bluuebunny/crossref_metadata_2025 huggingface dataset:
A critical review of urological practice during the coronavirus disease 2019 pandemic and the emerging role of telemedicine
Authors: Fonseka T , Ellis R , Salem HA
Published: September 2020

The recent coronavirus disease 2019 outbreak was met by major reconfiguration of Urology health care services with cancellation of elective surgery and deployment of non face to face models for providing outpatient care. Urologists were faced with challenging decisions to stratify their patients into risk groups for assigning the appropriate, safe method of care delivery. Guidelines were swiftly produced by Urological societies to enhance this process but there has been limited uniformity and multiple publications from several institutions. We have conducted this critical review to appraise the current recommendations for providing Urology care during the coronavirus disease 2019 pandemic. The secondary outcome was identifying novel models for care delivery. Results were presented in tables categorising the recommendation by disease and its risk stratification. Results were presented according to the aspect of care: triage for surgery, operative, post-operative and outpatient care. This review reported differing recommendations from Urological societies on the prioritisation of services with limited consideration for individual patient-related factors. Telemedicine has been utilised well during the pandemic to maintain patient pathways. The role of telemedicine in future Urological practice looks promising and more development is required.

Level of evidence:

Not applicable.
Turner syndrome through the lens of a gynaecologist
Authors: Jivraj Shehnaaz , Stillwell Susan
Published: September 2020

Turner syndrome is a rare condition affecting 1 in 2500 female births and yet is the most common sex chromosome abnormality in women. Described as a cradle-to-grave condition, it requires life-long multidisciplinary management. Accelerated atresia of the primordial follicular pool leads to premature ovarian insufficiency, which is an almost inevitable feature of Turner syndrome, especially in 45XO karyotype. Many patients will have had their diagnosis made in childhood and require paediatric endocrinology management especially for induction of puberty. At the age of 18, patients may then be transitioned to an adult service. Continuation of multidisciplinary care for these women requires input from specialist services in menopause care, reproductive medicine and high-risk pregnancy, cardiology, endocrinology, bone health and psychosocial care. A gynaecologist may take on the mantle of lead clinician especially during the perceived reproductive years of a Turner syndrome patient’s life, hinging together management input from other disciplines. This review attempts to summarise an overview of the involvement of such a multidisciplinary team in the management of a single but complex condition, through the lens of a gynaecologist.
Smart home technology solution for night-time wandering in persons with dementia
Authors: Ault Laura , Goubran Rafik , Wallace Bruce , Lowden Hailey , Knoefel Frank
Published: September 2020

Introduction

More than half of persons with dementia will experience night-time wandering, increasing their risk of falls and unattended home exits. This is a major predictor of caregiver burnout and one of the major causes of early institutionalization.

Methods

Using smart home technologies such as sensors, smart bulbs, pressure mats and speakers, the Night-time Wandering Detection and Diversion system is designed to assist caregivers and persons with dementia that are at risk of wandering at night. Being placed in homes around Ottawa for a 12-week trial, the system allows caregivers to rest peacefully in the night, as it detects when the person with dementia gets out of bed and automatically provides cue lighting to guide them safely to the washroom. The system also uses prerecorded audio prompts, if they venture from the bedroom, only waking the caregiver when the person with dementia opens an exit door.

Results

Thus far, the average depression and anxiety in caregivers have been improved after the 12 weeks, and most have said that they sleep more peacefully.

Conclusion

The system has proven successful in supporting the safety of persons with dementia as well as their caregivers.
Why do Norwegian parents choose free Christian schools for their children?
Authors: Hagesæther Gunhild , Sandsmark Signe
Published: September 2020

This article is based on replies from over 2,200 parents with children in Norwegian Christian free schools. More than half of them say that they have chosen the school because it is Christian. About the same number give the reasons that the school is academically good, has a friendly atmosphere, and their child wanted to attend that school. The parents of the youngest more often mention the school’s Christian basis. Of those who most actively practise their faith, more than four in five give this basis as one of their reasons for choosing the school.
Marginal Accuracy of Milled Versus Cast Cobalt Chromium Alloys in Long Span Implant-Supported Frameworks: A Systematic Review and Meta-analysis
Authors: Shah Simone , Nallaswamy Deepak , Ganapathy Dhanraj
Published: September 2020

Aim:

To assess if milled cobalt chromium (Co-Cr) alloy offers significantly better marginal accuracy than cast Co-Cr alloy for screw-retained long-span dental implant framework.

Materials and Methods:

A search PICO was formulated using suitable keywords and an electronic search was initiated. The databases of PubMed, Cochrane Library, Google Scholar and Embase were searched for related articles. Bibliographies of randomised control trials and reviews, identified in the electronic search, were analysed for studies published outside the electronically searched journals. Electronic search identified 26 studies. A total of 16 studies were eliminated after reading the abstracts. Out of the remaining 10 studies, 3 were eliminated based on the inclusion and exclusion criteria, and finally 7 studies were finalised for systematic review.

Results

Data were extracted from the included studies and analysed. The obtained data were suitable for meta-analysis, which showed an overall effect size z = 4.97 ( P < .001) at 95% CI showing a significant statistical difference between milled and cast Co-Cr frameworks.

