bluuebunny/crossref_metadata_2025 huggingface dataset:
Complete Response With Immunotherapy: A Case of Metastatic Bladder Cancer
Authors: Singh Balraj , Kaur Parminder , Gupta Sachin , Guragai Nirmal , Maroules Michael
Published: July 2021

Bladder cancer is the most common urinary tract malignancy. Platinum-based chemotherapy is the first line of treatment in locally advanced or metastatic bladder cancer. Immunotherapy has become a novel therapy option in a broad variety of malignancies including bladder cancer. Immunotherapy is approved as first line of treatment in patients who are ineligible for platinum-based chemotherapy and second-line treatment for metastatic urothelial cancer who progressed after platinum-based treatments. We present the case of an 83-year-old female with metastatic bladder cancer who was chemotherapy ineligible and had complete response with immune checkpoint inhibitor pembrolizumab.
Defining Return to Sport: A Systematic Review
Authors: Doege Joshua , Ayres Jack M. , Mackay Matthew J. , Tarakemeh Armin , Brown Symone M. , Vopat Bryan G. , Mulcahey Mary K.
Published: July 2021

Background:

Return to sport (RTS) commonly serves as a measure for assessment of clinical outcomes in orthopaedic sports medicine surgery. Unfortunately, while RTS is commonly utilized in research for this purpose, currently there is no widely accepted or standardized definition for when an athlete has officially returned to his or her sport.

Purpose:

To conduct a systematic review to evaluate and report the differences in specific definitions of RTS utilized in the orthopaedic surgery literature.

Study Design:

Systematic review; Level of evidence, 4.

Methods:

A systematic review was performed using PubMed, EMBASE, and Cochrane Trials databases per PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Search terms consisted of variations of “RTS” combined with variations of “orthopedic surgery” and “define” to capture as many relevant articles as possible. The definition of RTS was recorded and analyzed.

Results:

A total of 718 articles were identified in the initial search, 29 of which met eligibility criteria, providing a clear definition of RTS. Of the 29 studies included, 20 (69.0%) defined RTS as an athlete competing in a game or other competitive play. Three (10.3%) defined this as the athlete competing in a game or other competitive play but with an explicitly stated competition-level modifier of the athlete returning to his or her preinjury level of competition. Two articles (6.9%) included returning to training or practice, and the remaining 4 articles (13.8%) used terminology other than the standard RTS.

Conclusion:

There is variability in the definition of RTS used in orthopaedic sports medicine literature. Most studies refer to the athlete competing in a game or other competitive play. Other variants include returning to practice/training and explicitly defined competition levels and objectives. Future studies should aim to standardize the definition of RTS to facilitate more precise assessment of outcome after sports medicine surgery. Using terminology that describes components of the recovery and rehabilitation process, such as “return to participation” and “return to performance,” in addition to RTS will allow us to more clearly understand the athlete’s recovery and associated level of competition or performance.
Magnetic Resonance Imaging of the Hips of Runners Before and After Their First Marathon Run: Effect of Training for and Completing a Marathon
Authors: Horga Laura M. , Henckel Johann , Fotiadou Anastasia , Di Laura Anna , Hirschmann Anna C. , Hart Alister J.
Published: July 2021

Background:

No studies have focused on magnetic resonance imaging (MRI) of the hips of marathoners, despite the popularity and injury risks of marathon running.

Purpose:

To understand the effect of preparing for and completing a marathon run (42 km) on runners’ hip joints by comparing MRI findings before and after their first marathon.

Study Design:

Case-control study; Level of evidence, 3.

Methods:

A total of 28 healthy adults (14 males, 14 females; mean age, 32.4 years) were recruited after registering for their first marathon. They underwent 3-T MRI of both hips at 16 weeks before (time point 1) and 2 weeks after the marathon (time point 2). After the first MRI, 21 runners completed the standardized, 4 month--long training program and the marathon; 7 runners did not complete the training or the marathon. Specialist musculoskeletal radiologists reported and graded the hip joint structures using validated scoring systems. Participants completed the Hip disability and Osteoarthritis Outcome Score (HOOS) at both imaging time points.

Results:

At time point 1, MRI abnormalities of the hip joint were seen in 90% of participants and were located in at least 1 of these areas: labrum (29%), articular cartilage (7%), subchondral bone marrow (14%), tendons (17%), ligaments (14%), and muscles (31% had moderate muscle atrophy). At time point 2, only 2 of the 42 hips showed new findings: a small area of mild bone marrow edema appearance (nonweightbearing area of the hip and not attributable to running). There was no significant difference in HOOS between the 2 time points. Only 1 participant did not finish the training because of hip symptoms and thus did not run the marathon; however, symptoms resolved before the MRI at time point 2. Six other participants discontinued their training because of non–hip related issues: a knee injury, skin disease, a family bereavement, Achilles tendon injury, illness unrelated to training, and a foot injury unrelated to training.

