bluuebunny/crossref_metadata_2025 huggingface dataset:
Transoral Endoscopic Thyroidectomy Vestibular Approach: A Single-institution Experience of the First 50 Cases
Authors: Fernandez-Ranvier Gustavo , Meknat Aryan , Guevara Daniela , Taye Aida , Suh Hyunsuk , Inabnet William B.
Published: June 2020

Background. Transoral endoscopic thyroidectomy vestibular approach (TOETVA) has evolved from a novel procedure to a cosmetically appealing alternative to the traditional open thyroidectomy. TOETVA is limited to only high-volume centers with the hope to expand and demonstrate the safety, reproducibility, and application for the correct patient with thyroid disease. We present our experience with the first 50 TOETVA procedures performed at our institution. Methods. From September 2016 to June 2018, we performed 50 transoral endoscopic thyroidectomies via the vestibular approach for a variety of thyroid pathologies. Outcomes were analyzed from a prospectively maintained database. Patients were treated for a different range of thyroid pathologies. Results. A total of 12 (24%) patients underwent total thyroidectomy, whereas 38 (76%) patients underwent a subtotal thyroidectomy or thyroid lobectomy. The mean surgical time was 149 ± 40.0 (90-256) minutes for lobectomy and 217.6 ± 33.3 (175-276) minutes for total thyroidectomy. Of our 50 patients, 16 (32%) had postoperative transient lower lip numbness with an average time to recovery of 23.8 (.43-48) weeks, with 1 (2%) patient having persistent, but improving, lower lip numbness beyond the 6-month follow-up. There were 13 (26%) patients with transient chin numbness with an average time to recovery of 15.7 (2-48) weeks. Two (4%) patients had transient recurrent laryngeal nerve (RLN) injury with hoarseness, whereas 1 (2%) patient had permanent injury. Conclusion. The TOETVA is a safe and reproducible procedure. For selected patients, this technique is a viable alternative to conventional thyroidectomy.
Leadership and women: The space between us. Narrating the stories of senior female educational leaders in Malta
Authors: Vella Robert
Published: June 2020

The main objective of this research is to investigate the perceptions and experiences of senior female educational leaders in Malta, where senior leaders are considered as those leaders from the Minister of Education to leaders at directorial level. Although Malta’s laws relating to gender equity are in line with those of the European Union, traditional beliefs and values, including those shaped by the Catholic Church, mean that in many areas of social life, women and girls continue to be perceived as inferior. The study is framed within a constructivist and interpretivist paradigm and takes a narrative approach. Throughout 2017 to 2018, in-depth interview data was collected from eight senior female leaders in the Maltese education department. Data used from an ongoing doctoral study was analysed manually using a hybrid method in order to establish the relevant themes. The findings from the study demonstrated that women in educational leadership roles in Malta have to face challenges specific to their being female. The study recommends, among other things, real family friendly measures by organisations, organised professional development programmes for women in leadership and for those aspiring to be leaders, and training programmes focused on how to build healthy collegial relationships.
Effects of jump training on jumping performance of handball players: A systematic review with meta-analysis of randomised controlled trials
Authors: Ramirez-Campillo Rodrigo , Alvarez Cristian , Garcia-Hermoso Antonio , Keogh Justin WL , García-Pinillos Felipe , Pereira Lucas A , Loturco Irineu
Published: June 2020

This study aimed to assess the effects of jump training on the jumping performance of handball players compared with a control condition. The data sources utilised were PubMed, MEDLINE, Web of Science Core Collection and SCOPUS. Only peer-review randomised controlled trials were included. The inclusion criteria comprised: a jump training programme of at least 2 weeks; a control group; the assessment of the countermovement jump. The Physiotherapy Evidence Database scale was used to assess the risk of bias and methodological quality of eligible studies included in the meta-analysis. Risk of publication bias across studies was assessed using the extended Egger’s test. Cohen’s d effect sizes (ESs) were calculated from the countermovement jump and presented together with 95% confidence intervals (CIs). From 6108 records initially identified through database searching, 5 were eligible for meta-analysis. A significant improvement in countermovement jump height was observed, corresponding to 6.4 cm (95% CI = 4.9–7.9; Z = 8.4, p < 0.001), showing moderate heterogeneity ( I2 = 51.4%). The magnitude of the main effect was very large (ES = 2.2 (95% CI = 0.95–3.4), Z = 3.5, p < 0.001). Jump training is effective in increasing vertical jump performance in handball players. However, the insufficient number of studies conducted precluded analyses of moderator variables. In future, researchers are advised to conduct jump training studies of high methodological quality (e.g. randomised controlled trials) and assess different jump exercise prescriptions across handball players of different sexes, ages and competitive levels to analyse if exercise prescription and player characteristics may influence training responses.
On the Need to Differentiate the Temporal Trajectories of Ecosystem Structure and Functions in Restoration Programs
Authors: Ferraz Silvio , Brancalion Pedro H. S. , Guillemot Joannès , Meli Paula
Published: June 2020

