bluuebunny/crossref_metadata_2025 huggingface dataset:
Bortezomib-based therapy in non-transplant multiple myeloma patients: a retrospective cohort study from the FABIO project
Authors: Franchi Matteo , Vener Claudia , Garau Donatella , Kirchmayer Ursula , Di Martino Mirko , Romero Marilena , De Carlo Ilenia , Scondotto Salvatore , Stival Chiara , Della Porta Matteo Giovanni , Passamonti Francesco , Corrao Giovanni
Published: February 2021

Introduction:

Randomized clinical trials showed that bortezomib, in addition to conventional chemotherapy, improves survival and disease progression in multiple myeloma (MM) patients not eligible for stem cell transplantation. The aim of this retrospective population-based cohort study is the evaluation of both clinical and economic profile of bortezomib-based versus conventional chemotherapy in daily clinical practice.

Methods:

Healthcare utilization databases of six Italian regions were used to identify adult patients with non-transplant MM, who started a first-line therapy with bortezomib-based or conventional chemotherapy. Patients were matched by propensity score and were followed from treatment start until death, lost to follow-up or study end-point. Overall survival (OS) and restricted mean survival time (RMST) were estimated using the Kaplan–Meier method. Association between first-line treatment and risk of death was estimated by a conditional Cox proportional regression model. Average mean cumulative costs were estimated and compared between groups.

Results:

In the period 2010–2016, 3509 non-transplant MM patients met the inclusion criteria, of which 1157 treated with bortezomib-based therapy were matched to 1826 treated with conventional chemotherapy. Median OS and RMST were 33.9 and 27.9 months, and 42.9 and 38.4 months, respectively, in the two treatment arms. Overall, these values corresponded to a HR of death of 0.79 (95% CI 0.71–0.89) over a time horizon of 84 months. Average cumulative cost were 83,839 € and 54,499 €, respectively, corresponding to an incremental cost-effectiveness ratio of 54,333 € per year of life gained, a cost coherent with the willingness-to-pay thresholds frequently adopted from Western countries.

Conclusions:

These data suggested that, in a large cohort of non-transplant MM patients treated outside the experimental setting, first-line treatment with bortezomib-based therapy was associated with a favourable effectiveness and cost-effectiveness profile.
Fierce flames: Evoking wildfire disaster emotions through children’s drawings
Authors: Ribeiro Ana Sofia , Silva Isabel
Published: February 2021

In the aftermath of catastrophes, art based participatory research has proven to be a useful tool for evoking emotions and knowledge in affected children, as well as for informing risk education and recovery psychology practices. Framed by disaster risk reduction and environmental philosophy, this article analyses a sample of drawings produced by schoolchildren aged 6–10 years old affected by the wildfires of October 2017 in the central inland region of Portugal, obtained using a ‘draw and write’ technique. The children’s narratives expressed concerns for their own safety and that of others, as well as concern for ecological damage. Emotional distress was also reported. The verbal statements accompanying the drawings helped the children to express their narratives carefully, allowing them to become active participants in their own process of thinking about the phenomena. We argue that children’s drawings constitute a valuable methodology to access children’s experiences after a disaster, as their visual richness reaches more than humans worlds. We recommend training for professionals, age-appropriate levels of informational support and a children’s disaster intervention model.
White men and electric guns: Analysing the Amazonian dystopia through Shipibo-Konibo children’s drawings
Authors: de Carvalho Thaís
Published: February 2021

In Andean countries, the pishtaco is understood as a White-looking man that steals Indigenous people’s organs for money. In contemporary Amazonia, the Shipibo-Konibo people describe the pishtaco as a high-tech murderer, equipped with a sophisticated laser gun that injects electricity inside a victim’s body. This paper looks at this dystopia through Shipibo-Konibo children’s drawings, presenting composite sketches of the pishtaco and maps of the village before and after an attack. Children portrayed White men with syringes and electric guns as weaponry, while discussing whether organ traffickers could also be mestizos nowadays. Meanwhile, the comparison of children’s maps before and after the attack reveals that lit lampposts are paradoxically perceived as a protection at night. The paper examines changing features of pishtacos and the dual capacity of electricity present in children’s drawings. It argues that children know about shifting racial dynamics in the village’s history and recognise development’s oxymoron: the same electricity that can be a weapon is also used as a shield.
A case of an intramural, cavitated feline gastrointestinal eosinophilic sclerosing fibroplasia of the cranial abdomen in a domestic longhair cat
Authors: Davidson Gordon A , Taylor Samantha S , Dobromylskyj Melanie J , Gemignani Francesco , Renfrew Helen
Published: February 2021

Case summary

A 5-year-old neutered male domestic longhair cat was presented for the investigation of a cranial abdominal mass following a 1-month history of inappetence and lethargy. Abdominal ultrasound revealed a large cavitated mass confluent with the mesenteric aspect of the descending duodenum. At surgery, the mass was found to involve the pylorus, proximal duodenum and pancreas, and was non-resectable. Histopathological examination of surgical biopsies revealed a non-neoplastic process involving eosinophils and fibroplasia.

