bluuebunny/crossref_metadata_2025 huggingface dataset:
Comparison of Different Dosages and Volumes of Triamcinolone in the Treatment of Stenosing Tenosynovitis: A Prospective, Blinded, Randomized Trial
Authors: Leung Leslie Tze Fung , Hill Mark
Published: November 2020

Background:

Stenosing tenosynovitis is a condition due to a size mismatch between the flexor tendons and the first annular pulley. Corticosteroid injection is the mainstay treatment. The purpose of this study is to compare different dosages and volumes of triamcinolone in the treatment of primary stenosing tenosynovitis.

Methods:

Patients with primary Quinnell grades 1 or 2 stenosing tenosynovitis were recruited in this prospective, blinded, randomized trial. Patients were randomized into 1 of 2 groups. Group A received 0.25 mL of triamcinolone 40 mg/mL, mixed with 0.25 mL of 1% lidocaine with epinephrine (10 mg of triamcinolone, 0.5 mL in total volume). Group B received 0.5 mL of triamcinolone 40 mg/mL, mixed with 0.5 mL of 1% lidocaine with epinephrine (20 mg of triamcinolone, 1 mL in total volume). Patients were assessed by a blinded hand therapist at 2 and 4 weeks, and by a blinded hand surgeon at 6 weeks. The primary outcome was complete symptom resolution at 6 weeks. Both per-protocol and intention-to-treat analyses were performed.

Results:

One hundred ninety-one patients were recruited from 2009 to 2018. Eighty-two and 77 patients had complete data in group A and B, respectively. There was no difference in success rates in complete symptom resolution at 6 weeks between group A (59.8%) and group B (62.3%). The mean visual analogue pain scores on injection were 4.31 ± 2.11 for group A and 4.30 ± 2.09 for group B.

Conclusions:

Triamcinolone 10 mg was as effective as 20 mg in the resolution of symptoms of Quinnell grade 1 or 2 stenosing tenosynovitis at 6 weeks.
Reorienting The Production of Space: Rhythmanalysis, desire, and “The Siege of the Third Precinct”
Authors: Farrington Alex
Published: November 2020

Whenever scholars inquire into the relationship between space and power, you can almost invariably find a reference to Henri Lefebvre. However, his initial popularization by David Harvey involved an overemphasis on the political-economic dimensions of his work. This article revisits The Production of Space to show that Lefebvre considered rhythmanalysis – and not a political economy of space – as the ideal method for transforming space and everyday life. Lefebvre argues that a more embodied and intimate knowledge of spatial rhythms can inform the appropriation of space by its everyday inhabitants, in opposition to capital and state power. To demonstrate the radical political potential of rhythmanalysis, I follow my reading of The Production of Space with an examination of “The Siege of the Third Precinct in Minneapolis,” a rhythmanalytic account of the recent Minneapolis uprising. This account, which was circulated online to share tactical insights with other protesters, evokes a number of new avenues for rhythmanalytic research.
Minimizing aggregation errors when measuring potential access to services for social groups at the city scale
Authors: Wu Chengcheng , Powe Neil A , Copeland Alison
Published: November 2020

This research explores how to minimize aggregation errors when measuring potential access to services for social groups at the city scale. It develops a cadastral and address-based population weighting technique, the Household Space Weighting, to reduce aggregation errors caused by using population weighted centroids when applying the Have Their Centre In criterion (the Population Weighted Centroid technique). The Household Space Weighting technique is formally tested in a case study of General Practitioner practices in Newcastle upon Tyne, UK. The findings suggest that the Population Weighted Centroid technique produces inaccurate population estimates for 267 out of 910 output areas (29%) in the city. When applying the two techniques to measure access for social groups at the city scale, the absolute difference in the percentage of each social group with potential accessibility is 9–10% and the relative difference in the percentage of each social group with potential access is 18–20%, taking into account the overlay of service areas at the city scale. This suggests that if service planners or policy makers want to measure potential accessibility or potential access of social groups to services for cities, it would be useful to apply a more accurate technique, or at least be aware of the implications of applying the Population Weighted Centroid technique.
Effects of dexamethasone treatment on serous retinal detachment in ranibizumab-resistant diabetic macular edema
Authors: Bayat Alper Halil , Elçioğlu Mustafa Nuri
Published: November 2020

Purpose:

To evaluate outcome of intravitreal dexamethasone implant (IDI) treatment on serous retinal detachment (SRD) in patients with ranibizumab-resistant diabetic macular edema (DME).

Materials and methods:

Forty-eight eyes of 48 patients with DME resistant to ranibizumab were enrolled in this retrospective and comparative study. Patients were divided into two groups according to presence of serous retinal detachment: (1) SRD or (2) non-SRD groups. All patients had at least three monthly ranibizumab injections, after which they were treated with IDI. The best-corrected visual acuity (BCVA), central retinal thickness (CRT), use of antiglaucomatous drugs, and presence of cataract progression were noted at 1, 3, and 6 months post-IDI treatment.

Results:

There was not any statistically significant difference in terms of baseline characteristics of the patients. The mean CRT was declined in both groups at 1, 3, and 6 months ( p < 0.001). After IDI treatment, the mean BCVA was improved in both groups at 1, 3, and 6 months ( p < 0.001). When groups were compared, the change in CRT was higher in the SRD group ( p = 0.018), while there was no statistically significant difference between groups in terms of BCVA changes ( p = 0.448).

