bluuebunny/crossref_metadata_2025 huggingface dataset:
The outcomes of a novel two-stage proximal brachial artery to proximal basilic/brachial vein arteriovenous graft extension for dialysis access
Authors: Tabbara Marwan , Manzur-Pineda Karen , Labove Hannah , Sanchez Priscilla G , Martinez Laisel , Vazquez-Padron Roberto , Duque Juan C
Published: March 2022

Background:

We describe a technique to mature a basilic/brachial vein in the mid-arm in preparation for a second stage loop proximal brachial artery to basilic/brachial vein arteriovenous graft (BBAVG). This can occur after a failed basilic/brachial vein transposition or a lack of adequate veins in the distal arm. This allows a mature vein to be used in an end-to-end configuration as an outflow to a BBAVG while preserving proximal vessels for the future.

Methods:

This single-center retrospective study was performed from 2015 to 2021, including 104 AVG patients divided into three groups: (1) Patients who failed a basilic vein transposition and had an enlarged vein suitable for an AVG outflow; (2) Patients who had a small caliber basilic/brachial vein after the transposition, requiring a mid-arm brachial artery to brachial/basilic arteriovenous fistula (AVF) creation with a subsequent AVG extension; (3) and lastly, patients who had no distal arm veins available and required a primary brachial artery to basilic/brachial AVF with AVG extension. A survival analysis was performed looking at time to loss of primary and secondary patency, calculated with Kaplan-Meier estimates and Cox regression models adjusted for covariates.

Results:

The median follow-up time was 11 months (IQ = 11–30 months). The survival analysis showed 28% lost primary patency at a median time of 9 months, and 14% lost secondary patency at a median time of 61 months. Overall secondary patency of the vascular access measured at 12 months was 85.6%. Loss of primary ( p = 0.008) and secondary patency ( p = 0.017), as well as patency during the first 12 months ( p = 0.036), were all significantly associated with increased age when adjusting for covariates.

Conclusions:

Our results suggest that the graft extension technique using a mature vein from a previous fistula can result in reliable and durable access. This is important for patients with limited access for hemodialysis, as the axillary vein is preserved for future use if needed.
Performing islamophobia in the Australian parliament: The role of populism and performance in Pauline Hanson’s “burqa stunt”
Authors: Adam Sengul Kurt
Published: March 2022

Drawing on a multimodal approach to Critical Discourse Analysis (CDA), this research critically examines the 2017 “burqa stunt” of Australian far-right populist politician, Pauline Hanson. Adapting Scalmer's (2002) conceptualisation of the “political gimmick”, this paper makes the following arguments: Firstly, that Hanson's “burqa stunt” must be understood as an articulation of Islamophobia and political performance. It was the interplay of Hanson's radical right and populist ideologies that informed the stunt. As such, this paper bridges the ideational and performative approaches to populism. Secondly, the stunt was the product of the mediatisation of politics and the logics that govern contemporary media in Australia. The aim of Hanson's stunt was clear: to generate controversy and media attention. In this, the “burqa stunt” was incredibly successful and was extensively covered both nationally and internationally. The stunt was the most overt expression of the anti-Muslim racism that has defined Hanson's contemporary political resurgence. This paper furthers our growing understanding of how far-right populist actors strategically employ performance strategies designed to generate controversy and media attention. It also highlights how racist far-right actors are able to articulate Islamophobia in novel ways that exploit the logics of the contemporary media environment.
#Aboriginallivesmatter: Mapping Black Lives Matter discourse in Australia
Authors: Dejmanee Tisha , Millar Jeffrey , Lorenz Marni , Weber Kirsten , Zaher Zulfia
Published: March 2022

This paper explores the hashtag #AboriginalLivesMatter on Instagram which was widely used in Australia as part of a global Black Lives Matter (BLM) response in 2020. We map the participants and themes of #AboriginalLivesMatter through the quantitative coding and qualitative thematic analysis of 603 Instagram posts published with this hashtag in June 2020. We find that this conversation is largely driven by celebrities and non-Indigenous participants and framed by themes including expressing the problem as first-person experience, offering solutions, reporting, performing empty statements, and expressing US-centrism. Drawing on critiques of connective action and our analysis of the Instagram platform, we suggest that these findings are indicative of the tensions negotiated between incorporating allies on platforms that prioritise sharing first-person experiences; balancing the communicative capacities of Instagram with its inherently commercialised digital cultures; and, drawing on the spreadability of global digital movements while maintaining cultural specificity for local activists.
Practical knowledge of algorithms: The case of BreadTube
Authors: Cotter Kelley
Published: March 2022

