bluuebunny/crossref_metadata_2025 huggingface dataset:
Cochlear Implantation in Infants: Evidence of Safety
Authors: Deep Nicholas L. , Purcell Patricia L. , Gordon Karen A. , Papsin Blake C. , Roland Jr. J. Thomas , Waltzman Susan B.
Published: May 2021

The aim of this study was to investigate surgical, anesthetic, and device-related complications associated with cochlear implantation (CI) in children younger than 1 year of age. This was a multicenter, retrospective chart review of all children with severe-to-profound sensorineural hearing loss who underwent cochlear implantation with a Cochlear Nucleus Implant System before 1 year of age. Endpoints included perioperative course, major and minor surgical, anesthetic and device-related complications, and 30-day readmission rates. One hundred thirty-six infants (242 ears) met criteria. The mean age at implantation was 9.4 months (standard deviation 1.8). Six-month follow-up was reported in all patients. There were no major anesthetic or device-related complications. Adverse events were reported in 34 of implanted ears (14%; 7 major, 27 minor). Sixteen adverse events occurred ≤30 days of surgery, and 18 occurred >30 days of surgery. The 30-day readmission rate was 1.5%. The rate of adverse events did not correlate with preexisting medical comorbidities or duration under anesthesia. There was no significant difference detected in complication rate for patients younger than 9 months of age versus those 9 to 11 months of age. This study demonstrates the safety of CI surgery in infants and supports reducing the indication for cochlear implantation to younger than 1 year of age for children with bilateral, profound sensorineural hearing loss obtaining a Cochlear Nucleus Implant System.
Explaining the Care Experiences of Mothers of Children with Hirschsprung’s Disease: A Qualitative Study
Authors: Abbasiasl Hourieh , Hakim Ashrafalsadat , Zarea Kourosh
Published: May 2021

Hirschsprung’s disease is a gastrointestinal anomalies that disrupts excretion. In this disease, like other chronic diseases; mothers undergo a lot of care. Considering the concept of nursing care, it is important to understand the care and its effects on the parents, the child, and care improvement. The purpose of this study is to understand the care experiences of parents of children with Hirschsprung’s disease. In this qualitative study which was performed by content analysis approach, 12 participants were selected from mothers of children with Hirschsprung’s disease who were referred to pediatric surgeries through purposeful sampling. The data collection method was a half-structured interview. All interviews were recorded and then were handwritten word by word and data were analyzed using Elo and Kyngas qualitative content analysis method. Data analysis began from the time of the first interview and in parallel to the next interviews (simultaneous analysis). At the beginning, the first-level coding was done. Data analysis led to the emergence of 3 main themes: “erosion care, socio-economic challenges, acceptance, and position-matching,” and each of the themes included several sub-themes. The results of this study showed that parents of children with Hirschsprung despaired of concern and suffering from care which these suffers included physical, psychological, social, and material dimensions, but was also associated with satisfaction and acceptance of the disease. These findings emphasize that one of the most important tasks of nurses in clinical institutions, especially in relation to these children, is to provide proper family-centered care.
A Conceptual Characterization of Value Creation in Hospitality and Tourism Firms from a Complexity Perspective
Authors: Navarro-Meneses Francisco J
Published: May 2021

Hospitality and tourism firms are suffering more than others the devastating effects of the COVID-19 pandemic. Its recovery will require designing and implementing innovative value creation strategies that are hard to imagine with the simplifying cause-and-effect analytical frameworks so widespread today. Building on the narrative of the firm as a open complex adaptive system and the literature reviewed in economics and management, this article approaches value creation from the paradigm of complexity science and provides a conceptual bases that would allow value practitioners incorporate more realistic and holistic elements to its analysis. Several implications are outlined that could result from the adoption of this perspective and that might encourage a change in the mindset of scholars and firms’ managers. Guidelines for deeper exploration of value creation from complexity are also provided that could open new avenues for theoretical and methodological advance.
Hypochlorous Acid 0.01% vs Povidone-Iodine 5% for Ocular Antisepsis
Authors: Hejkal Thomas W. , Maloley Lauren A. , Kaddoura Layan
Published: May 2021

Purpose:

An alternative ocular antiseptic is needed for patients who do not tolerate povidone-iodine (PI). The purpose of this study is to compare the antimicrobial effect of hypochlorous acid (HA) 0.01% with PI 5% applied topically to the ocular surface.

Methods:

Swabs of the inferior conjunctiva and posterior lower eyelid margin of 40 patients were taken from both eyes and plated onto blood agar plates. One eye was treated with HA and the other with PI, and swabs were taken after 1-minute exposure. The eye treated with PI was rinsed with sterile saline and another swab was taken. Colony-forming units (CFUs) were recorded after 2 days. Patients rated the level of irritation after treatment in each eye.

Results:

HA and PI both gave significant reduction in CFUs from baseline ( P < .001 for HA and P = .002 for PI). The mean reduction in logCFU ± 95% CI was 0.850 ± 0.387 or greater for HA and 0.749 ± 0.385 or greater for PI; this was equivalent to a mean reduction of 7.1-fold or greater or 86% or greater (95% CI, 66%-94%) for HA and 5.6-fold or greater or 82% or greater (95% CI, 57%-93%) for PI. CFUs increased in 17 eyes after saline rinse. PI caused substantial irritation in 31 of the 40 participants, whereas no individuals had any irritation from topical HA.

