bluuebunny/crossref_metadata_2025 huggingface dataset:
Woven Endobridge Embolization Versus Microsurgical Clipping for Unruptured Anterior Circulation Aneurysms: A Propensity Score Analysis
Authors: Goertz Lukas , Liebig Thomas , Siebert Eberhard , Pennig Lenhard , Laukamp Kai Roman , Celik Erkan , Timmer Marco , Brinker Gerrit , Schlamann Marc , Goldbrunner Roland , Dorn Franziska , Krischek Boris , Kabbasch Christoph
Published: November 2020

BACKGROUND

Intrasaccular flow-disruption represents a new paradigm in endovascular treatment of wide-necked bifurcation aneurysms.

OBJECTIVE

To retrospectively compare Woven Endobridge (WEB) embolization with microsurgical clipping for unruptured anterior circulation aneurysms using propensity score adjustment.

METHODS

A total of 63 patients treated with WEB and 103 patients treated with clipping were compared based on the intention-to-treat principle. The primary outcome measures were immediate technical treatment success, major adverse events, and 6-mo complete aneurysm occlusion.

RESULTS

The technical success rates were 83% for WEB and 100% for clipping. Procedure-related complications occurred more often in the clipping group (13%) than the WEB group (6%, adjusted P < .01). However, the rates of major adverse events were comparable in both groups (WEB: 3%, clip: 4%, adjusted P = .53). At the 6-mo follow-up, favorable functional outcomes were achieved in 98% of the WEB embolization group and 99% of the clipping group (adjusted P = .19). Six-month complete aneurysm occlusion was obtained in 75% of the WEB group and 94% of the clipping group (adjusted P < .01).

CONCLUSION

Microsurgical clipping was associated with higher technical success and complete occlusion rates, whereas WEB had a lower complication rate. Favorable functional outcomes were achieved in ≥98% of both groups. The decision to use a specific treatment modality should be made on an individual basis and in accordance with the patient's preferences.
Preoperative and early postoperative seizures in patients with glioblastoma—two sides of the same coin?
Authors: Ahmadipour Yahya , Rauschenbach Laurèl , Santos Alejandro , Darkwah Oppong Marvin , Lazaridis Lazaros , Quesada Carlos M , Junker Andreas , Pierscianek Daniela , Dammann Philipp , Wrede Karsten H , Scheffler Björn , Glas Martin , Stuschke Martin , Sure Ulrich , Jabbarli Ramazan
Published: November 2020

Background

Symptomatic epilepsy is a common symptom of glioblastoma, which may occur in different stages of disease. There are discrepant reports on association between early seizures and glioblastoma survival, even less is known about the background of these seizures. We aimed at analyzing the risk factors and clinical impact of perioperative seizures in glioblastoma.

Methods

All consecutive cases with de-novo glioblastoma treated at our institution between 01/2006 and 12/2018 were eligible for this study. Perioperative seizures were stratified into seizures at onset (SAO) and early postoperative seizures (EPS, ≤21days after surgery). Associations between patients characteristics and overall survival (OS) with SAO and EPS were addressed.

Results

In the final cohort (n = 867), SAO and EPS occurred in 236 (27.2%) and 67 (7.7%) patients, respectively. SAO were independently predicted by younger age (P = .009), higher KPS score (P = .002), tumor location (parietal lobe, P = .001), GFAP expression (≥35%, P = .045), and serum chloride at admission (>102 mmol/L, P = .004). In turn, EPS were independently associated with tumor location (frontal or temporal lobe, P = .013) and pathologic laboratory values at admission (hemoglobin < 12 g/dL, [P = .044], CRP > 1.0 mg/dL [P = 0.036], and GGT > 55 U/L [P = 0.025]). Finally, SAO were associated with gross-total resection (P = .006) and longer OS (P = .030), whereas EPS were related to incomplete resection (P = .005) and poorer OS (P = .009).

Conclusions

In glioblastoma patients, SAO and EPS seem to have quite different triggers and contrary impact on treatment success and OS. The clinical characteristics of SAO and EPS patients might contribute to the observed survival differences.
Epidemiology of spinal cord and column tumors
Authors: Wewel Joshua T , O’Toole John E
Published: November 2020

The spine is a frequent location for metastatic disease. As local control of primary tumor pathology continues to improve, survival rates improve and, by extension, the opportunity for metastasis increases. Breast, lung, and prostate cancer are the leading contributors to spinal metastases. Spinal metastases can manifest as bone pain, pathologic fractures, spinal instability, nerve root compression, and, in its most severe form, spinal cord compression. The global extent of disease, the spinal burden, neurologic status, and life expectancy help to categorize patients as to their candidacy for treatment options. Efficient identification and workup of those with spinal metastases will expedite the treatment cascade and improve quality of life.
Use of infrared thermography to noninvasively assess neonatal piglet temperature
Authors: Schmitt Oceane , O’Driscoll Keelin
Published: November 2020

