bluuebunny/crossref_metadata_2025 huggingface dataset:
Hemorrhagic Cerebral Vascular Accident with Breakdown of Salt-Wasting Cerebral Syndrome in Acute Lymphoblastic Leukemia: Case Report
Authors: Ferreira Hugo Henrique de Freitas , Silva Alessandra Suelen Jardim , Júnior Lenilton Silva DA Silva , Oliveira Gustavo Henrique de Medeiros , Araujo Maria das Graças Pereira , Soares Victor lima , Bahia Frank , Oliveira Taissa Moura , Silva Dany GKC , Sales Valéria SF , Paiva Aldair Sousa , Cavalcanti Geraldo Barroso
Published: November 2020

Introduction:Cerebral Salt Losing Syndrome (SCLS) is defined as a renal loss of sodium during intracranial disease, leading to hyponatremia and decreased volume of extravascular fluid. Studies show the existence of an association with hemorrhagic stroke (HCV) and SCLS as a complication that significantly contributes to the morbidity and mortality of patients with acute lymphoid leukemia (ALL).Objective:To report a case of a patient with ALL who presented HCV with neurological lesion, showing repercussions in the nervous system through SCPS.Case Description:A 33-year-old female patient was referred to the specialized hematology service, complaining of petechiae spread in the trunk and limbs, high fever, progressive asthenia, generalized pain in addition to nausea and vomiting. Laboratory data showed pancytopenia and IgM and IgG serology reagent for dengue. Cytomorphological examination of peripheral blood showed the presence of 68% of lymphoid blast cells, later confirming by bone marrow aspirate immunophenotyping as a CD10 negative pre-B ALL (pro-B ALL). After the start of chemotherapy treatment, the patient presented episodes of generalized tonic-clonic seizure crisis that were repeated in the two days that followed, in addition to referring to intense paresthesia in the upper limbs and headache and referred to the Intensive Care Unit (ICU). Imaging exams showed heterogeneous right frontal hemorrhage compatible with HCV, and sagittal sinus thrombosis, with an increase in frontal hematoma with deviation of centro medial structures. Subsequently, he presented high urinary output (6,500 mL / 24 hours) with severe polydipsia, in addition to hyponatremia (129), hypouricemia (20) and decreased creatinine (0.3), urinary sodium concentration and urinary osmolarity, evolving with dehydration (+++ / 4+) and hemodynamic instability, establishing the diagnosis of SCPS. After intervention with flourcortisone and hydroelectrolytic replacement, the patient presented an improvement in the condition of SCLS and, with significant clinical improvement, the patient continues on specific cancer treatment, and without neurological sequelae.Conclusion:The correct clinical and laboratory diagnosis allows an early and safe intervention. Knowledge of this clinical entity enables specific treatment and a favorable outcome for the patient.

Disclosures

No relevant conflicts of interest to declare.
The Mechanism of Activated TGF-β1 Inhibiting GVL Effects of Bone Marrow NK Cells Leading to Early Relapse after Transplantation
Authors: Wang Dongyao , Zhu Xiaoyu , Sun Zimin
Published: November 2020

Allogeneic hematopoietic stem-cell transplantation (allo-HSCT) is one of the best ways to cure acute myeloid leukemia (AML). However, patients with AML undergoing allo-HSCT are at risk of relapse, the mechanism remains poorly understood. Here, we demonstrated the significant decrease of nature killer (NK) cells, and the declined proportion of multi-functional effector NK cells in bone marrow from patients who had a relapse in 3 months after allo-HSCT. Furthermore, we verified the levels of activated Transforming growth factor-β1 (TGF-β1), not the total TGF-β1, increased in bone marrow of these patients. This high level activated TGF-β1 was correlated with reduced cytotoxicity of NK cell, and contributed to immune escape of tumor cells. Moreover, the expression of glycoprotein A repetitions predominant (GARP), which is critical to TGF-β1 activation, high expressed in CD4+ T cells of patients who had a relapse. These data reveal a mechanism of immune escape and proposes approaches for therapeutic administration of NK cells in order to reverse suppression of activated TGF-β1 during early allo-HSCT.

