bluuebunny/crossref_metadata_2025 huggingface dataset:
Do journals raise their impact factor or SCImago ranking by self‐citing in editorials? A bibliometric analysis of trauma and orthopaedic journals
Authors: Jain Aanchal , Khor Keng Suan , Beard David , Smith Toby O. , Hing Caroline B.
Published: February 2021

Background

Impact factor (IF) is widely accepted as a measure of a journal's quality but it can be influenced by self‐citation. However, the SCImago Journal Rank (SJR) is based on journal prestige, excludes self‐citation and considers quality of citations of a journal. This study aimed to investigate journal editors' use of self‐citation and whether this correlated with IFs or SJR in trauma and orthopaedic (T&O) journals.

Methods

T&O journals on the SJR database were identified. From each journal, data including country of publication, number of annual issues, IF, SJR indicator and citable articles were extracted. The editorial(s) of each issue in 2018 were reviewed. The total number of times the editors cited their own previous work or their journal (in the preceding 2 years, 2016–2017) were identified. Regression analyses were performed to investigate the association of editorial self‐citation with journal IF or SJR indicator.

Results

Of the 270 journals identified, 43 T&O journals with 151 editorials were included in the final analysis. A positive correlation between journal self‐citation in the editorial and IF (P = 0.02) and SJR indicator (P = 0.02) was found. Citation by editors of their own publications within editorials also positively correlated with IF (P = 0.04) but not for SJR indicator (P = 0.19). There was a positive linear relationship between journal IF and SJR indicators (P < 0.01).

Conclusion

Editor self‐citation influences the IF and SJR indicators in T&O journals. Therefore, these metrics should be considered in conjunction with other factors such as audience, topics included and international presence when evaluating journals.
Disseminated intravascular coagulation: epidemiology, biomarkers, and management
Authors: Adelborg Kasper , Larsen Julie B. , Hvas Anne‐Mette
Published: February 2021

Disseminated intravascular coagulation (DIC) is a systemic activation of the coagulation system, which results in microvascular thrombosis and, simultaneously, potentially life‐threatening haemorrhage attributed to consumption of platelets and coagulation factors. Underlying conditions, e.g. infection, cancer, or obstetrical complications are responsible for the initiation and propagation of the DIC process. This review provides insights into the epidemiology of DIC and the current understanding of its pathophysiology. It details the use of diagnostic biomarkers, current diagnostic recommendations from international medical societies, and it provides an overview of emerging diagnostic and prognostic biomarkers. Last, it provides guidance on management. It is concluded that timely and accurate diagnosis of DIC and its underlying condition is essential for the prognosis. Treatment should primarily focus on the underlying cause of DIC and supportive treatment should be individualised according to the underlying aetiology, patient’s symptoms and laboratory records.
First Generation in Chilean Higher Education: Tension between Access and Inclusion in a Segmented University System
Authors: Jarpa‐Arriagada Carmen G. , Rodríguez‐Garcós Carlos
Published: February 2021

We analysed the Chilean university student selection processes, comparing ‘First Generation’ and ‘Continuist’ students, using the Chilean Higher Education population databases (2000–2015). Findings confirm that 60 percent of participants in the selection process are First Generation students. The data registers an increasing self‐exclusion phenomenon. Of the students who did not take the selection test after enrolling, 80 percent are First Generation and 18 are enrolled in a selective university, compared to 44 in the Continuist conglomerate. These differences may be explained by cultural capital in the Bourdieu sense, in conjunction with a diversified, massified and marketalised higher education system.
Association between positive grandparental involvement during childhood and generativity in late life among community‐dwelling, cognitively intact, older adults in Japan
Authors: Morita Ayako , Fujiwara Takeo
Published: February 2021

Aim

Generativity is increasingly being recognized as a key element of healthy aging. The present study investigated whether children who received more positive grandparental involvement would show higher generativity in late life.

Methods

In 2017, 173 older adults living in Wakuya City (Miyagi Prefecture, Japan), and who showed normal cognition based on the Quick Mild Cognitive Impairment Screen, participated in a self‐report life course survey (age range: 65–88 years). The association between positive grandparental involvement in childhood and generativity (measured by the Loyola Generativity Scale) was investigated using multiple linear regression adjusted for potential confounders.

Results

Compared with older adults without or had low positive grandparental involvement in childhood, a higher level of generativity was observed among those with medium (β = 1.93, 95% confidence interval [CI]: 0.24–3.62) and high positive grandparental involvement (β = 2.09, 95% CI: 0.32–3.87), adjusting for age, gender, memory performance, depressive symptoms, childhood socio‐economic status and parental involvement. The significant dose–response association remained even after further adjusting for education and current grandparental experiences.

