bluuebunny/crossref_metadata_2025 huggingface dataset:
Extra-osseous 99mTc methylene diphosphonate uptake detected enlargement of the knee joint in patient with polyarthritis
Authors: Caprio Maria Grazia , Manganelli Mariarosaria , Limone Simona , Sorbillo Massimiliano , Quarantelli Mario , Cuocolo Alberto , Mainolfi Ciro Gabriele
Published: November 2017

Bone scintigraphy is a nuclear scanning test used to find abnormalities in the skeleton. Certain abnormal processes involving soft tissues can also cause skeletal accumulation of radiotracer during bone scintigraphy. We present a case of periarticular knee soft tissue 99mTc methylene diphosphonate uptake in a patient with asymmetric polyarthritis. A 33-year-old patient with asymmetric polyarthritis, skin lesions and joint pain underwent bone scintigraphy. Total body examination showed an extra-osseous uptake in periarticular soft tissue of knees joints. A detailed history checkup, physical examination and laboratory tests were carried out to understand the link between the extra-osseous uptake and the phosphonate binding in periarticular soft tissue. To improve the anatomical description of the soft tissue of the knees and to clarify the nature of the extra-skeletal 99mTc methylene diphosphonate uptake, magnetic resonance imaging scan was performed. 99mTc-labeled phosphonate binding has been reported in a number of extra-osseous conditions, but to our knowledge, there are a few cases showing bone tracer uptake in polyarthritis. In polyarthritic patients, whole-body bone scintigraphy were useful in examining the whole joints and detecting possible dubious extra-osseous uptake; in fact, it is able to select subjects who require further in-depth analysis, for example, magnetic resonance imaging.
New therapeutic options provided by off-label deployment of stent graft for tailored arteriovenous access salvage: Two cases
Authors: Corti Riccardo , Quaretti Pietro , Galli Franco , Moramarco Lorenzo Paolo , Cionfoli Nicola , Leati Giovanni , Corbetta Riccardo , Tozzi Matteo
Published: November 2017

A tailored therapy to patient requirements by combining endovascular and surgical steps can be necessary to prolong the life of a vascular access. Stent grafts play a growing role for the therapy of dialytic access complications. Randomized multi-center trials, however, support the on-label use of stent grafts in the treatment of graft venous outflow and in-stent restenosis. The main contraindication to their use is an ongoing infection. We report two cases of new off-label application of Viabahn (Gore, flagstaff, USA) stent graft. In the first case, the failure of a radiocephalic early cannulation graft was treated by stent graft placement on the arterial inflow anastomosis, when emergent angiographic examination revealed the previously unknown high takeoff of the radial artery from the axillary artery. At 13-month follow-up, the target lesion remained untreated. In the second case, elbow stent graft occlusion with extended thrombosis occurred in a right radiocephalic fistula after 3 years of unassisted patency. Being the last option for vascular access, successful endovascular recanalization was carried out. After 3 months, however, the clinical setting relapsed. A two-stage hybrid strategy with vascular surgeon was arranged due to ongoing signs of local infection. Flow was restored by emergent thromboaspiration associated with a new stent graft placement as a endovascular bridge to subsequent surgical treatment. After 2 days, the overlapped stent grafts were excised as planned. Surgical rerouting was completed by polytetrafluoroethylene prosthetic bridge implantation across the elbow. At 4 months, the follow-up remained uneventful. In selected instances, the off-label use of stent grafts may expand the therapeutic options of the vascular access team.
The influence of consumer confidence on inter-format competition: An analysis based on the French Consumer Confidence Index
Authors: Ngobo Paul-Valentin , Ingarao Aurore
Published: November 2017

The multiple store formats (Drive, hypermarkets, hard discount stores, convenience stores) tend to strengthen inter-format competition in addition to the intra-format competition. Thus, when he or she has to shop, the consumer is now facing several solutions. Research in marketing was much interested in determining the choice of store formats using variables such as the composition of the assortment, price, and sales promotions. More recently, analysts have raised the issue of whether the economic context could affect households’ preferences for store formats without providing a convincing answer. To contribute to this debate, which is now important at a time when many economies are in crisis, this research examines the influence of consumer confidence on households’ spending per trip. An analysis of panel data during the 2004–2013 period and four store formats shows that the changes (increase, decrease) in consumer confidence have asymmetric and nonlinear effects on households’ spending per trip across the different store formats and this also depends on the economic cycle (expansion, contraction).
Follow-up monitoring in a cat with leishmaniosis and coinfections with Hepatozoon felis and ‘Candidatus Mycoplasma haemominutum’
Authors: Attipa Charalampos , Neofytou Kyriaki , Yiapanis Christos , Martínez-Orellana Pamela , Baneth Gad , Nachum-Biala Yaarit , Brooks-Brownlie Harriet , Solano-Gallego Laia , Tasker Séverine
Published: November 2017