Conclusions:

Both HA and PI were effective in reducing ocular bacterial load. Unlike PI, HA was not irritating to the eye. Saline rinse after topical PI may increase bacterial counts in some individuals.
Supporting a Merger of Entrepreneurship Curricula: Combining Organizational Frames and Theory of Change
Authors: Griffin Daniel Jacob , Heinrich William Frank
Published: May 2021

The field of entrepreneurship education is growing in both size and complexity within colleges and universities, leading to needed organization level adjustments. This applied case study (not a teaching case) follows a merger of two educational entities focused on entrepreneurship at Michigan State University (MSU). In a pattern consistent with difficulties experienced by other academic programs, MSU’s programs evolved independently and led to duplicated efforts and confusion for students and staff members. Entrepreneurship program leaders were tasked with merging two units and aligning efforts to improve pedagogical and organizational quality. Scholar practitioner consultants supported a merger process by using organizational frames to analyze previous practices and theory-of-change (ToC) tools to synthesize new designs for a merged unit. Participation in efforts provided an opportunity for personnel in two organizations to co-create and redesign their own program while developing a shared organizational purpose and process. Follow-up surveys and cluster analysis showed that this approach was able to facilitate convergence in mental models of the program and the merger process was met with a high level of approval. Case findings demonstrated that organizational frames and ToC tools have the potential to effectively address challenges in structural, human resource, and pedagogical layers of mergers.
Investigations on the actuation behaviour of friction stir–welded nickel titanium shape memory alloy using continuous fibre laser
Authors: Prabu S. S. Mani , Palani I. A.
Published: May 2021

The friction stir welding (FSW) is found to be an effective solid-state process to join Nickel Titanium (NiTi) shape memory alloy. The retention of shape memory effect has enabled the welded NiTi alloy to be exploited in various functional applications. In this article, the NiTi sheets of 1.2 mm thickness are welded using FSW. The tool selection, geometry design and process parameters required to weld NiTi sheets are explored. Interestingly, an attempt is made to actuate the welded NiTi alloy, using laser actuation technique. The laser beam is scanned over the sample at a particular speed, enabling the increase in temperature suitable for physical actuation. A minimum and maximum displacement of 10 mm and 28 mm are recorded for the laser powers of 10 W and 50 W, respectively. Apart from laser actuation, the dynamic mechanical analysis of the welded NiTi alloy is investigated.
Prisoner-on-prisoner drug searches in prisons in England and Wales: ‘Business as usual’
Authors: Wilkinson Joanne , Fleming Jenny
Published: May 2021

Prisoner reported drug and contraband searches in adult men’s prisons in England and Wales represented almost a quarter of reported and recorded ‘sexual assaults’ from 2004 to 2014. These searches are more likely to involve multiple perpetrators and weapon use than other types of sexual assaults and are most frequently carried out in the relative privacy of a cell. The research presented here is based on an analysis of Her Majesty’s Prison and Probation Service (formerly the National Offender Management Service) Incident Recording System data, providing insights into the proportion of recorded sexual assaults which are related to drug searches. This analysis enables a distinction to be made between prisoner-on-prisoner drug and contraband searches and other sexual assaults. Analysis shows that prisoner-on-prisoner searches are frequent, often pre-meditated, brutal and appear to be an accepted aspect of everyday prison life.
A Novel Therapeutic Approach for Cranial Fasciitis Utilizing Frameless Stereotaxy
Authors: Oliver Jeremie D. , Christian Eisha A. , Cassarino David S. , Francis Stacey H.
Published: May 2021

Cranial fasciitis is a rare cause of a painless, progressive skull mass in the pediatric population, having been described in only 80 cases in the literature to-date. While the etiology remains unknown, the pathogenesis is thought to be a reactive process causing a non-neoplastic fibroblastic proliferation arising from the deep fascia or periosteum of the cranium. Accurate diagnosis may be delayed due to the lack of physical signs and symptoms on presentation, as well as equivocal imaging for the other lesions included in the differential diagnosis. Importantly, in the case of cranial fasciitis, involved tissue is hard to decipher from normal tissue in the cranium, and margin recommendations have not yet been made clear in the current literature. Herein, we present a case of confirmed cranial fasciitis in a 2-year-old female patient in whom frameless stereotaxy was used intraoperatively to determine the extent of the lesion and ensure adequate resection and minimize recurrence risk.
Focused ultrasound enhances the anesthetic effects of topical lidocaine in rats
Authors: Kim Hyun-Chul , Lee Wonhye , Böhlke Mark , Yoon Kyungho , Yoo Seung-Schik
Published: May 2021

Background

High-intensity ultrasound has been used to induce acoustic cavitation in the skin and subsequently enhances skin permeability to deliver hydrophobic topical medications including lidocaine. In contrast, instead of changing skin permeability, pulsed application of low-intensity focused ultrasound (FUS) has shown to non-invasively and temporarily disrupt drug-plasma protein binding, thus has potential to enhance the anesthetic effects of hydrophilic lidocaine hydrochloride through unbinding it from serum/interstitial α1-acid glycoprotein (AAG).

