bluuebunny/crossref_metadata_2025 huggingface dataset:
Spontaneous regression of incidentally diagnosed bronchial squamous cell lung carcinoma after severe bronchitis: A case report
Authors: Kim Yoonjoo , Yoo Geon , Lee Da-Hye , Lee Choong-Sik , Chung Chaeuk
Published: May 2021

Spontaneous regression of lung cancer is exceptionally rare. But there have been several intriguing cases reported in early and even advanced stages of lung cancer. Although the exact mechanism remains to be elucidated, the inflammation and immunologic response have been suggested as one of the means of spontaneous regression. Chronic inflammation is generally known to induce and aggravate tumorigenesis, but the relationship between cancer and inflammation highly depends on the contexts. Here, we present a case of a 60-year-old male ex-smoker who complained of recurrent hemoptysis, cough, and purulent sputum. The initial chest CT scan revealed diffuse bronchial thickening and an endobronchial mass-like lesion in the left lingular segment. The bronchoscopic and pathological findings also suggested a diagnosis of squamous cell carcinoma with severe mucosal inflammation. He was treated with antibiotics for the bronchitis during the first 1 week and his symptoms markedly improved. After 3 weeks, he underwent a follow-up examination. Chest computed tomography and bronchoscopy revealed the significant improvement of the bronchial narrowing and mucosal edema. Biopsy was performed several times around the lesion where the tissue was initially taken. However, the pathological results showed only chronic inflammation of bronchi, not cancer cells. Fortunately, there was no recurrence of lung cancer in follow-up chest computed tomography or bronchoscopy for almost 5 years. In this case, the incidentally diagnosed bronchial squamous cell carcinoma disappeared after severe inflammatory reaction of the bronchial wall. The clinician should remind the risk of early lung cancer accompanied with bronchitis in high-risk patients of lung cancer and also be aware that although it is very rare, the lesions could spontaneously regress.
Early parastomal evisceration of small bowel following a loop ileostomy for malignant intestinal obstruction
Authors: Basnayake Oshan , Prasanthan Y , Jayarajah Umesh , Ganga NMPG , De Silva Kanishka
Published: May 2021

Evisceration of bowel through the stoma is a rare complication and only few cases have been reported. Although most cases occur in the context of long-standing parastomal hernias, early evisceration may also occur causing significant morbidity to patients. The reported patient is a 53-year-old male with bronchial asthma who was diagnosed to have metastatic colonic cancer underwent a trephine loop ileostomy for intestinal obstruction. On post-operative Day 7, he developed small bowel evisceration through the ileostomy site. The patient underwent an emergency laparotomy and found to have non-viable prolapsed small bowel segment at the stoma site. Furthermore, there were extensive peritoneal deposits and large para aortic lymph node mass and ascites compromising the peritoneal space. Resection of non-viable small bowel and ileostomy refashioning was carried out. The patient was managed in the intensive care unit and he gained function of the ileostomy on post-operative Day 2. On Day 5, he died due to subsequent pneumonia and worsening acute respiratory distress syndrome. Early parastomal evisceration is an extremely infrequent life-threatening complication that requires urgent treatment. Disseminated cancer, bowel obstruction, poor nutritional status, ascites and exacerbation of bronchial asthma were additional risk factors in our patient.
Perioperative Transfusion Associated With Increased Morbidity and Mortality in Geriatric Patients Undergoing Hip Fracture Surgery
Authors: Gupta Piyush , Kang Kevin K. , Pasternack Jordan B. , Klein Elliot , Feierman Dennis E.
Published: May 2021

Introduction:

Both conservative and liberal transfusion thresholds, in regard to hematocrit and hemoglobin levels, have been widely studied with varying outcomes. The aim of this study was to evaluate if transfusion administered peri- (anytime during the admission), pre-, intra-, or postoperatively an its association with morbidity and mortality in the geriatric population undergoing hip surgery.

Methods:

This study was an institutional review board approved retrospective analysis of data collected from 841 patients at a single urban institution who underwent surgical repairs for hip fractures from 2008 to 2010.

Results:

Our analysis included data from 841 surgical patients. Mean patient age was 83, 74% were female, 48% received spinal anesthesia while 52% underwent general anesthesia. Out of 841 patients, 425 were transfused during the perioperative period. Most transfusions occurred postoperatively. Perioperative, intraoperative and postoperative transfusion was associated with an increase in post-operative AKI. Intraoperative blood transfusion was associated with an increase in morbidity (11.6% increased to 22.2%) by 1.9 fold, AKI (3.9% increased to 11.1%) by 2.8 fold, as well as an increase in mortality (5.2 increased to 15.6%) within 60 days by 3 fold.

