bluuebunny/crossref_metadata_2025 huggingface dataset:
Stereotactic body radiation therapy in the treatment of ovarian cancer
Authors: Kowalchuk Roman O. , Waters Michael R. , Richardson K. Martin , Spencer Kelly , Larner James M. , Irvin William P. , Kersh Charles R.
Published: May 2020

Background

This study evaluates the outcomes and toxicity of stereotactic body radiation therapy (SBRT) in ovarian cancer.

Methods

This retrospective analysis considered all patients treated with SBRT from 2009 to 2018 with a primary ovarian tumor. Follow-up included PET-CT and CT scans at 2–3 month intervals. Statistical analysis primarily consisted of univariate analysis, Cox proportional hazards analysis, and the Kaplan-Meier method.

Results

The study included 35 patients with 98 treatments for lymph nodes (51), local recurrence (21), and de novo solid metastases (26). Median biologically effective dose (BED), gross tumor volume, and planning target volume were 38.40 Gy, 10.41 cc, and 25.21 cc, respectively. 52 lesions showed complete radiographic response, and two-year local control was 80%. Median overall survival (OS) was 35.2 months, and two-year progression-free survival (PFS) was 12%. On univariate analysis, Eastern Cooperative Oncology Group performance status > 0 was predictive of decreased OS (p = 0.0024) and PFS (p = 0.044). Factors predictive of local failure included lower BED (p = 0.016), treatment for recurrence (p = 0.029), and higher pre-treatment SUV (p = 0.026). Kaplan-Meier analysis showed BED ≤35 Gy (p < 0.005) and treatment for recurrence (p = 0.01) to be predictive of local failure. On Cox proportional hazards analysis, treatment of lymph nodes was predictive of complete radiographic response (hazard ratio (HR) = 4.95), as was higher BED (HR = 1.03). Toxicity included 27 cases of grade < 3 toxicity, and one grade 5 late toxicity of GI bleed from a radiation therapy-induced duodenal ulcer.

Conclusions

SBRT provides durable local control with minimal toxicity in ovarian cancer, especially with BED > 35 Gy and treatment for lymph nodes.
Cardiac operation under cardiopulmonary bypass during pregnancy
Authors: Liu Yanli , Han Fengzhen , Zhuang Jian , Liu Xiaoqing , Chen Jimei , Huang Huanlei , Wang Sheng , Zhou Chengbin
Published: May 2020

Background

Certain pregnant women suffer from cardiac pathology,and a few of them need cardiac operations under cardiopulmonary bypass during pregnancy. Feto-neonatal and maternal outcomes have not been sufficiently described.

Methods

We conducted a retrospective review of 22 cases of women undergoing cardiac operations under cardiopulmonary bypass during pregnancy in our hospital from Jan.2014 to Mar.2019.

Results

All 22 patients were alive after treatment. The types of cardiac disorders included congenital heart defects, rheumatic heart disease,infective endocarditis,aortic dissection, obstruction and/or thrombosis of a prosthetic valve. Only one case was a twin pregnancy,and the other 21 cases were singletons. Four fetuses died in the utero after surgery. Three patients chose termination of the pregnancy after the cardiac operations: one fetus was detected abnormity of the brain and the other two patients abandoned pregnancy. Fourteen fetuses were alive and born without any abnormity. Two fetuses suffered from neonatal intracranial hemorrhage and died after birth.

Conclusions

Cardiac operation under cardiopulmonary bypass during pregnancy is a challenge for physicians in multidisciplinary teams. Strictly evaluating the indication is vital. On the other hand, some patients can benefit from this management.
Comparison of survival outcomes of locally advanced cervical cancer by histopathological types in the surveillance, epidemiology, and end results (SEER) database: a propensity score matching study
Authors: Tian Tian , Gong Xing , Gao Xudong , Li Yanqing , Ju Wen , Ai Yiqin
Published: May 2020

Background

There has been limited research on the comparison of squamous cell carcinoma (SCC) and adenocarcinoma (AC) of cervical cancer and that lack of information may have significant bearing on the treatment of patients. We compared survival outcomes between squamous cell carcinoma and adenocarcinoma in locally advanced cervical cancer patients and examined factors related to the prognosis of cervical cancer.

Methods

We identified 4131 patients with stage IB2-IVA cervical cancer patients diagnosed between 2010 and 2015 by using the Surveillance, Epidemiology, and End Results (SEER) database. Variables related to the prognosis of cervical cancer were compared using both univariate and multivariate Cox models and log-rank method before and after propensity score matching. We compared the efficacy of radiotherapy alone to radiotherapy combined with chemotherapy or/and surgery in overall survival of SCC and AC.

Results

Our sample included 3385 patients with SCC (81.9%) and 746 patients with AC (18.1%). The 5-year overall survival on comparing the squamous cell carcinoma group and adenocarcinoma group was not significant (P > 0.05). Using propensity score matching, 676 pairs of patients were selected. The 5-year overall survival of matched patients did not differ significantly (P > 0.05). Histology was not independently associated with overall survival in multivariate Cox model (P > 0.05). Factors affecting overall survival included FIGO stage IVA (P < 0.05), chemotherapy (P < 0.05), and external radiation combined with brachytherapy (P < 0.05). Patients with SCC that were treated with radiation alone had significantly worse OS than AC patients receiving radiation only (P < 0.05).

