bluuebunny/crossref_metadata_2025 huggingface dataset:
Long-term follow-up after surgical repair of abdominal rectus diastasis: A Prospective Randomized Study
Authors: Swedenhammar Ebba , Strigård Karin , Emanuelsson Peter , Gunnarsson Ulf , stark Birgit
Published: April 2020

Background:

Abdominal rectus diastasis can lead to functional disability. There is no consensus regarding treatment. This was a prospective study on patients randomized to surgery using either Quill self-retaining sutures or retromuscular mesh for abdominal rectus diastasis repair. The primary aim of the study was to compare long-term recurrence after surgery. Secondary aims were abdominal muscle strength, pain, and quality of life.

Methods:

A total of 57 patients were eligible and 52 were investigated. A routine 1-year follow-up ruled out any patient with recurrence and this was followed up by clinical examination for recurrence and assessment of the secondary outcomes a median of 5 years (3.8–6.5 years) after surgery. Quality of life was assessed using the Short Form-36 questionnaire. Pain related to activity was evaluated using the Ventral Hernia Pain Questionnaire.

Results:

No recurrence of abdominal rectus diastasis was found. Significant improvements were seen between index surgery and long-term follow-up in all domains of Short Form-36. There were no significant differences in quality of life or self-reported muscle strength between the two surgical groups. Long-term pain remained unchanged compared to that at the 1-year follow-up. “Pain this week” had decreased significantly at long-term follow-up compared to prior to surgery (mesh p = 0.009, Quill p = 0.003).

Conclusions:

No recurrence of abdominal rectus diastasis appeared. There was no difference in quality of life or long-term pain between the two surgical groups. Implantation of retromuscular mesh entails more extensive surgery implying potentially higher risk for complications. This leads us to recommend reconstruction with double-row self-retaining sutures for the repair of abdominal rectus diastasis in patients with functional disability.
Exploring perceptions and use of the patient portal by young adults with type 1 diabetes: A qualitative study
Authors: Marsh Kathy K , Bush Ruth A , Connelly Cynthia D
Published: April 2020

Emerging adults have been raised in the digital age and are therefore prime candidates for using a patient portal to manage chronic conditions. The limited body of research both identifies the underutilization of the patient portal and suggests increased use of the portal for the chronically ill as a tool to alleviate caregiver stress, as well as a potential modality to assist emerging adults to manage their chronic illnesses. This qualitative study was completed to obtain an understanding of emerging adults familiarity with the electronic patient portal and to elicit the perception of the usefulness of the portal to support self-management of type I diabetes. Findings provide a preliminary understanding of how a sampling of emerging adults with type I diabetes uses, perceives the benefits of, and wants to improve technology for diabetes self-management.
Engaging with care: ethical issues in Participatory Research
Authors: Bussu Sonia , Lalani Mirza , Pattison Stephen , Marshall Martin
Published: April 2020

This paper contributes to the literature on ethics in Participatory Research by looking at the Researcher-in-Residence model and its application within health services research in three East London boroughs. The Researcher-in-Residence is embedded in the organisation to enable knowledge mobilisation and knowledge coproduction. Whereas negotiation of different types of expertise to coproduce evidence might raise issues of power differentials, the embedded nature of the role also requires careful negotiating of relationships. As the researcher is immersed in the context under evaluation, the boundaries between the researcher and the participants’ everyday working life can become blurred. The paper explores these ethical issues and suggests that, whereas the requirements of ethics committees, based on an ethics of principle, at times fail to offer appropriate guidelines for this methodological approach, an ethics of care based on relationships can offer a complementary framework to address some of the thorny challenges that emerge from everyday practice in participatory research.
The impact of TRIO Student Support Services on academic performance of non-traditional students at a public state college in Georgia
Authors: Bennett Christopher A , Hsiao E-Ling , Dees Dianne C , Kim Daesang , Bochenko Michael J
Published: April 2020

The purpose of this study was to investigate the impact of TRIO Student Support Services (SSS) on academic performance of non-traditional students and perceived experiences of its recent graduates at a public state college in Georgia. A mixed-methods design was employed for data collection including (1) year-to-year retention rates of 480 SSS and non-SSS students, (2) three-year graduation rates and cumulative grade point averages of 2010–2013 and 2013–2016 cohorts and (3) two focus group interviews with eight 2016 SSS graduates. Significant differences were found in year-to-year retention rates and three-year graduation rates between SSS and non-SSS students. The graduates also reported that TRIO SSS assisted them in degree completion by offering (1) academic advisement, (2) degree planning, (3) development of self-confidence through motivation and mentorship, (4) academic resources and (5) a family-oriented environment. The results proved that TRIO SSS-assisted non-traditional students interacting with academic and social components of the institution, which helped to increase student retention and graduation rates.
Knockdown of Rab9 Suppresses the Progression of Gastric Cancer Through Regulation of Akt Signaling Pathway
Authors: Zhu Yong , Shi Feng , Wang Meng , Ding Jian
Published: April 2020