Conclusions:

This may suggest that patients transfused prior to surgery, despite having met a specific trigger hemoglobin level earlier, may have been treated before deteriorating to a point that would cause future systemic implications.
The Role of Financial Identity Processes in Financial Behaviors and Financial Well-Being
Authors: Vosylis Rimantas , Sorgente Angela , Lanz Margherita
Published: May 2021

Financial identity formed during emerging adulthood is important for the regulation of youth financial behaviors, decisions, and long-term financial goals. This three-wave short-term longitudinal study investigates how youth develop a distinct manner of approaching and managing personal finances and reveals the structure and dynamics of financial identity development during emerging adulthood. Using the cross-lagged panel model analysis, it also investigates longitudinal reciprocal associations between financial identity processes, financial behaviors, and financial well-being of emerging adults. The sample consists of 533 Lithuanian higher education students (56.8% women; Mage = 18.93, SDage = 0.71) who took part in three assessment waves. The findings support the use of the three-factor model of financial identity formation and show that financial identity formation is shaped by emerging adults’ financial situation and contribute to the formation of financial behaviors and financial well-being. Practical implications of study results are also discussed.
Impact of Before and After Photographs on Parents of Children With Cleft Lip
Authors: Dengre Mranali , Forrest Christopher R. , Ho Emily S.
Published: May 2021

Introduction: Cleft lip with or without palate (CL/P) is a common facial deformity requiring surgical intervention whose aesthetic outcomes are typically represented by Before and After Photographs (BAPhotos). With the growing presence of social media, there are concerns about the role of BAPhotos in plastic surgery and their impact on patient’s expectations. Methods: A retrospective analysis of quality assurance survey and interview data was conducted to explore the impact of BAPhotos on parents and their expectations in the context of CL/P. Results: Thirty-five parents were interviewed regarding use of BAPhotos; 91% viewed BAPhotos on the following platforms: Google (n = 26), Facebook (n = 8), Instagram (n = 4), YouTube (n = 4), Snapchat (n = 1), and Other (n = 11). Half of the parents believed that BAPhotos influenced their treatment expectations and these parents were not less satisfied with their child’s surgical outcome than those who did not perceive being influenced (Mann-Whitney U = 124.5, P = .05). A higher proportion of parents who viewed BAPhotos on social platforms felt that their treatment expectations were influenced by BAPhotos (χ2, X (df = 1) = 4.49, P = .03). Thematic analysis revealed that parents’ emotional reaction to BAPhotos was shaped by the context of the photos; photos on social platforms that include patient stories (ie, Instagram, Facebook) were more often sources of emotional support. Conclusion: This study furthers our understanding of the impact BAPhotos have on parents of children with CL/P and areas of education regarding the dissemination of BAPhotos which have the potential to positively impact viewing of these photos.
Is Irradiated Homologous Costal Cartilage Reliable? A Meta-Analysis of Complication Rates in Rhinoplasty
Authors: Kadakia Nikita , Nguyen Cyrus , Motakef Saba , Hill Michael , Gupta Subhas
Published: May 2021

Background: Irradiated homologous costal cartilage (IHCC) may be a convenient, cost-effective and efficient alternative source of graft material in rhinoplasty; however, a systematic review and meta-analysis on this topic have not been previously performed. Objectives: We sought to summarize and pool data on complications associated with the use of IHCC grafting in rhinoplasty. Methods: A systematic review and meta-analysis was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses criteria. We conducted PubMed, Cochrane, Embase, Web of Science database searches, and screened articles using specific inclusion and exclusion criteria. Pooled complication rates were analyzed using a random-effects model. Results: Of the 13 studies that met criteria for systematic review, 11 studies involving 1017 patients, with 1956 IHCC grafts used, were included in the meta-analysis. Mean follow-up across all studies was 47 months. Overall, the pooled complication rates were 1.14% (95% CI: 0.3%-2.0%) for resorption, 0.5% (95% CI: 0.1%-0.9%) for warping, 1.2% (95% CI: 0.3%-2.1%) for infection, 1.0% (95% CI: 0.1%-2.0%) for mobility, and 0.8% (95% CI: 0.1%-1.6%) for graft removal or replacement. No allergic reactions or systemic disease associated with IHCC use were reported in any of the studies. Conclusions: The overall complications associated with IHCC use in rhinoplasty were very low. Costal cartilage allografts are an area of renewed interest that may represent an alternative to autologous costal cartilage grafting in rhinoplasty due to their low complication rates, convenience, cost-effectiveness, and elimination of donor-site complications.
Concomitant atlantoaxial and atlanto-occipital rotatory dislocation in children: Radiological features, diagnostic pitfalls, and long-term outcome
Authors: Koljonen Paul A , Cheung Kenneth MC
Published: May 2021

While the pathological manifestation of atlantoaxial rotatory dislocation has been well described in the medical literature, the combined dislocation of the atlantoaxial and atlanto-occipital joints, or OAARD – short for occipital-atlantoaxial rotatory dislocation – is a condition which has been poorly elucidated and probably underdiagnosed. We believe that the pathogenesis of combined atlantoaxial and atlanto-occipital dislocation is most likely a result of untreated atlantoaxial rotatory dislocation leading to chronic secondary compensation measures occurring at the occiput-C1 joints. Unique clinical and radiological features lead to difficulty in diagnosis, and conventional treatment algorithms may not apply. This paper describes a combination of clinical and radiological features which can help clinicians correctly diagnose and treat OAARD.
Migration Management and Changes in Mobility Patterns in the North and Central American Region
Authors: Faret Laurent , Téllez María Eugenia Anguiano , Rodríguez-Tapia Luz Helena
Published: May 2021