Conclusion

Greater positive grandparental involvement in childhood was associated with a higher level of generativity among community‐dwelling, cognitively intact, Japanese older adults. Geriatr Gerontol Int ••; ••: ••–•• Geriatr Gerontol Int 2021; ••: ••–••.
The effect ofGeoGebra software–supportedmathematics instruction on eighth‐grade students' conceptual understanding and retention
Authors: Birgin Osman , Uzun Yazıcı Kübra
Published: February 2021

The aim of this study was to investigate the effect of using dynamic geometry software (GeoGebra) on the eighth‐grade students' conceptual understanding and the retention of learning regarding linear equations and slope. In this study, a quasi‐experimental design with pre‐test, post‐test and delayed post‐test was employed. This study was conducted with 52 eighth‐grade Turkish students (experimental group,n = 25; control group,n = 27). While GeoGebra software‐supported instruction was carried out in the experimental group, textbook‐based direct instruction was continued in the control group. Data were collected with the conceptual understanding test (CUT) which consists of 38 questions including open‐ended, multiple choice and fill in the blanks. CUT was applied to the experimental and control groups as a pre‐test and post‐test at both the beginning and the end of the instruction, respectively. Seven weeks after the instruction, CUT was applied to both groups as a retention test. Data were analysed through SPSS 17.0 statistical software by using at‐test and ANCOVA test. It was indicated in the study results that GeoGebra software‐supported instruction for eighth‐grade students regarding linear equations and slope did significantly improve both their conceptual understanding and retention of learning in comparison to textbook‐based direct instruction.
Hypertension‐mediated organ damage regression associates with blood pressure variability improvement three years after successful treatment initiation in essential hypertension
Authors: Triantafyllidi Helen , Benas Dimitrios , Schoinas Antonios , Birmpa Dionyssia , Trivilou Paraskevi , Varytimiadi Efthimia , Voutsinos Dimitrios , Ikonomidis Ignatios
Published: February 2021

Blood pressure variability (BPV) has been associated with the development, progression, and severity of cardiovascular (CV) organ damage and an increased risk of CV morbidity and mortality. We aimed to explore any association between short‐term BPV reduction and hypertension‐mediated organ damage (HMOD) regression in hypertensive patients 3‐year post‐treatment initiation regarding BP control. 24‐h ambulatory blood pressure monitoring (24 h ABPM) was performed at baseline in 180 newly diagnosed and never‐treated hypertensive patients. We measured 24 h average systolic (24 h SBP) and diastolic BP (24 h DBP) as well as 24 h systolic (sBPV) and diastolic BPV (dBPV). Patients were initially evaluated and 3 years later regarding arterial stiffness (PWV), left ventricular hypertrophy (LVMI), carotid intima‐media thickness (cIMT), 24 h microalbumin levels (MAU), and coronary flow reserve (CFR). Successful BP treatment was defined as 24 h SBP/DBP < 130/80 mm Hg based on 2nd ABPM and subsequently, patients were characterized as controlled (n = 119, age = 53 ± 11 years) or non‐controlled (n = 61, age = 47 ± 11 years) regarding their BP levels. In the whole population and the controlled group, 24 h SBP/DBP, sBPV/dBPV, LVMI, and IMT were decreased. Additionally, LVMI improvement was related with both sBPV (p < .001) and dBPV reduction (r = .18, p = .02 and r = .20, p = .03, respectively). In non‐controlled hypertensives, PWV was increased. In multiple linear regression analysis, sBPV and dBPV reduction predicted LVMI improvement in total population and controlled group independently of initial office SBP, mean BP, and 24 h‐SBP levels. In middle‐aged hypertensive patients, a 3‐year antihypertensive treatment within normal BP limits, confirmed by 24‐h ABPM, leads to CV risk reduction associated with sBPV and dBPV improvement.
Monitoring of the Implementation of a Breastfeeding Guideline for 6 Years: A Mixed‐Methods Study Using an Interrupted Time Series Approach
Authors: Ruzafa‐Martinez Maria , Harillo‐Acevedo David , Ramos‐Morcillo Antonio Jesús
Published: February 2021

Background

Current literature provides poor information about the implementation of health‐promoting clinical practice guidelines (CPGs) and their longitudinal monitoring.

Purpose

The aim of this study was to evaluate the longitudinal impact of a CPG implementation program that promotes breastfeeding, its associated quantitative and qualitative indicators, and direct costs.

Design

A mixed‐methods design with a longitudinal approach was utilized, with an interrupted time series design and the analysis of reports from the implementation program as the qualitative approach.

Methods

The study setting was maternity and pediatric units of a health area in the Spanish health system. The implementation of a CPG for the promotion of breastfeeding was evaluated, which included a pre‐implementation year (2011), 3 years of implementation (2012–2014), and 2 years of post‐implementation (2015–2016). The sample was composed of mother–infant dyads. A segmented logistic regression analysis was utilized to evaluate the changes in the most important breastfeeding indicators. A deductive thematic content analysis was performed starting with quality indicators and a descriptive economic analysis.

Findings

In the 6 years of monitoring, 7,842 mother–infant dyads were recorded. The results of the quantitative indicators showed the presence of four stages: baseline, gain, adjustment, and sustainability or saturation. The breast milk at the first feeding had an increasing slope in the gain stage (24% per quarter; odds ratio [OR] = 1.24, 95% confidence interval [CI] 1.12–1.37). The exclusive breastfeeding at hospital discharge showed significant changes in the period of gain (OR = 2.45, 95% CI 1.95–3.08), which was maintained in the adjustment period, with an increase of 18% in the slope of the gain stage (OR = 1.18, 95% CI 1.06–1.32). The longitudinal distribution of the qualitative indicators showed a greater concentration of indicators towards the first half of each phase. The total cost was 209,575€ ($248,670.17).

Conclusions

The implementation of the breastfeeding CPG showed early, positive, and sustained results in the exclusive breastfeeding rates. The implementation implied the application of a complex intervention, with its qualitative indicators showing a wave‐shaped dynamic.

