bluuebunny/crossref_metadata_2025 huggingface dataset:
Human Amniotic Mesenchymal Stem Cell Sheets Encapsulating Cartilage Particles Facilitate Repair of Rabbit Osteochondral Defects
Authors: You Qi , Liu Ziming , Zhang Jun , Shen Mengjie , Li Yuwan , Jin Ying , Liu Yi
Published: January 2020

Background:

Human amniotic mesenchymal stem cells (hAMSCs) are being widely applied in various fields. Therefore, hAMSCs represent a promising candidate to facilitate cartilage regeneration. Nonetheless, no studies have investigated the application of hAMSC sheets to repair cartilage defects in vivo.

Purpose:

To evaluate hAMSC sheets encapsulating cartilage particles to promote repair of rabbit osteochondral defects.

Study Design:

Controlled laboratory study.

Methods:

hAMSC sheets were constructed with passage 3 hAMSCs. The phenotypic and structural characteristics of hAMSC sheets were evaluated by flow cytometry and scanning electron microscopy, respectively. The potential for chondrogenic differentiation of hAMSC sheets was assessed by cartilage-specific marker staining, immunohistochemistry, and mRNA and protein expression (SOX9, COLII, and ACAN). Osteochondral defects (diameter, 3.5 mm; depth, 3 mm) were created in the left patellar grooves of 20 New Zealand White rabbits (female or male). The defects were treated with hAMSC sheet/cartilage particles (n = 5), cartilage particles (n = 5), hAMSC sheets (n = 5), or fibrin glue (n = 5). Macroscopic and histological evaluations of the regenerated tissue were conducted after 3 months. The survival time and differentiation of transplanted hAMSCs in the defect area were evaluated by immunofluorescence.

Results:

hAMSC sheets had a multilayered structure, with cells stacked layer by layer. Importantly, hAMSC sheets highly expressed phenotypic markers of mesenchymal stem cells. Cartilage-specific marker staining and immunohistochemistry were positive, and mRNA and protein expression was higher in the chondrogenically induced hAMSC sheet group than in the hAMSC sheet group ( P < .05). hAMSC sheet/cartilage particles formed a large amount of hyaline-like cartilage in the defect area. In addition, macroscopic and histological scores were significantly higher than those in the other groups. Integration with surrounding normal cartilage and subchondral bone regeneration in the hAMSC sheet/cartilage particles group were better when compared with the other groups. A large number of human nuclear-specific antigen-positive cells were observed in the defect area of hAMSC sheet/cartilage particles and hAMSC sheet groups. Moreover, some positive cells expressed SOX9.

Conclusion:

hAMSC sheets encapsulating cartilage particles facilitate osteochondral defect repair.

Clinical Relevance:

Delivery of cells in the form of a cell sheet in conjunction with cartilage particles provides a novel approach for cell-based cartilage regeneration.
Emphatic Hegemony and Patriotic Gestures of the Literary Writing of Polish Women-Ethnographers
Authors: Kubica Grażyna
Published: January 2020

This article explores the literary writing of ethnographers, a genre that has not yet been systematically researched in Polish sociocultural anthropology. The theoretical framework of the article is built on the concepts of reflexivity and auto-ethnography. Its main goal was to trace these issues in three texts of female Polish ethnographers in the first half of the twentieth century. These authors represent three different structural situations in the field: a European researcher in a colonial context (Maria Czaplicka), a member of the intelligentsia studying peasants (Kazimiera Zawistowicz-Adamska), and an amateur “native ethnographer” in her own community (Maria Pilchówna). One of the results of the analysis is inventing the concept of “emphatic hegemony” grasping the situation when an empathic and sympathetic observer can be also a dominant and patronizing writer, even if she is a woman. Another feature of the analyzed texts lies in their patriotic subtext.
Populist Nationalism and the Challenges of Divided Nationhood: The Politics of Migration, Mobility, and Demography in Post-2010 Hungary
Authors: Waterbury Myra A.
Published: January 2020

This article uses the case of post-2010 Hungary to investigate the ways in which the concomitant trends of mobility, migration, and demographic decline may intersect to both challenge and bolster the discourses and policies of nationalist, populist governments in Central and Eastern Europe today. Using an expanded conception of “divided nationhood,” it explores the tensions and continuities in the Hungarian government’s populist discourse of protecting the nation as it is projected onto different national populations: Hungarians within Hungary, Hungarian emigrants, and Hungarian minorities in neighboring countries. While fears of migration and population decline provide useful fuel for the particular brand of populist nationalism we see in places like Hungary, the ability of leaders to offer a coherent and effective narrative of protection for the nation becomes significantly more complex when there are multiple internal and external populations to protect. The article highlights the strategies that the FIDESZ government has employed in order to (1) mobilize antimigrant rhetoric while marginalizing Hungarian emigrants; (2) respond to demographic deficiencies while supporting a conservative, populist narrative; and (3) maintain its access to symbolic, political, and demographic resources within the Hungarian minority communities. These strategies include a discursive reconceptualization of migration as something that comes only from outside Europe, the use of social and economic policies to selectively privilege key segments of the nation and exclude others, and the creation of a regional Hungarian nation with Budapest at the center.
Variable selection and estimation in causal inference using Bayesian spike and slab priors
Authors: Koch Brandon , Vock David M , Wolfson Julian , Vock Laura Boehm
Published: January 2020

