bluuebunny/crossref_metadata_2025 huggingface dataset:
On the electrostatic potential for the two-hyperboloid and double-cone of a single sheet with elliptic cross-section
Authors: Vafeas Panayiotis , Sten Johan C -E , Chatjigeorgiou Ioannis K
Published: December 2020

The study of the response of divergence-free electric fields near corners and edges, resembling singularities that accumulate charges, is significant in modern engineering technology. A sharp point can mathematically be modelled with respect to the tip of the one sheet of a double cone. Here, we investigate the behaviour of the generated harmonic potential function close to the apex of a single-sheeted two-hyperboloid with elliptic cross-section, whose asymptote is the corresponding elliptic double cone with one sheet present. Hence, the electrostatic potential problem, involving a single sheet of a two-hyperboloid, is developed using the theory of ellipsoidal-hyperboloidal harmonics, wherein the particular consideration enforces as solution in terms of generalised Lamé functions of non-integer order. A numerical method to determine these functions is outlined and tested. We demonstrate our technique to the solution of a classical boundary value problem in electrostatics, referring to a metallic and charged single-sheeted elliptic two-hyperboloid and its double-cone limit. Semi-analytical expressions for the related fields are derived, all cases being accompanied by the necessary numerical implementation.
Resource tracking for neglected tropical disease programmes: the first step for developing a sustainable financing strategy
Authors: Huang Xiao Xian , Toure Hapsatou , Biswas Gautam
Published: December 2020

The adequacy of resources for programme implementation is a premise for achieving the targets set in the road map for neglected tropical diseases (NTDs) 2021–2030. During the decade 2010–2020, international health aid and pharmaceutical donations have driven progress to control and eliminate NTDs. In the next decade, domestic financing will be critical to sustain NTD control and elimination programmes. Tracking domestic resources for NTD programmes through country health accounts, a relatively mature health system resource tracking platform, could be the first step in raising the visibility of NTDs in the discussion of national health resource allocation.
Environmental Protection
Authors: Hill Pamela
Published: December 2020

In 1962, Rachel Carson’s Silent Spring sounded an alarm: the natural environment is being dangerously degraded because of human activity. Ever since, environmental protection has been a major societal concern. A robust system of environmental laws has emerged in the United States, commercial activities are increasingly scrutinized for their environmental impact, and communities around the world are becoming aware of the environment as a global issue requiring international attention. The most important evidence comes from the environment itself: the planet is warming, water supplies are at risk, ecosystems are under stress, and species are being lost at an unprecedented rate. Environmental Protection: What Everyone Needs to Know® provides accessible information that will help readers navigate this complex and highly relevant subject. It gives background information on the origins and development of environmental protection; introductions to the main elements of environmental protection with concrete examples; the context for understanding current issues; definitions of key terms; scientific, legal, and economic underpinnings; and discussion of hot-button current issues from nanopollution to climate change. The reader will gain familiarity with phenomena like biodiversity, the greenhouse effect, fugitive emissions, and algal blooms while learning about the impact of landmark policy initiatives like the Clean Air Act, the Endangered Species Act, the Kyoto Protocol, and the Paris Agreement.
Climate Change
Authors: Romm Joseph
Published: December 2020

This is, for my money, the best single-source primer on the state of climate change. (New York Magazine) “The right book at the right time: accessible, comprehensive, unflinching, humane.” (The Daily Beast) “A must-read.” (The Guardian) The essential primer on what will be the defining issue of our time, CLIMATE CHANGE: What Everyone Needs to Know® is a clear-eyed overview of the science, conflicts, and implications of our warming planet. From Joseph Romm, Chief Science Advisor for National Geographic’s Years of Living Dangerously series and one of Rolling Stone’s “100 people who are changing America,” CLIMATE CHANGE offers user-friendly, scientifically rigorous answers to the most difficult (and commonly politicized) questions surrounding what climatologist Lonnie Thompson has deemed “a clear and present danger to civilization.” Questions about climate change addressed in this guide include:· How will climate change affect day-to-day life in the coming decades? · What are the implications of owning coastal property in the age of climate change? · Is retirement to South Florida (or the U.S. Southwest, or even Southern Europe) safe? · What are the implications of the United States’ withdrawal from the Paris climate treaty? · What does Donald Trump’s presidency mean for climate action in the United States and around the globe? · Are efforts to combat climate change making a difference? As the global response to climate change continues to evolve, CLIMATE CHANGE: What Everyone Needs to Know® offers smart, unblemished answers to the most difficult questions in an area dogged by misunderstanding and politicization.
2020: A Year of Let Down and Loss
Authors: Kennedy Maureen Shawn
Published: December 2020

Looking forward to a fresh start.
Because Black Lives Did Not Matter
Authors: Adams Virginia W.
Published: December 2020

Yes, all lives do matter—but some have been valued a lot less highly for quite some time.
Remdesivir Approved to Treat COVID-19 Amid Controversy
Authors: Aschenbrenner Diane S.
Published: December 2020

Remdesivir (Veklury) is the first antiviral drug approved to treat patients ages 12 and older who are hospitalized with COVID-19.

The drug is administered via slow IV infusion.

Elevated liver enzymes are common with treatment. Hypersensitivity reactions, including anaphylaxis, are possible.
Remdesivir in The Treatment of COVID-19
Authors: Rosenberg Karen
Published: December 2020

According to this study:

The antiviral remdesivir is superior to placebo in the treatment of patients hospitalized with COVID-19.

