bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Lutein and Zeaxanthin in Pregnancy (L-ZIP) study—carotenoid supplementation during pregnancy: ocular and systemic effects—study protocol for a randomized controlled trial
Authors: Addo Emmanuel Kofi , Gorusupudi Aruna , Allman Susan , Bernstein Paul S. 
Published: April 2021

Abstract
Background
Lutein (L), zeaxanthin (Z), and meso-zeaxanthin (MZ), collectively called the macular pigment (MP), are dietary carotenoids that preferentially localize in the macula of the human eye. MP protects the macula from photo-oxidative damage and enhances visual function. Inadequate maternal intake of carotenoids, coupled with the placental transfer of maternal carotenoids to support fetal brain and retina development, potentially put mothers at risk of depletion systemically and in their ocular tissues. Presently, maternal carotenoid status throughout pregnancy remains poorly characterized, and no prospective randomized controlled trial of L and Z supplementation via prenatal vitamins has assessed maternal and infants’ systemic and ocular carotenoid status during pregnancy. We hypothesize that prenatal maternal carotenoid supplementation will counteract maternal carotenoid depletion during pregnancy and will improve biomarkers of carotenoid status of both mothers and infants.

Methods
Lutein and Zeaxanthin in Pregnancy (L-ZIP) is a phase 2, single-center, prospective, double-masked, randomized active-controlled clinical trial conducted at the John A. Moran Eye Center, University of Utah, Salt Lake City, UT, USA. Participants consume a daily standard prenatal multivitamin with no added carotenoids and are randomized (1:1 allocation) to receive either a capsule containing 10 mg L and 2 mg Z in safflower oil (Carotenoid group) or a capsule containing only safflower oil with no added carotenoids (Control group) for a period of 6 to 8 months. Skin, serum, and ocular carotenoids are measured at every study visit (i.e., within the first trimester [baseline], second trimester, third trimester, and 0–2 weeks postpartum). Skin carotenoid assessment is by resonance Raman spectroscopy (RRS); serum carotenoid status is quantified using high-performance liquid chromatography (HPLC); and MP is measured with the dual-wavelength autofluorescence. Infants’ MP and foveal anatomy are assessed using RetCam retinal camera and Bioptigen SD-OCT, respectively. The primary outcomes are changes in maternal systemic and ocular carotenoid status during pregnancy.

Discussion
L-ZIP is the first prospective RCT to investigate maternal carotenoid status throughout pregnancy and to determine whether prenatal maternal carotenoid supplementation will offset maternal carotenoid depletion and improve biomarkers of maternal and infant’s carotenoid status. Findings from L-ZIP will strengthen recommendations regarding prenatal carotenoid supplementation and consequently inform policy decisions.

Trial registration
ClinicalTrials.gov NCT03750968. Registered on November 23, 2018
Diphyllobothrium sprakeri n. sp. (Cestoda: Diphyllobothriidae): a hidden broad tapeworm from sea lions off North and South America
Authors: Hernández-Orts Jesús S. , Kuzmina Tetiana A. , Gomez-Puerta Luis A. , Kuchta Roman 
Published: April 2021

Abstract
Background
The systematic of several marine diphyllobothriid tapeworms of pinnipeds has been revised in recent years. However, 20 species of Diphyllobothrium from phocids and otariids are still recognized as incertae sedis. We describe a new species of Diphyllobothrium from the intestine of California sea lions Zalophus californianus (Lesson) (type-host) and South American sea lions Otaria flavescens (Shaw).

Methods
Zalophus californianus from the Pacific coast of the USA and O. flavescens from Peru and Argentina were screened for parasites. Partial fragments of the large ribosomal subunit gene (lsrDNA) and the cytochrome c oxidase subunit 1 (cox1) mitochondrial gene were amplified for 22 isolates. Properly fixed material from California sea lions was examined using light and scanning electron microscopy.

