bluuebunny/crossref_metadata_2025 huggingface dataset:
English Medium Instruction and Human Linguistic Rights: Academic, Psychological and Cultural Suffering
Authors: Masri Taghreed
Published: December 2020

In higher education in the UAE, English is used as the medium of instruction, while academic Arabic is relegated to few electives that can be also taken in English. Policy makers perceive the transition from Arabic medium instruction (ami) schools to English medium instruction (emi) universities as normal and automatic. This study aims to explore how students see this transition, and whether they find it automatic and smooth, or embroiled in hardship and difficulties. It is based on a critical theoretical framework and is approached using exploratory critical methodology. Twenty semi-structured interviews were conducted with twenty undergraduate Arab students in three English-medium universities. Results showed that students faced psychological, academic, social and cultural difficulties associated with the transition from Arabic schools to English-medium instruction universities.
The State’s Duty to Consult Indigenous Peoples: Where Do We Stand 30 Years after the Adoption of the ilo Indigenous and Tribal Peoples Convention No. 169?
Authors: Ormaza Maria Victoria Cabrera , Oelz Martin
Published: December 2020

ILO Convention No. 169 remains the only treaty open for ratification specifically and exclusively dedicated to the promotion and protection of indigenous peoples’ rights. Its cornerstone is the State’s duty to consult indigenous peoples. This article presents the history of the emergence of the duty to consult indigenous peoples in ILO Convention No. 169, its normative content and related guidance from the ILO supervisory bodies. It further examines developments with regard to this duty in the UN and the Inter-American systems and explores the relationship between such developments and ILO Convention No. 169. The paper revisits State practice of countries that have ratified that Convention, illustrating progress and challenges relating to the implementation of regulatory frameworks for consultation with indigenous peoples.
Using Xunzi and Mencius to Adapt and Reclaim Modernity: A Reconstruction of Confucianism in the Modern Context
Authors: Guo Yi
Published: December 2020

Reconstructing Confucianism for the modern age presents us with two main tasks. The first is to borrow from the tradition of Xunzi 荀子 in order to face the challenges of Westernization and modernization and, in turn, modernize ourselves. The second is to embrace the tradition of Mencius 孟子 with the purpose of defining our own cultural and personal values, guarding against some of the pitfalls of modernization. In many ways, the Xunzi branch is more beneficial for the continuing growth of Confucianism: it is analytical – even scientific – in its approach to political theory. But, of course, it is not a complete system. Xunzi correctly discovered the dark side of human nature, but Mencius correctly discovered its good side. These two systems of philosophy are each well equipped for complementing the other’s shortcomings. This is why we advocate for a critical unification of Mencius’ and Xunzi’s philosophies, with the aim of helping Confucianism evolve into a philosophy that is relevant and prosperous in the twenty-first century.
The Limits of Text and Tradition: Theosophy, Translation, and Transnational Vedānta in the fin-de-siècle
Authors: Kuchuk Nika
Published: December 2020

Part of a larger project interrogating literal and discursive translation in late-colonial Vedāntic thought, this paper focuses on Helena Petrovna Blavatsky, founder of the Theosophical Society and its key ideologue. Blavatsky grounded her articulation of Theosophical teachings in a mysterious source text, purportedly written in a sacerdotal language known as the Senzar. In presenting herself as its translator, Blavatsky deftly maneuvers between competing philosophies of language and knowledge paradigms, from philology to occultism. This allows her to simultaneously frame Theosophy as continuous with Vedāntic and Buddhist thought and as superseding them, thus effectively articulating a new—universal—teaching. Utilizing translation theory as an analytical and hermeneutical lens, this paper examines some of Blavatsky’s more notable discursive mechanics and their textual afterlives, tracing the tensions between authorship and authority, tradition and innovation, the particular and the universal. It is proposed that attending to such translational practices (or claims thereof) points to broader questions of meaning-making and commensurability implicated in any project of articulating a tradition across linguistic, cultural, temporal and geographical spaces—as well as its limits and challenges.
Development of a Daily Multilayer Cropland Soil Moisture Dataset for China Using Machine Learning and Application to Cropping Patterns
Authors: Liu Yaling , Chen Dongdong , Mouatadid Soukayna , Lu Xiaoliang , Chen Min , Cheng Yu , Xie Zhenghui , Jia Binghao , Wu Huan , Gentine Pierre
Published: December 2020

Soil moisture (SM) links the water and energy cycles over the land–atmosphere interface and largely determines ecosystem functionality, positioning it as an essential player in the Earth system. Despite its importance, accurate estimation of large-scale SM remains a challenge. Here we leverage the strength of neural network (NN) and fidelity of long-term measurements to develop a daily multilayer cropland SM dataset for China from 1981 to 2013, implemented for a range of different cropping patterns. The training and testing of the NN for the five soil layers (0–50 cm, 10-cm depth each) yield R2 values of 0.65–0.70 and 0.64–0.69, respectively. Our analysis reveals that precipitation and soil properties are the two dominant factors determining SM, but cropping pattern is also crucial. In addition, our simulations of alternative cropping patterns indicate that winter wheat followed by fallow will largely alleviate the SM depletion in most parts of China. On the other hand, cropping patterns of fallow in the winter followed by maize/soybean seem to further aggravate SM decline in the Huang-Huai-Hai region and southwestern China, relative to prevalent practices of double cropping. This may be due to their low soil porosity, which results in more soil water drainage, as opposed to the case that winter crop roots help maintain SM. This multilayer cropland SM dataset with granularity of cropping patterns provides an important alternative and is complementary to modeled and satellite-retrieved products.
Land–Atmosphere Coupling at the U.S. Southern Great Plains: A Comparison on Local Convective Regimes between ARM Observations, Reanalysis, and Climate Model Simulations
Authors: Tao Cheng , Zhang Yunyan , Tang Qi , Ma Hsi-Yen , Ghate Virendra P. , Tang Shuaiqi , Xie Shaocheng , Santanello Joseph A.
Published: December 2020

