bluuebunny/crossref_metadata_2025 huggingface dataset:
Ovarian Mixed Epithelial Carcinoma With Extensive Bilateral Fallopian Tubes Metastases by the Low-grade Serous Carcinoma Component Mimicking Serous Tubal Intraepithelial Carcinoma: Case Presentation and Literature Review
Authors: Zhang Lin , Velazquez Miriam , Wang Xiaohong , Masand Ramya , Deavers Michael , Zhang Songlin
Published: December 2020

Seromucinous carcinoma of the ovary was a newly defined category in the revised 2014 World Health Organization Classification of Tumors of Female Reproductive Organs. It was defined as a carcinoma composed of predominantly of serous and endocervical-type mucinous epithelium. Foci containing clear cells, and areas of endometrioid and squamous differentiation are not uncommon. It is a rare entity with morphologic and immunophenotypic features overlapping other types of ovarian carcinoma. There are different opinions as to whether it is a distinct entity or a histologic variant of well-established entities. Subsequent, to the writing of this manuscript the WHO 2020 reclassified this tumor as a type of endometrioid carcinoma. Here we present a case of seromucinous carcinoma of bilateral ovaries that had variable differentiation and morphology at different sites. Tumor in the fallopian tubes, ovarian surfaces, omentum, and peritoneal surfaces displayed predominant features of low-grade serous carcinoma, while the tumor in the ovaries had predominant mucinous carcinoma morphology with a confluent/expansile growth pattern. The mucosal involvement of the fallopian tubes morphologically mimicked serous tubal intraepithelial carcinoma.
Vascular Pseudoinvasion After Endometrial Ablation
Authors: Karpathiou Georgia , Corsini Thomas , Dagher Sami , Chauleur Celine , Peoc’h Michel
Published: December 2020

Vascular pseudoinvasion or displacement of tumor or normal endometrial tissue is a potential pitfall in uterine pathology. The proposed mechanisms of this phenomenon are mostly associated with the uterine manipulator used during minimally invasive hysterectomies. The aim of this report is to describe vascular pseudoinvasion in a still unreported setting, that of a postendometrial ablation hysterectomy, and to provide a summary of studies dealing with artifactual or nonmalignant myometrial vessel involvement by normal or neoplastic endometrial tissue.
Missed Acute Coronary Syndrome During Telephone Triage at Out-of-Hours Primary Care: Lessons From A Case-Control Study
Authors: Erkelens Daphne C. , Rutten Frans H. , Wouters Loes T. , Kirkels Harmke G. , Poldervaart Judith M. , de Groot Esther , Damoiseaux Roger A. , Hoes Arno W. , Zwart Dorien L.
Published: December 2020

Objectives

Serious adverse events at out-of-hours services in primary care (OHS-PC) are rare, and the most often concern is missed acute coronary syndrome (ACS). Previous studies on serious adverse events mainly concern root cause analyses, which highlighted errors in the telephone triage process but are hampered by hindsight bias. This study compared the recorded triage calls of patients with chest discomfort contacting the OHS-PC in whom an ACS was missed (cases), with triage calls involving matched controls with chest discomfort but without a missed ACS (controls), with the aim to assess the predictors of missed ACS.

Methods

A case-control study with data from 2013 to 2017 of 9 OHS-PC in the Netherlands. The cases were matched 1:8 with controls based on age and sex. Clinical, patient, and call characteristics were univariably assessed, and general practitioner experts evaluated the triage while blinded to the final diagnosis or the case-control status.

Results

Fifteen missed ACS calls and 120 matched control calls were included. Cases used less cardiovascular medication (38.5% versus 64.1%, P = 0.05) and more often experienced pain other than retrosternal chest pain (63.3% versus 24.7%, P = 0.02) compared with controls. Consultation of the supervising general practitioner (86.7% versus 49.2%, P = 0.02) occurred more often in cases than in controls. Experts rated the triage of cases more often as “poor” (33.3% versus 10.9%, P = 0.001) and “unsafe” (73.3% versus 22.5%, P < 0.001) compared with controls.

Conclusions

To facilitate learning from serious adverse events in the future, these should also be bundled and carefully assessed without hindsight bias and within the context of “normal” clinical practice.
The Impact of Malpractice Claims on Physicians’ Well-Being and Practice
Authors: Vizcaíno-Rakosnik Marta , Martin-Fumadó Carles , Arimany-Manso Josep , Gómez-Durán Esperanza L.
Published: December 2020

Objectives

Malpractice litigation causes extreme stress. We examine the psychological impact of malpractice claims on physicians’ well-being and the consequences on patient care.

Methods

A confidential telephone survey, administered to physicians with both open and closed claims from the previous year, explored symptoms, well-being changes, needs, impairments, and practice changes.

Results

Of the 282 respondents, more than half (56.38%) reported a notable psychological reaction to the malpractice claim, with no differences between the open and closed claims (P = 0.2477) or between closed claims with and without a payout (P = 1). Physicians facing criminal proceedings were more likely to experience a notable psychological impact (P = 0.0206). Almost half of the respondents (45.39%) acknowledged practice changes: viewing patients as potential plaintiffs (45.39%), paying more attention to recordkeeping (42.19%), obtaining medicolegal training (37.94%), ordering more tests (36.17%), and avoiding specific kinds of patients (21.63%) or procedures (19.85%). Acknowledging a psychological impact was positively and significantly associated with professional practice changes (P < 0.0001), and the mean number of symptoms was significantly higher among those who acknowledged practice changes (P = 0.0001).

