understand the effect of fundoplication on outcomes in systemic sclerosis recipients.

Methods:

Between 2001 and 2019, 168 systemic sclerosis patients were referred for lung transplantation—51 (30.3%) were listed and 36 (21.4%) were transplanted. Recipients were stratified whether they underwent a fundoplication (n = 10, 27.8%) or not (n = 26, 72.2%). Freedom from chronic lung allograft dysfunction and survival were analyzed using log-rank test. Multivariable analysis for known risk factors was performed using a Cox-proportional hazards model.

Results:

Median time to fundoplication after transplantation was 16.4 months (interquartile range: 9.6–25.1) and all were laparoscopic (Dor 50%, Nissen 40%, Toupet 10%). There were no differences in acute rejection ⩾ A1 (26.9% vs 30%), or primary graft dysfunction grades 2–3 at 72 h (42.3% vs 40%) between groups. Recipients with fundoplication had an increased freedom from chronic lung allograft dysfunction (p = 0.035) and overall survival (p = 0.01). Fundoplication was associated with a reduced risk of mortality adjusting for other comorbidities (hazard ratio = 0.13; 95% confidence interval = 0.02–0.65; p = 0.014). Double and single lung transplant did not have different post-transplant survival.

Conclusion:

Fundoplication in systemic sclerosis lung transplant recipients is associated with greater freedom from chronic lung allograft dysfunction and overall survival. Screening for reflux and aspiration followed by early fundoplication may delay graft deterioration in this population.
Health Sector Allocationin India’s Budget (2021–2022): A Trick or Treat?
Authors: Bhatia Mrigesh , Singh D. P.
Published: May 2021

The Finance Minister of India Nirmala Sitharaman announced the Budget in February 2021, giving health and well-being as a top priority for the government, with an impressive increase of 137% over the previous year’s health sector budget. The need to strengthen primary, secondary and tertiary public healthcare systems was a clear message from the budget statement. The authors analyse the current budget in the context of chronic underinvestment in health and question whether this allocation will make any meaningful impact on the public health infrastructure as the impressive headline allocation appears to be more of a trick than a treat to the health sector.
Adaptive Immune Responses Associated with the Central Nervous System Pathology of Gulf War Illness
Authors: Nkiliza Aurore , Joshi Utsav , Evans James E , Ait-Ghezala Ghania , Parks Megan , Crawford Fiona , Mullan Michael , Abdullah Laila
Published: May 2021

Gulf War Illness is a multisymptomatic condition which affects 30% of veterans from the 1991 Gulf War. While there is evidence for a role of peripheral cellular and humoral adaptive immune responses in Gulf War Illness, a potential role of the adaptive immune system in the central nervous system pathology of this condition remains unknown. Furthermore, many of the clinical features of Gulf War Illness resembles those of autoimmune diseases, but the biological processes are likely different as the etiology of Gulf War Illness is linked to hazardous chemical exposures specific to the Gulf War theatre. This review discusses Gulf War chemical–induced maladaptive immune responses and a potential role of cellular and humoral immune responses that may be relevant to the central nervous system symptoms and pathology of Gulf War Illness. The discussion may stimulate investigations into adaptive immunity for developing novel therapies for Gulf War Illness.
The Carbamate, Physostigmine does not Impair Axonal Transport in Rat Cortical Neurons
Authors: Naughton Sean X , Beck Wayne D , Wei Zhe , Wu Guangyu , Baas Peter W , Terry Alvin V
Published: May 2021

Among the various chemicals that are commonly used as pesticides, organophosphates (OPs), and to a lesser extent, carbamates, are most frequently associated with adverse long-term neurological consequences. OPs and the carbamate, pyridostigmine, used as a prophylactic drug against potential nerve agent attacks, have also been implicated in Gulf War Illness (GWI), which is often characterized by chronic neurological symptoms. While most OP- and carbamate-based pesticides, and pyridostigmine are relatively potent acetylcholinesterase inhibitors (AChEIs), this toxicological mechanism is inadequate to explain their long-term health effects, especially when no signs of acute cholinergic toxicity are exhibited. Our previous work suggests that a potential mechanism of the long-term neurological deficits associated with OPs is impairment of axonal transport (AXT); however, we had not previously evaluated carbamates for this effect. Here we thus evaluated the carbamate, physostigmine (PHY), a highly potent AChEI, on AXT using an in vitro neuronal live imaging assay that we have previously found to be very sensitive to OP-related deficits in AXT. We first evaluated the OP, diisopropylfluorophosphate (DFP) (concentration range 0.001-10.0 µM) as a reference compound that we found previously to impair AXT and subsequently evaluated PHY (concentration range 0.01-100 nM). As expected, DFP impaired AXT in a concentration-dependent manner, replicating our previously published results. In contrast, none of the concentrations of PHY (including concentrations well above the threshold for impairing AChE) impaired AXT. These data suggest that the long-term neurological deficits associated with some carbamates are not likely due to acute impairments of AXT.
Chromosome-level genome assembly and manually-curated proteome of model necrotroph Parastagonospora nodorum Sn15 reveals a genome-wide trove of candidate effector homologs, and redundancy of virulence-related functions within an accessory chromosome
Authors: Bertazzoni Stefania , Jones Darcy A. B. , Phan Huyen T. , Tan Kar-Chun , Hane James K.
Published: May 2021

