bluuebunny/crossref_metadata_2025 huggingface dataset:
Can you see frailty? An exploratory study of the use of a patient photograph in the transcatheter aortic valve implantation programme
Authors: Lauck Sandra B , Achtem Leslie , Borregaard Britt , Baumbusch Jennifer , Afilalo Jonathan , Wood David A , Forman Jacqueline , Cheung Anson , Ye Jian , Webb John G
Published: September 2020

Background

Frailty is an important consideration in the assessment of transcatheter aortic valve implantation patients. The documentation of a patient photograph to augment the objective measurement of frailty has been adopted by some transcatheter aortic valve implantation multidisciplinary (TAVI) programmes.

Methods

We used a prospective two-part multimethod study design. In part A, we examined the concordance between the Essential Frailty Toolset (EFT) and the score attributed by healthcare professionals based on visual rating of photographs using kappa estimates and linear regression. In part B, we conducted a content analysis qualitative study to elicit information about how the TAVI multidisciplinary team used photographs to form impressions about frailty.

Findings

Part A: 94 healthcare professionals (registered nurses/allied health 65%; physicians 35%) rated 40 representative photographs (women 42.5%; mean age 83.4 ± 7.5; mobility aid 40%) between 0 (robust) and 5 (very frail). The estimate of weighted kappa was 0.2575 (95% confidence interval 0.082–0.433), indicating fair agreement between median healthcare professional visual and EFT score, especially when the EFT was 1 or 4. There was significant discordance among raters (kappa estimate 0.110, 95% confidence interval 0.079–0.141). Age, sex and mobility aid did not have a significant effect on score discordance. Part B: 12 members of the TAVI multidisciplinary team (registered nurses 27.5%; physicians 72.5%) were shown a series of six representative patient photographs. The following themes emerged from the data: (a) looking at the outside; (b) thinking about the inside; (c) use but with caution; and (d) a better approach.

Conclusion

A patient photograph offers complementary information to the multimodality assessment of TAVI patients.
The Challenges of Keeping an Intimate Relationship: An Evolutionary Examination
Authors: Apostolou Menelaos , Wang Yan
Published: September 2020

Keeping an intimate relationship is challenging, and many people face difficulties in doing so. In the current research, we have attempted to identify these difficulties, within the context of an evolutionary theoretical framework. More specifically, by using a combination of qualitative research methods in a sample of 163 Greek-speaking participants, we identified 78 such difficulties. By employing maximum likelihood analysis on the scores of 1,099 Greek-speaking participants, we classified these difficulties in 12 broader factors. The most important factor was “Fading away enthusiasm,” followed by “Long work hours” and “Lack of personal time and space.” Almost 70% of the participants indicated that at least one factor, and 41% indicated that three or more factors caused them difficulties. Significant sex effects were found for most factors, indicating that men and women differed in the importance they ascribed to these difficulties. Moreover, significant age, marital status and number of children effects were found for several factors.
Compressed sensing–based electromechanical admittance data loss recovery for concrete structural health monitoring
Authors: Li Hedong , Ai Demi , Zhu Hongping , Luo Hui
Published: September 2020

Considerable amount of electromechanical admittance data needs to be collected, transmitted and stored during in-situ and long-term structural health monitoring applications, and data loss could be inevitably met when processing the monitoring electromechanical admittance signals. In this article, an innovative compressed sensing–based approach is proposed to implement data recovery for electromechanical admittance technique–based concrete structural health monitoring. The basis of this approach is to first project the original conductance signature onto an observation vector as sampled data, and then transmit the observation vector with data loss to storage station, and finally recover the missing data via a compressed sensing process. For comparison, both convex optimization theory and orthogonal matching pursuit algorithm are introduced to accomplish the compressed sensing–based electromechanical admittance data loss recovery. Prior detection test of a concrete cube subjected to varied temperatures and practical monitoring experiment of full-scale concrete shield tunnel segment undergone bolt-loosened defects are utilized to validate the feasibility of the proposed approach. In lost electromechanical admittance data recovery process, two types of data loss, namely, single-consecutive-segment loss and multiple-consecutive-segment losses, in sampled data are taken into consideration for sufficiently interpreting the effectiveness and accuracy of the convex optimization and orthogonal matching pursuit approaches. In the temperature recognition and damage identification stage, amplitude and frequency shifts in resonance peaks, cooperated with a common statistical index called root-mean-squared-deviation, are harnessed to achieve the goal after the lossy conductance signatures are recovered. The results show that the orthogonal matching pursuit–based data recovery approach is superior to the convex optimization approach because of its smaller calculation of consumption as well as lower recovered errors.
“That’s just impossible in my kindergarten.” Advocating for ‘glocal' early childhood curriculum frameworks
Authors: Bautista Alfredo , Bull Rebecca , Ng Ee Lynn , Lee Kerry
Published: September 2020

As a result of globalization, kindergarten curriculum frameworks in Asia have been strongly influenced by Western theories, pedagogies, and values. In this article, we argue that Singapore’s Nurturing Early Learners and Hong Kong’s Kindergarten Education Curriculum Guide present key notions that are inconsistent with cultural values that are deeply rooted in these two societies. To overcome the challenges these inconsistencies trigger for teachers, principals, teacher educators, and parents, we advocate for the design of 'glocal' (global/local, explicitly hybrid) curriculum frameworks, based on principles that are culturally appropriate and socially situated. Drawing on recent research studies, we analyze current curriculum/practice gaps in relation to the notions of Child-Centeredness, Quality Interactions, Creativity and Self-Expression, and Play. In seeking the global/local balance that is needed in Singapore and Hong Kong, four alternative glocal notions are proposed: Child-Appropriateness, Pedagogical Quality, Arts Engagement, and Child-Led Activities. We conclude there is an urgent need for generating a solid corpus of local research in both jurisdictions, which should guide subsequent curriculum reforms and teacher preparation models. Our final aim is to contribute to early childhood education policy discussions in Asia, against the background of internationalization.
Estimated glucose disposal rate demographics and clinical characteristics of young adults with type 1 diabetes mellitus: A cross-sectional pilot study
Authors: Nishtala Revathi , Kietsiriroje Noppadol , Karam Mohammad , Ajjan Ramzi A , Pearson Sam
Published: September 2020

