bluuebunny/crossref_metadata_2025 huggingface dataset:
Challenges regarding the control of environmental sources of contamination in healthcare settings in low-and middle-income countries - a narrative review
Authors: Ogunsola Folasade T. , Mehtar Shaheen
Published: June 2020

Background

Healthcare-associated infections (HAI) especially outbreaks of multi-drug-resistant organisms within hospitals are recognized as a major contributor to morbidity and mortality of hospitalized patients. The healthcare environment can act as an amplifier of HAI during outbreaks. The risk of acquiring HAI are 20 times higher in Low-and-middle-income countries.

The purpose of this article is to review the challenges associated with controlling environmental contamination in low and lower-middle income countries (LMIC), highlighting possible solutions.

Method

This is a narrative review. A literature search was carried out in Google scholar, PubMed, Science Direct, EBSCOHOST, CENGAGE, Scopus, ProQuest, Clinical Key and African journals online using the key words - Health care Associated Infections (HCAIs) in LMICs, Challenges of HAIs in LMIC, Challenges of Prevention and Control of HAIs in LMICs, Environment of care and infection transmission, Contaminated environment and HAIs.

Results

From the accessed databases, 1872 articles related to environmental sources of contamination in healthcare settings were found. Of these, only 530 articles focused on LMICs. However, only 186 articles met the inclusion criteria studies published in English, conducted between 2000 and 2019 and exploring environmental sources of contamination in LMIC healthcare settings). The sources of environmental contamination in healthcare are numerous and commonly associated with poor governance, Inadequate infrastructure, human capacity and inadequate funding. Low awareness exists at all levels as to the role of the environment in healthcare outcomes and may explain in part the low priority given for funding.

Conclusion

Leadership and trained personnel, both Infection prevention and control practitioners and cleaners are crucial to drive and sustain the process to reduce environmental contamination in healthcare environments.
Depth-related variability in viral communities in highly stratified sulfidic mine tailings
Authors: Gao Shao-Ming , Schippers Axel , Chen Nan , Yuan Yang , Zhang Miao-Miao , Li Qi , Liao Bin , Shu Wen-Sheng , Huang Li-Nan
Published: June 2020

Background

Recent studies have significantly expanded our knowledge of viral diversity and functions in the environment. Exploring the ecological relationships between viruses, hosts, and the environment is a crucial first step towards a deeper understanding of the complex and dynamic interplays among them.

Results

Here, we obtained extensive 16S rRNA gene amplicon, metagenomics sequencing, and geochemical datasets from different depths of two highly stratified sulfidic mine tailings cores with steep geochemical gradients especially pH, and explored how variations in viral community composition and functions were coupled to the co-existing prokaryotic assemblages and the varying environmental conditions. Our data showed that many viruses in the mine tailings represented novel genera, based on gene-sharing networks. Siphoviridae, Podoviridae, and Myoviridae dominated the classified viruses in the surface tailings and deeper layers. Both viral richness and normalized coverage increased with depth in the tailings cores and were significantly correlated with geochemical properties, for example, pH. Viral richness was also coupled to prokaryotic richness (Pearson’s r = 0.65, P = 0.032). The enrichment of prophages in the surface mine tailings suggested a preference of lysogenic viral lifestyle in more acidic conditions. Community-wide comparative analyses clearly showed that viruses in the surface tailings encoded genes mostly with unknown functions while viruses in the deeper layers contained genes mainly annotated as conventional functions related to metabolism and structure. Notably, significantly abundant assimilatory sulfate reduction genes were identified from the deeper tailings layers and they were widespread in viruses predicted to infect diverse bacterial phyla.

Conclusions

Overall, our results revealed a depth-related distribution of viral populations in the extreme and heterogeneous tailings system. The viruses may interact with diverse hosts and dynamic environmental conditions and likely play a role in the functioning of microbial community and modulate sulfur cycles in situ.
Modulating pyrimidine ribonucleotide levels for the treatment of cancer
Authors: Mollick Tanzina , Laín Sonia
Published: June 2020

By providing the necessary building blocks for nucleic acids and precursors for cell membrane synthesis, pyrimidine ribonucleotides are essential for cell growth and proliferation. Therefore, depleting pyrimidine ribonucleotide pools has long been considered as a strategy to reduce cancer cell growth. Here, we review the pharmacological approaches that have been employed to modulate pyrimidine ribonucleotide synthesis and degradation routes and discuss their potential use in cancer therapy. New developments in the treatment of myeloid malignancies with inhibitors of pyrimidine ribonucleotide synthesis justify revisiting the literature as well as discussing whether targeting this metabolic pathway can be effective and sufficiently selective for cancer cells to warrant an acceptable therapeutic index in patients.
Pro-inflammatory cytokine ratios determine the clinical course of febrile neutropenia in children receiving chemotherapy
Authors: Siegmund Mira , Pagel Julia , Scholz Tasja , Rupp Jan , Härtel Christoph , Lauten Melchior
Published: June 2020

Background

Febrile neutropenia is a common and serious complication during treatment of childhood cancer. Empirical broad-spectrum antibiotics are usually administered until neutrophil cell count recovery. It was the aim of this study to investigate cytokine profiles as potential biomarkers using in-vitro sepsis models to differentiate between distinct clinical courses of febrile neutropenia (FN).