Relevance and novel information

This case report describes an uncommon feline gastrointestinal pathology with an unusual appearance that may provide an additional differential diagnosis other than neoplasia or abdominal abscess when confronted with a cavitated abdominal mass in cats.
Authoritarian values and institutional trust: Theoretical considerations and evidence from the Philippines
Authors: Pernia Ronald A
Published: February 2021

Studies on authoritarian values, which have mostly focused on authoritarian regimes and on democracies with spells of authoritarianism, suggest trust in public institutions. However, limited empirical evidence has been carried out in the Philippines where cycles of regime change and authoritarian leadership have characterized its post-authoritarian landscape. Examining multiple public opinion data from the Asian Barometer Survey, this study found that regardless of the political leadership across different regimes, Filipino citizens expressed attitudinal dispositions, i.e. conforming, anti-political pluralism, and support for strong leaders, that constitute authoritarian political values. But instead of a destabilizing effect, estimates from ordinary least squares indicate that Filipino citizens’ authoritarian tendencies enhance institutional trust—seen as an indicator of support for the political system. The findings of this study empirically challenge the view of democratization in the Philippines by foregrounding its ‘populist-authoritarian’ dimension. In addition, they provide evidence of a growing scholarship in comparative political studies that claims that courting confidence for political institutions and regime support does not necessitate a ‘liberal-democratic’ model.
Perinatal Mood and Anxiety Disorder Management in Multicenter Community Practices: Clinicians’ Training, Current Practices and Perceived Strategies to Improve Future Implementation
Authors: Puspitasari Ajeng J. , Heredia Dagoberto , Weber Elise , Betcher Hannah K , Coombes Brandon J. , Brodrick Ellen M. , Skinner Susan M. , Tomlinson Angie L. , Salik Shana S. , Allen Summer V. , O’Grady Jason S. , Johnson Emily K. , L’amoureux Tayler M. , Moore Katherine M.
Published: February 2021

Background:

This study aimed to explore clinicians’ perspectives on the current practice of perinatal mood and anxiety disorder (PMAD) management and strategies to improve future implementation.

Methods:

This study had a cross-sectional, descriptive design. A 35-item electronic survey was sent to clinicians (N = 118) who treated perinatal women and practiced at several community clinics at an academic medical center in the United States.

Results:

Among clinicians who provided care for perinatal women, 34.7% reported never receiving PMAD management training and 66.3% had less than 10 years of experience. Out of 10 patients who reported psychiatric symptoms, 47.8% of clinicians on average reported providing PMAD management to 1 to 3 patients and 40.7% noted that they conducted screening only when patient expresses PMAD symptoms. Suggested future improvements were providing training, developing a referral list, and establishing integrated behavioral health services.

Conclusions:

Results from this study indicated that while PMAD screening and management was implemented, improvements are warranted to meet established guidelines. Additionally, clinicians endorsed providing PMAD management to a small percentage of perinatal patients. Suggested strategies to increase adoption and implementation of PMAD management should be explored to improve access to behavioral health services for perinatal women.
Implementing a Geriatric Fracture Program in a Mixed Practice Environment Reduces Total Cost and Length of Stay
Authors: Lin Carol , Rosen Sonja , Breda Kathleen , Tashman Naomi , T. Black Jeanne , Lee Jae , Chiang Aaron , Rosen Bradley
Published: February 2021

Introduction:

Geriatric-orthopaedic co-management models can improve patient outcomes. However, prior reports have been at large academic centers with “closed” systems and an inpatient geriatric service. Here we describe a Geriatric Fracture Program (GFP) in a mixed practice “pluralistic” environment that includes employed academic faculty, private practice physicians, and multiple private hospitalist groups. We hypothesized GFP enrollment would reduce length of stay (LOS), time to surgery (TTS), and total hospital costs compared to non-GFP patients.

Materials and Methods:

A multidisciplinary team was created around a geriatric Nurse Practitioner (NP) and consulting geriatrician. Standardized geriatric focused training programs and electronic tools were developed based on best practice guidelines. Fracture patients >65 years old were prospectively enrolled from July 2018 – June 2019. A trained biostatistician performed all statistical analyses. A p < 0.05 was considered significant.

Results:

564 operative and nonoperative fractures in patients over 65 were prospectively followed with 153 (27%) enrolled in the GFP and 411 (73%) admitted to other hospitalists or their primary care provider (non-GFP). Patients enrolled in the GFP had a significantly shorter median LOS of 4 days, compared to 5 days in non-GFP patients (P < 0.001). There was a strong trend towards a shorter median TTS in the GFP group (21.5 hours v 25 hours, p = 0.066). Mean total costs were significantly lower in the GFP group ($25,323 v $29085, p = 0.022)

Discussion:

Our data shows that a geriatric-orthopaedic co-management model can be successfully implemented without an inpatient geriatric service, utilizing the pre-existing resources in a complex environment. The program can be expanded to include additional groups to improve care for entire geriatric fracture population with significant anticipated cost savings.

