bluuebunny/crossref_metadata_2025 huggingface dataset:
Structural controllability analysis based on dilations under leader–follower framework
Authors: Sun Shuhui , Ji Zhijian , Lin Chong , Liu Yungang
Published: September 2021

In this paper, the structural controllability of leader–follower systems over digraphs is discussed. Firstly, with the aid of leader–follower partition, we analyze the topological characteristics of systems without dilations. Moreover, we divide the digraph into the leader subgraph and the follower subgraph. By analyzing the topological characteristics of the follower subgraph, a sufficient condition to ensure the system structurally controllable is given. Furthermore, some special topologies of follower graphs are analyzed, such as unidirectional cycle graphs and directed paths, and the corresponding sufficient conditions of structural controllability are given. Meanwhile, a method to construct digraphs with structural controllability is presented. Finally, the strong structural controllability of directed tree graphs is considered, as well as the selection mechanism of leaders and the lower bound of the number of leaders under strong structural controllability are given. The above results reflect the effects of topologies on strong (or weak) structural controllability.
Markers of Immune Activation and Inflammation in Individuals With Postacute Sequelae of Severe Acute Respiratory Syndrome Coronavirus 2 Infection
Authors: Peluso Michael J , Lu Scott , Tang Alex F , Durstenfeld Matthew S , Ho Hsi-en , Goldberg Sarah A , Forman Carrie A , Munter Sadie E , Hoh Rebecca , Tai Viva , Chenna Ahmed , Yee Brandon C , Winslow John W , Petropoulos Christos J , Greenhouse Bryan , Hunt Peter W , Hsue Priscilla Y , Martin Jeffrey N , Daniel Kelly J , Glidden David V , Deeks Steven G , Henrich Timothy J
Published: September 2021

Background

The biological processes associated with postacute sequelae of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection (PASC) are unknown.

Methods

We measured soluble markers of inflammation in a SARS-CoV-2 recovery cohort at early (<90 days) and late (>90 days) timepoints. We defined PASC as the presence of 1 or more coronavirus disease 2019 (COVID-19)–attributed symptoms beyond 90 days. We compared fold-changes in marker values between those with and without PASC using mixed-effects models with terms for PASC and early and late recovery time periods.

Results

During early recovery, those who went on to develop PASC generally had higher levels of cytokine biomarkers including tumor necrosis factor–α (1.14-fold higher mean ratio [95% confidence interval {CI}, 1.01–1.28]; P = .028) and interferon-γ–induced protein 10 (1.28-fold higher mean ratio [95% CI, 1.01–1.62]; P = .038). Among those with PASC, there was a trend toward higher interleukin 6 levels during early recovery (1.29-fold higher mean ratio [95% CI, .98–1.70]; P = .07), which became more pronounced in late recovery (1.44-fold higher mean ratio [95% CI, 1.11–1.86]; P < .001). These differences were more pronounced among those with a greater number of PASC symptoms.

Conclusions

Persistent immune activation may be associated with ongoing symptoms following COVID-19. Further characterization of these processes might identify therapeutic targets for those experiencing PASC.
A genomic portrait of Sturnira parvidens: mitochondrial chromosome, repetitive elements, and microsatellite discovery
Authors: Baeza J Antonio , Rodríguez Melissa E , Ortega Jorge
Published: September 2021

The yellow-shouldered bat, Sturnira parvidens (Phyllostomidae), is an abundant and widespread species in southern North America and Mesoamerica. Despite its important ecological role, no genomic resources exist for this species. Using low-coverage short Illumina 150 bp pair-end reads sequencing, this study reports the mitochondrial chromosome and nuclear repetitive elements, including microsatellites, in S. parvidens. The mitochondrial genome of S. parvidens is 16,612 bp in length and is comprised of 13 protein-coding genes, 2 ribosomal RNA genes, and 22 transfer RNA genes. Repetitive elements constituted ~67% of the nuclear genome while ~33% of the genome represented single- or low-copy sequences. A moderate proportion of repetitive sequences (31% putative families) could not be assigned to known repeat element families. Considering only annotated repetitive elements, the most ubiquitous repetitive elements belonged to Class I-LINE and Satellite DNA, which were considerably more abundant than Class I-LTR elements and Class II-DNA transposons (TcMar-Mariner and hAT-Charlie). A total of 193 microsatellites were identified.
Outbursts and stellar properties of the classical Be star HD 6226
Authors: Richardson Noel D , Thizy Olivier , Bjorkman Jon E , Carciofi Alex , Rubio Amanda C , Thomas Joshua D , Bjorkman Karen S , Labadie-Bartz Jonathan , Genaro Matheus , Wisniewski John P , Wang Luqian , Gies Douglas R , Chojnowski S Drew , Daly Andrea , Edwards Thompson , Fowler Carlie , Gullingsrud Allison D , Habel Nolan , James David J , Kehoe Emily , Kuchta Heidi , Lane Alexis , Miroshnichenko Anatoly , Mishra Ashish , Pablo Herbert , Peploski Maurice , Pepper Joshua , Rodriguez Joseph E , Siverd Robert J , Stassun Keivan G , Stevens Daniel J , Trucks Jesica L , Windsor James , Wood Mackenna , Bertrand Étienne , Broussat Jean-Jacques , Bryssinck Erik , Buil Christian , Charbonnel Stéphane , de Bruin Arnold , Daglen Joe , Desnoux Valerie , Dull James , Garde Olivier , Graham Keith , Gurney Kevin , Halsey Alun , Fosanelli Patrik , Guarro Fló Joan , Houpert Franck , James Foster , Kreider Christian , Leadbeater Robin , Lester Tim , Li Dong , Maetz Alain , Stiewing Albert , Somogyi Peter , Terry Jean-Noël , Ubaud Stéphane , Waldschlaeger Ulrich
Published: September 2021