Background:

Estimated glucose disposal rate (eGDR) is a practical measure of Insulin Resistance (IR) which can be easily incorporated into clinical practice. We profiled eGDR in younger adults with type 1 diabetes mellitus (T1DM) by their demographic and clinical characteristics.

Methods:

In this single centre study, medical records of TIDM were assessed and eGDR tertiles correlated with demographic and clinical variables.

Results:

Of 175 T1DM individuals, 108 (61.7%) were males. Mean age (±SD) was 22.0 ± 1.6 years and median time from diagnosis 11.0 years (range 1–23). Individuals were predominantly Caucasian (81.7%), with 27.4% being overweight (BMI: 25–30 kg/m2) and 13.7% obese (BMI > 30 kg/m2). Mean total cholesterol (TC) levels were significantly lower in high and middle eGDR tertiles (4.4 ± 1 and 4.3 ± 0.8 mmol/l, respectively) compared with low eGDR tertile (4.8 ± 1, p < 0.05 for both). Triglyceride (TG) levels showed a similar trend at 1.1 ± 0.5 and 1.1 ± 0.5 mmol/l for high and middle eGDR tertile compared to low eGDR tertile (1.5 ± 1 mmol/l, p < 0.05 for both). Renal function was similar across eGDR tertiles and no difference in retinopathy was detected.

Conclusion:

TC and TG are altered in individuals with T1DM and low eGDR, suggesting that this subgroup requires optimal lipid management to ameliorate their vascular risk.
Demarcation Line Assessment in Anatomical Liver Resection: An Overview
Authors: Felli Eric , Urade Takeshi , Al-Taher Mahdi , Felli Emanuele , Barberio Manuel , Goffin Laurent , Ettorre Giuseppe M. , Marescaux Jacques , Pessaux Patrick , Swanstrom Lee , Diana Michele
Published: September 2020

Anatomical liver resection (ALR) is the preferred oncological approach for the treatment of primary liver malignancies, such as hepatocellular carcinoma and intrahepatic cholangiocarcinoma. The demarcation line (DL) is formed by means of selective vascular occlusion and is used by surgeons to guide ALR. Emerging intraoperative technologies are playing a major role to enhance the surgeon’s vision and ensure a precise oncologic surgery. In this article, a brief overview of modalities to assess the DL during ALRs is presented, from the established conventional techniques to future perspectives.
Reed Miller Nesbit: Broadening the Horizon of Genitourinary Surgery
Authors: Kapogiannis Filippos , Fasoulakis Konstantinos , Fragkoulis Charalampos , Tsiampa Eleni , Fasoulakis Charalampos
Published: September 2020

Nesbit has made his name synonymous with transurethral prostate resection and attained eminence by popularizing his technique, although his lifetime achievements and contributions reach many aspects of genitourinary surgery and pediatric urology. We believe our history article will bring memories back to more senior urologists, allow the youngsters to recall a true innovator and versatile surgeon, and appeal to a broad audience such as the readership of Surgical Innovation Journal.
Low-Dose Radiotherapy for Late-Stage COVID-19 Pneumonia?
Authors: Koukourakis Michael I.
Published: September 2020

Low dose radiotherapy has been used in the pre-antibiotic era for the treatment of all kind of pneumonia, with relative success. The unimaginable daily death toll of thousands of victims dying from COVID-19 pneumonia and the marginal therapeutic value of agents tested, brings forward the re-evaluation of the position of radiotherapy in the treatment of late stage lethal COVID-induced respiratory failure. A sound biological rationale supports this idea. Immunopathology studies show that excessive inflammation and infiltration of the lung parenchyma by immune cells is the cause of death. Mice lacking IFNαβ receptors remain unaffected by the virus. Radiotherapy at doses of 50-200cG may exert an intense anti-inflammatory effect and reduce the burden of inflammatory cells infiltrating the lungs. Whether radiotherapy, in conjunction with remdesivir and/or macrolides can reduce the dramatic death rates related to COVID-19 is an open challenge, under the absence of an alternative solution.
Long-term mortality in survivors of spontaneous intracerebral hemorrhage
Authors: Pasi Marco , Casolla Barbara , Kyheng Maéva , Boulouis Grégoire , Kuchcinski Grégory , Moulin Solène , Labreuche Julien , Hénon Hilde , Cordonnier Charlotte , Leys Didier
Published: September 2020

Background

Factors associated with long-term mortality after spontaneous intracerebral hemorrhage (ICH) have been poorly investigated.

Aim

Our objective was to identify variables associated with long-term mortality in a prospective cohort of 30-day ICH survivors.

Methods

We prospectively included consecutive 30-day spontaneous ICH survivors. We evaluated baseline and follow-up clinical characteristics and magnetic resonance imaging (MRI) markers of chronic brain injury as variables associated with long-term mortality using univariate and multivariable Cox proportional hazard regression models.

