bluuebunny/crossref_metadata_2025 huggingface dataset:
Anatomical and functional outcomes after hysterectomy and bilateral sacrospinous ligament fixation for stage IV uterovaginal prolapse: a prospective case series
Authors: Kavvadias Tilemachos , Schoenfisch Birgitt , Brucker Sara Yvonne , Reisenauer Christl
Published: August 2020

Background

Aim of this study is to examine pelvic floor symptoms, anatomical results and patients’ satisfaction after sacrospinous vaginal fixation for stage 4 pelvic organ prolapse.

Methods

All patients with stage 4 pelvic organ prolapse were treated with vaginal hysterectomy, native tissue cystocele and rectocele repair and bilateral sacrospinous vaginal fixation. Anatomical and functional outcomes according to the POPq classification system and the German version of the Australian pelvic floor questionnaire were assessed. Changes between baseline, first follow-up and second follow-up were assessed by the paired Wilcoxon rank test using R, version 3.5.1.

Results

20 patients were included in the study. Scores in all four domains of the pelvic floor symptom questionnaire (bladder, bowel, prolapse, sexual function) were significantly improved at 6 and 12-months follow-up. One patient presented with a symptomatic stage 3 cystocele that needed a second surgical intervention and two patients needed surgery due to a de novo stress urinary incontinence. There were no perioperative adverse events and all patients reported full satisfaction after surgery.

Conclusions

The vaginal approach with hysterectomy, native tissue repair and bilateral sacrospinous vaginal fixation seems to be a safe and effective method for the treatment of advanced stage POP, offering excellent relief in all pelvic floor symptoms.

Trial registration

ClinicalTrials.gov (NCT 02998216), December 20th, 2016.

Prospectively registered.
Highly enhanced ELISA sensitivity using acetylated chitosan surfaces
Authors: García-Maceira Tania , García-Maceira Fé I. , González-Reyes José A. , Paz-Rojas Elier
Published: August 2020

Background

The enzyme-linked immunosorbent assay (ELISA), is the most widely used and reliable clinical routine method for the detection of important protein markers in healthcare. Improving ELISAs is crucial for detecting biomolecules relates to health disorders and facilitating diagnosis at the early diseases stages. Several methods have been developed to improve the ELISA sensitivity through immobilization of antibodies on the microtiter plates. We have developed a highly sensitive ELISA strategy based on the preparation of acetylated chitosan surfaces in order to improve the antibodies orientation.

Results

Chitin surfaces were obtained by mixing small quantities of chitosan and acetic anhydride in each well of a microtiter plate. Anti-c-myc 9E10 low affinity antibody fused to ChBD was cloned and expressed in CHO cells obtaining the anti-c-myc-ChBD antibody. We found that anti c-myc-ChBD binds specifically to the chitin surfaces in comparison with anti-c-myc 9E10, which did not. Chitin surface was used to develop a sandwich ELISA to detect the chimeric human protein c-myc-GST-IL8 cloned and expressed in Escherichia coli. The ELISA assays developed on chitin surfaces were 6-fold more sensitive than those performed on standard surface with significant differences (p<0,0001).

Conclusions

As shown here, acetylated chitosan surfaces improve the antibody orientation on the substrate and constitute a suitable method to replace the standard surfaces given the stability over time and the low cost of its preparation.
Effects of forest structure on the interaction between avian hosts, dipteran vectors and haemosporidian parasites
Authors: van Hoesel Willem , Santiago-Alarcon Diego , Marzal Alfonso , Renner Swen C.
Published: August 2020

Background

Forest habitats are important biodiversity refuges for a wide variety of bird species. Parasitism may modulate host species presence and abundance, and parasite effects can change according to forest management practices. Such processes are not well studied in vector-borne avian haemosporidians. We analyzed the effects of forest management on bird-dipteran-haemosporidian interactions, using seven common bird species in managed and unmanaged beech forest habitats in northeastern Germany. We assumed that forest structural heterogeneity affects parasite population parameters in avian hosts (i.e., prevalence and parasitemia), through its effect on the condition of the avian host but also through varying vector abundances.

Results

Parasite prevalence was high (about 80%) and homogeneous across different beech forest categories (i.e., young, old, unmanaged) and for all bird species, except Erithacus rubecula (35%). Parasitemia varied across bird species but not across forest categories within each avian species (lowest parasitemia were found in E. rubecula, Turdus merula, and Turdus philomelos). In our study system, we found that vector abundance was not the main driver of parasite dynamics. We found that forest structure affects parasite infection probability directly and potentially host condition via available resources that have to be used either to combat infections (i.e., high parasitemia) or to maintain a good body condition.

Conclusions

The effects of each of the predictors were bird species-specific, and we found that Diptera vectors were not the foremost influence in our host-vector-parasite system. Effects of forest habitat variables indicated that for most bird species in this study, habitat regulation of infection probability was more likely (i.e., E. rubecula, Fringilla coelebs, Sylvia atricapilla), whereas for Parus major habitat characteristics impacted first individuals' body condition and subsequently the probability of infection. Our findings emphasize the need of species-specific analyses and to use continuous forest structural parameters (e.g., the proportion of gap, south facing aspect) to better understand habitat and land use effects on host-vector-parasite dynamics.
Attitudes of registered nurses about the end – of – life care in multi-profile hospitals: a cross sectional survey
Authors: Blaževičienė Aurelija , Laurs Lina , Newland Jamesetta A.
Published: August 2020

Background

End-of-life care is provided in a variety of healthcare settings, not just palliative care hospitals. This is one reason why it is very important to assess all barriers to end-of-life care and to provide safe and quality services to patients. This study was aimed at describing nurses’ attitudes in providing end-of-life care and exploring barriers and facilitating behaviors of nurses in multi-profile hospitals in Eastern Europe.

