bluuebunny/crossref_metadata_2025 huggingface dataset:
Intra-fractional dosimetric analysis of image-guided intracavitary brachytherapy of cervical cancer
Authors: Yan Junfang , Zhu Jiawei , Chen Kai , Yu Lang , Zhang Fuquan
Published: August 2021

Background

To assess the intra-fractional dosimetric variations of image-guided brachytherapy of cervical cancer.

Methods

A total of 38 fractions (9 patients) undergoing brachytherapy for cervical cancer underwent a CT scanning for treatment planning (planning CT) and a Cone-beam CT (CBCT) scanning immediately prior to delivery (pre-delivery CBCT). The variations of volumes as well as the dosimetric impact from treatment planning to delivery (intra-application) were evaluated. The dose volume histogram parameters including volume, D90 of high-risk clinical target volume (HRCTV) and D2cc of organs at risk (OARs) were recorded.

Results

The relative differences (mean ± 1SD) of the volume and D90 HRCTV across the two scans were − 2.0 ± 3.3% and − 1.2 ± 4.5%, respectively. The variations of D2cc for bladder, rectum, sigmoid and small intestine are − 0.6 ± 17.1%, 9.3 ± 14.6%, 7.2% ± 20.5% and 1.5 ± 12.6%, respectively. Most of them are statistically nonsignificant except the D2cc for rectum, which showed a significant increase (P = 0.001). Using 5% and 10% uncertainty of physical dose for HRCTV at a 6 Gy × 5 high-dose-rate schedule, the possibility of total equivalent doses in 2 Gy fractions (EQD2) lower than 85 Gy is close to 0% and 3%, respectively. Performing similar simulation at 15% and 20% uncertainty of a 4 Gy physical dose for OARs, the possibility of total EQD2 dose exceeding 75 Gy is about 70%. Less than 1% of the total EQD2 of OARs would exceed 80 Gy.

Conclusions

Average intra-fractional dosimetric variation of HRCTV was small in an interval of less than 1 h, and the possibility of total EQD2 exceeding 85 Gy is higher than 97%. The intra-fractional dosimetric variations of OARs might result in an overdose for OARs in a single fraction or the whole treatment. It is necessary to detect unfavorable anatomical changes by re-imaging and take interventions to minimize applied doses and reduce the risk of complications.
Dosimetric benefits of daily treatment plan adaptation for prostate cancer stereotactic body radiotherapy
Authors: Eckl Miriam , Sarria Gustavo R. , Springer Sandra , Willam Marvin , Ruder Arne M. , Steil Volker , Ehmann Michael , Wenz Frederik , Fleckenstein Jens
Published: August 2021

Background

Hypofractionation is increasingly being applied in radiotherapy for prostate cancer, requiring higher accuracy of daily treatment deliveries than in conventional image-guided radiotherapy (IGRT). Different adaptive radiotherapy (ART) strategies were evaluated with regard to dosimetric benefits.

Methods

Treatments plans for 32 patients were retrospectively generated and analyzed according to the PACE-C trial treatment scheme (40 Gy in 5 fractions). Using a previously trained cycle-generative adversarial network algorithm, synthetic CT (sCT) were generated out of five daily cone-beam CT. Dose calculation on sCT was performed for four different adaptation approaches: IGRT without adaptation, adaptation via segment aperture morphing (SAM) and segment weight optimization (ART1) or additional shape optimization (ART2) as well as a full re-optimization (ART3). Dose distributions were evaluated regarding dose-volume parameters and a penalty score.

Results

Compared to the IGRT approach, the ART1, ART2 and ART3 approaches substantially reduced the V37Gy(bladder) and V36Gy(rectum) from a mean of 7.4cm3and 2.0cm3to (5.9cm3, 6.1cm3, 5.2cm3) as well as to (1.4cm3, 1.4cm3, 1.0cm3), respectively. Plan adaptation required on average 2.6 min for the ART1 approach and yielded doses to the rectum being insignificantly different from the ART2 approach. Based on an accumulation over the total patient collective, a penalty score revealed dosimetric violations reduced by 79.2%, 75.7% and 93.2% through adaptation.

Conclusion

Treatment plan adaptation was demonstrated to adequately restore relevant dose criteria on a daily basis. While for SAM adaptation approaches dosimetric benefits were realized through ensuring sufficient target coverage, a full re-optimization mainly improved OAR sparing which helps to guide the decision of when to apply which adaptation strategy.
Neonatal cardiogenic shock revealing obstructive cardiac Hibernoma: case report
Authors: Gribaa Rym , Kacem Marwen , Ouannes Sami , Majdoub Wiem , Thabet Houssem , Ali Imen Ben , Elheraiche Aymen , Slim Mehdi , Hmissa Sihem , Neffati Elyes , Cherif Taieb , Kortas Chokri , Marah Jamli , Jerbi Sofiene
Published: August 2021

Background

Cardiac Hibernomas are very rare benign tumors and usually remain asymptomatic. Neonatal cardiogenic shock due to cardiac tumors is extremely very rare. Until this date a few cases of cardiac hibernoma have been reported in the literature.

Transthoracic echocardiography help in the differential diagnosis, but the definitive diagnosis is histological. The management strategy is not clearly codified.

The Aim is to report and discuss the clinical features of a cardiac Hibernoma and review the relevant literature.

Case presentation

We describe a case of a 2-day-old Caucasian full-term male neonate admitted in neonate intensive care with cardiogenic shock, having fluid resuscitation and inotropic drugs. Ventilatory support was started immediately with the subsequent reestablishment of normal blood pressure. Then he was transferred to the echocardiography laboratory.

