bluuebunny/crossref_metadata_2025 huggingface dataset:
Treatment Strategy for Odontogenic Sinusitis
Authors: Yoo Byung Joon , Jung Seon Min , Lee Ha Na , Kim Hyung Gu , Chung Jae Ho , Jeong Jin Hyeok
Published: July 2020

Background

The treatment options for odontogenic sinusitis (OS) include medical management including antibiotics and saline nasal irrigation, endoscopic sinus surgery (ESS), and dental treatment.

Objective

The purpose of this study was to evaluate whether OS caused by dental caries and periapical abscess can be cured by dental treatment alone and which patients should consider surgery early.

Methods

A total of 33 patients with OS caused by dental caries and periapical abscess were enrolled. Patients with OS caused by dental implants, trauma, surgery, or tooth extraction were excluded. All patients were initially treated with dental treatment and medical management without ESS. The patients were divided into two groups according to the results of dental treatment and multiple clinical parameters were compared between the two groups.

Results

Among the 33 enrolled patients, 22 patients (67%) were cured with dental and medical management, and 11 patients (33%) required ESS after the failure of dental and medical management. Based on the multivariate analysis results, patients who were smokers (OR 33.4) and had a higher Lund-Mackay score on CT (OR 2.0) required ESS after the failure of dental and medical treatment.

Conclusions

Two-thirds of the patients with OS caused by dental caries and periapical abscess were cured with dental treatment and medical management without ESS. We recommend dental treatment and medical management first in OS caused by dental caries and periapical abscess. However, we recommend early ESS in patients with smoking habits and severe CT findings of the sinus.
Long-term effects of a standardized feedback-driven quality improvement program for timely reperfusion therapy in regional STEMI care networks
Authors: Scholz Karl Heinrich , Lengenfelder Björn , Jacobshagen Claudius , Fleischmann Claus , Moehlis Hiller , Olbrich Hans G , Jung Jens , Maier Lars S , Maier Sebastian K G , Bestehorn Kurt , Friede Tim , Meyer Thomas
Published: July 2020

Aims

Current European Society of Cardiology guidelines state that repetitive monitoring and feedback should be implemented for ST-elevation myocardial infarction (STEMI) treatment, but no evidence is available supporting this recommendation. We aimed to analyze the long-term effects of a formalized data assessment and systematic feedback on performance and mortality within the prospective, multicenter Feedback Intervention and Treatment Times in STEMI (FITT-STEMI) study.

Methods

Regular interactive feedback sessions with local STEMI management teams were performed at six participating German percutaneous coronary intervention (PCI) centers over a 10-year period starting from October 2007.

Results

From the first to the 10th year of study participation, all predefined key-quality indicators for performance measurement used for feedback improved significantly in all 4926 consecutive PCI-treated patients – namely, the percentages of patients with pre-hospital electrocardiogram (ECG) recordings (83.3% vs 97.1%, p < 0.0001) and ECG recordings within 10 minutes after first medical contact (41.7% vs 63.8%, p < 0.0001), pre-announcement by telephone (77.0% vs 85.4%, p = 0.0007), direct transfer to the catheterization laboratory bypassing the emergency department (29.4% vs 64.2%, p < 0.0001), and contact-to-balloon times of less than 90 minutes (37.2% vs 53.7%, p < 0.0001). Moreover, this feedback-related continuous improvement of key-quality indicators was linked to a significant reduction in in-hospital mortality from 10.8% to 6.8% (p = 0.0244). Logistic regression models confirmed an independent beneficial effect of duration of study participation on hospital mortality (odds ratio = 0.986, 95% confidence interval = 0.976–0.996, p = 0.0087). In contrast, data from a nationwide PCI registry showed a continuous increase in in-hospital mortality in all PCI-treated STEMI patients in Germany from 2008 to 2015 (n = 398,027; 6.7% to 9.2%, p < 0.0001).

Conclusions

Our results indicate that systematic data assessment and regular feedback is a feasible long-term strategy and may be linked to improved performance and a reduction in mortality in STEMI management.
Characteristics and Circumstances of Falls in the Community-Dwelling Older Adult Population
Authors: Molés Julio María Pilar , Lavedán Santamaría Ana , Botigué Satorra Teresa , Masot Ariño Olga , Esteve Clavero Aurora , Maciá Soler María Loreto
Published: July 2020

Objective: The study aimed to describe the characteristics and circumstances of falls in the community-dwelling older adult population. Design: This was a cross-sectional observational and descriptive study involving primary health care centers in Lleida and Castellón de la Plana, Spain. Randomized sampling was used to include 966 individuals aged 75 years or older residing in single-family homes and in possession of a health care card. Data were obtained using the Survey on Fragility in Older People in Lleida (FRALLE survey). Study variables included the occurrence of falls in the past year and fall characteristics such as whether it was a first or successive fall, cause, season, and time of the day the fall occurred, whether the respondent fell flat on the ground, and time the participant remained on the floor. Other variables involved the circumstances of the fall, including the general location of the fall and specific location within the home if applicable, lighting/weather conditions, objects which may have precipitated the fall, floor conditions, and type of footwear. Results: The prevalence of falls was 25.9% with regard to the previous year, with 70% of these participants reporting having fallen previously. Falls most often occurred by accident, during the daytime, and in the winter. Variables that showed statistical significance with regard to age group were: falling flat on the ground ( P = .031), fall location ( P = .000), presence of an object favoring the fall ( P = .039), floor conditions ( P = .011), and type of footwear ( P = .029). By sex, variables that showed statistical significance included the need for assistance to get up ( P = .045) and type of footwear ( P = .028). Conclusions: The prevalence of falls was found to be similar in the studied cities. The results show the most common characteristics and circumstances of falls in older adults in the community, making it possible to guide future preventive strategies.
Reframing Neurodiversity as Competitive Advantage: Opportunities, Challenges, and Resources for Business and Professional Communication Educators
Authors: Ortiz Lorelei A.
Published: July 2020