A variety of therapeutic approaches are needed to continue to improve outcomes in COVID-19 patients.
Selection of the Study Participants
Authors: Capili Bernadette
Published: December 2020

Editor's note: This is the second article in a new series on clinical research by nurses. The series is designed to give nurses the knowledge and skills they need to participate in research, step by step. Each column will present the concepts that underpin evidence-based practice—from research design to data interpretation. The articles will also be accompanied by a podcast offering more insight and context from the author.
Cervical Pessary to Prevent Preterm Birth in Asymptomatic High-Risk Women: A Systematic Review and Meta-analysis
Authors: Conde-Agudelo Agustin , Romero Roberto , Nicolaides Kypros H.
Published: December 2020

(Abstracted from Am J Obstet Gynecol 2020;223:42–65.e2)

Preterm birth is associated with a multitude of short-term complications in infants compared with term delivery. These short-term complications include respiratory distress syndrome, bronchopulmonary dysplasia, necrotizing enterocolitis, sepsis, intraventricular hemorrhage, periventricular leukomalacia, and retinopathy of prematurity.
New perspectives on targeting RAF, MEK and ERK in melanoma
Authors: Dumaz Nicolas , Lebbé Céleste
Published: December 2020

Purpose of review

Although immune checkpoint inhibitors and small molecule inhibitors targeting the MAPK pathway have revolutionized the management of metastatic melanoma, long-term disease control occurs only for a minority of patients because of multiple resistance mechanisms. One way to tackle resistance is to develop the next-generation of RAF, MEK and ERK inhibitors using our understanding of the molecular mechanisms that fine-tune the MAPK pathway.

Recent findings

Studies on the regulation of the MAPK pathway have revealed a dominant role for homo-dimerization and hetero-dimerization of RAF, MEK and ERK. Allosteric inhibitors that break these dimers are, therefore, undergoing various stages of preclinical and clinical evaluation. Novel MEK inhibitors are less susceptible to differences in MEK's activation state and do not drive the compensatory activation of MEK that could limit efficacy. Innovations in targeting ERK originate from dual inhibitors that block MEK-catalyzed ERK phosphorylation, thereby limiting the extent of ERK reactivation following feedback relief.

The primary goal in RAF, MEK and ERK inhibitors’ development is to produce molecules with less inhibitor paradox and off-target effects, giving robust and sustained MAPK pathway inhibition.
Cryptotanshinone Attenuates Ischemia/Reperfusion-induced Apoptosis in Myocardium by Upregulating MAPK3
Authors: Wang Hefeng , Pang Wenhui , Xu Xingsheng , You Beian , Zhang Cuijuan , Li Dan
Published: December 2020

Chinese people have used the root of Salvia miltiorrhiza Bunge (called “Danshen” in Chinese) for centuries as an anticancer agent, anti-inflammatory agent, antioxidant, and cardiovascular disease drug. In addition, Danshen is considered to be a drug that can improve ischemia/reperfusion (I/R)-induced myocardium injury in traditional Chinese medicine. However, Danshen is a mixture that includes various bioactive substances. In this study, we aimed to identify the protective component and mechanism of Danshen on myocardium through network pharmacology and molecular simulation methods. First, cryptotanshinone (CTS) was identified as a potential active compound from Danshen that was associated with apoptosis by a network pharmacology approach. Subsequently, biological experiments validated that CTS inhibited ischemia/reperfusion-induced cardiomyocyte apoptosis in vivo and in vitro. Molecular docking techniques were used to screen key target information. Based on the simulative results, MAPKs were verified as well-connected molecules of CTS. Western blotting assays also demonstrated that CTS could enhance MAPK expression. Furthermore, we demonstrated that inhibition of the MAPK pathway reversed the CTS-mediated effect on cardiomyocyte apoptosis. Altogether, our work screened out CTS from Danshen and demonstrated that it protected cardiomyocytes from apoptosis.
Progression of Parapapillary Choroidal Microvascular Dropout After Disc Hemorrhage in Glaucoma Patients: 2 Case Reports
Authors: Lee Jong Sub , Lee Won June , Lim Han Woong , Seong Mincheol
Published: December 2020

Purpose:

Microvasculature dropout (MvD) is a novel finding seen in optical coherence tomography angiography (OCTA), which is characterized by a localized dehiscence of the choriocapillaris in the parapapillary atrophy area. Disc hemorrhage (DH) is an important factor often associated with the development and especially progression of glaucoma. Here, we present 2 cases of MvD progression with DH.

Methods and Results:

Case 1: A 62-year-old female patient with normal tension glaucoma in both her eyes had recurrent DH at the inferior area of her right eye. A new DH was observed in the inferotemporal area of the right eye with MvD progression on OCTA in the same direction three months from the baseline.

Case 2: A 57-year-old female patient with bilateral steroid-induced secondary glaucoma also had recurrent DH in her right eye. Four months from the baseline, DH occurred in the superotemporal and inferotemporal area of the right eye, and MvD was detected on OCTA in the superotemporal corresponding direction. After 19 months from the baseline, OCTA was repeated. The DH had resolved, but the superotemporal MvD persisted.

