bluuebunny/crossref_metadata_2025 huggingface dataset:
Fabrication of 3D Printed poly(lactic acid) strut and wet-electrospun cellulose nano fiber reinforced chitosan-collagen hydrogel composite scaffolds for meniscus tissue engineering
Authors: Gunes Oylum Colpankan , Kara Aylin , Baysan Gizem , Bugra Husemoglu Resit , Akokay Pinar , Ziylan Albayrak Aylin , Ergur Bekir Ugur , Havitcioglu Hasan
Published: June 2022

The main goal of the study was to produce chitosan-collagen hydrogel composite scaffolds consisting of 3D printed poly(lactic acid) (PLA) strut and nanofibrous cellulose for meniscus cartilage tissue engineering. For this purpose, first PLA strut containing microchannels was incorporated into cellulose nanofibers and then they were embedded into chitosan-collagen matrix to obtain micro- and nano-sized topographical features for better cellular activities as well as mechanical properties. All the hydrogel composite scaffolds produced by using three different concentrations of genipin (0.1, 0.3, and 0.5%) had an interconnected microporous structure with a swelling ratio of about 400% and water content values between 77 and 83% which is similar to native cartilage extracellular matrix. The compressive strength of all the hydrogel composite scaffolds was found to be similar (∼32 kPa) and suitable for cartilage tissue engineering applications. Besides, the hydrogel composite scaffold comprising 0.3% (w/v) genipin had the highest tan δ value (0.044) at a frequency of 1 Hz which is around the walking frequency of a person. According to the in vitro analysis, this hydrogel composite scaffold did not show any cytotoxic effect on the rabbit mesenchymal stem cells and enabled cells to attach, proliferate and also migrate through the inner area of the scaffold. In conclusion, the produced hydrogel composite scaffold holds great promise for meniscus tissue engineering.
Improved Yet Unsafe: At the Light of NFHS-V
Authors: Banerjee Subhanil , Dave Sumita , Siddiqui Imran Nadeem
Published: June 2022

Following UNICEF’s analysis of National Family Health Survey-III Data (NFHS-III), it was opined that households with access to better sanitation and better access to improved water sources have much better infant survival rates than the others. Sahu et al. (2015 , The Indian journal of medical research, 141(5), 709), Arun et al. (2017 , International Conference on Cognitive Computing and Information Processing (pp. 81–92), Springer) and Tripathy and Mishra (2017 , Journal of Tropical Pediatrics, 63(6), 431–439) supported these findings. However, Banerjee (2020a , Journal of Health Management, 22(1), 57–66), analysing NFHS-IV data, has vehemently criticised such findings and showed using regression with robust standard errors that improved access to better water sources leads to higher infant mortality. In another article published in the same year, Banerjee (2020b , Journal of Health Management, 22(3), 466–471) explained this paradox. Now with NFHS-V data coming out, time is apt to test the robustness of Banerjee’s findings (2002a). However, owing to the incomplete NFHS-V data published so far, unlike Banerjee (2002a) that has used data of 29 states, the present analysis is based on only 17 states. The findings support that the findings of Banerjee (2002a) were robust.
Multi-sided platforms and innovation: A competition law perspective
Authors: Marty Frédéric , Warin Thierry
Published: June 2022

We propose a simple theoretical model emphasizing the importance of a multi-sided platform (MSP) in fostering innovation. This model aims to assess the effects of structuring industries around an MSP on innovation dynamics and emphasizes the impact of cross-platform competition. It teaches us how to encourage cross-platform competition in terms of competition policy. The outcome is threefold. To begin, the presence of an MSP is critical for market innovation. Second, our findings indicate that skewed market power in favor of the MSP may stifle innovation in this industry, even if the negative impact on the industry’s rate of innovation is not immediately apparent. Finally, we demonstrate that industries with multiple MSPs have a higher rate of innovation. The model’s conclusions emphasize the critical importance of preserving the contestability of digital markets through competition rules enforcement. Even if the inherent technical characteristics of this industry result in a situation of dominance, competition rules should aim to preserve the possibility of market competition through, among other things, interoperability requirements, data portability requirements, and control of exclusivity clauses.
Psychological and psychosocial aspects of major trauma care in the United Kingdom: A scoping review of primary research
Authors: Olive Philippa , Hives Lucy , Wilson Neil , Ashton Amy , O’Brien Marie Claire , Mercer Gemma , Jassat Raeesa , Harris Catherine
Published: June 2022

Introduction

More people are surviving major trauma, often with life changing injuries. Alongside physical injury, many survivors of major trauma experience psychological and psychosocial impacts. Presently, there is little guidance at the UK national level for psychological and psychosocial aspects of major trauma care. Set in the context of the regional model of major trauma care implemented in the UK in 2012, the purpose of this review was to identify and bring together primary research about psychological and psychosocial aspects of major trauma care in the UK to produce an overview of the field to date, identify knowledge gaps and set research priorities.

Methods

A scoping review was undertaken. Seven electronic databases (MEDLINE, Cochrane Library, CINAHL, Embase, PsycINFO, SocINDEX with Full Text and PROSPERO) were searched alongside a targeted grey literature search. Data from included studies were extracted using a predefined extraction form and underwent bibliometric analysis. Included studies were then grouped by type of research, summarised, and synthesised to produce a descriptive summary and overview of the field.