Conclusions

Our results confirm the psychological impact of a malpractice claim and that impacted physicians are more likely to change their care practices, involving defensive medicine practices. Therefore, care for physicians facing malpractice claims needs to be considered under the umbrella of health care quality. Timely mental health referral paths could help mitigate the psychological impact and avoid the pernicious effects of negative practice changes.
How Much and What Local Adaptation Is Acceptable? A Comparison of 24 Surgical Safety Checklists in Switzerland
Authors: Fridrich Annemarie , Imhof Anita , Schwappach David L. B.
Published: December 2020

Objectives

In 2009, the World Health Organization (WHO) published the WHO Surgical Safety Checklist, and 3 years later, the Swiss Patient Safety Foundation adapted it for Switzerland. Several meta-analyses and systematic reviews showed ambiguous results on the effectiveness of surgical checklists. Most of them assume that the study checklists are almost identical, but in fact they are quite heterogeneous due to adaptations to local settings. This study aims to investigate the extent to which the checklists currently used in Switzerland differ and to discuss the consequences of local adaptations.

Methods

For the analysis, 24 checklists used in 18 Swiss hospitals are analyzed. First, general checklist characteristics are examined. Second, the checklist items are compared with the checklist items of the WHO and the Swiss Patient Safety Foundation.

Results

The checklists contain a median of 34.5 items (range, 15–76). Compared with the checklists of WHO and Patient Safety Switzerland, which contain 12 and 21 process checks and 10 and 9 conversation prompts, respectively, the study checklists contain a median of 15.5 process checks (range, 3–25) and a median of 4 conversation prompts (range, 0–10).

Conclusions

There are major differences between the study checklists and the reference checklists that raise doubts about the comparability of checklists. More resources must be invested in proper checklist adaptions and better guidance on how to adapt safety tools such as the surgical safety checklist needed to local conditions. In any case, details of the checklists used need to be clearly described in studies on checklist effectiveness.
Comparison of 18F-DOPA Versus 68Ga-DOTATOC as Preferred PET Imaging Tracer in Well-Differentiated Neuroendocrine Neoplasms
Authors: Veenstra Emile B. , de Groot Derk Jan A. , Brouwers Adrienne H. , Walenkamp Annemiek M.E. , Noordzij Walter
Published: December 2020

Purpose

The aim of this study was to retrospectively compare 18F-FDOPA versus 68Ga-DOTATOC PET in lesion detection rates and laboratory tumor markers in patients with neuroendocrine neoplasms (NENs).

Patients and Methods

All patients with histologically proven NEN between May 2015 and February 2019 were included who underwent both 18F-DOPA and 68Ga-DOTATOC PET scans within 6 months from each other (mean, 75; median, 38; range, 2–168 days). All patients, except those with pancreatic NEN, received carbidopa before 18F-DOPA PET. Based on the number of lesions on both modalities, patients were divided into 3 categories: more lesions on 18F-DOPA (DOPA > DOTA), more lesions on 68Ga-DOTATOC (DOTA > DOPA), and equal number of lesions (DOPA = DOTA). Tumor markers chromogranin A, serotonin, and 5-hydroxyindoleacetic acid (5-HIAA) within a maximum of 3 months around either scan were retrieved from the patients’ charts.

Results

18F-DOPA revealed significantly more lesions compared with 68Ga-DOTATOC (611 vs 385, P < 0.05). Twenty-four patients were included in the DOPA > DOTA group with 16 small intestinal (SI) NENs, 3 large intestinal, 4 pancreatic, and 1 tumor of unknown origin (TUO). For the 9 patients in the DOTA > DOPA group, 4 were SI, 2 pancreatic, 1 lung, and 2 TUOs. Twelve patients in the DOPA = DOTA group had 6 pancreatic tumors, 3 SI, 1 ovarian, and 2 TUOs. Only serotonin and 5-HIAA showed significant higher values for DOPA > DOTA compared with DOTA > DOPA (mean 24 vs 4, P < 0.05, and 320 vs 81, P < 0.05, respectively). Cutoff values of 20 nmol/109 for serotonin, 185 μg/L for chromogranin A, and 200 nmol/L for 5-HIAA were found to include almost exclusively DOPA > DOTA patients.

Conclusions

There is an advantage of carbidopa pretreated 18F-DOPA over 68Ga-DOTATOC PET, especially for large intestinal NENs with high levels of biomarkers. There seems to be a relationship between increased biomarker value and improved lesion detection rates with the 18F-DOPA PET scan, which requires further prospective analysis.
Chylopericardium Due to Residual Lymphangiomyoma Detected on 99mTc-Sulfur Colloid Lymphoscintigraphy
Authors: Hemrom Angel , Tupalli Avinash , Kumar Arunav , Mohan Nikhil , Kumar Rakesh
Published: December 2020

Lymphangiomyomas are relatively rare, benign neoplasms. Many patients present with symptoms including effusions, and some cases are incidentally detected. Surgical excision is the treatment of choice, but because of its location, complete surgical resection of a lymphangioma can be technically difficult, and recurrent cases can present with symptoms including effusions. 99mTc-sulfur colloid scan can be used to confirm the leak and nature of the effusion fluid. Here, we present an 8-year-old girl with recurrent pleural and pericardial effusions after lymphocele excision and total pericardiectomy. 99mTc-sulfur colloid lymphoscintigraphy was done to rule out secondary chylopericardium.
Sex-based Disparities in Hepatocellular Carcinoma Recurrence After Liver Transplantation
Authors: Cullaro Giuseppe , Rubin Jessica , Mehta Neil , Yao Francis , Verna Elizabeth C. , Lai Jennifer C.
Published: December 2020

Background.