Methods

A descriptive, correlational design was applied in this study, using a cross-sectional survey of 1320 registered nurses within 7 hospitals in Lithuania.

Results

Registered nurses working in the three different profiles emphasized safe and effective care and the importance of meeting the patient’s spiritual needs at the end of life. The main barriers assigned by nurses caring for patients at the end of life were angry family members, inadequate understanding of nursing care by the patient’s relatives; lack of time to talk to patients, lack of nursing knowledge to deal with the bereaved patient’s family, lack of evaluation of nurses’ opinions, and the evasion by physicians to talk about the diagnosis and their over-optimistic view of the situation. The main facilitating behaviors to improve nursing care were end-of-life training, volunteering, and family involvement.

Conclusions

Spiritual needs were identified by nurses as the primary needs of patients at the end of life. Family-related barriers remain one of the main barriers to end-of-life care. Also, the behavior of physicians and their relationship with nurses remains one of the most sensitive issues in end-of-life care.
The experiences of the process of planning, starting and organizing a culturally specific nursing home for Finnish-speaking older persons: a qualitative study
Authors: Hadziabdic Emina , Hjelm Katarina
Published: August 2020

Background

Globally there are growing multicultural and multilingual societies. As a result of extensive international migration, the number of elderly migrants has increased and will further increase in the future. This makes it necessary for elderly healthcare services to meet elderly migrants’ healthcare needs concerning language and cultural barriers. To our knowledge, previous research in the area of culturally specific nursing homes for migrant seniors is still limited. Thus, the study aimed to investigate the experiences of planning, starting and organizing a culturally specific nursing home for Finnish-speaking older persons.

Methods

An explorative qualitative study using both semi-structured individual interviews and focus group interviews as data collection. Thirteen informants were purposively recruited, two from Finnish-speaking association, seven healthcare professionals and two family members. Data were analysed by qualitative content analysis.

Results

Three categories, each with sub-categories, emerged from the data: 1) Motivation to develop this particular culture-specific nursing home; 2) Organizational issues and 3) Aspirations for the future. The study found that information from policy makers, the localization and activities of the nursing home, having healthcare staff who speak the minority language, organizing the nursing home as a mixture of older members of both the majority and the minority communities, all affected the planning, starting and organization of a culturally specific nursing home.

Conclusion

This study found that information, localization, activities and language adapted to elderly migrants affected the planning, starting and organization of a culturally specific nursing home for Finnish-speaking older persons. These findings should support the healthcare organization in planning, managing and organizing sustainable nursing home care for older people belonging to a minority in order to attain the aim of person-centered and equal healthcare.
Considerations for target oxygen saturation in COVID-19 patients: are we under-shooting?
Authors: Shenoy Niraj , Luchtel Rebecca , Gulani Perminder
Published: August 2020

Background

The current target oxygen saturation range for patients with COVID-19 recommended by the National Institutes of Health is 92–96%.

Main body

This article critically examines the evidence guiding current target oxygen saturation recommendation for COVID-19 patients, and raises important concerns in the extrapolation of data from the two studies stated to be guiding the recommendation. Next, it examines the influence of hypoxia on upregulation of ACE2 (target receptor for SARS-CoV-2 entry) expression, with supporting transcriptomic analysis of a publicly available gene expression profile dataset of human renal proximal tubular epithelial cells cultured in normoxic or hypoxic conditions. Finally, it discusses potential implications of specific clinical observations and considerations in COVID-19 patients on target oxygen saturation, such as diffuse systemic endothelitis and microthrombi playing an important pathogenic role in the wide range of systemic manifestations, exacerbation of hypoxic pulmonary vasoconstriction in the setting of pulmonary vascular endothelitis/microthrombi, the phenomenon of “silent hypoxemia” with some patients presenting to the hospital with severe hypoxemia disproportional to symptoms, and overburdened health systems and public health resources in many parts of the world with adverse implications on outpatient monitoring and early institution of oxygen supplementation.

Conclusions

The above factors and analyses, put together, call for an urgent exploration and re-evaluation of target oxygen saturation in COVID-19 patients, both in the inpatient and outpatient settings. Until data from such trials become available, where possible, it may be prudent to target an oxygen saturation at least at the upper end of the recommended 92–96% range in COVID-19 patients both in the inpatient and outpatient settings (in patients that are normoxemic at pre-COVID baseline). Home pulse oximetry, tele-monitoring, and earlier institution of oxygen supplementation for hypoxemic COVID-19 outpatients could be beneficial, where public health resources allow for their implementation.
The potential role of pneumococcal conjugate vaccine in reducing acute respiratory inflammation in community-acquired pneumococcal pneumonia
Authors: Shen Ching-Fen , Wang Shih-Min , Chi Hsin , Huang Yi-Chuan , Huang Li-Min , Huang Yhu-Chering , Lin Hsiao-Chuan , Ho Yu-Huai , Hsiung Chao A. , Liu Ching-Chuan ,   Taiwan Pediatric Infectious Disease Alliance
Published: August 2020

Background

Pneumococcal conjugate vaccine (PCV) reduces both invasive pneumococcal disease (IPD) and other pneumococcal infections worldwide. We investigated the impact of stepwise implementation of childhood PCV programs on the prevalence of pneumococcal pneumonia, severity of acute inflammation, and associations between breakthrough pneumonia and pneumococcal serotypes in Taiwan.

