bluuebunny/crossref_metadata_2025 huggingface dataset:
Phosphodiesterase-5 Inhibitors for Premature Ejaculation: Systematic Review and Meta-Analysis of Placebo-Controlled Trials
Authors: Zhang Xuebao , Chi Nan , Sun Miao , Shan Zhengfei , Zhang Yulian , Cui Yuanshan
Published: May 2020

The purpose of this analysis is to assess the efficacy and safety of phosphodiesterase-5 inhibitors (PDE5Is) for the treatment of premature ejaculation (PE). A comprehensive search was performed to ascertain from trials about PDE5Is for the treatment of PE and compare the results, including intravaginal ejaculatory latency time (IVELT), score of sexual satisfaction scale, and side effects, between the group treated with PDE5Is and that treated with placebo. Seven studies involving a total of 471 patients were included in this meta-analysis. This analysis showed that patients who were treated with PDE5Is had significantly increased IVELT (mean difference [MD] 2.60; 95% CI [1.85, 3.36]; p < .00001) and score of sexual satisfaction scale (MD 2.04; 95% CI [0.78, 3.30]; p = .002) compared with the group on placebo. More patients had side effects while taking PDE5Is, such as headache, dizziness, flushing, and nasal congestion. PDE5Is were significantly more effective than placebo in the treatment of PE. Side effects were more common among patients who were treated with PDE5Is.
Adaptive sliding mode control for disturbed multirobot systems performing target tracking under continuously time-varying topologies
Authors: Dong Lijing , Han Chongchong , Du Shengli
Published: May 2020

This article studies coordination control of the multirobot system for target tracking problem with disturbances in time-varying communication environment. An adaptive sliding mode control is designed to complete the target tracking task with the effect of disturbances and continuously time-varying topologies. This means that the communication between the robots is not switching among constant topologies but changes continuously along with time. The continuously time-varying topology is constructed by a set of fixed Laplacian matrices and variable scheduling functions, which is known as polytopic model structure. The designed adaptive sliding mode control can effectively lower the influence of disturbance and improve tracking performance even under the continuously time-varying topology. Furthermore, numerical simulations are given to demonstrate the effectiveness of the obtained results.
Diagnosis and management of inflammatory bowel disease-associated neoplasia: considerations in the modern era
Authors: Axelrad Jordan E. , Shah Shailja C.
Published: May 2020

Patients with inflammatory bowel disease (IBD) are at an increased risk of developing intestinal neoplasia—particularly colorectal neoplasia, including dysplasia and colorectal cancer (CRC)—as a primary consequence of chronic inflammation. While the current incidence of CRC in IBD is lower compared with prior decades, due, in large part, to more effective therapies and improved colonoscopic technologies, CRC still accounts for a significant proportion of IBD-related deaths. The focus of this review is on the pathogenesis; epidemiology, including disease- and patient-related risk factors; diagnosis; surveillance; and management of IBD-associated neoplasia.
A phase II study of atezolizumab for pretreated advanced/recurrent non-small cell lung cancer with idiopathic interstitial pneumonias: rationale and design for the TORG1936/AMBITIOUS study
Authors: Ikeda Satoshi , Kato Terufumi , Kenmotsu Hirotsugu , Ogura Takashi , Iwasawa Shunichiro , Iwasawa Tae , Kasajima Rika , Miyagi Yohei , Misumi Toshihiro , Yamanaka Takeharu , Okamoto Hiroaki
Published: May 2020

Background:

Approximately 10% of patients with non-small cell lung cancer (NSCLC) are complicated with comorbid interstitial pneumonia (IP) with a poor prognosis. The pharmacotherapy for advanced lung cancer occasionally induces fatal acute exacerbation of pre-existing IP. Due to the lack of prospective studies, there is an urgent need to establish a safe and effective pharmacotherapy, especially for second-line or later settings. Atezolizumab, an anti-programmed cell death-ligand 1 antibody, is thought to be the safest candidate for second-line therapy among various immune checkpoint inhibitors. Moreover, compared with patients without IP, the patients with comorbid IP may have higher tumor mutation burden (TMB) or microsatellite instability (MSI), which are partly associated with a more favorable response to immune checkpoint inhibitors.

Methods:

The Thoracic Oncology Research Group 1936/AMBITIOUS study is an ongoing, multicenter, single-arm, phase II trial to assess the safety and efficacy of atezolizumab for pretreated advanced/recurrent patients with NSCLC complicated with idiopathic, chronic fibrotic IP with a forced vital capacity of >70%. The patients will receive atezolizumab (1200 mg, day 1) every 3 weeks until the discontinuation criteria are met. The primary end point of this study is the 1-year survival rate, and a sample size of 38 patients is set. As a translational research, we will perform the analysis of TMB, somatic mutations, and MSI for nucleic acids extracted from archival tumor samples.

Discussion:

Since there is no standard second-line or later therapy of advanced NSCLC with IP, the results of this study are expected to have a major impact on clinical practice.