Case summary

A 6-year-old female neutered domestic shorthair cat from Cyprus was presented with multiple ulcerated skin nodules. Cytology and histopathology of the lesions revealed granulomatous dermatitis with intracytoplasmic organisms, consistent with amastigotes of Leishmania species. Biochemistry identified a mild hyperproteinaemia. Blood extraction and PCR detected Leishmania species, Hepatozoon species and ‘ Candidatus Mycoplasma haemominutum’ (CMhm) DNA. Subsequent sequencing identified Hepatozoon felis. Additionally, the rRNA internal transcribed spacer 1 locus of Leishmania infantum was partially sequenced and phylogeny showed it to cluster with species derived from dogs in Italy and Uzbekistan, and a human in France. Allopurinol treatment was administered for 6 months. Clinical signs resolved in the second month of treatment with no deterioration 8 months post-treatment cessation. Quantitative PCR and ELISA were used to monitor L infantum blood DNA and antibody levels. The cat had high L infantum DNA levels pretreatment that gradually declined during treatment but increased 8 months post-treatment cessation. Similarly, ELISA revealed high levels of antibodies pretreatment, which gradually declined during treatment and increased slightly 8 months post-treatment cessation. The cat remained PCR positive for CMhm and Hepatozoon species throughout the study. There was no clinical evidence of relapse 24 months post-treatment.

Relevance and novel information

To our knowledge, this is the first clinical report of a cat with leishmaniosis with H felis and CMhm coinfections. The high L infantum DNA levels post-treatment cessation might indicate that although the lesions had resolved, prolonged or an alternative treatment could have been considered.
Increases in Depressive Symptoms, Suicide-Related Outcomes, and Suicide Rates Among U.S. Adolescents After 2010 and Links to Increased New Media Screen Time
Authors: Twenge Jean M. , Joiner Thomas E. , Rogers Megan L. , Martin Gabrielle N.
Published: November 2017

In two nationally representative surveys of U.S. adolescents in grades 8 through 12 ( N = 506,820) and national statistics on suicide deaths for those ages 13 to 18, adolescents’ depressive symptoms, suicide-related outcomes, and suicide rates increased between 2010 and 2015, especially among females. Adolescents who spent more time on new media (including social media and electronic devices such as smartphones) were more likely to report mental health issues, and adolescents who spent more time on nonscreen activities (in-person social interaction, sports/exercise, homework, print media, and attending religious services) were less likely. Since 2010, iGen adolescents have spent more time on new media screen activities and less time on nonscreen activities, which may account for the increases in depression and suicide. In contrast, cyclical economic factors such as unemployment and the Dow Jones Index were not linked to depressive symptoms or suicide rates when matched by year.
Single-Leg Hop Test Performance and Isokinetic Knee Strength After Anterior Cruciate Ligament Reconstruction in Athletes
Authors: Sueyoshi Ted , Nakahata Akihiro , Emoto Gen , Yuasa Tomoki
Published: November 2017

Background:

Isokinetic strength and hop tests are commonly used to assess athletes’ readiness to return to sport after knee surgery.

Purpose/Hypothesis:

The purpose of this study was to investigate the results of single-leg hop and isokinetic knee strength testing in athletes who underwent anterior cruciate ligament reconstruction (ACLR) upon returning to sport participation as well as to study the correlation between these 2 test batteries. The secondary purpose was to compare the test results by graft type (patellar tendon or hamstring). It was hypothesized that there would be no statistically significant limb difference in either isokinetic knee strength or single-leg hop tests, that there would be a moderate to strong correlation between the 2 test batteries, and that there would be no significant difference between graft types.

Study Design:

Cross-sectional study; Level of evidence, 3.

Methods:

Twenty-nine high school and collegiate athletes who underwent ACLR participated in this study. At the time of return to full sport participation, a series of hop tests and knee extension/flexion isokinetic strength measurements were conducted. The results were analyzed using analysis of variance and Pearson correlation ( r).

Results:

The timed 6-m hop test was the only hop test that showed a significant difference between the involved and uninvolved limbs (2.3 and 2.2 seconds, respectively; P = .02). A significant difference between limbs in knee strength was found for flexion peak torque/body weight at 180 deg/s ( P = .03), flexion total work/body weight at 180 deg/s ( P = .04), and flexion peak torque/body weight at 300 deg/s ( P = .03). The strongest correlation between the hop tests and knee strength was found between the total distance of the hop tests and flexion total work/body weight at 300 deg/s ( r = 0.69) and between the timed 6-m hop test and flexion peak torque/body weight at 300 deg/s ( r = –0.54). There was no statistically significant difference in hop test performance or isokinetic knee strength between graft types.

Conclusion:

The single-leg hop tests and isokinetic strength measurements were both useful for a bilateral comparison of knee functional performance and strength. Knee flexion strength deficits and flexion-to-extension ratios seemed to be correlated with single-leg hop test performance. There was no difference in postoperative hop test performance or knee strength according to graft type.
Image, Text and Malaria: Creative Production of a Comic Book
Authors: Jyoti
Published: November 2017