Conclusions

The OS in AC of the cervix is similar to that SCC in when treated with radiotherapy combined with chemotherapy and/or surgery but better when treated with radiation alone.
Conducting operational research in humanitarian settings: is there a shared path for humanitarians, national public health authorities and academics?
Authors: Leresche Enrica , Truppa Claudia , Martin Christophe , Marnicio Ariana , Rossi Rodolfo , Zmeter Carla , Harb Hilda , Hamadeh Randa Sami , Leaning Jennifer
Published: May 2020

In humanitarian contexts, it is a difficult and multi-faceted task to enlist academics, humanitarian actors and health authorities in a collaborative research effort. The lack of research in such settings has been widely described in the past decade, but few have analysed the challenges in building strong and balanced research partnerships. The major issues include considering operational priorities, ethical imperatives and power differentials. This paper analyses in two steps a collaborative empirical endeavour to assess health service utilization by Syrian refugee and Lebanese women undertaken by the International Committee of the Red Cross (ICRC), the Lebanese Ministry of Public Health (MoPH) and the Harvard François-Xavier Bagnoud (FXB) Center.

First, based on challenges documented in the literature, we shed light on how we negotiated appropriate research questions, methodologies, bias analyses, resource availability, population specificities, security, logistics, funding, ethical issues and organizational cultures throughout the partnership.

Second, we describe how the negotiations required each partner to go outside their comfort zones. For the academics, the drivers to engage included the intellectual value of the collaboration, the readiness of the operational partners to conduct an empirical investigation and the possibility that such work might lead to a better understanding in public health terms of how the response met population needs. For actors responding to the humanitarian crisis (the ICRC and the MOPH), participating in a technical collaboration permitted methodological issues to be worked through in the context of deliberations within the wider epistemic community.

We find that when they collaborate, academics, humanitarian actors and health authorities deploy their respective complementarities to build a more comprehensive approach. Barriers such as the lack of uptake of research results or weak links to the existing literature were overcome by giving space to define research questions and develop a longer-term collaboration involving individual and institutional learning. There is the need ahead of time to create balanced decision-making mechanisms, allow for relative financial autonomy, and define organizational responsibilities. Ultimately, mutual respect, trust and the recognition of each other’s expertise formed the basis of an initiative that served to better understand populations affected by conflict and meet their needs.
Introducing the “Corona Curtain”: an innovative technique to prevent airborne COVID-19 exposure during emergent intubations
Authors: Hill Eric , Crockett Christopher , Circh Ryan W. , Lansville Frank , Stahel Philip F.
Published: May 2020

Background

The coronavirus disease 2019 (COVID-19) pandemic places healthcare workers at risk of exposure to the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). Emergency department (ED) staff are particularly vulnerable when managing patients with acute respiratory distress due to the aerosolization of the virus during endotracheal intubation. A simple and innovative intubation tent was designed with the intent of decreasing the risk of accidental viral transmission from emergent intubations during the COVID-19 pandemic.

Presentation of technique

The materials and assembly process of the novel “Corona Curtain” are described in technical detail, with the intent of allowing other providers to template the concept at their respective facilities.

Results

A total of 36 intubation tents were mounted in the ED at the Medical Center of Aurora, Colorado, on April 7, 2020, and thereafter consistently used for all intubations during the ongoing COVID-19 outbreak. The cost of raw materials and labor for the initial assembly averaged US $ 8.00 per construct. The price of the single-use plastic cover is variable depending on the vendor source.

Conclusion

The new “Corona Curtain” was designed to improve the safety of ED staff when performing urgent/emergent intubations during the current COVID-19 pandemic. The concept can easily be adopted to other patient care areas, including perioperative and intensive care units. Future validation studies are needed to determine the safety and efficacy of the intubation tents by quantifying the pre−/post-intubation exposure through “point-of-care” SARS-CoV-2 testing once these resources are more widely available.
Proteoglycan-4 regulates fibroblast to myofibroblast transition and expression of fibrotic genes in the synovium
Authors: Qadri Marwa , Jay Gregory D. , Zhang Ling X. , Richendrfer Holly , Schmidt Tannin A. , Elsaid Khaled A.
Published: May 2020

Background

Synovial tissue fibrosis is common in advanced OA with features including the presence of stress fiber-positive myofibroblasts and deposition of cross-linked collagen type-I. Proteoglycan-4 (PRG4) is a mucinous glycoprotein secreted by synovial fibroblasts and is a major component of synovial fluid. PRG4 is a ligand of the CD44 receptor. Our objective was to examine the role of PRG4-CD44 interaction in regulating synovial tissue fibrosis in vitro and in vivo.

Methods

OA synoviocytes were treated with TGF-β ± PRG4 for 24 h and α-SMA content was determined using immunofluorescence. Rhodamine-labeled rhPRG4 was incubated with OA synoviocytes ± anti-CD44 or isotype control antibodies and cellular uptake of rhPRG4 was determined following a 30-min incubation and α-SMA expression following a 24-h incubation. HEK-TGF-β cells were treated with TGF-β ± rhPRG4 and Smad3 phosphorylation was determined using immunofluorescence and TGF-β/Smad pathway activation was determined colorimetrically. We probed for stress fibers and focal adhesions (FAs) in TGF-β-treated murine fibroblasts and fibroblast migration was quantified ± rhPRG4. Synovial expression of fibrotic markers: α-SMA, collagen type-I, and PLOD2 inPrg4gene-trap (Prg4GT) and recombinedPrg4GTRanimals were studied at 2 and 9 months of age. Synovial expression of α-SMA and PLOD2 was determined in 2-month-oldPrg4GT/GT&Cd44−/−andPrg4GTR/GTR&Cd44−/−animals.