Methods

FUS, operating at fundamental frequency of 500 kHz, was applied pulse-mode (55-ms pulse duration, 4-Hz pulse repetition frequency) at a spatial-peak pulse-average intensity of 5 W/cm2. In vitro equilibrium dialysis was performed to measure the unbound concentration of lidocaine (lidocaine hydrochloride) from dialysis cassettes, one located at the sonication focus and the other outside the sonication path, all immersed in phosphate-buffered saline solution containing both lidocaine (10 µg/mL) and human AAG (5 mg/mL). In subsequent animal experiments (Sprague-Dawley rats, n = 10), somatosensory evoked potential (SSEP), elicited by electrical stimulations to the unilateral hind leg, was measured under three experimental conditions—applications of FUS to the unilateral thigh area at the site of administered topical lidocaine, FUS only, and lidocaine only. Skin temperature was measured before and after sonication. Passive cavitation detection was also performed during sonication to evaluate the presence of FUS-induced cavitation.

Results

Sonication increased the unbound lidocaine concentration (8.7 ± 3.3 %) from the dialysis cassette, compared to that measured outside the sonication path (P < 0.001). Application of FUS alone did not alter the SSEP while administration of lidocaine reduced its P23 component (i.e., a positive peak at 23 ms latency). The FUS combined with lidocaine resulted in a further reduction of the P23 component (in a range of 21.8 − 23.4 ms after the electrical stimulations; F(2,27) = 3.2 − 4.0, P < 0.05), indicative of the enhanced anesthetic effect of the lidocaine. Administration of FUS neither induced cavitation nor altered skin conductance or temperature, suggesting that skin permeability was unaffected.

Conclusions

Unbinding lidocaine from the plasma proteins by exposure to non-thermal low-intensity ultrasound is attributed as the main mechanism behind the observation.
American Society of Anesthesiologists Physical Status Classification as a reliable predictor of postoperative medical complications and mortality following ambulatory surgery: an analysis of 2,089,830 ACS-NSQIP outpatient cases
Authors: Foley Colin , Kendall Mark C. , Apruzzese Patricia , De Oliveira Gildasio S.
Published: May 2021

Background

Seventy percent of surgical procedures are currently performed in the outpatient setting. Although the American Society of Anesthesiologists (ASA) Physical Classification ability to predict risk has been evaluated for in-patient surgeries, an evaluation in outpatient surgeries has yet to be performed. The major goal of the current study is to determine if the ASA classification is an independent predictor for morbidity and mortality for outpatient surgeries.

Methods

The 2005 through 2016 NSQIP Participant Use Data Files were queried to extract all patients scheduled for outpatient surgery. ASA PS class was the primary independent variable of interest. The primary outcome was 30-day medical complications, defined as having one or more of the following postoperative outcomes: (1) deep vein thrombosis, (2) pulmonary embolism, (3) reintubation, (4) failure to wean from ventilator, (5) renal insufficiency, (6) renal failure, (7) stroke, (8) cardiac arrest, (9) myocardial infarction, (10) pneumonia, (11) urinary tract infection, (12) systemic sepsis or septic shock. Mortality was also evaluated as a separate outcome.

Results

A total of 2,089,830 cases were included in the study. 24,777 (1.19%) patients had medical complications and 1,701 (0.08%) died within 30 days. ASA PS IV patients had a much greater chance of dying when compared to healthy patients, OR (95%CI) of 89 (55 to 143), P < 0.001. Nonetheless, over 30,000 ASA PS IV patients had surgery in the outpatient setting. Multivariable analysis demonstrated a stepwise independent association between ASA PS class and medical complications (C statistic = 0.70), mortality (C statistic = 0.74) and readmissions (C statistic = 0.67). Risk stratifying ability was maintained across surgical procedures and anesthesia techniques.

Conclusions

ASA PS class is a simple risk stratification tool for surgeries in the outpatient setting. Patients with higher ASA PS classes subsequently developed medical complications or mortality at a greater frequency than patients with lower ASA PS class after outpatient surgery. Our results suggest that the ambulatory setting may not be able to match the needs of high-risk patients.
A systematic scoping review of approaches to teaching and assessing empathy in medicine
Authors: Zhou Yi Cheng , Tan Shien Ru , Tan Chester Guan Hao , Ng Matthew Song Peng , Lim Kia Hui , Tan Lorraine Hui En , Ong Yun Ting , Cheong Clarissa Wei Shuen , Chin Annelissa Mien Chew , Chiam Min , Chia Elisha Wan Ying , Lim Crystal , Wijaya Limin , Chowdhury Anupama Roy , Kwek Jin Wei , Fong Warren , Somasundaram Nagavalli , Ong Eng Koon , Mason Stephen , Krishna Lalit Kumar Radha
Published: May 2021

Background

Empathy is pivotal to effective clinical care. Yet, the art of nurturing and assessing empathy in medical schools is rarely consistent and poorly studied. To inform future design of programs aimed at nurturing empathy in medical students and doctors, a review is proposed.

Methods

This systematic scoping review (SSR) employs a novel approach called the Systematic Evidence Based Approach (SEBA) to enhance the reproducibility and transparency of the process. This 6-stage SSR in SEBA involved three teams of independent researchers who reviewed eight bibliographic and grey literature databases and performed concurrent thematic and content analysis to evaluate the data.

Results

In total, 24429 abstracts were identified, 1188 reviewed, and 136 included for analysis. Thematic and content analysis revealed five similar themes/categories. These comprised the 1) definition of empathy, 2) approaches to nurturing empathy, 3) methods to assessing empathy, 4) outcome measures, and 5) enablers/barriers to a successful curriculum.

