bluuebunny/crossref_metadata_2025 huggingface dataset:
The impact of a physician’s recommendation and gender on informed decision making: A randomized controlled study in a simulated decision situation
Authors: Meinhardt Anna Lea , Eggeling Marie , Cress Ulrike , Kimmerle Joachim , Bientzle Martina
Published: December 2020

Objective

This study examined the influence of physicians’ recommendations and gender on the decision‐making process in a preference‐sensitive situation.

Methods

N = 201 participants were put in a hypothetical scenario in which they suffered from a rupture of the anterior cruciate ligament (ACL). They received general information on two equally successful treatment options for this injury (surgery vs physiotherapy) and answered questions regarding their treatment preference, certainty and satisfaction regarding their decision and attitude towards the treatment options. Then, participants watched a video that differed regarding physician's recommendation (surgery vs physiotherapy) and physician's gender (female vs male voice and picture). Afterwards, they indicated again their treatment preference, certainty, satisfaction and attitude, as well as the physician's professional and social competence.

Results

Participants changed their treatment preferences in the direction of the physician's recommendation (P < .001). Decision certainty (P < .001) and satisfaction (P < .001) increased more strongly if the physician's recommendation was congruent with the participant's prior attitude than if the recommendation was contrary to the participant's prior attitude. Finally, participants’ attitudes towards the recommended treatment became more positive (surgery recommendation: P < .001; physiotherapy recommendation: P < .001). We found no influence of the physician's gender on participants’ decisions, attitudes, or competence assessments.

Conclusion

This research indicates that physicians should be careful with recommendations when aiming for shared decisions, as they might influence patients even if the patients have been made aware that they should take their personal preferences into account. This could be particularly problematic if the recommendation is not in line with the patient's preferences.
Factors influencing the opportunities of supporting staff to promote a healthy diet in adults with intellectual disabilities
Authors: Røstad‐Tollefsen Helen K. , Kolset Svein O. , Retterstøl Kjetil , Hesselberg Heidi , Nordstrøm Marianne
Published: December 2020

Background

Adults with intellectual disabilities living in residential houses have a high prevalence of obesity which is related to poor dietary habits.

Aim

The aim of this study was to assess supporting staff`s thoughts and experiences on factors influencing their opportunities to promote a healthy diet in adults with intellectual disabilities.

Methods

13 supporting staff members were recruited from 11 different residential houses in a community. Concept Mapping methodology was used, including group interviews, sorting, rating statement and analysing the results.

Results

Seven clusters most accurately captured the ideas of the supporting staff`. ‘Attitudes’, ‘Facilitating a healthy diet’, ‘Practical cooking skills’ and ‘Applied dietary knowledge’ were the four most important.

Conclusions

Multiple factors influence the opportunities of supporting staff to promote a healthy diet. A holistic approach addressing all relevant factors is necessary when developing interventions to address this complex issue in persons with intellectual disabilities.
Dermatoscopy of combined blue nevi: a multicentre study of the International Dermoscopy Society
Authors: Stojkovic‐Filipovic J. , Tiodorovic D. , Lallas A. , Akay B.N. , Longo C. , Rosendahl C. , Dobrosavljevic D. , Nazzaro G. , Argenziano G. , Zalaudek I. , Tromme I. , Tschandl P. , Puig S. , Lanssens S. , Kittler H.
Published: December 2020

Background

Combined blue nevi (CBN) may mimic melanoma and are relatively often biopsied for diagnostic reasons.

Objective

To better characterize CBN and to compare it with melanoma.

Methods

We collected clinical and dermatoscopic images of 111 histologically confirmed CBN and contrasted their dermatoscopic characteristics with 132 partly blue coloured melanomas. Furthermore, we compared the accuracy of human experts using pattern analysis with a computer algorithm based on deep learning.

Results

Combined blue nevi are usually flat or slightly elevated and, in comparison with melanoma, more frequent on the head and neck. Dermatoscopically, they are typified by a blue structureless part in combination with either brown clods (n = 52, 46.8%), lines (n = 28, 25.2%) or skin‐coloured or brown structureless areas (n = 31, 27.9%). In contrast with melanoma, the blue part of CBN is more often well defined (18.9% vs. 4.5%, P < 0.001) and more often located in the centre (22.5% vs. 5.3%, P < 0.001). Melanomas are more often chaotic (OR: 28.7, 95% CI: 14.8–55.7, P < 0.001), have at least one melanoma clue (OR: 10.8, 95% CI: 5.2–22.2 P < 0.001) in particular white lines (OR: 37.1, 95% CI: 13.4–102.9, P < 0.001). Using simplified pattern analysis (chaos and clues), two raters reached sensitivities of 93.9% (95% CI: 88.4–97.3%) and 92.4% (95% CI: 86.5–96.3%) at corresponding specificities of 59.5% (95% CI: 49.7–68.7%) and 65.8% (95% CI: 56.2–74.5%). The human accuracy with pattern analysis was on par with a state‐of‐the‐art computer algorithm based on deep learning that achieved an area under the curve of (0.92, 95% CI: 0.87–0.96) and a specificity of 85.3% (95% CI: 76.5–91.7%) at a given sensitivity of 83.6% (95% CI: 72.5–91.5%).