Methods

We conducted an observational study in FN episodes of pediatric oncology patients. Courses of neutropenia were defined as severe in case of proven blood stream infection or clinical evidence of complicated infection. We collected blood samples at various time points from the onset of FN and stimulated ex vivo with lipopolysaccharide (LPS) and Staphylococcus epidermidis (SE) for 24 h. Twenty-seven cytokine levels were measured in the whole blood culture supernatants by a multiplex immunoassay system.

Results

Forty-seven FN episodes from 33 children were investigated. IL-8, IL-1β, and MCP-1 expression increased significantly over time. IL-8, MIP-1α, MIP-1β, MCP-1, and TNF-α showed significantly lower concentration in patients with a clinically severe course of the FN.

Conclusions

Distinct patterns of cytokine profiles seem to be able to determine infectious FN and to predict the severity of its clinical course. If these data can be verified in a multi-centre setting, this may finally lead to an individualized treatment strategy facilitating antibiotic stewardship in these patients.
DNA methylation profiling demonstrates superior diagnostic classification to RNA-sequencing in a case of metastatic meningioma
Authors: Vasudevan Harish N. , Castro Maria R. H. , Lee Julieann C. , Villanueva-Meyer Javier E. , Bush Nancy Ann Oberheim , McDermott Michael W. , Solomon David A. , Perry Arie , Magill Stephen T. , Raleigh David R.
Published: June 2020

Meningiomas are the most common primary intracranial tumors, but meningioma metastases are rare. Accordingly, the clinical workup, diagnostic testing, and molecular classification of metastatic meningioma is incompletely understood. Here, we present a case report of multiply recurrent meningioma complicated by liver metastasis. We discuss the patient presentation, imaging findings, and conventional histopathologic characterization of both the intracranial lesion and the metastatic focus. Further, we perform multiplatform molecular profiling, comprised of DNA methylation arrays and RNA-sequencing, of six stereotactically-guided samples from the intracranial meningioma and a single ultrasound-guided liver metastasis biopsy. Our results show that DNA methylation clusters distinguish the liver metastasis from the intracranial meningioma samples, and identify a small focus of hepatocyte contamination with the liver biopsy. Nonetheless, DNA methylation-based classification accurately identifies the liver metastasis as a meningioma with high confidence. We also find that clustering of RNA-sequencing results distinguishes the liver metastasis from the intracranial meningiomas samples, but that differential gene expression classification is confounded by hepatocyte-specific gene expression programs in the liver metastasis. In sum, this case report sheds light on the comparative biology of intracranial and metastatic meningioma. Furthermore, our results support methylation-based classification as a robust method of diagnosing metastatic lesions, underscore the broad utility of DNA methylation array profiling in diagnostic pathology, and caution against the routine use of bulk RNA-sequencing for identifying tumor signatures in heterogeneous metastatic lesions.
Transplantation of induced neural stem cells (iNSCs) into chronically demyelinated corpus callosum ameliorates motor deficits
Authors: Sullivan Genevieve M. , Knutsen Andrew K. , Peruzzotti-Jametti Luca , Korotcov Alexandru , Bosomtwi Asamoah , Dardzinski Bernard J. , Bernstock Joshua D. , Rizzi Sandra , Edenhofer Frank , Pluchino Stefano , Armstrong Regina C.
Published: June 2020

Multiple Sclerosis (MS) causes neurologic disability due to inflammation, demyelination, and neurodegeneration. Immunosuppressive treatments can modify the disease course but do not effectively promote remyelination or prevent long term neurodegeneration. As a novel approach to mitigate chronic stage pathology, we tested transplantation of mouse induced neural stem cells (iNSCs) into the chronically demyelinated corpus callosum (CC) in adult mice. Male C57BL/6 mice fed 0.3% cuprizone for 12 weeks exhibited CC atrophy with chronic demyelination, astrogliosis, and microglial activation. Syngeneic iNSCs were transplanted into the CC after ending cuprizone and perfused for neuropathology 2 weeks later. Magnetic resonance imaging (MRI) sequences for magnetization transfer ratio (MTR), diffusion-weighted imaging (T2), and diffusion tensor imaging (DTI) quantified CC pathology in live mice before and after iNSC transplantation. Each MRI technique detected progressive CC pathology. Mice that received iNSCs had normalized DTI radial diffusivity, and reduced astrogliosis post-imaging. A motor skill task that engages the CC is Miss-step wheel running, which demonstrated functional deficits from cuprizone demyelination. Transplantation of iNSCs resulted in marked recovery of running velocity. Neuropathology after wheel running showed that iNSC grafts significantly increased host oligodendrocytes and proliferating oligodendrocyte progenitors, while modulating axon damage. Transplanted iNSCs differentiated along astrocyte and oligodendrocyte lineages, without myelinating, and many remained neural stem cells. Our findings demonstrate the applicability of neuroimaging and functional assessments for pre-clinical interventional trials during chronic demyelination and detect improved function from iNSC transplantation. Directly reprogramming fibroblasts into iNSCs facilitates the future translation towards exogenous autologous cell therapies.
Trajectory estimation and position correction for hopping robot navigation using monocular camera
Authors: Kovacs Gabor , Kunii Yasuharu , Maeda Takao , Hashimoto Hideki
Published: June 2020

