bluuebunny/crossref_metadata_2025 huggingface dataset:
An Introduction to Clinical Research
Authors: Page Piers , Carr James , Eardley William , Chadwick David , Porter Keith
Published: November 2020

This practical book is written specifically for junior doctors by a team of highly experienced authors, as an introductory guide to clinical research. It covers all areas that a junior doctor needs to consider, including funding, study design, ethics, data analysis, disseminating findings, and furthering one's research career. It presents a balance view of clinical research and is written by authors actively involved in clinical research both at the 'coal-face' and at a more supervisory level. Research can be a difficult process and it is essential to make sure that the project is set up in the correct way in order to get verifiable results. This easy-to-read guide is available to help junior doctors develop a good study design and present evidence of a sound academic practice, which will make obtaining funding more likely and be time-efficient. Getting started early in research and developing a solid, gradual understanding of clinical research through using this approachable book will be of huge benefit to junior doctors and their discipline.
MCQs in Travel Medicine
Authors: Colbert Dom
Published: November 2020

Specifically written for those preparing for examinations and practitioners in travel medicine, MCQs in Travel Medicine contains over 600 multiple choice questions with detailed explanations which both teach and challenge the reader. Questions are group by topic which is ideal for revision, enabling you to focus on specific areas including adventure travel, travellers' diarrhoea, malaria, sexually transmitted disease, and drugs used in travel medicine. The style and format of the questions mirror the format of the exam questions, and the book includes a self-test to aid revision. This easy-to-read comprehensive book is ideally suited for those in busy day-to-day practices and those preparing for examinations in travel medicine including the Certificate Exam of the International Society of Travel Medicine.
Before the Age of Blockbuster Drugs
Authors: Li Jie Jack
Published: November 2020

Blockbuster drugs are drugs with annual sales over $1 billion these days. As a testimony of changing times, a blockbuster drug was defined as a drug with more than $500 million in annual sales just a decade ago! While these blockbuster drugs save millions of lives and improve the quality of life for millions of others, pharmaceutical companies make considerable profit. In turn, drug makers then spend a tremendous amount of money on research and development of new blockbuster drugs, looking for new ones that will sustain the “life cycle” for the health of both patients (physical and mental) and the drug companies themselves (financial). Pharmaceutical companies are sometimes known as “merchants of life.” Indeed, their products affect people’s lives in many positive ways. But make no mistake; the drug industry is a for-profit entity, responsible to its shareholders. It must make a profit to survive. This is the contradiction of the pharmaceutical industry. However, things were not always like this until the last few decades. The first antihistamine (the substance that counteracts the effects of histamine; see chapter 4 for more details) was discovered by French pharmacologist Daniel Bovet in 1937. Between 1937 and 1941, Bovet conducted more than 3,000 experiments to find the chemical formulas upon which most of the antihistamines now prescribed are based. Antihistamines are effective in treating allergic reactions. His discovery led to development of the first antihistamine drug, diphenhydramine (Antergan), for treating allergies in 1942, but it did not reach the market because of toxicity issues. In 1944, another one of Bovet’s discoveries, pyrilamine (Neoantergan), was produced as a drug. He did not patent it and did not make a penny out of his important discovery. Not all was lost, however; Bovet won the Nobel Prize in Physiology or Medicine in 1957. General Robert Wood Johnson (1845–1910), one of the three brothers who founded Johnson & Johnson, wrote a credo that codified the company’s socially responsible approach to conducting business.
Imaging
Authors: Osmanovic Smajo
Published: November 2020

•Stereoscopic optic nerve photography has been considered the gold standard for documenting the optic nerve head (ONH)/retinal nerve fiber layer (RNFL) status. •Digital imaging technologies were developed recently to provide reproducible and more objective quantitative assessment of the ONH and RNFL. •Each technology measures different aspects of ONH and RNFL morphology; information obtained from different imaging devices is complementary and can be used to detect different abnormal features in the same patient. •Possible roles of ONH/RNFL imaging in clinical practice: •Documentation of ONH status• Glaucoma diagnosis •Detecting progression •Risk assessment •Screening for glaucoma •CSLO is based on a method of confocal imaging. •A diode laser (670 nm) (Fig 5.1A) scans the surface of posterior pole horizontally and vertically (x- and y-axes) with high speed. Reflected light is detected by a sensor after being filtered by a confocal pinhole which is conjugate to the focal plane of the retina. •By shifting the confocal pinhole, a series of planar scans are acquired at increasing depths and after alignment are combined to create 3-D topographic map of the retina and ONH surface. •Commercially available CSLO devices with major features are listed in Table 5.1. •Image acquisition with Heidelberg Retinal Tomography (HRT) is fast; single tomographic slices are captured in only 24 ms (faster than involuntary saccades or fixation movements). •Pupillary dilation is not needed. •Good images require adequate patient positioning, good fixation, clear media, appropriate focus, and centering the optic nerve in the image. •16 to 64 planar scans are acquired per set. Unusable scans are replaced by software until three useful sets are obtained. •The operator defines the optic disc margin by drawing a contour line along scleral ring. • A reference plane is determined by the HRT software 50 μm below the average height of the contour line in the inferior temporal quadrant. All structures above the reference plane and within the contour line are defined as a neuroretinal rim and are shown as blue (sloped) and green (flat) areas on the topography image (Fig 5.2c).
The Allure of Order
Authors: Mehta Jal
Published: November 2020