Conclusion

CBN usually lack melanoma clues, in particular white lines. The accuracy of pattern analysis for combined nevi is acceptable, and histopathologic confirmation may not be necessary in exemplary cases.
Exploring readiness for implementing best practices: A mixed methods study
Authors: Garcia Daisy S. , Camacho Carr Katherine , Yuwen Weichao
Published: December 2020

Rationale

Evidence‐based practice (EBP) can improve health care in underprivileged countries. Bolivia's EBP movement is nascent and the factors contributing to better implementation in nursing are unknown.

Aim

To explore Bolivian nurses' readiness to engage in EBP while highlighting the facilitators and barriers for pursuing EBP.

Method

The study used a sequential explanatory mixed methods study. First, general trends were disclosed via a survey of 170 nurses in La Paz, Bolivia, holding at least a baccalaureate regarding their perceived beliefs about EBP. The survey identified facilitators and barriers for implementing EBP in acute and ambulatory settings. Second, qualitative data was gathered via a focus group of nine nurses with the purpose of enhancing the survey results.

Results

The survey results showed that nurses believe that engaging in EBP can improve their clinical practice. However, the nurses' research behaviors were found to be infrequent. Lack of support from the nurses' clinics and hospitals and from non‐nursing professionals were identified as barriers for engaging in EBP. The qualitative results revealed underlying limitations to nurses' clinical practice, including “feeling undervalued”.

Conclusions

There is a dearth of EBP knowledge among Bolivian nurses stemming from a lack of preparation in EBP environments, including EBP training opportunities. This situation affects nurses' professional dimensions of relational work, power, and collaboration. Collaborative research among educators, professional nursing societies, and local and international organizations could provide initiatives for implementing EBP, based on local health profiles.
Description of Imasa heleensis, gen. nov., sp. nov. (Imasidae, fam. nov.), a Deep‐Branching Marine Malawimonad and Possible Key Taxon in Understanding Early Eukaryotic Evolution
Authors: Heiss Aaron A. , Warring Sally D. , Lukacs Kaleigh , Favate John , Yang Ashley , Gyaltshen Yangtsho , Filardi Christopher , Simpson Alastair G.B. , Kim Eunsoo
Published: December 2020

Malawimonadida is a deep‐level (arguably “kingdom‐scale”) lineage of eukaryotes whose phylogenetic affinities are uncertain but of great evolutionary interest, as the group is suspected to branch close to the root of the tree of eukaryotes. Part of the difficulty in placing Malawimonadida phylogenetically is its tiny circumscription: at present, it comprises only two described and one cultured but undescribed species, all of them are freshwater suspension‐feeding nanoflagellates. In this study, we cultivated and characterised Imasa heleensis gen. nov., sp. nov. (Imasidae fam. nov.), the first marine malawimonad to be described. Light and electron microscopy observations show that Imasa is largely similar to other malawimonads, but more frequently adheres to the substrate, often by means of a pliable posterior extension. Phylogenetic analyses based on two ribosomal RNA genes and four translated protein‐coding genes using three different taxon sets place Imasa as sister to the three freshwater malawimonad strains with strong support. Imasa’s mitochondrial genome is circular‐mapping and shows a similar gene complement to other known malawimonads. We conclude that Imasa represents an important expansion of the range of taxa available for future evolutionary study.
Diagnosis and management of rudimentary horn pregnancy rupture, misinterpreted as bicornuate uterus in the 14th week of pregnancy
Authors: Kozar Nejc , Serdinšek Tamara , Tašner Tanja , Reljič Milan , Gavrić Lovrec Vida , Kovač Vilma
Published: December 2020

We present a 26‐year‐old primigravida with rudimentary horn pregnancy rupture at 14 weeks of pregnancy. Uterine anomaly was first diagnosed at the time of nuchal translucency scan and was presumed to be a bicornuate uterus with normal intrauterine pregnancy in the right horn. One day later, she was admitted to our department with abdominal pain, shortly leading to massive hemoperitoneum and hypovolemic shock. Uterine rupture was confirmed ultrasonically, followed by immediate laparotomy. Ruptured rudimentary horn with already expulsed pregnancy was encountered during surgery. Despite significant advances in ultrasonography, diagnosis of prerupture stage remains controversial. However, high mortality of the condition should ensure low threshold for surgical exploration.
Development of An All‐Payer Quality Program for the Pennsylvania Rural Health Model
Authors: Herzog Mark B. , Fried Jonathan E. , Liebers David T. , MacKinney A. Clinton
Published: December 2020

Purpose

Measuring rural health care quality is challenging, and payer and government reporting requirements are frequently misaligned. The Pennsylvania Rural Health Model, a multipayer global budget demonstration for rural hospitals, initially required the proposal of an All‐Payer Quality (APQ) Program in which participating payers would have held participating hospitals accountable for performance on a common set of quality measures. We sought to identify quality measures appropriate for use in APQ measurement and reporting programs for globally budgeted rural hospitals.

Methods

A method was devised to identify, assess, and select quality measures from an environmental scan of core measure sets. An initial screen identified measures that were relevant, valid, and reliable. Four reviewers then independently assessed measures that passed the initial screen on a Likert scale of 1‐5 for relevance, validity, reliability, responsiveness, alignment, and feasibility, and they selected a proposed measure set guided by prespecified measure set criteria.

