bluuebunny/crossref_metadata_2025 huggingface dataset:
Two Candida auris Cases in Germany with No Recent Contact to Foreign Healthcare—Epidemiological and Microbiological Investigations
Authors: Steinmann Joerg , Schrauzer Thomas , Kirchhoff Lisa , Meis Jacques F. , Rath Peter-Michael
Published: May 2021

Candida auris has become a global fungal public health threat. This multidrug-resistant yeast is associated with nosocomial intra- and interhospital transmissions causing healthcare-associated infections. Here, we report on two C. auris cases from Germany. The two patients stayed in Germany for a long time before C. auris was detected during their hospitalization. The patients were isolated in single rooms with contact precautions. No nosocomial transmissions were detected within the hospital. Both C. auris isolates exhibited high minimum inhibitory concentrations (MICs) of fluconazole and one isolate additionally high MICs against the echinocandins. Microsatellite genotyping showed that both strains belong to the South Asian clade. These two cases are examples for appropriate in-hospital care and infection control without further nosocomial spread. Awareness for this emerging, multidrug-resistant pathogen is justified and systematic surveillance in European health care facilities should be performed.
Preferences for Updates on General Research Results: A Survey of Participants in Genomic Research from Two Institutions
Authors: Taylor Casey Overby , Manov Natalie Flaks , Crew Katherine D. , Weng Chunhua , Connolly John J. , Chute Christopher G. , Ford Daniel E. , Lehmann Harold , Rahm Alanna Kulchak , Kullo Iftikhar J. , Caraballo Pedro J. , Holm Ingrid A. , Mathews Debra
Published: May 2021

There is a need for multimodal strategies to keep research participants informed about study results. Our aim was to characterize preferences of genomic research participants from two institutions along four dimensions of general research result updates: content, timing, mechanism, and frequency. Methods: We conducted a web-based cross-sectional survey that was administered from 25 June 2018 to 5 December 2018. Results: 397 participants completed the survey, most of whom (96%) expressed a desire to receive research updates. Preferences with high endorsement included: update content (brief descriptions of major findings, descriptions of purpose and goals, and educational material); update timing (when the research is completed, when findings are reviewed, when findings are published, and when the study status changes); update mechanism (email with updates, and email newsletter); and update frequency (every three months). Hierarchical cluster analyses based on the four update preferences identified four profiles of participants with similar preference patterns. Very few participants in the largest profile were comfortable with budgeting less money for research activities so that researchers have money to set up services to send research result updates to study participants. Conclusion: Future studies may benefit from exploring preferences for research result updates, as we have in our study. In addition, this work provides evidence of a need for funders to incentivize researchers to communicate results to participants.
A Pharmacogenetic Study of CYP2C19 in Acute Coronary Syndrome Patients of Colombian Origin Reveals New Polymorphisms Potentially Related to Clopidogrel Therapy
Authors: Angulo-Aguado Mariana , Panche Karen , Tamayo-Agudelo Caroll Andrea , Ruiz-Torres Daniel-Armando , Sambracos-Parrado Santiago , Niño-Orrego Maria Jose , Páez Nathaly , Piñeros-Hernandez Laura B , Castillo-León Luisa-Fernanda , Pardo-Oviedo Juan Mauricio , Abaunza Katherine Parra , Laissue Paul , Contreras Nora , Calderón-Ospina Carlos Alberto , Fonseca-Mendoza Dora Janeth
Published: May 2021

Clopidogrel, an oral platelet P2Y12 receptor blocker, is used in the treatment of acute coronary syndrome. Interindividual variability in treatment response and the occurrence of adverse effects has been attributed to genetic variants in CYP2C19. The analysis of relevant pharmacogenes in ethnically heterogeneous and poorly studied populations contributes to the implementation of personalized medicine. We analyzed the coding and regulatory regions of CYP2C19 in 166 patients with acute coronary syndrome (ACS) treated with clopidogrel. The allele frequencies of CYP2C19 alleles *1, *2, *4, *17, *27 and *33 alleles were 86.1%, 7.2%, 0.3%, 10.2%, 0.3% and 0.3%, respectively. A new potentially pathogenic mutation (p.L15H) and five intronic variants with potential splicing effects were detected. In 14.4% of the patients, a new haplotype in strong linkage disequilibrium was identified. The clinical outcome indicated that 13.5% of the patients presented adverse drugs reactions with a predominance of bleeding while 25% of these patients were carriers of at least one polymorphic allele. We propose that new regulatory single-nucleotide variants (SNVs) might potentially influence the response to clopidogrel in Colombian individuals.
Creating a ‘Molecular Band-Aid’; Blocking an Exposed Protease Target Site in Desmoplakin
Authors: Hoover Catherine A. , Ott Kendahl L. , Manring Heather R. , Dew Trevor , Borzok Maegen A. , Wright Nathan T.
Published: May 2021

