bluuebunny/crossref_metadata_2025 huggingface dataset:
Impact of self-decision to stop cancer treatment on advanced genitourinary cancer patients
Authors: Kobayashi Hisato , Tsuchiyama Katsuki , Taga Minekatsu , Tokunaga Takahiro , Ito Hideaki , Yokoyama Osamu
Published: April 2021

Decision-making to stop cancer treatment in patients with advanced cancer is stressful, and it significantly influences subsequent end-of-life palliative treatment. However, little is known about the extent to which the patient's self-decisions influenced the prognostic period. This study focused on the patient's self-decision and investigated the impact of the self-decision to stop cancer treatment on their post-cancer treatment survival period and place of death.

We retrospectively analyzed 167 cases of advanced genitourinary cancer patients (kidney cancer: 42; bladder cancer: 68; prostate cancer: 57) treated at the University of Fukui Hospital (UFH), who later died because of cancer. Of these, 100 patients decided to stop cancer treatment by themselves (self-decision group), while the families of the remaining 67 patients (family's decision group) decided to stop treatment on their behalf because the patient's decision-making ability was already impaired. Differences in the post-cancer-treatment survival period and place of death between the 2 groups were examined. The association between place of death and survival period was also analyzed.

The median survival period after terminating cancer treatment was approximately 6 times longer in the self-decision group (145.5 days in self-decision group vs 23.0 days in family's decision group, P < .001). Proportions for places of death were as follows: among the self-decision group, 42.0% of patients died at UFH, 45.0% at other medical institutions, and 13.0% at home; among the family's decision group, 62.7% died at UFH, 32.8% at other medical institutions, and 4.5% at home. The proportion of patients who died at UFH was significantly higher among the family's decision group (P = .011). The median survival period was significantly shorter for patients who died at UFH (UFH: 30.0 days; other institutions/home: 161.0 days; P < .001).

Significantly longer post-cancer-treatment survival period and higher home death rate were observed among patients whose cancer treatment was terminated based on their self-decision. Our results provide clinical evidence, especially in terms of prognostic period and place of death that support the importance of discussing bad news, such as stopping cancer treatment with patients.
The efficacy and safety of gemcitabine-based induction chemotherapy for locally advanced nasopharyngeal carcinoma treated with concurrent chemoradiation
Authors: Fei Qian , Chen Han-Bo , Zhang Chun-Mei , Xu Jia-Jun , He Xia , Chen Song-Wang
Published: April 2021

Objectives:

To assess the efficacy and toxicity of gemcitabine-based induction chemotherapy followed by concurrent chemoradiotherapy (CCRT) in locally advanced nasopharyngeal carcinoma (LA-NPC).

Methods:

Both observational studies (OBS) and randomized controlled trials (RCT) were included in the meta-analysis. Systematic online searches were conducted in Web of Sciences, PubMed, Embase, meeting proceedings and ClinicalTrials.gov from the inception to May 25, 2020. The primary endpoint of interest was overall survival.

Results:

five OBSs and 2 RCTs including 1680 patients were incorporated in the analysis. The evidence from the RCTs showed that adding gemcitabine-based induction chemotherapy to CCRT significantly improved progression free survival (hazard ratio (HR): 0.60, 95% confidence interval (CI): 0.40–0.88; P = .010; chi square P = .25; I
2 = 24%) and overall survival (HR: 0.47; 95% CI: 0.28–0.80; P = 0.005; chi square P = .49, I
2 = 0%) and was related to a higher risk of hematological toxicities. Furthermore, based on the data of OBSs, overall survival (HR: 0.52; 95% CI: 0.31–0.88; P = .02; chi square P = .37, I
2 = 6%) was significantly improved in patients treated with gemcitabine-based induction chemotherapy compared to those treated with taxane-based induction chemotherapy. However, the progression free survival (HR: 0.67; 95% CI: 0.45–1.01; P = .06; chi square P = .74; I
2 = 0%) showed no significant difference.

Conclusions:

For LA-NPC patients, adding gemcitabine-based induction chemotherapy to CCRT significantly improved overall survival and progression free survival with a higher risk of hematological toxicities when compared to CCRT alone. Also, gemcitabine-based regimen could be used as an alternative induction chemotherapy regimen to taxane-based regimen in the treatment of LA-NPC.
A novel 125I seeds fixed on gastric tube for treatment of inoperable esophageal carcinoma
Authors: Jin Jing , Yu Yang , Jia Weikun , Li Wei
Published: April 2021

To explore the treatment benefit of 125I seeds fixed on a gastric tube in the early inoperable esophageal carcinoma (EC).

Three senile patients with early inoperable EC who were treated with brachytherapy between October 2017 and February 2019 were included in this study. 125I seeds were fixed on the gastric tube, which was then inserted on the surface of the EC. One patient suffered from severe pulmonary insufficiency; 1 patient underwent colon cancer surgery one week before treatment and suffered from liver dysfunction and esophageal varices; 1 patient suffered from venous embolism of lower extremities and pulmonary artery embolism.

All three patients were successfully operated and completed treatment. During the operation, no displacement and shedding of 125I seed gastric tube occurred. After surgery, the discomfort while swallowing and pain after eating were significantly improved. Moreover, dysphagia was relieved in patient 3. In addition, no complications, such as perforation or bleeding, occurred. Local lesions were effectively controlled.