Results

The 4 reviewers selected 10 quality measures from a list of 344 measures drawn from 8 core measure sets. One hundred twenty‐five measures satisfied screening criteria and were assessed. The mean total score was 21.5/30 (95% CI: 17.0‐26.0). Inter‐rater reliability was moderate (intraclass correlation coefficient range 0.544‐0.656).

Conclusion

A formal performance measure selection methodology can generate a set of rural‐appropriate health care quality measures for a multipayer rural hospital global budget program. This methodology could be replicated to select quality measures for inclusion in rural multipayer quality measurement and reporting programs.
The utility of Amies charcoal bacteriology swabs for storage of canine urine prior to culture
Authors: Olivares G. , Hermes D. , Manzanilla E. , Hughes K. , Clarke L. , Warland J.
Published: December 2020

Objective

To determine the usefulness of bacteriology swabs as a storage method of canine urine samples and the effect on quantitative bacterial culture.

Materials and Methods

Two hundred fourteen canine urine samples were collected by cystocentesis. The reference aliquot was placed in a sterile tube and processed for quantitative bacterial culture within 6 hours. A bacteriology swab was then immersed in the urine for 5 seconds and returned to the charcoal Amies media container. The urine samples in the sterile tube and bacteriology swab were stored at room temperature for 48 hours and processed for quantitative bacterial culture.

Results

Thirty‐seven of the samples were positive on reference culture with a total of 42 bacterial isolates. Samples stored in sterile tube and bacteriology swab had identical sensitivity and specificity for detection of bacteriuria (94.7% and 100%, respectively) with very good agreement (κ = 0.92; 95% CI 0.81 to 1.00). Agreement between the bacterial species of the reference sample and the bacteriology swab was higher (κ = 0.85; 95% CI 0.71 to 0.99) than compared to the sterile tube (κ = 0.78; 95% CI 0.62 to 0.94), but the overlapping confidence intervals mean improved agreement cannot be inferred.

Clinical Significance

Bacteriology swabs stored in Amies charcoal transport media should be considered an alternative method to preserve canine urine sample when immediate processing for quantitative bacterial culture is not possible. The sensitivity of culturing plain urine, stored for 48 hours in a sterile tube, for detection of bacteriuria, was higher than previously reported.
The influence of processing parameters of parboiled rice on its physiochemical and texture properties
Authors: Onmankhong Jiraporn , Jongyingcharoen Jiraporn Sripinyowanich , Sirisomboon Panmanas
Published: December 2020

The impact of different parboiled rice process conditions on physical (whiteness and yellowness), chemical (amylose and fat contents), and texture (hardness and toughness) properties was studied. The parboiled rice was produced from the Suphanburi 1 variety. The correlation between chemical and texture properties was also analyzed. To study the effect of the soaking process, the time (2, 3, and 6 hr) and temperature (65 and 75°C) of soaking were altered, while the steaming condition was fixed at 100°C for 20 min. To study the effect of the steaming process, the soaking condition was fixed at 65°C for 6 hr while steaming condition was altered, including time (10 and 20 min) and temperature (90 and 100°C). The results show that the different conditions influenced the physical and chemical properties of parboiled rice. The amylose content was negatively correlated (Hardness, r = −0.52) (Toughness, r = −0.38) and fat content was positive low correlated (Hardness, r = 0.20) (Toughness, r = 0.12) with textural properties. Due to the specification of parboiled rice for exportation varying according to customer requirements, the results of this research provided some useful information for parboiled rice factories.
Plasma symmetric dimethylarginine and creatinine concentrations and glomerular filtration rate in cats with normal and decreased renal function
Authors: Brans Marleen , Daminet Sylvie , Mortier Femke , Duchateau Luc , Lefebvre Hervé P. , Paepe Dominique
Published: December 2020

Background

Glomerular filtration rate (GFR) is the gold standard in assessing renal function but is impractical. Serum creatinine (sCr) has limited sensitivity in identifying early chronic kidney disease (CKD), whereas symmetric dimethylarginine (SDMA) has been commercialized as more accurate biomarker. Studies comparing SDMA and sCr with GFR in cats are limited.

Objectives

To further investigate the diagnostic performance of SDMA in nonazotemic and azotemic cats.

Animals

Forty‐nine client‐owned cats: 17 cats with CKD, 15 cats with diabetes mellitus (DM), and 17 healthy cats.

Methods

Retrospective study using spare blood samples from cats with documented sCr and GFR results for SDMA analysis. Diagnostic performances of SDMA and sCr were evaluated using correlation coefficients, sensitivities, specificities, and receiver operator characteristic curves.

Results

Compared to healthy cats and cats with DM, CKD cats had significantly higher SDMAplasma(26.7 ± 9.9 μg/dL) and sCr (249.7 ± 71.6 μmol/L [2.8 ± 0.8 mg/dL]; bothP < .001) values. SDMAplasma(τB= −0.57;P < .001) and sCr (τB= −0.56;P < .001) were significantly correlated with GFR. SDMAplasma(τB= 0.52;P < .001) had a significant relationship with sCr. SDMAplasmaand sCr had similar sensitivity (76%‐94% and 71%‐88%, respectively) in detecting reduced renal function. Creatinine had higher specificity (94%‐96%) than SDMAplasma(75%‐76%) (P < .05).