Desmoplakin (DSP) is a large (~260 kDa) protein found in the desmosome, a subcellular complex that links the cytoskeleton of one cell to its neighbor. A mutation ‘hot-spot’ within the NH2-terminal third of the DSP protein (specifically, residues 299–515) is associated with both cardiomyopathies and skin defects. In select DSP variants, disease is linked specifically to the uncovering of a previously-occluded calpain target site (residues 447–451). Here, we partially stabilize these calpain-sensitive DSP clinical variants through the addition of a secondary single point mutation—tyrosine for leucine at amino acid position 518 (L518Y). Molecular dynamic (MD) simulations and enzymatic assays reveal that this stabilizing mutation partially blocks access to the calpain target site, resulting in restored DSP protein levels. This ‘molecular band-aid’ provides a novel way to maintain DSP protein levels, which may lead to new strategies for treating this subset of DSP-related disorders.
The Nexus between Financial Performance and Equilibrium: Empirical Evidence on Publicly Traded Companies from the Global Financial Crisis Up to the COVID-19 Pandemic
Authors: Batrancea Larissa
Published: May 2021

Financial performance and financial equilibrium are two key aspects that should be monitored by any business manager interested in passing the test of time and overcoming unpredictable events such as economic crises. The organic link between financial performance and financial equilibrium has rarely been studied in the long run for companies listed on the stock market. The present article fills this gap in the literature by examining the degree to which financial performance influenced long-term financial equilibrium using data from 34 major companies publicly traded on the New York Stock Exchange and operating around the world in a wide variety of industries and sectors. The period of analysis spread over a decade (2007Q1–2020Q3) in order to cover two major crises that have marked the dawn of the third millennium and occurred relatively close to one another: the 2008 financial meltdown and the COVID-19 pandemic crisis. By means of panel data modelling, the study showed that the short-term and long-term financial equilibria of these public companies measured by current ratio, quick ratio and debt to equity ratio were significantly impacted by different financial performance indicators. The study addresses various implications of the empirical results and lays out avenues for future research.
Reconciling Remote Sensing Technologies with Personal Data and Privacy Protection in the European Union: Recent Developments in Greek Legislation and Application Perspectives in Environmental Law
Authors: Maniadaki Maria , Papathanasopoulos Athanasios , Mitrou Lilian , Maria Efpraxia-Aithra
Published: May 2021

Using remote sensing technologies to ensure environmental protection responds to the need of protection of a right and a public good and interest. However, the increasing introduction of these technologies has raised new challenges, such as their interference with the rights of privacy and personal data, which are also protected fundamental rights. In this paper the importance of remote sensing technologies as tools for environmental monitoring and environmental law enforcement is analyzed, while legal issues regarding privacy and data protection from their use for environmental purposes are presented. Existing legislation for reconciling emerging conflicts is also examined and major European Court of Human Rights (ECtHR) and Court of Justice of the European Union (CJEU) case law on the issue is approached. Finally, recent developments in Greek legislation and their application perspectives in environmental law are presented as a timely “case study”.
EXPLORIA, a New Way to Teach Maths at University Level as Part of Everything
Authors: Romero Pantaleón D. , Montes Nicolas , Barquero Sara , Aloy Paula , Ferrer Teresa , Granell Marusela , Millán Manuel
Published: May 2021

The main objective of this article has been to evaluate the effect that the implementation of the EXPLORIA project has had on the Engineering Degree in Industrial Design and Product Development. The EXPLORIA project aims to develop an integrated competence map of the learning process, where the subjects are no longer considered as isolated contents, by elaborating an integrated learning process where the competences and learning outcomes of the subjects are considered as a whole, global and comprehensive learning. The EXPLORIA project connects the competencies of the different STEAM subjects that make up the degree, designing a learning process as a logical, sequential and incremental itinerary. Through concepts on which the foundations of design are based—shape, volume, colour, space and structure—the competencies of the different subjects are defined in incremental learning levels: understanding, applying, experimenting and developing, all taken from Bloom’s taxonomy. Mathematics is linked to the rest of learning through active learning methodologies that make learning useful. This new methodology changes the student’s affective domain towards mathematics in which positive emotions are transformed into positive attitudes that will improve the learning result and therefore, the students’ academic results. To validate it, at the end of the paper, the academic results compared with previous years are shown, as well as an ad hoc survey of the students’ assessment of the new teaching methodology.
Peptide-Based Electrospun Fibers: Current Status and Emerging Developments
Authors: Bucci Raffaella , Georgilis Evangelos , Bittner Alexander M. , Gelmi Maria L. , Clerici Francesca
Published: May 2021

Electrospinning is a well-known, straightforward, and versatile technique, widely used for the preparation of fibers by electrifying a polymer solution. However, a high molecular weight is not essential for obtaining uniform electrospun fibers; in fact, the primary criterion to succeed is the presence of sufficient intermolecular interactions, which function similar to chain entanglements. Some small molecules able to self-assemble have been electrospun from solution into fibers and, among them, peptides containing both natural and non-natural amino acids are of particular relevance. Nowadays, the use of peptides for this purpose is at an early stage, but it is gaining more and more interest, and we are now witnessing the transition from basic research towards applications. Considering the novelty in the relevant processing, the aim of this review is to analyze the state of the art from the early 2000s on. Moreover, advantages and drawbacks in using peptides as the main or sole component for generating electrospun nanofibers will be discussed. Characterization techniques that are specifically targeted to the produced peptide fibers are presented.
Child Safety Assessment: Do Instrument-Based Decisions Concur with Decisions of Expert Panels?
Authors: Vial Annemiek , Assink Mark , Stams Geert Jan , Van der Put Claudia
Published: May 2021