Results

The searches identified 5,975 articles. Following screening, 43 primary research studies were included in the scoping review. The scoping review, along with previous research, illustrates that psychological and psychosocial impacts are to be expected following major trauma. However, it also found that these aspects of care are commonly underserved and that there are inherent inequities across major trauma care pathways in the UK.

Conclusion

Though the scoping review identified a growing body of research investigating psychological and psychosocial aspects of major trauma care pathways in the UK, significant gaps in the evidence base remain. Research is needed to establish clinically effective psychological and psychosocial assessment tools, corresponding interventions, and patient-centred outcome measures so that survivors of major trauma (and family members or carers) receive the most appropriate care and intervention.
Organisational learning during the coronavirus pandemic: A case study on models for extended learning and complexity management
Authors: Laitinen Ilpo , Ihalainen Jarkko
Published: June 2022

This study examines learning in an exceptional situation. The study was carried out during the 2020 COVID-19 pandemic, when the organisations’ operations changed suddenly as the crisis broke out. The aim of the study is to structure activities during the crisis and the learning related to the adaptation of organisations. The study compares organisational learning in two different types of organisations, one in the health care sector and the other in the social construction and property sector.
Stress and Susceptibility: A Systematic Review of Prenatal Epigenetic Risks for Developing Post-Traumatic Stress Disorder
Authors: Pierce Zachary P. , Black Jessica M.
Published: June 2022

This review aims to systematically assess the current literature about prenatal epigenetic markers that lead to post-traumatic stress disorder susceptibility across the lifespan. Studies included in this review met several research criteria: Studies included (1) participants with a PTSD diagnosis according to the DSM-5, (2) prenatal epigenetic marker data that could be analyzed, and (3) explicit references to postnatal PTSD susceptibility. Our study sample fit within a timeframe of 2002 (the earliest recorded studies of prenatal susceptibility to post-traumatic stress disorder in the databases used) and February 2021 when the literature search for this review was terminated. Studies for this review were collated from PubMed, MEDLINE, Science Direct, and Boston College School of Social Work Library databases. A systematic search was conducted in these databases using basic keyword terms, such as “PSTD resilience” and “PTSD vulnerability,” and then adding clarifying terms to refine specific searches, such as “epigenetics,” “genetics,” “epigenetic markers,” “haplotypes,” and “mRNA methylation.” Based on these criteria and research methods, 33 studies remained for inclusion in the review sample. This review suggests that BDNF Val66-Met, a polymorphism of FKBP5, and an altered messenger ribonucleic acid methylation marker in NR3C1 present most often in cases of PTSD. These epigenetic markers might be implicated in central neurological processes related to post-traumatic stress disorder symptomatology.
Managing the COVID-19 crisis by fiscal strategies: Lessons from four countries
Authors: Shi Yu , Chen Can , Park Sungho
Published: June 2022

The COVID-19 Crisis is urgent, global in scale, and has generated a massive impact globally. During the outbreak of the crisis, well-designed fiscal strategies play a critical role in effective crisis management. This article uses an international and comparative perspective to find fiscal strategies used by four countries including China, South Korea, the United States, and Italy to manage the COVID-19 crisis for the period of April 2020 to December 2021. It examines key similarities and differences regarding to these major fiscal strategies adopted by the four countries. This article offers important lessons and summarizes effective practices for other countries that were considering fiscal strategies to manage and deal with the economic and fiscal impacts induced by the COVID-19 crisis.
Storying and Recovering the Self: A Journey Towards Transformation in Men in Addictions and Trauma Recovery
Authors: Jordan Daniel , Walker Jude
Published: June 2022

This paper examines the stories of transformative learning of two men reflecting on their recovery from addictions and trauma. We employ the Hero’s journey as a useful frame within which to understand their stories of becoming more and progressing towards a recovered self. The article challenges the dominant biomedical model of addiction, and of recovery as being primarily about abstinence. It also provides further evidence for understanding transformative learning as a process of (re)integration which is supported through archetypal storytelling.
Twitter as a leadership actor — A communication as constitutive of organizing perspective on a ‘leaderless’ social movement
Authors: Poon Marilyn , Kohlberger Martina
Published: June 2022

We applied a communication as constitutive of organizing (CCO) perspective in a case study to examine Twitter’s influence on the leadership dynamics in the 2019 Hong Kong Protests. We argue that Twitter is a powerful nonhuman leadership actor by demonstrating how it coordinates a plenum of co-participating agencies to construct meaningful narratives. In addition, we show that while many social movements call themselves leaderless, because of Twitter’s co-participation, they are not leadership-less. Using digital methods, we first harvested movement-relevant tweets based on hashtags and retweet counts from a key event of the protests, and then analysed the video content in the three most-retweeted tweets. Our analysis shows that Twitter’s various mechanisms dictate how online conversations unfold, and that Twitter therefore influences how “authoritative text” is established. Our study contributes to the literature in three ways. First, we contribute to critical leadership studies by showing that Twitter is a leadership actor that enacts sociomaterial leadership, which further challenges the dominant human-centric and masculine views of leadership. In doing so, we reveal that the persistent leaderless movement narrative is a fantasy. Second, by illustrating how Twitter’s authorship mechanisms generate authority and polarity, we contribute to a stream of CCO studies showing that platforms influence power dynamics. Third, by attending to multivocality and dissensus, where a myriad of voices could speak up against the established and perceived injustice, we assert that Twitter as a leadership actor dictates specific modes of communication with performative effects.
Analysis of perceptual errors in skull-base pathology
Authors: Vong Stephen , Chang Jennifer , Assadsangabi Reza , Ivanovic Vladimir
Published: June 2022

Purpose

Medical errors result in significant mortality and morbidity. The purpose of this study is to analyze skull-base errors at a single tertiary institution, identify common anatomic sites of errors, and offer strategies to reduce errors in this region.