Potential time lags between human-mediated disturbances and the subsequent responses of ecosystems are critical for planning and implementing conservation and restoration actions. In this context, decoupling between the temporal trajectories of ecosystems structure and functions is particularly critical. Here, we stand out the need to differentiate the temporal trajectories of ecosystem structure and functions to be considered in ecological restoration programs. In cases when ecosystem functions persist after the degradation of the ecosystem structure, and when functions do not recover at the same rate as structure, some kind of ecosystem functioning credits or debts can occur. In other situations, an ongoing loss of the ecosystem function can occur even in the absence of further disturbance. Ecosystem restoration outcomes could be optimized in regions with ecosystem functioning credit, since mitigating the decline in functioning will be more efficient than recovering functions in highly degraded conditions. Ecological restoration programs should not only focus on structure-derived indicators but they should also consider the dynamics of ecosystem functions to guide land-planning decision-making.
Resolution without discontinuation: heart failure during clozapine treatment
Authors: Whiskey Eromona , Yuen Shirley , Khosla Emma , Piper Susan , O’Flynn David , Taylor David
Published: June 2020

Clozapine is an atypical antipsychotic recommended for patients with treatment-resistant schizophrenia whose illness has not responded adequately to treatment despite the sequential use of at least two different antipsychotic drugs at therapeutic doses. Unfortunately, clozapine is frequently discontinued due to both real and perceived serious, and potentially life-threatening, adverse effects, contributing to the underutilisation of the most effective treatment in refractory psychotic disorders. Here, we present the case of a 51-year-old man with treatment-resistant schizoaffective disorder, who was admitted to a locked rehabilitation unit for a clozapine rechallenge. Within 6 months after the clozapine rechallenge, he was diagnosed with heart failure likely secondary to his antipsychotic treatment. Clozapine-induced heart failure usually prompts immediate cessation of treatment. However, in this case, clozapine was continued with cardiology consultation. Ramipril and bisoprolol were initiated and the patient’s cardiac condition progressively improved over time. Clozapine-induced heart failure is a serious cardiovascular complication of treatment, usually resulting in discontinuation of treatment. Although there are cases of successful rechallenge, temporary cessation of treatment can lead to severe psychotic exacerbation and non-engagement with cardiac specialists. More evidence is required for continued use of clozapine in a patient with clozapine-induced cardiac complications.
Long‐term outcomes in pulmonary arterial hypertension by functional class: a meta‐analysis of randomized controlled trials and observational registries
Authors: Kim Nick H. , Fisher Micah , Poch David , Zhao Carol , Shah Mehul , Bartolome Sonja
Published: June 2020

Limited data about the long‐term prognosis and response to therapy in pulmonary arterial hypertension patients with World Health Organization functional class I/II symptoms are available. PubMed and Embase were searched for publications of observational registries and randomized, controlled trials in pulmonary arterial hypertension patients published between January 2001 and January 2018. Eligible registries enrolled pulmonary arterial hypertension patients ≥18 years, N > 30, and reported survival by functional class. Randomized, controlled trial inclusion criteria were pulmonary arterial hypertension patients ≥18 years, ≥6 months of treatment, and morbidity, mortality, or time to worsening as end points reported by functional class. The primary outcomes were survival for registries and clinical event rates for randomized, controlled trials. Separate random effects models were calculated for registries and randomized, controlled trials. Four randomized, controlled trials (n = 2482) and 10 registries (n = 6580) were included. Registries enrolled 9%–47% functional class I/II patients (the vast majority being functional class II) with various pulmonary arterial hypertension etiologies. Survival rates for functional class I/II patients at one, two, and three years were 93% (95% confidence interval (CI): 91%–95%), 86% (95% CI: 82%–89%), and 78% (95% CI: 73%–83%), respectively. The hazard ratio for the treatment effect in randomized, controlled trials overall was 0.61 (95% CI: 0.51–0.74) and 0.60 (95% CI: 0.44–0.82) for functional class I/II patients and 0.62 (95% CI: 0.49–0.78) for functional class III/IV. The calculated risk of death of 22% within three years for functional class I/II patients underlines the need for careful assessment and optimal treatment of patients with functional class I/II disease. The randomized, controlled trial analysis demonstrates that current medical therapies have a beneficial treatment effect in this population.
A case of recurrent varicose veins due to the multiple fistulas from superficial femoral artery
Authors: Watanabe Satoshi , Tsuji Takafumi , Fujita Shinya , Nishio Soji , Kyo Eisho
Published: June 2020

Recurrent varicose veins are considered to be caused by the recurrence of reflux but rarely may be secondary to other pathologies. A 39-year-old man complained of right lower leg skin pigmentation, pain and fatigue for several years. Duplex ultrasound revealed that the great saphenous vein diameter at the saphenofemoral junction level was 7.7 cm, and at the knee medial level was 14.4 cm. The reflux time at the proximal great saphenousvein level was 1.85 s. Endovenous laser ablation for dilated and refluxed great saphenous vein was performed. However, 1 year later, the symptoms recurred. Duplex ultrasound suspected abnormal arterial flow from the right superficial femoral artery to the recanalized segment of previously ablated great saphenous vein and anterior accessory saphenous vein. One month later, despite the successful re-endovenous laser ablation, the symptoms recurred. Computed tomography angiography showed three fistulous vessels from superficial femoral artery to anterior accessory saphenous vein. Combined treatments with endovenous laser ablation and coil embolization was performed. Ultimately, the fistulas were obliterated and the patient remained free of symptoms. Varicose veins due to the fistulas from superficial femoral artery are rare and difficult to diagnose but can be entirely treated with the percutaneous approach.
Anesthetic management with a neuromuscular relaxant and sugammadex in a patient with Prader–Willi syndrome: A case report
Authors: Kim Kyung Woo , Kim Seung Hwan , Ahn Eun Jin , Kim Hyo Jin , Choi Hey Ran , Bang Si Ra
Published: June 2020