Results
A total of four lsrDNA and 21 cox1 sequences were generated and aligned with published sequences of other diphyllobothriid taxa. Based on cox1 sequences, four diphyllobothriid tapeworms from O. flavescens in Peru were found to be conspecific with Adenocephalus pacificus Nybelin, 1931. The other newly generated sequences fall into a well-supported clade with sequences of a putative new species previously identified as Diphyllobothrium sp. 1. from Z. californianus and O. flavescens. A new species, Diphyllobothrium sprakeri n. sp., is proposed for tapeworms of this clade.

Conclusions
Diphyllobothrium sprakeri n. sp. is the first diphyllobothriid species described from Z. californianus from the Pacific coast of North America, but O. flavescens from Argentina, Chile and Peru was confirmed as an additional host. The present study molecularly confirmed the first coinfection of two diphyllobothriid species in sea lions from the Southern Hemisphere.

Graphical Abstract
Efficacy of low-dose methimazole in control of multiple relapses of Graves’ hyperthyroidism: a case report
Authors: Azizi Fereidoun , Amouzegar Atieh , Abdi Hengameh 
Published: April 2021

Abstract
Introduction
Methimazole (MMI) is the treatment of choice for patients with Graves’ disease. The major drawback of this treatment is the relapse of hyperthyroidism in half of the patients after discontinuation of the recommended conventional 12–18 months of MMI treatment. TSH receptor antibody (TRAb) concentration is recognized as the strongest predictor of hyperthyroidism relapse. In this case report, efficacy of low-dose MMI to control hyperthyroidism even after multiple recurrences in the setting of normal TRAb concentrations is shown.

Case presentation
An 80-year-old Iranian woman with Graves’ disease was treated with MMI for 31 years. While receiving treatment, she always had a normal serum TRAb concentration; however, three times during the 31 years she decided to stop MMI therapy, and each time the disease recurred 16–21 months after MMI withdrawal. It is noteworthy that she maintained euthyroidism with the low-dose 1.25–2.5 mg MMI daily without any adverse events during three decades of treatment.

Conclusions
Normal serum TRAb is not a sufficiently strong marker to predict relapse of Graves’ hyperthyroidism. Long-term therapy with low-dose MMI is an effective and safe treatment to sustain euthyroidism.
Refractory dermatitis contributed by pityriasis versicolor: a case report
Authors: Li Mingjia , Spaccarelli Natalie , Kendra Kari , Wu Richard C. , Verschraegen Claire 
Published: April 2021

Abstract
Background
Dermatologic toxicity is a very common immune-related adverse event (irAE) for patients with melanoma who are receiving immune checkpoint inhibitor therapy (ICI). Concurrent skin infection, such as in the case of pityriasis versicolor reported here, can mimic and/or exacerbate dermatologic toxicity from irAE.

Case presentation
A 58-year-old Caucasian man with a history of pityriasis versicolor infection and metastatic melanoma received ICI therapy. He developed progressively worsening pruritic maculopapular lesions 22 weeks into his treatment that ultimately covered 40% of his body. He was diagnosed with dermatologic toxicity due to ICI therapy with concurrent pityriasis versicolor. He was initially started on topical steroid and topical antifungal cream but achieved minimum improvement. His treatment was then escalated to oral prednisone, but it only achieved modest control of his dermatitis. All subsequent attempts to wean him from oral prednisone resulted in worsening of his dermatitis. Eventually he was started on oral fluconazole in combination with prednisone, which led to rapid resolution of his dermatitis.

Conclusion
We report a case of dermatological toxicity due to an irAE with concurrent pityriasis versicolor. The steroid treatment for irAE was likely exacerbating the underlying fungal infection, and the fungal infection was in term mimicking the symptoms of irAE. This patient’s severe dermatitis was only brought under control after receiving a more potent antifungal therapy in combination with a steroid. It is vital to look beyond the irAE when managing dermatitis in patients receiving ICI therapy.
Critique of Archived Life: Toward a Hesitation of Sikh Immigrant Accumulation
Authors: Judge Rajbir Singh , Brar Jasdeep Singh 
Published: April 2021