Methods

A Neuroradiology Quality Assurance Database of radiologic errors was searched for attending physician computer tomography and magnetic resonance imaging errors in skull-base pathology from 2014 to 2020. Data were limited to CT and MRI reports. Errors were separated into four subcategories (tumor, trauma, vascular, and congenital) and further divided by relevant anatomic site.

Results

A total of 90 skull-based errors were identified. Most errors were perceptual (87%), with common study types including MRI Brain (39%) and CT Head (24%). Most common errors were tumors (55%), followed by trauma (24%), vascular (10%), and congenital (7%). Six anatomic sites were identified and encompassed over half of errors (58%): sella, occipital bone, cerebellopontine angle/internal auditory canal (CPA/IAC), foramen magnum and clivus, cavernous sinus, and dural venous sinus.

Most of the skull-base errors were perceptual. Placing a strong emphasis on both the pathology and closely examining its critical anatomic site (sella, occipital bone, CPA/IAC, foramen magnum and clivus, cavernous sinus, and dural venous sinus) could potentially reduce up to 60% of errors in these regions.
Recent developments of Madhuca indica (Mahua) oil-based polymers: A mini review
Authors: Ganvit Vikash M , Sharma Rakesh K
Published: June 2022

Nowadays, the use of non-edible vegetable oils as the raw material for polymer development is growing in interest because of the scarcity and high demand for crude oil and also because of its eco-friendly approach. The utilization of non-edible oil to synthesize the applicable polymers reduces the usage of petrochemicals. To eliminate the reliance on petrochemicals, it is important to search for and extract alternate and domestic non-edible oils suitable for the synthesis of polymeric materials. This is now a promising research approach. The outstanding feature of indigenous, non-edible Madhuca indica oil (MO) is its chemical structure, with unsaturated sites and esters that are considerable ingredient polyols for the development of polymers. This review discusses the origin, structure and extraction of MO and systematically focuses on the recently developed polymers using oil as a renewable source of polyols. We have briefly reviewed MO-based polymeric materials such as alkyd resins like pentaalkyds for scratch resistance, glycerol alkyds for fly-ash coating, pentalkyd LC resins for display coating applications and epoxies of MO for biological coating materials. Also, the important polyurethanes in the pathways of MO-based fatty amide are transformed into the polyetherimide polyols through a step-growth reaction with bisphenol-A or bisphenol derivatives, which again react with isocyanates to produce MO-based PU for excellent adhesion and coating applications. Another type of waterborne polyurethane is made from polyesteramides. These PU coatings are used in the paint and pigment industries. We reviewed their synthesis and widespread use in coatings and composites.
An analysis of design recommendations for socially assistive robot helpers for effective human-robot interactions in senior care
Authors: Robinson Fraser , Nejat Goldie
Published: June 2022

As the global population ages, there is an increase in demand for assistive technologies that can alleviate the stresses on healthcare systems. The growing field of socially assistive robotics (SARs) offers unique solutions that are interactive, engaging, and adaptable to different users’ needs. Crucial to having positive human-robot interaction (HRI) experiences in senior care settings is the overall design of the robot, considering the unique challenges and opportunities that come with novice users. This paper presents a novel study that explores the effect of SAR design on HRI in senior care through a results-oriented analysis of the literature. We provide key design recommendations to ensure inclusion for a diverse set of users. Open challenges of considering user preferences during design, creating adaptive behaviors, and developing intelligent autonomy are discussed in detail. SAR features of appearance and interaction mode along with SAR frameworks for perception and intelligence are explored to evaluate individual developments using metrics such as trust, acceptance, and intent to use. Drawing from a diverse set of features, SAR frameworks, and HRI studies, the discussion highlights robot characteristics of greatest influence in promoting wellbeing and aging-in-place of older adults and generates design recommendations that are important for future development.
Macular microcirculation changes after macula-off rhegmatogenous retinal detachment repair with silicone oil tamponade evaluated by OCT-A: preliminary results
Authors: Christou Evita Evangelia , Stavrakas Panagiotis , Georgalas Ilias , Batsos Georgios , Christodoulou Eleni , Stefaniotou Maria
Published: June 2022

Background:

Rhegmatogenous retinal detachment (RRD) with macular involvement is a sight-threatening condition. Silicone oil (SO) is efficacious for retinal tamponade, especially in complex cases. Whether macular detachment per se or the potential tamponading agent may affect macular microcirculation after RRD repair is a matter of research.

Objectives:

To investigate macular microcirculation changes using optical coherence tomography angiography (OCT-A) after pars plana vitrectomy (PPV) with intravitreal SO for RRD repair in the early posttreatment period.

Design:

Prospective comparative cross-sectional study.

Data sources and Methods:

Fourteen eyes of 14 patients were included in the study. All eyes underwent a single successful PPV with SO tamponade for macula-off RRD. OCT-A was performed to analyze macular microcirculation and visual outcomes at 1 month postoperatively. The fellow unaffected eye was used as control.