Results

PRG4 reduced α-SMA content in OA synoviocytes (p < 0.001). rhPRG4 was internalized by OA synoviocytes via CD44 and CD44 neutralization attenuated rhPRG4’s antifibrotic effect (p < 0.05). rhPRG4 reduced pSmad3 signal in HEK-TGF-β cells (p < 0.001) and TGF-β/Smad pathway activation (p < 0.001). rhPRG4 reduced the number of stress fiber-positive myofibroblasts, FAs mean size, and cell migration in TGF-β-treated NIH3T3 fibroblasts (p < 0.05). rhPRG4 inhibited fibroblast migration in a macrophage and fibroblast co-culture model without altering active or total TGF-β levels. Synovial tissues of 9-month-oldPrg4GT/GTanimals had higher α-SMA, collagen type-I, and PLOD2 (p < 0.001) content andPrg4re-expression reduced these markers (p < 0.01).Prg4re-expression also reduced α-SMA and PLOD2 staining in CD44-deficient mice.

Conclusion

PRG4 is an endogenous antifibrotic modulator in the joint and its effect on myofibroblast formation is partially mediated by CD44, but CD44 is not required to demonstrate an antifibrotic effect in vivo.
Hop tests and psychological PROs provide a demanding and clinician-friendly RTS assessment of patients after ACL reconstruction, a registry study
Authors: Piussi Ramana , Beischer Susanne , Thomeé Roland , Hamrin Senorski Eric
Published: May 2020

Background

There is growing interest in assessing psychological well-being in patients after anterior cruciate ligament (ACL) reconstruction. It is unknown whether an assessment of psychological outcome in addition to tests of muscle function can facilitate decisions on return to sport (RTS). Therefore, the aim of this study was to evaluate passing rates in different physical RTS test batteries, with and without the inclusion of psychological outcome measures 1 year after ACL reconstruction.

Method

In this cross-sectional cohort study a total of 320 patients (51% men) aged 18–65 years were included 1 year after ACL reconstruction.Passing rates on different muscle function (MF) test batteries (with results presented as Limb Symmetry Index (LSI)), consisting of knee extension and flexion strength tests, 3 hop tests, and 2 psychological patient-reported outcomes (PROs); Quality of Life subscale from the Knee injury and Osteoarthritis Outcome Score (KOOS QoL) and ACL Return to Sport after Injury (ACL-RSI), were evaluated 1 year after ACL reconstruction. Muscle function test batteries comprised: 2 MF tests (vertical hop and hop for distance; pass = 90% LSI); 2 MF tests and 2 PRO (pass = 90% LSI, 62.5 points on KOOS QoL and 76.6 points on ACL-RSI), 5 MF tests (2 strength and 3 hop tests, pass = 90% LSI), and 5 MF tests and 2 PRO (pass = 90% LSI, 62.5 points on KOOS QoL and 76.6 points on ACL-RSI).

Results

Passing rates in the different test batteries were 47% for 2 MF tests, 19% for 2 MF tests and 2 PROs, 29% for 5 MF tests and 13% for 5 MF tests and 2 PROs. The use of psychological PROs together with tests of muscle function gave the lowest passing rate (13%). There was a very strong correlation between passing 2 hop tests and 2 PROs and passing 5 MF tests (rφ = 0.41) as well as passing 5 MF tests and 2 PROs (rφ = 0.79).

Conclusion

The use of hop tests together with psychological PROs provides a clinician-friendly RTS test battery for assessment 1 year after ACL reconstruction as the passing rate was 19% when using 2 hop-tests combined with 2 PROs, compared with 29% when using 5 tests of MF requiring advanced testing equipment.
The quality evaluation system establishment of mesenchymal stromal cells for cell-based therapy products
Authors: Xie Yuanyuan , Liu Wei , Liu Shuo , Wang Liudi , Mu Dan , Cui Yi , Cui Yanyan , Wang Bin
Published: May 2020

Background

Cell-based therapy products are supposed to be the most complex medicine products in the history of human medical care. In this study, we established a safety evaluation system for therapeutic stromal cells based on the existing regulations and current testing techniques to provide general quality requirements for human umbilical cord mesenchymal stromal cell (HUCMSC) therapy product.

Methods

In this system, we comprehensively evaluate the environmental monitoring program, quality control of critical raw materials and reagents, donor screening criteria, cell safety, quality, and biological effects, not only in line with the basic criteria of biological products, but also following the general requirements of drugs.

Results

The qualified HUCMSCs were tested for various clinical researches in our hospital, and no severe adverse reaction was observed in 225 patients during a 1-year follow-up period.