Hypothermia is risk factor for piglet neonatal mortality, especially for low birth weight piglets. Piglets with intrauterine growth retardation (IUGR) also have a higher mortality risk at birth. This study aimed to validate infrared thermography (IRT) as an alternative to rectal temperature (RT) to measure piglet temperature in the hour postpartum, and to identify piglets with thermoregulation difficulties. At birth (6.3 ± 0.35 min postpartum), 67 piglets were dried, weighed, scored for growth retardation (IUGR; 0–3), and isolated in a plastic box where IRT images were taken, followed by RT. Piglets were then returned to the farrowing pen, and the process repeated at 15, 30, and 60 min postpartum. Piglets were ranked according to their weight (quartiles: 0.57–1.27 kg, 1.27–1.5 kg, 1.5–1.74 kg, 1.74–2.44 kg). Temperatures (ear base and tip; minimum, maximum and average of back) were extracted from IRT images (Thermacam Researcher Pro 2.0). Pearson correlations between temperature measures were calculated, and the effect of time, IUGR score, and weight were included in linear mixed models (SAS 9.4). RT was correlated with all IRT data across time points (P < 0.05); correlations were strongest with the ear base, and weakest with the ear tip and minimum back temperature. Both IUGR score and weight rank affected ear base (P < 0.05) and RTs (P < 0.05). The lightest piglets, and piglets with severe IUGR had the lowest temperature, relative to their counterparts. Indeed, differences between all weights categories were significant for RT. Piglets with the lowest weight (0.27–1.27 kg) had lower ear base temperatures than piglets in the third quartile (1.5–1.74 kg; 35.2 ± 0.36 °C vs. 36.5 ± 0.35 °C, t64.9 = −4.51, P < 0.001) and the heaviest piglets (1.74–2.44 kg; 35.2 ± 0.36 °C vs. 36.4 ± 0.36 °C, t70.4 = −3.97, P < 0.005). Overall, piglets with severe IUGR (score 3) had a lower RT than normal piglets (score 0; 35.8 ± 0.46 °C vs. 37.2 ± 0.42 °C, t43.1 = 3.16, P < 0.05) and piglets with mild IUGR (score 1; 35.8 ± 0.46 °C vs. 37.1 ± 0.40 °C, t45.3 = 2.92, P < 0.05); and they also had lower temperature at the base of the ear than normal piglets (35.1 ± 0.42 °C vs. 36.3 ± 0.36 °C, t63.1 = 3.01, P < 0.05). These results confirmed that IRT is an interesting noninvasive tool for assessing neonatal piglets’ thermoregulatory abilities and could be used in research investigating successful interventions for piglets at risk of hypothermia.
When a Child Is Found Dead: The Role of the Forensic Nurse Death Investigator and Psychosocial Impact for Parents
Authors: Clements Paul Thomas , O’Neal Bobbi Jo
Published: November 2020

The traumatic death of a child is an immediately life-changing event. In all cases, a parent who finds that their child has died suddenly and violently is no longer the same person. Early in the chaotic aftermath of this journey, they will likely be disoriented and affectively numb because their sense of an otherwise predicted life trajectory has been destroyed in an instant. Subsequently, early in the arrival of the forensic nurse death investigator, there will be multidimensional challenges to be strategically navigated during scene investigation while simultaneously ensuring awareness of psychosocial issues that will have an enduring impact on an adaptive trajectory of bereavement for a surviving parent.
Whole exome sequencing for diagnosis of hereditary thrombocytopenia
Authors: Mekchay Ponthip , Ittiwut Chupong , Ittiwut Rungnapa , Akkawat Benjaporn , Le Grand Supang Maneesri , Leela-adisorn Netchanok , Muanpetch Suwanna , Khovidhunkit Weerapan , Sosothikul Darintr , Shotelersuk Vorasuk , Suphapeetiporn Kanya , Rojnuckarin Ponlapat
Published: November 2020

Hereditary thrombocytopenia comprises extremely diverse diseases that are difficult to diagnose by phenotypes alone. Definite diagnoses are helpful for patient (Pt) management.

To evaluate the role of whole exome sequencing (WES) in these Pts.

Cases with unexplained long-standing thrombocytopenia and/or suggestive features were enrolled to the observational study. Bleeding scores and blood smear were evaluated. The variant pathogenicity from WES was determined by bioinformatics combined with all other information including platelet aggregometry, flow cytometry, and electron microscopy (EM).

Seven unrelated Pts were recruited. All were female with macrothrombocytopenia. Clinical bleeding was presented in four Pts; extra-hematological features were minimal and family history was negative in every Pt. WES successfully identified all the 11 responsible mutant alleles; of these, four have never been previously reported. Pt 1 with GNE-related thrombocytopenia showed reduced lectin binding by flow cytometry, increased glycogen granules by EM and a novel homozygous mutation in GNE. Pts 2 and 3 had phenotypic diagnoses of Bernard Soulier syndrome and novel homozygous mutations in GP1BB and GP1BA, respectively. Pt 4 had impaired microtubule structures, concomitant delta storage pool disease by EM and a novel heterozygous TUBB1 mutation. Pt 5 had sitosterolemia showing platelets with reduced ristocetin responses and a dilated membrane system on EM with compound heterozygous ABCG5 mutations. Pts 6 and 7 had MYH9 disorders with heterozygous mutations in MYH9.

This study substantiates the benefits of WES in identifying underlying mutations of macrothrombocytopenia, expands mutational spectra of four genes, and provides detailed clinical features for further phenotype-genotype correlations.
Laparoscopic anterior resection of rectum for rectal deeply infiltrating endometriosis
Authors: Yang Yong-Ping , Yu Ling-Yun , Shi Jian , Li Jian-nan , Wang Min , Liu Tong-Jun
Published: November 2020

Laparoscopic anterior resection of rectum (AR) is one of surgical approaches for deeply infiltrating endometriosis (DIE). Up to date, no clinical trials have clearly analyzed the short-term and long-term complications post-surgically, indications or feasibilities for surgical procedure, or post-operative recovery. The aims of this trial were to evaluate the indications for laparoscopic AR, the short-term and long-term complications post-surgically, post-operative recovery.