Conclusion:

The presence of SRD resulted in higher anatomical gain. SRD had no effects on visual changes after dexamethasone treatment in patients with ranibizumab-resistant DME.
Epigenetic silencing of HTLV-1 expression by the HBZ RNA through interference with the basal transcription machinery
Authors: Gazon Hélène , Chauhan Pradeep Singh , Porquet Florent , Hoffmann Gabriela Brunsting , Accolla Roberto , Willems Luc
Published: November 2020

Key Points

By disrupting basal transcription machinery, HBZ RNA inhibits sense transcription of human T-cell leukemia virus type 1. Repression of genomic expression may allow entry into proviral latency and escape from immune response.
Current therapies for gastro-oesophageal reflux in the setting of chronic lung disease: state of the art review
Authors: McDonnell Melissa J. , Hunt Eoin B. , Ward Chris , Pearson Jeffrey P. , O'Toole Daniel , Laffey John G. , Murphy Desmond M. , Rutherford Robert M.
Published: November 2020

The inter-relationship between chronic respiratory disease and reflux disease in the airway reflux paradigm is extremely complex and remains poorly characterised. Reflux disease is reported to cause or contribute to the severity of a number of respiratory tract diseases including laryngeal disorders, sinusitis, chronic cough, asthma, COPD, idiopathic pulmonary fibrosis, cystic fibrosis, bronchiectasis and bronchiolitis obliterans post lung transplant. It is now appreciated that reflux disease is not simply caused by liquid acid reflux but rather by a variety of chemical refluxates originating from the stomach and duodenum due to a number of different mechanisms. Reflux disease can be challenging to diagnose, particularly proving its role in the causation of direct respiratory epithelial damage. Significant advances in oesophageal assessment and gastric biomarkers have emerged in recent years as our understanding increases. There are a number of treatments available for reflux disease, both medical and surgical, but there is a paucity of large randomised trials to evaluate their efficacy in the setting of chronic respiratory disease. Everyday clinical practice, however, informs us that treatment failure in reflux disease is common. This clinical review summarises associations between reflux disease in the setting of chronic respiratory diseases and examines available evidence regarding potential therapeutic strategies.
Acupuncture protects against cerebral ischemia–reperfusion injury via suppressing endoplasmic reticulum stress-mediated autophagy and apoptosis
Authors: Sun Xiaowei , Liu Hao , Sun Zhongren , Zhang Beng , Wang Xinyu , Liu Tingting , Pan Tingting , Gao Ying , Jiang Xicheng , Li Hongtao
Published: November 2020

Background

Acupuncture treatment possesses the neuroprotection potential to attenuate cerebral ischemia–reperfusion (I/R) injury. Endoplasmic reticulum (ER) stress has been suggested to be involved in the pathogenic mechanism of cerebral I/R injury. Whether acupuncture protects against cerebral I/R injury via regulating ER stress remains unclear. This study aimed to evaluate the role of ER stress in the neuroprotection of acupuncture against cerebral I/R injury and its underlying mechanisms.

Methods

Cerebral I/R injury was induced by middle cerebral artery occlusion (MCAO) in rats. Acupuncture was carried out at Baihui (GV 20), and Qubin (GB7) acupoints in rats immediately after reperfusion. The infarct volumes, neurological score, ER stress, autophagy and apoptosis were determined.

Results

Acupuncture treatment decreased infarct volume, neurological score and suppressed ER stress via inactivation of ATF-6, PERK, and IRE1 pathways in MCAO rats. Attributing to ER stress suppression, 4-PBA (ER stress inhibitor) promoted the beneficial effect of acupuncture against cerebral I/R injury. Whereas, ER stress activator tunicamycin significantly counteracted the neuroprotective effects of acupuncture. In addition, acupuncture restrained autophagy via regulating ER stress in MCAO rats. Finally, ER stress took part in the neuroprotective effect of acupuncture against apoptosis in cerebral I/R injury.

Conclusions

Our findings suggest that acupuncture offers neuroprotection against cerebral I/R injury, which is attributed to repressing ER stress-mediated autophagy and apoptosis.
Egr-1 mediates low-dose arecoline induced human oral mucosa fibroblast proliferation via transactivation of Wnt5a expression
Authors: Chen Qiang , Jiao Jiuyang , Wang Youyuan , Mai Zhihui , Ren Jing , He Sijie , Li Xiaolan , Chen Zheng
Published: November 2020

Background

Arecoline is an alkaloid natural product found in the areca nut that can induce oral submucous fibrosis and subsequent development of cancer. However, numerous studies have shown that arecoline may inhibit fibroblast proliferation and prevent collagen synthesis.

Results

High doses of arecoline (> 32 μg/ml) could inhibit human oral fibroblast proliferation, while low doses of arecoline (< 16 μg/ml) could promote the proliferation of human oral fibroblasts. Wnt5a was found to be both sufficient and necessary for the promotion of fibroblast proliferation. Egr-1 could mediate the expression of Wnt5a in fibroblasts, while NF-κB, FOXO1, Smad2, and Smad3 did not. Treatment with siRNAs specific to Egr-1, Egr inhibitors, or Wnt5a antibody treatment could all inhibit arecoline-induced Wnt5a upregulation and fibroblast proliferation.