Gastric tube with 125I seeds provides a new treatment protocol for inoperable EC and malignant obstruction of esophageal carcinoma.
Comparison of single and double dorsal wires in the extension block technique for mallet fractures
Authors: Polat Oktay , Bombaci Hasan , Kibar Birkan , Toy Serdar
Published: April 2021

Mallet fractures are avulsion fractures of the extensor tendon from the distal phalanx base and often occur due to sudden flexion or axial loading. In this study, we aimed to compare the clinical and radiological results of patients treated with single and double dorsal wires from the dorsal in the extension block method.

Patients to whom a single wire from dorsal was applied were assigned to Group 1 (n: 22), and those to whom double wires were applied were assigned to Group 2 (n: 23). Surgical treatment was decided for patients with more than 1/3 of the fracture fragment containing the joint surface and volar subluxation. The range of motion of the distal interphalangeal (DIP) joint was measured with a goniometer. The displacement of the fragment was measured before and after surgery on lateral radiographs. The presence of bridging callus formation on anterior-posterior and lateral radiographs was evaluated for a union.

There were 30 male (66.7%) and 15 (33.3%) female patients. The mean age of the patients was 32 years. Radiographic union was obtained in all patients. Pseudoarthrosis was not observed in any patient. The Crawford score was excellent in 13 (28.9%) cases, the score was good in 18 (40%) cases, the scores were moderate in 13 (28.9%) cases, and the score was poor in 1 case (2.2%). There were no complications in 35 (77.8%) cases, dorsal bump complications occurred in 9 cases (20%), and osteoarthritis and dorsal bump complications occurred in 1 (2.2%) case. We did not observe nail deformity, skin necrosis, infection, or fingertip sensitivity. We found similar functional and clinical results between the groups.

We recommend using single dorsal wire, as using double dorsal wires requires extra operation time, effort, and fluoroscopy.
Study on the effect of education for insulin injection in diabetic patients with new simulation tools
Authors: Liang Kaiyong , Xie Qiao , Nie Jieping , Deng Jieqing
Published: April 2021

Background:

Insulin is an essential therapy for treating diabetes, but many patients lack standard insulin injection skills.

Purpose:

We developed a standard training procedure based on a new simulation tool. Then we conducted a study to investigate the effect of this standard training on the ability of diabetic patients to inject themselves with insulin.

Methods:

After follow-up, a total of 120 patients with diabetes mellitus were included. These patients needed insulin therapy depending on their condition and had not previously learned insulin injection. We randomly divided them into the intervention group (60 cases) and the control group (60 cases). The control group was trained on insulin injection before being discharged according to the traditional method, and the intervention group was trained based on an improved simulation tool. All participants were trained as individuals or groups. Finally, we evaluated the learning effects of both groups.

Results:

The time spent at the training stage in the intervention group was shorter than the control group. We found that after applying simulation devices to mimic operations, the learning time for patients was reduced.

The first subcutaneous injection success rate was 73.33% in the intervention group, which was significantly higher than that in the control group by 46.67%. The score of the first subcutaneous injection and pre-discharge score in the test group was significantly higher than that of the control group. One month later, the score for injection skills in the 2 groups was higher than that before discharge, and the score in the trial group was still higher than that in the control group. The incidence of subcutaneous fat hyperplasia in the trial group was lower than that in the control group (3.3% vs 15%, P < .05). Moreover, the incidence of hypoglycemia (16.7% vs. 26.7%) was higher in the control group, but the difference was not statistically significant (P = .184).

Conclusions/implications for practice:

After applying simulation tools plus operating video and guideline as the standard procedure to train diabetic patients on insulin injection, all patients had a good grasp of using the insulin injection technique. This education method is safe, efficient, and worth promoting worldly.
Value of preoperative staging of endometrial carcinoma with contrast-enhanced ultrasonography
Authors: Tong Xiaozhen , Wu Xiaofen , Zhang Qiaohong
Published: April 2021

Introduction:

Endometrial carcinoma (EC) is the most common gynecologic carcinoma in developed countries and accounts for nearly 5% of carcinoma cases and more than 2% of deaths due to female carcinomas worldwide. Because of this reported risk, it is very important to diagnose and stage it accurately. Therefore, we investigated the staging accuracy of EC with contrast-enhanced ultrasonography (CEUS). Due to a lack of studies on the use of CEUS in staging EC, we performed a systematic review and meta-analysis.

Method:

We searched PubMed, EMBASE, Cochrane Library, Scopus, Web of science, China National Knowledge Infrastructure (CNKI), and CBM for studies on CEUS in EC diagnosis. Our search keywords were “ultrasonic angiography,” “endometrial neoplasms,” and their synonyms. The studies were screened according to the inclusion and exclusion criteria, and 4 tabular data were extracted. Quality evaluation was performed with the Quality Assessment of Diagnostic Accuracy Studies (QUADAS) scale. Statistical analysis was done with Stata version 15.1. A random effect model was selected to calculate the pooled sensitivity and specificity. The summary receiver operating characteristic (SROC) curve was obtained, and the area under the curve was calculated.

Result:

Fifteen studies with 685 patients were included in this quantitative synthesis. The pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio (OR) of CEUS in the diagnosis of EC was 0.81 (95% confidence interval, .76–.85), .90 (.87–.92), 8 (5.8–11.1), .21 (.16–.28), and 38 (22–67), respectively. The area under the curve was 0.93 (.90–.95).

