bluuebunny/crossref_metadata_2025 huggingface dataset:
Taming of the Testicular Pain Complicating Lumbar Disc Herniation With Spinal Manipulation
Authors: Chu Eric Chun Pu
Published: August 2020

Degenerative disease of the lumbar spine is often ignored as a potential cause of testicular pain because the exact link between the two remains uncertain. This article reports the case of a 60-year-old man with a 3-year history of low back pain and unexplained right testicular pain for 2 years. Painful symptoms were negatively affecting his social, physical, and sexual functions. After failure to achieve pain relief through multiple types of therapy, the patient sought chiropractic treatment for his condition. Lumbar spine magnetic resonance imaging (MRI) revealed disc protrusion at the L1/L2, L3/L4, and L4/L5 segments causing thecal sac indentations. Due to the absence of direct testicular causes, the medical impression was chronic testicular pain (CTP) complicating lumbar disc disease. The patient experienced regular improvement in his low back and testicular pain with complete resolution of both after 8 weeks of chiropractic treatment. This article describes an overlook of the etiology of this patient’s testicular pain and a successful option in treating the patient. CTP has multifactorial etiology. An excellent treatment outcome depends heavily on recognizing the origin of the pain.
Biomechanical Modeling of Connecting Intermetacarpal K-Wires in the Treatment of Metacarpal Shaft Fractures
Authors: Hutchison Richard L. , Boles Justina , Duan Yuanyuan
Published: August 2020

Background

Clinical series have been published using the configuration of 2 intercarpal Kirschner wires (K-wires) adjacent to the fracture being connected, but biomechanical analysis is lacking. The objective of this pilot biomechanical study was to model and compare the effects of externally connecting 2 intermetacarpal K-wires for the stabilization of transverse metacarpal shaft fractures. Our research hypothesis was that the connected constructs would be stiffer than the unconnected K-wires.

Methods

A 3-dimensional computer-based model of small finger transverse metacarpal fracture stabilization was designed with 3 transverse 1.1 mm K-wires being anchored to the adjacent metacarpal. Three arrangements were tested: all 3 K-wires in parallel, the middle K-wire angled toward the proximal wire, and the middle angled K-wire being rigidly fixed to the proximal K-wire. The proximal wire was proximal to the fracture. A finite element analysis was performed by applying a cantilever force of 100 N at the head of the metacarpal. The metacarpal was considered to be uniform in composition with parameters typical for human bone. Kirschner wire parameters for stainless steel were used. Force (N) versus displacement was measured.

Results

The configuration with the middle angled K-wire being rigidly fixed to the proximal K-wire showed greater stiffness (12 N/mm) than nonattached constructs. The connected construct was 2.3 times more stiff than the unattached parallel construct and 2.5 times more stiff than angling the middle K-wire without attachment.

Conclusions

In a computer model simulation, our results show that attaching 2 K-wires adjacent to the fracture provides more than twice the stiffness of unconnected K-wires.
Reduction of radiation exposure using low pulse rate fluoroscopy during neuroendovascular surgery
Authors: Shimizu Takeshi , Toyota Shingo , Nakagawa Kanji , Murakami Tomoaki , Kumagai Tetsuya , Mori Kanji , Taki Takuyu
Published: August 2020

Introduction

Endovascular surgery is minimally invasive, but the radiation exposure can be problematic. There is no report assessing whether radiation exposure can be reduced by using a low pulse rate during carotid artery stenting (CAS). The aim of this study was to evaluate whether reducing the pulse rate from 7.5 to 4 frames per second (f/s) can reduce the radiation exposure while maintaining safety during CAS procedure.

Methods

We retrospectively reviewed the radiation data and clinical features of all 100 patients who underwent CAS between 2014 and 2019. We changed the pulse rate from 7.5 to 4 f/s in 2017. The fluoroscopic time (FT), dose area product (DAP), and total air kerma (AK) were collected. Statistical analyses were performed between the pulse rate and clinical outcomes, including radiation exposure.
The pre-history of the communist future in Czechoslovakia: Case studies in architecture and revolutionary socialism before 1948
Authors: Zarecor Kimberly E
Published: August 2020

Scholars have recently written about the importance of Marxism and political agitation within architectural discourses of post-war East Central Europe. Less attention has been paid to the period before World War II and the ways in which Marxist language and concepts were already infused into interwar avant-garde practices and debates. This essay argues that a necessary corrective to this gap in the historiography is to write new histories of interwar revolutionary socialist architecture that do not presuppose the failures of the socialist project itself. These histories emerge from a time in Europe when Marxism offered an enticing alternative vision of the future in a region where economic and social deprivation was real and urgent. Three case studies in Czechoslovakia will be discussed: Karel Teige’s engagement with Hannes Meyer, the discourse of the Architectural Working Group, and early experimentation with the collective housing typology in Litvínov, Prague, and Zlín.
A review on the wavelet methods for sonar image segmentation
Authors: Tian Yuanyuan , Lan Luyu , Guo Haitao
Published: August 2020