Prader–Willi syndrome is a genetic disorder that is characterized by obesity, characteristic facial features, hypotonia, and sleep apnea. These abnormalities mean that airway management is difficult in such patients. Several previous reports suggest that neuromuscular blocking agents should not be used to reduce airway and respiratory complications in these patients. However, this is not always possible. Here, we report the case of a patient with Prader–Willi syndrome in whom anesthesia for ophthalmic surgery was managed successfully using sugammadex after administration of rocuronium.
Mobile Money, Output and Welfare Among Smallholder Farmers in Ghana
Authors: Peprah James Atta , Oteng Clement , Sebu Joshua
Published: June 2020

The objective of this study is to examine the impact of mobile money (m-money) adoption on some household outcomes such as farm output, welfare (consumption expenditure), and wealth (value of assets). Using primary data collected from three districts in Ghana, three Propensity Score Matching methods were employed to estimate the m-money adoption effect on the household outcomes. It is found that advertisements and higher than basic levels of education, among other variables, were important in influencing the adoption of m-money among smallholder farmers. The adoption of m-money was also seen to have an enhancing effect on the household outcome variables (farm output, welfare, and wealth) of smallholder farmers. The results suggest that mobile money can help enhance some of the smallholder economic outcomes that are relevant for rural development and poverty reduction. Policy options should consider expanding m-money services to smallholder farmers in rural areas.
Concurrent Prophylactic Mastectomy, Immediate Reconstruction, and Salpingo-Oophorectomy in High-Risk Patients: A Case Series
Authors: D’Abbondanza Josephine A. , George Ralph , Kives Sari , Musgrave Melinda A.
Published: June 2020

Purpose:

There are limited data on coordinated breast and gynecological risk-reduction surgery for high-risk patients in Canada. Therefore, this study aims to evaluate the patient demographics, surgical details, and outcomes of prophylactic mastectomy (PM) with immediate reconstruction and bilateral salpingo-oophorectomy (BSO) in high-risk patients.

Methods:

We conducted a retrospective chart review at an academic center of patients who concurrently underwent PM with immediate reconstruction and laparoscopic BSO over a 7-year period (March 2010-February 2017) were identified.

Results:

A total of 16 patients underwent PM with immediate reconstruction and concurrent BSO. The mean age at the time of surgery was 46.2 ± 6.6 years. Thirteen (81%) patients were carriers of the BRCA1 or BRCA2 mutation. Two patients had prophylactic surgical therapy for BRCA1 mutation and 14 (87.5%) patients had prior oncological treatment. The most common type of procedures performed were skin-sparing, nipple-sparing mastectomy (56.2%) and reconstruction with acellular dermal matrix and implants (43.8%). All patients underwent laparoscopic BSO. The average combined case time was 282.5 ± 81.3 minutes with an average postoperative hospital stay of 1.3 ± 0.5 days. Six (37.5%) patients presented with 30-day postoperative complications, with higher rates in the alloplastic group. There were no gynecological complications.

Conclusions:

In conclusion, our results demonstrate that a combined multidisciplinary surgical approach did not increase length of stay or 30-day complication rates. Furthermore, concurrent risk-reducing strategies are an effective option for patients at high risk of breast or ovarian cancer.
Reply to Comment on “An Unusual Case of Acquired Angioedema and Monoclonal Gammopathy of Renal Significance in a Middle-Aged Caucasian Female”
Authors: Roy Sasmit , Konala Venu Madhav , Kyaw Thurein , Chakraborty Sandipan , Naramala Srikanth , Gayam Vijay , Adapa Sreedhar , Bose Subhasish
Published: June 2020

We sincerely thank Dr Andrew Whyte, who keenly reviewed our case report and came up with critical reasoning to justify his thoughts and critique with regard to our published article, “An Unusual Case of Acquired Angioedema and Monoclonal Gammopathy of Renal Significance in a Middle-Aged Caucasian Female.” We agree with the author that hypocomplementemic urticarial vasculitis can be a reasonable contender as a diagnosis in this case. There are indeed some features in this case that do not entirely fit either classic presentation of acquired angioedema or hypocomplementemic urticarial vasculitis. Both diseases being equally rare, we tried to focus on the association of proliferative glomerulonephritis with angioedema-like features in this patient and considered acquired angioedema as the unifying diagnosis.
The Unintended Effects of Policy-Assigned Teacher Observations: Examining the Validity of Observation Scores
Authors: Hunter Seth B.
Published: June 2020