Conclusion:

Milled cobalt chromium frameworks are significantly more accurate than cast frameworks for long-span implant-supported frameworks used in dental prosthetic rehabilitation. More randomized controlled trials need to be conducted with a larger sample size to get a more authentic conclusion in a clinical scenario.
Three-dimensional, Scaffold-Free, Autologous Chondrocyte Transplantation: A Systematic Review
Authors: Riedl Moritz , Vadalà Gianluca , Papalia Rocco , Denaro Vincenco
Published: September 2020

Background:

A 3-dimensional, scaffold-free, and completely autologous form of chondrocyte transplantation (ACT3D) has been developed and applied in clinical practice in the past decade to overcome disadvantages of previous-generation procedures.

Purpose:

To document and analyze the available literature on the results of ACT3D in the treatment of articular chondral lesions in the knee and hip joints.

Study Design:

Systematic review; Level of evidence, 4.

Methods:

All studies published in English addressing ACT3D were identified and included those that fulfilled the following criteria: (1) level 1 through 4 evidence, (2) measures of radiological or functional/clinical outcome, and (3) outcome related to cartilage lesions of the knee and hip joints.

Results:

A total of 10 studies were selected: 2 randomized controlled trials, 1 cohort study, and 7 case series. The studies revealed significant increases in patients’ subjective quality of life, satisfaction, pain reduction, and improvement in joint function at short- to medium-term follow-up. Magnetic resonance imaging-assisted examination and second-look arthroscopy showed a hyaline-like repair tissue with a high degree of defect filling and integration.

Conclusion:

ACT3D shows promising results in the therapy of articular cartilage defects in the knee as well as in the hip, but well-designed, long-term studies are lacking. ACT3D might have relevant advantages over common matrix-associated autologous chondrocyte transplantation products, but systematic evaluation and randomized controlled studies are crucial to verify the potential of this tissue-engineered approach.
Teclistamab is an active T cell–redirecting bispecific antibody against B-cell maturation antigen for multiple myeloma
Authors: Pillarisetti Kodandaram , Powers Gordon , Luistro Leopoldo , Babich Alexander , Baldwin Eric , Li Yingzhe , Zhang Xiaochun , Mendonça Mark , Majewski Nate , Nanjunda Rupesh , Chin Diana , Packman Kathryn , Elsayed Yusri , Attar Ricardo , Gaudet François
Published: September 2020

B-cell maturation antigen (BCMA), a member of the tumor necrosis factor family of receptors, is predominantly expressed on the surface of terminally differentiated B cells. BCMA is highly expressed on plasmablasts and plasma cells from multiple myeloma (MM) patient samples. We developed a BCMAxCD3 bispecific antibody (teclistamab [JNJ-64007957]) to recruit and activate T cells to kill BCMA-expressing MM cells. Teclistamab induced cytotoxicity of BCMA+ MM cell lines in vitro (H929 cells, 50% effective concentration [EC50] = 0.15 nM; MM.1R cells, EC50 = 0.06 nM; RPMI 8226 cells, EC50 = 0.45 nM) with concomitant T-cell activation (H929 cells, EC50 = 0.21 nM; MM.1R cells, EC50 = 0.1 nM; RPMI 8226 cells, EC50 = 0.28 nM) and cytokine release. This activity was further increased in the presence of a γ-secretase inhibitor (LY-411575). Teclistamab also depleted BCMA+ cells in bone marrow samples from MM patients in an ex vivo assay with an average EC50 value of 1.7 nM. Under more physiological conditions using healthy human whole blood, teclistamab mediated dose-dependent lysis of H929 cells and activation of T cells. Antitumor activity of teclistamab was also observed in 2 BCMA+ MM murine xenograft models inoculated with human T cells (tumor inhibition with H929 model and tumor regression with the RPMI 8226 model) compared with vehicle and antibody controls. The specific and potent activity of teclistamab against BCMA-expressing cells from MM cell lines, patient samples, and MM xenograft models warrant further evaluation of this bispecific antibody for the treatment of MM. Phase 1 clinical trials (monotherapy, #NCT03145181; combination therapy, #NCT04108195) are ongoing for patients with relapsed/refractory MM.
Treatment of severe stable COPD: the multidimensional approach of treatable traits
Authors: van Dijk Marlies , Gan Christiaan T. , Koster T. David , Wijkstra Peter J. , Slebos Dirk-Jan , Kerstjens Huib A.M. , van der Vaart Hester , Duiverman Marieke L.
Published: September 2020

Now that additional treatment options for severe chronic obstructive pulmonary disease (COPD) have emerged in recent years, patients with severe COPD should not be left in the rather hopeless situation of �there is nothing to improve� any more. Inertia or fatalism is a disservice to our patients. Ranging from advanced care planning to quite intense and demanding therapies such as multidisciplinary pulmonary rehabilitation, (endoscopic) lung volume reduction, chronic noninvasive ventilation and lung transplantation, caregivers should try to provide a personalised treatment for every severe COPD patient. In this review, we aim to describe the multidimensional approach to these patients at our centre along the lines of treatable traits leading to specific additional treatment modalities on top of standard care.
Synthesis of MoIn2S4@CNTs Composite Counter Electrode for Dye-Sensitized Solar Cells
Authors: Yue Gentian , Cheng Renzhi , Gao Xueman , Fan Leqing , Mao Yangfan , Gao Yueyue , Tan Furui
Published: September 2020