The bright and understudied classical Be star HD 6226 has exhibited multiple outbursts in the last several years during which the star grew a viscous decretion disc. We analyse 659 optical spectra of the system collected from 2017 to 2020, along with a ultraviolet spectrum from the Hubble Space Telescope and high cadence photometry from both Transiting Exoplanet Survey Satellite (TESS) and the Kilodegree Extremely Little Telescope (KELT) survey. We find that the star has a spectral type of B2.5IIIe, with a rotation rate of 74 per cent of critical. The star is nearly pole-on with an inclination of 13${_{.}^{\circ}}$4. We confirm the spectroscopic pulsational properties previously reported, and report on three photometric oscillations from KELT photometry. The outbursting behaviour is studied with equivalent width measurements of H α and H β, and the variations in both of these can be quantitatively explained with two frequencies through a Fourier analysis. One of the frequencies for the emission outbursts is equal to the difference between two photometric oscillations, linking these pulsation modes to the mass ejection mechanism for some outbursts. During the TESS observation time period of 2019 October 7 to 2019 November 2, the star was building a disc. With a large data set of H α and H β spectroscopy, we are able to determine the time-scales of dissipation in both of these lines, similar to past work on Be stars that has been done with optical photometry. HD 6226 is an ideal target with which to study the Be disc-evolution given its apparent periodic nature, allowing for targeted observations with other facilities in the future.
Amplicon Remodeling and Genomic Mutations Drive Population Dynamics after Segmental Amplification
Authors: Morgenthaler Andrew B , Fritts Ryan K , Copley Shelley D
Published: September 2021

New enzymes often evolve by duplication and divergence of genes encoding enzymes with promiscuous activities that have become important in the face of environmental opportunities or challenges. Amplifications that increase the copy number of the gene under selection commonly amplify many surrounding genes. Extra copies of these coamplified genes must be removed, either during or after evolution of a new enzyme. Here we report that amplicon remodeling can begin even before mutations occur in the gene under selection. Amplicon remodeling and mutations elsewhere in the genome that indirectly increase fitness result in complex population dynamics, leading to emergence of clones that have improved fitness by different mechanisms. In this work, one of the two most successful clones had undergone two episodes of amplicon remodeling, leaving only four coamplified genes surrounding the gene under selection. Amplicon remodeling in the other clone resulted in removal of 111 genes from the genome, an acceptable solution under these selection conditions, but one that would certainly impair fitness under other environmental conditions.
Acute myocardial infarction and myocarditis following COVID-19 vaccination
Authors: Aye Y N , Mai A S , Zhang A , Lim O Z H , Lin N , Ng C H , Chan M Y , Yip J , Loh P -H , Chew N W S
Published: September 2021

Emerging reports raise concerns on the potential association between the COVID-19 vaccines and cardiac manifestations. We sought to evaluate cardiac complications associated with COVID-19 vaccination in a pooled analysis from our institution’s cohort study and systematic review. Consecutive patients admitted to a tertiary hospital in Singapore between 1 January 2021 and 31 March 2021, with the onset of cardiac manifestations within 14 days following COVID-19 vaccination, were studied. Furthermore, a systematic review was performed, with PubMed, Embase, Research Square, MedRxiv and LitCovid databases accessed from inception up to 29 June 2021. Relevant manuscripts reporting individual patient data on cardiac complications following COVID-19 vaccination were included. Thirty patients were included in the study cohort, with 29 diagnosed with acute myocardial infarction (AMI) and 1 with myocarditis. Five patients developed heart failure, two had cardiogenic shock, three intubated, and one had cardiovascular-related mortality. In the systematic review, 16 studies were included with 41 myocarditis and 6 AMI cases. In the pooled analysis of the study cohort and the systematic review, 35 patients had AMI and 42 had myocarditis. Majority were men, and myocarditis patients were younger than AMI patients. Myocarditis patients tended to present 72 h postvaccination, while AMI patients were older and typically presented 24 h postvaccination. Majority with AMI or myocarditis developed symptoms after the first and second vaccination dose, respectively. This pooled analysis of patients presenting with cardiac manifestations following COVID-19 vaccination highlights the differences between myocarditis and AMI presentations in temporal association with the vaccination.
How Many Immigrant-Friendly Communities Are in the United States? Classifying the Policy Stream
Authors: Smith Richard J , Schmitt-Sands Catherine
Published: September 2021