Conclusion:

Runners who completed a 4-month beginner training program before their first marathon run, plus the race itself, showed no hip damage on 3-T MRI scans.
Hip Abductor Muscle Strength Deficit as a Risk Factor for Inversion Ankle Sprain in Male College Soccer Players: A Prospective Cohort Study
Authors: Kawaguchi Kohei , Taketomi Shuji , Mizutani Yuri , Inui Hiroshi , Yamagami Ryota , Kono Kenichi , Takagi Kentaro , Kage Tomofumi , Sameshima Shin , Tanaka Sakae , Haga Nobuhiko
Published: July 2021

Background:

Previous studies have attempted to determine whether certain risk factors can predict the occurrence of inversion ankle sprains in male collegiate soccer players. However, no consensus has been reached on the predictive risk factors of inversion ankle sprain in this population.

Purpose:

To identify risk factors for inversion ankle sprains among male collegiate soccer players.

Study Design:

Cohort study; Level of evidence, 2.

Methods:

Included were 145 male collegiate soccer players in Japan who were assessed during a preseason medical checkup for potential risk factors of inversion ankle sprain. The preseason assessment included anthropometric measurements, joint laxity and flexibility, muscle flexibility, muscle strength, and balance ability, with a total of 33 variables. The participants were monitored during the 2019 season for inversion ankle sprains as diagnosed by physicians.

Results:

A total of 31 inversion ankle sprains in 31 players (21.4%) occurred during the season. Only the measured isometric hip abductor strength was significantly lower in injured players as compared with uninjured players. Logistic regression analysis revealed measured hip abductor muscle strength deficit as a significant risk factor for inversion ankle sprain (odds ratio, 0.978 [95% CI, 0.976-0.999]; P = .05).

Conclusion:

Hip abductor strength deficit was a risk factor for inversion ankle sprain in the study population. This finding could be useful for the prevention of inversion ankle sprains in male collegiate soccer players.
Patient Voice and Mission: Why Do Patients Choose Family Medicine and What Do They Value?
Authors: Horn Jennifer , Allen Summer V. , Boehmer Kasey R. , Pecina Jennifer L.
Published: July 2021

Known gaps exist between what patients value and institutions prioritize. We sought to incorporate patients’ reasons for valuing family medicine into a new Mission and Vision statement by deploying brief surveys to a convenience sample of patients. We conducted descriptive quantitative analyses of demographics and inductive content analysis of written responses. Patients returned 92 (20%) of 450 questionnaires. Responders were 63% female, mean age of 47 years. Patients noted distinguishing features of family medicine were (1) continuity of care, (2) all-encompassing care, and (3) trusted referrals. Some patients reported not knowing there was a distinction between family medicine and other primary care.
Focus Group Discussion as a Tool to Assess Patient-Based Outcomes, Practical Tips for Conducting Focus Group Discussion for Medical Students—Learning With an Example
Authors: Zacharia Balaji , Pai Puneeth Katapadi , Paul Manu
Published: July 2021

Patient-based outcomes (patient-reported outcomes) of any intervention can change according to factors like age, gender, region, culture, education, and socioeconomic status. Most of the available outcome measuring tools have a surgeon-related bias. Focus group discussion (FGD) is a simple and effective way to assess the outcome of an intervention. In FGD, people from similar backgrounds and experiences discuss a specific topic of interest. Our objective is to discuss the problems of common outcome measuring tools for patient satisfaction and to understand the method of conducting an FGD. We have set our own published article on patient-based outcomes after total knee arthroplasty (TKA) as an example for explaining the method of conducting an FGD. The planning, advantages, disadvantages, practicalities, and problems of conducting an FGD are explained. In conclusion, many of the tools used for assessing patient satisfaction is surgeon-centered. Focus group discussion is simple, cost-effective, requiring a small number of participants, and can be completed in a short period. It is an effective tool for assessing patient-based outcomes in TKA.
Emergency Service Perceptions and Experiences of Patients: “Not A Great Place, But Not Disturbing”
Authors: Mutlu Senan , Çetinkaya Aynur , Yılmaz Emel
Published: July 2021

This study was conducted to determine the emergency department experiences and perceptions of a group of patients who applied to the tertiary emergency department. The study was carried out using a qualitative approach. Forty patients who were admitted to the emergency department were included in the study. Data were collected by face-to-face interview. The frequency count (f) and participant codes (P) were used for the presentation of the findings. The themes and frequency counts obtained by analyzing the interviews with the patients were as follows: “Uncertainty/Obscurity: Anxiety and fear (f = 108),” “Waiting/being patient (f = 39),” “Pain and procedures (f = 119),” “Doctor and nurse comforting attitudes (f = 98),” “Being treated and recovering (f = 48),” “Calm and comfortable environment (f = 14).” This study showed that the emergency department is generally perceived as a healing environment, the most important need of the participants is to relieve the anxiety and fear caused by the unknown and the pain they feel.
A regional spatial planning model for multifunctional green infrastructure
Authors: Goodspeed Robert , Liu Ruoshui , Gounaridis Dimitrios , Lizundia Camilla , Newell Joshua
Published: July 2021