Clinical Relevance

Our findings contribute to the understanding and evolution of the main indicators of the implementation of a breastfeeding CPG, providing details on the magnitude of the effect, the process of change, and the associated costs.
Hypoadrenocorticism in dogs underUKprimary veterinary care: frequency, clinical approaches and risk factors
Authors: Schofield I. , Woolhead V. , Johnson A. , Brodbelt D. C. , Church D. B. , O'Neill D. G.
Published: February 2021

Objectives

To estimate the frequency, clinical approaches and risk factors of hypoadrenocorticism in dogs under UK primary veterinary care.

Materials and Methods

Dogs diagnosed with hypoadrenocorticism were identified from the UK VetCompass™ programme by searching anonymised electronic patient records. Pre‐existing and newly diagnosed cases of disease during 2016 were included. Cases were further sub‐categorised as having a laboratory‐confirmed or presumed diagnosis of hypoadrenocorticism based on the information recorded in the electronic patient records. Descriptive data were manually extracted. Multivariable logistic regression methods were used to identify demographic risk factors.

Results

There were 177 hypoadrenocorticism cases identified from 905,543 dogs in 2016; 72 laboratory‐confirmed and 105 presumed. The 1‐year period prevalence for hypoadrenocorticism in all dogs was 0.06% (95% confidence interval: 0.05‐0.07%). The most common presenting clinical signs in laboratory‐confirmed dogs were lethargy (51/66, 77.3%), anorexia (48/66, 66.7%) and vomiting (48/66, 66.7%). Hyperkalaemia was reported in 47 of 53 (88.7%), hyponatraemia in 46 of 53 (86.8%). Median sodium: potassium ratio was 19.00 (interquartile range: 16.20‐20.60). Breed, age, neuter status and insurance status were associated with a laboratory‐confirmed diagnosis of hypoadrenocorticism. No sex association with hypoadrenocorticism was observed in the multivariable model. The standard poodle had 51.38 times the odds (95% CI: 14.49‐182.18) of hypoadrenocorticism compared with crossbreeds. The labradoodle and West Highland white terrier also had increased odds.

Clinical Significance

This is the first epidemiological study to report on hypoadrenocorticism in dogs within the UK primary‐care population. These results provide benchmark data of current veterinary activity relating to hypoadrenocorticism in primary‐care practices.
Multi‐omic dissection of the drought resistance traits of soybean landrace LX
Authors: Zhao Bing , Zhang Shulin , Yang Wenqi , Li Bingyan , Lan Chen , Zhang Junli , Yuan Li , Wang Yu , Xie Qiguang , Han Jiwan , Mur Luis A. J. , Hao Xingyu , Roberts Jeremy A. , Miao Yuchen , Yu Ke , Zhang Xuebin
Published: February 2021

With diverse genetic backgrounds, soybean landraces are valuable resource for breeding programs. Herein, we apply multi‐omic approaches to extensively characterize the molecular basis of drought tolerance in the soybean landrace LX. Initial screens established that LX performed better with PEG6000 treatment than control cultivars. LX germinated better than William 82 under drought conditions and accumulated more anthocyanin and flavonoids. Untargeted mass spectrometry in combination with transcriptomic analyses revealed the chemical diversity and genetic basis underlying the overall performance of LX landrace. Under control and drought conditions, significant differences in the expression of a suite of secondary metabolism genes, particularly those involved in the general phenylpropanoid pathway and flavonoid but not lignin biosynthesis, were seen in LX and William 82. The expression of these genes correlated with the corresponding metabolites in LX plants. Further correlation analysis between metabolites and transcripts identified pathway structural genes and transcription factors likely are responsible for the LX agronomic traits. The activities of some key biosynthetic genes or regulators were confirmed through heterologous expression in transgenic Arabidopsis and hairy root transformation in soybean. We propose a regulatory mechanism based on flavonoid secondary metabolism and adaptive traits of this landrace which could be of relevance to cultivated soybean.
Temperature effects on gated silicon field emission array performance
Authors: Bhattacharya Ranajoy , Karaulac Nedeljko , Chern Winston , Akinwande Akintunde Ibitayo , Browning Jim
Published: February 2021

Silicon field emitter arrays (Si FEAs) are being explored as an electron source for vacuum channel transistors for high temperature electronics. Arrays of 1000 × 1000 silicon tip based gated field emitters were studied by measuring their electrical characteristics up to 40 V of DC gate bias with a 1.3 mA emission current at different temperatures from 25 to 400 °C. At ∼350 °C, residual gas analyzer measurements show that water desorption and carbon dioxide partial pressures increase significantly, the gate to emitter leakage current decreases by more than ten times, and the collector current increases by more than ten times. These improvements remained after heat-treatment but were then lost once the device was exposed to the atmosphere for several days. The improvements could be recovered upon additional baking suggesting that adsorbates (primarily water) on the surface affected field emission and surface leakage. It was also found that after heat-treatment, the electrical characteristics of the devices exhibited <3% variation in collector current at 40 V, which (without exposure to the atmosphere) can be termed as a weak temperature dependence. These results suggest that Si FEAs could be viable as a high temperature transistor.
Heart-Rate Variability Recording Time and Performance in Collegiate Female Rowers
Authors: Sherman Sara R. , Holmes Clifton J. , Hornikel Bjoern , MacDonald Hayley V. , Fedewa Michael V. , Esco Michael R.
Published: February 2021

