bluuebunny/crossref_metadata_2025 huggingface dataset:
Diagnostic value of Candida mannan antigen and anti‐mannan IgG and IgM antibodies for Candida infection
Authors: Wang Kaifei , Luo Yanping , Zhang Wei , Xie Sheling , Yan Peng , Liu Yang , Li Yanqin , Ma Xiuqing , Xiao Kun , Fu Han , Cai Jinyu , Xie Lixin
Published: November 2019

Objective

To assess the diagnostic value of serum Candida mannan antigen (MN) and anti‐mannan IgG and IgM antibodies for candidiasis.

Methods

This study was a prospective cohort study. Clinical data and venous blood samples from 23 medical centres in Beijing, China were collected between 1 January 2017 and 31 December 2018. All collected specimens were tested within one week for serum Candida MN and IgG and IgM antibodies using an ELISA kit.

Results

A total of 452 patients were enrolled, including 188 patients in the Candida exposure groups (56 patients with Candida bloodstream infection, 69 patients with Candida‐positive tracheal aspirate cultures and 63 patients with Candida‐positive urine cultures) and 264 patients in the control groups (212 healthy controls and 52 patients with bacteraemia). The receiver operating characteristic (ROC) curve of the 56 patients with Candida bloodstream infection and 212 healthy controls showed that serum MN and IgG had good diagnostic value. The area under the ROC curve (AUC) values were 0.812 (95% CI, 0.750‐0.873) and 0.866 (95% CI, 0.808‐0.924), respectively, wherein the MN specificity and sensitivity were 86.79% and 60.71%, and the IgG were 84.43% and 80.36%, respectively. The AUC of the combination of serum MN and IgG was 0.871(95% CI, 0.813‐0.929), and the specificity and sensitivity were 93.87% and 57.14%.

Conclusions

The serum levels of Candida MN and its IgG antibody have diagnostic value for Candida bloodstream infection, and combination of MN and IgG can improve diagnostic specificity and may provide a new approach for diagnosis of candidaemia.
Palliative sedation and medical assistance in dying: Distinctly different or simply semantics?
Authors: Booker Reanne , Bruce Anne
Published: November 2019

Medical assistance in dying (MAiD) and palliative sedation (PS) are both legal options in Canada that may be considered by patients experiencing intolerable and unmanageable suffering. A contentious, lively debate has been ongoing in the literature regarding the similarities and differences between MAiD and PS. The aim of this paper is to explore the propositions that MAiD and PS are essentially similar and conversely that MAiD and PS are distinctly different. The relevance of such a debate is apparent for clinicians and patients alike. Understanding the complex and multi‐faceted nuances between PS and MAiD allows patients and caregivers to make more informed decisions pertaining to end‐of‐life care. It is hoped that this paper will also serve to foster further debate and consideration of the issues associated with PS and MAiD with a view to improve patient care and the quality of both living and dying in Canada.
Epidemiological Characteristics of 1196 Patients with Spinal Metastases: A Retrospective Study
Authors: Wang Feng , Zhang Hao , Yang Li , Yang Xiong‐gang , Zhang Hao‐ran , Li Ji‐kai , Qiao Rui‐qi , Hu Yong‐cheng
Published: November 2019

Objectives

To describe the epidemiological characteristics of patients with spinal metastases between 2007 and 2019.

Methods

Patients with spinal metastases were identified from several clinical centers in China between January 2007 and July 2019. Demographics, primary tumor types, spinal involvement, and Clinical indicators of each patient were reviewed.

Results

A total of 1196 patients were included in this study, 717 males (59.95%) and 479 females (40.05%), with a male to female ratio of 1.50:1. Most patients (63.71%) were in the ages range of 50 to 69 years. The mean age was 58.6 ± 11.6 (range 13–89) years and the median age was 59.0 years. The average age of females was younger than that of males, and the difference was statistically significant. The proportion of male patients over 60 years old was higher than that of females, and the difference was statistically significant. The most common primary tumor was lung cancer (n = 437, 36.54%), followed by unknown origin (n = 194, 16.22%), kidney cancer (n = 78, 6.52%), breast cancer (n = 76, 6.35%), and liver/biliary cancer (n = 75, 6.27%). The most common primary tumor was lung cancer in both males and females, followed by unknown origin in males and breast cancer in females. There were 730 patients (61.04%) in the subgroup of the number<3; the highest level was lumbar vertebrae, with 250 patients (34.25%). The remaining 466 patients (38.96%) were included in the subgroup of the number ≥ 3; the highest level was tumor metastasis of multiple‐level of spine, with 334 patients (71.67%). Among the 1196 patients, spinal cord injury occurred in 54.01% of patients, 76.34% of patients developed moderate and above pain, 55.69% of patients had metastatic spinal cord compression, and only 26.67% of patients had a clear history of primary tumors.

Conclusion

This study provided a relatively detailed description of epidemiological characteristics in spinal metastases in China, which could assist orthopaedic surgeons to understand the clinical characteristics of spinal metastases, and is of great significance in guiding clinical diagnoses and scientific research.
En Bloc Resection and Pelvic Ring Reconstruction for Primary Malignant Bone Tumors Involving Sacroiliac Joint
Authors: Xu Ming , Zheng Kai , Zhao Jie , Bai Wen‐zhe , Yu Xiu‐chun
Published: November 2019

Objective

To observe the process of sacroiliac joint invasion by primary malignant tumors of sacrum and iliac bone, and to explore the methods of surgical resection and reconstruction.

