bluuebunny/crossref_metadata_2025_split huggingface dataset:
In vivo magnetic resonance imaging evidence of olfactory bulbs changes in a newborn with congenital Citomegalovirus: a case report
Authors: Bianchi Andrea , Coviello Caterina , Leonardi Valentina , Luzzati Michele , Chiti Stefano , Ermini Daniele , Miele Vittorio , Fainardi Enrico , Dani Carlo , Scola Elisa 
Published: November 2021

Abstract
Background
Citomegalovirus (CMV) infects approximately 1% of live newborns. About 10% of the infants affected by congenital CMV infection are symptomatic at birth and up to 60% of these infants will develop permanent neurological disabilities. Depending on gestational age (GA) at the time of infection, the involvement of central nervous system (CNS) can lead to malformations of cortical development, calcifications, periventricular white matter lesions and cysts, ventriculomegaly and cerebellar hypoplasia.

Case presentation
We report the MRI findings in a Caucasian female born at 32 weeks of post-menstrual age with post-birth diagnosis of congenital CMV infection showing an unusual and peculiar marked T2 hyperintensity of the inner part of olfactory bulbs in addition to the CMV related diffuse brain involvement. Despite the known extensively described fetal and neonatal Magnetic Resonance Imaging (MRI) findings in CMV infected fetuses and newborns, any in vivo MRI depiction of olfactory system damage have never been reported so far. Nevertheless, in murine studies CMV is known to infect the placenta during pregnancy showing particular tropism for neural stem cells of the olfactory system and previous neuropathologic study on CMV infected human fetal brains from 23 to 28 weeks of GA reported damage in the olfactory bulbs (OB) consisting in disseminated cytomegalic cells, inflammation, necrosis and neuronal and radial glial cell loss. Therefore, we assume an OB involvement and damage in congenital CMV infection.

Conclusion
To our knowledge this is the first in vivo MRI evidence of OB damage in a newborn with congenital CMV infection that may give new insights on CMV infection.
Resequencing of 388 cassava accessions identifies valuable loci and selection for variation in heterozygosity
Authors: Hu Wei , Ji Changmian , Liang Zhe , Ye Jianqiu , Ou Wenjun , Ding Zehong , Zhou Gang , Tie Weiwei , Yan Yan , Yang Jinghao , Ma Liming , Yang Xiaoying , Wei Yunxie , Jin Zhiqiang , Xie Jianghui , Peng Ming , Wang Wenquan , Guo Anping , Xu Biyu , Guo Jianchun , Chen Songbi , Wang Mingcheng , Zhou Yang , Li Xiaolong , Li Ruoxi , Xiao Xinhui , Wan Zhongqing , An Feifei , Zhang Jie , Leng Qingyun , Li Yin , Shi Haitao , Ming Ray , Li Kaimian 
Published: November 2021

Abstract
Background
Heterozygous genomes are widespread in outcrossing and clonally propagated crops. However, the variation in heterozygosity underlying key agronomic traits and crop domestication remains largely unknown. Cassava is a staple crop in Africa and other tropical regions and has a highly heterozygous genome.

Results
We describe a genomic variation map from 388 resequenced genomes of cassava cultivars and wild accessions. We identify 52 loci for 23 agronomic traits through a genome-wide association study. Eighteen allelic variations in heterozygosity for nine candidate genes are significantly associated with seven key agronomic traits. We detect 81 selective sweeps with decreasing heterozygosity and nucleotide diversity, harboring 548 genes, which are enriched in multiple biological processes including growth, development, hormone metabolisms and responses, and immune-related processes. Artificial selection for decreased heterozygosity has contributed to the domestication of the large starchy storage root of cassava. Selection for homozygous GG allele in MeTIR1 during domestication contributes to increased starch content. Selection of homozygous AA allele in MeAHL17 is associated with increased storage root weight and cassava bacterial blight (CBB) susceptibility. We have verified the positive roles of MeTIR1 in increasing starch content and MeAHL17 in resistance to CBB by transient overexpression and silencing analysis. The allelic combinations in MeTIR1 and MeAHL17 may result in high starch content and resistance to CBB.