Ted Kennedy and George W. Bush agreed on little, but united behind the No Child Left Behind Act (NCLB). Passed in late 2001, it was hailed as a dramatic new departure in school reform. It would make the states set high standards, measure student progress, and hold failing schools accountable. A decade later, NCLB has been repudiated on both sides of the aisle. According to Jal Mehta, we should have seen it coming. Far from new, it was the same approach to school reform that Americans have tried before. In The Allure of Order, Mehta recounts a century of attempts at revitalizing public education, and puts forward a truly new agenda to reach this elusive goal. Not once, not twice, but three separate times-in the Progressive Era, the 1960s and '70s, and NCLB-reformers have hit upon the same idea for remaking schools. Over and over again, outsiders have been fascinated by the promise of scientific management and have attempted to apply principles of rational administration from above. Each of these movements started with high hopes and ambitious promises, but each gradually discovered that schooling is not easy to "order" from afar: policymakers are too far from schools to know what they need; teachers are resistant to top-down mandates; and the practice of good teaching is too complex for simple external standardization. The larger problem, Mehta argues, is that reformers have it backwards: they are trying to do on the back-end, through external accountability, what they should have done on the front-end: build a strong, skilled and expert profession. Our current pattern is to draw less than our most talented people into teaching, equip them with little relevant knowledge, train them minimally, put them in a weak welfare state, and then hold them accountable when they predictably do not achieve what we seek. What we want, Mehta argues, is the opposite approach which characterizes top-performing educational nations: attract strong candidates into teaching, develop relevant and usable knowledge, train teachers extensively in that knowledge, and support these efforts through a strong welfare state. The Allure of Order boldly challenges conventional wisdom with a sweeping, empirically rich account of the last century of education reform, and offers a new path forward for the century to come.
The intracellular chloride channel 4 (CLIC4) activates systemic sclerosis fibroblasts
Authors: Wasson Christopher W. , Ross Rebecca. L. , Morton Ruth , Mankouri Jamel , Del Galdo Francesco
Published: November 2020

Objectives

Tissue fibrosis in SSc is driven by active fibroblasts (myofibroblasts). Previous studies have shown the intracellular chloride channel 4 (CLIC4) mediates the activation of cancer-associated fibroblasts. In this study we investigated the role of CLIC4 in SSc fibroblast activation.

Methods

Fibroblasts were obtained from full thickness skin biopsies from SSc patients (early-diffuse). RNA and protein were collected from the fibroblasts and CLIC4 transcript and protein levels were assessed by qPCR and western blot. SSc patient fibroblasts were treated with the chloride channel inhibitors nitro-2-(3-phenylpropylamino)benzoic acid and indyanyloxyacetic acid 94.

Results

CLIC4 was expressed at significantly higher levels in SSc patients’ fibroblasts compared with healthy controls, at both the transcript (3.7-fold) and protein (1.7-fold) levels. Inhibition of the TGF-β receptor and its downstream transcription factor SMAD3 led to a reduction in CLIC4 expression, confirming this pathway as the main driver of CLIC4 expression. Importantly, treatment of SSc fibroblasts with known pharmacological inhibitors of CLIC4 led to reduced expression of the myofibroblast markers collagen type 1 and α-smooth muscle actin, inferring a direct role for CLIC4 in disease pathogenesis.

Conclusions

We have identified a novel role for CLIC4 in SSc myofibroblast activation, which strengthens the similarities of SSc fibroblasts with cancer-associated fibroblasts and highlights this channel as a novel target for therapeutic intervention.
A potential role for zinc in restless legs syndrome
Authors: Chen Pan , Bornhorst Julia , Patton Stephanie , Bagai Kanika , Nitin Rachana , Miah Mahfuzur , Hare Dominic J , Kysenius Kai , Crouch Peter J , Xiong Lan , Rouleau Guy A , Schwerdtle Tanja , Connor James , Aschner Michael , Bowman Aaron B , Walters Arthur S
Published: November 2020

Study Objectives

Evaluate serum and brain noniron metals in the pathology and genetics of restless legs syndrome (RLS).

Methods

In two independent studies (cohorts 1 and 2), in which subjects either remained on medications or tapered off medications, we analyzed serum levels of iron, calcium, magnesium, manganese, copper, and zinc both in RLS patients and controls, and assessed the prevalence of the MEIS1 and BTBD9 risk alleles previously established through genome-wide association studies. Human brain sections and a nematode genetic model were also quantified for metal levels using mass spectrometry.

Results

We found a significant enrichment for the BTBD9 risk genotype in the RLS affected group compared to control (p = 0.0252), consistent with previous literature. Serum (p = 0.0458 and p = 0.0139 for study cohorts 1 and 2, respectively) and brain (p = 0.0413) zinc levels were significantly elevated in the RLS patients versus control subjects.

Conclusion

We show for the first time that serum and brain levels of zinc are elevated in RLS. Further, we confirm the BTBD9 genetic risk factor in a new population, although the zinc changes were not significantly associated with risk genotypes. Zinc and iron homeostasis are interrelated, and zinc biology impacts neurotransmitter systems previously linked to RLS. Given the modest albeit statistically significant increase in serum zinc of ~20%, and the lack of association with two known genetic risk factors, zinc may not represent a primary etiology for the syndrome. Further investigation into the pathogenetic role that zinc may play in restless legs syndrome is needed.
FromArgetoZenarge: adult morphology and phylogenetics of argid sawflies (Hymenoptera: Argidae)
Authors: Malagón-Aldana Leonardo A , Smith David R , Shinohara Akihiko , Vilhelmsen Lars
Published: November 2020