Conclusions:

The 2 cases presented here are the first to report on the relationship between MvD progression and DH. MvD as visualized in OCTA imaging looks to be of clinical importance, and hopefully future studies will reveal the actual connection between MvD, DH, and glaucoma progression.
Clinical Use of PanoMap for Glaucoma: Frequently Damaged Areas in Early Glaucoma
Authors: Lee Won June , Shin Yong Un , Lim Han Woong , Cho Heeyoon , Park Ki Ho , Seong Mincheol
Published: December 2020

Précis:

Recognizing the shortcomings of poor consistency of the fovea-disc relationship at different time points and comparing PanoMaps may well facilitate the understanding of the spatial relationship between parapapillary and macular areas in glaucoma.

Purpose:

The aims of this study are to analyze the spatial distribution of the frequently damaged areas in early glaucoma, compare the patterns between nonprogressors and progressors using the combined wide-field parapapillary and macular deviation maps (PanoMap), and to evaluate the consistency of the fovea-disc relationship in PanoMap. The fovea-disc distance (FDD) and fovea-disc axis (FDA) were compared at baseline and at the last follow-up.

Materials and Methods:

In total, 118 patients with early glaucoma and a minimum follow-up period of 3 years were included in this retrospective observational study. The pattern of structural changes was evaluated by averaging the PanoMaps of the enrolled patients at baseline and last follow-up. Longitudinal comparison of the FDD and FDA was performed at baseline and the last follow-up. Patients were divided into nonprogressor (n=44) and progressor (n=74), and the patterns of glaucoma progression in PanoMaps were compared between them.

Results:

At baseline, the glaucomatous damage was found more frequently in the macular compared with the parapapillary area. The spatial distribution of frequently damaged areas was similar between the nonprogressor and progressor. At the last follow-up, compared with the baseline structural change on the PanoMap, the progressive structural changes extended toward the fovea at both the parapapillary and macular areas in the progressor. The FDD and FDA were significantly different between the baseline and the last follow-up.

Conclusions:

The PanoMaps showed a clear spatial distribution of early glaucomatous changes, indicating that the damaged area was frequently observed in the macular area. As the consistency of the fovea-disc relationship in PanoMaps was not excellent, this aspect should be considered when interpreting the PanoMap.
Family Support for Adolescent Girls and Young Women Living With HIV in Zambia: Benefits, Challenges, and Recommendations for Intervention Development
Authors: Roberts Sarah T. , Edwards Patrick , Mulenga Drosin , Chelwa Nachela , Nyblade Laura , Brander Caila , Musheke Maurice , Mbizvo Michael , Subramanian Sujha
Published: December 2020

Lack of family involvement is barrier to antiretroviral therapy adherence among adolescent girls and young women (AGYW). This study assessed family support for AGYW's engagement along the HIV care continuum to inform the design of a family-focused intervention in Lusaka, Zambia. We conducted 16 in-depth interviews and four focus group discussions with 40 AGYW living with HIV. Three strategies were identified to strengthen family support. First, emotional and instrumental support are highly valued by AGYW and should be further developed or reinforced. Second, AGYW wanted more informational support and open discussion of HIV from family, and an intervention should aim to enhance these types of support. Third, existing appraisal support reinforced anticipated stigma among AGYW and discouraged disclosure, yet participants wished for more interactions with peers living with HIV. Appraisal support should therefore be reframed to help AGYW decide to whom they should disclose and how to do so safely.
Transcanal Endoscopic Management of Glomus Tympanicum: Multicentric Case Series
Authors: Fermi Matteo , Ferri Gaetano , Bayoumi Ebaied Tamer , Alicandri-Ciufelli Matteo , Bonali Marco , Badr El-Dine Mohamed , Presutti Livio
Published: December 2020

Objective:

The aim of this study was to report a multicentric surgical experience in the exclusive endoscopic management of glomus tympanicum (GT).

Study Design:

Retrospective case series review at two institutions.

Setting:

Tertiary referral centers.

Patients:

The study included 30 patients who underwent exclusive transcanal excision of GT between 2010 and 2017 at the two referral centers.

Interventions:

Exclusive endoscopic transcanal excision of GT type A1, A2, and B1 (modified Fisch-Mattox classification). All surgical procedures were performed by two senior surgeons (L.P.; M.B.).

Main Outcome Measures:

For each procedure, intraoperative features of the disease, postoperative complications, and functional outcomes were evaluated. Recurrent or residual diseases were clinically and radiologically assessed during the follow-up period.

Results:

None of the patients treated with transcanal endoscopic approach (TEA) experienced intraoperative complications, nor required conversion to microscopic approach. Gross total resection (GTR) was obtained in 90% of the cases, while a near total resection was advocated when the residual pathology had a close relationship with the internal carotid artery. Mean hospitalization time was 1.6 (±0.8 SD) days and no postoperative complications were reported. No recurrences were reported in the GTR group after a mean follow-up period of 38.1 (±28.7 SD) months.

Conclusions:

Middle ear paragangliomas with no mastoid involvement (Class A1, A2, and B1) can be safely managed by means of a transcanal endoscopic approach. Low rate of postoperative complications, short hospitalization, and high rate of gross total resection demonstrate that TEA is a safe and effective procedure.
Measurement Properties of the Hearing Environments and Reflection of Quality of Life (HEAR-QL) 28-item Questionnaire in Cholesteatoma
Authors: Leonard Colin G. , Dixon Peter R. , Cushing Sharon , Papsin Blake C. , Gordon Karen A. , James Adrian L.
Published: December 2020

Objective:

We sought to assess the reliability and construct validity of the Hearing Environments and Reflection on Quality of Life Adolescent (HEAR-QL 28) quality of life measure (QoL) in cholesteatoma.