Results

Of 560 patients with spontaneous ICH, 304 (54.2%) survived more than 30 days and consented for follow-up. During a median follow-up of 10 years (interquartile range: 8.0–10.5), 176 patients died. The cumulative survival rate at 10 years was 38%. In multivariable analysis, variables independently associated with long-term mortality were age (hazard ratio (HR) per 10-year increase: 1.68, 95% confidence interval (CI): 1.45–1.95), male gender (HR: 1.41, CI: 1.02–1.95), prestroke dependency (HR: 1.66, CI: 1.15–2.39), National Institutes of Health Stroke Scale score (HR per 1-point increase: 1.03, CI: 1.01–1.04), occurrence of any stroke (HR: 2.24, CI: 1.39–3.60), and dementia (HR: 1.51, CI: 1.06–2.16) during follow-up. Among MRI markers, only cerebral atrophy (HR per 1-point increase: 1.50, CI: 1.13–2.00) was independently associated with long-term mortality.

Conclusions

Preexisting comorbidities, clinical severity at presentation, and significant clinical event during follow-up are associated with long-term mortality. Among MRI markers of chronic brain injury, only cerebral atrophy is associated with long-term mortality.
Safety of day-case endovascular interventions for peripheral arterial disease in a rural, underserved area
Authors: Ansari Athar , Shah Moiz Ali , Shah Manaim Amir , Ansari Zahra
Published: September 2020

Background:

We aimed to investigate the safety of endovascular procedures undertaken in a single outpatient center located in a rural, underserved area. Endovascular procedures for Peripheral Arterial Disease (PAD) have become increasingly common in outpatient settings; their safety is yet to be determined in a rural, underserved area with no stand-by vascular surgeon on site.

Methods:

We undertook a retrospective case review of endovascular procedures for the investigation and management of lower extremity PAD between December 2012 and August 2015. Patients were classified by Rutherford score, degree of stenosis and length of lesions. Complications were major (requiring hospitalization) or minor, including perforation, distal embolization, hematoma, and allergic reactions, which could be treated immediately in the catheterization laboratory with no sequelae. Patients were monitored in the facility and followed up using clinical, biochemical and radiological parameters at 24 h and 1 month.

Results:

A total of 692 patients underwent endovascular procedures for the investigation and/or treatment of PAD, of which 608 were interventional. Of these patients, 10.20% experienced procedural complications, of which 0.66% were classified as major, including wire retention and retroperitoneal hemorrhage. In total, 99.34% were discharged safely on the same day as the procedure. No adverse events were reported at follow up.

Conclusion:

Endovascular procedures for PAD can be performed safely in a rural outpatient setting with low complication rates. Most complications are minor and do not require hospitalization. Outpatient procedures for PAD are safe and may widen access to specialist procedures in areas of socio-economic deprivation.
Early prediction of the 3-month outcome for individual acute ischemic stroke patients who received intravenous thrombolysis using the N2H3 nomogram model
Authors: Lv Shan , Song Yu , Zhang Fu-Liang , Yan Xiu-Li , Chen Jie , Gao Liang , Guo Zhen-Ni , Yang Yi
Published: September 2020

Background:

The aim of this study was to establish a nomogram model for individualized early prediction of the 3-month prognosis in patients with acute ischemic stroke (AIS) who were treated with intravenous recombinant tissue plasminogen activator (rt-PA) thrombolysis.

Methods:

A total of 691 patients were included in this study; 564 patients were included in the training cohort, while 127 patients were included in the test cohort. The main outcome measure was a 3-month unfavorable outcome (modified Rankin Scale 3–6). To construct the nomogram model, stepwise logistic regression analysis was applied to select the significant predictors of the outcome. The discriminative performance of the model was assessed by calculating the area under the receiver operating characteristic curve (AUC-ROC). A decision curve analysis was used to evaluate prognostic value of the model.

Results:

The initial National Institutes of Health Stroke Scale [NIHSS, odds ratio (OR), 1.35; 95% confidence interval (CI), 1.28–1.44; p < 0.001], delta NIHSS (changes in the NIHSS score from baseline to 24 h, OR, 0.75; 95% CI, 0.70–0.79; p < 0.001), hypertension (OR, 2.07; 95% CI, 1.32–3.31; p = 0.002), hyperhomocysteinemia (Hhcy, OR, 2.18; 95% CI, 1.20–4.11; p = 0.013), and the ratio of high-density lipoprotein cholesterol (HDL-C) to low-density lipoprotein cholesterol (LDL-C) (HDL-C/LDL-C, OR, 3.29; 95% CI, 1.00–10.89; p = 0.049) (N2H3) were found to be independent predictors of a 3-month unfavorable outcome from multivariate logistic regression analysis and were incorporated in the N2H3 nomogram model. The AUC-ROC of the training cohort was 0.872 (95% CI, 0.841–0.902), and the AUC-ROC of the test cohort was 0.900 (95% CI, 0.848–0.953).