Conclusion:

CEUS has a high sensitivity and specificity in the diagnosis of EC. It can be considered as an effective and feasible method for EC staging.
Qianzheng powder for the treatment of primary Hemifacial spasm
Authors: Chen Baoshan , A Rigun , Yue Ruizhen , Zhang Guangrong
Published: April 2021

Background:

Hemifacial spasm (HFS) is a clinical common neurological disease, its main performance for 1 side or 2 sides muscles (the orbicularis oculi muscle, expression, orbicularisoris muscles) recurrent paroxysmal, involuntary twitching, aggravating when excited or nervous, more severe cases of the disease may include difficulty in opening the eyes, crooked corners of the mouth, and twitching noises in the ears, etc.
[1]
Early manifestations of the disease are intermittent mild convulsions of the orbicularis oculi muscle, and then gradually spread to 1 side of the facial muscles, such as frowning muscles, nasal muscles, buccinalis muscles, etc, especially the most obvious spasms of the oral muscles, which can involve the ipsilateral platysma muscle in severe cases, with each twitch for a few seconds to a few minutes. The disease will affect the quality of life such as speaking, eating, seeing and so on, and even cause psychological effects such as inferiority, anxiety and depression. At present, the incidence of the disease in China is 11 per 1.1 million, females are more common than males. There are many ways to treat HFS, but the Qianzheng powder has a unique advantage in treating this disease. Therefore, our systematic review aims to evaluate the efficacy and safety of Qianzheng powder in the treatment of Primary Hemifacial spasm, and to provide a reliable basis for clinical decision makers.

Methods:

From its inception until April 2021, we will search electronic databases, including PubMed, Embase, Cochrane Library, China Biomedical Literature Database, China Knowledge Infrastructure, Wanfang Database, and China Scientific Journals Database. The authors will independently sift through studies, extract data information, and assess methodological quality using the Cochrane Risk of Bias tool. The RevManV. 5.3 software will be used for statistical analysis.

Results:

The results of this study, which will be published in a peerreviewed journal, will evaluate the efficacy and safety of Qianzheng powder in the treatment of primary Hemifacial spasm.

Conclusion:

This systematic review will provide reliable evidence-based basis for treating primary Hemifacial spasm with Qianzheng powder.

INPLASY Registration number:

INPLASY202130037.
Femoral nerve block versus fascia iliaca block for pain control in knee and hip arthroplasties
Authors: Fan Xiaohua , Cao Fei , Luo Ailin
Published: April 2021

Background:

This meta-analysis aimed to compare the efficiency of fascia iliaca compartment block (FICB) and femoral nerve block (FNB) for pain management in knee and hip surgeries.

Methods:

We searched four electronic databases (Pubmed, Embase, Cochrane library database, Web of Science) from inception to January 2019. Only randomized controlled trials (RCTs) were included. Two review authors independently extracted data for each included study. Primary outcomes were visual analogue scale at 12 hours, 24 hours, 48 hours, total morphine consumption, the length of hospital stay and the occurrence of nausea and vomiting. Standardized mean difference (SMD) or risk ratio (RR) and 95% confidence intervals (CIs) were calculated for continuous outcomes and discontinuous outcomes respectively. We used the Cochrane Risk of Bias tool to assess risk of bias. Stata 12.0 was used for meta-analysis.

Results:

Finally, 7 RCTs involving 508 patients (FICB = 254, FNB = 254) were included in this meta-analysis. Compared with FNB group, FICB has no benefit for visual analogue scale at 12 hours (SMD = 0.02, 95% CI, −0.15 to 0.19; P = .820), 24 hours (SMD = −0.02, 95% CI, −0.22 to 0.18; P = .806), and 48 hours (SMD = −0.02, 95% CI, −0.22 to 0.19; P = .872). No significant differences were found regarding total morphine consumption (SMD = −0.07, 95% CI, −0.29 to 0.15; P = .533). What's more, there was no significant difference between the length of hospital stay and the occurrence of nausea and vomiting (P > .05).

Conclusion:

FICB has equivalent pain control and morphine-sparing efficacy when compared with FNB. More high-quality RCTs are needed to identify the optimal drugs and volume of local infiltration protocols.
Chronic endogenous fungal endophthalmitis: diagnostic and treatment challenges
Authors: Abu Talib Dian Nadia , Yong Meng Hsien , Nasaruddin Rona Asnida , Che-Hamzah Jemaima , Bastion Mae-Lynn Catherine
Published: April 2021

Rationale:

Endogenous fungal endophthalmitis (EFE) is a sight-threatening complication of systemic fungemia. As the prevalence rises, treatment remains a challenge especially when there is a failure in first-line treatment or drug-resistant fungus. This case report studies a case of chronic EFE, focusing on the diagnostic procedures, treatment options, monitoring parameters and the treatment outcome

Patient concerns:

A 64-year-old man with underlying well controlled diabetes mellitus was treated with 2 weeks’ course of intravenous antifungal fluconazole for pyelonephritis as his blood culture grew Candida albicans. Concurrently, he complained of 3 months of bilateral painless progressive blurring of vision. At presentation, his visual acuity (VA) was light perception both eyes. Ocular examination revealed non granulomatous inflammation with dense vitritis of both eyes.

Diagnosis:

He was diagnosed with EFE but the condition responded poorly with the medications.