A ternary and composite MoIn2S4@CNTs counter electrode (CE) with a hedgehog ball structure was synthesized by using a facile one-step hydrothermal method. The composite MoIn2S4@CNTs film possesses large specific surface area through N2 adsorption-desorption isotherms test, which is advantageous to adsorb more electrolyte and provide larger active contact area for the electrode. In addition, the composite MoIn2S4@CNTs CE exhibits low charge transfer resistance and fine electrocatalytic ability made from a series of electrochemical tests including cyclic voltammetry, electrochemical impedance, and Tafel curves. Under optimal conditions, the DSSC based on the MoIn2S4@CNTs-2 composite CE achieves an impressive power conversion efficiency as high as 8.38%, which remarkably exceeds that of the DSSCs with the MoIn2S4 CE (7.44%) and the Pt electrode (8.01%). The current work provides a simplified preparation process for the DSSCs.
SWI/SNF complexes act through CBP-1 histone acetyltransferase to regulate acute functional tolerance to alcohol
Authors: Mathies Laura D. , Lindsay Jonathan H. , Handal Amal P. , Blackwell GinaMari G. , Davies Andrew G. , Bettinger Jill C.
Published: September 2020

Background

SWI/SNF chromatin remodeling genes are required for normal acute responses to alcohol inC. elegansand are associated with alcohol use disorder in two human populations. In an effort to discover the downstream genes that are mediating this effect, we identified SWI/SNF-regulated genes inC. elegans.

Results

To identify SWI/SNF-regulated genes in adults, we compared mRNA expression in wild type andswsn-1(os22ts)worms under conditions that produce inactiveswsn-1in mature cells. To identify SWI/SNF-regulated genes in neurons, we compared gene expression inswsn-9(ok1354)null mutant worms that harbor a neuronal rescue or a control construct.RNA sequencing was performed to an average depth of 25 million reads per sample using 50-base, paired-end reads. We found that 6813 transcripts were significantly differentially expressed betweenswsn-1(os22ts)mutants and wild-type worms and 2412 transcripts were significantly differentially expressed betweenswsn-9(ok1354)mutants andswsn-9(ok1354)mutants with neuronal rescue. We examined the intersection between these two datasets and identified 603 genes that were differentially expressed in the same direction in both comparisons; we defined these as SWI/SNF-regulated genes in neurons and in adults. Among the differentially expressed genes wascbp-1,aC. eleganshomolog of the mammalian CBP/p300 family of histone acetyltransferases. CBP has been implicated in the epigenetic regulation in response to alcohol in animal models and a polymorphism in the human CBP gene, CREBBP, has been associated with alcohol-related phenotypes. We found thatcbp-1is required for the development of acute functional tolerance to alcohol inC. elegans.

Conclusions

We identified 603 transcripts that were regulated by two different SWI/SNF complex subunits in adults and in neurons. The SWI/SNF-regulated genes were highly enriched for genes involved in membrane rafts, suggesting an important role for this membrane microdomain in the acute alcohol response. Among the differentially expressed genes wascbp-1;CBP-1 homologs have been implicated in alcohol responses across phyla and we found thatC. elegans cbp-1was required for the acute alcohol response in worms.
Social prescribing for individuals with mental health problems: a qualitative study of barriers and enablers experienced by general practitioners
Authors: Aughterson Henry , Baxter Louise , Fancourt Daisy
Published: September 2020

Background

There is growing evidence for the use of social prescribing as a means to improve the mental health of patients. However, there are gaps in understanding the barriers and enablers faced by General Practitioners (GPs) when engaging in social prescribing for patients with mental health problems.

Methods

This study uses a qualitative approach involving one-to-one interviews with GPs from across the UK. The COM-B model was used to elucidate barriers and enablers, and the Theoretical Domains Framework (TDF) and a Behaviour Change Theory and Techniques tool was used to identify interventions that could address these.

Results

GPs recognised the utility of social prescribing in addressing the high levels of psychosocial need they saw in their patient population, and expressed the need to de-medicalise certain patient problems. GPs were driven by a desire to help patients, and so they benefited from regular positive feedback to reinforce the value of their social prescribing referrals. They also discussed the importance of developing more robust evidence on social prescribing, but acknowledged the challenges of conducting rigorous research in community settings. GPs lacked the capacity, and formal training, to effectively engage with community groups for patients with mental health problems. Link workers, when available to GPs, were of fundamental importance in bridging the gap between the GP and community. The formation of trusting relationships was crucial at different points of the social prescribing pathway, with patients needing to trust GPs in order for them to agree to see a link worker or attend a community activity, and GPs requiring a range of strong inter-personal skills in order to gain patients’ trust and motivate them.