Background

The fungus Parastagonospora nodorum causes septoria nodorum blotch (SNB) of wheat (Triticum aestivum) and is a model species for necrotrophic plant pathogens. The genome assembly of reference isolate Sn15 was first reported in 2007. P. nodorum infection is promoted by its production of proteinaceous necrotrophic effectors, three of which are characterised – ToxA, Tox1 and Tox3.

Results

A chromosome-scale genome assembly of P. nodorum Australian reference isolate Sn15, which combined long read sequencing, optical mapping and manual curation, produced 23 chromosomes with 21 chromosomes possessing both telomeres. New transcriptome data were combined with fungal-specific gene prediction techniques and manual curation to produce a high-quality predicted gene annotation dataset, which comprises 13,869 high confidence genes, and an additional 2534 lower confidence genes retained to assist pathogenicity effector discovery. Comparison to a panel of 31 internationally-sourced isolates identified multiple hotspots within the Sn15 genome for mutation or presence-absence variation, which was used to enhance subsequent effector prediction. Effector prediction resulted in 257 candidates, of which 98 higher-ranked candidates were selected for in-depth analysis and revealed a wealth of functions related to pathogenicity. Additionally, 11 out of the 98 candidates also exhibited orthology conservation patterns that suggested lateral gene transfer with other cereal-pathogenic fungal species. Analysis of the pan-genome indicated the smallest chromosome of 0.4 Mbp length to be an accessory chromosome (AC23). AC23 was notably absent from an avirulent isolate and is predominated by mutation hotspots with an increase in non-synonymous mutations relative to other chromosomes. Surprisingly, AC23 was deficient in effector candidates, but contained several predicted genes with redundant pathogenicity-related functions.

Conclusions

We present an updated series of genomic resources for P. nodorum Sn15 – an important reference isolate and model necrotroph – with a comprehensive survey of its predicted pathogenicity content.
Simultaneous gastric cancer and breast cancer metastases to the stomach with lymph node collision tumor: a case report
Authors: Okamoto Takeshi , Suzuki Hidekazu , Fukuda Katsuyuki
Published: May 2021

Background

While double primary cancers are common in breast cancer patients, co-existence of primary gastric cancer and gastric metastases of breast cancer is exceedingly rare.

Case presentation

A 51-year-old woman receiving chemotherapy for breast cancer presented with melena and presyncope. A circumferential thickening of the pylorus and small submucosal tumor-like lesions in the gastric fundus and corpus were confirmed on endoscopy. Immunohistochemistry of biopsies revealed that the former was composed of poorly differentiated gastric cancer cells, while the latter were breast cancer metastases. Distal gastrectomy was performed. Pathological evaluation of the resected specimen revealed gastric adenocarcinoma in the pyloric lesion and breast countless cancer metastases throughout the remainder of the stomach, with positive margins. One lymph node had evidence of both stomach cancer and breast cancer metastases, forming a collision tumor. Despite a successful surgery, the patient died 6 months later due to progression of breast cancer.

Conclusion

We report a case of synchronous primary gastric adenocarcinoma and gastric metastases of breast cancer. Inter-disciplinary collaboration is crucial in determining the optimal treatment in double cancers.
Waist-to-height ratio and non-alcoholic fatty liver disease in adults
Authors: Sheng Guotai , Xie Qiyang , Wang Rongsheng , Hu Chong , Zhong Mingchun , Zou Yang
Published: May 2021

Background

The waist-to-height ratio (WHtR) has been recognised as a powerful indicator to evaluate non-alcoholic fatty liver disease (NAFLD) in recent years, but few related studies are available. Thus, clarifying the association between the WHtR and NAFLD may be beneficial to the prevention and treatment of NAFLD.