There is a growing interest in planning for green infrastructure, as well as a growing recognition of the multifunctional nature of green infrastructure, since it provides many social and environmental benefits to cities and regions. However, there is a lack of appropriate methods for prioritizing the locations for green infrastructure interventions. In response, this article proposes a spatial multi-criteria analysis for green infrastructure. We demonstrate the method at the regional scale for Southeast Michigan, as well as through two embedded case studies within this region. We show how the method can be adapted for rural parks and conservation planning, as well as for urban green infrastructure planning within the City of Detroit. Although lacking the analytical structure needed for some planning questions, and limited by data and access to appropriate technical skills, we argue the spatial planning approach strikes an appropriate balance between technical rigor and transparency required for collaborative planning practice. The described GIS-based analysis technique can be used as part of a planning process to identify locations for green infrastructure expansion or improvement in a way that acknowledges and balances their social and environmental benefits.
A Rare Case of Acute Hemorrhagic Retinopathy Following Intravitreal Melphalan Injection for Persistent Vitreous Seeds in Retinoblastoma
Authors: Rajan Renu P. , Kim Usha , Maitray Aditya , Jena Soumya , Sen Sagnik
Published: July 2021

Purpose:

This report describes a case of acute occlusive hemorrhagic complication after intravitreal melphalan for vitreous seeds in retinoblastoma.

Methods:

A case report is presented.

Results:

Intravitreal melphalan has been used extensively for vitreous seeds in retinoblastoma. Although melphalan is relatively safe at optimal doses, it can sometimes cause inadvertent complications like hemorrhagic events if the drug is administered close to the retina or in more pigmented eyes. We report a case of a 5-month-old patient with bilateral retinoblastoma who underwent enucleation of the right eye and 2 intravitreal melphalan injections in the left eye (20 µg/0.02 mL) at a 1-month interval for persistent vitreous seeds. After the second injection, there was a sudden decrease in the child’s visual acuity in the left eye, and the retina showed multiple intraretinal hemorrhages and diffuse chorioretinal atrophy.

Conclusion:

Intravitreal melphalan may cause acute hemorrhagic complications after intravitreal use for retinoblastoma seeds, especially in pigmented eyes.
Representing, commemorating, and memorizing terrorist attacks: Discussing the US and French experiences
Authors: Greenwald Alice M. , Chanin Clifford , Rousso Henry , Wieviorka Michel , Adraoui Mohamed-Ali
Published: July 2021

How do societies and states represent the historical, moral, and political weight of the terrorist attacks they have had to face? Having suffered in recent years from numerous terrorist attacks on their soil originating from jihadist movements, and often led by actors who were also their own citizens, France and the United States have set up—or seek to do so—places of memory whose functions, conditions of creation, modes of operation, and nature of the messages sent may vary. Three of the main protagonists and initiators of two museum-memorial projects linked to terrorist attacks have agreed to deliver their visions of the role and of the political, social, and historical context in which these projects have emerged. Allowing to observe similarities and differences between the American and French approach, this interview sheds light on the place of memory and feeling in societies struck by tragic events and seeking to cure their ills through memory and commemoration.
A targeted proteomics investigation of the obesity paradox in venous thromboembolism
Authors: Ten Cate Vincent , Koeck Thomas , Prochaska Jürgen , Schulz Andreas , Panova-Noeva Marina , Rapp Steffen , Eggebrecht Lisa , Lenz Michael , Glunz Julia , Sauer Madeleine , Ewert Raff , Halank Michael , Münzel Thomas , Heitmeier Stefan , Andrade-Navarro Miguel A. , Lackner Karl J. , Konstantinides Stavros V. , Leineweber Kirsten , Wild Philipp S.
Published: July 2021

The obesity paradox, the controversial finding that obesity promotes disease development but protects against sequelae in patients, has been observed in venous thromboembolism (VTE). The aim of this investigation was to identify a body mass–related proteomic signature in VTE patients and to evaluate whether this signature mediates the obesity paradox in VTE patients. Data from the Genotyping and Molecular Phenotyping in Venous ThromboEmbolism Project, a prospective cohort study of 693 VTE patients, were analyzed. A combined end point of recurrent VTE or all-cause death was used. Relative quantification of 444 proteins was performed using high-throughput targeted proteomics technology. Measurements were performed in samples collected during the acute VTE event and at 12-month follow-up. An 11-protein signature (CLEC4C, FABP4, FLT3LG, IL-17C, LEP, LYVE1, MASP1, ST2, THBS2, THBS4, TSLP) for body mass in VTE patients was identified. The signature did not significantly mediate the obesity paradox (change in hazard ratio [HR]: 0.04; likelihood ratio test of nested models = 7.7; P = .74), but its main constituent protein, leptin, was inversely associated with recurrent VTE or death (adjusted HR [95% confidence interval] per standard deviation increase: 0.66 [0.46-0.94]). This relationship was significantly (P = .007) modified by markers of leptin resistance (ie, high body mass index and high circulating matrix metalloproteinase-2 levels). Although the signature did not substantially explain the obesity paradox, leptin appears to be protective against disease recurrence and death in VTE patients. This protective effect was abrogated under conditions of leptin resistance and hence was unrelated to the obesity paradox.
Exploring the genomic resources and analysing the genetic diversity and population structure of Chinese indigenous rabbit breeds by RAD-seq
Authors: Liu Chenmiao , Wang Shuhui , Dong Xianggui , Zhao Jiping , Ye Xiangyang , Gong Ruiguang , Ren Zhanjun
Published: July 2021

Background

Chinese indigenous rabbits have distinct characteristics, such as roughage resistance, stress resistance and environmental adaptability, which are of great significance to the sustainable development of the rabbit industry in China. Therefore, it is necessary to study the genetic diversity and population structure of this species and develop genomic resources.