In this paper, a navigation and environment mapping method is presented for small exploration robots that use hopping motion. While previous research about hopping rovers mostly focuses on mobility and mechanical design, the motivation for the proposed method is to provide a fully autonomous navigation system using only a monocular camera. The method accurately estimates the hopping distance and reconstruct the 3D environment using Structure from Motion, proving that a monocular system is not only feasible, but accurate and robust at the same time. The relative scale problem of the reconstructed scene and trajectory is solved by the known gravity and parabolic motion constraints. After each hop, the error in landing position is corrected by a modified Iterative Closest Point algorithm with non-overlapping part elimination. The environmental point cloud is projected onto a 2D image, that is used to find the most suitable landing position for the next hop using protrusion based obstacle detection, and navigate the robot towards the goal direction. Both virtual environment simulations and real experiments confirm the feasibility and highlight the advantages of the presented method.
A modified surgical approach for hard and soft tissue reconstruction of severe periimplantitis defects: laser-assisted periimplant defect regeneration (LAPIDER)
Authors: Noelken Robert , Al-Nawas Bilal
Published: June 2020

Background

The main problem in periimplantitis is often the combination of severe periimplant bone loss with a contaminated implant surface and an insufficient soft tissue situation. Classic surgical concepts with crestal access to the bony defect and debridement of the surface most often lead to partial defect regeneration and a soft tissue recession. An incision directly above the pathologic bony lesion is contrary to general surgical treatment rules.

Aim

To overcome this problem, a new surgical concept was developed which allows to clean the implant surface, reconstruct the bony defect, and improve soft tissue height and thickness without cutting the papilla complex. This publication presents the innovative regenerative treatment approach for severe periimplantitis defects.

Material and methods

After diagnosis and non-surgical pre-treatment of a severe periimplantitis lesion, the following treatment protocol was applied: horizontal mucosal incision 5 mm apical to marginal mucosa, supraperiosteal preparation in apical direction, cutting through periosteum at the level of the implant apex, subperiosteal coronal flap elevation, exploration and cleaning of the periimplant defect, thorough debridement of the implant surface with the Er:YAG laser, subperiosteal grafting with connective tissue, grafting of the bony defect with autogenous bone chips from the mandibular ramus, and bilayered suturing of periosteum and mucosa. Implant survival, marginal bone levels, periimplant probing depths, recession, and facial mucosa thickness (PIROP ultrasonic measurement) were evaluated in a pilot case at 1-year follow-up examination.

Results

Inter-proximal, oral, and buccal marginal bone levels increased significantly to the level of the implant shoulder from pre-operative to 1-year follow-up examination. No signs of suppuration or periimplant infection were present. Probing depths and recession decreased significantly, while the facial mucosa thickness improved from pre-operative to final examination.

Conclusions

Marginal bone levels and soft tissue improvement suggest feasibility for the regeneration of severe periimplant hard and soft tissue deficiencies by this new treatment approach. With the use of this concept, the simultaneous implant surface cleansing and improvement of hard and soft tissue seem to be possible and unfavorable postoperative exposition of titanium surface might be prevented. Comparative studies are planned to quantify the effects of this new surgical protocol.
Patient perceived barriers to exercise and their clinical associations in difficult asthma
Authors: Freeman Anna T. , Hill David , Newell Colin , Moyses Helen , Azim Adnan , Knight Deborah , Presland Laura , Harvey Matthew , Haitchi Hans Michael , Watson Alastair , Staples Karl J. , Kurukulaaratchy Ramesh J. , Wilkinson Tom M. A.
Published: June 2020

Background

Exercise is recommended in guidelines for asthma management and has beneficial effects on symptom control, inflammation and lung function in patients with sub-optimally controlled asthma. Despite this, physical activity levels in patients with difficult asthma are often impaired. Understanding the barriers to exercise in people with difficult asthma is crucial for increasing their activity, and in implementing successful, disease modifying, and holistic approaches to improve their health.

Methods

62 Patients within the WATCH Difficult Asthma Cohort (Southampton, UK) completed an Exercise Therapy Burden Questionnaire (ETBQ). The results were analyzed with contemporaneous asthma-related data to determine relationships between perceived exercise barriers and asthma and comorbidity characteristics

Results

Patients were reflective of a difficult asthma cohort, 66% were female, and 63% were atopic. They had a high BMI (median [inter-quartile range]) of 29.3 [25.5–36.2], age of 53.5 [38.75, 65.25], impaired spirometry with FEV1 73% predicted [59.5, 86.6%] and FEV/FVC ratio of 72 [56.5, 78.0] and poor symptom control, as defined by an Asthma Control Questionnaire (ACQ6) result of 2.4 [1.28, 3.2]. A high perceived barriers to exercise score was significantly correlated with increased asthma symptoms (r = 0.452, p < 0.0001), anxiety (r = 0.375, p = 0.005) and depression (r = 0.363, p = 0.008), poor quality of life (r = 0.345, p = 0.015) and number of rescue oral steroid courses in the past 12 months (r = 0.257, p = 0.048). Lung function, blood eosinophil count, FeNO, Njimegen and SNOT22 scores, BMI and hospitalisations in the previous year were not related to exercise perceptions.

Conclusion

In difficult asthma, perceived barriers to exercise are related to symptom burden and psychological morbidity. Therefore, exercise interventions combined with psychological input such as CBT to restructure thought processes around these perceived barriers may be useful in facilitating adoption of exercise.
Recent advances in polymeric drug delivery systems
Authors: Sung Yong Kiel , Kim Sung Wan
Published: June 2020

Background

Polymeric drug delivery systems have been achieved great development in the last two decades. Polymeric drug delivery has defined as a formulation or a device that enables the introduction of a therapeutic substance into the body. Biodegradable and bio-reducible polymers make the magic possible choice for lot of new drug delivery systems. The future prospects of the research for practical applications has required for the development in the field.