Transthoracic echocardiography showed two echogenic masses in the right atrium and right ventricle.

The masses were extended to the pulmonary trunk. Pulmonary artery flow measurements showed the presence of pulmonary and tricuspid obstruction.

Surgery was rapidly considered since the baby was hemodynamically unstable.

Intraoperative evaluation showed a mass embedded in the interventricular septum that occupy the right ventricular cavity and the right atrium. The tumor involved also the chordae of the tricuspid. Partial resection was done. Tricuspid valve repair was performed by construction of new chordae from the autologous pericardium. The specimen was sent for histopathological analysis. The baby died immediately after surgery.

Histological examination of the surgical specimen revealed clear multivacuolated cells filled with lipid droplets and granular intense eosinophilic cytoplasm which confirms the diagnosis of Hibernoma.

Conclusion

Cardiac Hibernomas are rare benign tumors. The prognosis and treatment strategy is closely dependent on the location, initial clinical presentation and possible complications. The prognosis can be unfavorable if the tumor was obstructive and infiltrate the myocardium.
Descending thoracic aorta–abdominal aortic bypass and bilateral renal arterial blood circulation reconstruction are effective in atypical coarctation of the aorta with heart failure: a case report
Authors: Mikami Takuma , Kamada Takeshi , Yano Toshiyuki , Nakajima Tomohiro , Yasuda Naomi , Shibata Tsuyoshi , Nakanishi Keitaro , Harada Ryo , Naraoka Syuichi , Toda Kojiro , Nagano Nobutaka , Muranaka Atsuko , Kawaharada Nobuyoshi
Published: August 2021

Background

There are a lot of reports of the renal failure and heart failure due to coarctation of the aorta. However, there are no case reports in which revascularization dramatically improved left ventricular function in patients with progressive decline in left ventricular function. Herein, we present a rare case in which the left ventricular function was dramatically improved by surgical treatment for progressive left ventricular dysfunction due to atypical coarctation of the aorta.

Case presentation

A 58-year-old man underwent left axillary artery-bilateral femoral artery bypass at another hospital for atypical coarctation of the aorta due to Takayasu’s arteritis. Approximately 10 years later, he was re-hospitalized for heart failure, and the left ventricular ejection fraction gradually decreased to 28%. Computed tomography showed severe calcification and stenosis at the same site from the peripheral thoracic descending aorta to the lower abdominal aorta of the renal artery, and aortography showed delayed bilateral renal artery blood flow. An increase in plasma renin activity was also observed. Despite the administration of multiple antihypertensive drugs, blood pressure control was insufficient. We decided to perform surgical treatment to improve progressive cardiac dysfunction due to increased afterload and activated plasma renin activity. Descending thoracic aorta-abdominal aorta bypass and revascularization of the bilateral renal arteries via the great saphenous vein grafts were performed. Postoperative blood pressure control was improved, and the dose of antihypertensive drugs could be reduced. Plasma renin activity decreased, and transthoracic echocardiography 1.5 years later showed an improvement in contractility with a left ventricular ejection fraction of 58%.

Conclusion

In atypical coarctation of the aorta in patients with decreased bilateral renal blood flow, heart failure due to renal hypertension, and progressive decrease in left ventricular contractility, descending thoracic aorta-abdominal aortic bypass and bilateral renal artery recirculation can be extremely effective.
Total endoscopic left ventricle lipoma removal
Authors: Langenaeken Tom , Basoglu Aydin , Kaya Abdullah , Yilmaz Alaaddin
Published: August 2021

Background

Left ventricle (LV) lipoma is a very rare, benign cardiac tumor. Due to its rarity, LV lipoma is often misdiagnosed. Aspecific symptoms such as murmurs, arrhythmias, memory loss and palpitation may occur due to the mass effect.

Case presentation

We report a case report of a 42 year old woman who was found to have left ventricle mass after check-up for arrhytmia. By a fully endoscopic approach, the mass was successfully resected from the left ventricle without the need for sternotomy.

Conclusion

Total endoscopic removal of left ventricle lipoma’s can be done safely and has several advantages to conventional sternotomy. Larger studies are needed to confirm this hypothesis.
The impact of prehospital tranexamic acid on mortality and transfusion requirements: match-pair analysis from the nationwide German TraumaRegister DGU®
Authors: Imach Sebastian , Wafaisade Arasch , Lefering Rolf , Böhmer Andreas , Schieren Mark , Suárez Victor , Fröhlich Matthias ,   TraumaRegister DGU
Published: August 2021

Background

Outcome data about the use of tranexamic acid (TXA) in civilian patients in mature trauma systems are scarce. The aim of this study was to determine how severely injured patients are affected by the widespread prehospital use of TXA in Germany.

Methods

The international TraumaRegister DGU® was retrospectively analyzed for severely injured patients with risk of bleeding (2015 until 2019) treated with at least one dose of TXA in the prehospital phase (TXA group). These were matched with patients who had not received prehospital TXA (control group), applying propensity score-based matching. Adult patients (≥ 16) admitted to a trauma center in Germany with an Injury Severity Score (ISS) ≥ 9 points were included.