Conclusions:

With close multidisciplinary team work, a successful geriatric-orthopaedic comanagement model for geriatric fractures can be implemented in even a mixed practice environment without an inpatient geriatrics service.
Developing an Organizational Climate Diagnostic Instrument for Junior High Schools in Taiwan
Authors: Tang Hui-Wen Vivian , Lee Lynne
Published: February 2021

The study was designed as a linked two-phase investigation, aiming to psychometrically develop and validate a Chinese version of the “Organizational Climate Diagnostic Instrument for Junior High Schools” (OCDI-JH) for use in Taiwan. Through extensive literature reviews, the complex phenomena of school climate were decomposed into a priori school climate construct in the first phase of the study. The data were collected from two separate samples of 287 junior high school principals/teachers/administrators for exploratory factor analysis (EFA) and 295 for confirmatory factor analysis (CFA), which were performed to scrutinize the psychometric properties of the OCDI-JH comprising 22 items clustered under five dimensions of (a) Safety (three items), (b) Academic (three items), (c) Relationships (seven items), (d) Institutional Environment (five items), and (e) Leadership (four items). Importance-Performance and Gap Analysis (IPGA) was applied in the second-phase elicitation study on 15 school faculty members to detect climate factors to be strengthened in a selected junior high school for school improvement. Focusing explicitly on contextually specific evaluation that facilitate school improvement, the OCDI-JH offers promise as a robust school climate diagnostic appraisal with practical implications for improving school effectiveness and implications for future research directions.
Exam Room Culture
Authors: Hershberger Paul J , Conway Katharine , Chu Justin M
Published: February 2021

If the minds of patients could be read, one would likely discover thoughts related to the culture of the clinical environment. “Do I belong here?” “Will I be judged?” “Is it safe to be honest?” We consider what physicians can do to create a culture in the exam room that corresponds to features found in the cultures of successful organizations. These characteristics include an emphasis on psychological safety for patients, a willingness to be vulnerable on the part of the physician, and a sincere focus on the patient’s purpose. Our conclusion is that by prioritizing such elements, the clinical encounter may be more satisfying and productive for the patient and physician alike.
The impact of out-of-home placement characteristics with regard to suicidal risk among adult survivors of childhood abuse
Authors: Touati Camille Danner , Miljkovitch Raphaële , Sirparanta Aino , Deborde Anne-Sophie
Published: February 2021

Background:

Childhood abuse is associated with increased lifetime suicidal risk (SR). Among victims of abuse, children in out-of-home care are also at risk. Out-of-home placement is aimed at stopping further exposure to maltreatment and at providing the necessary security for proper development. Research suggests that placement arrangements may impact children’s mental health outcomes.

Objective:

The study was aimed at examining (1) the direct effects of different placement characteristics (i.e. age at first placement, number of placements, placement disruptions, total time in care, contact with biological parents, contact with siblings, placement with siblings) on SR and (2) whether these characteristics moderate the link between maltreatment and SR.

Participants:

The sample consisted of 77 adults (52 women; 25 men; mean age: 26.6 years) who received out-of-home care during childhood.

Method:

Participants completed the Childhood Trauma Questionnaire and the Mini International Neuropsychiatric Interview (for SR). Participants’ records were used to determine placement characteristics and maltreatment.

Results:

PLS-PM analyses suggest a significant role of risk (age at first placement, number of placements, placement disruptions, contact with biological parents) and protective factors (contact with siblings, foster home placement) on SR. Risk factors also moderate the link between maltreatment and SR.

Conclusions:

Interventions aimed at limiting risk factors during placement seem important to reduce SR.
Corticosteroids in Community-Acquired Pneumonia: A Review of Current Literature
Authors: Harris Lindsay K. , Crannage Andrew J.
Published: February 2021

Objective: To review the evidence and recommendations for the use of adjunctive corticosteroid therapy in community-acquired pneumonia (CAP). Data Sources: A literature search was conducted using PubMed (1993 to November 2020) using the search terms corticosteroids AND community-acquired pneumonia. Study Selection and Data Extraction: Pertinent randomized controlled trials, systematic reviews, and meta-analyses assessing the efficacy and safety of adjunctive corticosteroids in patients with pneumonia were evaluated for inclusion. Data Synthesis: Studies suggest that corticosteroids reduce time to clinical stability and length of hospital stay, but data regarding other important clinical outcomes, such as mortality, are limited. The greatest margin of benefit appears to be in patients with severe CAP. Evidence consistently demonstrates hyperglycemia as the most common adverse effect of corticosteroid therapy in CAP. Safety concerns regarding the potential impact of corticosteroids on the rate of CAP-related rehospitalizations require further investigation. Relevance to Patient Care and Clinical Practice: This review summarizes literature evaluating the efficacy and safety of adjunctive corticosteroids in patients with CAP. It also includes a discussion on current guideline recommendations, patient selection, corticosteroid regimens, adverse effect considerations, limitations, and future directions in this area of research. Conclusions: Studies reviewed suggest that corticosteroids are relatively beneficial and safe in patients with CAP, with the greatest benefit in severe CAP. Currently, the routine use of corticosteroids is not recommended by clinical practice guidelines with the exception of CAP and refractory septic shock. Further research is needed to better define the ideal role of corticosteroids in CAP.
STING and transplantation: can targeting this pathway improve outcomes?
Authors: Bader Cameron S. , Jin Lei , Levy Robert B.
Published: February 2021

Stimulator of interferon genes (STING) is an innate immune sensor of cytoplasmic dsDNA originating from microorganisms and host cells. STING plays an important role in the regulation of murine graft-versus-host disease (GVHD) after allogeneic hematopoietic stem cell transplantation (allo-HSCT) and may be similarly activated during other transplantation modalities. In this review, we discuss STING in allo-HSCT and its prospective involvement in autologous HSCT (auto-HSCT) and solid organ transplantation (SOT), highlighting its unique role in nonhematopoietic, hematopoietic, and malignant cell types.
Heightened activation of embryonic megakaryocytes causes aneurysms in the developing brain of mice lacking podoplanin
Authors: Hoover Christopher , Kondo Yuji , Shao Bojing , McDaniel Michael J. , Lee Robert , McGee Samuel , Whiteheart Sidney , Bergmeier Wolfgang , McEver Rodger P. , Xia Lijun
Published: February 2021