Using the 9-yr warm-season observations at the Atmospheric Radiation Measurement Southern Great Plains site, we assess the land–atmosphere (LA) coupling in the North American Regional Reanalysis (NARR) and two climate models: hindcasts with the Community Atmosphere Model version 5.1 by Cloud-Associated Parameterizations Testbed (CAM5-CAPT) and nudged runs with the Energy Exascale Earth System Model Atmosphere Model version 1 Regionally Refined Model (EAMv1-RRM). We focus on three local convective regimes and diagnose model behaviors using the local coupling metrics. NARR agrees well with observations except a slightly warmer and drier surface with higher downwelling shortwave radiation and lower evaporative fraction. On clear-sky days, it shows warmer and drier early-morning conditions in both models with significant underestimates in surface evaporation by EAMv1-RRM. On the majority of the ARM-observed shallow cumulus days, there is no or little low-level clouds in either model. When captured in models, the simulated shallow cumulus shows much less cloud fraction and lower cloud bases than observed. On the days with late-afternoon deep convection, models tend to present a stable early-morning lower atmosphere more frequently than the observations, suggesting that the deep convection is triggered more often by elevated instabilities. Generally, CAM5-CAPT can reproduce the local LA coupling processes to some extent due to the constrained early-morning conditions and large-scale winds. EAMv1-RRM exhibits large precipitation deficits and warm and dry biases toward mid-to-late summers, which may be an amplification through a positive LA feedback among initial atmosphere and land states, convection triggering and large-scale circulations.
Venous malformations: Coagulopathy control and treatment methods
Authors: Budge Eleanor J , Khalil Allam Muhammad AA , Mechie Imogen , Scully Marie , Agu Obi , Lim Chung Sim
Published: December 2020

Venous malformations (VMs) are ectatic channels which arise as a result of vascular dysmorphogenesis, commonly caused by activating mutations in the endothelial tyrosine kinase receptor (TIE2)/phosphatidylinositol 3-kinase (PI3Kinase) pathway. With a prevalence of 1% in the general population, and a diverse clinical presentation depending on site, size and tissue involvement, their treatment requires a personalised and multidisciplinary approach. Larger lesions are complicated by local intravascular coagulopathy (LIC) causing haemorrhagic and/or thrombotic complications which can progress to disseminated intravascular coagulopathy (DIC).

Methods

We performed a literature review using a PubMed® search and identified 15 articles to include. References of these texts were examined to further expand the literature review. Principle findings: Several treatment options have been explored, including compression, sclerotherapy, laser therapy, cryoablation and surgery in addition to the management of LIC with low-molecular-weight-heparin (LMWH) and other anticoagulants. Targeted molecular therapies acting on the phosphatidylinositol 3-kinase (PI3Kinase)/Protein Kinase B (AKT)/mammalian target of rapamycin (mTOR) pathway are newly emerging.

Conclusion

Despite a wealth of literature, larger, multi-centric, randomised and prospective trails are required to offer further clarification on the therapeutic management of coagulopathy control and to provide symptomatic benefit to patients with VMs. There should be efforts to provide long term follow up and to use standardised risk stratification tools and quality of life (QOL) questionnaires to aid comparison of agents and treatment protocols.
Chemosensitizing micelles self-assembled from amphiphilic TPGS-indomethacin twin drug for significantly synergetic multidrug resistance reversal
Authors: Chen* Ran , Wang* Zhexiang , Wu Shuo , Kuang Xingyu , Wang Xiu , Yan Guoqing , Tang Rupei
Published: December 2020

Vitamin E d-ɑ-tocopheryl poly(ethylene glycol) 1000 succinate (TPGS) and indomethacin (IDM) can reverse multidrug resistance (MDR) via inhibiting P-glycoprotein (P-gp) and multidrug resistance associated protein 1 (MRP1) respectively, but their drawbacks in physicochemical properties limit their clinical application. To overcome these defects and enhance MDR reversal, the amphiphilic TPGS-IDM twin drug was successfully synthesized via esterification, and could self-assemble into free and paclitaxel-loaded (PTX-loaded) micelles. The micelles exhibited lower CMC values (5.2 × 10−5 mg/mL), long-term stability in PBS (pH 7.4) for 7 days and SDS solution (5 mg/mL) for 3 days, and effective drug release at esterase/pH 5.0. Moreover, the micelles could down-regulate ATP levels and promote ROS production in MCF-7/ADR via the mitochondrial impairment, therefore achieving MDR reversal and cell apoptosis. Additionally, the PTX-loaded micelles could significantly inhibit the cell proliferation and promote apoptosis for MCF-7/ADR via the synergistic chemosensitizing effect of TPGS and IDM, and synergistic cytotoxic effect of TPGS and PTX. Thus, the chemosensitizing micelles self-assembled from amphiphilic TPGS-indomethacin twin drug have the great potentials for reversing MDR in clinical cancer therapy.
Numerical analysis and performance optimization of a spiral fertilizer distributor in side deep fertilization of a paddy field
Authors: Tang Han , Jiang Yeming , Wang Jinwu , Wang Jinfeng , Zhou Wenqi
Published: December 2020