Conclusion

In this study, we establish a systemic quality control and potent assays to guarantee the safety and effectiveness of HUCMSCs based on a minimum set of standards in MSC-based product.
Performance bounds for diversity receptions over a new fading model with arbitrary branch correlation
Authors: Olutayo Adebola , Cheng Julian , Holzman Jonathan F.
Published: May 2020

The performance of a new (Beaulieu-Xie) fading model is analyzed using bounds. This recently proposed fading model can be used to describe both line-of-sight and non-line-of-sight components of a fading channel having different diversity orders. We consider the outage probability and error rate performance of maximal ratio combining, equal-gain combining, and selection combining over arbitrarily correlated Beaulieu-Xie fading channels. Closed-form expressions for upper and lower bounds to the outage probability and error rate are obtained, and it is shown that these bounds are asymptotically tight in the high signal-to-noise ratio regime. The analytical results are verified via Monte Carlo simulations. It is shown that the Beaulieu-Xie fading model can be more useful than the Ricean and Nakagami-m fading models in characterizing environments with both line-of-sight and multiple reflected specular components.
A class of Hilbert-type multiple integral inequalities with the kernel of generalized homogeneous function and its applications
Authors: Hong Yong , Liao Jianquan , Yang Bicheng , Chen Qiang
Published: May 2020

Let $x=(x_{1},x_{2},\ldots,x_{n})$x=(x1,x2,…,xn), and let $K(u(x),v(y))$K(u(x),v(y)) satisfy $u(rx)=ru(x)$u(rx)=ru(x), $v(ry)=rv(y)$v(ry)=rv(y), $K(ru,v)=r^{\lambda\lambda_{1}}K(u, r^{-\frac{\lambda_{1}}{\lambda_{2}}}v)$K(ru,v)=rλλ1K(u,r−λ1λ2v), and $K(u,rv)=r^{\lambda\lambda_{2}}K(r^{-\frac{\lambda_{2}}{\lambda_{1}}}u, v)$K(u,rv)=rλλ2K(r−λ2λ1u,v). In this paper, we obtain a necessary and sufficient condition and the best constant factor for the Hilbert-type multiple integral inequality with kernel $K(u(x),v(y))$K(u(x),v(y)) and discuss its applications in the theory of operators.
Hopf bifurcation control for the main drive delay system of rolling mill
Authors: Wang Jinbin , Ma Lifeng , Wang Yong
Published: May 2020

In this work, the Hopf bifurcation of the main drive delay system of rolling mill is controlled and analyzed by designing a nonlinear controller. The time-delay is selected as a bifurcation parameter, and the following conclusions are obtained through analysis: (1) in the absence of state feedback control, the system will generate the Hopf bifurcation at the expense of its stability when the bifurcation parameter exceeds the threshold value; (2) in the state under feedback control, the occurrence of Hopf bifurcation is effectively delayed and the stable region of the system is also well extended. More importantly, we can change the properties of bifurcation periodic solutions by selecting the appropriate gain parameters. Some numerical simulations reveal that under the nonlinear feedback control, the vibration amplitude of the system can be effectively reduced.
Sharing values of q-difference-differential polynomials
Authors: Li Jian , Liu Kai
Published: May 2020

This paper is devoted to the uniqueness of q-difference-differential polynomials of different types. Using the idea of common zeros and common poles (Chin. Ann. Math., Ser. A 35:675–684, 2014), we improve the conditions of the former theorems and obtain some new results on the uniqueness of q-difference-differential polynomials of meromorphic functions.
Global existence of classical solutions for two-dimensional isentropic compressible Navier–Stokes equations with small initial mass
Authors: Li Wei , Shang Zhaoyang , Tang Fuquan
Published: May 2020

In this paper, we consider the initial-boundary value problem of two-dimensional isentropic compressible Navier–Stokes equations with vacuum on the square domain. Based on the time-weighted uniform estimates, we prove that the classical solution exists globally in time if the initial mass$\|\rho_{0}\|_{L^{1}}$∥ρ0∥L1of the fluid is small. Here, we do not require the initial energy or the upper bound of the initial density to be small.
Substance use prevention services in juvenile justice and behavioral health: results from a national survey
Authors: Funk Rodney , Knudsen Hannah K. , McReynolds Larkin S. , Bartkowski John P. , Elkington Katherine S. , Steele Ellen H. , Sales Jessica M. , Scott Christy K.
Published: May 2020

Background

This study examined the national availability of substance use prevention (SUP) within juvenile justice (JJ) and their primary behavioral health (BH) providers, and the relationships between the availability of SUP and agency-level measures of organizational structure, staffing, and youth characteristics. A three-stage national probability sampling process was used to select participants for a national survey that included, among other facets of community supervision (CS) and BH practices, questions on agency characteristics, youth characteristics, whether the agency/provider directly provided SUP services, and whether the agency/provider directly provided substance use and/or mental health treatment. This paper focuses on SUP services along with agency/provider and youth characteristics related to providing SUP.

Results

The response rate for both CS agencies (n = 195) and BH providers (n = 271) was 96%. Complex samples logistic regression initially examined univariate associations of each variable and identified candidates for a final multivariate model. Overall, only one-third of CS and BH providers reported offering SUP services, with BH providers being significantly more likely than CS agencies to provide SUP services. In addition, likelihood of SUP was significantly lower among agencies where the substance use distribution of the caseload was below the median. Controlling for master’s level staff and the substance use distribution, CS agencies were about 67% less likely to offer SUP when compared to BH providers.

Conclusions

Given the high rates of substance use among justice-involved youth and that substance use is an established risk for several negative behaviors, outcomes, and health conditions, these findings suggest that evidence-based prevention services should likely be expanded in justice settings, and perhaps included as part of CS programs, even when youth do not initially present with SU service needs.
Effects of boron toxicity on growth, oxidative damage, antioxidant enzymes and essential oil fingerprinting in Mentha arvensis and Cymbopogon flexuosus
Authors: Choudhary Sadaf , Zehra Andleeb , Naeem M. , Khan M. Masroor A. , Aftab Tariq
Published: May 2020

Background

Boron (B) is an essential micronutrient and necessary to plants for their proper growth. The concentration of B in soil and plant is greatly critical for the growth and productivity. Even at the low amount available in soils, B can be extremely toxic to plants especially in semi-arid and arid environments. In the present study, the effects of high B concentrations (2.5, 5, 10, 20 and 30 mg/kg) were elucidated on two important essential oil-bearing plants;Mentha arvensisandCymbopogon flexuosuswhich are aromatic and antimicrobial herbs having well-known medicinal values.