We conducted a prospective study of 29 patients. They were divided into 2 groups. The period of follow-up was 12 months post-surgery. In our study, we recruited patents with laparoscopic AR experiencing failure of medical treatment (3 months) or associated infertility (>2cycles). The operative data and short term and long term complications were recorded. The outcomes of laparoscopic AR group were assessed by questionnaires, such as NRS (numeric rating scale), KESS (Knowles-Eccersley-Scott Symptom Questionnaire), VAS (visual analogue scale), WCS (Wexner constipation score) and ABS (Abdominal Bloating Score), which were compared with the outcomes of medicine group at set time points of baseline, 3 months, 6 months, 9 months and 12 months. The overall outcomes of the two groups were assessed with 5-point Likert Scale.

Patients in surgery group were recovery rapidly without serious short term or long term complications. All of NRS, KESS, VAS, WCS, and ABS in surgery group were getting better greatly than that in medicine group (3.04 ± 1.91 vs 5.41 ± 3.01, 5.64 ± 1.54 vs 7.01 ± 1.03, 0.50 ± 0.38 vs 3.58 ± 2.01, 4.43 ± 1.02 vs 8.92 ± 2.45, and 0.61 ± 0.34 vs 1.42 ± 0.71) at 3 months post-operation. However, the advantage of surgery group was almost vanished at 12 months (4.02 ± 2.53 vs 5.99 ± 2.31, 7.42 ± 3.17 vs 10.98 ± 2.53, 1.59 ± 1.3 vs 2.23 ± 1.59, 6.01 ± 2.53 vs 7.90 ± 3.25, and 1.31 ± 1.05 vs 1.39 ± 1.02). Furthermore, we compared the overall outcomes between the 2 groups with 5-point Likert Scale, with confirmation of the advantage at 3 months post-surgically. Additionally, we compared these questionnaires, with the finding that VAS and 5-point Likert Scale of surgery group had the same changes. Finally, a table of indications for laparoscopic AR were tabulated according our clinical experience.

Patients can receive benefit from both medicine and laparoscopic AR. However, laparoscopic AR has obvious advantage of rapid symptom relief. Further studies and clinical data collections are required for indications and feasibility of combined therapy.
Infliximab as Rescue Therapy for Hospitalized Patients With Crohn's Disease Failing Intravenous Corticosteroids
Authors: Patel Anish Vinit , Moore Jacqueline , Sultan Keith
Published: November 2020

Background:

Infliximab (IFX) has been shown to be effective rescue therapy for hospitalized ulcerative colitis patients failing intravenous (IV) corticosteroids (CS). There is little evidence, however, describing its use in similar hospitalized Crohn's Disease (CD) patients.

Study Question:

To determine if IFX is an effective rescue therapy for IV CS resistant CD patients.

Study Design:

A retrospective study of inpatients with CD who received IFX as rescue therapy at 2 tertiary care hospitals from January 1, 2006, to December 31, 2016. Records were reviewed for demographics, disease activity, preadmission and inpatient treatment, surgical rates, and 30- and 90-day readmission rates. Measures and Outcomes: Efficacy of IFX as rescue therapy was defined by discharge without surgery and readmission rates. Only patients failing IV CS before IFX were included in the final analysis.

Results:

Forty patients received IFX, of which 17 had failed IV CS. Four patients were receiving outpatient IFX therapy, but still received IV CS during hospitalization before IFX. The mean duration of IV CS therapy before IFX was 6.9 days. Of the 15 patients (88%) who responded to rescue IFX, the median hospital stay following IFX was 3 days (range 3–18 days). Readmission rates were 29% and 47% at 30 and 90 days respectively, without further surgeries noted.

Conclusions:

In our series of hospitalized CD patients failing IV CS, those treated with IFX had low rates of urgent surgery and a generally rapid response to treatment, supporting IFX as an effective rescue therapy. By only including those with prior failure of IV CS, we have likely excluded patients for whom IFX was given in the hospital for reasons other than severe disease. Our results suggest that individuals with severe acute CD flare can be treated with early introduction of IFX, avoiding prolonged CS use, and hospitalization.
The Two Sides of the Title Retention Clauses: The Caterpillar Case
Authors: Pathak Akhileshwar
Published: November 2020

Contracts term of commercial sale of goods have a ‘title retention clause’, preventing the transfer of ownership till the seller is fully paid. The unpaid seller gets the right to repossess the goods from the buyer. Exigencies of businesses have led to introduction of further clauses allowing the buyer to use or sub-sell the goods even before the transfer of ownership. The United Kingdom Court of Appeal judgment in the Caterpillar Case brings out the effects of the contradictions of a title retention clause qualified by the right of the buyer to use or sub-sell.
Stability versus fragility: new evidence from 84 banks
Authors: Ali Mohsin , Haroon Omair , Rizvi Syed Aun R. , Azmi Wajahat
Published: November 2020

Purpose

This paper aims to examine whether competition from Islamic banks add to the financial stability and profitability of financial sector and to assess the sources of such (in)stability.

Design/methodology/approach

Using Herfindahl–Hirschman Index as a measure of competition and Z-score as a measure of stability, the authors run panel GMM regressions to assess their association with data from 84 banks in Indonesia and Malaysia over a period from 2005 to 2018.