Disclosures

No relevant conflicts of interest to declare.
Impaired Hepcidin Metabolism Promotes Hemolysis Induced Hepatobiliary Injury in Sickle Cell Disease
Authors: Vats Ravi , Novelli Enrico M , Sundd Prithu , Gladwin Mark T , Pradhan Tirthadipa
Published: November 2020

Sickle cell disease (SCD) is an autosomal-recessive-genetic disorder that affects millions of people worldwide. Although hepatic crisis affects 10-40% of hospitalized SCD patients and can progress to fatal liver failure, the current treatment is primarily supportive and the molecular pathophysiology remains largely unknown. We found that transgenic, humanized SCD mice developed liver injury with age, manifested by increased inflammation, necrosis and hepatic iron accumulation. The presence of iron particles in SCD liver was confirmed by transmission electron micrograph (TEM) analysis and prussian blue staining which revealed increased iron accumulation in the central and midzonal region of the SCD liver tissue. An increase in aggregates of iron pigment reminiscent of hemosiderin-laden macrophages was also observed in SCD liver tissue. Interestingly, the SCD mice also showed significant enrichment of both hepatic (p=0.02) and serum iron (p=0.04) compared to control AS mice. We determined the expression level of genes commonly involved in iron homeostasis by RT-PCR. Interestingly, a significantly lower expression level of hepcidin transcripts was observed in the hepatocytes of SCD mice compared to control mice (AS) (p=0.01).

In order to define the pathways controllinghepcidintranscription in SCD, we performed an RNA-seq analysis in the liver of SCD mice. Remarkably, our data showed significant misexpression of BMP signaling pathways. Further analysis revealed a significant misexpression in BMP2 and 6 levels in the liver of SCD mice by western blot. Reduced levels of hepcidin were also confirmed in serum samples from SCD patients compared to controls. Work is currently underway to understand how BMP2/6 might hypothetically regulate hepcidin expression in the liver. In summary, our results reveal a significant defect in iron homeostasis in the liver of SCD mice, suggesting that impaired iron homeostasis may contribute to hepatobiliary injury in SCD independent of blood transfusions. Our study also highlights the importance of hepcidin as potential therapeutic target in regulation of hepatic injury in SCD.

Disclosures

No relevant conflicts of interest to declare.
CD4+ T-cell reconstitution predicts survival outcomes after acute graft-versus-host-disease: a dual-center validation
Authors: de Koning Coco , Prockop Susan , van Roessel Ichelle , Kernan Nancy , Klein Elizabeth , Langenhorst Jurgen , Szanto Celina , Belderbos Mirjam , Bierings Marc , Boulad Farid , Bresters Dorine , Cancio Maria , Curran Kevin , Kollen Wouter , O’Reilly Richard , Scaradavou Andromachi , Spitzer Barbara , Versluijs Birgitta , Huitema Alwin , Lindemans Caroline , Nierkens Stefan , Boelens Jaap Jan
Published: November 2020

Acute graft-versus-host-Disease (aGVHD) is a major cause of morbidity and mortality after allogeneic hematopoietic cell transplantation (HCT). We previously showed that early CD4+ T-cell immune reconstitution (IR; CD4+ IR) predicts survival after HCT. Here, we studied the relation between CD4+ IR and survival in patients developing aGVHD. Pediatric patients undergoing first allogeneic HCT at University Medical Center Utrecht (UMC)/Princess Máxima Center (PMC) or Memorial Sloan Kettering Cancer Center (MSK) were included. Primary outcomes were nonrelapse mortality (NRM) and overall survival (OS), stratified for aGVHD and CD4+ IR, defined as ≥50 CD4+ T cells per μL within 100 days after HCT or before aGVHD onset. Multivariate and time-to-event Cox proportional hazards models were applied, and 591 patients (UMC/PMC, n = 276; MSK, n = 315) were included. NRM in patients with grade 3 to 4 aGVHD with or without CD4+ IR within 100 days after HCT was 30% vs 80% (P = .02) at UMC/PMC and 5% vs 67% (P = .02) at MSK. This was associated with lower OS without CD4+ IR (UMC/PMC, 61% vs 20%; P = .04; MSK, 75% vs 33%; P = .12). Inadequate CD4+ IR before aGVHD onset was associated with significantly higher NRM (74% vs 12%; P < .001) and inferior OS (24% vs 78%; P < .001). In this retrospective analysis, we demonstrate that early CD4+ IR, a simple and robust marker predictive of outcomes after HCT, is associated with survival after moderate to severe aGVHD. This association must be confirmed prospectively but suggests strategies to improve T-cell recovery after HCT may influence survival in patients developing aGVHD.
COVID-19 and COPD: a narrative review of the basic science and clinical outcomes
Authors: Higham Andrew , Mathioudakis Alexander , Vestbo Jørgen , Singh Dave
Published: November 2020