Methods

From January 2009 to November 2017, there were nine patients with primary malignant bone tumors involving sacroiliac joints, five males and four females, aged from 16 to 63 years, with an average age of 35 years. Of these there were three cases of primitive neuroectodermal tumors, three cases of chondrosarcoma, and three cases of osteosarcoma. Pelvic ring reconstruction was performed with longitudinal half sacrum, sacroiliac joint and partial iliac bone block excision and screw‐rod system combined with bone grafting.

Results

The operation time was 155–310 min, with an average of 245 ± 55 min, and the bleeding volume was 1400–8500 ml, with an average of 3111 ± 2189 ml. Follow‐up ranged from 5 to 108 months, with a median follow‐up of 24 months. Three patients (33.3%) had local recurrence, three patients (33.3%) survived without tumors, and one patient had lung metastasis 2 years after operation, and survived with tumors. Five patients (55.6%) died, of which four died of lung metastasis and one died of brain metastasis. Survival analysis showed that the 3‐year overall survival rate was 57%. Bone grafts did not heal in four patients, and bone grafts healed in five patients. The healing time ranged from 5 to 7 months, with an average of 6.2 months. Complications: one patient developed deep infection 2 months after operation; one patient had skin edge necrosis; titanium rod loosening and displacement were found in two patients with nonunion of bone graft, and no fracture of nail rod was found. The MSTS 93 functional score of nine patients ranged from 20% to 50%, with an average of 34%.

Conclusion

The tumors around the sacroiliac joint often invade the contralateral bone by ligament, and the en bloc resection and pelvic ring reconstruction for primary malignant bone tumors involving sacroiliac joint was feasible.
Biotic and abiotic factors driving the diversification dynamics of Crocodylia
Authors: Solórzano Andrés , Núñez‐Flores Mónica , Inostroza‐Michael Oscar , Hernández Cristián E.
Published: November 2019

Species diversity patterns are governed by complex interactions among biotic and abiotic factors over time and space, but are essentially the result of the diversification dynamics (differential speciation and extinction rates) over the long‐term evolutionary history of a clade. Previous studies have suggested that temporal variation in global temperature drove long‐term diversity changes in Crocodylia, a monophyletic group of large ectothermic organisms. We use a large database of crocodylian fossil occurrences (192 spp.) and body mass estimations, under a taxic approach, to characterize the global diversification dynamics of crocodylians since the Cretaceous, and their correlation with multiple biotic and abiotic factors in a Bayesian framework. The diversification dynamic of crocodylians, which appears to have originated in the Turonian (c. 92.5 Ma), is characterized by several phases with high extinction and speciation rates within a predominantly low long‐term mean rate. Our results reveal long‐term diversification dynamics of Crocodylia to be a highly complex process driven by a combination of biotic and abiotic factors which influenced the speciation and extinction rates in dissimilar ways. Higher crocodylian extinction rates are related to low body mass disparity, indicating selective extinctions of taxa at both ends of the body mass spectrum. Speciation rate slowdowns are noted when the diversity of the clade is high and the warm temperate climatic belt is reduced. Our finding supports the idea that temporal variations of body mass disparity, self‐diversity, and the warm climate belt size provided more direct mechanistic explanations for crocodylian diversification than do proxies of global temperature.
Genome‐wide association study reveals loci associated with seed longevity in common wheat (Triticum aestivum L.)
Authors: Zuo Jing Hong , Chen Feng Ying , Li Xiao Ying , Xia Xian Chun , Cao Hong , Liu Jin Dong , Liu Yong Xiu
Published: November 2019

Seed longevity could significantly determine seed regeneration cycle and greatly affect wheat production. With the 90 K chip assays, a genome‐wide association study was performed to identify seed longevity‐related markers and loci in common wheat. Seed germination ratios (GR) under artificially ageing of 166 wheat accessions across three environments were evaluated to assess seed longevity. Totally, 23 longevity‐related loci were identified in the study, explaining 6.7%–11.4% of the phenotypic variations. Of these, QlgGR.cas‐1A and QlgGR.cas‐2B.2 were deemed as stable loci associated with wheat seed longevity. Fifteen loci were found overlapped with known quantitative trait loci or genes. Besides, QlgGR.cas‐1A, QlgGR.cas‐2B.2, QlgGR.cas‐3D.1, QlgGR.cas‐3D.2, QlgGR.cas‐4A.2, QlgGR.cas‐5A.1, QlgGR.cas‐5A.2 and QlgGR.cas‐6A.1 were colocated with seed dormancy‐related loci. Significant additive effects were obtained for seed longevity by pyramiding favourable alleles. Several candidate genes were found involved in signal transduction and stress resistance pathways by sequencing analysis of significantly longevity‐related molecular markers. These results might provide new sights into the genetic architecture of seed longevity.
Traditional or Economic Values? Analyzing Absentee Landowner Attitudes Amid Social and Agricultural Transformation in Japan
Authors: Katano Yohei , Greenberg Pierce , Agnone Jon
Published: November 2019