The growing ubiquity of algorithms in everyday life has prompted cross-disciplinary interest in what people know about algorithms. The purpose of this article is to build on this growing literature by highlighting a particular way of knowing algorithms evident in past work, but, as yet, not clearly explicated. Specifically, I conceptualize practical knowledge of algorithms to capture knowledge located at the intersection of practice and discourse. Rather than knowing that an algorithm is/does X, Y, or Z, practical knowledge entails knowing how to accomplish X, Y, or Z within algorithmically mediated spaces as guided by the discursive features of one’s social world. I conceptualize practical knowledge in conversation with past work on algorithmic knowledge and theories of knowing, and as empirically grounded in a case study of a leftist online community known as “BreadTube.”
Investigation of the influence of formed, non-rotationally symmetrical pin geometries and their effect on the joint quality of steel and aluminium sheets by direct pin pressing
Authors: Römisch David , Kraus Martin , Merklein Marion
Published: March 2022

Resource-saving and sustainable production is becoming increasingly important regarding social, political and economic aspects, thus making the use of lightweight-construction technologies a current trend. For this reason, multi-material-systems made of high-strength steel and aluminium as well as metal and fibre-reinforced plastics gain in importance. However, different material properties, e.g. stiffness, thermal expansion coefficients or chemical incompatibilities, are challenging for conventional joining technologies. Joining by cold formed pin structures has shown to have high potential for joining multi-material-systems. These pins can be joined either by direct pin pressing into an unperforated joining partner or by caulking, where the pins are inserted through a pre-punched joining partner and the pin head is upset, resulting in a form-fit joint. Usually, cylindrical pins are used for joining. However, non-rotationally symmetrical pin geometries offer the possibility of introducing a predetermined breaking point or reinforcing a connection in the principal force direction. In this work, cylindrical pins as well as non-rotationally symmetrical pin geometries, such as polygonal and oval pin structures, are cold extruded from the sheet metal plane of an HCT590X+Z dual phase steel and joined in the next step with an EN AW-6014 aluminium using direct pin pressing. Since the formation of an undercut has an crucial influence on the joint strength, the investigations will be focused on the resulting joint geometry. In addition, the effect of different pin heights will be examined to analyse the joint formation at different levels of compression of the pin structures. Finally, the joints are evaluated regarding their joint strength in tensile shear tests and cross tension tests. Here the flow resistance of the geometry used as well as the pin height and thus the strain hardening of the pin base during the extrusion of the pins play a decisive role for the shear strength.
A novel removable appliance for canine retraction: a case report
Authors: Smorthit Kelly , Little Rachel
Published: March 2022

This case report outlines the use of a modified Leighton’s retractor as a method for canine retraction in a patient with severe hypodontia, a history of aggressive periodontitis with tooth loss and idiopathic root resorption affecting multiple teeth. Treatment involved an upper removable appliance in combination with a lower sectional fixed appliance with the aim of improving aesthetics and function for the patient, whilst balancing the need to minimise treatment duration and modify treatment mechanics to reduce the orthodontic risks.
A Scoping Review of the Literature on Sleep Quality in Adult Lung Transplant Recipients
Authors: Simanovski Jane , Ralph Jody
Published: March 2022

Introduction: Lung transplant recipients face challenging postoperative complications and are at risk for poor sleep quality. Sleep quality, as a complex clinical phenomenon, has multiple subjective and objective connotations. Measures and definitions of sleep quality are not standardized. Objective: A scoping review methodology was used to systematically map the relevant literature, provide an overview of available sleep quality measures, and to identify knowledge gaps. Methods: A systematic search of published and gray literature enabled knowledge synthesis of the last 10 years of evidence documenting sleep quality in lung transplant recipients. The search revealed 246 articles with only 12 sources meeting the eligibility criteria. Results: Sources varied in terms of definitions and measures of sleep quality. Subjective, objective, or a combination of both measures were used across the relevant literature with findings confirming that poor sleep quality was common in lung transplant recipients. Significant associations with poor sleep quality included younger age, female gender, exposure to tacrolimus, anxiety, and depression. Discussion: Systematic literature assessing sleep quality in lung transplant recipients is sparse and lacks conceptual and operational definitions. Future research can focus on designing prospective observational studies. Subjective and objective measures for sleep quality need to be validated in lung transplant recipients. Further rigorous research is needed to standardize measures of sleep quality and to further examine potential risk factors that affect sleep after lung transplantation.
Motivating Collective Action in Diverse Groups: Person of Color Identity, Prototypicality Perceptions, and Environmental Attitudes
Authors: Chin Jason C. , Mártir Luna Gustavo A. , Huo Yuen J. , Pérez Efrén O.
Published: March 2022

People of color (PoC) face common threats as marginalized ethno-racial groups, yet it remains unclear what drives a diverse range of people to collectively mobilize. Relative to White Americans, PoC are disproportionately endangered by environmental pollution. We suggest that when facing common threats, such as environmental injustice, making salient PoC-Identity (PoC-ID)—a superordinate category encompassing non-White groups—may motivate its members to collectively act. In a study with nationally representative samples of Black, Latinx, and Asian Americans ( N = 1,866), we found that higher levels of PoC-ID predicted attitudes and behavioral intentions to confront environmental injustices, which were mediated by anger about environmental injustices and efficacy as PoC. Although PoC-ID consistently explained Black Americans’ attitudes and behavioral intentions, its influence among Latinx and Asian Americans was moderated by self-perceived prototypicality as PoC. We discuss how these findings advance understanding of the psychological mechanisms of coalition-building among marginalized groups.
The importance of social media users’ responses in tackling digital COVID-19 misinformation in Africa
Authors: Stewart Ruth , Madonsela Andile , Tshabalala Nkululeko , Etale Linda , Theunissen Nicola
Published: March 2022