Unbiased estimation of causal effects with observational data requires adjustment for confounding variables that are related to both the outcome and treatment assignment. Standard variable selection techniques aim to maximize predictive ability of the outcome model, but they ignore covariate associations with treatment and may not adjust for important confounders weakly associated to outcome. We propose a novel method for estimating causal effects that simultaneously considers models for both outcome and treatment, which we call the bilevel spike and slab causal estimator (BSSCE). By using a Bayesian formulation, BSSCE estimates the posterior distribution of all model parameters and provides straightforward and reliable inference. Spike and slab priors are used on each covariate coefficient which aim to minimize the mean squared error of the treatment effect estimator. Theoretical properties of the treatment effect estimator are derived justifying the prior used in BSSCE. Simulations show that BSSCE can substantially reduce mean squared error over numerous methods and performs especially well with large numbers of covariates, including situations where the number of covariates is greater than the sample size. We illustrate BSSCE by estimating the causal effect of vasoactive therapy vs. fluid resuscitation on hypotensive episode length for patients in the Multiparameter Intelligent Monitoring in Intensive Care III critical care database.
Robert Bruce Sloane and the mid-twentieth-century struggles of academic psychiatry
Authors: Duffin Jacalyn
Published: January 2020

In 1957, British-born R Bruce Sloane became the founding head of a Canadian academic department of psychiatry in a city that had already been served by a busy asylum for more than a century. He plunged into the work with enthusiasm, but encountered blatant opposition and skepticism, prompting his departure. He went on to conduct research in the United States. Archives and oral testimony reveal the attitudes thwarting Sloane’s plans to improve teaching, research, and service—attitudes that may typify a general hostility toward psychiatry in other centers at that time.
The Independence of Central Banks, Political Institutional Quality and Financial Sector Development in Africa
Authors: Agoba Abel Mawuko , Abor Joshua Yindenaba , Osei Kofi Achampong , Sa-Aadu Jarjisu
Published: January 2020

Central Bank Independence (CBI) as a mechanism for achieving lower inflation and effective regulation and supervision of the financial sector should promote financial sector development. Though there is not much difference in CBI legal provisions, it seems to be more effective in developed countries than in African countries. There are suggestions that this could be due to differences in political institutional quality. Using panel data from 1970 to 2012, we find that CBI does not promote financial development in Africa. The impact of CBI is dependent on the level of development of a country. CBI promotes financial development more in countries with strong political institutions.

JEL codes: E02; E44; E58
Building Policy Coherence for Sound Waste Electrical and Electronic Equipment Management in a Developing Country
Authors: Oteng-Ababio Martin , van der Velden Maja , Taylor Mark B.
Published: January 2020

This article explores the compatibility of Ghana’s e-waste policy (Act 917) in the country’s socioeconomic context. Our article starts with two main questions based on our empirical engagements with the act which, contextually, mimics the extended producer responsibility. First, we question the pessimistic imaginaries about the e-waste industry that seeks its outright trade ban or promotes a single version of recycling. Second, we query if the underlying assumptions and basic mechanisms of extended producer responsibility can create the enabling environment to actualize sound e-waste management. Based on prevailing context, the imaginaries appear socially peripheral, isolated, and powerless, and we call for a broader, unbiased, in-depth, critical systems thinking for understanding the complexities and multidimensional nature of the waste electrical and electronic equipment industry. We suggest that it is by fostering the positive synergies across sectors and among policies that environmentally sound e-waste policy outcomes can be achievable.
Evaluation of pharmacist interventions in a head and neck medical oncology clinic
Authors: Lau Kimberly M , Saunders Ila M , Sacco Assuntina G , Barnachea Linda C
Published: January 2020

Introduction

Head and neck cancers (HNC) are a complex and heterogeneous group of cancers, often necessitating a multidisciplinary approach across the care continuum. Oncology pharmacists are uniquely qualified to play a vital role on a multidisciplinary team and provide specialized care to optimize medication therapy.

Methods

This was a retrospective chart review evaluating the role of a board-certified oncology pharmacist in the head and neck oncology clinic at an academic, comprehensive cancer center from April 2017 through March 2018. The primary objective of the study was to describe the types of interventions made by the oncology pharmacists. Secondary objectives included quantifying time spent on patient education and number of prescriptions sent to pharmacies.

Results

The pharmacist had 873 encounters with 151 patients, resulting in 2080 interventions. Approximately 57% of the interventions were performed in the clinic. Patient education (58%), facilitation of new prescriptions or refill requests (49.9%), and supportive care management (32.6%) were the most frequent interventions. The oncology pharmacist spent 154.1 h on patient education and sent 811 prescriptions to pharmacies, with 63.6% of prescriptions sent to the institution’s cancer center pharmacy.