Trial registration:

Japan Registry of Clinical Trials, jRCTs031190084, registered 26 August 2019 - retrospectively registered, https://jrct.niph.go.jp/en-latest-detail/jRCTs031190084
Evaluation of Metabolites and Antioxidant Activity in Pumpkin Species
Authors: Abbas Hafiz Muhammad Khalid , Huang He-Xun , Huang Wen-Jie , Xue Shu-Dan , Yan Shi-Juan , Wu Ting-Quan , Li Jun-Xing , Zhong Yu-Juan
Published: May 2020

Cucurbita species ( Cucurbita moschata and Cucurbita maxima) are rich sources of nutrients, especially carotenoids and carbohydrates. Metabolites in pulps of C. moschata and C. maxima lines were examined by high-performance liquid chromatography and gas chromatography–mass spectrometry. Our results revealed that glucose and sucrose were the dominant sugars in C. maxima and C. moschata, respectively. A correlation was found between Brix percentage and sucrose levels as compared with glucose and fructose. A greater amount of myo-inositol had accumulated in C. moschata lines compared with C. maxima. Conversely, total carotenoids and antioxidant activity were found to be higher in C. maxima lines than in C. moschata. A strong correlation of glucose, fructose, and sucrose with β-carotene and violaxanthin revealed that it will be difficult to develop pumpkin cultivars with both high inositol and carotenoid levels. In conclusion, the composition of carbohydrates and carotenoids was more diverse in C. moschata lines than in C. maxima lines. Our results will contribute to a better understanding of metabolite changes in the fruits of these as well as other pumpkin species.
The Role of C-8 OH on the Antioxidant Activity of Norwogonin and Isowogonin
Authors: Zhang Qiushan , Shao Jin , Zhao Tong , He Lei , Ma Huiping , Jing Linlin
Published: May 2020

In the present study, the antioxidant property of 4 flavones (moslosooflavone, wogonin, isowogonin, and norwogonin) was evaluated using 6 different assays: 1,1-diphenyl-2-picrylhydrazyl (DPPH·), superoxide (O2 •−), and nitric oxide (NO) radical scavenging assays, ferrous iron chelation, reducing power, and total antioxidant capacity. The 4 flavones exhibited antioxidant activities with decreasing order as norwogonin > isowogonin >> wogonin> moslosooflavone. The present results demonstrated that norwogonin and isowogonin exhibited excellent antioxidant activity, which was mainly based on the presence of C-8 hydroxyl group.
Patient perspectives and experience on the diagnostic pathway of lung cancer: A qualitative study
Authors: Christensen Helle Marie , Huniche Lotte
Published: May 2020

Objectives:

Lung cancer is one of the most common types of cancer, with high mortality rate and a significant burden of symptoms. It is therefore important to assess patients’ perceived quality of life during the diagnostic process and treatment. Knowledge of and attention to patients’ perspectives, experiences, and expectations in relation to lung cancer diagnostic pathways is limited. The aim of the study is to contribute with patients’ and relatives’ experiences with and their assessment of the quality of a hospital-based lung cancer diagnostic pathway.

Methods:

A qualitative study was conducted, comprising participant observation with 20 patients and semi-structured interviews with further 19 patients referred to the Lung Cancer Package, which initiates a fast track diagnostic pathway in a hospital setting. Data were obtained over a period of 9 months and analysed in collaboration with an interdisciplinary team of health professionals. The purpose was to further develop existing management strategies of the fast track diagnostic pathway based on patient’s perspectives.

Results:

Patients associated the fast track diagnostic pathway with high levels of anxiety due to the immediate risk of a lung cancer diagnosis. Although patients experienced the fast track programme as very challenging, they still wanted to move through the diagnostic pathway as quickly as possible. The patients expressed a need for support from relatives and repeatedly required information in multiple formats from health professionals throughout the diagnostic pathway.

Conclusions:

The study provided insight into the need for developing the fast track diagnostic pathway with a focus on patient anxiety, network involvement, and information strategies. The results qualified clinical practice with an increased focus on managing patients’ anxiety, raised awareness to involve relatives in the diagnostic process, and relaying information in dialogue with patients and their relatives, including management strategies to support patients through diagnostic investigations in the fast track programme.
Altered cardiorespiratory regulation during exercise in patients with Parkinson’s disease: A challenging non-motor feature
Authors: Sabino-Carvalho Jeann L , Vianna Lauro C
Published: May 2020

The incidence of Parkinson’s disease is increasing worldwide. The motor dysfunctions are the hallmark of the disease, but patients also experience non-motor impairments, and over 40% of the patients experience coexistent abnormalities, such as orthostatic hypotension. Exercise training has been suggested as a coping resource to alleviate Parkinson’s disease symptoms and delay disease progression. However, the body of knowledge is showing that the cardiovascular response to exercise in patients with Parkinson’s disease is altered. Adequate cardiovascular and hemodynamic adjustments to exercise are necessary to meet the metabolic demands of working skeletal muscle properly. Therefore, since Parkinson’s disease affects parasympathetic and sympathetic branches of the autonomic nervous system and the latter are crucial in ensuring these adjustments are adequately made, the understanding of these responses during exercise in this population is necessary. Several neural control mechanisms are responsible for the autonomic changes in the cardiovascular and hemodynamic systems seen during exercise. In this sense, the purpose of the present work is to review the current knowledge regarding the cardiovascular responses to dynamic and isometric/resistance exercise as well as the mechanisms by which the body maintains appropriate perfusion pressure to all organs during exercise in patients with Parkinson’s disease. Results from patients with Parkinson’s disease and animal models of Parkinson’s disease provide the reader with a well-rounded knowledge base. Through this, we will highlight what is known and not known about how the neural control of circulation is responding during exercise and the adaptations that occur when individuals exercise regularly.
Pseudomonas aeruginosa infection of shoulder joint after latissimus dorsi tendon transfer: A case report
Authors: Panella Antonio , Baglioni Marco , Rifino Francesco , De Crescenzo Angelo , Notarnicola Angela , Moretti Biagio
Published: May 2020

