bluuebunny/crossref_metadata_2025 huggingface dataset:
Coccidioidal Hepatic Abscess in a Patient With Disseminated Coccidioidomycosis: A Case Report
Authors: Raza Nadia , Nasrawi Faisal , Heidari Arash , Kuran Rasha , Amin Navinchandra , Johnson Royce
Published: July 2021

Coccidioidomycosis is an infection caused by inhalation of arthroconidia of Coccidioides. Forty percent of patients will develop mild and self-limited respiratory infection, and a small fraction of these individuals will develop extrapulmonary disseminated disease. This is the case of a patient with a known history of disseminated coccidioidomycosis, who initially presented for symptoms of persistent pneumonia. On evaluation, the patient was found to have a hepatic abscess for which he underwent percutaneous drainage. Culture grew Coccidioides immitis, and the patient was treated with systemic antifungal. This is a rare case of disseminated coccidioidomycosis in the liver.
Dealing with violence: Varied reactions from frontline workers acting in highly vulnerable territories
Authors: Lotta Gabriela , Lima-Silva Fernanda , Favareto Arilson
Published: July 2021

This paper aims to understand the multiple strategies developed by frontline workers to deal with situations of violence in vulnerable territories. We analyze the micro-dynamics within which workers operate to understand how the State deals with violence. Empirically, we analyzed data from interviews with 140 frontline workers implementing different policies not directly related to violence in neighborhoods located in the city of Sao Paulo, Brazil, known for their populations’ precariousness and vulnerability. The results expand the understanding of the different ways in which violence expresses itself in these places and show that the reactions developed by frontline workers are more complex than those suggested by the existing literature. The multiple violence to which these workers are exposed is used and manipulated by them in various ways during policy implementation. Frontline workers can ignore, negotiate with, or combat violence. They use their agency to develop different reactions based on how they and the policies are embedded or disconnected to the territories.
Economic Impacts of the US–China Trade War on the Asian Economy: An Applied Analysis of IDE-GSM
Authors: Kumagai Satoru , Gokan Toshitaka , Tsubota Kenmei , Isono Ikumo , Hayakawa Kazunobu
Published: July 2021

In this article, we attempt to estimate the economic impacts of the US–China trade war that began in 2018. We used IDE-GSM, a computational general equilibrium simulation model, to estimate the economic impacts of a ‘full-confrontation’ scenario wherein both countries impose 25% additional tariffs on all goods imported from each other for 3 years 2019 onwards. In our calculation, the economic impact for the United States is −0.4% and −0.5% for China. Some Asian countries benefit from the trade war. As far as it remains bilateral, the trade war is only an issue for the concerned parties. We also ran the US–world trade war scenario, wherein the United States and all other countries impose a 25% additional tariff on all goods. The negative impact on the global economy is –0.8%, much more significant than the 0.1% impact from the US–China trade war. Thus, it is clear that the world cannot afford to engage in a multilateral trade war.

JEL Codes: C68, F13
Patellar Tendon Allograft Reconstruction
Authors: Spivey Matthew G. , Campbell Michael P. , Gammon Lee G. , Vap Alexander R.
Published: July 2021

Background:

Chronic patellar tendon injuries can cause significant functional deficits due to anterior knee pain, extension weakness, and extensor lag. With chronic injuries, the tissue is inadequate and of poor quality. Chronic injuries require autograft or allograft for augmentation or reconstruction. We present reconstruction of a chronic patellar tendon injury with Achilles tendon allograft.

Indications:

Chronic patellar tendon injuries causing functional deficits, including knee extension weakness, extensor lag, and anterior knee pain.

Technique Description:

A longitudinal incision is made over the patellar tendon, and the patellar tendon is excised. Two guide pins are drilled in a retrograde fashion through the patella and are overdrilled with a reamer. A trough is made at the tibial tubercle using an oscillating saw. The Achilles allograft calcaneal bone block is contoured to the appropriate size, and then press fit into the trough. Two 4.0-mm fully threaded cannulated screws with washers are used to secure the bone block. The fresh frozen Achilles allograft is doubled over, and a double Krackow running locking suture is placed. A V-Y advancement of the quadriceps tendon is performed to ensure adequate advancement of the patella. The limbs of the Krackow suture are pulled through the patella drill holes and tied with knee in full extension.

Results:

At 1 year, patients can expect near full range of motion with minimal extensor lag. Reconstruction results in improved pain and function as compared with preoperatively, as well as return to activities.

Conclusion:

Achilles tendon allograft is a good option for reconstructing chronic patellar tendon injuries. Advantages of the Achilles allograft include the bone-to-bone healing at the tibia, lack of donor site morbidity, and the large amount of tissue available for reconstruction.
Assessing cyclists’ routing preferences by analyzing extensive user setting data from a bike-routing engine
Authors: Hardinghaus Michael , Nieland Simon
Published: July 2021

Introduction

Many municipalities aim to support the uptake of cycling as an environmentally friendly and healthy mode of transport. It is therefore crucial to meet the demand of cyclists when adapting road infrastructure. Previous studies researching cyclists’ route choice behavior deliver valuable insights but are constrained by laboratory conditions, limitations in the number of observations, or the observation period or relay on specific use cases.