The sonar image segmentation is needed such as in underwater object orientation and recognition, in collision prevention and navigation of underwater robots, in underwater investigation and rescue, in seafloor object seeking, in seafloor salvage, and in marine military affairs like torpedo detection. The wavelet-based methods have the ability of multiscale and multiresolution, and they are apt at edge detection and feature extraction of images. The applications of these methods to the sonar image segmentation are increasingly raised. The contents of the article are to classify the sonar image segmentation methods with wavelets and to describe main ideas, advantages, disadvantages, and conditions of use of every method. In the methods for sonar image region (or texture) segmentation, the thought of multiscale (or multiresolution) analysis of the wavelet transform is usually combined with other theories or methods such as the clustering algorithms, the Markov random field, co-occurrence matrix, Bayesian theory, and support vector machine. In the methods for sonar image edge detection, the space–frequency local characteristics of the wavelet transform are usually utilized. The wavelet packet-based and beyond wavelet-based methods can usually reach more precise segmentation. The article also gives 12 directions (or development trends predicted) of the sonar image segmentation methods with wavelets which should be researched deeply in the future. The aim of writing this review is to make the researchers engaged in sonar image segmentation learn about the research works in the field in a short time. Up to now, the similar reviews in this field have not been found.
Reexamining the Findings of the American Psychological Association’s 2015 Task Force on Violent Media: A Meta-Analysis
Authors: Ferguson Christopher J. , Copenhaver Allen , Markey Patrick
Published: August 2020

In 2015, the American Psychological Association (APA) released a task-force technical report on video-game violence with a concurrent resolution statement linking violent games to aggression but not violent crime. The task-force report has proven to be controversial; many scholars have criticized language implying conclusive evidence linking violent games to aggression as well as technical concerns regarding the meta-analysis that formed the basis of the technical report and resolution statement. In the current article, we attempt a reevaluation of the 2015 technical report meta-analysis. The intent of this reevaluation was to examine whether the data foundations behind the APA’s resolution on video-game violence were sound. Reproducing the original meta-analysis proved difficult because some studies were included that did not appear to have relevant data, and many other available studies were not included. The current analysis revealed negligible relationships between violent games and aggressive or prosocial behavior, small relationships with aggressive affect and cognitions, and stronger relationships with desensitization. However, effect sizes appeared to be elevated because of non-best-practices and researcher-expectancy effects, particularly for experimental studies. It is concluded that evidence warrants a more cautious interpretation of the effects of violent games on aggression than provided by the APA technical report or resolution statement.
The effectiveness of afatinib in patients with lung adenocarcinoma harboring complex epidermal growth factor receptor mutation
Authors: Wu Shang-Gin , Yu Chong-Jen , Yang James Chih-Hsin , Shih Jin-Yuan
Published: August 2020

Background and aims:

Epidermal growth factor receptor tyrosine kinase inhibitors (EGFR TKIs) are effective against classical EGFR mutations in lung cancer. However, their effectiveness and the prognosis of lung cancer patients with complex EGFR mutations are not well delineated. Therefore, we aimed to investigate the treatment effectiveness of different EGFR TKIs in patients with complex EGFR mutations.

Patients and methods:

From 2005 to 2020, we collected lung adenocarcinoma tissue samples for EGFR mutation analysis using direct Sanger sequencing. Patients with EGFR mutations treated with EGFR TKIs as first-line treatment were enrolled. Clinical characteristics, EGFR mutation status, treatment response, progression-free survival (PFS), and overall survival (OS) were analyzed.

Results:

Among 2675 patients with EGFR mutations, 239 (8.9%) had complex EGFR mutations, of whom 125 received EGFR TKI treatment as first-line treatment. Multivariate analysis revealed that afatinib was a more favorable factor for PFS than gefitinib [hazard ratio (HR), 2.01; 95% confidence interval (CI), 1.11–3.62] and erlotinib (HR, 2.61; 95% CI, 1.31–5.22), especially in patients with uncommon mutation patterns. Afatinib treatment as first-line treatment was also associated with longer OS compared with erlotinib (HR, 2.48; 95% CI, 1.20–5.12). Classical mutation pattern was associated with longer PFS ( p = 0.001) and OS ( p = 0.020). Secondary T790M was detected in 22 of 52 (42.3%) patients who had re-biopsied tissue samples after acquiring resistance to EGFR TKIs. There was no significant difference in secondary T790M formation after acquired resistance to the three EGFR TKIs ( p = 0.261). Furthermore, three (5.8%) patients had small-cell lung cancer transformation.

Conclusion:

Afatinib is an effective first-line treatment for patients with lung adenocarcinoma harboring complex EGFR mutations, especially those with uncommon mutation patterns.
Plant-Based Diets: A Primer for School Nurses
Authors: Cooper Christen Cupples
Published: August 2020

As the primary healthcare professionals in the school setting, school nurses field questions about diet and exercise. Nurses’ familiarity with nutrition and dietary patterns can help them respond to student concerns. Plant-based diets, those which promote eating mostly fruits and vegetables with smaller portions of animal foods, have recently gained popularity in the United States. Most plant foods are rich in fiber, antioxidants, and complex carbohydrates, as well as vitamins and minerals that support good health and maintenance of a healthy weight. Most children and adolescents can meet their nutrient needs on a plant-based diet, but should be careful to include a wide variety of foods in the diet in order to achieve nutrient adequacy.
Critical-care resource allocation during the coronavirus disease 2019 pandemic in Singapore: A brief narrative review
Authors: Chia Elisha Wan Ying , Tay Kuang Teck
Published: August 2020