Objective

Digital technologies present both an opportunity and a threat for advancing public health. At a time of pandemic, social media has become a tool for the rapid spread of misinformation. Mitigating the impacts of misinformation is particularly acute across Africa, where WhatsApp and other forms of social media dominate, and where the dual threats of misinformation and COVID-19 threaten lives and livelihoods. Given the scale of the problem within Africa, we set out to understand (i) the potential harm that misinformation causes, (ii) the available evidence on how to mitigate that misinformation and (iii) how user responses to misinformation shape the potential for those mitigating strategies to reduce the risk of harm.

Methods

We undertook a multi-method study, combining a rapid review of the research evidence with a survey of WhatsApp users across Africa.

Results

We identified 87 studies for inclusion in our review and had 286 survey respondents from 17 African countries. Our findings show the considerable harms caused by public health misinformation in Africa and the lack of evidence for or against strategies to mitigate against such harms. Furthermore, they highlight how social media users’ responses to public health misinformation can mitigate and exacerbate potential harms. Understanding the ways in which social media users respond to misinformation sheds light on potential mitigation strategies.

Conclusions

Public health practitioners who utilise digital health approaches must not underestimate the importance of considering the role of social media in the circulation of misinformation, nor of the responses of social media users in shaping attempts to mitigate against the harms of such misinformation.
The Perceived Risk of Hospitalization in Primary Health Care – The Importance of Multidimensional Assessment
Authors: Santos Sara , Veiga Pedro Mota , Paúl Constança
Published: March 2022

Ageing has increased the use of health services, with a corresponding rise in avoidable hospitalizations. We aimed to assess and characterize the perceived risk of hospitalization in primary health care (PHC). 118 individuals aged ≥65 years, PHC patients, were assessed using the Community Risk Assessment Instrument by their General Practitioner, who identified their perceived risk of hospitalization, at one year. The instrument is composed of three domains (mental state, daily living activities (ADLs) state and medical state). Multivariate logistic regression was used to identify the best model to predict the risk of hospitalization. Four models were estimated, one for each domain and one with all the variables of the instrument. 58.5% were identified as being at risk of hospitalization. The best predictive models are those that include functionality assessment variables (ADL model and Community Assessment of Risk Instrument model). The model that includes all the variables of three domains presents the best predictive value. Mobility problems (Odds Ratio (OR) 16.18 [CI: 1.63–160.53]), meal preparation (OR 10.93 [CI: 1.59–75.13]), communication (OR 6.91 [CI: 1.37–34.80]) and palliative care (OR 4.84 [CI: 1.14–20.58]) are the best predictors of hospitalization risk. The use of multidimensional assessment tools can allow the timely identification of people at risk, contributing to a reduction in hospitalizations.
A systematic review of municipal smart water for climate adaptation and mitigation
Authors: Lassiter Allison , Leonard Nicole
Published: March 2022

This study examines how research on smart water is contributing to climate-resilient municipal water systems around the globe. We identify smart water research trends over time, relationships with climate adaptation and mitigation goals, and applicability to places with developed or developing water and electrical infrastructure. To do so, we systematically review the literature, identifying research on Information Communication Technology-enabled technologies related to water supply, wastewater, and stormwater management. We assess the relationship between each study and climate adaptation and mitigation objectives: managing greater variation in water quantity, leading to scarcity and increased stormwater; managing declining water quality; and low-carbon water systems. We find 96 relevant studies and identify five major categories of research addressing climate adaptation and mitigation: monitoring, modeling, system design, system feedbacks, and uptake and implementation. We find there is a recent acceleration in smart water research, with a concentration of studies focused on modeling. There is an emphasis on water efficiency using data from Advanced Metering Infrastructure, which is most applicable to cities with developed water grids and consistent electrical supplies. Secondarily, there is a concentration of work using distributed sensors for early detection of water quality degradation, which is being done in all municipal contexts. There is far less research on uptake and implementation of smart approaches, especially at the institutional level. In addition, there is relatively little work that explicitly relates smart water technologies to reducing greenhouse gas emissions. While smart water approaches are applicable everywhere, there is a need to for expanded focus on areas without developed water grids or consistent electricity for smart water to meaningfully contribute to Sustainable Development Goal 6.
Long‐term Follow‐up of Cytologically Indeterminate Thyroid Nodules Found Benign on Molecular Testing: A Validation Study
Authors: White Michelle K. , Thedinger William B. , Dhingra Jagdish K.
Published: March 2022

Objective

Molecular testing has revolutionized management of indeterminate thyroid nodules (Bethesda categories III and IV). Few studies have attempted to validate the negative predictive value of molecular tests. Using long‐term observation as a surrogate for surgical resection, we sought to examine the false‐negative rate of “benign” indeterminate thyroid nodules on molecular testing.

