bluuebunny/crossref_metadata_2025 huggingface dataset:
Epidemiology of Blindness From Facial Trauma: A Multi-Centre Nigerian Study
Authors: Famurewa Bamidele A. , Oginni Fadekemi Olufunmilayo , Adewara Bolajoko A. , Fomete Benjamin , Aniagor Chukwudi , Aluko-Olokun Bayo , Morgan Regina E. , Amedari McKing I.
Published: December 2021

Study Design

This is a multi-centre retrospective study.

Objective

To determine the prevalence of blindness and pattern of facial trauma associated with blindness among Nigerians.

Methods

A multi-centre retrospective study of all patients with facial trauma resulting in blindness, that were co-managed by maxillofacial surgeons and ophthalmologists in 4 Nigerian public tertiary hospitals between January 2010 and December 2019 was undertaken. Data was analysed by IBM SPSS Statistics (version 21.0 for windows, IBM© Inc, Chicago, IL).

Results

Of 2070 patients who presented with major facial injuries during the study period, 61 eyes of 56 (2.7%) patients were blind. Blindness was bilateral and unilateral in 5 (8.9%) and 51 (92.1%) patients, respectively. The mean age (SD) at presentation was 36.2 (16.6) years, and 47 (83.9%) of these patients were males. Road traffic accident (n = 27; 48%) was the commonest mechanism of facial trauma, the cheek (n = 18; 40.9%) was the commonest site of associated soft tissue injury and zygomatic complex fracture (n = 19; 24.1%) was the commonest related fracture. Globe rupture (n = 34; 55.7%) was the leading cause of blindness. Enucleation (n = 7; 13.2%) and evisceration (n = 22; 41.5%) were performed on 29 eyes of which 12 (41.4%) patients had ocular prosthesis post-operatively.

Conclusions

Blindness was recorded in 2.7% of Nigerians with facial trauma. The commonest mechanism of trauma and cause of blindness in at least one eye were road traffic accident and globe rupture, respectively. Eye removal surgery was necessary in about half of the blind eyes.
High-risk multiple myeloma: how to treat at diagnosis and relapse?
Authors: Mateos María-Victoria , Martínez Borja Puertas , González-Calle Verónica
Published: December 2021

Patients with multiple myeloma have experienced a great improvement in survival over the past century because of the introduction of novel therapeutic strategies. However, a subgroup of patients with poorer outcomes than expected is considered high risk and identified by the presence of patient- and disease-based factors such as frailty, extramedullary disease, cytogenetic abnormalities, or even relapses occurring earlier than expected according to the baseline factors. Although the management of patients with high-risk features is not well established because of the lack of specific trials in this subgroup of patients and because of their underrepresentation in the clinical trials, treatment should be planned on 2 pillars: (1) poor prognosis with the presence of high-risk features can be at least improved or even abrogated by achieving a deep and sustained response over time, and (2) this can most likely be obtained through using the best therapeutic options and in a response-adapted way. Some clinical trials that have been planned or are ongoing include only patients with high-risk features, using the most effective therapies (proteasome inhibitors, immunomodulatory drugs, and anti-CD38 monoclonal antibodies) as well as chimeric antigen receptor T cells and T-cell engagers that will unravel what the best therapeutic approach will be to overcome the poor prognosis of the presence of high-risk features.
Minimal residual disease in multiple myeloma: why, when, where
Authors: Yee Andrew J. , Raje Noopur
Published: December 2021

Improvements in multiple myeloma therapy have led to deeper responses that are beyond the limit of detection by historical immunohistochemistry and conventional flow cytometry in bone marrow samples. In parallel, more sensitive techniques for assessing minimal residual disease (MRD) through next-generation flow cytometry and sequencing have been developed and are now routinely available. Deep responses when measured by these assays correspond with improved outcomes and survival. We review the data supporting MRD testing as well as its limitations and how it may fit in with current and future clinical practice.
Clots in unusual places: lots of stress, limited data, critical decisions
Authors: Mathew Carol , Zumberg Marc
Published: December 2021

Although much less common than deep vein thrombosis of the lower extremities or lungs, clots in unusual locations, including the splanchnic, cerebral, retinal, upper-extremity, and renal locations, present with significant morbidity and mortality. In the last 2 decades, treatment of clots in these unusual locations is primarily managed medically, with interventional and surgical approaches reserved for more severe or refractory cases. The hematologist is well positioned to provide consultation to organ-specific specialties (ie, neurosurgery, hepatology, ophthalmology), especially because acquired and congenital hypercoagulability plays a major role, and anticoagulation is often the primary treatment. Historically, treatment has been based on expert opinion, but systematic reviews and meta-analyses have recently been published. Various societies have produced guidelines for the treatment of clots in unusual locations; however, randomized clinical trial data remain scarce. In the last few years, increasing data have emerged concerning the efficacy of the direct oral anticoagulants in treating clots in unusual locations. Cases have recently been described highlighting atypical thrombosis associated with COVID-19 infection as well as with the ChAdOx1 nCoV-19 (AstraZeneca) vaccine and Johnson and Johnson's Janssen Ad26.COV2.S vaccine. This article reviews clots in unusual locations with an emphasis on the splanchnic (mesenteric, portal, splenic, hepatic) and cerebral circulation. Through a case-based approach, key questions are posed, and data are presented to help guide diagnosis and treatment.
Relapsed disease: off-the-shelf immunotherapies vs customized engineered products
Authors: Karmali Reem
Published: December 2021