The comics medium is a powerful tool for communication. It employs the language of both text and images. The placement, interrelationship and transition of panels, speech balloons, gutters, lines, script and picture plane are some of the elements that evoke a sense of time and place in comics. The success of comics as an effective medium depends on experiences common to both the creator and audience. In the light of this understanding of the language of comics, and theorisation regarding the ‘production’ of culture, this article analyses the creation procedure of a comic book made to communicate health messages among schoolchildren under a health project run by the directorate of Vector Borne Disease Control Programme in India. Designing Communications 2 2  Name changed. I have used pseudo names for all the private institutes and professionals. , a private agency contracted by the government for its public health programmes, became the site for this production process. The production involved various ‘actants’ 3 3  A. J. Greimas (1983) developed the actantial model where he talked about six actants or facets that define a narrative algorithm. These actants include the subject, the object, the sender, the receiver, the helper and the opponent. This model was further used by Bruno Latour and others in the development of actor–network theory (widely known as ANT) where the focus shifted from action to systems or networks. from the field. It was also constrained by the limits set by the ‘genre’, hence a specific art world. I call the production of such a comic book a ‘creative production’ because it involves a dynamic interplay between the artists’ creativity and the bureaucratic boundaries of the profession of advertising. Following Howard Becker’s idea that artistic production is collective, I describe the detailed contribution of major actors involved in the process of comic book production.
Crystal-chemical aspects of the roméite group, A2Sb2O6Y, of the pyrochlore supergroup
Authors: Bosi Ferdinando , Christy Andrew G. , Hålenius Ulf
Published: November 2017

Four specimens of the roméite-group minerals oxyplumboroméite and fluorcalcioroméite from the Långban Mn-Fe deposit in Central Sweden were structurally and chemically characterized by single-crystal X-ray diffraction, electron microprobe analysis and infrared spectroscopy. The data obtained and those on additional roméite samples from literature show that the main structural variations within the roméite group are related to variations in the content of Pb2+, which is incorporated into the roméite structure via the substitution Pb2+→A2+ where A2+ = Ca, Mn and Sr. Additionally, the cation occupancy at the six-fold coordinated B site, which is associated with the heterovalent substitution BFe3+ + Y☐→BSb5++YO2-, can strongly affect structural parameters.

Chemical formulae of the roméite minerals group are discussed. According to crystal-chemical information, the species associated with the name ‘kenoplumboroméite’, hydroxycalcioroméite and fluorcalcioroméite most closely approximate end-member compositions Pb2(SbFe3+)O6☐, Ca2(Sb5+Ti) O6(OH) and (CaNa)Sb2O6F, respectively. However, in accord with pyrochlore nomenclature rules, their names correspond to multiple end-members and are best described by the general formulae: (Pb,#)2(Sb,#)2O6☐, (Ca,#)2(Sb,#)2O6(OH) and (Ca,#)Sb2(O,#)6F, where ‘#’ indicates an unspecified charge-balancing chemical substituent, including vacancies.
Antibodies targeting surface membrane antigens in patients with chronic graft-versus-host disease
Authors: Wang Kathy S. , Kim Haesook T. , Nikiforow Sarah , Heubeck Alexander T. , Ho Vincent T. , Koreth John , Alyea Edwin P. , Armand Philippe , Blazar Bruce R. , Soiffer Robert J. , Antin Joseph H. , Cutler Corey S. , Ritz Jerome
Published: November 2017

Key Points

Patients with cGVHD develop antibodies targeting cell membrane antigens. Targeted antigens are broadly expressed in acute myeloblastic leukemia cells and in tissues affected by cGVHD.
Immature CML cells implement a BMP autocrine loop to escape TKI treatment
Authors: Grockowiak Elodie , Laperrousaz Bastien , Jeanpierre Sandrine , Voeltzel Thibault , Guyot Boris , Gobert Stéphanie , Nicolini Franck E. , Maguer-Satta Véronique
Published: November 2017

Key Points

TKI-resistant CML patients display persistent BMP pathway alterations in leukemic immature cells and their niche. A subpopulation of TKI-resistant leukemic stem cells survives through binding of BMP4 to BMPR1b, which preserves TWIST-1-expressing cells.
Development of an automatic sorting system for fresh ginsengs by image processing techniques
Authors: Jeong Seokhoon , Lee Yong-Min , Lee Sangjoon
Published: November 2017

This study was conducted with the objective of implementing a smart IoT (internet of things) factory consisting of an automatic 6-year-old fresh ginseng grade classification device. Conventionally, washed 6-year-old ginseng from farmlands is manually sorted into three grades using classification criteria such as weight and shape. However, the cost associated with this classification process has been on the increase. Consequently, to reduce this associated cost, we developed an automatic ginseng sorting device that classifies 6-year-old ginseng according to weight and shape via image processing and sends the classification results to a factory server over a network. Evaluations conducted of the performance of the developed machine using 100 units of 6-year-old ginseng showed that it has a high recognition rate, with an accuracy of 94% for Grade 1, 98% for Grade 2, and 90% for Grade 3.
Correlation of chemostratigraphy, total organic carbon, sequence stratigraphy, and bioturbation in the Woodford Shale of south-central Oklahoma
Authors: Coleman Sabrina M. , Jordan Douglas W.
Published: November 2017