Several state policies link high-stakes consequences to teacher evaluations, which tend to be heavily weighted by observation scores. However, research has only recently investigated the validity of these scores in field settings. This study examines the sensitivity of teacher observation scores to the number of observations assigned by state policy and the assignment of prior-year composite measures produced by the evaluation system. Regression discontinuity and local regression designs exploit discontinuities in both assignment processes. The evidence suggests that assignment to a lower prior-year composite score does not bias observation scores, but the assignment to more policy-assigned observations introduces substantial negative bias. The degree of negative bias is most pronounced among early-career teachers, as suggested by theory. Implications are discussed.
Promoting the Inclusion of Mindfulness and Contemplative Practices in the College Classroom
Authors: Vilvens Heather L. , Frame Debra L. , Owen Patrick C.
Published: June 2020

College students may be particularly stressed as they struggle to balance college life, work, family, and relationships, while engaging in career exploration and attempting to find meaning and purpose in their lives. The current practitioner action research project explored incorporating mindfulness and contemplative practices into the higher education classroom to uncover students’ perceptions of how useful the activities might be for managing their personal stress and anxiety. Thirty-two freshman and sophomore students from a regional campus of a large university consented to participate in the semester-long study, where brief, weekly mindfulness activities were integrated into in-class and out-of-class assignments during an introductory Personal Health course. Study findings indicated that the majority of student participants found mindfulness practices were helpful when it came to decreasing stress and anxiety or relaxing. Making time outside the classroom to practice mindfulness behaviors, however, was a barrier. These findings have both practical and positive implications for future higher education classroom interventions. As such, the authors contend that college-level instructors should incorporate mindfulness and contemplative activities into the curricula of their health education courses to help college students master mindfulness strategies and encourage their use in reducing stress and anxiety.
Time to Laryngoscopy for Hoarseness in Canada: Are the American Academy of Otolaryngology Guidelines Feasible?
Authors: Howlett Joel , Singer Joel , Lee Terry , Hu Amanda
Published: June 2020

Objectives

To determine if a Canadian voice center is meeting the recommended time to laryngoscopy for hoarseness per the clinical practice guideline of the American Academy of Otolaryngology–Head and Neck Surgery.

Study Design

Retrospective chart audit.

Setting

Tertiary referral Canadian voice center.

Participants and Methods

A total of 149 adult patients presenting with hoarseness over 6 months were included. Primary outcome measures were the time from onset of symptoms to laryngoscopy and the time from referral to laryngoscopy. Secondary outcome measures included patient‐ and disease‐modifying factors, diagnosis, and clinical management. Analysis was performed to determine what factors were associated with meeting the guideline.

Results

Patients were evaluated by the laryngologist after 21.9 ± 37.6 months (mean ± SD) of symptoms. One‐third (34.2%) of patients were seen within 3 months; 10.7% were seen within 4 weeks. Logistic regression showed that patients with neurologic symptoms (odds ratio, 4.04; 95% CI, 1.31‐12.43; P =. 015) and endotracheal intubation (odds ratio, 5.94; 95% CI, 2.21‐15.95; P <. 001) were associated with being seen within 3 months. Patients who had recent intubation (odds ratio, 6.04; 95% CI, 1.99‐18.34; P =. 002) were associated with being seen within 4 weeks.

Conclusion

It is an ongoing challenge for our Canadian voice center to meet the American Academy of Otolaryngology–Head and Neck Surgery’s clinical practice guideline for recommended time to laryngoscopy. Patients with more severe pathologies were consistently triaged more urgently. It is debatable whether this 4‐week time recommendation is generalizable to a socialized health care system.
Impact of a Clinical Decision-Support Tool on Venous Thromboembolism Prophylaxis in Acutely Ill Medical Patients
Authors: George Brandon , Gonzales Samantha , Patel Krishna , Petit Stephanie , Franck Andrew J. , Bovio Franck Jessica
Published: June 2020

Background: Adherence to guideline-based venous thromboembolism (VTE) prophylaxis recommendations is often inadequate. Effective improvement strategies are needed. Objective: The purpose of this quality improvement initiative was to increase use of the facility’s preferred pharmacologic VTE prophylaxis, reduce unnecessary VTE prophylaxis use, and reduce use of pharmacologic VTE prophylaxis in high bleeding risk patients, in accordance with guideline-based recommendations. Methods: Clinical pharmacists spearheaded the development and implementation of a clinical decision-support tool (CDST) integrated within a Veterans Health Administration electronic health record (EHR). The CDST focused on VTE prophylaxis in acutely ill medical patients and guided prescribers to guideline-based recommendations. Following review and approval, the CDST underwent activation in the EHR. A subsequent intervention occurred, year 2 post-intervention, which embedded this CDST into the EHR admission process and admission menus. A drug message was added in the EHR to alert prescribers that low-molecular-weight heparin was the preferred agent. Measures were evaluated pre-intervention, year 1 post-intervention, and year 2 post-intervention. Results: After intervention, there were statistically significant increases in the proportion of patients receiving the facility’s preferred pharmacologic VTE prophylaxis agent, enoxaparin, and a statistically significant decrease in the proportion of unwarranted VTE prophylaxis. The proportion of inappropriate pharmacologic VTE prophylaxis in high bleeding risk patients decreased, but this result did not reach statistical significance. Conclusion: The improvements observed suggest the beneficial role of CDSTs integrated into the EHR to increase adherence to guideline-based VTE prophylaxis recommendations.
Origins and characterization of variants shared between databases of somatic and germline human mutations
Authors: Meyerson William , Leisman John , Navarro Fabio C. P. , Gerstein Mark
Published: June 2020

Background

Mutations arise in the human genome in two major settings: the germline and the soma. These settings involve different inheritance patterns, time scales, chromatin structures, and environmental exposures, all of which impact the resulting distribution of substitutions. Nonetheless, many of the same single nucleotide variants (SNVs) are shared between germline and somatic mutation databases, such as between the gnomAD database of 120,000 germline exomes and the TCGA database of 10,000 somatic exomes. Here, we sought to explain this overlap.