Infection rates of arthroscopic procedures have been consistently reported at approximately 1% and are even less common in shoulder arthroscopy (0.3%). We are unaware of any prior reports of infection associated with an arthroscopic-assisted latissimus dorsi transfer and report on a 60-year-old male who experienced this event. At the 2-month follow-up, he reported an infection of the shoulder joint, characterized by a fistula on the portal scar. Laboratory tests revealed a Pseudomonas aeruginosa infection which was treated with arthroscopic irrigation and debridement of the shoulder joint followed by oral antibiotics for 6 weeks. At 1-year follow-up no findings of infection were presented. To our knowledge, this is the first case of P. aeruginosa infection of the shoulder after an arthroscopic-assisted latissimus dorsi tendon transfer. Because the empirical pharmacological therapy initially adopted did not produce a clinically important improvement, a more organism-specific antibiotic was used. In conclusion, the key points of positive results were surgical approach with careful washout, debridement of surgical accesses, and targeted antibiotic therapy.
Magnetic resonance imaging to estimate tissue deformations during penile clamp application: A case series
Authors: Lemmens Joe , Peko Cohen Lea , Worsley Peter R , Everitt Chris , Broadbridge Jackie , Gefen Amit , Rees Rowland W , Drake Marcus , Macaulay Margaret C , Fader Mandy , Bader Dan L
Published: May 2020

Background:

Penile clamps provide a means of preventing urinary incontinence in males following radical prostatectomy. In order for the devices to function, significant mechanical loads need to be applied to the penile tissues to close the urethra. However, such loads have the potential to cause damage to the vulnerable skin and underlying soft tissues. Accordingly, the study aimed to estimate the magnitudes of tissue deformations resulting from penile clamp application in three individual cases.

Methods:

Three individuals were recruited who currently use penile clamps to manage urinary incontinence following radical prostatectomy. Magnetic resonance images (MRI) of the penis were taken to produce a series of high contrast coronal and sagittal images both before and during the application of two commercially available clamps, modified for MRI compatibility. Tissue thickness measurements were estimated with the clamps in-situ and normalised to the unloaded baseline state.

Results:

The estimated magnitude of tissue deformations resulting from clamp application ranged between 68% and 84%. There were minimal differences in these deformations between the clamp designs, both of which appeared effective in closing the urethra. Local stress concentrations were observed in the tissues, which were deformed around the shape of the clamp.

Conclusions:

MRI enabled quantification of local tissue deformation during penile clamp application. The results revealed that clamps created large tissue deformations in all three cases, regardless of design. This information could inform the development of new clamp designs and materials to minimise the potential for tissue damage.

Level of evidence:

4
What is the incidence of renal impairment in patients presenting with renal colic?
Authors: Aitken Neill , Nointin Natasha , Bhattacharjee Rahul , Adamson Elliott , Pham Chris , Klim Sharon , Kelly Anne-Maree
Published: May 2020

Objective:

Nonsteroidal anti-inflammatory drugs (NSAIDs) are the recommended agents for treatment of renal colic pain. Some clinicians express concern about their prescription when renal function in unknown. This study aimed to determine the prevalence of renal impairment in patients presenting to emergency departments (ED) with a clinical diagnosis of renal colic.

Patients and methods:

This retrospective observational study included patients with an ED diagnosis of renal colic. Exclusions were patients younger than 18, previous inclusion and missing medical records. The primary outcome of interest was the proportion of patients with abnormal estimated glomerular filtration rate (eGFR), stratified by eGFR group.

Results:

A total of 1805 patients were studied: median age 46 years and 72% male. In the population overall, the proportion with eGFR less than 45 was 2.6% (95% confidence interval (CI) 2–3.4%). In the subgroup without known renal impairment, the proportion with eGFR less than 45 was 1.7% (95% CI 1.2–2.4%). On multivariate analysis, the only variable predictive of eGFR less than 45 in patients without known renal impairment was age 60 years or older (odds ratio 1.09, 95% CI 1.06–1.12).

Conclusion:

The proportion of patients with clinical renal colic who have an eGFR less than 45 at ED presentation is very low (<2%). This evidence supports administration of NSAIDs for pain relief in patients without known renal impairment before eGFR is known.