To improve the quality of side deep fertilization in paddy fields and study the dynamic change in fertilizer particles in fertilizer boxes, a model connecting the mechanical components and fertilizer based on the discrete element method was established, and a numerical simulation analysis of the spiral fertilizer distributor was conducted with EDEM software. The primary factors affecting the uniformity and stability of the fertilizer were studied. Using an orthogonal experimental design and numerical simulation technology, the speed, lead and diameter of a steel wire were selected as experimental factors, the mean fertilization value and the fertilization coefficient of the variation were selected as evaluating indicators, a mathematical model between the factors and indicators was established by virtual orthogonal testing, and the numerical processing was optimized with Design-Expert 6.0.10 software. The results showed that the primary and secondary factors affecting the comprehensive performance occurred in the following sequence: steel wire speed > steel wire diameter > steel wire lead. When the speed, lead, and diameter of the steel wire were 15 r/min, 65 mm and 7 mm, respectively, the operation performance was superior. High-speed video camera analysis and bench tests showed that the results were consistent with the simulation optimization. The mean value and the coefficient of variation of fertilization were 9.39 g and 3.71%, respectively, which satisfy the agronomic requirements for paddy field side deep fertilization.
A large meta-analysis establishes the role of MRD negativity in long-term survival outcomes in patients with multiple myeloma
Authors: Munshi Nikhil C. , Avet-Loiseau Herve , Anderson Kenneth C. , Neri Paola , Paiva Bruno , Samur Mehmet , Dimopoulos Meletios , Kulakova Margarita , Lam Annette , Hashim Mahmoud , He Jianming , Heeg Bart , Ukropec Jon , Vermeulen Jessica , Cote Sarah , Bahlis Nizar
Published: December 2020

The prognostic value of minimal residual disease (MRD) for progression-free survival (PFS) and overall survival (OS) was evaluated in a large cohort of patients with multiple myeloma (MM) using a systematic literature review and meta-analysis. Medline and EMBASE databases were searched for articles published up to 8 June 2019, with no date limit on the indexed database. Clinical end points stratified by MRD status (positive or negative) were extracted, including hazard ratios (HRs) on PFS and OS, P values, and confidence intervals (CIs). HRs were estimated based on reconstructed patient-level data from published Kaplan-Meier curves. Forty-four eligible studies with PFS data from 8098 patients, and 23 studies with OS data from 4297 patients were identified to assess the association between MRD status and survival outcomes. Compared with MRD positivity, achieving MRD negativity improved PFS (HR, 0.33; 95% CI, 0.29-0.37; P < .001) and OS (HR, 0.45; 95% CI, 0.39-0.51; P < .001). MRD negativity was associated with significantly improved survival outcomes regardless of disease setting (newly diagnosed or relapsed/refractory MM), MRD sensitivity thresholds, cytogenetic risk, method of MRD assessment, depth of clinical response at the time of MRD measurement, and MRD assessment premaintenance and 12 months after start of maintenance therapy. The strong prognostic value of MRD negativity and its association with favorable outcomes in various disease and treatment settings sets the stage to adopt MRD as a treatment end point, including development of therapeutic strategies. This large meta-analysis confirms the utility of MRD as a relevant surrogate for PFS and OS in MM.
Application of machine learning in the management of acute myeloid leukemia: current practice and future prospects
Authors: Eckardt Jan-Niklas , Bornhäuser Martin , Wendt Karsten , Middeke Jan Moritz
Published: December 2020

Machine learning (ML) is rapidly emerging in several fields of cancer research. ML algorithms can deal with vast amounts of medical data and provide a better understanding of malignant disease. Its ability to process information from different diagnostic modalities and functions to predict prognosis and suggest therapeutic strategies indicates that ML is a promising tool for the future management of hematologic malignancies; acute myeloid leukemia (AML) is a model disease of various recent studies. An integration of these ML techniques into various applications in AML management can assure fast and accurate diagnosis as well as precise risk stratification and optimal therapy. Nevertheless, these techniques come with various pitfalls and need a strict regulatory framework to ensure safe use of ML. This comprehensive review highlights and discusses recent advances in ML techniques in the management of AML as a model disease of hematologic neoplasms, enabling researchers and clinicians alike to critically evaluate this upcoming, potentially practice-changing technology.
Zanubrutinib for the treatment of MYD88 wild-type Waldenström macroglobulinemia: a substudy of the phase 3 ASPEN trial
Authors: Dimopoulos Meletios , Sanz Ramon Garcia , Lee Hui-Peng , Trneny Marek , Varettoni Marzia , Opat Stephen , D'Sa Shirley , Owen Roger G. , Cull Gavin , Mulligan Stephen , Czyz Jaroslaw , Castillo Jorge J. , Motta Marina , Siddiqi Tanya , Gironella Mesa Mercedes , Granell Gorrochategui Miquel , Talaulikar Dipti , Zinzani Pier Luigi , Askari Elham , Grosicki Sebastian , Oriol Albert , Rule Simon , Kloczko Janusz , Tedeschi Alessandra , Buske Christian , Leblond Veronique , Trotman Judith , Chan Wai Y. , Michel Jan , Schneider Jingjing , Tan Ziwen , Cohen Aileen , Huang Jane , Tam Constantine S.
Published: December 2020