Methods

In total, 983 children diagnosed with community-acquired pneumococcal pneumonia were enrolled between January 2010 and December 2015.

Results

Proportions of pneumococcal vaccinations increased each year in age-stratified groups with PCV7 (32.2%) as the majority, followed by PCV13 (12.2%). The proportion of pneumococcal pneumonia decreased each year in age-stratified groups, especially in 2–5 year group. Serotype 19A is the leading serotype either in vaccinated (6.4%) or unvaccinated patients (5.2%). In particular, vaccinated patients had significantly higher lowest WBC, lower neutrophils, lower lymphocytes and lower CRP values than non-vaccinated patients (p < 0.05). After stratifying patients by breakthrough infection, those with breakthrough pneumococcal infection with vaccine coverage serotypes had more severe pneumonia disease (p < 0.05).

Conclusion

Systematic childhood pneumococcal vaccination reduced the prevalence of community-acquired pneumococcal pneumonia, especially in 2–5 year group. Serotype 19A was the major serotype for all vaccine types in patients with pneumococcal pneumonia and severity of acute inflammatory response was reduced in vaccinated patients.
Differentiating novel coronavirus pneumonia from general pneumonia based on machine learning
Authors: Liu Chenglong , Wang Xiaoyang , Liu Chenbin , Sun Qingfeng , Peng Wenxian
Published: August 2020

Background

Chest CT screening as supplementary means is crucial in diagnosing novel coronavirus pneumonia (COVID-19) with high sensitivity and popularity. Machine learning was adept in discovering intricate structures from CT images and achieved expert-level performance in medical image analysis.

Methods

An integrated machine learning framework on chest CT images for differentiating COVID-19 from general pneumonia (GP) was developed and validated. Seventy-three confirmed COVID-19 cases were consecutively enrolled together with 27 confirmed general pneumonia patients from Ruian People’s Hospital, from January 2020 to March 2020. To accurately classify COVID-19, region of interest (ROI) delineation was implemented based on ground-glass opacities (GGOs) before feature extraction. Then, 34 statistical texture features of COVID-19 and GP ROI images were extracted, including 13 gray-level co-occurrence matrix (GLCM) features, 15 gray-level-gradient co-occurrence matrix (GLGCM) features and 6 histogram features. High-dimensional features impact the classification performance. Thus, ReliefF algorithm was leveraged to select features. The relevance of each feature was the average weights calculated by ReliefF in n times. Features with relevance larger than the empirically set threshold T were selected. After feature selection, the optimal feature set along with 4 other selected feature combinations for comparison were applied to the ensemble of bagged tree (EBT) and four other machine learning classifiers including support vector machine (SVM), logistic regression (LR), decision tree (DT), and K-nearest neighbor with Minkowski distance equal weight (KNN) using tenfold cross-validation.

Results and conclusions

The classification accuracy (ACC), sensitivity (SEN), specificity (SPE) of our proposed method yield 94.16%, 88.62% and 100.00%, respectively. The area under the receiver operating characteristic curve (AUC) was 0.99. The experimental results indicate that the EBT algorithm with statistical textural features based on GGOs for differentiating COVID-19 from general pneumonia achieved high transferability, efficiency, specificity, sensitivity, and impressive accuracy, which is beneficial for inexperienced doctors to more accurately diagnose COVID-19 and essential for controlling the spread of the disease.
Association of CYP19A1 and CYP1A2 genetic polymorphisms with type 2 diabetes mellitus risk in the Chinese Han population
Authors: Yang Yafeng , Wang Ping
Published: August 2020

Background

Type 2 diabetes mellitus (T2DM), one of the global health issues, is a group of metabolic diseases and is affected by several genetic loci in the clinical phenotype. This study intended to ascertain associations betweenCYP19A1andCYP1A2gene polymorphisms with the T2DM risk in Chinese Han.

Methods

Seven single nucleotide polymorphisms (SNPs) in total including five ofCYP19A1(rs4646, rs6493487, rs1062033, rs17601876 and rs3751599) and two ofCYP1A2(rs762551 and rs2470890) from 512 T2DM patients and 515 non-diabetic controls were genotyped in the platform of Agena MassARRAY. SPSS 18.0 was utilized for analyzing genotyping results. Logistic regression models were conducted for the risk assessment by the odds ratios (ORs) and 95% confidence intervals (CIs).

Results

The results suggested a significant association between genotype GC of rs1062033 with a decreased T2DM risk (OR = 0.73, 95% CI = 0.55–0.96,P = 0.025) under the co-dominant (heterozygous) model. The results of stratification analysis with age and gender adjustment revealed that the effects of all selected SNPs inCYP19A1andCYP1A2on the T2DM susceptibility were dependent on age, body mass index (BMI) and disease progression (P <  0.05). The haplotype analysis was further conducted and the results indicated that Crs1062033Grs17601876Ars3751599inCYP19A1played a protective role (OR = 0.48, 95% CI = 0.25–0.91,P = 0.026) in T2DM patients with diabetic retinopathy.