Dramatic federal immigration policy proposals and executive actions appear to be a reaction to state and local governments that have taken leadership in responding to immigration. Some local governments have endorsed welcoming immigrants to stabilize high-poverty urban neighborhoods and to enhance regional economic development. Others embrace immigrant incorporation consistent with the social work grand challenge to achieve equal opportunity and justice. This research estimates the number of immigrant-friendly cities and counties in the United States. To generate this estimate, authors prepared a local government policy scan of all municipalities and counties in the United States with a population of more than 500 persons to identify policies designed to recruit or specifically serve immigrants. Authors also categorized these immigrant-friendly policies on a continuum ranging from rhetoric to outreach, integration, and facilitation. Only 7% of cities and 6% of counties were found to have immigrant-friendly policy. However, when taking population into account, nearly half of all people in the municipal sample live in a place with an immigrant-friendly policy. Article concludes with the discussion of the implications for social policy and social work practice.
A Hybrid Concept-Based Clinical Practicum Course: An Innovative Approach to Baccalaureate Nursing Education in a Rural Area
Authors: Owens Rhoda A. , Christian Stephanie J.
Published: September 2021

Reports have called for a radical change in the delivery of nursing education to meet the challenges of providing safe, quality care in a complex health care system. This article presents a new, concept-based bachelor of science in nursing clinical practicum course with hybrid delivery. A concept-based curriculum prepares students for practice by facilitating the development of clinical reasoning and judgment skills. Evaluations from students and faculty indicated positive learning outcomes. The hybrid delivery accommodated students’ varied schedules while practicing in facilities in three rural states.
The Emerging Field of Regenerative Aesthetics—Where We Are Now
Authors: Zarbafian Misha , Fabi Sabrina G. , Dayan Steven , Goldie Kate
Published: September 2021

BACKGROUND

Regenerative aesthetics is an emerging branch of regenerative medicine with therapies aimed at recapturing youthful structure and function using the body's own systems.

OBJECTIVE

To introduce the field of regenerative aesthetics, and to explore themes and evidence surrounding current and emerging therapies in the field.

MATERIALS AND METHODS

A review of the literature was performed for each of the 3 pillars of regeneration; namely, stem cells, biochemical cues, and scaffolds.

RESULTS

Herein, we provide an overview of the field of regenerative aesthetics, a discussion surrounding the 3 pillars of regeneration, and an overview of the evidence supporting current and emerging therapeutic modalities that could play a pivotal role in the future of aesthetic treatments.

CONCLUSION

An enhanced understanding of this field can serve to further enhance our awareness about the regenerative effects of therapies we already offer, in addition to providing inspiration for future innovation.
Scapholunate and lunotriquetral interosseous ligament augmentation with internal bracing in perilunate dislocation
Authors: Kang Soo-Hwan , Chae Seungbum , Kim Jongmin , Lee Jiwon , Park Il-Jung
Published: September 2021

Rationale:

The goals of surgical treatment of the perilunate dislocation (PLD) are confirmation of reduction, ligament repair, and supplemental fixation of the bony architecture. Open reduction and direct repair of the torn ligament are recommended for acute PLD. However, repair of the scapholunate interosseous ligament (SLIL) and lunotriquetral interosseous ligament (LTIL) is often unreliable, and secure repair is challenging. Internal bracing (IB) is an augmentation method that uses high-strength non-absorbable tape and enhances strength and support during the critical period of ligamentous healing. However, there is a paucity of data on the application of IB for PLD in the wrist. We report 3 cases of PLD that were augmented with IB after SLIL and LTIL repair.

Patient concerns:

All 3 cases were men who visited our emergency department with wrist after falling off a ladder.

Diagnoses:

Initial radiographs revealed a dorsal PLD.

Interventions:

Surgically, complete rupture of the SLIL and LTIL were confirmed. K-wires were placed into the scaphoid and lunate and used as joysticks to correct the intercalated segment instability pattern. This usually requires correcting scaphoid flexion and lunate extension and closing the scapholunate interval. Prior to SLIL and LTIL repair, temporary intercarpal fixation was performed with K-wires to maintain the carpal relationship. The dorsal SLIL and LTIL were carefully repaired using suture anchors. However, ligament repair was unreliable, and insecure. In view of the likelihood of insufficient repair, we performed IB augmentation using synthetic tape.

Outcomes:

At the last follow-up, all cases were pain-free and had returned to all activities. The last follow-up radiographs showed good alignment of the carpal bones and no arthritic changes.

Lessons:

IB augmentation can reduce the period of K-wire fixation and cast immobilization and can enable early joint motion. We believe that interosseous ligament augmentation using IB is a reasonable treatment option for PLD.
Chinese herbal medicine for mild cognitive impairment using mini-mental state examination
Authors: Wang Wei , Diwu Yongchang , Liu Qi , Zhou Yuan , Sayed Tayeb Islam , Wang Dongkun , Gou Yurui
Published: September 2021

Introduction:

The prevalence of mild cognitive impairment (MCI) in the elderly population aged 60 to 84 years ranges from 6.7% to 25.2%, and the effective prevention and reversal of MCI progression to Alzheimer disease (AD) is crucial. The mini mental state examination (MMSE) is the most commonly used screening tool in Chinese outpatient clinics, with sufficient sensitivity and specificity to allow useful stratification from average to abnormal with adequate consideration of age and education.

Objective:

To investigate the clinical significance of Chinese herbs on MMSE scores in MCI patients and discuss the effectiveness of Chinese herbs through pharmacology.