Main body

Natural polymers such as arginine, chitosan, dextrin, polysaccharides, poly (glycolic acid), poly (lactic acid), and hyaluronic acid have been treated for polymeric drug delivery systems. Synthetic polymers such as poly (2-hydroxyethyl methacrylate), poly(N-isopropyl acrylamide)s, poly(ethylenimine)s, dendritic polymers, biodegradable and bio-absorbable polymers have been also discussed for polymeric drug delivery. Targeting polymeric drug delivery, biomimetic and bio-related polymeric systems, and drug-free macromolecular therapeutics have also treated for polymeric drug delivery. In polymeric gene delivery systems, virial vectors and non-virial vectors for gene delivery have briefly analyzed. The systems of non-virial vectors for gene delivery are polyethylenimine derivatives, polyethylenimine copolymers, and polyethylenimine conjugated bio-reducible polymers, and the systems of virial vectors are DNA conjugates and RNA conjugates for gene delivery.

Conclusion

The development of polymeric drug delivery systems that have based on natural and synthetic polymers are rapidly emerging to pharmaceutical fields. The fruitful progresses have made in the application of biocompatible and bio-related copolymers and dendrimers to cancer treatment, including their use as delivery systems for potent anticancer drugs. Combining perspectives from the synthetic and biological fields will provide a new paradigm for the design of polymeric drug and gene delivery systems.
The effect of tranexamic acid in patients with TBI: a systematic review and meta-analysis of randomized controlled trials
Authors: Du Chao-nan , Liu Bo-xue , Ma Qing-fang , Yang Ming-fei
Published: June 2020

To conduct a systematic review and meta-analysis and evaluate the effect of tranexamic acid in patients with traumatic brain injury. PubMed, EMBASE, and CENTRAL (Cochrane Central Register of Controlled Trials) were searched to identify randomized controlled trials and evaluate the effect of tranexamic acid in traumatic brain injury patients. The primary outcome was mortality. Two reviewers extracted the data independently. The random effect meta-analysis was used to estimate the aggregate effect size of 95% confidence intervals. Six randomized controlled trials investigating tranexamic acid versus placebo and 30073 patients were included. Compared with placebo, tranexamic acid decreased the mortality (RR = 0.92; 95% CI, 0.87–0.96; p < 0.001) and growth of hemorrhagic mass (RR = 0.78; 95% CI, 0.61–0.99; p = 0.04). However, tranexamic acid could not decrease disability or independent, neurosurgery, vascular embolism, and stroke. Current evidence suggested that compared with placebo, tranexamic acid could reduce mortality and growth of hemorrhagic mass. This finding indicated that patients with traumatic brain injury should be treated with tranexamic acid.
Gesture during math instruction specifically benefits learners with high visuospatial working memory capacity
Authors: Aldugom Mary , Fenn Kimberly , Cook Susan Wagner
Published: June 2020

Background

Characteristics of both teachers and learners influence mathematical learning. For example, when teachers use hand gestures to support instruction, students learn more than others who learn the same concept with only speech, and students with higher working memory capacity (WMC) learn more rapidly than those with lower WMC. One hypothesis for the effect of gesture on math learning is that gestures provide a signal to learners that can reduce demand on working memory resources during learning. However, it is not known what sort of working memory resources support learning with gesture. Gestures are motoric; they co-occur with verbal language and they are perceived visually.

Methods

In two studies, we investigated the relationship between mathematical learning with or without gesture and individual variation in verbal, visuospatial, and kinesthetic WMC. Students observed a videotaped lesson in a novel mathematical system that either included instruction with both speech and gesture (Study 1) or instruction with only speech (Study 2). After instruction, students solved novel problems in the instructed system and transfer problems in a related system. Finally, students completed verbal, visuospatial, and kinesthetic working memory assessments.

Results

There was a positive relationship between visuospatial WMC and math learning when gesture was present, but no relationship between visuospatial WMC and math learning when gesture was absent. Rather, when gesture was absent, there was a relationship between verbal WMC and math learning.

Conclusion

Providing gesture during instruction appears to change the cognitive resources recruited when learning a novel math task.
Effect of prey density of meloidogyne incognita on the predation efficiency of the predator, fictor composticola (nematoda: diplogasteridae)
Authors: Sidhu Harjot Singh , Kanwar Rambir Singh
Published: June 2020

Predatory nematodes are important as they fed upon several prey nematode species. The diplogasterid predators are characterized by distinguished alterations in feeding apparatus. The diplogasterid predator, Fictor composticola, feeds on different categories of nematodes like microbivorous, mycophagous, and plant-parasitic nematodes. This study was undertaken under in-vitro conditions, in 1% water-agar plates, and in pots under screen house. In lab. study, 250, 500, 1000, 2000 freshly hatched juveniles of Meloidogyne incognita, and 2 females and 2 males of F. composticola were released in each plate. Observations on prey consumed were recorded after 24 and 48 hrs. of deliverance. Prey consumption of F. composticola boosted as the number of prey increased from 250 to 2000 per plate. At prey density of 500 per plate, maximum per cent consumption was observed and minimum at prey density 2000 per plate. Maximum predation found at a prey population density of 2000 individuals and minimum in 250 individuals per plate. This finding led to the conclusion of increased contacts between prey and predator at higher densities. In the pot experiment, plant height and shoot weight were reduced significantly over untreated control at 500 J2 and above. Root weight increased at 500 and 1000 levels, though it was similar to the control at 2000 level due to poor root development at this level. The number of galls and egg masses of M. incognita and final population of predator increased with increasing inoculum level of M. incognita.
Effect of intercropping on the parasitoids, Encarsia spp. and Trichogramma spp. in cotton fields, India
Authors: Devi Suman , Ram Pala , Rolania Krishna
Published: June 2020