AbstractIn 2016, the Pioneering Punjabi Digital Archive (PPDA) went online. Attempting to reveal how the Punjabi community struggled and then thrived in California, the PPDA accumulates narratives of Punjabi American life. Against such models of archival intimacy and recovery, which look to cultivate limitless public access to a knowable and transparent subject while reducing structural precarity to the failure of an exceptional Punjabi, this article hesitates in a vexed archival space without guarantees. Within this hesitation, it explores the traces of untimely lives displaced in creating archival legibility—traces that reveal a different form of being that challenge the additive logic of the PPDA. This hesitation is cultivated through a comparative approach that couples archival and ethnographic research based on articles about Punjabi American life in both the archive and public sphere alongside ethnographic work conducted with Sikh immigrants who work in canneries and the fields. The aim is to pause in the present impasse to consider the nonbecoming of unknown forms—an ethnographic “reaching and ungrasping” in which the future is not fixed as a requirement for thinking, refusing the accumulating demands of narrative sequence that archiving presents.
“He Rests from His Labors”: Racialized Recreation and Missionary Science in Colonial Korea
Authors: Kramer Derek J. 
Published: April 2021

AbstractThis article examines how Anglo-American evangelicals in colonial Korea employed racialized understandings of the environment to justify a culture of recreation and health. In the metropole and periphery, missionary researchers studying climate, geography, and public health asserted a science-based injunction to rest that was intended to maintain a population of evangelical workers. The production of this scientific research, external to the Japanese colonial state, allowed the missionary community to establish a rationale for collective segregation from the local populations they sought to save. In Korea, this dynamic is profiled through the history of a missionary resort at Sorai beach. Initially believed to have contributed to the suicide of an evangelical worker in 1895, within a few years the Sorai area rapidly transformed. In step with the broader culture of summer recreation that emerged in Korea during the 1910s and 1920s, the missionaries recast Sorai from a deleterious space into a site of strategic and devotional rest.
Entrepreneurs of the National Past: The Discourse of Ethnic Indigeneity and Indigenous Cultural Writing in China
Authors: Zhang Yanshuo 
Published: April 2021

AbstractThis article probes a long-overlooked concept in modern China—ethnic indigeneity—to propose new ways of looking at the relationship between the Chinese nation and its multiethnic minority groups. The Western scholarly community has long held that because the Chinese state uses the Marxist-tainted term shaoshu minzu (ethnic minorities) as the official designation for the non-Han people, the concept of indigeneity is irrelevant to understanding China and its ethnic diversity. This article investigates how reform-era China has witnessed the emergence of an indigenous cultural consciousness exhibited by the non-Han people such as the Qiang people from southwest China. The article argues that minority groups like the Qiang are enthusiastic about “enterprising” their ethnic identities by writing minority histories into the foundational myths of a multiethnic, unified China and challenging the historical hierarchy of the “civilized” Han center and its “uncultured” non-Han peripheries. By analyzing locally produced scholarly and touristic discourses, ethnocultural writing, and filming efforts in southwest China, the article proposes that “indigeneity” entails the interactive processes for a minority group to carve out its cultural, economic, and political spaces of creative belonging within the state by conversing with national narratives and contending for the epistemological authority to represent itself in multiethnic China.
Sounding the Ineffable: Third-Century Chinese Whistling as an Alternative Voice
Authors: Zheng Yiren 
Published: April 2021