Conclusion:

The study presented the N2H3 nomogram model, with initial NIHSS score, delta NIHSS, hypertension, Hhcy, and HDL-C/LDL-C as predictors. It therefore provides an individualized early prediction of the 3-month unfavorable outcome in AIS patients treated with intravenous rt-PA thrombolysis.
Hereditary spastic paraplegia: An “ears of the lynx” magnetic resonance imaging sign in a patient with recessive genetic type 11
Authors: Romagnoli Emiliano Ruiz , Akly Manuel Perez , Miquelini Luis A , Funes Jorge A , Besada Cristina H
Published: September 2020

Hereditary spastic paraplegias are an uncommon group of monogenic diseases that include 79 types of genetic disorders. The most frequent cause of recessive hereditary spastic paraplegia is a mutation in the spastic paraplegia gene type 11 followed by type 15. This group is usually associated with non-specific clinical features like cognitive decline and may precede the progressive weakness and spasticity of lower limbs. The magnetic resonance imaging hallmark of hereditary spastic paraplegia is thinning of the spinal cord. However, brain magnetic resonance imaging may provide relevant clues for specific hereditary spastic paraplegia subtypes, and thinning of the corpus callosum has been described as the most frequent abnormality in almost one-third of recessive hereditary spastic paraplegias. Moreover, a characteristic abnormality affecting the forceps minor of the corpus callosum has been recently reported as the “ears of the lynx” sign and is highly suggestive of type 11 and 15 hereditary spastic paraplegias. We report a patient who was diagnosed with hereditary spastic paraplegia type 11 by exome genetic testing, presenting the ears of the lynx sign in the first magnetic resonance imaging assessment.
Incidence and risk factors of oral feeding intolerance in acute pancreatitis: Results from an international, multicenter, prospective cohort study
Authors: Pothoulakis Ioannis , Nawaz Haq , Paragomi Pedram , Jeong Kwonho , Talukdar Rupjyoti , Kochhar Rakesh , Goenka Mahesh Kumar , Gulla Aiste , Singh Vikesh K. , Gonzalez Jose A. , Ferreira Miguel , Barbu Sorin T. , Stevens Tyler , Gutierrez Silvia C. , Zarnescu Narcis O. , Capurso Gabriele , Easler Jeffrey , Triantafyllou Konstantinos , Pelaez‐Luna Mario , Thakkar Shyam , Ocampo Carlos , de‐Madaria Enrique , Wu Bechien U. , Cote Gregory A. , Abebe Kaleab , Tang Gong , Lahooti Ali , Phillips Anna E. , Papachristou Georgios I.
Published: September 2020

Background

Inability to advance to an oral diet, or oral feeding intolerance, is a common complication in patients with acute pancreatitis associated with worse clinical outcomes. The factors related to oral feeding intolerance are not well studied.

Objective

We aimed to determine the incidence and risk factors of oral feeding intolerance in acute pancreatitis.

Methods

Patients were prospectively enrolled in the Acute Pancreatitis Patient Registry to Examine Novel Therapies in Clinical Experience, an international acute pancreatitis registry, between 2015 and 2018. Oral feeding intolerance was defined as worsening abdominal pain and/or vomiting after resumption of oral diet. The timing of the initial feeding attempt was stratified based on the day of hospitalization. Multivariable logistic regression was performed to assess for independent risk factors/predictors of oral feeding intolerance.

Results

Of 1233 acute pancreatitis patients included in the study, 160 (13%) experienced oral feeding intolerance. The incidence of oral feeding intolerance was similar irrespective of the timing of the initial feeding attempt relative to hospital admission day (p = 0.41). Patients with oral feeding intolerance were more likely to be younger (45 vs. 50 years of age), men (61% vs. 49%), and active alcohol users (44% vs. 36%). They also had higher blood urea nitrogen (20 vs. 15 mg/dl; p < 0.001) and hematocrit levels (41.7% vs. 40.5%; p = 0.017) on admission; were more likely to have a nonbiliary acute pancreatitis etiology (69% vs. 51%), systemic inflammatory response syndrome of 2 or greater on admission (49% vs. 35%) and at 48 h (50% vs. 26%), develop pancreatic necrosis (29% vs. 13%), moderate to severe acute pancreatitis (41% vs. 24%), and have a longer hospital stay (10 vs. 6 days; all p < 0.04). The adjusted analysis showed that systemic inflammatory response syndrome of 2 or greater at 48 h (odds ratio 3.10; 95% confidence interval 1.83–5.25) and a nonbiliary acute pancreatitis etiology (odds ratio 1.65; 95% confidence interval 1.01–2.69) were independent risk factors for oral feeding intolerance.

Conclusion

Oral feeding intolerance occurs in 13% of acute pancreatitis patients and is independently associated with systemic inflammatory response syndrome at 48 h and a nonbiliary etiology.
Activation of cholinergic anti-inflammatory pathway involved in therapeutic actions of α-mangostin on lipopolysaccharide-induced acute lung injury in rats
Authors: Yang Zhe , Yin Qin , Olatunji Opeyemi Joshua , Li Yan , Pan Shu , Wang Dan-dan , Zuo Jian
Published: September 2020

Introduction:

Alpha-mangostin (MAN) possesses a wide variety of pharmacological effects. In this study, we investigated its effect on cholinergic anti-inflammatory pathway (CAP), and tested if CAP regulation was involved in the therapeutic action on acute lung injury (ALI).

Methods:

Male Sprague Dawley rats were pre-treated with MAN (40 mg/kg) for 3 days and ALI was induced with an intraperitoneal injection of lipopolysaccharide (LPS). Certain rats received monolateral vagotomy or sham surgery. The effects on inflammatory reactions and relevant pathways in ALI rats or LPS pre-treated RAW 264.7 cells were investigated by histological, immunohistochemical, immunoblotting, RT-qPCR, and immunofluorescence assays, while levels of proinflammatory cytokines, acetylcholine (Ach) and the enzymatic activity of acetylcholinesterase (AchE) were determined by corresponding quantitative kits.