The Argidae is the second most diverse family of the ‘Symphyta’ with more than 900 described species. Here we present the first comprehensive phylogenetic study for the family. We compare the adult skeleton anatomy of representatives of 57 described argid genera from different biogeographic regions. We score 223 characters for 117 terminal taxa, and apply maximum parsimony inference to reconstruct the phylogeny, using equal weights and implied weights analyses. The Argidae sensu stricto, i.e. all Argidae except Zenarge, are consistently retrieved as monophyletic. The position of Zenarge changes according to the implied weighting parameters: ((Zenarge+Pergidae)+Argidae) at low (1–3) k-values, (Zenarge+(Pergidae+Argidae)) at high (4–30) k-values. We describe in detail the skeletal anatomy of Zenarge turneri and propose to raise it to family status: Zenargidae stat. revis. We consider the ridge on the teloparameres (=harpes) of the male genitalia to be the main autapomorphy of adults of the Argidae sensu stricto. We recover two main clades within the family and suggest recognizing these as the subfamilies Arginae and Sterictiphorinae. We trace the evolution of characters on the preferred implied weights tree. The genera Arge, Didymia, Pampsilota, Ptenos and Sphacophilus were paraphyletic.
Assessing Aerated Vermicompost Tea Combined with Microbial Biological Control Agents for Suppression of Fusarium and Rhizoctonia
Authors: Wylie Andrew C. , Punja Zamir K.
Published: November 2020

Biological control of plant diseases is important in organic greenhouse vegetable production, where fungicide use is limited. Organic producers use microbially diverse substrates, including composts, as media for plant growth. Previous research into the impact of vermicompost on the efficacy of applied biocontrol agents is limited. An in vitro assay was developed to test the efficacy of two biological control agents in a competitive microbial background. Suppression of the pathogen Fusarium oxysporum f. sp. radicis-cucumerinum by Clonostachys rosea f. catenulata (Gliocladium catenulatum strain J1446 [Prestop]) and Bacillus subtilis strain QST 713 (Rhapsody), was assessed on agar media amended with aerated vermicompost tea (ACT). Pathogen growth was reduced more by C. rosea than ACT alone, and C. rosea was equally effective when combined with ACT. In contrast, B. subtilis reduced pathogen growth less than ACT and, when combined, reduced pathogen growth no more than ACT alone. Both biocontrol agents were similarly tested with ACT against F. oxysporum f. sp. radicis-cucumerinum and Rhizoctonia solani on cucumber and radish. Additive, neutral, and antagonistic responses, depending on host, pathogen, and biocontrol agent, were observed. ACT alone provided more consistent disease suppression on cucumber compared with B. subtilis or C. rosea. In combination, disease suppression was most often better than each biocontrol alone but not better than ACT alone. ACT had antagonistic or additive interactions with C. rosea in the radish/R. solani pathosystem, depending on the experiment. The specific and general suppression of plant diseases by biological control agents in microbially rich environments is variable and warrants further study.
Ballistic Supracondylar Distal Femur Fractures Have Lower Rates of Intra-articular Extension Than Blunt Distal Femur Fractures
Authors: Portney Daniel A. , Reddy Manoj , Baker Hayden P. , Dillman Daryl B. , Dirschl Douglas R. , Strelzow Jason A.
Published: November 2020

Objectives:

To compare the relative frequencies of intra-articular extension of supracondylar distal femur fractures in blunt versus ballistic trauma and the diagnostic accuracy of conventional radiography in identifying intra-articular extension in these fractures.

Design:

A retrospective review.

Setting:

Urban academic trauma center.

Study group:

Thirty-eight patients were included for analysis, with 19 blunt and 19 ballistic mechanism distal femur fractures.

Intervention:

Fleiss' kappa score was calculated in determining interobserver reliability of the OTA/AO classification. Radiographic specificity and sensitivity were compared using Fischer exact testing. Quantitative data were compared using 2-tailed t-testing for continuous variables and chi-square tests for proportions.

Main outcome measurements:

Rate of intra-articular extension of ballistic versus blunt supracondylar femur fractures.

Results:

Seventeen of 19 patients (89.5%) with blunt trauma had intra-articular involvement compared with 5 of 19 patients (26.3%) with ballistic trauma (P = 0.001). For blunt fractures, preoperative radiographs were 94% sensitive for the detection of intra-articular extension compared with 100% sensitive for ballistic fractures (P = 1.000). We identified one case, in the blunt cohort, where the operative plan changed from intramedullary nail to open reduction and internal fixation as a result of the additional coronal plane fracture pattern identified on CT. There were no such occurrences in the ballistic cohort.

Conclusions:

The rate of intra-articular extension for ballistic supracondylar femur fractures is lower than blunt distal femur fracture. There were low rates of missed intra-articular fractures and changes in operative plans after reviewing CT imaging for both blunt and ballistic distal femur fractures.

Level of Evidence:

Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
Risk Factors for Deep Surgical Site Infection in Patients With Operatively Treated Tibial Plateau Fractures: A Retrospective Multicenter Study
Authors: Henkelmann Ralf , Frosch Karl-Heinz , Mende Meinhard , Gensior Tobias J. , Ull Christopher , Braun Philipp-Johannes , Katthagen Christoph , Glaab Richard , Hepp Pierre
Published: November 2020

Objectives:

To identify the potential controllable risk factors for surgical site infection (SSI).

Design:

A retrospective cohort study.

Setting:

Seven Level-I trauma centers.

Patients/Participants:

Patients with OTA/AO 41 B or C tibial plateau fractures (n = 2106).