Innovations in immuno-oncology for lymphomas have outpaced therapeutic developments in any other cancer histology. In the 1990s, rituximab, a CD20 monoclonal antibody, drastically changed treatment paradigms for B-cell non-Hodgkin lymphomas (B-NHLs). In parallel, the concept that T cells could be genetically reprogrammed and regulated to address tumor cell evasion was developed. Twenty years later, this concept has materialized—3 customized engineered CD19 chimeric antigen receptor T-cell (CART) constructs have been embraced as third-line therapies and beyond for aggressive B-NHL. Responses with CARTs are durable in 30% to 40% of patients, with consistent results in older patients, primary refractory disease, high-grade B-cell lymphoma, and patients with concurrent secondary central nervous system disease, all features historically associated with poorer outcomes. Challenges associated with the administration of CARTs include cumbersome and time-consuming manufacturing processes, toxicities, and cost, not to mention a substantial risk of relapse. Fortunately, as our understanding of how to manipulate the immune system to achieve full antitumor potential has grown, so has the rapid development of off-the-shelf immunotherapies, with CD20/CD3 bispecific antibodies standing out above all others. These agents have shown promising activity in aggressive B-NHL and have the potential to circumvent some of the challenges encountered with customized engineered products. However, toxicities remain substantial, dosing schedules intensive, and experience limited with these agents. Novel customized and off-the-shelf therapeutics as well as rational combinations of these agents are underway. Ultimately, growing experience with both customized engineered and off-the-shelf immunotherapies will provide guidance on optimal methods of delivery and sequencing.
Controversies in the management of early-stage Hodgkin lymphoma
Authors: Blum Kristie A.
Published: December 2021

Positron emission tomography (PET)–adapted chemotherapy and radiotherapy approaches are currently used for the initial treatment of early-stage Hodgkin lymphoma (HL) with progression-free survival and overall survival exceeding 85% and 95%, respectively. However, despite general agreement on the prognostic value of interim PET in HL, frontline treatment approaches vary among institutions with respect to how pretreatment clinical risk factors determine treatment selection, the definition of PET negativity, which chemotherapy regimen to initiate and how many cycles to administer, and when to incorporate radiation. Furthermore, as recent trials have confirmed improved efficacy and manageable toxicity when brentuximab and checkpoint inhibitors are combined with frontline regimens such as doxorubicin, vinblastine, and dacarbazine in advanced-stage HL, these agents are now under evaluation as frontline therapy in early-stage HL. A number of issues will affect the use of these agents in early-stage HL, including the costs, early and late toxicities with these agents, patient population (favorable or unfavorable risk groups), how to incorporate them (concurrently or sequentially), and whether they can ultimately replace cytotoxic therapy with similar efficacy and fewer late effects. Future treatment paradigms for early-stage HL may change significantly once randomized studies are completed incorporating these agents into frontline therapy. Ideally, frontline use of brentuximab and checkpoint inhibitors in early-stage HL will result in improved outcomes compared with current PET-adapted approaches with decreased risks of late toxicities that continue to afflict long-term survivors of HL.
What factors guide treatment selection in mycosis fungoides and Sezary syndrome?
Authors: Kim Youn H.
Published: December 2021

Cutaneous T-cell lymphoma (CTCL) comprises a spectrum of T-cell lymphomas with primary skin involvement. Mycosis fungoides (MF) and Sezary syndrome (SS) are the common subtypes of CTCL in which patients present with widely diverse profiles of skin involvement and varying extents of extracutaneous disease. Patients with early-stage disease have an excellent prognosis and are managed primarily with skin-directed therapies; however, those with advanced-stage MF or SS often require multiple lines and recurrent courses of systemic therapies. Many options are available when considering systemic agents, and it is often challenging to know how to prioritize therapies to address a patient's objective disease and quality of life issues. Appreciating the disease heterogeneity and understanding the patient's overall disease profile (eg, skin, lymph nodes, blood, large cell transformation) serve as a useful framework in aligning therapies that can optimally treat active sites of disease. Tissue or blood biomarkers can be integrated into our process of prioritizing therapies and personalizing management in MF or SS. Multidisciplinary management and optimizing supportive care are additional key elements for a favorable outcome. Appropriate patients with high-risk disease should be considered for allogeneic hematopoietic stem cell transplant.
Diagnosis and therapeutic decision-making for the neutropenic patient
Authors: Connelly James A. , Walkovich Kelly
Published: December 2021

Determining the cause of a low neutrophil count in a pediatric or adult patient is essential for the hematologist's clinical decision-making. Fundamental to this diagnostic process is establishing the presence or lack of a mature neutrophil storage pool, as absence places the patient at higher risk for infection and the need for supportive care measures. Many diagnostic tests, eg, a peripheral blood smear and bone marrow biopsy, remain important tools, but greater understanding of the diversity of neutropenic disorders has added new emphasis on evaluating for immune disorders and genetic testing. In this article, a structure is provided to assess patients based on the mechanism of neutropenia and to prioritize testing based on patient age and hypothesized pathophysiology. Common medical quandaries including fever management, need for growth factor support, risk of malignant transformation, and curative options in congenital neutropenia are reviewed to guide medical decision-making in neutropenic patients.
How to evaluate and treat the spectrum of TMA syndromes in pregnancy
Authors: Scully Marie
Published: December 2021