Results:

Oral administration of MAN reduced the severity of ALI, while vagotomy surgery antagonized this effect. MAN restored the decline in α7 nicotinic acetylcholine receptor (α7nAchR) in the lungs of ALI rats, and promoted the expression of α7nAchR and choline acetyltransferase (CHAT) in RAW 264.7 cells. Although AchE expression was barely affected by MAN at 5 μg/ml, its catalytic activity was reduced by almost 95%. Extracellular rather than intracellular Ach was notably raised shortly after MAN treatment. Furthermore, MAN at 5 μg/ml effectively inhibited LPS-induced increase in phosphorylation and nucleus translocation of p65 subunit, and secretion of TNF-α and IL-1β, which was then offset by methyllycaconitine citrate hydrate.

Conclusion:

MAN activated CAP by increasing peripheral Ach and up-regulating α7nAchR expression, which eventually led to NF-κB inhibition and remission of acute inflammations.
The Materials Utilized in Cranial Reconstruction: Past, Current, and Future
Authors: Meyer Haley , Khalid Syed I. , Dorafshar Amir H. , Byrne Richard W.
Published: September 2020

Background:

Cranioplasty (CP) is associated with high complication rates compared to other common neurosurgical procedures. Several graft materials are used for CP, which may contribute to the high complication rates, but data in the literature regarding the influence of graft material on post-CP outcomes are inconsistent making it difficult to determine if, when, and to what extent the graft material impacts the rate of perioperative complications. There is an increased demand to identify and develop superior graft materials.

Objective:

To review and compare the indications, risks, complications, and patient results associated with the use of different graft materials for cranial reconstructions.

Design:

A search through EBSCO host was conducted using the keywords “craniectomy” or “decompressive craniectomy,” “cranioplasty,” and “materials.” The search was limited to literature published in the English language from 2005 until the present. Ultimately, 69 articles were included in this review. Due to the heterogeneity of the study populations, results, statistical analyses, and collecting methods, no statistical analyses could be performed.

Conclusions:

Several graft materials have been adapted for use in cranial reconstructions with inconsistent results making it unclear if or when one material may be indicated over others. Advances in computer-aided design have led to improved patient-specific implants, but the ideal graft material is still being sought after in ongoing research efforts. Reviewing materials currently available, as well as those in clinical trials, is important to identify the limitations associated with different implants and to guide future research.
Spatial accessibility to kindergartens using a spectrum combinational approach: Case study of Shanghai using cellphone data
Authors: Chen Zifeng , Zhou Xingang , Yeh Anthony GO
Published: September 2020

Spatial accessibility to kindergartens is a critical issue related to the transport safety of children. Young children should be escorted to kindergartens by adults, and trips to kindergartens are occasionally dependent on parents’ home–work trips because parents may escort their children to kindergartens en route to work. Many types of school trip can be categorized into two main types: “Home–School” and “Home–School–Work” trips. However, existing studies have tended to focus on only one type of school trip and have disregarded the other type in the assessment of accessibility. The present study examines accessibility to kindergartens by considering both types of school trips. The basic two-step floating catchment area method is used to measure the accessibility of “Home–School” trips and the commuter-based two-step floating catchment area is used for “Home–School–Work” trips. This study proposes a spectrum combinational approach, which combines both types of trips according to their actual percentages, to provide a realistic assessment of accessibility to kindergartens. An empirical study is conducted in Shanghai by combining cellphone big data and traditional data from a census. Results indicate that, compared with the spectrum combinational approach, the inequality of accessibility would be underestimated if we only focus on “Home–School” trips in the measurement of accessibility, but overestimated if we only focus on “Home–School–Work” trips. The proposed spectrum combinational approach, by modifying the trip assumptions on which accessibility evaluation is based, constitutes a novel and more realistic accessibility measurement of spatial accessibility to kindergartens.
AKT signaling restrains tumor suppressive functions of FOXO transcription factors and GSK3 kinase in multiple myeloma
Authors: Bloedjes Timon A. , de Wilde Guus , Maas Chiel , Eldering Eric , Bende Richard J. , van Noesel Carel J. M. , Pals Steven T. , Spaargaren Marcel , Guikema Jeroen E. J.
Published: September 2020

The phosphatidylinositide-3 kinases and the downstream mediator AKT drive survival and proliferation of multiple myeloma (MM) cells. AKT signaling is active in MM and has pleiotropic effects; however, the key molecular aspects of AKT dependency in MM are not fully clear. Among the various downstream AKT targets are the Forkhead box O (FOXO) transcription factors (TFs) and glycogen synthase kinase 3 (GSK3), which are negatively regulated by AKT signaling. Here we show that abrogation of AKT signaling in MM cells provokes cell death and cell cycle arrest, which crucially depends on both FOXO TFs and GSK3. Based on gene expression profiling, we defined a FOXO-repressed gene set that has prognostic significance in a large cohort of patients with MM, indicating that AKT-mediated gene activation is associated with inferior overall survival. We further show that AKT signaling stabilizes the antiapoptotic myeloid cell leukemia 1 (MCL1) protein by inhibiting FOXO- and GSK3-mediated MCL1 turnover. In concordance, abrogation of AKT signaling greatly sensitized MM cells for an MCL1-targeting BH3-mimetic, which is currently in clinical development. Taken together, our results indicate that AKT activity is required to restrain the tumor-suppressive functions of FOXO and GSK3, thereby stabilizing the antiapoptotic protein MCL1 in MM. These novel insights into the role of AKT in MM pathogenesis and MCL1 regulation provide opportunities to improve targeted therapy for patients with MM.
Phase 2 multiple-dose study of an FcRn inhibitor, rozanolixizumab, in patients with primary immune thrombocytopenia
Authors: Robak Tadeusz , Kaźmierczak Maciej , Jarque Isidro , Musteata Vasile , Treliński Jacek , Cooper Nichola , Kiessling Peter , Massow Ute , Woltering Franz , Snipes Rose , Ke Juan , Langdon Grant , Bussel James B. , Jolles Stephen
Published: September 2020