To make decisions on children’s immediate safety, child welfare agencies have been using safety assessment instruments for decades. However, very little research on the quality of these instruments has been conducted. This study is the first to inspect the concurrent validity of a child safety assessment instrument by comparing its outcomes to a different measure of immediate child safety. It was examined to what extent decisions of practitioners using a safety assessment instrument concur with decisions of child maltreatment expert panels. A total of 26 experts on immediate child safety participated in 7 expert panels, in which the safety of children as described in 24 vignettes was discussed. Additionally, 74 practitioners rated the same vignettes using the ARIJ safety assessment instrument. The instrument-based safety decisions of practitioners concurred for a small majority with the safety decisions reached by the expert panels (58% agreement). Expert panels often identified more types of immediate safety threats than practitioners using the instrument; however, the latter group more often deemed the child to be in immediate danger than the first group. These findings provide indications on how the instrument can be improved and give insight into how immediate safety decisions are made.
Sustainable Closed-Loop Mask Supply Chain Network Design Using Mathematical Modeling and a Fuzzy Multi-Objective Approach
Authors: Setiawan Roy , Salman Rabia , Khairov Bari Galimovich , Karpov Valeriy Vasilyevich , Dmitrievna Danshina Svetlana , Vladimirovna Vasyutkina Lidia , Alekseevna Prodanova Natalia , Zhenzhebir Viacheslav , Nuyanzin Evgeny , Kapustina Nadezhda , Hasanzadeh Kalajahi Ali
Published: May 2021

The outbreak of the deadly coronavirus, which is increasing the number of victims every day, has created many changes in today’s world. The use of various masks is the most important social tool against this virus. Given the importance of rapid and quality supply of masks in the current situation, it is necessary to study supply chain in particular. In this research, the design of a closed chain supply chain network for different types of masks is assessed. The studied supply chain includes suppliers, manufacturers, distributors, and retailers in the forward flow and collection centers, separate centers, recycling centers, and disposal centers in the backward flow. In this regard, a multi-objective mathematical model with the objectives of increasing the total profit and reducing the total environmental impact, and maximizing social responsibility is presented. The optimization of this mathematical model has been done using a fuzzy optimization approach in GAMS software. The results of this study show that maximizing the total profit and minimizing the environmental effects and maximizing social responsibility are in contrast to each other. In addition, the sensitivity analysis indicated that the customers’ demand can affect all aspects of the sustainable supply chain simultaneously.
Surface Modification of Polyethersulfone (PES) with UV Photo-Oxidation
Authors: Cisse Ibrahim , Oakes Sarah , Sachdev Shreen , Toro Marc , Lutondo Shin , Shedden Devon , Atkinson Kristen Margaret , Shertok Joel , Mehan Michael , Gupta Surendra K. , Takacs Gerald A.
Published: May 2021

Polyethersulfone (PES) films are widely employed in the construction of membranes where there is a desire to make the surface more hydrophilic. Therefore, UV photo-oxidation was studied in order to oxidize the surface of PES and increase hydrophilicity. UV photo-oxidation using low pressure mercury lamps emitting both 253.7 and 184.9 nm radiation were compared with only 253.7 nm photons. The modified surfaces were characterized using X-ray photoelectron spectroscopy (XPS), atomic force microscopy (AFM), and water contact angle (WCA) measurements. Both sets of lamps gave similar results, showing an increase of the oxygen concentration up to a saturation level of ca. 29 at.% and a decrease in the WCA, i.e., an increase in hydrophilicity, down to ca. 40°. XPS detected a decrease of sp2 C-C aromatic group bonding and an increase in the formation of C-O, C=O, O=C-O, O=C-OH, O-(C=O)-O, and sulphonate and sulphate moieties. Since little change in surface roughness was observed by AFM, the oxidation of the surface caused the increase in hydrophilicity.
Diving Deeper into Wreck Diver Motivations and Attitudes
Authors: Edney Joanne , Dimmock Kay , Boyd William E.
Published: May 2021

Increased demand by dive tourists for high-quality underwater wreck sites requires managers to balance heritage conservation and tourism at these vulnerable sites to ensure quality diving experiences while protecting underwater cultural heritage. Integral to effective management is a comprehensive understanding of wreck diver characteristics, motivations, and attitudes. This paper reports the outcomes of an international survey of 724 wreck divers including demographics, dive experience, motivations to wreck dive and attitudes to underwater cultural heritage protection. Wreck divers are motivated to see historic shipwrecks, artefacts, and marine life. Most are generally supportive of management controls to protect underwater cultural heritage. Conceptual models of wreck divers’ motivations and attitudes were developed to illustrate nuanced complexities in motivations and attitudes, which can inform management strategies to support operational decisions and destination marketing.
Folding Control in the Path of Type 5 Secretion
Authors: Dautin Nathalie
Published: May 2021