Study Design

Case series with retrospective data collection and chart review.

Setting

Large community‐based practice with multiple satellite offices.

Methods

All patients with thyroid nodules that underwent ultrasound‐guided fine‐needle aspiration biopsy between 2013 and 2019 were evaluated through retrospective analysis. Cytologically indeterminate nodules reflexively underwent molecular testing to guide clinical management. Observation was recommended for lesions with benign molecular testing, and these nodules were followed clinically and by ultrasound.

Results

A total of 2011 nodules underwent fine‐needle aspiration, of which 280 (14%) were indeterminate thyroid nodules. Of those 280 nodules, 100 (36%) were benign on molecular testing. Three samples were excluded from analysis due to patient deaths from unrelated causes. Surgical resection was recommended in 16 of the 97 nodules (17%), with the majority due to size and compressive symptoms. Histopathology was available in 14 nodules that underwent surgery, with 1 demonstrating minimally invasive follicular carcinoma.

Conclusion

While molecular testing is safe to use in guiding management of indeterminate thyroid nodules, consideration of individualized clinical factors and close long‐term follow‐up remains paramount.
Effects of cadmium contamination on bacterial and fungal communities in Panax ginseng-growing soil
Authors: Sun Hai , Shao Cai , Jin Qiao , Li Meijia , Zhang Zhenghai , Liang Hao , Lei Huixia , Qian Jiaqi , Zhang Yayu
Published: March 2022

Background

Cadmium (Cd) contamination in soil poses a serious safety risk for the development of medicine and food with ginseng as the raw material. Microorganisms are key players in the functioning and service of soil ecosystems, but the effects of Cd-contaminated ginseng growth on these microorganisms is still poorly understood. To study this hypothesis, we evaluated the effects of microorganisms and Cd (0, 0.25, 0.5, 1.0, 2.0, 5.0, and 10.0 mg kg-1 of Cd) exposure on the soil microbial community using Illumina HiSeq high-throughput sequencing.

Results

Our results indicated that Cd-contaminated soil affected the soil microbial diversity and composition, and bacterial diversity was affected more than fungal diversity in Cd-contaminated soil, especially according to Shannon indices. The abundance of the soil microbial community decreased and the composition changed according to the relative abundances at the phylum level, including those of Saccharibacteria and Gemmatimonadetes in bacteria and Mortierellomycota in fungi. The LEfSe algorithm was used to identify active biomarkers, and 45 differentially abundant bacterial taxonomic clades and 16 differentially abundant fungal taxonomic clades were identified with LDA scores higher than 4.0. Finally, a heatmap of Spearman's rank correlation coefficients and canonical discriminant analysis (CDA) indicated that some key biomarkers, Arenimonas, Xanthomonadales, Nitrosomonadaceae, Methylophilales, Caulobacterales, Aeromicrobium, Chitinophagaceae, Acidimicrobiales, Nocardioidaceae, Propionibacteriales, Frankiales, and Gemmatimonadaceae, were positively correlated with the total and available Cd (p<0.05) but negatively correlated with AK, AP, and pH (p<0.05) in the bacterial community. Similarly, in the fungal community, Tubaria, Mortierellaceae, and Rhizophagus were positively correlated with the total and available Cd but negatively correlated with AK, AP, TK, and pH.

Conclusion

Cd contamination significantly affected microbial diversity and composition in ginseng-growing soil. Our findings provide new insight into the effects of Cd contamination on the microbial communities in ginseng-growing soil.
Adjusting for verification bias in diagnostic accuracy measures when comparing multiple screening tests - an application to the IP1-PROSTAGRAM study
Authors: Day Emily , Eldred-Evans David , Prevost A. Toby , Ahmed Hashim U. , Fiorentino Francesca
Published: March 2022

Introduction

Novel screening tests used to detect a target condition are compared against either a reference standard or other existing screening methods. However, as it is not always possible to apply the reference standard on the whole population under study, verification bias is introduced. Statistical methods exist to adjust estimates to account for this bias. We extend common methods to adjust for verification bias when multiple tests are compared to a reference standard using data from a prospective double blind screening study for prostate cancer.

Methods

Begg and Greenes method and multiple imputation are extended to include the results of multiple screening tests which determine condition verification status. These two methods are compared to the complete case analysis using the IP1-PROSTAGRAM study data. IP1-PROSTAGRAM used a paired-cohort double-blind design to evaluate the use of imaging as alternative tests to screen for prostate cancer, compared to a blood test called prostate specific antigen (PSA). Participants with positive imaging (index) and/or PSA (control) underwent a prostate biopsy (reference standard).

Results

When comparing complete case results to Begg and Greenes and methods of multiple imputation there is a statistically significant increase in the specificity estimates for all screening tests. Sensitivity estimates remained similar across the methods, with completely overlapping 95% confidence intervals. Negative predictive value (NPV) estimates were higher when adjusting for verification bias, compared to complete case analysis, even though the 95% confidence intervals overlap. Positive predictive value (PPV) estimates were similar across all methods.