During early embryonic development in mammals, including humans and mice, megakaryocytes (Mks) first originate from primitive hematopoiesis in the yolk sac. These embryonic Mks (eMks) circulate in the vasculature with unclear function. Herein, we report that podoplanin (PDPN), the ligand of C-type lectin-like receptor (CLEC-2) on Mks/platelets, is temporarily expressed in neural tissue during midgestation in mice. Loss of PDPN or CLEC-2 resulted in aneurysms and spontaneous hemorrhage, specifically in the lower diencephalon during midgestation. Surprisingly, more eMks/platelets had enhanced granule release and localized to the lower diencephalon in mutant mouse embryos than in wild-type littermates before hemorrhage. We found that PDPN counteracted the collagen-1–induced secretion of angiopoietin-1 from fetal Mks, which coincided with enhanced TIE-2 activation in aneurysm-like sprouts of PDPN-deficient embryos. Blocking platelet activation prevented the PDPN-deficient embryo from developing vascular defects. Our data reveal a new role for PDPN in regulating eMk function during midgestation.
Ontology-guided segmentation and object identification for developmental mouse lung immunofluorescent images
Authors:   LungMAP Consortium, Masci Anna Maria , White Scott , Neely Ben , Ardini-Polaske Maryanne , Hill Carol B. , Misra Ravi S. , Aronow Bruce , Gaddis Nathan , Yang Lina , Wert Susan E. , Palmer Scott M. , Chan Cliburn
Published: February 2021

Background

Immunofluorescent confocal microscopy uses labeled antibodies as probes against specific macromolecules to discriminate between multiple cell types. For images of the developmental mouse lung, these cells are themselves organized into densely packed higher-level anatomical structures. These types of images can be challenging to segment automatically for several reasons, including the relevance of biomedical context, dependence on the specific set of probes used, prohibitive cost of generating labeled training data, as well as the complexity and dense packing of anatomical structures in the image. The use of an application ontology helps surmount these challenges by combining image data with its metadata to provide a meaningful biological context, modeled after how a human expert would make use of contextual information to identify histological structures, that constrains and simplifies the process of segmentation and object identification.

Results

We propose an innovative approach for the semi-supervised analysis of complex and densely packed anatomical structures from immunofluorescent images that utilizes an application ontology to provide a simplified context for image segmentation and object identification. We describe how the logical organization of biological facts in the form of an ontology can provide useful constraints that facilitate automatic processing of complex images. We demonstrate the results of ontology-guided segmentation and object identification in mouse developmental lung images from the Bioinformatics REsource ATlas for the Healthy lung database of the Molecular Atlas of Lung Development (LungMAP1) program

Conclusion

We describe a novel ontology-guided approach to segmentation and classification of complex immunofluorescence images of the developing mouse lung. The ontology is used to automatically generate constraints for each image based on its biomedical context, which facilitates image segmentation and classification.
Mapping and validation of a major QTL for primary root length of soybean seedlings grown in hydroponic conditions
Authors: Chen Huatao , Kumawat Giriraj , Yan Yongliang , Fan Baojie , Xu Donghe
Published: February 2021

Background

The root system provides nutrient absorption and is closely related to abiotic stress tolerance, but it is difficult to study the roots under field conditions. This study was conducted to identify quantitative trait loci (QTL) associated with primary root length (PRL) during soybean seedling growth in hydroponic conditions. A total of 103 F7 recombinant inbred lines (RILs) derived from a cross between K099 (short primary root) and Fendou 16 (long primary root) were used to identify QTL for PRL in soybean. The RIL population was genotyped with 223 simple sequence repeats markers covering 20 chromosomes. Phenotyping for primary root length was performed for 3-weeks plants grown in hydoponic conditions. The identified QTL was validated in near isogenic lines and in a separate RIL population.

Results

QTL analysis using inclusive composite interval mapping method identified a major QTL on Gm16 between SSR markers Sat_165 and Satt621, explaining 30.25 % of the total phenotypic variation. The identified QTL, qRL16.1, was further confirmed in a segregating population derived from a residual heterozygous line (RHLs-98). To validate qRL16.1 in a different genetic background, QTL analysis was performed in another F6 RIL population derived from a cross between Union (medium primary root) and Fendou 16, in which a major QTL was detected again in the same genomic region as qRL16.1, explaining 14 % of the total phenotypic variation for PRL. In addition, the effect of qRL16.1 was confirmed using two pair of near-isogenic lines (NILs). PRL was significantly higher in NILs possessing the qRL16.1 allele from Fendou 16 compared to allele from K099.

Conclusions

The qRL16.1 is a novel QTL for primary root length in soybean which provides important information on the genetic control of root development. Identification of this major QTL will facilitate positional cloning and DNA marker-assisted selection for root traits in soybean.
Impact of a visual indicator on the noise level in an emergency medical dispatch centre - a pilot study
Authors: Outrey Justin , Pretalli Jean-Baptiste , Pujol Sophie , Brembilla Alice , Desmettre Thibaut , Lambert Christophe , Labourey Jean-Marc , Mauny Frédéric , Khoury Abdo
Published: February 2021

Background

Noise levels are monitored in call centres. A maximum of 52 to 55 dB(A) is recommended in order to prevent adverse events. We aimed at assessing the noise level and the impact of a visual noise indicator on the ambient noise level in a French Regional Emergency Medical Dispatch Centre (EMDC).