Results

Application of different concentrations of B showed growth inhibitory effects on plant as evident by shoot and root lengths, fresh and dry weights of shoot in the studied plants. Treatments of B also reduced the total chlorophyll and carotenoid content, chlorophyll fluorescence and reduced the activities of carbonic anhydrase and nitrate reductase enzymes. Moreover, B stress considerably increased the proline content and lipid peroxide content as compared to control. The activities of antioxidant enzymes like catalase, peroxidase and superoxide dismutase were also significantly increased under B stress. The content of essential oil ofM. arvensisandC. flexuosusincreased at 2.5 mg/kg of B and decreased with further increase in concentrations of B.

Conclusion

The findings of present work suggest that increasing concentrations of B inhibited growth and photosynthetic pigments, increased oxidative damage and activities of antioxidant enzymes; however, a mild stress of B increased essential oil production inM. arvensisandC. flexuosusplants.
Evaluation of a novel portable three-dimensional scapular kinematics assessment system with inter and intraobserver reproducibility and normative data for healthy adults
Authors: Ruiz Ibán Miguel Angel , Paniagua Gonzalez Andrea , Muraccini Marco , Asenjo Gismero Cristina , Varini Alessandro , Berardi Antonella , Mantovani Matteo
Published: May 2020

Purpose

To evaluate the intra and interobserver reproducibility of a new system that assesses the three-dimensional humero-scapulo-thoracic kinematics using wearable technology in an outpatient setting. To obtain normative data with the system for scapular angular motions in three planes.

Methods

The SHoW Motion 3D kinematic tracking system is a motion analysis system that uses wireless wearable non-invasive inertial-magnetic sensors to assess the three-dimensional kinematics of the shoulder girdle. The sensors are placed over the skin in the sternum, scapular spine and arm to precisely define angular motions of the humerus and the scapula with three Degrees of Freedom (DOF) for each segment.

The system was used to measure the scapular angular motions in three planes (upward/downward rotation, internal/external rotation and anterior/posterior tilt) during two shoulder full-range movements (flexion/extension and abduction/abduction) in both shoulders of 25 healthy volunteers (13 males and 12 females, mean age: 37 [standard deviation 11.1] years). In a first measuring session one examiner made two evaluations alternating with another examiner that made a third evaluation. In a second session, one week apart, the first examiner made a fourth evaluation.

A mean curve was computed from the normalized data for each measurement to obtain normative data for scapular angular kinematics. Intra and inter-observer reproducibility was evaluated using Root Mean Square Error Estimation (RMSE) and Coefficients for Multiple Correlations (CMC).

Results

Both shoulders of the 25 volunteers were evaluated four times. The two hundred resulting kinematic analyses were pooled to get normative values for relations between humeral elevation angles and the three angular movements of the scapula.

The system showed at least very good (CMC > 0.90) intra and inter-observer reproducibility for scapular tilt and upward-downward rotations both in flexion and abduction. For scapular internal-external rotation the results were acceptable (CMC > 0.75) but not as good, especially for the abduction movement. RMSE calculations showed consistently good reproducibility with RSME< 4° for all three angles evaluated in flexion and abduction.

Conclusion

The SHoW Motion 3D kinematic tracking system is a quick, reproducible and easy to use system for the assessment of scapular angular kinematics in healthy adults. The data obtained is similar to that obtained with other validated methods.

Level of evidence

Level II.

Clinical relevance

The presented system is portable, easy to use and fast. It also has good intra and inter-observer reproducibility, making it a good tool to assess objectively scapular dyskinesis in the clinical setting. The normative data obtained is consistent with previous information available.
COVID-19 - ESSKA guidelines and recommendations for resuming elective surgery
Authors: Mouton Caroline , Hirschmann Michael T. , Ollivier Matthieu , Seil Romain , Menetrey Jacques
Published: May 2020

The roadmap to elective surgery resumption after this COVID-19 pandemic should be progressive and cautious. The aim of this paper was to give recommendations and guidelines for resuming elective orthopedic surgery in the safest environment possible. Elective surgery should be performed in COVID-free facilities and hospital stay should be as short as possible. For matters of safety, patients considered first for surgery should be carefully selected according to COVID infection status/exposure, age, ASA physical status classification system / risk factors, socio-professional situation and surgical indication. A strategy for resuming elective surgery in four phases is proposed. Preoperative testing for COVID-19 infection is highly recommended. In any cases, COVID symptoms including fever and increased temperature should be constantly monitored until the day of surgery. Elective surgery should be postponed at the slightest suspicion of a COVID-19 infection. In case of surgery, adapted personal protective equipment in terms of gowns, gloves, masks and eye protection is highly recommended and described.
In vitro characterization of PrismaLung+: a novel ECCO2R device
Authors: Hospach Ingeborg , Goldstein Jacques , Harenski Kai , Laffey John G. , Pouchoulin Dominique , Raible Manuela , Votteler Stefanie , Storr Markus
Published: May 2020

Background

Invasive mechanical ventilation is lifesaving in the setting of severe acute respiratory failure but can cause ventilation-induced lung injury. Advances in extracorporeal CO2 removal (ECCO2R) technologies may facilitate more protective lung ventilation in acute respiratory distress syndrome, and enable earlier weaning and/or avoid invasive mechanical ventilation entirely in chronic obstructive pulmonary disease exacerbations. We evaluated the in vitro CO2 removal capacity of the novel PrismaLung+ ECCO2R device compared with two existing gas exchangers.