Conclusions

Nurturing empathy in medicine occurs in stages, thus underlining the need for it to be integrated into a formal program built around a spiralled curriculum. We forward a framework built upon these stages and focus attention on effective assessments at each stage of the program. Tellingly, there is also a clear need to consider the link between nurturing empathy and one’s professional identity formation. This foregrounds the need for more effective tools to assess empathy and to better understand their role in longitudinal and portfolio based learning programs.
An online discussion between students and teachers: a way forward for meaningful teacher feedback?
Authors: Hunukumbure Agra Dilshani , Horner Philippa Jane , Fox Jonathan , Thakerar Viral
Published: May 2021

Background

Student evaluation is an essential component in feedback processes in faculty and learner development. Ease of use and low cost have made paper evaluation forms a popular method within teaching programmes, but they are often seen as a formality, offering variable value towards the improvement of teaching. Students report poor motivation to engage with existing feedback tools whilst teachers describe receiving vague, contradicting, or irrelevant information.

We believe that feedback for teachers needs to be a two-way process, similar to feedback for students, for it to be effective. An online feedback tool has been implemented for third-year medical students from Imperial College London to promote open discussion between teachers and students. The feedback tool is accessible throughout students’ clinical attachment with the option of maintaining anonymity. We aim to explore the benefits and challenges of this online feedback tool and assess its value as a method for teacher feedback.

Methods

Qualitative data was obtained from both volunteer third-year medical students of Imperial College London and Clinical Teaching Fellows using three focus groups and a questionnaire. Data was analysed through iterative coding and thematic analysis to provide over-arching analytical themes.

Results

Twenty-nine students trialled this feedback tool with 17 responding to the evaluative questionnaire. Four over-arching themes were identified: reasons for poor participation with traditional feedback tools; student motivators to engage with ‘open feedback’; evaluative benefits from open feedback; concerns and barriers with open feedback.

Conclusion

This feedback tool provides a platform for two-way feedback by encouraging open, transparent discussion between teachers and learners. It gives a unique insight into both teachers and peers’ perspectives. Students engage better when their responses are acknowledged by the teachers. We elaborate on the benefits and challenges of public open feedback and approaches to consider in addressing the self-censorship of critical comments.
A comprehensive survey of developmental programs reveals a dearth of tree-like lineage graphs and ubiquitous regeneration
Authors: Mani Somya , Tlusty Tsvi
Published: May 2021

Background

Multicellular organisms are characterized by a wide diversity of forms and complexity despite a restricted set of key molecules and mechanisms at the base of organismal development. Development combines three basic processes—asymmetric cell division, signaling, and gene regulation—in a multitude of ways to create this overwhelming diversity of multicellular life forms. Here, we use a generative model to test the limits to which such processes can be combined to generate multiple differentiation paths during development, and attempt to chart the diversity of multicellular organisms generated.

Results

We sample millions of biologically feasible developmental schemes, allowing us to comment on the statistical properties of cell differentiation trajectories they produce. We characterize model-generated “organisms” using the graph topology of their cell type lineage maps. Remarkably, tree-type lineage differentiation maps are the rarest in our data. Additionally, a majority of the “organisms” generated by our model appear to be endowed with the ability to regenerate using pluripotent cells.

Conclusions

Our results indicate that, in contrast to common views, cell type lineage graphs are unlikely to be tree-like. Instead, they are more likely to be directed acyclic graphs, with multiple lineages converging on the same terminal cell type. Furthermore, the high incidence of pluripotent cells in model-generated organisms stands in line with the long-standing hypothesis that whole body regeneration is an epiphenomenon of development. We discuss experimentally testable predictions of our model and some ways to adapt the generative framework to test additional hypotheses about general features of development.
Association between MTNR1B polymorphisms and obesity in African American: findings from the Jackson Heart Study
Authors: Tchio Cynthia , Musani Solomon K. , Quarshie Alexander , Tosini Gianluca
Published: May 2021

Background

Melatonin is a hormone that is secreted at night by the pineal gland. It exerts its function by binding to the MT1 and MT2 receptors, which are encoded by the MTNR1A and MTNR1B genes, respectively. Previous studies reveal that MTNR1B variants are associated with insulin secretion impairments and an increased body mass index (BMI) in individuals of European and Asian ancestries. Obesity is highly prevalent in the US and disproportionately affects African Americans. Here, we hypothesized that common single nucleotide polymorphisms (SNPs) imputed in 1000 Genomes in the MTNR1B gene are associated with adiposity in African American adult men and women and that the association is modified by insomnia.

Methods

We used an additive genetic model to describe the association between the adiposity traits (BMI and waist circumference) and selected MTNR1B variants in 3,029 Jackson Heart Study participants, with an average age of 55.13 ± 12.84 years, and 62% were women. We regressed the adiposity measures on the estimated allelic or genotypic dosage at every selected SNP and adjusted for age, sex, population stratification, and insomnia. Thirty common SNPs, spanning the MTNR1B gene, with a minor allele frequency ≥ 5%, a call rate ≥ 90%, a Hardy–Weinberg equilibrium p value > 10–6, were available for the analysis.

Results

The allele T of rs76371840 was associated with adiposity (OR = 1.47 [1.13—1.82]; PFDR-adjusted = 0.0499), and the allele A of rs8192552 showed a significant association with waist circumference (β = 0.023 ± 0.007; PFDR-adjusted = 0.0077) after correcting for multiple testing. When insomnia was included in the adiposity analysis model, the following four variants became significantly associated with adiposity: rs6483208; rs4388843; rs4601728; and rs12804291.