Conclusion

The incorporation of an oncology pharmacist in the HNC team optimized patient care through comprehensive and timely interventions across the care continuum. Our study is the first to highlight the vital role oncology pharmacists have in improving the overall quality of care of HNC patients. Future directions include exploring the impact of oncology pharmacist interventions on select Quality Oncology Practice Initiative measures by the American Society of Clinical Oncology.
Taxane-induced peripheral neuropathy and quality of life in breast cancer patients
Authors: Salehifar Ebrahim , Janbabaei Ghasem , Alipour Abbas , Tabrizi Nasim , Avan Razieh
Published: January 2020

Purpose

Taxane-induced peripheral neuropathy (TIPN) is a common and bothersome toxicity. This study aimed to determine the incidence and severity of TIPN in patients with breast cancer and to investigate the relationship between TIPN and quality of life.

Methods

A total of 82 breast cancer patients with TIPN symptoms were included in this study. The criteria of National Cancer Institute-Common Terminology Criteria for Adverse Events (NCI-CTCAE v4.03) and the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire (QLQ-C30, version 3.0) were used to evaluate grading of sensory neuropathy and quality of life, respectively. Analysis of the data was done by IBM SPSS statistics version 23.

Results

A total of 346 patients received taxane-based chemotherapy and 82 patients (23.7%) experience TIPN. The mean (SD) global health status/quality of life, physical functioning, role functioning, and pain subscales were 60.63 (5.26), 80.64 (9.05), 81.77 (10.41), and 43.88 (11.27), respectively. There were significant negative correlations between global health status/quality of life, physical functioning, and role functioning subscales with the grade of neuropathy (r = −0.33, −0.80, and −0.61, respectively) and positive correlation between pain subscale and the grade of neuropathy (r = 0.70).

Conclusion

This study shows a clear association between TIPN and worsened quality of life. These findings emphasize on detecting and management of TIPN in an effort to improve the quality of life of breast cancer patients.
Vascular changes with optical coherence tomography angiography during aura of migraine: A case report
Authors: Bingöl Kızıltunç Pınar , Atilla Huban
Published: January 2020

Purpose:

To demonstrate macular and optic disk vessel changes by optical coherence tomography angiography during and after a migraine attack with aura

Methods:

Case report

Results:

A 34-year-old healthy female patient was evaluated by optical coherence tomography angiography imaging during visual aura with phosphenes in the left visual field. Optical coherence tomography angiography imaging showed diffuse narrowing of the retinal vessels, decreased radial peripapillary capillary density, and decreased superficial and deep foveal vessel density in the right eye. These changes improved 3 hours after visual aura. The patient suffered from right eye pain and right-sided headache, which are typical for migraine, after the visual aura.

Conclusion:

These findings indicate that blood flow during migraine attack is reduced not only in the brain but also in the eye. Eye pain in migraine patients may be due to decreased blood flow in the eye. Restoring the vascular changes 3 hours after the visual aura suggests that vascular changes may be transient during a migraine attack.
MRI differences between MOG antibody disease and AQP4 NMOSD
Authors: Salama Sara , Khan Majid , Shanechi Amirali , Levy Michael , Izbudak Izlem
Published: January 2020

Background:

MOG antibody and AQP4 antibody seropositive diseases are immunologically distinct subtypes of neuromyelitis optica spectrum disorders (NMOSD) with similar clinical presentations. MRI findings can be instrumental in distinguishing MOG antibody disease from AQP4 antibody NMOSD.

Objectives:

The aim of this study is to characterize the neuroradiological differences between MOG antibody disease and AQP4 antibody NMOSD with the aim to distinguish between the two entities.

Methods:

This is a retrospective study of 26 MOG and 25 AQP4 seropositive patients in which MRI features of the brain, spinal cord, and orbit were compared.

Results:

The majority of the abnormal findings in the MOG cohort were located on orbital MRIs, while spinal cord magnetic resonance (MR) abnormalities were more common in the AQP4 cohort. Brain abnormalities showed some overlap, but cortical gray/juxtacortical white matter involvement was distinct to MOG patients, while area postrema involvement was a rare feature.

Conclusion:

Cortical gray/juxtacortical white matter lesions on brain MRI might help distinguish MOG antibody disease from AQP4-positive NMOSD. These findings could be of value in distinguishing the two entities as early as the first presentation.
Establishment of an internationally agreed minimum data set for acute telestroke
Authors: Cadilhac Dominique A , Bagot Kathleen L , Demaerschalk Bart M , Hubert Gordian , Schwamm Lee , Watkins Caroline L , Lightbody Catherine Elizabeth , Kim Joosup , Vu Michelle , Pompeani Nancy , Switzer Jeffrey , Caudill Juanita , Estrada Juan , Viswanathan Anand , Hubert Nikolai , Ohannessian Robin , Hargroves David , Roberts Nicholas , Ingall Timothy , Hess David C , Ranta Annemarei , Padma Vasantha , Bladin Christopher F
Published: January 2020

Introduction

Globally, the use of telestroke programmes for acute care is expanding. Currently, a standardised set of variables for enabling reliable international comparisons of telestroke programmes does not exist. The aim of the study was to establish a consensus-based, minimum dataset for acute telestroke to enable the reliable comparison of programmes, clinical management and patient outcomes.