Technological advances in handheld X-ray fluorescence (HHXRF) have been instrumental in demonstrating the utility of chemostratigraphic data to create higher order sequence stratigraphic interpretations. This study seeks to identify the correlation between chemostratigraphy, total organic carbon, sequence stratigraphy, and bioturbation in the Woodford Shale of south-central Oklahoma using HHXRF and X-ray diffraction technologies. The use of multiproxy correlations allows for higher confidence identifying lateral changes in the Woodford Shale. Elemental data collected through HHXRF can be used as proxies to better understand the depositional environment of a formation. Titanium, Zr, K, and Al are all proxies for transgression and regression. Silica is associated with so many different elements that Si alone does not provide useful information; however, the ratio of Si/Al coupled with detrital proxies can give information on the presence of possible algal blooms, continentally derived sediment, or hiatal surfaces. Furthermore, relationships between other elements can give further understanding to bottom-water conditions at the time of deposition. This study examines the relationships between Mo, V, Ni, and P along with other elements and laboratory-collected data to further understand the bottom-water conditions during deposition of the organic-rich muds that make up the Woodford Shale in south-central Oklahoma. To some extent, it is then possible to correlate these higher-resolution understandings to open-hole well logs to increase our understanding, where the core is unavailable.
Whole-aperture characteristics and controlling factors of pore structure in the Chang 7th continental shale of the Upper Triassic Yanchang Formation in the southeastern Ordos Basin, China
Authors: Yang Wei , Song Yan , Jiang Zhenxue , Luo Qun , Wang Qianyou , Yuan Yuan , Zhang Chen , Chen Lei
Published: November 2017

Quantitative assessment is still lacking on the pore-sizes distribution of micropores and mesopores, and the major controlling factors remain enigmatic for the continental Chang 7th shale reservoirs in southeastern Ordos Basin. In this study, scanning electron microscopy, organic geochemical analysis, low-temperature gas adsorption, high-pressure mercury injection, and X-ray diffraction analysis were conducted on 29 core samples from representative eight wells in the Xiasiwan-Yanchang area, yielding a particular investigation on characteristics and controlling factors of the structure in the Chang 7th shale. The Chang 7th shale is mainly characterized by organic and secondary micropore and mesopore, respectively, ranging the peaks of pore size from 0.35 to 0.65 nm, 0.75 to 1.00 nm, 1.10 to 1.35 nm, and from 4 to 13 nm. Whole-aperture characterization of the pore structure shows that meso- and macropores demonstrate a major contribution to total pore volume (PV), and the surface area is mainly provided by micro- and mesopores with pore radii less than 20 nm. A weak positive variation was identified between the PV of micromesopores and total organic carbon content, implying that micropores are currently in the process of developing. The micromesopore specific surface area and volume, respectively, yield a significant positive and weak variation with the quartz and clay mineral content, suggesting that siliceous minerals are favorable for micromesopore development. The infusion of siliceous biogenic debris and silica-replaced carbonate biogenic debris from the northeastern and southwestern source areas, respectively, is likely responsible for development of biogenic siliceous minerals in the Chang 7th shale. Furthermore, the hollow cavities in siliceous organisms have considerably contributed to the preservation of primary pores owing to their characteristic skeleton-supported framework.
Health-related quality of life of postmenopausal women with hormone receptor–positive, HER2- advanced breast cancer treated with ribociclib + letrozole: Results from MONALEESA-2.
Authors: Verma Sunil , O'Shaughnessy Joyce , Burris Howard A. , Campone Mario , Alba Emilio , Chandiwana David , Manson Stephanie , Sutradhar Santosh C. , Monaco Mauricio , Janni Wolfgang
Published: November 2017

133

Background: In the MONALEESA-2 trial, ribociclib + letrozole significantly improved progression-free survival and showed higher overall response rates vs placebo + letrozole in hormone receptor–positive, HER2– advanced breast cancer. Here, we present key patient-reported outcomes including health-related quality of life (HRQoL). Methods: Six hundred sixty-eight patients were randomized (n = 334 for each treatment group). Patient-reported outcomes were evaluated during treatment and at progression using the European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30 and QLQ-BR23. Changes from baseline in all subscales were analyzed using a linear mixed-effects model, and time to 10% deterioration was compared between treatment arms using the stratified log-rank test. Results: Questionnaire adherence rates were high ( > 90%). During treatment, HRQoL (global health status/QoL score) was maintained and similar in both treatment arms. At progression/end of treatment, HRQoL worsened numerically in both arms. Time to definitive 10% deterioration of HRQoL was similar between treatment groups, slightly favoring the ribociclib + letrozole arm (hazard ratio, 0.944; 95% confidence interval, 0.720–1.237). No statistically or clinically relevant differences were observed for key symptoms using EORTC QLQ-C30 including fatigue, nausea, and vomiting. There was clinically relevant improvement ( > 5 points) in pain from baseline to post baseline (through cycle 15) in the ribociclib + letrozole arm, but only mild improvement (≤5 points) in the placebo + letrozole arm. Conclusions: Ribociclib + letrozole maintained HRQoL, and a numerical trend favoring ribociclib + letrozole was observed for pain reduction and delay. Clinical trial information: NCT01958021.
The advance directive completion rates in the hematopoietic stem cell transplant population in a major transplant cancer center.
Authors: Zachariah Finly , Popplewell Leslie , Forman Stephen J. , Gorospe Gerardo , Wong-Toh Judy , Morse Denise , Emanuel Lindsay , Ito-Hamerling Gayle , Garcia Nellie , Horak David , Kassouny Dicran , Ohanesian Priscilla , Buga Sorin , Dale William , Mooney Stefanie , Tegtmeier Bernard , Banerjee Chandana , Patel Purvi , Alvarnas Joseph C.
Published: November 2017