Agricultural landownership in Japan has changed drastically over the last century due to post‐World War II land reforms and cultural, political, and economic shifts in the subsequent decades. Initial land reform shifted the concentrated ownership of land from the wealthy to small‐scale farmers. But as Japan industrialized and became more urban‐centered, a substantial amount of rural land has been left abandoned or unmanaged by descendants of those farmers. This paper analyzes the attitudes of absentee agricultural landowners in Japan to better understand the prevalence of economically rational versus traditional attitudes toward land ownership. We draw on the rural sociological literature on place attachment to hypothesize why some absentee landowners feel a strong tie to the land of their ancestors, while others would be willing to sell for a reasonable price. We use unique survey data obtained from 466 absentee agricultural landowners in Japan. Logistic regression results indicate that attachment to place, gender, age, educational attainment, and usage of land is significant predictors of whether landowners hold traditional, rather than economic, values. We discuss the implications of these findings for the future of sustainable agricultural land management in Japan.
A calibrated imputation method for secondary data analysis of survey data
Authors: Da Silva Damião N. , Zhang Li‐Chun
Published: November 2019

In practical survey sampling, missing data are unavoidable due to nonresponse, rejected observations by editing, disclosure control, or outlier suppression. We propose a calibrated imputation approach so that valid point and variance estimates of the population (or domain) totals can be computed by the secondary users using simple complete‐sample formulae. This is especially helpful for variance estimation, which generally require additional information and tools that are unavailable to the secondary users. Our approach is natural for continuous variables, where the estimation may be either based on reweighting or imputation, including possibly their outlier‐robust extensions. We also propose a multivariate procedure to accommodate the estimation of the covariance matrix between estimated population totals, which facilitates variance estimation of the ratios or differences among the estimated totals. We illustrate the proposed approach using simulation data in supplementary materials that are available online.
Preparing for (life after) death: Advance care directives and cyclic temporalities
Authors: Zivkovic Tanya
Published: November 2019

This paper explores the disjuncture between medico‐legal trajectories of living and dying, in which lives start and stop, and the cyclic comings and goings of Buddhist and Hindu bodies. Drawing on fieldwork with Buddhist and Hindu communities in Adelaide, South Australia, I attend to the multiple temporalities that become implicated in end‐of‐life decision‐making about how and when a person may die. Thus, I reorient advance care planning from the linear projection of a single life towards cyclic considerations of the life course. In regarding life and death as ongoing I make space for temporalities of living and dying that run counter to public policy instruments, which focus on an irrevocable, yet calculable, end to life. I demonstrate how advance care planning processes and documents that construct the life course as advancing in a singular, linear and predictable trajectory overlook the multiple temporalities and directions that lives and deaths may take.
Determinants associated with areas with higher tuberculosis mortality rates: an ecological study
Authors: Verônica Melo Almeida Lima Shirley , Victor Muniz Rocha João , de Araújo Karina Conceição Gomes Machado , Antonio Prado Nunes Marco , Nunes Carla
Published: November 2019

Objective

To characterise tuberculosis deaths in a region of northeast Brazil during the period from 2006 to 2017 and to identify determinants associated with areas with higher tuberculosis mortality rates.

Methods

Ecological descriptive study of deaths from tuberculosis with multivariate mapping and logistic regression, carried out from 2006 to 2017 in the 75 municipalities of Sergipe, Brazil. The focus of the analysis was the mean mortality rate from tuberculosis, dichotomised according to the median. The independent variables were selected based on the conceptual model of the social determinants of health.

Results

Mortality due to tuberculosis in Sergipe, Brazil, was most prevalent among males, mixed‐race people, and people over 40 years old and with a low level of education. Multivariate logistic regression identified the mean incidence rate for tuberculosis (aOR: 1.06), the proportion of HIV testing (aOR: 7.10), people without primary education and with informal occupation (aOR: 1.26) and people living in urban households without waste collection service (aOR: 0.10) as determinants associated to municipalities with higher tuberculosis mortality rates, with area under the ROC curve of 84% (P‐value 0.000). Mapping revealed evident spatial variability.

Conclusions

The tuberculosis epidemic in Brazil is determined by access to health services, especially the provision of HIV testing among those diagnosed with tuberculosis, accelerated urbanisation with large pockets of poverty and unsanitary housing conditions, corroborating global trends.
Toxicity and outcome in cats with oral squamous cell carcinoma after accelerated hypofractionated radiotherapy and concurrent systemic treatment
Authors: Marconato Laura , Weyland Mathias , Tresch Nina , Rossi Federica , Leone Vito , Rohrer Bley Carla
Published: November 2019