Methods

An initial scoping review of variables was conducted, supplemented by reaching out to colleagues leading some of these programmes in different countries. An international expert panel of clinicians, researchers and managers ( n = 20) from the Australasia Pacific region, USA, UK and Europe was convened. A modified-Delphi technique was used to achieve consensus via online questionnaires, teleconferences and email.

Results

Overall, 533 variables were initially identified and harmonised into 159 variables for the expert panel to review. The final dataset included 110 variables covering three themes (service configuration, consultations, patient information) and 12 categories: (1) details about telestroke network/programme ( n = 12), (2) details about initiating hospital ( n = 10), (3) telestroke consultation ( n = 17), (4) patient characteristics ( n = 7), (5) presentation to hospital ( n = 5), (6) general clinical care within first 24 hours ( n = 10), (7) thrombolysis treatment ( n = 10), (8) endovascular treatment ( n = 13), (9) neurosurgery treatment ( n = 8), (10) processes of care beyond 24 hours ( n = 7), (11) discharge information ( n = 5), (12) post-discharge and follow-up data ( n = 6).

Discussion

The acute telestroke minimum dataset provides a recommended set of variables to systematically evaluate acute telestroke programmes in different countries. Adoption is recommended for new and existing services.
Introducing the Red Tent: A Discursive and Critically Hopeful Exploration of Women’s Circles in a Neoliberal Postfeminist Context
Authors: Castro Madeleine
Published: January 2020

Red Tents (RTs) are women’s circles that have increased in popularity in recent years, but they are an under-researched movement. This article explores the way in which RTs are presented online by those involved. Setting these groups in a postfeminist context, and building on the work of Longman, I explore the place of RTs in relation to neoliberal discourses of individualism and autonomy. Via an analysis of the RTs online presence, I argue that the RT presents as a place of acceptance (of self and others) where negative emotions can be aired and bonds between women are formed. While acknowledging several caveats to accepting this presentation at face value – not least the potential perpetuation of hegemonic power relations, systemic inequalities and privilege, particularly regarding biological essentialism and whiteness – I also assert that the full picture is more nuanced. Drawing on a feminist position of possibility, ultimately I argue that RTs appear to offer a refuge of resistance from neoliberalism.
Cities, selective admission, and economic sorting
Authors: Glick Lior
Published: January 2020

In the last few decades, residency in some of the world’s desired destination cities has become a privilege, as housing supply has not kept pace with population growth. This has led to a significant rise in housing prices and consequently to the exclusion of middle- and low-income populations on a large scale.

These developments have received only scant attention in political theory despite their prominence in local policymaking and their contribution to processes of redrawing the boundaries of inclusion into local political communities.

My focus in this article is on the question ‘is it morally permissible for cities to sort members by economic means, and grant the better-off privileged access to residency?’ I explore this question by examining the main arguments used to support the city’s right to selectively admit would-be members. This allows me to delineate the limitations of the city’s general duty to be accessible to all segments of society and to present particular cases where the city has special obligations to incorporate nonmembers.
The role of mathematics and thinking for democracy in the digital society
Authors: Bredberg Johan
Published: January 2020

In today’s digital society, people encounter a lot of information on a daily basis. This information should be understood by citizens in order for them to be able to properly engage in political issues, something the population of a healthy democracy does. Much of such information involves mathematics and fully comprehending it requires so-called quantitative literacy. All students should learn this as well as critical thinking at school. The article also discusses how abstract mathematics can indirectly be beneficial for democracy.
Students as Stakeholders: Understanding Expectations Can Increase Student Retention
Authors: James Jennifer L.
Published: January 2020

Adult student persistence in online programs is lower than in traditional college classrooms, but more adult learners are enrolling in online programs. Little research is available on students’ needs and expectations for their success in online courses. A quantitative correlational study was conducted on student expectations of online learning using persistence factors of time, technological skills, and difficulty. Nontraditional students experience unique challenges to academic development stemming from problems at home, low-socioeconomic status, minimal off-campus support, and isolating discourse of academia. The intent of this article is to present new data on connections between student expectations and their persistence. Data were collected from 205 participants, 24 years or older, enrolled in at least one course in a series of online courses. Two factors were identified as significant correlations with student persistence: (a) difficulty level of course content and (b) time commitment.
Using a thermal manikin to determine evaporative resistance and thermal insulation – A comparison of methods
Authors: Toma Róbert , Kuklane Kalev , Fojtlín Miloš , Fišer Jan , Jícha Miroslav
Published: January 2020

Heat transfer from the human body, especially through the evaporation of sweat from the skin, is often restricted when protective clothing is used, which may result in overheating. For this reason, it is important to consider the parameters of protective clothing as input data in physiological models, such as predicted heat strain. The two most important parameters are thermal insulation and evaporative resistance with clothing area factor strongly influencing both. These parameters were determined for two clothing ensembles using a (dry) non-sweating thermal manikin. First, the clothing area factor was determined using the photographic method. Second, thermal insulation was measured in both static and dynamic conditions, and multiple equations for predicting dynamic thermal insulation from static ones were evaluated. Third, methodology for measuring evaporative resistance based on pre-wetted skin was adopted and multiple corrections were assessed. Finally, sensitivity analyses were completed using PHS to determine the impact of different equations on the duration limited exposure. For the thermal insulation measurements, we found that predictive equation (32) from ISO 9920 was the most accurate, but choosing the correct equation for protective clothing proved challenging. Although a manikin’s surface temperature is widely used for calculating evaporative resistance, the skin temperature should be used instead, since it is correct from a physical point of view and there is a difference of up to 15% in the results. Because these measures are used in thermal risk analyses conditions, a high degree of accuracy and a knowledge of the inputs must be guaranteed.
Study on creating the three-dimensional shape of apparel by thermal bonding of thermoplastic polyurethane film and vacuum forming molding
Authors: Yu Qiuyu , Zhou Feng , Jing Lingxiao , Song Jing , Xiang Yi , Mo Yu , Zhao Yu
Published: January 2020