This article outlines opportunities and challenges of teaching neurologically diverse students in the business communication course, providing basic resources and information for instructors to supplement their knowledge and pedagogical ability to support neurodiverse students. While the business communication course may represent obstacles for neurodiverse students, it also provides the ideal opportunity for them to practice and develop the soft skills that are essential to their success. Included are implications for neurodiversity as competitive advantage as employers look to harness the unique talents of neurodivergent graduates through active recruitment programs and universities increase programming to support these diverse and talented students.
The effect of socioemotional wealth on the relationship between entrepreneurial orientation and family business performance
Authors: Hernández-Linares Remedios , Kellermanns Franz W , López-Fernández María Concepción , Sarkar Soumodip
Published: July 2020

This study examines how five key entrepreneurial orientation (EO) dimensions—risk taking, innovativeness, proactiveness, competitive aggressiveness, and autonomy—affect family business performance, as well as the moderating effect of socioemotional wealth (SEW) on these relationships. The findings, based on a sample of 609 Spanish and Portuguese family firms, reveal that not all EO dimensions are equally important for performance, as only proactiveness, competitive aggressiveness, and autonomy were significant. However, we also find that the EO–performance relationship is affected by concern for SEW preservation, as our SEW measure moderates risk taking positively and innovativeness negatively.

JEL CLASSIFICATION: L20; L26; M10
Factors associated with the presence of headache in hospitalized COVID-19 patients and impact on prognosis: a retrospective cohort study
Authors: Trigo Javier , García-Azorín David , Planchuelo-Gómez Álvaro , Martínez-Pías Enrique , Talavera Blanca , Hernández-Pérez Isabel , Valle-Peñacoba Gonzalo , Simón-Campo Paula , de Lera Mercedes , Chavarría-Miranda Alba , López-Sanz Cristina , Gutiérrez-Sánchez María , Martínez-Velasco Elena , Pedraza María , Sierra Álvaro , Gómez-Vicente Beatriz , Arenillas Juan Francisco , Guerrero Ángel L.
Published: July 2020

Introduction

Headache is one of the most frequent neurologic manifestations in COVID-19. We aimed to analyze which symptoms and laboratory abnormalities were associated with the presence of headache and to evaluate if patients with headache had a higher adjusted in-hospital risk of mortality.

Methods

Retrospective cohort study. We included all consecutive patients admitted to the Hospital with confirmed SARS-CoV-2 infection between March 8th and April 11th, 2020. We collected demographic data, clinical variables and laboratory abnormalities. We used multivariate regression analysis.

Results

During the study period, 576 patients were included, aged 67.2 (SD: 14.7), and 250/576 (43.3%) being female. Presence of headache was described by 137 (23.7%) patients. The all-cause in-hospital mortality rate was 127/576 (20.0%). In the multivariate analysis, patients with headache had a lower risk of mortality (OR: 0.39, 95% CI: 0.17–0.88,p = 0.007). After adjusting for multiple comparisons in a multivariate analysis, variables that were independently associated with a higher odds of having headache in COVID-19 patients were anosmia, myalgia, female sex and fever; variables that were associated with a lower odds of having headache were younger age, lower score on modified Rankin scale, and, regarding laboratory variables on admission, increased C-reactive protein, abnormal platelet values, lymphopenia and increased D-dimer.

Conclusion

Headache is a frequent symptom in COVID-19 patients and its presence is an independent predictor of lower risk of mortality in COVID-19 hospitalized patients.
Comparison of various risk scores for the prognosis of hemorrhagic upper gastrointestinal mucosal disorder
Authors: Kita Shinya , Shirai Yasuyuki , Yoshida Tomoharu , Shiraishi Kei , Nakamura Ayako , Kawano Michitaka , Kinoshita Yoshihiro , Noguchi Tatsuya , Ito Syunsuke
Published: July 2020

Background

Various risk scores have been proposed that are useful for the management of upper gastrointestinal bleeding (UGIB), which is an important disease in emergency medicine. Few studies have examined the usefulness of Charlson Comorbidity index (CCI) in this disease, which evaluates the patient’s general condition by scoring the patient’s underlying disease. There have been no studies investigating the efficacy of CCI compared to other risk scores in the management of UGIB requiring endoscopic hemostasis.

Methods

In addition to the Glasgow-Blatchford score, AIMS65 score, and Rockall score, we investigated the efficacy of the outcome prediction obtained by the original CCI and the updated CCI, scored only with respect to the underlying disease. We also examined the cutoff value when using the risk score. This retrospective study included 265 patients with hemorrhagic upper gastrointestinal mucosal lesions who underwent emergency endoscopic hemostasis during a 6-year period between 2011 and 2016 in our hospital.