Conclusions

Egr-1 mediates the effect of low dose arecoline treatment on human oral mucosa fibroblast proliferation by transactivating the expression of Wnt5a. Therefore, Egr inhibitors and Wnt5a antibodies are potential therapies for treatment of oral submucosal fibrosis and oral cancer.
Pre-hospital predictors of an adverse outcome among patients with dyspnoea as the main symptom assessed by pre-hospital emergency nurses - a retrospective observational study
Authors: Kauppi Wivica , Herlitz Johan , Karlsson Thomas , Magnusson Carl , Palmér Lina , Axelsson Christer
Published: November 2020

Background

Dyspnoea is one of the most common reasons for patients contacting emergency medical services (EMS). Pre-hospital Emergency Nurses (PENs) are independently responsible for advanced care and to meet these patients individual needs. Patients with dyspnoea constitute a complex group, with multiple different final diagnoses and with a high risk of death. This study aimed to describe on-scene factors associated with an increased risk of a time-sensitive final diagnosis and the risk of death.

Methods

A retrospective observational study including patients aged ≥16 years, presenting mainly with dyspnoea was conducted. Patients were identified thorough an EMS database, and were assessed by PENs in the south-western part of Sweden during January to December 2017. Of 7260 missions (9% of all primary missions), 6354 were included. Among those, 4587 patients were randomly selected in conjunction with adjusting for unique patients with single occasions. Data were manually collected through both EMS- and hospital records and final diagnoses were determined through the final diagnoses verified in hospital records. Analysis was performed using multiple logistic regression and multiple imputations.

Results

Among all unique patients with dyspnoea as the main symptom, 13% had a time-sensitive final diagnosis. The three most frequent final time-sensitive diagnoses were cardiac diseases (4.1% of all diagnoses), infectious/inflammatory diseases (2.6%), and vascular diseases (2.4%). A history of hypertension, renal disease, symptoms of pain, abnormal respiratory rate, impaired consciousness, a pathologic ECG and a short delay until call for EMS were associated with an increased risk of a time-sensitive final diagnosis. Among patients with time-sensitive diagnoses, approximately 27% died within 30 days. Increasing age, a history of renal disease, cancer, low systolic blood pressures, impaired consciousness and abnormal body temperature were associated with an increased risk of death.

Conclusions

Among patients with dyspnoea as the main symptom, age, previous medical history, deviating vital signs, ECG pattern, symptoms of pain, and a short delay until call for EMS are important factors to consider in the prehospital assessment of the combined risk of either having a time-sensitive diagnosis or death.
Knowledge, attitude and practice towards anthrax in northern Ethiopia: a mixed approach study
Authors: Romha Gebremedhin , Girmay Weldemelak
Published: November 2020

Background

Anthrax is the second most highly prioritized zoonotic disease in Ethiopia due to its negative impact at the household level, causing disease and production losses in livestock and severe disease in humans. This study seeks to assess the knowledge of, attitudes towards, and practices addressing (KAPs) anthrax in the communities of Eastern Tigray, Northern Ethiopia.

Methods

A cross-sectional survey was conducted concurrently with focus group discussions (FGDs) and key informant interviews (KIIs) between May 2019 and April 2020. A total of 862 respondents participated in the questionnaire survey. Of these, 800 were local community members while 62 were professionals working at health service institutions. In addition, qualitative data were collected using six FGDs and 11 KIIs.

Results

Sixty-two percent (496/800) of the community respondents said that they were aware of anthrax while 38% (304/800) of them did not. Only 9.3% (74/800) of the respondents reported that the causative agent of anthrax is germs/microbial. About 56.5% (35/62) of professional respondents said that it is bacterial. More than 60% (64.1%, 513/800) of the respondents did not know that whether the disease was zoonotic or not. Regarding clinical signs, 26.3 (210/800) and 36.8% (294/800) of the respondents could identify at least one in animals and humans, respectively, while 21.3 (170/800) and 20.1% (161/800) knew one or more transmission routes in animals and humans, respectively. Moreover, 43.4% (347/800) and 45.6% (365/800) of the respondents mentioned one or more control/prevention method(s) in animals and humans, respectively. Regarding qualitative results, some of the participants knew the disease (in animals) by their local names:LalishandTafia(splenomegaly), andGulbus(abdominal cramps and shivering). Some reported that anthrax was exclusively a human disease while others recognized its zoonotic potential after the clinical signs in both animals and humans were listed.

Conclusion

The KAP of the participants regarding anthrax was low. There was no consistent understanding of the disease among the participants. The study also revealed that the participants did not receive consistent, adequate, and continuous education regarding the disease.
Gastrointestinal mucormycosis due to Rhizopus microsporus following Streptococcus pyogenes toxic shock syndrome in an HIV patient: a case report
Authors: Yinadsawaphan Thanaboon , Ngamskulrungroj Popchai , Chalermwai Wipapat , Dhitinanmuang Wutthiseth , Angkasekwinai Nasikarn
Published: November 2020

Background

Gastrointestinal (GI) mucormycosis is a rare and often deadly form of mucormycosis. Delayed diagnosis can lead to an increased risk of death. Here, we report a case of GI mucormycosis following streptococcal toxic shock syndrome in a virologically suppressed HIV-infected patient.