Results

After strict filtering to exclude common germline polymorphisms and sites with poor coverage or mappability, we found 336,987 variants shared between the somatic and germline databases. A uniform statistical model explains 34% of these shared variants; a model that incorporates the varying mutation rates of the basic mutation types explains another 50% of shared variants; and a model that includes extended nucleotide contexts (e.g. surrounding 3 bases on either side) explains an additional 4% of shared variants. Analysis of read depth finds mixed evidence that up to 4% of the shared variants may represent germline variants leaked into somatic call sets. 9% of the shared variants are not explained by any model. Sequencing errors and convergent evolution did not account for these. We surveyed other factors as well: Cancers driven by endogenous mutational processes share a greater fraction of variants with the germline, and recently derived germline variants were more likely to be somatically shared than were ancient germline ones.

Conclusions

Overall, we find that shared variants largely represent bona fide biological occurrences of the same variant in the germline and somatic setting and arise primarily because DNA has some of the same basic chemical vulnerabilities in either setting. Moreover, we find mixed evidence that somatic call-sets leak appreciable numbers of germline variants, which is relevant to genomic privacy regulations. In future studies, the similar chemical vulnerability of DNA between the somatic and germline settings might be used to help identify disease-related genes by guiding the development of background-mutation models that are informed by both somatic and germline patterns of variation.
Stress cardiomyopathy associated with the first manifestation of multiple sclerosis: a case report
Authors: Rapp Daniel , Keßler Mirjam , Pinkhardt Elmar , Otto Markus , Tumani Hayrettin , Senel Makbule
Published: June 2020

Background

We present a case with a close temporal association of the first diagnosis of multiple sclerosis and stress cardiomyopathy.

Case presentation

A 19-year-old man experienced severe dyspnoea. The cardiac biomarkers troponin T and NT-proBNP were elevated, and transthoracic echocardiography showed basal hypokinesia. The man was diagnosed with stress cardiomyopathy after main differential diagnoses such as acute coronary syndrome, myocarditis, and pheochromocytoma were excluded. Furthermore, the patient reported vertigo and paraesthesia. Brain and spinal MRI revealed T2-hyperintense lesions with a prominent acute lesion in the pontomedullary area. Cerebrospinal fluid findings revealed a lymphocytic pleocytosis and intrathecal IgG synthesis. Serum neurofilaments were elevated. The patient was diagnosed with MS, and treatment with intravenous Methylprednisolone was initiated. The brainstem lesion due to multiple sclerosis was assumed to be the cause of stress cardiomyopathy. The patient fully recovered.

Conclusion

Stress cardiomyopathy may be linked with the first manifestation of multiple sclerosis in the presented case since pontomedullary lesions could affect the sympathetic nervous system. This case highlights the importance of neurological history and examination in young patients with unexplained acute cardiac complaints.
Correction to: Is body image a predictor of women’s depression and anxiety in postmenopausal women?
Authors: Simbar Masoumeh , Nazarpour Soheila , Majd Hamid Alavi , Andarvar Khadijeh Dodel , Torkamani Zahra Jafari , Rahnemaei Fatemeh Alsadat
Published: June 2020

An amendment to this paper has been published and can be accessed via the original article.
Risk estimation of the SARS-CoV-2 acute respiratory disease outbreak outside China
Authors: Kim Soyoung , Choi Sunhwa , Ko Youngsuk , Ki Moran , Jung Eunok
Published: June 2020

Background

On December 31, 2019, the World Health Organization was alerted to the occurrence of cases of pneumonia in Wuhan, Hubei Province, China, that were caused by an unknown virus, which was later identified as a coronavirus and named the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). We aimed to estimate the reproductive number of SARS-CoV-2 in the Hubei Province and evaluate the risk of an acute respiratory coronavirus disease (COVID-19) outbreak outside China by using a mathematical model and stochastic simulations.

Results

We constructed a mathematical model of SARS-CoV-2 transmission dynamics, estimated the rate of transmission, and calculated the reproductive number in Hubei Province by using case-report data from January 11 to February 6, 2020. The possible number of secondary cases outside China was estimated by stochastic simulations in various scenarios of reductions in the duration to quarantine and rate of transmission. The rate of transmission was estimated as 0.8238 (95% confidence interval [CI] 0.8095–0.8382), and the basic reproductive number as 4.1192 (95% CI 4.0473–4.1912). Assuming the same rate of transmission as in Hubei Province, the possibility of no local transmission is 54.9% with a 24-h quarantine strategy, and the possibility of more than 20 local transmission cases is 7% outside of China.