Conclusion

This population-based case-control study suggested thatCYP19A1andCYP1A2variations might affect the susceptibility of T2DM. The findings provide a theoretical basis for searching the clinical therapeutic markers and attractive drug targets of T2DM.
Retraction Note: Endoplasmic reticulum stress triggers Xanthoangelol-induced protective autophagy via activation of JNK/c-Jun Axis in hepatocellular carcinoma
Authors: Li Zichao , Zhang Luying , Gao Mingquan , Han Mei , Liu Kaili , Zhang Zhuang , Gong Zhi , Xing Lifei , Shi Xianzhou , Lu Kui , Gao Hui
Published: August 2020

An amendment to this paper has been published and can be accessed via the original article.
Intrauterine growth restriction alters growth performance, plasma hormones, and small intestinal microbial communities in growing-finishing pigs
Authors: Xiong Liang , You Jinming , Zhang Wanghong , Zhu Qian , Blachier Francois , Yin Yulong , Kong Xiangfeng
Published: August 2020

Background

The interaction of the gut microbiota with key metabolic and physiological processes may be associated with poor growth outcomes in animals born with intrauterine growth restriction (IUGR).

Results

Growth performance, plasma hormone concentrations, and intestinal microbiota composition were analyzed in IUGR pigs and in normal birth weight (NBW) pigs when the NBW pigs reached 25, 50, and 100 kg of body weight (BW). Compared to NBW pigs, IUGR pigs had lower initial, weaned, and final BW, and lower average daily gain and average daily feed intake in all the considered time points. In the 25 kg BW group, IUGR pigs had higher concentrations of plasma ghrelin and pancreatic polypeptide (PP), but lower insulin concentration than NBW pigs, while the situation was reversed in the 50 kg BW group. As compared to NBW pigs, IUGR pigs had higher microbial alpha diversity in the jejunum and ileum; in the 50 and 100 kg BW groups, IUGR pigs had higher Firmicutes abundance but lower Proteobacteria abundance in the jejunum, and lower Lactobacillus abundance in the jejunum and ileum; in the 25 kg BW group, IUGR pigs showed higher unclassified Ruminococcaceae abundance in the ileum; and in 25 and 50 kg BW groups, IUGR pigs showed lower Ochrobactrum abundance in the jejunum. Spearman’s correlation revealed that Lactobacillus was negatively correlated with growth performance, while unclassified Ruminococcaceae was positively correlated. Predictive metagenomic analysis detected significantly different expression of genes in the intestinal microbiota between IUGR and NBW pigs, suggesting different metabolic capabilities between the two groups.

Conclusions

Growing-finishing IUGR pigs showed lower growth performance, higher microbial alpha diversity, and differences in plasma hormone concentrations compared to NBW pigs. Alterations in the abundance of Firmicutes, Proteobacteria, Ruminococcaceae, Lactobacillus, and Ochrobactrum in the small intestine may be associated with IUGR, and may therefore serve as a future target for gut microbiota intervention in growing-finishing IUGR pigs.
China’s practice to prevent and control COVID-19 in the context of large population movement
Authors: Xu Tie-Long , Ao Mei-Ying , Zhou Xu , Zhu Wei-Feng , Nie He-Yun , Fang Jian-He , Sun Xin , Zheng Bin , Chen Xiao-Fan
Published: August 2020

Background

The emerging infectious disease, coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), poses a serious threat in China and worldwide. Challenged by this serious situation, China has taken many measures to contain its transmission. This study aims to systematically review and record these special and effective practices, in hope of benefiting for fighting against the ongoing worldwide pandemic.

Methods

The measures taken by the governments was tracked and sorted on a daily basis from the websites of governmental authorities (e.g. National Health Commission of the People’s Republic of China). And the measures were reviewed and summarized by categorizations, figures and tables, showing an ever-changing process of combating with an emerging infectious disease. The population shift levels, daily local new diagnosed cases, daily mortality and daily local new cured cases were used for measuring the effect of the measures.

Results

The practices could be categorized into active case surveillance, rapid case diagnosis and management, strict follow-up and quarantine of persons with close contacts, and issuance of guidance to help the public understand and adhere to control measures, plus prompt and effective high-level policy decision, complete activation of the public health system, and full involvement of the society. Along with the measures, the population shift levels, daily local new diagnosed cases, and mortality were decreased, and the daily local new cured cases were increased in China.

Conclusions

China’s practices are effective in controlling transmission of SARS-CoV-2. Considering newly occurred situations (e.g. imported cases, work resumption), the control measures may be adjusted.
Children’s Oncology Group AALL0434: A Phase III Randomized Clinical Trial Testing Nelarabine in Newly Diagnosed T-Cell Acute Lymphoblastic Leukemia
Authors: Dunsmore Kimberly P. , Winter Stuart S. , Devidas Meenakshi , Wood Brent L. , Esiashvili Natia , Chen Zhiguo , Eisenberg Nancy , Briegel Nikki , Hayashi Robert J. , Gastier-Foster Julie M. , Carroll Andrew J. , Heerema Nyla A. , Asselin Barbara L. , Rabin Karen R. , Zweidler-Mckay Patrick A. , Raetz Elizabeth A. , Loh Mignon L. , Schultz Kirk R. , Winick Naomi J. , Carroll William L. , Hunger Stephen P.
Published: August 2020

PURPOSE

Nelarabine is effective in inducing remission in patients with relapsed and refractory T-cell acute lymphoblastic leukemia (T-ALL) but has not been fully evaluated in those with newly diagnosed disease.