Since the beginning of the twenty-first century, changes have occurred in the regional dynamics of international migration and in the ways governments manage human mobility. This article argues that the migratory system connecting the three northern countries of Central America (Guatemala, El Salvador, and Honduras) with Mexico and the United States has not been accompanied by regional management of migratory flows. Instead, a succession of government plans and projects reveals a perspective marked by the effects of the “externalization” of US borders, leading to more complex migration routes and increased vulnerability of migrants. The article discusses how externalized control policies influence migratory spaces, routes, and timelines, and leave many stranded in transit countries before they eventually arrive at their intended destinations. Reconsidering the process of mobility in light of migration management policies would appropriately enlarge the traditional economic, social, cultural, and environmental factors that affect migration strategies.
Correlation of End-Tidal Carbon Dioxide with Arterial Carbon Dioxide in Mechanically Ventilated Neonates: A Scoping Review
Authors: Martins Ingra Pereira Monti , Nakato Adriane Muller , Hembecker Paula Karina , Ioshii Sérgio Ossamu , Nohama Percy
Published: May 2021

Monitoring CO2 levels in intubated neonates is highly relevant in the face of complications associated with altered CO2 levels. Thus, this review aims to present the scientific evidence in the literature regarding the correlation between arterial carbon dioxide measured by non-invasive methods in newborns submitted to invasive mechanical ventilation. The search was carried out from January 2020 to January 2021, in the Scopus, Medline, The Cochrane Library, Web of Science, CINAHL and Embase databases. Also, a manual search of the references of included studies was performed. The main descriptors used were: “capnography,” “premature infant,” “blood gas analysis,” and “mechanical ventilation.” As a result, 221 articles were identified, and 18 were included in this review. A total of 789 newborns were evaluated, with gestational age between 22.8 and 42.2 weeks and birth weight between 332 and 4790 g. Capnometry was the most widely used non-invasive method. In general, the correlation and agreement between the methods evaluated in the studies were strong/high. The birth weight did not influence the results. The gestational age of fewer than 37 weeks implied, in its majority, a moderate correlation and agreement. Therefore, we can conclude that there was a predominance of a strong correlation between arterial blood gases and non-invasive methods, although there are variations found in the literature. Even so, the results were promising and may provide valuable data for future studies, which are necessary to consolidate non-invasive methods as a reliable and viable alternative to arterial blood gasometry.
Dengvaxia: the world’s first vaccine for prevention of secondary dengue
Authors: Tully Danielle , Griffiths Carrie L.
Published: May 2021

The objective of this manuscript was to review and evaluate the efficacy and safety data of Dengvaxia for the treatment of severe secondary dengue infection. Dengvaxia is the brand name for chimeric yellow fever-dengue-tetravalent dengue vaccine (CYD-TDV). A literature search through PubMed was conducted using the keywords ‘dengue vaccine’, ‘Dengvaxia’, ‘efficacy’ or ‘safety’. Trials were selected if they appropriately assessed vaccine efficacy or were related to the vaccine approval process for CYD-TDV. Findings from this review underline the evolution of vaccine efficacy against seroprevalence, serotypes, and various ages. There are currently no preventive measures or antiviral treatments for dengue; CYD-TDV is the first vaccine to receive US Food and Drug Administration approval. Protective responses seen with the complete administration of CYD-TDV can become a standardized tool as part of a world vaccination program.
The interplay between maternal childhood maltreatment, parental coping strategies as well as endangered parenting behavior during the current SARS-CoV-2 pandemic
Authors: Köhler-Dauner Franziska , Clemens Vera , Hildebrand Katherina , Ziegenhain Ute , Fegert Jörg M.
Published: May 2021

The SARS-CoV-2-pandemic is associated different challenges, especially for families. The disruption and challenges require parents to develop strategies to cope with the current situation. One factor that may influence how parents deal with pandemic-associated stressors are experiences of parental childhood maltreatment (CM), which represent a high risk of engaging in endangered parenting. A decisive candidate for the connection between parental CM and the transgenerational transmission could be the parental ability to employ coping strategies. Mothers of a well-documented birth cohort for investigating the pathways leading to resilience or vulnerability in the transgenerational transmission of CM were imbedded in an online “SARS-CoV-2 pandemic survey” assessing maternal ability for coping strategies and the dimension of endangered maternal parenting behavior. 91 mothers completed the online survey. To describe the maternal CM, data from a longitudinal survey were used. Our mediation analysis shows a significant positive relationship between the sum of maternal CM experiences, lack of coping strategies and endangered parenting behavior. This suggests a partial mediation of the association between CM and endangered parenting behavior as the direct effect remained significant when the maternal lack of coping strategies was included as the mediator. Parental CM is a risk factor for coping with stressful situation as well as for endangered parenting behavior. The ability to deal with stress seems to have a significant influence on the context of a possible transgenerational transmission of CM. The results underline the need to consider the unique needs of families with children and to support them as to how to overcome the current crisis.
Challenges of the Blue Economy: evidence and research trends
Authors: Martínez-Vázquez Rosa María , Milán-García Juan , de Pablo Valenciano Jaime
Published: May 2021

Background

The Blue Economy is a recent field of study that encompasses economic activities that depend on the sea, often associated with other economic sectors, including tourism, maritime transport, energy and fishing. Blue growth supports the sustainable growth of the maritime and marine sectors as the oceans and seas are engines of the global economy and have great potential for growth and innovation. This article undertakes a bibliometric analysis in the terms of Blue Economy (BE), Maritime Economy (MAE), Ocean Economy (OE), Marine Economy (ME), and Blue Growth (BG) to analyze the scientific production of this field of study. Analysis of the authors’ definitions of BE, BG, ME and OE provides interesting relationships divided into sustainability and governance; economics and ecosystem protection; industrial development and localization; and the growth of the ocean economy, with development as the central axis that encompasses them. The main contribution is to find out if there is a link between the BE and the CE through the keyword study.