Methods:

Three English databases and 4 Chinese databases we have searched, and the risk of bias was assessed according to the Cochrane tool. Statistics will be used for heterogeneity assessment, sensitivity analysis, data synthesis, funnel plot generation and subgroup analysis. If sufficiently homogeneous studies are found, a Meta-analysis will be performed, with subgroups describing any differences.

Results:

A total of 21 studies were included, 4 studies were placebo-controlled, 14 Chinese Herbal Medicines (CHMs) were compared with other cognitive improvements, 3 CHMs were combined with other medications, and the results of 17 studies favored the herbal group.

Conclusion:

The results indicate that herbal medicine can improve MMSE scores, and herbal medicine combined with other drugs that can improve cognition can significantly improve MMSE scores, but there are methodological flaws in the study. Experimental studies have found a basis for the ability of herbs to improve cognition and memory impairment, and herbal medicine has great potential to improve MCI cognition. Keywords mild cognitive impairment, herbal medicine, MMSE, systematic evaluation, meta-analysis. PROSPERO international prospective register of systematic reviews protocol registration number: CRD42020202368
The efficacy and safety of acupuncture in nonalcoholic fatty liver disease
Authors: Chen Peiwen , Zhong Xin , Dai Yunkai , Tan Meiao , Zhang Gaochuan , Ke Xuehong , Huang Keer , Zhou Zunming
Published: September 2021

Background:

The aim of this study was to determine the efficacy and safety of acupuncture treatment (AT) or acupuncture plus conventional medicine (CM) versus CM alone using a meta-analysis of all published randomized controlled trials (RCTs) for nonalcoholic fatty liver disease (NAFLD).

Methods:

Eight databases were searched independently from inception to April 30, 2020. RCTs were included if they contained reports on the use acupuncture or the use of acupuncture combined with CM and compared with the use of CM. Summary odds ratio (OR) and 95% confidence intervals (CIs) were used to calculate the overall clinical efficacy. Secondary outcomes, namely aspartate aminotransferase, alanine aminotransferase, total cholesterol, triglyceride, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, and body mass index, were calculated by mean difference with 95% CIs.

Results:

After the final screening, 8 RCTs with 939 patients were included. This meta-analysis showed that AT was superior to CM in improving overall clinical efficacy (OR = 3.19, 95% CI: 2.06–4.92, P 
< .00001). In addition, AT plus CM could significantly improve overall clinical efficacy compared to treatment with CM alone (OR = 5.11, 95% CI: 2.43–10.75, P 
< .0001). Moreover, the benefits were also demonstrated in other outcomes, including alanine aminotransferase, aspartate aminotransferase, total cholesterol, triglyceride, high-density lipoprotein cholesterol, and low-density lipoprotein cholesterol indexes. However, AT plus CM could not decrease body mass index levels in comparison with CM. The safety profile of Acupuncture therapy was satisfactory. Taichong, Zusanli, Fenglong, and Sanyinjiao were major acupoints on NAFLD treatment.

Conclusion:

Acupuncture may be effective and safe for treatment of NAFLD. However, due to insufficient methodological quality and sample size, further high-quality studies are needed.
Comparison of the outcomes between laparoscopic surgery and conventional open surgery in treating patients with stage II endometrial carcinoma
Authors: Liu Ya , Jin Yunfeng , Lu Yuemei , Zhong Xiaorong , Lu Hong
Published: September 2021

Background:

Endometrial carcinoma is a prevalent form of cancer. In fact, its incidence ranks fourth among European and North American females. Moreover, it is the most common gynecological malignant disease. Laparotomy, bilateral salpingo-oophorectomy, total abdominal hysterectomy, etc were common methods adopted in conventional open surgery. Recent developments in laparoscopic surgery (LPS) has made it more effective. The present study aims to compare the outcomes between LPS and a conventional open surgical procedure to treat stage II endometrial carcinoma patients.

Methods:

A comprehensive search will be conducted on Cochrane library, PubMed, Web of Science, EMBASE, and China National of Knowledge Infrastructure to collect LPS and conventional open surgery in treating stage II endometrial carcinoma. The search will consider all articles published since the inception of the databases till July 2021. A pair of scholars will perform independent screening of the literature and extracted data to evaluate the bias risk in the selected studies. Afterwards, RevMan5.3 software will be used to conduct a meta-analysis.

Conclusion:

This study will conduct a meta-analysis to compare the clinical efficacy of LPS and conventional open surgery in the treatment of stage II endometrial carcinoma.
Global trends and performances of Mediterranean diet
Authors: Pan Ciming , Jiang Nan , Cao Beiling , Dong Changwu
Published: September 2021

Background:

The Mediterranean diet (MD) is an ancient eating habit that is believed to contribute to a healthy lifestyle. Unsurprisingly, research on the MD is growing rapidly as people pay more attention to health preservation and prevention, treatment and rehabilitation of chronic diseases. Previous reviews focused more on the effects of MD on a particular disease which has enhanced its significance in the medicine field. However, few studies have attempted to provide a comprehensive summary and analysis of this topic. This study evaluates the global research trends of scientific outputs related to MD from multiple perspectives, using a bibliometric analysis and visualization tool (CiteSpace software) to scientifically analyze the knowledge from the literature.