Results

The updated CCI and AIMS65 score correlated with prognosis in multivariate analysis (p = 0.002 and p = 0.003, respectively). In clinical practice, the prognosis might be worse if both updated CCI and AIMS65 score were 3 point or more.

Conclusion

In addition to the AIMS65 score, the updated CCI can be a useful tool for managing upper gastrointestinal mucosal disorder bleeding that requires endoscopic hemostasis.
Characteristics and management of testicular torsion in patients admitted to the Urology Department at Chris Hani Baragwanath Academic Hospital
Authors: Mukendi Alain Mwamba , Kruger Deirdre , Haffejee Mohamed
Published: July 2020

Background

The study was carried out to determine the trend of referrals with testicular torsion; the pre-surgery duration of symptoms; the rate of orchidectomy; as well as the seasonality and the age-related laterality of testicular torsion.

Methods

This was a retrospective study conducted at Chris Hani Baragwanath Academic Hospital using patients’ records from 2006 to 2018 from which data were obtained and analyzed.

Results

A total of 308 patients with testicular torsion were included in this study; the mean age was 17.2 ± 4.12 (10–33) years. The median (IQR) time from onset to hospital was 47 h, and 194/308 (63%) underwent orchidectomy. Although the orchidectomy rate was higher (95%) in those who had surgery beyond 72 h, 3.6% had reperfusion after detorsion in theater followed by orchidopexy. In the 112 patients who underwent a bilateral orchidopexy, the time from onset of symptoms to surgery was significantly shorter at a median (IQR) of 13 (9–26) h, compared to 144 (40–264) h in the 194 patients who had an orchidectomy (p < 0.0001). The odds of presenting with a right -sided testicular torsion increases by 6% (p = 0.047) for every 1-year increase in age.

Conclusion

This study shows that there is a significant association between the pre-surgery duration of symptoms and the testicular salvage rate. Testicular salvage is possible beyond 72 h from the onset of symptoms, although the salvage rate reduces from 75% within 24 h to 3.6% beyond 72 h. In addition, it also shows that older patients tend to present with right-sided torsion.
Towards behaviour based testing to understand the black box of autonomous cars
Authors: Utesch Fabian , Brandies Alexander , Pekezou Fouopi Paulin , Schießl Caroline
Published: July 2020

Background

Autonomous cars could make traffic safer, more convenient, efficient and sustainable. They promise the convenience of a personal taxi, without the need for a human driver. Artificial intelligence would operate the vehicle instead. Especially deep neural networks (DNNs) offer a way towards this vision due to their exceptional performance particularly in perception. DNNs excel in identifying objects in sensor data which is essential for autonomous driving. These networks build their decision logic through training instead of explicit programming. A drawback of this technology is that the source code cannot be reviewed to assess the safety of a system. This leads to a situation where currently used methods for regulatory approval do not work to validate a promising new piece of technology.

Objective

In this paper four approaches are highlighted that might help understanding black box technical systems for autonomous cars by focusing on its behaviour instead. The method of experimental psychology is proposed to model the inner workings of DNNs by observing its behaviour in specific situations. It is argued that penetration testing can be applied to identify weaknesses of the system. Both can be applied to improve autonomous driving systems. The shadowing method reveals behaviour in a naturalistic setting while ensuring safety. It can be seen as a theoretical driving exam. The supervised driving method can be utilised to decide if the technology is safe enough. It has potential to be developed into a practical driving exam.
Genome-wide evolutionary characterization and expression analysis of SIAMESE-RELATED family genes in maize
Authors: Zhang Zhengquan , Qu Jianzhou , Li Feifei , Li Silu , Xu Shutu , Zhang Renhe , Xue Jiquan , Guo Dongwei
Published: July 2020

Abstracts

Background

The SIAMESE (SIM) locus is a cell-cycle kinase inhibitor (CKI) gene that has to date been identified only in plants; it encodes a protein that promotes transformation from mitosis to endoreplication. Members of the SIAMESE-RELATED (SMR) family have similar functions, and some are related to cell-cycle responses and abiotic stresses. However, the functions of SMRs are poorly understood in maize (Zea mays L.).

Results

In the present study, 12 putative SMRs were identified throughout the entire genome of maize, and these were clustered into six groups together with the SMRs from seven other plant species. Members of the ZmSMR family were divided into four groups according to their protein sequences. Various cis-acting elements in the upstream sequences of ZmSMRs responded to abiotic stresses. Expression analyses revealed that all ZmSMRs were upregulated at 5, 20, 25, and 35 days after pollination. In addition, we found that ZmSMR9/11/12 may have regulated the initiation of endoreplication in endosperm central cells. Additionally, ZmSMR2/10 may have been primarily responsible for the endoreplication regulation of outer endosperm or aleurone cells. The relatively high expression levels of almost all ZmSMRs in the ears and tassels also implied that these genes may function in seed development. The effects of treatments with ABA, heat, cold, salt, and drought on maize seedlings and expression of ZmSMR genes suggested that ZmSMRs were strongly associated with response to abiotic stresses.