Study Design:

Observational.

Setting:

Tertiary referral center.

Patients:

One hundred seventeen patients with a diagnosis or history of cholesteatoma completed HEAR-QL 28. In addition to patients within the age range recommended for HEAR-QL 28 (13–18 yr), patients under 13 years old who were able to complete HEAR-QL 28 without parental assistance were included.

Intervention (s):

Completion of HEAR-QL 28 QoL measure.

Main Outcome Measure (s):

HEAR-QL 28 score, four tone average pure tone audiogram hearing threshold and categorical classification of hearing loss as mild, moderate, and severe.

Results:

HEAR-QL 28 did not demonstrate discriminative ability on the basis of audiometric threshold, but did discriminate between participants hearing normally (four tone average pure tone audiogram <30 dB HL) (HEAR-QL 86/100) after cholesteatoma surgery from those with unilateral hearing loss (HEAR-QL 73/100) (p < 0.001). Those with unilateral loss could in turn be differentiated from those with bilateral loss (HEAR-QL 60/100) (p < 0.006).

Conclusion:

HEAR-QL 28 is valid measure of QoL in cholesteatoma with no evidence of redundancy and excellent internal consistency. The importance of considering QoL impact of cholesteatoma is highlighted by 17% of participants reporting the normality or abnormality of their hearing differently from their audiometric threshold. The HEAR-QL 28 provides insight into the ability to cope with their hearing environment in a specific environment.
Diagnostic and therapeutic challenges of chronic obstructive pulmonary disease in the elderly
Authors: Allen Brian , Aboussouan Loutfi S.
Published: December 2020

Purpose of review

Chronic obstructive pulmonary disease (COPD) imposes a large burden on the global population and even more so for the elderly who face significant obstacles in the diagnosis, management, and psychosocial effects of the disease. This review describes the current challenges and key points in the management of COPD in the elderly.

Recent findings

Lower limit rather than fixed cut off of the FEV1/FVC ratio can improve the diagnosis and better predict COPD mortality. High relative to standard dose influenza vaccination reduces confirmed cases of influenza overall and reduces hospitalizations in older nursing home residents. Simple interventions that include electronic health record tracking can significantly improve vaccination rates. Although many inhaler and nebulized medications are available for the elderly, the final regimen is usually determined by a combination of expense, issues with proper device use (from difficulty with coordination, hand grip, inspiratory flows or cognitive function) and the side effect profile. Fortunately, the switch to cheaper or better covered alternatives can be well tolerated with improvement in adherence and exacerbations of COPD. Finally, caution should be made against ageism, which may be a factor in the recommendation of rehabilitation or palliative care in the elderly COPD patient, as both are underused despite evidence of benefit.

Although care for the elderly COPD patient can be difficult, we summarize key points that the physician should be cognizant of to provide comprehensive care.
Association of malnutrition with postoperative complication risk after curative surgery for oral cancer
Authors: Tsai Yao-Te , Lai Chia-Hsuan , Huang Tzu-Hao , Hsieh Ching-Chuan , Huang Ethan I. , Lee Yi-Chan , Yeh Hsuan-Keng , Tsai Ming-Shao , Chang Geng-He , Hsu Cheng-Ming
Published: December 2020

Malnutrition is common among patients who have oral cavity squamous cell carcinoma (OSCC), but its effect on the incidence of postoperative complications remains uncertain. Validated nutrition and complication assessment tools were used to evaluate the effects of nutrition on the likelihood of postoperative complications after curative surgery for OSCC.

A retrospective study that spanned January 2014 to December 2018 enrolled 70 patients who received curative surgery for OSCC. Nutritional status before surgery was evaluated with the scored Patient-Generated Subjective Global Assessment (PG-SGA), and patients were classified as either well-nourished (rating A) or malnourished (ratings B and C). Complications 30 days after the operation were graded using Clavien-Dindo classification. The perioperative clinicopathological characteristics of the groups were compared, and risk factors for postoperative complications were identified through logistic regression.

A total of 44 (62.8%) patients formed the malnourished group, and they tended to be older (P = .03), weigh less (P = .001), have lower Body Mass Index (P = .003), higher PG-SGA scores (P < .001), higher neutrophil-to-lymphocyte ratio (P = .034), more postoperative complications (P < .001), and longer hospital stays (P = .021). Major complications (Clavien–Dindo classification ≥ IIIa) were experienced by 18.5% (n = 13) of patients and were more common in the malnourished group (P = .007). Multivariate logistic regression demonstrated that PG-SGA score ≥4 was an independent risk factor for postoperative complications (hazard ratio = 4.929, P = .008).

Malnutrition defined using the PG-SGA is an independent risk factor for postoperative complications of curative surgery in patients with OSCC. More prospective studies are warranted to confirm our findings.
Decreased albumin is associated with elevated N-terminal pro-brain natriuretic peptide and poor long-term prognosis in patients with chronic heart failure
Authors: Yi Sheng , Chen Menghua
Published: December 2020

At present, the association between albumin, N-terminal pro-brain natriuretic peptide (NT-proBNP) and long-term prognosis in patients with chronic heart failure (CHF) is unclear. Therefore, the purpose of this study is to explore the relationship between albumin, NT-proBNP and all-cause mortality in CHF patients.