Results

The matching yielded two comparable cohorts (n = 2275 in each group), and the mean ISS was 32.4 ± 14.7 in TXA group vs. 32.0 ± 14.5 in control group (p = 0.378). Around a third in both groups received one dose of TXA after hospital admission. TXA patients were significantly more transfused (p = 0.022), but needed significantly less packed red blood cells (p ≤ 0.001) and fresh frozen plasma (p = 0.023), when transfused. Massive transfusion rate was significantly lower in the TXA group (5.5% versus 7.2%, p = 0.015). Mortality was similar except for early mortality after 6 h (p = 0.004) and 12 h (p = 0.045). Among non-survivors hemorrhage as leading cause of death was less in the TXA group (3.0% vs. 4.3%, p = 0.021). Thromboembolic events were not significantly different between both groups (TXA 6.1%, control 4.9%, p = 0.080).

Conclusion

This is the largest civilian study in which the effect of prehospital TXA use in a mature trauma system has been examined. TXA use in severely injured patients was associated with a significantly lower risk of massive transfusion and lower mortality in the early in-hospital treatment period. Due to repetitive administration, a dose-dependent effect of TXA must be discussed.
Bone marrow mesenchymal stem cells promote remyelination in spinal cord by driving oligodendrocyte progenitor cell differentiation via TNFα/RelB-Hes1 pathway: a rat model study of 2,5-hexanedione-induced neurotoxicity
Authors: Li Shuangyue , Guan Huai , Zhang Yan , Li Sheng , Li Kaixin , Hu Shuhai , Zuo Enjun , Zhang Cong , Zhang Xin , Gong Guanyu , Wang Ruoyu , Piao Fengyuan
Published: August 2021

Background

N-hexane, with its metabolite 2,5-hexanedine (HD), is an industrial hazardous material. Chronic hexane exposure causes segmental demyelination in the peripheral nerves, and high-dose intoxication may also affect central nervous system. Demyelinating conditions are difficult to treat and stem cell therapy using bone marrow mesenchymal stem cells (BMSCs) is a promising novel strategy. Our previous study found that BMSCs promoted motor function recovery in rats modeling hexane neurotoxicity. This work aimed to explore the underlying mechanisms and focused on the changes in spinal cord.

Methods

Sprague Dawley rats were intoxicated with HD (400 mg/kg/day, i.p, for 5 weeks). A bolus of BMSCs (5 × 107 cells/kg) was injected via tail vein. Demyelination and remyelination of the spinal cord before and after BMSC treatment were examined microscopically. Cultured oligodendrocyte progenitor cells (OPCs) were incubated with HD ± BMSC-derived conditional medium (BMSC-CM). OPC differentiation was studied by immunostaining and morphometric analysis. The expressional changes of Hes1, a transcription factor negatively regulating OPC-differentiation, were studied. The upstream Notch1 and TNFα/RelB pathways were studied, and some key signaling molecules were measured. The correlation between neurotrophin NGF and TNFα was also investigated. Statistical significance was evaluated using one-way ANOVA and performed using SPSS 13.0.

Results

 The demyelinating damage by HD and remyelination by BMSCs were evidenced by electron microscopy, LFB staining and NG2/MBP immunohistochemistry. In vitro cultured OPCs showed more differentiation after incubation with BMSC-CM. Hes1 expression was found to be significantly increased by HD and decreased by BMSC or BMSC-CM. The change of Hes1 was found, however, independent of Notch1 activation, but dependent on TNFα/RelB signaling. HD was found to increase TNFα, RelB and Hes1 expression, and BMSCs were found to have the opposite effect. Addition of recombinant TNFα to OPCs or RelB overexpression similarly caused upregulation of Hes1 expression. The secretion of NGF by BMSC and activation of NGF receptor was found important for suppression of TNFα production in OPCs.

Conclusions

 Our findings demonstrated that BMSCs promote remyelination in the spinal cord of HD-exposed rats via TNFα/RelB-Hes1 pathway, providing novel insights for evaluating and further exploring the therapeutical effect of BMSCs on demyelinating neurodegenerative disease.
On a new linear operator formulated by Airy functions in the open unit disk
Authors: Ibrahim Rabha W. , Baleanu Dumitru
Published: August 2021

In this note, we formulate a new linear operator given by Airy functions of the first type in a complex domain. We aim to study the operator in view of geometric function theory based on the subordination and superordination concepts. The new operator is suggested to define a class of normalized functions (the class of univalent functions) calling the Airy difference formula. As a result, the suggested difference formula joining the linear operator is modified to different classes of analytic functions in the open unit disk.
Integration of global metabolomics and lipidomics approaches reveals the molecular mechanisms and the potential biomarkers for postoperative recurrence in early-stage cholangiocarcinoma
Authors: Padthaisong Sureerat , Phetcharaburanin Jutarop , Klanrit Poramate , Li Jia V. , Namwat Nisana , Khuntikeo Narong , Titapun Attapol , Jarearnrat Apiwat , Wangwiwatsin Arporn , Mahalapbutr Panupong , Loilome Watcharin
Published: August 2021

Background

Cholangiocarcioma (CCA) treatment is challenging because most of the patients are diagnosed when the disease is advanced, and cancer recurrence is the main problem after treatment, leading to low survival rates. Therefore, our understanding of the mechanism underlying CCA recurrence is essential in order to prevent CCA recurrence and improve patient outcomes.

Methods

We performed 1H-NMR and UPLC-MS-based metabolomics on the CCA serum. The differential metabolites were further analyzed using pathway analysis and potential biomarker identification.