Recently, a multimodal approach to oral squamous cell carcinoma (SCC) in cats, combining medical treatment and accelerated radiation therapy, showed a substantial outcome improvement in a small pilot study. Herein we retrospectively review 51 cats with unresectable, histologically confirmed oral SCC and a complete initial staging work‐up: cats in group A (n = 24) received medical anti‐angiogenic treatment consisting of bleomycin, piroxicam and thalidomide, cats in group B (n = 27) received the anti‐angiogenic treatment and concurrent accelerated hypofractionated radiation therapy with 48Gy delivered in 10 fractions. Overall median progression‐free interval (PFI) was poor with 70 days (95% CI: 48;93). In the irradiated cats (group B), however, PFI was significantly longer with 179 days (95% CI: 58;301) days, vs 30 days (95% CI: 23;38) in medically only treated cats (P < .001). Overall median overall survival (OS) was 89 days (95% CI: 55;124), again significantly longer in the irradiated cats (group B) with 136 (95% CI: 40;233) vs 38 days (95% CI: 23;54) (P < .001). In 8 of the 27 (29.6%) cats in group B, however, severe toxicity (grade 3) occurred. Neither onset nor severity of toxicity could be associated with any of the tested variables, including anatomic site, tumour size, clinical stage and duration of neoadjuvant medical treatment. Given the potential severe acute effects and the impact on quality of life after chemo‐radiotherapy, owners must be clearly informed about the risks of treatment. With the overall poor outcome and high occurrence of acute toxicity, we cannot recommend the use of this accelerated radiation protocol combined with anti‐angiogenic therapy for oral SCC in cats.
Sound production mechanism in the semiterrestrial crab Neohelice granulata (Brachyura, Varunidae)
Authors: Sal Moyano María P. , Ceraulo María , Mazzola Salvatore , Buscaino Giuseppa , Gavio María A.
Published: November 2019

Very few studies of sound production in the Brachyura have simultaneously identified the type of individuals (e.g., sex) producing acoustic signals, the structures involved in making sound and the social context. The emission and type of sound signals in Neohelice granulata were previously characterized, but the sex and the body structures involved in the sound production mechanism were not determined. In the present study, experiments conducted in the laboratory demonstrated that acoustic signals were produced by males through an up–down movement of the cheliped by rubbing the merus against the pterygostomial area of the carapace. The micromorphology of the merus showed that it has a ridge of tubercles which may act as a plectrum, while the pterygostomial area bears tubercles and might function as the pars stridens. Acoustic signals were displayed more frequently in the presence of receptive females. Agonistic encounters among males also occurred more often in the presence of receptive females. The authors propose that Neohelice granulata males use their chelipeds to produce sound signals in a mating context, probably to attract the receptive female and/or to repel other males when a receptive female is present. Thus, the display might have a reproductive function influencing mate choice.
Does Lower Lean Body Mass Mediate the Relationship Between Falls and Higher Body Mass Index in Asian Older Persons?
Authors: Kioh Sheng H. , Mat Sumaiyah , Kamaruzzaman Shahrul B. , Ibrahim Fatimah , Mokhtar Mas S. , Hairi Noran N. , Cumming Robert G. , Myint Phyo K. , Tan Maw P.
Published: November 2019

The current evidence on the relationship between a higher body mass index (BMI) and falls in older adults is conflicting. This study, therefore, evaluated the relationship between BMI and falls and explored underlying mechanisms for this relationship. Data from 1,340 individuals from the Malaysian Elders Longitudinal Research study, obtained through home-based computer-assisted interviews and followed by hospital-based health checks, were utilized. A history of the presence of falls in the previous 12 months was obtained. The presence of at least one fall in the past 12 months was associated with a higher BMI (odds ratio = 1.03, 95% confidence interval [1.01, 1.06]). The relationship between a higher BMI and falls was, however, attenuated by a lower percentage of lean body mass, which accounted for 69% of the total effect of BMI on the risk of falls. Future studies should now investigate this aforementioned relationship prospectively.
Association and Dose–Response Relationship of Self-Reported Physical Activity and Disability Among Adults ≥50 Years: National Health and Nutrition Examination Survey, 2011–2016
Authors: Delaney Margaret , Warren Meghan , Kinslow Brian , de Heer Hendrik , Ganley Kathleen
Published: November 2019

Disability is a tremendous public health challenge. No study has assessed whether meeting U.S. Physical Activity guidelines is associated with disability in mobility tasks, activities of daily living, and social participation among U.S. older adults. Using 2011–2016 National Health and Nutrition Examination Survey data, this study examined this relationship among 8,309 individuals aged ≥50 years. Most participants (n = 4,272) did not achieve guidelines, and 2,912 participants were completely inactive. People who did not meet guidelines had higher odds of disability compared with those who did (adjusted odds ratio [AOR] = 1.80) in addition to difficulty with mobility tasks (AOR = 1.85), activities of daily living (AOR = 1.66), and social participation (AOR = 2.09). There was a dose–response effect for each level of activity (inactive, insufficient, and meeting and exceeding recommendations). Among adults aged ≥50 years, meeting the U.S. guidelines was associated with better social and physical functioning.
Do Physical Activity, Caloric Intake, and Sleep Vary Together Day to Day? Exploration of Intraindividual Variability in 3 Key Health Behaviors
Authors: Hooker Stephanie A. , Oswald Laura B. , Reid Kathryn J. , Baron Kelly G.
Published: November 2019