Conclusion

The reproductive number for SARS-CoV-2 transmission dynamics is significantly higher compared to that of the previous SARS epidemic in China. This implies that human-to-human transmission is a significant factor for contagion in Hubei Province. Results of the stochastic simulation emphasize the role of quarantine implementation, which is critical to prevent and control the SARS-CoV-2 outbreak outside China.
Prognostic perspectives of PD-L1 combined with tumor-infiltrating lymphocytes, Epstein-Barr virus, and microsatellite instability in gastric carcinomas
Authors: Choi Euno , Chang Mee Soo , Byeon Sun-ju , Jin Heejin , Jung Kyeong Cheon , Kim Haeryoung , Lee Kook Lae , Kim Won , Park Jin Hyun , Kim Ki Hwan , Kim Jin-Soo , Choi In Sil , Han Dong-Seok , Ahn Hye Seong , Heo Seung Chul
Published: June 2020

Background

The prognostic potential of PD-L1 is currently unclear in gastric carcinomas, although the immune checkpoint PD-1/PD-L1 inhibitors have produced promising results in clinical trials.

Methods

We explored the prognostic implications of programmed death ligand 1 (PD-L1) in 514 consecutive surgically-resected gastric carcinomas. Overall survival and recurrence-free survival were evaluated. Immunohistochemistry for PD-L1, CD8, FOXP3, and PD-1, and molecular grouping by in situ hybridization for Epstein-Barr virus (EBV)-encoded small RNAs and multiplex PCR for microsatellite instability (MSI) markers were performed. Additionally, to explore the function inherent to PD-L1, PD-L1-specific siRNA transfection, cell proliferation, invasion, migration and apoptosis assays were conducted in five gastric carcinoma cell lines.

Results

PD-L1(+) tumor and immune cells were observed in 101 (20%) and 244 patients (47%), respectively. “Tumoral PD-L1(+)/immune cell PD-L1(-)/CD8+/low tumor-infiltrating lymphocytes (TILs),” and more advanced-stage tumors were associated with unfavorable clinical outcomes in the entire cohort through multivariate analysis. Furthermore, tumoral PD-L1(+)/FOXP3+/low TILs were associated with worse clinical outcomes in EBV-positive and MSI-high carcinomas. Tumoral PD-L1(+) alone was an adverse prognostic factor in EBV-positive carcinomas, but not in MSI-high carcinomas, whereas PD-L1(+) immune cells or FOXP3+/high TILs alone were correlated with a favorable prognosis. PD-L1 knockdown in gastric carcinoma cells suppressed cell proliferation, invasion and migration, and increased apoptosis, which were all statistically significant in two EBV(+) cell lines, but not all in three EBV(−) cell lines.

Conclusions

The prognostic impact of PD-L1 may depend on the tumor microenvironment, and statuses of EBV and MSI, although PD-L1 innately promotes cancer cell survival in cell-based assays. The combination of “tumoral PD-L1/immune cell PD-L1/CD8+ TILs” may serve as an independent prognostic factor. Tumoral PD-L1(+)/immune cell PD-L1(−)/CD8+/low TILs showing a worse prognosis may be beneficial for combinatorial therapies of anti-PD-L1/PD-1 and anti-cytotoxic T-lymphocyte associated antigen 4 (CTLA4) that would promote effector T cells, thus attack the tumor.
Are our babies off to a healthy start? The state of implementation of the Global strategy for infant and young child feeding in Europe
Authors: Zakarija-Grković Irena , Cattaneo Adriano , Bettinelli Maria Enrica , Pilato Claudia , Vassallo Charlene , Borg Buontempo Mariella , Gray Helen , Meynell Clare , Wise Patricia , Harutyunyan Susanna , Rosin Stefanie , Hemmelmayr Andrea , Šniukaitė-Adner Daiva , Arendt Maryse , Gupta Arun
Published: June 2020

Background

To protect children’s right to optimal nutrition, WHO/UNICEF developed a Global Strategy for Infant and Young Child Feeding, endorsed by all 53 WHO/EURO Member States. The World Breastfeeding Trends Initiative (WBTi) is a tool for monitoring implementation of the Global Strategy. It comprises 15 indicators, ten referring to policies and programmes, and five to feeding practices. Each is scored on a scale of 10, giving a total score of 150 for Global Strategy implementation. To date, 18 WHO/EURO Member States – Armenia, Austria, Belgium, Bosnia and Herzegovina, Croatia, France, Georgia, Germany, Italy, Lithuania, North Macedonia, Malta, Moldova, Portugal, Spain, Turkey, Ukraine and United Kingdom – have conducted a WBTi assessment and produced a report.

Methods

Between June 2018 and May 2019, all 18 WBTi European reports were carefully read and analysed by a group of national WBTi coordinators. Descriptive data analysis, including inter-country comparisons, was conducted using frequencies and percentages. This paper summarises the findings. The full 88-page report will be published on the WBTi website.

Results

Three-quarters of 18 European countries have adequate maternity protection, and two-thirds have breastfeeding initiation rates of 50% or higher. However, ‘Preparedness and planning for appropriate and safe Infant and Young Child Feeding (IYCF) in emergencies’ is seriously neglected. Breastfeeding duration is far below WHO recommendations, with an average of 8.7 months. Only three European countries have a budget allocated for implementing IYCF policies and plans, and a third currently have no Baby-friendly designated maternity facilities. Bottle feeding is prevalent, despite its inherent risks, monitoring of IYCF practices is inadequate, with most countries not routinely collecting data, and violations of the International Code of Marketing of Breast-milk Substitutes are commonplace.