Methods

We conducted an observational study in the EMDC of the SAMU25 (University Hospital of Besancon). We measured the noise level using a SoundEarII® noise indicator (Dräger Medical SAS, France). The measurement took place in two phases on three consecutive days from 00:00 to 11:59 PM. At baseline, phase 1, the device recorded the average ambient noise for each minute without visual indication. Secondly, phase 2 included a sensor mounted with a light that would turn on green if noise was below 65 dB(A), orange if noise ever exceeded 65 and red if it exceeded 75 dB(A).

Results

In the presence of the visual noise indicator, the LAeq was significantly lower than in the absence of visual noise indicator (a mean difference of − 4.19 dB; P < 10–3). It was higher than 55 dB(A) in 84.9 and 43.9% of the time in phases 1 and 2, respectively.

Conclusions

The noise levels were frequently higher than the standards, and sometimes close to recommended limits, requiring preventive measures. The noise indicator had a positive effect on the ambient noise level. This work will allow the implementation of effective prevention solutions and, based on future assessments, could improve operators’ well-being and better care for patient.
The role of PNPLA3 and TM6SF2 polymorphisms on liver fibrosis and metabolic abnormalities in Brazilian patients with chronic hepatitis C
Authors: Oliveira Arthur Ivan N. , Malta Fernanda M. , Zitelli Patricia Momoyo Y. , Salles Ana Paula M. , Gomes-Gouvea Michele S. , Nastri Ana Catharina S. , Pinho Joao Renato R. , Carrilho Flair J. , Oliveira Claudia P. , Mendes-Corrêa Maria Cássia , Pessoa Mario G. , Mazo Daniel F.
Published: February 2021

Background

Despite the growing body of knowledge about TM6SF2 and PNPLA3 polymorphisms in non-alcoholic fatty liver disease, their influence in the spectrum of HCV liver disease is not yet fully defined. Besides that, admixed populations, such as Brazilians, were not included in most of the studies.

Methods

This cross-sectional study enrolled 365 treatment-naïve patients with HCV and 134 healthy individuals. TM6SF2 (rs58542926 c.499C > T) and PNPLA3 (rs738409 c.444C > G) polymorphisms were evaluated regarding their association with clinical and laboratory data, histological liver steatosis and fibrosis, and with components of the metabolic syndrome.

Results

In HCV subjects, the frequencies of TM6SF2 CC and CT + TT were 89% and 11%, while PNPLA3 frequencies of CC and CG + GG were 51.4% and 48.6%. In the univariate logistic regression analysis, the TM6SF2 CT + TT genotype in HCV was associated with significant liver fibrosis (p = 0.047; OR 1.953; 95% CI 1.009–3.788). In comparison to the CT + TT genotype, the TM6SF2 CC genotype in HCV was associated with older age (p = 0.002), higher frequency of arterial hypertension (p = 0.032), obesity (p = 0.030), metabolic syndrome (p = 0.014) and lower total cholesterol levels (p = 0.036). The PNPLA3 GG subjects had lower body mass index than CG/ CC individuals (p = 0.047). None of the polymorphisms, or their combinations, was independently associated with hepatic steatosis or fibrosis. On the other hand, older age, lower serum levels of total cholesterol, and higher serum levels of alanine aminotransferase and alkaline phosphatase were associated with liver fibrosis in the multivariate logistic regression analysis.

Conclusion

In this evaluation of an admixed HCV population, neither TM6SF2 nor PNPLA3 polymorphisms were independently associated with hepatic steatosis or fibrosis. Other factors seem more influential than these specific polymorphisms in isolation. More studies are warranted to clarify the role of the TM6SF2 and PNPLA3 polymorphisms in Brazilians with HCV.
Migration of fish bones into abdominal para‐aortic tissue from the duodenum after leading to duodenal perforation: a case report
Authors: Wang Rong , He Jinyan , Chen Zhengquan , Wen Kunming
Published: February 2021

Background

Migration of fish bones into abdominal para-aortic tissue after penetrating the junction of 3rd and 4th part of duodenum is incredibly rare.

Case presentation

A 68-year-old man was admitted to our hospital with persistent colic in the lower abdomen after eating fish two weeks ago. Abdominal computed tomography (CT) scan showed High density streaks along the anterior and lower edges of the 3rd part of duodenum with peripheral exudation and localized peritonitis. Esophagogastroduodenoscopy didn’t find foreign bodies and perforations in the digestive tract. Laparoscopic surgery and intraoperative endoscopy were made to detect foreign bodies and perforation site was found. After transition to open surgery, the fish bone was found in abdominal para-aortic tissue and removed without complications. Postoperative recovery is smooth, and the patient resumed normal diet and was discharged.

Conclusions

It is difficult to choose a treatment plan for foreign bodies at the 3rd part of the duodenum, because it is difficult to judge the damage caused by the foreign body to the intestine and the positional relationship with the surrounding important organs. Conservative treatment or surgical treatment both have huge risks. The handling of this situation will extremely test the psychology, physical strength and professional experience of the surgeon.
Instrument to evaluate the knowledge of patient with cirrhosis on his disease: construction and validity
Authors: Stelmach Mariana , de Almeida Medeiros Kayo Augusto , Carvalho Bárbara Justo , Pipek Leonardo Zumerkorn , de Mesquita Gustavo Heluani Antunes , Nii Fernanda , Martines Diego Ramos , Iuamoto Leandro Ryuchi , D’Albuquerque Luiz Augusto Carneiro , Meyer Alberto , Andraus Wellington
Published: February 2021

Background

The application of measurement instruments is a strategy to evaluate the patient's knowledge about the disease. This study aims to build an instrument that evaluates the patient's knowledge about liver cirrhosis.