Interventions:

He was treated with intravitreal (IVT) amphotericin B and fluconazole was continued. Vitrectomy was performed and intraoperative findings included bilateral fungal balls in the vitreous and retina with foveal traction in the left eye. Postoperatively, vision acuity was 6/24, N8 right eye and 2/60, N unable for left eye with extensive left macular scar and hole. Vitreous cultures were negative. He received multiple IVT amphotericin B and was started on topical steroid eye drops for persistent panuveitis with systemic fluconazole. Ocular improvement was seen after switching to IVT and topical voriconazole. Despite this, his ocular condition deteriorated and he developed neovascular glaucoma requiring 3 topical antiglaucoma agents. Panretinal photocoagulation was subsequently performed.

Outcomes:

At 3 months’ follow-up, his vision acuity remained at 6/24 for right eye and 2/60 for the left eye. There was no recurrence of inflammation or infection in both eyes.

Lessons:

Voriconazole could serve as a promising broad spectrum tri-azole agent in cases of failure in first-line treatment or drug-resistant fungus.
COVID-19 infection manifesting as a severe gastroparesis flare
Authors: Song Jun , Bhuta Rajiv , Baig Kamal , Parkman Henry P. , Malik Zubair
Published: April 2021

Rationale:

Coronavirus disease 2019 (COVID-19) is a disease caused by infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which commonly presents with symptoms including fever, cough, and dyspnea. More recently, however, some patients have tested positive for COVID-19 after developing gastrointestinal (GI) symptoms either solely or in conjunction with respiratory symptoms. This may be due to SARS-CoV-2 infection of the GI tract. In patients with chronic GI illnesses, COVID-19 may initially present as a flare of their underlying GI conditions as viruses have historically been implicated in exacerbations of GI disorders, including gastroparesis.

Patient concerns:

We report a case of a 37-year-old female with a history of diabetic gastroparesis who presented to the Emergency Department (ED) with nausea and vomiting similar to her gastroparesis flares.

Diagnoses:

Her symptoms in the ED failed to improve with fluids and anti-emetic medications. After developing a fever, she was tested and found to be positive for COVID-19.

Interventions:

She was started on antibiotic, steroid, and antiviral medications.

Outcomes:

Her symptoms improved, her fever defervesced on day 4 of hospitalization, and she was discharged on day 5 of hospitalization. The patient reported symptom improvement at a follow-up outpatient gastroenterology visit 2 months after hospitalization.

Lessons:

To the best of our knowledge, at the present time, this is the first report of a patient with COVID-19 presenting with signs and symptoms of a gastroparesis flare. This case illustrates that COVID-19 may present in an exacerbation of symptoms of an underlying disorder, such as a severe gastroparesis flare, in a patient with underlying gastroparesis. Initial presentation of these patients manifesting as a flare of their chronic GI disease, more severe than usual, should prompt an index of suspicion for COVID-19.
The complete spectrum of pentalogy of Cantrell in one of a set of dizygotic twins
Authors: Zvizdic Zlatan , Sefic-Pasic Irmina , Mesic Amira , Terzic Sabina , Vranic Semir
Published: April 2021

Rationale:

Pentalogy of Cantrell (POC) is an extremely rare syndrome with an estimated incidence of 1:65,000 to 200,000 live births. Its complete form includes a midline epigastric abdominal wall defect, defects affecting the lower sternum, anterior diaphragm, diaphragmatic pericardium, and various intracardiac defects.

Patient concerns:

We report a case of complete POC affecting only the first-born of a set of premature dizygotic twins.

Diagnosis:

A giant omphalocele with an eviscerated liver and bowel on prenatal, obstetric ultrasonography at 24 gestational weeks was observed. At birth, physical examination confirmed a massive (10 × 8 cm) epigastric omphalocele in which a significant part of the liver was seen. A postnatal echocardiogram revealed the presence of an ostium secundum atrial septal defect, perimembranous ventricular septal defect, and moderate pulmonary stenosis. X-ray showed an abnormal intrathoracic positioned stomach, which was confirmed with a plain x-ray of the upper intestinal tract with hydrosoluble contrast. Computed tomography (CT) scan revealed the sternum's absence and a close connection between the pericardial sac and the stomach wall.

Interventions:

The patient underwent surgical intervention at 18 days of age.

Outcomes:

Despite adequate and appropriate postoperative treatment, the baby rapidly deteriorated and died 72 hours after surgery.

Lessons:

POC is a complex, high-mortality syndrome whose management requires a multidisciplinary approach and meticulous planning. Despite all efforts, POC carries a poor prognosis, particularly in patients affected by its complete form.
Clinical evaluation of high intensity interval training exercise in coronary heart disease patients after percutaneous coronary intervention
Authors: Cheng Xiaohui , Huang Jian , Zhu Jing , Li Hui , Gu Haibo
Published: April 2021

Background:

Although the effect of high intensity interval training (HIIT) was gradually explicit, little is explored about the role and the validity of HIIT on patients following percutaneous coronary intervention (PCI). As far as we know, no evidence has been established to assess HIIT program for coronary heart disease (CHD) patients attending cardiac rehabilitation after PCI. Therefore, this systematic review and meta-analysis will be conducted to assess the efficacy and safety of HIIT program for CHD patients attending cardiac rehabilitation after PCI.

Methods:

Seven electronic databases including Web of Science, Embase, PubMed, Wanfang Data, Scopus, Science Direct, Cochrane Library will be searched in March 2021 by 2 independent reviewers. Study included in this systematic review and meta-analysis has to meet all of the following inclusion criteria in the PICOS order:

Data extraction will be performed independently, and any conflict will be resolved before final analysis. Review Manager software (v 5.3; Cochrane Collaboration) is used for the meta-analysis.