Conclusion and Clinical Importance

In this study of azotemic and nonazotemic cats, SDMA was a reliable marker to identify decreased GFR. However, superiority of SDMA over sCr could not be confirmed.
The Culling: Pandemic, Gerocide, Generational Affect
Authors: Cohen Lawrence
Published: December 2020

Old age has been central to public health rationalities and contestations of the 2019–2020 coronavirus pandemic. This article thinks through what age is and does in pandemic times by juxtaposing four domains of ethical publicity in which age comes to matter: (1) mass fatality of old persons under conditions of variable unpreparedness; (2) circulation of social‐Darwinist argument for herd immunity through culling of the weak; (3) everyday challenges of late life care as these are amplified under quarantine; and (4) long‐term conditions of economic and political impasse and environmental collapse, experienced as failure of older generations and abandonment of younger ones, a situation here termed generational affect. It asks to what extent the figure of the cullable old renders racialized disparities natural and makes sense through a generational affect in which the world feels as if the survival of the young is in question.
Examining the Relations Between Spatial Skills, Spatial Anxiety, and K‐12 Teacher Practice
Authors: Atit Kinnari , Rocha Kelsey
Published: December 2020

Spatial skills are important for student success in STEM disciplines at the K‐12 educational level. Teachers' spatial skills and feelings about completing spatial tasks influence their teaching as well as their students' spatial learning. However, the relation between teachers' spatial skills and their spatial anxiety is not well understood. Here we investigated if teachers' spatial skills influence two kinds of small‐scale spatial anxiety: (a) anxiety for tasks involving visual imagery and (b) anxiety for tasks involving mental manipulations. In addition, we investigated if teachers' spatial skills in conjunction with their small‐scale spatial anxiety influence the integration of spatial practices, such as gestures and diagrams, into their teaching. Eighty‐two K‐12 teachers completed two subscales of small‐scale spatial anxiety, a measure of spatial skills, and a teaching activities questionnaire. Results indicate that teachers' spatial skills are negatively associated with their spatial anxiety for mental manipulation tasks, and positively associated with their use of spatial practices. These findings highlight the need to account for teachers' spatial skills when considering how to improve students' spatial learning.
DNA metabarcoding illuminates the black box of soil animal biodiversity
Authors: Decaëns Thibaud
Published: December 2020

Identifying the determinants of the distribution of soil organism communities at different spatial scales is essential to our understanding of the functioning of terrestrial ecosystems. Indeed, spatial patterns of soil biota, and the factors that determine them, influence spatial patterns of many ecological processes such as the decomposition of organic detritus, the release of nutrients and, ultimately, the spatial structure of plant communities (Ettema & Wardle, 2002). However, our ability to describe and understand the spatial distribution of soil communities is severely hampered by taxonomic and methodological limitations, significantly reducing our ability to infer ecological and evolutionary mechanisms from observed patterns. In a From the Cover article in this issue of Molecular Ecology, Arribas et al. (2020) used a high‐throughput sequencing approach, i.e., haplotype‐level‐COI metabarcoding, to bypass these road blocks and analyse the spatial arrangements of soil arthropods communities at different phylogenetic levels, from haplotypes to nested operational units. They found that local assemblage composition was primarily explained by habitat, and that community similarity decreased with distance in a similar way in all habitats and geographical regions, and at all hierarchical levels. This highlights that both habitat filtering and dispersal limitation are major drivers of local‐scale assembly process in soil arthropod communities. Beyond these significant results, their study also highlights how DNA‐based approaches, by producing combined description of genetic and taxonomic diversity, opens up new perspectives to soil spatial ecology and macroecology.
Patterns of mortality in endangered Cook Inlet beluga whales: Insights from pairing a long‐term photo‐identification study with stranding records
Authors: McGuire Tamara L. , Shelden Kim E. W. , Himes Boor Gina K. , Stephens Amber D. , McClung John R. , Garner Christopher , Goertz Caroline E. C. , Burek‐Huntington Kathleen A. , O'Corry‐Crowe Greg , Wright Bruce
Published: December 2020

Mortality is a demographic metric crucial for understanding the dynamics of endangered populations such as Cook Inlet beluga whales (CIBWs, Delphinapterus leucas), but patterns of mortality are currently not well understood for CIBWs, making decisions about recovery actions challenging. We combined long‐term photo‐ID data from approximately 420 individual belugas identified during the period 2005–2017 with stranding data from 95 dead belugas to identify patterns of mortality with respect to age, sex, geographic range, cause of death, and to estimate minimum mortality rates. Reported mortality was greatest for adults of reproductive age, followed by calves, with fewer subadults and no adults older than 49 years in the stranding data set despite lifespans of 70+ years reported in other beluga populations. Dead females and males were evenly represented. Live stranding was the predominant assigned cause of death but represented only ~33% of deaths of known cause. Causal factors for the majority of deaths and live strandings are unknown. Annual mortality estimated from reported carcasses relative to total population size averaged 2.2%. Our analysis advances our current understanding of mortality patterns in CIBWs but linking a greater proportion of carcasses to photo‐ID individuals would further improve our understanding; we conclude with recommendations for achieving this.
Maximum insertion torque loss after miniscrew placement in orthodontic patients: A randomized controlled trial
Authors: Migliorati Marco , Drago Sara , Amorfini Leonardo , Nucera Riccardo , Silvestrini‐Biavati Armando
Published: December 2020

Objectives

To compare torque recordings of immediately loaded orthodontic miniscrews between insertion time and different post‐placement timepoints (2 weeks, 4 weeks and removal time, respectively).