Level of evidence:

Not applicable for this multicentre audit.
The Effects of Instagram Use, Social Comparison, and Self-Esteem on Social Anxiety: A Survey Study in Singapore
Authors: Jiang Shaohai , Ngien Annabel
Published: May 2020

Social media have been growing rapidly during the past decade. However, it remains unclear whether social media make people more emotionally healthy or less. This study aims to explore the effect of Instagram use on individuals’ social anxiety. With a general basis of the three-stage model of interactive media use for health promotion, we conducted a cross-sectional online survey study ( N = 388) in the context of Singapore and empirically tested a mediation pathway linking Instagram use to social anxiety. The results indicated that Instagram use did not directly increase social anxiety. Instead, social comparison, a proximal outcome, and self-esteem, an intermediate outcome played mediating roles, supporting the complete mediation effects. This finding provides important theoretical and practical implications for the design of health campaigns and education in this digital era to enhance the positive effect of social media on health and emotional well-being.
Concussion disclosure in middle and high school youth: Who gets the message and are they trained to receive it?
Authors: Wicklund Alissa , Coatsworth J Douglas
Published: May 2020

Background

Disclosure of concussion is vital for proper diagnosis and treatment. Youth have many stakeholders to whom they may disclose concussion, including parents, peers, coaches, and school personnel. We examined whom high school and middle school youth report concussion and the level of concussion education of the recipients of the disclosure.

Methods

Data were analyzed from 2362 students, 680 parents, and 150 school personnel who completed an online survey about concussion reporting, education, and training.

Results

Youth were most likely to disclose concussions to parents, particularly mothers, and their peer group. Middle school youth reported to teachers and school nurses at higher rates than high school youth. High school youth were more likely to disclose concussion to coaches and athletic trainers than middle school youth. While mothers were the most likely recipient of youths’ reporting, they were least likely to have received concussion education.

Conclusions

Recipients of youth concussion disclosure differs by school level. Parents are the most common recipients of disclosure. The role of school personnel and coaches changes as youth enter high school. Youth primarily report concussions to parents, yet parents receive the least amount of concussion training. These findings highlight the need for targeted concussion training for stakeholder groups as their role in disclosure may differ by school age.
Tending the Field of Mindfulness-Based Programs: The Development of International Integrity Guidelines for Teachers and Teacher Training
Authors: Kenny Maura , Luck Patricia , Koerbel Lynn
Published: May 2020

Since Jon Kabat-Zinn first introduced a contemporary, secularized application of mindfulness for the relief of pain and stress in physical health-care settings, there has been a significant and rapid expansion of the range of mindfulness-based programs (MBPs) designed for various health care, education, workplace, and other settings. As is common with developing programs, these often run ahead of carefully considered and researched effectiveness evaluations. This raises questions of how to best train mindfulness teachers to skillfully facilitate such interventions while minimizing the potential for harm. In this article, we describe the work of an international group of senior teacher trainers who met to develop guidelines on the ethics and standards for teacher trainers and their training pathways. In this article, we will define MBPs; describe the process by which these international guidelines were developed; and share details of the collaborative team who made up the international network that worked on them. We offer these guidelines as “living documents” that specifically set out: (1) ethical standards for mindfulness teachers and trainers; (2) criteria and standards for teacher trainers; and (3) criteria and standards for training pathways. As “living documents,” these will continue to be commented on and refined over time. Given that MBPs offered within secular settings in most countries currently have limited oversight or accreditation processes, we hope these guidelines will provide support and clarity to the teachers of all established and emerging MBPs, and their trainers and supervisors.
Massive Spondylectomy for Metastatic Spinal Cord Compression From Non–Small-Cell Lung Cancer With Local Failure After Radiotherapy
Authors: Xu Wei , Yang Minglei , Zhao Chenglong , Wang Peng , Deng Kan , Yang Xinghai , Wei Haifeng , Xiao Jianru
Published: May 2020

Study Design.:

A retrospective multivariate analysis.

Objective.:

To analyze clinical outcomes of surgical treatment and prognostic factors of local failure after stereotactic body radiation therapy (SBRT) in patients with spinal metastatic non–small-cell lung cancer (NSCLC).

Methods.:

This study included patients with metastatic spinal cord compression (MSCC) from spinal NSCLC after radiotherapy who received massive spondylectomy for circumferential decompression of spinal cord and reconstruction of spinal stability in our center between May 2006 and February 2017. Neurological function was evaluated using the Frankel score. Overall survival (OS) was estimated by the Kaplan-Meier method. Factors with Pvalues ≤.1 were subjected to multivariate analysis for OS by proportional hazard analysis. Values of P<.05 were considered statistically significant.

Results.:

The mean age of the 55 included patients (36 male and 19 female) was 57.76 ± 8.94 (median 58, range 36-77) years, with a mean postoperative OS of 14.98 ± 14.81 (median 10.0, range 1-84) months. Neurological function was improved in 46 (83.6%) of the 55 patients after surgery. Prognostic analysis suggested that preoperative frankel score (FS) score, visceral metastasis, D-dimer (D-D) level, and neutrophil/lymphocyte ratio (NLR) were independent prognostic factors for selected patients.