Conclusions

Our data indicate that polymorphisms in the MTNR1B gene are associated with obesity traits in African Americans. To the best of our knowledge, this is the first study to explore the effect of insomnia on the association between the circadian MTNR1B genetic variants and metabolic traits in an African American sample population. We observed that insomnia affected the association between the MTNR1B variants and adiposity.
Estimates of epidemiology, mortality and disease burden associated with progressive fibrosing interstitial lung disease in France (the PROGRESS study)
Authors: Nasser Mouhamad , Larrieu Sophie , Boussel Loic , Si-Mohamed Salim , Bazin Fabienne , Marque Sébastien , Massol Jacques , Thivolet-Bejui Françoise , Chalabreysse Lara , Maucort-Boulch Delphine , Hachulla Eric , Jouneau Stéphane , Le Lay Katell , Cottin Vincent
Published: May 2021

Background

There is a paucity of data on the epidemiology, survival estimates and healthcare resource utilisation and associated costs of patients with progressive fibrosing interstitial lung disease (PF-ILD) in France. An algorithm for extracting claims data was developed to indirectly identify and describe patients with PF-ILD in the French national administrative healthcare database.

Methods

The French healthcare database, the Système National des Données de Santé (SNDS), includes data related to ambulatory care, hospitalisations and death for 98.8% of the population. In this study, algorithms based on age, diagnosis and healthcare consumption were created to identify adult patients with PF-ILD other than idiopathic pulmonary fibrosis between 2010 and 2017. Incidence, prevalence, survival estimates, clinical features and healthcare resource usage and costs were described among patients with PF-ILD.

Results

We identified a total of 14,413 patients with PF-ILD. Almost half of them (48.1%) were female and the mean (± standard deviation) age was 68.4 (± 15.0) years. Between 2010 and 2017, the estimated incidence of PF-ILD ranged from 4.0 to 4.7/100,000 person-years and the estimated prevalence from 6.6 to 19.4/100,000 persons. The main diagnostic categories represented were exposure-related ILD other than hypersensitivity pneumonitis (n = 3486; 24.2%), idiopathic interstitial pneumonia (n = 3113; 21.6%) and rheumatoid arthritis-associated ILD (n = 2521; 17.5%). Median overall survival using Kaplan–Meier estimation was 3.7 years from the start of progression. During the study, 95.2% of patients had ≥ 1 hospitalisation for respiratory care and 34.3% were hospitalised in an intensive care unit. The median (interquartile range) total specific cost per patient during the follow-up period was €25,613 (10,622–54,287) and the median annual cost per patient was €18,362 (6856–52,026), of which €11,784 (3003–42,097) was related to hospitalisations. Limitations included the retrospective design and identification of cases through an algorithm in the absence of chest high-resolution computed tomography scans and pulmonary function tests.

Conclusions

This large, real-world, longitudinal study provides important insights into the characteristics, epidemiology and healthcare resource utilisation and costs associated with PF-ILD in France using a comprehensive and exhaustive database, and provides vital evidence that PF-ILD represents a high burden on both patients and healthcare services.

Trial registration ClinicalTrials.gov, NCT03858842. ISRCTN, ISRCTN12345678. Registered 3 January 2019—Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT03858842
The assessment of risk factors for long-term survival outcome in ypN0 patients with rectal cancer after neoadjuvant therapy and radical anterior resection
Authors: Zeman Marcin , Czarnecki Marek , Chmielik Ewa , Idasiak Adam , Skałba Władysław , Strączyński Mirosław , Paul Piotr J. , Czarniecka Agnieszka
Published: May 2021

Background

The main negative prognostic factors in patients with rectal cancer after radical treatment include regional lymph node involvement, lymphovascular invasion, and perineural invasion. However, some patients still develop cancer recurrence despite the absence of the above risk factors.

The aim of the study was to assess clinicopathological factors influencing long-term oncologic outcomes in ypN0M0 rectal cancer patients after neoadjuvant therapy and radical anterior resection.

Methods

A retrospective survival analysis was performed on a group of 195 patients. We assessed clinicopathological factors which included tumor regression grade, number of lymph nodes in the specimen, Charlson comorbidity index (CCI), and colorectal anastomotic leakage (AL).

Results

In the univariate analysis, AL and CCI > 3 had a significant negative impact on disease-free survival (DFS), disease-specific survival (DSS), and overall survival (OS). After the division of ALs into early and late ALs, it was found that only patients with late ALs had a significantly worse survival. The multivariate Cox regression analysis showed that CCI > 3 was a significant adverse risk factor for DFS (HR 5.78, 95% CI 2.15–15.51, p < 0.001), DSS (HR 7.25, 95% CI 2.25–23.39, p < 0.001), and OS (HR 3.9, 95% CI 1.72–8.85, p = 0.001). Similarly, late ALs had a significant negative impact on the risk of DFS (HR 5.05, 95% CI 1.97–12.93, p < 0.001), DSS (HR 10.84, 95% CI 3.44–34.18, p < 0.001), and OS (HR 4.3, 95% CI 1.94–9.53, p < 0.001).