Conclusion

This study elucidates the barriers and enablers to social prescribing for patients with mental health problems, from the perspectives of GPs. Recommended interventions include a more systematic feedback structure for GPs and more formal training around social prescribing and developing the relevant inter-personal skills. This study provides insight for GPs and other practice staff, commissioners, managers, providers and community groups, to help design and deliver future social prescribing services.
Physician related barriers towards insulin therapy at primary care centres in Trinidad: a cross-sectional study
Authors: Motilal Shastri
Published: September 2020

Background

Physician related factors with respect to insulin therapy can contribute to diabetes mellitus (DM) mismanagement. Patient related factors have been previously explored in a Trinidad survey. The main objective of this study was to explore primary care physicians’ (PCPs) related barriers towards insulin therapy.

Methods

A cross-sectional study on a convenience sample of PCPs in the public primary care system was done using an online survey.

Results

Of the 170 PCPs contacted, 75 (44%) responded. There were 47 females (62.7%) and 28 males (37.3%) with a mean age of 35.9 yrs. Nearly 40% of physicians admitted that the education given to patients was inadequate to allow initiation of insulin therapy. Half the respondents admitted to insufficient consultation times and inadequate appointment frequency to allow for intensification of insulin therapy. Forty percent of PCPs admitted that HbA1c results were unavailable to guide their management decisions. Only 6.7% of physicians said they had access to rapid acting insulin, while 5.3% said they had access to insulin pens.

Conclusion

PCPs in Trinidad treating diabetes at the public primary care clinics face several barriers in administering proper insulin therapy. Addressing these factors can improve glycemic control in this population.
International relevance of two measures of awareness of age-related change (AARC)
Authors: Sabatini Serena , Ukoumunne Obioha C. , Ballard Clive , Brothers Allyson , Kaspar Roman , Collins Rachel , Kim Sarang , Corbett Anne , Aarsland Dag , Hampshire Adam , Brooker Helen , Clare Linda
Published: September 2020

Background

A questionnaire assessing awareness of positive and negative age-related changes (AARC gains and losses) was developed in the US and Germany. We validated the short form of the measure (AARC-10 SF) and the cognitive functioning subscale from the 50-item version of the AARC (AARC-50) questionnaire in the UK population aged 50 and over.

Methods

Data from 9410 participants (Mean (SD) age = 65.9 (7.1)) in the PROTECT cohort were used to explore and confirm the psychometric properties of the AARC measures including: validity of the factor structure; reliability; measurement invariance across men and women, individuals with and without a university degree, and in middle age, early old age, and advanced old age; and convergent validity with measures of self-perception of aging and mental, physical, and cognitive health. We explored the relationship between demographic variables (age, sex, marital status, employment, and university education) and AARC.

Results

We confirmed the two-factor structure (gains and losses) of the AARC-10 SF and the AARC-50 cognitive functioning subscale. Both scales showed good reliability and good convergent validity for AARC losses, but weak convergent validity for AARC gains. For both scales metric invariance was held for the two subgroups defined by education level and age. For the AARC-50 subscale, but not for the AARC-10 SF, strong invariance was also held for the two subgroups defined by sex. Age, sex, marital status, employment, and university education predicted AARC gains and losses.

Conclusions

The AARC-10 SF and AARC-50 cognitive functioning subscale identify UK individuals who perceive age-related changes in their mental, physical, and cognitive health.
The wrong Spirochaete? Acute kidney injury in a returning traveller with syphilis – a case report
Authors: Cook Hannah , Gompels Mark
Published: September 2020

Background

Syphilis has seen an increased incidence in recent years and can have serious and irreversible consequences if left un-diagnosed and untreated. This case report describes a presentation of syphilis and acute kidney injury – a scenario sparsely described in existing literature.

Case presentation

This 43-year old Man who has Sex with Men (MSM) presented to the emergency department with a 3-week history of vomiting and headaches, progressing to include pyrexia. These symptoms started following his return from a 2-week cruise in Central America throughout which he had been well. He had a background of well-controlled human immunodeficiency virus (HIV).

On admission he had an Acute Kidney Injury (AKI) stage 3, without hydronephrosis, presumed to be pre-renal. Leptospirosis, the main differential, was negative serologically. ‘Pyrexia of unknown origin’ testing was performed, and cefuroxime commenced. Later in the admission, syphilis testing indicated an acute infection and he completed a full treatment course of benzylpenicillin. This, alongside intravenous fluids, resulted in symptom and renal resolution in 9 days and restoration of renal function.

Conclusions

Renal complications in syphilis are rare, furthermore the majority of those documented occur in latent syphilis and are irreversible. There are limited numbers of other documented cases of AKI in acute syphilis, which like the gentleman in this case were reversible and did not lead to permanent kidney damage.

This case adds to the knowledge base of AKI in initial presentation of syphilis. It also demonstrates not only the importance of taking a sexual history in patients with new infective symptoms but that testing for syphilis in at-risk groups regardless of history should be performed given its rising incidence. These considerations by physicians can lead to prompt diagnosis and management of syphilis and improve patient care and long-term outcomes.
Genetic risk-factors for anxiety in healthy individuals: polymorphisms in genes important for the HPA axis
Authors: Lindholm Heléne , Morrison India , Krettek Alexandra , Malm Dan , Novembre Giovanni , Handlin Linda
Published: September 2020

Background

Two important aspects for the development of anxiety disorders are genetic predisposition and alterations in the hypothalamic-pituitary-adrenal (HPA) axis. In order to identify genetic risk-factors for anxiety, the aim of this exploratory study was to investigate possible relationships between genetic polymorphisms in genes important for the regulation and activity of the HPA axis and self-assessed anxiety in healthy individuals.