Patients with Waldenström macroglobulinemia (WM) lacking activating mutations in the MYD88 gene (MYD88WT) have demonstrated relatively poor outcomes to ibrutinib monotherapy, with no major responses reported in a phase 2 pivotal study. Zanubrutinib is a novel, selective Bruton tyrosine kinase (BTK) inhibitor designed to maximize BTK occupancy and minimize off-target activity. The ASPEN study consisted of a randomized comparison of zanubrutinib and ibrutinib efficacy and safety in patients with WM who have the MYD88 mutation, as well as a separate cohort of patients without MYD88 mutation (MYD88WT) or with unknown mutational status who received zanubrutinib. Results from the latter single-arm cohort are reported herein. Efficacy endpoints included overall, major and complete (CR) or very good partial response (VGPR) rates, progression-free survival (PFS), duration of response (DOR), and overall survival (OS). Twenty-eight patients (23 relapsed/refractory; 5 treatment-naïve) were enrolled, including 26 with centrally confirmed MYD88WT disease and 2 with unknown MYD88 mutational status. At a median follow-up of 17.9 months, 7 of 26 MYD88WT patients (27%) had achieved a VGPR and 50% a major response (partial response or better); there were no CRs. At 18 months, the estimated PFS and OS rates were 68% and 88%, respectively, while the median DOR had not been reached. Two patients discontinued zanubrutinib due to adverse events. Treatment-emergent hypertension, atrial fibrillation, and major hemorrhages were reported in 3, 1 and 2 patients (including 1 concurrent with enoxaparin therapy), respectively. Results of this substudy demonstrate that zanubrutinib monotherapy can induce high quality responses in patients with MYD88WT WM. This trial is registered on www.clinicaltrials.gov as NCT #03053440.
A JAK2/IDH1-mutant MPN clone unmasked by ivosidenib in an AML patient without antecedent MPN
Authors: Xiao Wenbin , Miles Linde A. , Bowman Robert L. , Durani Vidushi , Tian Helen S. , DelGaudio Nicole L. , Mishra Tanmay , Zhu Menglei , Zhang Yanming , Stump Sarah E. , Tallman Martin S. , Levine Ross L. , Cai Sheng F.
Published: December 2020

Key Points

Myeloid neoplasm (MPN) clones can evolve from acute myeloid leukemia to gain dominance with isocitrate dehydrogenase inhibition. Pro-differentiation agents such as ivosidenib can unmask MPN sequelae.
Evidence of thrombotic microangiopathy in children with SARS-CoV-2 across the spectrum of clinical presentations
Authors: Diorio Caroline , McNerney Kevin O. , Lambert Michele , Paessler Michele , Anderson Elizabeth M. , Henrickson Sarah E. , Chase Julie , Liebling Emily J. , Burudpakdee Chakkapong , Lee Jessica H. , Balamuth Frances B. , Blatz Allison M. , Chiotos Kathleen , Fitzgerald Julie C. , Giglia Therese M. , Gollomp Kandace , Odom John Audrey R. , Jasen Cristina , Leng Tomas , Petrosa Whitney , Vella Laura A. , Witmer Char , Sullivan Kathleen E. , Laskin Benjamin L. , Hensley Scott E. , Bassiri Hamid , Behrens Edward M. , Teachey David T.
Published: December 2020

Most children with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection have mild or minimal disease, with a small proportion developing severe disease or multisystem inflammatory syndrome in children (MIS-C). Complement-mediated thrombotic microangiopathy (TMA) has been associated with SARS-CoV-2 infection in adults but has not been studied in the pediatric population. We hypothesized that complement activation plays an important role in SARS-CoV-2 infection in children and sought to understand if TMA was present in these patients. We enrolled 50 hospitalized pediatric patients with acute SARS-CoV-2 infection (n = 21, minimal coronavirus disease 2019 [COVID-19]; n = 11, severe COVID-19) or MIS-C (n = 18). As a biomarker of complement activation and TMA, soluble C5b9 (sC5b9, normal 247 ng/mL) was measured in plasma, and elevations were found in patients with minimal disease (median, 392 ng/mL; interquartile range [IQR], 244-622 ng/mL), severe disease (median, 646 ng/mL; IQR, 203-728 ng/mL), and MIS-C (median, 630 ng/mL; IQR, 359-932 ng/mL) compared with 26 healthy control subjects (median, 57 ng/mL; IQR, 9-163 ng/mL; P < .001). Higher sC5b9 levels were associated with higher serum creatinine (P = .01) but not age. Of the 19 patients for whom complete clinical criteria were available, 17 (89%) met criteria for TMA. A high proportion of tested children with SARS-CoV-2 infection had evidence of complement activation and met clinical and diagnostic criteria for TMA. Future studies are needed to determine if hospitalized children with SARS-CoV-2 should be screened for TMA, if TMA-directed management is helpful, and if there are any short- or long-term clinical consequences of complement activation and endothelial damage in children with COVID-19 or MIS-C.
Growth and Selective Etch of Phosphorus-Doped Silicon/Silicon–Germanium Multilayers Structures for Vertical Transistors Application
Authors: Li Chen , Lin Hongxiao , Li Junjie , Yin Xiaogen , Zhang Yongkui , Kong Zhenzhen , Wang Guilei , Zhu Huilong , Radamson Henry H.
Published: December 2020