Results:

Vessel density (VD) in the superficial capillary plexus (SCP) was significantly lower at each macular region (fovea, parafovea, and perifovea) of SO-treated eyes compared with the fellow eyes (all p = 0.001). Similarly, perfusion density (PD) in the SCP was significantly lower at each macular region than the fellow eyes (all p = 0.001). There was enlargement of foveal avascular zone (FAZ) area and decrease of circularity at RRD eyes compared with the fellow ones (all p = 0.001). Postoperative logMAR visual acuity (VA) was significantly lower in treated eyes than fellow eyes and correlated inversely with foveal, parafoveal, and perifoveal VD and PD SCP (all p < 0.001). Postoperative VA had no correlation with FAZ parameters.

Conclusion:

Enlargement of FAZ SCP and decrease in VD and PD SCP during the short-term follow-up were possibly attributable to ischemic changes in the macular area after RRD repair with SO tamponade. In this preliminary study, the flow density in macular capillary plexus may represent an indicator of visual outcomes.
RCAN1-mediated calcineurin inhibition as a target for cancer therapy
Authors: Lao Mengyi , Zhang Xiaozhen , Yang Hanshen , Bai Xueli , Liang Tingbo
Published: June 2022

Cancer is the leading cause of mortality worldwide. Regulator of calcineurin 1 (RCAN1), as a patent endogenous inhibitor of calcineurin, plays crucial roles in the pathogenesis of cancers. Except for hypopharyngeal and laryngopharynx cancer, high expression of RCAN1 inhibits tumor progression. Molecular antitumor functions of RCAN1 are largely dependent on calcineurin. In this review, we highlight current research on RCAN1 characteristics, and the interaction between RCAN1 and calcineurin. Moreover, the dysregulation of RCAN1 in various cancers is reviewed, and the potential of targeting RCAN1 as a new therapeutic approach is discussed.
Assessment of Rice Sheath Blight Resistance Including Associations with Plant Architecture, as Revealed by Genome-Wide Association Studies
Authors: Li Danting , Zhang Fantao , Pinson Shannon R. M. , Edwards Jeremy D. , Jackson Aaron K. , Xia Xiuzhong , Eizenga Georgia C.
Published: June 2022

Background

Sheath blight (ShB) disease caused by Rhizoctonia solani Kühn, is one of the most economically damaging rice (Oryza sativa L.) diseases worldwide. There are no known major resistance genes, leaving only partial resistance from small-effect QTL to deploy for cultivar improvement. Many ShB-QTL are associated with plant architectural traits detrimental to yield, including tall plants, late maturity, or open canopy from few or procumbent tillers, which confound detection of physiological resistance.

Results

To identify QTL for ShB resistance, 417 accessions from the Rice Diversity Panel 1 (RDP1), developed for association mapping studies, were evaluated for ShB resistance, plant height and days to heading in inoculated field plots in Arkansas, USA (AR) and Nanning, China (NC). Inoculated greenhouse-grown plants were used to evaluate ShB using a seedling-stage method to eliminate effects from height or maturity, and tiller (TN) and panicle number (PN) per plant. Potted plants were used to evaluate the RDP1 for TN and PN. Genome-wide association (GWA) mapping with over 3.4 million SNPs identified 21 targeted SNP markers associated with ShB which tagged 18 ShB-QTL not associated with undesirable plant architecture traits. Ten SNPs were associated with ShB among accessions of the Indica subspecies, ten among Japonica subspecies accessions, and one among all RDP1 accessions. Across the 18 ShB QTL, only qShB4-1 was not previously reported in biparental mapping studies and qShB9 was not reported in the GWA ShB studies. All 14 PN QTL overlapped with TN QTL, with 15 total TN QTL identified. Allele effects at the five TN QTL co-located with ShB QTL indicated that increased TN does not inevitably increase disease development; in fact, for four ShB QTL that overlapped TN QTL, the alleles increasing resistance were associated with increased TN and PN, suggesting a desirable coupling of alleles at linked genes.

Conclusions

Nineteen accessions identified as containing the most SNP alleles associated with ShB resistance for each subpopulation were resistant in both AR and NC field trials. Rice breeders can utilize these accessions and SNPs to develop cultivars with enhanced ShB resistance along with increased TN and PN for improved yield potential.
Spring waters as an indicator of nitrate and pesticide pollution of rural watercourses from nonpoint sources: results of repeated monitoring campaigns since the early 2000s in the low mountain landscape of Saarland, Germany
Authors: Weber Gero , Kubiniok Jochen
Published: June 2022

Background

Spring waters, which are fed mainly by near-surface groundwater, provide a comprehensive picture of emissions of nitrate and other pollutants caused by the type and intensity of land use in the topographic catchment area. One aim of this study was to develop a model for predicting the contribution of nonpoint-source inputs to the nitrate load of small- and medium-sized watercourses based on the type of agricultural use in the catchment areas.

Methods

Fifty-five springs in the German Land Saarland and the adjacent Rhineland-Palatinate were monitored for pollutants during three monitoring periods of at least 12 months between 2000 and 2019. The catchment areas are representative of the natural regions in the study area and are outside the influence of settlements and other developments. In addition to nitrate and other physicochemical parameters, 25 agriculturally impacted springs were screened for pesticides and their metabolites.