The 2019 coronavirus disease (COVID-19) pandemic is caused by severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2). Clinical outcomes, including mortality, are worse in males, older individuals and patients with comorbidities. COPD patients are included in shielding strategies due to their susceptibility to virus-induced exacerbations, compromised pulmonary function and high prevalence of associated comorbidities. Using evidence from basic science and cohort studies, this review addresses key questions concerning COVID-19 and COPD. First, are there mechanisms by which COPD patients are more susceptible to SARS-CoV-2 infection? Secondly, do inhaled corticosteroids offer protection against COVID-19? And, thirdly, what is the evidence regarding clinical outcomes from COVID-19 in COPD patients? This up-to-date review tackles some of the key issues which have significant impact on the long-term outlook for COPD patients in the context of COVID-19.
Effects of the anesthesiologist’s experience on postoperative hoarseness after double-lumen endotracheal tube intubation: a single-center propensity score-matched analysis
Authors: Kamimura Yuji , Nakanishi Toshiyuki , Sato Aiji Boku , Osaga Satoshi , Kako Eisuke , Sobue Kazuya
Published: November 2020

Background

Postoperative hoarseness after general anesthesia is associated with patient discomfort and dissatisfaction. A recent large retrospective study showed that single-lumen endotracheal tube intubation by a trainee did not alter the incidence of postoperative pharyngeal symptoms compared with intubation by a senior anesthesiologist. However, there is limited information about the relationship between the anesthesiologist’s experience and hoarseness after double-lumen endotracheal tube intubation. We tested the hypothesis that double-lumen endotracheal tube intubation performed by a trainee increases the incidence of postoperative hoarseness compared to intubation by a senior anesthesiologist.

Methods

This retrospective observational study included patients who underwent lung resection between April 2015 and March 2018 at a university hospital. Double-lumen endotracheal tube intubation was carried out with a Macintosh laryngoscope. We divided the patients into 2 groups - one group comprised of patients who were intubated by a trainee anesthesiologist with < 2 years of experience, and the other group comprised of those who underwent intubation by a senior anesthesiologist with ≥2 years of experience. The primary outcome was the incidence of postoperative hoarseness 24 h after surgery and we collected data on postoperative hoarseness using a checklist of postanesthetic adverse events. One-to-one propensity score matching was conducted and P values < 0.05 were considered statistically significant.

Results

There was a total of 256 eligible patients, of which 153 underwent intubation by trainee anesthesiologists, and the remaining 103 patients were intubated by a senior anesthesiologist. The one-to-one propensity score matching resulted in 96 pairs of patients for the groups. The incidence of postoperative hoarseness 24 h after surgery was significantly higher in patients who were intubated by a trainee anesthesiologist than in patients who were intubated by a senior anesthesiologist (9.4% vs. 2.1%, respectively; P = 0.03).