Findings

Increasing competition from Islamic banks in East Asian banking industry adds to the stability of the system while it does not affect profitability. This stability is derived from both asset and liability side.

Research limitations/implications

While adding to the literature on banking and Islamic finance, this paper suggests to the policy makers that policies promoting Islamic banking will tend to assist in enhancing financial sector stability.

Practical implications

Growth in alternative financial instruments brings steadiness within the financial structure. Such growth and competition should be encouraged.

Originality/value

The paper exploits an interesting setting of dual-banking industry in two large Muslim-majority developing country for testing two competing theories: competition-fragility and competition-stability. Such a setting also allowed us to examine whether increasing stability of financial sector is driven by demand or supply.
Effect of transit road quality on trade costs in East Africa
Authors: Kaminchia Sheila
Published: November 2020

This paper provides an empirical estimate of the effect that upgrading of roads along the two main transit routes in the East African Community (EAC) had on the total bilateral trade costs facing manufacturing industries. The transit routes are the Northern Corridor and the Central Corridor, which link the capital cities of Burundi, Kenya, Rwanda, Tanzania, and Uganda to the seaports of Mombasa in Kenya and Dar es Salaam in Tanzania. This paper exploits information on the condition of roads along these routes, which is published by government and donor agencies. The reports pertain to road projects that were completed in the period 2004–2010, and indicate that the share of paved roads in good condition along the Corridors doubled between 2003 and 2010. This study estimates that the increase in the quality of transit roads lowered both domestic and cross‐border trade costs, and that the latter effect is larger than the former. The study also finds that the increase in trade volumes due to better transit roads is attributable to industries producing output with above median weight. These industries dominate the EAC manufacturing sector, suggesting that a compositional change in cross‐border trade flows arising from better transit roads is unlikely.
Bimonthly surveillance of wild rodents and chigger mites in urban parks in Daegu from 2018 to 2019
Authors: Kim Yeong Bu , Choi Moon Bo , Kwon Ohseok
Published: November 2020

Tsutsugamushi disease is caused byOrientia tsutsugamushi, which is transmitted to humansviachigger mites in wild rodents, among other animal hosts. It has become a recurring health problem in South Korea with increasing numbers of cases since 2010s and most cases occurring in October through December. However, studies on chigger mites and wild rodents in urban areas in South Korea are inadequate. Thus, this study aimed to analyze the species composition of chigger mites and wild rodents, their seasonal distribution, and pathogen rates of chigger mitesviaa 2‐year surveillance study at six urban parks in Daegu. Monthly surveillance of wild rodents and chigger mites was conducted at urban parks in Daegu from 2018 to 2019. Chigger mites were isolated from the collected rodents bimonthly. A total of 31 rodents were collected, with a trap rate and percentage of chigger mite infection of 0.52 and 61.3%, respectively. A total of 273 chigger mites were collected, with a chigger index (CI) of 14.4. Six species of chigger mites from two genera were collected, withLeptotrombidium pallidumbeing the most common (n = 127, 31.8%). Chigger mites were most frequent at riverside parks (n = 95, 34.8%). To detectO. tsutsugamushiin chigger mites, 40 pools of chigger mites (n = 273) were analyzed. All analyzed pools showed negative results. In conclusion, the populations of chigger mites and wild rodents in the six parks surveyed were smaller than those in the other regions in South Korea. Both the population and minimum positive rates of chigger mites in urban Daegu indicated a low threat of Tsutsugamushi disease. However, attention should still be paid to preventing this disease.
A closed max‐t test for multiple comparisons of areas under the ROC curve
Authors: Blanche Paul , Dartigues Jean‐François , Riou Jérémie
Published: November 2020

Comparing areas under the ROC curve (AUCs) is a popular approach to compare prognostic biomarkers. The aim of this paper is to present an efficient method to control the family‐wise error rate when multiple comparisons are performed. We suggest to combine the max‐t test and the closed testing procedures. We build on previous work on asymptotic results for ROC curves and on general multiple testing methods to efficiently take into account both the correlations between the test statistics and the logical constraints between the null hypotheses. The proposed method results in an uniformly more powerful procedure than both the single‐step max‐t test procedure and popular stepwise extensions of the Bonferroni procedure, such as Bonferroni–Holm. As demonstrated in this paper, the method can be applied in most usual contexts, including the time‐dependent context with right censored data. We show how the method works in practice through a motivating example where we compare several psychometric scores to predict the t‐year risk of Alzheimer's disease. The example illustrates several multiple testing settings and demonstrates the advantage of using the proposed methods over common alternatives. R code has been made available to facilitate the use of the methods by others.
Baseline structural and functional magnetic resonance imaging predicts early treatment response in schizophrenia with radiomics strategy
Authors: Cui Long‐Biao , Fu Yu‐Fei , Liu Lin , Wu Xu‐Sha , Xi Yi‐Bin , Wang Hua‐Ning , Qin Wei , Yin Hong
Published: November 2020