Methods

The in vitro CO2 removal capacity of the PrismaLung+ (surface area 0.8 m2, Baxter) was compared with the PrismaLung (surface area 0.35 m2, Baxter) and A.L.ONE (surface area 1.35 m2, Eurosets) devices, using a closed-loop bovine blood–perfused extracorporeal circuit. The efficacy of each device was measured at varying pCO2 inlet (pinCO2) levels (45, 60, and 80 mmHg) and blood flow rates (QB) of 200–450 mL/min; the PrismaLung+ and A.L.ONE devices were also tested at a QB of 600 mL/min. The amount of CO2 removed by each device was assessed by measurement of the CO2 infused to maintain circuit equilibrium (CO2 infusion method) and compared with measured CO2 concentrations in the inlet and outlet of the CO2 removal device (blood gas analysis method).

Results

The PrismaLung+ device performed similarly to the A.L.ONE device, with both devices demonstrating CO2 removal rates ~ 50% greater than the PrismaLung device. CO2 removal rates were 73 ± 4.0, 44 ± 2.5, and 72 ± 1.9 mL/min, for PrismaLung+, PrismaLung, and A.L.ONE, respectively, at QB 300 mL/min and pinCO2 45 mmHg. A Bland–Altman plot demonstrated that the CO2 infusion method was comparable to the blood gas analysis method for calculating CO2 removal. The resistance to blood flow across the test device, as measured by pressure drop, varied as a function of blood flow rate, and was greatest for PrismaLung and lowest for the A.L.ONE device.

Conclusions

The newly developed PrismaLung+ performed more effectively than PrismaLung, with performance of CO2 removal comparable to A.L.ONE at the flow rates tested, despite the smaller membrane surface area of PrismaLung+ versus A.L.ONE. Clinical testing of PrismaLung+ is warranted to further characterize its performance.
Cultural responsiveness in the Incredible Years parenting programme for refugees: a case study
Authors: Danbolt Anne Marit Vesteraas
Published: May 2020

The Incredible Years is a parenting programme that has been implemented in several countries, and in later years also used in groups consisting of newly arrived immigrant families. The aim of this paper is to explore how refugee parents perceive the cultural responsiveness in the Incredible Years programme offered to a group of newly arrived refugee parents in a municipality in Norway. A key feature of the implementation was the role of the interpreters, as they were considered co-workers with the group leaders and held key roles in the Incredible Years programme. Whilst the dialogic nature of the Incredible Years programme and the open-mindedness of the group leaders promoted a reasonable responsiveness in the implementation, the empowered role of the interpreters was the most crucial point in securing a responsive cross-cultural dialogue. In a situation characterised by uncertainty, the social capital of the family seemed to gain increased value, and the participants were hesitant to discuss any problems with their children. The findings are useful for the provision of the Incredible Years programme to immigrant or refugee families who will need interpreters to take part in the courses.
A comparison of biologicals in the treatment of adults with severe asthma – real-life experiences
Authors: Kotisalmi Emma , Hakulinen Auli , Mäkelä Mika , Toppila-Salmi Sanna , Kauppi Paula
Published: May 2020

Background

Anti-IgE (omalizumab) and anti-IL5/IL5R (reslizumab, mepolizumab and benralizumab) treatments are available for severe allergic and eosinophilic asthma. In these patients, studies have shown beneficial effects in oral corticosteroid use and exacerbations. The aim of this retrospective single-center study was to evaluate the effect of biological therapy on severe asthma and to compare different therapies.

Methods

We collected and analysed results of anti-IL5/IL5R and anti-IgE therapies for asthma from January 2009 until October 2019 in specialized care. We compared number of exacerbations, asthma symptoms and use of per oral corticosteroids and antimicrobics because of asthma before and during biological therapy, and in a separate analysis need for per oral corticosteroids, antimicrobics or surgery due to upper respiratory tract diseases in asthmatics receiving biologicals. The analyses were done using the Chi square test, T-test or Mann-Whitney U -test, the Kruskall-Wallis test or the Wilcoxon test.

Results

Of 64 patients, 40 used continuous per oral corticosteroid therapy prior to biological therapy. The mean daily dose of per oral corticosteroid was reduced in those with anti-IL5/IL5R therapy (− 3.0 mg, p = 0.02). The number of annual per oral corticosteroid courses decreased in both the anti-IL5/IL5R (− 2.8 courses, p < 0.05) and anti-IgE groups (− 1.3 courses, p < 0.05). The number of annual antibiotic courses (− 0.7 courses, p = 0.04) and total number of exacerbation events (− 4.4 events/year, p < 0.05) were reduced in the anti-IL5/IL5R group. In the 55 asthma patients analysed for upper respiratory tract findings, the results suggested a reduction in need for chronic rhinosinusitis surgery during biological therapy.

Conclusions

Results with biological therapies in this real-life clinical setting are comparable to those reported in clinical trials. Biological therapy reduces exacerbations and per oral corticosteroid use.