Thrombotic microangiopathy (TMA) is the broad definition for thrombocytopenia, microangiopathic hemolytic anemia, and end-organ damage. Two important categories are thrombotic thrombocytopenic purpura (TTP) and complement-mediated hemolytic-uremic syndrome (CM-HUS). Pregnancy and the immediate postpartum period are associated with TMAs specific to pregnancy in rare situations. These include pregnancy-induced hypertension, preeclampsia, and hemolysis, elevated liver enzymes, and low platelets. TTP and CM-HUS may present in pregnancy. However, the diagnosis may not be immediately obvious as they share characteristics of pregnancy-related TMAs. Within this review, we discuss investigations, differential diagnosis of TMAs in pregnancy, and management. The importance is a risk of maternal mortality but also poor fetal outcomes in relation to TTP and CM-HUS. Treatment of these disorders at presentation in pregnancy is discussed to achieve remission and prolong fetal viability if possible. In subsequent pregnancies, a treatment pathway is presented that has been associated with successful maternal and fetal outcomes. Critical to this is a multidisciplinary approach involving obstetricians, the fetal medicine unit, and neonatologists.
Psychosocial and financial issues after hematopoietic cell transplantation
Authors: Buchbinder David , Khera Nandita
Published: December 2021

With improvement in survival after hematopoietic cell transplantation (HCT), it has become important to focus on survivors' psychosocial issues in order to provide patient-centered care across the transplant continuum. The goals of this article are to describe updates in the literature on certain psychosocial domains (emotional/mental health and social/financial) in HCT survivors, offer a brief overview of the status of the screening and management of these complications, and identify opportunities for future practice and research. An evidence-based approach to psychosocial care can be broken down as primary (promoting health, raising awareness, and addressing risk factors), secondary (screening and directing early pharmacological and nonpharmacological interventions), and tertiary (rehabilitating, limiting disability, and improving quality of life) prevention. Implementing such an approach requires close coordination between multiple stakeholders, including transplant center staff, referring hematologist/oncologists, and other subspecialists in areas such as palliative medicine or psychiatry. Innovative models of care that leverage technology can bring these stakeholders together to fulfill unmet needs in this area by addressing barriers in the delivery of psychosocial care.
Acute GVHD: think before you treat
Authors: Newell Laura F. , Holtan Shernan G.
Published: December 2021

The treatment of acute graft-versus-host disease (aGVHD) has become more nuanced in recent years with the development of improved risk classification systems and a better understanding of its complex, multisystem pathophysiology. We review contemporary approaches to the risk stratification and initial treatment of aGVHD, including ongoing clinical trials. We summarize the findings that led to the first US Food and Drug Administration approval for steroid-refractory aGVHD (SR-aGVHD), ruxolitinib, as well as some of the challenges clinicians still face in treating SR-aGVHD. Finally, we discuss the evaluation and management of steroid-dependent aGVHD, which affects approximately one-third of patients who have long-term, waxing and waning symptoms distinct from chronic GVHD. Future clinical trials for aGVHD treatment may identify steroid-sparing approaches for patients who have a high likelihood of response and approaches to improve tissue repair and dysbiosis for those unlikely to respond to immunosuppression alone.
Smoldering multiple myeloma: evolving diagnostic criteria and treatment strategies
Authors: Visram Alissa , Cook Joselle , Warsame Rahma
Published: December 2021

The adage for smoldering myeloma (SMM) has been to observe without treatment, until criteria for active multiple myeloma were satisfied. Definitions and risk stratification models have become more sophisticated, with prognostication tailored to include high-risk cytogenetics as per the most recent International Myeloma Working Group 2020 risk model. Moreover, progress in defining genomic evolution and changes in the bone marrow microenvironment through the monoclonal continuum have given insight into the complexities underlying the different patterns of progression observed in SMM. Given recent data showing improved progression-free survival with early intervention in high-risk SMM, the current dilemma is focused on how these patients should be treated. This case-based article maps the significant advancements made in the diagnosis and risk stratification of SMM. Data from landmark clinical trials will also be discussed, and ongoing trials are summarized. Ultimately, we outline our approach to SMM and hope to impart to the reader a sound concept of the current clinical management of SMM.
AL amyloidosis: untangling new therapies
Authors: Bal Susan , Landau Heather
Published: December 2021

Systemic light chain (AL) amyloidosis is a protein misfolding disorder characterized by the deposition of abnormal immunoglobulin light chains in fibrillary aggregates, resulting in end-organ damage. Several unique challenges face treating physicians, including delayed diagnosis, advanced vital organ involvement, and morbidity with treatment. Aggressive supportive care and risk-adapted application of plasma cell–directed therapies are the cornerstones of management. The therapeutic revolution in multiple myeloma will likely further expand the arsenal against plasma cells. Careful investigation of these agents will be critical to establish their role in this fragile population. The promise of fibril-directed therapies to restore organ function remains despite early disappointments. In this review, we discuss new therapies to tackle AL amyloidosis using a case-based approach.
Diamond-Blackfan anemia
Authors: Da Costa Lydie M. , Marie Isabelle , Leblanc Thierry M.
Published: December 2021

Diamond-Blackfan anemia (DBA) is an inherited bone marrow failure syndrome, characterized as a rare congenital bone marrow erythroid hypoplasia (OMIM#105650). Erythroid defect in DBA results in erythroblastopenia in bone marrow as a consequence of maturation blockade between the burst forming unit–erythroid and colony forming unit–erythroid developmental stages, leading to moderate to severe usually macrocytic aregenerative (<20 × 109/L of reticulocytes) anemia. Congenital malformations localized mostly in the cephalic area and in the extremities (thumbs), as well as short stature and cardiac and urogenital tract abnormalities, are a feature of 50% of the DBA-affected patients. A significant increased risk for malignancy has been reported. DBA is due to a defect in the ribosomal RNA (rRNA) maturation as a consequence of a heterozygous mutation in 1 of the 20 ribosomal protein genes. Besides classical DBA, some DBA-like diseases have been identified. The relation between the defect in rRNA maturation and the erythroid defect in DBA has yet to be fully defined. However, recent studies have identified a role for GATA1 either due to a specific defect in its translation or due to its defective regulation by its chaperone HSP70. In addition, excess free heme-induced reactive oxygen species and apoptosis have been implicated in the DBA erythroid phenotype. Current treatment options are either regular transfusions with appropriate iron chelation or treatment with corticosteroids starting at 1 year of age. The only curative treatment for the anemia of DBA to date is bone marrow transplantation. Use of gene therapy as a therapeutic strategy is currently being explored.
Multi-omics analysis of an immune-based prognostic predictor in non-small cell lung cancer
Authors: Zheng Yang , Tang Lili , Liu Ziling
Published: December 2021