Intercropping in cotton is of great significance, which helps to reduce the population of insect pests by attracting natural enemies to the field and helping to get stabilized yield and high profit advantage. The study was conducted with 4 intercrops, viz., sesame,Sesamum indicumL.; pigeonpea,Cajanus cajanL.; pearl millet,Pennisetum glaucumL.; and sorghum,Sorghum bicolorL. in an experimental area during 2016 and 2017 autumn season. The objective was to study the population of parasitoids influenced by the intercrops in cotton. This is a triangular relationship between the host, parasitoids, and environment. AsEncarsiaspp. (Hymenoptera: Aphelinidae) andTrichogrammaspp. (Hymenoptera: Trichogrammatidae) are the main parasitoids of insect pests of cotton, thus the study was undertaken on these parasitoids. The results revealed that the highest parasitization of whitefly,Bemisia tabaci(Gennadius) pupae byEncarsiaspp., was recorded in cotton-pigeonpea 1:1 (33.22%), which was at par with cotton-pigeonpea 2:1 (32.16%), whereas the second highest one was in cotton-sesame 1:1 (27.33%), while the lowest parasitization was recorded in the control (16.16%). On the activity ofTrichogrammaspp., the significant highest percent was recorded in cotton-sesame 1:1 (10.93%), while no activity was recorded in cotton-pigeonpea, cotton-sorghum, cotton-pearl millet, and control treatments.
Revisiting hydroxychloroquine and chloroquine for patients with chronic immunity-mediated inflammatory rheumatic diseases
Authors: dos Reis Neto Edgard Torres , Kakehasi Adriana Maria , de Medeiros Pinheiro Marcelo , Ferreira Gilda Aparecida , Marques Cláudia Diniz Lopes , da Mota Licia Maria Henrique , dos Santos Paiva Eduardo , Pileggi Gecilmara Cristina Salviato , Sato Emília Inoue , Reis Ana Paula Monteiro Gomides , Xavier Ricardo Machado , Provenza José Roberto
Published: June 2020

Hydroxychloroquine and chloroquine, also known as antimalarial drugs, are widely used in the treatment of rheumatic diseases and have recently become the focus of attention because of the ongoing COVID-19 pandemic. Rheumatologists have been using antimalarials to manage patients with chronic immune-mediated inflammatory rheumatic diseases for decades. It is an appropriate time to review their immunomodulatory and anti-inflammatory mechanisms impact on disease activity and survival of systemic lupus erythematosus patient, including antiplatelet effect, metabolic and lipid benefits. We also discuss possible adverse effects, adding a practical and comprehensive approach to monitoring rheumatic patients during treatment with these drugs.
The effect of patellar facet angle on patellofemoral alignment and arthritis progression in posterior-stabilized total knee arthroplasty without patellar resurfacing
Authors: Kim Chang-Wan , Lee Chang-Rack , Huh Tae-Yung
Published: June 2020

Background

The purpose of this study was to evaluate the effect of patellar facet angle on pre- and postoperative patellofemoral alignment and the progress of arthritis of the patellofemoral joint in posterior-stabilized total knee arthroplasty (PS TKA) without patellar resurfacing.

Methods

Patients who had a PS TKA for a varus osteoarthritic knee who were followed up for more than 2 years were included in this study. The radiologic and clinical outcomes were compared between 72 knees (group A) whose patellar facet angle was greater than 126° (> 126°) and 32 knees (group B) whose patellar facet angle was smaller than or equal to 126° (≤ 126°). For the radiologic assessment, the Kellgren-Lawrence grade, mechanical femorotibial angle, Insall-Salvati ratio, patellar tilt angle, patellar displacement and the osteosclerosis of the patellar ridge were evaluated. The range of motion (ROM) and patient-reported outcomes (the Knee Society knee score, the Knee Society function score, the Feller patellar score, and the Kujala patellofemoral score) were used for the clinical assessment.

Results

The preoperative patellar tilt angle was 9.8° (standard deviation [SD] 5.5) and 14.6° (SD 4.1) in group A and group B, respectively, a significant difference (p < 0.001). Other preoperative radiologic parameters and preoperative patient-reported outcomes and ROM showed no significant difference between the two groups (all parameters (p > 0.05). At the last-follow-up, 22 knees (30.6%) showed progression of osteosclerosis of the patellar ridge in group A and 13 knees (40.6%) showed progression of osteosclerosis in group B (p = 0.371). The postoperative radiologic and clinical outcomes showed no significant difference between the two groups (all parameters, p > 0.05).