Background: Little is known about how daily fluctuations in health behaviors relate to chronic disease risk. The goal of this study was to examine whether variability in physical activity, caloric intake, and sleep is related to body composition (body mass index and body fat percentage). Methods: Healthy adults (N = 103; 64% female) were monitored for 7 days to assess physical activity (SenseWear Armband), caloric intake (daily food diaries), and sleep duration and timing (Actiwatch Spectrum). Data were analyzed using correlations (between- and within-subjects correlations) and regression. Results: The results demonstrated that variabilities in physical activity, caloric intake, and sleep were unrelated. Caloric intake and sleep variability were unrelated to body composition. At greater levels of physical activity variability, any level of physical activity was protective for body composition. Conclusions: These results suggest that among healthy adults, variabilities in health behaviors may be independent of each other, and physical activity variability may be more strongly related to body composition among those who are less active.
Comparative Genomics Guides Elucidation of Vitamin B12Biosynthesis in Novel Human-AssociatedAkkermansiaStrains
Authors: Kirmiz Nina , Galindo Kadir , Cross Karissa L. , Luna Estefani , Rhoades Nicholas , Podar Mircea , Flores Gilberto E.
Published: November 2019

There is significant interest in the therapeutic and probiotic potential of the common gut bacteriumAkkermansia muciniphila. However, knowledge of both the genomic and physiological diversity of this bacterial lineage is limited. Using a combination of genomic, molecular biological, and traditional microbiological approaches, we identified at least four species-level phylogroups with differing functional potentials that affect how these bacteria interact with both their human host and other members of the human gut microbiome. Specifically, we identified and isolatedAkkermansiastrains that were able to synthesize vitamin B12. The ability to synthesize this important cofactor broadens the physiological capabilities of human-associatedAkkermansiastrains, fundamentally altering our understanding of how this important bacterial lineage may affect human health.
Laboratory Exercise To Measure Restriction Enzyme Kinetics
Authors: Blassick Caroline , David Benjamin , Storm Audra , Jensen Paul , Jensen Karin
Published: November 2019

Enzymes are ubiquitous in the fields of biology and microbiology, catalyzing critical reactions and enabling a broad range of biotechnological applications. Despite the important role that enzyme catalysis plays in biological processes, undergraduate students often struggle to understand enzyme kinetics in the classroom. In an attempt to improve students’ understanding of the topic, we present a relatively short and inexpensive laboratory activity designed to give students hands-on experience with generating and manipulating enzyme kinetic data. Students perform restriction digests of DNA at various time points, visualize the reaction products on an agarose gel, and quantify their data in order to construct Lineweaver-Burk plots which compare the effects of a restriction enzyme and its engineered version. The activity may be completed in a single two-hour lab session and, unlike other enzyme assays designed for laboratory courses, does not require a microplate reader to complete. The activity allows students to see connections between a visual data set and quantitative kinetic data, in order to solidify their understanding of enzyme kinetics. Students also learn the skills of gel electrophoresis and image quantification using ImageJ software. This lab activity is ideal for undergraduate laboratory courses which address enzyme kinetics and DNA technology.
Polymorphisms in the Most Oncolytic Reovirus Strain Confer Enhanced Cell Attachment, Transcription, and Single-Step Replication Kinetics
Authors: Mohamed Adil , Smiley James R. , Shmulevitz Maya
Published: November 2019

Reovirus serotype 3 Dearing (T3D) is in clinical trials for cancer therapy. Recently, it was discovered that highly related laboratory strains of T3D exhibit large differences in their abilities to replicate in cancer cells
in vitro
, which correlates with oncolytic activity in a murine model of melanoma. The current study reveals two mechanisms for the enhanced efficiency of T3D
PL
in cancer cells. Due to polymorphisms in two viral genes, within the first round of reovirus infection, T3D
PL
binds to cells more efficiency and more rapidly produces viral RNAs; this increased rate of infection relative to that of the less oncolytic strains gives T3D
PL
a strong inherent advantage that culminates in higher virus production, more cell death, and higher virus spread.
Conversion surgery for positive peritoneal washing cytology in pancreatic cancer
Authors: Mitachi Katsutaka , Ariake Kyohei , Motoi Fuyuhiko , Unno Michiaki
Published: November 2019

Positive peritoneal washing cytology (PPC) of pancreatic carcinoma is defined as distant metastasis in the American Joint Committee on Cancer or Union for International Cancer Control’s tumour, node, metastases classification. However, surgical resection was believed to be the only method that prolong survival; thus, many institutions perform pancreatectomy for PPC, despite the unfavourable prognosis. Therefore, a more preferable alternative treatment for PPC is required. A 64-year-old man with resectable pancreatic tail cancer presented to our hospital. PPC was detected at first laparotomy; thus, pancreatectomy was avoided and gemcitabine with nabpaclitaxel (GnP) was administered. After four courses of GnP treatment, PPC converted to negative, as evaluated by abdominal port cytology. Thus, distal pancreatectomy was performed, and R0 resection was achieved. He has been healthy for more than 24 months since the first laparotomy. Initial chemotherapy with the intention of converting the cytological status followed by surgical treatment might become a useful treatment strategy for PPC.
Ruptured primary mucinous cystadenoma of spleen leading to mucinous ascites
Authors: Gupta Jagdish , Gupta Archit
Published: November 2019

Mucinous cystadenoma are rare benign mucin-producing tumours. Primary mucinous neoplasms most commonly involve ovary, pancreas or appendix. They may rupture to produce mucous ascites/pseudomyxoma peritonei. We are describing a 51-year-old man who presented to us with symptomatic gallstone disease but during preoperative ultrasound was found to have cystic lesions in spleen with free fluid in the abdomen. Splenectomy and drainage of mucin were done. Histopathology was done and a final diagnosis of primary mucinous cystadenoma of spleen with mucinous ascites was made.
Trial design for ineffectiveness research: a mixed-methods survey
Authors: Riggs Kevin , Richman Joshua , Kertesz Stefan
Published: November 2019