Intervention:

Various surgical treatments for tibial plateau fractures.

Main Outcome Measurements:

The primary outcome was SSI after the index operation. The secondary outcomes were the risk factors for SSI, identified using backward stepwise generalized multiple regression analysis.

Results:

Of the 2106 enrolled patients, 94 had deep SSIs. The average SSI rate was 4.5%. Fracture morphology revealed type B injuries in 57.5% and type C in 42.5% of the patients. Univariate regression analysis revealed that several factors, namely, number of comorbidities [>6 vs. none; odds ratio (OR) 8.01, 95% confidence interval (CI) 2.8–22.8, P < 0.001], diabetes mellitus (OR 3.5, 95% CI 2.0–6.3, P < 0.001), high body mass index (OR 1.3, 95% CI 1.1–1.6, P = 0.001), OTA/AO fracture type C (OR 5.6, 95% CI 3.3–9.5, P < 0.001), compartment syndrome (OR 9.1, 95% CI 5.7–14.8, P < 0.001), and open fracture (OR 6.6, 95% CI 3.7–11.7, P < 0.001), were associated with a significantly higher SSI risk. Analysis of microbial sensitivity tests revealed that 55.1% of the pathogens were resistant to perioperative antibiotic prophylaxis.

Conclusions:

Most of the identified risk factors cannot be controlled or are subject to other factors that are difficult to control. However, our data suggest that the choice of perioperative antibiotic prophylaxis may influence the rate of SSI. This possibility should be investigated in a prospective randomized controlled trial.

Level of Evidence:

Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
Epidemiology of Chronic Critical Illness in Japan: A Nationwide Inpatient Database Study
Authors: Ohbe Hiroyuki , Matsui Hiroki , Fushimi Kiyohide , Yasunaga Hideo
Published: November 2020

OBJECTIVES:

The epidemiology of chronic critical illness is not well known. We aimed to estimate the prevalence, mortality, and costs associated with chronic critical illness in Japan.

DESIGN:

A nationwide inpatient administrative database study in Japan from April 2011 to March 2018.

SETTING:

Six hundred seventy-nine acute-care hospitals with ICU beds in Japan.

PATIENTS:

Adult patients who met our definition for chronic critical illness: one of six eligible clinical conditions (prolonged acute mechanical ventilation, tracheotomy, stroke, traumatic brain injury, sepsis, and severe wound) plus at least 8 consecutive days in an ICU.

INTERVENTIONS:

None.

MEASUREMENTS AND MAIN RESULTS:

Among 2,395,016 ICU admissions during the study period, 216,434 (9.0%) met the definition for chronic critical illness. The most common eligible condition was prolonged acute mechanical ventilation (73.9%), followed by sepsis (50.6%), tracheostomy (23.8%), and stroke (22.8%). Overall inhospital mortality was 28.6%. The overall age-specific population prevalence was 42.0 per 100,000. The age-specific population prevalence steadily increased with age, reaching 109.6 per 100,000 in persons aged greater than 85 years. With extrapolation to national estimates in Japan, there were 47,729 chronic critical illness cases in 2011 and the number remained similar at 46,494 cases in 2017. Hospitalization costs increased gradually, rising from U.S.$2.3 billion in 2011 to U.S.$2.7 billion in 2017. Inhospital mortality decreased from 30.6% to 28.2%, whereas the proportion of patients with total/severe dependence increased from 29.6% to 33.2% and the proportion of patients with decreased consciousness at discharge increased from 18.7% to 19.6%.

CONCLUSIONS:

Using a nationwide inpatient database in Japan, we found substantial clinical and economic burdens of chronic critical illness in Japan. Chronic critical illness was particularly common in elderly people. Although inhospital mortality of chronic critical illness patients continues to decrease, costs and patients with dependence for activities of daily living or decreased consciousness at discharge are increasing.
A double-blind, randomized, placebo- and positive-controlled phase III trial of 1% benvitimod cream in mild-to-moderate plaque psoriasis
Authors: Cai Lin , Chen Gen-Hui , Lu Qian-Jin , Zheng Min , Li Yu-Zhen , Chen Jin , Zheng Jie , Zhang Fu-Ren , Yu Jian-Bin , Yang Sen , Li Fu-Qiu , Xiao Sheng-Xiang , Sun Qiu-Ning , Xu Jin-Hua , Gao Xing-Hua , Fang Hong , Gao Tian-Wen , Hao Fei , Liu Quan-Zhong , Tu Ya-Ting , Li Ruo-Yu , Wang Bao-Xi , Deng Dan-Qi , Zheng Qing-Shan , Liu Hong-Xia , Zhang Jian-Zhong
Published: November 2020

Background

Benvitimod cream, a novel synthetic small molecule, was effective in treating mild-to-moderate plaque psoriasis. We conducted a phase III clinical trial to assess the efficacy and safety of benvitimod cream in patients with mild-to-moderate plaque psoriasis.

Methods

We randomly assigned 686 patients (2:1:1) to receive 1% benvitimod cream, 0.005% calcipotriol ointment or placebo twice a day for 12 weeks. The primary efficacy end points were the percentage of patients with a 75% or greater reduction from baseline in the psoriasis area and severity index (PASI 75) score and with a score of 0 or 1 in static physician's global assessment (sPGA) at week 12.