The shape of apparel is one of the most important elements in fashion design, for example, the three-dimensional shape of apparel can be quite creative and fashionable. The current technologies for creating the three-dimensional shape of apparel are many, but have their limitations in dealing with various fabrics, particularly light and soft fabrics. This article presents a new method to rapidly create three-dimensional shape of apparel for avoiding the aforementioned disadvantages. The method combines thermal bonding of thermoplastic polyurethane film and vacuum forming. In this study, 12 kinds of commercial fabrics were selected and then tested. All these fabrics were first bonded to thermoplastic polyurethane film and then rapidly applied to the vacuum forming machine to form the three-dimensional mold-like shape. This research analyzed the factors of molding a fabric to a good three-dimensional shape of apparel and the relative tests to be carried out for validating its stability for the selected fabric samples. There are two main contributions of this study. The first is to propose a more effective method for three-dimensional shape of apparel in fashion design. The second is to provide useful information for fabric selection and determination of bonding temperature in molding.
Last years of life
Authors: Feathers Luke , Rowe-Haynes Cassy
Published: January 2020

The provision of high-quality palliative and end-of-life care can be a very rewarding and important part of general practice. In this article, we explore how to identify patients at risk of dying in the next year. To help with this, we will look at some of the illness trajectories of cancer, organ failure, multi-morbidity and frailty. Finally, we will share some strategies and phrases that may be helpful in conversations when giving support to patients and planning for the future.
Advance care planning and treatment escalation plans
Authors: Courtney Ellie
Published: January 2020

Medicine has advanced rapidly over the past 100 years. People are living longer, sometimes with multiple chronic diseases. When they develop life-limiting conditions, some already old and frail, achieving balance between intervening too much and too little can be a huge challenge. In many areas of the UK treatment escalation plans (TEPs) are replacing do not resuscitate orders. The aims of this article are to explore the use of TEPs and the role of advance care planning, covering the legal framework and providing some practical guidance about how to approach this important conversation.
Efficacy of extended, comprehensive outpatient cardiac rehabilitation on cardiovascular risk factors: A nationwide registry
Authors: Reich Bernhard , Benzer Werner , Harpf Hanns , Hofmann Peter , Mayr Karl , Ocenasek Helmuth , Podolsky Andrea , Pokan Rochus , Porodko Michael , Puelacher Christoph , Sareban Mahdi , Traninger Heimo , Ziegelmeyer Wolfgang , Niebauer Josef
Published: January 2020

Aim

Cardiac rehabilitation (CR) is a key component of the treatment of cardiac diseases. The Austrian outpatient CR model is unique, as it provides patients with an extended professionally supervised, multidisciplinary program of 4–6 weeks of phase II (OUT-II) and 6–12 months of phase III (OUT-III) CR. The aim of this analysis was to assess the efficacy of the Austrian outpatient CR model using a nationwide registry.

Methods

Data of all consecutive patients ( N = 7560) who completed OUT-II and/or OUT-III between 1 January 2005 and 31 December 2015 were entered prospectively into a registry. OUT-III patients were analyzed separately according to whether the preceding phase II was performed as outpatient (OUT-II/OUT-III, N = 2403) or in-patient (IN-II/OUT-III, N = 2789). All patients underwent assessment of anthropometry, resting blood pressure, lipid profile, fasting blood glucose, exercise capacity, quality of life, anxiety and depression.

Results

During OUT-II, patients significantly improved their metabolic risk factor profile and increased exercise capacity by 14.3%. OUT-II/OUT-III patients achieved an additional increase in exercise capacity by 10%, further improvement in high-density lipoprotein (HDL) and stabilization of the remaining risk factors. IN-II/OUT-III patients increased their maximal exercise capacity by 18.4% and there was improvement in blood pressure, HDL, low-density lipoprotein and glucose levels.

Conclusion

Extended, professionally supervised, multidisciplinary outpatient CR in a large nationwide registry of consecutive patients consistently improved maximal exercise capacity and relevant modifiable cardiovascular risk factors beyond effects seen after IN- or OUT-II alone.
Monocyte-mediated inflammation and cardiovascular risk factors in type 2 diabetes mellitus: A systematic review and meta-analysis of pre-clinical and clinical studies
Authors: Mokgalaboni Kabelo , Dludla Phiwayinkosi V , Nyambuya Tawanda M , Yakobi Sinethemba H , Mxinwa Vuyolwethu , Nkambule Bongani B
Published: January 2020

Background

Monocyte-mediated inflammation increases the risk of developing type 2 diabetes mellitus and cardiovascular disease. This is the first systematic review and meta-analysis of studies reporting on monocyte-mediated inflammation in type 2 diabetes mellitus.