Conclusions
This study provides insights into allelic variation in heterozygosity associated with key agronomic traits and cassava domestication. It also offers valuable resources for the improvement of cassava and other highly heterozygous crops.
Uncertainty of leukoencephalopathies: a case report
Authors: Taha Mohamed A. , Diesing T. Scott 
Published: November 2021

Abstract
Background
Adult-onset leukoencephalopathies are a group of heterogeneous disorders characterized by white matter abnormalities. Leukoencephalopathy is usually encountered in children, but here we report a case with adult-onset leukoencephalopathy. Also, we explore this concept of uncertainty in medicine by discussing the approach to this case that has multiple possible etiologies.

Case presentation
A 70-year-old Caucasian male presented with a subacute onset of cognitive impairment and mood disturbances associated with behavioral changes. Neuroimaging demonstrated high-intensity lesions involving cerebral white matter. Progressive dementia and cognitive decline followed. Multiple possible etiologies are discussed based on the patient presentation and risk factors.

Conclusion
Adult-onset leukoencephalopathy can become a diagnostic challenge. Certain approaches need to be developed to explore the uncertainty of such conditions and to improve diagnostic yield.
Carney’s triad in an adult male from a tertiary care center in India: a case report
Authors: Tansir Ghazal , Dash Nihar Ranjan , Galodha Saurabh , Das Prasenjit , Shamim Shamim Ahmed , Rastogi Sameer 
Published: November 2021

AbstractBackgroundCarney’s triad is a rare syndrome comprising gastrointestinal stromal tumor, extra-adrenal paraganglioma, and pulmonary chondroma along with newer additions of adrenal adenoma and esophageal leiomyoma. The triad is completely manifest in only 25–30% cases, with most patients presenting with two out of three parts of the syndrome. Wild-type succinate-dehydrogenase-deficient gastric gastrointestinal stromal tumor forms the most common component of Carney’s triad and is usually multicentric and multifocal. It usually demonstrates indolent behavior and resistance to imatinib; hence, the management remains predominantly surgical. Pulmonary chondromas are commonly unilateral and multiple with slow-growing nature, which allows for conservative management. Adrenocortical adenomas are found in 20% of patients and are usually detected as incidentalomas.Case presentationA 49-year-old Asian male presented with upper gastrointestinal bleed and was diagnosed with multiple gastric succinate-dehydrogenase-deficient gastrointestinal stromal tumors. On evaluation, he was found to have left pulmonary chondroma and non-secretory adrenal adenoma, thus completing the Carney’s triad. He underwent surgery with sleeve gastrectomy and excision of the antral tumor nodule, while the adrenal and pulmonary tumors have been under close follow-up.ConclusionLiterature regarding Carney’s triad is scarce, especially from the Indian setting. Our report aims to highlight the various manifestations of this syndrome with emphasis on management of wild-type succinate-dehydrogenase-deficient gastrointestinal stromal tumor. Radical gastric surgeries do not offer a survival advantage in this condition; hence, more conservative modalities of resection can be adopted.
Investigation of the robustness of Cupriavidus necator engineered strains during fed-batch cultures
Authors: Boy Catherine , Lesage Julie , Alfenore Sandrine , Guillouet Stéphane E. , Gorret Nathalie 
Published: November 2021

AbstractIt is of major interest to ensure stable and performant microbial bioprocesses, therefore maintaining high strain robustness is one of the major future challenges in industrial microbiology. Strain robustness can be defined as the persistence of genotypic and/or phenotypic traits in a system. In this work, robustness of an engineered strain is defined as plasmid expression stability, cultivability, membrane integrity and macroscopic cell behavior and was assessed in response to implementations of sugar feeding strategies (pulses and continuous) and two plasmid stabilization systems (kanamycin resistance and Post-Segregational Killing hok/sok). Fed-batch bioreactor cultures, relevant mode to reach high cell densities and higher cell generation number, were implemented to investigate the robustness of C. necator engineered strains. Host cells bore a recombinant plasmid encoding for a plasmid expression level monitoring system, based on eGFP fluorescence quantified by flow cytometry. We first showed that well-controlled continuous feeding in comparison to a pulse-based feeding allowed a better carbon use for protein synthesis (avoiding organic acid excretion), a lower heterogeneity of the plasmid expression and a lower cell permeabilization. Moreover, the plasmid stabilization system Post-Segregational Killing hok/sok, an autonomous system independent on external addition of compounds, showed the best ability to maintain plasmid expression level stability insuring a greater population homogeneity in the culture. Therefore, in the case of engineered C. necator, the PSK system hok/sok appears to be a relevant and an efficient alternative to antibiotic resistance system for selection pressure, especially, in the case of bioprocess development for economic and environmental reasons.
Innovation, firm productivity, and export survival: firm-level evidence from ASEAN developing countries
Authors: Jitsutthiphakorn Utumporn 
Published: November 2021