Setting and sample population

Parallel trial with an allocation ratio of 1:1. Eligibility criteria were needs of fixed orthodontic treatment, no systemic disease and absence of using drugs altering bone metabolism.

Material and methods

Patients received miniscrews, 2.0 mm diameter and 10 mm length. All miniscrews underwent inter‐radicular placement, and they were placed in the maxilla or in the mandible, palatally or buccally. No pre‐drilling was performed. Miniscrews were loaded immediately after the insertion and were used for distalization, intrusion, extrusion, mesialization or indirect anchorage. Patients were randomly divided into three groups. For each patient, Maximum Insertion Torque (MIT) was evaluated at baseline. MIT was measured again after 2 weeks and after 4 weeks by tightening the screw a quarter of turn in Groups 1 and 2, respectively. At the end of the treatment, maximal removal torque was evaluated in Group 3. Torque variation with respect to insertion time was considered as the primary outcome. Baseline and longitudinal differences were tested using the linear mixed‐effects (LME) model.

Results

Forty seven patients and 74 miniscrews were followed up. An association existed between maximum insertion torque and the observation time. A torque decrease of 26.9% and 30% after 2 weeks was observed for mandibular and maxillary miniscrews, respectively. After 1 month, torque values were similar to the baseline records. The overall success rate was 79.7%. No serious harm was observed.

Conclusions

Maximum insertion torque undergoes a loss during the first 2 weeks, and its values may depend on the insertion site and the anchorage purpose. Removal torque value is almost the same as the initial torque after 1 month.
An appraisal of highest quality studies reporting malignant transformation of oral lichen planus based on a systematic review
Authors: González‐Moles Miguel Ángel , Ramos‐García Pablo , Warnakulasuriya Saman
Published: December 2020

Objectives

We present a critical review of the papers published in the international scientific literature on malignant transformation of oral lichen planus (OLP). Our aim is to report the most realistic estimate of the proportion of OLP cases with malignant transformation based on the highest quality of evidence.

Materials and Methods

Following a literature search, we selected 89 papers that were published on this topic until November 2020. We applied to these papers an adaptation of the methodological quality criteria of the QUIPS tool and we ordered all of them according to their methodological quality. The papers that were in the upper quartile of methodological quality (10 papers) were selected and analyzed.

Results

The pooled proportion (expressed as percentage) of malignant transformation of OLP reported in these high methodological quality papers was 2.28% (95% confidence intervals = 1.49–3.20).

Conclusions

We observe that the proportion of malignancy is higher in research carried out under strict methodological quality criteria. In this critical review, we propose criteria for conducting follow‐up studies on OLP to report on malignant transformation under strict quality standards.
Excision margin of T3 basal cell carcinoma in maxillofacial area: A retrospective cohort study of Asians
Authors: Sheng Surui , Qi Shuqun , Pan Jian , Qin Xingjun
Published: December 2020

Objectives

Basal cell carcinoma is the most common skin cancer worldwide. Surgical excision is considered as the mainstay of treatment, while the evidence of excision margin in advanced stage is lacking, especially in maxillofacial area.

Materials and Methods

We conducted a 2‐center retrospective cohort study. Disease‐free survival rate was estimated for 116 Asian patients with T3 basal cell carcinoma in maxillofacial area who received stand surgical excision with margin of 3–5 mm (Group A), 6–9 mm (Group B), and 10–15 mm (Group C).

Results

For the entire cohort, five‐year disease‐free survival rates of Groups A, B, and C were 82.1%, 93.5%, and 92.4%, respectively. When compared with Group B, Group A was correlated with lower disease‐free survival rate (HR 5.48, p = .04), and Group C was not associated with different disease‐free survival rate (HR 0.85, p = .62). Perineural invasion (p = .006) and pathologic subtypes of infiltrative basal cell carcinoma (p = .01) were independent prognosticator for disease‐free survival rate.

Conclusions

This multicenter cohort study validated that T3 basal cell carcinoma Asian patients of maxillofacial area treated with excision margin of 6–9 mm had a substantial benefit of disease‐free survival rate and skin conservation.
Osteonecrosis of the jaw risk factors in bisphosphonate‐treated patients with metastatic cancer
Authors: Van Poznak Catherine , Reynolds Evan L. , Estilo Cherry L. , Hu Mimi , Schneider Bryan Paul , Hertz Daniel L. , Gersch Christina , Thibert Jacklyn , Thomas Dafydd , Banerjee Mousumi , Rae James M. , Hayes Daniel F.
Published: December 2020

Background

A case–control study was performed to define clinical and genetic risk factors associated with osteonecrosis of the jaw in patients with metastatic cancer treated with bisphosphonates.

Methods

Clinical data and tissues were collected from patients treated with bisphosphonates for metastatic bone disease who were diagnosed with osteonecrosis of the jaw (cases) and matched controls. Clinical data included patient, behavioral, disease, and treatment information. Genetic polymorphisms in CYP2C8 (rs1934951) and other candidate genes were genotyped. Odds ratios from conditional logistic regression models were examined to identify clinical and genetic characteristics associated with case or control status.