Results

At an early stage, the metabolites involved in energy metabolisms, such as pyruvate metabolism, and the TCA cycle, are downregulated, while most lipids, including TGs, PCs, PEs, and PAs, are upregulated in recurrence patients. This metabolic feature has been described in cancer stem-like cell (CSC) metabolism. In addition, the CSC markers CD44v6 and CD44v8-10 are associated with CD36 (a protein involved in lipid uptake) as well as with recurrence-free survival. We also found that citrate, sarcosine, succinate, creatine, creatinine and pyruvate, and TGs have good predictive values for CCA recurrence.

Conclusion

Our study demonstrates the possible molecular mechanisms underlying CCA recurrence, and these may associate with the existence of CSCs. The metabolic change involved in the recurrence pathway might be used to determine biomarkers for predicting CCA recurrence.
Acclimation with humic acids enhances maize and tomato tolerance to salinity
Authors: Souza Aline Costa , Zandonadi Daniel Basílio , Santos Mirella Pupo , Canellas Natália Oliveira Aguiar , de Paula Soares Cleiton , da Silva Irineu Luiz Eduardo Souza , de Rezende Carlos Eduardo , Spaccini Riccardo , Piccolo Alessandro , Olivares Fabio Lopes , Canellas Luciano Pasqualoto
Published: August 2021

Background

Salinity is one of the major environmental threats to agriculture, limiting plant growth and reducing crop yield. The use of humic substances to alleviate salt stress in plants is well reported, but the mechanisms remain unclear. This work aimed to apply humic acids on seedlings to acclimate plants to tolerate further salt stress exposition as a pre-treatment.

Materials and methods

Two independent experiments with mono (maize) and dicot (tomato) seedlings were carried out. Maize was primed by humic acids (4 mM C) and further submitted to moderate salinity exposition (60 mM NaCl). The acclimation period of maize seedlings was characterized by ion balance and transcriptomic analysis of salt response genes. The tomato seedlings were also primed by humic acids (4 mM C) and exposed further to salinity (200 mM NaCl), and we measured only physiological aspect, including the activity of plasma membrane proton pumps and net photosynthesis rate.

Results

Seedlings primed by humic acids minimized the salinity stress by changing ion balance, promoting plasma membrane proton pumps activity and enhancing photosynthesis rate and plant growth. We showed for the first time that maize seedlings treated with humic acids had a high transcription level of salt responsive genes and transcription factors even before the salt exposition.

Conclusion

Humic acids previously activate cellular and molecular salt defence machinery, anticipating the response and reducing salinity stress. This is a key knowledge to manipulate manufactured biostimulants based on humic substances towards a maximized crop protection.

Graphic abstract
A web-based prospective cohort study of home, leisure, school and sports injuries in France: a descriptive analysis
Authors: Rojas Castro Madelyn Yiseth , Orriols Ludivine , Basha Sakr Dunia , Contrand Benjamin , Dupuy Marion , Travanca Marina , Sztal-Kutas Catherine , Avalos Marta , Lagarde Emmanuel
Published: August 2021

Background

Home and leisure injuries (HLIs) are a major public health problem. Cohort studies among general population are needed for targeted preventive actions but remain scarce. We quantify and qualify the HLIs collected prospectively in the MAVIE (Mutualists against Home and Leisure Injuries) observatory, a web-based cohort among volunteers of the French general population.

Methods

Participants reported HLIs from November 2014 to December 2019. We calculated crude and standardized incidence rates (SIRs) on the entire cohort, for each of the selected socio-demographic variables and each of the injury circumstances (place and activity), mechanisms, and injury severity levels. We also described other HLIs characteristics and consequences.

Results

Out of the 29,931 household members enrolled in the cohort, 12,419 participants completed the questionnaires. Among them, 8640 participants provided follow-up data, leading to a follow-up of 6302 persons for 5.2 years and 2483 HLIs were reported. We obtained a SIR of 85.0 HLIs per 1000 persons-years. Most reported injuries did not require emergency department attendance or hospitalization (64%). SIRs were higher in children (< 15 years of age) (109.1 HLIs per 1000 persons-years; 95% CI, 78.2–140.1) and adults aged 70 years and older (123.7 HLIs per 1000 persons-years; 95% CI, 79.2–168.3). Struck or hit by fall was the most frequent injury mechanism (52%) and also among the most severe injuries (73% of Struck or hit by fall HLIs ending with hospitalization). Sport (without contact with nature), and leisure and play activities were the injury circumstances with higher SIRs, 15.2 HLIs per 1000 persons-years (95% CI, 14.6–15.8) and 11.2 HLIs per 1000 persons-years (95% CI, 10.7–11.6), respectively. Outdoor sport activity (in contact with nature) was the circumstance with the highest proportion of hospitalizations (18% of outdoor sports HLIs ending with hospitalization).

Conclusion

The incidences, causes, and consequences of HLI differ by age group and are mainly related to the performance of certain activities. Although the participants in the MAVIE cohort were not representative of the French population. Our study identified potential sub-populations and specific types of HLIs that should be targeted by future studies concerning risk factors and prevention programs.
Increased risk of postsurgical macular edema in high stage idiopathic epiretinal membranes
Authors: Iuliano Lorenzo , Cisa di Gresy Gloria , Fogliato Giovanni , Corbelli Eleonora , Bandello Francesco , Codenotti Marco
Published: August 2021

Purpose

To assess the rate of occurrence and the risk factors of postsurgical macular edema (PSME) in eyes with idiopathic epiretinal membrane (iERM) or full-thickness macular hole (FTMH).

Methods

Retrospective longitudinal analysis of all subjects scheduled for vitrectomy with or without combined cataract surgery over a 6-month period. Electronic medical charts and imaging data were analyzed preoperatively and at 1, 3 and 6 months after surgery.