Vertical gate-all-around field-effect transistors (vGAAFETs) are considered as the potential candidates to replace FinFETs for advanced integrated circuit manufacturing technology at/beyond 3-nm technology node. A multilayer (ML) of Si/SiGe/Si is commonly grown and processed to form vertical transistors. In this work, the P-incorporation in Si/SiGe/Si and vertical etching of these MLs followed by selective etching SiGe in lateral direction to form structures for vGAAFET have been studied. Several strategies were proposed for the epitaxy such as hydrogen purging to deplete the access of P atoms on Si surface, and/or inserting a Si or Si0.93Ge0.07 spacers on both sides of P-doped Si layers, and substituting SiH4 by SiH2Cl2 (DCS). Experimental results showed that the segregation and auto-doping could also be relieved by adding 7% Ge to P-doped Si. The structure had good lattice quality and almost had no strain relaxation. The selective etching between P-doped Si (or P-doped Si0.93Ge0.07) and SiGe was also discussed by using wet and dry etching. The performance and selectivity of different etching methods were also compared. This paper provides knowledge of how to deal with the challenges or difficulties of epitaxy and etching of n-type layers in vertical GAAFETs structure.
Malignant mesothelioma of the spermatic cord mimicking a benign inguinoscrotal swelling: case report with review of literature
Authors: Singh Iqbal , Aravind T. K. , Behera Dibya Priyadarsini , Panesar Natasha , Jain Dhruv
Published: December 2020

Background

Spermatic cord malignant mesotheliomas (SCM) are extremely rare tumours arising from the tunica vaginalis of the spermatic cord (only 18 cases reported—worldwide in the literature). Paratesticular malignant mesotheliomas (PMM) account for about 0.3–1.4% of all mesotheliomas, while those from the spermatic cord account for less than 10% of paratesticular tumours. Spermatic cord mesotheliomas may be overlooked commonly owing to its unique ability to mimic benign disorders associated with a thickened cord, leading to loss of timely management in many cases. Hence, this case report hence serves to provide pointers to the urologist/surgeon and alerts them towards timely diagnosis and early management of SCM’s besides adding to its limited literature.

Case presentation

We present a case of spermatic cord mesothelioma (SCM) in a 39-year-old male presenting to our clinic with persistentcomplaints of left inguinoscrotal swelling with a vague dull-aching, poorly localising pain sensation over the inguinoscrotal region associated with a persistent dragging sensation for more than a year. Initial evaluation suggested and inclined us towards the diagnosis a benign pathology (spermatocele); however, the persistence of symptoms (pain and swelling) despite prior therapeutic measures initiated elsewhere prompted us to consider an FNAC (which was benign) and surgical exploration which surprisingly revealed the diagnosis of SCM. Owing to the wide spread nature of the disease, the patient was started on palliative chemotherapy. He is currently is doing clinically well on a 1-year follow-up.

Conclusion

Spermatic cord malignant mesothelioma is an extremely rare tumour with an unique tendency to masquerade and mimic cord thickening also associated with several other benign groin/inguinoscrotal swellings. In all such cases, a high index of suspicion should be entertained by the urologist, even in the absence of classical risk factors for SCM like prior asbestos exposure while evaluating patients presenting with persistent expanding inguinoscrotal swellings associated with non-resolving symptoms.
Analysis of gastroscopy results among healthy people undergoing a medical checkup: a retrospective study
Authors: Huang Haosu , Rong Yanting , Wang Meng , Guo Zimeng , Yu Yanghua , Long Zhenpu , Chen Xiaoxiao , Wang Hanyue , Ding Junjie , Yan Lu , Peng Jie
Published: December 2020

Background

The association of upper gastrointestinal endoscopic findings with sex, age, and Helicobacter pylori infection in asymptomatic healthy people is unclear. The aim of this study was to retrospectively determine the associations of upper gastrointestinal endoscopic findings in asymptomatic healthy people with sex, age, and H. pylori infection.

Methods

A retrospective study was conducted on 2923 patients from a health examination center in Xiangya Hospital between September 2015 and September 2019. Data on sex, age, H. pylori infection, and gastroscopy results were collected.

Results

Among 2923 asymptomatic patients who underwent gastroscopy, 2911 (99.59%) had abnormal results. The top three results were chronic gastritis (95.11%), peptic ulcer (17.45%), and duodenitis (9.17%). Inflammation of the gastric mucosa in chronic gastritis was more severe in the H. pylori-positive group. The incidence of peptic ulcer decreased with increasing age and was higher in men, patients aged < 30 years, and H. pylori-positive patients. The incidence of polyps was higher in women (9.54%) than in men (5.94%), and the incidence in individuals aged ≥60 years (11.63%) was higher than that in those aged < 60 years (6.83%). The pathological results of gastric polyps depended on the location of the lesion.