Women with chronic liver disease have lower rates of hepatocellular carcinoma (HCC) as compared to men; it is unknown if there are sex-based differences in HCC recurrence postliver transplant.

Methods.

We conducted an analysis of patients who underwent liver transplant for HCC in the United Network for Organ Sharing/Organ Procurement and Transplantation Network from January 1, 2012 through December 31, 2017.

Results.

A total of 12 711 patients underwent liver transplant for HCC: 2909 (23%) women and 9802 (73%) men. Women had significantly lower rates of postliver transplant HCC recurrence than men (4.0% versus 5.4%, P = 0.002). A cox-regression analysis for postliver transplant HCC recurrence highlighted that even after accounting for etiology of cirrhosis, alpha-fetoprotein at liver transplant, tumor diameter, tumor pathology, and vascular invasion, female sex was associated with a 25% lower risk of postliver transplant HCC recurrence (95% confidence interval: 0.57–0.99). There were no interactions between female sex and the following variables: age, type of locoregional therapy, alpha-fetoprotein, donor sex, body mass index, or nonalcoholic steatohepatitis etiology (P > 0.05 for each).

Conclusions.

This study demonstrates an independent effect of sex on risk for HCC recurrence postliver transplant. Our data highlight an opportunity to better understand HCC tumor biology by investigating the drivers of this sex-based difference in HCC recurrence.
Sesamol alleviates chronic intermittent hypoxia-induced cognitive deficits via inhibiting oxidative stress and inflammation in rats
Authors: Zhang Panpan , Wang Yanhui , Wang Hongyang , Cao Jie
Published: December 2020

Chronic intermittent hypoxia (CIH) is a major pathophysiological feature of obstructive sleep apnea (OSA), which can cause oxidative stress and inflammation which can further impair the nervous system. Cognitive impairment is a common complication of the nervous system in OSA. Sesamol, a natural extract from Sesamum plants, is believed to have strong antioxidant and anti-inflammation capacity, which has a powerful neuroprotective function. But whether sesamol can improve CIH-induced cognitive impairment is unclear. This study aimed to explore whether sesamol can improve CIH-induced cognitive impairment and its relative mechanism in the model rats with OSA. Rats were exposed to CIH for 8 h a day for 2, 4, 6, and 8 weeks separately and concurrently were treated with sesamol (20 mg/kg/day, intraperitoneal). The Morris water maze (MWM) test was used to evaluate their learning and memory function. The activity of the superoxide dismutase (SOD) and the level of malondialdehyde were measured to evaluate the oxidative stress in the hippocampus of the rats. The levels of tumour necrosis factor-alpha (TNF-α) and interleukin-1 beta (IL-1β) in the hippocampus were quantified to analyse neuroinflammation by ELISA. The MWM test showed that sesamol improved learning and memory impairment in CIH-exposed rats. We also found that the sesamol-treated CIH-exposed rats had significantly increased the activity of SOD, as well as reduced the level of malondialdehyde in the hippocampus. In addition, sesamol also reduced the levels of TNF-α and IL-1β in the hippocampus. These data show that sesamol is able to alleviate cognitive impairments in CIH-exposed rats, with its neuroprotective effects likely inhibiting oxidative stress and inflammation.
MPTP toxicity causes vocal, auditory, orientation and movement defects in the echolocation bat
Authors: Wu Wan-Jhen , Lu Chen-Wen , Wang Sheue-Er , Lin Ching-Lung , Su Li-Yu , Wu Chung-Hsin
Published: December 2020

1-Methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP) can damage dopaminergic neurons in the substantia nigra in many mammals with biochemical and cellular changes that are relatively similar to those observed in Parkinson’s disease. Our study examined whether MPTP-treated echolocation bats can cause changes in bat echolocation system. By considering ultrasound spectrums, auditory brainstem-evoked potentials and flight trajectories of normal bats, we observed that the vocal, auditory, orientation and movement functions of MPTP-treated bats were significantly impaired, and they exhibited various symptoms resembling those in patients with Parkinson’s disease. Our immunohistochemistry and western blot analyses further indicated that expression of vocal-related FOXP2 in the superior colliculus, auditory-related otoferlin in the inferior colliculus, dopamine synthesis-related aromatic l-amino acid decarboxylase in the substantia nigra and dopamine receptor in the striatum was significantly decreased. Furthermore, protein expression related to inflammation, oxidative stress and apoptosis in the substantia nigra was significantly increased in MPTP-treated bats. These results indicate that inflammation, oxidative stress and apoptosis may be instrumental in dopaminergic neurodegeneration in the substantia nigra. The vocal, auditory and orientation and movement dysfunctions of MPTP-treated bats are relatively consistent with symptoms of Parkinson’s disease.
Modelling and dynamic state estimation of a doubly fed induction generator wind turbine
Authors: Shahriari Sayyed Ali Akbar
Published: December 2020

Purpose

This paper aims to propose an 18th-order nonlinear model for doubly fed induction generator (DFIG) wind turbines. Based on the proposed model, which is more complete than the models previously developed, an extended Kalman filter (EKF) is used to estimate the DFIG state variables.