Conclusions

Late AL and CCI > 3 are the factors that may have an impact on long-term oncologic outcomes. The impact of lymph node yield on understaging was not demonstrated.
Publisher Correction to: Off label use of Aripiprazole shows promise as a treatment for Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS): a retrospective study of 101 patients treated with a low dose of Aripiprazole
Authors:   Journal of Translational Medicine
Published: May 2021

An amendment to this paper has been published and can be accessed via the original article.
From simple and specific zymographic detections to the annotation of a fungus Daldinia caldariorum D263 that encodes a wide range of highly bioactive cellulolytic enzymes
Authors: Lin Meng-Chun , Kuo Hsion-Wen , Kao Mu-Rong , Lin Wen-Dar , Li Chen-Wei , Hung Kuo-Sheng , Yang Sheng-Chih , Yu Su-May , Ho Tuan-Hua David
Published: May 2021

Background

Lignocellulolytic enzymes are essential for agricultural waste disposal and production of renewable bioenergy. Many commercialized cellulase mixtures have been developed, mostly from saprophytic or endophytic fungal species. The cost of complete cellulose digestion is considerable because a wide range of cellulolytic enzymes is needed. However, most fungi can only produce limited range of highly bioactive cellulolytic enzymes. We aimed to investigate a simple yet specific method for discovering unique enzymes so that fungal species producing a diverse group of cellulolytic enzymes can be identified.

Results

The culture medium of an endophytic fungus, Daldinia caldariorum D263, contained a complete set of cellulolytic enzymes capable of effectively digesting cellulose residues into glucose. By taking advantage of the unique product inhibition property of β-glucosidases, we have established an improved zymography method that can easily distinguish β-glucosidase and exoglucanase activity. Our zymography method revealed that D263 can secrete a wide range of highly bioactive cellulases. Analyzing the assembled genome of D263, we found over 100 potential genes for cellulolytic enzymes that are distinct from those of the commercially used fungal species Trichoderma reesei and Aspergillus niger. We further identified several of these cellulolytic enzymes by mass spectrometry.

Conclusions

The genome of Daldinia caldariorum D263 has been sequenced and annotated taking advantage of a simple yet specific zymography method followed by mass spectrometry analysis, and it appears to encode and secrete a wide range of bioactive cellulolytic enzymes. The genome and cellulolytic enzyme secretion of this unique endophytic fungus should be of value for identifying active cellulolytic enzymes that can facilitate conversion of agricultural wastes to fermentable sugars for the industrial production of biofuels.
Hereditary pheochromocytoma/paraganglioma syndrome with a novel mutation in the succinate dehydrogenase subunit B gene in a Japanese family: two case reports
Authors: Hirose Rei , Tsurutani Yuya , Sugisawa Chiho , Inoue Kosuke , Suematsu Sachiko , Nagata Maki , Hasegawa Naoki , Kakuta Yukio , Yonamine Masato , Takekoshi Kazuhiro , Kimura Noriko , Saito Jun , Nishikawa Tetsuo
Published: May 2021

Background

Pheochromocytoma and paraganglioma caused by succinate dehydrogenase gene mutations is called hereditary pheochromocytoma/paraganglioma syndrome. In particular, succinate dehydrogenase subunit B mutations are important because they are strongly associated with the malignant behavior of pheochromocytoma and paraganglioma . This is a case report of a family of hereditary pheochromocytoma/paraganglioma syndrome carrying a novel mutation in succinate dehydrogenase subunit B.

Case presentation

A 19-year-old Japanese woman, whose father died of metastatic paraganglioma, was diagnosed with abdominal paraganglioma, and underwent total resection. Succinate dehydrogenase subunit B genetic testing detected a splice-site mutation, c.424-2delA, in her germline and paraganglioma tissue. Afterwards, the same succinate dehydrogenase subunit B mutation was detected in her father’s paraganglioma tissues.In silicoanalysis predicted the mutation as “disease causing.” She is under close follow-up, and no recurrence or metastasis has been observed for 4 years since surgery.

Conclusions

We detected a novel succinate dehydrogenase subunit B mutation, c.424-2delA, in a Japanese family afflicted with hereditary pheochromocytoma/paraganglioma syndrome and found the mutation to be responsible for hereditary pheochromocytoma/paraganglioma syndrome. This case emphasizes the importance of performing genetic testing for patients with pheochromocytoma and paraganglioma suspected of harboring the succinate dehydrogenase subunit B mutation (that is, metastatic, extra-adrenal, multiple, early onset, and family history of pheochromocytoma and paraganglioma) and offer surveillance screening to mutation carriers.
On instability of Rayleigh–Taylor problem for incompressible liquid crystals under $L^{1}$-norm
Authors: Liu Mengmeng , Lin Xueyun
Published: May 2021

We investigate the nonlinear Rayleigh–Taylor (RT) instability of a nonhomogeneous incompressible nematic liquid crystal in the presence of a uniform gravitational field. We first analyze the linearized equations around the steady state solution. Thus we construct solutions of the linearized problem that grow in time in the Sobolev space $H^{4}$

H
4

, then we show that the RT equilibrium state is linearly unstable. With the help of the established unstable solutions of the linearized problem and error estimates between the linear and nonlinear solutions, we establish the nonlinear instability of the density, the horizontal and vertical velocities under $L^{1}$

L
1

-norm.
Clinical features and prognostic factors of intensive and non-intensive 1014 COVID-19 patients: an experience cohort from Alahsa, Saudi Arabia
Authors: Alhumaid Saad , Al Mutair Abbas , Al Alawi Zainab , Al Salman Khulud , Al Dossary Nourah , Omar Ahmed , Alismail Mossa , Al Ghazal Ali M. , Jubarah Mahdi Bu , Al Shaikh Hanan , Al Mahdi Maher M. , Alsabati Sarah Y. , Philip Dayas K. , Alyousef Mohammed Y. , Al Brahim Abdulsatar H. , Al Athan Maitham S. , Alomran Salamah A. , Ahmed Hatim S. , Al-Shammari Haifa , Elhazmi Alyaa , Rabaan Ali A. , Al-Tawfiq Jaffar A. , Al-Omari Awad
Published: May 2021

Background

COVID-19 is a worldwide pandemic and has placed significant demand for acute and critical care services on hospitals in many countries.