Results

The results show a significant increase in articles and citations over the last decade. The articles address the importance of different sectors of BE and the interest of governments in promoting it for the development of their national economies. Using bibliometric mapping tools (VOSviewer), it is possible to find possible links between concepts such as CE and BE through the BG and to visualize trending topics for future research. Nascent and future research trends include terms such as small-scale fisheries, aquatic species, biofuel, growth of the coastal BE, internationalization and blue degrowth (BD), the latter approaches aspects of BG from a critical perspective.

Conclusions

In conclusion, it highlights the need for alliances between the sectors that compose BG with the incorporation of the CE in order to achieve a sustainable BE in both developed and developing countries. Through the keyword analysis it is shown that the BG strategy is the bridge between the BE and the CE. The CE presents itself as a promising alternative that could mitigate tensions between stakeholders who support both growth and degrowth positions.
Estimating commuting modal split by using the Best-Worst Method
Authors: Duleba Szabolcs , Moslem Sarbast , Esztergár-Kiss Domokos
Published: May 2021

Method

This paper endeavors to introduce a new approach to modal split estimation. In the frame of the research, a customized model of the recently created Best-Worst Method (BWM) is applied to evaluate mode choice alternatives by transport experts. The integrated BWM model is tested on a real-world case study in Budapest, the capital of Hungary, where a small number of selected experts estimate the modal split of three different groups clustered based on the distance of their commuting.

Results

The results clearly demonstrate the popularity of public transport among all groups, while car is estimated to be used primarily by short- and mid-distance commuters. The coherence of the responses is tested along with sensitivity analysis and rank correlation comparison. Moreover, the final results are compared to the official modal split data of the city.

Recommendations

Based on the findings, it can be concluded that the application of BWM results in competitive accuracy compared to the mainstream methodologies, moreover BWM needs significantly less cost and time effort during the survey procedure.
An improved DNA-binding hot spot residues prediction method by exploring interfacial neighbor properties
Authors: Zhang Sijia , Wang Lihua , Zhao Le , Li Menglu , Liu Mengya , Li Ke , Bin Yannan , Xia Junfeng
Published: May 2021

Background

DNA-binding hot spots are dominant and fundamental residues that contribute most of the binding free energy yet accounting for a small portion of protein–DNA interfaces. As experimental methods for identifying hot spots are time-consuming and costly, high-efficiency computational approaches are emerging as alternative pathways to experimental methods.

Results

Herein, we present a new computational method, termed inpPDH, for hot spot prediction. To improve the prediction performance, we extract hybrid features which incorporate traditional features and new interfacial neighbor properties. To remove redundant and irrelevant features, feature selection is employed using a two-step feature selection strategy. Finally, a subset of 7 optimal features are chosen to construct the predictor using support vector machine. The results on the benchmark dataset show that this proposed method yields significantly better prediction accuracy than those previously published methods in the literature. Moreover, a user-friendly web server for inpPDH is well established and is freely available athttp://bioinfo.ahu.edu.cn/inpPDH.

Conclusions

We have developed an accurate improved prediction model, inpPDH, for hot spot residues in protein–DNA binding interfaces by given the structure of a protein–DNA complex. Moreover, we identify a comprehensive and useful feature subset including the proposed interfacial neighbor features that has an important strength for identifying hot spot residues. Our results indicate that these features are more effective than the conventional features considered previously, and that the combination of interfacial neighbor features and traditional features may support the creation of a discriminative feature set for efficient prediction of hot spot residues in protein–DNA complexes.
Genome-wide detection of CNVs and their association with performance traits in broilers
Authors: Fernandes Anna Carolina , da Silva Vinicius Henrique , Goes Carolina Purcell , Moreira Gabriel Costa Monteiro , Godoy Thaís Fernanda , Ibelli Adriana Mércia Guaratini , Peixoto Jane de Oliveira , Cantão Maurício Egídio , Ledur Mônica Corrêa , de Rezende Fernanda Marcondes , Coutinho Luiz Lehmann
Published: May 2021

Background

Copy number variations (CNVs) are a major type of structural genomic variants that underlie genetic architecture and phenotypic variation of complex traits, not only in humans, but also in livestock animals. We identified CNVs along the chicken genome and analyzed their association with performance traits. Genome-wide CNVs were inferred from Affymetrix® high density SNP-chip data for a broiler population. CNVs were concatenated into segments and association analyses were performed with linear mixed models considering a genomic relationship matrix, for birth weight, body weight at 21, 35, 41 and 42 days, feed intake from 35 to 41 days, feed conversion ratio from 35 to 41 days and, body weight gain from 35 to 41 days of age.