Methods

DNA from 72 healthy participants, 37 women and 35 men, were included in the analyses. Their DNA was extracted and analysed for the following Single Nucleotide Polymorphisms (SNP)s: rs41423247 in the NR3C1 gene, rs1360780 in the FKBP5 gene, rs53576 in the OXTR gene, 5-HTTLPR in SLC6A4 gene and rs6295 in the HTR1A gene. Self-assessed anxiety was measured by the State and Trait Anxiety Inventory (STAI) questionnaire.

Results

Self-assessed measure of both STAI-S and STAI-T were significantly higher in female than in male participants (p = 0.030 and p = 0.036, respectively). For SNP rs41423247 in the NR3C1 gene, there was a significant difference in females in the score for STAI-S, where carriers of the G allele had higher scores compared to the females that were homozygous for the C allele (p < 0.01). For the SNP rs53576 in the OXTR gene, there was a significant difference in males, where carriers of the A allele had higher scores in STAI-T compared to the males that were homozygous for the G allele (p < 0.01).

Conclusion

This study shows that SNP rs41423247 in the NR3C1 gene and SNP rs53576 in the OXTR gene are associated with self-assessed anxiety in healthy individuals in a gender-specific manner. This suggests that these SNP candidates are possible genetic risk-factors for anxiety.
Spatial analysis of hypospadias cases in northern France: taking clinical data into account
Authors: Lauriot Dit Prevost Arthur , Genin Michael , Occelli Florent , Priso René-Hilaire , Besson Remi , Lanier Caroline , Sharma Dyuti
Published: September 2020

Background

Strong evidence for a causal role of environmental factors in a congenital anomaly is still difficult to produce. The collection of statistical data is crucial for gaining a better understanding of the epidemiology and pathophysiology of these anomalies. We aimed to evaluate spatial variations in hypospadias within our region and it’s association to socioeconomic and ecological factors, taking clinical data into account.

Methods

All boys with hypospadias born in northern France and seen in Lille University Medical Center (Lille, France) between 1999 and 2012 were included in the analysis. We retrospectively collected geographic data, clinical data (especially known confounding factors associated with an elevated risk of hypospadias), and demographic, socio-economic and ecological data. We analyzed the entire study population and subsequently the subset of boys lacking confounding factors.

Results

The study sample of 975 cases of hypospadias over the 13-year period resulted in an incidence of 25.4/10,000 male births, and was characterized by significant spatial heterogeneity (p < 0.005) and autocorrelation (p < 0.001). We detected two high-incidence clusters that differed with regard to their land use. After the exclusion of 221 patients with confounding factors, two high-incidence clusters with significant disease risks (1.65 and 1.75, respectively;p < 0.001) and a significant difference in land use (p < 0.001) again appeared. The first cluster contained a higher median [interquartile range] proportion of artificialized land (0.40 [0.22;0.47]) than the remaining “neutral areas” (0.19 [0.08;0.53]) did (p < 0.001). Conversely, the second cluster contained a higher median proportion of rural land (0.90 [0.78;0.96]) than the “neutral areas” (0.81 [0.47;0.92]) did (p < 0.001). The median deprivation index was significantly lower in the urban cluster (0.47 [0.42;0.55]) and significantly higher in the rural cluster (0.69 [0.56;0.73]) (p < 0.001).

Conclusions

Our results evidenced the heterogeneous spatial distribution of cases of hypospadias in northern France. We identified two clusters with different environmental and social patterns – even after the exclusion of known confounding factors.
Toothbrush deterioration and parents’ suggestions to improve the design of toothbrushes used by children with special care needs
Authors: Zhou Ni , Wong Hai Ming , McGrath Colman
Published: September 2020

Background

Biting objects was a parafunctional oral habit among children with special care needs. Chewing or biting toothbrushes could expedite the process of toothbrush wear. However, few studies evaluated the deterioration levels of toothbrushes used by children with special needs. This study aimed to assess the deterioration level of toothbrushes used by children with special care needs, and collect parents’ feedbacks to improve the design of children’s toothbrushes.

Methods

The cross-sectional study recruited 277 children who had special care needs. Children’s toothbrushing behaviors, background information, and parents’ comments on toothbrushes were obtained. Toothbrush deterioration was assessed by bristle wear and bite mark scores. Higher scores indicated severe deterioration.