Results

From 101 patients diagnosed with iERM or FTMH, 71 patients were eligible for the study. Forty-nine eyes with iERM (69.0%) and 22 eyes with FTMH (31.0%) underwent vitrectomy either isolated (31.0%) or combined with cataract extraction (69.0%). The overall rate of PSME was 26.7%, without differences between the two groups (P = 0.9479). Combined cataract extraction did not affect the overall occurrence of PSME rate in both groups (P = 0.9255 in FTMH and P = 0.8658 in iERM). If grouped by stage, eyes with stage 4 iERM though disclosed an increased rate of PSME (57.1%) compared to lower (1 to 3) stages (14.3%, P = 0.0021), particularly when combined with cataract surgery (71.4% vs. 15.4% in stages ≤ 3, P = 0.0021). The PSME odds ratio for a stage 4 iERM is 8 (95% CI: 1.933–33.1; P = 0.0041) compared to stages 3 and below.

Conclusions

PSME remains a clinically relevant and frequent event after surgery for iERM and FTMH. Patients with stage 4 iERM have an 8-fold higher likelihood of developing PSME in a 6-month postsurgical period compared to iERM in 1–3 stages, especially when combined with cataract extraction.
Combined treatment of an aortosplenic bypass followed by coil embolization in the treatment of pancreaticoduodenal artery aneurysms caused by median arcuate ligament compression: a report of two cases
Authors: Kii Shuhei , Kamachi Hirofumi , Abo Daisuke , Kato Takuya , Tsuruga Yousuke , Wakayama Kenji , Kakisaka Tatsuhiko , Soyama Takeshi , Kamiyama Toshiya , Ooka Tomonori , Wakasa Satoru , Taketomi Akinobu
Published: August 2021

Background

Pancreaticoduodenal artery aneurysms (PDAAs) are rare visceral aneurysms, and prompt intervention/treatment of all PDAAs is recommended at the time of diagnosis to avoid rupture of aneurysms. Herein, we report two cases of PDAA caused by the median arcuate ligament syndrome, treated with surgical revascularization by aortosplenic bypass followed by coil embolization.

Case presentation

Case 1 A 54-year-old woman presented with a chief complaint of severe epigastralgia and was diagnosed with two large fusiform inferior PDAAs and celiac axis occlusion. To preserve the blood flow of the pancreatic head, duodenum, liver, and spleen, we performed elective surgery to release the MAL along with aortosplenic bypass. At 6 days postoperatively, transcatheter arterial embolization was performed. At the 8-year 6-month follow-up observation, no recurrent perfusion of the embolized PDAAs or rupture had occurred, including the non-embolized small PDAA, and the bypass graft had excellent patency.

Case 2 A 39-year-old man who had been in good health was found to have a PDAA with celiac stenosis during a medical checkup. Computed tomography and superior mesenteric arteriography showed severe celiac axis stenosis and a markedly dilated pancreatic arcade with a large saccular PDAA. To preserve the blood flow of the pancreatic arcade, we performed elective surgery to release the MAL along with aortosplenic bypass. At 9 days postoperatively, transcatheter arterial embolization was performed. At the 6-year 7-month follow-up observation, no recurrent perfusion or rupture of the PDAA had occurred, and the bypass graft had excellent patency.

Conclusion

Combined treatment with bypass surgery and coil embolization can be an effective option for the treatment of PDAAs associated with celiac axis occlusion or severe stenosis.
Neurological manifestations in mild and moderate cases of COVID-19
Authors: Abdel Azim Ghada Saed , Osman Marwa Abdellah
Published: August 2021

Background

The coronavirus disease due to SARS COVID-2 emerged from Wuhan city in China in December 2019 and rapidly spread to more than 200 countries all over the world as a global health pandemic. Its primary presentation is respiratory and cardiac. However, some neurological manifestations are also reported. We tried to explore the reported neurological manifestations in a group of non-hospitalized mild and moderate COVID-19 patients. We contacted 107 patients via phone calls and e-mail messages, within 10 days of clinical presentation. The collected data regarded the neurological and non-neurological symptoms of the disease using a questionnaire that collected medical information of each patient.

Results

It is found that 100% of patients have been reported with at least one neurological symptom during the first 10 days of COVID-19 presentation. The most common were headache which recorded 72% of the total. Then anosmia–dysgeusia which reached 52%, then myalgia with 44%, fatigue with 33% and dizziness with 32%. While the less common was numbness, migraine, loss of concentration, and seizures.

Conclusion

There are many neurological manifestations found to be very common in COVID-19 patients even in mild cases, which when added to the increasing reports of serious cases of Guillain–Barre syndrome, acute necrotizing encephalopathy, myelitis, stroke, and encephalitis in COVID-19 patients support CNS invasion of the virus and assures the importance of neurological assessment of COVID-19 patients both in the acute phase of infection and after recovery for potential neurological sequelae.
The pillars determining financial inclusion among SMEs in Egypt: service awareness, access and usage metrics and macroeconomic policies
Authors: ElDeeb Mohamed Samy , Halim Yasser Tawfik , Kamel Esmat Mostafa
Published: August 2021