Conclusions

Although a narrow patellar facet angle was related to an increase of lateral tilting of the patella, it showed no impact on the preoperative clinical assessment. The radiologic and clinical outcomes evaluated after the PS TKA showed no statistical difference according to the patellar shape. Although the patellar shape evaluated by the patellar facet angle can partially affect the preoperative patellofemoral alignment, this study result indicated insignificant clinical relevance of the patellar shape in the PS TKA.
Breast cancer imaging features as a predictor of the hormonal receptor status, HER2neu expression and molecular subtype
Authors: Algazzar Maged Abdelfattah Ali , Elsayed Elsayed El-Mekkawy , Alhanafy Alshimaa Mahmoud , Mousa Waleed Abdelfattah
Published: June 2020

Background

Determination of the hormonal receptor (HR) status, HER2neu expression, and the molecular subtype has valuable diagnostic, therapeutic, and prognostic implications for breast cancer as breast cancer stratification during the last two decades has become dependent upon the underlying biology. The aim of this study is to assess the correlation between imaging features of breast cancer and the HR status, HER2neu expression, and the molecular subtype. Sixty breast cancer patients underwent breast ultrasound, mammography, and MRI evaluation. Pathological evaluation using immunohistochemistry and FISH was used to detect the HR status, HER2/neu expression, and the molecular subtype. Those findings were then correlated with the radiologic data.

Results

HR-positive tumors were associated with posterior acoustic shadowing (34/44, 77.3%; p = 0.004). Hormonal-negative tumors presenting as masses were more likely circumscribed on US and MRI compared to hormonal positive mass tumors (6/14, 42.9% vs 3/36, 7.7%; p = 0.003 on US and 6/13, 46.3% vs 3/36, 8.3%; P = 0.007 on MRI) and had malignant DCE kinetics with washout curves compared to the hormonal positive group (10/16, 62.5% vs 4/44, 9.1%; P < 0.001). HER2neu-positive tumors were significantly associated with calcifications and multifocality on mammography compared to HER2neu-negative group (9/13, 69% vs 12/34, 25.5%; P = 0.007) and (7/13, 53% vs 3/47, 6%; P < 0.001). TNBC and HER2neu-enriched were associated with washout kinetic curve pattern (57.1% and 66.7%, respectively). TNBCs were associated with circumscribed margins on US and MRI (6/9, 66.7%; P < 0.001).

Conclusion

Microcalcifications, margins, posterior acoustic features, and malignant washout kinetics strongly correlate with the hormonal receptor status, HER2neu status, and molecular subtype of breast cancer. These findings may suggest the molecular subtype of breast cancer and further expand the role of imaging.
Closed versus conventional IV catheter in performing coronary CT Angiography
Authors: Harraz Mohamed M. , Abouissa Ahmed H. , Kamr Wael H.
Published: June 2020

Background

The purpose of this study was to compare the performance of a closed IV catheter system (CICS) with conventional IV catheters for IV contrast infusion in terms of contrast enhancement and associated complications during coronary CT angiography.

It is a retrospective study of 54 patients for whom a follow-up CCTA was requested were included for this study. Those patients had previous experience with the insertion of a 18 g conventional IV catheter which allows a flow rate of ≥ 6 ml/s and the complications during injection were registered. Patients were informed that a new IV catheter (The BD Nexiva™ Diffusics™ Closed IV Catheter System 22 g while still meeting a high flow rate > 6 m/s) will be used for their examination. We analyzed mean vascular attenuations in the ascending aorta, left main coronary artery, left ventricular (LV) cavity, and descending aorta (DA). Their feedback was collected regarding pain and the number of trials for catheter insertion. In addition, the access site was evaluated for any complication e.g. perforation, contrast extravasation or contamination.

Result

All patients were very satisfied with the new cannula. The catheter was inserted from the first trials. No one has perforation or extravasation. Mean vascular attenuations of the left main coronary artery, LV cavity, and DA were significantly higher during the use 0f the BD Nexiva™ Diffusics™ Closed IV Catheter System (all P ≤ 0.001).

Conclusion

Although the CICS has a small lumen, it allows a high flow rate; therefore, IV access required for CCTA can be secured with higher vascular attenuation and fewer complications. It is encouraged to use the CIVC system for CT angiographic studies, in particular CCTA.
Transperineal ultrasound of fetal head progression in prolonged labor: women’s acceptance and ability to predict the mode of delivery
Authors: Solaiman Sara A. , Atwa Khaled A. , Gad Azza A. , al-Shatouri Mohammad
Published: June 2020

Background

Digital transvaginal examination of fetal head progression is subjective evaluation with many limitations. Using ultrasound (US) in the assessment of labor progression in prolonged labor is the current trend to predict the mode of delivery. The study intends to evaluate the women’s acceptance to the transperineal ultrasound (TPUS) compared with digital transvaginal examination, and its ability to predict the mode of delivery in prolonged labor. We included 28 pregnant ladies in a prolonged active phase of first or second stages of labor and followed them till delivery. TPUS was used to measure the fetal head–perineum distance (FHPD) and the angle of fetal head descent.

Results

Of the 28 participants, 53.5% of them delivered vaginally and 46.5% by Cesarean section (CS). All pregnant ladies described the TPUS as more convenient and less painful than digital vaginal examination. Cervical dilatation was negatively correlated with FHPD, and positively correlated with angle of fetal head descent. Both FHPD and angle of fetal head descent had a strong significant negative correlation. Using a cutoff value of 115° for the angle of fetal head descent, the positive predictive value (PPV) of vaginal delivery was 87%; using a cutoff value of 4.2 cm for FHPD, the PPV for vaginal delivery was 85%.