Conclusions

Double-lumen endotracheal tube intubation by trainee anesthesiologists with < 2 years of experience increased the incidence of postoperative hoarseness 24 h after surgery compared to intubation by senior anesthesiologists with ≥2 years of experience.
Changes in treatment strategy over time for arteriovenous malformation in a Japanese high-volume center
Authors: Komatsu Katsuya , Takagi Yasushi , Ishii Akira , Kikuchi Takayuki , Yamao Yukihiro , Yoshida Kazumichi , Miyamoto Susumu
Published: November 2020

Background

Despite rapid developments in devices used to treat arteriovenous malformation (AVM), a randomised trial of Unruptured Brain Arteriovenous malformations published in 2014 recommended conservative treatment for nonhemorrhagic AVM. The purpose of the current retrospective study was to confirm how AVM treatment in Japan has changed and to assess the safety of treatment for hemorrhagic and nonhemorrhagic AVMs.

Methods

We enrolled 242 consecutive patients with AVM; each patient’s treatment was selected and performed at our hospital. The type of onset, Spetzler–Martin (S–M) grade, age, sex, selected treatment, mortality, and morbidity were compared between the first and second periods of our study.

Results

In patients with grade I–III AVM, the selected treatment changed between the first and second periods; however, in grade IV and V patients, the selected treatment did not change. Overall, interventions by microsurgery alone decreased (p < 0.001), the proportion of total treatments including microsurgery decreased (p = 0.005), interventions using stereotactic radiosurgery (SRS) alone increased (p = 0.009), and interventions including SRS increased (p = 0.002). Morbidity associated with intervention was 0.92% in the first period and 0% in the second period, and mortality was 0.92% in the first period and 1.67% in the second.

Conclusions

With the development of new devices, the selected treatment was changed in patients with S–M grade I–III AVM, but was not changed in patients with grade IV and V. The complication rate was low and did not change throughout the periods. These findings suggest that the safety of treatment depends on a full understanding of device development and the selection of proper treatment, not on hemorrhagic onset. Further treatment innovations are expected to change the treatment for grade IV and V AVMs.
The South African National HIV Pregnancy Cohort: evaluating continuity of care among women living with HIV
Authors: Clouse Kate , Malope-Kgokong Babatyi , Bor Jacob , Nattey Cornelius , Mudau Maanda , Maskew Mhairi
Published: November 2020

Background

South Africa is home to more people living with HIV than any other country, including nearly one in three pregnant women attending antenatal care. Access to antiretroviral therapy (ART) has increased substantially since the start of the national ART program in 2004, with > 95% ART coverage during pregnancy and delivery, and vertical transmission of HIV greatly reduced. However, women who initiate ART during pregnancy are at heightened risk of dropping out of care, particularly after delivery, leading to the potential for viral transmission, morbidity and mortality. It is difficult to evaluate the success of policies of expanded access to ART care, and assess continuity of care, due to the lack of a national longitudinal HIV care database. Also, patient movement between unlinked facilities. For the first time on a national level, we propose to utilize routinely-collected laboratory data to develop and validate a cohort of pregnant women living with HIV in South Africa in a way that is uniquely robust to facility transfer.

Methods

Using laboratory test data matched to facility type, we will identify entry to antenatal care to build the cohort, then describe key treatment milestones, including 1) engagement in antenatal care, 2) initiation of ART, 3) HIV viremia, and 4) continuity of HIV care in the postpartum period. Second, we will measure the effect of system-wide factors impacting continuity of care among pregnant women. We will assess policies of expanded treatment access on continuity of care using regression-discontinuity analyses. We then will assess mobility and its effect on continuity of care during and after pregnancy. Third, we will identify individual-level risk factors for loss from HIV care in order to develop targeted interventions to improve engagement in HIV care.

Discussion

This work will create the world’s largest national cohort of pregnant women living with HIV. This novel cohort will be a powerful tool available to policymakers, clinicians and researchers for improving our understanding of engagement in care among pregnant women in South Africa and assessing the performance of the South African national ART program in caring for pregnant women living with HIV.

Trial registration

N/A (not a clinical trial).
Antimicrobial activities and mechanism of action of Cymbopogon khasianus (Munro ex Hackel) Bor essential oil
Authors: Singh Gurpreet , Katoch Meenu
Published: November 2020

Background

Due to concerns regarding the safety of the chemical control measures, the trend is shifting globally towards the use of natural compounds as antimicrobial agent especially, plant essential oils.