Case presentation

A 25-year-old Thai woman with a well-controlled HIV infection and Grave’s disease was admitted to a private hospital with a high-grade fever, vomiting, abdominal pain, and multiple episodes of mucous diarrhea for 3 days. On day 3 of that admission, the patient developed multiorgan failure and multiple hemorrhagic blebs were observed on all extremities. A diagnosis of streptococcal toxic shock was made before referral to Siriraj Hospital – Thailand’s largest national tertiary referral center. On day 10 of her admission at our center, she developed feeding intolerance and bloody diarrhea due to bowel ischemia and perforation. Bowel resection was performed, and histopathologic analysis of the resected bowel revealed acute suppurative transmural necrosis and vascular invasion with numerous broad irregular branching non-septate hyphae, both of which are consistent with GI mucormycosis. Peritoneal fluid fungal culture grew a grayish cottony colony of large non-septate hyphae and spherical sporangia containing ovoidal sporangiospores. A complete ITS1–5.8S-ITS2 region DNA sequence analysis revealed 100% homology with Rhizopus microsporus strains in GenBank (GenBank accession numbers KU729104 and AY803934). As a result, she was treated with liposomal amphotericin B. However and in spite of receiving appropriate treatment, our patient developed recurrent massive upper GI bleeding from Dieulafoy’s lesion and succumbed to her disease on day 33 of her admission.

Conclusion

Diagnosis of gastrointestinal mucormycosis can be delayed due to a lack of well-established predisposing factors and non-specific presenting symptoms. Further studies in risk factors for abdominal mucormycosis are needed.
Kinetic changes in virology, specific antibody response and imaging during the clinical course of COVID-19: a descriptive study
Authors: Wang Qiu-jing , Yao Yan-zhen , Song Jun-shuai , Wang Qiao , Xu Li-yun , Bao Zhou-jun , Mao Dai-wen , Zhou Ji-hang , Zhang Zhe-en , Wang Yan , Li Yi-wei , Wang He-ping , Li Lue , Pan Hai-yan , Zhang Guo-qiang , Li Shi-bo
Published: November 2020

Background

To explore the kinetic changes in virology, specific antibody response and imaging during the clinical course of COVID-19.

Methods

This observational study enrolled 20 patients with COVID-19, who were hospitalized between January 20–April 6, 2020, in the two COVID-19 designated hospitals of Zhoushan, Zhejiang and Rushan, Shandong, China, The laboratory findings, imaging, serum response to viral infection, and viral RNA level in the throat and stool samples were assessed from onset to recovery phase in patients with COVID-19.

Results

SARS-COV-2 RNA was positive as early as day four. It remained positive until day 55 post-onset in the sputum-throat swabs and became negative in most cases (55%) within 14 days after onset. Lymphocytopenia occurred in 40% (8/20) of patients during the peak infection period and returned to normal at week five. The most severe inflammation in the lungs appeared in week 2 or 3 after onset, and this was completely absorbed between week 6 and 8 in 85.7% of patients. All patients had detectable antibodies to the receptor binding domain (RBD), and 95% of these patients had IgG to viral N proteins. The antibody titer peaked at week four. Anti-S IgM was positive in 7 of 20 patients after week three.

Conclusions

All COVID-19 patients in this study were self-limiting and recovered well though it may take as long as 6–8 weeks. Our findings on the kinetic changes in imaging, serum response to viral infection and viral RNA level may help understand pathogenesis and define clinical course of COVID-19.
Frontline treatment patterns and attrition rates by subsequent lines of therapy in patients with newly diagnosed multiple myeloma
Authors: Fonseca Rafael , Usmani Saad Z. , Mehra Maneesha , Slavcev Mary , He Jianming , Cote Sarah , Lam Annette , Ukropec Jon , Maiese Eric M. , Nair Sandhya , Potluri Ravi , Voorhees Peter M.
Published: November 2020

Background

For patients with multiple myeloma (MM), each additional line of therapy (LOT) is associated with lower response rates, shorter treatment duration and treatment-free intervals, and increased rates of toxicities and comorbidities. Here, we examine frontline treatment patterns, and attrition rates by LOT among newly diagnosed MM (NDMM) patients in the United States who were eligible or ineligible for autologous stem cell transplant (ASCT).

Methods

Data were identified from three US patient-level databases collectively covering the period January 2000 to September 2018. Patients had an index diagnosis of MM on or after January 1, 2007, medical and prescription insurance coverage at diagnosis, a 1-year look-back period prior to the index diagnosis, no prior malignancies in the 1-year period before index diagnosis, and had received ≥1 LOT.

Results

Among patients who did not receive ASCT (non-transplant; n = 22,062), 12,557 (57%) received only 1 LOT and 9505 (43%) received > 1 LOT. Patients receiving only 1 LOT were significantly older, had higher mean Charlson Comorbidity Index (CCI) scores, and higher incidences of comorbidities. Among the 2763 patients receiving ASCT, 2184 received > 1 LOT, and 579 (21%) received only 1 LOT (ie, ASCT was the last treatment). 1682 (61%) patients received induction therapy as frontline treatment, of whom 187 (11%) also received consolidation therapy. The latter group was younger than those who received only induction therapy, had lower mean CCI scores, and comparable or lower incidences of selected comorbidities. The most common frontline therapy for non-transplant and transplant-eligible patients was bortezomib/dexamethasone and bortezomib/lenalidomide/dexamethasone, respectively. Attrition rates across all LOTs were high for non-transplant patients (range, 43–57%) and transplant patients (range, 21–37%). Treatment duration decreased by LOT for non-transplant patients and was consistent across LOTs for transplant patients.