Conclusions

European governments are not doing enough to protect, promote and support sound infant and young child feeding practices. Political commitment at the highest level and adequate funding are required to ensure optimal IYCF for Europe’s babies. This report highlights worrying gaps, thereby providing governments, international organisations and other concerned parties with an opportunity to invest in priority areas and, by doing so, hopefully create a better future for our babies.
Digital tools for the recruitment and retention of participants in randomised controlled trials: a systematic map
Authors: Frampton Geoff K. , Shepherd Jonathan , Pickett Karen , Griffiths Gareth , Wyatt Jeremy C.
Published: June 2020

Background

Recruiting and retaining participants in randomised controlled trials (RCTs) is challenging. Digital tools, such as social media, data mining, email or text-messaging, could improve recruitment or retention, but an overview of this research area is lacking. We aimed to systematically map the characteristics of digital recruitment and retention tools for RCTs, and the features of the comparative studies that have evaluated the effectiveness of these tools during the past 10 years.

Methods

We searched Medline, Embase, other databases, the Internet, and relevant web sites in July 2018 to identify comparative studies of digital tools for recruiting and/or retaining participants in health RCTs. Two reviewers independently screened references against protocol-specified eligibility criteria. Included studies were coded by one reviewer with 20% checked by a second reviewer, using pre-defined keywords to describe characteristics of the studies, populations and digital tools evaluated.

Results

We identified 9163 potentially relevant references, of which 104 articles reporting 105 comparative studies were included in the systematic map. The number of published studies on digital tools has doubled in the past decade, but most studies evaluated digital tools for recruitment rather than retention. The key health areas investigated were health promotion, cancers, circulatory system diseases and mental health. Few studies focussed on minority or under-served populations, and most studies were observational. The most frequently-studied digital tools were social media, Internet sites, email and tv/radio for recruitment; and email and text-messaging for retention. One quarter of the studies measured efficiency (cost per recruited or retained participant) but few studies have evaluated people’s attitudes towards the use of digital tools.

Conclusions

This systematic map highlights a number of evidence gaps and may help stakeholders to identify and prioritise further research needs. In particular, there is a need for rigorous research on the efficiency of the digital tools and their impact on RCT participants and investigators, perhaps as studies-within-a-trial (SWAT) research. There is also a need for research into how digital tools may improve participant retention in RCTs which is currently underrepresented relative to recruitment research.

Registration

Not registered; based on a pre-specified protocol, peer-reviewed by the project’s Advisory Board.
Nodular pulmonary deposition disease in a patient with the acquired immunodeficiency syndrome: a case report
Authors: Mezzanotte Jessica N. , Gibbons-Fideler I-Sanna , Shilo Konstantin , Lustberg Mark , Devarakonda Srinivas
Published: June 2020

Background

Pulmonary nodules are a common cause for concern in patients with human immunodeficiency virus and acquired immunodeficiency syndrome. Most commonly, they are the result of an infection, given the patients’ immunocompromised state; however, in some cases, pulmonary nodules in patients with human immunodeficiency virus and patients with acquired immunodeficiency syndrome can result from cellular or protein deposits. We report a rare case of nodular pulmonary light chain deposition disease in a patient with acquired immunodeficiency syndrome and monoclonal gammopathy of undetermined significance.

Case presentation

A 53-year-old African American woman with acquired immunodeficiency syndrome had pulmonary nodules detected incidentally by imaging of her lungs. Pulmonary tuberculosis was high on the differential diagnosis, but she had a negative test result for pulmonary tuberculosis. Imaging also revealed multiple lucent bone lesions, and earlier in the year, serum protein electrophoresis had shown an immunoglobulin G-kappa monoclonal protein (M spike). She was mildly anemic, so there was concern for progression to myeloma; however, the result of her bone marrow biopsy was unremarkable. Lung biopsy revealed finely granular eosinophilic material with negative Congo red staining, consistent with light chain deposition disease.

Conclusions

The extent of this patient’s light chain deposition disease was thought to be caused by a combination of acquired immunodeficiency syndrome and monoclonal gammopathy of undetermined significance, and the interval decrease in lung nodule size after restarting antiretroviral therapy confirms this hypothesis and also highlights a potentially unique contribution of the hypergammaglobulinemia to this disease process in patients with human immunodeficiency virus and patients with acquired immunodeficiency syndrome .
Prevalence of vitamin D deficiency in the pregnant women: an observational study in Shanghai, China
Authors: Li Huijuan , Ma Jing , Huang Runzhi , Wen Yuhua , Liu Guanghui , Xuan Miao , Yang Ling , Yang Jun , Song Lige
Published: June 2020

Background

Maternal vitamin D deficiency has been a worldwide concern in recent years. However the epidemiological data of vitamin D deficiency among large group of Chinese pregnant women is limited. This study is to evaluate the prevalence of vitamin D deficiency among pregnant women in Shanghai, China and to analyze the association of vitamin D status with some pregnancy outcomes (gestational diabetes and low birth weight).