Results

Since the first measurements were taken in 2000, the vast majority of agriculturally impacted springs have consistently exhibited high nitrate concentrations of between 20 and 40 mg/L NO3−. Springs not influenced by agriculture contained an average of 3.6 mg/L nitrate. The extreme values observed in the early 2000s decreased to the limit value of 50 mg/L, but most of the springs with moderate levels exhibited an increase to approximately 30 mg/L. The number of pesticidal agents detected in the spring waters demonstrated a clear correlation with the watershed’s amount of arable land and the nitrate content detected. Moreover, we found a highly significant correlation between nitrate content and the share of cropland in the catchment area. From this, we derived a regression model that could be used to quantify the share of nitrate pollution attributable to nonpoint-source inputs for larger catchments in the region under investigation.

Conclusion

Nitrate discharged from farmland has not decreased since the European Water Framework Directive (EU WFD) entered into force. At the historically extremely heavily polluted sites, measures have been implemented that have led to compliance with the limit value of the Nitrate Directive. However, below this limit, nitrate levels have increased significantly almost everywhere in the last two decades. We therefore recommend introducing stricter requirements for official water pollution control, such as the marine ecological target value.
rprimer: an R/bioconductor package for design of degenerate oligos for sequence variable viruses
Authors: Persson Sofia , Larsson Christina , Simonsson Magnus , Ellström Patrik
Published: June 2022

Background

This paper presents a new R/Bioconductor package, rprimer, for design of degenerate oligos and PCR assays for sequence variable viruses. A multiple DNA sequence alignment is used as input data, while the outputs consist of comprehensive tables (data frames) and dashboard-like plots. The workflow can be run directly from the R console or through a graphical user interface (Shiny application). Here, rprimer is demonstrated and evaluated by using it to design two norovirus genogroup I (GI) assays: one RT-qPCR assay for quantitative detection and one RT‑PCR assay for Sanger sequencing and polymerase-capsid based genotyping.

Results

The assays generated were evaluated using stool samples testing positive for norovirus GI. The RT-qPCR assay accurately amplified and quantified all samples and showed comparable performance to a widely-used standardised assay, while the RT-PCR assay resulted in successful sequencing and genotyping of all samples. Merits and limitations of the package were identified through comparison with three similar freely available software packages. Several features were comparable across the different tools, but important advantages of rprimer were its speed, flexibility in oligo design and capacity for visualisation.

Conclusions

An R/Bioconductor package, rprimer, was developed and shown to be successful in designing primers and probes for quantitative detection and genotyping of a sequence-variable virus. The package provides an efficient, flexible and visual approach to degenerate oligo design, and can therefore assist in virus research and method development.
Comparison between erector spinae plane block and paravertebral block regarding postoperative analgesic consumption following breast surgery: a randomized controlled study
Authors: Elewa Ahmed M. , Faisal Mohammed , Sjöberg Folke , Abuelnaga Mohamed E.
Published: June 2022

Background

Pain control following breast surgery is of utmost importance in order to reduce the chance of chronic pain development, and facilitate early rehabilitation. The erector spinae plane block (ESPB) is a recently developed regional anaesthesia procedure successfully used for different types of surgical procedures including thoracic and abdominal surgeries.

Methods

A double-blind, randomized, controlled trial was conducted on 90 patients who were scheduled for modified radical mastectomy (MRM). Patients were randomly categorized into groups I (women who underwent ESPB), II (women who underwent paravertebral block (PVB), and III (women who underwent general anaesthesia).

Results

The ESPB (4.9 ± 1.2 mg) and PVB (5.8 ± 1.3 mg) groups had significantly lower total morphine consumption than the control group had (16.4 ± 3.1 mg; p < 0.001). Notably, patients in the ESPB group had insignificantly lower morphine consumption than those in the PVB group had (p = 0.076). Moreover, patients in the ESPB and PVB groups had a significantly longer time to first required anaesthesia than those in the control group (7.9 ± 1.2 versus 7.5 ± 0.9 versus 2 ± 1.2 h, respectively; p < 0.001). The postoperative visual analog scale scores were lower in the ESPB and PVB groups than in the control group on the first 24 h after the procedure (p < 0.001).

Conclusion

ESPB and PVB provide effective postoperative analgesia for women undergoing MRM. The ESPB appears to be as effective as the PVB.

Trial registration

The study was registered before the enrolment of the first patient at the Pan African Clinical Trial Registry (www.pactr.org) database. Identification number for the registry is (PACTR202008836682092).
A poor outcome in non-occlusive thrombo-embolic limb ischaemia related to the dislocation of mural thrombus from an abdominal aortic aneurysm
Authors: Li Ying-Sheng , Li Ying-Ching
Published: June 2022

Background

Acute thrombosis of an abdominal aortic aneurysm with acute limb ischaemia is an unusual complication and is associated with high mortality. Dislocation of the intrasaccular mural thrombus could be one of the mechanisms. For the most part, acute limb ischaemia presents with absent pulses, compatible with the clinical findings, which include pain, paraesthesia, and paralysis. Herein, we report a rare condition with detectable distal pulses in advanced limb ischaemia due to poor perfusion caused by the dislocation of mural thrombus from an abdominal aortic aneurysm.