The type 5 secretion system (T5SS) is one of the more widespread secretion systems in Gram-negative bacteria. Proteins secreted by the T5SS are functionally diverse (toxins, adhesins, enzymes) and include numerous virulence factors. Mechanistically, the T5SS has long been considered the simplest of secretion systems, due to the paucity of proteins required for its functioning. Still, despite more than two decades of study, the exact process by which T5SS substrates attain their final destination and correct conformation is not totally deciphered. Moreover, the recent addition of new sub-families to the T5SS raises additional questions about this secretion mechanism. Central to the understanding of type 5 secretion is the question of protein folding, which needs to be carefully controlled in each of the bacterial cell compartments these proteins cross. Here, the biogenesis of proteins secreted by the Type 5 secretion system is discussed, with a focus on the various factors preventing or promoting protein folding during biogenesis.
Improving Clearance for Renal Replacement Therapy
Authors: Lee Seolhyun , Sirich Tammy L. , Meyer Timothy W.
Published: May 2021

The adequacy of hemodialysis is now assessed by measuring the removal of a single solute, urea. The urea clearance provided by current dialysis methods is a large fraction of the blood flow through the dialyzer, and, therefore, cannot be increased much further. However, other solutes, which are less effectively cleared than urea, may contribute more to the residual uremic illness suffered by patients on hemodialysis. Here, we review a variety of methods that could be used to increase the clearance of such nonurea solutes. New clinical studies will be required to test the extent to which increasing solute clearances improves patients’ health.
Can early treatment of twitcher mice with high dose AAVrh10-GALC eliminate the need for BMT?
Authors: Rafi Mohammad A , Luzi Paola , Wenger David A
Published: May 2021

Introduction: Krabbe disease (KD) is an autosomal recessive disorder caused by mutations in the galactocerebrosidase (GALC) gene resulting in neuro-inflammation and defective myelination in the central and peripheral nervous systems. Most infantile patients present with clinical features before six months of age and die before two years of age. The only treatment available for pre-symptomatic or mildly affected individuals is hematopoietic stem cell transplantation (HSCT). In the animal models, combining bone marrow transplantation (BMT) with gene therapy has shown the best results in disease outcome. In this study, we examine the outcome of gene therapy alone. Methods: Twitcher (twi) mice used in the study, have a W339X mutation in the GALC gene. Genotype identification of the mice was performed shortly after birth or post-natal day 1 (PND1), using polymerase chain reaction on the toe clips followed by restriction enzyme digestion and electrophoresis. Eight or nine-day-old affected mice were used for gene therapy treatment alone or combined with BMT. While iv injection of 4 × 1013 gc/kg of body weight of viral vector was used originally, different viral titers were also used without BMT to evaluate their outcomes. Results: When the standard viral dose was increased four- and ten-fold (4X and 10X) without BMT, the lifespans were increased significantly. Without BMT the affected mice were fertile, had the same weight and appearance as wild type mice and had normal strength and gait. The brains showed no staining for CD68, a marker for activated microglia/macrophages, and less astrogliosis than untreated twi mice. Conclusion: Our results demonstrate that, it may be possible to treat human KD patients with high dose AAVrh10 without blood stem cell transplantation which would eliminate the side effects of HSCT.
Role of Librarians and Medical Information Experts in Response to Covid-19 in Iran
Authors: Aliasghari Nasrin
Published: May 2021

Human being has always faced different critical situations and unpredictable events such as floods, earthquakes and terrible infectious diseases such as cholera, plague, tuberculosis and influenza. However, it is believed that the Coronavirus (Covid-19) has been the most shocking pandemic that led to destructive effects in all geographical areas of the world and all aspect of terrestrial life. The governments increasingly enact quarantines, curfews, closures, and other restrictive controls against the countries, citizens, and institutions and deploy their facilities to tackle the infection and prevent its spread (1). Amid the anxiety of lock downs and the cancellation of educational programs around the world, researcher support has not stopped, and a group of knowledge brokers, led by librarians and medical informantionists, are constantly providing information services. Information is an urgent and essential commodity in any crisis. Therefore, librarians and information experts have to be always prepared to meet the information needs of society and provide the users with access to information.
Assessment of Diet Diversity in Patients with Celiac Disease in East Azerbaijan-Iran: A Cross-Sectional Study
Authors: Nikniaz Zeinab , Mahdavi Reza , Akhavan Sabbagh Mojgan , Nikniaz Leila , Shirmohammadi Masood
Published: May 2021