Results

In this study, we used restriction site-associated DNA sequencing (RAD-seq) to obtain 1,006,496 SNP markers from six Chinese indigenous rabbit breeds and two imported rabbit breeds. Jiuyishan and Fujian Yellow rabbits showed the highest nucleotide diversity (π) and decay of linkage disequilibrium (LD), as well as higher observed heterozygosity (Ho) and expected heterozygosity (He), indicating higher genetic diversity than other rabbits. The inbreeding coefficient (FIS) of New Zealand rabbits and Belgian rabbits was higher than that of other rabbits. The neighbour-joining (NJ) tree, principal component analysis (PCA), and population structure analysis of autosomes and Y chromosomes showed that Belgian, New Zealand, Wanzai, Sichuan White, and Minxinan Black rabbits clustered separately, and Fujian Yellow, Yunnan Colourful, and Jiuyishan rabbits clustered together. Wanzai rabbits were clearly separated from other populations (K = 3), which was consistent with the population differentiation index (FST) analysis. The selection signature analysis was performed in two populations with contrasting coat colours. With Sichuan White and New Zealand rabbits as the reference populations and Minxinan Black and Wanzai rabbits as the target populations, 408, 454, 418, and 518 genes with a selection signature, respectively, were obtained. Gene Ontology (GO) classification and Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analysis were performed on the genes with a selection signature. The results showed that the genes with a selection signature were enriched in the melanogenesis pathway in all four sets of selection signature analyses.

Conclusions

Our study provides the first insights into the genetics and genomics of Chinese indigenous rabbit breeds and serves as a valuable resource for the further effective utilization of the species.
Mapping QTL for spike fertility and related traits in two doubled haploid wheat (Triticum aestivum L.) populations
Authors: Pretini Nicole , Vanzetti Leonardo S. , Terrile Ignacio I. , Donaire Guillermo , González Fernanda G.
Published: July 2021

Background

In breeding programs, the selection of cultivars with the highest yield potential consisted in the selection of the yield per se, which resulted in cultivars with higher grains per spike (GN) and occasionally increased grain weight (GW) (main numerical components of the yield). In this study, quantitative trait loci (QTL) for GW, GN and spike fertility traits related to GN determination were mapped using two doubled haploid (DH) populations (Baguette Premium 11 × BioINTA 2002 and Baguette 19 × BioINTA 2002).

Results

In total 305 QTL were identified for 14 traits, out of which 12 QTL were identified in more than three environments and explained more than 10% of the phenotypic variation in at least one environment. Eight hotspot regions were detected on chromosomes 1A, 2B, 3A, 5A, 5B, 7A and 7B in which at least two major and stable QTL sheared confidence intervals. QTL on two of these regions (R5A.1 and R5A.2) have previously been described, but the other six regions are novel.

Conclusions

Based on the pleiotropic analysis within a robust physiological model we conclude that two hotspot genomic regions (R5A.1 and R5A.2) together with the QGW.perg-6B are of high relevance to be used in marker assisted selection in order to improve the spike yield potential. All the QTL identified for the spike related traits are the first step to search for their candidate genes, which will allow their better manipulation in the future.
Comparison of fatigue and fatigability correlates in Korean breast cancer survivors and differences in associations with anxiety, depression, sleep disturbance, and endocrine symptoms: a randomized controlled trial
Authors: Jang Min Kyeong , Han Jeehee , Kim Sung Hae , Ko Yun Hee , Kim Soo Yeon , Kim Sue
Published: July 2021

Background

Fatigue is one of the most common and burdensome symptoms experienced by cancer patients. In interventions intended to reduce fatigue in such patients, fatigability, or perception of fatigue contextualized to activities of fixed intensity and duration, may also be measured. This study investigated the effects of a 15-month intervention on fatigue and fatigability in breast cancer survivors (BCS); explored the fatigue-fatigability relationship; and evaluated the impacts of fatigue and fatigability on anxiety, depression, sleep disturbance, and endocrine symptoms.

Methods

A randomized controlled trial design was applied to an exercise program called BLESS (Better Life after cancer, Energy, Strength, and Support). The intervention included this 12-week exercise program and four follow-up contacts intended to promote exercise adherence over the following year. Participants were women aged 20 to 69 who had been diagnosed with stage I, II, or III breast cancer; had completed active treatment; and had moderate or higher fatigue. At the completion of the intervention, the survey responses of 40 BCS were evaluated using the chi-square test and multiple regression analysis. The Korean versions of the Revised Piper Fatigue Scale and Pittsburgh Fatigability Scale were used to measure fatigue and fatigability, respectively.

Results

There was no significant difference in fatigue or fatigability between the experimental and control groups at intervention completion. However, the control group showed a stronger association than the experimental group between fatigue and physical fatigability. In the control group, fatigue and fatigability were significantly associated with anxiety, depression, sleep disturbance, and endocrine symptoms. In the experimental group, only the cognitive/mood fatigue score and depression were significantly associated. Only endocrine symptoms influenced mental fatigability (B = − 0.185, P < 0.05), and only depression influenced cognitive/mood fatigue (B = 1.469, P < 0.05).