In the midst of the coronavirus disease 2019 (COVID-19) pandemic, where cases continue to increase exponentially every day, it is important to consider the future implications that this may have on the health-care system, the most feared situation being a shortage of critical-care resources, where difficult decisions have to be made about the allocation of scarce resources. In this brief narrative review, we conduct literature searches for COVID-19 ethical guidelines on critical-care resource allocation. Synthesising this information, we evaluate the relevant ethical principles and thereafter provide recommendations contextualised to Singapore. This brief narrative review aims to serve as a useful set of guiding principles for health-care professionals in Singapore, should the need for allocation of scarce resources arise.
Upregulation of long noncoding RNA SNHG1 indicates a poor prognosis in patients with gastric cancer
Authors: Zhu Hua-Li , Zou Jing
Published: August 2020

It is indicated that the dysregulation of long noncoding RNAs (lncRNAs) is implicated in cancer progression. However, the clinical significance of lncRNA small nucleolar RNA host gene 1 (SNHG1) in gastric cancer remains elusive. The expression levels of SNHGs and the association of SNHG1/10/11 with the clinical characteristics in patients with gastric cancer were analyzed by The Cancer Genome Atlas RNA-seq data. A Cox proportional hazard regression model was used to evaluate the association of SNHG1/10/11 expression with the clinical outcomes in patients with gastric cancer. It was demonstrated that SNHG1/10/11 expression levels were dramatically elevated in gastric cancer tissue samples as compared with the adjacent normal tissues. Increased expression of SNHG1 had no correlation with the clinicopathological parameters, but acted as an independent prognostic factor of poor survival (hazard ration (HR) = 0.590, 95% confidence interval (CI) = 0.399–0.872, P = 0.008) and tumor recurrence (HR = 2.457, 95% CI = 1.442–4.186, P = 0.001) in patients with gastric cancer. In addition, knockdown of SNHG1 in vitro inhibited the proliferation and invasion of gastric cancer cells. Our findings showed that the upregulation of lncRNA SNHG1 indicated a poor prognosis in patients with gastric cancer and might offer a promising therapeutic target for gastric cancer.
Keloids: Current and emerging therapies
Authors: Ojeh Nkemcho , Bharatha Ambadasu , Gaur Uma , Forde Andrew LeRoy
Published: August 2020

Keloids are pathological scars that grow over time and extend beyond the initial site of injury after impaired wound healing. These scars frequently recur and rarely regress. They are aesthetically disfiguring, can cause pain, itching, discomfort as well as psychological stress, often affecting quality of life. Many treatment modalities, including surgical and non-surgical, have been explored and have been reported to be beneficial; however, none have been absolutely satisfactory or optimal for the treatment of all keloid subtypes to date. This poses a major challenge to clinicians. Often, a combinational therapeutic approach appears to offer the best results with higher patient satisfaction compared to monotherapy. The aetiopathogenesis of keloids is not fully elucidated; however, with recent advances in molecular biology and genetics, insight is being gained on the complex process of scar formation and hence new therapeutic and management options for keloids. In this paper, we explore the literature and summarise the general concepts surrounding keloid development and review both current (corticosteroids, surgical excision, silicone-based products, pressure therapy, radiotherapy, cryotherapy, laser therapy, imiquimod and 5-fluorouracil) and emerging (stem cell therapy, mitomycin C, verapamil, interferons, bleomycin, botulinum toxin type A and angiotensin-converting enzyme inhibitors) treatments. Increased knowledge and understanding in this area may potentially lead to the discovery and development of novel therapeutic options that are more efficacious for all keloid types.

Lay Summary

[Formula: see text] Keloids are problematic scars that are difficult to treat and manage. The aetiopathogenesis of keloids is not clear; however, recent advances in molecular biology and genetics are beginning to shed light on the underlying mechanisms implicated in keloid scar formation which will hopefully lead to the development of treatment options for all keloid types. This review summarises current and emerging therapies.
The Role of Attentional Control in Cognitive Deficits Associated With Chronic Pain
Authors: Godfrey Hazel K. , Walsh Amy T. , Fischer Ronald , Grimshaw Gina M.
Published: August 2020

Cognitive deficits in chronic pain are often attributed to difficulties in attentional control. According to the deficit view, these difficulties stem from a reduction in attentional capacity driven by attentional focus on pain experience; alternatively, according to the motivated-attention view, attentional biases toward pain-relevant threats in the environment reduce attention available for everyday tasks and goals. We tested both accounts using a task in which 72 people with chronic pain and 72 without chronic pain performed a simple perceptual task while attempting to ignore pain-relevant images of body mutilations or neutral scenes. They also completed a common test of attentional control. Although people with chronic pain reported subjective difficulty with attentional control and were slower on both tasks, groups did not differ on behavioral measures of attentional control. Findings suggest that attentional control may not be an optimal target for interventions intended to improve cognitive function in chronic pain.
Spontaneous clinical tumor lysis syndrome in solid renal tumor: first case report in non-metastatic renal carcinoma
Authors: Cesar Bruno Nogueira , Nunes Nilo Eduardo Delboni , Hazin Maria Amelia Aguiar , Foresto Renato Demarchi , Kirsztajn Gianna Mastroianni , Durao Junior Marcelino Souza
Published: August 2020