Primary immune thrombocytopenia (ITP) is a predominantly immunoglobulin G (IgG)-autoantibody-mediated disease characterized by isolated thrombocytopenia. Rozanolixizumab, a subcutaneously infused humanized monoclonal anti-neonatal Fc receptor (FcRn) antibody, reduced serum IgG in healthy volunteers. In this phase 2, multicenter, open-label study, patients with persistent/chronic primary ITP received 1 to 5 once-weekly subcutaneous infusions of rozanolixizumab (cumulative doses, 15-21 mg/kg). Primary objectives were safety and tolerability, and secondary objectives were clinical efficacy (change in platelet count) and pharmacodynamic effect (change in IgG). In all, 51 (77.3%) of 66 patients reported 1 or more adverse events (AEs), all mild-to-moderate, most commonly headaches (26 [39.4%] of 66), of which 15 were treatment related. Four patients had serious AEs, but none were treatment related. No AEs resulted in discontinuation of the study drug. No serious infections occurred. Platelet counts of ≥50 × 109/L were achieved at least once at any time after multiple infusions (5 × 4, 3 × 7, or 2 × 10 mg/kg: 35.7%, 35.7%, and 45.5% of patients, respectively) or single infusions (15 or 20 mg/kg: 66.7% and 54.5% patients, respectively). Minimum mean IgG levels and maximum mean platelet counts both occurred by day 8 in the higher (15 and 20 mg/kg) single-dose cohorts and maximum platelet count occurred by day 11 onward in the multiple-dose cohorts. No clinically meaningful changes occurred in IgA, IgM, IgE, or albumin levels. In patients with persistent/chronic primary ITP, rozanolixizumab demonstrated a favorable safety profile and rapid, substantial platelet increases concordant with substantial IgG reductions, especially with single doses. By day 8, in the 15 and 20 mg/kg single-dose cohorts, >50% patients achieved clinically relevant platelet responses (≥50 × 109/L), coinciding with the lowest mean IgG levels. These data support phase 3 development of rozanolixizumab in persistent/chronic primary ITP. This trial was registered at www.clinicaltrials.gov as #NCT02718716.
Inter-scanner reproducibility of brain volumetry: influence of automated brain segmentation software
Authors: Liu Sirui , Hou Bo , Zhang Yiwei , Lin Tianye , Fan Xiaoyuan , You Hui , Feng Feng
Published: September 2020

Background

The inter-scanner reproducibility of brain volumetry is important in multi-site neuroimaging studies, where the reliability of automated brain segmentation (ABS) tools plays an important role. This study aimed to evaluate the influence of ABS tools on the consistency and reproducibility of the quantified brain volumetry from different scanners.

Methods

We included fifteen healthy volunteers who were scanned with 3D isotropic brain T1-weighted sequence on three different 3.0 Tesla MRI scanners (GE, Siemens and Philips). For each individual, the time span between image acquisitions on different scanners was limited to 1 h. All the T1-weighted images were processed with FreeSurfer v6.0, FSL v5.0 and AccuBrain® with default settings to obtain volumetry of brain tissues (e.g. gray matter) and substructures (e.g. basal ganglia structures) if available. Coefficient of variation (CV) was calculated to test inter-scanner variability in brain volumetry of various structures as quantified by these ABS tools.

Results

The mean inter-scanner CV values per brain structure among three MRI scanners ranged from 6.946 to 12.29% (mean, 9.577%) for FreeSurfer, 7.245 to 20.98% (mean, 12.60%) for FSL and 1.348 to 8.800% (mean value, 3.546%) for AccuBrain®. In addition, AccuBrain® and FreeSurfer achieved the lowest mean values of region-specific CV between GE and Siemens scanners (from 0.818 to 5.958% for AccuBrain®, and from 0.903 to 7.977% for FreeSurfer), while FSL-FIRST had the lowest mean values of region-specific CV between GE and Philips scanners (from 2.603 to 16.310%). AccuBrain® also had the lowest mean values of region-specific CV between Siemens and Philips scanners (from 1.138 to 6.615%).

Conclusion

There is a large discrepancy in the inter-scanner reproducibility of brain volumetry when using different processing software. Image acquisition protocols and selection of ABS tool for brain volumetry quantification have impact on the robustness of results in multi-site studies.
Complicated COVID-19 in pregnancy: a case report with severe liver and coagulation dysfunction promptly improved by delivery
Authors: Ronnje Louise , Länsberg John-Kalle , Vikhareva Olga , Hansson Stefan R. , Herbst Andreas , Zaigham Mehreen
Published: September 2020

Background

It has been proposed that pregnant women and their fetuses may be particularly at risk for poor outcomes due to the coronavirus (COVID-19) pandemic. From the few case series that are available in the literature, women with high risk pregnancies have been associated with higher morbidity. It has been suggested that pregnancy induced immune responses and cardio-vascular changes can exaggerate the course of the COVID-19 infection.

Case presentation

A 26-year old Somalian woman (G2P1) presented with a nine-day history of shortness of breath, dry cough, myalgia, nausea, abdominal pain and fever. A nasopharyngeal swab returned positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Her condition rapidly worsened leading to severe liver and coagulation impairment. An emergency Caesarean section was performed at gestational week 32 + 6 after which the patient made a rapid recovery. Severe COVID-19 promptly improved by the termination of the pregnancy or atypical HELLP (Hemolysis, Elevated Liver Enzymes and Low Platelet Count) exacerbated by concomitant COVID-19 infection could not be ruled out. There was no evidence of vertical transmission.