Methods:

The core collection database of Web of Science was used to retrieve the bibliographic records related to MD from 1984 to March 30, 2021. CiteSpace was used to generate and analyze visual representations of the complex data input, including number of publications, research performances in journals, authors, institutions, countries and co-occurrence networks of keywords and co-citation references.

Results:

Overall, the number of MD publications has shown a significant upward trend since 2012. Nutrients and American Journal of Clinical Nutrition contained the most articles related to MD, indicating that they were important platforms for related research. Martinez-gonzalez Ma and Estruch Ramon are the authors with the highest number of publications related to MD, and it is noteworthy that these 2 authors have close cooperation in this field. The countries with the most publications are Spain and the United States, and the institutions with the most publications are Univ Navarra, Inst Salud Carlos III. The main research disciplines are “Mediterranean diet,” “risk,” “cardiovascular disease,” “adherence,” “obesity,” “coronary heart disease,” “diet,” “health,” “physical activity” and “risk factor”. Estruch R's 2013 study on cerebrovascular disease and Tricopoulou A's 2003 mortality study were cited 881 cases for 437 times, respectively, showing the importance of these 2 articles in this field.

Conclusion:

The current global trends of MD research as well as people's increasing awareness of healthcare and healthy lifestyle imply that MD research is expected to become increasingly popular with further breakthroughs.
Neuromyelitis optica spectrum disorder with active replication of hepatitis B virus and seropositive anti-aquaporin-4 antibody
Authors: Lei Jiaying , Wang Hong
Published: September 2021

Rationale:

Neuromyelitis optica spectrum disorder (NMOSD) associated with active replication of hepatitis B virus (HBV) is rare. High-dose corticosteroids are the mainstay treatment of NMOSD; however, these may cause reactivation of viral replication in patients with stable HBV which may lead to liver damage. Therefore, care should be placed in corticosteroid use in patients with NMOSD and HBV infection.

Patient concerns:

Herein, we report the case of a 31-year-old woman with NMOSD and HBV infection who was seropositive for anti-aquaporin-4 antibody. The stable and HBV carrier status of the patient led to the deferment of antiviral and hepatoprotective agents in early treatment. However, liver function impairment was detected during follow-up, with an improvement in the best-corrected visual acuity.

Diagnoses:

The patient was diagnosed with NMOSD with active replication of HBV and seropositive anti-aquaporin-4 antibody considering the medical history and ancillary examinations.

Interventions:

To manage NMOSD, intravenous high-dose methylprednisolone (20 mg/kg d) was administered for 5 days which was gradually tapered to oral steroids. However, liver function impairment was observed during follow-up; therefore, anti-HBV drugs (entecavir) and hepatoprotective drugs (bicyclol or polyunsaturated phosphatidylcholine) were administered.

Outcomes:

A marked improvement was observed in the patient's best-corrected visual acuity after 4 weeks of treatment. However, follow-up examinations revealed liver function damage which necessitated administration of antiviral and hepatoprotective drugs. Liver function normalized after 1 month.

Lesson:

This case underscores the importance of preventive treatment of liver protection in patients with HBV infection prior to or simultaneous with glucocorticoid therapy and furthermore, there is an urgent need to develop authoritative guidelines regulating corticosteroid use in the treatment of patients with HBV infection.
The effectiveness and safety of Chuna manual therapy adjuvant to Western medicine in patients with chronic obstructive pulmonary disease
Authors: Kim Kwan-Il , Lee Beom-Joon , Jung Hee-Jae
Published: September 2021

Background

In chronic obstructive pulmonary disease (COPD) management, greater emphasis has been placed on symptomatic improvement and enhanced quality of life in patients. Manual therapy among respiratory rehabilitation programs has received much attention recently, with the publication of numerous studies. In South Korea, a method known as Chuna Manual Therapy (CMT) has been applied in the management of COPD patients and in clinical practice, but the clinical basis for safety and effectiveness is yet to be established. Therefore, rigorously designed randomized controlled trials are required. We aimed to evaluate the feasibility of assessing the add-on effect and safety of CMT administered with standard Western medicine therapy for the treatment of COPD.

Methods

This is a randomized, single-blind, single-center clinical pilot trial. Patients with COPD receiving standard drug therapy are randomly divided into an experimental group (n = 20) and a control group (n = 20) at a 1:1 ratio. The experimental group receives CMT adding to the standard medical therapy once a week for 8 weeks. The control group receives only the standard drug treatment. The trial is conducted with an outcome assessor and statistician blinding. The primary outcome is the 6-minute walk test. The secondary outcomes include the pulmonary function test, the Modified Medical Research Council, visual analog scale for dyspnea, COPD assessment test, quality of life using the St. George's respiratory questionnaire, EuroQOL five dimensions questionnaire, and Korean pattern identification questionnaire. Adverse events are also be evaluated.

Conclusions

The results of this study will provide the feasibility of a large-scale clinical trial to establish high-quality clinical evidence of CMT for COPD.