Results

The study population consisted of 76 cases and 126 controls. In the final multivariable clinical model, patients with osteonecrosis of the jaw were less likely to have received pamidronate than zoledronic acid (odds ratio = 0.18, 95% Confidence interval: 0.03–0.97, p = .047) and more likely to have been exposed to bevacizumab (OR = 5.15, 95% CI: 1.67–15.95, p = .005). The exploratory genetic analyses suggested a protective effect for VEGFC rs2333496 and risk effects for VEGFC rs7664413 and PPARG rs1152003.

Conclusions

We observed patients with ONJ were more likely to have been exposed to bevacizumab and zoledronic and identified potential genetic predictors that require validation prior to clinical translation.
Comparison of Interlaminar and Transforaminal Approaches for Treatment of L5/S1 Disc Herniation by Percutaneous Endoscopic Discectomy
Authors: Gao Aiguo , Yang Huilin , Zhu Liyan , Hu Zhangjie , Lu Binbin , Jin Qi , Wang Ye , Gu Xiaofeng
Published: December 2020

Objective

The aim of this study was to compare the clinical efficacy of percutaneous endoscopic interlaminar discectomy (PEID) and percutaneous endoscopic transforaminal discectomy (PETD) in treating L5/S1 disc herniation.

Methods

A retrospective analysis of 76 patients with L5/S1 intervertebral disc herniation was performed. There were two surgical treatment groups: one with patients receiving PEID and the other with patients receiving PETD. The two groups were compared by length of surgery, times of intraoperative X‐ray exposure, postoperative time in bed, length of hospital stay, operative complications, patient's assessment of pain using a visual analogue scale (VAS), and disability using the Oswestry disability index (ODI) before and after surgery.

Results

Subjects in the PEID group were in surgery for 60.90 ± 13.11 min and needed intraoperative X‐ray exposure 4.10 ± 1.09 times. Patients in this group were ambulatory by 7.52 ± 1.08 h after surgery and were hospitalized for 5.05 ± 0.92 days. In contrast, patients in the PETD group were in surgery for 84.06 ± 15.58 min and needed intraoperative X ray exposure 12.81 ± 8.46 times. These patients were ambulatory by 7.06 ± 0.91 h after surgery and remained in the hospital for 4.94 ± 0.80 days. Based on these data, operation time and fluoroscopy time were significantly less (P < 0.002 and P < 0.001, respectively) for subjects in the PEID group. However, ambulatory time and hospitalization were similar for both in terms of pain relief and decreased disability, and subjects in both groups responded well to the surgery and showed a significant decrease in both VAS and ODI scores at their 1‐year follow‐up (P < 0.01). Furthermore, there were no statistically significant differences between the two surgeries in terms of pain relief and decrease in disability.

Conclusion

For L5/S1 disc herniation, PEID and PETD provide similar results for patients. However, PEID has the advantage over PETD in that it is a shorter procedure and exposes the patient to less radiation.

Keywords
Multiple Fractures of Cervical Vertebrae Combined with Arcuate Foramen and Vertebral Artery Occlusion: A Case Report and Literature Review
Authors: Wang Wei‐hao , Liu Zhao‐yong , Guo Huan‐cheng , Wang Hu
Published: December 2020

Background

The arcuate foramen is a complete or partial bony bridge over the vertebral artery groove of atlas. The mechanism of the arcuate foramen is not clearly understood. Omission of the arcuate foramen sometimes causes lethal iatrogenic injury during spinal surgery.

Case Presentation

We describe a patient who was diagnosed with multiple fractures of the cervical vertebrae, arcuate foramen, and right vertebral artery occlusion based on clinical and radiological exams. After conservative treatment, he resumed a normal and productive life.

Conclusions

Arcuate foramen is a common variation that causes symptoms such as dizziness, headache, and migraine. If the patient does not develop severe symptoms, conservative treatment can achieve very good results without the necessity to remove the bone bridge. When serious symptoms occur, surgical treatment to resect the bony ridges can relieve the symptoms dramatically.
10 kHz Spinal Cord Stimulation for the Treatment of Failed Back Surgery Syndrome with Predominant Leg Pain: Results from a Prospective Study in Patients from the Dutch Healthcare System
Authors: Kallewaard Jan Willem , Gültuna Ismail , Hoffmann Vincent , Elzinga Lars , Munnikes Renate , Verbrugge Lisette , Minne Veerle , Reiters Pascalle , Subbaroyan Jeyakumar , Santos Angela , Rotte Anand , Caraway David
Published: December 2020

Introduction

Persistent back/and or leg pain is a common outcome after spinal surgery (otherwise known as failed back surgery syndrome [FBSS]). Studies have shown that spinal cord stimulation (SCS) at 10 kHz provides effective analgesia in FBSS patients with both back and leg pain symptoms and in those with predominant back pain. This study is the first to evaluate the therapy in FBSS patients with predominant leg pain.

Methods

The safety and efficacy of 10 kHz SCS was evaluated in an uncontrolled, open‐label, prospective study of FBSS patients with predominant leg pain in the Netherlands. Follow‐ups were performed at 1, 3, 6, and 12 months post implantation.