Methods

This systematic review and meta-analysis was registered in the international prospective register of a systematic review: CRD42019132902. The MEDLINE, EMBASE and Google scholar electronic databases were searched, and a random-effects model was used to generate pooled standardised mean differences between patients with type 2 diabetes mellitus and healthy controls.

Results

The clinical studies (n = 20) comprised of 1065 patients with type 2 diabetes mellitus and 1103 healthy controls. Notably, the levels of monocyte activation were higher in patients with type 2 diabetes mellitus compared to healthy controls (standardised mean difference  = 0.47, 95% confidence interval (0.10, 0.84), p = 0.01) (χ2 = 65.72, I2 = 83%, p < 0.00001). Patients with type 2 diabetes mellitus had an increased risk of cardiovascular disease compared to healthy controls (standardised mean difference  = 0.37, 95% confidence interval (0.13, 0.61), p = 0.003) (χ2 = 958.77, I2 = 95%, p < 0.00001). All included pre-clinical studies reported on the C57BL/6 mice strain, with a majority of the studies 57% of reporting on high fat diet-induced C57BL/6 mice model. The overall quality of the studies was good with a median score and range of 16 (13–19).

Conclusion

Our meta-analysis suggests that there is increased monocyte activation in patients with type 2 diabetes mellitus.
Long-term results after femoral thrombendarterectomy combined with simultaneous endovascular intervention in intermittent claudication and critical ischemia
Authors: Altreuther Martin , Mattsson Erney
Published: January 2020

Objective:

This population-based retrospective cohort study investigates long-term results of femoral thrombendarterectomy combined with simultaneous endovascular intervention of the iliac or femoropopliteal vessels, or both, with focus on freedom from recurrent intervention, limb salvage and survival.

Methods:

All patients undergoing femoral thrombendarterectomy and simultaneous endovascular intervention between 1999 and 2013 were included. Stratification was according to clinical symptoms, intermittent claudication or critical ischemia, with subgroups for rest pain and ulcer/gangrene, and for type of endovascular intervention, iliac, femoropopliteal or both. We assessed technical success, 30-day complications, freedom from recurrent intervention, survival and amputation free survival in all patients. Limb salvage was assessed in patients with critical ischemia.

Results:

We identified 151 operations in 143 patients with a total of 164 limbs treated. A total of 13 patients had bilateral and 8 patients had subsequent contralateral operations. Indication was intermittent claudication in 87 (57.6%) and critical ischemia in 64 (42.4%) operations. Thirty-day mortality, only observed in critical ischemia, was 5/64 (7.8%). Freedom from recurrent intervention after 5 years was 91% in intermittent claudication and 70% in critical ischemia. In total, 84% of the patients with claudication were improved at the end of the study. Limb salvage at 5 years was 75% in critical ischemia, 93% in rest pain and 64% in patients with ulcer or gangrene.

Conclusion:

Femoral thrombendarterectomy combined with endovascular iliac or femoropopliteal intervention has good and durable results in intermittent claudication and critical ischemia, especially in patients with rest pain. In most cases, a single operation is sufficient.
Knowledge and practices of fundoscopy among general practitioners in Qassim Province, Saudi Arabia, for the management of diabetic retinopathy and diabetic macular edema: A cross-sectional study
Authors: Al-Rashidi Sultan H , Al-Thunayyan Faris S , Alsuhaibani Khalid A , Alharbi Abdulmajeed A , Alharbi Khalid A
Published: January 2020

Objectives:

Blindness is one of the most widespread final pathways of diabetic retinopathy and its associated diabetic macular edema. The general practitioners are the first to encounter these diabetic patients. Fundoscopy is now considered as an ideal way for the diagnosis of patients with diabetic retinopathy. Therefore, this study was undertaken to know the ability and skills of general practitioners for the diagnosis and management of patients with diabetic retinopathy and diabetic macular edema.

Methods:

This study was conducted in all major cities in Qassim province of Saudi Arabia during January to May 2017. A validated questionnaire was used to assess the general practitioners’ knowledge and practice for the management of diabetic retinopathy and diabetic macular edema. Questions related to referrals, diagnosis, and treatment options to diabetic retinopathy and diabetic macular edema were asked to the general practitioners.

Results:

Of 96 general practitioners, 76 returned the questionnaire with a response rate of 79.2%. Only 26.3% general practitioners referred patients with type 1 diabetes to ophthalmologists as per guidelines set by the American Academy of Ophthalmology, whereas 74% of general practitioners showed good knowledge for referring patients with type 2 diabetes to ophthalmology clinics. Lack of knowledge was also noticed for the treatment of diabetic retinopathy, as only 36.8% of general practitioners replied positive for dilated fundus examination option, whereas 78.9% of general practitioners chose laser photocoagulation as a treatment option. Similar response from them was observed for patients with diabetic macular edema. Furthermore, data also showed years in practice of general practitioners was well correlated with their knowledge for the management of diabetic retinopathy and diabetic macular edema.