Methods

The cross-sectional study population was from a large-scale health examination programme called ‘human dock’ in Japan. In this study, 14,125 participants in this health examination programme were included. To understand the association between the WHtR and NAFLD more intuitively, we grouped the WHtR values into quintiles and used a multivariable logistic regression model to assess WHtR and its quintile with NAFLD risk. Moreover, we used the generalised additive model to model the association between WHtR and NAFLD to explore their non-linear relationship.

Results

The prevalence of NAFLD among participants in this study was 17.59%, with an average age of 43.53 ± 8.89 years. After adjusting for all non-collinear covariables, we observed a 66% increase in the NAFLD risk per SD increase in WHtR. Furthermore, in the quintile groups of WHtR, the participants in quintile 2, quintile 3, quintile 4, and quintile 5 had 3.62-fold, 5.98-fold, 9.55-fold, and 11.08-fold increased risks of NAFLD, respectively, compared with those in quintile 1 (Ptrend < 0.0001). Non-linear relationship analysis revealed threshold and saturation effects between WHtR and NAFLD in which a WHtR of approximately 0.4 might be the threshold effect of NAFLD risk, 0.6 might be the saturation effect of NAFLD risk. Additionally, subgroup analysis showed that the interaction between WHtR and BMI was significant.

Conclusions

Our results suggest that in adults, the WHtR is associated with NAFLD, and the association is not purely linear but non-linear, with significant threshold and saturation effects.
Neutrophil-lymphocyte ratio as a predictor of delirium in older internal medicine patients: a prospective cohort study
Authors: Zhao Yanli , Yue Jirong , Lei Peng , Lin Taiping , Peng Xuchao , Xie Dongmei , Gao Langli , Shu Xiaoyu , Wu Chenkai
Published: May 2021

Backgrounds

Delirium is a common neuropsychiatric syndrome in older hospitalized patients. Previous studies have suggested that inflammation and oxidative stress contribute to the pathophysiology of delirium. However, it remains unclear whether neutrophil-lymphocyte ratio (NLR), an indicator of systematic inflammation, is associated with delirium. This study aimed to investigate the value of NLR as an independent risk factor for delirium among older hospitalized patients.

Methods

We conducted a prospective study of 740 hospitalized patients aged ≥ 70 years in the geriatric ward of West China Hospital of Sichuan University. Neutrophil and lymphocyte counts were collected within 24 h after hospital admission. Delirium was assessed on admission and every 48 h thereafter. We used the receiver operating characteristic analysis to assess the ability of the NLR for predicting delirium. The optimal cut-point value of the NLR was determined based on the highest Youden index (sensitivity + specificity − 1). Patients were categorized according to the cut-point value and quartiles of NLR, respectively. We then used logistic regression to identify the unadjusted and adjusted associations between NLR as a categorical variable and delirium.

Results

The optimal cut-point value of NLR for predicting delirium was 3.626 (sensitivity: 75.2 %; specificity: 63.4 %; Youden index: 0.386). The incidence of delirium was significantly higher in patients with NLR > 3.626 than NLR ≤ 3.626 (24.5 % vs. 5.8 %; P < 0.001). Significantly fewer patients in the first quartile of NLR experienced delirium than in the third (4.3 % vs. 20.0 %; P < 0.001) and fourth quartiles of NLR (4.3 % vs. 24.9 %; P < 0.001). Results from the multivariable logistic regression models showed that NLR was independently associated with delirium.

Conclusions

NLR is a simple and practical marker that can predict the development of delirium in older internal medicine patients.
Increasing availability of lower energy meals vs. energy labelling in virtual full-service restaurants: two randomized controlled trials in participants of higher and lower socioeconomic position
Authors: Marty Lucile , Reed Sasha M. , Jones Andrew J. , Robinson Eric
Published: May 2021

Background

There are a range of interventions designed to promote healthier food choices in full-service restaurants. However, it is unclear how these interventions affect dietary choices in people of lower and higher socioeconomic position (SEP).

Methods

A total of 2091 US participants recruited online completed Study 1 (n = 1001) and Study 2 (n = 1090). Recruitment was stratified by participant highest education level, resulting in higher SEP and lower SEP groups. In a between-subjects design, participants made hypothetical food choices (main dish, plus optional sides and desserts) from six restaurants menus in the absence vs. presence of menu energy labelling and from menus with baseline (10%) vs. increased availability (50%) of lower energy main dishes. Data were collected and analysed in 2019. Two studies were conducted in order to examine replicability and generalisability of findings across different restaurant menu types.