Methods

The present study analyzes a dataset of over 450,000 observations of cyclists’ routing settings for the navigation of individual trips in Berlin, Germany. It therefore analyzes query data recorded in the bike-routing engine BBBike and clusters the many different user settings with regard to preferred route characteristics.

Results and Conclusion

Results condense the large number of routing settings into characteristic preference clusters. Compared with earlier findings, the big data approach highlights the significance of short routes, side streets and the importance of high-quality surfaces for routing choices, while cycling on dedicated facilities seems a little less important.

Consequentially, providing separated cycle facilities along main roads – often the main focal point of cycle plans – should be put into the context of an integrated strategy which fulfills distinct preferences to achieve greater success. It is therefore particularly important to provide a cycle network in calm residential streets as well as catering for short, direct cycle routes.
Comparative transcriptome analysis reveals sesquiterpenoid biosynthesis among 1-, 2- and 3-year old Atractylodes chinensis
Authors: Zhao Jianhua , Sun Chengzhen , Shi Fengyu , Ma Shanshan , Zheng Jinshuang , Du Xin , Zhang Liping
Published: July 2021

Background

Atractylodes chinensis (DC.) Koidz is a well-known medicinal plant containing the major bioactive compound, atractylodin, a sesquiterpenoid. High-performance liquid chromatography (HPLC) analysis demonstrated that atractylodin was most abundant in 3-year old A. chinensis rhizome, compared with those from 1- and 2-year old rhizomes, however, the molecular mechanisms underlying accumulation of atractylodin in rhizomes are poorly understood.

Results

In this study, we characterized the transcriptomes from rhizomes of 1-, 2- and 3-year old (Y1, Y2 and Y3, respectively) A. chinensis, to identify differentially expressed genes (DEGs). We identified 240, 169 and 131 unigenes encoding the enzyme genes in the mevalonate (MVA), methylerythritol phosphate (MEP), sesquiterpenoid and triterpenoid biosynthetic pathways, respectively. To confirm the reliability of the RNA sequencing analysis, eleven key gene encoding factors involved in the sesquiterpenoid and triterpenoid biosynthetic pathway, as well as in pigment, amino acid, hormone and transcription factor functions, were selected for quantitative real time PCR (qRT-PCR) analysis. The results demonstrated similar expression patterns to those determined by RNA sequencing, with a Pearson’s correlation coefficient of 0.9 between qRT-PCR and RNA-seq data. Differential gene expression analysis of rhizomes from different ages revealed 52 genes related to sesquiterpenoid and triterpenoid biosynthesis. Among these, seven DEGs were identified in Y1 vs Y2, Y1 vs Y3 and Y2 vs Y3, of which five encoded four key enzymes, squalene/phytoene synthase (SS), squalene-hopene cyclase (SHC), squalene epoxidase (SE) and dammarenediol II synthase (DS). These four enzymes directly related to squalene biosynthesis and subsequent catalytic action. To validate the result of these seven DEGs, qRT-PCR was performed and indicated most of them displayed lower relative expression in 3-year old rhizome, similar to transcriptomic analysis.

Conclusion

The enzymes SS, SHC, SE and DS down-regulated expression in 3-year old rhizome. This data corresponded to the higher content of sesquiterpenoid in 3-year old rhizome, and confirmed by qRT-PCR. The results of comparative transcriptome analysis and identified key enzyme genes laid a solid foundation for investigation of production sesquiterpenoid in A. chinensis.
Association of dietary calcium intake, total and ionized serum calcium levels with preeclampsia in Ethiopia
Authors: Gebreyohannes Rahel D. , Abdella Ahmed , Ayele Wondimu , Eke Ahizechukwu C.
Published: July 2021

Background

Preeclampsia is a well-known cause of maternal mortality and morbidity in Ethiopia. The exact pathophysiology has not been fully understood. Calcium and magnesium deficiencies have been given emphasis to play roles in the pathophysiology. Although evidence is abundant, they are equivocal. The study aimed to see the association of dietary calcium intake, serum total calcium level and ionized calcium level with preeclampsia. It also evaluated the association between dietary calcium intake and serum calcium levels.

Materials and methods

An unmatched case–control study was conducted in Gandhi Memorial, Tikur Anbessa, and Zewditu Memorial Hospitals, all in Addis Ababa, between October to December, 2019. Cases were 42 women with preeclampsia and controls were 42 normotensive women. The medical and obstetric history was gathered using a structured questionnaire and the dietary calcium intake information using a 24-h dietary recall. The serum levels of total serum calcium and ionized (free) calcium were measured using an inductively coupled mass spectrophotometer. Bivariate and multivariate logistic regression and Pearson correlation test were utilized during data analysis.

Results

In comparison with controls, women with preeclampsia had lower mean (± 1SD) levels of ionized calcium level (1.1 mmol/l ± 0.11), total serum calcium level (1.99 mmol/l ± 0.35) and lower median (IQR) dietary calcium intake (704 mg/24 h,458–1183). The odds of having preeclampsia was almost eight times greater in those participants with low serum ionized calcium level (OR 7.5, 95% CI 2.388–23.608) and three times higher in those with low total serum calcium level (OR 3.0, 95% CI 1.024–9.370). Low dietary calcium intake also showed statistically significant association with preeclampsia (OR 3.4, 95% CI 1.092 -10.723). Serum ionized calcium level and total serum calcium level showed positive correlation of moderate strength (p = 0.004, r = 0.307), but no correlation was found between dietary calcium intake with both forms of serum calcium levels.