Design/methodology/approach

State estimation is a popular approach in power system control and monitoring because of minimizing measurement noise level and obtaining non-measured state variables. To estimate all state variables of DFIG wind turbine, it is necessary to develop a model that considers all state variables. So, an 18th-order nonlinear model is proposed for DFIG wind turbines. EKF is used to estimate the DFIG state variables based on the proposed model.

Findings

An 18th-order nonlinear model is proposed for DFIG wind turbines. Furthermore, based on the proposed model, its state variables are estimated. Simulation studies are done in four cases to verify the ability of the proposed model in the estimation of state variables under noisy, wind speed variation and fault condition. The results demonstrate priority of the proposed model in the estimation of DFIG state variables.

Originality/value

Evaluating DFIG model to estimate its state variables precisely.
The steering effects of citations and metrics
Authors: Ma Lai
Published: December 2020

Purpose

This paper aims to understand the nature of citations and metrics in the larger system of knowledge production involving universities, funding agencies, publishers, and indexing and data analytic services.

Design/methodology/approach

First, the normative and social constructivist views of citations are reviewed to be understood as co-existing conditions. Second, metrics are examined through the processes of commensuration by tracing the meanings of metrics embedded in various kinds of documents and contexts. Third, the steering effects of citations and metrics on knowledge production are discussed. Finally, the conclusion addresses questions pertaining to the validity and legitimacy of citations as data and their implications for knowledge production and the conception of information.

Findings

The normative view of citations is understood as an ideal speech situation; the social constructivist view of citation is recognised in the system of knowledge production where citing motivations are influenced by epistemic, social and political factors. When organisational performances are prioritised and generate system imperatives, motives of competition become dominant in shaping citing behaviour, which can deviate from the norms and values in the academic lifeworld. As a result, citations and metrics become a non-linguistic steering medium rather than evidence of research quality and impact.

Originality/value

This paper contributes to the understanding of the nature of citations and metrics and their implications for the conception of information and knowledge production.
Employee reactiveness and inclusive leadership: time to manage emotional diversity
Authors: Rawat Preeti S. , Lyndon Shiji , Pradhan Manas Ranjan , Jose Jackson , Kollenchira Milcah , Mehta Grishma
Published: December 2020

Purpose

The different perspectives of diversity have until recently ignored emotional diversity primarily because emotions were discounted as “irrational.” To highlight the need for a broader integrative view of emotions in the workplace, the question addressed in the study was whether inclusive leadership helped emotionally reactive employees improve their performance and whether these employees displayed potential leadership qualities for future roles.

Design/methodology/approach

The study was qualitative. This cross-sectional study applied qualitative methods to gather the required information. Sixteen business heads across different sectors in India were purposively chosen for in-depth interviews with respondents. The interviews were semi-structured. The approach of theoretical sampling was adopted. From the initial set of questions, the next set of questions was evolved and the itineration was continued until saturation was achieved.

Findings

The results showed that mentoring and empowerment helped emotionally reactive employees improve their performance. On the question of their potential leadership role, the results were mixed.

Research limitations/implications

The follower (protégé) perception, if also taken, can validate whether the person-centered style helped in the performance improvement of the followers. The responses of the leaders were based on their memory and no reports were checked from their office records to corroborate the same.

Practical implications

Researchers have argued that worker behavior and productivity are directly affected by employee affect and emotional states. The study contributes significantly to creating emotionally inclusive workplaces.

Originality/value

The study is focused on the role of diversity of emotions in the workplace impacting productivity. Emotions are vital and affect the workplace significantly. The study focused on what organizations could do to handle emotionally reactive employees at work. The study showed that inclusive leadership through mentoring and empowerment helped in assimilating difficult employees into the mainstream work.
Managing career plateau: case of Aster Retail, UAE
Authors: Trivedi Bhumi Mahesh , Varkkey Biju
Published: December 2020

Purpose

The purpose of this paper is to discuss how Aster Retail (AR), UAE, handled career plateau challenge by adopting multiple strategies and earning employee commitment and motivation for business growth.

Design/methodology/approach

The organization addressed two types of plateaus – structural and content by creating both vertical and lateral opportunities/options for employees, and supporting them with resources to build required capabilities, and managing their career aspirations. The strategies also helped AR to remain true to the organization’s philosophy, “We will treat you well.”

Findings

The study enunciates how HR initiatives can add value by converting the negative phenomenon of plateau, into an opportunity for employees to grow.

Originality/value

The study has three contributions: How in a retail organization with strong promoter principles and values, both structural and content plateau are addressed, and linked with business strategies? The study sheds light on how organizational and HR support for career management addresses employee plateau, particularly for solid citizens. makes the employees feel “not plateaued” at all; and in the long run, why and how HR managers should focus more on proactively addressing content plateau than structural plateau.
Hybridization capture of larch (Larix Mill.) chloroplast genomes from sedimentary ancient DNA reveals past changes of Siberian forest
Authors: Schulte Luise , Bernhardt Nadine , Stoof‐Leichsenring Kathleen , Zimmermann Heike H. , Pestryakova Luidmila A. , Epp Laura S. , Herzschuh Ulrike
Published: December 2020