Conclusion

Statistical methods are required to adjust for verification bias in accuracy estimates of screening tests. Expanding Begg and Greenes method to include multiple screening tests can be computationally intensive, hence multiple imputation is recommended, especially as it can be modified for low prevalence of the target condition.
Effect of alcohol on clinical complications of hepatitis virus-induced liver cirrhosis: a consecutive ten-year study
Authors: Abassa Kodjo-Kunale , Wu Xiao-Ying , Xiao Xiu-Ping , Zhou Hao-Xiong , Guo Yun-Wei , Wu Bin
Published: March 2022

Background and aims

Although coexisting alcohol-induced liver disease and hepatitis B or C virus-induced liver cirrhosis (ALD + HBV or ALD + HCV) has been the center of recent hepatology researches, numerous controversies still persist. This study aimed to showcase the influence of alcohol on the laboratory values and on the clinical outcomes of patients with hepatitis B and C virus-induced liver cirrhosis.

Methods

Patients diagnosed with liver cirrhosis (n = 22,287) from January 2010 to December 2019 were enrolled, and divided into five groups according to the etiology: alcohol-induced liver disease (ALD, 1652 cases), hepatitis B virus (HBV, 18,079 cases), hepatitis C virus (HCV, 682 cases), ALD + HBV (1594 cases) and ALD + HCV (280 cases). Laboratory results and proportion of different liver cirrhosis complications were contrasted between groups.

Results

The proportions of patients with Child Pugh grade C (28.0% vs 18.8%, P < 0.001) or MELD greater than 18 (24.1% vs 18.5%, P < 0.001) in the ALD + HBV group exceeded significantly those in the HBV group. Multivariate logistic regression revealed that the risk of hepatocellular carcinoma (HCC) and that of esophageal gastric variceal bleeding (EGVB) in the ALD + HBV group was respectively 2.01-fold and 1.74-fold that in the HBV group (HCC: OR = 2.01, 95% CI [1.58–2.55]; EGVB: OR = 1.74, 95% CI [1.30–2.33]) after adjusting for potential confounders. Furthermore, a linear-by-linear analysis test showed a decrease in the risk of HCC and EGVB with the duration of alcohol abstinence. Moreover, patients with both antiviral treatment and alcohol abstinence had the lowest risk of HCC and EGVB (HCC: OR = 0.10, 95% CI [0.05–0.20], P < 0.001; EGVB: OR = 0.17, 95% CI [0.06–0.45], P < 0.001) compared to those without any treatment, those with abstinence alone and those with antiviral therapy alone. Similar pattern was noticed while comparing the ALD + HCV group to the HCV group.

Conclusion

Heavy alcohol use increased the severity of liver function impairment and the prevalence of HCC and EGVB in hepatitis virus-induced liver cirrhosis patients. Remarkably, long-term alcohol abstinence coupled with antiviral treatment effectively decreased the risk of HCC and EGVB in these populations.
Epidemiological characterization of Clonorchis sinensis infection in humans and freshwater fish in Guangxi, China
Authors: Xie Yihong , Kanankege Kaushi S. T. , Jiang Zhihua , Liu Shun , Yang Yichao , Wan Xiaoling , Perez Andres M.
Published: March 2022

Background

Clonorchiasis is a widespread yet neglected foodborne disease with over 85% of all cases found in China. Guangxi province, located in southeastern China, ranks among the highest endemic provinces. We explore the epidemiological status and determinants of Clonorchis sinensis (C. sinensis) infection in humans and freshwater fish in Guangxi, China.

Methods

Data on C. sinensis infection in humans from January 2008 to December 2017were extracted from the China Information System for Disease Control and Prevention. An active surveillance of C. sinensis infection in fish was conducted in 2016–2017. County level data including potential environmental, social-economical and behavioral determinants was also collected. Univariate and multivariate logistic regression models were used to explore the determinants of C. sinensis infection in humans and fish. Simple and multiple zero-inflated Poisson regression models were fit to assess the associated factors of clonorchiasis in humans at the county level.

Results

Totally, 4526 C. sinensis cases were reported between 2008 and 2017, with an annual prevalencerate of 0.96/100,000 persons. Of 101 counties in Guangxi, 97 reported at least 1 case. Among 2,098 fish samples, 203 (9.7%) from 70 counties contained C. sinensis. The rate was higher in small fish including Pseudorasbora parva (45.3%), Misgurnus anguillicaudatus (41.2%), Hemicculter leuciclus (34.5%), unclassified small fishes (30.9%), Cyprinidae (20.0%), Cirrhinus molitorella (16.4%), Carassius auratus (13.6%) and Cyprinus carpio (13.3%), while it was lower in fish species that are usually used in preparing raw fish dishes including Ctenopharyngodon idellus (3.6%), Spinibarbus denticulatus (3.7%), Monopterus albus (6.4%), Cyprinus carpio (4.4%), Oreochromis mossambicus (3.3%) and Spualiobarbus Curriculus (6.6%). The C. sinensis infection in fish was only associated with fish species. The estimated human clonorchiasis prevalence at the county level was positively associated with raw fish consumption habits and certain rivers.