Conclusion

This study showed significant association between low dietary calcium intake and low serum calcium levels with preeclampsia, hence this can be used as a supportive local evidence for the current context-specific recommendation of calcium supplementation in societies with low-dietary calcium consumption in an attempt to prevent preeclampsia, therefore implementation study should be considered in Ethiopia to look for the feasibility of routine supplementation.
Validity and reliability of the simplified Chinese patient-reported outcomes version of the common terminology criteria for adverse events
Authors: Yang Shan-Shan , Chen Lei , Liu Ying , Lu Hai-Jun , Huang Bo-Jie , Lin Ai-Hua , Sun Ying , Ma Jun , Xie Fang-Yun , Mao Yan-Ping
Published: July 2021

Background

The psychometric properties of the simplified Chinese version of the Patient-Reported Outcomes version of the Common Terminology Criteria for Adverse Events (PRO-CTCAE) have not been assessed. Therefore, we aimed to assess its validity, reliability, and responsiveness.

Patients and methods

A Chinese version of the PRO-CTCAE and the European Organization for Research and Treatment of Cancer Core Quality of Life Questionnaire (QLQ-C30) were distributed to 1580 patients from four cancer hospitals in China. Validity assessments included construct validity, measured by Pearson’s correlations and confirmatory factor analysis (CFA), and known-groups validity, measured by t-tests. The assessment of reliability included internal consistency, measured by Cronbach’s ɑ, and test-retest reliability, measured by the intraclass correlation (ICC). Responsiveness was assessed by standardized response means (SRMs).

Results

Data from 1555 patients who completed the instruments were analyzed. The correlations were high between PRO-CTCAE items and parallel QLQ-C30 symptom scales (r > 0.60, p < 0.001), except for fatigue (severity: r = 0.49). Moreover, CFA showed the PRO-CTCAE structure was a good fit with the data (Root Mean Square Error of Approximation = 0.046). Known-groups validity was also confirmed. Cronbach’s ɑ of all item clusters were greater than 0.9 and the median test-retest reliability coefficients of the 38 items were 0.85 (range = 0.71–0.91). In addition, the SRMs of PRO-CTCAE items were greater than 0.8, indicating strong responsiveness.

Conclusion

The simplified Chinese version of the PRO-CTCAE showed good reliability, validity, and responsiveness.
Topiramate induced bilateral hypopyon uveitis and choroidal detachment: a report of two cases and review of literature
Authors: Tyagi Mudit , Behera Shashwat , Senthil Sirisha , Pappuru Rajeev R. , Ambiya Vikas , Dikshit Siddharth
Published: July 2021

Background

Topiramate (TPM) is a drug commonly used by neurophysicians and psychiatrists for a plethora of indications. Topiramate has been reported to induce acute angle closure glaucoma as an adverse effect. However, there is limited literature on Topiramate causing hypopyon uveitis and intense ocular inflammation. It is imperative for ophthalmologists as well as physicians to be aware of the potential sight threatening ocular adverse effects of Topiramate. We report 2 rare consecutive cases of severe hypopyon uveitis and choroidal detachments after using Topiramate.

Case presentation

Two patients presented with sudden onset of angle closure, bilateral hypopyon uveitis and choroidal detachments. On reassessing a detailed treatment history, it was found that both patient were taking oral Topiramate which had been started 2 weeks before the onset of ocular symptoms. The bilateral hypopyon and angle closure were considered to be induced by Topiramate and the drug was discontinued. The patients were started on oral and topical steroids which led to resolution of hypopyon uveitis and choroidal detachments. The visual acuity improved and the intraocular pressure also got normalised in both the cases.

Conclusions

Topiramate can lead to a bilateral hypopyon uveitis and severe ocular inflammation. An urgent cessation of topiramate along with topical and systemic steroids is required to prevent serious complications.
Prognosis and treatment of 46 Chinese pediatric cystic fibrosis patients
Authors: Chen Qionghua , Shen Yuelin , Xu Hui , Tang Xiaolei , Yang Haiming , Zhao Shunying
Published: July 2021

Background

Since public awareness of cystic fibrosis (CF) has increased, more children have been diagnosed with CF in China. This study aimed to investigate medical and other challenges faced by pediatric CF patients in China.

Method

Treatments and treatment outcomes were retrospectively analyzed for 46 pediatric CF patients diagnosed from August 2009 to June 2019. Pre- and post-treatment results were compared using independent samples t-test.

Results

Of 46 pediatric CF study patients, four died and five were lost to follow-up. Thirty-seven patients were monitored for 0.03 to 9.21 years; patients exhibited fewer attacks of respiratory tract infections after diagnosis (4.49 ± 2.13 episodes/year before diagnosis vs 1.97 ± 1.87 times/year after 1-year treatment, p < 0.05), significantly reduced sputum production and experienced 1.62 ± 1.71 exacerbations/year. Patient mean body mass index was 16.87 ± 3.53 and pancreatic malfunction persisted in 15 patients. For 17 children, no significant differences in lung function were found at follow-up as compared to lung function at diagnosis (FEV1: 82.45% ± 16.56% vs 75.26% ± 22.34%, FVC: 87.18% ± 13.64% vs 86.99% ± 19.95%, FEF75%: 46.51% ± 28.78% vs 36.63% ± 24.30%, P = 0.27, 0.97, 0.20, respectively). Pseudomonas aeruginosa (17/27) and bronchiectasis (22/22) were found during follow-up evaluation. Twenty-four patients (64.8%) maintained good adherence to therapies. Overall, azithromycin and tobramycin treatments were administered for 0.5–62 months and 0.5–48 months, respectively, and triggered no obvious adverse reactions.