Multimodal neuroimaging features provide opportunities for accurate classification and personalized treatment options in the psychiatric domain. This study aimed to investigate whether brain features predict responses to the overall treatment of schizophrenia at the end of the first or a single hospitalization. Structural and functional magnetic resonance imaging (MRI) data from two independent samples (N = 85 and 63, separately) of schizophrenia patients at baseline were included. After treatment, patients were classified as responders and non‐responders. Radiomics features of gray matter morphology and functional connectivity were extracted using Least Absolute Shrinkage and Selection Operator. Support vector machine was used to explore the predictive performance. Prediction models were based on structural features (cortical thickness, surface area, gray matter regional volume, mean curvature, metric distortion, and sulcal depth), functional features (functional connectivity), and combined features. There were 12 features after dimensionality reduction. The structural features involved the right precuneus, cuneus, and inferior parietal lobule. The functional features predominately included inter‐hemispheric connectivity. We observed a prediction accuracy of 80.38% (sensitivity: 87.28%; specificity 82.47%) for the model using functional features, and 69.68% (sensitivity: 83.96%; specificity: 72.41%) for the one using structural features. Our model combining both structural and functional features achieved a higher accuracy of 85.03%, with 92.04% responder and 80.23% non‐responders to the overall treatment to be correctly predicted. These results highlight the power of structural and functional MRI‐derived radiomics features to predict early response to treatment in schizophrenia. Prediction models of the very early treatment response in schizophrenia could augment effective therapeutic strategies.
Chromosome 14 deletions, rings, and epilepsy genes: A riddle wrapped in a mystery inside an enigma
Authors: Vaisfeld Alessandro , Spartano Serena , Gobbi Giuseppe , Vezzani Annamaria , Neri Giovanni
Published: November 2020

The ring 14 syndrome is a rare condition caused by the rearrangement of one chromosome 14 into a ring‐like structure. The formation of the ring requires two breakpoints and loss of material from the short and long arms of the chromosome. Like many other chromosome syndromes, it is characterized by multiple congenital anomalies and developmental delays. Typical of the condition are retinal anomalies and drug‐resistant epilepsy. These latter manifestations are not found in individuals who are carriers of comparable 14q deletions without formation of a ring (linear deletions). To find an explanation for this apparent discrepancy and gain insight into the mechanisms leading to seizures, we reviewed and compared literature cases of both ring and linear deletion syndrome with respect to both their clinical manifestations and the role and function of potentially epileptogenic genes. Knowledge of the epilepsy‐related genes in chromosome 14 is an important premise for the search of new and effective drugs to combat seizures. Current clinical and molecular evidence is not sufficient to explain the known discrepancies between ring and linear deletions.
Probing the hierarchy of evidence to identify the best strategy for placing class II dental composite restorations using current materials
Authors: Ferracane Jack L. , Lawson Nathaniel C.
Published: November 2020

Objective

The objective of this review is to present a synopsis of the existing clinical and in vitro evidence regarding placement of direct class II restorations with dental composites of varying viscosities, focusing on the marginal integrity achievable.

Overview

The literature on class II composites placed with various techniques was searched through PubMed, Scopus, and the citations of identified articles, focusing on aspects related to adaptation and clinical performance. Studies comparing layering of conventional composite to layering with a flowable liner, including the “snow plow technique,” use of warmed composite, flowable bulk‐fill liners with a conventional composite capping layer, and bulk‐fill restorative in a single or incremental fill (including placement with sonic energy and dual‐curing)

Conclusions

In vitro and clinical evidence does not support any one specific method or material type for achieving optimal performance when restoring class II cavity preparations with current dental composites.

Clinical significance

Although there are many available placement methods and types of composite materials on the market for use in class II restorations, the reasonable success presented in the clinical and laboratory literature for the various approaches suggests that the most important factor for achieving success is likely careful and proper placement and light‐curing technique, independent of the approach.
Delayed hypersensitivity to antiepileptic drugs in children
Authors: Mori Francesca , Blanca‐Lopez Natalia , Caubet Jean‐Christoph , Demoly Pascal , Du Toit George , Gomes Eva R. , Kuyucu Semanur , Romano Antonino , Soyer Ozge , Tsabouri Sophia , Atanaskovic‐Markovic Marina
Published: November 2020

Background

Antiepileptic drugs (AEDs) are widely used for the treatment of epilepsy, but they can be associated with the development of mainly delayed/non‐immediate hypersensitivity reactions (HRs). Although these reactions are usually cutaneous, self‐limited, and spontaneously resolve within days after drug discontinuation, sometime HR reactions to AEDs can be severe and life‐threatening.

Aim

This paper seeks to show examples on practical management of AED HRs in children starting from a review of what it is already known in literature.

Results

Risk factors include age, history of previous AEDs reactions, viral infections, concomitant medications, and genetic factors. The diagnostic workup consists of in vivo (intradermal testing and patch testing) and in vitro tests [serological investigation to exclude the role of viral infection, lymphocyte transformation test (LTT), cytokine detection in ELISpot assays, and granulysin (Grl) in flow cytometry. Treatment is based on a prompt drug discontinuation and mainly on the use of glucocorticoids.