Results

Three hundred twenty-one toothbrushes were collected. Children who used 2 to 6 toothbrushes in a 3-month period showed higher toothbrush deterioration scores than children who used a single toothbrush. Over 40% children’s toothbrushes presented excessive wear. Excessive wear was associated with social skills and parents’ education background. Distinct bite marks tended to exist on toothbrushes which had been used by children who showed challenging behaviors during toothbrushing (OR = 1.96, 95%CI1.15–3.32, p < 0.05). Approximately 27% parents reported that children’s toothbrushes should be modified. Parents recommended that the size of toothbrush heads, the angle of handles, and the texture/length/distribution/diameter of bristles should be adjusted. Besides, ideal toothbrushes should be able to provide verbal or visual instructions to children, motivate children to brush teeth, simplify toothbrushing procedure, and protect children who had toothbrush-biting habits.

Conclusions

Excessive wear and distinct bite marks can be found on toothbrushes that had been used by children with special care needs. Toothbrush deterioration was associated with children’s social skills, toothbrushing behaviors, and parents’ educational attainment. The commercially available toothbrushes should be modified to meet the additional needs of young children.
Flash glucose monitoring system was applied to cortisol treatment for a patient with congenital adrenal hyperplasia and 17α-hydroxylase deficiency
Authors: Xiang Chenyu , Han Minmin , Zhang Yi , Yin Jianhong , Pei Li’e , Yang Jing , Liu Yunfeng
Published: September 2020

Background

Congenital adrenal hyperplasia (CAH) with 17α-hydroxylase deficiency is a rare disease; patients often require lifetime cortisol treatment. In this case report, we presented a patient with CAH and 17α-hydroxylase deficiency, who was previously misdiagnosed as having primary aldosteronism. Furthermore, the flash glucose monitoring system (FGMS) was used to ascertain a suitable cortisol therapeutic regimen for this patient.

Case presentation

A 29-year-old woman presented with sex dysgenesis, hypertension and hypokalaemia. She had been diagnosed with primary aldosteronism at a local hospital. The re-measured aldosterone level in our hospital was below the normal range after antihypertensive medication adjustment, suggesting that the primary aldosteronism was a misdiagnosis. The patient was finally diagnosed as having CAH with 17α-hydroxylase deficiency according to the endocrine profile, adrenocorticotropic hormone stimulation test, and genetic analysis. Then, the patient was recommended cortisol treatment, during which the endocrine profile, blood pressure, plasma potassium level, and blood glucose level were observed to ascertain a suitable dosage. The FGMS was used to monitor blood glucose level, which indicated that the patient’s glucose metabolism was maintained normally under the final treatment dosage.

Conclusion

The misdiagnosis might have been because of the effects of the antihypertension medications on aldosterone and renin levels. The final dosage of cortisol treatment achieved a normal endocrine profile, while maintaining the homeostasis of blood glucose level, plasma potassium level and blood pressure. FGMS may be an effective method to ascertain a suitable cortisol therapeutic regimen for patients with CAH and 17α-hydroxylase deficiency.
Co-construction of the family-focused support conversation: a participatory learning and action research study to implement support for family members whose relatives are being discharged for end-of-life care at home or in a nursing home
Authors: Duke Sue , Campling Natasha , May Carl R. , Lund Susi , Lunt Neil ,   Hospital to Home Co-researcher group, Bartlett Gemma , Harris Lucy , Flannery Elizabeth , Connolly Michael , Booth Pam , Galpin Gillian , Wells Emma , Price Elizabeth , Faulkner-Butcher Alison , Petch Leanne , Ward Chris , Richardson Alison
Published: September 2020

Background

Many people move in and out of hospital in the last few weeks of life. These care transitions can be distressing for family members because they signify the deterioration and impending death of their ill relative and forthcoming family bereavement. Whilst there is evidence about psychosocial support for family members providing end-of-life care at home, there is limited evidence about how this can be provided in acute hospitals during care transitions. Consequently, family members report a lack of support from hospital-based healthcare professionals.

Methods

The aim of the study was to implement research evidence for family support at the end-of-life in acute hospital care. Informed by Participatory Learning and Action Research and Normalization Process Theory (NPT) we co-designed a context-specific intervention, the Family-Focused Support Conversation, from a detailed review of research evidence. We undertook a pilot implementation in three acute hospital Trusts in England to assess the potential for the intervention to be used in clinical practice. Pilot implementation was undertaken during a three-month period by seven clinical co-researchers - nurses and occupational therapists in hospital specialist palliative care services. Implementation was evaluated through data comprised of reflective records of intervention delivery (n = 22), in-depth records of telephone implementation support meetings between research team members and co-researchers (n = 3), and in-depth evaluation meetings (n = 2). Data were qualitatively analysed using an NPT framework designed for intervention evaluation.

Results

Clinical co-researchers readily incorporated the Family-Focused Support Conversation into their everyday work. The intervention changed family support from being solely patient-focused, providing information about patient needs, to family-focused, identifying family concerns about the significance and implications of discharge and facilitating family-focused care. Co-researchers reported an increase in family members’ involvement in discharge decisions and end-of-life care planning.

Conclusion

The Family-Focused Support Conversation is a novel, evidenced-based and context specific intervention. Pilot implementation demonstrated the potential for the intervention to be used in acute hospitals to support family members during end-of-life care transitions. This subsequently informed a larger scale implementation study.