Method

This study includes three phases. The first one was the construction of the instrument based on a literature review. In the second phase, five experts were participated in the evaluation of the instrument, to check the validity of the content. Quantitative and qualitative analyzes were made. The tool used was the CVI (Content Validity Index) and it was used the semantic study of the questions. The third phase was the process of the restructuring the instrument.

Results

The final version of the instrument consisted of 36 questions. The instrument was evaluated in 91.7 by the average CVI and 94.4% by the universal CVI.

Conclusions

The questions are properly structured and clear, therefore, understandable. Thus, the final instrument presented satisfactory content validity, so that, it reached the aim of this study.
The relationship between inequitable gender norms and provider attitudes and quality of care in maternal health services in Rwanda: a mixed methods study
Authors: Doyle Kate , Kazimbaya Shamsi , Levtov Ruti , Banerjee Joya , Betron Myra , Sethi Reena , Kayirangwa Marie Rose , Vlahovicova Kristina , Sayinzoga Felix , Morgan Rosemary
Published: February 2021

Background

Rwanda has made great progress in improving reproductive, maternal, and newborn health (RMNH) care; however, barriers to ensuring timely and full RMNH service utilization persist, including women’s limited decision-making power and poor-quality care. This study sought to better understand whether and how gender and power dynamics between providers and clients affect their perceptions and experiences of quality care during antenatal care, labor and childbirth.

Methods

This mixed methods study included a self-administered survey with 151 RMNH providers with questions on attitudes about gender roles, RMNH care, provider-client relations, labor and childbirth, which took place between January to February 2018. Two separate factor analyses were conducted on provider responses to create a Gender Attitudes Scale and an RMNH Quality of Care Scale. Three focus group discussions (FGDs) conducted in February 2019 with RMNH providers, female and male clients, explored attitudes about gender norms, provision and quality of RMNH care, provider-client interactions and power dynamics, and men’s involvement. Data were analyzed thematically.

Results

Inequitable gender norms and attitudes – among both RMNH care providers and clients – impact the quality of RMNH care. The qualitative results illustrate how gender norms and attitudes influence the provision of care and provider-client interactions, in addition to the impact of men’s involvement on the quality of care. Complementing this finding, the survey found a relationship between health providers’ gender attitudes and their attitudes towards quality RMNH care: gender equitable attitudes were associated with greater support for respectful, quality RMNH care.

Conclusions

Our findings suggest that gender attitudes and power dynamics between providers and their clients, and between female clients and their partners, can negatively impact the utilization and provision of quality RMNH care. There is a need for capacity building efforts to challenge health providers’ inequitable gender attitudes and practices and equip them to be aware of gender and power dynamics between themselves and their clients. These efforts can be made alongside community interventions to transform harmful gender norms, including those that increase women’s agency and autonomy over their bodies and their health care, promote uptake of health services, and improve couple power dynamics.
Reference ranges of fetal superior vena cava blood flow velocities and pulsatility index in the second half of pregnancy: a longitudinal study
Authors: Stefopoulou Maria , Herling Lotta , Johnson Jonas , Lindgren Peter , Kiserud Torvid , Acharya Ganesh
Published: February 2021

Background

Fetal superior vena cava (SVC) is essentially the single vessel returning blood from the upper body to the heart. With approximately 80-85% of SVC blood flow representing cerebral venous return, its interrogation may provide clinically relevant information about fetal brain circulation. However, normal reference values for fetal SVC Doppler velocities and pulsatility index are lacking. Our aim was to establish longitudinal reference intervals for blood flow velocities and pulsatility index of the SVC during the second half of pregnancy.

Methods

This was a prospective study of low-risk singleton pregnancies. Serial Doppler examinations were performed approximately every 4 weeks to obtain fetal SVC blood velocity waveforms during 20–41 weeks. Peak systolic (S) velocity, diastolic (D) velocity, time-averaged maximum velocity (TAMxV), time-averaged intensity-weighted mean velocity (TAMeanV), and end-diastolic velocity during atrial contraction (A-velocity) were measured. Pulsatility index for vein (PIV) was calculated.

Results

SVC blood flow velocities were successfully recorded in the 134 fetuses yielding 510 sets of observations. The velocities increased significantly with advancing gestation: mean S-velocity increased from 24.0 to 39.8 cm/s, D-velocity from 13.0 to 19.0 cm/s, and A-velocity from 4.8 to 7.1 cm/s. Mean TAMxV increased from 12.7 to 23.1 cm/s, and TAMeanV from 6.9 to 11.2 cm/s. The PIV remained stable at 1.5 throughout the second half of pregnancy.