Results

Across both studies, increasing the availability of lower energy main menu options decreased the average energy content of the ordered main dish (− 129 kcal, 95% CI [− 139; − 119]) and total energy ordered (− 117 kcal, 95% CI [− 138; − 95]) in both higher and lower SEP participants. Energy labelling significantly reduced the energy content of ordered main dishes in higher SEP participants (− 41 kcal, 95% CI [− 54; − 29]), but not lower SEP participants (− 5 kcal, 95% CI [− 22; 11]). However, energy labelling reduced total energy ordered (− 83 kcal, 95% CI [− 105; − 60]) irrespective of SEP.

Conclusions

In two virtual experiments, increasing the availability of lower energy restaurant main menu options impacted on main menu dish choice and decreased total energy ordered irrespective of SEP. Energy labelling had a less pronounced effect on total energy ordered and had a larger impact on the energy content of main menu dish choice in higher as opposed to lower SEP participants.

Trial registration

Clinicaltrials.gov NCT04336540 retrospectively registered (7 April, 2020).
Body composition outcomes of Healthy Fit and the role of acculturation among low-income Hispanics on the US-Mexico border
Authors: Lopez Diane I. , Chacon Lauren , Vasquez Denise , Brown Louis D.
Published: May 2021

Background

Hispanic immigrants continue to experience higher rates of overweight and obesity compared to their non-Hispanic counterparts. Acculturation may contribute to unhealthy weight gain among immigrant populations by shifting dietary patterns from high fruit and vegetable consumption to unhealthier high fat diets. Healthy Fit, a culturally tailored community health worker (CHW) intervention, aims to reduce obesity related outcomes by providing physical activity and nutrition education and resources in a low-income Hispanic population. This study aims to evaluate outcomes of Healthy Fit participants and examine changes in body composition in relation to level of acculturation at baseline and follow-up.

Method

In this longitudinal observational study, CHWs recruited 514 participants from community events and agencies serving low-income Hispanic populations in El Paso, Texas from 2015 to 2016. Following an in-person health screening, eligible participants received nutrition and physical activity education guided by fotonovelas, comic-like educational books. Telephone follow-ups made at 1, 3, and 6 months by CHWs encouraged follow-through on referrals. 288 participants completed the screening again during the 12-month follow-up.

Results

The sample was predominantly Hispanic (96%), female (82%), uninsured (79%), had a household income of less than $19,999 (70%), foreign-born (79%), preferred Spanish (86%) and few rated themselves as good or excellent for English proficiency (27%). Overall, Healthy Fit participants significantly improved (i.e., decreased) BFP by 0.71% (t = 2.47, p = 0.01) but not BMI (b = .01, t = − 0.14, p = .89). Contrary to expectations, acculturation was not associated with lower BMI (b = 0.09, p = 0.84) or BFP (b = 0.13, p = 0.85) at baseline. However, acculturation predicted changes in both BMI (b = 0.30, p = 0.03) and BFP (b = 1.33, p = 0 .01) from baseline to follow-up. Specifically, the low acculturation group improved in body composition measures over time and the high acculturation group did not improve in either measure.

Conclusion

Findings suggest Healthy Fit was most effective among less acculturated individuals. The influence of acculturation on the efficacy of nutrition and exercise interventions suggests that Hispanics should not be treated as a homogenous subgroup.
Knowledge, attitude and practice of Sari birth cohort members during early weeks of COVID-19 outbreak in Iran
Authors: Shahbaznejad Leila , Navaeifar Mohammad Reza , Movahedi Faeze Sadat , Hosseinzadeh Fatemeh , Fahimzad Seyed Alireza , Serati Shirazi Zahra , Rezai Mohammad Sadegh
Published: May 2021

Background

It has been determined that the coronavirus disease 2019 (COVID-19) pandemic needs social distancing and proper measures to prevent its spreading. This study aimed to determine COVID-19 knowledge, attitude, and practice among Sari Birth Cohort (SBC) members.

Methods

In this cross-sectional study linked to the SBC in north of Iran, mothers living in Sari and its suburbs from March 28 to April 8, 2020 were evaluated. The measurement tool was an online researcher-made, self-reported knowledge, attitude, and practice questionnaire related to COVID-19.

Results

In total, 1449 mothers with a mean age of 31.51 ± 5.73 years participated. Of them, 82.4% had good knowledge (98.6% in healthcare workers and 79.2% in housewives, p = 0.000). Most of them were worried about spread of the disease in the country (97.4%) and agreed that COVID-19 will finally be successfully controlled around the world (72.2%). Sleep disturbance was reported in 42.7% of mothers. Eighty-eight percent of cases wore masks and gloves when leaving home, 99.4% washed their hands frequently while 12.9% went to any crowded places. People with better knowledge followed safer practices (p = 0.000) and were more worried about the spread of the disease in the country and infection (among themselves and their first-degree relatives) (p = 0.000).