Background

Inhibitors targeting immune checkpoints, such as PD-1/PD-L1 and CTLA-4, have prolonged survival in small groups of non-small cell lung cancer (NSCLC) patients, but biomarkers predictive of the response to the immune checkpoint inhibitors (ICIs) remain rare.

Methods

The nonnegative matrix factorization (NMF) was performed for TCGA-NSCLC tumor samples based on the LM22 immune signature to construct subgroups. Characterization of NMF subgroups involved the single sample gene set variation analysis (ssGSVA), and mutation/copy number alteration and methylation analyses. Construction of RNA interaction network was based on the identification of differentially expressed RNAs (DERs). The prognostic predictor was constructed by a LASSO-Cox regression model. Four GEO datasets were used for the validation analysis.

Results

Four immune based NMF subgroups among NSCLC patients were identified. Genetic and epigenetic analyses between subgroups revealed an important role of somatic copy number alterations in determining the immune checkpoint expression on specific immune cells. Seven hub genes were recognized in the regulatory network closely related to the immune phenotype, and a three-gene prognosis predictor was constructed.

Conclusions

Our study established an immune-based prognosis predictor, which might have the potential to select subgroups benefiting from the ICI treatment, for NSCLC patients using publicly available databases.
Video display terminal use and other risk factors for abnormal blinking in children: gender differences
Authors: Zhao Hui , Wu Shi-Nan , Zhang Qi , Zhao Chen , Shu Hui-Ye , Ge Qian-Min , Shao Yi
Published: December 2021

Objective

To explore the risk factors for abnormal blinking in children and compare these between boys and girls.

Methods

Children attending the Children's Optometry Clinic between June 2019 and June 2020 were recruited for the study. The time they had spent viewing video displays (VDTt) over the past 6 months was recorded. Incomplete blinking (IB) and blinking rate were measured and all participants were allocated to groups based on their blink rate (<20 times/min = normal blinking group, NBG; ≥20 times/min = abnormal blinking group, ABG). Tear film (TF) stability was also evaluated. The corresponding statistical methods are used to analyze the data.

Results

A total of 87 boys and 80 girls were enrolled in the study. No significant difference in age was found between the 2 groups. There was a significant difference in TF stability between the two groups (P<0.05). According to binary logistic analysis, VDTt and ocular protection index (OPI) are important risk factors for abnormal blinking, with cut-off values of 1.75 hours and 1.014 respectively in boys; and 1.25 hours and 1.770 respectively in girls. The average of lipid layer thickness was an important protective factor for children using VDT for long periods, with a cut-off value of 58.5 nm in boys and 53.5nm in girls.

Conclusion

Risk factors for abnormal blinking in both boys and girls include VDTt and OPI.
RPE disruption and hyper-transmission are early signs of secondary CNV with punctate inner choroidopathy in structure-OCT
Authors: Chen Yanru , Chen Qian , Li Xiaoxin , Li Minghan
Published: December 2021

Purpose

To study whether retinal pigment epithelium (RPE) disruption and choroidal hyper-transmission on spectral-domain optical coherence tomography (SD-OCT) are signs of inflammatory neovascularization (CNV) in punctate inner choroidopathy (PIC).

Methods

This is a prospective cohort study. Seventeen patients (18 eyes) were diagnosed as PIC without CNV at baseline. Changes of morphological characteristics including choroidal hyper-transmission, hypo-transmission, RPE disruption, and ellipsoid zone (EZ) damage on SD-OCT were observed and recorded at baseline, 4, 8 and 12 weeks, respectively. The occurrence of CNV was detected by OCTA at each visit. Fisher’s exact test was used to compare the relationship with each morphological sign and evaluate the predictable capability of secondary CNV in PIC (PIC+CNV) based on the structure changes on OCT.

Results

Among the 18 eyes, a total of 5 eyes (27.8%) developed PIC+CNV subsequently within 4 weeks follow-up. At 4, 8 and 12 weeks of follow-up, RPE disruption and choroidal hyper-transmission were found in all 5 PIC+CNV eyes. The incidence of RPE disruption was significant higher in PIC+CNV eyes compared with PIC eyes (P=0.001). PIC eyes with hyper-transmission had a higher risk for developing CNV compared with those without hyper-transmission (P=1.17×10-3). 2 out of 5 PIC+CNV eyes had a choroidal hypo-transmission component adjacent to hyper-transmission zone at 4 weeks of follow-up, and hypo-transmission could be observed in all 5 PIC+CNV eyes at 8 weeks of follow-up. The incidence of choroidal hypo-transmission was significant higher in PIC+CNV eyes than PIC eyes after 8 weeks. EZ damage began to recover at 4 weeks of follow-up and had no significant difference in the PIC eyes and PIC+CNV eyes (P=0.150, 0.196, 0.353).