Conclusion

TPUS is more convenient, more accepted, and less painful than digital vaginal examination. Angle of head descent and FHPD are reliable predictors of the mode of delivery in prolonged labor.
Predictors of subclinical shoulder joint affection in patients with rheumatoid arthritis by ultrasonography
Authors: Alian Samah M. , Elsiad Elsayed A. , Elsayed Alzahraa E. , Hammad Mohamed A.
Published: June 2020

Background

To assess subclinical involvement of shoulder joints in patients with rheumatoid arthritis (RA) by using musculoskeletal ultrasound (MSUS) and detect their predictors.

Results

We found 75% of the patients have subclinical ultrasound changes in their shoulder joints where 65% of the patient’s shoulders are affected. About 57.5% of the shoulder joints showed peri-articular structural changes by ultrasound, while the articular changes were 36.9% with the most frequent one being supraspinatus tendinopathy (43.12%) followed by subacromial-subdeltoid bursitis [total (31.87%), effusion (16.87%), and synovial hypertrophy (15%)], supraspinatus tendon partial tear (30.62%), and long head of biceps tenosynovitis (effusion only) (28.75%), while the least frequencies were glenohumeral joint erosion (11.25%) and synovitis (12.5%). Older age and longer disease duration were significant predictors for the peri-articular changes with p value < 0.5, while high disease activity, seropositive rheumatoid factor, and long disease duration were significant predictors for the articular changes with p value < 0.5.

Conclusion

Although shoulders were clinically silent in RA patients, we found a high percentage of subclinical abnormalities detected by MSUS, which were more predominant in the peri-articular structures. MSUS is a simple and non-invasive technique that can be used to detect RA shoulder subclinical affection.
Predictors of subclinical cardiovascular affection in Egyptian patients with juvenile idiopathic arthritis subtypes
Authors: Alian Samah M. , Esmail Hanan A. , Gabr Marwa M. , Elewa Enass A.
Published: June 2020

Background

To assess the subclinical cardiovascular affection in juvenile idiopathic arthritis (JIA) Egyptian patient subtypes using Doppler ultrasonography (US) for carotid and femoral arteries and detecting their predictors

Results

Forty percent of the patients were polyarticular type, while 40% were systemic onset and 20% were oligoarticular. There was a statistically significant difference between JIA and controls in all parameters of subclinical atherosclerosis by ultrasonography except right external carotid velocity and (right and left) femoral velocity. There was also a highly significant increase in intima-media thickness (IMT) in systemic onset type of JIA. There was a statistically positive correlation between increased internal carotid velocity (right and left) and high erythrocyte sedimentation rate (ESR), high-sensitivity C-reactive protein (hs-CRP), lipid profile, and disease activity. High disease activity and lipid profile were valid predictors of subclinical atherosclerotic cardiovascular affection in JIA.

Conclusion

Increased cardiovascular risks and subclinical atherosclerosis in patients with JIA especially systemic onset type may be due to higher prevalence of multiple risk factors in these patients. Doppler ultrasonography is a simple, non-invasive technique which can be used to detect subclinical atherosclerosis in JIA. Control of disease activity by treat to target strategy and proper diet control should be applied for every patient with JIA especially those with systemic onset type for future prevention of cardiovascular disease.
Interface between community intellectual disability and general adult psychiatry services
Authors: Hawramy Muzafar
Published: June 2020

People with intellectual disability can have a range of common mental health difficulties that sit at the interface of two psychiatry subspecialties: intellectual disability and general adult psychiatry. Clinical presentations, comorbidities and complexities can affect the setting of boundaries between the two disciplines. This article touches on current concepts, drives for inclusion of people with intellectual disability in mainstream psychiatry services and some of the difficulties at the interface. It focuses on potential solutions for managing this interface between the two subspecialties.
Encouraging recruitment into psychiatry: practical initiatives
Authors: Halder Neel , Mulliez Zoé
Published: June 2020

This article highlights key findings from a recent Royal College of Psychiatrists project showing that many UK medical schools are embracing the dual challenge of raising students’ interest in psychiatry and ensuring that all doctors can support patients with mental illness. It focuses on two novel approaches to boosting recruitment into psychiatry: I'm a Medic Get Me Out of Here, an online outreach activity enabling schoolchildren to ask questions of health professionals in real time; and a living library, which creates a safe space for dialogue where topics are discussed openly between human books (professionals) and readers (undergraduate students) to challenge stereotypes. It is recommended that sharing these and other examples of good practice will help all medical schools encourage recruitment in psychiatry more widely.
Salvage Therapy With Multikinase Inhibitors and Immunotherapy in Advanced Adrenal Cortical Carcinoma
Authors: Miller Kevin C , Chintakuntlawar Ashish V , Hilger Crystal , Bancos Irina , Morris John C , Ryder Mabel , Smith Carin Y , Jenkins Sarah M , Bible Keith C
Published: June 2020

Background

Median overall survival is 12 to 15 months in patients with metastatic adrenal cortical carcinoma (ACC). Etoposide, doxorubicin, and cisplatin with or without the adrenolytic agent mitotane is considered the best first-line approach in this context, but has limited activity and no curative potential; additional salvage therapeutic options are needed.

Methods

Fifteen total patients with recurrent/metastatic ACC were treated with single-agent multikinase inhibitors (MKI) (n = 8), single-agent PD-1 inhibition (n = 8), or cytotoxic chemotherapy plus PD-1 inhibition (n = 4) at our institution as later-line systemic therapies in efforts to palliate disease and attempt to achieve a therapeutic response when not otherwise possible using standard approaches.