Results

We identified 23,214 autosomal CNVs, merged into 5042 distinct CNV regions (CNVRs), covering 12.84% of the chicken autosomal genome. One significant CNV segment was associated with BWG on GGA3 (q-value = 0.00443); one significant CNV segment was associated with BW35 (q-value = 0.00571), BW41 (q-value = 0.00180) and BW42 (q-value = 0.00130) on GGA3, and one significant CNV segment was associated with BW on GGA5 (q-value = 0.00432). All significant CNV segments were verified by qPCR, and a validation rate of 92.59% was observed. These CNV segments are located nearby genes, such asKCNJ11, MyoD1andSOX6, known to underlie growth and development. Moreover, gene-set analyses revealed terms linked with muscle physiology, cellular processes regulation and potassium channels.

Conclusions

Overall, this CNV-based GWAS study unravels potential candidate genes that may regulate performance traits in chickens. Our findings provide a foundation for future functional studies on the role of specific genes in regulating performance in chickens.
Manometrically jackhammer esophagus with fluoroscopically/endoscopically distal esophageal spasm: a case report
Authors: Sirinawasatien Apichet , Sakulthongthawin Pallop
Published: May 2021

Background

Jackhammer esophagus is a rare esophageal motility disorder that can result in dysphagia, chest pain, and gastro-esophageal reflux symptoms. High-resolution manometry is the gold standard for diagnosis, while corkscrew esophagus on upper gastrointestinal endoscopy is an uncommon manifestation.

Case presentation

72-year-old man who presented with progressive dysphagia for three months without symptoms of chest pain or heartburn. Initial workup showed a corkscrew esophagus on upper gastrointestinal endoscopy; subsequently, high-resolution manometry revealed an esophago-gastric junction outflow obstruction with hypercontractile (jackhammer) esophagus. Treatment with calcium channel blockers and proton pump inhibitors was successful and relieved his symptoms near completion.

Conclusions

Even though the corkscrew esophagus is typically for distal esophageal spasm, the hypercontractile (jackhammer) esophagus can appear. The high-resolution manometry can help to distinguish each specific motility disorder.
Needs of older persons living in long-term care institutions: on the usefulness of cluster approach
Authors: Tobis Sławomir , Jaracz Krystyna , Kropińska Sylwia , Talarska Dorota , Hoe Juanita , Wieczorowska-Tobis Katarzyna , Suwalska Aleksandra
Published: May 2021

Background

Long-term care units’ residents do not constitute a homogeneous population. Providing effective care, tailored to individual needs, is crucial in this context. It can be facilitated by suitable tools and methods, which include needs assessment along with the physical, psychological and social aspects of care. We thus applied a cluster approach to identify their putative groupings to enable the provision of tailored care.

Methods

The needs of 242 residents of care homes in four Polish cities (Poznan, Wroclaw, Bialystok and Lublin), aged 75–102 years (184 females), with the Mini-Mental State Examination (MMSE) score ≥ 15 points, were assessed with the CANE (Camberwell Assessment of Need for the Elderly) questionnaire. Their independence in activities of daily living was evaluated by the Barthel Index (BI), and symptoms of depression by the Geriatric Depression Scale (GDS). The results of MMSE, BI and GDS were selected as variables for K-means cluster analysis.

Results

Cluster 1 (C1), n = 83, included subjects without dementia according to MMSE (23.7 ± 4.4), with no dependency (BI = 85.8 ± 14.4) and no symptoms of depression (GDS = 3.3 ± 2.0). All subjects of cluster 2 (C2), n = 87, had symptoms of depression (GDS = 8.9 ± 2.1), and their MMSE (21.0 ± 4.0) and BI (79.8 ± 15.1) were lower than those in C1 (p = 0.006 and p = 0.046, respectively). Subjects of cluster 3 (C3), n = 72, had the lowest MMSE (18.3 ± 3.1) and BI (30.6 ± 18,8, p < 0.001 vs. C1 & C2). Their GDS (7.6 ± 2.3) were higher than C1 (p < 0.001) but lower than C2 (p < 0.001). The number of met needs was higher in C2 than in C1 (10.0 ± 3.2 vs 8.2 ± 2.7, p < 0.001), and in C3 (12.1 ± 3.1) than in both C1 and C2 (p < 0.001). The number of unmet needs was higher in C3 than in C1 (1.2 ± 1.5 vs 0.7 ± 1.0, p = 0.015). There were also differences in the patterns of needs between the clusters.

Conclusions

Clustering seems to be a promising approach for use in long-term care, allowing for more appropriate and optimized care delivery. External validation studies are necessary for generalized recommendations regarding care optimization in various regional perspectives.
Incidental extraspinal imaging findings on adult EOS full body radiographs: prevalence and clinical importance
Authors: Wood Lily , Martin Christopher , Polly David , Luchsinger Samuel , Takahashi Takashi
Published: May 2021

Purpose

The purpose of this study was to review our institutional experience with the EOS machine in order to identify the incidence and clinical significance of incidental extraspinal findings (IESF) in an adult spinal deformity population.

Methods

Our institutional database was queried for all full-length standing radiographs generated by the EOS machine. Dictations were reviewed and the number of incidental extraspinal findings were classified using a previously described system. All findings related to the spine were excluded. A subset of electronic medical records were reviewed to determine further workup for individual findings of suspected clinical significance.