Three hundred fifty two CHF patients were recruited in our study, and patients were divided into 2 groups according to the mean (37.16 g/L) of albumin concentration [low group (albumin < 37.16 g/L) and high group (albumin≥37.16 g/L)]. Differences between groups was compared by odds ratio (OR) and 95% confidence interval (CI).

NT-proBNP in the high group was significantly lower than that in the low group at baseline [1811.50 (698.75–4037.00) vs 3479.50 (1538.50–7824.25), P < .001]. Spearman correlation analysis showed that there was a negative correlation between albumin and NT-pro BNP log10 transform (ρ= −0.217, P < .001). Furthermore, curve fitting further confirmed that albumin was negatively correlated with NT-proBNP. After a median follow-up of 1726 days, 90 patients in the high group occur all-cause mortality, and 98 patients in the low group occur all-cause mortality (46.88% vs 61.25%, OR = 0.29, 95% CI: 0.08–0.50). After adjusting for the selected confounding covariates by multivariate regression analysis, decreased albumin was still associated with increased all-cause mortality (high group vs low group: OR = 0.62, 95% CI: 0.39–0.97).

Decreased albumin is associated with elevated NT-ProBNP and poor long-term prognosis in CHF patients. Clinicians need to pay enough attention to the nutritional status of CHF patients.
Dietary interventions and irritable bowel syndrome – what really works?
Authors: Surdea-Blaga Teodora , Cozma-Petrut Anamaria , Dumitraşcu Dan Lucian
Published: December 2020

Purpose of review

The review examines the latest research on the use of dietary interventions in the management of irritable bowel syndrome (IBS) in order to understand what is the evidence supporting the efficacy of a dietary approach in this disorder.

Recent findings

A general dietary advice should be offered to all IBS patients. Psyllium supplementation is recommended in IBS with both constipation and diarrhea predominance. There is increasing evidence showing the beneficial effects of a low fermentable oligo-, di-, monosaccharides, and polyols (FODMAP) diet (LFD) on IBS symptoms. FODMAPs that are well tolerated should be reintroduced in daily diet, to increase acceptability of the diet, and limit potentially harmful effects. The benefits observed with the gluten-free diet seem determined by the reduction of FODMAPs rather than gluten. Modulation of gut microbiota using probiotics shows promising results, but there are unanswered questions regarding the optimal strains, dose and duration of treatment. Additional evidence is also needed for the role of prebiotics and synbiotics in IBS.

Food is both trigger of IBS symptoms and therapeutic tool. Recent studies demonstrated the beneficial effects of LFD on symptom control, as well as the role of probiotics, which seem to contribute to gut health and function.
Bone loss in patients with inflammatory bowel disease: cause, detection and treatment
Authors: Bravenboer Nathalie , Oostlander Angela E. , van Bodegraven Adriaan A.
Published: December 2020

Purpose of review

Inflammatory bowel disease (IBD) is associated with bone loss leading to osteoporosis and increased fracture risk. Bone loss is the result of changes in the balanced process of bone remodeling. Immune cells and cytokines play an important role in the process of bone remodeling and it is therefore not surprising that cytokines as observed in IBD are involved in bone pathology. This review discusses the role of cytokines in IBD-associated bone loss, including the consequences for treatment.

Recent findings

Many studies have been conducted that showed the effect of a single cytokine on bone cells in vitro, including interleukin (IL)-1β, IL-6, IL-8, IL-12/IL-23, IL-17, IL-18, IL-32 and interferon-γ. Recently new members of the IL-1 family (IL-1F) have been related to IBD but the consequences for bone health remain uncertain.

Overall, patients have to deal with a cocktail of cytokines, present in their serum. The combination of cytokines can affect bone cells differently compared to the effects of a single cytokine. This implicates that treatment, focused on reducing the inflammation could work best for bone health as well. Vitamin D might also play a role in this.
Diagnosis and Management of Gestational Trophoblastic Disease: A Comparative Review of National and International Guidelines
Authors: Tsakiridis Ioannis , Giouleka Sonia , Kalogiannidis Ioannis , Mamopoulos Apostolos , Athanasiadis Apostolos , Dagklis Themistoklis
Published: December 2020

Importance

Gestational trophoblastic disease (GTD) is associated with increased mortality and morbidity in women of reproductive age, if managed in a suboptimal way, left untreated, or diagnosed after the development of extensive metastases.

Objective

The aims of this study were to review and compare the recommendations from published guidelines on these tumors of placental origin.

Evidence Acquisition

A descriptive review of guidelines from the Royal College of Obstetricians and Gynecologists, the International Federation of Gynecology and Obstetrics, the European Society for Medical Oncology, and the Royal Australian and New Zealand College of Obstetricians and Gynecologists on GTD was carried out.

Results

All the guidelines agree that suction evacuation is the optimal management for hydatidiform molar pregnancy and that chemotherapy, either single-agent (for low risk) or multiagent (for high risk), is the preferred treatment modality for choriocarcinoma. There is also a consensus that a future pregnancy should be avoided during follow-up; therefore, an effective contraception method should be used. All medical societies recommend the registration of such patients to GTD screening centers, endorse the use of International Federation of Gynecology and Obstetrics 2000 scoring system, and mention that the diagnosis of gestational trophoblastic neoplasia (GTN) should be based on the clinical presentation (from the genital tract and the metastatic sites) and the human chorionic gonadotropin evaluation. Additionally, all 4 medical societies recommend the surgical management of placental site trophoblastic tumors or epithelioid trophoblastic tumors, as chemotherapy is less effective in these cases. However, there is controversy regarding the appropriate follow-up after the treatment of hydatidiform mole, the administration of anti-D immunoglobulin, the time of oxytocin infusion, and the salvage regimens that may be used in cases of resistant or recurrent GTN.