Purpose: To assess the agreement of the root mean square of successive R-R interval (RMSSD) values when recorded immediately upon waking to values recorded later in the morning prior to practice, and to determine the associations of the RMSSD recordings with performance outcomes in female rowers. Methods: A total of 31 National Collegiate Athletic Association Division I rowers were monitored for 6 consecutive days. Two seated RMSSD measurements were obtained on at least 3 mornings using a smartphone-based photoplethysmography application. Each 1-minute RMSSD measure was recorded following a 1-minute stabilization period. The first (T1) measurement occurred at the athlete’s home following waking, while the second (T2) transpired upon arrival at the team’s boathouse immediately before practice. From the measures, the RMSSD mean and coefficient of variation were calculated. Two objective performance assessments were conducted on an indoor rowing ergometer on separate days: 2000-m time trial and distance covered in 30 minutes. Interteam rank was determined by the coaches, based on subjective and objective performance markers. Results: The RMSSD mean (intraclass correlation coefficient = .82; 95% CI, .63 to .92) and RMSSD coefficient of variation (intraclass correlation coefficient = .75; 95% CI, .48 to .88) were strongly correlated at T1 and T2, P < .001. The RMSSD mean at T1 and T2 was moderately associated with athlete rank (r = −.55 and r = −.46, respectively), 30-minute distance (r = .40 and r = .41, respectively), and 2000 m at T1 (r = −.37), P < .05. No significant correlations were observed for the RMSSD coefficient of variation. Conclusion: Ultrashort RMSSD measurements taken immediately upon waking show very strong agreement with those taken later in the morning, at the practice facility. Future research should more thoroughly investigate the relationship between specific performance indices and the RMSSD mean and coefficient of variation for female collegiate rowers.
Relationship Between Wellness Index and Internal Training Load in Soccer: Application of a Machine Learning Model
Authors: Perri Enrico , Simonelli Carlo , Rossi Alessio , Trecroci Athos , Alberti Giampietro , Iaia F. Marcello
Published: February 2021

Purpose: To investigate the relationship between the training load (TL = rate of perceived exertion × training time) and wellness index (WI) in soccer. Methods: The WI and TL data were recorded from 28 subelite players (age = 20.9 [2.4] y; height = 181.0 [5.8] cm; body mass = 72.0 [4.4] kg) throughout the 2017/2018 season. Predictive models were constructed using a supervised machine learning method that predicts the WI according to the planned TL. The validity of our predictive model was assessed by comparing the classification’s accuracy with the one computed from a baseline that randomly assigns a class to an example by respecting the distribution of classes (B1). Results: A higher TL was reported after the games and during match day (MD)-5 and MD-4, while a higher WI was recorded on the following days (MD-6, MD-4, and MD-3, respectively). A significant correlation was reported between daily TL (TLMDi) and WI measured the day after (WIMDi+1) (r = .72, P < .001). Additionally, a similar weekly pattern seems to be repeating itself throughout the season in both TL and WI. Nevertheless, the higher accuracy of ordinal regression (39% [2%]) compared with the results obtained by baseline B1 (21% [1%]) demonstrated that the machine learning approach used in this study can predict the WI according to the TL performed the day before (MD<i). Conclusion: The machine learning technique can be used to predict the WI based on a targeted weekly TL. Such an approach may contribute to enhancing the training-induced adaptations, maximizing the players’ readiness and reducing the potential drops in performance associated with poor wellness scores.
Muscle Fiber Typology and Its Association With Start and Turn Performance in Elite Swimmers
Authors: Mallett Adam , Bellinger Phillip , Derave Wim , Lievens Eline , Kennedy Ben , Rice Hal , Minahan Clare
Published: February 2021

Purpose: To determine the association between estimated muscle fiber typology and the start and turn phases of elite swimmers during competition. Methods: International and national competition racing performance was analyzed from 21 female (FINA points = 894 ± 39: 104.5 ± 1.8% world record ratio [WRR]) and 25 male (FINA points = 885 ± 54: 104.8 ± 2.1% WRR) elite swimmers. The start, turn, and turn out times were determined from each of the swimmers’ career best performance times (FINA points = 889 ± 48: 104.7 ± 2.0% WRR). Muscle carnosine concentration was quantified by proton magnetic resonance spectroscopy in the gastrocnemius and soleus and was expressed as a carnosine aggregate z score relative to an age- and gender-matched nonathlete control group to estimate muscle fiber typology. Linear mixed models were employed to determine the association between muscle fiber typology and the start and turn times. Results: While there was no significant influence of carnosine aggregate z score on the start and turn times when all strokes and distance events were entered into the model, the swimmers with a higher carnosine aggregate z score (ie, faster muscle typology) had a significantly faster start time in 100-m events compared with the swimmers with a lower carnosine aggregate z score (P = .02, F = 5.825). The start and turn times were significantly faster in the male compared with the female swimmers in the 100-m events compared with other distances, and between the 4 different swimming strokes (P < .001). Conclusion: This study suggests that start times in sprint events are partly determined (and limited) by muscle fiber typology, which is highly relevant when ∼12% of the overall performance time is determined from the start time.
Experimental and theoretical explorations of nanocarriers’ multistep delivery performance for rational design and anticancer prediction
Authors: Bao Weier , Tian Falin , Lyu Chengliang , Liu Bin , Li Bin , Zhang Luyao , Liu Xianwu , Li Feng , Li Dan , Gao Xiaoyong , Wang Shuo , Wei Wei , Shi Xinghua , Li Yuan
Published: February 2021