Results:

The results of this research will be delivered in a peer-reviewed journal.

Conclusion:

This study expects to provide credible and scientific clinical evidence for the efficacy and safety of HIIT program for CHD patients attending cardiac rehabilitation after PCI.

OSF registration number:

10.17605/OSF.IO/AUMR6.
Effect of smartphone app on post-traumatic stress disorder in COVID-19 convalescent patients
Authors: Wang Yunyan , Yang Xia , Chen Haiyan , Xu Yanfang
Published: April 2021

Background:

The outbreak of Coronavirus Disease 2019 (COVID-19) seriously affects humans’ health worldwide physically and mentally. Studies revealed that the prevalence of post-traumatic stress disorder (PTSD) increased under this condition. PTSD can change the structure of patients’ central nervous system, and increase the risk of anxiety or depression, thus greatly affecting the quality of patients’ life and their families. PTSD is preventable, and the effects of early prevention are better. Non-drug intervention can prevent or reduce the psychological sequelae after hospitalization, help patients understand the experience during hospitalization, and be beneficial to their psychological rehabilitation. Whether smartphone app based intervention can be an alternative therapy for PTSD in terms of COVID-19 convalescent patients is still controversial. Therefore, we conducted a meta-analysis and systematic review to evaluate the effects of smartphone app based intervention on PTSD in COVID-19 convalescent patients, so as to provide some guidance for clinical application.

Methods:

The literatures that are related to the smartphone app based intervention and PTSD in COVID-19 convalescent patients from inception to February 2021 will be searched. The following databases are our focused areas: ClinicalTrials.gov, Cochrane Central Register of Controlled Trials repositories, PubMed, EmBase, and Web of Science databases. According to the inclusion and exclusion criteria, 2 investigators would independently screen the literature extract data and evaluate the risk of bias in the included studies. Meta-analysis was performed with RevMan5.3 software.

Results:

The results of this meta-analysis will be submitted to a peer-reviewed journal for publication.

Conclusion:

The conclusion of our study could provide evidence for the judgment of whether smartphone app based intervention is an effective intervention on PTSD in COVID-19 convalescent patients.

PROSPERO registration number:

CRD42021240340.
Impact of a Resiliency Training to Support the Mental Well-being of Front-line Workers
Authors: Grabbe Linda , Higgins Melinda K. , Baird Marianne , Pfeiffer Katherine M.
Published: April 2021

Background:

Front-line workers (FLW) are at risk for secondary traumatic stress, burnout, and related psychiatric sequelae: depression, anxiety, suicidality, posttraumatic stress disorder, and sleep and substance use disorders. FLW are in need of self-care programs to support their mental health.

Methods:

Quasi-experimental study to assess the impact of a simple mental well-being and emotional regulation training, the Community Resiliency Model (CRM), using a convenience sample of FLW. Baseline scores of mental well-being and stress measures were compared with follow-up scores at 3 time points. Outcomes were psychological wellness (World Health Organization-5 Well-being Index); resilience (Connor-Davidson Resilience Scale-10); traumatic stress (Secondary Traumatic Stress Scale); physical symptoms (Somatic Symptom Scale-8).

Results:

Of the 104 participants who enrolled and attended the CRM training, 73 (70.2%) completed at least 1 posttest. Well-being scores increased at 1 year with a small-moderate effect size (Cohen d=0.32). Resilience scores increased with a small-moderate effect size by 1 year (Cohen d=0.36). Secondary traumatic stress scores declined, with the largest effect at 1 week (Cohen d=0.49). Somatic symptoms decreased at each posttest, with the largest change occurring from baseline to 1 week (d=0.39). Participants reported an awareness of body sensations helped them when overwhelmed as a means of calming themselves.

Conclusions:

After a 3-hour CRM training, participants reported improved mental well-being and decreased secondary traumatic stress and somatic symptoms. This simple body awareness intervention may be a good resource during the COVID-19 pandemic.
Health Care Use and Out-of-pocket Spending by Persons With Dementia Differ Between Europe and the United States
Authors: Lenzen Sabrina , Bakx Pieter , Bom Judith , van Doorslaer Eddy
Published: April 2021

Background:

Persons with dementia need much care, but what care is used and how the burden of financing is divided between persons with dementia, caregivers, and public programs may differ between countries.

Objective:

The objective of this study was to compare how health care use and out-of-pocket (OOP) spending associated with dementia differ between the United States and Europe, with and without controlling for background characteristics.

Research Design:

We use prospectively collected survey data from the United States-based Health and Retirement Study (n=48,877) and the Survey of Health, Ageing, and Retirement in Europe (n=98,971) including all adults over the age of 70 years. Dementia status is imputed using a validated algorithm. After first reporting the observed differences in care use, we analyze how care use is associated with dementia using multivariate regressions, controlling for other health conditions and background characteristics.

Results:

Persons with dementia in the United States use 50% less formal home care per year than persons living with dementia in Europe [mean (SD)=236.8 h (1047.4) vs. 463.3 h (1371.2)], but use more nursing home care [75.1 d (131.4) vs. 45.5 d (119.4)). Dementia is associated with higher OOP spending in the United States than Europe [4406 USD (95% confidence interval, 3914–4899) vs. 246 USD (73–418)—2017 price levels].