Conclusions

Longitudinal reference intervals of SVC blood flow velocities and PIV were established for the second half of pregnancy. The SVC velocities increased with advancing gestation, while the PIV remained stable from 20 weeks to term.
Assessing patient cosmetic satisfaction after glaucoma drainage device surgery for different patch grafts
Authors: Milibari Doaa S. , Fatani Dalal , Ahmad Abeer , Owaidhah Ohoud , AlObeidan Saleh A. , Almobarak Faisal A. , Malik Rizwan
Published: February 2021

Background

The use of a tissue patch graft is common practice with a glaucoma drainage device (GDD). Patch grafts can be visible in the palpebral fissure and may be cosmetically displeasing for some patients. The aim of this study was to report the cosmetic satisfaction of pericardial, scleral, and corneal patch grafts related to superior GDD surgery.

Methods

Baseline clinical data were collected for consecutive patients with glaucoma operated between 2014 and 2019 at two tertiary eye care institutions (for superiorly-placed) Ahmad glaucoma valve implant using sclera, cornea and pericardium patch graft. A patient questionnaire that contained 4 concise questions, with a Likert-scale grading relating to cosmetic satisfaction was administered by a telephone-based interview. Responses and scores for each question were compared across patients who received the three different types of graft. A binominal logistic regression analysis was used to assess the effects of age, gender, type of graft, number of previous ocular surgeries, and final visual acuity to explain differences.

Results

We included 92 patients who met our inclusion criteria (24 patients received a corneal patch graft, 30 who received sclera and 38 who received pericardium). The mean (±SD) age was 50 (±17.5) years, and the average follow up was 20.7 (± 18.6) months. Regardless of the type of patch graft, most (67–84%) of patients were satisfied with the appearance of their eyes. Patients who received cornea or sclera were more likely to report that their eye looked ‘abnormal’ by others. Younger age was significantly associated with the response to this question.

Conclusion

Patients are generally satisfied with the appearance of their eye following GDD surgery with each of the patch grafts for superiorly-placed GDDs. Younger patients with cornea or sclera were more likely to report that their eyes looked abnormal.
How can wellbeing at work and sustainable employability of gifted workers be enhanced? A qualitative study from a capability approach perspective
Authors: van Casteren Patricia A.J. , Meerman Jan , Brouwers Evelien P.M. , van Dam Arno , van der Klink Jac J.L.
Published: February 2021

Background

Being gifted with a very high IQ (> 98 percentile) can provide an advantage in the occupational context but can also come with its` own specific challenges. Where some studies found higher than average levels of wellbeing at work and successful careers amongst the gifted, other studies report boredom and less job satisfaction. This poses the question what gifted people value in work, and which factors are associated with the achievement of valued work related outcomes, wellbeing and sustainable employability. In this study these questions were explored using the value driven capability approach as a theoretical framework.

Method

A qualitative approach was chosen and 16 in-depth semi-structured interviews with gifted workers (IQ > 130) were conducted. The transcripts were analysed using a reflexive thematic analysis aimed at identifying the work related outcomes participants aspired to achieve and the contextual and personal factors that affected the actualisation of these outcomes.

Results

Participants placed great value on the opportunity to learn, to use their knowledge and skills, and tended to have high ethical standards. If realized, these values contributed to wellbeing whereas if not fulfilled, this often resulted in frustration and sadness. The most important personal factors associated with wellbeing at work and sustainable employability were the level of organizational awareness, self-knowledge, a willingness to compromise, and fear of stigmatisation. Contextually a facilitating leadership style of managers was important, allowing the worker autonomy and decision latitude. Socially, participants enjoyed others as sparring partners but often had an aversion to small talk which could lead to social avoidance and loneliness.

Conclusions

If gifted workers managed (to get) what they valued in work, this was associated with wellbeing and sustainable employment Coaching aimed at improving organizational awareness, specific social skills (e.g. small talk, adaptability) and understanding their own cognitive processes could be valuable. The application of an autonomy supporting facilitative leadership style by supervisors would be beneficial. Further research should try to confirm the findings using quantitative methods and needs to examine more closely the impact of stigmatisation and leadership styles.
Use of masks in public places in Poland during SARS-Cov-2 epidemic: a covert observational study
Authors: Ganczak Maria , Pasek Oskar , Duda – Duma Łukasz , Świstara Dawid , Korzeń Marcin
Published: February 2021

Background

Face masks have been employed in the COVID-19 pandemic plans as a public and personal health control measure against the spread of SARS-CoV-2. In Poland, obligatory wearing of masks in public spaces was introduced on April 10th, 2020; a relaxation of previous universal measures was announced on May 29th, 2020, limiting use to indoor public places.

Objective

To assess use of masks or other protective devices in public spaces in Poland during the SARS-Cov-2 epidemic.

Methods

A non-participatory covert observational study was conducted on three dates, (10.05/18.05/25.05.2020) at public spaces in 13 regions with different risks. Ten consecutive individuals were observed by each of 82 medical students (n = 2460 observations), using a structured checklist.

Results

Among 2353 observed persons, the female/male ratios were 1.0, 1.1, and 1.0 on the three dates. Almost three quarters - 73.6% (n = 552/750) were using masks on date 1, 66.5% (544/818) on date 2; and 65.7% (516/785) on date 3. Cloth masks predominated on all dates (64.7–62.3%-62.6%), followed by medical (23.4–28.5%-26.9%). Being female (OR = 1.77–1.47-1.53 respectively) and location in a closed space (OR = 2.60–2.59-2.32) were each associated with higher usage. Participants in sports were about two times less likely to use masks (OR = 0.64–0.53-0.53) as compared to other activities. The proportion using masks correctly decreased gradually over time (364/552; 65.9%; 339/544; 62.3% and 304/516; 58.9%). More females wore masks correctly (date 1: 205/294; 69.7% vs 159/258; 61.6%, and date 3: 186/284; 65.5% vs 118/232; 50.9%; p = 0.045; p = 0.0008 respectively). Uncovered noses (47.3–52.7%) and masks around the neck (39.2–42.6%) were the most frequent incorrect practices.