Results

The results showed that 50.4% of patients in the benvitimod group achieved PASI 75, which was significantly higher than that in the calcipotriol (38.5%,P < 0.05) and placebo (13.9%,P < 0.05) groups. The proportion of patients achieving an sPGA score 0 or 1 was 66.3% in the benvitimod group and 63.9% in the calcipotriol group, which were both significantly higher than that in the placebo group (34%,P < 0.05). In the long-term follow-up study, 50.8% of patients experienced recurrence. After retreatment with 1% benvitimod, 73.3% of patients achieved an sPGA score of 0 or 1 again at week 52. Adverse events included application site irritation, follicular papules, and contact dermatitis. No systemic adverse reactions were reported.

Conclusion

During this 12-week study, benvitimod cream was demonstrated with high effectiveness and safety in patients with mild-to-moderate plaque psoriasis.

Trial Registration

Chinese Clinical Trial Registry (ChiCTR), ChiCTR-TRC-13003259; http://www.chictr.org.cn/showprojen.aspx?proj=6300.
Pranayama and Nursing
Authors: İlter Sümeyra Mihrap , Ovayolu Özlem
Published: November 2020

The importance of complementary and supportive applications is increasing. Pranayama, which is one of these methods, has a positive effect on health with its philosophy and discipline that are specific to it. It is also an important step in yoga, which is an ancient Indian science and lifestyle, and is translated as “breath science, breath control, and willful breathing.” In Sanskrit, pranayama consists of the words prana, which means “life force, vital energy, vitality,” and yama, which means “control.” According to the science of yoga, if humans can learn to control prana, they can also control their body, emotions, and mind. The fact that pranayama is a simple self-control technique that increases the awareness of breathing and shows that it is an influential and cost-effective practice for the patient in the management of symptoms, which is a responsibility of nurses. In this respect, the purpose of the present study was to provide information to health care professionals to be able to use pranayama types in symptom management, to provide evidence-based information to health care professions concerning concepts and philosophy of pranayama to guide nurses in clinical practice. For this purpose, the results of the studies searched in the PubMed database using the key words “pranayama” and “nursing” are shared.
Ten-Year Outcome of Glaucoma Drainage Device Surgery After Penetrating Keratoplasty
Authors: Purtskhvanidze Konstantine , Saeger Mark , Frimpong-Boateng Adjoa , Rüfer Florian , Roider Johann , Nölle Bernhard
Published: November 2020

Precis:

In eyes with intractable glaucoma, drainage devices provide long-term control of intraocular pressure also after penetrating keratoplasty (PK). There is a high incidence of corneal graft failure.

Purpose:

To compare very long-term results of eyes with glaucoma drainage device (GDD) after PK.

Methods:

We retrospectively reviewed medical records of all patients who underwent GDD placement after PK at our institution between 2001 and 2017. Forty eyes of 40 patients were studied. Glaucoma outcome was assessed by postoperative intraocular pressure (IOP), number of medications, and need for further glaucoma surgery. Corneal outcome was assessed by graft rejection, failure, and visual acuity. Surgical procedures before and during the study period, and their complications were evaluated.

Results:

The mean follow-up was 125.0±52.3 (median, 116.5) months. Twenty of 40 eyes had a follow-up of at least 10 years. The mean preoperative IOP was 34.0±8.3 (median, 32.0) mm Hg with 3.2±1.3 (median, 3.5) glaucoma medications. At last postoperative follow-up, the mean IOP decreased to 12.7±4.9 (median, 14.0) mm Hg with 1.0±1.2 (median, 0.0) glaucoma medications. GDD implantation successfully controlled glaucoma in 88%, 88%, 85%, 80%, 78%, 75%, and 70% of eyes, at 1, 2, 3, 4, 5, 7, and 10 years, respectively. At last follow-up 68% showed glaucoma success. The corneal grafts remained clear in 74%, 63%, 45%, 45%, 37%, 32%, and 26% of eyes at 1, 2, 3, 4, 5, 7, and 10 years, respectively. Only 7 corneal grafts (17.5%) remained clear at last follow-up.

Conclusions:

A GDD can successfully control intractable glaucoma even after a very long period of time also after PK. However, the survival of the corneal grafts is low.
Heart Rate Variability Analysis in Workers Exposed to Methyl Bromide as a Quarantine Treatment
Authors: Choi Jungmi , Hong Young-Seoub , Cha Wonseok , Mo Hyoung-ho , Park Min-Goo
Published: November 2020

Objective:

To determine whether methyl bromide (MB) fumigation work for plants imported in Korea affects workers’ health by assessing heart rate variability (HRV).

Methods:

We measured HRV indices (TP, VLF, LF, HF, HR, SDNN, pNN50 and HRV-index) and urinary bromide ion (Br−) in 62 fumigators (study group) and 34 inspectors (the control group) before and after fumigation work. In addition, the relationship between Br− concentration and HRV indices was analysed.

Results:

The fumigators’ post-work HRV indices and Br− level were changed compared with their pre-work values (P < 0.001). Conversely, inspectors’ values were not shown a difference before and after work. The HRV indices in all subjects were negatively correlated with the Br− levels (P < 0.05).

Conclusions:

Fumigators with high Br− concentrations and low post-work HRV indices following MB fumigation work experienced adverse effects on their autonomic nervous systems.
Prognostic Nomogram for pancreatic cancer with lung metastasis: a SEER database-based study
Authors: Ding Jiachun , Ren Jiaqiang , Chen Fan , Yue Yangyang , Ren Chao , Wang Xirui , Ma Qingyong , Wu Zheng , Wang Zheng
Published: November 2020

Objectives:

To establish Nomogram to predict the overall survival (OS) rate of pancreatic cancer patients with lung metastasis by utilizing the database of the Surveillance, Epidemiology, and End Results (SEER) Program.