Abstract Background and Objectives: Due to the high limitations of gluten-free diet, it seems that the diversity of diet in patients with celiac disease is affected. Therefore, in order to provide specific dietary advices to these patients, it is necessary to conduct a study on the diversity of these patients' diets. Therefore, the aim of this study was to investigate the dietary diversity score in adult patients with celiac disease. Material and Methods: In the present cross-sectional study, 130 celiac patients were selected from the celiac disease (CD) registry database of East Azerbaijan province, Iran. The dietary intake data was obtained by an 80-item semi-quantitative food frequency questionnaire. For determining diet diversity score (DDS), food items were categorized in five groups and 23 subgroups. To be counted as a "consumer" for any of the food groups categories, a respondent needed to consume one-half serving. The total score was between 0 and 10 and each subgroup score was between 0 and 2. The higher scores indicate the better diet diversity and the values less than 3, 3-5 and six and over were considered as low, moderate and high diet diversity scores respectively. The data were analysed using SPSS. The DDS was compared between adherences and non-adherents with on-way ANCOVA by adjusting to cofounding factors including age, sex, body mass index, energy intake, disease duration and gluten-free diet duration. Results: The mean age of celiac patients was 36.74±8.61 years. The mean total DDS was 3.97 ±1.36. The highest DDS was related to the fruit group (1.42 ± 0.68) and the lowest score was related to the meat group (0.40 ± 0.68). The result of covariance test showed that there were no significant differences between adherents and non-adherents regarding the DDS total score and subgroups scoes (P>0.05). The total DDS was less than 3 in 22.5% of patients, was between 3 and 5 in 73.3% of patients and six and over in 4.16% of patients. Conclusion: According to the results of the present study, the celiac patients had low DDS in all food groups. So, from the practical point of view, necessary educations should be provided to celiac patients to consume the gluten-free alternative to increase their diet diversity.
Evaluation of Physicochemical and Microbial Quality Control of Hemodialysis Machines Water in Hospitals
Authors: Abbaszadeh Michael , Mosaferi Mohammad , Firouzi Parisa , Abedpour Mohammad  Ali , Sheykholeslami Samira
Published: May 2021

Abstract Background and Objectives: Water quality is important for preparation of dialysis solution due to its direct relationship with blood of patients with renal failure. The aim of this study was to evaluate the chemical and microbial quality of inlet and outlet water of dialysis devices in hospitals of East Azerbaijan province. Material and Methods: This study was a descriptive-analytical study in which the water of dialysis ward of three hospitals affiliated to East Azerbaijan University of Medical Sciences was investigated. The results of physicochemical (45 cases) and microbial (163 cases) of dialysis water were extracted from the relevant archives in two stages before and after reverse osmosis treatment during 2014-2016. Independent t-test and one-way ANOVA were used for statistical analysis while extracting descriptive statistical parameters. Data analysis was done using Excel and SPSS 23 software. Results: Evaluation of the efficiency of reverse osmosis system showed that there was a significant difference between water quality, before and after the system. Except for calcium, magnesium, fluoride and nitrate, the concentrations of other cations and anions in 100% of samples were lower than the European Pharmacopoeia standard. Incoming water samples to dialysis machine in 4.9% of cases had total coliform contamination and there was no fecal coliform in any of the samples. The frequency and frequency of tests in hospitals are not observed and despite the risk of heavy metals, heavy metals tests are not performed on dialysis water for the health of dialysis patients. Conclusion: The need to develop a national standard for controlling dialysis water, testing all quality parameters of dialysis water according to standards in regular times and timeframes, informing hospital managers and environmental health experts about the importance of dialysis water quality in health and increasing life expectancy of dialysis patients is felt.
Global health diplomacy at the intersection of trade and health in the COVID-19 era
Authors: Chattu Vijay Kumar , Pooransingh Shalini , Allahverdipour Hamid
Published: May 2021

Global health diplomacy has gained significant importance and undoubtedly remained high on the agendas of many nations, regional and global platforms amid the coronavirus disease 2019 (COVID-19) pandemic. Many countries have realized the importance of the health sector and the value of a healthy workforce. However, there is little control on issues related to trade that impact on human health due to the dominance of profit-oriented business lobbies. A balance, however, needs to be struck between economic profits and a healthy global population. This paper aimed to highlight the importance of building capacity in global health diplomacy, especially during the COVID-19 pandemic so that health personnel may effectively negotiate on the multisectoral stage to secure the resources they need. The recent proposal to waive off certain provisions of the Trade-Related Aspects of Intellectual Property Rights (TRIPS) agreement for the prevention, containment and treatment of COVID-19 by India and South Africa at the World Trade Organization (WTO) presents an important opportunity for all governments to unite and stand up for public health, global solidarity, and equitable access at the international level so that both developed and developing nations may enjoy improved health outcomes related to the COVID-19 pandemic.
Understanding the process for developing sleep disorders among Japanese workers: a qualitative study
Authors: Toyoshima Ayako , Moriyama Michiko , Yamashita Hidehisa , Rahman Md Moshiur , Huq KATM Ehsanul , Jahan Yasmin , Kazawa Kana
Published: May 2021

Background: Sleep disorders have an enormous impact on occupational health and are counterproductive from an economic perspective. However, the processes of causing sleep disorders from psychosocial aspects have not yet been known. The purpose of this study was to describe how sleep disorders develop among workers with respect to different psychosocial conditions. Methods: A conventional qualitative content analysis was conducted with a semi-structured interview among twenty-seven workers (14 males and 13 females) who were diagnosed with sleep disorders or had a self-reported history of sleep difficulties. Study participants were recruited from a specialized clinic and communities using snowball sampling. This paper adhered to the Standards for Reporting Qualitative Research (SRQR) checklist. Results: The results showed that there were four steps involved in the sleep disorders development process. Firstly, participants with sleep disorders developed ‘early warning signs’ with 11 categories of triggers; secondly, ‘aggravating factors’ on top of these early warning signs; thirdly, workers tried to ‘cope with’ their sleep disorders in the ways they thought would be effective. Finally, when coping failed to improve the quality of sleep, it led to the onset of sleep disorders. Conclusion: The development of sleep disorders and triggers of psychosocial factors were revealed. An occupational health nurse can bring these findings in practice for preventing worker’s sleep disorders.
Complete root coverage in severe gingival recession with unfavorable prognosis using the tunneling technique
Authors: Javaid Mohammad Ahmad , Sohail Aamna , Ahmed Raafay
Published: May 2021