Conclusion

The present study is the first to conduct a genome-wide analysis of members of the ZmSMR family by investigating their locations in chromosomes, identifying regulatory elements in their promoter regions, and examining motifs in their protein sequences. Expression analysis of different endosperm developmental periods, tissues, abiotic stresses, and hormonal treatments suggests that ZmSMR genes may function in endoreplication and regulate the development of reproductive organs. These results may provide valuable information for future studies of the functions of the SMR family in maize.
Screening and identification of BP100 peptide conjugates active against Xylella fastidiosa using a viability-qPCR method
Authors: Baró Aina , Badosa Esther , Montesinos Laura , Feliu Lidia , Planas Marta , Montesinos Emilio , Bonaterra Anna
Published: July 2020

Background

Xylella fastidiosa is one of the most harmful bacterial plant pathogens worldwide, causing a variety of diseases, with huge economic impact to agriculture and environment. Although it has been extensively studied, there are no therapeutic solutions to suppress disease development in infected plants. In this context, antimicrobial peptides represent promising alternatives to traditional compounds due to their activity against a wide range of plant pathogens, their low cytotoxicity, their mode of action that make resistance more difficult and their availability for being expressed in plants.

Results

Peptide conjugates derived from the lead peptide BP100 and fragments of cecropin, magainin or melittin were selected and tested against the plant pathogenic bacteria X. fastidiosa. In order to screen the activity of these antimicrobials, and due to the fastidious nature of the pathogen, a methodology consisting of a contact test coupled with the viability-quantitative PCR (v-qPCR) method was developed. The nucleic acid-binding dye PEMAX was used to selectively quantify viable cells by v-qPCR. In addition, the primer set XF16S-3 amplifying a 279 bp fragment was selected as the most suitable for v-qPCR. The performance of the method was assessed by comparing v-qPCR viable cells estimation with conventional qPCR and plate counting. When cells were treated with peptide conjugates derived from BP100, the observed differences between methods suggested that, in addition to cell death due to the lytic effect of the peptides, there was an induction of the viable but non-culturable state in cells. Notably, a contact test coupled to v-qPCR allowed fast and accurate screening of antimicrobial peptides, and led to the identification of new peptide conjugates active against X. fastidiosa.

Conclusions

Antimicrobial peptides active against X. fastidiosa have been identified using an optimized methodology that quantifies viable cells without a cultivation stage, avoiding underestimation or false negative detection of the pathogen due to the viable but non-culturable state, and overestimation of the viable population observed using qPCR. These findings provide new alternative compounds for being tested in planta for the control of X. fastidiosa, and a methodology that enables the fast screening of a large amount of antimicrobials against this plant pathogenic bacterium.
Responses of leaf morphology, NSCs contents and C:N:P stoichiometry of Cunninghamia lanceolata and Schima superba to shading
Authors: Liu Qingqing , Huang Zhijun , Wang Zhengning , Chen Yanfang , Wen Zhumei , Liu Bo , Tigabu Mulualem
Published: July 2020

Background

The non-structural carbohydrates (NSCs), carbon (C), nitrogen (N), and phosphorus (P) are important energy source or nutrients for all plant growth and metabolism. To persist in shaded understory, saplings have to maintain the dynamic balance of carbon and nutrients, such as leaf NSCs, C, N and P. To improve understanding of the nutrient utilization strategies between shade-tolerant and shade-intolerant species, we therefore compared the leaf NSCs, C, N, P in response to shade between seedlings of shade-tolerant Schima superba and shade-intolerant Cunninghamia lanceolate. Shading treatments were created with five levels (0, 40, 60, 85, 95% shading degree) to determine the effect of shade on leaf NSCs contents and C:N:P stoichiometry characteristics.

Results

Mean leaf area was significantly larger under 60% shading degree for C. lanceolata while maximum mean leaf area was observed under 85% shading degree for S. superba seedlings, whereas leaf mass per area decreased consistently with increasing shading degree in both species. In general, both species showed decreasing NSC, soluble sugar and starch contents with increasing shading degree. However shade-tolerant S. superba seedlings exhibited higher NSC, soluble sugar and starch content than shade-intolerant C. lanceolate. The soluble sugar/starch ratio of C. lanceolate decreased with increasing shading degree, whereas that of S. superb remained stable. Leaf C:N ratio decreased while N:P ratio increased with increasing shading degree; leaf C:P ratio was highest in 60% shading degree for C. lanceolata and in 40% shading degree for S. superba.

Conclusion

S. superba is better adapted to low light condition than C. lanceolata through enlarged leaf area and increased carbohydrate reserves that allow the plant to cope with low light stress. From mixed plantation viewpoint, it would be advisable to plant S. superba later once the canopy of C. lanceolata is well developed but allowing enough sunlight.
Nuclear proteome of virus-infected and healthy potato leaves
Authors: Rajamäki Minna-Liisa , Sikorskaite-Gudziuniene Sidona , Sarmah Nandita , Varjosalo Markku , Valkonen Jari P. T.
Published: July 2020

Background

Infection of plants by viruses interferes with expression and subcellular localization of plant proteins. Potyviruses comprise the largest and most economically damaging group of plant-infecting RNA viruses. In virus-infected cells, at least two potyviral proteins localize to nucleus but reasons remain partly unknown.