16

Background: Advance Care Planning (ACP) is central to patient-centered care and helps assure treatment aligns with a patient’s goals, values, and priorities. ACP is often poorly incorporated into the hematopoietic stem cell transplantation (HSCT) population, with reported advance directive (AD) rates of 23-50%. At City of Hope National Medical Center (COH), concerted efforts to improve the overall number of ADs in HSCT was undertaken and evaluated. Methods: The Department of Supportive Care Medicine at COH, in collaboration with medical faculty and administrative support, created a patient-centered ACP program. The first two years (2013/2014) broadly focused on all new COH patients. The last two years (2015/2016) included a specific focus on patients undergoing HSCT. The primary goal was a completed AD in the electronic medical record before day 0 of transplant. In addition to provider and transplant team engagement, major time points for supportive care integration to facilitate AD completion were identified including: 1) registration, 2) new patient orientation, 3) the clinical visit when transplant was decided, 4) pre-transplant education class, 5) clinical social work psychosocial assessment visit, and 6) the pre-transplant hospital days. AD completion rates were calculated with Odds Ratio and Mantel-Haenszel Chi-Square using Epi Info StatCalc. Results: Between 2012 and 2016 at COH, 1784 transplants were performed. For HSCT patients in 2012, baseline AD capture rate before day 0 of transplant was 28.6%. With the institutional AD program, the AD capture rate before day 0 of transplant was 31.6% for 2014, compared with 2012 [odds ratio, 1.17(95% CI, 0.85-1.60); p = .33]. With both institutional and hematology specific programs, AD capture rate before day 0 was 69.5% for 2016, compared to 2014[odds ratio, 4.30 (95% CI, 3.14-5.91); p < .001]. Conclusions: Compared to 2012, the institutional AD program in 2014 insignificantly impacted HSCT AD completion rates. Improving the rate of AD completion from 28.6% to 69.5% in HSCT patients required both institutional AD efforts and a targeted program. Nevertheless, more work is needed to improve AD completion rates before transplant to 100%.
The effect of nurse-led pain education of patients with painful bone metastases on pain and quality of life: A multicenter randomized trial.
Authors: Geerling Jenske I. , Raijmakers Natasja , Mul Veronique E.M. , de Nijs Ellen JM , Oudhof Marianne A , de Bock Gertruida Hendrika , De Graeff Alexander , van der Linden Yvette M , Reyners Anna K.L.
Published: November 2017

203

Background: Radiotherapy (RT) is an effective treatment for painful bone metastases, although pain is not always sufficiently controlled. Pain management education may improve patient empowerment and, consequently, reduce pain intensity. The effect of nurse-led education (NLE) in patients undergoing RT for painful bone metastases was investigated as compared to care as usual (CAU). Primary endpoint was pain intensity at 12 weeks, secondary outcome was quality of life (QoL). Methods: In this multicentre, randomised phase 3 study, patients referred for short schedule RT, with uncontrolled pain (a score of ≥5 on a 0-10 numeric rating scale (NRS)), were randomised between NLE or CAU before start of RT. The NLE consisted of a structured interview including assessment of pain knowledge, verbal and written education on all aspects of pain and follow-up phone calls at 1, 4, 8 & 12 weeks to address pain-related questions. Patients in CAU received leaflets on RT, cancer pain and opioid use. Patient characteristics were assessed at baseline. Pain intensity and QoL were evaluated with the Brief Pain Inventory, EORTC QLQ-C15-PAL and EORTC QLQ-BM22 at baseline, and week 1, 4, 8 & 12. Power calculation showed that there were 89 patients per arm needed to detect a 10% difference in number of patients with a NRS < 5 at 12 weeks(1-sided α = 0.05; β 0.8). Results: Between May 2011-April 2016, 354 patients were randomised (176 NLE, 178 CAU), 38 were excluded (30 NRS < 5 at baseline, 7 no short schedule RT, 1 missing informed consent). At twelve weeks, 185 (NLE 95) had completed follow-up (72 stopped filling out questionnaires, 59 died prematurely). Baseline characteristics were similar in both groups; mean age 65 years, 56% men. At week 12, more patients in NLE than in CAU had controlled pain (NRS < 5; respectively 66% and 52%, p = 0.036). Moreover, patients in NLE reached faster a pain score < 5 than patients in CAU (31 versus 54 days respectively, p = 0.026). On all time points, no significant differences in QoL were found between both groups. Conclusions: Controlled pain, i.e. a pain intensity < 5, was reached faster and by more patients with painful bone metastases undergoing RT by the addition of nurse-led pain education. Clinical trial information: NCT01358539.
Barriers to online patient portal adoption among adult oncology patients.
Authors: Siegel Craig , Gill Ammara , Esteghamat Naseem , Tu Yifan , Rodin Miriam B.
Published: November 2017