Conclusion

Dealing with AED HRs is challenging. The primary goal in the diagnosis and management of HRs to AEDs should be trying to accurately identify the causal trigger and simultaneously identify a safe and effective alternative anticonvulsant. There is therefore an ongoing need to improve our knowledge of HS reactions due to AED medications and in particular to improve our diagnostic capabilities.
A safer way of dry needling therapy for gastrocnemius muscles: ultrasound guidance
Authors: Bagcier Fatih , Yurdakul Ozan Volkan
Published: November 2020

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Complete Genome Sequence of an Environmental Bacillus cereus Isolate Belonging to the Bacillus anthracis Clade
Authors: Irenge Leonid M. , Bearzatto Bertrand , Ambroise Jérôme , Gala Jean-Luc
Published: November 2020

We report here the complete genome sequence of a
Bacillus cereus
isolate identified in a soil sample from Namibia. This isolate is closely related to the
B. anthracis
clade. While the plasmids (500 and 12 kb) carry no detectable
B. anthracis
virulence gene, the large plasmid shares a 50-kb continuous region similar to plasmid pXO1.
Diagnostic accuracy of neonatal foot length to identify preterm and low birthweight infants: a systematic review and meta-analysis
Authors: Folger Lian V , Panchal Pratik , Eglovitch Michelle , Whelan Rachel , Lee Anne CC
Published: November 2020

Introduction

Eighty percent of neonatal deaths occur among babies born preterm and/or small for gestational age (SGA). In sub-Saharan Africa and South Asia, approximately 40% of births occur outside of health facilities, and gestational age (GA) and birth weight are commonly unknown. Foot length (FL) has been proposed as a simple, surrogate measurement to identify and triage small babies born in the community. We conducted a systematic review and meta-analysis of the diagnostic accuracy of newborn FL to classify preterm and low birthweight infants.

Methods

PubMed, EMBASE, Cochrane, Web of Science, POPLINE and WHO Global Health Library databases were searched. Studies of live-born infants that compared FL with GA and/or birth weight were included. Data on diagnostic accuracy were summarised, described, and pooled, as appropriate.

Results

Six hundred and two studies were identified and 41 included. Techniques for measuring FL included use of a firm plastic ruler, callipers, footprint or a measuring board. Twelve studies assessed the diagnostic accuracy of FL to identify preterm births; however, data were not pooled given heterogeneity and low quality of GA. 19 studies used FL to identify low birthweight infants (<2500 g, <2000 g). Among studies in Asia (n=3), FL<7.7 cm had pooled sensitivity and specificity of 87.6% (95% CI 61.1% to 99.0%) and 70.9% (95% CI 23.5% to 95.1%), respectively, to identify <2500 g infants. FL<7.3 cm had 82.1% (95% CI 63.7% to 92.2%) sensitivity and 82.1% (95% CI 59.2% to 90.8%) specificity for identifying <2000 g infants (n=3). In the African studies (n=3), FL<7.9 cm had pooled sensitivity and specificity of 92.0% (95% CI 85.6% to 95.7%) and 71.9% (95% CI 44.5% to 89.1%), respectively, to identify <2500 g neonates.

Conclusions

FL is a simple proxy measure that can identify babies of low birthweight with high sensitivity, though somewhat lower specificity. Additional research is needed to determine the validity of FL to identify preterm infants, and understand the programmatic impact of screening on healthcare seeking and outcomes.

PROSPERO registration number

CRD42015020499
Ten years of progress towards universal health coverage: has China achieved equitable healthcare financing?
Authors: Chen Mingsheng , Zhou Guoliang , Si Lei
Published: November 2020

Introduction

This study aims to systematically evaluate vertical and horizontal equity in the Chinese healthcare financing system over the period 2008–2018 during the progress towards Universal Health Coverage (UHC), and to examine how both types of equity have changed during this period.

Methods

Household information on healthcare payments was collected from 2398 households involving 7021 individuals in 2008, 3600 households involving 10 466 individuals in 2013 and 3660 households involving 11 550 individuals in 2018. Redistributive effects of healthcare financing system were decomposed into progressivity, pure horizontal inequity and reranking. Progressivity analysis and the Aronson-Johnson-Lambert decomposition method were adopted to measure the vertical equity and horizontal equity of healthcare financing.

Results

Over the period 2008–2018, healthcare financing through indirect taxes showed a slightly prorich structure and healthcare financing through direct taxes showed a propoor structure in both urban and rural areas. Urban Employee Basic Medical Insurance experienced redistribution from the poor to the rich during the period 2008–2013, but then experienced redistribution from the rich to the poor during the period 2013–2018. Urban Resident Basic Medical Insurance (URBMI), New Rural Cooperative Medical Scheme (NRCMS), Urban and Rural Resident Basic Medical Insurance (URRBMI) and out-of-pocket payments experienced redistribution from the poor to the rich over the entire period.

Conclusion

China’s healthcare financing has experienced redistribution from the poor to the rich during 10 years of progress toward the UHC. UHC improved access to and utilisation of healthcare in urban areas. The flat rate contribution mechanism should be renovated for URBMI, NRCMS and URRBMI.
Feasibility of in-office MRI-targeted partial gland cryoablation for prostate cancer: an IDEAL stage 2A study
Authors: Basourakos Spyridon P , Al Hussein Al Awamlh Bashir , Bianco Fernando J , Patel Neal A , Laviana Aaron , Margolis Daniel J , Mosquera Juan M , McClure Timothy D , Yu Miko , Hu Jim C
Published: November 2020

Objectives

Cryoablation for prostate cancer is typically performed under general anaesthesia. We explore the safety, feasibility and costs of in-office MRI-targeted prostate partial gland cryoablation (PGC) under local anaesthesia. We hypothesise that an office-based procedure under local anaesthesia may yield greater patient convenience and lower health costs with similar outcomes to a general anaesthesia approach.

Design/participants/setting/interventions

Retrospective study of men diagnosed with clinically significant prostate cancer (grade group (GG) ≥2) who elected to undergo in-office PGC under local anaesthesia.