Results

This study presented the antibacterial potential of Cymbopogon khasianus essential oil (CKEO) against human pathogens: Pseudomonas aeruginosa, Salmonella typhimurium, Escherichia coli, Klebsiella pneumoniae, Bacillus subtilis, Staphylococcus aureus and Candida albicans with MIC ranging from 20 to 100 μg/mL. CKEO, in comparison to its major constituent, geraniol, showed better MICs against tested pathogens. In combination studies, the effective concentrations of CKEO and streptomycin were reduced from 20 to 5 μg/mL and 11 to 0.7 ng/mL against E. coli. This suggests their synergistic action. However, CKEO showed partial synergy with ciprofloxacin. To understand the efficacy of CKEO, time-kill kinetics was performed. CKEO took the half time to show the bactericidal effect in comparison to streptomycin at their 2x MICs (double the MIC), while their combination took only 30 min for this. Fluorescence and surface electron microscopic and protein estimation studies suggested the multi-target action of CKEO-streptomycin combination against E. coli. Further, CKEO alone/in combination exhibited less than 10% haemolytic activity at its MIC.

Conclusion

These results indicate that CKEO is a potentially safe alternative for the treatment of various pathogenic bacterial strains. It could be used for a variety of applications including human health, food storage, aquaculture, etc.
Systematic review and meta-analysis of risk factor for postoperative delirium following spinal surgery
Authors: Zhang Hao Jie , Ma Xue Hai , Ye Jin Biao , Liu Cong Zhi , Zhou Zhi Yang
Published: November 2020

Background

Postoperative delirium is a common psychiatric disorder among patients who undergo spinal surgery. The purpose of current meta-analysis was to assess the potential risk factors related to delirium in spinal surgery.

Methods

We searched the following databases: PubMed, EMBASE, the Cochrane Library, and Web of Science, from inception to July 2020. Two reviewers independently assessed the quality of the included studies using the previously described Newcastle-Ottawa Scale (NOS). We included spinal surgery patients who suffered with delirium or not. Stata 12.0 was used for meta-analysis.

Results

Thirteen trial studies that met our inclusion criteria were incorporated into the meta-analysis. Postoperative delirium was associated with an increase of the duration of hospital stay (P = 0.044) and increased perioperative readmission rate (P = 0.013) and economic costs (P = 0.002). This meta-analysis demonstrates that there were twenty-two risk factors: general characteristic: old age, female patients, history of surgery, diabetes mellitus, hypertension; preoperative data: low hematocrit, low hemoglobin, low albumin, low sodium, depression; operative data: operating time, total blood loss; postoperative data: low sodium, low hemoglobin, low hematocrit, low albumin, fever, low potassium, blood sugar, and visual analog scale (VAS).

Conclusions

Delirium not only prolongs the length of hospital stay, but also increases readmission rate and the economic costs. Several risk factors including old age, female patients, history of surgery, diabetes mellitus, low hematocrit, low hemoglobin, low albumin, low sodium, depression; operative data: operating time, total blood loss, low sodium, low hemoglobin, low hematocrit, low albumin, fever, low potassium, blood sugar, and VAS were significant predictors for postoperative delirium after spinal surgery.
Health-related articles on Syria before and after the start of armed conflict: a scoping review for The Lancet-American University of Beirut Commission on Syria
Authors: Abdul-Khalek Rima A. , Kayyal Walaa , Akkawi Abdul Rahman , Almalla Mohamad , Arif Khurram , Bou-Karroum Lama , El-Harakeh Amena , Elzalabany Manal K. , Fadlallah Racha , Ghaddar Fatima , Kashlan Danna , Kassas Sara , Khater Tania , Mobayed Nisreen , Rahme Dalal , Saifi Omran , Jabbour Samer , El-Jardali Fadi , Akl Elie A. , Jawad Mohammed
Published: November 2020

Introduction

Armed conflict may influence the size and scope of research in Arab countries. We aimed to assess the impact of the 2011 Syrian conflict on health articles about Syria published in indexed journals.