High-quality research demonstrating a lack of effectiveness may facilitate the ‘de-adoption’ of ineffective health services. However, there has been little debate on the optimal design for ineffectiveness research—studies exploring the research hypothesis that an intervention is ineffective. The aim of this study was to explore investigators’ preferences for trial design for ineffectiveness research. We conducted a mixed-methods online survey with principle investigators identified from clinicaltrials.gov. A vignette described researchers planning a trial to test a widely used intervention they hypothesised was ineffective. One multiple-choice question asked whether a superiority trial or equivalence trial design was favoured, and one free-response question asked about the reasons for that choice. Free-response answers were analysed using content analysis to identify related reasons. 139 participants completed the survey (completion rate 37.5%). Overall, 56.8% favoured superiority trials, 27.3% favoured equivalence trials and 15.8% were unsure. Reasons identified for favouring superiority trials were: (1) evidence of superiority should be required to justify active treatment, (2) superiority trials are more familiar, (3) placebo should not be the comparator in equivalence trials and (4) superiority trials require smaller sample sizes. Reasons identified for favouring equivalence trials were: (1) negative superiority trials represent a lack of evidence of effectiveness, not evidence of ineffectiveness and (2) the research hypothesis should not be the same as the null hypothesis. A minority of experienced researchers favour equivalence trials for ineffectiveness research, and misconceptions and lack of familiarity with equivalence trials may be contributing factors.
Prehospital time and mortality in patients requiring a highest priority emergency medical response: a Danish registry-based cohort study
Authors: Mills Elisabeth Helen Anna , Aasbjerg Kristian , Hansen Steen Moeller , Ringgren Kristian Bundgaard , Dahl Michael , Rasmussen Bodil Steen , Torp-Pedersen Christian , Søgaard Peter , Kragholm Kristian
Published: November 2019

Objective

To examine the association between time from emergency medical service vehicle dispatch to hospital arrival and 1-day and 30-day mortality.

Design

Register-based cohort study.

Setting

North Denmark Region (≈8000 km2, catchment population ≈600 000).

Participants

We included all highest priority dispatched ambulance transports in North Denmark Region in 2006–2012.

Interventions

Using logistic regression and the g-formula approach, we examined the association between time from emergency dispatch to hospital arrival and mortality for presumed heart, respiratory, cerebrovascular and other presumed medical conditions, as well as traffic or other accidents, as classified by emergency dispatch personnel.

Main outcome measures

1-day and 30-day mortality.

Results

Among 93 167 individuals with highest priority ambulances dispatched, 1948 (2.1%) were dead before the ambulance arrived and 19 968 (21.4%) were transported to the hospital under highest priority (median total prehospital time from dispatch to hospital arrival 47 min (25%–75%: 35–60 min); 95th percentile 84 min). Among 18 709 with population data, 1-day mortality was 10.9% (n=2038), and was highest for patients with dyspnoea (20.4%) and lowest for patients with traffic accidents (2.8%). Thirty-day mortality was 18.3% and varied between 36.6% (patients with dyspnoea) and 3.7% (traffic accidents). One-day mortality was not associated with total prehospital time, except for presumed heart conditions, where longer prehospital time was associated with decreased mortality: adjusted OR for >60 min vs 0–30 min was 0.61 (95% CI 0.40 to 0.91). For patients with dyspnoea, OR for >60 min vs 0–30 min was 0.90 (95% CI 0.56 to 1.45), for presumed cerebrovascular conditions OR 1.41 (95% CI 0.53 to 3.78), for other presumed medical conditions OR 0.84 (95% CI 0.70 to 1.02), for traffic accidents OR 0.65 (95% CI 0.29 to 1.48) and for other accidents OR 0.84 (95% CI 0.47 to 1.51). Similar findings were found for 30-day mortality.

Conclusions

In this study, where time from emergency dispatch to hospital arrival mainly was <80 min, there was no overall relation between this prehospital time measure and mortality.
Experiences among firefighters and police officers of responding to out-of-hospital cardiac arrest in a dual dispatch programme in Sweden: an interview study
Authors: Hasselqvist-Ax Ingela , Nordberg Per , Svensson Leif , Hollenberg Jacob , Joelsson-Alm Eva
Published: November 2019

Objectives

The objective of this study was to explore firefighters’ and police officers’ experiences of responding to out-of-hospital cardiac arrest (OHCA) in a dual dispatch programme.

Design

A qualitative interview study with semi-structured, open-ended questions where critical incident technique (CIT) was used to collect recalled cardiac arrest situations from the participants’ narratives. The interviews where transcribed verbatim and analysed with inductive content analysis.

Setting

The County of Stockholm, Sweden.

Participants

Police officers (n=10) and firefighters (n=12) participating in a dual dispatch programme with emergency medical services in case of suspected OHCA of cardiac or non-cardiac origin.