Conclusions

There is need for consistent international practice protocols, which will lead to an earlier diagnosis and eventually to a more effective management of GTD worldwide and decrease in the recurrence rate and in the associated morbidity and mortality.

Target Audience

Obstetricians and gynecologists, family physicians.

Learning Objectives

After participating in this activity, the learner should be better able to assess the diagnostic aspects of GTD; evaluate treatment options for hydatidiform mole and GTN; and describe the appropriate follow-up options for cases complicated with GTD.
The Role of a NICU Hepatology Consult Service in Assessing Liver Dysfunction in the Premature Infant
Authors: Potter Carol
Published: December 2020

Liver dysfunction is common in the neonatal intensive care unit (NICU). Literature exists on the presentation of primary liver disease in the NICU but little has been published on general liver dysfunction in the NICU. This is a retrospective observational study of hepatology consultations and outcomes in a large referral NICU. 157 babies were evaluated by a single hepatologist and followed to resolution of disease, death, or lost to follow-up as outpatients. Infectious etiologies were the most common cause for liver dysfunction in the NICU, followed by shock, genetic abnormalities, cardiac disease, large heme loads, and hypothyroidism. Primary liver disease was rare. Liver dysfunction in the sick preterm infant was often multifactorial, and the distribution of diagnoses differs from that seen in the term baby. The liver dysfunction may last well beyond discharge from the NICU and may result in death.
123I Scan With Whole-Body Retention Measurement at 48 Hours for Simplified Dosimetry Before 131I Treatment of Metastatic Thyroid Cancer
Authors: Durski Jolanta M. , Hruska Carrie B. , Bogsrud Trond V. , Ryder Mabel , Johnson Geoffrey B.
Published: December 2020

A previously published model (Atkins) allows for calculation of 131I maximum tolerated activity on the basis of 48-hour whole-body retention of 131I on a pretherapy diagnostic scan. Our practice uses iodine 123I for diagnostic imaging of metastatic thyroid cancer for staging before 131I therapy, with images typically acquired 24 hours after administration of the radiopharmaceutical. We explored the feasibility of an additional 123I whole-body scan and retention measurement at 48 hours, with application of the model to estimate maximum tolerated activity of radioiodine before 131I treatment of metastatic thyroid cancer.
De-implementation of Axillary Dissection in Women With Breast Cancer is Largely Driven By Site-level Contextual Effects
Authors: Gleisner Ana L. , Moss Angela , Friedman Chloe , Suresh Krithika , Grunwald Gary , Torphy Robert J. , Leonard Laura D. , Colborn Kathryn , Ahrendt Gretchen , Tevis Sarah , Christian Nicole , Abud Viviane L. , de Araujo Thiago B. , Beaty Laurel E. , Thieu Daniel , Glorioso Thomas J. , Kim Simon , Daugherty Stade
Published: December 2020

Objective:

To assess the contribution of unknown institutional factors (contextual effects) in the de-implementation of cALND in women with breast cancer.

Summary of Background Data:

Women included in the National Cancer Database with invasive breast carcinoma from 2012 to 2016 that underwent upfront lumpectomy and were found to have a positive sentinel node.

Methods:

A multivariable mixed effects logistic regression model with a random intercept for site was used to determine the effect of patient, tumor, and institutional variables on the risk of cALND. Reference effect measures

were used to describe and compare the contribution of contextual effects to the variation in cALND use to that of measured variables.

Results:

By 2016, cALND was still performed in at least 50% of the patients in a quarter of the institutions. Black race, younger women and those with larger or hormone negative tumors were more likely to undergo cALND. However, the width of the 90% reference effect measures range for the contextual effects exceeded that of the measured site, tumor, time, and patient demographics, suggesting institutional contextual effects were the major drivers of cALND de-implementation. For instance, a woman at an institution with low-risk of performing cALND would have 74% reduced odds of having

a cALND than if she was treated at a median-risk institution, while a patient at a high-risk institution had 3.91 times the odds.

Conclusion:

Compared to known patient, tumor, and institutional factors, contextual effects had a higher contribution to the variation in cALND use.
Algibacillus agarilyticus gen. nov., sp. nov., isolated from the surface of the red algae Gelidium amansii
Authors: Meng Xue , Chang Ya-Qi , Wang Huan , Du Zong-Jun
Published: December 2020

A novel Gram-stain-negative, strictly aerobic, coccoid and agar-hydrolysing bacterium, designated RQJ05T, was isolated from the marine red algae Gelidium amansii collected from the coastal area of Rizhao, PR China. Cells of strain RQJ05T were approximately 0.8–1.0×1.3–3.0 µm in size and motile by means of a polar flagellum. Growth occurred at 4–33 °C (optimum, 25–30 °C), pH 7.0–8.5 (optimum, pH 7.5–8.0) and in the presence of 1.0–7.0 % (w/v) NaCl (optimum, 2.0–3.0 %). Strain RQJ05T showed oxidase-positive and catalase-negative activities. Phylogenetic analysis based on 16S rRNA gene sequences indicated that strain RQJ05T formed a phylogenetic lineage with members of the family