44

Background: Recent research shows tele-health and remote access technology enhances patient-provider communication. Among oncology patients, studies demonstrate that electronic access promotes improved treatment adherence and symptom management and provides better continuity of care and patient satisfaction. In a previous audit, we found only 26% of our oncology patients had activated our EHR (EPIC) online patient portal. MyChart facilitates communication by allowing patients to see results and email providers through a secure network. We undertook this study to discover patient opinions about MyChart and barriers to wider adoption. Methods: A short, self-administered questionnaire was distributed to a convenience sample of patients in waiting areas or the infusion center of the outpatient oncology clinic. Results: 76/108 patients knew of MyChart; 32 did not. 54/76 (71.1%) of patients who knew of MyChart had used it. 81.5% of 54 users were very or somewhat satisfied with it. Users rated features of MyChart on a 5 point scale: certain their confidentiality is protected 4.7,ability to track tests 4.4,receiving faster answers 3.0,and ease of contacting providers 2.8. 21 non-users gave several reasons for not using MyChart: preference to speak with a live person 38.1%, discomfort with the internet 23.8%, not having internet 19.0%, concern about personal information on the internet 14.3%, and too complicated 9.5%. Among 32patients not previously aware of MyChart, 43.7% said they would definitely or probably start using it.56.3% thought MyChart would make it easier to contact providers and 53.1%cited convenience over telephone.However, 28.1%,preferred speaking to a live person; 12.5% were uncomfortable with the internet, and 9.4% expressed concern with their information on the internet. Conclusions: In this sample, 50% of respondents used MyChart. Patients using MyChart were generally satisfied, specifically with confidentiality and ability to monitor their care. Barriers to increased use included a desire to speak directly to providers and lack of internet skill or access. While those using MyChart were confident that it was secure and confidential, those not using expressed concern about this issue.
Problem areas identified by cancer patients with a positive distress screen in the medical clinic.
Authors: Deshields Teresa L. , Ruhland Mary Jane
Published: November 2017

63

Background: NCCN has been advocating for distress screening since the inaugural Distress Management Guidelines in 1999. ASCO’s Quality Oncology Practice Initiative incorporated an indicator of patients’ emotional well-being in 2009. The ACoS Commission on Cancer established mandatory distress screening as an accreditation requirement for cancer programs in January 2015. This latter requirement dramatically increased the number of cancer programs doing routine distress screening. We examined distress screening results at a comprehensive cancer center. Methods: Results of distress screening were reviewed in the following clinical areas: medical oncology, radiation oncology, gynecologic oncology, and otolaryngology. Distress screening was completed verbally as a part of the vitals assessment, using the NCCN Distress Thermometer and Problem List. Only patients with a positive screen ( < 6 on 0-10 rating scale) completed the Problem List, identifying relevant problem areas (Emotional, Family, Practical, Physical, Spiritual and Other). The MA or RN doing the distress screening entered the distress rating and the endorsed problem area(s) in the electronic medical record. Results: In the first 5 months of 2017, 11,155 screening results were entered into the medical record. The percent of positive screens ranged from 5.7 to 8.6%, with X = 6.6% of screens being positive for distress. The most common problem areas were Emotional, endorsed with X = 72.5% of positive screens (range = 33.5-96.6%); Physical, endorsed with X = 67.52% of positive screens (range = 42.8-86.4%); and Practical, endorsed with X = 43.1% of positive screens (range = 20.1-59.9%). Conclusions: While some cancer centers use a psychologically-focused screening method (e.g. PHQ-9, BDI), distress is a bio-psychosocial construct, which requires a screening method that includes multiple domains. Furthermore, the triage related to distress screening may best be accomplished by the cancer team at the clinic visit, so that physical problems can be further assessed and addressed during the visit. The medical team can also make referrals to social work or psychological services to address related problem areas, when identified by patients.
Randomized, Multicenter, Placebo-Controlled Clinical Trial of Duloxetine Versus Placebo for Aromatase Inhibitor–Associated Arthralgias in Early-Stage Breast Cancer: SWOG S1202
Authors: Henry N. Lynn , Unger Joseph M. , Schott Anne F. , Fehrenbacher Louis , Flynn Patrick J. , Prow Debra M. , Sharer Carl W. , Burton Gary V. , Kuzma Charles S. , Moseley Anna , Lew Danika L. , Fisch Michael J. , Moinpour Carol M. , Hershman Dawn L. , Wade James L.
Published: November 2017

Purpose

Adherence to aromatase inhibitor (AI) therapy for early-stage breast cancer is limited by AI-associated musculoskeletal symptoms (AIMSS). Duloxetine is US Food and Drug Administration approved for treatment of multiple chronic pain disorders. We hypothesized that treatment of AIMSS with duloxetine would improve average joint pain compared with placebo.

Methods

This randomized, double-blind, phase III trial included AI-treated postmenopausal women with early-stage breast cancer and who had average joint pain score of ≥ 4 out of 10 that developed or worsened since AI therapy initiation. Patients were randomly assigned 1:1 to duloxetine or placebo for 13 weeks. The primary end point was average joint pain through 12 weeks, examined using multivariable linear mixed models, adjusted for stratification factors (baseline pain score of 4 to 6 v 7 to 10 and prior taxane use). Clinically significant change in average pain was defined as a ≥ 2-point decrease from baseline.

Results

Of 299 enrolled patients, 127 patients treated with duloxetine and 128 who received placebo were evaluable for the primary analysis. By 12 weeks, the average joint pain score was 0.82 points lower for patients who received duloxetine compared with those who received placebo (95% CI, −1.24 to −0.40; P = .0002). Similar patterns were observed for worst joint pain, joint stiffness, pain interference, and functioning. Rates of adverse events of any grade were higher in the duloxetine-treated group (78% v 50%); rates of grade 3 adverse events were similar.