Methods

We conducted a scoping review on Syrian health-related articles using seven electronic databases. We included clinical, biomedical, public health, or health system topics published between 1991 and 2017. We excluded animal studies and studies conducted on Syrian refugees. We used descriptive and social network analyses to assess the differences in rates, types, topics of articles, and authorship before and after 2011, the start of the Syrian conflict.

Results

Of 1138 articles, 826 (72.6%) were published after 2011. Articles published after 2011 were less likely to be primary research; had a greater proportion reporting on mental health (4.6% vs. 10.0%), accidents and injuries (2.3% vs. 18.8%), and conflict and health (1.7% vs. 7.8%) (all p < 0.05); and a lower proportion reporting on child and maternal health (8.1 to 3.6%, p = 0.019). The proportion of research articles reporting no funding increased from 1.1 to 14.6% (p < 0.01). While international collaborations increased over time, the number of articles with no authors affiliated to Syrian institutions overtook those with at least one author affiliation to a Syrian institution for the first time in 2015.

Conclusion

To our knowledge, this is the first study to examine the impact of armed conflict on health scholarship in Syria. The Syrian conflict was associated with a change in the rates, types, and topics of the health-related articles, and authors’ affiliations. Our findings have implications for the prioritization of research funding, development of inclusive research collaborations, and promoting the ethics of conducting research in complex humanitarian settings.
Comprehensive genetic testing combined with citizen science reveals a recently characterized ancient MC1R mutation associated with partial recessive red phenotypes in dog
Authors: Anderson Heidi , Honkanen Leena , Ruotanen Päivi , Mathlin Julia , Donner Jonas
Published: November 2020

Background

The Melanocortin 1 Receptor (MC1R) plays a central role in regulation of coat color determination in various species and is commonly referred to as the “E (extension) Locus”. Allelic variation of theMC1Rgene is associated with coat color phenotypesEM(melanistic mask),EG(grizzle/domino) ande1–3(recessive red) in dogs. In addition, a previous study of archeological dog specimens over 10,000 years of age identified a variant p.R301C in theMC1Rgene that may have influenced coat color of early dogs.

Results

Commercial genotyping of 11,750 dog samples showed the R301C variant of theMC1Rgene was present in 35 breeds or breed varieties, at an allele frequency of 1.5% in the tested population. We detected no linkage disequilibrium between R301C and other tested alleles of the E locus. Based on current convention we propose that R301C should be considered a novel allele of the E locus, which we have termedeAfor “e ancient red”. Phenotype analysis of owner-provided dog pictures reveals that theeAallele has an impact on coat color and is recessive to wild typeEand dominant to theealleles. In dominant black (KB/*) dogs it can prevent the phenotypic expression of the K locus, and the expressed coat color is solely determined by the A locus. In the absence of dominant black,eA/eAandeA/egenotypes result in the coat color patterns referred to in their respective breed communities as domino in Alaskan Malamute and other Spitz breeds, grizzle in Chihuahua, and pied in Beagle.

Conclusions

This study demonstrates a large genotype screening effort to identify the frequency and distribution of theMC1RR301C variant, one of the earliest mutations captured by canine domestication, and citizen science empowered characterization of its impact on coat color.
Augmented wealth in Switzerland: the influence of pension wealth on wealth inequality
Authors: Kuhn Ursina
Published: November 2020

Entitlements for social security and occupational pensions present a major wealth component and play a central role for financial security. However, most individual-level data lacks information on pension wealth. By linking various data sources, this contribution estimates the present value of future pension entitlements in Switzerland for statutory pensions, occupational pensions and third pillar accounts and analyses the distribution of augmented wealth, which combines pension wealth and net worth. The CH-SILC survey from 2015 is used to estimate real assets, financial assets and pension wealth of retired individuals. The pension entitlements of non-retired individuals are simulated on the basis of their earning history from administrative records following the accrual method and assuming a real discount rate of 2%. When pension wealth is added to net worth, average wealth doubles, and the Gini-coefficient declines by 26%. The equalising effect is particularly strong for social security pensions. The wealth distribution differs strongly between the three pillars of the pension system; there are also strong differences between gender and age groups. In Switzerland, wealth accumulation continues after retirement age.
Adverse drug reactions associated with treatment in patients with chronic rheumatic diseases in childhood: a retrospective real life review of a single center cohort
Authors: Said Manar Amanouil , Silva Liana Soido Teixeira e , de Oliveira Rocha Aline Maria , Alves Gustavo Guimarães Barreto , Piotto Daniela Gerent Petry , Len Claudio Arnaldo , Terreri Maria Teresa
Published: November 2020