Alteromonadaceae

and exhibited 16S rRNA gene sequence similarities of 92.6, 91.3, 90.2 and 90.1 % to

Catenovulum maritimum

Q1T,

Catenovulum agarivorans

YM01T,

Paraphotobacterium marinum

NSCS20N07DT and

Algicola sagamiensis

B-10-31T, respectively. The major cellular fatty acids of strain RQJ05T were summed feature 3 (C16 : 1
 ω7c and/or C16 : 1
 ω6c), C16 : 0 and summed feature 8 (C18 : 1
 ω7c and/or C18 : 1
 ω6c). The major polar lipids of strain RQJ05T were phosphatidylethanolamine, phosphatidylglycerol and two aminophospholipids. Strain RQJ05T contained Q-8 as the major respiratory quinone. The genomic DNA G+C content was 39.0 mol%. On the basis of genotypic, phenotypic and phylogenetic evidence, strain RQJ05T is presented as a representative of a novel species in a new genus, for which the name Algibacillus agarilyticus gen. nov., sp. nov. is proposed. The type strain is RQJ05T (=KCTC 62846T=MCCC 1H00352T).
Differential TLR7-mediated cytokine expression by R848 in M-CSF- versus GM-CSF-derived macrophages after LCMV infection
Authors: Alothaimeen Torki , Trus Evan , Basta Sameh , Gee Katrina
Published: December 2020

Granulocyte-macrophage colony-stimulating factor (GM-CSF) and macrophage colony-stimulating factor (M-CSF) play an important role in macrophage (MФ) development by influencing their differentiation and polarization. Our goal was to explore the difference between M-CSF- and GM-CSF-derived bone marrow MФ responsiveness to TLR7-mediated signalling pathways that influence cytokine production early after infection in a model of acute virus infection. To do so, we examined cytokine production and TLR7-mediated signalling at 1 h post-lymphocytic choriomeningitis virus (LCMV) Armstrong (ARM) infection. We found that R848-induced cytokine expression was enhanced in these cells, with GM-CSF cells exhibiting higher proinflammatory cytokine expression and M-CSF cells exhibiting higher anti-inflammatory cytokine expression. However, R848-mediated signalling molecule activation was diminished in LCMV-infected M-CSF and GM-CSF macrophages. Interestingly, we observed that TLR7 expression was maintained during LCMV infection of M-CSF and GM-CSF cells. Moreover, TLR7 expression was significantly higher in M-CSF cells compared to GM-CSF cells. Taken together, our data demonstrate that although LCMV restrains early TLR7-mediated signalling, it primes differentiated MФ to enhance expression of their respective cytokine profiles and maintains levels of TLR7 expression early after infection.
Treatment provision for adults with ADHD during the COVID-19 pandemic: An exploratory study on patient and therapist experience with on-site sessions using face masks vs. telepsychiatric sessions
Authors: Wyler Helen , Liebrenz Michael , Ajdacic-Gross Vladeta , Seifritz Erich , Young Susan , Burger Pascal , Buadze Anna
Published: December 2020

Background

Maintaining the therapeutic care of psychiatric patients during the first wave of the COVID-19 pandemic in Switzerland required changes to the way in which sessions were conducted, such as telepsychiatric interventions or the use of face masks during on-site sessions. While little is known about how face masks affect the therapeutic experience of patients and therapists, the effectiveness of telepsychiatry is well documented for several psychiatric disorders. However, research on the benefits of telepsychiatry in adult patients with attention-deficit/hyperactivity disorder (ADHD) remains scarce. This seems problematic since the symptoms typically associated with ADHD, such as attention problems and distractibility, may lessen the utility of telepsychiatry for this particular group. The present study’s aim was to explore how adult patients with ADHD and their therapists experienced therapy sessions during the COVID-19 pandemic in three different settings: face-to-face with the therapist wearing a face mask, via telephone, or via videoconferencing.

Methods

In this exploratory, quantitatively driven mixed-method study (quantitative questionnaire data and qualitative data from open-ended responses), we assessed patients’ evaluation of the session, their treatment satisfaction, and patients’ and therapists’ ratings of therapeutic alliance. We also collected qualitative comments on both sides’ experience of the session. Overall, 97 therapist and 66 patient questionnaires were completed. Results are reported for theN= 60 cases for which data from both parties were available. Sequential multiple regressions adjusted for therapist and number of sessions were used for the main quantitative analyses.

Results

Telepsychiatric sessions were rated as significantly less deep than face-to-face sessions, an effect that was mainly driven by lower ratings in the videoconferencing group and, as suggested by further analyses, may decline over time. No other statistically significant differences were observed. Elements that were mentioned as facilitating or complicating a session differed markedly between patients and therapists.

Conclusions

Both settings, on-site with the therapist wearing a face mask and telepsychiatric, seem to be valid options to continue treatment of adults with ADHD during a situation such as the COVID-19 pandemic. Aspects such as patient preference, session content, and therapeutic methods may be useful to identify the most suitable modality.
Prevalence of Occupation Associated with Increased Mobility During COVID-19 Pandemic
Authors: Shacham Enbal , Scroggins Stephen , Ellis Matthew , Garza Alexander
Published: December 2020

Objective

Identifying geographic-level prevalence of occupations associated with mobility during local stay-at-home pandemic mandate.