Spontaneous tumor lysis syndrome is a rare emergency in onco-nephrology that results from extensive cancer cell lysis independent of antitumoral therapy. It is common among hematological tumors and can be rarely seen with solid tumors. In medical literature, there is only one case report with spontaneous tumor lysis syndrome in renal cell carcinoma and it was associated with metastases. To the best of our knowledge, this is the first report of spontaneous tumor lysis syndrome in non-metastatic renal cell carcinoma.
A Single-Center Evaluation of Extended Infusion Piperacillin/Tazobactam for Empiric Treatment in the Intensive Care Unit
Authors: Tucker Kendall , Benning Molly , Ryan Keenan , Walraven Carla , Jakeman Bernadette
Published: August 2020

Background: Piperacillin/tazobactam (PTZ) extended infusion (EI) is often used empirically in the intensive care unit (ICU). Gram-negative (GN) organisms with PTZ minimum inhibitory concentrations (MICs) >16/4 µg/mL are considered intermediate or resistant. Objective: The objective of this study was to evaluate MICs of GN isolates from the ICU to determine whether the hospital protocol for PTZ 3.375 g EI over 4 hours administered every 8 hours is an appropriate empiric regimen for ICU patients and to evaluate patient-specific risk factors associated with elevated MICs. Methods: All ICU patients admitted during 2017 with a confirmed GN organism from a non-urinary source were included for retrospective chart review. Patients with cystic fibrosis or cultures obtained >48 hours prior to ICU admission were excluded. Demographics, GN organism, culture source, risk factors for resistance, susceptibility profile, comorbidities, and creatinine clearance were collected. Appropriateness was defined as PTZ MIC ≤16/4 µg/mL in >80% of isolates. Results: Two hundred and thirty-one patients were included. The average patient was 56 years old. The majority of patients were white (64.1%) and male (69.7%). Pseudomonas aeruginosa (41%) was the most common organism isolated. Overall, 28% of GN isolates had MICs >16/4 µg/mL. Dialysis ( P = .01), intravenous antibiotics within 90 days ( P < .001), and presence of wounds/trauma ( P = .01) were associated with elevated MICs. Conclusion: Current PTZ EI 3.375 g dosing regimens may not provide adequate empiric coverage for some GN organisms in ICU patients, especially for those who have previously received intravenous antibiotics, are on dialysis, or have wounds/trauma.
Defining the Role of the Advanced Pharmacy Technician: Perspective Dissonance
Authors: Dering-Anderson Allison M. , Blaha Madeline E. , Neville Judith L.
Published: August 2020

Background: Pharmacy technicians serve as pharmacist extenders. Attempts at advancing their practice have not been as rapid as the profession would prefer. We postulated that a barrier to this advancement is lack of agreement between pharmacists and technicians on how advancement should occur and on what it means. Objective: The objectives were to evaluate the differences in definitions and expectations of “technician advancement” between pharmacists and pharmacy technicians as potential impediments to advancement. Methods: Multimodal: An initial questionnaire for pharmacy technicians was collected during the American Association of Pharmacy Technicians Annual Convention to identify major topics for further survey. From those data, a survey was developed to ask pharmacists and pharmacy technicians about “technician advancement.” Surveys were provided to technicians in seminar settings; to members of the Nebraska Pharmacists Association; and via online platforms such as Facebook. Additionally, face-to-face targeted interviews were conducted with pharmacy technicians attending American Association of Pharmacy Technicians conventions and with the pharmacy technician and pharmacist leaders at the Nebraska Pharmacists Association. Results: Responses show that pharmacists’ expectations for advancing the practice of pharmacy technicians and the expectations of the technicians themselves vary widely. A notable finding is that 96% of all technicians responding see technician payment as a significant issue in advancement, while less than 4% of pharmacists commented on rate of pay. Conclusion: While both pharmacists and pharmacy technicians are hopeful for pharmacy technician role advancement, there is substantial disagreement about the definition of advancement that may be a barrier to the process.
Genomics-assisted prediction of salt and alkali tolerances and functional marker development in apple rootstocks
Authors: Liu Jing , Shen Fei , Xiao Yao , Fang Hongcheng , Qiu Changpeng , Li Wei , Wu Ting , Xu Xuefeng , Wang Yi , Zhang Xinzhong , Han Zhenhai
Published: August 2020

Background

Saline, alkaline, and saline-alkaline stress severely affect plant growth and development. The tolerance of plants to these stressors has long been important breeding objectives, especially for woody perennials like apple. The aims of this study were to identify quantitative trait loci (QTLs) and to develop genomics-assisted prediction models for salt, alkali, and salt-alkali tolerance in apple rootstock.

Results

A total of 3258 hybrids derived from the apple rootstock cultivars ‘Baleng Crab’ (Malus robusta Rehd., tolerant) × ‘M9’ (M. pumila Mill., sensitive) were used to identify 17, 13, and two QTLs for injury indices of salt, alkali, and salt–alkali stress via bulked segregant analysis. The genotype effects of single nucleotide polymorphism (SNP) markers designed on candidate genes in each QTL interval were estimated. The genomic predicted value of an individual hybrid was calculated by adding the sum of all marker genotype effects to the mean phenotype value of the population. The prediction accuracy was 0.6569, 0.6695, and 0.5834 for injury indices of salt, alkali, and salt–alkali stress, respectively. SNP182G on MdRGLG3, which changes a leucine to an arginine at the vWFA-domain, conferred tolerance to salt, alkali, and salt-alkali stress. SNP761A on MdKCAB, affecting the Kv_beta domain that cooperated with the linked allelic variation SNP11, contributed to salt, alkali, and salt–alkali tolerance in apple rootstock.