Background

Adverse drug reactions (ADRs) are the sixth leading causes of death worldwide; monitoring them is fundamental, especially in patients with disorders like chronic rheumatic diseases (CRDs). The study aimed to describe the ADRs investigating their severity and associated factors and resulting interventions in pediatric patients with CRDs.

Methods

A retrospective, descriptive and analytical study was conducted on a cohort of children and adolescents with juvenile idiopathic arthritis (JIA), juvenile systemic lupus erythematosus (JSLE) and juvenile dermatomyositis (JDM). The study evaluated medical records of the patients to determine the causality and the management of ADRs. In order to investigate the risk factors that would increase the risk of ADRs, a logistic regression model was carried out on a group of patients treated with the main used drug.

Results

We observed 949 ADRs in 547 patients studied. Methotrexate (MTX) was the most frequently used medication and also the cause of the most ADRs, which occurred in 63.3% of patients, followed by glucocorticoids (GCs). Comparing synthetic disease-modifying anti-rheumatic drugs (sDMARDs) vs biologic disease-modifying anti-rheumatic drugs (bDMARDs), the ADRs attributed to the former were by far higher than the latter. In general, the severity of ADRs was moderate and manageable. Drug withdrawal occurred in almost a quarter of the cases. In terms of risk factors, most patients who experienced ADRs due to MTX, were 16 years old or younger and received MTX in doses equal or higher than 0.6 mg/kg/week. Patients with JIA and JDM had a lower risk of ADRs than patients with JSLE. In the multiple regression model, the use of GCs for over 6 months led to an increase of 0.5% in the number of ADRs.

Conclusions

Although the ADRs highly likely affect a wide range of children and adolescents with CRDs they were considered moderate and manageable cases mostly. However, triggers of ADRs need further investigations.
Effects of febrile seizures in mesial temporal lobe epilepsy with hippocampal sclerosis on gene expression using bioinformatical analysis
Authors: Li Yinchao , Wang Chengzhe , Wang Peiling , Li Xi , Zhou Liemin
Published: November 2020

Background

To investigate the effect of long-term febrile convulsions on gene expression in mesial temporal lobe epilepsy with hippocampal sclerosis (MTLE-HS) and explore the molecular mechanism of MTLE-HS.

Methods

Microarray data of MTLE-HS were obtained from the Gene Expression Omnibus database. Differentially expressed genes (DEGs) between MTLE-HS with and without febrile seizure history were screened by the GEO2R software. Pathway enrichment and gene ontology of the DEGs were analyzed using the DAVID online database and FunRich software. Protein–protein interaction (PPI) networks among DEGs were constructed using the STRING database and analyzed by Cytoscape.

Results

A total of 515 DEGs were identified in MTLE-HS samples with a febrile seizure history compared to MTLE-HS samples without febrile seizure, including 25 down-regulated and 490 up-regulated genes. These DEGs were expressed mostly in plasma membrane and synaptic vesicles. The major molecular functions of those genes were voltage-gated ion channel activity, extracellular ligand-gated ion channel activity and calcium ion binding. The DEGs were mainly involved in biological pathways of cell communication signal transduction and transport. Five genes (SNAP25, SLC32A1, SYN1, GRIN1,andGRIA1) were significantly expressed in the MTLE-HS with prolonged febrile seizures.