Rabs have been reported to be involved in the carcinogenesis process and in the progression of cancer. However, it is unclear whether or not Rab9 is associated with the development of cancer. In the present study, we aimed to investigate the role of Rab9 in the biological functions of gastric cancer cells. The gastric cancer cell lines AGS and MKN45 were transfected with siRNA-Rab9 to block the expression of Rab9. The cell viability, proliferation, migration, invasion, and apoptosis were examined using Cell Count Kit-8, colony formation, wound healing, Transwell, and flow cytometry assays, respectively. Our data showed that silencing of Rab9 significantly inhibited the viability, proliferation, migration, and invasion abilities of AGS and MKN45 cells. Moreover, transfection with siRab9 promoted the rate of apoptosis in AGS and MKN45 cells through regulating the Bcl-2–Bax axis and the Caspase cascade. We also found that silencing of Rab9 inhibited activation of the Akt signaling pathway by downregulating the phosphorylation level of Akt. In conclusion, our data suggest that Rab9 plays an oncogenic role in the progression of gastric cancer, providing a potential target for the treatment of gastric cancer.
Authentic leadership and teachers’ voice behaviour: The mediating role of psychological empowerment and moderating role of interpersonal trust
Authors: Zhang Sen , Bowers Alex J , Mao Yaqing
Published: April 2020

Teachers’ voice behaviour plays a critical role in school reform by providing constructive suggestions to promote teaching, students’ learning and school management. This study investigates how and under what conditions principals’ authentic leadership contributes to teachers’ voice behaviour. Data collected from 982 teachers in 38 primary schools in mainland China were analysed using regression analysis and bootstrapping tests. The research tested a moderated mediation model of authentic leadership effects on teachers’ voice behaviour in which teacher psychological empowerment was included as the mediator and interpersonal trust as the moderator. The results affirmed the partial mediation model, finding significant direct and indirect effects of principals’ authentic leadership on teachers’ voice behaviour. Moreover, interpersonal trust positively moderated the relationship between psychological empowerment and teachers’ voice behaviour, and also strengthened the whole mediating mechanism. When teachers perceived a higher level of interpersonal trust, the effects of principals’ authentic leadership on teachers’ voice behaviour were stronger than for counterparts who perceived a low level of interpersonal trust. Our discussion highlights the benefits of understanding the impact of authentic leadership on teachers’ voice behaviour in relation to interpersonal trust and their psychological empowerment and indicates how teachers can play a role in implementing the perceived situation practically.
Perioperative stroke-related mortality after non-cardiovascular, non-neurological procedures: A retrospective risk factor evaluation of common surgical comorbidities
Authors: Reinert Nathan J , Patel Bansri M , Al-Robaidi Khaled , Gao Xiaotian , Fabio Anthony , Jadhav Ashutosh , Muluk Visala S , Esper Stephen A , Zuckerbraun Brian S , Thirumala Parthasarathy D
Published: April 2020

Background

Perioperative stroke-related mortality in the non-cardiovascular, non-neurological surgery population is an uncommon, yet devastating outcome. A combination of emboli and hypoperfusion may cause large vessel occlusions leading to perioperative strokes and mortality. Identifying independent risk factors for perioperative stroke-related mortality may enhance risk-stratification algorithms and preventative therapies.

Objectives

This study utilised cause-of-death data to determine independent risk scores for common surgical comorbidities that may lead to perioperative stroke-related mortality, including atrial fibrillation and asymptomatic carotid stenosis.

Methods

This retrospective, IRB-exempt, case–control study evaluated non-cardiovascular, non-neurological surgical patients in a claims-based database. ICD-10-CM and ICD-9-CM codes identified cause of death and comorbidity incidences, respectively. A multivariate regression analysis then established adjusted independent risk scores of each comorbidity in relation to perioperative stroke-related mortality.

Results

Patients with atrial fibrillation were more likely (1.7 aOR, 95% CI (1.1, 2.8) p = 0.02) to die from perioperative stroke-related mortality than from other causes. No association was found with asymptomatic carotid stenosis. Further, in-hospital strokes (25.9 aOR, 95% CI (16.0, 41.8) p < 0.001) or diabetes (1.8 aOR, 95% CI (1.1, 2.9) p = 0.02) may increase perioperative stroke-related mortality risk.

Conclusions

Atrial fibrillation, diabetes and in-hospital strokes may be independent risk factors for perioperative stroke-related mortality in the non-cardiovascular, non-neurological surgery population.
The effect of gum chewing on postoperative ileus in open colorectal surgery patients: A review
Authors: Sammut Roberta , Trapani Josef , Deguara Justin , Ravasi Valeria
Published: April 2020

Background

Postoperative ileus is a common complication of abdominal surgery, leading to prolonged hospital stay and associated costs. Gum chewing may be a safe, cheap intervention to reduce postoperative ileus.

Methods

The aim was to investigate the effect of gum chewing on postoperative ileus in open colorectal surgery patients. A literature search was conducted between December 2018 and March 2019 on CINAHL, Cochrane Central Register of Controlled Trials, and Cochrane Database of Systematic Reviews, MEDLINE, Academic Search Complete, PubMed, Scopus and Google Scholar. The keywords used included ‘ileus’, ‘chewing gum’, ‘mastication’ and ‘sham feeding’. Papers had to include adults undergoing open colorectal surgery. The studies were appraised using Critical Appraisal Skills Programme tools and the results summarised using a narrative review.

Results

A total of three systematic reviews and three randomised controlled trials were included in the study. The studies show a significant to highly significant effect of gum chewing on postoperative ileus-related outcomes. The trials however in general utilised a weak design.