Conclusions

In this analysis, a substantial proportion of patients with NDMM who received frontline therapy did not appear to receive a subsequent LOT. These high attrition rates underscore the need to use the most optimal treatment regimens upfront rather than reserving them for later LOTs in which the clinical benefit may decrease.
Motivational climate, need satisfaction, self-determined motivation, and physical activity of students in secondary school physical education in China
Authors: Chen Ruzhuan , Wang Lijuan , Wang Bingnan , Zhou Yulan
Published: November 2020

Background

On the basis of the integration constructs from self-determination theory (SDT) and achievement goal theory (AGT), this study aims to investigate the relationship among classroom motivational climate from four perspectives (i.e. autonomy support, relatedness support, task-involving climate and ego-involving climate), three psychological needs (i.e. autonomy, competence and relatedness), self-determined motivation and physical activity (PA) in secondary physical education (PE).

Methods

Participants consisted of 1186 Chinese students aged 11 to 16 years from three secondary schools in Shanghai. Accelerometers were utilized to measure moderate to vigorous physical activity (MVPA). Questionnaires were used to measure SDT variables (i.e. classroom motivational climate, perceived competence, autonomy, relatedness and self-determined motivation). Structural equation modelling (SEM) was adopted to analyse the hypothesised relationship.

Results

SEM analysis revealed that task-involving climate and autonomy support were positively associated with autonomy, relatedness and competence. Relatedness support was positively related with autonomy and relatedness, whereas ego-involving climate was only associated with competence. The three psychological needs positively affected self-determined motivation, and self-determined motivation positively affected the MVPA time of secondary school students in PE lessons.

Conclusion

These findings support a model of motivation that integrates SDT and AGT, provides new insight into understanding MVPA in Chinese PE, and establishes a solid basis for intervention research.
Characteristics and distribution of obesity in the Arab-American population of southeastern Michigan
Authors: Kamatham Saivaishnavi , Trak Joseph , Alzouhayli Suma , Fehmi Ziad , Rahoui Nabil , Sulieman Noor , Khoury Zaina , Fehmi Omar , Rakine Hanan , El-Masri Dana , Ujayli Deema , Elhagehassan Hanin , Naaman James , Almsaddi Firas , Salloum Michael , Farooquee Iqra , Syed Nadia , Kim Seongho , Lattouf Omar , Cote Michele L. , Ali-Fehmi Rouba
Published: November 2020

Background

Arab-Americans constitute ~ 5% of Michigan’s population. Estimates of obesity in Arab-Americans are not up-to-date. We aim to describe the distribution of and factors associated with obesity in an Arab-American population in Southeastern Michigan (SE MI).

Methods

Retrospective medical record review identified n = 2363 Arab-American patients seeking care at an Arab-American serving clinic in SE MI, located in a city which is home to a large proportion of Arab-Americans in the United States (US). Body mass index (BMI) was the primary outcome of interest. Distribution of BMI was described using percentages, and logistic regression models were constructed to examine the association between obesity, other comorbid conditions and health behaviors. This cohort was compared to Michigan’s Behavioral Risk Factor Surveillance System (BRFSS) data from 2018 (n = 9589) and to a cohort seeking care between 2013 and 2019 from a free clinic (FC) located in another city in SE MI (n = 1033).

Results

Of the 2363 Arab-American patients, those who were older or with HTN, DM or HLD had a higher prevalence of obesity than patients who were younger or without these comorbidities (all p-value < 0.001). Patients with HTN were 3 times as likely to be obese than those without HTN (95% CI: 2.41–3.93; p < 0.001). Similarly, the odds of being obese were 2.5 times higher if the patient was diabetic (95% CI: 1.92–3.16; p < 0.001) and 2.2 times higher if the patient had HLD (95% CI: 1.75–2.83; p < 0.001). There was no significant difference in obesity rates between Arab-Americans (31%) and the BRFSS population (32.6%). Compared to Arab-Americans, patients seen at the FC had a higher obesity rate (52.6%; p < 0.001) as well as significantly higher rates of HTN, DM and HLD (all p < 0.001).

Conclusion

Overall obesity rates in Arab-Americans were comparable to the population-based BRFSS rates, and lower than the patients seen at the FC. Further studies are required to understand the impact of obesity and the association of comorbidities in Arab-Americans.
Characteristics and predictors of muscle strength deficit in mechanical ankle instability
Authors: Hou Zong-chen , Miao Xin , Ao Ying-fang , Hu Yue-lin , Jiao Chen , Guo Qin-wei , Xie Xing , Zhao Feng , Pi Yan-bin , Li Nan , Zhang Zhi-yu , Jiang Dong
Published: November 2020

Purpose

Muscle strength training is a common strategy for treating chronic ankle instability (CAI), but the effectiveness decreases for mechanical ankle instability (MAI) patients with initial severe ligament injuries. The purpose of this study was to investigate the characteristics and the potential predictors of muscle strength deficit in MAI patients, with a view to proposing a more targeted muscle strength training strategy.

Methods

A total of 220 MAI patients with confirmed initial lateral ankle ligament rupture and a postinjury duration of more than 6 months were included. All patients underwent a Biodex isokinetic examination of the ankle joints of both the affected and unaffected sides. Then, the associations between the limb symmetry index (LSI) (mean peak torque of the injury side divided by that of the healthy side) and the patients’ sex, body mass index, postinjury duration, presence of intra-articular osteochondral lesions, presence of osteophytes and ligament injury pattern (i.e., isolated anterior talofibular ligament (ATFL) injury or combined with calcaneofibular ligament injury) were analysed.