Conclusions:

Health care use and OOP spending differ between Europe and the United States. The far greater reliance on nursing home care in the United States likely causes much higher expenditures for people with dementia and insurance programs alike.
Pterygoid Base Pneumatization Simulating Residual Disease—A Pitfall of Structural Imaging in Juvenile Nasal Angiofibroma
Authors: Sakthivel Pirabu , Thakar Alok , Verma Hitesh , Bhalla Ashu Seith , Arunraj Sreedharan Thankarajan , Kumar Rakesh
Published: April 2021

As prostate-specific membrane antigen (PSMA) expression is universal in juvenile nasopharyngeal angiofibroma, it is commonly used for specifically differentiating recurrences from surgical site reparative tissues. Postoperative contrast-enhanced MRI revealed a residual disease in the left pterygoid base, but there was no PET/CT uptake with 68Ga-labeled PSMA at the same site. In retrospect, in comparison with preoperative PET/CT, it was found that the pterygoid base pneumatization was showing enhancement in contrast-enhanced MRI and not in functional PSMA. Postoperative 68Ga-PSMA PET/CT is a useful clinical tool in ambivalent diagnostic conditions avoiding morbidities.
Increased 68Ga-FAPI-04 Uptake in Schmorl Node in a Patient With Gastric Cancer
Authors: Lin Rong , Lin Zefang , Zhang Jiaying , Yao Shaobo , Miao Weibing
Published: April 2021

A 78-year-old man with a newly diagnosed gastric adenocarcinoma underwent 18F-FDG and 68Ga-FAPI-04 PET/CT before treatment. Both 18F-FDG and 68Ga-FAPI-04 PET/CT demonstrated intense radioactivity in the gastric cancer. However, the benign Schmorl node in the inferior endplate of the T5 vertebrae showed increased uptake of 68Ga-FAPI-04, which was not FDG avid. Two months after radical gastrectomy of the gastric cancer (pT1aN0M0, IA), a follow-up CT showed that the Schmorl node in T5 vertebrae remained unchanged.
Update on MRI for Oral Cavity
Authors: Chi Joan M. , Hagiwara Mari
Published: April 2021

Magnetic resonance imaging (MRI) is the imaging modality of choice to evaluate the complex anatomy and pathology of the oral cavity. In this article, an overview of MRI findings of common benign lesions in the oral cavity including congenital, vascular, and inflammatory/infectious lesions will be reviewed. In addition, MRI findings of common benign and malignant oral cavity tumors will be presented.
Zero-TE MRI: Potential Applications in the Oral Cavity and Oropharynx
Authors: Smith Mark , Bambach Sven , Selvaraj Bhavani , Ho Mai-Lan
Published: April 2021

Zero-echo time (ZTE) magnetic resonance imaging (MRI) is the newest in a family of MRI pulse sequences that involve ultrafast sequence readouts, permitting visualization of short-T2 tissues such as cortical bone. Inherent sequence properties enable rapid, high-resolution, quiet, and artifact-resistant imaging. ZTE can be performed as part of a “one-stop-shop” MRI examination for comprehensive evaluation of head and neck pathology. As a potential alternative to computed tomography for bone imaging, this approach could help reduce patient exposure to ionizing radiation and improve radiology resource utilization. Because ZTE is not yet widely used clinically, it is important to understand the technical limitations and pitfalls for diagnosis. Imaging cases are presented to demonstrate potential applications of ZTE for imaging of oral cavity, oropharynx, and jaw anatomy and pathology in adult and pediatric patients. Emerging studies indicate promise for future clinical implementation based on synthetic computed tomography image generation, 3D printing, and interventional applications.
Simulation Based Educational Intervention for Enhancing Irrigation Skills of Nurses Caring for Patients With Cutaneous Continent Urinary Diversions and Orthotopic Neobladders
Authors: Merandy Kyle , Chambers Lakisha Lee , Morgan Karen , Cane Danielle , Barimah Louise McLean , Vasquez Marizel , Rosenberg Jay
Published: April 2021

PURPOSE:

The purpose of this study was to investigate the effect of a nurse practitioner-led simulation-based education program on nursing knowledge and confidence in the care of patients with a cutaneous continent urinary diversion (Indiana pouch) or orthotopic neobladder.

DESIGN:

Single-group, before-after study.

SUBJECTS AND SETTING:

The sample comprised 11 RNs practicing at New York Presbyterian Hospital in New York City. Subjects were predominantly female, ethnically diverse, and held a bachelor's degree. About half of the subjects had less than 3 years of experience, and more than half reported prior experience caring for patients with a urinary diversion.

METHODS:

Participants completed a demographic survey, and a continent urinary diversion confidence survey and pretest measuring knowledge of nursing care of patients with a urinary diversion. Following baseline data collection, an educational session focused on the irrigation of a continent urinary diversion was made available for participants to review. An onsite simulation experience was scheduled several weeks later. Investigators provided education on proper irrigation of a continent urinary diversion and observed participants' skills when irrigating a continent urinary diversion on a high-fidelity simulated patient mannequin. The simulation intervention was followed by video replay and debrief providing feedback on each participant's performance. At the conclusion of the onsite simulation intervention, participants completed a postintervention confidence survey and a knowledge posttest related to the care of a continent urinary diversion. The Wilcoxon signed rank test was used to analyze baseline and postintervention changes in nursing knowledge and confidence.

RESULTS:

Participants achieved significant improvements in knowledge (P = .005) and confidence (P = .009) following the simulation-based educational intervention.