Results

Original database query based on radiology reports returned a total of 1857 EOS studies. Duplicate studies, studies without the entire body, and patients with more than 1 study during the search period were excluded. 503 patient studies (55.5% female, mean age 59-years-old, range 18 to 91-years-old) met inclusion criteria. The overall rate of incidental extraspinal findings in our study was 60.4% (304 findings in 503 patients). Most findings were classified as Minor. The rate of Major and Moderate findings was 4.8%. The final rate of clinically significant incidental extraspinal findings was 0.8% and included 3 presumed metastatic lesions in long bones and 1 pulmonary nodule.

Conclusion

To our knowledge this is the first study that reports the rate of incidental extraspinal findings on full body EOS studies. We report a low rate (0.8%) of clinically significant incidental extraspinal findings which is lower than that of CT or MRI. Further research is warranted in comparing EOS and standard radiography.
Higher CD19+CD25+ Bregs are independently associated with better graft function in renal transplant recipients
Authors: Ibrahim Eman H. , Aly Mostafa G. , Opelz Gerhard , Morath Christian , Zeier Martin , Süsal Caner , Sayed Douaa M. , Hassan Eman , Ekpoom Naruemol , Daniel Volker
Published: May 2021

Background

The Identification of B cell subsets with regulatory functions might open the way to new therapeutic strategies in the field of transplantation, which aim to reduce the dose of immunosuppressive drugs and prolong the graft survival. CD25 was proposed as a marker of a B-cell subset with an immunosuppressive action termed Bregs. The effect of CD19 + CD25 + Bregs on graft function in renal transplant recipients has not yet been elucidated. We investigated a potential impact of CD19 + CD25 + Bregs on renal graft function as well as a possible interaction of CD19 + CD25 + Bregs with peripheral Tregs in healthy controls, end-stage kidney disease patients (ESKD), and renal transplant recipients. Moreover, we aimed to investigate the association of CD19 + CD25 + Bregs with serum IL-10, TGF-ß1, and IFN-γ in the same study groups.

Method

Thirty-one healthy controls, ninety renal transplant recipients, and eighteen ESKD patients were enrolled. We evaluated the CD19 + CD25 + Bregs and Treg absolute counts. Next, we investigated CD19 + CD25 + Bregs as predictors of good graft function in multiple regression and ROC analyses. Finally, we evaluated the association between CD19 + CD25+ Bregs and serum IL-10, TGF-ß, and IFN-γ.

Results

ESKD patients and renal transplant recipients showed lower counts of CD19 + CD25+ Bregs compared to healthy controls (p < 0.001). Higher CD19 + CD25+ Breg counts were independently associated with a better GFR in renal transplant recipients (unstandardized B coefficient = 9,p = 0.02). In these patients, higher CD19 + CD25+ Bregs were independently associated with higher Treg counts (unstandardized B = 2.8,p = 0.004). In ROC analysis, cut-offs for CD19 + CD25 + Breg counts and serum TGF-ß1 of 0.12 cell/μl and 19,635.4 pg/ml, respectively, were shown to provide a good sensitivity and specificity in identifying GFR ≥ 30 ml/min (AUC = 0.67, sensitivity 77%, specificity 43%; AUC = 0.65, sensitivity 81%, specificity 50%, respectively). Finally, a significant positive association between CD19 + CD25+ Bregs and TGF-ß1 was shown in renal transplant recipients (r = 0.255,p = 0.015).

Conclusions

Our findings indicate that higher counts of CD19 + CD25+ Bregs are independently associated with better renal function and higher absolute Treg counts in renal transplant recipients.
Characteristics, clinical and laboratory data and outcomes of pregnant women with confirmed SARS-CoV-2 infection admitted to Al-Zahra tertiary referral maternity center in Iran: a case series of 24 patients
Authors: Vaezi Maryam , Mirghafourvand Mojgan , Hemmatzadeh Shahla
Published: May 2021

Background

Physiological changes during pregnancy put pregnant women at higher risk for COVID-19 complications. The objective of this study was to evaluate clinical and laboratory characteristics and outcomes of 24 COVID-19 pregnant patients and their newborns referred to the Al-Zahra tertiary maternity hospital in Tabriz, Iran.

Methods

Clinical records of 24 COVID-19 confirmed pregnant patients were retrospectively reviewed from10 March 2020 to 15 April 2020. Vertical transition was assessed through neonatal pharyngeal swab samples. The study has been approved by the Tabriz University Medical Ethics Committee (IR.TBZMED.REC.1399.497).

Results

There were 24 hospitalized cases with clinical symptoms and confirmed diagnosis of COVID-19. The mean age of cases was 26.5 years; most were nulliparous (54.2%), in their third trimester (62.5%) and were in the type A blood group. Clinical symptoms in order of prevalence were cough, fever, dyspnea, myalgia, anosmia, and diarrhea. Oxygen saturation (SpO2) in 70.8% cases was in the normal range (greater than 93%). The risk of premature labor or abortion in cases showed no increase. 12 cases were in ongoing normal status; on follow up, 11 cases had delivered their babies at term and one had ended in IUFD because of pregnancy-induced hypertension. All delivered babies were healthy. Caesarean section in all cases was performed under obstetric indications or maternal demand, and no relation was found between COVID-19 and Caesarean delivery. Neonatal outcomes according to gestational age in 8 cases out of 11 (72.72%) were desirable; neonatal morbidity and mortality resulted from pregnancy complications. Blood pH in 6 neonates was assessed due to immaturity and NICU admission, all of which were in normal ranges except one case related to HELLP syndrome. There was no evidence of vertical transmission.