Conclusions

The genomics-assisted prediction models can potentially be used in breeding saline, alkaline, and saline-alkaline tolerant apple rootstocks. The QTLs and the functional markers may provide insight for future studies into the genetic variation of plant abiotic stress tolerance.
Bioaerosol sampling of patients with suspected pulmonary tuberculosis: a study protocol
Authors: Patterson Benjamin , Koch Anastasia , Gessner Sophia , Dinkele Ryan , Gqada Melitta , Bryden Wayne , Cobelens Frank , Little Francesca , Warner Digby F. , Wood Robin
Published: August 2020

Background

Tuberculosis (TB) is transmitted in bioaerosols containing Mycobacterium tuberculosis (Mtb). Despite being central to ongoing TB transmission, no routine diagnostic assay exists to measure Mtb in bioaerosols. Furthermore, published studies of Mtb in bioaerosol samples have been limited to individuals with sputum-positive pulmonary TB. Notably, TB diagnosis is based on clinical symptoms and sputum laboratory findings. This is despite the fact that approximately half of all patients commencing TB treatment are sputum-negative, resulting in a high proportion of presumptive treatments. Here, we propose to use a sensitive air sampling protocol to investigate the prevalence of Mtb-containing bioaerosols in both sputum-positive and sputum-negative TB suspects, at the same time evaluating the potential to identify unrecognized transmitters of TB.

Methods

Our parallel-group design will identify viable Mtb in bioaerosols produced by individuals attending a TB clinic in South Africa. Sampling will be performed on eligible individuals presenting with symptoms indicative of TB and repeated at 14 days if initially positive. Participants will be prospectively classified into three distinct groups based on National TB Control Program (NTBCP) criteria: Group A, TB notification with sputum-based laboratory confirmation; Group B, TB notification with empiric diagnosis; and Group C, individuals not notified. Group C individuals with detectable Mtb bioaerosol will be monitored until resolution of clinical and laboratory status. Collection of bioaerosol specimens will be via two consecutive sampling modalities: (1) direct sampling following a specific respiratory manoeuvre; and (2) indirect sampling during passive respiratory activity. Bioaerosol specimens will be analyzed for viable Mtb using DMN-trehalose staining and live-cell fluorescence microscopy. Mtb genomes and mycobacterial and host lipids will be detected using droplet digital PCR and mass spectrometry analyses, respectively. The primary objective is to determine the prevalence of Mtb bioaerosols in all TB clinic attendees and in each of the groups. Secondary objectives are to investigate differences in prevalence of Mtb bioaerosol by HIV status and current isoniazid preventive therapy (IPT) use; we will also determine the impact of anti-TB chemotherapy on Mtb-containing bioaerosol production.

Discussion

Respiratory bioaerosol has a potential role in non-invasive TB diagnosis, infectivity measurement and treatment monitoring.

Trial registration

ClinicalTrials.gov: NCT04241809. Date of Registration: 27/1/2020.
Large calcified renal artery aneurysm in the renal sinus misdiagnosed as an intrapelvic calculus followed by mistakenly performed PCNL: a case report
Authors: Chen Chao , Wang Xuliang , Xin Fang , He Lugeng , Jiang Kang , Shao Jia , Xie Liping
Published: August 2020

Background

Renal artery aneurysms (RAAs) are rare and usually asymptomatic, and some RAAs can be associated with calcifications, which may lead to misdiagnoses as renal calculi, which are then mistakenly treated.

Case presentation

A 69-year-old female patient was admitted to the hospital with no discomfort and was diagnosed with a large right renal calculus. The ultrasound and computed tomography urography (CTU) scan suggested a large calculus in the right pelvis with hydrops of the kidney. Therefore, we chose percutaneous nephrolithotomy (PCNL) to treat the right renal calculus, but no calculi were found in the renal pelvis. When we removed the mucosa of the renal pelvis with a holmium laser, we observed a fluctuating unruptured aneurysm with calcification. Therefore, the previous diagnosis of a renal calculus was disregarded. The operation was stopped immediately, and then computed tomography (CT) angiography was performed, confirming the right renal aneurysm with calcification. Then, Renal artery aneurysm (RAA) coil embolization was performed. After a long-term follow-up, the patient recovered well.

Conclusions

The RAA of this patient had calcific changes, which led us to errors in the diagnosis. Hence, it is very important for surgeons to effectively distinguish between renal calculi and aneurysms with ring-like calcifications. Our case report looks back at the thrilling situation during the operation and advises surgeons on how to deal with this situation properly.
Efficacy of adipose derived stem cells on functional and neurological improvement following ischemic stroke: a systematic review and meta-analysis
Authors: Yousefifard Mahmoud , Shamseddin Jebreil , Babahajian Asrin , Sarveazad Arash
Published: August 2020

Background

The evidence on the efficacy of adipose derived stem cells (ADSCs) in the treatment of stroke is controversial. Therefore, the aim of present systematic review and meta-analysis is to evaluate the efficacy of ADSCs administration in the treatment of animal models of ischemic stroke.

Methods

An extensive search was performed on electronic databases of Medline, Embase, Scopus, CENTRAL and Web of Science until December 31, 2018. Animal studies that used ADSCs in treatment of ischemic stroke were included. The data were recorded as mean and standard deviation and then a pooled standardized mean difference (SMD) with 95% confidence interval (95% CI) was reported.