Conclusion:

The general practitioners included in this study showed lack of knowledge in handling patients with diabetic retinopathy and diabetic macular edema. Therefore, refresher courses are needed that highlight the acquisition of their skills in fundoscopy.
Activation of IL-10+ B cells: A novel immunomodulatory mechanism for therapeutic bacterial suspensions
Authors: Salazar Alberto , Nieto Jane E , Velazquez-Soto Henry , Jiménez-Martínez Maria C
Published: January 2020

Objectives:

Bacterial components are used to improve immune responses in patients with respiratory infections. Pharmacological formulations of bacterial components include a mixture of bacterial antigens, some of which are complete inactivated bacteria, that is, named bacterial suspensions; while others are fragments of bacteria, which are presented as bacterial lysates. Although bacterial lysates have been broadly used as immune-stimulators, the biological support for the therapeutic effectiveness of bacterial suspension has not yet been studied. Thus, the aim of our study was to investigate the immunological activity induced by bacterial suspension.

Methods:

This work was an exploratory translational study. Peripheral blood mononuclear cells were obtained from healthy donors and cultured in time–dose dependent assays with a commercial bacterial suspension. Flow cytometry was used for phenotypic analysis and for determining soluble cytokines in culture supernatants.

Results:

We observed that bacterial suspension activates B cells in a dose-dependent manner. Peripheral blood mononuclear cells were able to secrete IL-6 and IL-10 after 24 h of bacterial suspension stimulation. TLR2 expression was observed mainly on CD19+ CD38Lo B cells after 72 h of culture; remarkably, most of the TLR2+ CD19+ cells were also IL-10+.

Conclusion:

Our findings suggest that bacterial suspension induces the activation of B cell subsets as well as the secretion of IL-6 and IL-10. Expression of TLR2 on CD19+ cells could act as an activation loop of IL-10+ B regulatory cells. The clinical implications of these findings are discussed at the end of this article.
Natural history, diagnosis and treatment approach to fibrostenosing Crohn’s disease
Authors: El Ouali Sara , Click Benjamin , Holubar Stefan D. , Rieder Florian
Published: January 2020

Stricturing Crohn’s disease (CD) is a significant clinical problem. The presence of a stricture may be suggested by clinical symptoms. Cross‐sectional imaging using computed tomography or magnetic resonance enterography is essential in diagnosing strictures as it allows further characterization and evaluation for complications such as abscess, fistulizing disease or malignancy. Managing small bowel stricturing CD should be approached in a multidisciplinary fashion. Medical therapy can be considered in strictures which are not associated with complications, with most of the data supporting anti‐TNF strategies in this setting. If the disease is refractory to medical therapy, endoscopic therapy or surgery should be performed. Endoscopic balloon dilation (EBD) is an option for short, uncomplicated and straight strictures that are within reach of a colonoscope. Although EBD has good short‐term outcomes, repeat dilation is often required. Surgical options mainly include resection and strictureplasty. Strictures refractory to medical therapy, not amenable or refractory to EBD, or associated with complications or malignancy should be managed surgically. However, surgery may also be considered at an earlier stage depending on disease characteristics and patient preference. Postoperative recurrence is common, highlighting the importance of careful monitoring of the patient postoperatively and optimization of medical management accordingly. There is a pressing need to develop anti‐fibrotics for the treatment of stricturing CD. This requires the development of standardized diagnostic criteria, patient‐reported outcome measures and validation of endpoints in fibrostenotic CD. The STAR consortium is pioneering this effort in order to allow development and testing of anti‐fibrotics in future clinical trials.
Ascites in a young male: idiopathic FIP1L1-PDGFRA-negative hypereosinophilic syndrome
Authors: Kasinathan Ganesh , Sathar Jameela
Published: January 2020

Introduction

Idiopathic hypereosinophilic syndrome is defined as persistently elevated peripheral blood absolute eosinophil count of more than 1.5 × 109/L for at least six months with no obvious secondary cause.

Case Presentation

We report the case of a 26-year-old gentleman of Malay ethnicity who presented to the medical department with a three-week history of abdominal distension associated with dyspepsia and epigastric pain. Physical examination revealed ascites. The complete blood count portrayed peripheral leucocytosis with eosinophilia of 8.84 × 109/L. Parasitic serology was negative. Paracentesis analysis showed exudative ascites with an absolute eosinophil count of 8 × 109/L. He was referred to the haematology department. He was noticed to have bilateral tonsillitis and pruritic skin rash at the legs. There were no palpable lymph nodes or organomegaly. A peripheral blood film showed 44% eosinophils with no excess blasts. Clonal eosinophilic fusion studies did not detect FIP1L1-PDGFRA mutation. JAK2 V617F and BCR-ABL1 mutations were undetected. Serum B12 and tryptase levels were normal. A whole-body computed tomography imaging showed bowel wall thickening at the duodenum, jejunum, ileum, rectosigmoid and splenic flexure. Sections of fragments taken from the endoscopy showed features of eosinophilic gastritis and colitis on histology. Bone marrow biopsy depicted marked eosinophilia. He was started on oral imatinib mesylate 200 mg daily and oral prednisolone 0.5 mg/kg daily which was tapered based on response. He achieved complete remission and is now asymptomatic.