Conclusion

The presence of choroidal hyper-transmission and RPE disruption on SD-OCT is associated with the PIC+CNV. SD-OCT imaging facilitates the differentiation and track of the progression of inflammatory lesions and secondary CNV in PIC.
Long-term effectiveness of behavioural intervention in preschool children with attention deficit hyperactivity disorder in Southeast China – a randomized controlled trial
Authors: Huang Xin-xin , Ou Ping , Qian Qin-fang , Huang Yan
Published: December 2021

Background

Attention-deficit hyperactivity disorder (ADHD) is the most common behavioral disorder. Behavioural intervention in preschool children with ADHD is considered effective. This study discussed the long-term effectiveness of behavioural intervention in the context of nondrug therapy.

Methods

The study was a prospective, randomised controlled trial in which 201 preschoolers diagnosed with ADHD who were not receiving any treatment were assigned to two groups from January 2018 to May 2019, 101 were assigned to the conventional group and 100 to the behavioural intervention group. The behavioural intervention group included parental training, behavioural therapy, attention training, relief therapy and game therapy, in addition to the conventional group offerings. Children were evaluated at a baseline, at the end of the 12-month intervention and six months after the intervention. The primary and secondary outcome variables included attention time, the impulse-hyperactivity and hyperactivity index from Conners parent symptom questionnaire (PSQ), full-scale attention quotient (FAQ) and full-scale response control quotient (FRCQ) from integrated visual and auditory comprehensive continuous performance tests. The attention time was observed and recorded by parents, and others were performe(PSQ)d by physicians in the clinic. All statistical analyses were conducted using SPSS V26.0 (IBM), including the descriptive statistics and mixed-effects models and so on.

Results

The participants’ mean age was (66.17±9.00) months in the behavioural group and (67.54±6.22) months in the conventional group .A total of 190 participants completed a follow-up six months after the intervention. The attention time, Conners parent symptom questionnaire (PSQ), full-scale attention quotient (FAQ) and full-scale response control quotient (FRCQ) increased significantly over time, and the behavioural group improvements were higher than those of conventional group. There was a significant main effect of time (pretest/posttest/follow-up) and group on all outcome measures (t =-12.549-4.069, p<0.05), and a significant interaction of time and group on attention time, impulsivity/hyperactivity, FAQ and FRCQ (t =-3.600-3.313, p<0.05).

Conclusion

Behavioural intervention can effectively improve behaviour management and relieve symptoms in children with ADHD. These effects lasted at least six months. This study provides a promising approach for improving clinical efficacy with preschool children with ADHD.
Rapid identification of pathogens associated with ventilator-associated pneumonia by Nanopore sequencing
Authors: Wu Nan , Ranjan Piyush , Tao Changyu , Liu Chao , Yang Ence , He Bei , Erb-Downward John R. , Bo Shining , Zheng Jiajia , Guo Chenxia , Liu Beibei , Sun Lina , Yan Wei , Wang Meng , Wang Wenting , Wen Jianing , Yang Ping , Yang Lin , Tian Qiaoshan , Dickson Robert P. , Shen Ning
Published: December 2021

Background

Aetiology detection is crucial in the diagnosis and treatment of ventilator-associated pneumonia (VAP). However, the detection method needs improvement. In this study, we used Nanopore sequencing to build a quick detection protocol and compared the efficiency of different methods for detecting 7 VAP pathogens.

Methods

The endotracheal aspirate (ETA) of 83 patients with suspected VAP from Peking University Third Hospital (PUTH) was collected, saponins were used to deplete host genomes, and PCR- or non-PCR-amplified library construction methods were used and compared. Sequence was performed with MinION equipment and local data analysis methods were used for sequencing and data analysis.

Results

Saponin depletion effectively removed 11 of 12 human genomes, while most pathogenic bacterial genome results showed no significant difference except for S. pneumoniae. Moreover, the average sequence time decreased from 19.6 h to 3.62 h. The non-PCR amplification method and PCR amplification method for library build has a similar average sensitivity (85.8% vs. 86.35%), but the non-PCR amplification method has a better average specificity (100% VS 91.15%), and required less time. The whole method takes 5–6 h from ETA extraction to pathogen classification. After analysing the 7 pathogens enrolled in our study, the average sensitivity of metagenomic sequencing was approximately 2.4 times higher than that of clinical culture (89.15% vs. 37.77%), and the average specificity was 98.8%.

Conclusions

Using saponins to remove the human genome and a non-PCR amplification method to build libraries can be used for the identification of pathogens in the ETA of VAP patients within 6 h by MinION, which provides a new approach for the rapid identification of pathogens in clinical departments.
Analysis of maturation dynamics and developmental competence of in vitro matured oocytes under time-lapse monitoring
Authors: Yang Qiyu , Zhu Lixia , Wang Meng , Huang Bo , Li Zhou , Hu Juan , Xi Qingsong , Liu Jing , Jin Lei
Published: December 2021

Background

To improve the developmental competence of in vitro cultured oocytes, extensive literature focused on maturation rate improvement with different additives in culture medium, while studies investigating the maturation dynamics of oocytes during in vitro maturation (IVM) and the influencing factors on oocyte viability are scarce.

Methods

The study involved a retrospective observation by time-lapse monitoring of the IVM process of 157 donated GV oocytes from 59 infertile couples receiving ICSI in 2019, in Tongji Hospital, Wuhan, China. The GV oocytes derived from controlled ovarian hyperstimulation (COH) cycles underwent rescue IVM (R-IVM), and the maturation dynamics, including GVBD time (GV-MI), time from GVBD to maturation (MI-MII), maturation time (GV-MII), and MII arrest duration (MII-ICSI), were recorded by time-lapse monitoring. The matured oocytes were inseminated at different MII arrest points and subsequent embryo developments were assessed. The effects of baseline clinical characteristics, oocyte diameters, and maturation dynamics on the developmental competence of the oocytes were also analyzed.