Gingival recession defined as the apical migration of the gingival margin leads to the exposure of root surface. This in turn may lead to compromised esthetics, dentine hypersensitivity and attachment loss. Severe gingival recession is typically managed surgically. However, achieving complete root coverage in cases of severe gingival recession, especially in the mandibular canine region is quite challenging. Different surgical techniques have been described in the literature to manage this condition. Tunnelling technique is one such technique which has shown promising results. Use of connective tissue graft with tunnelling technique has demonstrated favorable results in cases with mild to moderate gingival recession. Here we report a case where connective tissue graft was used in conjunction with tunnelling technique to achieve complete root coverage despite severe gingival recession and unfavorable prognosis.
Coagulopathy: Another side effect of coronavirus infection
Authors: Sadoughi Fatemeh , Maleki Dana Parisa , Hallajzadeh Jamal , Asemi Zatollah , Mansournia Mohammad Ali , Yousefi Bahman
Published: May 2021

Recently, coronavirus disease 2019 (COVID-19) has been considered as a major health problem around the globe. This severe acute respiratory syndrome has a bunch of features, such as high transmission rate, which are adding to its importance. Overcoming this disease relies on a complete understanding of the viral structure, receptors, at-risk cells or tissues, and pathogenesis. Currently, researches have shown that besides the lack of a proper anti-viral therapeutic method, complications provided by this virus are also standing in the way of decreasing its mortality rate. One of these complications is believed to be a hematologic manifestation. Commonly, three kinds of coagulopathies are detected in COVID-19 patients: disseminated intravascular coagulation (DIC), pulmonary embolism (PE), and deep vein thrombosis (DVT). In this paper, we have reviewed the relation between these conditions and coronavirus-related diseases pathogenesis, severity, and mortality rate.
Vital capacity and valvular dysfunction could serve as non-invasive predictors to screen for exercise pulmonary hypertension in the elderly based on a new diagnostic score
Authors: Wernhart Simon , Hedderich Jürgen , Weihe Eberhard
Published: May 2021

Introduction: Exercise pulmonary hypertension (exPH) has been defined as total pulmonary resistance (TPR) >3 mm Hg/L/min and mean pulmonary artery pressure (mPAP) >30 mm Hg, albeit with a considerable risk of false positives in elderly patients with lower cardiac output during exercise. Methods:We retrospectively analysed patients with unclear dyspnea receiving right heart catheterisation at rest and exercise (n=244) between January 2015 and January 2020. Lung function testing, blood gas analysis, and echocardiography were performed. We elaborated a combinatorial score to advance the current definition of exPH in an elderly population (mean age 67.0 years±11.9). A stepwise regression model was calculated to non-invasively predict exPH. Results: Analysis of variables across the achieved peak power allowed the creation of a model for defining exPH, where three out of four criteria needed to be fulfilled: Peak power ≤100 Watt, pulmonary capillary wedge pressure ≥18 mm Hg, pulmonary vascular resistance >3 Wood Units, and mPAP ≥35 mm Hg. The new scoring model resulted in a lower number of exPH diagnoses than the current suggestion (63.1% vs. 78.3%). We present a combinatorial model with vital capacity (VCmax) and valvular dysfunction to predict exPH (sensitivity 93.2%; specificity 44.2%, area under the curve 0.73) based on our suggested criteria. The odds of the presence of exPH were 2.1 for a 1 l loss in VCmax and 3.6 for having valvular dysfunction. Conclusion: We advance a revised definition of exPH in elderly patients in order to overcome current limitations. We establish a new non-invasive approach to predict exPH by assessing VCmax and valvular dysfunction for early risk stratification in elderly patients.
Does the extent of collaterals influence the severity of the myocardial injury as assessed by elevation in biomarkers?
Authors: Dubey Gajendra , Sharma Kamal , Patel Iva , Mansuri Zeeshan , Sharma Vishal
Published: May 2021