AbstractThis article examines the role of whistling as an elusive voice in the literary world from around the third century onward. It argues that as an alternative to normalized forms of vocal, musical, and poetic expression, whistling destabilized, blurred, and reconfigured notions of voice, language, writing, and music within the larger context of Six Dynasties thought and aesthetics. Despite the wide range of vocalizations (e.g., wailing, the tiger's roar) associated with whistling in premodern China, the whistling examined in this article refers to a particular vocal art commonly practiced by the literati. It reached its height around the third century, signaled by a rise in literary texts that illustrate its musical features, elaborate its mechanism, and tell stories about whistlers. An analysis of two main texts on whistling, Rhapsody on Whistling (third century) and Principles of Whistling (circa eighth century), uncovers the act of whistling as a gap: it is not yet a voice, not quite a kind of music, and it is beyond the realm of language. The whistler does not produce the whistling; it is his breath—passing through a bodily gap—that activates his body as a musical instrument, making the whistled sound an echo even before it sounds.
Metabolic Effects of Cortisol Treatment in a Marine Teleost, the Sea Raven
Authors: Vijayan M. M. , Mommsen T. P. , Glémet H. C. , Moon T. W. 
Published: April 2021

ABSTRACT
Sea raven (Hemitripterus americanus) given intraperitoneal implants of coconut oil containing cortisol (50 mg kg−1) and sampled 5 days later had plasma cortisol, glucose and urea concentrations higher than in a sham-implanted group. No differences in plasma ammonia, free amino acid or fatty acid concentrations were apparent between the cortisol-and sham-treated groups. There was no change in hepatic glycogen content, whereas glutamine synthetase, allantoicase, arginase, aspartate aminotransferase, tyrosine aminotransferase, alanine aminotransferase, glutamate dehydrogenase, phosphoenolpyruvate carboxykinase and 3-hydroxyacyl-coenzyme A dehydrogenase activities were higher in the cortisol-treated fish liver compared with the sham-implanted fish. On the basis of these general increases in enzyme activities, our results suggest that cortisol stimulates nitrogen metabolism in the sea raven. Amino acid catabolism may be a major source of substrate for gluconeogenesis and/or oxidation, while fatty acid mobilization may provide the fuel for endogenous use by the liver in cortisol-treated sea raven. These results further support the hypothesis that cortisol plays a role in the regulation of glucose production in stressed fish.
Treatment of Chronic Large and Persistent Macular Hole by a new technique in a Tertiary Care Hospital
Authors: Khan Tanweer Hasan , Syed Fawad Rizvi , Syed Asaad Mahmood , Feroz Lubna 
Published: April 2021

Objective: To assess the anatomical and functional outcomes of treating chronic persistent large macular hole by macular hole hydrodissection technique in a tertiary eye care hospital.
Methods: This interventional case series study was conducted in the Vitreoretinal department of LRBT Tertiary Teaching Eye Hospital, Karachi, from October 2017 to March 2018, with follow-ups till February 2019. The study included eighteen cases of chronic (symptoms of loss of central vision ≥ 2years), persistent (previously failed macular hole surgery), large (aperture diameter of ≥ 400µm) macular hole. Out of the eighteen patients, eight (44.4%) were males and ten (55.6%) were females. All operated patients underwent macular hole hydrodissection by balanced salt solution using a silicone soft tip extrusion cannula. Patients were followed up post operatively to assess post-operative complications and surgical results.
Results: Among eighteen patients with a mean aperture diameter of 477.1±102.9 µm and basal diameter of 849.4± 92.6µm, complete anatomical closure was achieved in sixteen (88.8%). Five (27.7%) out of the eighteen patients achieved best corrected visual acuity improvement of 6/36, whereas seven (38.8%) patients reached up to a BCVA of 6/60, with maximum improvement of two lines. The mean post-operative follow-up was 332.3± 46.7 days.
Conclusion: Macular hole hydrodissection is a relatively new emerging technique with promising results for the closure of chronic persistent large macular hole.
doi: https://doi.org/10.12669/pjms.37.4.3618
How to cite this:Khan TH, Rizvi SF, Mahmood SA, Feroz L. Treatment of Chronic Large and Persistent Macular Hole by a new technique in a Tertiary Care Hospital. Pak J Med Sci. 2021;37(4):979-982. doi: https://doi.org/10.12669/pjms.37.4.3618
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
A quality improvement project to reduce restrictive interventions in a mental health service
Authors: Savarimuthu Darren , Jung Katja 
Published: April 2021