Results

There was significantly weaker muscle strength on the affected side than on the unaffected side in all directions (p < 0.05). The LSI in plantar flexion was significantly lower than that in dorsiflexion at 60°/s (0.87 vs 0.98, p < 0.001). A lower LSI in eversion was significantly correlated with female sex (0.82 vs 0.94, p = 0.016) and isolated ATFL injury (0.86 vs 0.95, p = 0.012). No other factors were found to be associated with muscle strength deficits.

Conclusion

MAI patients showed significant muscle strength deficits on the affected side, especially in plantar flexion. There were greater strength deficits in eversion in females and individuals with an isolated ATFL injury. Thus, a muscle strength training programme for MAI patients was proposed that focused more on plantar flexion training and eversion training for females and those with an isolated ATFL injury.
Echolocating bats can adjust sensory acquisition based on internal cues
Authors: Boonman Arjan , Rieger Itai , Amichai Eran , Greif Stefan , Eitan Ofri , Goldshtein Aya , Yovel Yossi
Published: November 2020

Background

Sensory systems acquire both external and internal information to guide behavior. Adjustments based on external input are much better documented and understood than internal-based sensory adaptations. When external input is not available, idiothetic—internal—cues become crucial for guiding behavior. Here, we take advantage of the rapid sensory adjustments exhibited by bats in order to study how animals rely on internal cues in the absence of external input. Constant frequency echolocating bats are renowned for their Doppler shift compensation response used to adjust their emission frequency in order to optimize sensing. Previous studies documented the importance of external echoes for this response.

Results

We show that the Doppler compensation system works even without external feedback. Bats experiencing accelerations in an echo-free environment exhibited an intact compensation response. Moreover, using on-board GPS tags on free-flying bats in the wild, we demonstrate that the ability to perform Doppler shift compensation response based on internal cues might be essential in real-life when echo feedback is not available.

Conclusions

We thus show an ecological need for using internal cues as well as an ability to do so. Our results illustrate the robustness of one particular sensory behavior; however, we suggest this ability to rely on different streams of information (i.e., internal or external) is probably relevant for many sensory behaviors.
Genomic profile of MYCN non-amplified neuroblastoma and potential for immunotherapeutic strategies in neuroblastoma
Authors: Lee Eunjin , Lee Ji Won , Lee Boram , Park Kyunghee , Shim Joonho , Yoo Keon Hee , Koo Hong Hoe , Sung Ki Woong , Park Woong-Yang
Published: November 2020

Background

MYCN amplification is the most important genomic feature in neuroblastoma (NB). However, limited studies have been conducted on the MYCN non-amplified NB including low- and intermediate-risk NB. Here, the genomic characteristics of MYCN non-amplified NB were studied to allow for the identification of biomarkers for molecular stratification.

Methods

Fifty-eight whole exome sequencing (WES) and forty-eight whole transcriptome sequencing (WTS) samples of MYCN non-amplified NB were analysed. Forty-one patients harboured WES and WTS pairs.

Results

In the MYCN non-amplified NB WES data, maximum recurrent mutations were found in MUC4 (26%), followed by RBMXL3 (19%), ALB (17%), and MUC16 and SEPD8 (14% each). Two gene fusions, CCDC32-CBX3 (10%) and SAMD5-SASH1 (6%), were recurrent in WTS analysis, and these fusions were detected mostly in non-high-risk patients with ganglioneuroblastoma histology. Analysis of risk-group-specific biomarkers showed that several genes and gene sets were differentially expressed between the risk groups, and some immune-related pathways tended to be activated in the high-risk group. Mutational signatures 6 and 18, which represent DNA mismatch repair associated mutations, were commonly detected in 60% of the patients. In the tumour mutation burden (TMB) analysis, four patients showed high TMB (> 3 mutations/Mb), and had mutations in genes related to either MMR or homologous recombination. Excluding four outlier samples with TMB > 3 Mb, high-risk patients had significantly higher levels of TMB compared with the non-high-risk patients.

Conclusions

This study provides novel insights into the genomic background of MYCN non-amplified NB. Activation of immune-related pathways in the high-risk group and the results of TMB and mutational signature analyses collectively suggest the need for further investigation to discover potential immunotherapeutic strategies for NB.
Body mass index and cardiovascular outcomes in patients with acute coronary syndrome by diabetes status: the obesity paradox in a Korean national cohort study
Authors: Park Se-Jun , Ha Kyoung Hwa , Kim Dae Jung
Published: November 2020

Background

The “obesity paradox” has not been elucidated in the long-term outcomes of acute coronary syndrome (ACS). We investigated the association between obesity and cardiovascular (CV) outcomes in ACS patients with and without diabetes.

Methods

We identified 6978 patients with ACS aged 40–79 years from the Korean National Health Insurance Service-Health Screening Cohort between 2002 and 2015. Baseline body mass index (BMI) was categorized as underweight (< 18.5 kg/m2), normal weight (18.5–22.9 kg/m2), overweight (23.0–24.9 kg/m2), obese class I (25.0–29.9 kg/m2), and obese class II (≥ 30.0 kg/m2). The primary outcome was major adverse CV events (MACE)—CV death, myocardial infarction (MI), and stroke. The secondary outcomes were the individual components of MACE, hospitalization for heart failure (HHF), and all-cause death.