Conclusion

No obvious declines in clinical presentation or lung function were found in Chinese pediatric CF patients after receiving standard therapeutic and active treatments, although malnutrition and low compliance were persistent challenges.
Using health impact assessment (HIA) to understand the wider health and well-being implications of policy decisions: the COVID-19 ‘staying at home and social distancing policy’ in Wales
Authors: Green Liz , Ashton Kathryn , Azam Sumina , Dyakova Mariana , Clemens Timo , Bellis Mark A.
Published: July 2021

Background

Health Impact Assessment (HIA) is promoted as a decision-informing tool by public health and governmental agencies. HIA is beneficial when carried out as part of policy development but is also valuable as a methodology when a policy is being implemented to identify and understand the wider health and well-being impacts of policy decisions, particularly when a decision needs to be taken rapidly to protect the population. This paper focusses on a HIA of the ‘Staying at Home and Social Distancing Policy’ or ‘lockdown’ in response to the COVID-19 pandemic in Wales conducted by the Welsh national public health institute. It describes the process and findings, captures the learning and discusses how the process has been used to better understand the wider health and well-being impacts of policy decisions beyond direct health harm. It also examines the role of public health institutes in promoting and using HIA.

Methods

A HIA was conducted following a standard HIA five step process. A literature review was undertaken alongside 15 qualitative semi-structured interviews with key stakeholders, and relevant health and demographic data were collated. The results were triangulated and analysed to form a holistic assessment of the policy decision and its impacts.

Results

A wide range of major health and well-being impacts of the lockdown in Wales were identified across the determinants of health, which included positive and negative social, economic, environmental and mental well-being impacts beyond the impact on direct health. Populations affected included children and young people, those on low incomes and women as well as those whose health has been directly impacted by COVID-19 such as older people. The work highlighted the benefit that HIA can bring in emphasizing impacts which can inform policy and shared learning with others.

Conclusion

HIA is a largely underused tool to understand the impact of policy and political decisions, particularly when a decision has been taken at speed. This case study highlights how HIA provide evidence and information for advocacy and further work by public health institutes, health agencies and policy makers.
Analysis of conventional and alternative CRISPR/Cas9 genome editing to enhance a single-base pair knock-in mutation
Authors: Edmondson Carina , Zhou Qi , Liu Xuan
Published: July 2021

Background

The use of CRISPR/Cas9 technologies in generating single-base pair knock-in mutations has recently exploded in the number of methods available. However, with the growing expansion of new technologies, it can be difficult to determine the best method for genome editing.

Results

In this study, we evaluated a number of CRISPR/Cas9 approaches for deriving cell lines with knock-in base pair edits to create a phosphorylation mutation and provide a breakdown of editing efficiencies and suggestions for improvement. Overall, our studies suggest that using pre-formed ribonucleoprotein (RNP) complexes is a reliable editing method to generate homozygous single-base pair mutations. We also show that antibiotic selection coupled homologous recombination is an efficient tool for generating highly specific heterozygous mutations.

Conclusion

The methods and/or combination of methods outlined in this study can be used to help other researchers with similar goals in single-base pair genome editing.
Medical student wellness in the United States during the COVID-19 pandemic: a nationwide survey
Authors: Nikolis Louis , Wakim Andrea , Adams William , DO Prempreet Bajaj
Published: July 2021

Background

As United States (US) medical students suffer higher rates of depression and anxiety than the general population, the wellness of medical students is particularly salient. One definition describes wellness as having eight dimensions: Intellectual, emotional, physical, social, occupational, financial, environmental, and spiritual. As the coronavirus (COVID-19) pandemic poses unique challenges for medical students, we aimed to compare medical student wellness before and during the COVID-19 pandemic.

Methods

An informal survey was created to assess eight wellness dimensions and was distributed via Survey Monkey to US allopathic and osteopathic medical students via email and social media. The survey was administered from March 29, 2020 to June 23, 2020. Univariable and multivariable linear mixed-effects models were used to estimate the change in students’ overall wellness using an 11-point scale ranging from 0 (least well) to 10 (most well). Generalized estimating equations were used to estimate the change in students’ responses to the eight dimensions before and during the COVID-19 pandemic.

Results

On multivariable analysis, students reported a decline in their overall wellness during COVID-19 (Mdiff = -1.08; p < .001). Asian respondents reported little change in overall wellness (M = -0.65) when compared to White respondents (M = -1.16) and Black respondents (M = -1.57). Students felt less supported and comfortable with their social (OR = 0.47) and daily (OR = 0.45) environments and expressed decreased satisfaction with their exercise (OR = 0.85), sense of purpose (OR = 0.33), and financial status (OR = 0.75). Students also expressed lower confidence (OR = 0.15) and satisfaction (OR = 0.11) with their medical education and increased anxiety (OR = 3.37) and depression (OR = 2.05).