Conclusions

Fatigue and fatigability showed different correlations with cancer-related symptoms after the exercise intervention. Future assessments of fatigability in intervention studies will allow measurement of the spectrum of patients’ abilities to overcome fatigue at various physical activity levels while capturing different aspects of cancer-related symptoms.

Trial registration

This study was retrospectively registered on Clinical Research Information Service (KCT0005763; date of registration: 31/12/2020).
Patients’ perspectives on the experience of absconding from a psychiatric hospital: a qualitative study
Authors: Kaggwa Mark Mohan , Acai Anita , Rukundo Godfrey Zari , Harms Sheila , Ashaba Scholastic
Published: July 2021

Background

Absconding (i.e., escaping) is common among patients with mental illness admitted to psychiatric hospitals. Patients use various strategies to make absconding successful due to the experiences faced during admission. We conducted a study to identify patients’ perspectives on the experience of absconding from the psychiatry facility.

Methods

We conducted 10 in-depth interviews with patients with a history of absconding from the hospital who were accessing care at the Mbarara Regional Referral Hospital in Mbarara city Uganda. Interviews were audio-recorded, translated when required, transcribed into English, and analyzed thematically to identify relevant themes.

Results

Participants ranged in age from 18 to 55 and the majority (n = 9) were male. Most had absconded at least twice from a psychiatric facility. We identified different experiences that influenced patients’ engagement in absconding from the psychiatry hospital ward. These included: (1) stigma, (2) experiences with caregivers: mixed emotions, (3) poor resources and services, and (4) the influence of mental illness symptoms. The loneliness of stigma, negative emotions associated with the loss of important roles given the nature and framework of caregiving on the psychiatric ward, as well as the stress of limited resources were a salient part of the patient experience as it relates to absconding.

Conclusion

Our findings indicate that absconding is a symptom of a larger problem with a mental health system that perpetuates stigma in its design, isolates patients and makes them feel lonely, and forces patients to rely on caregivers who infantilize them and take away all their freedom in a facility with no basic services. For many patients, this makes absconding the only option. Within such a system, all stakeholders (policymakers, health-care providers, caregivers, and patients) should be involved in rethinking how psychiatric facilities should be operated to make the journey of patient recovery more positive.
Population-based utility scores for HPV infection and oropharyngeal squamous cell carcinoma among Indigenous Australians
Authors: Ju Xiangqun , Canfell Karen , Howard Kirsten , Garvey Gail , Hedges Joanne , Smith Megan , Jamieson Lisa
Published: July 2021

Background

Oropharyngeal squamous cell carcinoma (OPSCC) is associated with high mortality. Human papillomavirus (HPV) infection is a significant risk factor for OPSCC. Utilities are fundamental values representing the strength of individuals’ preferences for specific health-related outcomes. Our study aim was to work in partnership with Indigenous communities in South Australia to develop, pilot test and estimate utility scores for health states related to HPV, HPV vaccination, precursor OPSCC and its treatment, and early stage OPSCC among Indigenous Australians.

Methods

Development and pilot testing of hypothetical HPV and OPSCC health states, specifically through the lens of being Indigenous Australian, was conducted with an Indigenous Reference Group. Six health states were decided upon, with utility scores calculated using a two-stage standard gamble approach among a large convenience sample of Indigenous Australians aged 18+ years residing in South Australia. The rank, percentage of perfect health and utility score of each health state was summarised using means, and medians at 12 months and lifetime duration. Potential differences by age, sex and residential location were assessed using the Wilcox Rank Sum test.

Results

Data from 1011 participants was obtained. The mean utility scores decreased with increasing severity of health states, ranging from 0.91–0.92 in ‘screened, cytology normal, HPV vaccination’ and ‘screened, HPV positive, endoscopy normal’, to less than 0.90 (ranging from 0.87–0.88) in lower grade conditions (oral warts and oral intraepithelial neoplasia) and less than 0.80 (ranging from 0.75–0.79) in ‘early stage throat cancer’. Higher utility scores were observed for ‘screened, cytology normal and HPV vaccination’ among younger participants (18–40 years), for ‘early stage invasive throat cancer’ among females, and for ‘oral intraepithelial neoplasia’ and ‘early stage invasive throat cancer’ among metropolitan-dwelling participants.

Conclusion

Among a large sample of Indigenous Australians, utility for oral HPV infection and OPSCC decreased with severity of health states. Older participants, as well as males and those residing in non-metropolitan locations, had decreased utility for high-grade cytology and early invasive cancer states. Our findings are an important contribution to cost-utility and disease prevention strategies that seek to inform policies around reducing HPV infection and OPSCC among all Australians.
Tools for measuring technical skills during gynaecologic surgery: a scoping review
Authors: Hennings Louise Inkeri , Sørensen Jette Led , Hybscmann Jane , Strandbygaard Jeanett
Published: July 2021

Background

Standardised assessment is key to structured surgical training. Currently, there is no consensus on which surgical assessment tool to use in live gynaecologic surgery. The purpose of this review is to identify assessment tools measuring technical skills in gynaecologic surgery and evaluate the measurement characteristics of each tool.