CONCLUSIONS:

A nurse practitioner-led simulation-based educational program for RNs caring for patients with continent urinary diversions demonstrates enhanced nursing knowledge and confidence caring for patients with continent urinary diversions. We anticipate this experience will enhance care we provided to patients undergoing cystectomy and continent cutaneous urinary diversion or orthotopic neobladder construction.
Resistance to nitrofurantoin is an indicator of extensive drug-resistant (XDR) Enterobacteriaceae
Authors: Khamari Balaram , Kumar Prakash , Pradeep Bulagonda Eswarappa
Published: April 2021

Introduction. Nitrofurantoin is one of the preferred antibiotics in the treatment of uropathogenic multidrug-resistant (MDR) infections. However, resistance to nitrofurantoin in extensively drug-resistant (XDR) bacteria has severely limited the treatment options.

Gap statement. Information related to co-resistance or collateral sensitivity (CS) with reference to nitrofurantoin resistant bacteria is limited.

Aim. To study the potential of nitrofurantoin resistance as an indicator of the XDR phenotype in

Enterobacteriaceae

.

Methods. One hundred (45 nitrofurantoin-resistant, 21 intermediately resistant and 34 nitrofurantoin-susceptible)

Enterobacteriaceae

were analysed in this study. Antibiotic susceptibility testing (AST) against nitrofurantoin and 17 other antimicrobial agents across eight different classes was performed by using the Vitek 2.0 system. The isolates were screened for the prevalence of acquired antimicrobial resistance (AMR) and efflux pump genes by PCR.

Results. In total, 51 % of nitrofurantoin-resistant and 28 % of intermediately nitrofurantoin resistant isolates exhibited XDR characteristics, while only 3 % of nitrofurantoin-sensitive isolates were XDR (P=0.0001). Significant co-resistance was observed between nitrofurantoin and other tested antibiotics (β-lactam, cephalosporin, carbapenem, aminoglycoside and tetracycline). Further, the prevalence of AMR and efflux pump genes was higher in the nitrofurantoin-resistant strains compared to the susceptible isolates. A strong association was observed between nitrofurantoin resistance and the presence of bla
PER-1, bla
NDM-1, bla
OXA-48, ant(2) and oqxA-oqxB genes. Tigecycline (84 %) and colistin (95 %) were the only antibiotics to which the majority of the isolates were susceptible.

Conclusion. Nitrofurantoin resistance could be an indicator of the XDR phenotype among

Enterobacteriaceae

, harbouring multiple AMR and efflux pump genes. Tigecycline and colistin are the only antibiotics that could be used in the treatment of such XDR infections. A deeper understanding of the co-resistance mechanisms in XDR pathogens and prescription of AST-based appropriate combination therapy may help mitigate this problem.
The impact of intra-specific diversity in the rhizobia-legume symbiosis
Authors: Fields Bryden , Moffat Emma K. , Friman Ville-Petri , Harrison Ellie
Published: April 2021

Rhizobia - nitrogen-fixing, root-nodulating bacteria - play a critical role in both plant ecosystems and sustainable agriculture. Rhizobia form intracellular infections within legumes roots where they produce plant accessible nitrogen from atmospheric nitrogen and thus reduce the reliance on industrial inputs. The rhizobia-legume symbiosis is often treated as a pairwise relationship between single genotypes, both in research and in the production of rhizobial inoculants. However in nature individual plants are infected by a high diversity of rhizobia symbionts. How this diversity affects productivity within the symbiosis is unclear. Here, we use a powerful statistical approach to assess the impact of diversity within the Rhizobium leguminosarum - clover symbiosis using a biodiversity-ecosystem function framework. Statistically, we found no significant impact of rhizobium diversity. However this relationship was weakly positive - rather than negative - indicating that there is no significant cost to increasing inoculant diversity. Productivity was influenced by the identity of the strains within an inoculant; strains with the highest individual performance showed a significant positive contribution within mixed inoculants. Overall, inoculant effectiveness was best predicted by the individual performance of the best inoculant member, and only weakly predicted by the worst performing member. Collectively, our data suggest that the Rhizobium leguminosarum - clover symbiosis displays a weak diversity-function relationship, but that inoculant performance can be improved through the inclusion of high performing strains. Given the wide environmental dependence of rhizobial inoculant quality, multi-strain inoculants could be highly successful as they increase the likelihood of including a strain well adapted to local conditions across different environments.
The emergence, surge and subsequent wave of the SARS-CoV-2 pandemic in New York metropolitan area: The view from a major region-wide urgent care provider
Authors: Rane Madhura S. , Profeta Angela , Poehlein Emily , Kulkarni Sarah , Robertson McKaylee , Gainus Chris , Parikh Ashish , LeBenger Kerry , Frogel Daniel , Nash Denis
Published: April 2021

Background

Describing SARS-CoV-2 testing and positivity trends among urgent care users is crucial for understanding the trajectory of the pandemic.

Objective

To describe demographic and clinical characteristics, positivity rates, and repeat testing patterns among patients tested for SARS-CoV-2 at CityMD, an urgent care provider in the New York City metropolitan area.

Design

Retrospective study of all persons testing for SARS-CoV-2 between March 1, 2020 and January 8, 2021 at 115 CityMD locations in the New York metropolitan area.

Patients

Individuals receiving a SARS-CoV-2 diagnostic or serologic test.

Measurements

Test and individual level SARS-CoV-2 positivity by PCR, rapid antigen, or serologic tests.