Methods

A spatio-temporal ecological framework was applied to determine census-tracts that had significantly higher rates of occupations likely to be deemed essential: food-service, business and finance, healthcare support, and maintenance. Real-time mobility data was used to determine the average daily percent of residents not leaving their place of residence. Spatial regression models were constructed for each occupation proportion among census-tracts within a large urban area.

Results

After adjusting for demographics, results indicate census-tracts with higher proportion of food-service workers, healthcare support employees, and office administration staff are likely to have increased mobility.

Conclusions

Increased mobility among communities is likely to exacerbate COVID-19 mitigation efforts. This increase in mobility was also found associated with specific demographics suggesting it may be occurring among underserved and vulnerable populations. We find that prevalence of essential employment presents itself as a candidate for driving inequity in morbidity and mortality of COVID-19.

Three-question Summary

Employees and workers deemed essential during the COVID-19 pandemic are likely to endure additional risk of infection due to community exposure. While preliminary reports are still quantifying this risk, we set out to examine if prevalence of specific occupations could be used to evaluate overall community-level risk based on stay-at-home mandate adherence.

Study results suggest that that not only are certain occupation geo-spatially associated with movement outside the home but are also associated with demographic characteristics likely to contribute to inequity of COVID-19 morbidity.

Often, nuanced inequities are lost in the larger data samples, being able to identify possible inequities from other sources such as prevalence of occupation among communities, remains an important and applicable alternative.
Bored, isolated and anxious: Experiences of prolonged hospitalization during high-risk pregnancy and preferences for improving care
Authors: Louis-Jacques Adetola F. , Vamos Cheryl , Torres Jessica , Dean Kathryn , Hume Emma , Obure Renice , Wilson Ronee
Published: December 2020

Antepartum women who experience prolonged hospitalization are at greater risk for increased stress, anxiety, and depression. The purpose of this study was to examine women’s and healthcare staff’s experiences with prolonged hospitalizations during pregnancy and explore patient-centered intervention options. Guided by Social Support Theory, we conducted qualitative (focus group/interviews) and quantitative (surveys) methods. Patient survey respondents (N=57) were mostly white (77%), non-Hispanic (86%), and married (65%). Qualitative data (N=17) revealed challenges to women’s wellbeing related to: a) lack of knowledge; b) stress and anxiety; c) loss of independence; and d) social isolation in hospital; regarding concerns about hospitalization and competing demands at home. Suggested strategies for improving women’s experiences included interventions that involve family/friends, improved information sharing, and increased onsite services to facilitate a positive experience. This critical groundwork informed development of theory-based, patient-centered interventions to increase knowledge and enhance social support, among women who experience prolonged hospitalization during pregnancy.
Association of University Reopening Policies with New Confirmed COVID-19 Cases in the United States
Authors: Li Yang , Ma Cheng , Tang Weijing , Zhang Xuefei , Zhu Ji , Nallamothu Brahmajee K.
Published: December 2020

Importance

Reopening of universities in the U.S. has been controversial in the setting of the coronavirus disease 2019 (COVID-19) pandemic.

Objective

To investigate (1) the association between new COVID-19 cases since September 1st with the number of students returning to campus in each county across the U.S. and (2) how different reopening policies at universities correlated with new COVID-19 cases.

Design

Observational cohort study using publicly available data sources. Multivariable regression models estimated both effects of university reopening and different reopening policies.

Settings and Participants

Populations in U.S. counties reporting new confirmed COVID-19 cases from August 1st to October 22nd.

Exposures

(1) total enrollment of students under the in-person or hybrid policies per county population and (2) proportion of online and hybrid enrollment within each county.

Main Outcomes and Measures

Mean number of daily new confirmed COVID-19 cases per 10,000 county population from September 1st to October 22nd.

Results

For 2,893 counties included in the study, mean number of daily confirmed cases per 10,000 county population rose from 1.51 from August 1st to August 31st to 1.98 from September 1st to October 22nd. Mean number of students returning to universities was 2.1% (95% CI, 1.8% to 2.3%) of the county population. The number of students returning to campus had an increased association (β = 2.006, P < 0.001) with new confirmed COVID-19 cases within the local county region where the institution resided. For 1,069 U.S. counties with universities, the mean proportion of online enrollment within each county was 40.1% (95% CI, 37.4% to 42.8%), with most students enrolling in-person or hybrid mode. In comparison to holding classes in-person, reopening universities online (β = -0.329, P < 0.001) or in a hybrid mode (β = -0.272, P = 0.012) had a decreased association with new confirmed COVID-19 cases.

Conclusions and Relevance

A higher number of students returning to campus in U.S. counties was associated with an increase in new confirmed COVID-19 cases; reopening online or partially online was associated with slower spread of the virus, in comparison to in-person reopening.

Key Points

Question

Are students returning to universities and specific reopening policies associated with new confirmed coronavirus cases in United States?

Findings

In this cohort study of 2,893 U.S. counties, the number of students returning to campus was significantly associated with a higher number of new confirmed COVID-19 cases. In 1,069 U.S. counties with universities, online or hybrid reopening was significantly associated with a lower risk of new cases compared with in-person reopening.

Meaning

An increased risk of coronavirus infection was seen in surrounding regions after universities reopened last fall, and this effect was largest in those holding in-person classes.