Conclusions

Gum chewing decreases postoperative ileus following colorectal surgery. More robust trials are required to confirm these findings. Due to the low risk of harm and cost of using gum chewing, its use is recommended even in the interim.
Alginate-encapsulated brain-derived neurotrophic factor–overexpressing mesenchymal stem cells are a promising drug delivery system for protection of auditory neurons
Authors: Schwieger Jana , Hamm Anika , Gepp Michael M. , Schulz André , Hoffmann Andrea , Lenarz Thomas , Scheper Verena
Published: April 2020

The cochlear implant outcome is possibly improved by brain-derived neurotrophic factor treatment protecting spiral ganglion neurons. Implantation of genetically modified mesenchymal stem cells may enable the required long-term brain-derived neurotrophic factor administration. Encapsulation of mesenchymal stem cells in ultra-high viscous alginate may protect the mesenchymal stem cells from the recipient’s immune system and prevent their uncontrolled migration. Alginate stability and survival of mesenchymal stem cells in alginate were evaluated. Brain-derived neurotrophic factor production was measured and its protective effect was analyzed in dissociated rat spiral ganglion neuron co-culture. Since the cochlear implant is an active electrode, alginate–mesenchymal stem cell samples were electrically stimulated and alginate stability and mesenchymal stem cell survival were investigated. Stability of ultra-high viscous-alginate and alginate–mesenchymal stem cells was proven. Brain-derived neurotrophic factor production was detectable and spiral ganglion neuron survival, bipolar morphology, and neurite outgrowth were increased. Moderate electrical stimulation did not affect the mesenchymal stem cell survival and their viability was good within the investigated time frame. Local drug delivery by ultra-high viscous-alginate-encapsulated brain-derived neurotrophic factor–overexpressing mesenchymal stem cells is a promising strategy to improve the cochlear implant outcome.
Considerations for multi-centre conditioned pain modulation (CPM) research; an investigation of the inter-rater reliability, level of agreement and confounders for the Achilles tendon and Triceps Surae
Authors: Murphy Myles , Gibson William , Chivers Paola , Docking Sean , Rio Ebonie
Published: April 2020

Objective:

This study aimed to investigate the inter-rater reliability of the conditioned pain modulation (CPM) effect.

Methods:

The reliability between two examiners assessing the CPM effect via pressure pain thresholds and induced using the cold pressor test of 28 healthy volunteers at the mid-portion Achilles tendon (AT) and Triceps Surae musculotendinous junction was performed. Reliability was calculated using intraclass correlation coefficient (ICC). Confounders were assessed using multivariable generalised estimating equations (GEEs). Bias in the level of agreement was assumed if the confidence intervals (CIs) of the mean difference in Bland–Altman plots did not cross the line of equality.

Results:

The inter-rater reliability of the CPM effect was poor to moderate in the AT (ICC 95% CI = 0.00–0.66) and Triceps Surae (ICC 95% CI = 0.00–0.69). However, when accounting for confounders within the GEE, there were no differences between testers and Bland–Altman plots reported good agreement between testers. Habitual completion of running-related physical activity was a confounder for both the AT parallel-paradigm (p = 0.017) and sequential-paradigm (p = 0.029). Testing order was a confounder for the AT (p = 0.023) and Triceps Surae (p = 0.014) parallel-paradigm.

Conclusion:

This study suggests the CPM effect may be site specific (i.e. differences between the AT and Triceps Surae exist). In addition, differences in the reliability between examiners are likely due to the influence of confounders and not examiner technique and therefore appropriate analysis should be used in research investigating the CPM effect.
Laparoscopic management of massive recurrent endometrioma with atypical presentation: A case report
Authors: Bindra Vimee , Ponnamaneni Anusha Rao
Published: April 2020

Endometriosis affects 10%–15 % of reproductive age group population. Pelvic endometriosis usually involves ovaries, and it is reported to involve both ovaries in one-third to one-half of cases. Ovarian endometriomas rarely exceed 10–15 cm in diameter. Our case is that of a 31-year-old P1L1 who presented with increasing abdominal girth, and imaging revealed a huge cystic mass extending till the diaphragm around 29 × 24 × 19 cm3 which was later found to be a case of recurrent endometriosis. This was managed by laparoscopy, and the volume of the chocolate fluid evacuated was approximately 11,300 mL. It is rare for endometriomas to grow up to such a large size. This case stresses the importance of suspicion of recurrent endometrioma even in atypical presentations and the need for follow-up in known cases of endometriosis to identify early recurrence.
The BTK inhibitor ibrutinib may protect against pulmonary injury in COVID-19–infected patients
Authors: Treon Steven P. , Castillo Jorge J. , Skarbnik Alan P. , Soumerai Jacob D. , Ghobrial Irene M. , Guerrera Maria Luisa , Meid Kirsten , Yang Guang
Published: April 2020

Treon et al provide early clinical data supporting a theoretical rationale for continuing ibrutinib in patients receiving the drug during COVID-19 illness.
An Improved Rosin Transfer Process for the Reduction of Residue Particles for Graphene
Authors: Shahzad Kashif , Jia Kunpeng , Zhao Chao , Yan Xiangyu , Yadong Zhang , Usman Muhammad , Luo Jun
Published: April 2020