Trial registration

n/a.
Differences in clerkship development between public and private Brazilian medical schools: an overview
Authors: Zanolli Mauricio Braz , Streit Derly Silva , Maciel Dione Tavares , Muraguchi Evelin Massae Ogata , Martins Milton Arruda , Fátima Lopes Calvo Tibério Iolanda
Published: September 2020

Background

Around the world, it is very expensive to become a physician. Although public medical schools are less expensive than private medical schools, tuition fees are charged at public medical schools in the majority of countries. In Brazil, public medical schools, with the exception of municipal schools, are free. There has been little investigation of any differences in conditions offered by paid or free medical schools or what occurs in public and private clerkships in Brazil. We investigated the clerkship conditions offered to the students in both public and private Brazilian medical schools by gathering the opinions of clerkship coordinators and others responsible for clerkships.

Methods

A cross-sectional, descriptive, analytical study using an electronic questionnaire was answered by clerkship coordinators to compare the clerkships of 30 public and 38 private Brazilian medical schools from all regions of the country. The questionnaires covered various aspects of the clinical environments, student supervision, faculty development, student assessments, rotation evaluations and extracurricular activities developed by students.

Results

We observed significant differences between public and private medical schools in several aspects investigated. Based on the opinions of the clerkship coordinators, with the exception of access to university hospitals, which was predominantly offered by public medical schools, private medical schools offer better clerkship conditions. The main differences were related to the number of positions, infrastructure, clinical learning environments, faculty development, student assessments, rotation evaluations and students’ extracurricular activities.

Conclusion

This is the first study comparing Brazilian medical clerkships in private and public medical schools and provides a general vision of these programmes. It is necessary to further investigate clerkship development in the Brazilian medical school system and to study the differences between private and public medical schools globally.
Relationship between level of empathy during residency training and perception of professionalism climate
Authors: Aziz Aliya B. , Ali Syeda Kauser
Published: September 2020

Background

Empathy is one of the vital personality attributes for all physicians. It is essential for establishing general interpersonal relationships among doctors and patients. Unfortunately, there is evidence for the decline of physician’s empathy during the clinical training phase and is a major concern for medical educators worldwide. One of the major factors reported for the decline of this trait is an unprofessional learning environment.

Objective

This study examines the relationship between empathy level and perception of climate of professionalism among residents.

Method

The study participants included 70 residents of Obstetrics & Gynecology and Pediatrics departments of a private sector tertiary care hospital in Karachi, Pakistan. Two self-administered internet based surveys - Jefferson Scale of Physician Empathy (JSPE) and “Professionalism Climate Instrument”(PCI) - were administered to assess the level of empathy among the participants and their perception of professionalism in the learning environment. The relationship between the level of empathy and professionalism was analyzed using Spearman rank correlation.

Results

The overall response rate was 81.4% with mean empathy level of 103 ± 13. The internal consistency of each scale measured by Cronbach’s coefficient α was 0.76 for JSPE and 0.65 for PCI. No significant difference was observed in the mean empathy scores between senior and junior residents of both specialties. Statistically significant difference in empathy scores existed between female and male residents (p = 0.012; 95% CI, 2.27 to 17.59). The mean PCI score was 106 + 8.88 with no significant difference among residents of two specialties. Professionalism score was not found to vary with either the year of residency or gender. Empathy score and professionalism climate were not found to be correlated (rs = 0.56, p = 0.64).

Conclusion

The findings suggested that empathy is a relatively stable trait that remains unchanged during residency training programs. Female residents had higher empathic concern than the male trainees, however, the empathy level of the participants was not found to be influenced by the climate of professionalism.
The role of histogram analysis in diffusion-weighted imaging in the differential diagnosis of benign and malignant breast lesions
Authors: Jin Ya-Nan , Zhang Yan , Cheng Jing-Liang , Zhang Xiao-Pan , Hu Ying , Shao Xiao-Ning
Published: September 2020

Background

The present study aims to investigate the role of histogram analysis of intravoxel incoherent motion (IVIM) in the differential diagnosis of benign and malignant breast lesions.

Methods

The magnetic resonance imaging and clinical data of 55 patients (63 lesions) were retrospectively analyzed. The multi-b-valued diffusion-weighted imaging image was processed using the MADC software to obtain the gray-scaled maps of apparent diffusion coefficient (ADC)-slow, ADC-fast and f. The MaZda software was used to extract the histogram metrics of these maps. Combined with the conventional sequence images, the region of interest (ROI) was manually drawn along the edge of the lesion at the maximum level of the gray-scale image, and the difference of the data was analyzed between the benign and malignant breast lesions.

Results

There were 29 patients with 37 benign lesions, which included 23 fibroadenomas, 6 adenosis, 1 breast cysts, 4 intraductal papillomas, and 3 inflammations of breast. Furthermore, 26 malignant lesions in 26 patients, which included 20 non-specific invasive ductal carcinomas, 5 intraductal carcinomas and 1 patient with squamous cell carcinoma. The ADC-slow (mean and the 50th percentile) and f (minimum, mean, kurtosis, the 10th percentile and 50th percentile) of these malignant breast lesions were significantly lower than those of benign lesions (P < 0.05), while ADC-fast (kurtosis) and f (variance, skewness) of these malignant breast lesions were significantly higher than those of benign lesions (P < 0.05).