Methods:

We obtained the data of 363 pancreatic cancer patients with lung metastasis who were diagnosed between 2010 and 2016 from the SEER database. These patients were randomly divided into training (n = 255) and validation (n = 108) cohorts. The Cox proportional hazards regression model was performed to evaluate the prognostic effects of multiple clinicopathologic factors on OS. Significant prognostic factors were combined to build Nomogram. The predictive performance of Nomogram was evaluated via internal (training cohort data) and external validation (validation cohort data) by calculating index of concordance (C-index) and plotting area under curve (AUC) and calibration curves. All data from SEER database have been fully de-identified and may be used without further independent ethics committee approval.

Results:

In the training cohort, the results of Cox proportional hazards regression model showed that, tumor location, surgery, chemotherapy and other organ of metastasis were significantly associated with the survival prognosis (P < .05). These factors were used to establish Nomogram. The Nomogram showed good accuracy in predicting OS rate, with C-index of 0.727 [95%CI was (0.689, 0.764)] in internal validation and C-index of 0.738 [95%CI was (0.679, 0.796)] in external validation. All calibration curves showed excellent consistency between prediction by Nomogram and actual observation.

Conclusion:

Novel Nomogram for pancreatic cancer patients with lung metastasis was established to predict OS in our study. It has good prognostic significance. And it could provide the clinicians with more accurate and practical predictive tools which can quickly and accurately assess the patients’ survival prognosis individually, and make clinical suggestion for doctors in the follow-up treatment of patients.
Faecal microbiota transplantation: what’s beyond Clostridium difficile infection?
Authors: Tamilarasan Aravind Gokul , Krishnananthan Thanuja
Published: November 2020

Over the last decade, major advancements have been made in our understanding of both the beneficial and detrimental role that microorganisms play in our innate functioning. Research into the intestinal microbiota has moved from the laboratory into our medical clinics and is being put forth as an effective therapy for a range of medical conditions, not only limited to the gastrointestinal system. The clearest example of this progression has been in the treatment of Clostridium difficile infection; however, faecal microbiota transplantation has also been shown to have a positive effect in the treatment of inflammatory disorders, such as ulcerative colitis. In this review article, we will appraise the existing literature examining the role the intestinal microbiota plays in the pathogenesis of disease and the therapeutic utility of faecal microbiota transplantation in restoring homeostasis. In many cases, these studies are in a preclinical setting, are small in scale and often are not placebo-controlled; however, the results from these studies report interesting associations between intestinal dysbiosis and disease development, as well as the beneficial effects of faecal microbiota transplantation in reversing this process.
Comparative analysis of epidemiology, etiology, and outcomes between elderly and young and middle-aged acute pancreatitis patients: a retrospective, single-center study
Authors: Pu Wenjing , Luo Gang , Chen Tao , Jing Lihua , Chen Xia
Published: November 2020

Objective

The aim of this study was to analyze the etiology and epidemiology of the patients with first-attack acute pancreatitis of two-age groups.

Methods

This is a retrospective comparative study of 2965 patients aged 18 years and older with first-attack acute pancreatitis between 2013 and 2018 in the Affiliated Hospital of Southwest Medical University. Patients divided into the elderly group (age > or = 60 years) and the young and middle-aged group (age <60 years). The etiology tendency and clinical characteristics were analyzed.

Results

In the elderly group, the proportions of women to men was higher compared with the young and middle-aged group (1.48 vs. 0.69, P < 0.001). The primary etiology of acute pancreatitis in two groups were biliary tract diseases. The main etiology of the young and middle-aged group among men was alcohol and among women was biliary disease. Comparing with the young and middle-aged group, the elderly patients had a higher proportion of hypertension, ischemic heart disease, and cerebrovascular disease (P < 0.001). Meanwhile, the proportions of system inflammatory reaction syndrome, multiple organ dysfunction syndrome (MODS), and shock were also higher in the elderly group (P < 0.001). Mortality in the elderly group and the young and middle-aged group was 1.69 and 0.72%, respectively.

Conclusions

Biliary tract diseases were the predominant etiological factor in two groups. The two groups had different etiological proportions according to gender, complications, comorbidities, and outcomes. Furthermore, elderly patients are more likely to with complications, comorbidities, and highly mortality rate. We should pay more attention to realize the characteristics of acute pancreatitis at different ages.
An Executive Strategy to Support Long-Term Clinician Engagement Amid the COVID-19 Pandemic
Authors: Berkow Steven , Virkstis Katherine , Herleth Anne , Whitemarsh Karl , Rewers Lauren
Published: November 2020

The COVID-19 pandemic has left frontline staff burned out and exhausted. Meanwhile, executives need to ask more of their staff to ensure organizational viability. In this article, the authors propose that executives commit to taking specific actions to create a more supportive work environment and form an executive-clinician compact. This article outlines the 5 actions executives should take to bolster staff engagement and resilience long-term.
RNs' Perceptions of Engagement and Communication in the Workplace
Authors: Moore Lora , Abell Cathy H. , Harris Kacy , Farrell C. Thomas
Published: November 2020

OBJECTIVE

This study examines nurses' perceptions of communication and engagement in the workplace.

BACKGROUND

Work engagement and communication are both important concepts in the healthcare environment.

METHODS

Inferential analyses were conducted using the Utrecht Work Engagement Scale and Farley's Communication Assessment Questionnaire, along with descriptive and bivariate analyses.