Results

In this study, we examined changes in the nuclear proteome of leaf cells from a diploid potato line (Solanum tuberosum L.) after infection with potato virus A (PVA; genus Potyvirus; Potyviridae) and compared the data with that acquired for healthy leaves. Gel-free liquid chromatography–coupled to tandem mass spectrometry was used to identify 807 nuclear proteins in the potato line v2–108; of these proteins, 370 were detected in at least two samples of healthy leaves. A total of 313 proteins were common in at least two samples of healthy and PVA-infected leaves; of these proteins, 8 showed differential accumulation. Sixteen proteins were detected exclusively in the samples from PVA-infected leaves, whereas other 16 proteins were unique to healthy leaves. The protein Dnajc14 was only detected in healthy leaves, whereas different ribosomal proteins, ribosome-biogenesis proteins, and RNA splicing–related proteins were over-represented in the nuclei of PVA-infected leaves. Two virus-encoded proteins were identified in the samples of PVA-infected leaves.

Conclusions

Our results show that PVA infection alters especially ribosomes and splicing-related proteins in the nucleus of potato leaves. The data increase our understanding of potyvirus infection and the role of nucleus in infection. To our knowledge, this is the first study of the nuclear proteome of potato leaves and one of the few studies of changes occurring in nuclear proteomes in response to plant virus infection.
Neonatal lupus with left bundle branch block and cardiomyopathy: a case report
Authors: Rumancik Brad , Haggstrom Anita N. , Ebenroth Eric S.
Published: July 2020

Background

Cardiac manifestations of neonatal lupus include an array of structural and conduction abnormalities due to placental transference of maternal anti-SSA/Ro and anti-SSB/La autoantibodies. Late-onset neonatal lupus cardiomyopathies, occurring outside the neonatal period, is an infrequently reported manifestation with unknown pathophysiology and poorly defined treatment regimens. Due to the rarity of this condition, additional studies and case reports are required to better understand and manage late-onset neonatal lupus cardiomyopathies.

Case presentation

A 4-week-old female, born to a mother with known anti-SSA/Ro and anti-SSB/La autoantibodies, presents with classic cutaneous manifestations for neonatal lupus and is found to have left bundle branch block, severely dilated cardiomyopathy with an ejection fraction of 25%, and a thin echogenic dyskinetic ventricular septum. Weekly second trimester and 30-week fetal echocardiograms showed no signs of structural or conduction abnormalities. There were no histologic signs of inflammation on cardiac tissue biopsy. After a complicated hospital course, she was successfully treated with biventricular pacemaker, intravenous immunoglobulin, and plasmapheresis.

Conclusions

We present a case of late-onset neonatal lupus with severe dilated cardiomyopathy, a dyskinetic ventricular septum, and left bundle branch block. To our knowledge, the dyskinetic ventricular septum has never been reported and left bundle branch block is rarely reported in NL. This case further validates the need for long term cardiac follow up for patients born with NL, even if lacking cardiac manifestations in the peripartum period. We characterize a unique presentation of a rare clinical entity, highlighting the diagnostic challenges, and describe a successful treatment course.
A stepped-wedge randomised-controlled trial assessing the implementation, impact and costs of a prospective feedback loop to promote appropriate care and treatment for older patients in acute hospitals at the end of life: study protocol
Authors: Lee Xing J. , Farrington Alison , Carter Hannah , Shield Carla , Graves Nicholas , McPhail Steven M. , Harvey Gillian , White Ben P. , Willmott Lindy , Cardona Magnolia , Hillman Ken , Callaway Leonie , Barnett Adrian G.
Published: July 2020

Background

Hospitalisation rates for the older population have been increasing with end-of-life care becoming a more medicalised and costly experience. There is evidence that some of these patients received non-beneficial treatment during their final hospitalisation with a third of the non-beneficial treatment duration spent in intensive care units. This study aims to increase appropriate care and treatment decisions and pathways for older patients at the end of life in Australia. This study will implement and evaluate a prospective feedback loop and tailored clinical response intervention at three hospitals in Queensland, Australia.

Methods

A stepped-wedge cluster randomised trial will be conducted with up to 21 clinical teams in three acute hospitals over 70 weeks. The study involves clinical teams providing care to patients aged 75 years or older, who are prospectively identified to be at risk of non-beneficial treatment using two validated tools for detecting death and deterioration risks. The intervention’s feedback loop will provide the teams with a summary of these patients’ risk profiles as a stimulus for a tailored clinical response in the intervention phase. The Consolidated Framework for Implementation Research will be used to inform the intervention’s implementation and process evaluation. The study will determine the impact of the intervention on patient outcomes related to appropriate care and treatment at the end of life in hospitals, as well as the associated healthcare resource use and costs. The primary outcome is the proportion of patients who are admitted to intensive care units. A process evaluation will be carried out to assess the implementation, mechanisms of impact, and contextual barriers and enablers of the intervention.

Discussion

This intervention is expected to have a positive impact on the care of older patients near the end of life, specifically to improve clinical decision-making about treatment pathways and what constitutes appropriate care for these patients. These will reduce the incidence of non-beneficial treatment, and improve the efficiency of hospital resources and quality of care. The process evaluation results will be useful to inform subsequent intervention implementation at other hospitals.