Conclusions

This case adds to the growing body of evidence which raises concerns about the possible negative maternal outcomes of COVID-19 infection during pregnancy and advocates for pregnant women to be recognized as a vulnerable group during the current pandemic.
A prospective observational study on critically ill children with diaphragmatic dysfunction: clinical outcomes and risk factors
Authors: Xue Yang , Yang Chun-Feng , Ao Yu , Qi Ji , Jia Fei-Yong
Published: September 2020

Background

Diaphragmatic dysfunction (DD) has a great negative impact on clinical outcomes, and it is a well-recognized complication in adult patients with critical illness. However, DD is largely unexplored in the critically ill pediatric population. The aim of this study was to identify risk factors associated with DD, and to investigate the effects of DD on clinical outcomes among critically ill children.

Methods

Diaphragmatic function was assessed by diaphragm ultrasound. According to the result of diaphragmatic ultrasound, all enrolled subjects were categorized into the DD group (n = 24) and the non-DD group (n = 46). Collection of sample characteristics in both groups include age, sex, height, weight, primary diagnosis, complications, laboratory findings, medications, ventilatory time and clinical outcomes.

Results

The incidence of DD in this PICU was 34.3%. The level of CRP at discharge (P = 0.003) in the DD group was higher than the non-DD group, and duration of elevated C-reactive protein (CRP) (P < 0.001), sedative days (P = 0.008) and ventilatory treatment time (P < 0.001) in the DD group was significantly longer than the non-DD group. Ventilatory treatment time and duration of elevated CRP were independently risk factors associated with DD. Patients in the DD group had longer PICU length of stay, higher rate of weaning or extubation failure and higher mortality.

Conclusion

DD is associated with poorer clinical outcomes in critically ill childern, which include a longer PICU length of stay, higher rate of weaning or extubation failure and a higher mortality. The ventilatory treatment time and duration of elevated CRP are main risk factors of DD in critically ill children.

Trial registration

Current Controlled Trials ChiCTR1800020196, Registered 01 Dec 2018.
Sex differences in dementia: on the potentially mediating effects of educational attainment and experiences of psychological distress
Authors: Hasselgren Caroline , Ekbrand Hans , Halleröd Björn , Mellqvist Fässberg Madeleine , Zettergren Anna , Johansson Lena , Skoog Ingmar , Dellve Lotta
Published: September 2020

Background

Old-age dementias are known to disproportionally affect women as well as individuals with low educational attainment. The higher lifetime risk of dementia among women is usually attributed to their longer life expectancy. However, the impact of sex, and subsequent gender inequity, is likely to be more multifaceted than this explanation implies. Not least because of historical inequities in access to education between the sexes and the gender and socio-economic gradients in risk factors such as stress, depression and social isolation. Consequently, the present study sought to test whether differences in educational attainment and experiences of general psychological distress mediate the association between female sex and dementia.

Methods

The study utilizes data obtained through the Gothenburg H70 Birth Cohort Study and the Prospective Populations Study on Women (n = 892). Data were analysed using Confirmatory Factor Analysis (CFA) and Structural Equation Modelling (SEM) with Weighted Least Squares Means and Variance adjusted (WLSMV) estimation. General psychological distress was indicated by a latent variable and constructed from five manifest items (previous depression, stress, self-esteem, chronic loneliness and satisfaction with social situation) that were all measured at baseline.

Results

While the results could not corroborate that education directly mediates the effect of sex on dementia, level of distress was predicted by both female sex (0.607, p < .001) and education (− 0.166, p < .01) and, in turn, shown to be significantly associated with dementia (0.167, p < .05), also after controlling for confounders. When time from baseline to diagnosis was increased through sequential exclusion of dementia cases, the effect of distress on dementia was no longer significant.

Conclusion

The overall findings suggest that social (dis) advantage predicts general psychological distress, which thereby constitutes a potential, and rarely acknowledged, pathway between female sex, education, and dementia. They further underline the importance of attending to both education and distress as ‘gendered’ phenomena when considering the nature of their associations with dementia. However, the possibility of reverse causality bias must be acknowledged and the need for longitudinal studies with longer follow-up stressed.
Prevalence and risk factors associated with severe pre-eclampsia among postpartum women in Zanzibar: a cross-sectional study
Authors: Machano Mwashamba M. , Joho Angelina A.
Published: September 2020

Background

Severe pre-eclampsia is more dominant in low and middle-income countries. In Sub-Saharan Africa, severe pre-eclampsia remains a major public health problem contributing to high rates of maternal mortality. Few studies have investigated the relationship between severe pre-eclampsia and associated factors in East Africa. The aim of this study was to determine the prevalence and risk factors associated with severe pre-eclampsia among postpartum women in Zanzibar.

Methods

A hospital based analytical cross-sectional study design was used. Purposive sampling was utilized for the selection of hospitals. Proportionate sampling was used for selection of representatives from each hospital and participants were selected using systematic random sampling. Postpartum mothers were included in the study. The study was conducted by an interviewer who administered a questionnaire with close ended questions and chart review for data gathering. SPSS version 23 was used for data analysis and descriptive and multiple logistic regression was performed for control of confounders.