Trial registration

Korean Clinical Trial Registry (http://cris.nih.go.kr; registration number: KCT0006119).
Efficacy of erzhu jiedu recipe on hepatitis B cirrhosis with hyperalphafetoproteinemia
Authors: Chen Tian-Yang , Mai Jing-Yin , Zhang Ping , Xue Jian-Hua , He Sheng-Li , Xi Jun , Chen Jian-Jie , Cheng Yang
Published: September 2021

Background:

Hepatitis B cirrhosis with hyperalphafetoproteinemia is the intermediate stage of liver cirrhosis progressing to hepatocellular carcinoma (HCC), there is no effective way to treat precancerous lesions of liver in modern medicine. In recent decades, clinical and experimental evidence shows that Chinese medicine (CM) has a certain beneficial effect on Hepatitis B Cirrhosis. Therefore, this trial aims to evaluate the efficacy and safety of a CM erzhu jiedu recipe (EZJDR) for the treatment of Hepatitis B Cirrhosis with Hyperalphafetoproteinemia.

Methods:

We designed a randomized, double blind, placebo-controlled clinical trial. A total of 72 patients of Hepatitis B Cirrhosis with hyperalphafetoproteinemia were randomized in 2 parallel groups. Patients in the control group received placebo granules similar to the EZJDR. In the EZJDR group, patients received EZJDR twice a day, after meals, for 48 weeks. The primary efficacy measures were changes in serum alpha-fetoprotein (AFP) and alpha-fetoprotein alloplasm (AFP-L3); The secondary indicators of efficacy are changes in liver function indicators, HBV-DNA level; Liver stiffness measurement (LSM); Hepatic portal vein diameter; T lymphocyte subgroup indexes during treatment. All data will be recorded in case report forms and analyzed by Statistical Analysis System software. Adverse events will also be evaluated.

Results:

The results showed that EZJDR can significantly inhibit the levels of AFP and AFP-L3 in patients with hepatitis B cirrhosis and hyperalphafetoproteinemia and have good security.

Ethics and dissemination:

The study protocol was approved by the Medical Ethics Committee of Shuguang Hospital, affiliated with University of Traditional Chinese Medicine, Shanghai (NO.2018-579-08-01).

Trial registration:

This trial was registered on Chinese Clinical Trial Center (NO.ChiCTR1800017165).
Risk of acute kidney injury among patients with carbon monoxide poisoning
Authors: Huang Tai-Lin , Tung Min-Che , Lin Cheng-Li , Chang Kuang-Hsi
Published: September 2021

There is a lack of evidence supporting the association between carbon monoxide (CO) poisoning and acute kidney injury (AKI). Hence, the present study aimed to evaluate the association between CO poisoning and AKI.

From 2000 to 2011, we identified patients diagnosed with CO poisoning from the inpatient claims data. Patients aged below 20 years, who had a history of chronic kidney disease or end-stage renal disease before the index date and had incomplete medical information were excluded. Control patients without CO poisoning were randomly selected from all National Health Insurance beneficiaries, and the same exclusion criteria were used. The control group was frequency matched to patients with CO poisoning based on age, sex, and year of CO poisoning diagnosis. Cox proportional hazards regression analyses were conducted to assess the effects of CO poisoning on the risk of AKI. The hazard ratios and 95% confidence interval (CI) were calculated in the models.

Compared with the control cohort, patients with severe CO poisoning were 3.77 times more likely to develop AKI (95% CI = 2.20-6.46), followed by those with less severe CO poisoning (adjusted hazard ratio = 2.21, 95% CI = 1.61-3.03).

The findings of this nationwide study suggest an increased risk of AKI in patients with CO poisoning.
Analysis of changes in the volume of edema around brain contusions and the influencing factors
Authors: Liu Hai-Bing , Xu Wei-Ming , Wang Shou-Sen , Wei Liang-Feng , Hong Jing-Fang , Wang Cheng , Xian Liang
Published: September 2021

Traumatic brain injury (TBI), a common neurosurgical condition, has well-known treatment guidelines. However, the mechanisms underlying the varying severity of brain edema secondary to TBI are largely unknown, leading to controversial treatments.

This study seeks to measure edema volumes around brain contusions in different regions, analyze factors related to differences in edema volume and provide a theoretical basis for brain edema treatment.

Data from 113 brain contusion patients treated at the Department of Neurosurgery of Fuzhou General Hospital from January 2017 to November 2019 were analyzed retrospectively. Based on computed tomography (CT) data, the patients were divided into the venous group (brain contusion in regions with large cortical veins, n = 47) and the nonvenous group (brain contusions in other regions, n = 66). Here, 3D Slicer software was used to calculate the brain contusion volume on the first CT obtained after injury and the brain contusion volume and its surrounding edema on the 5th day after injury. The brain contusion volume to surrounding edema volume ratio was calculated, and the number of patients who showed brain contusion progression requiring surgery was determined. Hematocrit (Hct), fibrinogen (Fg), and d-dimer levels within 6 hours and on the 5th day after admission were also compared.

Patients in the venous group had a significantly increased percentage of area with edema around the brain contusion compared with patients in the nonvenous group (P < .05), and the 2 groups showed no significant difference in the number of patients with brain contusion progression or surgical treatment (P > .05) or Hct, Fg, or d-dimer (D-D) levels. For all patients, Hct, Fg, and D-D levels within 6 hours after admission were significantly different from those on the 5th day (P < .05 for all).