PATIENTS AND METHODS

From 2007 to 2014, Children’s Oncology Group trial AALL0434 (ClinicalTrials.gov identifier: NCT00408005 ) enrolled 1,562 evaluable patients with T-ALL age 1-31 years who received the augmented Berlin-Frankfurt-Muenster (ABFM) regimen with a 2 × 2 pseudo-factorial randomization to receive escalating-dose methotrexate (MTX) without leucovorin rescue plus pegaspargase (C-MTX) or high-dose MTX (HDMTX) with leucovorin rescue. Intermediate- and high-risk patients were also randomly assigned after induction to receive or not receive six 5-day courses of nelarabine that was incorporated into ABFM. Patients who experienced induction failure were nonrandomly assigned to HDMTX plus nelarabine. Patients with overt CNS disease (CNS3; ≥ 5 WBCs/μL with blasts) received HDMTX and were randomly assigned to receive or not receive nelarabine. All patients, except those with low-risk disease, received cranial irradiation.

RESULTS

The 5-year event-free and overall survival rates were 83.7% ± 1.1% and 89.5% ± 0.9%, respectively. The 5-year disease-free survival (DFS) rates for patients with T-ALL randomly assigned to nelarabine (n = 323) and no nelarabine (n = 336) were 88.2% ± 2.4% and 82.1% ± 2.7%, respectively ( P = .029). Differences between DFS in a four-arm comparison were significant ( P = .01), with no interactions between the MTX and nelarabine randomizations ( P = .41). Patients treated with the best-performing arm, C-MTX plus nelarabine, had a 5-year DFS of 91% (n = 147). Patients who received nelarabine had significantly fewer isolated and combined CNS relapses compared with patients who did not receive nelarabine (1.3% ± 0.63% v 6.9% ± 1.4%, respectively; P = .0001). Toxicities, including neurotoxicity, were acceptable and similar between all four arms.

CONCLUSION

The addition of nelarabine to ABFM therapy improved DFS for children and young adults with newly diagnosed T-ALL without increased toxicity.
Methimazole Treatment and Risk of Acute Pancreatitis: A Population-based Cohort Study
Authors: Pecere Alessandro , Caputo Marina , Sarro Andrea , Ucciero Andrealuna , Zibetti Angelica , Aimaretti Gianluca , Marzullo Paolo , Barone-Adesi Francesco
Published: August 2020

Context

A warning has been recently issued by the European Medicine Agency (EMA) regarding a potential increased risk of acute pancreatitis (AP) in methimazole (MMI) users.

Objective

To investigate the association between MMI and the diagnosis of AP in a population-based study.

Materials and Methods

A retrospective analysis of administrative health databases was conducted (2013–2018). Relevant data were obtained from: (1) inhabitants registry, (2) hospital discharge records (ICD-9-CM 577.0), and (3) drug claims registry (ATC H03BB02). We evaluated AP risk in MMI users in 18 months of treatment, stratifying results by trimester. Poisson regression was used to estimate the age- and sex-adjusted rate ratios (RR), and the relative 95% confidence intervals (CI), comparing rates of AP between MMI users and nonusers. The absolute risk of AP in MMI users was also calculated.

Results

A total of 23 087 new users of MMI were identified. Among them, 61 hospitalizations occurred during the study period. An increase in AP risk was evident during the first 3 trimesters of therapy (RR 3.40 [95% CI: 2.12–5.48]; RR 2.40 [95% CI: 1.36–4.23]; RR 2.80 [95% CI: 1.66–4.73]), but disappeared thereafter. The AP absolute risk in MMI users during the first 18 months of treatment was less than 0.4% in all sex and age classes.

Conclusions

Our results support the EMA warning, suggesting an increased risk of AP associated with MMI use. However, such an increase seems limited to the first months of MMI treatment. Moreover, in absolute terms, the probability of AP is low among patients, well below 1%.
Distant Metastasis in Pediatric and Adolescent Differentiated Thyroid Cancer: Clinical Outcomes and Risk Factor Analyses
Authors: Sugino Kiminori , Nagahama Mitsuji , Kitagawa Wataru , Ohkuwa Keiko , Uruno Takashi , Matsuzu Kenichi , Suzuki Akifumi , Tomoda Chisato , Hames Kiyomi Yamada , Akaishi Junko , Masaki Chie , Ito Koichi
Published: August 2020

Context

The specific characteristics of pediatric and adolescent differentiated thyroid cancer (DTC) is the more frequent occurrence of distant metastasis (DM) compared with adult DTC.

Objective

To investigate the clinical outcomes of DM in this population and analyze risk factors related to DM.

Design, Setting, and Participants

Medical records of 171 patients with DTC < 19 years old, who underwent initial surgery between 1979 and 2014 were retrospectively reviewed.

Main Outcome Measure

Clinical responses to radioiodine (RAI) therapy evaluated by the American Thyroid Association (ATA) guidelines for adult DTC and Response Evaluation Criteria in Solid Tumors (RECIST) criteria. Risk factors related to distant-metastasis-free survival (DMFS).