Results

After adjustment for confounding variables, compared to normal-weight patients without diabetes (reference group), obese class I patients with and without diabetes had a lower risk of MACE, but only significant in patients without diabetes (with diabetes: hazard ratio [HR] 0.95, 95% confidence interval [CI] 0.78–1.14; without diabetes: HR 0.78, 95% CI 0.62–0.97). Obese class II patient with diabetes had a higher risk of MACE with no statistical significance (HR 1.14, 95% CI 0.82–1.59). Underweight patients with and without diabetes had a higher risk of MACE, but only significant in patients with diabetes (with diabetes: HR 1.79, 95% CI 1.24–2.58; without diabetes: HR 1.23, 95% CI 0.77–1.97).

Conclusion

In ACS patients, obesity had a protective effect on CV outcomes, especially in patients without diabetes.
Validation of a Spanish version of the health-related quality of life (HRQoL) measure for Chronic Otitis Media (COMQ-12)
Authors: Otoya-Tono Ana M. , Pérez-Herrera Lucía C. , Peñaranda Daniel , Moreno-López Sergio , Sánchez-Pedraza Ricardo , García Juan Manuel , Phillips John S. , Peñaranda Augusto
Published: November 2020

Background

Evaluation of health-related quality of life (HRQoL) is considered an important aspect of clinical assessment and health research. Chronic Otitis Media (COM) is related to the quality of life deterioration subsequent to COM symptoms, social communication impairments, and lower work performance. However, there is no reliable information regarding the impact of this disease on health and quality of life in many resource-poor countries. Therefore, we translated into Spanish the Chronic Otitis Media Questionnaire-12 (COMQ-12) for the evaluation of HRQoL of Chronic Otitis Media (COM) in adult patients. Also, we assessed the psychometric properties of the Spanish version of the questionnaire.

Methods

Two otology referral centers in Bogotá, Colombia were included. The Spanish version of COMQ-12 was applied twice to 200 adult patients with confirmed COM diagnosis and 31 healthy controls to perform the validation process and assess the internal consistency of this questionnaire. Psychometric characteristics (internal consistency, test–retest reliability, and construct validity) of the COMQ-12 were assessed. Exploratory Factor Analysis and Confirmatory Factor Analysis were conducted via structural equation modeling to test the questionnaire’s structure.

Results

The Spanish version of the COMQ-12 showed good internal consistency (Cronbach’s Alpha: 0.86, McDonald’s Omega: 0.89). Coefficients corresponding to Lin’s Concordance test and test–retest reliability were 0.95 and 0.83 respectively. Correlation between the Visual Analogue Scale (VAS) and the COMQ-12 was 0.68 (95% CI 0.59–0.75, p value < 0.001). Factor analysis of the Spanish version of the COMQ-12 indicated a questionnaire structure with three domains: smelly discharge related symptoms; hearing loss related symptoms; and impact on work, lifestyle, and health services.

Conclusion

This Spanish version of the COMQ-12 showed high reliability and high internal consistency. This questionnaire can be used as an objective clinical tool to assess the HRQoL of patients who have a COM diagnosis.

Trial registration

Hospital Universitario Fundación Santa Fe, Ethical Committee Registration ID: CCEI-8807-2018. Hospital de San José, Ethical Committee: Record number 500, DI-I-0632-18.
Time interval-based indication for liver resection of metastasis from pancreatic cancer
Authors: Mitsuka Yusuke , Yamazaki Shintaro , Yoshida Nao , Yan Masahiro , Higaki Tokio , Takayama Tadatoshi
Published: November 2020

Background

Surgical indications for liver metastases from pancreatic ductal adenocarcinoma (PDAC) are lacking because outcomes are usually poor. However, liver resection and the recent progress in perioperative chemotherapy have been observed to improve survival.

Methods

We performed liver resection for liver metastases from PDAC only under the following criteria: (1) liver-only metastasis, (2) up to three tumors, and (3) no increase in the number of metastases during the 3-month observation period. No limitations were placed on the location or size of liver metastasis. In this study, we aimed to validate our surgical criteria and analyze factors affecting survival in patients with PDAC.

Results

Seventy-nine patients underwent curative resection for PDAC between 2005 and 2015. Seventy-one patients experienced recurrence, with liver-only recurrence in 17 patients. Among these, nine patients underwent liver resection and eight did not. The median survival time was significantly better for patients who underwent liver resection (55 months) than for those with other recurrences (17.5 months, p = 0.016). The median survival after liver recurrence was significantly better in the liver resection group (31 months) than in the non-liver resection group (7 months, p = 0.0008). The median disease-free interval (DFI) after pancreatectomy was significantly longer in the liver resection group (21 months; range, 3–44 months) than in the non-liver resection group (3 months; range, 2–7 months; p = 0.02).

Conclusion

Good indications for liver metastases from PDAC include solitary metachronous tumors and longer DFIs.
Factors associated with the recruitment of foreign nurses in Japan: a nationwide study of hospitals
Authors: Hirano Yuko O. , Tsubota Kunio , Ohno Shun
Published: November 2020

Background

Nurse migration under bilateral agreements is a recent global trend, although lack of consultation with the health industries has led to challenges in the recruitment of foreign nurses by hospitals. To analyze the prevailing perception of hospitals on the Economic Partnership Agreement (EPA), under which Japan opened the doors to foreign nurses, we surveyed hospitals that are yet to employ foreign nurses.