Objectives

To determine the predictors of severe COVID-19 disease requiring admission to an ICU by comparing patients who were ICU admitted to non-ICU groups.

Methods

A cohort study was conducted for the laboratory-confirmed COVID-19 patients who were admitted to six Saudi Ministry of Health’s hospitals in Alahsa, between March 1, 2020, and July 30, 2020, by reviewing patient’s medical records retrospectively.

Results

This cohort included 1014 patients with an overall mean age of 47.2 ± 19.3 years and 582 (57%) were males. A total of 205 (20%) of the hospitalized patients were admitted to the ICU. Hypertension, diabetes and obesity were the most common comorbidities in all study patients (27.2, 19.9, and 9%, respectively). The most prevalent symptoms were cough (47.7%), shortness of breath (35.7%) and fever (34.3%). Compared with non-ICU group, ICU patients had older age (p ≤ 0.0005) and comprised a higher proportion of the current smokers and had higher respiratory rates (p ≤ 0.0005), and more percentage of body temperatures in the range of 37.3–38.0 °C (p ≥ 0.0005); and had more comorbidities including diabetes (p ≤ 0.0005), hypertension (p ≥ 0.0005), obesity (p = 0.048), and sickle cell disease (p = 0.039). There were significant differences between the non-ICU and ICU groups for fever, shortness of breath, cough, fatigue, vomiting, dizziness; elevated white blood cells, neutrophils, alanine aminotransferase and alkaline aminotransferase, lactate dehydrogenase, and ferritin, and decreased hemoglobin; and proportion of abnormal bilateral chest CT images (p < 0.05). Significant differences were also found for multiple treatments (p < 0.05). ICU patients group had a much higher mortality rate than those with non-ICU admission (p ≤ 0.0005).

Conclusion

Identifying key clinical characteristics of COVID-19 that predict ICU admission and high mortality can be useful for frontline healthcare providers in making the right clinical decision under time-sensitive and resource-constricted environment.
Men and muscularity research: a review
Authors: Lennon Sharron J. , Johnson Kim K. P.
Published: May 2021

Over the past 25 years, understanding males’ interest in and outcomes of muscularity has developed into a major area of study. Research has been fueled by the development of measures of both the attitudinal and behavioral aspects of a desire to increase muscularity. Our research purpose was to critically assess muscularity research. Using a database search, the ancestry approach, and searching key journals, we identified empirical refereed journal articles with men as participants published from 2000 to 2019 to serve as our data. Our analyses revealed several individual characteristics (e.g., perfectionism, holding to traditional masculine norms) and socio-cultural influences (e.g., media, verbal commentary) that fueled men’s desire to be muscular. In experimental research, exposure to muscular male ideal images has resulted in low body image scores for young men in investigations that utilized pre-test, post-test designs. In survey research, muscularity was positively related to several risky behaviors or behaviors that could become risky if taken to the extreme. Overall, the reviewed research was conducted in western countries and researchers primarily utilized non-probability samples of undergraduate men. Recommendations for future research are provided.
Cross-sectional evaluation of clinical and immunological parameters at partially microgrooved vs machined abutments in humans
Authors: Iglhaut Gerhard , Salomon Sebastian , Fretwurst Tobias , Thomas Peter , Endres Janina , Kessler Selina , Summer Burkhard
Published: May 2021

Objective

The objective of the present study was to examine the clinical and immunological parameters in samples collected from the peri-implant crevicular fluid (PICF) of machined titanium (M) abutments compared to titanium abutments with a laser-microtextured surface (LMS) on dental implants.

Material and methods

A total of 40 patients with one titanium implant, half of them (n=20) provided with a M abutment (control group) and the other half (n=20) with LMS abutments (test group), were included in the study. Clinical parameters pocket probing depth (PD), full-mouth plaque score (FMPS), radiographic bone loss (RBL), clinical attachment level (CAL), mucosal recession (MR), bleeding on probing (BOP), and width of keratinized mucosa (KM) were evaluated. The peri-implant sulcus fluid was analyzed for cytokines IL-1α, IL-1β, IL-6, IL-8, and IL-10 via flow cytometry.

Results

Clinical evaluation demonstrated no significant difference of PD (mean LMS = 3.50 mm/SD 0.95 mm vs mean M = 3.45 mm/SD 0.76 mm (p=0.855)), MR (mean LMS = 0.30 mm/SD 0.57 mm vs mean M = 0.35 mm/SD 0.67 mm (p=0.801)), CAL (mean LMS = 3.60 mm/SD 1.14 mm vs mean M = 3.55 mm/SD 0.89 mm (p=0.878)), and KM (mean LMS = 2.03 mm/SD 1.08 mm vs mean M = 2.13 mm/SD 0.92 mm (p=0.754)) between LMS and M abutments. LMS abutments showed less BOP than M abutments (26.7% vs 30.8%), but statistically not significant (p = 0.2235). Radiographic bone loss (mean LMS = 0.22 mm/SD 0.44 mm vs mean M = 0.59 mm/SD 0.49 mm) was reduced in the test group in comparison with the control group (p=0.016). In the collected PICF, the levels of pro-inflammatory cytokines IL-1α (median LMS = 180.8 pg/ml vs M = 200.9 pg/ml (p=0.968)) and IL-1β (median LMS = 60.43 pg/ml vs M = 83.11 pg/ml (p=0.4777)) were lower, and the levels of IL-6 (median LMS = 180.8 pg/ml vs M = 200.9 pg/ml (p<0.0001)) were significantly lower in the test group. In contrast, the levels of IL-8 (median LMS = 255.7 pg/ml vs M = 178.7 pg/ml (p=0.3306)) were higher in the test group, though not significantly. The levels of anti-inflammatory IL-10 were significantly increased in the test group (LMS median = 0.555 pg/ml vs M median = 0.465 pg/ml (p=0.0365)). IL-1β showed a significant correlation to radiologic bone loss (p=0.0024). The other variables IL-1α, IL-6, IL-8, and IL-10 had no significant correlation to radiological bone loss.