Trial registration

Australia New Zealand Clinical Trial Registry (ANZCTR), ACTRN12619000675123p (approved 6 May 2019),
Being active 1½ years after hip fracture: a qualitative interview study of aged adults’ experiences of meaningfulness
Authors: Rasmussen Birgit , Nielsen Claus Vinther , Uhrenfeldt Lisbeth
Published: July 2020

Background

Being active is vital and a source of well-being. However, 18 months after hip fracture (HF), progress seems to have come to a halt. Aged adults may feel vulnerable, experiencing ongoing dependency and limited possibilities for socializing. How they experience the meaningfulness of being active during these circumstances is unknown. The aim of this study was to explore experiences of the meaningfulness of being active for aged adults 18 months after HF.

Methods

A phenomenological-hermeneutic methodology based on the philosophies of Heidegger and Gadamer was applied. Data were collected using individual interviews conducted in participants’ homes. The study was part of a longitudinal study, and three former interviews helped build trusting relationships with participants and focus the semi-structured interview guide. An existential theory of well-being and suffering considering health to be a balancing of mobility and dwelling was applied.

Participants were nine aged adults 65 years or older with pre-fracture dependency included in the study 18 months earlier while still in hospital after HF. The interpretation was a process of analyzing data by moving between the parts and the whole as a means of gaining a deeper understanding and continuously testing pre-understandings. The analysis followed five steps: a) getting a sense of the whole b) delineating and condensing meaning units, c) interpreting meaning units, d) relating to study purpose, and e) developing themes and sub-themes.

Results

Two main themes emerged. The main-theme “Feeling the continuity of life “had four sub-themes: “Gratitude for present possibilities, ““Connected with earlier life-experience, ““Thoughtfully managing vulnerability, “and “Belonging with other people. “The main-theme “Feeling vulnerable “had two sub-themes: “Thwarted “and “Sad and regretting lost continuity in life.“.

Conclusions

Eighteen months after HF, aged adults seem to be struggling on their own to be active in meaningful ways. To maintain hope, relieve the strain in everyday life, and maintain a sense of safety and self-confidence, they may need help. However, to avoid suffering, there is a need to balance additional training and a struggle for progress with well-being experiences in terms of feeling gratitude, restoring a sense of normality, and feeling kinship with other people.
The value of CT, MRI, and PET-CT in detecting retropharyngeal lymph node metastasis of head and neck squamous cell carcinoma
Authors: Kim Jin Hwan , Choi Kyu Young , Lee Sang-Hyo , Lee Dong Jin , Park Bum Jung , Yoon Dae Young , Rho Young-Soo
Published: July 2020

Background

The diagnostic accuracies of the imaging studies should be clearly acknowledged in managing head and neck cancer patients; however, the accuracies of preoperative imaging studies in detecting retropharyngeal lymph node (RPLN) metastasis are still not clarified. This study was to evaluate diagnostic accuracies of computed tomography (CT), magnetic resonance imaging (MRI), and positron emission tomography-computed tomography (PET-CT) in detecting RPLN metastasis of head and neck squamous cell carcinomas.

Methods

For 123 patients who had performed RPLN dissection during the surgery of their squamous cell carcinoma of the head and neck, preoperative CT, MRI, and/or PET-CT were reviewed for RPLN metastasis in a blinded fashion by one experienced radiologist. Sensitivity, specificity, positive predictive value, negative predictive value, and overall accuracy of each imaging modality were assessed, by comparing with the histopathologic findings of the resected RPLNs that served as the standard of reference.

Results

RPLNs were pathologically positive for metastasis in 43 of the 123 patients (35%). Sensitivity, specificity, positive predictive value, negative predictive value, and overall accuracy in detecting metastasis to RPLN were 65, 94, 85, 83, and 84% for CT; 74, 94, 87, 87 and 87% for MRI; 83, 93, 89, 89 and 89% for PET-CT, respectively. When all the three imaging modalities were considered together (n = 74), they offered sensitivity of 90%, specificity of 91%, positive predictive value of 87%, negative predictive value of 93%, and accuracy of 91%.

Conclusions

The preoperative imaging studies offered relatively high specificity rates, but rather low sensitivity rates. The three imaging modalities altogether increased diagnostic accuracies, which highlights the potential of the three studies when used altogether can minimize missed diagnoses of RPLN metastasis.
Impact of initial dialysis modality on the survival of patients with ESRD in eastern China: a propensity-matched study
Authors: Yao Xi , Lei Wenhua , Shi Nan , Lin Weiqiang , Du Xiaoying , Zhang Ping , Chen Jianghua
Published: July 2020

Background

There are conflicting research results about the survival differences between hemodialysis(HD) and peritoneal dialysis (PD). The present study estimated the survival and the relative mortality hazard for incident HD and PD patients with end stage renal disease (ESRD) in eastern China.

Methods

This study examined a cohort of patients with ESRD who initiated dialysis therapy in Zhejiang province between Jan of 2010 and Dec of 2014, followed up until the end of 2015. PD patients were matched in a 1:1 fashion with HD patients, and Kaplan–Meier analysis was used to explore the survival of them. The Cox proportional hazard regression model was applied to identify the factors that predict survival by treatment modality. Subgroup analyses were conducted by stratifying patients according to gender, age, causes of ESRD and comorbidities.