Conclusions

Most of the SBC members had a good level of knowledge about COVID-19 but were worried about a long-term pandemic period. They also had good practices regarding the prevention of the disease.
Factors and predictive model associated with perioperative complications after long fusion in the treatment of adult non-degenerative scoliosis
Authors:   Deciphering Disorders Involving Scoliosis and COmorbidities (DISCO) study, Wu Nan , Shao Jiashen , Zhang Zhen , Wang Shengru , Li Ziquan , Zhao Sen , Yang Yang , Liu Lian , Yu Chenxi , Liu Sen , Zhao Zhengye , Du You , Zhang Yuanqiang , Wang Lianlei , Zhao Yu , Yu Keyi , Zhao Hong , Shen Jianxiong , Qiu Guixing , Wu Zhihong , Zhang Terry Jianguo
Published: May 2021

Introduction

Adult non-degenerative scoliosis accounts for 90% of spinal deformities in young adults. However, perioperative complications and related risk factors of long posterior instrumentation and fusion for the treatment of adult non-degenerative scoliosis have not been adequately studied.

Methods

We evaluated clinical and radiographical results from 146 patients with adult non-degenerative scoliosis who underwent long posterior instrumentation and fusion. Preoperative clinical data, intraoperative variables, and perioperative radiographic parameters were collected to analyze the risk factors for perioperative complications. Potential and independent risk factors for perioperative complications were evaluated by univariate analysis and logistic regression analysis.

Results

One hundred forty-six adult non-degenerative scoliosis patients were included in our study. There were 23 perioperative complications for 21 (14.4%) patients, eight of which were cardiopulmonary complications, two of which were infection, six of which were neurological complications, three of which were gastrointestinal complications, and four of which were incision-related complication. The independent risk factors for development of total perioperative complications included change in Cobb angle (odds ratio [OR] = 1.085, 95% CI = 1.035 ~ 1.137, P = 0.001) and spinal osteotomy (OR = 3.565, 95% CI = 1.039 ~ 12.236, P = 0.043). The independent risk factor for minor perioperative complications is change in Cobb angle (OR = 1.092, 95% CI = 1.023 ~ 1.165, P = 0.008). The independent risk factors for major perioperative complications are spinal osteotomy (OR = 4.475, 95% CI = 1.960 ~ 20.861, P = 0.036) and change in Cobb angle (OR = 1.106, 95% CI = 1.035 ~ 1.182, P = 0.003).

Conclusions

Our study indicate that change in Cobb angle and spinal osteotomy are independent risk factors for total perioperative complications after long-segment posterior instrumentation and fusion in adult non-degenerative scoliosis patients. Change in Cobb angle is an independent risk factor for minor perioperative complications. Change in Cobb angle and spinal osteotomy are independent risk factors for major perioperative complications.
Severe osteolysis and periprosthetic femoral fracture 45 years after acrylic hemiarthroplasty of the hip: a case report
Authors: Ishikura Hisatoshi , Nakamura Masaki , Matsuda Kenta , Tanaka Takeyuki , Kawano Hirotaka , Tanaka Sakae
Published: May 2021

Background

Hip arthroplasty using acrylic prosthesis was once conducted; however, it has now been abandoned because of early breakages and wear of material. Therefore, complications or revision surgeries due to the use of acrylic prostheses are becoming rare.

Case presentation

A 76-year-old woman presented with a sudden onset of severe pain in her left femur while walking. Radiographs revealed severe osteolysis and periprosthetic femoral fracture 45 years after the initial hemiarthroplasty using an acrylic prosthesis. We performed a Girdlestone resection arthroplasty by removing the prosthesis and fixing the fracture site using an intramedullary nail and metal plate. The patient was pain-free in her hip and leg 2 years and 9 months after the surgery. Although she walked with a cane or crutches, no postoperative complications were observed.

Conclusions

The combined use of an intramedullary nail and plate fixation with resection arthroplasty could offer acceptable results for patients with severe osteolysis and periprosthetic fracture after femoral head replacement using an acrylic prosthesis. Our report seems relevant because it not only reminds us of the significant steps made in the development of modern total hip arthroplasty; it also highlights one of the surgical options for severe osteolysis and periprosthetic fracture of the hip.