Results

Totally, 157 GV oocytes were collected. GVBD happened in 111 oocytes, with a median GV-MI duration of 3.7 h. The median MI-MII duration was 15.6 h and the median GV-MII duration was 19.5 h. The maturation rate reached 56.7% at 24 h and 66.9% at 48 h, and the clinical factors, including patient age, FSH level, AMH level, ovarian stimulation protocol, and serum estradiol and progesterone levels on hCG trigger day, showed no effects on the 24-h maturation rate. The normal fertilization rate of oocytes resuming meiosis within 8 h and matured within 24 h was significantly higher than that of oocytes resuming meiosis after 8 h and matured after 24 h. Furthermore, among those oocytes matured within 24 h, the high-quality embryo formation rate of oocytes resuming meiosis within 4.5 h and matured within 19 h was significantly higher. All stated time was measured from the start point of IVM. Additionally, for oocytes from patients with serum progesterone levels less than 1 ng/ml on hCG trigger day, the high-quality embryo formation rate was significantly increased.

Conclusion

R-IVM technology could increase the available embryos for patients in routine COH cycles, but excessive culture beyond 24 h is not recommended. GV-MI duration of the oocyte, recorded by time-lapse system, and serum progesterone levels of patients on hCG trigger day can significantly affect the developmental potential of the IVM oocytes.
RE: [No Subject]—On Nonbinary Gender
Authors: Bey Marquis
Published: December 2021

This essay attempts to imagine what nonbinary gender might be through an autotheoretical and imaginative email exchange between the author, as “X,” and the author’s gender as nonbinary. Indeed, theorized conversationally throughout are the difficulties and potentialities of nonbinary gender, or nonbinariness as a refusal of gender.
The use of digital magnification to reduce radiation dose in the cardiac catheter laboratory
Authors: Dalvi Shailesh , Roberts Hywel Mortimer , Bellamy Christopher , Rees Michael
Published: December 2021

Objectives:

To audit whether using magnification of images by use of a large viewing screen using digital matrix magnification which enlarges the image by 33% without using the X-ray machine zoom magnification protocols on a Siemens Artis Zee X-ray machine in a cardiac catheter laboratory results in a reduction of kerma–area product (KAP) for both diagnostic and interventional procedures. This reduction was predicted in an in vitro study in our laboratory, which has previously shown a 20.4% reduction in KAP.

Methods:

A retrospective analysis was conducted of the radiation exposure to compare the measured KAP recorded during the period when conventional magnification with automatic brightness and dose control was used on a Siemens Artis Zee X-ray machine with a flat panel detector and when magnification settings were avoided by using a large screen to enlarge and project a non-magnified image by digital magnification. The analysis was carried out for patients having a diagnostic coronary angiogram and those having an interventional coronary procedure.

Results:

For diagnostic coronary angiograms the median KAP per procedure in the period using conventional magnification was 2124.5 µGy.m2 compared to 1401 µGy.m2 when image matrix magnification was used, a 34% reduction (p < 0.0001). For interventional coronary procedures, the median KAP per procedure in the period using conventional magnification was 3791 µGy.m2 compared to 2568.5 µGy.m2 when image matrix magnification was used, a 32% reduction (p < 0.0001).

Conclusion:

Avoiding using conventional magnification in the cardiac catheter laboratory and using a large screen to magnify images was associated with a statistically significant greater than 30% reduction in KAP.

Advances in knowledge:

This paper is the proof in clinical practice of a theoretical conclusion that radiation dose (KAP) is reduced by use of Image matrix magnification using a large viewing screen without the need to use X-ray tube magnification without significant loss of image resolution in interventional cardiology. The same approach will be useful in interventional radiology.
Multisystem inflammatory syndrome in children associated with SARS-CoV-2: extracardiac radiological findings
Authors: Ucan Berna , Kaynak Sahap Seda , Cinar Hasibe Gokce , Tasci Yildiz Yasemin , Uner Cigdem , Polat Meltem , Derinkuyu Betul Emine
Published: December 2021

Objective:

Multisystem inflammatory syndrome in children (MIS-C) is seen as a serious delayed complication of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. The aim of this study was to describe the most common imaging features of MIS-C associated with SARS-CoV-2.

Methods:

A retrospective review was made of the medical records and radiological imaging studies of 47 children (26 male, 21 female) in the age range of 25 months–15 years who were diagnosed with MIS-C between August 2020 and March 2021. Chest radiographs were available for all 47 patients, thorax ultrasound for 6, chest CT for 4, abdominal ultrasound for 42, abdomen CT for 9, neck ultrasound for 4, neck CT for 2, brain CT for 1, and brain MRI for 3.

Results:

The most common finding on chest radiographs was perihilar–peribronchial thickening (46%). The most common findings on abdominal ultrasonography were mesenteric inflammation (42%), and hepatosplenomegaly (38%, 28%). Lymphadenopathy was determined in four patients who underwent neck ultrasound, one of whom had deep neck infection on CT. One patient had restricted diffusion and T2 hyperintensity involving the corpus callosum splenium on brain MRI, and one patient had epididymitis related with MIS-C.

Conclusion:

Pulmonary manifestations are uncommon in MIS-C. In the abdominal imaging, mesenteric inflammation, hepatosplenomegaly, periportal edema, ascites and bowel wall thickening are the most common findings.