Introduction: Quantitative analysis of cardiac biomarkers, troponin I and CPK-MB, estimates the extent of myocardial injury while extent of benefit from coronary collateral circulation (CCC) to protect myocardium during acute myocardial infarction (AMI) needs validation. We analysed if the extent of collaterals had impact on baseline biomarkers at the time of coronary angiogram. Methods: We analysed 3616 consecutive patients who presented with AMI and underwent invasive coronary angiography (CAG) with intent to revascularisation with biomarkers assessment at the time of CAG. CCC to Infarct related artery (IRA) were graded as per Rentrop grading viz. poorly-developed CCC (Grade 0/1 as Group A) and well-developed CCC (Grade 2/3 as Group B). Results: Both groups (A and B) were matched for demographics, traditional risk factors, SYNTAX 1 Score, time to CAG from onset of angina and eGFR. 36.59% of patients had Non-ST segment elevation myocardial infarction (NSTEMI) as compared to 63.41% ST -segment elevation infarction (STEMI). Overall Troponin I (P=0.01, P=0.01) and CPK MB (P=0.00, P=0.002) values were lower in group B in both NSTEMI and STEMI groups respectively. Troponin I and CPK-MB were significantly lower in group B [with NSTEMI for SVD (Single vessel disease) (P=0.05) and DVD (Double vessel disease) (P=0.04),but not for TVD (Triple vessel disease) and with STEMI in SVD (P=0.01), DVD (P=0.01) and TVD (P=0.001)]. Conclusion: Patients with well-developed coronary collaterals had a lower rise in biomarkers in AMI as compared to those with poor collaterals amongst both NSTEMI and STEMI groups.
Measurements of surface scale changes in different denture base materials by stereophotogrammetric technique
Authors: Deste Gökay Gonca , Özkan Pelin , Durkan Rukiye , Oyar Perihan
Published: May 2021

Background. This study aimed to evaluate the surface scale changes in the denture base material using different polymerization techniques, such as heat-cure/pressure polymerization system and injection molding technique with the stereophotogrammetric technique. The function of a complete denture is related to the adaptation of its base to the supporting areas. Proper adaptation of the base depends on the stability and retention of dentures. The surface scale changes of dentures during processing and in service are of great importance since they affect the denture base material’s fit. Methods. This study focused on the use of a computer-assisted stereophotogrammetric method for measuring changes in the volume of three different denture base resins of an edentulous maxillary ridge. A stone master model simulating the shape of an edentulous maxillary arch was used to prepare three groups of denture base resins. The stereophotographs were evaluated to determine the surface scale differences of maxillary jaws. Results. The results showed no significant differences between the denture borders for three denture base materials (P > 0.05). Conclusion. In the evaluation made using this technique, no significant difference was found in the different polymerization techniques in terms of surface scale changes for three denture base materials. Stereophotogrammetry, especially the digital stereophotogrammetric technique, has several useful research applications in prosthodontics.
Evaluation of microcrack formation during root canal preparation using hand, rotary files and self-adjusting file in primary teeth: An in vitro study
Authors: Panda Anup , Shah Krishna , Budakoti Varsha , Dere Krishna , Virda Mira , Jani Jina
Published: May 2021

Background. Pediatric endodontics is a field with constant evolution, resulting in the shifting of paradigms from the use of conventional hand files to rotary files for biomechanical preparation in primary teeth. Biomechanical preparation plays a crucial role in the success of root canal treatment. Primary teeth need special attention since they differ from permanent teeth in root canal morphology. Cleaning and shaping of the canals damage the root dentin, leading to dentinal cracks. Newer techniques for root canal preparation, including Ni-Ti rotary files and SAF system, have been developed for use in pediatric endodontics to overcome the drawbacks of conventional methods. The present study compared dentinal defects formed by rotary systems in primary teeth. Methods. Eighty primary teeth were included. The teeth were decoronated with a diamond disc. All the roots were inspected for any pre-existing cracks or craze lines under transmitted light under a stereomicroscope. The specimens were then divided into four groups (n=20): group 1: control, group 2: hand files (HF), group 3: ProTaper files, and group IV: SAF files. The samples were instrumented according to the group they were assigned to. Results. The HF and SAF groups exhibited fewer microcracks. Dentinal microcracks were observed in roots prepared with rotary ProTaper files. There were significant differences between HF/SAF and rotary files (P<0.05). Conclusion. Stainless steel hand K-files and SAF instruments resulted in fewer dentinal damage than the ProTaper Universal files. SAF exhibited satisfactory results with minimal or no crack formation.
Comparative evaluation of dentin volume removal and centralization of the root canal after shaping with the ProTaper Universal, ProTaper Gold, and One-Curve instruments using micro-CT
Authors: Yalniz Hatice , Koohnavard Mehrdad , Oncu Aysenur , Celikten Berkan , Orhan Ayse Isil , Orhan Kaan
Published: May 2021

Background. The main goal of our study was to assess the volume of dentin removed and transportation in root canals using ProTaper Universal (PTU), ProTaper Gold (PTG) and One-Curve (OC). Ni-Ti rotary instruments in extracted human teeth using by micro-CT. Methods: Thirty human upper 1st premolar teeth with two separate root canals and sturdy, mature root tips were used in the present study. Specimens were decoronated and root length was standardized for micro CT scanning before root canal preparation done. The teeth were randomly separated into three categories (n = 10) according to the rotary NiTi system used for canal instrumentation, i.e., PTU (Dentsply, Maillefer), PTG (Dentsply, Maillefer), and OC (Micro-Mega SA). After root canal preparation, samples were scanned again on micro-CT by the same scanning parameters. Surface area, canal volume, structure model index (SMI), percentage of uninstrumented area and transportation parameters were obtained for each sample before and after micro-CT analyse. Results: No significant differences between the PTG and PTU in terms of the total volume of removed dentin, surface area and percentage of uninstrumented areas were found. However, regarding to parameters above, OC showed a lower efficacy than PTG and PTU in coronal section. Regarding canal transportation, PTG and OC showed lower mean transportation values at all levels. Conclusion: This paper demonstrated the root canal shaping abilities of the PTU, PTG, and OC NiTi file systems. The PTG and OC systems were associated less canal transportation and a better ability to preserve dentinal walls than PTU. There was no significance different between all rotary file systems for SMI values however, PTU and PTG showed greater canal volume and surface area change than OC file systems in coronal section.
A comparison of renal functional outcomes after partial nephrectomy with and without pedicle clamping
Authors: Bagheri Amin , Hasanzadeh Nokashti Kamaleddin , Farshi Alireza , Ghojazadeh Morteza
Published: May 2021