Results

Among a total of 22,379 enrolled patients (17,029 HD patients and 5350 PD patients), 5350 matched pairs were identified, and followed for a median of 29 months (3 ~ 72 months). Kaplan-Meier survival curve revealed that overall mortality rate was significantly higher in HD patients than in PD patients (log-rank test, P < 0.001), after adjusting by gender, age, primary causes of ESRD and comorbidities. HD was consistently associated with an increased risk for morality compared with PD in the matched cohort (adjusted hazard ratio (AHR): 1.140, 95%CI: 1.023 ~ 1.271). In subgroup analyses, male, younger patients, or nondiabetic patients aged less than 65 years after adjustment of covariates, initiating with PD was associated with a significantly lower mortality compared with HD. In the multivariate Cox proportional risks model, age, diabetic nephropathy (DN), other/unknown causes of ESRD, and patients with a history of cardiovascular disease or cancer showed statistical significance in explaining survival of incident ESRD patients.

Conclusions

ESRD patients who initiated dialysis with PD yielded superior survival rates compared to HD. Increased use of PD as initial dialysis modality in ESRD patients could be encouraged in Chinese population.
Detection of water-molecular-motion configuration in patients with lupus nephritis: a primary study using diffusion-weighted imaging
Authors: Shi Huilan , Wang Yanyan , Yan Tiekun , Jia Junya , Li Dong , Wei Li , Shang Wenya , Zheng Zhenfeng
Published: July 2020

Background

Lupus nephritis (LN) is one of most common types of secondary glomerulonephritis, which is characterized by longitudinal pathological changes. Microstructural lesions of LN will impact the motion of water molecules, which can be detected by diffusion-weighted imaging (DWI). There are few reported measurements of water diffusion in patients with LN, and the nature of water diffusion across the entire depth of the renal parenchyma remains largely unknown.

Methods

Twenty adult patients with LN and 11 healthy volunteers underwent DWI inspection. Renal biopsy samples were characterized based on the revised ISN/RPS 2003 classification. The apparent-diffusion coefficient (ADC) was calculated via fitting into a mono-exponential model. To compare the ADC level across the entire renal parenchyma between the two groups, repeated-measures analysis of variance (RM-ANOVA) was performed. ADC data derived from DWI pictures were transformed into tridimensional maps by MATLAB software.

Results

Compared with data from healthy volunteers, lower average ADC values with major undulatory magnitudes were found in patients with LN, especially in the cortical zone. Tridimensional maps of patients with LN displayed geographic terrain-like canyons and/or valleys that were different from the corresponding terrain-like flatlands and/or plateaus in healthy volunteers. A heterogeneity of ADC values was found in bilateral kidneys. Left kidneys predominated higher ADC values in patients with LN. The ADC values across the entire renal parenchyma exhibited statistically significant differences among the three identified pathological subclasses (P < 0.001).

Conclusions

Analysis of the motion of water molecules across the entire renal parenchyma may be helpful for better understanding the pathological conditions of LN, for which microstructural and functional heterogeneity may be detected and visualized via DWI.
Exploring health literacy in patients with chronic kidney disease: a qualitative study
Authors: Stømer Une Elisabeth , Wahl Astrid Klopstad , Gøransson Lasse Gunnar , Urstad Kristin Hjorthaug
Published: July 2020

Background

Patients with chronic kidney disease make day-to-day decisions about how to self-manage their disease. Chronic kidney disease (CKD) includes a risk for progression towards end-stage renal disease and the development of comorbidities, such as cardiovascular disease, which represents the leading cause of death among these patients. To reduce these risks, CKD patients are recommended to follow a healthy lifestyle with physical activity, food and fluid restrictions, and adherence to complex medication regimes throughout all phases of the disease. To manage the complexity of this health situation, health literacy (HL) is considered essential. The current prevailing understanding is that HL is a multidimensional concept and comprises a range of cognitive, affective, social, and personal skills that determine the motivation and ability to gain access to, understand, and use health information. Recently, we investigated multiple aspects of HL in CKD patients in a quantitative cross-sectional study utilizing the Health Literacy Questionnaire (HLQ) and observed that finding good health information and appraising health information were the most challenging aspects of HL. This study aimed to explore CKD patients’ lived experiences of different dimensions of HL presented in the HLQ.

Methods

This qualitative study utilized in-depth semistructured interviews. Twelve patients with different levels of HL were included. The interviews were analyzed using thematic analysis as described by Braun and Clarke.

Results

We identified three main themes that were significant for CKD patients’ HL: 1. Variation in people’s attitudes and behavior as health information seekers, 2. The problem of fragmented healthcare in the context of multimorbidity makes the healthcare system challenging to navigate, and 3. The value of a good relationship with healthcare providers.

Conclusion

CKD patients take different approaches to health information. Limiting or avoiding health information may be a strategy used by some individuals to cope with the disease and does not necessarily mean that health information is inaccessible or difficult to understand. Comorbidity and a fragmented healthcare system can make the healthcare system challenging to navigate. A good and trusting relationship with healthcare providers seems to promote several aspects of HL and should be promoted to optimize CKD patients’ HL.
A longitudinal study of bonding failure related to aspects of posttraumatic stress symptoms after childbirth among Japanese mothers
Authors: Suetsugu Yoshiko , Haruna Megumi , Kamibeppu Kiyoko
Published: July 2020

Background

Posttraumatic stress symptoms (PTSS) after childbirth may affect mother-infant bonding. This study examined the relationship between aspects of PTSS after childbirth and bonding failure for mothers at 1 month and 4 months after delivery.