Background/aims This article describes a quality improvement project that aimed to reduce restrictive interventions on an acute psychiatric ward. In light of a service level agreement and based on a trust-wide target, the purpose of the project was to reduce restrictive interventions by 20% within a period of 6 months. It was also anticipated that a least restrictive environment could have a positive impact on patient experience. Methods Three evidence-based interventions were introduced to the ward during the quality improvement project. These included positive behaviour support, the Safewards model and the productive ward initiative. Results There was a 63% reduction in restrictive interventions over a 6-month period through the successful implementation of a series of evidence-based interventions to manage behaviours that challenge on the mental health ward. Conclusions The project identified collaborative team working, staff training and adequate resources as essential elements in the success of the quality improvement initiative. However, co-production was found to be crucially significant in bringing sustainable changes in ward environment and in addressing restrictive practices.
Repeated filling of elastomeric infuser pumps for home-based subcutaneous medications: a case series
Authors: Julião Miguel , Sobral Maria Ana , Runa Daniela , Calçada Paula , Calaveiras Patrícia , Chaves Petra , Gonçalves Célia , Faria de Sousa Paulo , Bruera Eduardo 
Published: April 2021

Background: Several medical devices have been developed for continuous subcutaneous drug infusion for home palliative care (HPC), such as elastomeric infuser pumps (EIP). There is no evidence on the repeated filling of EIP for continuous subcutaneous delivery for HPC. Aim: A clinical case series report of terminally-ill patients cared for in HPC, with repeated filling of EIPs for home-based subcutaneous medications. Methods: A retrospective analysis of each patient's EIP-related entries in an anonymised database regarding: 1) EIP general functioning aspects; 2) clinical aspects: symptom control and local skin complications. Overall and per-patient cost-saving was also calculated. Findings: A total of 10 cases were analysed (four 50-hour EIP and six 30-hour EIP). All EIPs had a mean number of refillings (standard deviation (SD), mode) of 1.6 ((0.5), 2); with 3.2 drugs on average used in each EIP ((1.4), 4). Approximate total mean (SD) usage time for both types of EIP was 87 (29) hours; and all EIP were used, on average (SD), 49 (23) hours more than its labelled duration. All EIPs showed a complete reservoir deflation between refilling. Only one patient had a minor skin complication and no symptom aggravation was observed, except for two cases with mild anxiety and agitation. Cost-saving analysis for the complete case series showed that EIP refillings saved, on average, €24 per-patient and a total of nearly €240, for both types of infuser pumps. Conclusion: This preliminary study suggests that refilling is safe and reduces cost. Future research on EIP refilling using controlled and systematic methodologies are warranted.
Barriers to implementing palliative care in intensive care units: perceptions of physicians and nurses in Jordan
Authors: Khater Wejdan A , Akhu-Zaheya Laila M , AL-Nabulsi Hadeel W , Shattnawi Khulood K , Shamieh Omar , Joseph Rachel 
Published: April 2021

Background: Palliative care (PC) aims to relieve a person's suffering and provide the best possible quality of life (QoL) to people with chronic illnesses. Despite the significant impact of PC services on the QoL of patients, barriers exist that prevent healthcare providers from facilitating PC in intensive care units (ICUs). Aim: The purpose of this study was to explore the perceived barriers to implementing PC in ICUs. Methods: A qualitative approach was used to conduct 17 semi-structured interviews with clinicians across two ICUs (urban and suburban) in Jordan. Thematic analysis was used for the transcribed interviews. Results: Five main themes emerged: the ICU is a demanding and complex care environment; lack of preparation to implement PC; PC is a nicety, not a necessity; healthcare system-related barriers; and lack of cultural acceptance of PC. Lack of knowledge and training was identified as a major barrier for the effective implementation of PC by both physicians and nurses. Conclusion: Equipping healthcare providers with the knowledge and expertise to provide PC is essential to dispel myths related to PC and facilitate PC provision. Developing an interdisciplinary care team will support the effective implementation of PC services in any setting. Establishing national PC policies will foster the ethical and legal practice of PC in Jordan.