Results

Analysis of 60 critical incidents was performed resulting in three consecutive time sequences (preparedness, managing the scene and the aftermath) with related categories, where first responders described the complexity of the cardiac arrest situation. Detailed information about the case and the location was crucial for the preparedness, and information deficits created stress, frustration and incorrect perceptions about the victim. The technical challenges of performing cardiopulmonary resuscitation and managing the airway was prominent and the need of regular team training and education in first aid was highlighted.

Conclusions

Participating in dual dispatch in case of suspected OHCA was described as a complex technical and emotional process by first responders. Providing case discussions and opportunities to give, and receive feedback about the case is a main task for the leadership in the organisations to diminish stress among personnel and to improve future OHCA missions.
Knowledge and attitudes of syphilis and syphilis pre-exposure prophylaxis (PrEP) among men who have sex with men in Vancouver, Canada: a qualitative study
Authors: Nath Ronita , Grennan Troy , Parry Robin , Baharuddin Fahmy , Connell James P , Wong Jason , Grace Daniel
Published: November 2019

Objectives

In British Columbia, Canada, syphilis is at record-high rates, with over 80% of cases in 2017 seen in gay, bisexual and other men who have sex with men (GBM). The syphilis epidemic is of particular concern for those living with HIV, since syphilis may lead to more serious complications in this population. We sought to explore syphilis-related knowledge and attitudes around biomedical prevention options for syphilis, with the goal of informing effective strategies to prevent syphilis.

Design

We conducted a qualitative study consisting of in-depth, individual interviews from December 2016 to June 2017. Our interviews focused on participants’ knowledge about syphilis and perceptions regarding syphilis pre-exposure prophylaxis (PrEP). Interviews were analysed using Grounded Theory.

Participants

Twenty-five GBM were interviewed (64% white; median age: 43 years), including men living with HIV and/or with a history of syphilis.

Setting

Vancouver, British Columbia.

Results

Five interrelated themes emerged. First, GBM were aware of the local syphilis epidemic. Second, syphilis-related knowledge differed according to syphilis and HIV serostatus. Third, competing ideas emerged regarding men’s concerns about syphilis. While our participants expressed concern about getting syphilis, they also described the importance of sexual pleasure. Fourth, many participants said that syphilis was not perceived to be alarming; preventing HIV infection remained a primary concern for many. Finally, while syphilis PrEP was appealing to those living with HIV or a prior syphilis diagnosis, others were concerned about antibiotic resistance, cost and side effects.

Conclusions

Our participants organised their safer sex strategies around HIV, not syphilis. Although syphilis-related knowledge was relatively high among GBM living with HIV and those with a prior syphilis diagnosis, this knowledge did not appear to be related with safer sexual practices, such as increased condom use. This work highlights the importance of examining other potential prevention solutions, such as syphilis PrEP.
Assessment on patient outcomes of primary hip replacement: an interrupted time series analysis from ‘The National Joint Registry of England and Wales’
Authors: Garriga Cesar , Murphy Jacqueline , Leal Jose , Arden Nigel K , Price Andrew James , Prieto-Alhambra Daniel , Carr Andrew J , Rangan Amar , Cooper Cyrus , Peat George , Fitzpatrick Ray , Barker Karen L , Judge Andrew
Published: November 2019

Objectives

Effects of the UK Department of Health’s national Enhanced Recovery After Surgery (ERAS) Programme on outcomes after primary hip replacement.

Design

Natural experimental study using interrupted time series to assess the changes in trends before, during and after ERAS implementation (April 2009 to March 2011).

Setting

Surgeries in the UK National Joint Registry were linked with Hospital Episode Statistics containing inpatient episodes from National Health Service trusts in England and patient reported outcome measures.

Participants

Patients aged ≥18 years from 2008 to 2016.

Main outcome measures

Regression coefficients of monthly means of length of hospital stay, bed day cost, change in Oxford Hip Scores (OHS) 6 months post-surgery, complications 6 months post-surgery and revision rates 5 years post-surgery.

Results

438 921 primary hip replacements were identified. Hospital stays shortened from 5.6 days in April 2008 to 3.6 in December 2016. There were also improvements in bed day costs (£7573 in April 2008 to £5239 in December 2016), positive change in self-reported OHS from baseline to 6 months post-surgery (17.7 points in April 2008 to 22.9 points in December 2016), complication rates (4.1% in April 2008 to 1.7% March 2016) and 5 year revision rates (5.9 per 1000 implant-years (95% CI 4.8 to 7.2) in April 2008 to 2.9 (95% CI 2.2 to 3.9) in December 2011). The positive trends in all outcomes started before ERAS was implemented and continued during and after the programme.

Conclusions

Patient outcomes after hip replacement have improved over the last decade. A national ERAS programme maintained this improvement but did not alter the existing rate of change.
Examination of CIs in health and medical journals from 1976 to 2019: an observational study
Authors: Barnett Adrian Gerard , Wren Jonathan D
Published: November 2019

Objectives

Previous research has shown clear biases in the distribution of published p values, with an excess below the 0.05 threshold due to a combination of p-hacking and publication bias. We aimed to examine the bias for statistical significance using published confidence intervals.

Design

Observational study.

Setting

Papers published inMedlinesince 1976.

Participants

Over 968 000 confidence intervals extracted from abstracts and over 350 000 intervals extracted from the full-text.