RESULTS

Job vigor was negatively associated with the level of informed communication and indirect communication, whereas greater job dedication was found to be associated with more informed communication. Additionally, a statistically significant correlation between years of experience and vigor and absorption was noted, although age did not demonstrate the same relationship. Ultimately, nurse characteristics played an important role in the perception of communication in the work environment and in job enthusiasm.

CONCLUSIONS

Nurse administrators must create a culture that values communication and communicate skillfully using various methods to meet the needs of different employees.
Evaluation of a Multisite Nurse-Led Mobility Plan
Authors: Workman Charlie A. , Davies Claire C. , Ogle Karen C. , Arthur Charity , Tussey Kathy
Published: November 2020

OBJECTIVE

The aim of this study was to examine the effect of nurses' mobility plan use on patients' length of stay, discharge destination, falls, physical therapy consults, and nurses' knowledge, attitudes, and beliefs regarding patient mobility.

BACKGROUND

Functional decline due to decreased mobility during hospitalization results in diminished quality of life. Sixty-five percent of older inpatients lose the ability to ambulate during hospitalization and 30% do not regain that capability.

METHODS

Using a quasi-experimental design, nurses' use of a mobility assessment on 4 patient outcome variables was examined before (n = 2,259) and after (n = 3,649) use. Nurses' attitudes, knowledge, and beliefs regarding mobility were also examined.

RESULTS

Positive changes in patient variables occurred. Limited change occurred relative to nurses' knowledge, attitudes, and beliefs.

CONCLUSIONS

Implementing a nurse-led mobility plan enhances therapy resource utilization through identification of appropriate consults and improves patients' discharge home. In addition, nurses' knowledge, attitudes, and beliefs toward patient mobility planning can be positively influenced.
Magnetic Resonance Vessel Wall Imaging in Central Nervous System Vasculitides
Authors: Padrick Matthew M. , Maya Marcel M. , Fan Zhaoyang , Szumski Nicholas , Lyden Patrick D. , Song Shlee S. , Dumitrascu Oana M.
Published: November 2020

Introduction:

We aim to report 3 cases of central nervous system (CNS) vasculitides, in which high-resolution magnetic resonance vessel wall imaging (HR-VWI) findings were instrumental in the diagnosis and management.

Case Report:

Case 1: A 41-year-old obese, smoker female with arterial hypertension presented with recurrent transient ischemic attacks. Computed topography angiography demonstrated bilateral middle cerebral artery (MCA) stenosis. HR-VWI revealed uniform enhancement and thickening of the arterial wall, suggestive of MCA vasculitis. The patient reported chronic calf rash that was biopsied and revealed unspecified connective tissue disease. With immunomodulation, patient remained asymptomatic and 6-month surveillance HR-VWI showed improved MCA stenoses.

Case 2: A 56-year-old male with herpes simplex virus 1 encephalitis was treated with antiviral therapy and improved clinically. Two months later, the brain magnetic resonance imaging revealed new temporo-parietal edema and distal MCA hyperintense vessels. HR-VWI showed MCA concentric smooth contrast enhancement, that was attributed to postinfectious vasculitis and had resolved on follow-up HR-VWI.

Case 3: A 41-year-old male presented with 1-week of headache and encephalopathy. Brain magnetic resonance imaging revealed punctate multifocal acute ischemic infarcts and no contrast-enhancement. HR-VWI showed multifocal diffuse enhancement of distal cerebral vasculature. Patient subsequently developed branch retinal artery occlusion and hearing loss and was diagnosed with Susac syndrome. No recurrent symptoms were noted after immunotherapy initiation.

Conclusions:

In these 3 cases, HR-VWI identified distinctive vascular inflammatory changes, which were crucial to guide the etiological workup, positive diagnosis, surveillance neuroimaging, and targeted treatment. HR-VWI is an important diagnostic tool in CNS vasculitides, by providing nuanced information about arterial wall integrity and pathology.
Sexual Behavior and Sexually Transmitted Infection Outcomes Among Men Who Have Sex With Men and Transgender Women Participating in a Study of the Timing of Antiretroviral Therapy in Lima, Peru
Authors: Montaño Michalina A. , Alfaro Ricardo , Ness Tara , Ganoza Carmela , Gonzales Pedro , Sanchez Jorge , Lama Javier R. , Duerr Ann C.
Published: November 2020

Background

We assessed sexual behavior and incidence of sexually transmitted infections (STIs) among men who have sex with men and transgender women participating in Sabes, a study of an expanded treatment as prevention strategy focused on early diagnosis and treatment of HIV infection in Lima, Peru (2013–2017).

Methods

Sabes participants were tested monthly for HIV to identify acute or early infections, and HIV-positive participants were randomized to receive antiretroviral therapy immediately (immediate arm) or after 24 weeks (deferred arm) during a 48-week follow-up period. Sexual behavior was assessed at randomization (baseline) and every 12 weeks thereafter. Participants were tested for urethral and rectal chlamydia and gonorrhea and for syphilis at baseline, 12, 24, and 48 weeks. We describe patterns of sexual behavior during the 48-week follow-up period and compare sexual behavior and STI incidence between study arms.

Results

After randomization, 207 HIV-positive participants completed questionnaires and STI testing at 2 or more visits. After HIV diagnosis, participants in both arms reported increases in condom use with main and casual partners and decreased drug and alcohol use before or during anal sex. We observed no between-arm differences in sexual behavior. Deferred arm participants had higher incidence of chlamydia (incidence rate ratio, 2.33; 95% confidence interval, 1.14–4.77) but not gonorrhea or syphilis.