Results

This study included a total of 400 participants with a 100% response rate. Participants ranged from 17 to 45 years of age with mean age (SD) of 28.78 (±6.296). The prevalence of severe pre-eclampsia among postpartum women was 26.3% (n = 105). After adjusting for the possible confounders, factors associated with severe pre-eclampsia were; maternal age group of 15–20 years (AOR 3.839; 95% C. I 1.037–14.210), pregnancy from new partner/husband (AOR 7.561; 95% C. I 3.883–14.724), family history of high blood pressure (AOR 6.446; C. I 3.217–12.917), diabetes prior to conception (AOR 55.827; 95% C. I 5.061–615.868), having high blood pressure in a previous pregnancy (AOR 19.382; 95% C. I 4.617–81.364), paternal age above 45 (AOR 2.401; 95% C. I 1.044–5.519) and multifetal gestation (AOR 7.62; 95% CI 2.01–28.84).

Conclusion

The prevalence of severe pre-eclampsia among postpartum women in Zanzibar is high. Common risk factors in this setting include maternal age of 15–20 years, pregnancy with a new partner, family history of high blood pressure, pre-existing diabetes prior to conception, a history of high blood pressure in previous pregnancy paternal age greater than 45 and multifetal gestation.
Correction to: Use of an oxygen planar optode to assess the effect of high velocity microsprays on oxygen penetration in a human dental biofilms in-vitro
Authors: Khosravi Yalda , Kandukuri Rala D. P. , Palmer Sara R. , Gloag Erin S. , Borisov Sergey M. , Starke E. Michelle , Ward Marilyn T. , Kumar Purnima , de Beer Dirk , Chennu Arjun , Stoodley Paul
Published: September 2020

An amendment to this paper has been published and can be accessed via the original article.
Intimate partner violence against women and its association with pregnancy loss in Ethiopia: evidence from a national survey
Authors: Tiruye Tenaw Yimer , Chojenta Catherine , Harris Melissa L. , Holliday Elizabeth , Loxton Deborah
Published: September 2020

Background

Intimate partner violence (IPV) is major public health problem that affects many dimensions of women’s health. However, the role of IPV on women’s reproductive health in general and pregnancy loss in particular, is largely unknown in Ethiopia. Therefore, this study investigated the association between IPV and pregnancy loss in Ethiopia.

Methods

A retrospective analysis of nationally representative data from the 2016 Ethiopian Demographic and Health Survey (EDHS) was conducted. Married women of reproductive age (15–49 years) who participated in the domestic violence sub-study of the survey were included in the analysis. Adjusted odds ratios were estimated using multilevel logistic regression models to represent the association of IPV with outcome variable.

Results

Among 4167 women included in the analysis, pregnancy loss had been experienced by 467 (11.2%). In total, 1504 (36.1%) participants reported having ever experienced any form of IPV, with 25.1, 11.9, and 24.1% reporting physical, sexual and emotional IPV respectively. A total of 2371 (56.9%) women had also experienced at least one act of partner controlling behaviour. After adjusting for potential confounders, a significant association was observed between IPV (a composite measure of physical, sexual and emotional abuse) and pregnancy loss (Adjusted Odds Ratio (AOR) 1.54, 95% Confidence Interval (CI): 1.12, 2.14). The odds of pregnancy loss were also higher (AOR 1.72, 95% CI: 1.06, 2.79) among women who had experienced multiple acts of partner controlling behaviours, compared with women who had not experienced partner controlling behaviours. The intra-class correlation coefficient (ICC) indicated that pregnancy loss exhibits significant between-cluster variation (p < 0.001); about 25% of the variation in pregnancy loss was attributable to differences between clusters.

Conclusion

IPV against women, including partner controlling behaviour, is significantly associated with pregnancy loss in Ethiopia. Therefore, there is a clear need to develop IPV prevention strategies and to incorporate IPV interventions into maternal health programs.
Catastrophic costs of tuberculosis care in a population with internal migrants in China
Authors: Lu Liping , Jiang Qi , Hong Jianjun , Jin Xiaoping , Gao Qian , Bang Heejung , DeRiemer Kathryn , Yang Chongguang
Published: September 2020

Background

The internal rural-to-urban migration is one of the major challenges for tuberculosis (TB) control in China. Patient costs incurred during TB diagnosis and treatment could cause access and adherence barriers, particularly among migrants. Here, we estimated the prevalence of catastrophic costs of TB patients and its associated factors in an urban population with internal migrants in China.

Methods

A cross-sectional survey was conducted to enroll culture-confirmed pulmonary TB patients in Songjiang district, Shanghai, between December 1, 2014, and December 31, 2015. Consenting participants completed a questionnaire, which collected direct and indirect costs before and after the diagnosis of TB. The catastrophic cost was defined as the annual expenses of TB care that exceeds 20% of total household disposable income. We used logistic regression to identify factors associated with catastrophic costs.

Results

Overall, 248 drug-susceptible TB patients were enrolled, 70% (174/248) of them were from migrants. Migrant patients were significantly younger compared to resident patients. The total costs were 25,824 ($3689) and 13,816 ($1974) Chinese Yuan (RMB) in average for resident and migrant patients, respectively. The direct medical cost comprised about 70% of the total costs among both migrant and resident patients. Overall, 55% (132 of 248) of patients experienced high expenses (>10% of total household income), and 22% (55 of 248) experienced defined catastrophic costs. The reimbursement for TB care only reduced the prevalence of catastrophic costs to 20% (49 of 248). Meanwhile, 52% (90 of 174) of the internal migrants had no available local health insurance. Hospitalizations, no available insurance, and older age (> 45-year-old) contributed significantly to the occurrence of catastrophic costs.

Conclusions

The catastrophic cost of TB service cannot be overlooked, despite the free policy. Migrants have difficulties benefiting from health insurance in urban cities. Interventions, including expanded medical financial assistance, are needed to secure universal TB care.