Conclusions.:

Massive spondylectomy could provide circumferential decompression and improve the neurological function of patients with MSCC from spinal NSCLC after radiotherapy. A preoperative FS score of C/D, no visceral metastasis, D-D <1000 μg/L, and NLR <5 are predictors of better prognosis.
Theorizing Struggle in the Social Factory
Authors: Mumby Dennis K.
Published: May 2020

This essay explores possibilities for expanding how critical organization scholars theorize and examine processes of struggle in the capital–labor relationship. Arguing for a more expansive conception of the typical sphere of struggle, I explore the intersections of branding, communicative capitalism, and the entrepreneurial self as a way to theorize struggle in the “social factory.” I suggest that the focus of critical scholars on the “indeterminacy of labor” at the point of production as the key to struggle in the capital–labor relationship should be expanded to encompass an exploration of the “politics of indeterminacy” within the broader cycle of value in motion in the capital accumulation process. A politics of indeterminacy attempts to capture the struggles (around meaning, value, affect, identity, etc.) that unfold throughout the sites and stages of the capital accumulation process. Moreover, conceiving of the capital accumulation process as a dialectical movement of the “unity in contradiction” between value and anti-value provides critical scholars with additional conceptual resources to explore struggle in the organizing process.
The sialyltransferase ST3Gal-IV guides murine T-cell progenitors to the thymus
Authors: Sitte Selina , Doehler Daniela , Sperandio Markus , Marth Jamey D. , Voehringer David
Published: May 2020

T lymphocytes are important players in beneficial and detrimental immune responses. In contrast to other lymphocyte populations that develop in the bone marrow, T-cell precursors need to migrate to the thymus for further development. The interaction of P-selectin and P-selectin glycoprotein ligand-1 (PSGL-1) is crucial for thymic entry of T-cell precursors during settings of T-cell lineage reconstitution. PSGL-1 has to be sialylated to function as a ligand for P-selectin, and the sialyltransferase ST3Gal-IV might play a critical role in this process. We therefore investigated the role of ST3Gal-IV for T-cell development using competitive mixed bone marrow chimeric mice. We found that ST3Gal-IV is dispensable for homing and engraftment of hematopoietic precursors in the bone marrow. However, ST3Gal-IV deficiency affects seeding of the thymus by early T-cell progenitors, leading to impaired restoration of the peripheral T-cell compartment. This defect could be restored by ectopic retroviral expression of ST3Gal-IV in hematopoietic stem cells derived from ST3Gal-IV–deficient donor mice. Our findings show that ST3Gal-IV plays a critical and nonredundant role for efficient T-cell lineage reconstitution after bone marrow transplantation.
A survey of the working status of family medicine physicians in clinics and hospitals in Korea
Authors: Shin Hyun-Young
Published: May 2020

Background

In the approximately 35 years since family medicine was established in South Korea, family medicine physicians have sought to expand their expertise to cover clinical fields beyond primary medicine. This study examines their working status and compares the working conditions of family medicine physicians in clinics and hospitals in Korea.

Methods

We conducted an online survey with 4057 family medicine physicians in Korea in 2016. The results were analyzed using descriptive statistics.

Results

Of the respondents, 572 doctors were working in clinics and 441 in hospitals. In the analysis of treatment pattern by doctors, the rate of chronic disease management was 84.7% in clinics and 93.4% in hospitals (p <  0.001), and the rate of diseases covered by national insurance was 74.8% in clinics and 76.9% in hospitals (p = 0.005). Among physicians younger than 40 years, the rate of chronic disease management and diseases covered by national insurance were 64.6 and 68.0% in clinics and 93.6 and 78.5% in hospitals, retrospectively.

Conclusions

Family medicine physicians working in hospitals have higher rates of chronic disease management and diseases covered by national insurance. This discrepancy of treatment pattern became larger for doctors younger than 40 years. More in-depth studies of the treatment pattern and its tendencies between family medicine physicians in clinics and hospitals are needed in the future.
General methods for measuring and comparing medical interventions in childbirth: a framework
Authors: Svelato Alessandro , Ragusa Antonio , Manfredi Piero
Published: May 2020

Background

The continue increase of interventions during labour in low risk population is a controversial issue of the current obstetric literature, given the lack of evidence demonstrating the benefits of unnecessary interventions for women or infants’ health. This makes it important to have approaches to assess the burden of all medical interventions performed.

Methods

Exploiting the nature of childbirth intervention as a staged process, we proposed graphic representations allowing to generate alternative formulas for the simplest measures of the intervention intensity namely, the overall and type-specific treatment ratios. We applied the approach to quantify the change in interventions following a protocol termed Comprehensive Management (CM), using data from Robson classification, collected in a prospective longitudinal cohort study carried out at the Obstetric Unit of the Cà Granda Niguarda Hospital in Milan, Italy.

Results

Following CM a substantial reduction was observed in the Overall Treatment Ratio, as well as in the ratios for augmentation (amniotomy and synthetic oxytocin use) and for caesarean section ratio, without any increase in neonatal and maternal adverse outcomes. The key component of this reduction was the dramatic decline in the proportion of women progressing to augmentation, which resulted not only the most practiced intervention, but also the main door towards further treatments.

Conclusions

The proposed framework, once combined with Robson Classification, provides useful tools to make medical interventions performed during childbirth quantitatively measurable and comparable. The framework allowed to identifying the key components of interventions reduction following CM. In its turn, CM proved useful to reduce the number of medical interventions carried out during childbirth, without worsening neonatal and maternal outcomes.
Are cancer patients better off if they participate in clinical trials? A mixed methods study
Authors: Engelbak Nielsen Zandra , Eriksson Stefan , Schram Harsløf Laurine Bente , Petri Suzanne , Helgesson Gert , Mangset Margrete , Godskesen Tove E.
Published: May 2020

Background

Research and cancer care are closely intertwined; however, it is not clear whether physicians and nurses believe that clinical trials offer the best treatment for patients and, if so, whether this belief is justified. The aim of this study was therefore: (i) to explore how physicians and nurses perceive the benefits of clinical trial participation compared with standard care and (ii) whether it is justified to claim that clinical trial participation improves outcomes for cancer patients.