Siberian larch (Larix Mill.) forests dominate vast areas of northern Russia and contribute important ecosystem services to the world. It is important to understand the past dynamics of larches in order to predict their likely response to a changing climate in the future. Sedimentary ancient DNA extracted from lake sediment cores can serve as archives to study past vegetation. However, the traditional method of studying sedimentary ancient DNA—metabarcoding—focuses on small fragments, which cannot resolve Larix to species level nor allow a detailed study of population dynamics. Here, we use shotgun sequencing and hybridization capture with long‐range PCR‐generated baits covering the complete Larix chloroplast genome to study Larix populations from a sediment core reaching back to 6700 years from the Taymyr region in northern Siberia. In comparison with shotgun sequencing, hybridization capture results in an increase in taxonomically classified reads by several orders of magnitude and the recovery of complete chloroplast genomes of Larix. Variation in the chloroplast reads corroborates an invasion of Larix gmelinii into the range of Larix sibirica before 6700 years ago. Since then, both species have been present at the site, although larch populations have decreased with only a few trees remaining in what was once a forested area. This study demonstrates for the first time that hybridization capture applied directly to ancient DNA of plants extracted from lake sediments can provide genome‐scale information and is a viable tool for studying past genomic changes in populations of single species, irrespective of a preservation as macrofossil.
Adoptive transfer of placental ischemia‐stimulated natural killer cells causes a preeclampsia‐like phenotype in pregnant rats
Authors: Travis Olivia K. , Baik Cedar , Tardo Geilda A. , Amaral Lorena , Jackson Carmilya , Greer Mallory , Giachelli Chelsea , Ibrahim Tarek , Herrock Owen T. , Williams Jan M. , Cornelius Denise C.
Published: December 2020

Problem

The Reduced Uterine Perfusion Pressure (RUPP) rat model of placental ischemia recapitulates many characteristics of preeclampsia including maternal hypertension, intrauterine growth restriction (IUGR), and increased cytolytic natural killer cells (cNKs). While we have previously shown a 5‐fold higher cytotoxicity of RUPP NKs versus normal pregnant NKs, their role in RUPP pathophysiology remains unclear. In this study, we tested the hypotheses that (1) adoptive transfer of RUPP‐stimulated NKs will induce maternal hypertension and IUGR in normal pregnant control (Sham) rats and (2) adoptive transfer of Sham NKs will attenuate maternal hypertension and IUGR in RUPP rats.

Method of Study

On gestation day (GD)14, vehicle or 5 × 106RUPP NKs were infused i.v. into a subset of Sham rats (Sham+RUPP NK), and vehicle or 5 × 106Sham NKs were infused i.v. into a subset of RUPP rats (RUPP+Sham NK;n = 12/group). On GD18, Uterine Artery Resistance Index (UARI) was measured. On GD19, mean arterial pressure (MAP) was measured, animals were sacrificed, and blood and tissues were collected for analysis.

Results

Adoptive transfer of RUPP NKs into Sham rats resulted in elevated NK activation, UARI, placental oxidative stress, and preproendothelin expression as well as reduced circulating nitrate/nitrite. This led to maternal hypertension and IUGR. RUPP recipients of Sham NKs demonstrated normalized NK activation, sFlt‐1, circulating and placental VEGF, and UARI, which led to improved maternal blood pressure and normal fetal growth.

Conclusion

These data suggest a direct role for cNKs in causing preeclampsia pathophysiology and a role for normal NKs to improve maternal outcomes and IUGR during late gestation.
Retrospective survival analysis of stage II–III rectal cancer: tumour regression grade, grading and lymphovascular invasion are the only predictors
Authors: Morini Andrea , Annicchiarico Alfredo , Romboli Andrea , Ricco' Matteo , Crafa Pellegrino , Montali Filippo , Dell'Abate Paolo , Costi Renato
Published: December 2020

Background

Tumour regression grade is gaining interest as a prognostic factor of patients undergoing neoadjuvant chemoradiotherapy and surgery for locally advanced rectal cancer.

Methods

A series of 68 consecutive patients with locally advanced rectal cancer treated by neoadjuvant chemoradiotherapy and surgery between 2010 and 2016 was retrospectively studied. The impact on disease‐free survival (DFS) and overall survival (OS) of several criteria was analysed. Univariate analysis was performed through Kaplan–Meier statistics. Multivariate analysis was performed through Cox regression model. Using criteria found to be related to long‐term outcomes, a predictive model of patient's OS was calculated.

Results

Poor tumour regression grade – TRG3 (P = 0.010), poor grading – G3 (P = 0.001) and lymphovascular invasion (LVI; P = 0.030) were associated with short OS at univariate analysis. OS was associated with TRG3 and G3 at multivariate analysis (P = 0.016 and P = 0.027, respectively). DFS was associated with LVI (P = 0.001), G3 tumours (P = 0.046) and TRG3 (P = 0.045) at univariate analysis. At multivariate analysis, only LVI was associated with DFS (P = 0.041). A score, pondering the impact of three parameters (2 points for TRG3, 2 for G3 and 1 for LVI), was created and resulted to predict patient OS (P = 0.008), ranging from 94.5 months (score = 0–1) to 32 months (score = 3–5).

Conclusion

TRG3 and G3 were associated with poor OS, and LVI was the most significant predictor of DFS. An easy‐to‐use score may allow for a more accurate prediction of OS.
Thyroid gland metastasis from renal cell carcinoma: a case series and literature review
Authors: Tjahjono Richard , Phung Daniel , Gurney Howard , Gupta Ruta , Riffat Faruque , Palme Carsten E.
Published: December 2020

Background

Renal cell carcinoma (RCC) is the most common malignancy that metastasises to the thyroid. This study aims to better understand the clinical characteristics of patients with thyroid metastasis from RCC.