Method

We utilized the scoping review methodology and searched PubMed, Medline, Embase and Cochrane. Inclusion criteria were studies that analysed assessment tools in live gynaecologic surgery. Kane’s validity argument was applied to evaluate the assessment tools in the included studies.

Results

Eight studies out of the 544 identified fulfilled the inclusion criteria. The assessment tools were categorised as global rating scales, global and procedure rating scales combined, procedure-specific rating scales or as a non-procedure-specific error assessment tool.

Conclusion

This scoping review presents the current different tools for observational assessment of technical skills in intraoperative, gynaecologic surgery. This scoping review can serve as a guide for surgical educators who want to apply a scale or a specific tool in surgical assessment.
Experiences and perceptions of perinatal depression among new immigrant Chinese parents: a qualitative study
Authors: Li Qiao , Xue Wenqing , Gong Wenjie , Quan Xin , Li Quanlei , Xiao Lina , Xu Dong , Caine Eric D. , Poleshuck Ellen L.
Published: July 2021

Background

Immigrant status, acculturation level, race and ethnicity have been found to contribute to the utilization of mental health services in the perinatal period. This study explored perinatal experiences and perceptions among Chinese immigrant mothers and their spouses, as well as the possible barriers and facilitators that affect their health care utilization.

Methods

We recruited 13 women ages 18–35 years born in mainland China, living in Rochester, New York, and residing less than 5 years in the United States. Participants primary language was Mandarin Chinese and all had given birth to at least one live infant within the past 7 years. Participants’ age was at least 18 years old at the time of delivery. Five spouses also participated. We divided women in two focus groups and held one focus group for men, with data collection including demographic questionnaires and semi-structured focus group questions conducted in December 2014. Data were analyzed following thematic analysis.

Results

Four themes emerged: experiences of perinatal depression; perceptions of perinatal depression; general preventive and coping strategies; and attitudes toward the supportive use social media applications (apps) and text messaging during the perinatal period. Participants had limited knowledge of perinatal depression and had difficulty distinguishing between normal perinatal mood fluctuations and more severe symptoms of depression. They discussed immigrant-related stress, conflicts with parents/in-laws while “doing the month”, the perceived gap between the ideal of “perfect moms” and reality, and challenges with parenting as the causes of perinatal depression. Women approved of screening for the condition but were conservative about follow-up interventions. As for the management of perinatal depression, participants preferred to deal with the problem within the family before seeking external help, due to potential stigma as well as Chinese traditional culture. They were receptive to obtaining pertinent health information from anonymous social media apps, preferring these to personal text messages.

Conclusion

The recent immigrant Chinese parents to the United States in the study had limited knowledge of perinatal depression and did not make full use of mental health services for support due to language and cultural barriers. Screening for perinatal depression is only the first step. Future research should explore what interventions may serve as an acceptable approach to overcoming these gaps.
Humoral immune responses during SARS-CoV-2 mRNA vaccine administration in seropositive and seronegative individuals
Authors: Fraley Elizabeth , LeMaster Cas , Geanes Eric , Banerjee Dithi , Khanal Santosh , Grundberg Elin , Selvarangan Rangaraj , Bradley Todd
Published: July 2021

Background

The global pandemic of coronavirus disease 2019 (COVID-19) is caused by infection with the SARS-CoV-2 virus. Currently, there are three approved vaccines against SARS-CoV-2 in the USA, including two based on messenger RNA (mRNA) technology that has demonstrated high vaccine efficacy. We sought to characterize humoral immune responses, at high resolution, during immunization with the BNT162b2 (Pfizer-BioNTech) vaccine in individuals with or without prior history of natural SARS-CoV-2 infection.

Methods

We determined antibody responses after each dose of the BNT162b2 SARS-CoV-2 vaccine in individuals who had no prior history of SARS-CoV-2 infection (seronegative) and individuals that had previous viral infection 30–60 days prior to first vaccination (seropositive). To do this, we used both an antibody isotype-specific multiplexed bead-based binding assays targeting multiple SARS-CoV-2 viral protein antigens and an assay that identified potential SARS-CoV-2 neutralizing antibody levels. Moreover, we mapped antibody epitope specificity after immunization using SARS-CoV-2 spike protein peptide arrays.

Results

Antibody levels were significantly higher after a single dose in seropositive individuals compared to seronegative individuals and were comparable to levels observed in seronegative individuals after two doses. While IgG was boosted by vaccination for both seronegative and seropositive individuals, only seronegative individuals had increased IgA or IgM antibody titers after primary immunization. We identified immunodominant peptides targeted on both SARS-CoV-2 spike S1 and S2 subunits after vaccination.