Methods

A mixed methods approach was used employing semi-structured interviews with 57 physicians and nurses in oncology and haematology and a literature review of the evidence for trial superiority, i.e. the idea that receiving treatment in a clinical trial leads to a better outcome compared with standard care. Inductive thematic analysis was used to examine the interview data. A literature review comprising nine articles was conducted according to a conceptual framework developed by Peppercorn et al. and evaluated recent evidence on trial superiority.

Results

Our findings show that many physicians and nurses make claims supporting trial superiority, however very little evidence is available in the literature comparing outcomes for trial participants and non-participants that supports their assertions.

Conclusions

Despite the recent rapid development and use of targeted therapy and immunotherapy, we find no support for trial participation to provide better outcomes for cancer patients than standard care. Hence, our present results are in line with previous results from Peppercorn et al. A weaker version of the superiority claim is that even if a trial does not bring about a direct positive effect, it brings about indirect positive effects. However, as the value of such indirect effects is dependent on the individual’s specific circumstances and preferences, their existence cannot establish the general claim that treatment in trials is superior. Belief in trial superiority is therefore unfounded. Hence, if such beliefs are communicated to patients in a trial recruitment context, it would provide misleading information. Instead emphasis should be on patients volunteering to give an altruistic contribution to the furthering of knowledge and to the potential benefit of future patients.
Modified percutaneous Kyphoplasty technique in the treatment of osteoporotic thoracolumbar burst fractures: could it reduce the odds of cement leakage?
Authors: Deng Xuan-geng , Xiong Xiao-ming , Wan Dun , Shi Hua-gang , Mei Guo-long , Cui Wei
Published: May 2020

Background

Osteoporotic thoracolumbar burst fracture (OTLBF) is common in seniors. Due to the fracture of the posterior vertebra and spinal canal occupancy, the risk of cement leakage and spine injury is high in OTLBF patients, thus the application of vertebroplasty and kyphoplasty is limited in these patients. This study aims to investigate the efficacy and safety of the modified percutaneous kyphoplasty (MPKP) in the treatment of OTLBF.

Methods

Clinical data of the OTLBF patients treated with MPKP and the osteoporotic thoracolumbar compression fracture (OTLCF) patients undergone PKP from January 2014 to June 2016 were collected. The key procedure of the MPKP was to fill the bone cavity with gel-foam by the first balloon inflation and to press the gel-foam by a second balloon inflation. Pain intensity, Oswestry disability index (ODI), and bone cement leakage of the patients in the two groups were analyzed.

Results

In the burst fracture group, the overall spinal canal occupancy was relatively low, and the maximum occupancy was 1/3 of the sagittal diameter of the spinal canal. The surgical duration was longer in the burst fracture group (39.0 ± 5.0 min with 95% CI: 37.7, 40.3) than in the compression fracture group (31.7 ± 4.3 min with 95% CI: 31.1, 32.3), and the difference between the two groups was statistically significant (Z = -8.668 and P = 0.000). Both the Oswestry disability index (ODI) and the visual analog scales (VAS) were apparently improved, but there was no significant difference between the two groups. Cement leakage occurred in 13 out of the 53 cases (24.5%) in the burst fracture group and 35 out of the 193 cases (18.1%) in the compression fracture group, and there was no significant difference between the two groups (Z = − 1.038 and P = 0.299). Neither group had consequential symptoms, such as spinal cord lesion, pain, and numbness of the peripheral nerve.

Conclusion

Similar to the efficacy of PKP in the treatment of OTLCF, MPKP efficiently reduced the cement leakage rate and improved the safety of the surgery, although it prolonged the surgical duration and introduced more surgical steps.
Practice guidelines on migrants’ health: assessment of their quality and reporting
Authors: Lotfi Tamara , Itani Mohamad I. , Howeiss Pamela , Kilzar Lama , Rizk Nesrine A. , Akl Elie A.
Published: May 2020

Background

Migrants may carry with them communicable and non communicable diseases as they move to the host country. Screening migrants may help in improving their health status and in preventing the spread of infections to the host population.

Objective

To identify and assess the quality of published practice guidelines addressing migrants’ health.

Methods

We included practice guidelines addressing migrants’ health at the clinical, public health or health systems levels. We searched Medline, Embase, the National Guideline Clearinghouse and the Canadian Medical Association’s Clinical Practice Guidelines Database. Two teams of two reviewers conducted in duplicate and independent manner study selection, data abstraction, assessment of the guideline quality (using the AGREE II instrument), and assessment of the quality of the reporting (using the RIGHT statement).