Case presentation

A 74-year-old male patient with underlying hypertension and chronic renal disease presented at the emergency room with bilateral lower limb paralysis after falling on his back in the bathroom an hour prior. He reported numbness and weakness of his lower limbs, which was gradually worsening, over the past week. Physical examination showed cyanotic mottling of the lower limbs with paralysis. However, the dorsalis pedis pulse was intact. Computed tomography angiography showed a 7.3 cm abdominal aortic aneurysm containing highly irregular mural thrombus in the early phase, with slow perfusion of the contrast medium in the arteries below the bifurcation during the delayed phase. After traumatic spinal injury was excluded, an emergent endovascular aneurysm repair was performed. Although vital signs were initially stable post-surgery, both lower limbs were still paralysed and did not improve. He then experienced reperfusion injury with metabolic acidosis. There was no urine output despite intravenous hydration. Laboratory data included potassium 7.7 mEq/L, lactate 110 mg/dL, white blood cells 23,700/uL, and myoglobin 46,590 ng/mL. Even under critical medical care and continuous venovenous hemofiltration, his hemodynamic status worsened. He developed hypotension and needed endotracheal intubation because of loss of consciousness and respiratory failure. The patient finally died due to ventricular tachycardia even after several rounds of cardiopulmonary resuscitation with cardioversion.

Conclusion

The unusual clinical presentation of detectable lower limb pulses in advanced limb ischaemia showed that poor blood perfusion related to dislocation of mural thrombus in abdominal aortic aneurysm might mislead clinicians and delay accurate diagnosis and treatment.
Examining telehealth use among primary care patients, providers, and clinics during the COVID-19 pandemic
Authors: Der-Martirosian Claudia , Chu Karen , Steers W. Neil , Wyte-Lake Tamar , Balut Michelle D. , Dobalian Aram , Heyworth Leonie , Paige Neil M. , Leung Lucinda
Published: June 2022

Background

At the onset of COVID-19, there was a rapid expansion of telehealth (video/telephone) visits to maintain delivery of primary care (PC) services at the Veterans Health Administration (VA). This study examines patient, provider, and site-level characteristics of any virtual and video-based care in PC.

Methods

Interrupted time series (ITS) design was conducted using VA administrative/clinical, electronic healthcare data, 12-months before and 12-months after COVID-19 onset (set at March 2020) at the VA Greater Los Angeles Healthcare System (GLA), between 2019 and 2021. Patients with at least one visit to a VA PC clinic at GLA (n = 547,730 visits) were included in the analysis. The two main outcomes for this study were 1) any telehealth (versus in-person), as well as 2) video-based care (versus telephone). For the ITS analysis, segmented logistic regression on repeated monthly observations of any telehealth and video-based care was used.

Results

Percent telehealth and video use increased from 13.9 to 63.1%, and 0.3 to 11.3%, respectively, before to after COVID-19 onset. According to adjusted percentages, GLA community-based clinics (37.7%, versus 29.8% in hospital-based clinics, p < .001), social workers/pharmacists/dietitians (53.7%, versus 34.0% for PC clinicians, p < .001), and minority groups, non-Hispanic African Americans (36.3%) and Hispanics (34.4%, versus 35.3% for Whites, p < .001) were more likely to use telephone than video. Conversely, mental health providers (43.3%) compared to PC clinicians (15.3%), and women (for all age groups, except 75+) compared to men, were more likely to use video than telephone (all p’s < .001).

Conclusions

Since telehealth care provision is likely to continue after COVID-19, additional research is needed to identify which PC outpatient services are better suited for telephone (e.g., case management) versus video-based care (e.g., integrated mental health visits). Additionally, it is important to understand how all clinics can systematically increase access to both telephone- and video-based PC services, while ensuring equitable care for all patient populations.
Direct intracranial invasion of eccrine spiradenocarcinoma of the scalp: a case report and literature review
Authors: Kibe Yuji , Tanahashi Kuniaki , Ohtakara Kazuhiro , Okumura Yuka , Ohka Fumiharu , Takeuchi Kazuhito , Nagata Yuichi , Motomura Kazuya , Akahori Sho , Mizuno Akihiro , Sasaki Hiroo , Shimizu Hiroyuki , Yamaguchi Junya , Nishikawa Tomohide , Yokota Kenji , Saito Ryuta
Published: June 2022

Background

Eccrine spiradenocarcinoma (SC), also known as malignant eccrine spiradenoma, is a rare malignant cutaneous adnexal neoplasm arising from long-standing benign eccrine spiradenoma. Malignant skin tumors rarely show direct intracranial invasion. However, once the intracranial structure is infiltrated, curative excision with sufficient margins can become extremely difficult, particularly when the venous sinuses are involved. No effective adjuvant therapies have yet been established. Here, we report an extremely rare case of scalp eccrine SC with direct intracranial invasion, which does not appear to have been reported previously.

Case presentation

An 81-year-old woman presented with a large swelling on the parietal scalp 12 years after resection of spiradenoma from the same site. The tumor showed intracranial invasion with involvement of the superior sagittal sinus and repeated recurrences after four surgeries with preservation of the sinus. The histopathological diagnosis was eccrine SC. Adjuvant high-precision external beam radiotherapy (EBRT) proved effective after the third surgery, achieving remission of the residual tumor. The patient died 7 years after the first surgery for SC.