Main outcome measures

A total of 55 men with GG ≥2 prostate cancer underwent PGC under local anaesthesia, and 35 of 43 men (81.4%) who attained ≥6 months of follow-up post-treatment underwent MRI-targeted surveillance biopsy. We used MRI findings and targeted biopsy to characterise post-PGC oncological outcomes. Complications were categorised using Common Terminology Criteria for Adverse Events (CTCAE). Expanded Prostate Cancer Index-Clinical Practice was used to characterise urinary and sexual function scores at baseline, 4 and 9 months post-PGC. Time-driven activity-based costing was used to determine healthcare costs of in-office PGC.

Results

Five (9.1%) men experienced CTCAE score 3 adverse events. Urinary and sexual function did not change significantly from baseline to 4 months (p=0.20 and p=0.08, respectively) and 9 months (p=0.23 and p=0.67, respectively). Twenty-two men (62.9%) had no cancer or GG1 and 13 (37.1%) men had GG≥2 on post-PGC biopsy. Moreover, the median cost of in-office PGC was US$4,463.05 (range US$4,087.19–US7,238.16) with disposables comprising 69% of the cost.

Conclusions

In-office PGC is feasible under local anaesthesia with favourable functional outcome preservation and adverse events profile at significantly lower costs compared with a general anaesthesia approach.
A two-dimensional perspective of healthcare leadership in non-Western contexts
Authors: Gulati Kamal , Sarkar Chitra , Duits Ashley , Busari Jamiu O
Published: November 2020

As we witness an alarming change in the delivery of healthcare worldwide, there is a need for transformational leadership that can inspire and empower healthcare professionals, and patients alike. Due to the lack of economic, infrastructural and human resources especially in developing countries, the organisation and delivery of healthcare services is even more challenging. Hence, the focus of leadership development in resource-limited environments should be to facilitate knowledge building, interprofessional collaboration, empowerment and inclusion.

In this paper, we use two exemplary cases to illustrate the impact of, and the challenges facing leadership capacity building in non-Western contexts with special reference to India and Curaçao. These cases demonstrate that there is a place for validated medical leadership models in developing countries with promising outcomes for the collective health status of communities at large. Such models, however, need to be contextualised to fit the individual country"s economic and sociopolitical context. Also, the stakeholders should be prepared to create healthy professional cultures that embrace respect (for self and others) and focus on effective communication practices within their local environments.
Semi-Interpenetrating Polymer Networks Based on N-isopropylacrylamide and 2-acrylamido-2-methylpropane Sulfonic Acid for Intramolecular Force-Compensated Sensors
Authors: Binder Simon , Zschoche Stefan , Voit Brigitte , Gerlach Gerald
Published: November 2020

Stimulus-responsive hydrogels are swellable polymers that take up a specific volume depending on a measured variable present in solution. Hydrogel-based chemical sensors make use of this ability by converting the resulting swelling pressure, which depends on the measured variable, into an electrical value. Due to the tedious swelling processes, the measuring method of intramolecular force compensation is used to suppress these swelling processes and, thus, significantly increase the sensor’s response time. However, intramolecular force compensation requires a bisensitive hydrogel. In addition to the sensitivity of the measured variable the gel has to provide a second sensitivity for intrinsic compensation of the swelling pressure. At the same time, this hydrogel has to meet further requirements, e.g. high compressive strength. Until now, interpenetrating polymer networks (IPN) have been used for such a force-compensatory effective hydrogel, which are complex to manufacture. In order to significantly simplify the sensor design and production, a simpler synthesis of the bisensitive hydrogel is desirable. This paper presents a new bisensitive hydrogel based on semi-interpenetrating polymer networks. It is based on a copolymer network consisting of N-isopropylacrylamide (NiPAAm) and 2-acrylamido-2-methylpropane sulfonic acid (AMPS) and long PAMPS strands that permeate it. Measurements show, that this hydrogel meets all essential requirements for intramolecular force compensation and is at the same time much easier to synthesize than previously used IPN hydrogels.
Polymer Modified Carbon Fiber Microelectrodes for Precision Neurotransmitter Metabolite Measurements
Authors: Wonnenberg Pauline , Cho Whirang , Liu Favian , Asrat Thomas , Zestos Alexander G.
Published: November 2020

Carbon fiber-microelectrodes (CFMEs) are considered to be one of the standard electrodes for neurotransmitter detection such as dopamine (DA). DA is physiologically important for many pharmacological and behavioral states, but is readily metabolized on a fast, subsecond timescale. Recently, DA metabolites such as 3-methoxytyramine (3-MT) and 3,4-dihydroxyphenylacetaldehyde (DOPAL) were found to be involved in physiological functions, such as movement control and progressive neuro degeneration. However, there is no current assay to detect and differentiate them from DA. In this study, we demonstrate the co-detection of similarly structured neurochemicals such as DA, 3-MT, and DOPAL. We accomplished this through electrodepositing CFMEs with polyethyleneimine (PEI) and poly(3,4-ethylenedioxythiophene) polystyrene sulfonate (PEDOT:PSS) polymers. This endowed the bare unmodified CFMEs with surface charge, physical, and chemical differences, which resulted in the improved sensitivity and selectivity of neurotransmitter detection. The differentiation and detection of 3-MT, DOPAL, and DA will potentially help further understand the important physiological roles that these dopaminergic metabolites play in vivo.
Platinum Sputtered on Nb-doped TiO2 Films Prepared by ALD: Highly Active and Durable Carbon-free ORR Electrocatalyst
Authors: Hussain Sajid , Erikson Heiki , Kongi Nadezda , Tarre Aivar , Ritslaid Peeter , Kikas Arvo , Kisand Vambola , Kozlova Jekaterina , Aarik Jaan , Tamm Aile , Sammelselg Väino , Tammeveski Kaido
Published: November 2020