Conclusion

The incidence of abnormal upper gastrointestinal endoscopic results is high in asymptomatic healthy people undergoing a check-up and is associated with sex, age, and H. pylori infection. Gastroscopy should be considered part of a routine health check.
A propensity score matching analysis for cardio metabolic risk of antipsychotics in patients with schizophrenia using Japanese claims data
Authors: Kusumi Ichiro , Inoue Sachie , Baba Kenji , Nosaka Tadashi , Anzai Toshihisa
Published: December 2020

Background

The aim of this study was to evaluate the cardio-metabolic risk in schizophrenia patients treated by atypical antipsychotic drugs compared with that in those treated without atypical antipsychotic drugs using a nationwide insurance claims database and medical examination database in Japan.

Methods

Eligible patients were defined as those meeting the following two criteria: (i) A diagnosis of schizophrenia (ICD-10 code: F20) was made between 1 January 2005 and 31 December 2017, with data available for at least 6 months before the diagnosis was made (index month), and (ii) health check-up data were available within ±3 months of the index month. The primary endpoint was changes in cardio-metabolic risk based on the Suita score at 1 year, and the secondary endpoints were changes in medical examination data related to cardio-metabolic risk (total cholesterol [TC], triglyceride, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, body mass index [BMI], and hemoglobin A1c) at 1 year. The primary endpoint was evaluated by multivariate analysis, with the cumulative chlorpromazine equivalent amount and the baseline Suita score added as covariates.

Results

One-hundred eighty five pairs of propensity score (PS)-matched patients were evaluated. Patients receiving atypical antipsychotic drugs exhibited a greater change in the Suita score and a risk of coronary heart disease based on the Suita score of 0.530 and 0.098%, respectively, than patients not receiving atypical antipsychotic drugs, but there was no significant difference (p = 0.412 and 0.610). The significant changes in TC and BMI were determined as 6.525 mg/dL and 0.380 kg/m2 greater, respectively, in patients treated with atypical antipsychotic drugs (p = 0.037 and 0.011).

Conclusions

There were no significant increases in changes in the Suita score at 1 year by treatment with atypical antipsychotic drugs compared with treatment without atypical antipsychotic drugs. However, the TC and BMI were significantly higher in patients treated with atypical antipsychotic drugs.
Surgical decision-making for ossification of the posterior longitudinal ligament versus other types of degenerative cervical myelopathy: anterior versus posterior approaches
Authors: Kwok Suzanna Sum Sum , Cheung Jason Pui Yin
Published: December 2020

Background

The debate between anterior or posterior approach for pathologies such as cervical spondylotic myelopathy (CSM) and ossification of the posterior longitudinal ligament (OPLL) have drawn heated debate but are still inconclusive.

Main body of the abstract

A narrative review was performed specifically to study the differences pertaining to OPLL and other causes of degenerative cervical myelopathy (DCM). Current evidence suggests that anterior approach is preferred for K-line (−) OPLL, K-line (+) with canal occupying ratio > 60% and DCM with pre-existing cervical kyphosis. Posterior approach is preferred for K-line (+) OPLL with canal-occupying ratio < 50–60%, and multi-level CSM. No particular advantage for either approach was observed for DCM in a lordotic cervical spine. Anterior approach is generally associated with more complications and thus needs to be weighed carefully during decision-making. The evidence is not convincing for comparing single versus multi-level involvement, and the role of patients' co-morbidity status, pre-existing osteoporosis and co-existent spinal pathologies in influencing patient outcome and surgical options. This should be a platform for future research directives.

Conclusion

From this review, evidence is still inconclusive but there are some factors to consider, and DCM and OPLL should be considered separately for decision-making. Anterior approach is considered for pre-existing cervical kyphosis in DCM, for K-line (−) regardless of canal-occupying ratio, and K-line (+) and canal-occupying ratio > 60% for OPLL patients. Posterior approach is considered for patients with multi-level pathology for DCM, and K-line (+) and canal-occupying ratio < 50–60% for OPLL.
Surgical treatment for basilar invagination with irreducible atlantoaxial dislocation: transoral atlantoaxial reduction plate fixation vs occipitocervical fixation
Authors: Zou Xiaobao , Ouyang Bieping , Yang Haozhi , Wang Binbin , Ge Su , Chen Yuyue , Ni Ling , Zhang Shuang , Xia Hong , Yang Jingcheng , Ma Xiangyang
Published: December 2020

Background

Transoral atlantoaxial reduction plate (TARP) fixation or occipitocervical fixation (OF) is an effective treatment for basilar invagination (BI) with irreducible atlantoaxial dislocation (IAAD). But, all current clinical studies involved a single surgical procedure. The clinical effects of TARP and OF operation for BI with IAAD have yet to be compared. We therefore present this report to compare the treatment of TARP and OF procedure for BI with IAAD.

Methods

Fifty-six patients with BI with IAAD who underwent TARP or OF operation from June 2011 to June 2017 were retrospectively analyzed. Among these, 35 patients underwent TARP operation (TARP group), and 21 patients underwent OF operation (OF group). We compared the difference of clinical, radiological, and surgical outcomes between the TARP and OF groups postoperatively.

Results

Compared with OF group, the operative time and blood loss in TARP group were lower. There was no statistical difference in the atlantodental interval (ADI), clivus canal angle (CCA), cervicomedullary angle (CMA), distance between the top of the odontoid process and the Chamberlain line (CL) and Japanese Orthopaedic Association (JOA) score between the TARP and OF groups preoperatively, but the improvements of these parameters in the TARP group were superior to those in the OF group postoperatively. The fusion rates were higher in the TARP group than those in the OF group at the early stage postoperatively.