Introduction: Considering the mixed results reported about partial nephrectomy with and without pedicle clamping, this study aimed to compare the impacts of these two techniques on renal functional outcome. Materials and methods: this descriptive analytical study was conducted on 40 patients with renal cancer who underwent partial nephrectomy. They were randomly assigned to pedicle clamping (20 patients) and non-clamping groups(20 patients). The day before surgery, the routine tests as well as DTPA scan were carried out and some questions were asked from them; during the surgery, the amount of blood loss and the duration of pedicle clamping were measured; and after the surgery, the needed tests were performed for all of the patients. Also, 3 months after being discharged from the hospital, DTPA scan was carried out for all of the patients once again. Finally, the obtained data were all fed into SPSS v18 and the needed statistical analyses were performed. Results: The levels of operative blood loss(P=0.000) and blood transfusion(P=0.001) in non-pedicle clamping group were higher than other group. The mean duration of surgery in the clamping group was 139.2 minutes and non-pedicle group 149 minutes (P=0.258). The results of renal scans 3 months after the surgery indicated that the level of renal function decline in the pedicle clamping group was significantly higher than that in the non-pedicle clamping group(P=0.000). Conclusion: The results of this study indicated that partial nephrectomy without pedicle clamping can lead to a better renal function in the short run.
Segmentation of cancer cell in histopathologic images of breast cancer and lesion area in skin cancer images using convolutional neural networks
Authors: Fooladi Saber , Farsi Hassan , Mohamadzadeh sajad
Published: May 2021

Background: Pathological analysis plays an important role in the diagnosis, prediction and planning of cancer treatment. Using digital pathology, ie, scanning and storing digital parts of patient tissue, tools for analyzing these complex images now can be developed. Doctors use a computer diagnostic system from an intelligent assistant to accurately diagnose. These systems have great benefits in improving treatment efficacy. Methods: In this study, the deep neural network classifier has been used with the help of the Tensor Flow framework and the use of the Keras-library. Input images are initially transmitted from a low pass filter to reduce noise effects. The pre-processed images are then imported into a convolutional neural network. Results: The results of the research reveal a significant difference in the accuracy values between different methods with the proposed method, which in some cases indicates an increase of more than 14.18% in the accuracy of the diagnosis. Another advantage of the proposed method is to provide high sensitivity to histopathologic images, which shows an increase of 12 to 18 percent compared to other studies. The reason for this is the excellence of extracting high-level features through convolutional neural network, which is accompanied by a reduction in the size of the feature vector. Conclusion: The results showed a accuracy of %98.6 for skin lesions and %96.1 accuracy for breast cancer histopathologic findings, which offers promising results compared to the results of other studies.
Investigation of the physicochemical and pharmacognostical properties of Anzaroot (The manna of Astragalus sarcocola Dymock.) according to the World Health Organization
Authors: Esmaeeli Hadi , Davoodi Ali , Azadbakht Masoud , Azadbakht Mohammad
Published: May 2021

Background: Anzaroot is a manna produced from Astragalus sarcocola Dymock (Family Leguminosae) that is widely distributed in Fars, Kerman, Baluchestan and Hormozgan in Iran. Since the study of the physicochemical properties and quality control (QC) of herbal materials results in the validation and standardization for clinical uses, in accordance with World Health Organization (WHO) guidelines, it is necessary to carry out for Anzaroot which has indication in traditional medicine. Methods: Anzaroot was identified and determinated scientific name by a systematic specialist after purchasing from Niak pharmaceutical co. in gorgan. Physicochemical and pharmacognostical properties of Anzaroot have been determinated According to the WHO guidlines. Results: Anzaroot is a very bitter, crisp and fragile manna and non-stick in dry state, which is seen as separate binary grains under the microscope. The moisture content, foreign matter, sucrose content, total ash and water-soluble ash were reported 5.25 ± 0.2, 2.8 ± 0.2, 12.09 ± 0.04, 9.8 ± 0.5 and 2.9±0.15, respectively. It has significant foaming index, 72% Solublity in water and less than 50% in 96% ethanol and not swelling index. The levels of lead, mercury and cadmium were 0.0006, 0.0002 and 0.0007 ppm and total flavonoid content was reported 18.61 μg/ml with respect to standard Quercetin at 415 nm. Conclusion: This study can be a novel idea for the discovery or development of pharmaceutical products based on Anzaroot of Iran and its diverse therapeutic properties, such as the common cold, contusion, and bone fracture in traditional medicine.