Trial registration

NCT04158050, retrospectively registered 6.11.2019.
Adverse impact of univentricular pacing for the patient with functional single ventricle: successful conversion to cardiac resynchronization therapy
Authors: Sugimoto Ai , Takigiku Kiyohiro , Shiraishi Shuichi , Takahashi Masashi , Tsuchida Masanori
Published: May 2020

Background

In a Fontan candidate, univentricular pacing may cause delay in interventricular conduction, which induces asynchronous contraction. Cardiac resynchronization therapy is expected to be an effective mode of therapy in such a case.

Case presentation

A 7-month-old girl, diagnosed with dextrocardia, congenitally corrected transposition of the great artery [situs solitus, L-loop, and L-transposition], ventricular septal defect, infundibular and pulmonary valvular stenosis, and straddling of the tricuspid valve, was considered as a candidate for the Fontan procedure. She had undergone Blalock-Taussig shunt, and epicardial univentricular pacemaker implantation for persistent complete atrioventricular block. She underwent a bidirectional cavopulmonary shunt concomitant with ventricular lead translocation from the morphological left ventricle to the morphological right ventricle. After discharge, ventricular dyssynchrony was noted and cardiac failure persisted. She was converted to cardiac resynchronization therapy (CRT) at 13 months of age. Two-dimensional speckle tracking imaging was used by cardiologists to determine the most suitable pacing site. CRT rapidly corrected the heart failure; thus, she underwent the Fontan procedure after 1.5 years. Five years have passed since the cardiac resynchronization therapy; her interventricular synchrony is maintained well and the level of brain natriuretic peptide remains within normal range.

Conclusion

We describe the successful conversion from single ventricular pacing to CRT, in a case of congenitally corrected transposition of the great artery indicated for the Fontan procedure. The long-term prognosis of cardiac resynchronization therapy is undetermined in the pediatric population; therefore, further follow-up is required.
The Cystic Fibrosis Impact Questionnaire: qualitative development and cognitive evaluation of a new patient-reported outcome instrument to assess the life impacts of cystic fibrosis
Authors: McCarrier Kelly P. , Hassan Mariam , Hodgkins Paul , Suthoff Ellison , McGarry Lisa J. , Martin Mona L.
Published: May 2020

Background

Patients with cystic fibrosis (CF) experience significant disease burden, including progressive pulmonary decline and reduced survival. This multicenter qualitative study was conducted to develop a new patient-reported outcome (PRO) measure to assess the impact of CF on patients’ quality of life: the Cystic Fibrosis Impact Questionnaire (CF-IQ).

Semi-structured qualitative concept elicitation (CE) interviews with patients and caregivers documented CF-related symptoms, impacts, and treatment experiences. Coded interview data were considered alongside existing PROs, published literature, and expert opinion to develop an initial scale. Three rounds of cognitive interviews evaluated respondent comprehension and facilitated refinement of the CF-IQ.

Results

Adult (N = 20) and pediatric (N = 22) patients with CF and their parents/caregivers (N = 22) completed CE interviews at 7 US clinics. The sample included patients aged 6–58 years, 57% females, and represented a broad range of disease severity (forced expiratory volume in 1 s range: 22%–127% predicted). Interviews identified 59 unique CF-related impact concepts in domains, including activity limitations (physical, social, leisure), functional limitations (school, work), vulnerability/lack of control, emotional impact, treatment burden, and future outlook. Concept saturation was achieved, and a draft questionnaire was developed. Findings from the cognitive interviews (n = 18) confirmed that instructions, items, and response scales were relevant and clear, and interpreted as intended by patients.

Conclusion

The CF-IQ is a 40-item novel PRO scale assessing a comprehensive set of patient-relevant concepts to characterize the multifaceted nature of CF. Qualitative interview data support the content validity of the CF-IQ, which is currently undergoing additional psychometric evaluation in patients with CF.
Optimizing biological control agents for controlling nematodes of tomato in Egypt
Authors: Abd-Elgawad Mahfouz M. M.
Published: May 2020

Tomato is a major vegetable crop in Egypt and worldwide. Yet, many plant-parasitic nematodes (PPNs), especially Meloidogyne spp. and Rotylenchulus reniformis are a devastating threat to tomato cultivation in Egypt. This review addresses their biology, ecology, and economic importance from the standpoint of pest management. Soil treatment with synthetic nematicides has given some protection and enhanced tomato yields, but health hazards and environmental pollution are obstructing their intensive use. Moreover, some of such nematicides are being banned from the market. Therefore, safe biological control agents (BCAs) and their bioactive compounds should better be researched and developed to effectively replace hazardous nematicides. Abamectin, produced during the fermentation process of the actinomycete Streptomyces avermitilis, is recommended to manage PPNs of tomato in Egypt but further exploration should allocate where BCAs can reliably act with other agricultural inputs. Examples are given herein to streamline their development via synergistic interaction with compatible inputs such as chemicals and organic manure. Moreover, optimizing their delivery, interaction, and persistence under field conditions through novel ways such as the use of endophytic fungi and bacteria as well as bioactive molecules/nano-particles that have systemic activity in the nematode-infected plants should further be investigated and broadly disseminated.
New traveling wave solutions of MHD micropolar fluid in porous medium
Authors: Jamil Muhammad , Ahmed Arsalan
Published: May 2020