Outcome measures

Cumulative distributions of lower and upper confidence interval limits for ratio estimates.

Results

We found an excess of statistically significant results with a glut of lower intervals just above one and upper intervals just below 1. These excesses have not improved in recent years. The excesses did not appear in a set of over 100 000 confidence intervals that were not subject to p-hacking or publication bias.

Conclusions

The huge excesses of published confidence intervals that are just below the statistically significant threshold are not statistically plausible. Large improvements in research practice are needed to provide more results that better reflect the truth.
Association of the low e′ and high E/e′ with long-term outcomes in patients with normal ejection fraction: a hospital population-based observational cohort study
Authors: Seko Yuta , Kato Takao , Shiba Masayuki , Morita Yusuke , Yamaji Yuhei , Haruna Yoshizumi , Nakane Eisaku , Hayashi Hideyuki , Haruna Tetsuya , Inoko Moriaki
Published: November 2019

Objective

We aimed to evaluate the association of the severity of left ventricular (LV) diastolic dysfunction with long-term outcomes in patients with normal ejection fraction.

Design

Retrospective study.

Setting

A single centre in Japan.

Participants

We included 3576 patients who underwent both scheduled transthoracic echocardiography and ECG between 1 January and 31 December 2013, in a hospital-based population after excluding valvular diseases or low ejection fraction (<50%) or atrial fibrillation and categorised them into three groups: septal tissue Doppler early diastolic mitral annular velocity (e′)≥7 (without relaxation disorder, n=1593), e′<7 and early mitral inflow velocity (E)/e′≤14 (with relaxation disorder and normal LV end-diastolic pressure, n=1337) and e′<7 and E/e′>14 (with relaxation disorder and high LV end-diastolic pressure, n=646).

Primary and secondary outcome measures

The primary outcome measure was a composite of all-cause death and major adverse cardiac events (MACE). The secondary outcome measure were all-cause death and MACE, separately.

Results

The cumulative 3-year incidences of the primary outcome measures were significantly higher in the e′<7 and E/e′≤14 (19.0%) and e′<7 and E/e′>14 group (23.4%) than those for the e′≥7 group (13.0%; p<0.001). After adjusting for confounders, the excess 3-year risk of primary outcome for the groups with e′<7 and E/e′≤14 related to e′≥7 (HR: 1.24; 95% CI 1.02 to 1.52) and e′<7 and E/e′>14 related to e′<7 (HR: 1.57; 95% CI 1.28 to 1.94) were significant. The severity of diastolic dysfunction was associated with incrementally higher risk for primary outcomes (p<0.001).

Conclusion

The severity of LV diastolic dysfunction using e′<7 and E/e′>14 was associated with the long-term prognosis in patients with normal ejection fraction in an incremental fashion.
Very early family-based intervention for anxiety: two case studies with toddlers
Authors: Hirshfeld-Becker Dina R , Henin Aude , Rapoport Stephanie J , Wilens Timothy E , Carter Alice S
Published: November 2019

Anxiety disorders represent the most common category of psychiatric disorder in children and adolescents and contribute to distress, impairment and dysfunction. Anxiety disorders or their temperamental precursors are often evident in early childhood, and anxiety can impair functioning, even during preschool age and in toddlerhood. A growing number of investigators have shown that anxiety in preschoolers can be treated efficaciously using cognitive–behavioural therapy (CBT) administered either by training the parents to apply CBT strategies with their children or through direct intervention with parents and children. To date, most investigators have drawn the line at offering direct CBT to children under the age of 4. However, since toddlers can also present with impairing symptoms, and since behaviour strategies can be applied in older preschoolers with poor language ability successfully, it ought to be possible to apply CBT for anxiety to younger children as well. We therefore present two cases of very young children with impairing anxiety (ages 26 and 35 months) and illustrate the combination of parent-only and parent–child CBT sessions that comprised their treatment. The treatment was well tolerated by parents and children and showed promise for reducing anxiety symptoms and improving coping skills.
How many serial sections are needed to detect apoptosis in endoscopic biopsies with gastrointestinal graft versus host disease?
Authors: Wong Newton ACS , Marks David I
Published: November 2019

Aims

The hallmark histological feature of acute gastrointestinal graft versus host disease (GI GVHD) is epithelial apoptosis. This is the first formal evaluation of how many serial sections are required to consistently detect apoptotic bodies in endoscopic biopsies from various GI locations in patients with clinically validated GI GVHD.

Methods, results and conclusions

Assessment of 1008 serial sections showed that apoptotic bodies are uniformly distributed among such sections of gastric, duodenal and colorectal biopsies from these patients. Assessment of 59 further biopsies showed that assessing 12 serial sections should suffice to detect GVHD in gastric, duodenal and colorectal biopsies using thresholds of one apoptotic body per biopsy fragment or one apoptotic body per 4 mm2. Assessing 12 serial sections should also suffice to detect GVHD in duodenal and colorectal biopsies using the threshold of 6 apoptotic bodies per 10 contiguous crypts, but it remains uncertain whether this assessment and threshold can be applied to gastric biopsies.
Real data transforming the real world
Authors: Dean Rachel
Published: November 2019

This month Rachel Dean says using all sorts of data can support innovation and safety.