Conclusion

Within the limitations of this study, titanium implants provided with laser-microtextured surface abutments seem to demonstrate less pro-inflammatory and more anti-inflammatory activity and to show reduced radiographic bone loss compared to machined titanium abutments.

Clinical relevance

The use of laser-microtextured surface abutments might have the potential to support peri-implant tissue health.
Serotype distribution of invasive, non-invasive and carried Streptococcus pneumoniae in Malaysia: a meta-analysis
Authors: Lister Alex J. J. , Le Cheng Foh , Cheah Eddy Seong Guan , Desa Mohd Nasir Mohd , Cleary David W. , Clarke Stuart C.
Published: May 2021

Background

Pneumococcal pneumonia is the leading cause of under-five mortality globally. The surveillance of pneumococcal serotypes is therefore vital for informing pneumococcal vaccination policy and programmes. Pneumococcal conjugate vaccines (PCVs) have been available as an option in the private healthcare setting and beginning December 2020, PCV10 was incorporated as part of routine national immunisation programme (NIP) in Malaysia. We searched existing literature on pneumococcal serotype distribution across Malaysia to provide an overall view of this distribution before the implementation of PCV10.

Methods

Online databases (PubMed, Ovid MEDLINE and Scopus), reference lists of articles identified, and grey literature (Malaysian Ministry of Health website, WHO website) were systematically searched for relevant literature on pneumococcal serotype distribution across Malaysia up to 10th November 2020. No lower date limit was set to maximise the number of target reports returned. Results of serotypes were split by age categories, including ≤5 years, > 5 years and unreported for those that did not specify.

Results

The search returned 18 relevant results, with a total of 2040 isolates. The most common serotypes across all disease types were 19F (n = 313, 15.3% [95%CI: 13.8–17.0]), 23F (n = 166, 8.1% [95%CI: 7.0–9.4]), 14 (n = 166, 8.1% [95%CI: 7.0–9.4]), 6B (n = 163, 8.0% [95%CI: 6.9–9.2]) and 19A (n = 138, 6.8% [95%CI: 5.8–7.9]).

Conclusion

Four of the most common serotypes across all isolate sources in Malaysia are covered by PCV10, while PCV13 provides greater serotype coverage in comparison to PCV10. There is still a need for surveillance studies, particularly those investigating serotypes in children under 5 years of age, to monitor vaccine effectiveness and pneumococcal population dynamic following implementation of PCV10 into routine immunisation.
A Selective Androgen Receptor Modulator (OPK-88004) in Prostate Cancer Survivors: A Randomized Trial
Authors: Pencina Karol M , Burnett Arthur L , Storer Thomas W , Guo Wen , Li Zhuoying , Kibel Adam S , Huang Grace , Blouin Michelle , Berry Donna L , Basaria Shehzad , Bhasin Shalender
Published: May 2021

Background

Androgen deficiency is common among prostate cancer survivors, but many guidelines consider history of prostate cancer a contraindication for testosterone replacement. We determined the safety and efficacy of a selective androgen receptor modulator (OPK-88004) in symptomatic, testosterone-deficient men who had undergone radical prostatectomy for low-grade, organ-confined prostate cancer.

Methods

In this placebo-controlled, randomized, double-blind trial, 114 men, ≥19 years of age, who had undergone radical prostatectomy for low-grade, organ-localized prostate cancer, undetectable PSA (<0.1 ng/mL) for ≥2 years after radical prostatectomy and testosterone deficiency were randomized in stages to placebo or 1, 5, or 15 mg OPK-88004 daily for 12 weeks. Outcomes included PSA recurrence, sexual activity, sexual desire, erectile function, body composition, muscle strength and physical function measures, mood, fatigue, and bone markers.

Results

Participants were on average 67.5 years of age and had severe sexual dysfunction (mean erectile function and sexual desire domain scores 7.3 and 14.6, respectively). No participant experienced PSA recurrence or erythrocytosis. OPK-88004 was associated with a dose-related increase in whole-body (P < 0.001) and appendicular (P < 0.001) lean mass and a significantly greater decrease in percent body fat (P < 0.001) and serum alkaline phosphatase (P < 0.001) than placebo. Changes in sexual activity, sexual desire, erectile function, mood, fatigue, physical performance, and bone markers did not differ among groups (P = 0.73).

Conclusions

Administration of OPK-88004 was safe and not associated with PSA recurrence in androgen-deficient men who had undergone radical prostatectomy for organ-confined prostate cancer. OPK-88004 increased lean body mass and decreased fat mass but did not improve sexual symptoms or physical performance.