Methods

A retrospective case series of patients with thyroid metastasis from RCC between 2008 and 2020 from two tertiary centres were examined. MEDLINE and PubMed database searches were performed to retrieve the relevant literature.

Results

Fifteen patients (eight males) were identified, with a median age of 57.0 (interquartile range (IQR) 51.0–63.0) at time of RCC diagnosis. Median time to thyroid metastasis was 92.0 months (IQR 40.0–156.0), with 12 (80.0%) patients undergoing thyroidectomy within 2 months of diagnosis. No patients developed post‐operative complications or local thyroid recurrence. The two most common non‐thyroid metastatic sites in this case series are lungs and bone (five patients, respectively; 33.3%) and pancreas (four patients; 26.7%). Ten (66.6%) patients underwent systemic chemotherapy, and five (33.4%) patients underwent radiotherapy for other sites of metastasis. Median survival following thyroid metastasis was 54.0 months (IQR 15.0–100.0). The literature review was conducted through MEDLINE and PubMed database searches, and 30 papers were considered relevant to this review. Results from our study are comparable to those reported in the literature.

Conclusion

Thyroid metastases can occur long after nephrectomy and portends a better prognosis. To prevent development of central neck disease, thyroidectomy should be considered.
Management of Boerhaave syndrome in Australasia: a retrospective case series and systematic review of the Australasian literature
Authors: Allaway Matthew G. R. , Morris Paul D. , B. Sinclair Jane‐Louise , Richardson Arthur J. , Johnston Emma S. , Hollands Michael J.
Published: December 2020

Background

Boerhaave syndrome is a rare and life‐threatening condition characterized by a spontaneous transmural tear of the oesophagus. There remains wide variation in the condition's management with non‐operative management (NOM) and surgery being the two main treatment strategies. The aim was to review the presentation, management and outcomes for patients treated for Boerhaave syndrome at our institution and to compare these data with that previously reported within the Australasian literature.

Methods

A retrospective case series was performed for consecutive patients diagnosed with Boerhaave syndrome at our institution between January 2000 and January 2020. A systematic review of the Australasian literature was also performed.

Results

In case series, 15 patients were included (n = 2 NOM, n = 13 operative). The most common operative technique was primary repair with intercostal drainage via thoracotomy. Major complications occurred in 11 (73%) patients. Median Comprehensive Complication Index was 53.4 (interquartile range: 50). There was a significantly lower Comprehensive Complication Index associated with primary repair when compared to oesophageal resection (P = 0.01). There was one death, in the operative management group. Median length of hospital stay was 33 days (interquartile range: 58). In systematic review, 11 articles were included; four case series and seven case reports. From these, 23 patients met inclusion criteria. The majority of patients (83%) were managed operatively, with only four undergoing NOM. Seven patients died, representing an overall mortality rate of 30%.

Conclusions

We provide an updated overview of the management of Boerhaave syndrome within Australasia. Aggressive operative management is associated with reasonable outcomes.
Transabdominal and transperineal ultrasound vs routine care before instrumental vaginal delivery – A randomized controlled trial
Authors: Barros Joana G. , Afonso Maria , Martins Ana T. , Carita Ana I. , Clode Nuno , Ayres‐de‐Campos Diogo , Graça Luís M.
Published: December 2020

Introduction

The role of intrapartum ultrasound as an ancillary method to instrumental vaginal delivery is yet to be determined. This study aimed to compare the use of transabdominal and transperineal ultrasound with routine clinical care before performing an instrumental vaginal delivery, regarding the incidence of adverse maternal and neonatal outcomes.

Material and Methods

A randomized controlled trial was conducted between October 2016 and March 2019 in two tertiary care maternity hospitals in Lisbon, Portugal. Women at term, with full cervical dilatation, singleton fetuses in cephalic presentation, and with an established indication for instrumental vaginal delivery, were approached for enrollment. After informed consent was obtained, randomization into one of two groups was carried out. In the experimental arm, women underwent transabdominal ultrasound for determination of the fetal head position and transperineal ultrasound for evaluation of the angle of progression, before instrumental vaginal delivery. In the control arm, no ultrasound was carried out before instrumental vaginal delivery. Primary outcomes were composite measures of maternal and neonatal morbidity. Composite maternal morbidity consisted of severe postpartum hemorrhage, perineal trauma, and prolonged hospital stay. Composite neonatal morbidity consisted of low 5‐minute Apgar score, umbilical artery metabolic acidosis, birth trauma, and neonatal intensive care unit admission.

Results

A total of 222 women were enrolled (113 in the experimental arm and 109 in the control arm). No significant differences between the two arms were found in composite measures of maternal (23.9% in the experimental group vs 22.9% in the control group, odds ratio 1.055, 95% CI 0.567‐1.964) or neonatal morbidity (9.7% in the experimental group vs 6.4% in the control group, odds ratio 1.571, 95% CI 0.586‐4.215), nor in any of the individual outcomes.