In this work, an improved rosin transfer process is initiated. An anisole coating is introduced based on the rosin transfer process to reduce the residue particles on the surface of transferred graphene. Rosin/graphene and anisole/rosin/graphene samples are handled without baking and with baking at different temperatures, i.e., 100 °C, 150 °C, and 200 °C. Atomic force microscopy (AFM) and Raman spectroscopy are employed to characterize the surface properties of transferred graphene. The removal of the protective rosin layer and anisole/rosin layers without baking is found to be more effective and beneficial compared to the conventional PMMA transfer process. Furthermore, better results in terms of reduced surface roughness and residue particles are accomplished by introducing anisole in the improved rosin transfer process. Uniform and low sheet resistance (Rsh) is also observed across transferred graphene using this improved process.
Prostaglandin E2 stimulates COX-2 expression via mitogen-activated protein kinase p38 but not ERK in human follicular dendritic cell-like cells
Authors: Cho Whajung , Choe Jongseon
Published: April 2020

Background

Prostaglandin E2 (PGE2) is an endogenous lipid mediator of inflammation. Its production is regulated by the rate-limiting upstream enzyme cyclooxygenase-2 (COX-2). We have recently demonstrated that the major cell type expressing COX-2 in the germinal center is follicular dendritic cell (FDC). In this study, to elucidate the molecular mechanism of PGE2in COX-2 production, we asked whether mitogen-activated protein kinases ERK and p38 might regulate COX-2 expression.

Results

FDC-like cells were used to analyze the phosphorylation kinetics of ERK and p38 and the impact of genetic knockdown. PGE2stimulation gave rise to a rapid increase of p38 but not ERK phosphorylation. In contrast, IL-1β induced phosphorylation of both MAPKs. Knockdown of p38 resulted in a marked suppression of COX-2 expression induced by either PGE2or IL-1β. ERK knockdown did not significantly affect the effect of PGE2and IL-1β on COX-2 induction. The differential results of p38 and ERK siRNA transfection were reproduced in the production of prostaglandins and in experiments performed with pharmacologic inhibitors.

Conclusions

Our data indicate that p38 is essentially required for PGE2to induce COX-2 expression in FDC-like cells. The current study helps to expand our understanding of the biological function of FDC at the molecular level and provides a potential rationale for the pharmacologic or genetic approaches to regulate p38 MAPK in the treatment of various inflammatory disorders.
Effects of nitroglycerin versus labetalol on peripheral perfusion during deliberate hypotension for sinus endoscopic surgery: a randomized, controlled, double-blinded trial
Authors: Zayed Marwa , Nassar Heba , Hasanin Ahmed , Saleh Amany H. , Hassan Passaint , Saad Dalia , Mahmoud Sahar , Abo Bakr Ghada , Fouad Eman , Saleh Norhan , Ismail Maha , El-Hadi Hani
Published: April 2020

Background

Deliberate hypotension is used to provide a bloodless field during functional endoscopic sinus surgery; however, the impact of controlled hypotension during anesthesia on peripheral tissue perfusion has not been extensively evaluated. The aim of this study was to compare the impact of nitroglycerin- versus labetalol-induced hypotension on peripheral perfusion.

Methods

The present randomized, double-blinded, controlled trial included adult patients undergoing endoscopic sinus surgery. Patients were allocated to one of two groups according to the drug received for induction of deliberate hypotension: nitroglycerin (n = 20) or labetalol (n = 20). Mean arterial pressure was maintained at 55–65 mmHg in both groups. Both study groups were compared according to pulse oximeter-derived peripheral perfusion index (primary outcome), serum lactate level, mean arterial pressure, heart rate, surgical field score, and intraoperative blood loss.

Results

Forty patients were included in the final analysis. The nitroglycerin group exhibited a higher peripheral perfusion index at nearly all records (p < 0.0001) and lower postoperative serum lactate levels (1.3 ± 0.2 mmol/L vs. 1.7 ± 0.4 mmol/L; p = 0.001) than the labetalol group. The peripheral perfusion index was higher in the nitroglycerin group than at baseline at most intraoperative readings. The median surgical field score was modestly lower in the labetalol group than in the nitroglycerin group in the first 20 min (2 [interquartile range (IQR) 2–2.5] versus 1.5 [IQR 1–2]; p = 0.001). Both groups demonstrated comparable and acceptable surgical field scores in all subsequent readings.

Conclusion

Nitroglycerin-induced deliberate hypotension was accompanied by higher peripheral perfusion index and lower serum lactate levels than labetalol-induced deliberate hypotension during sinus endoscopic surgery.

Trial registration

The study was registered at clinicaltrials registry system with trial number: NCT03809065. Registered at 19 January 2019. This study adheres to CONSORT guidelines.
Clinical efficacy, safety and tolerability of Aliskiren Monotherapy (AM): an umbrella review of systematic reviews
Authors: Zhao Qiyuan , Shen Jiantong , Lu Jingya , Jiang Qi , Wang Yuanyuan
Published: April 2020

Background

Aliskiren is a newly developed drug. Its role in lowering BP has been recognized. However, the role of aliskiren in treating heart and renal diseases are still controversial.

Objective

To evaluate the existing evidence about clinical efficacy, safety and tolerability of aliskiren monotherapy (AM).

Methods

An umbrella review of systematic reviews of interventional studies. We searched Pubmed, Embase and Cochrane Library up to June 2019. Two reviewers applied inclusion criteria to the select potential articles independently. The extract and analyze of accessible data were did by two reviewers independently too. Discrepancies were resolved with discussion or the arbitration of the third author.