Conclusion

Results of treatment with duloxetine for AIMSS were superior to those of placebo among women with early-stage breast cancer, although it resulted in more frequent low-grade toxicities.
Cardiac Arrest in the Operating Room: Resuscitation and Management for the Anesthesiologist: Part 1
Authors: Moitra Vivek K. , Einav Sharon , Thies Karl-Christian , Nunnally Mark E. , Gabrielli Andrea , Maccioli Gerald A. , Weinberg Guy , Banerjee Arna , Ruetzler Kurt , Dobson Gregory , McEvoy Matthew D. , O’Connor Michael F.
Published: November 2017

Cardiac arrest in the operating room and procedural areas has a different spectrum of causes (ie, hypovolemia, gas embolism, and hyperkalemia), and rapid and appropriate evaluation and management of these causes require modification of traditional cardiac arrest algorithms. There is a small but growing body of literature describing the incidence, causes, treatments, and outcomes of circulatory crisis and perioperative cardiac arrest. These events are almost always witnessed, frequently known, and involve rescuer providers with knowledge of the patient and their procedure. In this setting, there can be formulation of a differential diagnosis and a directed intervention that treats the likely underlying cause(s) of the crisis while concurrently managing the crisis itself. Management of cardiac arrest of the perioperative patient is predicated on expert opinion, physiologic rationale, and an understanding of the context in which these events occur. Resuscitation algorithms should consider the evaluation and management of these causes of crisis in the perioperative setting.
Safety and Effectiveness of a Novel Facemask for Positive Pressure Ventilation
Authors: Brown Tod A. , Szabo Tamas A. , Bridges Kathryn H. , Sabbagh Michel J. , Hand William R. , Wolf Bethany J. , Warters Robert D.
Published: November 2017

BACKGROUND:

Manual positive pressure ventilation is an essential skill in a variety of clinical situations. The C&E technique is commonly used with standard facemasks to provide effective ventilation. The Tao mask is a novel design that allows a more ergonomic grip. A seal between the mask and face is made with downward pressure of the palm, centered on the mask, and jaw lift is achieved with 4 fingers centered under the mandible. The purpose of this study was to evaluate the safety and effectiveness of the Tao mask compared to a standard mask before and after the administration of neuromuscular blockade (NMB) using 2 previously established ventilation scales.

METHODS:

One hundred fifty-two patients >18 years of age who were scheduled for general anesthesia were recruited. All care team members were shown a brief instructional video on the use of the Tao mask. After induction of general anesthesia with a standardized protocol, each patient was ventilated with both the standard (Vital Signs #082510) and Tao masks and effectiveness was measured using the Han and Warters scales. This process was repeated after NMB. The sequence of masks was determined with a random-number generator.

RESULTS:

Tao mask ventilation scores were significantly better than standard mask scores on both the Han scale and the Warters scale before the administration of NMB (P < .001 for both). Tao mask scores were also significantly better than standard mask scores on the Warters scale after the administration of NMB (P < .001). However, there was no significant difference on the Han scale between the 2 mask types after NMB (P = .180). On the Warters scale, there were significantly fewer patients who were difficult to ventilate with the Tao mask than the standard mask before NMB (18 vs 40; P < .001) and after NMB (8 vs 17; P = .005). No adverse events were reported with either mask.

CONCLUSIONS:

Our results indicate that the Tao mask demonstrated equivalent safety and superior effectiveness compared to a standard mask. The study design favored the standard mask because all participating practitioners had multiple years of experience with the standard mask and no prior experience with the Tao mask. Since the incidence of inadequate mask ventilation goes up significantly with inexperienced operators, the improved effectiveness of the Tao mask could be even more profound with novice operators.
Developing a sense of touch
Authors: Jenkins Blair A. , Lumpkin Ellen A.
Published: November 2017

The sensation of touch is mediated by mechanosensory neurons that are embedded in skin and relay signals from the periphery to the central nervous system. During embryogenesis, axons elongate from these neurons to make contact with the developing skin. Concurrently, the epithelium of skin transforms from a homogeneous tissue into a heterogeneous organ that is made up of distinct layers and microdomains. Throughout this process, each neuronal terminal must form connections with an appropriate skin region to serve its function. This Review presents current knowledge of the development of the sensory microdomains in mammalian skin and the mechanosensory neurons that innervate them.
Fibroblast growth factors: key players in regeneration and tissue repair
Authors: Maddaluno Luigi , Urwyler Corinne , Werner Sabine
Published: November 2017

Tissue injury initiates a complex repair process, which in some organisms can lead to the complete regeneration of a tissue. In mammals, however, the repair of most organs is imperfect and results in scar formation. Both regeneration and repair are orchestrated by a highly coordinated interplay of different growth factors and cytokines. Among the key players are the fibroblast growth factors (FGFs), which control the migration, proliferation, differentiation and survival of different cell types. In addition, FGFs influence the expression of other factors involved in the regenerative response. Here, we summarize current knowledge on the roles of endogenous FGFs in regeneration and repair in different organisms and in different tissues and organs. Gaining a better understanding of these FGF activities is important for appropriate modulation of FGF signaling after injury to prevent impaired healing and to promote organ regeneration in humans.
RNAi targeting Caenorhabditis elegans α-arrestins has little effect on lifespan
Authors: Park Sangsoon , Jung Yoonji , An Seon Woo A. , Son Heehwa G. , Hwang Wooseon , Lee Dongyeop , Artan Murat , Park Hae-Eun H. , Jeong Dae-Eun , Lee Yujin , Lee Seung-Jae V.
Published: November 2017

Background: α-arrestins are a family of proteins that are implicated in multiple biological processes, including metabolism and receptor desensitization.