Conclusions

In this small randomized controlled trial that was stopped for futility before reaching the required sample size, transabdominal and transperineal ultrasound performed just before instrumental vaginal delivery did not reduce the incidence of adverse maternal and neonatal outcomes, when compared with routine clinical care.
Measuring Multi‐Dimensional Labour Law Violation with an Application to South Africa
Authors: Bhorat Haroon , Kanbur Ravi , Stanwix Benjamin , Thornton Amy
Published: December 2020

The rights of workers contained in labour law are multi‐dimensional, and where workers face violations in more than one dimension, this compounds worker vulnerability. Yet, past analysis has tended to concentrate on compliance one dimension at a time — often with an almost exclusive focus on minimum wages. How can we conceptualize and measure compliance with labour laws more comprehensively? This article draws on the multi‐dimensional poverty literature to set up an index that measures the extent of labour law violation along different dimensions. This index is then applied to South Africa to illustrate its application, and examine the insights such an index can provide on the nature and granular structure of compliance and levels of worker vulnerability. A quantile regression approach reveals how correlates of compliance vary substantially across the distribution of violation, highlighting that the probability of violation at the individual level is not linear but multiplicative in nature. As in the field of poverty studies, the development of multi‐dimensional measures for labour violation can offer a broader understanding of the impact of overlapping vulnerabilities.
p62 is a useful predictive marker for tumour regression after chemoradiation therapy in patients with advanced rectal cancer: an immunohistochemical study
Authors: Kobayashi Toshinori , Ishida Mitsuaki , Miki Hisanori , Matsumi Yuki , Fukui Toshiro , Hamada Madoka , Tsuta Koji , Sekimoto Mitsugu
Published: December 2020

Aim

This study aimed to evaluate the relationship between p62 expression status and tumour regression grade in advanced rectal cancer.

Methods

We enrolled 47 consecutive patients with advanced rectal cancer who underwent chemoradiation therapy (CRT) before surgery. p62 expression in the biopsy specimens was immunohistochemically evaluated, and p62 expression score (staining intensity × positive tumour cells, %) was calculated (range 0–300). The relationship between p62 expression score and CRT effect was analysed.

Results

The staining intensity was +2 and +3 in 29 and 18 patients, respectively. The median proportion of positive neoplastic cells was 87.8%, and that of the p62 expression score was 200. Stronger staining intensity and a higher proportion of p62‐positive neoplastic cells were significantly associated with CRT non‐effectiveness (P = 0.0002 and P = 0.0116, respectively), and a higher p62 expression score was significantly associated with CRT non‐effectiveness (P < 0.0001). The optimal cut‐off value for predicting the CRT effect was 240.

Conclusions

A higher p62 expression score was significantly associated with less CRT effectiveness in patients with advanced rectal cancer. Analysis of p62 expression score using biopsy specimens is a useful and easily assessable prediction marker for CRT effect and might help select patients who can undergo a ‘watch‐and‐wait’ strategy after CRT.
N‐Sulphonatoalkyl indophenine derivatives: Design, synthesis and dyeing properties on wool, silk and nylon fabrics
Authors: Cai Jinfang , Jiang Hua , Cui Zhihua , Chen Weiguo
Published: December 2020

The importance of quinonoidal planarity in improving the wet fastness of acid dyes was studied in a new series of N‐sulphonatoalkyl‐substituted indophenine derivatives. These derivatives were synthesised via the sulphonatoalkylation reaction of isatins with alkanesultone or sodium bromoalkanesulphonate followed by the indophenine reaction. The effects of the position of sulphonic acid groups, length of the alkyl chain, and electron‐donating/withdrawing groups on geometry, electronic structure, solubility, and absorption properties were systematically examined and correlated with the performances of the dyes on wool, silk and nylon fabrics. The N‐sulphonatoalkyl indophenine dyes could exhibit a blue colour in N,N‐dimethylformamide (DMF) and on silk or nylon fabric but a purplish colour in water and on wool fabric. Methoxy groups had a negative impact on the molar extinction coefficient and dye exhaustion, leading to relatively poor dyeing performance. In comparison, fluorine or chlorine atoms were less influential. The introduction of nitro groups could induce a yellowness to the dyed fabrics caused by the strengthened absorption at the region of 360 to 420 nm and reduce the dyeing rate and wet fastness level due to the low dye–fibre affinity. In general, the N‐sulphonatoalkyl indophenine dyes exhibited satisfactory washing and rubbing fastness, especially on dyed nylon fabric. This study provides insight into the structure–property relationship of indophenine dyes and demonstrates that sulphonatoalkylation is an efficient methodology for designing high‐performance textile dyestuffs based on quinonoidal heterocyclic structures.
Relation of sputum neutrophilia to the development of chronic lung allograft dysfunction after lung transplantation
Authors: Sikkeland Liv Ingunn Bjoner , Durheim Michael Thomas , Riste Tonje Bøyum , Kongerud Johny , Alexis Neil E. , Holm Are Martin
Published: December 2020