Conclusions

Clonorchiasis is highly prevalent in both humans and freshwater fish in Guangxi. Environmental, social-economic and behavioral determinants contribute to the high prevalence as well as the significant differential distribution by county. Regular surveillance should be implemented for clonorchiasis to demonstrate the change in epidemiology and burden, which will benefit the design of interventions.
Evaluation of liver fibrosis in chronic hepatitis B patients with 2D shear wave elastography with propagation map guidance: a single-centre study
Authors: Kavak Seyhmus , Kaya Safak , Senol Ayhan , Sogutcu Nilgun
Published: March 2022

Background

The aims of this study were to evaluate liver fibrosis with two-dimensional (2D) shear wave elastography (SWE) in patients with chronic hepatitis B (CHB), to compare 2D-SWE with histopathology and to determine the change in liver stiffness values after antiviral therapy.

Material and methods

A total of 253 patients with CHB were included in this prospective study. 2D-SWE with propagation map guidance to measure liver stiffness, fibrosis-4 index (FIB-4) and aspartate aminotransferase to platelet ratio index (APRI) scoring and additional liver biopsy were performed in patients with CHB. Liver stiffness was measured again at 24 and 48 weeks in all patients. The Spearman rank correlation test was used to analyse the correlation between variables, and receiver operating curve analysis was used to evaluate the diagnostic performance in terms of fibrosis.

Results

Liver stiffness measurements made with 2D-SWE demonstrated a significant positive correlation with the fibrosis stage and FIB-4 score (rs = 0.774 and 0.337, respectively, p < 0.001 for both). The area under the curve value for kPa for the prediction of significant fibrosis was 0.956 (95% CIs) (0.920–0.991), and the optimal cut-off value was 8.2 kPa (sensitivity: 92.7% and specificity: 78.9%); these values were 0.978 (95% CIs, 0.945–1.000) and 10.1 kPa (sensitivity: 92.9% and specificity: 96.4%) for the prediction of severe fibrosis. After antiviral treatment, a decrease in liver stiffness values measured by 2D-SWE was detected (mean kPa values at 0 and 48 weeks; 9.24 and 7.36, respectively, p < 0.001).

Conclusion

In conclusion, the measurement of liver stiffness with 2D-SWE has high diagnostic performance in the determination of hepatic fibrosis and can be used to evaluate the response to treatment in patients receiving antiviral therapy.
An unusual occurrence of opsoclonus and liver enzymes elevation in a patient with acute motor and sensory axonal neuropathy subtype of Guillain-Barré syndrome
Authors: Alzuhaily Hasan , khashaneh Eman , Albkhetan Sanaa , Abbas Fatima
Published: March 2022

Background

Acute motor and sensory axonal neuropathy (AMSAN) is a subtype of Guillain-Barré syndrome (GBS) differentiated by nerve conduction studies (NCS) and characterized by symmetric ascending paralysis often involving respiratory muscles. While opsoclonus, which is involuntary chaotic rapid eye movements, is not a common manifestation of GBS. Moreover, little published data are available on the relation between liver enzymes elevation and GBS.

Case presentation

A 42-year-old man presented to Al Mouwassat University Hospital with weakness in all limbs and dyspnea. Examination showed an elevated respiratory rate, hyporeflexia, and decreased strength of upper and lower limbs. Analysis of cerebrospinal fluid revealed an albuminocyto-dissociation suggesting the diagnosis of GBS and subsequent plasmapheresis. NCS confirmed a diagnosis of AMSAN. Elevation in liver enzymes was noticed prompting further exploration with no positive findings. Despite treatment efforts, the patient developed severe dyspnea, deterioration in cognitive abilities, and opsoclonus with a normal brain MRI. Unfortunately, he developed respiratory failure which lead to his death.

Conclusion

In this case, we highlight the occurrence of opsoclonus which is a rarely-encountered manifestation of GBS, in addition to an unexplained elevated liver enzyme, the thing that could contribute to larger research to further comprehend the pathophysiology of GBS.
Autonomic dysfunction detected by skin sympathetic response in Lambert-Eaton myasthenic syndrome: a case report
Authors: Zhang Jinghong , Huang Xusheng , Shi Qiang
Published: March 2022

Background

Lambert-Eaton myasthenic syndrome (LEMS) is a type of paraneoplastic syndrome that may initially manifest itself with proximal weakness and gait abnormalities. Approximately up to 50% of LEMS patients have a primary autonomic dysfunction.

Case presentation

We present here a case of a 75-year-old male with symmetric proximal muscle weakness, dry mouth and constipation. The cutaneous response to scratch and upright tilt-table testing were positive. A repetitive nerve stimulation test showed that there was a decremental response of compound muscle action potential (CMAP) amplitude at 3 Hz while an incremental response at 20 Hz. The presence of antibodies against voltage-gated calcium channels (VGCC) confirmed the diagnosis. Because of the prominent symptom of autonomic disorder, the patient further underwent the test of skin sympathetic response (SSR). Lower amplitude and longer response duration were found in palms, while it evoked no response in soles.