Conclusions

Medical students reported declines in overall wellness and individual wellness dimensions. These findings can be used to implement changes to improve medical student wellness.
Reallocations in acne healthcare: exploring the possible roles and added value of non-physicians by a mixed-methods study design
Authors: de Vries Femke , Welbie Marlies , Tjin Esther , Driessen Rieke , van de Kerkhof Peter
Published: July 2021

Background

A highly promoted opportunity for optimizing healthcare services is to expand the role of non-physician care providers by care reallocation. Reallocating care from physicians to non-physicians can play an important role in solving systemic healthcare problems such as care delays, hospital overcrowding, long waiting lists, high work pressure and expanding healthcare costs. Dermatological healthcare services, such as the acne care provision, are well suited for exploring the opportunities for care reallocation as many different types of care professionals are involved in the care process. In the Netherlands, acne care is mainly delivered by general practitioners and dermatologists. The Dutch healthcare system also recognizes non-physician care providers, among which dermal therapists and beauticians are the most common professions. However, the role and added value of non-physicians is still unclear. The present study aimed to explore the possibilities for reallocating care to non-physicians and identify drivers for and barriers to reallocation.

Methods

A mixed-method design was used collecting quantitative and qualitative data from representatives of the main 4 Dutch professions providing acne care: dermatologists, GP’s, Dermal therapists and beauticians.

Results

A total of 560 questionnaires were completed and 24 semi-structured interviews were conducted. A broad spectrum of non-physician tasks and responsibilities were delineated. Interviewed physicians considered acne as a low-complexity skin condition which made them willing to explore the possibilities for reallocating. A majority of all interviewees saw a key role for non-physicians in counselling and supporting patients during treatment, which they considered an important role for increasing patients’ adherence to proposed treatment regimes, contributing to successful clinical outcome. Also, the amount of time non-physicians spend on patients was experienced as driver for reallocation. Legislation and regulations, uncertainties about the extent of scientific evidence and proper protocols use within the non-physician clinical practice were experienced as barriers influencing the possibilities for reallocation.

Conclusions

Delineated roles and drivers demonstrate there is room and potential for reallocation between physicians and non-physicians within acne healthcare, when barriers are adequately addressed.
Perturbation of semaphorin and VEGF signaling in ACDMPV lungs due to FOXF1 deficiency
Authors: Karolak Justyna A. , Gambin Tomasz , Szafranski Przemyslaw , Maywald Rebecca L. , Popek Edwina , Heaney Jason D. , Stankiewicz Paweł
Published: July 2021

Background

Alveolar capillary dysplasia with misalignment of pulmonary veins (ACDMPV) is a rare lethal congenital lung disorder in neonates characterized by severe progressive respiratory failure and refractory pulmonary hypertension, resulting from underdevelopment of the peripheral pulmonary tree. Causative heterozygous single nucleotide variants (SNVs) or copy-number variant (CNV) deletions involving FOXF1 or its distant lung-specific enhancer on chromosome 16q24.1 have been identified in 80–90% of ACDMPV patients. FOXF1 maps closely to and regulates the oppositely oriented FENDRR, with which it also shares regulatory elements.

Methods

To better understand the transcriptional networks downstream of FOXF1 that are relevant for lung organogenesis, using RNA-seq, we have examined lung transcriptomes in 12 histopathologically verified ACDMPV patients with or without pathogenic variants in the FOXF1 locus and analyzed gene expression profile in FENDRR-depleted fetal lung fibroblasts, IMR-90.

Results

RNA-seq analyses in ACDMPV neonates revealed changes in the expression of several genes, including semaphorins (SEMAs), neuropilin 1 (NRP1), and plexins (PLXNs), essential for both epithelial branching and vascular patterning. In addition, we have found deregulation of the vascular endothelial growth factor (VEGF) signaling that also controls pulmonary vasculogenesis and a lung-specific endothelial gene TMEM100 known to be essential in vascular morphogenesis. Interestingly, we have observed a substantial difference in gene expression profiles between the ACDMPV samples with different types of FOXF1 defect. Moreover, partial overlap between transcriptome profiles of ACDMPV lungs with FOXF1 SNVs and FENDRR-depleted IMR-90 cells suggests contribution of FENDRR to ACDMPV etiology.

Conclusions

Our transcriptomic data imply potential crosstalk between several lung developmental pathways, including interactions between FOXF1-SHH and SEMA-NRP or VEGF/VEGFR2 signaling, and provide further insight into complexity of lung organogenesis in humans.
Breastfeeding counseling based on formative research at primary healthcare Services in Mexico
Authors: Bueno-Gutiérrez Diana , Castillo Edgar Uriel Romero , Mondragón Angélica Emili Hernández
Published: July 2021

Background

Breastfeeding rates in Mexico are far from World Health Organization (WHO) recommendations with 28.8% of Exclusive Breastfeeding (EBF) under 6 months of age, according to the 2018 National Health and Nutrition Survey. Formative research has shown that culturally appropriate counseling is an effective breastfeeding intervention. The objective of the current study was to evaluate the effect of interpersonal counseling on EBF in a primary healthcare center in Tijuana, México.