Conclusions

Scalp SC with direct intracranial invasion is extremely rare. Radical resection with tumor-free margins is the mainstay of treatment, but the involvement of venous sinuses makes this unfeasible. High-precision EBRT in combination with maximal resection preserving the venous sinuses could be a treatment option for local tumor control.
Posterior reversible encephalopathy syndrome secondary to acute post-streptococcal glomerulonephritis in a child: a case report from the Tibetan plateau
Authors: Bazhu  , Shi Yanhui , Ren Shuang , Shu Liang , Li Qiang
Published: June 2022

Background

Posterior reversible encephalopathy syndrome (PRES) is a disorder of reversible vasogenic brain oedema with acute neurologic symptoms. It is a rare but serious disease that affects the central nervous system. PRES is a rare complication of acute post-streptococcal glomerulonephritis (APSGN). High altitude can accelerate vasogenic brain oedema by increasing cerebral blood flow (CBF), impairing cerebral autoregulation and promoting vascular inflammation. We report a case of PRES induced by acute post-streptococcal glomerulonephritis in a high-altitude environment.

Case presentation

A fourteen-year-old Tibetan girl presented with progressive headache with haematuria, facial swelling, dizziness and vomiting for 2 weeks as well as multiple episodes of tonic–clonic seizures for 14 h. She was diagnosed with APSGN based on laboratory tests and clinical symptoms. Brain magnetic resonance imaging (MRI) and computed tomography (CT) revealed bilateral frontal, parietal and occipital lesions that were compatible with the radiological diagnosis of PRES. The treatments included an antibiotic (penicillin), an antiepileptic drug, and hyperbaric oxygen (HBO) therapy. Follow-up MRI obtained 1 week after admission and CT obtained 4 weeks and 6 weeks after admission demonstrated complete resolution of the brain lesions.

Conclusions

The case illustrates a rare occurrence of PRES following APSGN in a 14-year-old child in the Tibetan Plateau. The hypoxic conditions of a high-altitude setting might lower the cerebral autoregulation threshold and amplify the endothelial inflammatory reaction, thus inducing PRES in patients with APSGN. It is important to recognize the clinical and radiologic features of PRES, and adjuvant HBO therapy can promote rapid recovery from this condition in high-altitude areas.
Anti-N-methyl-D-aspartate receptor encephalitis: characteristics and rapid diagnostic approach in the emergency department
Authors: Xu Jin , Zhao Na , Guan Hongzhi , Walline Joseph Harold , Zhu Huadong , Yu Xuezhong
Published: June 2022

Background

Anti-N-methyl-D-aspartate receptor (anti-NMDAR) encephalitis is a common type of autoimmune encephalitis. Patients with this condition are frequently very ill but are often misdiagnosed in the Emergency Department (ED). The objective of this study was to analyze the clinical characteristics of anti-NMDAR patients in the ED and to identify any associations with a diagnosis of anti-NMDAR encephalitis.

Methods

We performed a retrospective analysis of a prospectively obtained cohort of ED patients from May 2011 to December 2017. We identified patients diagnosed with anti-NMDAR encephalitis in this cohort and extracted key patient characteristics and clinical data, including patient gender, age, presentation, modified Rank Score (m-RS), laboratory test results, significant treatments, and mortality.

Results

Eighty-seven patients with anti-NMDAR encephalitis were identified. 54 (62.1%) were female, 23 (26.4%) were < 18 years old, 14 (16.1%) had teratoma, and 45 (51.7%) had an m-RS ≥ 4. Fever, altered mental status, and seizures were the most common symptoms, with a > 50% incidence of each symptom in the cohort. The sensitivity of CSF oligoclonal band (OB) testing was 78.9%. 22 (25.3%) were admitted to the ICU, 20 (23.0%) patients were intubated, but only one patient died (1.1%). 47 (54.0%) were misdiagnosed prior to ED arrival. All patients underwent immunotherapy as first-line treatment for anti-NMDAR encephalitis.

Conclusions

A majority of anti-NMDAR encephalitis patients presenting to the ED were female and were likely to be misdiagnosed prior to arrival. Patients with symptoms of fever, altered mental status, and seizures need a lumbar puncture, including CSF OB testing, for definitive diagnosis.
Emodin inhibits invasion and migration of hepatocellular carcinoma cells via regulating autophagy-mediated degradation of snail and β-catenin
Authors: Qin Binyu , Zeng Zhili , Xu Jianliang , Shangwen Jing , Ye Zeng Jie , Wang Shutang , Wu Yanheng , Peng Gongfeng , Wang Qi , Gu Wenyi , Tang Ying
Published: June 2022

Background

Previous studies reported that emodin extracted from Rheum palmatum L. exerts antiproliferation and antimetastatic effects in a variety of human cancer types. However, the role of emodin in hepatocellular carcinoma (HCC) remain unknown.

Methods

EdU and colony formation assays were performed to evaluate the effects of emodin on proliferation. The mobility capacities of HCC treated with emodin were evaluated using wound healing assay. Transwell invasion and migration assays were performed to evaluate anti-migratory and anti-invasive effects of emodin on HCC. Annexin V-FITC/PI was performed to analyze the apoptosis. PI stain was performed to analyze cell cycle. RNA sequencing technology was used to identify the differentially expressed genes (DEGs) induced by emodin in HCC. The impact of emodin on autophagic flux in HepG2 cells was examined by mCherry-GFP-LC3 analysis. Western blot was used to assess the protein expressions of epithelial-mesenchymal transition (EMT), autophagy, PI3K/AKT/mTOR and Wnt/β-catenin signaling pathway.