Conclusion

These findings demonstrated the antibody responses to SARS-CoV-2 immunization in seropositive and seronegative individuals and provide support for the concept of using prior infection history as a guide for the consideration of future vaccination regimens. Moreover, we identified key epitopes on the SARS-CoV-2 spike protein that are targeted by antibodies after vaccination that could guide future vaccine and immune correlate development.
Development of a Clinical Global Impression of Change (CGI-C) and a Caregiver Global Impression of Change (CaGI-C) measure for ambulant individuals with Duchenne muscular dystrophy
Authors: Staunton Hannah , Trennery Claire , Arbuckle Rob , Guridi Maitea , Zhuravleva Elena , Furlong Pat , Fischer Ryan , Hall Rebecca
Published: July 2021

Background

In clinical trials for rare diseases, such as Duchenne muscular dystrophy, clinical outcome assessments (COA) used to assess treatment benefit are often generic and may not be sensitive enough to detect change in specific patient populations. Thus, there is a need for disease specific COAs that track meaningful change among individuals. When developing such measures, input from clinicians, caregivers and patients is critical for assessing clinically relevant concepts and ensuring validity of the measure.

Method

The aim of this study was to develop two Duchenne-specific global impression items for use in clinical trials. The development of the Duchenne Clinical Global Impression of Change (CGI-C) and Caregiver Global Impression of Change (CaGI-C) was informed by findings from concept elicitation (CE) interviews with clinicians, caregivers and individuals with Duchenne. Through cognitive debriefing (CD) interviews, clinicians and caregivers evaluated draft CGI-C and CaGI-C items to ensure relevance and understanding of the items and instructions. Suggestions made during the CD interviews were incorporated into the finalized CGI-C and CaGI-C measures.

Results

The symptoms most frequently reported by clinicians, caregivers and individuals with Duchenne were muscle weakness, fatigue, cardiac difficulties and pain. Regarding physical functioning, all three populations noted that small changes in functional ability were meaningful, particularly when independence was impacted. Caregivers and clinicians reported that changes in speed, endurance and quality of movement were important, as was improvement in the ability of individuals to keep up with their peers. A change in the ability to complete everyday activities was also significant to families. These results were used to create two global impression of change items and instruction documents for use by clinicians (CGI-C) and caregivers (CaGI-C). Overall, both items were well understood by participants. The descriptions and examples developed from the CE interviews were reported to be relevant and appropriate for illustrating different levels of meaningful change in patients with Duchenne. Modifications were made based on caregiver and clinician CD feedback .

Conclusions

As part of a holistic measurement strategy, such COA can be incorporated into the clinical trial setting to assess global changes in relevant symptoms and functional impacts associated with Duchenne.
Incidence trends and survival prediction of urothelial cancer of the bladder: a population-based study
Authors: He Hairong , Liu Tianjie , Han Didi , Li Chengzhuo , Xu Fengshuo , Lyu Jun , Gao Ye
Published: July 2021

Background

The aim of this study is to determine the incidence trends of urothelial cancer of the bladder (UCB) and to develop a nomogram for predicting the cancer-specific survival (CSS) of postsurgery UCB at a population-based level based on the SEER database.

Methods

The age-adjusted incidence of UCB diagnosed from 1975 to 2016 was extracted, and its annual percentage change was calculated and joinpoint regression analysis was performed. A nomogram was constructed for predicting the CSS in individual cases based on independent predictors. The predictive performance of the nomogram was evaluated using the consistency index (C-index), net reclassification index (NRI), integrated discrimination improvement (IDI), a calibration plot and the receiver operating characteristics (ROC) curve.

Results

The incidence of UCB showed a trend of first increasing and then decreasing from 1975 to 2016. However, the overall incidence increased over that time period. The age at diagnosis, ethnic group, insurance status, marital status, differentiated grade, AJCC stage, regional lymph nodes removed status, chemotherapy status, and tumor size were independent prognostic factors for postsurgery UCB. The nomogram constructed based on these independent factors performed well, with a C-index of 0.823 and a close fit to the calibration curve. Its prediction ability for CSS of postsurgery UCB is better than that of the existing AJCC system, with NRI and IDI values greater than 0 and ROC curves exhibiting good performance for 3, 5, and 8 years of follow-up.

Conclusions

The nomogram constructed in this study might be suitable for clinical use in improving the clinical predictive accuracy of the long-term survival for postsurgery UCB.
Secondarily estimated cure fraction and five-year recurrence-free conditional survival probabilities among patients undergoing surgical resection for hepatocellular carcinoma presenting with minor gross vascular invasion
Authors: Bae Byungje , Song Sung Kyu , Choi Eunyoung , Chung Chul-Woon , Park Yongkeun
Published: July 2021

Background

Surgical resection (SR) has been selectively applied in hepatocellular carcinoma (HCC) presenting with minor gross vascular invasion (mGVI) which is defined when tumor invasion is confined to second-order portal branches or segmental branches of hepatic vein. However, little data of long-term outcomes are available for supporting the role of SR as a potentially curable therapeutic option for HCC presenting with mGVI. This study is aimed to estimate a statistical cure fraction and the improvement of recurrence-free conditional survival (RFCS) over time among patients undergoing SR for HCC presenting with mGVI.

Methods

The literature search was conducted focusing on previous studies that investigated the long-term survival rates of patients after SR for HCC presenting with mGVI. The reference cohort was extracted from a study including patients undergoing SR for HCC without vascular invasion. A non-mixture cure model was adopted to estimate the statistical cure fraction. The 5-year RFCS probabilities were also calculated.