Methods

This was a randomized controlled trial pilot with a sample of mothers with infants under 4 months of age from a primary care center. Participants were randomized into two groups: 1) Control group, received counseling on immunizations and standard infant feeding information, and 2) Intervention group, receiving breastfeeding counseling using a socio-ecological framework. Changes in breastfeeding attitudes, self-efficacy and EBF were evaluated at 2 months post-intervention.

Results

A total of 80 mothers completed the 2 month follow up assessment (40 in each group). The mean age at baseline was 26.4 years for mothers and 1.4 months for infants. There was a 30% increase in EBF at 2 months follow up in the intervention group and 15% decrease in the control group post-intervention. We observed a significant improvement in breastfeeding attitudes (P = 0.0001), self-efficacy (P = 0.046) and EBF (P = 0.0001) in the intervention group. Reported obstacles were discomfort of breastfeeding in public (23%), infant dissatisfaction (23%), pain (19%), insufficient milk supply (15%) and returning to work (8%).

Conclusions

Breastfeeding counseling based on previous formative research improved breastfeeding attitudes, self-efficacy and practices in this population. These findings suggest that the promotion of breastfeeding utilizing a socio-ecological framework may improve breastfeeding rates by addressing the needs of women within their varying sociocultural contexts.

Trial registration

ACTRN: ACTRN12621000915853. Retrospectively registered.
Prevalence and determinants of low social support during pregnancy among Australian women: a community-based cross-sectional study
Authors: Bedaso Asres , Adams Jon , Peng Wenbo , Sibbritt David
Published: July 2021

Background

Pregnancy is a time for women in which the need for social support is crucial. Social support reduces stressors and improves the emotional and physical well-being of pregnant women. Women receiving low social support during pregnancy are at risk of substances use, developing mental illness, and adverse birth outcomes. The current study aims to determine the prevalence and determinants of low social support during pregnancy among Australian women.

Methods

Data were obtained from the 1973–1978 cohort of Australian Longitudinal Study on Women’s Health (ALSWH) and those who report being pregnant (n = 493) were included in the current analyses. Social support was assessed using Medical Outcomes Study Social Support index (MOSS). A logistic regression model was applied to identify determinants of low social support, separately for each MOSS domain.

Result

The study found that 7.1% (n = 35) of pregnant women reported low social support. Significant determinants of low emotional support were non-partnered (AOR = 4.4, 95% CI: 1.27, 14.99), difficulty managing on available income (AOR = 3.1, 95% CI: 1.18, 8.32), experiencing depressive symptoms (AOR = 8.5, 95% CI: 3.29, 22.27) and anxiety symptoms (AOR = 2.9, 95% CI: 1.26, 7.03). Significant determinants of low affectionate support were suffering from depressive symptoms (AOR = 5.3, 95% CI: 1.59, 17.99), having anxiety symptoms (AOR: 6.9, 95% CI: 2.21, 22.11) and being moderately/very stressed (AOR: 3, 95% CI: 1.17, 7.89). Significant determinants of low tangible support were difficulty managing available income (AOR = 3, 95% CI: 1.29, 6.95), and being depressed (AOR = 2.8, 95% CI: 1.48, 5.34).

Conclusion

The study revealed that 7.1% of pregnant women reported low social support. Having a mental health problems, being stressed, being from low socio-economic status and being non-partnered were significant determinants of low social support during pregnancy. Maternal health professionals and policymakers can use this information to screen pregnant women at risk of receiving low social support and improve the level of support being provided.
Review of control strategies for lower-limb exoskeletons to assist gait
Authors: Baud Romain , Manzoori Ali Reza , Ijspeert Auke , Bouri Mohamed
Published: July 2021

Background

Many lower-limb exoskeletons have been developed to assist gait, exhibiting a large range of control methods. The goal of this paper is to review and classify these control strategies, that determine how these devices interact with the user.

Methods

In addition to covering the recent publications on the control of lower-limb exoskeletons for gait assistance, an effort has been made to review the controllers independently of the hardware and implementation aspects. The common 3-level structure (high, middle, and low levels) is first used to separate the continuous behavior (mid-level) from the implementation of position/torque control (low-level) and the detection of the terrain or user’s intention (high-level). Within these levels, different approaches (functional units) have been identified and combined to describe each considered controller.

Results

291 references have been considered and sorted by the proposed classification. The methods identified in the high-level are manual user input, brain interfaces, or automatic mode detection based on the terrain or user’s movements. In the mid-level, the synchronization is most often based on manual triggers by the user, discrete events (followed by state machines or time-based progression), or continuous estimations using state variables. The desired action is determined based on position/torque profiles, model-based calculations, or other custom functions of the sensory signals. In the low-level, position or torque controllers are used to carry out the desired actions. In addition to a more detailed description of these methods, the variants of implementation within each one are also compared and discussed in the paper.