Results

Twenty articles were included in the present meta-analysis. It was observed that administration of ADSCs improves motor function (SMD = 2.52, 95% CI: 1.67 to 3.37, p < 0.0001) and neurological status (SMD = 2.05, 95% CI: 1.33 to 2.78, p < 0.0001) in animals following an ischemic stroke. Multivariate meta-regression showed the model of stroke induction (p = 0.017) and the number of transplanted cells (p = 0.007) affect the efficacy of ADSCs administration on motor function improvement following the stroke.

Conclusion

Moderate to high levels of evidence indicate a strong efficacy of ADSCs transplantation on motor function and neurological improvement following ischemic stroke in animal models. However, no reports regarding the dose-response effect of ADSCs administration on stroke exist in the literature. As a result, further pre-clinical studies are recommended to be conducted on the matter.
The impact of supply-side and demand-side interventions on use of antenatal and maternal services in western Kenya: a qualitative study
Authors: Hirai Mitsuaki , Morris Jamae , Luoto Jill , Ouda Rosebel , Atieno Nancy , Quick Robert
Published: August 2020

Background

Antenatal care (ANC) and delivery by skilled providers have been well recognized as effective strategies to prevent maternal and neonatal mortality. ANC and delivery services at health facilities, however, have been underutilized in Kenya. One potential strategy to increase the demand for ANC services is to provide health interventions as incentives for pregnant women. In 2013, an integrated ANC program was implemented in western Kenya to promote ANC visits by addressing both supply- and demand-side factors. Supply-side interventions included nurse training and supplies for obstetric emergencies and neonatal resuscitation. Demand-side interventions included SMS text messages with appointment reminders and educational contents, group education sessions, and vouchers to purchase health products.

Methods

To explore pregnant mothers’ experiences with the intervention, ANC visits, and delivery, we conducted focus group discussions (FGDs) at pre- and post-intervention. A total of 19 FGDs were held with pregnant mothers, nurses, and community health workers (CHWs) during the two assessment periods. We performed thematic analyses to highlight study participants’ perceptions and experiences.

Results

FGD data revealed that pregnant women perceived the risks of home-based delivery, recognized the benefits of facility-based delivery, and were motivated by the incentives to seek care despite barriers to care that included poverty, lack of transport, and poor treatment by nurses. Nurses also perceived the value of incentives to attract women to care but described obstacles to providing health care such as overwork, low pay, inadequate supplies and equipment, and insufficient staff. CHWs identified the utility and limitations of text messages for health education.

Conclusions

Future interventions should ensure that adequate workforce, training, and supplies are in place to respond to increased demand for maternal and child health services stimulated by incentive programs.
Immunotherapy and associated immune-related adverse events at a large UK centre: a mixed methods study
Authors: Jamieson Liz , Forster Martin D. , Zaki Kam , Mithra Sanjena , Alli Heena , O’Connor Anne , Patel Apini , Wong Ian C. K. , Chambers Pinkie
Published: August 2020

Background

The development and rapid uptake of immune checkpoint inhibitors (CPI) has changed the outlook for patients with cancer. However, CPIs have different adverse event (AE) profiles to other systemic therapies, and prompt AE management is essential to assure optimal outcomes. In order to understand what and when adverse events are experienced, reported and managed during CPI treatment, a mixed methods study was conducted, including a case note review of patients who were receiving immunotherapy and semi-structured interviews with patients to understand their experience, management and reporting of AEs after receiving immune CPI treatment.

Methods

This mixed methods study was conducted at a large cancer hospital in the United Kingdom. A case note review identified how and where patients reported AEs. Data relating to patients with lung, bladder, prostate and head & neck cancers who received CPI treatment between 01/04/2015 and 31/07/2018 were extracted from e-prescribing databases and clinical data were included for analysis at a single time point (31 July 2018). Semi-structured interviews were conducted with patients receiving CPI treatment, exploring experience of AEs and reasons for delays in AE reporting and management.

Results

Sixty-two patients were included in the case note review, with 78 AEs being experienced by 36 patients (58%), including one patient experiencing 10 AEs. Serious AEs were experienced by 12 patients (19%) and ten AEs (17%) required oral steroids as treatment. The majority of AEs were reported to clinicians prior to further dosing, although milder AEs were often not addressed until subsequent clinic appointments. Interviews with 13 patients yielded major themes: variability, causality, decision making and impact.

Conclusion

Most CPI-associated AEs are manageable if reported and treated promptly. Both the case note review and interviews found that reporting of non-serious AEs is often left until routine clinic visits, despite impacting patient experience, leaving the opportunity for AEs to be left unreported and implying a potential benefit for real time monitoring. Our study highlights a need to provide patients with reminders around AEs and their timely reporting even when apparently innocuous; patients must understand that AEs can occur at any cycle and even following treatment completion.
The risk of acute events among patients with sickle cell disease in relation to early or late initiation of care at a specialist center: evidence from a retrospective cohort study
Authors: Rankine-Mullings Angela Edna , Logan Twila Mae , King Lesley-Gaye , Cunningham-Myrie Colette Andrea , Scott Clive Robert , Knight-Madden Jennifer Marcelle
Published: August 2020

Background

The greatest disease burden of sickle cell disease occurs early in life. Understanding factors that reduce disease related events in this period is therefore important. Hence, we assessed the impact of early care at a specialist center on the incidence of acute events during the first five years.