Results

Three retrospective studies were secondarily analyzed. The probability of being statistically cured after SR for HCC presenting with mGVI was 7.3% (95% confidence interval, 4.4%–11.2%) in the mGVI group, lower than that of the reference cohort (hazard ratio, 1.81; 95% confidence interval, 1.59–2.05). The estimated 5-year RFCS probabilities improved with each additional year of survival. Moreover, 1 year after SR, the 5-year RFCS probabilities of patients with HCC presenting with mGVI was essentially the same as that of the reference cohort.

Conclusions

This study shows that a cure can be expected in around seven percent of patients undergoing SR for HCC presenting with mGVI. Furthermore, recurrence-free survival expectancy improves dramatically over time among those patients who do not have recurrence. Overall, these findings suggest that SR should be considered as a potentially curable treatment for patients with HCC presenting with mGVI.
More blastocysts are produced from fewer oocytes in ICSI compared to IVF – results from a sibling oocytes study and definition of a new key performance indicator
Authors: Chamayou Sandrine , Ragolia Carmen , Alecci Carmelita , Storaci Giorgia , Romano Simona , Sapienza Roberta , Maglia Elena , Liprino Annalisa , Cardea Clementina , Fichera Michele , Guglielmino Antonino
Published: July 2021

Background

Which fertilization method, between ICSI and IVF in split insemination treatments, has the highest clinical efficiency in producing clinically usable blastocyst?

Methods

211 infertile couples underwent split insemination treatments for a non-severe male factor. 1300 metaphase II (MII) oocytes were inseminated by conventional IVF and 1302 MII oocytes were micro-injected with the same partner’s semen. Embryo development until blastocyst stage on day V and clinical outcomes were valuated trough conventional key performance indicators (KPI), and new KPIs such as blastocyst rate per used MII oocytes and the number of MII oocytes to produce one clinically usable blastocyst from ICSI and IVF procedures.

Results

The results were  globally analyzed and according to ovarian stimulation protocol, infertility indication, and female age. The conventional KPI were online with the expected values from consensus references. From global results, 2.3 MII oocyte was needed to produce one clinically usable blastocyst after ICSI compared to 2.9 MII oocytes in IVF. On the same way, more blastocysts for clinical use were produced from fewer MII oocytes in ICSI compared to IVF in all sub-groups.

Conclusions

In split insemination treatments, the yield of clinically usable blastocysts was always superior in ICSI compared to IVF. The new KPI "number of needed oocytes to produce one clinically usable embryo" tests the clinical efficiency of the IVF laboratory.
High-parameter cytometry unmasks microglial cell spatio-temporal response kinetics in severe neuroinflammatory disease
Authors: Spiteri Alanna G. , Terry Rachel L. , Wishart Claire L. , Ashhurst Thomas M. , Campbell Iain L. , Hofer Markus J. , King Nicholas J. C.
Published: July 2021

Background

Differentiating infiltrating myeloid cells from resident microglia in neuroinflammatory disease is challenging, because bone marrow-derived inflammatory monocytes infiltrating the inflamed brain adopt a ‘microglia-like’ phenotype. This precludes the accurate identification of either cell type without genetic manipulation, which is important to understand their temporal contribution to disease and inform effective intervention in its pathogenesis. During West Nile virus (WNV) encephalitis, widespread neuronal infection drives substantial CNS infiltration of inflammatory monocytes, causing severe immunopathology and/or death, but the role of microglia in this remains unclear.

Methods

Using high-parameter cytometry and dimensionality-reduction, we devised a simple, novel gating strategy to identify microglia and infiltrating myeloid cells during WNV-infection. Validating our strategy, we (1) blocked the entry of infiltrating myeloid populations from peripheral blood using monoclonal blocking antibodies, (2) adoptively transferred BM-derived monocytes and tracked their phenotypic changes after infiltration and (3) labelled peripheral leukocytes that infiltrate into the brain with an intravenous dye. We demonstrated that myeloid immigrants populated only the identified macrophage gates, while PLX5622 depletion reduced all 4 subsets defined by the microglial gates.

Results

Using this gating approach, we identified four consistent microglia subsets in the homeostatic and WNV-infected brain. These were P2RY12hiCD86−, P2RY12hiCD86+and P2RY12loCD86−P2RY12loCD86+. During infection, 2 further populations were identified as 'inflammatory' and 'microglia-like' macrophages, recruited from the bone marrow. Detailed kinetic analysis showed significant increases in the proportions of both P2RY12lomicroglia subsets in all anatomical areas, largely at the expense of the P2RY12hiCD86−subset, with the latter undergoing compensatory proliferation, suggesting replenishment of, and differentiation from this subset in response to infection. Microglia altered their morphology early in infection, with all cells adopting temporal and regional disease-specific phenotypes. Late in disease, microglia produced IL-12, downregulated CX3CR1, F4/80 and TMEM119 and underwent apoptosis. Infiltrating macrophages expressed both TMEM119 and P2RY12 de novo, with the microglia-like subset notably exhibiting the highest proportional myeloid population death.

Conclusions

Our approach enables detailed kinetic analysis of resident vs infiltrating myeloid cells in a wide range of neuroinflammatory models without non-physiological manipulation. This will more clearly inform potential therapeutic approaches that specifically modulate these cells.