Results

We found that emodin inhibited the growth of HepG2 cells in a dose- and time-dependent manner. In addition, emodin inhibited cell proliferation, induced S and G2/M phases arrest, and promoted apoptosis in HepG2 cells. The migration and invasion of HepG2 cells were also suppressed by emodin. Enrichment analysis revealed that DEGs involved in cell adhesion, cancer metastasis and cell cycle arrest. Moreover, western bolt results show that emodin-induced autophagy promotes Snail and β-catenin degradation. We also found that blocking autophagic flux after emodin treatment caused EMT reversal. Furthermore, the PI3K agonist Y-P 740 significantly reversed the phosphorylation levels of GSK3β and mTOR. These results indicated that emodin induced autophagy and inhibited the EMT in part through suppression of the PI3K/AKT/mTOR and Wnt/β-catenin pathways.

Conclusion

Our study indicated that emodin inhibited cell metastasis in HCC via the crosstalk between autophagy and EMT.
Predictive value of baseline metabolic tumor volume in early-stage favorable Hodgkin Lymphoma – Data from the prospective, multicenter phase III HD16 trial
Authors: van Heek Lutz , Stuka Colin , Kaul Helen , Müller Horst , Mettler Jasmin , Hitz Felicitas , Baues Christian , Fuchs Michael , Borchmann Peter , Engert Andreas , Dietlein Markus , Voltin Conrad-Amadeus , Kobe Carsten
Published: June 2022

Background

18F -fluorodeoxyglucose (FDG) positron emission tomography (PET) plays an important role in the staging and response assessment of lymphoma patients. Our aim was to explore the predictive relevance of metabolic tumor volume (MTV) and total lesion glycolysis (TLG) in patients with early stage Hodgkin lymphoma treated within the German Hodgkin Study Group HD16 trial.

Methods

18F-FDG PET/CT images were available for MTV and TLG analysis in 107 cases from the HD16 trial. We calculated MTV and TLG using three different threshold methods (SUV4.0, SUV41% and SUV140%L), and then performed receiver-operating-characteristic analysis to assess the predictive impact of these parameters in predicting an adequate therapy response with PET negativity after 2 cycles of chemotherapy.

Results

All three threshold methods analyzed for MTV and TLG calculation showed a positive correlation with the PET response after 2 cycles chemotherapy. The largest area under the curve (AUC) was observed using the fixed threshold of SUV4.0 for MTV- calculation (AUC 0.69 [95% CI 0.55–0.83]) and for TLG-calculation (AUC 0.69 [0.55–0.82]). The calculations for MTV and TLG with a relative threshold showed a lower AUC: using SUV140%L AUCs of 0.66 [0.53–0.80] for MTV and 0.67 for TLG [0.54–0.81]) were observed, while with SUV41% an AUC of 0.61 [0.45–0.76] for MTV, and an AUC 0.64 [0.49–0.80]) for TLG were seen.

Conclusions

MTV and TLG do have a predictive value after two cycles ABVD in early stage Hodgkin lymphoma, particularly when using the fixed threshold of SUV4.0 for MTV and TLG calculation.

Trial registration

ClinicalTrials.gov NCT00736320.
Irregular delay of adjuvant chemotherapy correlated with poor outcome in stage II-III colorectal cancer
Authors: Chen Yuanyuan , Xu Mingyue , Ye Qianwen , Xiang Jia , Xue Tianhui , Yang Tao , Liu Long , Yan Bing
Published: June 2022

Aims

Adjuvant chemotherapy (ACT) plays an important role in improving the survival of stage II-III colorectal cancer (CRC) patients after curative surgery. However, the prognostic role of irregular delay of ACT (IDacT) for these patients has been less studied.

Materials and methods

A total of 117 stage II-III CRC patients who underwent radical resection and received at least 3 months ACT were enrolled retrospectively. The significance of IDacT, including total delay (TD) and delaypercycle (DpC), in predicting disease-free survival (DFS) was determined using receiver operating characteristic curve (ROC) analysis. The survival differences between the TD, DpC-short and DpC-long subgroups were tested using Kaplan–Meier analysis, and risk factors for prognosis were determined using a Cox proportional hazards model.

Results

Using 35.50 and 3.27 days as the optimal cut-off points for TD and DpC, respectively, ROC analysis revealed that TD and DpC had sensitivities of 43.60% and 59.00% and specificities of 83.30% and 62.80%, respectively, in predicting DFS (both P < 0.05). No differences in the clinicopathological parameters were found between the TD, DpC-short or -long subgroups except histological differentiation in different TD subgroups and combined T stages in different DpC subgroups (bothP = 0.04). Patients in the TD or DpC-long group exhibited significantly worse survival than in the -short group (TD: Log rank = 9.11, P < 0.01; DpC: Log rank = 6.09,P = 0.01). DpC was an independent risk factor for prognosis (HR = 2.54, 95% CI: 1.32–4.88,P = 0.01).

Conclusions

IDacT had a profound effect on the outcome for stage II-III CRC. Although TD and DpC were significant for the prognosis, DpC was more robust, and patients who presented DpC for a long time had a significantly worse DFS.