Results

Two of 8 patients (25%) treated with single-agent MKI achieved a partial response (PR), including 1 PR lasting 23.5 months. Another 3 patients (38%) had stable disease (SD); median progression-free survival (PFS) with single-agent MKI was 6.4 months (95% confidence interval [CI] 0.8—not reached). On the other hand, 2 of 12 patients (17%) treated with PD-1 inhibitors (either alone or in combination with cytotoxic chemotherapy) attained SD or better, with 1 patient (8%) achieving a PR; median PFS was 1.4 months (95% CI 0.6-2.7).

Conclusions

Our single-institution experience suggests that select ACC patients respond to late-line MKI or checkpoint inhibition despite resistance to cytotoxic agents. These treatments may be attractive to ACC patients with limited other therapeutic options. The use of MKI and immunotherapy in ACC warrants prospective investigation emphasizing parallel correlative studies to identify biomarkers that predict for response.
(Un)Complicating Mwanga’s Sexuality in Nakisanze Segawa’s The Triangle
Authors: Nabutanyi Edgar Fred
Published: June 2020

The late nineteenth-century Bugandan king Kabaka Mwanga is perhaps one of the most controversial Ugandan historical personalities because of the perceptions that have shaped and continue to shape how his sexuality is understood. The Kabaka’s sexuality, which has been placed at the center of contemporary sexuality debates in the country, is colored by complexly paradoxical spatial and chronological registers. These registers that stretch from the colonial to postcolonial moments in public discourses in the country variously mobilize Mwanga’s sexuality for propaganda purposes. While the colonial archive mobilizes Mwanga to argue that colonialism and Christianity rescued Ugandans from homosexuality, two versions of the postcolonial library simultaneously lionize and demonize this historical figure for differing ideological purposes. While the earlier postcolonial library briefly constructed Mwanga as a patriot who resisted colonialism, the most recent postcolonial record characterized by an alliance between the Ugandan state and Pentecostal Christianity demonizes Mwanga to justify their project of criminalizing same-sexualities. Writing in the throes of these topically polarizing Ugandan sexuality debates of the last decade, Ugandan novelist Nakisanze Segawa strategically inserts Mwanga’s nonnormative sexuality in the first section of her debut historical/political thriller novel to provide a counter characterization of a historical figure whose sexuality has been used as a metaphor in Ugandan public discourses on sexuality. Nabutanyi argues that Segawa’s representation of Mwanga, which counteracts his politicized portrayal, shows how same-sex loving men are ordinary and flawed.
Through The Lens of Modernity
Authors: Mbasalaki Phoebe Kisubi
Published: June 2020

This article is a contribution to the conversation on what lies at the crux of the contradiction of South Africa’s progressive constitution and legal framework with reference to sexuality and limited access of the rights these convey for a vast number of people in same-sex relationships. This article locates what lies at the heart of this contradiction as rooted in the (colonial) cultural archive of gender and sexuality that has historically privileged heterosexuality. We continue to see this through neoliberal universalist rights approaches, in which the nongovernmental organizational narrative is deeply imbricated. Organizations like Dutch international human rights funder Hivos that have funded the championing of sexual rights often fail to fully engage with and interrogate this (colonial) cultural archive. This is the customary in its hegemonic form. By deploying an intersectional decolonial approach, this article sheds light on the locus of colonial difference and offers three nuanced infrapolitical narratives of African same-sex intimacies operating at this locus—queering the customary—and this way reimagining African sexuality, thereby offering an epistemic reconstitution.
belated: interruption
Authors: Macharia Keguro
Published: June 2020

The article “belated : interruption” stages an encounter between queer and Africa.
Impact of dosimetric differences between CT and MRI derived target volumes for external beam cervical cancer radiotherapy
Authors: Batumalai Vikneswary , Burke Siobhan , Roach Dale , Lim Karen , Dinsdale Glen , Jameson Michael , Ochoa Cesar , Veera Jacqueline , Holloway Lois , Vinod Shalini
Published: June 2020

Objectives:

The use of MRI is becoming more prevalent in cervical cancer external beam radiotherapy (RT). The aim of this study was to investigate the impact of dosimetric differences between CT and MRI-derived target volumes for cervical cancer external beam RT.

Methods:

An automated planning technique for volumetric modulated arc therapy was developed. Two automated planning plans were generated for 18 cervical cancer patients where planning target volumes (PTVs) were generated based on CT or MRI data alone. Dose metrics for planning target volumes and organs at risk (OARs) were compared to analyse any differences based on imaging modality.

Results:

All treatment plans were clinically acceptable. Bladder doses (V40) were lower in MRI-based plans (p = 0.04, 53.6 ± 17.2 % vs 60.3 ± 13.1 % for MRI vs CT, respectively). The maximum dose for left iliac crest showed lower doses in CT-based plans (p = 0.02, 47.8 ± 0.7 Gy vs 47.4 ± 0.4 Gy MRI vs CT, respectively). No significant differences were seen for other OARs.

Conclusions:

The dosimetric differences of CT- and MRI-based contouring variability for this study was small. CT remains the standard imaging modality for volume delineation for these patients.

Advances in knowledge:

This is the first study to evaluate the dosimetric implications of imaging modality on target and OAR doses in cervical cancer external beam RT.