AbstractThis firm-level study investigates the importance of innovation as a determinant of firm productivity and how firm productivity could impact firm export survival. This is the first integration of the innovation approach, productivity approach, and firm survival approach to explore their linkages at the regional level in ASEAN developing countries. Using the panel database from the World Bank Enterprise Survey, which covers six developing countries in ASEAN—the Philippines, Indonesia, Vietnam, Laos, Cambodia, and Myanmar—and also covers six selected industries, we construct four equations: innovation inputs, innovation output, firm productivity, and export survival. The four equations’ findings suggest that the technology level of the sector, firm size, and exports are significant factors for R&D expenditure (innovation input). R&D expenditure is a significant driver of a firm’s product and process innovation (innovation output). Increasing firm productivity in the six ASEAN developing countries we considered is driven by process innovation rather than product innovation, and productive firms are more likely to survive in the export market.
Resistant starch: Implications of dietary inclusion on gut health and growth in pigs: a review
Authors: Tan Felina P. Y. , Beltranena Eduardo , Zijlstra Ruurd T. 
Published: November 2021

AbstractStarch from cereal grains, pulse grains, and tubers is a major energy substrate in swine rations constituting up to 55% of the diet. In pigs, starch digestion is initiated by salivary and then pancreatic α-amylase, and has as final step the digestion of disaccharides by the brush-border enzymes in the small intestine that produce monosaccharides (glucose) for absorption. Resistant starch (RS) is the proportion of starch that escapes the enzymatic digestion and absorption in the small intestine. The undigested starch reaches the distal small intestine and hindgut for microbial fermentation, which produces short-chain fatty acids (SCFA) for absorption. SCFA in turn, influence microbial ecology and gut health of pigs. These fermentative metabolites exert their benefits on gut health through promoting growth and proliferation of enterocytes, maintenance of intestinal integrity and thus immunity, and modulation of the microbial community in part by suppressing the growth of pathogenic bacteria while selectively enhancing beneficial microbes. Thus, RS has the potential to confer prebiotic effects and may contribute to the improvement of intestinal health in pigs during the post-weaning period. Despite these benefits to the well-being of pigs, RS has a contradictory effect due to lower energetic efficiency of fermented vs. digested starch absorption products. The varying amount and type of RS interact differently with the digestion process along the gastrointestinal tract affecting its energy efficiency and host physiological responses including feed intake, energy metabolism, and feed efficiency. Results of research indicate that the use of RS as prebiotic may improve gut health and thereby, reduce the incidence of post-weaning diarrhea (PWD) and associated mortality. This review summarizes our current knowledge on the effects of RS on microbial ecology, gut health and growth performance in pigs.
An assessment of nursing mothers’ and young people’s access to proprietary and patent medicine vendors’ services in rural communities of south-eastern Nigeria: implication for review of national drug policy
Authors: Uneke C. J. , Obeka I. , Uneke B. I. , Umeokonkwo A. , Nweze C. A. , Otubo K. I. , Uguru O. E. 
Published: November 2021

Abstract
Background
Patent and proprietary medicine vendors (PPMVs) form part of the informal healthcare system and are the first point of call for 75% of Nigerians who live in rural and underserved areas where there is limited access to healthcare services. This group of healthcare providers are located close to communities and are easily accessible to the people. This study seeks to determine how PPMVs influence access to medicines among nursing mothers and young people and how this progresses South Eastern Nigeria towards universal health coverage.