Over the past decade, financial inclusion has been a trending topic and key priority in developing countries seeking to build a resilient financial sector and pursuing economic growth. Most of the recently launched financial inclusion initiatives in Egypt, especially those aligned with the 2030 sustainability strategy, have targeted marginalized and excluded individuals. Only a few have addressed the financial inclusion of small- and medium-sized enterprises (SMEs). Accordingly, this paper aims to identify the main pillars of financial inclusion for SMEs. In keeping up with the mainstream literature, it introduces a number of financial inclusion determinants designed to attract SMEs. They include supply-side determinants such as access to financial services and marketing awareness campaigns, which act as tools to segment financial services and market their benefits to SMEs, and demand-side determinants, which involve the use of financial services. Finally, there is an assessment of the macroeconomic risks to investors and SMEs. The researchers’ methodology was based on first deriving a novel dataset from responses to a questionnaire addressing bankers who manage SME portfolios, second analyzing the dataset through descriptive and inferential statistics and third undertaking a twofold econometric estimation. The econometric estimations started with principal component analysis (PCA) and proceeded to a logistic regression to determine the significant variables pertinent to increasing the financial inclusion of SMEs. The PCA suggested three main pillars determining financial inclusion. They are integrated marketing tools, which increase SMEs’ awareness of and access to the most sophisticated banking services, usage of banking services, and assessment of the macroeconomic risks that would prevent SMEs from gaining access to financial services. As well, the interaction term between the variables derived from the three pillars accounts for a variability of 86.6% in the level of financial inclusion of Egypt’s SMEs.
Phase I or II Study of Ribociclib in Combination With Topotecan-Temozolomide or Everolimus in Children With Advanced Malignancies: Arms A and B of the AcSé-ESMART Trial
Authors: Bautista Francisco , Paoletti Xavier , Rubino Jonathan , Brard Caroline , Rezai Keyvan , Nebchi Souad , Andre Nicolas , Aerts Isabelle , De Carli Emilie , van Eijkelenburg Natasha , Thebaud Estelle , Corradini Nadege , Defachelles Anne-Sophie , Ducassou Stephane , Morscher Raphael J. , Vassal Gilles , Geoerger Birgit
Published: August 2021

PURPOSE

AcSé-ESMART is a proof-of-concept, phase I or II, platform trial, designed to explore targeted agents in a molecularly enriched cancer population. Arms A and B aimed to define the recommended phase II dose and activity of the CDK4/6 inhibitor ribociclib with topotecan and temozolomide (TOTEM) or everolimus, respectively, in children with recurrent or refractory malignancies.

PATIENTS AND METHODS

Ribociclib was administered orally once daily for 16 days after TOTEM for 5 days (arm A) or for 21 days with everolimus orally once daily continuously in a 28-day cycle (arm B). Dose escalation followed the continuous reassessment method, and activity assessment the Ensign design. Arms were enriched on the basis of molecular alterations in the cell cycle or PI3K/AKT/mTOR pathways.

RESULTS

Thirty-two patients were included, 14 in arm A and 18 in arm B, and 31 were treated. Fourteen patients had sarcomas (43.8%), and 13 brain tumors (40.6%). Main toxicities were leukopenia, neutropenia, and lymphopenia. The recommended phase II dose was ribociclib 260 mg/m2 once a day, temozolomide 100 mg/m2 once a day, and topotecan 0.5 mg/m2 once a day (arm A) and ribociclib 175 mg/m2 once a day and everolimus 2.5 mg/m2 once a day (arm B). Pharmacokinetic analyses confirmed the drug-drug interaction of ribociclib on everolimus exposure. Two patients (14.3%) had stable disease as best response in arm A, and seven (41.2%) in arm B, including one patient with T-acute lymphoblastic leukemia with significant blast count reduction. Alterations considered for enrichment were present in 25 patients (81%) and in eight of nine patients with stable disease; the leukemia exhibited CDKN2A/B and PTEN deficiency.

CONCLUSION

Ribociclib in combination with TOTEM or everolimus was well-tolerated. The observed activity signals initiated a follow-up study of the ribociclib-everolimus combination in a population enriched with molecular alterations within both pathways.
Study on the periodic solution of the (3 + 1)-dimensional extended quantum Zakharov-Kuznetsov equation in plasma physics
Authors: Wang Kang-Jia , Wang Guo-Dong
Published: August 2021

In the current work, we consider the (3 + 1)-dimensional extended quantum Zakharov-Kuznetsov (Z-K) equation which is used widely to explain the propagations of the waves arising in plasma physics. The variational theory together with the Hamiltonian method are employed to construct the periodic solution of the equation. As expected, the obtained solution agrees well with the solution by He's variational method, which strongly proves the correctness of the proposed method. Finally, we illustrate the solutions through one example in the form of 3-D and 2-D plots. The obtained results show that the method is simple but effective, which is expected to shed a bright light on the study of the nonlinear partial differential equations arising in physics.
Pulse Oximetry Waveform Represents an Earlier Ventricular Contraction in Relation to the Intraarterial Blood Pressure Tracing and Electrocardiogram on Multichannel Monitors: A Case Series
Authors: Tripathi Nilay , Tripathi Mukesh , Pandey Mamta
Published: August 2021

Multichannel patient monitors apparently display the electrocardiogram, intra-arterial blood pressure, and pulse oximetry waveforms in synchrony during sinus cardiac rhythm. We recorded 20 events of a premature cardiac contraction on multichannel monitors from 10 patients. Interestingly, during premature cardiac contraction, the low-amplitude arterial trace was aligned with the premature electrocardiogram, but the low-amplitude pulse oximetry plethysmograph was aligned with the next normal electrocardiogram and arterial tracing. In conclusion, the pulse oximetry plethysmograph tracing is offset by 1 ventricular depolarization on the electrocardiogram (QRS) and the arterial tracing on multichannel monitors.
A polycystin-2 protein with modified channel properties leads to an increased diameter of renal tubules and to renal cysts
Authors: Grosch Melanie , Brunner Katrin , Ilyaskin Alexandr V. , Schober Michael , Staudner Tobias , Schmied Denise , Stumpp Tina , Schmidt Kerstin N. , Madej M. Gregor , Pessoa Thaissa D. , Othmen Helga , Kubitza Marion , Osten Larissa , de Vries Uwe , Mair Magdalena M. , Somlo Stefan , Moser Markus , Kunzelmann Karl , Ziegler Christine , Haerteis Silke , Korbmacher Christoph , Witzgall Ralph
Published: August 2021