Conclusions

Despite reported increases in condom use, the overall high incidence of STIs reflects some ongoing condomless sex among HIV-positive men who have sex with men and transgender women, highlighting the importance of regular STI screening and counseling to support consistent condom use among HIV-positive individuals at risk for STIs.
Alterations in Ki67 Labeling Following Treatment of Poorly Differentiated Neuroendocrine Carcinomas
Authors: Vyas Monika , Tang Laura H. , Rekhtman Natasha , Klimstra David S.
Published: November 2020

Assessment of the Ki67 index is critical for grading well-differentiated neuroendocrine tumors (WD-NETs), which can show a broad range of labeling that defines the WHO grade (G1-G3). Poorly differentiated neuroendocrine carcinomas (PD-NECs) have a relatively high Ki67 index, >20% in all cases and commonly exceeding 50%. After anecdotally observing PD-NECs with an unexpectedly low and heterogeneous Ki67 index following chemotherapy in 5 cases, we identified 15 additional cases of treated high-grade neuroendocrine neoplasms (HG-NENs). The study cohort comprised 20 cases; 11 PD-NECs, 8 mixed adenoneuroendocrine carcinomas, and 1 WD-NET, G3 from various anatomic sites (gastrointestinal tract, pancreas, larynx, lung, and breast). The Ki67 index was evaluated on pretreatment (when available) and posttreatment samples. Topographic heterogeneity in the Ki67 index was expressed using a semi-quantitative score of 0 (no heterogeneity) to 5 (>80% difference between maximal Ki67 and minimal Ki67 indices). Relative to the pretreatment group (n=9, mean Ki67 of 86.3%, range 80% to 100%), the neoplasms in the posttreatment group (n=20, mean Ki67 of 47.7%, range 1% to 90%) showed a significantly lower Ki67 index (18/20 cases). Of the 18 cases with a relatively low Ki67 index, 15 showed heterogeneous labeling (mean heterogeneity score of 2.3, range 1 to 5) and in 3 cases it was a homogeneously low. This phenomenon was observed in all subtypes of HG-NENs. In 6 cases, the alterations in Ki67 index following treatment were sufficient to place these HG-NENs in the WHO G1 or G2 grade, erroneously suggesting a diagnosis of WD-NET, and in 9 cases there was sufficient heterogeneity in the Ki67 index to suggest that a limited biopsy may sample an area of low Ki67, even though hotspot regions with a Ki67 index of >20% persisted. In 7 cases, the alterations in the Ki67 index were accompanied by morphologic features resembling a WD-NET. These observations suggest that there is a potential for misinterpretation of previously treated PD-NECs as WD-NETs, or for assigning a lower grade in G3 WD-NETs. While the prognostic significance of treatment-associated alterations in Ki67 index is unknown, awareness of this phenomenon is important to avoid this diagnostic pitfall when evaluating treated NENs.
Patients’ Perception of Long-term Outcome After Laparoscopic Ventral Mesh Rectopexy; Single Tertiary Center Experience
Authors: Singh Sandeep , Ratnatunga Keshara , Bolckmans Roel , Iqbal Naeem , Jones Oliver , Lindsey Ian , Gorissen Kim , Cunningham Chris
Published: November 2020

Objective:

To assess patients' long-term outcome and satisfaction after laparoscopic ventral mesh rectopexy (LVMR).

Summary of Background Data:

Data on the long-term outcome and satisfaction of patients undergoing LVMR are limited.

Methods:

Patients who underwent LVMR between 2004 and 2017 were identified from a prospectively maintained database. We attempted to contact all patients by telephone for an interview using a standardized questionnaire to record pre-LVMR symptoms, long-term outcome, and overall satisfaction.

Results:

Total number of patients who underwent LVMR was 848 and 99(12%) were deceased at follow-up. In the end, 544 (64%) patients were contacted successfully and 478 (56%) were able to complete the questionnaire. Median time elapsed since surgery was 7 years and mean age was 62 years. Patients' reported preoperative symptoms were obstructed defecation syndrome in 40%, fecal incontinence in 22%, combination of obstructed defecation syndrome and fecal incontinence in 21% and other conditions in 17%. Bowel symptoms were reported as improved by 69% of patients and worse by 12%. Pelvic pain was reported to be improved in 47% of the patients after LVMR but new onset of pelvic pain appeared in 15%. Sexual function was reported to be better and worse with equal frequency. Overall, 63% of the patients were satisfied with the outcome and 76% would recommend this procedure to others with similar symptoms.

Conclusion:

LVMR offers acceptable long-term outcomes and satisfaction. There is a mixed impact on pelvic pain and sexual function which requires careful consideration in counseling patients for this procedure.
Sir James Whyte Black OM. 14 June 1924—22 March 2010
Authors: McGrath John Christie , Bond Richard A.
Published: November 2020

James Whyte Black was a Scottish pharmacologist who trained in medicine at St Andrews University and had a career in drug invention and academic pharmacology, moving several times between universities and the pharmaceutical industry. He was awarded the 1988 Nobel Prize in Physiology or Medicine for his drug invention method, which was to build molecules around the structure of a natural chemical activator of a pathway involved in the aetiology of a disease. This produced two extremely useful drug categories, beta-blockers and histamine H
2
-antagonists, with huge impact on the previously intractable diseases of angina, hypertension and stomach ulcers. In 2000 he was awarded the UK's highest honour, the Order of Merit (OM). His ideas on analytical pharmacology had a significant effect on the development of the discipline in the late twentieth century.