Results

During the study period, 3.4 million COVID tests were performed on 1.8 million individuals. In New York City, CityMD diagnosed 268,298 individuals, including 17% of all reported cases. Testing levels were higher among 20-29 year olds, non-Hispanic Whites, and females compared with other groups. About 24.8% (n=464,902) were repeat testers. Test positivity was higher in non-Hispanic Black (6.4%), Hispanic (8.0%), and Native American (8.0%) patients compared to non-Hispanic White (5.4%) patients. Overall seropositivity was estimated to be 21.7% (95% Confidence Interval [CI]: 21.6-21.8) and was highest among 10-14 year olds (27.3%). Seropositivity was also high among non-Hispanic Black (24.5%) and Hispanic (30.6%) testers, and residents of the Bronx (31.3%) and Queens (30.5%). Using PCR as the gold standard, SARS-CoV-2 rapid tests had a false positive rate of 5.4% (95%CI 5.3-5.5).

Conclusion

Urgent care centers can provide broad access to critical evaluation, diagnostic testing and treatment of a substantial number of ambulatory patients during pandemics, especially in population-dense, urban epicenters.
Contrasting patterns of microbial dominance in theArabidopsis thalianaphyllosphere
Authors: Lundberg Derek S. , de Pedro Jové Roger , Na Ayutthaya Pratchaya Pramoj , Karasov Talia L. , Shalev Or , Poersch Karin , Ding Wei , Bollmann-Giolai Anita , Bezrukov Ilja , Weigel Detlef
Published: April 2021

Sphingomonasis one of the most abundant bacterial genera in the phyllosphere of wildArabidopsis thaliana,but relative toPseudomonas, the ecology ofSphingomonasand its interaction with plants remains elusive. We analyzed the genomic features of over 400Sphingomonasisolates collected from localA. thalianapopulations, which revealed high intergenomic diversity, in contrast to genetically much more uniformPseudomonasisolates found in the same host populations. Variation inSphingomonasplasmid complements and additional genomic features suggest high adaptability of this genus, and the widespread presence of protein secretion systems hints at frequent biotic interactions. While some of the isolates showed plant-protective properties in lab tests, this was a rare trait. To begin to understand the extent of strain sharing across alternate hosts, we employed amplicon sequencing and a novel bulk-culturing metagenomics approach on bothA. thalianaand neighboring plants. Our data reveal thatSphingomonasandPseudomonasboth thrive on other diverse plant hosts, but thatSphingomonasis a poor competitor in dying or dead leaves.
Universal prediction of cell cycle position using transfer learning
Authors: Zheng Shijie C. , Stein-O’Brien Genevieve , Augustin Jonathan J. , Slosberg Jared , Carosso Giovanni A. , Winer Briana , Shin Gloria , Bjornsson Hans T. , Goff Loyal A. , Hansen Kasper D.
Published: April 2021

Background

The cell cycle is a highly conserved, continuous process which controls faithful replication and division of cells. Single-cell technologies have enabled increasingly precise measurements of the cell cycle both as a biological process of interest and as a possible confounding factor. Despite its importance and conservation, there is no universally applicable approach to infer position in the cell cycle with high-resolution from single-cell RNA-seq data.

Results

Here, we present tricycle, an R/Bioconductor package, to address this challenge by leveraging key features of the biology of the cell cycle, the mathematical properties of principal component analysis of periodic functions, and the use of transfer learning. We estimate a cell cycle embedding using a fixed reference dataset and project new data into this reference embedding; an approach that overcomes key limitations of learning a dataset dependent embedding. Tricycle then predicts a cell-specific position in the cell cycle based on the data projection. The accuracy of tricycle compares favorably to gold-standard experimental assays, which generally require specialized measurements in specifically constructedin vitrosystems. Using internal controls which are available for any dataset, we show that tricycle predictions generalize to datasets with multiple cell types, across tissues, species and even sequencing assays.

Conclusions

Tricycle generalizes across datasets, is highly scalable and applicable to atlas-level single-cell RNA-seq data.
Multi-scale predictive modeling discovers Ibudilast as a polypharmacological agent to improve hippocampal-dependent spatial learning and memory and mitigate plaque and tangle pathology in a transgenic rat model of Alzheimer’s disease
Authors: Oliveros Giovanni , Wallace Charles H. , Chaudry Osama , Liu Qiao , Qiu Yue , Xie Lei , Rockwell Patricia , Figueiredo-Pereira Maria , Serrano Peter A.
Published: April 2021

Alzheimer’s disease (AD) is a multifactorial disease that exhibits cognitive deficits, neuronal loss, amyloid plaques, neurofibrillary tangles and neuroinflammation in the brain. We developed a multi-scale predictive modeling strategy that integrates machine learning with biophysics and systems pharmacology to model drug actions from molecular interactions to phenotypic responses. We predicted that ibudilast (IBU), a phosphodiesterase inhibitor and toll-like receptor 4 (TLR4) antagonist, inhibited multiple kinases (e.g., IRAK1 and GSG2) as off-targets, modulated multiple AD-associated pathways, and reversed AD molecular phenotypes. We address for the first time the efficacy of ibudilast (IBU) in a transgenic rat model of AD. IBU-treated transgenic rats showed improved cognition and reduced hallmarks of AD pathology. RNA sequencing analyses in the hippocampus showed that IBU affected the expression of pro-inflammatory genes in the TLR signaling pathway. Our results identify IBU as a potential therapeutic to be repurposed for reducing neuroinflammation in AD by targeting TLR signaling.