Methods
A cross-sectional descriptive study was conducted using a purposive sampling technique. Two slightly different pre-tested and validated 5-point Likert scale questionnaires were used to survey the nursing mothers and young people (18–20 years old). The questionnaire for nursing mothers assessed the perception regarding PPMV services and community access to medicines used for the treatment of childhood infections. The questionnaire for young people assessed the services rendered by the PPMVs including family planning, and major enablers/barriers towards to access to medicine.

Results
A total of 159 nursing mothers and 148 youths participated in the study. Up to 60% of both population had a minimum of secondary school qualification. About 90% of the nursing mothers were married and 88% were nursing babies from 1 to 12 months. Results show that the PPMVs were the first point of call for healthcare needs among the respondents and they are easily accessible and sell affordable medicines. The nursing mothers frequently treat their children’s cough with antibiotics with a mean rating (MNR) of 4.7 out of 5 points and most source these antibiotics from PPMV shops. Up to 90% of the nursing mothers reported that the children got well after the treatment. The drugs mostly purchased by the youths from the PPMVs included antimalarials (95%), analgesics (87.7%) and antibiotics (81.3%). Only 25.5% of the respondents purchased family planning commodities. Most of the respondents sought health care from PPMVs with a MNR of 3.4. Patronage of PPMVs for and usage of family planning products by the respondents had MNRs ranging from 1.4 to 1.8.

Conclusion
PPMVs are bridging the gap in healthcare delivery in the rural and underserved areas. Training of this group of practitioners and appropriate monitoring will go a long way in ensuring that the services they render are efficient, effective and improve the health indices in a low-income setting.
Role of small private drug shops in malaria and tuberculosis programs in Myanmar: a cross-sectional study
Authors: Thet May Me , Khaing Myat Noe Thiri , Zin Su Su , Oo Sandar , Aung Ye Kyaw , Thein Si Thu 
Published: November 2021

Abstract
Background
The role of community drug shops in providing primary care has been recognized as important in Myanmar as in other countries. The contribution by private community drug shops to National Tuberculosis case notifications and National Malaria testing and positive cases is significant. Population Services International Myanmar (PSI/Myanmar) has been successfully training and engaging community drug shops to screen presumptive Tuberculosis to make referrals to public health clinics and perform malaria rapid diagnostic tests (mRDT) to malaria fever cases and provide management accordingly.

Objectives
The study aims to identify barriers to service provision of the trained providers at the drug shops that are currently engaged in PSI/Myanmar Tuberculosis and malaria programs. Exploring their needs enabled us to identify and address barriers, to provide evidence for better linkage with the primary care system.

Method
A mixed method study was conducted with the service providers at the drug shops. A quantitative follow up survey was done with 177 trained Tuberculosis service providers and 65 trained malaria service providers. A total of 32 qualitative in-depth interviews were completed. Seventeen Tuberculosis trained providers and 15 malaria trained providers participated in individual interviews. Content analysis approach was used to generate themes for the data analysis.

Results
From the survey, the majority of drug shops reported that they performed appropriate first steps, particularly referring symptomatic Tuberculosis cases and offering mRDT testing to fever cases. Nevertheless, in-depth interviews with them revealed they did not adhere to the national guidelines for every client. There was a need to emphasize the importance of following the national guidelines for referring patients with prolonged cough and fever cases management. For those who were trained in Tuberculosis case referral, support from program staff was needed to make smooth referrals. Those who were trained in malaria often considered differential diagnosis of fever other than malaria and did not test with malaria rapid diagnostic test due to declining numbers of malaria cases.

Conclusion
The study findings highlighted that the drug shops trained in Tuberculosis referral seemed to have the potential to fully engage into the primary care health system if provided with suitable support and supervision. On the other hand, those trained in malaria case management might be less motivated to engage in the era of declining malaria endemicity.
Barriers and facilitators for integration of guidelines on operating health shops: a case of family planning services
Authors: Zulu Joseph M. , Sitali Doreen , Shroff Zubin Cyrus , Lamba Geetanjali , Sichone George , Michelo Charles , Mpandamabula Chileshe H. , Mwambazi Wesely , Mwenda Cecilia , Chavula Malizgani P. 
Published: November 2021

Abstract
Background
The Zambia Medicines Regulatory Authority (ZAMRA) piloted the implementation of Guidelines on Operating Health Shops in Zambia in 2016, with a view to making basic medicines more accessible to communities. The guidelines aim to transform ordinary drug shops into health shops, which are dispensing facilities permitted to sell a ZAMRA-prescribed list of medicines over the counter. However, studies that explore the integration and uptake of guidelines into the health system are lacking. This study aims to inform future improved implementation of these guidelines by examining the current acceptability of guidelines within the Zambian health system, especially in relation to family planning services.