Mutations in the PKD2 gene cause autosomal-dominant polycystic kidney disease but the physiological role of polycystin-2, the protein product of PKD2, remains elusive. Polycystin-2 belongs to the transient receptor potential (TRP) family of non-selective cation channels. To test the hypothesis that altered ion channel properties of polycystin-2 compromise its putative role in a control circuit controlling lumen formation of renal tubular structures, we generated a mouse model in which we exchanged the pore loop of polycystin-2 with that of the closely related cation channel polycystin-2L1 (encoded by PKD2L1), thereby creating the protein polycystin-2poreL1. Functional characterization of this mutant channel in Xenopus laevis oocytes demonstrated that its electrophysiological properties differed from those of polycystin-2 and instead resembled the properties of polycystin-2L1, in particular regarding its permeability for Ca2+ ions. Homology modeling of the ion translocation pathway of polycystin-2poreL1 argues for a wider pore in polycystin-2poreL1 than in polycystin-2. In Pkd2poreL1 knock-in mice in which the endogenous polycystin-2 protein was replaced by polycystin-2poreL1 the diameter of collecting ducts was increased and collecting duct cysts developed in a strain-dependent fashion.
Sodium Thiosulfate Reduces Acute Kidney Injury in Patients Undergoing Cytoreductive Surgery Plus Hyperthermic Intraperitoneal Chemotherapy with Cisplatin: A Single-Center Observational Study
Authors: Kurreck Annika , Gronau Felix , Alberto Vilchez Miguel Enrique , Abels Wiltrud , Enghard Philipp , Brandl Andreas , Francis Roland , Föhre Bettina , Lojewski Christian , Pratschke Johann , Thuss-Patience Peter , Modest Dominik , Rau Beate , Feldbrügge Linda
Published: August 2021

Background

Cytoreductive surgery (CRS) in combination with hyperthermic intraperitoneal chemotherapy (HIPEC) represents a multimodal treatment concept for patients with peritoneal surface malignancies. The use of intraperitoneal cisplatin (CDDP) is associated with a risk of acute kidney injury (AKI). The aim of this study is to evaluate the protective effect of perioperative sodium thiosulfate (STS) administration on kidney function in patients undergoing CRS and CDDP-based HIPEC.

Patients and Methods

We retrospectively analyzed clinical data of all patients who underwent CRS and CDDP-based HIPEC at our hospital between March 2017 and August 2020. Patients were stratified according to the use of sodium thiosulfate (STS vs. no STS). We compared kidney function and clinical outcome parameters between both groups and determined risk factors for postoperative AKI on univariate and multivariate analysis. AKI was classified according to acute kidney injury network (AKIN) criteria.

Results

Of 238 patients who underwent CRS and CDDP-based HIPEC, 46 patients received STS and 192 patients did not. There were no significant differences in baseline characteristics. In patients who received STS, a lower incidence (6.5% vs. 30.7%; p = 0.001) and severity of AKI (p = 0.009) were observed. On multivariate analysis, the use of STS (OR 0.089, p = 0.001) remained an independent kidney-protective factor, while arterial hypertension (OR 5.283, p < 0.001) and elevated preoperative urea serum level (OR 5.278, p = 0.032) were predictors for postoperative AKI.

Conclusions

The present data suggest that STS protects patients from AKI caused by CRS and CDDP-based HIPEC. Further prospective studies are needed to validate the benefit of STS among kidney-protective strategies.
Curved Approach in High Jump Induces Greater Jumping Height without Greater Joint Kinetic Exertions than Straight Approach
Authors: SADO NATSUKI , YOSHIOKA SHINSUKE , FUKASHIRO SENSHI
Published: August 2021

Purpose

The most height-specific jumping mode, the athletic high jump, is characterized as a running single-leg jump (RSLJ) from a curved approach. The main advantage of a curved approach is believed to be facilitation of bar clearance. However, the effect of a curved approach on center-of-mass (CoM) height generation has not been clarified. Here, we show that the curved RSLJ (C-RSLJ) is more suitable than the straight RSLJ (S-RSLJ) for CoM height generation.

Methods

We collected data using motion capture from 13 male high jumpers (personal best, 2.02–2.31 m) that performed C-RSLJ and S-RSLJ. We then compared the energy generation contributing to CoM height (E
vert) in each approach.

Results

All participants attained greater CoM height in C-RSLJ than in S-RSLJ (difference, 0.055 ± 0.024 m). Three-dimensional joint kinematics and kinetics were similar between both approaches, except for the ankle plantar-flexion torque, which was smaller in C-RSLJ. The sum of positive work was comparable between the approaches, whereas the sum of negative work in C-RSLJ was significantly smaller than in S-RSLJ. The shank forward rotation induced a larger difference in E
vert generation between C-RSLJ and S-RSLJ (0.80 ± 0.36 J·kg−1) than any other segment (≤0.36 J·kg−1).