Conclusions

In this case, we present the detailed results of SSR test on a patient suffering LEMS with autonomic disorder. Since autonomic dysfunction has a significant impact on clinical management and SSR test is an effective detection method, we recommend that SSR test be performed on patients with LEMS regularly.
Self-directed passive-aggressive behaviour as an essential component of depression: findings from two cross-sectional observational studies
Authors: Schanz C. G. , Equit M. , Schäfer S. K. , Michael T.
Published: March 2022

Background

The self-control model of depression suggests depressive symptoms to derive from distorted self-monitoring, dysfunctional self-evaluation and reduced self-reward as well as increased self-punishment. Building on this model a relationship between self-directed passive-aggressive behaviour, that is, harmful inactivity, and depression has been assumed. This association has been supported by a recent study in an inpatient sample. However, it remains unclear if patients with depressive disorders report more self-directed passive-aggressive behaviour than patients without depressive disorders and if self-directed passive aggression mediates the associations between distorted self-monitoring and dysfunctional self-evaluation with depressive symptoms.

Methods

Study 1 compared self-directed passive-aggressive behaviour levels between 220 psychotherapy outpatients with (n = 140; 67.9% female; Mage = 40.0) and without (n = 80; 65.0% female; Mage = 36.2) depressive disorders. Diagnoses were made based on the Structured Clinical Interview for DSM-IV. Study 2 examined self-directed passive-aggressive behaviour as a mediator of the relationship between distorted self-monitoring and dysfunctional self-evaluation and self-reported depressive symptoms in 200 undergraduate Psychology students.

Results

Compared to outpatients without depressive disorders, outpatients with depressive disorder reported significantly more self-directed passive aggression (d = 0.51). Furthermore, Study 2 verified self-directed passive-aggressive behaviour as a partial mediator of the relationship between dysfunctional attitudes (abcs = .22, 95%-CI: .14, .31), attributional style (abcs = .20, 95%-CI: .13, .27), ruminative response style (abcs = .15, 95%-CI: .09, .21) and depressive symptoms.

Conclusion

Self-directed passive-aggressive behaviour partially mediates the association between distorted self-monitoring and dysfunctional self-evaluation with depressive symptoms. Future longitudinal studies need to examine a potential causal relationship that would form a base to include interventions targeting self-directed passive-aggressive behaviour in prevention and treatment of depression.

Trial registration

Both studies were preregistered at the German Clinical Trials Register (DRKS00014005 and DRKS00019020).
Understanding how to live with hepatitis B: a qualitative investigation of peer advice for Chinese people living with hepatitis B in Australia
Authors: Wallace Jack , Xiao Yinzong , Howell Jess , Thompson Alex , Allard Nicole , Adamson Emily , Richmond Jacqui , Hajarizadeh Behzad , Eagle Melanie , Doyle Joseph , Hellard Margaret
Published: March 2022

Background

Hepatitis B is a chronic viral infection, a leading cause of primary liver cancer and identified as a major public health priority by the World Health Organization. Despite a high proportion of people in Australia who have been diagnosed with hepatitis B, significant gaps remain in health care access and in accurate knowledge about hepatitis B. Most people with hepatitis B in Australia were born in China, where the infection has an intergenerational impact with significant social implications resulting from the infection. Understanding how people of Chinese ethnicity with hepatitis B understand and respond to hepatitis B is imperative for reducing morbidity, mortality, and the personal and social impact of the infection.

Methods

Qualitative semi-structured interviews with people with hepatitis B of Chinese ethnicity recruited through a specialist service identified the advice people with hepatitis B thought was important enough to inform the experience of people newly diagnosed with hepatitis B. A thematic analysis of the data privileged the lived experience of participants and their personal, rather than clinical, explanations of the virus.

Results

Hepatitis B infection had psychological and physical consequences that were informed by cultural norms, and to which people had responded to with significant behavioural change. Despite this cohort being engaged with specialist clinical services with access to the most recent, comprehensive, and expert information, much of the advice people with hepatitis B identified as important for living with hepatitis B was not based on biomedical understandings. Key suggestions from people with hepatitis B were to form sustainable clinical relationships, develop emotional resilience, make dietary changes, regulate energy, and issues related to disclosure.

Conclusions

The study highlights conflicts between biomedical and public health explanations and the lived experience of hepatitis B among people of Chinese ethnicity in Australia. Beliefs about hepatitis B are embedded within cultural understandings of health that can conflict with bio-medical explanations of the infection. Acknowledging these perspectives provides for insightful communication between health services and their clients, and the development of nuanced models of care informed by the experience of people with hepatitis B.
The prevalence of posterior inferior tibiofibular ligament and inferior tibiofibular transverse ligament injuries in syndesmosis-injured ankles evaluated by oblique axial magnetic resonance imaging: a retrospective study
Authors: Shiwaku Kousuke , Teramoto Atsushi , Iba Kousuke , Otsubo Hidenori , Kamiya Tomoaki , Shoji Hiroaki , Watanabe Kota , Yamashita Toshihiko
Published: March 2022

Background

Transverse ligament and posterior inferior tibiofibular ligament injuries have not been investigated till date because these are difficult to evaluate using standard magnetic resonance imaging. This study aimed to investigate the prevalence of transverse ligament and posterior inferior tibiofibular ligament injuries in syndesmosis-injured ankles using oblique axial magnetic resonance imaging.