Methods

A total of 34,417 pregnant women in Shanghai were included in this study from January 2014 to December 2017, and the serum 25-hydroxyvitamin D [25(OH)D] concentrations were measured at 16th week of gestation by electrochemiluminescence assay. Seventy five grams of glucose was used to conduct oral glucose tolerance test during 24-28th week of gestational in all enrolled persons and the birth weight of newborns was recorded.

Results

The median serum 25(OH) D concentration in the pregnant women during 4 years was 42.87 nmol/L (32.88–51.90 nmol/L). 9.9% of the population were severe vitamin D deficient [25(OH)D < 25 nmol/L], 60.1% were deficient [25 nmol/L ≤ 25(OH)D < 50 nmol/L], 28.4% were insufficient [50 nmol/L ≤ 25(OH)D < 75 nmol/L] and only 1.6% of the enrolled population reached the level of adequate [25(OH)D ≥ 75 nmol/L]. Serum 25(OH) D concentrations showed significant difference among seasons with the highest level in winter and the lowest level in summer. Women with advanced maternal age were more likely to have better vitamin D status compared with younger women. The 25(OH) D levels were significantly different among 2014–2017. The year of 2017 had the highest 25(OH) D level with the median serum concentration reaching 47.80 nmol/L (41.00–55.00 nmol/L), while the lowest appeared in 2016 which has median 25(OH) D concentration at 38.87 nmol/L (28.76–49.97 nmol/L). No relations were found between the 25(OH) D status and the rate of gestational diabetes or low birth weight of newborns.

Conclusion

Pregnant women in Shanghai were generally deficient in vitamin D status and the level of vitamin D was related to season and age. No evidence showed vitamin D deficiency in pregnant women contributes to the rate of gestational diabetes or low birth weight of newborns in this study. These results suggest that most of the pregnant women may need vitamin D supplementation to achieve adequate vitamin D level.
Art, life, and the fashion museum: for a more solidarian exhibition practice
Authors: Wallenberg Louise
Published: June 2020

This article departs from the century-long understanding that fashion connects ‘life and art’, an understanding once advocated by Hans Siemsen in his avantgarde journal Zeit-Echo, to discuss how the museum constitutes an important space, or arena, where this connection is taking place. The museum as we know it is a space dedicated to displaying objects of art—and to some degree, of everyday life objects—and as such it constitutes a space for the linkage between the aesthetic and the profane, between art and life. However, as will be argued, as a space that has increasingly become dedicated to fashion—as a cultural, social and not least economic phenomenon—the museum does not embrace its full potential in displaying and problematizing fashion’s close and real relation to actual life, and especially, the very lives that produce it. The museum and its curatorial practices, it will be argued, ought to strive less to offer its audiences spectacular displays of extravagant designer fashion—and instead dare to deal with the urgent quest for and necessity of a reformed fashion industry in which textile and garment workers can actually lead safe and liveable lives.
Application of endoscopic endonasal approach in skull base surgeries: summary of 1886 cases in a single center for 10 consecutive years
Authors: Li Chuzhong , Zhu Haibo , Zong Xuyi , Wang Xinsheng , Gui Songbai , Zhao Peng , Liu Chunhui , Bai Jiwei , Cao Lei , Zhang Yazhuo
Published: June 2020

Background

Endonasal endoscopic skull base surgery has undergone rapid technological developments and is now widely performed, but its strengths and weaknesses deserve further investigation and deliberation. This study was performed to investigate the surgical indications, complications, and technical advantages and disadvantages of endonasal endoscopic skull base surgery.

Methods

The clinical data of 1886 endoscopic endonasal skull base surgeries performed in our ward at Beijing Tiantan Hospital from June 2006 to June 2016 were retrospectively analyzed.

Results

One thousand ninety-three (73.4%, 1490) pituitary adenomas, 54 (24.9%, 217) chordomas, 28 (80.0%, 35) craniopharyngiomas, and 15 (83.3%, 18) meningiomas underwent total resection. Two patients died postoperatively, both having pituitary adenomas. Other postoperative complications included olfactory disorders (n = 226, 11.9%), postoperative cerebrospinal fluid leakage (n = 78, 4.1%), hypopituitarism (n = 74, 3.9%), diabetes insipidus (n = 64, 3.4%), intracranial infection (n = 36, 1.9%), epistaxis (n = 24, 1.3%), vascular injury (n = 8, 0.4%), optic nerve injury (n = 8, 0.4%), and oculomotor movement impairment (n = 4, 0.2%). In total, 1517 (80.4%) patients were followed up for 6 to 126 months (average, 42.5 months) postoperatively. A total of 196 (13.2%) pituitary adenomas and 13 (37.1%) craniopharyngiomas recurred but no meningiomas recurred. Chordomas recurred in 97 (44.7%) patients, in whom 5-year survival rate was 65%.

Conclusion

Endoscopic surgery is an innovative surgical technique and the first choice for most midline extradural lesions such as chordomas, and an excellent choice for pituitary adenomas. It probably will be a good technique for many kinds of craniopharyngiomas and a common technique for most of skull base meningiomas, so the surgical indications of these cases should be chosen carefully to make good use of its respective advantages.