Results

Eventually, our review identified 14 eligible studies. Results showed that for essential hypertension patients, aliskiren showed a great superiority over placebo in BP reduction, BP response rate and BP control rate. Aliskiren and placebo, ARBs or ACEIs showed no difference in the number or extent of adverse events. For heart failure patients, AM did not reduce BNP levels (SMD -0.08, − 0.31 to 0.15) or mortality rate (RR 0.76, 0.32 to 1.80), but it decreased NT-proBNP (SMD -0.12, − 0.21 to − 0.03) and PRA levels (SMD 0.52, 0.30 to 0.75), increased PRC levels (SMD -0.66, − 0.8 to − 0.44). For patients who are suffered from hypertension and diabetes and/or nephropathy or albuminuria at the same time, aliskiren produced no significant effects (RR 0.97, 0.81 to 1.16).

Conclusion

We found solid evidence to support the benefits of aliskiren in the treatment of essential hypertension, aliskiren can produce significant effects in lowering BP and reliable safety. However, the effects of aliskiren in cardiovascular and renal outcomes were insignificant.

Trial registration

Study has been registered in PROSPERO (CRD42019142141).
Correction to: Keys to success of a community of clinical practice in primary care: a qualitative evaluation of the ECOPIH project
Authors: Tintorer David Lacasta , Domínguez Josep Maria Manresa , Pujol-Rivera Enriqueta , Beneyto Souhel Flayeh , Tuduri Xavier Mundet , Saigí-Rubió Francesc
Published: April 2020

Following publication of the original article [1], the authors opted to update affiliation 3 in order to comply with the current regulations for the submission of Doctoral Thesis by compendium of articles, the Universitat Autónoma de Barcelona Doctoral School asks us to update the affiliation number 3, adding “Departament de Medicina” at the beginning, as follows:
Study on advance care planning in care dependent community-dwelling older persons in Germany (STADPLAN): protocol of a cluster-randomised controlled trial
Authors: Schnakenberg Rieke , Silies Katharina , Berg Almuth , Kirchner Änne , Langner Henriette , Chuvayaran Yuliya , Köberlein-Neu Juliane , Haastert Burkhard , Wiese Birgitt , Meyer Gabriele , Köpke Sascha , Hoffmann Falk
Published: April 2020

Background

In Germany, advance care planning (ACP) was first introduced by law in 2015. However, ACP is still uncommon in Germany and only few people have advance directive forms. This study aims to evaluate an ACP program in care dependent community-dwelling persons, compared to optimised usual care.

Methods

A cluster-randomised controlled trial of 12 months duration will be conducted in 3 German study sites comparing the pretested ACP-counselling offered by trained nurses with a control group receiving optimised usual care. Using external concealed randomisation, 16 home care services each will be included in the intervention and the control group (30 participants per cluster; n = 960). Eligibility criteria for patients are: ≥60 years, somehow care dependent, adequate German language skills, assumed life-expectancy of ≥4 weeks, and cognitive ability for participation.

ACP will be delivered by trained nurse facilitators of the respective home care services and communication will include proxy decision-makers. The primary endpoint will be patient activation, assessed by the Patient Activation Measure (PAM-13). Secondary endpoints include ACP-engagement, proportion of prepared advance directives, number and duration of hospitalisations, quality of life as well as depression and anxiety. Further, comprehensive economic and process evaluations will be conducted.

Discussion

STADPLAN is the first study in Germany that assesses an adapted ACP intervention with trained nurses in home care services and the first international study focusing on cost effectiveness of ACP in community-dwelling older persons. The results will help to improve the understanding and communicating of patients’ preferences regarding medical treatment and care and thereby contribute to patients’ autonomy.

Trial registration

German Clinical Trials Register: DRKS00016886 (Date of registration: 04.06.2019).
A case of Henoch-Schönlein purpura associated with scrub typhus
Authors: Im Jae Hyoung , Choi Suk Jin , Chung Moon-Hyun , Lee Seung Yun , Park Young Kyoung , Kwon Hea Yoon , Baek Ji Hyeon , Lee Jin-Soo
Published: April 2020

Background

Henoch-Schönlein purpura (HSP) may be caused by several allergens. However, to date, HSP caused byOrientia tsutsugamushihas not been reported. Here, we report an unusual rash with features of HSP caused byOrientia tsutsugamushi.

Case presentation

A man visited a tertiary hospital with bilateral symmetrical purpura and fever. He presented with an eschar in the left popliteal fossa and proteinuria. He was diagnosed with tsutsugamushi disease by indirect fluorescent antibody and positive polymerase chain reaction tests. Purpura biopsy demonstrated a feature of leukocytoclastic vasculitis and IgA deposition in dermal vessels, indicative of HSP.

Conclusions

When examining patients with unique rashes, such as in this case, we suggest investigating out-door activities and evidence of mite bites. Furthermore, differential diagnosis of tsutsugamushi disease should be considered when necessary.
A 64-year-old woman with raccoon eyes following kidney biopsy: a case report
Authors: Mei Shuqin , Zhao Yunyang , Li Lin , Mei Changlin , Dai Bing
Published: April 2020

Background

Raccoon eyes or periorbital ecchymosis is caused by blood tracking into periorbital tissues, which is mostly recognized in injuries of head and neck, basal skull fractures, convexity fractures and facial fractures. It was also reported in systematic disorders, such as multiple myeloma, amyloidosis, Kaposi’s sarcoma, migraine and neuroblastoma. However, it is unusual to see a patient showing periorbital purpura after kidney biopsy with no other ecchymosis. Here, we firstly reported this rare symptom after kidney biopsy in a patient who was finally diagnosed as immunoglobulin light chain (AL) amyloidosis.