Methods

An anonymous questionnaire was developed and distributed to eligible hospitals; it assessed managers’ perception of Japan’s policy on the recruitment of foreign nurses and their intentions to hire foreign nurses under the EPA (hereafter called EPA nurses). We randomly selected 1879 hospitals, or 22% of the hospitals in Japan (n = 8540), with more than 20 beds. We used descriptive statistics, a Chi-square test, and logistic regression analysis to identify the predictors and developed a model to predict the likelihood of their intention to recruit EPA nurses in the future.

Results

In total, 432 hospitals were eligible for further analysis (response rate: 22.9%). Half (50%) of the hospital managers were considerably interested in Japan’s policy on recruiting EPA nurses, although only 20% intended to recruit EPA nurses in the future. Willingness to recruit EPA nurses was associated with the degree of interest in the policy (OR 9.38; 95% CI 4.42–19.90) and managers’ perception of EPA nurses (OR 5.32, 95% CI 2.38–11.89).

Conclusions

To attract more hospitals to recruit foreign nurses, it is essential for the Japanese government and the sending countries to review their EPA systems. Utilizing returning nurses to assist language acquisition by the forthcoming EPA nurses could be a provisional solution. For a more fundamental solution, long-term provision, from prior to their migration until their return migration, is needed to encourage brain circulation, as opposed to brain drain, between sending and receiving countries.
Accurate and objective determination of myalgic encephalomyelitis/chronic fatigue syndrome disease severity with a wearable sensor
Authors: Palombo Turner , Campos Andrea , Vernon Suzanne D. , Roundy Shad
Published: November 2020

Background

Approximately 2.5 million people in the U.S. suffer from myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). This disease negatively impacts patients’ ability to function, often resulting in difficulty maintaining employment, sustaining financial independence, engaging socially with others, and in particularly severe cases, consistently and adequately performing activities of daily living. The focus of this research was to develop a sensor-based method to measure upright activity defined as time with feet on the floor and referred to as UpTime, as an indicator of ME/CFS disease severity.

Methods

A commercially available inertial measurement unit (IMU), the Shimmer, was selected for this research. A Kalman filter was used to convert IMU data collected by the Shimmer to angle estimates. Angle estimate accuracy was confirmed by comparison to a motion capture system. Leg angle estimates were then converted to personalized daily UpTime scores using a critical angle of 39º from vertical to differentiate between upright (feet on the floor) and not upright. A 6-day, case–control study with 15 subjects (five healthy controls, five moderate-level ME/CFS, and five severe-level ME/CFS) was conducted to determine the utility of UpTime for assessing disease severity.

Results

UpTime was found to be a significant measure of ME/CFS disease severity. Severely ill ME/CFS patients spend less than 20% of each day with feet on the floor. Moderately ill ME/CFS patients spend between 20–30% of each day with feet on the floor. Healthy controls have greater than 30% UpTime. IMU-measured UpTime was more precise than self-reported hours of upright activity which were over-estimated by patients.

Conclusions

UpTime is an accurate and objective measure of upright activity, a measure that can be used to assess disease severity in ME/CFS patients. Due to its ability to accurately monitor upright activity, UpTime can also be used as a reliable endpoint for evaluating ME/CFS treatment efficacy. Future studies with larger samples and extended data collection periods are required to fully confirm the use of UpTime as a measure of disease severity in ME/CFS. With the added perspective of large-scale studies, this sensor-based platform could provide a recovery path for individuals struggling with ME/CFS.
OKlahoma Nitrone-007: novel treatment for diffuse intrinsic pontine glioma
Authors: Thomas Lincy , Smith Nataliya , Saunders Debra , Zalles Michelle , Gulej Rafal , Lerner Megan , Fung Kar-Ming , Carcaboso Angel M. , Towner Rheal A.
Published: November 2020

Background

Diffuse intrinsic pontine glioma (DIPG) is the most common brainstem cancer in childhood. This rapidly progressing brainstem glioma holds a very dismal prognosis with median survival of less than 1 year. Despite extensive research, no significant therapeutic advancements have been made to improve overall survival in DIPG patients.

Methods

Here, we used an orthotopic xenograft pediatric DIPG (HSJD-DIPG-007) mouse model to monitor the effects of anti-cancer agent, OKlahoma Nitrone-007 (OKN-007), as an inhibitor of tumor growth after 28 days of treatment. Using magnetic resonance imaging (MRI), we confirmed the previously described efficacy of LDN-193189, a known activin A receptor, type I (ACVR1) inhibitor, in decreasing tumor burden and found that OKN-007 was equally efficacious.

Results

After 28 days of treatment, the tumor volumes were significantly decreased in OKN-007 treated mice (p < 0.01). The apparent diffusion coefficient (ADC), as a measure of tissue structural alterations, was significantly decreased in OKN-007 treated tumor-bearing mice (p < 0.0001). Histological analysis also showed a significant decrease in CD34 expression, essential for angiogenesis, of OKN-007 treated mice (p < 0.05) compared to LDN-193189 treated mice. OKN-007-treated mice also significantly decreased protein expression of the human nuclear antigen (HNA) (p < 0.001), ACVR1 (p < 0.0001), and c-MET (p < 0.05), as well as significantly increased expression of cleaved caspase 3 (p < 0.001) and histone H3 K27-trimethylation (p < 0.01), compared to untreated mouse tumors.

Conclusions

With the dismal prognosis and limited effective chemotherapy available for DIPG, there is significant room for continued research studies, and OKN-007 merits further exploration as a therapeutic agent.