Conclusions

Findings suggest that clinical symptoms in pregnancy were similar to non-pregnant women, no rise in risk of premature labor or abortion was seen, and vertical transmission was not observed in none of cases. Lymphopenia was the leading laboratory change. Given asymptomatic cases despite severe forms of infection in pregnancies, we propose screening in all suspected cases. All placentas and newborns should be tested in the field for vertical transmission.
Progress towards Every Newborn Action Plan (ENAP) implementation in Iran: obstacles and bottlenecks
Authors: Mirbaha-Hashemi Fariba , Tayefi Batool , Rampisheh Zahra , Tehrani-Banihashemi Arash , Ramezani Mozhdeh , Khalili Narjes , Pournik Omid , Taghizadeh-Asl Rahim , Habibelahi Abbas , Heidarzadeh Mohammad , Moradi-Lakeh Maziar
Published: May 2021

Background

Neonatal mortality accounts for more than 47% of deaths among children under five globally but proper care at and around the time of birth could prevent about two-thirds of these deaths. The Every Newborn Action Plan (ENAP) offers a plan and vision to improve and achieve equitable and high-quality care for mothers and newborns. We applied the bottleneck analysis tool offered by ENAP to identify obstacles and bottlenecks hindering the scale-up of newborn care across seven health system building blocks.

Methods

We applied the every newborn bottleneck analysis tool to identify obstacles hindering the scale-up of newborn care across seven health system building blocks. We used qualitative methods to collect data from five medical universities and their corresponding hospitals in three provinces. We also interviewed other national experts, key informants, and stakeholders in neonatal care. In addition, we reviewed and qualitatively analyzed the performance report of neonatal care and services from 16 medical universities around the country.

Results

We identified many challenges and bottlenecks in the scale-up of newborn care in Iran. The major obstacles included but were not limited to the lack of a single leading and governing entity for newborn care, insufficient financial resources for neonatal care services, insufficient number of skilled health professionals, and inadequate patient transfer.

Conclusions

To address identified bottlenecks in neonatal health care in Iran, some of our recommendations were as follows: establishing a single national authorizing and leading entity, allocating specific budget to newborn care, matching high-quality neonatal health care providers to the needs of all urban and rural areas, maintaining clear policies on the distribution of NICUs to minimize the need for patient transfer, and using the available and reliable private sector NICU ambulances for safe patient transfer.
Prenatal diagnosis of Meier-Gorlin syndrome 7: a case presentation
Authors: Li Xia , Zhang Lan-Zhen , Yu Lin , Long Zhao-Lua , Lin An-Yun , Gou Chen-Yu
Published: May 2021

Background

Meier-Gorlin syndrome 7 (MGS7) is a rare autosomal recessive condition. We reported a fetus diagnosed with Meier-Gorlin syndrome 7. The antenatal sonographic images were presented, and compound heterozygous mutations of CDC45 on chromosome 22 were identified by whole-exome sequencing (WES).

Case presentation

Fetal growth restriction (FGR), craniosynostosis, and brachydactyly of right thumb were found in a fetus of 28th gestational weeks. The fetus was diagnosed as MGS7 clinically. After extensive counseling, the couple opted for prenatal diagnosis by cordocentesis and termination of pregnancy. Karyotype analysis and WES were performed. Chromosomal karyotyping showed that the fetus was 46, XY. There were 2 mutations of CDC45, the causal gene of MGS7 on chromosome 22, which were inherited from the couple respectively were identified by WES. Facial dysmorphism, brachydactyly of right thumb, and genitalia abnormally were proved by postpartum autopsy, and craniosynostosis was confirmed by three-dimensional computed tomography (3D-CT) reconstruction.

Conclusions

It is possible to detect multiple clinical features of Meier-Gorlin syndrome in prenatal sonography. Deteriorative FGR complicated with craniosynostosis indicates MGS7. Combination of 2D and 3D ultrasonography helps to detect craniosynostosis. The affected fetus was confirmed a compound heterozygote of CDC45 related MGS by whole-exome sequencing, which is critical in identifying rare genetic diseases.
The Will Rogers phenomenon, breast cancer and race
Authors: Nittala Mary R. , Mundra Eswar K. , Packianathan S. , Mehta Divyang , Smith Maria L. , Woods William C. , McKinney Shawn , Craft Barbara S. , Vijayakumar Srinivasan
Published: May 2021

Background

The Will Rogers phenomenon [WRP] describes an apparent improvement in outcome for patients’ group due to tumor grade reclassification. Staging of cancers is important to select appropriate treatment and to estimate prognosis. The WRP has been described as one of the most important biases limiting the use of historical cohorts when comparing survival or treatment. The main purpose of this study is to assess whether the WRP exists with the move from the AJCC 7th to AJCC 8th edition in breast cancer [BC] staging, and if racial differences are manifested in the expression of the WRP.

Methods

This is a retrospective analysis of 300 BC women (2007–2017) at an academic medical center. Overall survival [OS] and disease-free survival [DFS] was estimated by Kaplan-Meier analysis. Bi and multi-variate Cox regression analyses was used to identify racial factors associated with outcomes.