Case presentation

A 64-year old woman was admitted to our clinic with 1.5 years history of sub-nephrotic proteinuria and slowly progressive deterioration of renal function. Laboratory -investigations revealed an M-peak in the λ fraction of IgA and concentrations of serum free-light-chain (FLC) were 44.95 mg/L for κ isotype and 173 mg/L for λ isotype. Unexpectedly the patient showed periorbital purpura 24 h later after kidney biopsy with no more other ecchymosis. Renal biopsy showed massively glomerulosclerosis, interstitial fibrosis with positively Congo red staining in mesangial areas. For fluorescent staining, the kidney tissue showed strongly λ light-chain deposition. The fibrils (8-12 nm in diameter) were confirmed by electron micrograph.

Conclusions

This case firstly reported this rare symptom after the kidney biopsy in a patient who was finally diagnosed as AL amyloidosis. And this unique sign of periorbital ecchymosis warrants more attention as an early cue of amyloidosis.
Correction to: The contribution of iron deficiency to the risk of peripartum transfusion: a retrospective case control study
Authors: VanderMeulen H. , Strauss R. , Lin Y. , McLeod A. , Barrett J. , Sholzberg M. , Callum J.
Published: April 2020

Following publication of the original article [1], we have been notified that there is a missing conflict of interest.
Associations between meeting sleep, physical activity or screen time behaviour guidelines and academic performance in Australian school children
Authors: Howie Erin K. , Joosten John , Harris Courtenay J. , Straker Leon M.
Published: April 2020

Background

Current guidelines suggest too little sleep, too little physical activity, and too much sedentary time are associated with poor health outcomes. These behaviours may also influence academic performance in school children. The primary purpose of this study was to examine the relationships between sleep, physical activity, or sedentary behaviours and academic performance in a school with a well-developed and integrated technology use and well-being program.

Methods

This was a cross-sectional survey of students (n = 934, Grades 5–12) in an Australian school with a bring-your-own device (tablet or laptop computer) policy. Students reported sleep, physical activity, and sedentary (screen and non-screen) behaviours. Academic performance was obtained from school records. Linear regressions were used to test the association between behaviours and academic performance outcomes.

Results

Seventy-four percent of students met sleep guidelines (9 to 11 h for children 5–13 years and 8 to 10 h for 14–17 year olds), 21% met physical activity guidelines (60 min of moderate-to-vigorous physical activity every day), and 15% met screen time guidelines (no more than 2 h recreational screen time per day); only 2% met all three. There were no associations between meeting sleep guidelines and academic performance; however later weekend bedtimes were associated with poorer academic performance (− 3.4 points on the Average Academic Index, 95%CI: − 5.0, − 1.7, p < .001). There were no associations between meeting physical activity guidelines and academic performance. Meeting screen guidelines was associated with higher Average Academic Index (5.8, 95%CI: 3.6, 8.0, p < .001), Maths 7.9, 95%CI: 4.1, 11.6, p < .001) and English scores (3.8, 95%CI: 1.8, 5.8, p < .001) and higher time in sedentary behaviours was associated with poorer academic performance, including total sedentary behaviours in hrs/day (5.8 points on Average Academic Index, 95%CI: 3.6, 8.0, p < .001. Meeting at least two of the three behaviour guidelines was associated with better academic performance.

Conclusions

Sleep and sedentary behaviours were linked to academic performance. School communities should emphasize comprehensive wellness strategies to address multiple behaviours to maximize student health and academic success.
Relationship between lower limb torsion and coronal morphologies of the femur and tibia in patients with medial knee osteoarthritis
Authors: Nejima Shuntaro , Akamatsu Yasushi , Kobayashi Hideo , Tsuji Masaki , Mitsuhashi Shota , Sasaki Takahiro , Kumagai Ken , Inaba Yutaka
Published: April 2020

Background

To investigate the relationship between femoral or tibial torsion and hip-knee-ankle angle (HKA), mechanical lateral distal femoral angle (mLDFA), or mechanical medial proximal tibial angle (mMPTA) in patients with medial knee osteoarthritis (OA).

Methods

A total of 75 knees were enrolled. Femoral and tibial torsions were measured by superimposing the axial planes of computed tomography images. The relationship between femoral or tibial torsion and HKA, mLDFA, or mMPTA on radiographs was examined.

Results

The mean femoral torsion was 12.2 ± 8.5° internally; femoral internal and external torsions were observed in 70 and 5 knees, respectively. The mean tibial external torsion was 18.0 ± 7.4° externally; tibial external torsion was observed in all 75 knees. Femoral internal and tibial external torsions increased with lower mMPTA (r = 0.33,P = 0.003;r = − 0.32,P = 0.005, respectively) but were not related to HKA or mLDFA.