Conclusion

The diagnosis of hypereosinophilic syndrome should be considered in a patient with unexplained ascites. Secondary sinister causes such as malignancy should always be excluded.
Survival following the placement of gastrostomy tube in patients with multiple sclerosis
Authors: Grandidge Lisa , Chotiyarnwong Chayaporn , White Sean , Denning Jessica , Nair Krishnan Padmakumari Sivaraman
Published: January 2020

Background

Around a third of people with multiple sclerosis (MS) experience dysphagia. There is a need for disease-specific information on survival following placement of gastrostomy tube in people with MS.

Objective

We aimed to study survival following gastrostomy in patients with MS.

Methods

We reviewed medical records, home enteral feeding database and death certificates of people with MS who had gastrostomy from 2005 to 2017. Cox regression analysis was performed to identify independent predictors associated with mortality after gastrostomy.

Results

Median survival of 53 patients with MS after gastrostomy was 21.73 months. Median duration of hospital stay after gastrostomy was 14 days (IQR 5.25, 51.5). Survival at 30 days, 3 months, 1, 2, 5 and 10 years were 100% (53/53), 98.1% (52/53), 81.1% (43/53), 54.7% (29/53), 22.4% (11/49) and 6.8% (3/44), respectively. Of 53 patients, 24 died due to respiratory tract infection. Patients who had gastrostomy tube before 50 years of age survived longer (median 28.48 months) compared with those who had the gastrostomy after age 50 years (median 17.51 months) ( p = 0.040).

Conclusion

Around 54% of patients with MS survived two or more years following gastrostomy. Younger patients had better survival. The most frequent cause of death was respiratory infection.
Mothers for Others: An Interpretative Phenomenological Analysis of Gestational Surrogates’ Child Relinquishment Experiences
Authors: Ferolino Austin P , Camposo Mia Angelica D , Estaño Karla Christianne L , Tacbobo Jessa Marie R
Published: January 2020

Background:

Previous studies have shown that surrogates reported high satisfaction with the surrogacy process and no psychological difficulties as a result of child relinquishment. However, the experiential dimension of child relinquishment is an understudied area.

Objective:

This study sought to provide a more detailed portrait of gestational surrogates’ child relinquishment experiences and the meanings they give to this experience.

Method:

Semistructured interviews were conducted with 3 women who experienced commercial gestational surrogacy for the first time. Interview transcripts were transcribed and analyzed using interpretative phenomenological analysis.

Results:

Three superordinate themes were generated from the transcripts: (1) undertaking an act of altruism, (2) going through a different kind of motherhood, and (3) promoting a positive body image.

Conclusion:

Such insights can provide essential knowledge for mental health professionals who are interested in the development of psychological support tailored to promote a smooth emotional transfer of the baby from the surrogate to the intended couple.
An unsuspected and unrecognized cause of medication overuse headache in a chronic migraineur—essential oil-related medication overuse headache: A case report
Authors: Mathew Thomas , John Saji K
Published: January 2020

Essential oils are widely used by people for common ailments like headache and backache. We report a case of chronic daily headache in an adolescent migraineur refractory to most antimigraine drugs secondary to topical application of essential oils containing camphor and eucalyptus. A 14-year-old boy presented with chronic daily headache of 1-year duration, refractory to four antimigraine drugs including valproate and topiramate. He was daily applying a balm called Amruthanjan (10% camphor and 14.5% eucalyptus) on his forehead to relieve headache. Patient had complete relief of headache in 2 weeks after stopping the balm application. All his antimigraine drugs were tapered and stopped over a period of 3 months. At 1-year follow-up, he is headache free. Brain-stimulant essential oils of camphor and eucalyptus may be an important unrecognized cause of medication overuse headache.
Primary immunodeficiencies reveal the molecular requirements for effective host defense against EBV infection
Authors: Tangye Stuart G. , Latour Sylvain
Published: January 2020

Epstein-Barr virus (EBV) is an enigma; on one hand, it infects and persists in latent form in the vast majority of the global population, causing relatively benign disease in otherwise healthy individuals. On the other hand, EBV represents the first identified oncogenic virus, capable of causing ≥7 different types of malignancies, usually in immunocompromised individuals. Furthermore, some individuals with defined inborn errors of immunity exhibit extreme susceptibility to EBV-induced disease, developing severe and often fatal infectious mononucleosis, hemophagocytic lymphohistiocytosis, lymphoproliferative disease, and/or EBV+ B-cell lymphoma. Thus, host and pathogen have coevolved to enable viral persistence and survival with minimal collateral damage to the healthy host. However, acquired or genetic disruptions to host defense that tip the balance in favor of EBV can have catastrophic effects. The study of primary immunodeficiencies has provided opportunities to define nonredundant requirements for host defense against EBV infection. This has not only revealed mechanisms underlying EBV-induced disease in these primary immunodeficiencies but also identified molecules and pathways that could be targeted to enhance the efficacy of an EBV-specific vaccine or treat severe EBV infection and pathological consequences in immunodeficient hosts.