Conclusions

TARP and OF operations are effective surgical treatment for BI with IAAD, but the performance of reduction and decompression and earlier bone fusion rates of TARP procedure are superior to those of OF.
Caregiver burden among informal caregivers in the largest specialized palliative care unit in Malaysia: a cross sectional study
Authors: Ahmad Zubaidi Zati Sabrina , Ariffin Farnaza , Oun Cindy Teoh Cy , Katiman Diana
Published: December 2020

Background

Informal caregivers (IC) are often overshadowed by the attention required by the terminally ill. This study aims to reveal the estimated proportion of caregiver burden, psychological manifestations and factors associated with caregiver burden among IC in the largest specialized Palliative Care Unit (PCU) in Malaysia.

Methods

This was a cross-sectional study involving IC attending a PCU. Caregiver burden and psychological manifestations were measured using previously translated and validated Zarit Burden Interview and DASS-21 questionnaires respectively. Two hundred forty-nine samples were selected for analysis.

Result

The mean ZBI score was 23.33 ± 13.7. About half of the population 118(47.4%) was found to experienced caregiver burden whereby majority have mild to moderate burden 90(36.1%). The most common psychological manifestation among IC is anxiety 74(29.7%) followed by depression 51(20.4%) and stress 46(18.5%). Multiple logistic regression demonstrated that women who are IC to patients with non-malignancy were less likely to experience caregiver burden. IC who were highly educated and spent more than 14 h per day caregiving were at least twice likely to experience caregiver burden. Finally, those with symptoms of depression and anxiety were three times more likely to suffer from caregiver burden.

Conclusion

Caregiver burden among IC to palliative patients is prevalent in this population. IC who are men, educated, caregiving for patients with malignancy, long hours of caregiving and have symptoms of depression and anxiety are at risk of developing caregiver burden. Targeted screening should be implemented and IC well-being should be given more emphasis in local policies.
Medical heuristics and action-research: professionalism versus science
Authors: Unger Jean-Pierre , Morales Ingrid , De Paepe Pierre
Published: December 2020

Background

Professional knowledge aims at improving practice. It reduces uncertainty in decision-making, improves effectiveness in action and relevance in evaluation, stimulates reflexivity, and subjects practice to ethical standards. Heuristics is an approach to problem-solving, learning, and discovery employing a practical methodology that, although not optimal, is sufficient for achieving immediate goals. This article identifies the desirable, heuristic particularities of research in professional, medical practice; and it identifies what distinguishes this research from scientific research.

Main text

We examine the limits of biomedical and sociological research to produce professional knowledge. Then, we derive the heuristic characteristics of professional research from a meta-analysis of two action-research projects aimed at securing access to essential generic drugs in Senegal and improving physicians’ self-assessment and healthcare coordination in Belgium.

To study healthcare, biomedical sciences ignore how clinical decisions are implemented. Decisions are built into an articulated knowledge system, such as (clinical) epidemiology, where those studied are standardisable - while taking care of patients is an idiosyncratic, value-based, person-to-person process that largely eludes probabilistic methodologies. Social sciences also reach their limits here because descriptive, interpretative methods cannot help with gesture and speech quality, while the management of the patient’s suffering and risks makes each of them unique. Research into medical professionalism is normative as it is intended to formulate recommendations. Scientific data and descriptions are useful to the practitioner randomly, only from the similarities in the environment of the authors and their readers. Such recommendations can be conceived of as strategies, i.e., multi-resource and multi-stage action models to improve clinical and public health practice. Action learning and action-research are needed to design and implement these strategies, because their complexity implies trial and error. To validate a strategy, repeated experiences are needed. Its reproducibility assumes the description of the context. To participate in medical action-research, the investigator needs professional proficiency - a frequent difficulty in academic settings.

Conclusion

Some criteria to assess the relevance of publicly funded clinical and public health research can be derived from the difference between scientific and professional knowledge, i.e. the knowledge gained with real-life experience in the field.
Investment case for two-year post university speciality training in family medicine in Tajikistan: how much is needed for continuing and scaling up the improved education of family doctors?
Authors: Kempers Jari , Bohle Leah F. , Topa Alexandra , Ross Greta , Kasymova Zukhra , Yarbaeva Shakhlo , Rotaru Cristina , Prytherch Helen
Published: December 2020

Background

A new two-year Post University Specialty Training (PUST) programme in family medicine was introduced to improve the quality of postgraduate speciality medical education in Tajikistan. Postgraduate education of family doctors (FDs) needs to be urgently scaled up, as 38% of FD positions in Tajikistan remained unfilled in 2018. Moreover, the international financial support for the PUST programme is ending. This investment case assesses the minimum funding needed for the continuation and scale-up of PUST and establishes the rationale for the investment in the light of a recent evaluation.

Methods

The costs of the programme were calculated for 2018 and a scale-up forecast made for the period 2019–2023. The impact of the scale-up on the shortage of FDs was assessed. An evaluation using a Multiple Choice Questionnaire and Objective Structured Clinical Examination (OSCE) assessed and compared theoretical knowledge, clinical skills and competencies of PUST trained and conventionally trained FDs.