Conclusion

Femoral and tibial torsions were correlated with varus inclination of the proximal tibia in patients with medial knee OA.
Effect of preoperative vitamin D deficiency on functional outcomes after high tibial osteotomy: a retrospective case control study
Authors: Choi Wonchul , Kim Jae Hwa , Byun Seong-Eun , Ryu Han-Seung , Rojas David
Published: April 2020

Background

This study aimed to evaluate the effects of vitamin D deficiency on the functional outcomes following a high tibial osteotomy (HTO).

Methods

Clinical data of 209 patients (327 knees) who underwent HTO done by a single surgeon were retrospectively registered for the study. Ninety-four patients (94 knees) who underwent HTO were analyzed. Patients were assigned into two groups according to their preoperative serum vitamin D levels (D- Deficiency and S- Sufficient); < 20 ng/ml (group D, N = 48) and ≥ 20 ng/ml (group S, N = 46) respectively. A subjective form of International Knee Documentation Committee (IKDC) score, mechanical alignment, and cartilage status before and 1 year following HTO were studied between groups.

Results

The mean postoperative IKDC score was significantly higher in group S (p = 0.012). Moreover, the difference of IKDC score between pre- and post- HTO was also significantly higher in group S (p = 0.006). Preoperative vitamin D level and IKDC score did not show a significant correlation. Serum vitamin D level was found to be moderately correlated to postoperative IKDC score (r = 0.342 and, p = 0.001). A moderately positive correlation between serum vitamin D level and improvement of IKDC score following osteotomy was appreciated (r = 0.381 and, p < 0.001).

Conclusion

Patients with vitamin D deficiency had less satisfactory functional outcomes within 1 year from HTO surgery. Our results suggest that preoperative serum vitamin D level is one of the factors affecting the outcome after HTO. We recommended analyzing serum vitamin D levels as part of the routine workup in patients undergoing HTO.
A comparison of stage-specific all-cause mortality between testicular sex cord stromal tumors and germ cell tumors: results from the National Cancer Database
Authors: Zuniga Kyle B. , Washington Samuel L. , Porten Sima P. , Meng Maxwell V.
Published: April 2020

Background

Testicular sex cord stromal tumors (SCSTs) are managed similarly to germ cell tumors (GCTs); however, few studies have directly compared outcomes between these tumor types. Using the National Cancer Database (NCDB), we sought to compare overall and stage-specific all-cause mortality (ACM) between SCSTs versus GCTs.

Methods

NCDB was queried for patients diagnosed with SCSTs and GCTs between 2004 and 2013. Descriptive statistics were used to compare sociodemographic and clinical characteristics between groups. Univariable and multivariable Cox proportional hazards regression analyses were used to assess associations with ACM.

Results

We identified 42,192 patients diagnosed with testicular cancer between 2004 and 2013, with 280 having SCSTs and 41,912 patients having GCTs. Median age for SCSTs and GCTs was 45 (interquartile range [IQR] 34–59) and 34 (IQR 27–43), respectively (p < 0.001). Median follow-up was 39 and 52 months, respectively. Overall, patients with SCSTs had greater risk of ACM compared to those with GCTs (HR 1.69, 95% CI 1.14–2.50). Private insurance, greater education, and fewer comorbidities were associated with reduced risk of ACM (p < 0.05 for all). Among those with stage I disease, tumor type was not associated with ACM on multivariable analysis. Among those with stage II/III disease, patients with SCSTs had increased risk of ACM compared to patients with GCTs (HR 3.29, 95% CI 1.89–5.72).

Conclusions

Patients with advanced SCSTs had worse survival outcomes compared to those with advanced GCTs. These data suggest a need for further investigation to ascertain effective management recommendations for SCSTs.
Determinants of depression among nursing students in Cameroon: a cross-sectional analysis
Authors: Njim Tsi , Mbanga Clarence , Mouemba Dave , Makebe Haman , Toukam Louise , Kika Belmond , Mulango Isabelle
Published: April 2020

Background

Nursing students are highly susceptible to depression given the heavy workload and clinical demands of the curriculum. Depression has negative impacts on their health and academic performance. This study aimed to determine the determinants of depression amongst nursing students in the English-speaking regions of Cameroon.

Methods

A cross-sectional analysis of 447 nursing students recruited from a combination of state-owned and private nursing institutions in the English-speaking regions of Cameroon from January – April 2018 was carried out. Independent correlates of depression were determined using multivariable regression analysis, with the level of significance set at 95%.

Results

The overall prevalence of depression (Patient Health Questionnaire - 9 > 4) and major depressive disorder (Patient Health Questionnaire - 9 > 9) in these students was 69.57 and 26.40% respectively. Independent correlates of depression were found to be: total Oldenburg Burnout Inventory score (aOR: 1.18; 95% CI: 1.11, 1.25; p value < 0.01); level of studies (aOR: 0.72; 95% CI: 0.55, 0.94; p value = 0.02) and occurrence of a life-changing crises (aOR: 2.13; 95% CI: 1.28, 3.55, p value < 0.01).

Conclusion

The prevalence of depression amongst nursing students in Cameroon is high. Determinants proposed in this study require further assessment to facilitate early identification and management of depression in this high-risk group, in order to limit the negative effects linked with the condition.
Weekend effect on mortality by medical specialty in six secondary hospitals in the Helsinki metropolitan area over a 14-year period
Authors: Tolvi Morag , Mattila Kimmo , Haukka Jari , Aaltonen Leena-Maija , Lehtonen Lasse
Published: April 2020

Background

The weekend effect is the phenomenon of a patient’s day of admission affecting their risk for mortality. Our study reviews the situation at six secondary hospitals in the greater Helsinki area over a 14-year period by specialty, in order to examine the effect of centralization of services on the weekend effect.