Methods: Here, we sought to examine the roles of α-arrestins in the longevity of Caenorhabditis elegans through an RNA interference screen.

Results: We found that knocking down each of 24 out of total 29 C. elegans α-arrestins had little effect on lifespan. Thus, individual C. elegans α-arrestins may have minor effects on longevity.

Conclusions: This study will provide useful information for future research on the functional role of α-arrestins in aging and longevity.
Perturbation of PALB2 function by the T413S mutation found in small cell lung cancer
Authors: Bleuyard Jean-Yves , Butler Rosie M. , Esashi Fumiko
Published: November 2017

Background: Germline mutations in the PALB2 gene are associated with the genetic disorder Fanconi anaemia and increased predisposition to cancer. Disease-associated variants are mainly protein-truncating mutations, whereas a few missense substitutions are reported to perturb its interaction with breast cancer susceptibility proteins BRCA1 and BRCA2, which play essential roles in homology-directed repair (HDR). More recently, PALB2 was shown to associate with active genes independently of BRCA1, and through this mechanism, safeguards these regions from DNA replicative stresses. However, it is unknown whether PALB2 tumour suppressor function requires its chromatin association.

Methods: Mining the public database of cancer mutations, we identified four potentially deleterious cancer-associated missense mutations within the PALB2 chromatin association motif (ChAM). To assess the impact of these mutations on PALB2 function, we generated cell lines expressing PALB2 variants harbouring corresponding ChAM mutations, and evaluated PALB2 chromatin association properties and the cellular resistance to camptothecin (CPT). Additionally, we examined the accumulation of γH2A.X and the RAD51 recombinase as readouts of DNA damage signalling and HDR, respectively.

Results: We demonstrate that a small-cell lung cancer (SCLC)-associated T413S mutation in PALB2 impairs its chromatin association and confers reduced resistance to CPT, the only FDA-approved drug for relapsed SCLC. Unexpectedly, we found a less efficient γH2A.X nuclear foci formation in PALB2 T413S expressing cells, whereas a near-normal level of RAD51 nuclear foci was visible.

Conclusions: These findings support the importance of PALB2 chromatin association in the suppression of tumours, including SCLC, an unusually aggressive type of cancer with poor prognosis. PALB2 T413S has little impact on RAD51 recruitment, likely due to its intact interaction with BRCA1 and BRCA2. However, this mutant shows inefficient DNA stress signalling. This finding sheds new light on the function of PALB2, playing a role in efficient DNA stress signalling through constitutive chromatin association.
Innovative characteristics of the labor market subjects: analysis and main directions of formation
Authors: Рабцевич Андрей , Rabcevich Andrey
Published: November 2017

The monograph is devoted to the study of peculiarities of identification and analysis, as well as methods of formation of the innovative characteristics of the main subjects of the labor market - the employee and the employer.
The author defines the condition and activities of employees and employers as the object of economic analysis, reveals the possibility of studying the characteristics of these labor market subjects.
The set of innovative characteristics of the employee includes the entrepreneurial initiative of the population, the professional level and adequacy to modern requirements of the labor market. In turn, the innovative characteristics of the employer includes the current level of production efficiency, the level of production activity in innovative development, as well as the quality and reproduction of workplaces.
Then in the monograph proposed the methodic of analysis of the labor market subject's characteristics compliance to the innovative development of economy based on the «Pattern» method with the elements of linear scaling.
In this methodic the regional labor market is perceived as a system of municipal (local) components, respectively, conducted the analysis of the innovative orientation (level of development of innovative characteristics) of Bashkortostan Republic labor market subjects in the context of labor markets of urban districts and municipal areas.
The results of testing the proposed methodic allows performing grouping and typologization of situations on the local labor markets in the region by the degree of formation of the innovative characteristics of the labor market subjects, and also allows to identify the characteristics of employees and employers, which received the weak development within the local labor markets of the Bashkortostan Republic
The author offers an original mechanism for increasing the willingness of the employees to the innovative development of regional economic system, as well as the mechanism of activation of innovative processes in the economy through integrated development of the employers innovative characteristics which is a systems of directions of normative-legal, organizational and economic nature and systems of measures and methods of influence on the characteristics of labor market subjects to improve their readiness for implementation of tasks of innovative development of economy.
In addition, the necessary conditions for improving the level of innovative orientation of constituent entities of regional labor market are represented.
Designed for students, postgraduates, employees of scientific research organizations and higher educational institutions, specialists in public administration, who interested in a comprehensive study of the labor market and methods of solving socio-economic problems of the territories through the interaction between employees and employers.