Conclusions

Practices were not in line with official recommendations, especially among males, and deteriorated over time. Cloth masks were predominantly used in public spaces. Health promotion, through utilizing all available communication channels, would be helpful to increase compliance.
Reducing the kyphosis effect of anterior short thoracolumbar/lumbar scoliosis correction with an autograft fulcrum effect
Authors: Farshad Mazda , Frey Andrea , Jentzsch Thorsten , Betz Michael , Widmer Jonas , Spirig José Miguel
Published: February 2021

Background

Anterior scoliosis correction is a powerful technique with the disadvantage of a kyphotic effect on lumbar and thoracolumbar curves. We aimed to investigate whether a cognizant interposition of a rib graft anteriorly and at the concave side of the scoliotic curve causes significant fulcrum effect to enforce scoliosis correction and to reduce interfusional kyphosis in anterior scoliosis corrections.

Methods

Twenty otherwise comparable patients with lumbar and thoracolumbar adolescent idiopathic scoliosis (AIS) curves undergoing anterior short scoliosis correction with (n = 10) or without (n = 10, matched for age, gender and degree of deformity) fulcrum effect were retrospectively compared by means of radiographic measurements (sagittal and coronal profile, Cobb angles and intersegmental deformity correction angles) to evaluate the effect of this modified surgical technique.

Results

The overall amount of scoliosis correction was similar with 74 and 60% of initial curves of 57° and 53° in the case and control group respectively with a mean of 3 fused segments (4 screws).

Statistically relevant differences were found for intersegmental coronal cobb angles at the apex of 20° to 3° and 17° to 9° with and without fulcrum, respectively (p < 0.05). Creation of kyphosis in the fused segments was reduced with an interfusional kyphotic sagittal cobb angle of 15° pre-operatively vs. 3° post-operatively compared to the control group (13° pre-operatively vs. 18° post-operatively), (p < 0.05).

Conclusions

Interfusional hyperkyphosis associated with anterior scoliosis correction for thoracolumbar/lumbar curves can be reduced with cognizant positioning of the bone autograft at the antero-lateral (concave) site in the intervertebral region to create a fulcrum effect.

Trial registration

Registered at swissethics: BASEC No.: 2018–00180.
Posterior fixation can further improve the segmental alignment of lumbar degenerative spondylolisthesis with oblique lumbar interbody fusion
Authors: Wu Jingye , Ge Tenghui , Zhang Ning , Li Jianing , Tian Wei , Sun Yuqing
Published: February 2021

Background

For patients with degenerative spondylolisthesis, whether additional posterior fixation can further improve segmental alignment is unknown, compared with stand-alone cage insertion in oblique lumbar interbody fusion (OLIF) procedure. The aim of this study was to compare changes of the radiographical segmental alignment following stand-alone cage insertion and additional posterior fixation in the same procedure setting of OLIF for patients with degenerative spondylolisthesis.

Methods

A retrospective observational study. Selected consecutive patients with degenerative spondylolisthesis underwent OLIF procedure from July 2017 to August 2019. Five radiographic parameters of disc height (DH), DH-Anterior, DH-Posterior, slip ratio and segmental lordosis (SL) were measured on preoperative CT scans and intraoperative fluoroscopic images. Comparisons of those radiographic parameters prior to cage insertion, following cage insertion and following posterior fixation were performed.

Results

A total of thirty-three patients including six males and twenty-seven females, with an average age of 66.9 ± 8.7 years, were reviewed. Totally thirty-six slipped levels were assessed with thirty levels at L4/5, four at L3/4 and two at L2/3. Intraoperatively, with only anterior cage support, DH was increased from 8.2 ± 1.6 mm to 11.8 ± 1.7 mm (p < 0.001), DH-Anterior was increased from 9.6 ± 2.3 mm to 13.4 ± 2.1 mm (p < 0.001), DH-Posterior was increased from 6.1 ± 1.9 mm to 9.1 ± 2.1 mm (p < 0.001), the slip ratio was reduced from 11.1 ± 4.6% to 8.3 ± 4.4% (p = 0.020) with the slip reduction ratio 25.6 ± 32.3%, and SL was slightly changed from 8.7 ± 3.7° to 8.3 ± 3.0°(p = 1.000). Following posterior fixation, the DH was unchanged (from 11.8 ± 1.7 mm to 11.8 ± 2.3 mm, p = 1.000), DH-Anterior and DH-Posterior were slightly changed from 13.4 ± 2.1 mm and 9.1 ± 2.1 mm to 13.7 ± 2.3 mm and 8.4 ± 1.8 mm respectively (P = 0.861, P = 0.254), the slip ratio was reduced from 8.3 ± 4.4% to 2.1 ± 3.6% (p < 0.001) with the slip reduction ratio 57.9 ± 43.9%, and the SL was increased from 8.3 ± 3.0° to 10.7 ± 3.6° (p = 0.008).

Conclusions

Compared with stand-alone cage insertion, additional posterior fixation provides better segmental alignment improvement in terms of slip reduction and segmental lordosis in OLIF procedures in the treatment of lumbar degenerative spondylolisthesis.