Results

DM was observed in 29 patients, and all were lung metastases. The pattern of lung metastasis was classified into 3 categories: macronodular, micronodular, and no apparent nodule (detected only by RAI scintigraphy). Patients with excellent responses according to the ATA guideline criteria or complete remission of the RECIST criteria were most frequently observed in those with no apparent nodule. Significant factors related to DMFS were sex, clinical lymph node metastasis (LNM), extrathyroidal extension, and number of LNM. Subjects were divided into 3 groups according to the number of risk factors: low risk (no risk factors); intermediate risk (1 risk factor); and high risk (≥2 risk factors). Twenty-year DMFS rates in the low-, intermediate-, and high-risk groups were 99.0%, 71.7%, and 28.6%, respectively.

Conclusion

To achieve the full efficacy of RAI therapy, early diagnosis of DM before apparent metastases appear is desirable. The selective approach would be preferable for pediatric and adolescent DTC.
Mechanical feedback-loop regulation of morphogenesis in plants
Authors: Sampathkumar Arun
Published: August 2020

Morphogenesis is a highly controlled biological process that is crucial for organisms to develop cells and organs of a particular shape. Plants have the remarkable ability to adapt to changing environmental conditions, despite being sessile organisms with their cells affixed to each other by their cell wall. It is therefore evident that morphogenesis in plants requires the existence of robust sensing machineries at different scales. In this Review, I provide an overview on how mechanical forces are generated, sensed and transduced in plant cells. I then focus on how such forces regulate growth and form of plant cells and tissues.
Ultrabrief Screens for Detecting Delirium in Postoperative Cognitively Intact Older Adults
Authors: Sillner Andrea Yevchak , Ngo Long , Jung Yoojin , Inouye Sharon , Boltz Marie , Leslie Douglas , Marcantonio Edward R , Fick Donna M
Published: August 2020

The authors’ sought to develop an ultrabrief screen for postoperative delirium in cognitively intact patients older than 70 years undergoing major elective surgery. All possible combinations of one-, two- and three-item screens and their sensitivities, specificities, and 95% confidence intervals were calculated and compared with the delirium reference standard Confusion Assessment Method (CAM). Among the 560 participants (mean age, 77 years; 58% women), delirium occurred in 134 (24%). We considered 1,100 delirium assessments from postoperative days 1 and 2. The screen with the best overall performance consisted of three items: (1) Patient reports feeling confused, (2) Months of the year backward, and (3) “Does the patient appear sleepy?” with sensitivity of 92% and specificity of 72%. This brief, three-item screen rules out delirium quickly, identifies a subset of patients who require further testing, and may be an important tool to improve recognition of postoperative delirium.
The Changing Landscape of Uncomplicated Gram‐Negative Bacteremia: A Narrative Review to Guide Inpatient Management
Authors: Chan Jeannie D , Bryson‐Cahn Chloe , Kassamali‐Escobar Zahra , Lynch John B , Schleyer Anneliese M
Published: August 2020

Gram‐negative bacteremia secondary to focal infection such as skin and soft‐tissue infection, pneumonia, pyelonephritis, or urinary tract infection is commonly encountered in hospital care. Current practice guidelines lack sufficient detail to inform evidence‐based practices. Specifically, antimicrobial duration, criteria to transition from intravenous to oral step‐down therapy, choice of oral antimicrobials, and reassessment of follow‐up blood cultures are not addressed. The presence of bacteremia is often used as a justification for a prolonged course of antimicrobial therapy regardless of infection source or clinical response. Antimicrobials are lifesaving but not benign. Prolonged antimicrobial exposure is associated with adverse effects, increased rates of Clostridioides difficile infection, antimicrobial resistance, and longer hospital length of stay. Emerging evidence supports shorter overall duration of antimicrobial treatment and earlier transition to oral agents among patients with uncomplicated Enterobacteriaceae bacteremia who have achieved adequate source control and demonstrated clinical stability and improvement. After appropriate initial treatment with an intravenous antimicrobial, transition to highly bioavailable oral agents should be considered for total treatment duration of 7 days. Routine follow‐up blood cultures are not cost‐effective and may result in unnecessary healthcare resource utilization and inappropriate use of antimicrobials. Clinicians should incorporate these principles into the management of gram‐negative bacteremia in the hospital.
A geoeconomia do desenvolvimento chinês: das Quatro Modernizações à Belt and Road Initiative (BRI) | The geoeconomics of Chinese Development: from Four Modernizations to Belt and Road Initiative (BRI)
Authors: Farias Helio Caetano , Martins Pedro Mendes
Published: August 2020