Results

The annual costs of the programme were US$ 228,000 in 2018. The total investment needed for scaling up PUST from 31 new FDs in 2018 to 100 FD graduates each year by 2023 was US$ 802,000.However, when the retirement of FDs and population growth are considered, the scale-up will result only in maintaining the current level of FDs working and not solve the country’s FD shortage. The PUST FDs demonstrated significantly better clinical skills than the conventionally trained interns, scoring 60 and 45% of OSCE points, respectively. Theoretical knowledge showed a similar trend; PUST FDs answered 44% and interns 38% of the questions correctly.

Conclusions

The two-year PUST programme has clearly demonstrated it produces better skilled family doctors than the conventional one-year internship, albeit some enduring quality concerns do still prevail. The discontinuation of international support for PUST would be a major setback and risks potentially losing the benefits of the programme for family medicine and also other specialities. To guarantee the supply of adequately trained FDs and address the FD shortage, the PUST should be continued and scaled up. Therefore, it is essential that international support is extended and a gradual transition to sustainable national financing gets underway.
The TRIFLOW study: a randomised, cross-over study evaluating the effects of extrafine beclometasone/formoterol/glycopyrronium on gas trapping in COPD
Authors: Dean James , Panainte Catalina , Khan Naimat , Singh Dave
Published: December 2020

Background

The effects of triple therapy on gas trapping in COPD are not fully understood. We evaluated the effects of the long acting bronchodilator components of the extrafine single inhaler triple therapy beclometasone dipropionate/formoterol/glycopyrronium (BDP/F/G) pMDI on gas trapping.

Methods

This open-label, randomised, single centre, 2-way cross-over study recruited 23 COPD patients taking inhaled corticosteroid combination treatments and with residual volume (RV) > 120% predicted at screening. Inhaled BDP was taken during run-in and washout periods. Baseline lung function (spirometry, lung volumes, oscillometry) was measured over 12 h prior to randomisation to BDP/F/G or BDP/F for 5 days followed by washout and crossover. Lung function was measured prior to dosing on day 1 and for 12 h post-dose on day 5.

Results

Co-primary endpoint analysis: BDP/F/G had a greater effect than BDP/F on FEV1 area under the curve over 12 h (AUC0–12) (mean difference 104 mls, p = 0.0071) and RV AUC0–12 (mean difference − 163 mls, p = 0.0028). Oscillometry measurements showed a greater effect of BDP/F/G on the difference between resistance at 5 and 20 Hz (R5–R20) AUC0–12, which measures small airway resistance (mean difference − 0.045 kPa/L/s, p = 0.0002). Comparison of BDP/F with the baseline measurements (BDP alone) showed that F increased FEV1 AUC0–12 (mean difference 227 mls) and improved RV AUC0–12 (mean difference − 558 mls) and R5–R20 AUC0–12 (mean difference − 0.117 kPa/L/s), all p < 0.0001.

Conclusions

In COPD patients with hyperinflation, the G and F components of extrafine BDP/F/G improved FEV1, RV and small airway function. These long acting bronchodilators target small airway function, thereby improving gas trapping and airflow.

Trial registration The study was retrospectively registered at ClinicalTrials.gov on 15th February 2019 (No.: NCT03842904, https://clinicaltrials.gov/ct2/show/NCT03842904).
Impact of a 2-year trial of nutritional ketosis on indices of cardiovascular disease risk in patients with type 2 diabetes
Authors: Athinarayanan Shaminie J. , Hallberg Sarah J. , McKenzie Amy L. , Lechner Katharina , King Sarah , McCarter James P. , Volek Jeff S. , Phinney Stephen D. , Krauss Ronald M.
Published: December 2020

Background

We have previously reported that in patients with type 2 diabetes (T2D) consumption of a very low carbohydrate diet capable of inducing nutritional ketosis over 2 years (continuous care intervention, CCI) resulted in improved body weight, glycemic control, and multiple risk factors for cardiovascular disease (CVD) with the exception of an increase in low density lipoprotein cholesterol (LDL-C). In the present study, we report the impact of this intervention on markers of risk for atherosclerotic cardiovascular disease (CVD), with a focus on lipoprotein subfraction particle concentrations as well as carotid-artery intima-media thickness (CIMT).

Methods

Analyses were performed in patients with T2D who completed 2 years of this study (CCI; n = 194; usual care (UC): n = 68). Lipoprotein subfraction particle concentrations were measured by ion mobility at baseline, 1, and 2 years and CIMT was measured at baseline and 2 years. Principal component analysis (PCA) was used to assess changes in independent clusters of lipoprotein particles.

Results

At 2 years, CCI resulted in a 23% decrease of small LDL IIIb and a 29% increase of large LDL I with no change in total LDL particle concentration or ApoB. The change in proportion of smaller and larger LDL was reflected by reversal of the small LDL subclass phenotype B in a high proportion of CCI participants (48.1%) and a shift in the principal component (PC) representing the atherogenic lipoprotein phenotype characteristic of T2D from a major to a secondary component of the total variance. The increase in LDL-C in the CCI group was mainly attributed to larger cholesterol-enriched LDL particles. CIMT showed no change in either the CCI or UC group.

Conclusion

Consumption of a very low carbohydrate diet with nutritional ketosis for 2 years in patients with type 2 diabetes lowered levels of small LDL particles that are commonly increased in diabetic dyslipidemia and are a marker for heightened CVD risk. A corresponding increase in concentrations of larger LDL particles was responsible for higher levels of plasma LDL-C. The lack of increase in total LDL particles, ApoB, and in progression of CIMT, provide supporting evidence that this dietary intervention did not adversely affect risk of CVD.