Conclusions

Compared with a straight approach, a curved approach induces greater CoM height without increasing joint kinetic exertions during takeoff. The curved approach changes the initial condition of the takeoff and promotes the transformation of horizontal kinetic energy into E
vert. This study provides novel practical perspectives for high jumpers and highlights the importance of segment biomechanics in human motor performance.
Automatic segmentation of lung tumors on CT images based on a 2D & 3D hybrid convolutional neural network
Authors: Gan Wutian , Wang Hao , Gu Hengle , Duan Yanhua , Shao Yan , Chen Hua , Feng Aihui , Huang Ying , Fu Xiaolong , Ying Yanchen , Quan Hong , Xu Zhiyong
Published: August 2021

Objective:

A stable and accurate automatic tumor delineation method has been developed to facilitate the intelligent design of lung cancer radiotherapy process. The purpose of this paper is to introduce an automatic tumor segmentation network for lung cancer on CT images based on deep learning.

Methods:

In this paper, a hybrid convolution neural network (CNN) combining 2D CNN and 3D CNN was implemented for the automatic lung tumor delineation using CT images. 3D CNN used V-Net model for the extraction of tumor context information from CT sequence images. 2D CNN used an encoder–decoder structure based on dense connection scheme, which could expand information flow and promote feature propagation. Next, 2D features and 3D features were fused through a hybrid module. Meanwhile, the hybrid CNN was compared with the individual 3D CNN and 2D CNN, and three evaluation metrics, Dice, Jaccard and Hausdorff distance (HD), were used for quantitative evaluation. The relationship between the segmentation performance of hybrid network and the GTV volume size was also explored.

Results:

The newly introduced hybrid CNN was trained and tested on a dataset of 260 cases, and could achieve a median value of 0.73, with mean and stand deviation of 0.72 ± 0.10 for the Dice metric, 0.58 ± 0.13 and 21.73 ± 13.30 mm for the Jaccard and HD metrics, respectively. The hybrid network significantly outperformed the individual 3D CNN and 2D CNN in the three examined evaluation metrics (p < 0.001). A larger GTV present a higher value for the Dice metric, but its delineation at the tumor boundary is unstable.

Conclusions:

The implemented hybrid CNN was able to achieve good lung tumor segmentation performance on CT images.

Advances in knowledge:

The hybrid CNN has valuable prospect with the ability to segment lung tumor.
Perceived stress and generalized anxiety in the Indian population due to lockdown during the COVID-19 pandemic: a cross-sectional study
Authors: Wakode Naina , Wakode Santosh , Santoshi John
Published: August 2021

Background: Research on the psychosocial toll of the COVID-19 pandemic is being conducted in various countries. This study aimed to examine stress levels and causal stressors for perceived stress and generalized anxiety in the Indian population related to the lockdown during the COVID-19 pandemic.

Methods: A total of 300 adults were invited to participate in the online study via snowball and virtual snowball sampling. They were requested to complete electronic survey forms for assessing perceived stress and anxiety, and questions related to psychosocial stressors. Frequency and percentage were used for categorical variables. Unpaired t-test was applied to compare responses based on gender, level of education, employment, and place of residence. A p-value of <0.05 was considered statistically significant.

Result: In total, 257 out of the 300 invited, responded and completed the survey. Men accounted for 58% (n=149) of the respondents. Overall, 84% (n=217) of participants had moderate to severe levels of perceived stress and 88% (n=228) had moderate to severe levels of anxiety. Women, as well as those not employed, reported significantly higher perceived stress and anxiety, urban residents reported higher perceived stress, while level of education had no difference in terms of perceived stress as well as anxiety. Fear of contracting COVID-19 was the highest stressor followed by difficulties in executing a routine exercise schedule and worry about the future.

Conclusion: The psychosocial impact of the nationwide lockdown on the Indian population has been high. Vulnerable groups for increased stress and anxiety include women, younger ages, and the unemployed. The stressors recognized include fear of contracting COVID-19, inability to execute a routine exercise schedule and worry about the future.
Using citation tracking for systematic literature searching - study protocol for a scoping review of methodological studies and a Delphi study
Authors: Hirt Julian , Nordhausen Thomas , Appenzeller-Herzog Christian , Ewald Hannah
Published: August 2021

Background: Up-to-date guidance on comprehensive study identification for systematic reviews is crucial. According to current recommendations, systematic searching should combine electronic database searching with supplementary search methods. One such supplementary search method is citation tracking. It aims at collecting directly and/or indirectly cited and citing references from "seed references". Tailored and evidence-guided recommendations concerning the use of citation tracking are strongly needed.

Objective: We intend to develop recommendations for the use of citation tracking in systematic literature searching for health-related topics. Our study will be guided by the following research questions: What is the benefit of citation tracking for systematic literature searching for health-related topics? Which methods, citation indexes, and other tools are used for citation tracking? What terminology is used for citation tracking methods?

Methods: Our study will have two parts: a scoping review and a Delphi study. The scoping review aims at identifying methodological studies on the benefit and use of citation tracking in systematic literature searching for health-related topics with no restrictions on study design, language, and publication date. We will perform database searching in MEDLINE (Ovid), CINAHL (EBSCOhost), Web of Science Core Collection, two information science databases, web searching, and contact experts in the field. Two reviewers will independently perform study selection. We will conduct direct backward and forward citation tracking on included articles. Data from included studies will be extracted using a prespecified extraction sheet and presented in both tabular and narrative form. The results of the scoping review will inform the subsequent Delphi study through which we aim to derive consensus recommendations for the future practice and research of citation tracking.