This paper aims to determine the exact solutions of non-Newtonian fluid namely micropolar fluid with MHD in a porous medium by traveling wave method. The governing equations of incompressible micropolar fluid with MHD in a porous medium are non-linear PDEs reduced to ODEs through wave parameterξ=mx+ny+Ut. The set of new exact solutions are determined for five different cases. In special cases, the solution for micropolar fluid with and without MHD and porous effects can also be obtained from general solutions. Furthermore, these solution reduces to a Newtonian solution if we put vortex viscosityκ→0. Finally, the influence of the material and other parameters of interest on the fluid motion, as well as a comparison among micropolar and Newtonian fluids is also analyzed by 2D and 3D graphical illustrations.
Phase I/II Study of CPX-351 Followed by Fludarabine, Cytarabine, and Granulocyte-Colony Stimulating Factor for Children With Relapsed Acute Myeloid Leukemia: A Report From the Children’s Oncology Group
Authors: Cooper Todd M. , Absalon Michael J. , Alonzo Todd A. , Gerbing Robert B. , Leger Kasey J. , Hirsch Betsy A. , Pollard Jessica , Razzouk Bassem I. , Aplenc Richard , Kolb E. Anders
Published: May 2020

PURPOSE

Effective regimens are needed for children with relapsed acute myeloid leukemia (AML). AAML1421 is a phase I/II study of CPX-351, a liposomal preparation of daunorubicin and cytarabine. AAML1421 sought to determine the recommended phase II dose (RP2D) of CPX-351 and the response rate after up to 2 cycles of therapy.

PATIENTS AND METHODS

Children > 1 and ≤ 21 years of age with relapsed/refractory AML were eligible for dose finding; those in first relapse were eligible for the efficacy phase. Dose-limiting toxicity (DLT) assessment occurred during cycle 1. Two cycles of therapy were offered (cycle 1: CPX-351; cycle 2: FLAG [fludarabine 30 mg/m2/dose on days 1-5; cytarabine 2,000 mg/m2/dose on days 1-5; and granulocyte-colony stimulating factor 5 µg/kg/dose, days 1-5 and day 15 through absolute neutrophil count > 500/µL]). Response was assessed after each cycle.

RESULTS

Thirty-eight patients enrolled: 6 in the dose-finding phase and 32 in the efficacy phase. During dose finding, 1/6 patients experienced a DLT (grade 3 decrease in ejection fraction). The RP2D was 135 units/m2 on days 1, 3, and 5. Toxicities of grade ≥ 3 during cycle 1 included fever/neutropenia (45%), infection (47%), and rash (40%). There was no toxic mortality. Best responses included 20 complete response (CR; 54%), 5 CR with partial recovery of platelet count (CRp; 14%), and 5 CR with incomplete blood count recovery (14%). Twenty-one of 25 with CR/CRp had no detectable residual disease (RD; 84%) by flow cytometry. Hematopoietic stem cell transplantation (HSCT) was used as consolidation in 29/30 responders (96.7%); 20/25 (80%) had no RD before HSCT.

CONCLUSION

The RP2D of CPX-351 is 135 units/m2/dose on days 1, 3, and 5. Toxicity was manageable, and protocol therapy was effective. Response rates are superior to prior published North American cooperative group clinical trials for children with AML in first relapse.
A systematic review on diagnostic test accuracy of magnetic resonance neurography versus clinical neurosensory assessment for post-traumatic trigeminal neuropathy in patients reporting neurosensory disturbance
Authors: Van der Cruyssen Frederic , Peeters Frederik , Croonenborghs Tomas-Marijn , Fransen Jasper , Renton Tara , Politis Constantinus , Casselman Jan , Jacobs Reinhilde
Published: May 2020

Objectives:

To perform a systematic review of published studies on diagnostic accuracy of magnetic resonance neurography (MRN) vs clinical neurosensory testing (NST) for post-traumatic trigeminal neuropathy (PTTN) in patients reporting neurosensory disturbances (NSD).

Methods:

Human studies except case reports, reviews, systematic reviews and meta-analyses were included. PubMed, Embase, Web of Science and Cochrane Library were consulted. Risk of bias assessment was conducted using the Quality Assessment of Diagnostic Accuracy Studies 2 tool. Predetermined data extraction parameters were noted and summarized.

Results:

8 studies met eligibility criteria of which 7 were retrospective, representing 444 subjects. Most studies were at high risk of bias with low applicability concerns. Populations and objectives were divergent with a large variation in timing (3 days–17 years post injury) and parameters (multiple coil designs, fat suppression techniques, additional contrast agent) of MRI acquisition. T2weighted 3 T imaging with short echo times (2.2–100 ms) and fat suppression was applied in seven studies, techniques varied. Determination of sensitivity and specificity could not be performed due to the methodological variation between studies and lacking comparative data between index and reference tests. Based on limited data, PTTN correlated reasonably well between clinical assessment, intraoperative findings and MRN abnormalities (k = 0.57). Increased signal intensity correlated with persistency of neurosensory disturbances in one study. Intra- (ICC 0.914–0.927) and interobserver (k = 0.70–0.891) MRN variability was considered good to excellent. One retrospective study showed substantial impact of MRN on clinical decision making in one-third of patients.

Conclusion:

Currently, there is insufficient scientific knowledge to support or refute the use of MRN. Based on limited data, MRN seems promising and reliable in detection and grading of PTTN. Methodological issues underline the importance for prospective blinded studies with standardization of signal intensity calculation and rigorous reporting of MRI acquisition parameters.