Results

Out of 2732 citations captured by the electronic search, we included 24 eligible practice guidelines, all addressing the level of post-arrival to the host country and published between 2011 and 2017. The majority of guidelines (57%) addressed non-communicable diseases, 95% addressed screening, while 52% addressed prevention and treatment respectively. The majority of the guidelines reported their funding sources. 86% used the GRADE approach as part of the development process. The included guidelines scored high on the majority of the items, and low on the following two domains of the AGREE II instrument: rigor of development and applicability. The mean number of the RIGHT checklist items met by the included guidelines was 27, out of a total of 35. Most of the guidelines were based on systematic reviews (95.6%). A minority of the included guidelines (26%) reported considering the values and preferences of the target populations or the costs and resource implications (30%) in the formulation of recommendations.

Conclusion

We identified 23 practice guidelines addressing migrants’ health, the majority of which addressed screening services. The vast majority of the captured guidelines targeted screening because the population of interest is migrants, meaning that the intention of the guidelines is to deal with additional factors than usual ones, such as prevalence of disease in country of origin, endemic diseases and others.

The guidelines suffered limitations on two quality domains (rigor of development and applicability), and have room for improvement of their reporting.
Point‐of‐care bedside ultrasound examination for the exclusion of clinically significant ankle and fifth metatarsal bone fractures; a single blinded prospective diagnostic cohort study
Authors: Crombach Aniek , Azizi Nasim , Lameijer Heleen , El Moumni Mostafa , ter Maaten Jan C.
Published: May 2020

Objective

The aim of this study was to assess the diagnostic value of point‐of‐care bedside ultrasound (PoCUS) as in usual clinical practice in suspected ankle and fifth metatarsal bone fractures, compared to the standard of radiographic imaging.

Methods

This prospective study included patients ≥17 years presenting to the Emergency Department with ankle trauma and positive Ottawa Ankle Rules. All patients underwent PoCUS of the ankle by a (resident) emergency physician, the images were assessed by an ultrasound expert. Both were blinded for the medical history and clinical findings of the patients. Radiography of the ankle followed, evaluated by a radiologist blinded from the PoCUS findings. Primary outcome measures were sensitivity and specificity of PoCUS.

Results

A total of 242 patients were included, with 35 (22%) clinically significant (non‐avulsion) fractures observed with radiography. The sensitivity of PoCUS in detecting clinically significant fractures by all sonographers was 80.0% (95% Confidence Interval (CI) 63.0 to 91.6%), specificity 90.3% (95% CI 83.7 to 94.9%), positive predictive value 70.0% (95% CI 57.0 to 80.3%) and the negative predictive value 94.1% (95% CI 89.1 to 96.9%). The sensitivity of PoCUS in detecting clinically significant fractures by the expert was 82.8% (95% CI 66.3 to 93.4%), specificity 99.2% (95% CI 95.5 to 99.9%), positive predictive value 96.7% (95% CI 80.3 to 99.5%) and the negative predictive value 95.3% (95% CI 91.0 to 98.2%).

Conclusion

PoCUS combined with the OAR has a good diagnostic value in usual clinical practice in the assessment of suspected ankle and fifth metatarsal bone fractures compared to radiographic imaging. More experience with PoCUS will improve the diagnostic value.

Trial registration

Registered in the local Research Register, study number 201500597.
Serum lncRNA HAND2-AS1 is downregulated in diabetic patients with chronic renal failure and ameliorates cell apoptosis
Authors: Dong Changqing , Liu Shengmao , Li Yanling , Cui Yingchun
Published: May 2020

Background

LncRNA HAND2-AS1 has been reported to be a tumor suppressor in several types of malignancy, while its involvement in other human diseases is unclear. Our preliminary RNA-seq analysis revealed the downregulation of lncRNA HAND2-AS1 in diabetic patients with chronic renal failure, indicating the involvement of lncRNA HAND2-AS1 in this disease. This study was therefore carried out to explore the role of lncRNA HAND2-AS1 in the development of chronic renal failure in diabetic patients.

Methods

Mouse podocyte cells and plasma samples of diabetic patients (46 diabetic patients with chronic renal failure, 38 diabetic patients without obvious complications and 42 healthy volunteers) were used in this study. Cell apoptosis assay and PCR were performed.

Results

LncRNA HAND2-AS1 was downregulated in diabetic patients with chronic renal failure but not in diabetic patients without obvious complications. Downregulation of lncRNA HAND2-AS1 distinguished diabetic patients with chronic renal failure from diabetic patients and healthy controls. High glucose environment did not affect the expression of lncRNA HAND2-AS1 in mouse podocyte cells. Overexpression of lncRNA HAND2-AS1 inhibited the apoptosis of mouse podocyte cells under high glucose treatment.