Cortical venous obstruction may be the most important factor influencing edema around brain contusions. The Fg level decreased slightly, and the D-D level increased to its peak rapidly after mild-moderate TBI. This change was followed by a gradual increase in the former and a gradual decrease in the latter.
Acupuncture treatment of glaucoma based on radar plots
Authors: Liu Yu , Li Zhangxin , Gao Ruixin , Wang Wei , Cao Tingting , Ma Suhong
Published: September 2021

Background:

Glaucoma is the second most blinding eye disease in the world. Currently, lowering the intraocular pressure through various methods is the main treatment of glaucoma. Acupuncture has been effectively and safely used in the treatment of glaucoma. However, the evidence for the efficacy of acupuncture in the treatment of glaucoma is controversial, leading to inconsistent findings from systematic evaluations at abroad and home. Therefore, this protocol aims to provide a multivariate evaluation on the quality of evidences from current systematic reviews (SRs) and/or meta-analyzes (MAs) of acupuncture in the treatment of glaucoma, and literature quality, thus providing an intuitive and reliable evidence synthesis and basis for clinical decision making.

Methods:

MAs/SRs about the acupuncture treatment of glaucoma will be searched online, including Chinese Biomedical Literature Database (CBM), China Science and Technology Journal Database (VIP), China National Knowledge Infrastructure (CNKI), WanFang Database (WF), Web of Science, Embase, PubMed, and Cochrane Library. Two investigators will independently screen literatures according to inclusion and exclusion criteria and extract data. A multivariate evaluation of the included literature will be performed by depicting radar plots in 6 aspects as follows: Year of publication, study type, SRs assessment through the Assessment of Multiple Systematic Reviews 2 (AMSTAR 2), literature quality assessment through the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA), homogeneity, and publication bias. The Grading of Recommendations Assessment, Development, and Evaluation evidence quality assessment tool will be used to grade and evaluate the quality of outcome indicators of the included literatures.

Results:

This study will be submitted for publication in a peer-reviewed journal.

Conclusion:

We would like to provide a visual and scientific approach for clinical decision making of acupuncture treatment of glaucoma through a accessible and useful assessment of systematic reviews.
Nasal packing with Merocel in a glove finger after endoscopic endonasal reduction of medial blowout fracture
Authors: Kim Ji Hwan , Lee Jun Yong , Lee Joo-Yeon , Shim Woo Sub , Wee Jee Hye , Jung Hahn Jin
Published: September 2021

After endoscopic endonasal reduction (EER) for medial blowout fracture (BOF), nasal packing may be necessary for sustaining the reduced orbital contents. This study aimed to introduce a new packing technique using Merocel in a glove finger.

We retrospectively reviewed 131 patients with a mean age of 42.2 years (range, 13–80 years), who underwent EER for medial BOF, followed by a postoperative nasal packing of Merocel in a glove finger, between March 2016 and December 2019. Sex, age, side and cause of trauma, pre-operative diplopia and enophthalmos, duration from the occurrence of trauma to surgery, postoperative diplopia, enophthalmos, complications like sinusitis, and revision surgery were evaluated.

The most common cause of injury was physical assault in 47 cases and a fall or slip event in 34. Pre-operatively 22 patients had diplopia and 1 patient had enophthalmos. Mean duration after trauma to the surgery was 13.2 days (range, 1–29 days). The mean operative time was 34.1 minutes (range, 10–70 minutes). Four weeks after operation, the nasal packing was removed at an outpatient clinic, with minimal pain, discomfort, and bleeding and no evidence of infection or inflammation. A computed tomography scan performed at 3 months postoperatively showed no re-bulging. The computed tomography image of 1 patient showed frontal sinus haziness; the patient had a headache and underwent endoscopic sinus surgery for symptomatic relief. Three patients had diplopia and 1 had enophthalmos at final follow-up. No other major postoperative complications were noted.

Merocel in a glove finger packing technique proved itself to be safe and effective after EER for medial BOF.
Vertebral artery hypoplasia as an independent risk factor of posterior circulation atherosclerosis and ischemic stroke
Authors: Dinç Yasemin , Özpar Rifat , Emir Büşra , Hakyemez Bahattin , Bakar Mustafa
Published: September 2021

Vertebral artery hypoplasia (VAH) is a frequent anatomical variation of vertebral arteries, with emerging evidence suggesting that it contributes to posterior circulation ischemia. However, the relationship between VAH and ischemic stroke remains unknown. Hence, this study aimed to determine the prevalence of VAH in patients diagnosed with acute ischemic stroke who were followed up in a neurology clinic and to determine if it can potentially be a risk factor for atherosclerotic stenosis in vertebrobasilar circulation.

This retrospective study included 609 patients diagnosed with acute ischemic stroke between January 1, 2019 and January 1, 2020. Demographic of patients, risk factors, radiological and clinical characteristics were evaluated.

Posterior circulation was very common in patients with VAH, and the most common locations of atherosclerotic stenosis were V1 and V4 segments of the vertebral artery and the middle segment of basilar artery. Analysis of the risk factors for atherosclerotic stenosis in patients with posterior circulation acute ischemic stroke suggested that VAH was an independent risk factor.