Methods

This longitudinal study surveyed 130 mothers at 1 month (T1) and 4 months (T2) after delivery. We performed multiple regression analysis with the Postpartum Bonding Questionnaire (PBQ) as the dependent variable and the Impact of Event Scale-Revised (IES-R), Edinburgh Postnatal Depression Scale (EPDS), Relationship Questionnaire (RQ), Family Adaptation, Partnership, Growth, Affection, and Resolve score (F.APGAR), and demographic data as independent variables.

Results

The rate of mothers with an IES-R score of ≥ 25 was 6.2% at T1 and 3.8% at T2. The IES-R and the EPDS were relevant factors for the PBQ at T1. The IES-R was not a relevant factor, but the EPDS was a relevant factor for the PBQ at T2. The IES-R at T1 was not a predictor for the PBQ at T2. The PBQ at T1 was the largest predictor for the PBQ at T2, when compared with the EPDS, F.APGAR, and dismissive attachment pattern (RQ) at T1.

Conclusions

PTSS after childbirth had a strong influence on bonding failure at T1. However, the important factor affecting bonding failure was not PTSS after childbirth, but depression at T2. If PTSS after childbirth are accompanied by depression at T2, bonding failure may be affected. Bonding failure affected by PTSS after childbirth at T1 could affect bonding failure at T2. Health professionals should assess the degree of PTSS after childbirth and start to care for mothers at T1.
Dietary Approaches to Stop Hypertension (DASH) diets and breast cancer among women: a case control study
Authors: Heidari Zeinab , Mohammadi Elahe , Aghamohammadi Vahideh , Jalali Saba , Rezazadeh Arezoo , Sedaghat Fatemeh , Assadi Mojan , Rashidkhani Bahram
Published: July 2020

Background

Studying entire dietary patterns is a promising alternative approach to overcome limitations of the single food or nutrient approach. We evaluated the relationship between the scores of 4 established Dietary Approaches to Stop Hypertension (DASH) diet indexes and breast cancer risk among Iranian women.

Methods

This case-control study was carried out on 408 eligible women (136 cases and 272 hospital-based controls). A validated 168 item semi-quantitative food frequency questionnaire was used for assessing usual dietary intakes. DASH index scores were generated based on predefined algorithms for each of the 4 previously described indexes (Dixon’s, Mellen’s, Fung’s and Günther’s DASH diet index). Unconditional logistic regression analysis was performed to estimate odds ratio (OR) and 95% confidence intervals (CIs) for score categories or quintiles of DASH diet indexes and breast cancer risk in multivariate adjusted models.

Results

Women in the highest categories of the Mellen’s and Günther’s scores had lower odds of breast cancer than those in the lowest quintiles (Mellen’s OR:0.50; 95% CI:0.62–0.97; P-trend:0.02; Günther’s OR:0.48; 95% CI:0.25–0.93; P-trend:0.05). However, no significant associations were found between Dixon’s and Fung’s DASH score and breast cancer risk. Modification by menopausal status revealed that breast cancer risk was only reduced in postmenopausal women with higher scores on Mellen’s index (OR:0.24; 95% CI:0.08–0.68; P-trend:0.04).

Conclusion

A greater adherence to 2 of the 4 DASH indexes (Mellen’s and Günther’s indexes) was associated with decreased risk of breast cancer.
Efficacy of combining intravitreal injections of ranibizumab with micropulse diode laser versus intravitreal injections of ranibizumab alone in diabetic macular edema (ReCaLL): a single center, randomised, controlled, non-inferiority clinical trial
Authors: Furashova Olga , Strassburger Patrick , Becker Klio Ai , Engelmann Katrin
Published: July 2020

Background

To evaluate if a combination therapy with micropulse diode laser (MPL) shows non-inferiority on visual acuity (BCVA) within 12 months in comparison to standard therapy, i.e. intravitreal injection of ranibizumab alone.

Setting

Institutional. Prospective randomized single-center trial.

Methods

Patients with diabetic macular edema (DME) received three intravitreal injections of 0.5 mg ranibizumab during the upload phase and were then randomised 1:1 to receive either the same dosage of ranibizumab (0.5 mg) injections pro re nata alone (IVOM-Group; n = 9), or with two additional treatments with micropulse diode laser (IVOM+Laser-Group; n = 10). The primary endpoint was change in BCVA after 12 months. Secondary endpoints were change in central macular thickness and overall number of ranibizumab injections.

Results

BCVA increased significantly in both groups (IVOM: + 5.86, p < 0.001; IVOM+Laser: + 9.30; p < 0.001) with corresponding decrease in central macular thickness (IVOM: − 105 μm, p < 0.01; IVOM+Laser: − 125 μm; p < 0.01). Patients with additional laser treatment had better visual improvement (group comparison p = 0.075) and needed fewer ranibizumab injections (cumulative proportion of injections 9.68 versus 7.46 in IVOM-Group and IVOM+Laser-Group, respectively).

Conclusion

Non-inferiority of combination therapy in comparison to standard therapy alone could be demonstrated. Patients with additional laser therapy needed fewer ranibizumab injections.

Trial registration

Registered 10 February 2014 on ClinicalTrials.gov; NCT02059772.