Chronic lung allograft dysfunction (CLAD) is a serious complication after lung transplantation (LuTx) and is associated with elevated proportions of neutrophils in bronchoalveolar lavage (BAL). Induced sputum is a less‐invasive sampling method than BAL and assesses markers of inflammation on the surfaces of large central airways. We wanted to examine whether % neutrophil levels in induced sputum were elevated prior to CLAD diagnosis among LuTx recipients, and whether sputum markers of inflammation can be used as a tool for predicting the development of CLAD. Induced sputum samples were collected at 1, 3, 6, 12, and 24 months post‐LuTx in 36 patients with a history of COPD or pulmonary fibrosis, and of these, 16 developed CLAD either during or after the sputum surveillance period. At 2 years, median (IQR) % neutrophils in induced sputum were significantly higher among patients with CLAD compared with those without CLAD [73 (52‐80) % vs 59 (41‐76) %, p = .01]. Interestingly, we found a significant increase in the rate of change in % neutrophils beginning at 90 days preceding the diagnosis of CLAD. This suggests using sputum neutrophil percentage as a surveillance modality for monitoring lung allograft function after LuTx.
Cervical dysplasia in a patient with inherited epidermodysplasia verruciformis—A mere coincidence?
Authors: Singh Amrit P. , Jeffus Susanne K. , Shalin Sara C.
Published: December 2020

Epidermodysplasia verruciformis (EV) is a rare inherited or acquired genodermatosis caused by increased susceptibility to infection by the beta subtypes of human papillomavirus (HPV). The co‐occurrence of EV with high‐risk (HR) HPV infection leading to cervical dysplasia is unreported in the literature to date. We report a patient with inherited EV who developed extensive anogenital and cervical dysplasia linked to concurrent HR‐HPV infection. Literature review suggests that there is a negative correlation of cervical dysplasia and cervical cancer with EV, which suggests that this patient's presentation and course are exceptional.
Alcohol retail privatisation in Canadian provinces between 2012 and 2017. Is decision making oriented to harm reduction?
Authors: Giesbrecht Norman , Wettlaufer Ashley , Stockwell Tim , Vallance Kate , Chow Clifton , April Nicole , Asbridge Mark , Callaghan Russell , Cukier Samantha , Hynes Geoff , Mann Robert E. , Solomon Robert , Thomas Gerald , Thompson Kara
Published: December 2020

Introduction

Policy changes may contribute to increased alcohol‐related risks to populations. These include privatisation of alcohol retailing, which influences density of alcohol outlets, location of outlets, hours of sale and prevention of alcohol sales to minors or intoxicated customers. Meta‐analyses, reviews and original research indicate enhanced access to alcohol is associated with elevated risk of and actual harm. We assess the 10 Canadian provinces on two alcohol policy domains—type of alcohol control system and physical availability of alcohol—in order to track changes over time, and document shifting changes in alcohol policy.

Methods

Our information was based on government documents and websites, archival statistics and key informant interviews. Policy domains were selected and weighted for their degree of effectiveness and population reach based on systematic reviews and epidemiological evidence. Government representatives were asked to validate all the information for their jurisdiction.

Results

The province‐specific reports based on the 2012 results showed that 9 of 10 provinces had mixed retail systems—a combination of government‐run and privately owned alcohol outlets. Recommendations in each provincial report were to not increase privatisation. However, by 2017 the percentage of off‐premise private outlets had increased in four of these nine provinces, with new private outlet systems introduced in several.

Discussion and Conclusions

Decision‐making protocols are oriented to commercial interests and perceived consumer convenience. If public health and safety considerations are not meaningfully included in decision‐making protocols on alcohol policy, then it will be challenging to curtail or reduce harms.
Effects of dapagliflozin on prevention of major clinical events and recovery in patients with respiratory failure because of COVID‐19: Design and rationale for the DARE‐19 study
Authors: Kosiborod Mikhail , Berwanger Otavio , Koch Gary G. , Martinez Felipe , Mukhtar Omar , Verma Subodh , Chopra Vijay , Javaheri Ali , Ambery Philip , Gasparyan Samvel B. , Buenconsejo Joan , Sjöström C. David , Langkilde Anna Maria , Oscarsson Jan , Esterline Russell
Published: December 2020

Aims

Coronavirus disease 2019 (COVID‐19) is caused by a novel severe acute respiratory syndrome coronavirus 2. It can lead to multiorgan failure, including respiratory and cardiovascular decompensation, and kidney injury, with significant associated morbidity and mortality, particularly in patients with underlying metabolic, cardiovascular, respiratory or kidney disease. Dapagliflozin, a sodium‐glucose cotransporter‐2 inhibitor, has shown significant cardio‐ and renoprotective benefits in patients with type 2 diabetes (with and without atherosclerotic cardiovascular disease), heart failure and chronic kidney disease, and may provide similar organ protection in high‐risk patients with COVID‐19.

Materials and methods

DARE‐19 (NCT04350593) is an investigator‐initiated, collaborative, international, multicentre, randomized, double‐blind, placebo‐controlled study testing the dual hypotheses that dapagliflozin can reduce the incidence of cardiovascular, kidney and/or respiratory complications or all‐cause mortality, or improve clinical recovery, in adult patients hospitalized with COVID‐19 but not critically ill on admission. Eligible patients will have ≥1 cardiometabolic risk factor for COVID‐19 complications. Patients will be randomized 1:1 to dapagliflozin 10 mg or placebo. Primary efficacy endpoints are time to development of new or worsened organ dysfunction during index hospitalization, or all‐cause mortality, and the hierarchical composite endpoint of change in clinical status through day 30 of treatment. Safety of dapagliflozin in individuals with COVID‐19 will be assessed.

Conclusions

DARE‐19 will evaluate whether dapagliflozin can prevent COVID‐19‐related complications and all‐cause mortality, or improve clinical recovery, and assess the safety profile of dapagliflozin in this patient population. Currently, DARE‐19 is the first large randomized controlled trial investigating use of sodium‐glucose cotransporter 2 inhibitors in patients with COVID‐19.