Results

Sixty out of 68 patients (88%) experienced sufficient pain relief during a stimulation trial. Of these, 58 proceeded to permanent implantation of a 10 kHz SCS system. After 12 months of treatment, 80% of patients experienced ≥ 50% reduction in baseline leg pain, and a similar proportion (76%) experienced ≥ 50% reduction in baseline back pain. At least two‐thirds of patients were also leg pain and back pain remitters (visual analog scale [VAS] ≤ 2.5 cm). The therapy was also associated with a general improvement in patients’ quality of life, as measured by secondary outcomes including disability, perception of health improvement, mental well‐being, and satisfaction. A positive impact on opioid consumption was also observed.

Conclusions

Consistent with previous findings, 10 kHz SCS for the treatment of FBSS patients with predominant radicular symptoms is safe and effective and is associated with improved quality of life.
Effectiveness of Epiduroscopy for Patients with Failed Back Surgery Syndrome: A Systematic Review and Meta‐analysis
Authors: Geudeke Matthijs W. , Krediet Annelot C. , Bilecen Süleyman , Huygen Frank J.P.M. , Rijsdijk Mienke
Published: December 2020

Introduction

Low‐back or leg pain in patients suffering from failed back surgery syndrome (FBSS) is often severe, having a major impact on functionality and quality of life. Despite conservative and surgical treatments, pain can be persistent. An alternative treatment option is epiduroscopy, a minimally invasive procedure based on mechanical adhesiolysis of epidural fibrosis. As epidural fibrosis is speculated to be a major contributor in the pathophysiologic process of FBSS, this review evaluates the effectiveness of epiduroscopy in FBSS patients.

Methods and materials

A systematic literature search was performed in PubMed, Embase, and Cochrane databases. Critical appraisal was performed using validated tools. Meta‐analysis was performed using generic inverse variance analysis.

Results

From the 286 identified articles, nine studies were included. The visual analogue scale (VAS) average was 7.6 at baseline, 4.5 at 6, and 4.3 at 12 months. The Oswestry Disability Index (ODI) average was 61.7% at baseline, 42.8% at 6, and 46.9% at 12 months. An average of 49% of patients experienced significant pain relief at 6 and 37% at 12 months. Meta‐analysis showed a pooled VAS mean difference of 3.4 (2.6 to 4.1; 95% confidence interval [CI]) and 2.8 (1.6 to 4.0; 95% CI) and pooled ODI mean difference of 19.4% (12.5 to 26.4%; 95% CI) and 19.8% (13.8 to 25.9%; 95% CI) at 6 and 12 months, respectively.

Conclusion

Current literature demonstrates a clinically relevant reduction in pain and disability scores at 6 to 12 months after mechanical adhesiolysis in FBSS patients. The quality of evidence is moderate, and the level of recommendation is weak. Practitioners should consider the benefits of epiduroscopy after weighing the risks for individual patients with FBSS.
Recurrent angioedema in childhood: hereditary angioedema or histaminergic angioedema?
Authors: Ocak Melike , Nain Ercan , Şahiner Ümit Murat , Akin Mustafa Şenol , Karabiber Esra , Şekerel Bülent Enis , Soyer Özge
Published: December 2020

Background

Recurrent angioedema is a rare entity during childhood. This study aimed to clarify differences between hereditary angioedema (HAE) and histaminergic angioedema (HA) in children.

Methods

Fifty‐seven children with HAE (male 36.8%, 8.9 years [5.4‐12.5]) and 42 children with recurrent HA (male 42.9%, 11.5 years [8.1‐16.8]) were analyzed.

Results

The median age at symptom onset (6 [3‐10]; 7.8 [4.5‐13] years), frequency of angioedema episodes within last year (3 [2‐5]; 5 [2‐10]), and duration of symptoms (48 [24‐48]; 24 [12‐48] hours) were similar in the HAE and HA group, respectively. Recurrent urticaria was observed in 7.3% (n = 3) of patients in the HAE group and in 45.2% (n = 19) of the HA group (P < .001). While angioedema episodes involving the lips (n = 30; 71.4%; P = .035) and eyelids (n = 28; 66.7%; P = .012) were observed more frequently in the HA group, gastrointestinal involvement/abdominal pain (n = 15; 36.6%) was more common in HAE (P < .001). Itching as a prodromal symptom was detected in 47.6% (n = 20) of HA patients versus 14.6% (n = 6) of those with HAE (P = .002). In the logistic regression analysis for the diagnosis of HAE, a family history of angioedema (OR = 58.289 [95% CI 10.656‐318.853], P < 001) and trauma (OR = 35.208 [95% CI [4.368‐283.794]], P = .001) as a triggering factor were determined to be independent variables.

Conclusion

A family history of angioedema, trauma as a triggering factor, and abdominal pain should suggest the diagnosis of HAE and the need for further investigation.
An infant with localized vasoconstriction following topical propranolol exposure for infantile hemangioma
Authors: Saerens Julie , Gutermuth Jan , Janmohamed Sherief R.
Published: December 2020

We describe a 3‐month‐old child with an infantile hemangioma on the forehead with a blanched macule provoked by topical treatment with propranolol. This observation demonstrates that topically applied (non‐selective) beta‐blockers may induce blanched macules at the site of application, a side effect due to peripheral vasoconstriction of blood vessels by non‐selective beta‐2 blockade. This side effect was linked due to overuse and was reversible. This case illustrates the importance of providing thorough instructions regarding topical propranolol application.
Is ibuprofen superior to indomethacin for patent ductus arteriosus in Japanese preterm infants?
Authors: Matsumura Shun , Masutani Satoshi , Oshima Ayumi , Kanai Masayo , Namba Fumihiko , Ishiguro Akio , Kabe Kazuhiko
Published: December 2020

Background

Many clinical trials have indicated that ibuprofen (IBU) has similar effects to indomethacin (IND) on the closure of patent ductus arteriosus (PDA) with fewer adverse effects. Owing to the scarce evidence on IBU use in Japan because of its recent approval we performed this observational study to compare the efficacy and safety of IBU with the efficiency and safety of IND.