Conclusion

The histogram analysis of ADC-slow (mean and the 50th percentile), ADC-fast (kurtosis) and f (minimum, mean, kurtosis, the 10th percentile and 50th percentile. Variance, skewness) can provide a more objective and accurate basis for the differential diagnosis of benign and malignant breast lesions.
Transcription factor expression as a predictor of colon cancer prognosis: a machine learning practice
Authors: Liu Jiannan , Dong Chuanpeng , Jiang Guanglong , Lu Xiaoyu , Liu Yunlong , Wu Huanmei
Published: September 2020

Background

Colon cancer is one of the leading causes of cancer deaths in the USA and around the world. Molecular level characters, such as gene expression levels and mutations, may provide profound information for precision treatment apart from pathological indicators. Transcription factors function as critical regulators in all aspects of cell life, but transcription factors-based biomarkers for colon cancer prognosis were still rare and necessary.

Methods

We implemented an innovative process to select the transcription factors variables and evaluate the prognostic prediction power by combining the Cox PH model with the random forest algorithm. We picked five top-ranked transcription factors and built a prediction model by using Cox PH regression. Using Kaplan-Meier analysis, we validated our predictive model on four independent publicly available datasets (GSE39582, GSE17536, GSE37892, and GSE17537) from the GEO database, consisting of 925 colon cancer patients.

Results

A five-transcription-factors based predictive model for colon cancer prognosis has been developed by using TCGA colon cancer patient data. Five transcription factors identified for the predictive model is HOXC9, ZNF556, HEYL, HOXC4 and HOXC6. The prediction power of the model is validated with four GEO datasets consisting of 1584 patient samples. Kaplan-Meier curve and log-rank tests were conducted on both training and validation datasets, the difference of overall survival time between predicted low and high-risk groups can be clearly observed. Gene set enrichment analysis was performed to further investigate the difference between low and high-risk groups in the gene pathway level. The biological meaning was interpreted. Overall, our results prove our prediction model has a strong prediction power on colon cancer prognosis.

Conclusions

Transcription factors can be used to construct colon cancer prognostic signatures with strong prediction power. The variable selection process used in this study has the potential to be implemented in the prognostic signature discovery of other cancer types. Our five TF-based predictive model would help with understanding the hidden relationship between colon cancer patient survival and transcription factor activities. It will also provide more insights into the precision treatment of colon cancer patients from a genomic information perspective.
Whole-exome sequencing reveals potential mechanisms of drug resistance to FGFR3-TACC3 targeted therapy and subsequent drug selection: towards a personalized medicine
Authors: Tong Zhou , Yan Cong , Dong Yu-An , Yao Ming , Zhang Hangyu , Liu Lulu , Zheng Yi , Zhao Peng , Wang Yimin , Fang Weijia , Zhang Feifei , Jiang Weiqin
Published: September 2020

Background

Drug resistance is a major obstacle to effective cancer therapy. In order to detect the change in tumor genomic states under drug selection pressure, we use next-generation sequencing technology to investigate the underlying potential mechanisms of drug resistance.

Methods

In our study, we presented a bladder cancer patient who had been a bona fide responder to first-line gemcitabine plus cisplatin regimen and second-line pazopanib (tyrosine kinase inhibitor (TKI) for FGFR3-TACC3 fusion) but finally had disease progression as an ideal case for showing genomic alteration during drug resistance. We applied whole-exome sequencing and ultra-deep target sequencing to the patient pre- and post- pazopanib resistance. Protein-protein interaction (PPI) network and Gene Ontology (GO) analyses were used to analysis protein interactions and genomic alterations. Patient-derived xenograft (PDX) model was built to test drug sensitivity.

Results

Twelve mutations scattered in 12 genes were identified by WES pre- pazopanib resistance, while 63 mutations in 50 genes arose post- pazopanib resistance. PPI network showed proteins from multiple epigenetic regulator families were involved post- pazopanib resistance, including subunits of chromatin remodeler SWI/SNF complex ARID1A/1B and SMARCA4, histone acetylation writers CREBBP, histone methylation writer NSD1 and erasers KDM6A/5A. GO enrichment analysis showed pazopanib resistance genes were prominently tagged for chromatin modification, transcription, as well as gland development, leaving genes with the best adaptive FGFR TKI-coping mechanisms. In addition, significantly elevated tumor mutational burden suggested possible utility of immunotherapy. Intriguingly, PDX model suggested that, sensitivity to original chemotherapy regimen (cisplatin) was restored in patient tumor post-pazopanib.

Conclusions

Epigenetic regulation may play a role in acquired TKI resistance. Our study traced the complete tumor genomic variation course from chemo-resistant but TKI-sensitive to TKI-resistant but chemo-(re) sensitive, revealing the potential complex dynamic drug-driven mechanisms of resistance.
Correction to: Molecular networking in the neuronal ceroid lipofuscinoses: insights from mammalian models and the social amoeba Dictyostelium discoideum
Authors: Huber Robert J.
Published: September 2020

An amendment to this paper has been published and can be accessed via the original article.