Methods

This was a retrospective cohort study among Jamaican children with sickle cell disease. Medical records of patients born January, 2004 to December, 2009, who were registered at the Sickle Cell Unit, a specialist care facility, were abstracted for dates of initiation to care, first occurrence and frequency of the outcomes of interest (vaso-occlusive crises, acute splenic sequestration, acute chest syndrome, and infection). Patients were classified according to whether initiation of care was before (early) or after 5 months of age (late). Using standardized t-tests, χ2 tests, and a multiple-failure survival analysis the rates of acute events between groups were compared.

Results

Of the total study group (n= 290), homozygous sickle cell disease accounted for 97% and 95% of the early (n=113) and late groups (n=177) respectively. The mean age of presentation in the early and late group was 0.2 and 2.3 years (p<0.01), with a mean length of follow-up of 5.2 and 3.2 years respectively (p<0.01). Vaso-occlusive crisis (n=880) and acute chest syndrome (n= 571) together accounted for 91.6% of the total number of events (n=1584). The risk of vaso-occlusive crisis and acute chest syndrome (among patients who presented with these acute events) was significantly higher in the “late” group, by 43% (Incidence rate ratio, (IRR) = 1.43,p<0.001); 95% CI (1.18-1.72) and 40% (IRR=1.40.p=0.002), 95% CI (1.12-1.75) respectively compared to “early” group. There was no difference in risk between groups for acute splenic sequestration and infection among persons presenting with these events.

Conclusion

The risk of acute events in children with sickle cell disease exposed to early care at a specialist care is significantly less. Therefore, widespread screening with rapid referral to a specialist center stands to reduce substantial morbidity in Jamaica and other regions with high prevalence of sickle cell disease.
Perspectives of HIV-positive and -negative people who use drugs regarding the criminalization of HIV non-disclosure in Canada: a qualitative study
Authors: Ng Cara , Chayama Koharu Loulou , Krüsi Andrea , Small Will , Knight Rod
Published: August 2020

Background

While previous research has identified how criminalization of HIV non-disclosure can have deleterious effects on those living with HIV, the perspectives of people who use drugs – a population disproportionately affected by HIV– should be more meaningfully considered in these discussions.

Methods

Using constant comparative techniques, data from 60 interviews with men and women living with and without HIV and who use drugs in Vancouver were analyzed to explore their perceptions about Canada’s HIV non-disclosure legal framework.

Results

Participants’ perspectives on the framework involved three themes: understandings of HIV risk; HIV-related stigma; and their own experiences with HIV. While several participants favored the punitive character of the legal framework, these arguments were premised on misinformed and stigmatized assumptions regarding HIV.

Conclusions

The paper concludes by discussing the challenges and opportunities for resisting HIV stigma and misconceptions about HIV within the context of personal accounts that, at times, support criminalization of non-disclosure.
E-cigarette environmental and fire/life safety risks in schools reported by secondary school teachers
Authors: Fakeh Campbell Maryanne L. , Sansone Andrew , Gonzalez Lauren N. , Schroth Kevin R. J. , Shendell Derek G.
Published: August 2020

Background

To identify if e-cigarette usage is an on-campus problem for secondary schools and evaluate initial school survey responses. More specifically, this survey can aid in identifying where students are seen using e-cigarettes, if smoke alarms have been newly inserted on school property, if smoke alarms have been tampered with to allow for vaping without detection; and, if any e-cigarette fires or explosions have occurred on school property.

Methods

This survey, disseminated to New Jersey secondary school teachers across seven sessions January–July 2019, resulted in 104 complete responses of 109 respondents. The survey was conducted after fire prevention, exit/egress, and life safety portions of “OSHA 10 Plus for General Industry” courses. Survey questions included number of times teachers observed students vaping and location where vaping in last 12 months, fire alarm installation and tampering, and fires or explosions and injuries from vaping/e-cigarette devices.

Results

Many (63%) respondents reported very or moderately common rates of vaping within their schools; however, three of four questions regarding school fire and smoke alarm use specifically to detect vaping had a majority of unsure/I don’t know responses.

Conclusion

Results suggested concerns regarding student vaping and e-cigarette use inside and outside secondary schools. Improved school detection and response are warranted.

Trial registration

Not applicable.
Diagnostic utility of patient history, clinical examination and screening tool data to identify neuropathic pain in low back related leg pain: a systematic review and narrative synthesis
Authors: Mistry Jai , Heneghan Nicola R. , Noblet Tim , Falla Deborah , Rushton Alison
Published: August 2020

Background

Low back-related leg pain (LBLP) is a challenge for healthcare providers to manage. Neuropathic pain (NP) is highly prevalent in presentations of LBLP and an accurate diagnosis of NP in LBLP is essential to ensure appropriate intervention. In the absence of a gold standard, the objective of this systematic review was to evaluate the diagnostic utility of patient history, clinical examination and screening tool data for identifying NP in LBLP.

Methods

This systematic review is reported in line with PRISMA and followed a pre-defined and published protocol. CINAHL, EMBASE, MEDLINE, Web of Science, Cochrane Library, AMED, Pedro and PubMed databases, key journals and the grey literature were searched from inception to 31 July 2019. Eligible studies included any study design reporting primary diagnostic data on the diagnostic utility of patient history, clinical examination or screening tool data to identify NP in LBLP, in an adult population. Two independent reviewers searched information sources, assessed risk of bias (QUADAS-2) and used GRADE to assess overall quality of evidence.