RESUMO Após o final da Guerra Fria, muitos analistas passaram a analisar a forma pela qual o sistema internacional se estruturaria. Dentre esses, destaca-se a contribuição de Edward Luttwak que cunhou o termo geoeconomia para ressaltar as tendências do sistema internacional, na qual as rivalidades interestatais seriam crescentemente moldadas por instrumentos comerciais e econômicos. A Belt and Road Initiative (BRI) pode ser analisada como mais um projeto geoeconômico criado para atender as demandas internas da economia chinesa e, ao mesmo tempo, garantir a projeção internacional do país. Trata-se de uma estratégia de inserção internacional recorrente na história chinesa que fundamenta o desenvolvimento econômico a partir de uma leitura sobre os condicionantes da competição geopolítica internacional.Palavras-Chave: Geoeconomia; Desenvolvimento Econômico; China. ABSTRACTAfter the end of the Cold War, analysts began to analyze how the international system would be structured. These contributions include the Edward Luttwak's, who coined the term geoeconomics to analyze the trends in the international system. Interstate rivalries would be increasingly influenced by commercial and economic instruments. The Belt and Road Initiative (BRI) can be viewed as another geo-economic project designed to meet the demands of economy as well as to ensure the China’s international projection. It is a strategy of recurrent international insertion in Chinese history, in which economic development is based on the conditions of international geopolitical competition.Keywords: Geoeconomics; Economic Development; China.Recebido em: 20 dez. 2019 | Aceito em: 25 mai. 2020.
Crises políticas na América Latina: convergências e dissensos entre OEA e Unasul na busca pela democracia | Political crises in Latin America: convergences and disagreements between OAS and Unasur in the search for democracy
Authors: Barros Marinana Andrade e
Published: August 2020

Com o fim da Guerra Fria, a promoção da democracia passou a integrar o cerne da agenda internacional. Na América do Sul, este fenômeno teve contornos bastante peculiares, fruto da polarização política regional vivida nas primeiras décadas do século XXI e da consequente sobreposição de organizações internacionais que lidam com o tema. Nesse contexto, OEA e Unasul se destacaram por sua centralidade, trazendo em suas normas e em suas reações às crises políticas tanto consonâncias quanto contrastes.Palavras-chave: Promoção da democracia; OEA; Unasul.ABSTRACTWith the end of the Cold War, the promotion of democracy became an important part of the international agenda. In South America, this phenomenon had very peculiar contours, because of the regional political polarization experienced in the first decades of the 21st century and the consequent overlap of international organizations that deal with the theme. In this context, OAS and Unasur stood out for their centrality, bringing in their norms and their reactions to political crises both consonances and contrasts.Keywords: Democracy promotion; OAS; Unasur. Recebido em: 29 fev. 2020 | Aceito em:  17 jul. 2020.
Enabling the person with moderate dementia to remain at home
Authors: Nazarko Linda
Published: August 2020

Most older people would prefer to remain at home and receive care at home until the end of life. In the UK, around 16% of older people die at home ( Hall et al, 2011:3 , Figure 1:1) and around 10% of people with dementia die at home ( Public Health England (PHE), 2019 ). In Europe, including the UK, the population is ageing and it is important that older people are enabled to remain at home whenever possible ( Hall et al, 2011 ). As dementia progresses, this can become more difficult, but can be managed if the appropriate support is provided. This article explores ways to support people with moderate dementia to remain at home.
When is COVID-19 not COVID-19? Staying vigilant in travel health
Authors: Umeed Margaret
Published: August 2020

Margaret Umeed explains the need to consider other conditions when assessing returning travellers
Delivering immunisations during the COVID-19 pandemic
Authors: Heffernan Catherine
Published: August 2020

Catherine Heffernan details efforts to maintain continuity in childhood vaccination during the outbreak
Bone marrow oedema syndrome of the foot and ankle in a paediatric population: A retrospective case series with serial MRI evaluation
Authors: De Houwer Hannah , Van Beek Nathalie , Prinsen Sandra , Van Riet Anne , De Roeck Jeoffrey , Verfaillie Stefaan
Published: August 2020

Purpose

By means of a case series we wanted to describe and correlate the clinical and imaging features of bone marrow oedema syndrome (BMOS) of the foot and ankle in children.

Methods

A retrospective data study was performed on patients born on or after 01 January 2001 who underwent multiple MRI scans of the foot and ankle for pain symptoms. Six patients who presented with increased signal intensity on T2-weighted MR imaging without any underlying causes or concomitant pathology were included.

Results

All patients, three boys and three girls with a mean age of 11 years (8 to 14), displayed patchy areas of increased signal intensity on T2-weighted and turbo inversion recovery magnitude (TIRM) images. On average, six tarsal bones were involved (4 to 8). In all patients, treatment consisted of rest and/or protected weight-bearing. The mean time for symptoms to improve during treatment was 6 months (1 to 16). The mean duration of treatment was nine months (3 to 16). In all patients clinical and imaging symptoms were strongly correlated and regressed in time.

Conclusion

BMOS as a pathological entity should be considered in paediatric patients with foot and ankle pain without a clear underlying cause, and characteristic T2-weighted and TIRM signal intensity increase on MRI images. As BMOS is transient and self-limiting, conservative treatment is advised while the oedema regresses. An early diagnosis of this pathology could prevent unnecessary diagnostic investigations and invasive treatments.

Level of Evidence

IV
Irradiation level related to intraoperative imaging device in paediatric elastic stable intramedullary nailing: Preliminary prospective study on 51 patients using PCXMC software
Authors: Prod'homme Marc , Docquier Pierre-Louis , Miri Othmane , Sans-Merce Marta , Tabard-Fougère Anne , Ceroni Dimitri , Lascombes Pierre
Published: August 2020

Purpose

Radiation-induced cancers due to imaging devices concern above all the growing child, however, to date, intraoperative irradiation doses are not well-documented in children. The goal of the study was to evaluate the intraoperative doses received by patients operated with the use of a C-arm in traumatology, as well as the lifetime attributable risk of cancer death (LAR) related to the irradiation of the imaging device.