Conclusions

We therefore conclude that lncRNA HAND2-AS1 may participate in the development of chronic renal failure in diabetic patients by regulating cell apoptosis.
Adaptive dictionary learning based on local configuration pattern for face recognition
Authors: Wei Dongmei , Chen Tao , Li Shuwei , Jiang Dongmei , Zhao Yuefeng , Li Tianping
Published: May 2020

Sparse representation based on classification and collaborative representation based classification with regularized least square has been successfully used in face recognition. The over-completed dictionary is crucial for the approaches based on sparse representation or collaborative representation because it directly determines recognition accuracy and recognition time. In this paper, we proposed an algorithm of adaptive dictionary learning according to the inputting testing image. First, nearest neighbors of the testing image are labeled in local configuration pattern (LCP) subspace employing statistical similarity and configuration similarity defined in this paper. Then the face images labeled as nearest neighbors are used as atoms to build the adaptive representation dictionary, which means all atoms of this dictionary are nearest neighbors and they are more similar to the testing image in structure. Finally, the testing image is collaboratively represented and classified class by class with this proposed adaptive over-completed compact dictionary. Nearest neighbors are labeled by local binary pattern and microscopic feature in the very low dimension LCP subspace, so the labeling is very fast. The number of nearest neighbors is changeable for the different testing samples and is much less than that of all training samples generally, which significantly reduces the computational cost. In addition, atoms of this proposed dictionary are these high dimension face image vectors but not lower dimension LCP feature vectors, which ensures not only that the information included in face image is not lost but also that the atoms are more similar to the testing image in structure, which greatly increases the recognition accuracy. We also use the Fisher ratio to assess the robustness of this proposed dictionary. The extensive experiments on representative face databases with variations of lighting, expression, pose, and occlusion demonstrate that the proposed approach is superior both in recognition time and in accuracy.
A survey of fuzzy logic in wireless localization
Authors: Alakhras Marwan , Oussalah Mourad , Hussein Mousa
Published: May 2020

Positioning and location estimation of targets either for mobile or stationary nodes is very important, especially after the astonishing developments of the wired and/or wireless communications, as well as the popularity of handheld devices. To assist in accessing services or managing resources, numerous users, application developers, and service providers require accurate position information. Owing to the boom of multisensory systems, wireless technology, and autonomous systems, many positioning systems have been proposed. These positioning systems differ based on the adopted technology, type of sensory information, communication protocol, algorithm, and accuracy level. These different approaches impose a non-negligible amount of uncertainty and challenges; in such case, fuzzy-logic-based localization systems offer an attractive and feasible approach to overcome some of the reported challenges and handle uncertainties, depending on its proven mathematical framework for handling vagueness and uncertainty. Intuitively, fuzzy sets and fuzzy inference systems are initially intended to incorporate granularity and flexibility of human knowledge, which characterize complex system behaviors without explicitly requiring precise mathematical models or when a complete and exhaustive list of comprehending factors are ill known.

This study demonstrates the benefits of fuzzy sets, fuzzy logic, and fuzzy inference systems in wireless positioning problems. Notably, as a way to benefit both the academic community and practitioners of system positioning, we review and investigate various fuzzy-related techniques and methodologies. To the best of our knowledge, this is the first comprehensive review that focuses solely on fuzzy-based positioning systems.
Determining optimal strategies for primary prevention of cardiovascular disease: systematic review, cost-effectiveness review and network meta-analysis protocol
Authors: Uthman Olalekan A. , Al-Khudairy Lena , Nduka Chidozie U. , Court Rachel , Mistry Hema , Melendez-Torres G . J. , Taylor-Phillips Sian , Clarke Aileen
Published: May 2020

Background

Despite recent improvements in the burden of cardiovascular disease (CVD) in the UK, deaths from CVD are relatively high compared with other high-income countries. An estimated 7 million people in the UK are living with CVD, and the healthcare cost is approximately £11 billion annually. In more than 90% of cases, the risk of a first heart attack is thought to be related to modifiable risk factors including smoking, poor diet, lipidemia, high blood pressure, inactivity, obesity and excess alcohol consumption. The aim of the study is to synthesise evidence for the comparative effectiveness and cost-effectiveness of different interventions for the primary prevention of CVD.

Methods

We will systematically search databases (for example, MEDLINE (Ovid), Embase (Ovid), Cochrane Library) and the reference lists of previous systematic reviews for randomised controlled trials that assess the effectiveness and cost-effectiveness of any form of intervention aimed at adult populations for the primary prevention of CVD, including but not limited to lipid lowering medications, blood pressure lowering medications, antiplatelet agents, nutritional supplements, dietary interventions, health promotion programmes, physical activity interventions or structural and policy interventions. Interventions may or may not be targeted at high-risk groups. Publications from any year will be considered for inclusion. The primary outcome will be all cause mortality. Secondary outcomes will be cardiovascular diseases related mortality, major cardiovascular events, coronary heart disease, incremental costs per quality-adjusted life years gained. If data permits, we will use network meta-analysis to compare and rank effectiveness of different interventions, and test effect modification of intervention effectiveness using subgroup analyses and meta-regression analyses.

Discussion

The results will be important for policymakers when making decisions between multiple possible alternative strategies to prevent CVD. Compared to results from existing multiple separate pairwise meta-analyses, this overarching synthesis of all relevant work will enhance decision-making. The findings will be crucial to inform evidence-based priorities and guidelines for policies and planning prevention strategies of CVD.

Systematic review registration

PROSPERO CRD42019123940.
Coupled elliptic systems depending on the gradient with nonlocal BCs in exterior domains
Authors: Cianciaruso Filomena , Muglia Luigi , Pietramala Paolamaria
Published: May 2020

We study the existence and multiplicity of positive radial solutions for a coupled elliptic system in exterior domains where the nonlinearities depend on the gradients and the boundary conditions are nonlocal. We use a new cone to establish the existence of solutions by means of fixed point index theory.