Methods

Of the 28,591,840 patient visits from the years 2000–2013 in our hospital district, we extracted in-patients treated only in secondary hospitals who died during their hospital stay or within 30 days of discharge. We categorized patients based on the type of each admission, namely elective versus emergency, and according to the specialty of their clinical service provider and main diagnosis.

Results

A total of 456,676 in-patients (292,399 emergency in-patients) were included in the study, with 17,231 deaths in-hospital or within 30 days of discharge. A statistically significant weekend effect was observed for in-hospital and 30-day post-discharge mortality among emergency patients for 1 of 7 specialties. For elective patients, a statistically significant weekend effect was visible in in-hospital mortality for 4 of 8 specialties and in 30-day post-discharge mortality for 3 of 8 specialties. Surgery, internal medicine, and gynecology and obstetrics were most susceptible to this phenomenon.

Conclusions

A weekend effect was present for the majority of specialties for elective patients, indicating a need for guidelines for these admissions. More disease-specific research is necessary to find the diagnoses, which suffer most from the weekend effect and adjust staffing accordingly.
Enhanced NETosis generation in radiographic axial spondyloarthritis: utility as biomarker for disease activity and anti-TNF-α therapy effectiveness
Authors: Ruiz-Limon Patricia , Ladehesa-Pineda Maria Lourdes , Castro-Villegas Maria del Carmen , Abalos-Aguilera Maria del Carmen , Lopez-Medina Clementina , Lopez-Pedrera Chary , Barbarroja Nuria , Espejo-Peralbo Daniel , Gonzalez-Reyes Jose Antonio , Villalba Jose Manuel , Perez-Sanchez Carlos , Escudero-Contreras Alejandro , Collantes-Estevez Eduardo , Font-Ugalde Pilar , Jimenez-Gomez Yolanda
Published: April 2020

Background

Radiographic axial spondyloarthritis (r-axSpA) is a chronic inflammatory form of arthritis in which tumor necrosis factor (TNF)-α, a potent inducer of inflammatory response and a key regulator of innate immunity and of Th1 immune responses, plays a central role. NETosis is a mechanism of innate immune defense that is involved in diverse rheumatology diseases. Nevertheless, spontaneous NETosis generation in r-axSpA, its association to disease pathogenesis, and the NETosis involvement on anti-TNF-α therapy’s effects has never been explored.

Methods

Thirty r-axSpA patients and 32 healthy donors (HDs) were evaluated. Neutrophil extracellular trap (NET) formation, mediators of signal-transduction cascade required for NETosis induction and cell-free NETosis-derived products were quantified. An additional cohort of 15 r-axSpA patients treated with infliximab (IFX) for six months were further analyzed. In vitro studies were designed to assess the effects of IFX in NETosis generation and the inflammatory profile triggered.

Results

Compared to HDs, neutrophils from r-axSpA patients displayed augmented spontaneous NET formation, elevated expression of NET-associated signaling components, nuclear peptidylarginine deiminase 4 translocation and increased citrullinated histone H3. Furthermore, patients exhibited altered circulating levels of cell-free NETosis-derived products (DNA, nucleosomes and elastase). Additional studies revealed that cell-free NETosis-derived products could be suitable biomarkers for distinguish r-axSpA patients from HDs. Correlation studies showed association between cell-free NETosis-derived products and clinical inflammatory parameters. Besides, nucleosomes displayed potential as a biomarker for discriminate patients according to disease activity.

IFX therapy promoted a reduction in both NETosis generation and disease activity in r-axSpA patients. Mechanistic in vitro studies further unveiled the relevance of IFX in reducing NET release and normalizing the augmented inflammatory activities promoted by NETs in mononuclear cells.

Conclusions

This study reveals that NETosis is enhanced in r-axSpA patients and identifies the NETosis-derived products as potential disease activity biomarkers. In addition, the data suggests the potential role of NET generation analysis for assessment of therapeutic effectiveness in r-axSpA.
Novel insight into the regulatory roles of diverse RNA modifications: Re-defining the bridge between transcription and translation
Authors: Shi Hanhan , Chai Peiwei , Jia Renbing , Fan Xianqun
Published: April 2020

RNA modifications can be added or removed by a variety of enzymes that catalyse the necessary reactions, and these modifications play roles in essential molecular mechanisms. The prevalent modifications on mRNA include N6-methyladenosine (m6A), N1-methyladenosine (m1A), 5-methylcytosine (m5C), 5-hydroxymethylcytosine (hm5C), pseudouridine (Ψ), inosine (I), uridine (U) and ribosemethylation (2’-O-Me). Most of these modifications contribute to pre-mRNA splicing, nuclear export, transcript stability and translation initiation in eukaryotic cells. By participating in various physiological processes, RNA modifications also have regulatory roles in the pathogenesis of tumour and non-tumour diseases. We discussed the physiological roles of RNA modifications and associated these roles with disease pathogenesis. Functioning as the bridge between transcription and translation, RNA modifications are vital for the progression of numerous diseases and can even regulate the fate of cancer cells.