Methods

From 1 April 2017 to 31 March 2019, we started a multicentre study and prospectively recruited all consecutive children who needed elastic stable intramedullary nailing (ESIN) for long-bone fracture. We collected demographic and operative data, with dose reports including duration and doses. The main outcome was the effective dose (ED) in millisievert (mSv), calculated with PCXMC software, and the secondary outcome was the LAR expressed as a percentage.

Results

In all, 51 patients operated on using 2D C-arm imaging were included in this study. The mean ED was 0.085 mSv (sd 0.10; 0.002 to 0.649). Overall LAR was 6.5 x 10−4% (sd 6.7 x 10−4%; 0.1 x 10−4% to 28.3x10−4%). Univariate linear regression showed a significant association between ED and irradiation time (p < 0.001). There was no significant association between ED and other outcomes (p > 0.05).

Conclusion

Treatment of long-bone fractures by ESIN found a low level of effective doses with utilization of the C-arm device in current practice. Further studies on a larger sample are needed to confirm these results.

Level of Evidence

II
Indications for gastrocsoleus lengthening in ambulatory children with cerebral palsy: A Delphi consensus study
Authors: Rutz Erich , McCarthy James , Shore Benjamin J. , Shrader M. Wade , Veerkamp Matthew , Chambers Henry , Davids Jon R. , Kay Robert M. , Narayanan Unni , Novacheck Tom F. , Pierz Kristan , Rhodes Jason , Shilt Jeffrey , Theologis Tim , Van Campenhout Anja , Dreher Thomas , Graham Kerr
Published: August 2020

Purpose

Equinus is the most common deformity in cerebral palsy (CP) and gastrocsoleus lengthening (GSL) is the most commonly performed surgery to improve gait and function in ambulatory children with CP. Substantial variation exists in the indications for GSL and surgical technique. The purpose of this study was to review surgical anatomy and biomechanics of the gastrocsoleus and to utilize expert orthopaedic opinion through a Delphi technique to establish consensus for surgical indications for GSL in ambulatory children with CP.

Methods

A 17-member panel, of Fellowship-trained paediatric orthopaedic surgeons, each with at least 9 years of clinical post-training experience in the surgical management of children with CP, was established. Consensus for the surgical indications for GSL was achieved through a standardized, iterative Delphi process.

Results

Consensus was reached to support conservative Zone 1 surgery in diplegia and Zone 3 surgery (lengthening of the Achilles tendon) was contraindicated. Zone 2 or Zone 3 surgery reached general agreement as a choice in hemiplegia and under-correction was preferred to any degree of overcorrection. Agreement was reached that the optimum age for GSL surgery was 6 years to 10 years and should be avoided in children aged under 4 years. Physical examination measures with the child awake and under anaesthesia were important in decision making. Gait analysis was supported both for decision making and for assessing outcomes, in combination with patient reported outcomes (PROMS).

Conclusions

The results from this study may encourage informed practice evaluation, reduce practice variability, improve clinical outcomes and point to questions for further research.

Level of Evidence

V
Is Branding Going Gothic? A Descent into the Mallström
Authors: Brown Stephen
Published: August 2020

The horror, the horror. Be afraid, be very afraid. Don't look now. I'm warning you. You'll regret it. In academia, remember, no one can hear you scream. The horror, the horror. Be afraid, be very afraid. Don't look now. I'm warning you. You'll regret it. In academia, remember, no one
can hear you.
Examining the relevance of emotions for regulation of food wastage behaviour: A research agenda
Authors: Srivastava Medha , Srivastava Saurabh Kumar
Published: August 2020

Purpose
 Research has pointed towards the emotional component of decisions contributing to the wastage of food at the end of the supply chain. The present study reviews food wastage literature to reveal the role of emotions with respect to regulation, reduction and
prevention of food wastage among consumers.
 Research methodology
 The study is literature-driven and seeks to uncover latent emotional motives underlying the actions leading to the wastage of food. It utilises previous studies in the fields of consumption emotions,
food wastage, pro-environmental behaviour and sustainability to offer unconventional research propositions that underline the interplay of these variables.
 Findings
 Based upon the literature, the paradoxical nature of anticipated emotions' influence was considered
and confirmed. The findings suggest that the anticipation of experiencing positive emotions due to desires of being recognised as a good provider or expressing one's affection may lead to actions that contribute to increased wastage, while anticipating that a negative affect experience may
create a positive outcome with regard to food wastage.
 Limitations
 The majority of prior research, related to the relevance of emotions for food wastage behaviour, has focused on negative emotions, leaving a perceptible dearth of insights about the role of positive
emotions.
 Contributions
 The study builds a novel narrative of how emotions channelise behaviour concerning food wastage, and proffers an argument for a more rigorous examination of emotions, both positive and negative, anticipated in a situation leading to food
wastage at the stage of consumption. It also identifies potential avenues for research into emotions related to food wastage.
Technique for measuring very small angle changes
Authors: Kloepfer Jeremiah , Yuen Robert , Gibb Robert
Published: August 2020

A method for making accurate and precise measurements of small angles is described using an interferometer and a test fixture with reference control surfaces. The test is relatively insensitive to test fixture alignment. Typical measurement uncertainties are better than 0.2 arcsec (

1

σ

). This technique is applicable for verifying the angular stability of opto-mechanical systems that must undergo rigorous environmental testing.