Findings of the study suggest that VAH pre-disposes atherosclerotic stenosis in vertebrobasilar circulation, although its mechanism remains unknown. Hemodynamic parameters associated with atherosclerosis could not be measured in vivo. Thus, to better understand the underlying mechanism, conducting studies that examine blood flow parameters with high-resolution magnetic resonance angiography in patients diagnosed with acute cerebral ischemia patients with VAH is warranted.
Utility of “reposition-flap” in the reconstruction of the avulsed thumb
Authors: Pertea Mihaela , Ciobanu Petru , Velenciuc Natalia , Poroch Vladimir , Filip Alexandru , Moraru Dan Cristian , Lunca Sorinel , Veliceasa Bogdan
Published: September 2021

Injuries that result in thumb amputation cause a loss of 50% of hand function. Microsurgical replantation remains the gold standard of thumb reconstruction techniques. The non-microsurgical technical variants of thumb reconstruction described so far aim to create a neo-thumb of adequate length, stable, opposable, sensitive, and last but not least esthetically pleasing appearance. Avulsion of the distal phalanx and the absence of the nail will determine a functional deficit but also an unesthetic appearance. When replantation is not possible or the patient refuses to “sacrifice” another anatomical region for thumb reconstruction, the “reposition-flap” technique can be used. Although often controversial, this surgical technique deserves proper attention and should be used in some cases. We studied a group of 32 patients with distal thumb amputations. In patients with amputations in zone II according to Tamai, with interphalangeal joint preservation, the thumb was reconstructed using “reposition-flap” with an O’Brien flap in 15 cases. In the remaining 17 cases where the amputation was at the level of the interphalangeal joint, we used the same technique, but the thumb neopulp was reconstructed with the Littler heterodigital neurovascular flap harvested from the ulnar border of the middle finger in 11 cases or radial border of the ring finger in 6 cases. The results were evaluated from a functional (Kapandji score), sensitive (2-point discrimination, Semmes-Weinstein test) but also esthetically (patient satisfaction) point of view. Donor site morbidity, cold intolerance, the presence of nail dystrophy, and bone resorbtion were also assessed. The disabilities of the arm, shoulder and hand score was evaluated for each patient. Although various surgical and microsurgical techniques for thumb reconstruction are described, when choosing the technique to use we must first consider patient's wishes. A well-informed patient will be able to make, with the surgeon, the best decision for him concerning the reconstruction option.
Prevalence and correlates of university students’ perceived stress in southwestern Saudi Arabia
Authors: Alsaleem Mohammed A. , Alsaleem Safar A. , Shehri Sarah Al , Awadalla Nabil J. , Mirdad Tarek M. , Abbag Fuad I. , Mahfouz Ahmed A.
Published: September 2021

The university period can be stressful for most students. It may be due to exposure to various stressors. Objectives: To establish the prevalence and factors associated with high perceived stress among university undergraduates in south-western Saudi Arabia.

A self-administered survey was conducted among a representative sample of King Khalid University students through a cross-sectional study. Data obtained included socio-economic, academic characteristics, and grade point average (GPA) scores. Stress was assessed using the Perceived Stress Scale.

This study included 2467 students. The average Perceived Stress Scale score was 19.13 ± 6.56, which was notably higher (P = .02) among health care undergraduates (19.45 ± 6.49) compared to others (18.85 ± 6.61). High perceived stress prevalence rate was 12.7% (13.6% in health care institutions and 12.0% in non-healthcare institutions). Multivariable analysis revealed that high perceived stress was considerably greater among females (adjusted odds ratio [aOR] = 2.35, 95% confidence interval:167–3.30), smokers (aOR = 1.65), those with an unsatisfactory income (aOR = 3.10), and healthcare students (aOR=1.33). In contrast, it was negatively associated with the GPA score (aOR= 0.77).

High perceived stress is a substantial problem among university students. Female students and healthcare students are at a greater risk. High stress is correlated with smoking, lower GPA scores, and perceived insufficient family income.
Impact of different bilateral knee extension strengths on lower extremity performance
Authors: Cho Kilchoon , Suzuki Makoto , Iso Naoki , Okabe Takuhiro , Goto Hiroshi , Hirata Keisuke , Shimizu Junichi
Published: September 2021

Despite the impact of leg muscle strength on lower extremity motor performance—including walking and sit-to-stand transfer—it remains difficult to predict the relationship between bilateral leg muscle strength and lower extremity performance. Therefore, this study was designed to predict lower extremity function through the differential modeling of logarithmic and linear regression, based on knee extension strength.

The study included 121 individuals living in the same community. The bilateral strengths of the knee extensors were measured using a handheld dynamometer, and the Timed Up & Go test (TUG) performance time and 5-m minimum walking times were assessed to predict lower extremity motor functions. Bilateral normalized knee extension muscle strengths and lower extremity motor function scores, including walking or TUG performance times, were assessed on the logarithmic and linear models. The Akaike information criterion (AIC) was used to evaluate the coefficient compatibility between the logarithmic regression model and the linear regression model.

The AIC value for the linear model was lower than that for the logarithmic model regarding the walking time. For walking time estimation in the linear model, the coefficient value of knee extension strength was larger on the strong than on the weak side; however, the AIC value for the logarithmic model was lower than that for the linear model regarding TUG performance time. In the logarithmic model's TUG performance time estimation, the coefficient value of knee extension strength was larger on the weak than on the strong side.

In conclusion, our study demonstrated different models reflecting the relationship between both legs’ strengths and lower extremity performance, including the walking and TUG performance times.