An α-lactalbumin-based anticancer nanocarrier platform was designed for efficient rational design and potent in vivo prediction.
Denitrifying pathways dominate nitrous oxide emissions from managed grassland during drought and rewetting
Authors: Harris E. , Diaz-Pines E. , Stoll E. , Schloter M. , Schulz S. , Duffner C. , Li K. , Moore K. L. , Ingrisch J. , Reinthaler D. , Zechmeister-Boltenstern S. , Glatzel S. , Brüggemann N. , Bahn M.
Published: February 2021

Isotopic measurements showed that N
2
O production during drought is unexpectedly dominated by denitrification of organic nitrogen.
Vacancy ordering induced topological electronic transition in bulk Eu
2
ZnSb
2
Authors: Yao Honghao , Chen Chen , Xue Wenhua , Bai Fengxian , Cao Feng , Lan Yucheng , Liu Xingjun , Wang Yumei , Singh David J. , Lin Xi , Zhang Qian
Published: February 2021

Topological electronic structures emerge from order in a high-performance Zintl-phase thermoelectric.
Parallel, linear, and subnanometric 3D tracking of microparticles with Stereo Darkfield Interferometry
Authors: Rieu Martin , Vieille Thibault , Radou Gaël , Jeanneret Raphaël , Ruiz-Gutierrez Nadia , Ducos Bertrand , Allemand Jean-François , Croquette Vincent
Published: February 2021

Inserting a simple mask in a microscope enables 3D tracking of single cells and subnanometer force spectroscopy.
Myosin-driven actin-microtubule networks exhibit self-organized contractile dynamics
Authors: Lee Gloria , Leech Gregor , Rust Michael J. , Das Moumita , McGorty Ryan J. , Ross Jennifer L. , Robertson-Anderson Rae M.
Published: February 2021

Microtubules enable organized myosin-driven contraction by providing flexural rigidity and enhanced connectivity to actin networks.
Nsp1 protein of SARS-CoV-2 disrupts the mRNA export machinery to inhibit host gene expression
Authors: Zhang Ke , Miorin Lisa , Makio Tadashi , Dehghan Ishmael , Gao Shengyan , Xie Yihu , Zhong Hualin , Esparza Matthew , Kehrer Thomas , Kumar Anil , Hobman Tom C. , Ptak Christopher , Gao Boning , Minna John D. , Chen Zhijian , García-Sastre Adolfo , Ren Yi , Wozniak Richard W. , Fontoura Beatriz M.A.
Published: February 2021

SARS-CoV-2 Nsp1 protein binds the mRNA export receptor NXF1-NXT1 to inhibit nuclear export of mRNAs and promote infection.
Effect of Membrane Potential on Entry of Lactoferricin B-Derived 6-Residue Antimicrobial Peptide into Single Escherichia coli Cells and Lipid Vesicles
Authors: Hossain Farzana , Dohra Hideo , Yamazaki Masahito
Published: February 2021

Bacterial cells have a membrane potential (Δφ), but the effect of Δφ on the action of cell-penetrating peptide-type antimicrobial peptides (AMPs) is not clear. Here, we investigated the effect of Δφ on the action of a fluorescent probe-labeled AMP derived from lactoferricin B, Rh-LfcinB(4–9).
DNA Detectives: Outreach Activity Teaching Students to Identify Fish Eggs Using DNA Barcoding
†
Authors: Kerr Makenzie , Breitbart Mya
Published: February 2021

Fish are an important resource worldwide and their management requires a combination of strategies, including the protection of spawning areas. However, the identification of fish early life stages, especially fish eggs, is challenging due to the lack of distinguishing morphological features.
Microscopic Communities: Interdisciplinary Exploration of Microbes in the Classroom
†
Authors: Surtees Jennifer A. , Small Sandra K. , Tripp Jennifer N. , Shanahan Lynn E.
Published: February 2021

Children are aware of microbes from a young age and are rightly encouraged to wash their hands to prevent illness. However, myriad microbes live in, on, and around us, most of which are benign or beneficial.
Goggles and White Lab Coats: Students’ Perspectives on Scientists and the Continued Need to Challenge Stereotypes
Authors: Gormally Cara , Inghram Rachel
Published: February 2021

For undergraduate students, feeling an affinity with a science community is a key factor related to interest and persistence in science. Thus, how students perceive scientists can affect their sense of belonging.
Functional optimisation in chondrosarcoma of the subglottis: a novel surgical approach
Authors: Daniels Jessica , Durant Susanna , Goswamy Jay
Published: February 2021

Chondrosarcoma of the larynx is rare accounting for approximately 1% of laryngeal cancers; clear cell subtype is a rare variant. Given the low risk of occult nodal disease, they present a unique opportunity to maximise tissue preservation in order to optimise both recovery and long-term functional outcomes. We present a case of laryngeal clear cell chondrosarcoma causing critical airway obstruction. An emergency tracheostomy was performed and mapping biopsies were taken. The tumour originated from the cricoid and extended into both arytenoid superstructures precluding cricotracheal resection. A modified narrow-field laryngectomy was performed, preserving all pharyngeal mucosa and neurovascularly intact infrahyoids. Organ preservation surgery is preferred in the management of laryngeal chondrosarcoma. If laryngectomy is required, the surgeon must ensure that all uninvolved, functional tissue is preserved carefully to improve swallow and voice outcomes postoperatively. We describe a novel technique used to achieve this outcome.
Methicillin-resistantStaphylococcus aureus(MRSA) panniculitis in a patient undergoing stem cell mobilisation
Authors: Ng Ada Pei Yu , Chee Yen-Lin , Wong SB Justin , Jen Wei-Ying
Published: February 2021