Methodology
Data collected through documentary review, key informant interviews with district pharmacists, staff from ZAMRA and in-depth interviews with 24 health shop owners and dispensers were analyzed using thematic analysis. A conceptual framework on the integration of health innovations into health systems guided the analysis.

Results
The Guidelines on Operating Health Shops were implemented to address the problem of inadequate access to quality medicines especially in rural areas. Factors that facilitated the acceptability of the guidelines included their perceived relevance and simplicity, comprehensive training and improved knowledge among health shop operators on the guidelines, development of a governance and reporting structure or steering committee at the national level as well as perceived improved health outcomes at the community level. Factors that hindered acceptability of the guidelines included the high cost of implementing them, a restricted list of drugs which affected consumer choice, limited communication between the local council and the operators of health shops, health shop owners not owning the health shop premises restricting their ability to adapt the building, and cultural norms which constrained uptake of family planning services.

Conclusion
In addition to training, facilitating the acceptability of the guidelines among health shop owners requires paying attention to operational issues such as location, ownership of the shop, size of infrastructure as well as financial costs of implementing guidelines through decentralizing the registration process and thus reducing the cost of registration. It is also important to have effective communication strategies between operators and the regulators of health shops.
Long-term outcomes of two first-generation trabecular micro-bypass stents (iStent) with phacoemulsification in primary open-angle glaucoma: eight-year results
Authors: Salimi Ali , Watt Harrison , Harasymowycz Paul 
Published: November 2021

AbstractBackgroundThe short- and medium-term outcomes of iStent have been extensively studied; however, only few studies have investigated its long-term outcomes. Here, we assessed the long-term efficacy and safety of two iStents with concomitant cataract surgery in glaucomatous eyes while also evaluating measures of disease stability using visual field and optical coherence tomography (OCT) of the optic nerve and the macula throughout 8 years of follow-up.MethodsThis longitudinal, single-center consecutive case series included glaucomatous eyes that underwent implantation of two first-generation trabecular micro-bypass stents (iStent) with concomitant cataract surgery. Eight-year efficacy outcomes included mean intraocular pressure (IOP) and medications, as well as surgical success. Eight-year safety outcomes included best-corrected visual acuity (BCVA), visual field mean deviation (VF-MD), cup-to-disc ratio (CDR), retinal nerve fiber layer (RNFL) thickness, ganglion cell-inner plexiform layer (GC-IPL) thickness, and adverse events.ResultsA total of 62 eyes with primary open-angle glaucoma (POAG) were included. At 8 years postoperative, IOP reduced by 26% from 19.2 ± 3.9 mmHg preoperatively to 14.2 ± 2.4 mmHg (P < 0.001), 91.1% of eyes achieved IOP ≤ 18 mmHg (vs. 51.6% preoperatively), 69.6% of eyes achieved IOP ≤ 15 mmHg (vs. 14.5% preoperatively), and 25% of eyes achieved IOP ≤ 12 mmHg (vs. 1.6% preoperatively). Medication use decreased by 17.9% from 2.8 ± 1.1 preoperatively to 2.3 ± 1.2 (P = 0.018). Surgical success was 90%, as six eyes underwent subsequent glaucoma surgeries. Safety measures of BCVA, CDR, RNFL thickness and GC-IPL thickness remained stable through 8 years postoperative. VF-MD remained stable until postoperative year 5 and subsequently progressed according to the natural history of glaucomatous disease.ConclusionsImplantation of two iStents with concomitant cataract surgery is an effective and safe treatment option for surgery-naïve POAG eyes, evidenced by significant IOP and medication reductions, reasonable surgical success, and favorable safety outcomes, throughout the 8-year follow-up. Our data additionally supports the efficacy of this combined procedure in stabilizing or slowing disease progression.