The oxygen reduction reaction (ORR) activity and durability of Pt nanoparticles sputtered on Nb-doped TiO2 coated glassy carbon and titanium electrodes were investigated. The Nb-TiO2 thin-film coatings were deposited by atomic layer deposition. Scanning electron microscopy and atomic force microscopy analysis revealed a uniform coating of the electrode substrates with doped-metal oxide. X-ray photoelectron spectroscopy analysis confirmed the presence of Nb, Ti, and Pt metals on the electrode surface. Electrochemical characterization of the prepared catalysts was performed by cyclic voltammetry and CO stripping experiments in 0.05 M H2SO4 solution. The Pt/Nb-TiO2 catalyst showed remarkable electrocatalytic activity toward the ORR at a very low Pt loading of 8.6 μg cm−2. The accelerated durability test confirmed that Pt/Nb-TiO2 catalyst was more durable than the commercial Pt/C (20 wt.%). More importantly, the prepared Pt/Nb-TiO2 electrocatalyst showed a considerable increase in the electrochemically active surface area as well as the ORR activity after the durability test.
Review—Electrochemical Sensors for Large and Small Molecules in Biofluids
Authors: Krishnan Sadagopan
Published: November 2020

Per the 2020 National Diabetes Statistics Report (2018 estimates), 34.2 million people of all ages (10.5% of the US population) had diabetes, and 88.0 million Americans (34.5% of all US adults) had prediabetes (an increase from 79 million in 2010). Diagnosed diabetic conditions cost the nation $327 billion in 2017, a 26% increase from the prior estimate of $245 billion in 2012. Thus, substantial health and economic burdens are placed on the nation and globally, added with the ongoing COVID-19 pandemic and its negative impacts on pre-existing health conditions (e.g., diabetic and autoimmune disorders). Our research goal is to contribute to the development of user-friendly, point-of-care sensors that would offer monitoring ultra-low clinically relevant levels of desired biomarkers by minimally invasive and non-invasive ways (e.g., picomolar serum/blood insulin, small molecules in urine, and large serum antibodies). We explored a wide range of surface chemistries and electroanalytical techniques for successfully measuring the described markers. Independent validations of our electrochemical sensors with surface plasmon resonance binding assays and commercial biological assays (although tedious and relatively more expensive than electrochemical approaches), and applications for real samples have been accomplished. Our ongoing efforts focus on new label-free point-of-care sensors for infectious disease markers.
A Modified Salp Swarm Algorithm Based on the Perturbation Weight for Global Optimization Problems
Authors: Fan Yuqi , Shao Junpeng , Sun Guitao , Shao Xuan
Published: November 2020

Metaheuristic algorithms are often applied to global function optimization problems. To overcome the poor real-time performance and low precision of the basic salp swarm algorithm, this paper introduces a novel hybrid algorithm inspired by the perturbation weight mechanism. The proposed perturbation weight salp swarm algorithm has the advantages of a broad search scope and a strong balance between exploration and exploitation and retains a relatively low computational complexity when dealing with numerous large-scale problems. A new coefficient factor is introduced to the basic salp swarm algorithm, and new update strategies for the leader position and the followers are introduced in the search phase. The new leader position updating strategy has a specific bounded scope and strong search performance, thus accelerating the iteration process. The new follower updating strategy maintains the diversity of feasible solutions while reducing the computational load. This paper describes the application of the proposed algorithm to low-dimension and variable-dimension functions. This paper also presents iteration curves, box-plot charts, and search-path graphics to verify the accuracy of the proposed algorithm. The experimental results demonstrate that the perturbation weight salp swarm algorithm offers a better search speed and search balance than the basic salp swarm algorithm in different environments.
Detailed Study on the Mechanical Properties and Activation Energy of Natural Rubber/Chloroprene Rubber Blends during Aging Processes
Authors: Nguyen Trong Quang , Dang Viet Hung , Nguyen Pham Duy Linh , Bui Chuong , La Duong Duc
Published: November 2020

Selection of a suitable thermal aging process could render desirable mechanical properties of the rubbers or blended rubbers. In this work, the effect of the aging processes on the mechanical properties and activation energies of natural rubbers (NR) and NR/chloroprene rubbers (CR) blends with low CR contents (5–10%) was investigated. Three aging processes including heat aging (at 110°C for 22 hours), mechanical aging (under dynamic loading to 140% strain for 16000 cycles), and complex aging (heat and mechanical aging) were studied. The results revealed that the compatibility of CR in natural rubber matrix had a significant effect on the dynamic properties of the blended rubber and negligible effect on the static properties. The changes in activation energies of the blended rubber during aging processes were calculated using Arrhenius relation. The calculated changes (ΔUc, ΔUd, and ΔUT) in activation energies were consistent with the results of mechanical properties of the blended rubber. Interestingly, the change in activation energies using complex aging conditions (ΔUc) was mostly equal to the total changes in activation energies calculated separately from heat aging (ΔUT) and mechanical aging (ΔUd) conditions. This indicates that, in complex aging conditions, the heat and dynamic loading factors act independently on the properties of the blended rubber.