Methods

We included infants (gestational age < 30 weeks) with hemodynamically significant PDA under a prophylactic IND protocol for intraventricular hemorrhage who were treated with either IND (n = 30) or IBU (n = 30). We compared a PDA closing effect, changes in ultrasonography findings, and adverse effects between the groups.

Results

There was no significant difference in the rates of PDA closure in the first treatment course (IND vs IBU: 46.7% vs 50.0%, P = 0.796) and surgical closure (IND vs IBU: 20.0% vs 20.0%, P = 1.000) between the groups. Both groups showed significant oliguria (IND vs IBU: 30.0% vs 23.3%, P = 0.559) and increased serum creatinine levels after treatment. However, an increase in serum creatinine level by >0.3 mg/dL, a criterion for acute kidney injury, was less frequent in the IBU group (35.7%) compared with that in the IND group (84.2%, P = 0.004). There were no significant differences in echocardiographic changes and jaundice and hypoglycemia incidence rates between the groups.

Conclusions

Except for an increase in serum creatinine levels by >0.3 mg/dL, which was less frequent with IBU, IBU had similar efficacy and safety as IND for preterm PDA. Ibuprofen and IND should be cautiously administered.
Emotion context insensitivity in depression: Toward an integrated and contextualized approach
Authors: Bylsma Lauren M.
Published: December 2020

Major depressive disorder (MDD) is characterized by pervasive mood disturbance as well as deficits in emotional processing, reactivity, and regulation. There is accumulating evidence that MDD is characterized by emotional patterns consistent with environmental disengagement, as reflected in attenuated positive and negative emotional reactivity, consistent with Emotion Context Insensitivity (ECI) theory. However, MDD individuals vary considerably in the extent to which they exhibit specific alterations in patterns of emotional responding. Emotions are complex, multicomponent processes that invoke responses across multiple functional domains and levels of analysis, including subjective experience, behavior, autonomic regulation, cognition, and neural processing. In this article, I review the current state of the literature on emotional responding and MDD from the lens of ECI. I focus on the importance of assessing emotional indices from multiple levels of analysis across development and contexts. I also discuss methodological and measurement issues that may contribute to inconsistent findings. In particular, I emphasize how psychophysiological measures can help elucidate emotional processes that underlie the pathophysiology of MDD as part of an integrated and contextualized approach.
Optimal Control of False Discovery Criteria in the Two-Group Model
Authors: Heller Ruth , Rosset Saharon
Published: December 2020

The highly influential two-group model in testing a large number of statistical hypotheses assumes that the test statistics are drawn independently from a mixture of a high probability null distribution and a low probability alternative. Optimal control of the marginal false discovery rate (mFDR), in the sense that it provides maximal power (expected true discoveries) subject to mFDR control, is known to be achieved by thresholding the local false discovery rate (locFDR), the probability of the hypothesis being null given the set of test statistics, with a fixed threshold. We address the challenge of controlling optimally the popular false discovery rate (FDR) or positive FDR (pFDR) in the general two-group model, which also allows for dependence between the test statistics. These criteria are less conservative than the mFDR criterion, so they make more rejections in expectation. We derive their optimal multiple testing (OMT) policies, which turn out to be thresholding the locFDR with a threshold that is a function of the entire set of statistics. We develop an efficient algorithm for finding these policies, and use it for problems with thousands of hypotheses. We illustrate these procedures on gene expression studies.
Event‐Predictive Cognition: A Root for Conceptual Human Thought
Authors: Butz Martin V. , Achimova Asya , Bilkey David , Knott Alistair
Published: December 2020

Our minds navigate a continuous stream of sensorimotor experiences, selectively compressing them into events. Event‐predictive encodings and processing abilities have evolved because they mirror interactions between agents and objects—and the pursuance or avoidance of critical interactions lies at the heart of survival and reproduction. However, it appears that these abilities have evolved not only to pursue live‐enhancing events and to avoid threatening events, but also to distinguish food sources, to produce and to use tools, to cooperate, and to communicate. They may have even set the stage for the formation of larger societies and the development of cultural identities. Research on event‐predictive cognition investigates how events and conceptualizations thereof are learned, structured, and processed dynamically. It suggests that event‐predictive encodings and processes optimally mediate between sensorimotor processes and language. On the one hand, they enable us to perceive and control physical interactions with our world in a highly adaptive, versatile, goal‐directed manner. On the other hand, they allow us to coordinate complex social interactions and, in particular, to comprehend and produce language. Event‐predictive learning segments sensorimotor experiences into event‐predictive encodings. Once first encodings are formed, the mind learns progressively higher order compositional structures, which allow reflecting on the past, reasoning, and planning on multiple levels of abstraction. We conclude that human conceptual thought may be grounded in the principles of event‐predictive cognition constituting its root.