Advances in knowledge:

The imaging findings of MIS-C are non-specific and can mimic many other pathologies. Radiologists should be aware that these findings may indicate the correct diagnosis of MIS-C.
Electromagnetic fields and applications for anisotropic / photonic structures
Authors: Κάτσινος Κωνσταντίνος
Published: December 2021

Το πρώτο μέρος αφορά τoν σχεδιασμό κεραίας με σκοπό την εμφύτευση της σε περιβάλλον ανθρώπινου ιστού. Πιο συγκεκριμένα, η κεραία προορίζεται για την ενσωμάτωση της σε εφαρμογές τύπου βηματοδότη, δηλαδή σε εφαρμογές που έχουν ως περιβάλλον την μορφολογία του ανθρώπινου στήθους. Επιπλέον πραγματοποιείται εκτενής συγκριτική μελέτη όλων των συνδυασμών των τεχνικών σμίκρυνσης που αναφέρονται στην βιβλιογραφία, προκειμένου να εξαχθεί ένας οδηγός για τους σχεδιαστές εμφυτεύσιμων κεραιών, όσον αφορά τις δυνατότητες σμίκρυνσης που προσφέρει ο κάθε συνδυασμός και επομένως να διευκολύνει την διαδικασία σχεδίασης.Το δεύτερο, και κύριο μέρος, της διδακτορικής διατριβής πραγματεύεται την επίλυση ηλεκτρομαγνητικών (ΗΜ) προβλημάτων διαφόρων τύπων. Αρχικά, αναπτύχθηκε μια μέθοδος με σκοπό τον υπολογισμό του σκεδαζόμενου ηλεκτρομαγνητικού πεδίου από κυλινδρικούς σκεδαστές, με άπειρο μήκος κατά μήκος του άξονα του κυλίνδρου. Κύριος πυλώνας της μεθόδου αυτής αποτέλεσε η χρήση των Coupled Fields Volume Integral Equations (CFVIEs), καθώς και η ανάπτυξη των άγνωστων πεδίων σε αναπτύγματα τύπου Dini. Η μέθοδος αυτή μπορεί να χειριστεί με ευκολία ηλεκτρικά μεγάλες διατάξεις, οι οποίες αποτελούνται από ισοτροπικά/ανισοτροπικά υλικά, ακόμη και με υψηλή ανομοιογένεια. Στην συνέχεια, αναπτύχθηκε υπολογιστική μέθοδος για την εξαγωγή των κυματαριθμών αποκοπής για την περίπτωση του κυλινδρικού κυματοδηγού κυκλικής διατομής, με μεταλλικά τοιχώματα. Η μέθοδος αυτή, επίσης, στηρίχθηκε στις CFVIEs καθώς και στα αναπτύγματα τύπου Dini. Τέλος, αναπτύχθηκε ασυμπτωτική μέθοδος για τον υπολογισμό των μιγαδικών συντονισμών των Whispering Gallery Modes (WGM) για την περίπτωση κυλινδρικού συντονιστή. Για την εξαγωγή των ασυμπτωτικών εκφράσεων χρησιμοποιήθηκε η συνάρτηση Airy.
Κοινωνική τάξη και εμπειρία της φυλακής
Authors: Σπυρέα Σοφία
Published: December 2021

Η παρούσα διατριβή μελετά την επίδραση της κοινωνικής τάξης (νοούμενη ως ομάδα με συγκεκριμένα συμφέροντα, διακριτά από τα συμφέροντα άλλων ομάδων) στην εμπειρία του ποινικοσωφρονιστικού εγκλεισμού, δηλαδή της στέρησης της ελευθερίας στη φυλακή. Το πρίσμα είναι εγκληματολογικό/κοινωνιολογικό, υπό την έννοια ότι η φυλακή θεωρήθηκε πεδίο επενέργειας διαφορετικών δυνάμεων οι οποίες διαμορφώνουν (και αποκρυσταλλώνονται σε) διαφορετικές σχέσεις εξουσίας. Ακολουθήθηκε μεθοδολογικά ο τριγωνισμός, στις μεθόδους έρευνας και ανάλυσης, και πραγματοποιήθηκαν συνολικά 121 συνεντεύξεις με κρατούμενους και 66 συνεντεύξεις με μέλη του προσωπικού. Παράλληλα, λήφθηκαν δεδομένα αρχειακού υλικού ενώ τηρήθηκε Ημερολόγιο Έρευνας. Τα αποτελέσματα δείχνουν ότι η κοινωνική τάξη επηρεάζει σημαντικά την εμπειρία του εγκλεισμού αλλά πρέπει να συνυπολογιστούν και άλλοι παράγοντες, όπως η εθνικότητα και το ιστορικό παρανομίας, για να οδηγηθούμε σε αποκρυσταλλωμένη εικόνα αυτής της εμπειρίας. Έτσι, τα άτομα των λεγόμενων ανώτερων τάξεων, δηλαδή τα μέλη των βουλευομένων σωμάτων και τα ανώτερα διοικητικά και διευθυντικά στελέχη του δημοσίου και ιδιωτικού τομέα, θα έχουν γενικά μια «λιγότερο οδυνηρή» εμπειρία εγκλεισμού, συγκριτικά με άλλους κρατουμένους, αλλά θα τη βιώνουν ως δύσκολη. Τα άτομα των λεγόμενων κατώτερων τάξεων, δηλαδή οι ανειδίκευτοι εργάτες, οι χειρωνάκτες και οι μικροεπαγγελματίες, εάν ανήκουν σε αδύναμη εθνο-πολιτισμική μειονότητα, θα έχουν μια «οδυνηρή» εμπειρία εγκλεισμού. Τέλος, για τα άτομα που φέρουν υψηλό κεφάλαιο παρανομίας η κοινωνική τάξη είναι αδιάφορη και θα έχουν μια «ανώδυνη», συγκριτικά με άλλους κρατούμενους, εμπειρία εγκλεισμού. Συνολικά, η παρούσα διατριβή αποτελεί ένα υπόδειγμα αποσύνθεσης και ανασύνθεσης μέσω επαναπλαισίωσης, ήτοι εξετάζει μεμονωμένα κάθε όψη της ζωής intra muros και, στη συνέχεια, στη βάση των ευρημάτων, ανασυνθέτει το υπό διερεύνηση θέμα προκειμένου να ελέγξει τις υποθέσεις. Από μια κοινωνιολογική οπτική, η μελέτη υπογραμμίζει την ανάγκη να ληφθούν υπόψη διαφορετικές πηγές δύναμης (ή κεφαλαίου), εκτός από την κοινωνική τάξη, προκειμένου να κατανοηθεί η εμπειρία του εγκλεισμού.
Classification of Digital Technologies in the Sphere of Public Procurement and corporate Readiness for Their Implementation
Authors: Umnova M. , Kokoreva A. , Ikonnikov O.
Published: December 2021