Results

From 762 studies, 11 studies were included. Nine studies out of the 11 were at risk of bias. Moderate level evidence supports a cluster of eight signs (age, duration of disease, paroxysmal pain, pain worse in leg than back, typical dermatomal distribution, worse on coughing/sneezing/straining, finger to floor distance and paresis) for diagnosing lumbosacral nerve root compression, demonstrating moderate/high sensitivity (72%) and specificity (80%) values. Moderate level evidence supports the use of the StEP tool for diagnosing lumbar radicular pain, demonstrating high sensitivity (92%) and specificity (97%) values.

Conclusions

Overall low-moderate level evidence supports the diagnostic utility of patient history, clinical examination and screening tool data to identify NP in LBLP. The weak evidence base is largely due to methodological flaws and indirectness regarding applicability of the included studies. The most promising diagnostic tools include a cluster of 8 patient history/clinical examination signs and the StEP tool. Low risk of bias and high level of evidence diagnostic utility studies are needed, in order for stronger recommendations to be made.
Quantification of hip effusion-synovitis and its cross-sectional and longitudinal associations with hip pain, MRI findings and early radiographic hip OA
Authors: Ahedi Harbeer , Aitken Dawn , Blizzard Leigh , Cicuttini Flavia , Jones Graeme
Published: August 2020

Background

Hip effusion-synovitis may be relevant to osteoarthritis (OA) but is of uncertain etiology. The aim of this study was to describe the cross-sectional and longitudinal associations of hip effusion-synovitis with clinical and structural risk factors of OA in older adults.

Methods

One hundred ninety-six subjects from the Tasmanian Older Adult Cohort (TASOAC) study with a right hip STIR (Short T1 Inversion Recovery) Magnetic Resonance Imaging (MRI) on two occasions were included. Hip effusion-synovitis CSA (cm2) was assessed quantitatively. Hip pain was determined by WOMAC (Western Ontario and McMaster Universities Osteoarthritis) while hip bone marrow lesions (BMLs), cartilage defects (femoral and/or acetabular) and high cartilage signal were assessed on MRI. Joint space narrowing (0–3) and osteophytes (0–3) were measured on x-ray using Altman’s atlas.

Results

Of 196 subjects, 32% (n = 63) had no or a small hip effusion-synovitis while 68% (n = 133) subjects had a moderate or large hip effusion-synovitis. Both groups were similar but those with moderate or large hip effusion-synovitis were older, had higher BMI and more hip pain. Cross-sectionally, hip effusion-synovitis at multiple sites was associated with presence of hip pain [Prevalence ratio (PR):1.42 95%CI:1.05,1.93], but not with severity of hip pain. Furthermore, hip effusion-synovitis size associated with femoral defect (βeta:0.32 95%CI:0.08,0.56). Longitudinally, and incident hip cartilage defect (PR: 2.23 95%CI:1.00, 4.97) were associated with an increase in hip effusion-synovitis CSA. Furthermore, independent of presence of effusion-synovitis, hip BMLs predicted incident (PR: 1.62 95%CI: 1.13, 2.34) and worsening of hip cartilage defects (PR: 1.50 95%CI: 1.20, 1.86). While hip cartilage defect predicted incident (PR: 1.11 95%CI: 1.03, 1.20) and worsening hip BMLs (PR: 1.16 95%CI: 1.04, 1.30).

Conclusions

Hip effusion-synovitis at multiple sites (presumably reflecting extent) may be associated with hip pain. Hip BMLs and hip cartilage defects are co-dependent and predict worsening hip effusion-synovitis, indicating causal pathways between defects, BMLs and effusion-synovitis.
The incidence of regression after the non-surgical treatment of symptomatic lumbar disc herniation: a systematic review and meta-analysis
Authors: Wang Yi , Dai Guogang , Jiang Ling , Liao Shichuan
Published: August 2020

Background

Although the regression of symptomatic lumbar disc herniation (SLDH) has been widely reported, little data exist regarding the generalized incidence of regression (IR). We aimed to review the varying IRs and to synthesize the pooled IR of non-surgically-treated SLDH.

Methods

Four electronic databases were searched for relevant studies pertaining to the regression of SLDH after non-surgical treatment and for potential studies that may have reported morphological changes in lumbar disc herniation in the follow-up results of SLDH patients treated non-surgically. The main outcome was the regression of SLDH. A random effects model was used to determine the pooled IR of SLDH.

Results

We identified 13,672 articles, 38 of which were eligible for analysis. Our analysis included 2219 non-surgically treated SLDH patients, 1425 of whom presented regression. The pooled IR was 63% (95% CI 0.49–0.77). In subgroup analyses, studies that quantitatively measured the regression of SLDH yielded statistically higher pooled IRs than those that used qualitative methods. The pooled IRs gradually increased in randomized controlled trials and prospective and retrospective studies. The pooled IR varied from 62 to 66% after the sequential omission of any single study. Meta-regression showed that study types, herniation levels and regression measurements caused heterogeneity.

Conclusions

We report an overall IR of 63% among non-surgically treated SLDH patients, thus providing clinical decision makers with quantitative evidence of IR. Based on our systematic review, we suggest a follow-up timeline with time points 4 and 10.5 months after onset when deciding whether to perform surgery for SLDH.