Methicillin-resistantStaphylococcus aureus(MRSA) can cause a wide range of skin infections, however MRSA panniculitis without bacteremia is a rare manifestation. Here, we report a woman in her 20s with relapsed Hodgkin lymphoma undergoing stem cell mobilisation who presented with bilateral subcutaneous nodules over her shins. Ultrasound scan of one nodule showed non-specific inflammatory changes. Punch biopsy of a nodule showed lobular panniculitis with Gram-positive cocci. Blood cultures were negative but a culture from the biopsy grew MRSA. She was started on doxycycline with improvement in her symptoms. This case serves as a reminder to consider infections as a cause of panniculitis in immunocompromised patients.
Syndrome of inappropriate antidiuretic hormone secretion in a patient with pituitary apoplexy
Authors: Sonmez Ince Melda , Banka Ajaz
Published: February 2021

Pituitary apoplexy (PA) is an endocrine emergency presenting with headache, visual and hormonal disturbances. Syndrome of inappropriate antidiuretic hormone secretion (SIADH) is rare after PA. A 64-year-old woman presented with acute frontal headache and nausea with normal neurological examination. Labs included normal sodium and creatinine. Echo showed new-onset congestive heart failure (CHF) and MRI of the brain revealed PA. She had normal cortisol levels and low thyroid stimulating hormone with normal thyroxine (T4) levels. During her hospitalisation, patient developed hyponatraemia. Initially, this was attributed to CHF and she was treated with tolvaptan with normalisation of sodium. One week later, she was readmitted with diarrhoea and hyponatraemia. She was euvolaemic on examination indicating compensated CHF. Despite fluid challenge, patient had no improvement of sodium levels. The diagnosis of SIADH was made. Clinicians should suspect SIADH in patients with hyponatraemia in the setting of PA with normal T4and cortisol levels.
Transulnar coronary intervention complicated by compartment syndrome
Authors: Smits Matthijs W L , van der Schaaf Rene J , Herrman Jean-Paul , Kuipers Remko S
Published: February 2021

We describe a case of a compartment syndrome after transulnar coronary intervention. As far as we are aware of, this is the first report of such a complication after a transulnar approach described in the literature. Compartment syndrome is a very rare but possibly devastating complication of coronary angiography and percutaneous coronary interventions. We retrospectively observed an incidence rate of 0.007% after 13,948 coronary angiographies or 0.013% after 7532 interventions performed through the wrist in our centre in the last 5 years. Rapid recognition and treatment of this rare complication may prevent long-term morbidity and are thus of utmost importance. General measures should be taken to reduce this incidence of this serious complication.
Organisational aspects and assessment practices of Australian memory clinics: an Australian Dementia Network (ADNeT) Survey
Authors: Mehrani Inga , Kochan Nicole A , Ong Min Yee , Crawford John D , Naismith Sharon L , Sachdev Perminder S
Published: February 2021

Objectives

Conducting a national survey of clinicians and administrators from specialised dementia assessment services (memory clinics) in Australia to examine their current organisational aspects and assessment procedures and inform clinical tool harmonisation as part of the Australian Dementia Network—memory clinics project.

Design

A cross-sectional survey.

Setting

Public and private memory clinics across Australia.

Participants

150 individual clinicians completed the survey between May and August 2019. Responses could be given anonymously. Most clinics were publicly funded services (83.2%) and in metropolitan regions (70.9%).

Outcome measures

Descriptive data on organisational aspects of memory clinics (eg, waiting times, staffing); the three most commonly used assessment tools per assessment type (eg, self-report) and cognitive domain (eg, attention).

Results

Since the last national survey in 2009, the number of memory clinics across Australia has increased substantially but considerable variability has remained with respect to funding structure, staffing and assessment procedures. The average clinic employed 2.4 effective full-time staff (range 0.14–14.0). The reported waiting time for an initial assessment ranged from 1 week to 12 months with a median of 7 weeks. While most clinics (97%) offered follow-up assessments for their clients, only a few (31%) offered any form of cognitive intervention. We identified over 100 different cognitive assessment tools that were used at least ‘sometimes’, with widespread use of well-established core screening tools and a subset of common neuropsychological tests.

Conclusion

This paper presents a current snapshot of Australian memory clinics, showing considerable heterogeneity with some common core elements. These results will inform the development of national memory clinic guidelines. Furthermore, our data make a valuable contribution to the international comparison of clinical practice standards and advocate for greater harmonisation to ensure high-quality dementia care.
Combination of vasculature targeting, hypofractionated radiotherapy, and immune checkpoint inhibitor elicits potent antitumor immune response and blocks tumor progression
Authors: Pierini Stefano , Mishra Abhishek , Perales-Linares Renzo , Uribe-Herranz Mireia , Beghi Silvia , Giglio Andrea , Pustylnikov Sergei , Costabile Francesca , Rafail Stavros , Amici Augusto , Facciponte John G , Koumenis Costantinos , Facciabene Andrea
Published: February 2021

Background

Tumor endothelial marker 1 (TEM1) is a protein expressed in the tumor-associated endothelium and/or stroma of various types of cancer. We previously demonstrated that immunization with a plasmid-DNA vaccine targeting TEM1 reduced tumor progression in three murine cancer models. Radiation therapy (RT) is an established cancer modality used in more than 50% of patients with solid tumors. RT can induce tumor-associated vasculature injury, triggering immunogenic cell death and inhibition of the irradiated tumor and distant non-irradiated tumor growth (abscopal effect). Combination treatment of RT with TEM1 immunotherapy may complement and augment established immune checkpoint blockade.