Results

Our patient cohort included 30.3% Caucasians [Whites] and 69.7% African-Americans [Blacks]. Stages I, II, III, and IV were 46.2, 26.3, 23.1, and 4.4% of Whites; 28.7, 43.1, 24.4, and 3.8% of Blacks respectively, in anatomic staging (p = 0.043). In prognostic staging, 52.8, 18.7, 23, and 5.5% were Whites while 35, 17.2, 43.5, and 4.3% were Blacks, respectively (p = 0.011).

A total of Whites (45.05% vs. 47.85%) Blacks, upstaged. Whites (16.49% vs. 14.35%) Blacks, downstaged. The remaining, 38.46 and 37.79% patients had their stages unchanged.

With a median follow-up of 54 months, the Black patients showed better stage-by-stage 5-year OS rates using 8th edition compared to the 7th edition (p = 0.000). Among the Whites, those who were stage IIIA in the 7th but became stage IB in the 8th had a better prognosis than stages IIA and IIB in the 8th (p = 0.000). The 8th showed complex results (p = 0.176) compared to DFS estimated using the 7th edition (p = 0.004).

Conclusion

The WRP exists with significant variability in the move from the AJCC 7th to the 8th edition in BC staging (both White and Black patients). We suggest that caution needs to be exercised when results are compared across staging systems to account for the WRP in the interpretation of the data.
Italian onco-haematological patients’ preferences in bad news communication: a preliminary investigation
Authors: Bongelli Ramona , Bertolazzi Alessia , Piccioni Ludovica , Burro Roberto
Published: May 2021

Background

The manner in which bad news is communicated in oncological contexts can affect patients’ engagement, their coping strategies and therapeutic compliance. Although this topic has been broadly investigated since the nineties, to the best of our knowledge, little has been written about Italian patients’ experiences and preferences concerning what the oncologists should disclose and how they should intimate patients about their health conditions in different stages of oncological disease.

Methods

In an attempt to fill this gap, an online self-report questionnaire was administered to a sample of Italian onco-haematological patients. Data were analysed both qualitatively (by a content analysis) and quantitatively (by descriptive analysis and Generalized Linear Mixed Model).

Results

While the majority of patients elected to know the truth during their clinical course, a polarisation between those arguing that the truth be fully disclosed and those claiming that the truth be communicated in a personalised way was observed at the attitude level. Among demographic variables accounted for, age seems to most affect patients’ preferences. Indeed, younger Italian patients decidedly reject concealment of the truth, even when justified by the beneficence principle. This result could be a reaction to some protective and paternalistic behaviours, but it could even reflect a relation according to which the more the age increases the more the fear of knowing rises, or an intergenerational change due to different ways of accessing the information. The qualitative analysis of the final open-ended question revealed three main sources of problems in doctor-patient encounters: scarcity of time, absence of empathy and use of not-understandable language that makes it difficult for patients to assume a more active role.

Conclusions

The results of the present study, which represents a preliminary step in the subject investigation, will be deployed for the construction and validation of a more sophisticated questionnaire. Better awareness of the Italian onco-haematological patients’ preferences concerning bad news communication and truth-telling could be useful in adopting more suitable medical practices and improving doctor-patient relationships.
MR-guided microwave ablation of hepatocellular carcinoma (HCC): is general anesthesia more effective than local anesthesia?
Authors: Li Zhaonan , Wang Chaoyan , Li Jing , Liu Zaoqu , Jiao Dechao , Han Xinwei
Published: May 2021

Background

Percutaneous magnetic resonance-guided (MR-guided) MWA procedures have traditionally been performed under local anesthesia (LA) and sedation. However, pain control is often difficult to manage, especially in some cases when the tumor is large or in a specific location, such as near the abdominal wall or close to the hepatic dome. This study retrospectively compared the results of general anesthesia (GA) and local anesthesia (LA) for MR-guided microwave ablation (MWA) in patients with hepatocellular carcinoma (HCC ≤ 5.0 cm) to investigate whether different anesthesia methods lead to different clinical outcomes.

Methods

The results of the analysis include procedure-related complications, imaging response, and the time to complete two sets of procedures. According to the type of anesthesia, the Kaplan-Meier method was used to compare the local tumor progression (LTP) of the two groups who underwent MR-guided MWA.

Results

All patients achieved technical success. The mean ablation duration of each patient in the GA group and LA group was remarkably different (P = 0.012). Both groups had no difference in complications or LTP (bothP > 0.05). Notably, the tumor location (challenging locations) and the number of lesions (2–3 lesions) could be the main factors affecting LTP (p = 0.000,p = 0.015). Univariate Cox proportional hazard regression indicated that using different anesthesia methods (GA and LA) was not associated with longer LTP (P = 0.237), while tumor location (challenging locations) and the number of lesions (2–3 lesions) were both related to shorter LTP (P = 0.000,P = 0.020, respectively). Additionally, multivariate Cox regression further revealed that the tumor location (regular locations) and the number of lesions (single) could independently predict better LTP (P = 0.000,P = 0.005, respectively).

Conclusions

No correlation was observed between GA and LA for LTP after MR-guided MWA. However, tumors in challenging locations and the number of lesions (2–3 lesions) appear to be the main factors affecting LTP.