Conclusions

By listing and comparing the features of the reviewed controllers, this work can help in understanding the numerous techniques found in the literature. The main identified trends are the use of pre-defined trajectories for full-mobilization and event-triggered (or adaptive-frequency-oscillator-synchronized) torque profiles for partial assistance. More recently, advanced methods to adapt the position/torque profiles online and automatically detect terrains or locomotion modes have become more common, but these are largely still limited to laboratory settings. An analysis of the possible underlying reasons of the identified trends is also carried out and opportunities for further studies are discussed.
The toxicology and detoxification of Aconitum: traditional and modern views
Authors: Chan Yau-Tuen , Wang Ning , Feng Yibin
Published: July 2021

Aconitum carmichaeli Debx.-derived herbal medicine has been used for anti-inflammation and anti-arrhythmia purpose for more than two thousand years. It is processed into Chuanwu (Radix Aconiti praeparata) and Fuzi (Radix Aconiti lateralis praeparata) in Traditional Chinese Medicine, which are two useful drugs but with toxic properties. There have been patients poisoned by accidental ingestion of Aconitum plants or misuse of the herbal drug, and this is of great concern to study in-depth. In this review, we provided the traditional and contemporary practice of using Aconitum herbs as medicine, from functions, processing methods to toxicity in ethnomedicine aspects to discuss the underlying connections of traditional and modern understanding on the toxicity of Aconitum plants. We summarized the functions and toxicology of the herbal drugs are analyzed from chemical and clinical aspects, with the help of traditional and modern knowledge of medicine. The medicinal doses and lethal doses determined by researches are summarized, and the usage and processing methods are updated and reviewed in the modern view. In addition, clinical management of poisoned cases using western medicine is discussed. This review provides insights and awareness of safety when using Aconitum-derived herbal medicine, and the application of modern scientific knowledge to optimize the detoxification processes. We suggest the possibility to renew the current standard processing method from the official Pharmacopoeia all over the world.
Overexpression of LIMK1 in hippocampal excitatory neurons improves synaptic plasticity and social recognition memory in APP/PS1 mice
Authors: Zhang Haiwang , Ben Zablah Youssif , Liu An , Lee Dongju , Zhang Haorui , Meng Yanghong , Zhou Changxi , Liu Xingde , Wang Yiming , Jia Zhengping
Published: July 2021

Accumulating evidence indicates that the actin regulator cofilin is overactivated in Alzheimer’s Disease (AD), but whether this abnormality contributes to synaptic and cognitive impairments in AD is unclear. In addition, the brain region and cell types involved remain unknown. In this study, we specifically manipulate LIMK1, the key protein kinase that phosphorylates and inactivates cofilin, in the hippocampus of APP/PS1 transgenic mice. Using local injections of the AAV virus containing LIMK1 under the control of the CaMKIIα promoter, we show that expression of LIMK1 in hippocampal excitatory neurons increases cofilin phosphorylation (i.e., decreases cofilin activity), rescues impairments in long-term potentiation, and improves social memory in APP/PS1 mice. Our results suggest that deficits in LIMK1/cofilin signaling in the hippocampal excitatory neurons contribute to AD pathology and that manipulations of LIMK1/cofilin activity provide a potential therapeutic strategy to treat AD.
Anopheles bionomics in a malaria endemic area of southern Thailand
Authors: Wamaket Narenrit , Khamprapa Oranicha , Chainarin Sittinont , Thamsawet Panisa , Ninsaeng Ubolrat , Thongsalee Suttipong , Suwan Veerast , Sakolvaree Jira , Takhampunya Ratree , Davidson Silas A. , McCardle Patrick W. , Sa-angchai Patiwat , Mukaka Mavuto , Kiattibutr Kirakorn , Khamsiriwatchara Amnat , Nguitragool Wang , Sattabongkot Jetsumon , Sirichaisinthop Jeeraphat , Kobylinski Kevin C.
Published: July 2021

Background

Ivermectin mass drug administration (MDA) could accelerate malaria elimination in the Greater Mekong Subregion. This study was performed to characterize the bionomics of Anopheles in Surat Thani province, Thailand.

Methods

Mosquitoes were collected via human landing collections between February and October 2019. Anopheles mosquitoes were morphologically identified to species. Primary Anopheles malaria vectors were dissected to assess parity status, and a subset were evaluated for molecular identification and Plasmodium detection.

Results

A total of 17,348 mosquitoes were collected during the study period; of these, 5777 were Anopheles mosquitoes. Morphological studies identified 15 Anopheles species, of which the most abundant were Anopheles minimus (s.l.) (87.16%, n = 5035), An. dirus s.l. (7.05%, n = 407) and An. barbirostris s.l. (2.86%, n = 165). Molecular identification confirmed that of the An. minimus s.l. mosquitoes collected, 99.80% were An. minimus (s.s.) (n = 484) and 0.2% were An. aconitus (n = 1), of the An. dirus (s.l.) collected, 100% were An. baimaii (n = 348), and of the An. maculatus (s.l.) collected, 93.62% were An. maculatus (s.s.) (n = 44) and 6.38% were An. sawadwongporni (n = 3). No Anopheles mosquito tested was Plasmodium positive (0/879). An average of 11.46 Anopheles were captured per collector per night. There were differences between species in hour of collection (Kruskal–Wallis H-test: χ2 =  80.89, P < 0.0001, n = 5666), with more An. barbirostris (s.l.) and An. maculatus (s.l.) caught earlier compared to An. minimus (s.l.) (P = 0.0001 and P < 0.0001, respectively) and An. dirus (s.l.) (P = 0.0082 and P < 0.001, respectively). The proportion of parous An. minimus (s.l.) captured by hour increased throughout the night (Wald Chi-square: χ2 = 17.31, P = 0.000, odds ratio = 1.0535, 95% confidence interval 1.0279–1.0796, n = 3400). Overall, An. minimus (s.l.) parity was 67.68% (2375/3509) with an intra-cluster correlation of 0.0378. A power calculation determined that an An. minimus (s.l.) parity reduction treatment effect size = 34%, with four clusters per treatment arm and a minimum of 300 mosquitoes dissected per cluster, at an α = 0.05, will provide 82% power to detect a significant difference following ivermectin MDA.