Methods

Mice bearing bilateral subcutaneous CT26 colorectal or TC1 lung tumors were treated with a novel heterologous TEM1-based vaccine, in combination with RT, and anti-programmed death-ligand 1 (PD-L1) antibody or combinations of these therapies, tumor growth of irradiated and abscopal tumors was subsequently assessed. Analysis of tumor blood perfusion was evaluated by CD31 staining and Doppler ultrasound imaging. Immunophenotyping of peripheral and tumor-infiltrating immune cells as well as functional analysis was analyzed by flow cytometry, ELISpot assay and adoptive cell transfer (ACT) experiments.

Results

We demonstrate that addition of RT to heterologous TEM1 vaccination reduces progression of CT26 and TC1 irradiated and abscopal distant tumors as compared with either single treatment. Mechanistically, RT increased major histocompatibility complex class I molecule (MHCI) expression on endothelial cells and improved immune recognition of the endothelium by anti-TEM1 T cells with subsequent severe vascular damage as measured by reduced microvascular density and tumor blood perfusion. Heterologous TEM1 vaccine and RT combination therapy boosted tumor-associated antigen (TAA) cross-priming (ie, anti-gp70) and augmented programmed cell death protein 1 (PD-1)/PD-L1 signaling within CT26 tumor. Blocking the PD-1/PD-L1 axis in combination with dual therapy further increased the antitumor effect and gp70-specific immune responses. ACT experiments show that anti-gp70 T cells are required for the antitumor effects of the combination therapy.

Conclusion

Our findings describe novel cooperative mechanisms between heterologous TEM1 vaccination and RT, highlighting the pivotal role that TAA cross-priming plays for an effective antitumor strategy. Furthermore, we provide rationale for using heterologous TEM1 vaccination and RT as an add-on to immune checkpoint blockade as triple combination therapy into early-phase clinical trials.
Ipilimumab and nivolumab/pembrolizumab in advanced hepatocellular carcinoma refractory to prior immune checkpoint inhibitors
Authors: Wong Jeffrey Sum Lung , Kwok Gerry Gin Wai , Tang Vikki , Li Bryan Cho Wing , Leung Roland , Chiu Joanne , Ma Ka Wing , She Wong Hoi , Tsang Josephine , Lo Chung Mau , Cheung Tan To , Yau Thomas
Published: February 2021

Background

Programmed cell death protein 1 (PD-1) pathway blockade with immune checkpoint inhibitors (ICIs) is a standard therapy in advanced hepatocellular carcinoma (HCC) nowadays. No strategies to overcome ICI resistance have been described. We aimed to evaluate the use of ipilimumab and anti-PD-1 ICIs (nivolumab or pembrolizumab) combinations in patients with advanced HCC with progression on prior ICIs.

Methods

Patients with advanced HCC with documented tumor progression on prior ICIs and subsequently received ipilimumab with nivolumab/pembrolizumab were analyzed. Objective response rate (ORR), median duration of response (DOR), time-to-progression (TTP), overall survival (OS), and treatment-related adverse events (TRAEs) were assessed.

Results

Twenty-five patients were included. The median age was 62 (range: 51–83). About 68% were of Child-Pugh (CP) Grade A and 48% had primary resistance to prior ICI. At median follow-up of 37.7 months, the ORR was 16% with a median DOR of 11.5 months (range: 2.76–30.3). Three patients achieved complete response. The median TTP was 2.96 months (95% CI: 1.61 to 4.31). Median OS was 10.9 months (95% CI: 3.99 to 17.8) and the 1 year, 2 year and 3 year survival rates were 42.4%, 32.3% and 21.6%, respectively. The ORR was 16.7% in primary resistance group and 15.4% in acquired resistance group (p=1.00). All responders were of CP A and Albumin-Bilirubin (ALBI) Grade 1 or 2. CP and ALBI Grades were significantly associated with OS (p=0.006 and p<0.001, respectively). Overall, 52% of patients experienced TRAEs and 12% experienced Grade 3 or above TRAEs.

Conclusions

Ipilimumab and nivolumab/pembrolizumab can achieve durable antitumor activity and encouraging survival outcomes with acceptable toxicity in patients with advanced HCC who had prior treatment with ICIs.
The ALPHA Project: Establishing consensus and prioritisation of global community recommendations to address major challenges in lupus diagnosis, care, treatment and research
Authors: Tse Karin , Sangodkar Sanjyot , Bloch Lauren , Arntsen Kathleen , Bae Sang-Cheol , Bruce Ian N , Connolly-Strong Erin , Costenbader Karen H , Dickerson Bradley , Dörner Thomas , Evans Sydney , Kalunian Kenneth , Kao Amy H , Manzi Susan , Morand Eric F , Raymond Sandra C , Rovin Brad H , Schanberg Laura Eve , Von Feldt Joan M , Werth Victoria P , Williams Derricott Angel , Zook David , Franson Timothy , Getz Kenneth , Peña Yaritza , Hanrahan Leslie M
Published: February 2021