The digitalization of public procurement is a popular topic of discussion in both the scientific and business world. Currently, government procurement of goods and services in Russia does not use the full potential of digital technologies and is at the stage of electronization and automation. Technologies such as big data analytics, the Internet of Things, cloud computing, and additive manufacturing are not yet widely used. This article examines this problem from two sides. First, the existing and promising digital technologies of public procurement are studied, their classification is given by complexity, level of application and functions. The directions for the development of digital technologies are discussed using examples in Russian and foreign practice. Secondly, attention is also paid to the problem of organizations' readiness for digital transformation in technological and organizational aspects, taking into account the influence of environmental factors.
Refractory Orbital Myositis in Systemic Lupus Erythematosus - A Role for Rituximab
Authors: Rodrigues Morais Joana , Rodrigues Santos Raquel , Pires Costa Paula , Fonseca Tomás , Farinha Fátima
Published: December 2021

Orbital myositis in systemic lupus erythematosus (SLE) is a rare entity with risk of serious complications. Timely treatment with effective immunosuppressors is desirable. We report a case of a 32-year-old female patient with SLE who presented with an acute ocular pain and extraorbital muscle thickening, consistent with orbital myositis. Association with SLE was made after exclusion of other aetiologies. Due to refractoriness to steroids, off-label rituximab was initiated with clinical and imaging parameter improvement.
Autonomy and capacity: the ethical and legal considerations
Authors: Bifarin Oladayo , Stonehouse David
Published: December 2021

This article discusses the important concept of autonomy and what this means for patients and their families. This concept is the first of the four ethical principles identified by Beauchamp and Childress (2019) and is an important legal issue. First, the ethical position of autonomy will be explored, before moving on to discuss the legal aspects. Next, definitions will be presented, and the relevant and pertinent parts of the Nursing and Midwifery Council (NMC) (2018) code introduced. Finally, closely linked to autonomy is capacity. This link will be discussed, highlighting the processes and considerations that need to be considered if a person’s capacity is reduced.
Easier, quicker, safer: an enhanced instrument count procedure
Authors: Szekretar Andrea
Published: December 2021

Andrea Szekretar, Theatre Scrub Team Leader and Advanced Scrub Practitioner, Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust was runner up in the Innovation Award category of the BJN Awards 2021
From staff nurse to nurse consultant: Team working part 7: developing a positive ethos
Authors: Fowler John
Published: December 2021

John Fowler, Educational Consultant, explores ways to enhance teamwork
Tarsal tunnel syndrome: current rationale, indications and results
Authors: Rodríguez-Merchán E. Carlos , Moracia-Ochagavía Inmaculada
Published: December 2021

Tarsal tunnel syndrome (TTS) is a neuropathy due to compression of the posterior tibial nerve and its branches.

It is usually underdiagnosed and its aetiology is very diverse. In 20% of cases it is idiopathic.

There is no test that diagnoses it with certainty. The diagnosis is usually made by correlating clinical history, imaging tests, nerve conduction studies (NCSs) and electromyography (EMG).

A differential diagnosis should be made with plantar fasciitis, lumbosacral radiculopathy (especially S1 radiculopathy), rheumatologic diseases, metatarsal stress fractures and Morton’s neuroma.

Conservative management usually gives good results. It includes activity modification, administration of pain relief drugs, physical and rehabilitation medicine, and corticosteroid injections into the tarsal tunnel (to reduce oedema).

Abnormally slow nerve conduction through the posterior tibial nerve usually predicts failure of conservative treatment.

Indications for surgical treatment are failure of conservative treatment and clear identification of the cause of the entrapment. In these circumstances, the results are usually satisfactory. Surgical success rates vary from 44% to 96%.

Surgical treatment involves releasing the flexor retinaculum from its proximal attachment near the medial malleolus down to the sustentaculum tali. Ultrasound-guided tarsal tunnel release is possible.

A positive Tinel’s sign before surgery is a strong predictor of surgical relief after decompression.

Surgical treatment achieves the best results in young patients, those with a clear aetiology, a positive Tinel’s sign prior to surgery, a short history of symptoms, an early diagnosis and no previous ankle pathology.

Cite this article:EFORT Open Rev2021;6:1140-1147. DOI: 10.1302/2058-5241.6.210031