Methods

The patients who were diagnosed with syndesmosis injury using magnetic resonance imaging (MRI) within 7 days of the trauma were included. Patients with concomitant fractures were excluded. A total of 34 patients (1 woman and 33 men) with an average age of 22 years (range, 14–64 years) were included. The anterior inferior tibiofibular, interosseous, transverse, and posterior inferior tibiofibular ligaments were classified as intact, partial tear, or complete tear using usual axial and oblique axial MRIs.

Results

There were 8 (23.5%) ankles with an intact, 21 (61.8%) ankles with a partially torn, and 5 (14.7%) ankles with a complete tear of transverse ligament. There were 20 (58.8%) ankles with an intact, 12 (35.3%) ankles with a partially torn, and 2 (5.9%) ankles with a complete tear of posterior inferior tibiofibular ligament. Overall, 50% of the transverse ligament injuries occurred without posterior inferior tibiofibular ligament involvement.

Conclusions

The oblique axial magnetic resonance imaging scan revealed that the prevalence of transverse ligament and posterior inferior tibiofibular ligament injuries in syndesmosis-injured ankles were 76.5 and 41.2%, respectively.
Clinical characteristics of immune tolerance after pediatric liver transplantation
Authors: Tang Yan , Chen Jingyu , Chen Bailin , Guo Chunbao
Published: March 2022

Background

Clinical operational tolerance is the ultimate goal for liver transplantation. This study aimed to investigate the clinical characteristics of immune tolerance after pediatric liver transplantation and to identify the possible predictors.

Methods

The clinical data from 37 cases of pediatric patients 2 year later after liver transplantation surgery in the Children’s Hospital of Chongqing Medical University, China, were retrospectively analyzed. According to the status of the current immunosuppressant medications of the patients, they were divided into tolerance (n = 15) and Control (n = 22) groups. The current status regarding prope/operational tolerance was reviewed and screened based on the immunosuppressant medications.

Results

The patients in the tolerance group were younger than that of Controls (p < 0.001). The children in the tolerance group experienced no acute rejection episode and exhibited no obvious abnormalities in the liver function during the continuous follow-up period. The primary disease of the tolerance group were more often diagnosed with biliary atresia (p = 0.011), and received with a living donor liver graft (p = 0.005). There were less glomerular function, diabetes mellitus, arterial hypertension events presented in the tolerance group compared with the control group, indicating low toxicity profile.

Conclusion

In the current study, there were really certain quantity of recipients following liver transplantation attained long term immune tolerance, with low toxicity and satisfied liver graft function. The younger age of the recipient and maternal donor seems to promote long-term clinical immune tolerance. Further work in larger series should be required to describe the overall perspective of tolerance.
A case of atypical reninoma with mild hypertension and normal plasma renin activity but elevated plasma renin concentration
Authors: Wang Baoping , Ding Li , Xu Shuanghua , Fan Yuxin , Wang Jiabo , Zhao Xin , Fu Diansheng , Bian Bo , Tang Kunlong , Ni Chunsheng , Dong Zuoliang , He Qing , Liu Ming
Published: March 2022

Background

Reninoma is a rare, benign renal neoplasm. Typical clinical features include severe hypertension, secondary hyperaldosteronism, hypokalaemia and metabolic alkalosis caused by the overproduction of renin.

Case presentation

A 25-year-old lean Chinese woman with no family history of hypertension was hospitalized for stage 1 hypertension that gradually developed over two years. Endocrine investigation showed hyperreninemia without hyperaldosteronism and hypokalaemia. Interestingly, although the patient had an elevated plasma renin concentration (PRC), her plasma renin activity (PRA) was in the normal range. Abdominal contrast-enhanced computed tomography (CT) scanning revealed a solid, low-density, renal cortical mass with delayed enhancement. Selective renal vein sampling (SRVS) was performed, and a lateralization of the renin secretion from the left kidney was found. Enucleation of the tumour led to a rapid remission of hypertension and hyperreninemia. Based on pathological findings, the patient was diagnosed with reninoma. Immunohistochemical staining of the tumour was positive for Renin, CD34, Vimentin, and synaptophysin (Syn) and negative for somatostatin receptor 2 (SSTR2) and chromogranin A (CgA).

Conclusions

Reninoma can present as mild hypertension without hyperaldosteronism and hypokalaemia. The clinical features of reninoma may depend on the degree of activation of the renin-angiotensin-aldosterone system (RAAS). PRC should be incorporated in the differential diagnosis of secondary hypertension.