The Addressing Lupus Pillars for Health Advancement (ALPHA) Project is a global consensus effort to identify, prioritise and address top barriers in lupus impacting diagnosis, care, treatment and research. To conduct this process, the ALPHA Project convened a multistakeholder Global Advisory Committee (GAC) of lupus experts and collected input from global audiences, including patients. In phase I, the ALPHA Project used expert interviews and a global survey of lupus experts to identify and categorise barriers into three overarching pillars: drug development, clinical care and access to care. In phase II, reported here, the GAC developed recommended actionable solutions to address these previously identified barriers through an in-person stakeholder meeting, followed by a two-round scoring process. Recommendations were assessed for feasibility, impact and timeline for implementation (FIT), where potential FIT component values were between 1 and 3 and total scores were between 3 and 9. Higher scores represented higher achievability based on the composite of the three criteria. Simplifying and standardising outcomes measures, including steroid sparing as an outcome (drug development) and defining the lupus spectrum (clinical care) ranked as the highest two priority solutions during the GAC meeting and received high FIT scores (7.67 and 7.44, respectively). Leveraging social media (access to care) received the highest FIT score across all pillars (7.86). Cross-cutting themes of many solutions include leveraging digital technology and applying specific considerations for special populations, including paediatrics. Implementing the recommendations to address key barriers to drug development, clinical care and access to care is essential to improving the quality of life of adults and children with lupus. Multistakeholder collaboration and guidance across existing efforts globally is warranted.
Health-related quality of life 1–3 years post-myocardial infarction: its impact on prognosis
Authors: Pocock Stuart , Brieger David B , Owen Ruth , Chen Jiyan , Cohen Mauricio G , Goodman Shaun , Granger Christopher B , Nicolau José C , Simon Tabassome , Westermann Dirk , Yasuda Satoshi , Hedman Katarina , Mellström Carl , Andersson Sundell Karolina , Grieve Richard
Published: February 2021

Objective

To assess associations of health-related quality of life (HRQoL) with patient profile, resource use, cardiovascular (CV) events and mortality in stable patients post-myocardial infarction (MI).

Methods

The global, prospective, observational TIGRIS Study enrolled 9126 patients 1–3 years post-MI. HRQoL was assessed at enrolment and 6-month intervals using the patient-reported EuroQol-5 dimension (EQ-5D) questionnaire, with scores anchored at 0 (worst possible) and 1 (perfect health). Resource use, CV events and mortality were recorded during 2-years’ follow-up. Regression models estimated the associations of index score at enrolment with patient characteristics, resource use, CV events and mortality over 2-years’ follow-up.

Results

Among 8978 patients who completed the EQ-5D questionnaire, 52% reported ‘some’ or ‘severe’ problems on one or more health dimensions. Factors associated with a lower index score were: female sex, older age, obesity, smoking, higher heart rate, less formal education, presence of comorbidity (eg, angina, stroke), emergency room visit in the previous 6 months and non-ST-elevation MI as the index event. Compared with an index score of 1 at enrolment, a lower index score was associated with higher risk of all-cause death, with an adjusted rate ratio of 3.09 (95% CI 2.20 to 4.31), and of a CV event, with a rate ratio of 2.31 (95% CI 1.76 to 3.03). Patients with lower index score at enrolment had almost two times as many hospitalisations over 2-years’ follow-up.

Conclusions

Clinicians managing patients post-acute coronary syndrome should recognise that a poorer HRQoL is clearly linked to risk of hospitalisations, major CV events and death.

Trial registration number

ClinicalTrials.gov Registry (NCT01866904) (https://clinicaltrials.gov).
Natural course of tricuspid regurgitation and prognostic implications
Authors: Bannehr Marwin , Edlinger Christoph Roland , Kahn Ulrike , Liebchen Josephin , Okamoto Maki , Hähnel Valentin , Dworok Victoria , Schipmann Fabian , Kücken Tanja , Bramlage Karin , Bramlage Peter , Haase-Fielitz Anja , Butter Christian
Published: February 2021

Objective

Functional tricuspid regurgitation (TR) is a frequent finding in echocardiography. Literature suggests significant TR is associated with poor prognosis. Still, data remain limited. This study aimed to evaluate long-term prognostic implications in patients with TR.

Methods

In this observational cohort study, data from 1650 consecutive patients were analysed. Primary endpoint was all-cause mortality. Mean follow-up time was 1090 days. TR grades at baseline and follow-up were compared. Survival analyses were performed to identify prognostic factors.

Results

At baseline, 14.1% patients showed no, 63.8% mild, 17.4% moderate and 4.7% severe TR. 359 patients (21.8%) died within the study period. TR at baseline was associated with excess mortality. Moderate and severe TR were of prognostic implication in all subgroups irrespective of systolic pulmonary artery pressure (sPAP) (</≥40 mm Hg) and left ventricular ejection fraction (LV-EF) (</≥50%). Survival was worst in patients with moderate and severe TR and concomitant elevated sPAP or reduced LV-EF at 1 and 3 years, respectively (p<0.001; p<0.001). In a multivariate model, including cardiac and non-cardiac risk factors, moderate and severe TR, sPAP and impaired right ventricular (RV) function were independent predictors for survival (HR 1.89, CI 1.07 to 3.36, p=0.029; HR 2.93, CI 1.57 to 5.49, p=0.001; HR 1.44, CI 1.25 to 1.65, p<0.001; HR 1.43, CI 1.14 to 1.79, p=0.002). Overall progression of TR on follow-up was 28.4%. Patients with TR progression showed significantly worse survival (HR 1.44, CI 1.11 to 1.81; p=0.006).

Conclusion

While TR progressed over time, it was associated with impaired long-term survival. TR grade, RV dysfunction, sPAP and TR progression were independent predictors for survival.