Conclusions

The study area in Surat Thani province is an ideal location to evaluate the impact of ivermectin MDA on An. minimus parity.

Graphical abstract
Cognitively unimpaired individuals with a low burden of Aβ pathology have a distinct CSF biomarker profile
Authors: Milà-Alomà Marta , Shekari Mahnaz , Salvadó Gemma , Gispert Juan Domingo , Arenaza-Urquijo Eider M. , Operto Grégory , Falcon Carles , Vilor-Tejedor Natalia , Grau-Rivera Oriol , Sala-Vila Aleix , Sánchez-Benavides Gonzalo , González-de-Echávarri José Maria , Minguillon Carolina , Fauria Karine , Niñerola-Baizán Aida , Perissinotti Andrés , Simon Maryline , Kollmorgen Gwendlyn , Zetterberg Henrik , Blennow Kaj , Suárez-Calvet Marc , Molinuevo José Luis ,   for the ALFA study
Published: July 2021

Background

Understanding the changes that occur in the transitional stage between absent and overt amyloid-β (Aβ) pathology within the Alzheimer’s continuum is crucial to develop therapeutic and preventive strategies. The objective of this study is to test whether cognitively unimpaired individuals with a low burden of Aβ pathology have a distinct CSF, structural, and functional neuroimaging biomarker profile.

Methods

Cross-sectional study of 318 middle-aged, cognitively unimpaired individuals from the ALFA+ cohort. We measured CSF Aβ42/40, phosphorylated tau (p-tau), total tau (t-tau), neurofilament light (NfL), neurogranin, sTREM2, YKL40, GFAP, IL6, S100B, and α-synuclein. Participants also underwent cognitive assessments, APOE genotyping, structural MRI, [18F]-FDG, and [18F]-flutemetamol PET.

To ensure the robustness of our results, we used three definitions of low burden of Aβ pathology: (1) positive CSF Aβ42/40 and < 30 Centiloids in Aβ PET, (2) positive CSF Aβ42/40 and negative Aβ PET visual read, and (3) 20–40 Centiloid range in Aβ PET. We tested CSF and neuroimaging biomarker differences between the low burden group and the corresponding Aβ-negative group, adjusted by age and sex.

Results

The prevalence and demographic characteristics of the low burden group differed between the three definitions. CSF p-tau and t-tau were increased in the low burden group compared to the Aβ-negative in all definitions. CSF neurogranin was increased in the low burden group definitions 1 and 3, while CSF NfL was only increased in the low burden group definition 1. None of the defined low burden groups showed signs of atrophy or glucose hypometabolism. Instead, we found slight increases in cortical thickness and metabolism in definition 2.

Conclusions

There are biologically meaningful Aβ-downstream effects in individuals with a low burden of Aβ pathology, while structural and functional changes are still subtle or absent. These findings support considering individuals with a low burden of Aβ pathology for clinical trials.

Trial registration

NCT02485730
Percutaneous cryoablation of chondroblastoma and osteoblastoma in pediatric patients
Authors: Serrano Elena , Zarco Federico , Gill Anne E. , Hawkins C. Matthew , Macías Napoleón , Inarejos Clemente Emilio J. , Torner Ferran , Barber Ignasi , Corominas Daniel , González Enrique Ladera , López-Rueda Antonio , Gómez Fernando M.
Published: July 2021

Background

To review the safety and efficacy of percutaneous cryoablation for the treatment of chondroblastoma and osteoblastoma in the pediatric and adolescent population.

Materials and methods

A retrospective review from 2016 to 2020 was performed to evaluate clinical and imaging response to percutaneous cryoablation in 11 symptomatic patients with diagnosis of chondroblastoma and osteoblastoma treated from two pediatric hospitals with at least 12-month follow-up. Technical success (correct needle placement and potential full coverage of the tumor with the planned ablation zone) and clinical success (relief of the symptoms) were evaluated. The primary objective was to alleviate pain related to the lesion(s). Immediate and late complications were recorded. Patients were followed in clinic and with imaging studies such as MRI or CT for a minimum of 6 months.

Results

A total of 11 patients were included (mean 14 years, age range 9–17; male n = 8). Diagnoses were osteoblastoma (n = 4) and chondroblastoma (n = 7). Locations were proximal humerus (n = 1), femur condyle (n = 1), and proximal femur (n = 1) tibia (n = 3), acetabulum (n = 3), thoracic vertebra (n = 1) and lumbar vertebra (n = 1). Cryoablation was technically successful in all patients. Clinical success (cessation of pain) was achieved in all patients. No signs of recurrence were observed on imaging follow-up in any of the patients. One of the patients developed periprocedural right L2–L3 transient radiculopathy as major immediate complication.

Conclusions

Percutaneous image-guided cryoablation can be considered potentially safe and effective treatment for chondroblastoma and osteoblastoma in children and adolescents.