Conclusion

The pathogenesis of MTLE-HS involves multiple genes, and prolonged febrile seizures could cause differential expression of genes. Thus, investigations of those genes may provide a new perspective into the mechanism of MTLE-HS.
EGFR/ErbB2-Targeting Lapatinib Therapy for Aggressive Prolactinomas
Authors: Cooper Odelia , Bonert Vivien S , Rudnick Jeremy , Pressman Barry D , Lo Janet , Salvatori Roberto , Yuen Kevin C J , Fleseriu Maria , Melmed Shlomo
Published: November 2020

Context

Approximately 10% to 20% of prolactinomas are resistant to dopamine agonist therapy. The ErbB signaling pathway may drive aggressive prolactinoma behavior.

Objective

We evaluated lapatinib, an ErbB1-epidermal growth factor receptor (EGFR)/ErbB2 or human EGFR2 (HER2) tyrosine kinase inhibitor (TKI), in aggressive prolactinomas.

Design

A prospective, phase 2a multicenter trial was conducted.

Setting

This study took place at a tertiary referral pituitary center.

Patients

Study participants included adults with aggressive prolactinomas showing continued tumor growth despite maximally tolerated dopamine agonist therapy.

Intervention

Intervention included oral lapatinib 1250 mg/day for 6 months.

Main Outcome Measures

The primary end point was 40% reduction in any tumor dimension assessed by magnetic resonance imaging at study end; tumor response was assessed by Response Evaluation Criteria in Solid Tumors criteria. Secondary end points included prolactin (PRL) reduction, correlation of response with EGFR/HER2 expression, and safety.

Results

Owing to rigorous inclusion criteria, of 24 planned participants, only 7 consented and 4 were treated. None achieved the primary end point but 3 showed stable disease, including 2 with a 6% increase and 1 with a 16.8% decrease in tumor diameter. PRL response was not always concordant with tumor response, as 2 showed 28% and 59% increases in PRL. The fourth participant had a PRL-secreting carcinoma and withdrew after 3 months of lapatinib because of imaging and PRL progression. EGFR/HER2 expression did not correlate with treatment response. Lapatinib was well tolerated overall, with reversible grade 1 transaminitis in 2 patients, grade 2 rash in 2 patients, and grade 1 asymptomatic bradycardia in 2 patients.

Conclusions

An oral TKI such as lapatinib may be an effective option for a difficult-to-treat patient with an aggressive prolactinoma.
Bone Mineral Density and Turnover After Sleeve Gastrectomy and Gastric Bypass: A Randomized Controlled Trial (Oseberg)
Authors: Hofsø Dag , Hillestad Thor Olav Widerøe , Halvorsen Erling , Fatima Farhat , Johnson Line Kristin , Lindberg Morten , Svanevik Marius , Sandbu Rune , Hjelmesæth Jøran
Published: November 2020

Context

Bariatric surgery, particularly Roux-en-Y gastric bypass (RYGB), is associated with an increased risk of osteoporotic fractures. It is unknown whether RYGB or sleeve gastrectomy (SG) have different effects on bone health.

Objective

To compare changes in bone mineral density and markers of bone turnover 1 year after SG and RYGB.

Design, Setting, Patients, and Interventions

Randomized, triple-blind, single-center trial at a tertiary care center in Norway. The primary outcome was diabetes remission. Patients with severe obesity and type 2 diabetes were randomized and allocated (1:1) to SG or RYGB.

Main Outcome Measures

Changes in areal bone mineral density (aBMD) and bone turnover markers.

Results

Femoral neck, total hip, and lumbar spine aBMD, but not total body aBMD, decreased significantly more after RYGB (n = 44) than after SG (n = 48) (mean [95% confidence interval] between group differences -2.8% [-4.7 to -0.8], -3.0% [-5.0 to -0.9], -4.2% [-6.4 to -2.1], and -0.5% [-1.6 to 0.6], respectively). The increase in procollagen type 1 N-terminal propeptide (P1NP) and C-telopeptide of type I collagen (CTX-1) were approximately 100% higher after RYGB than after SG (between group difference at 1 year, both P < 0.001). The changes in femoral neck, total hip, and lumbar spine aBMDs and the changes in P1NP and CTX-1 were independently associated with the surgical procedure (all P < 0.05) and not weight change.

Conclusions

Roux-en-Y gastric bypass was associated with a greater reduction in aBMD and a greater increase in bone turnover markers compared with SG. This finding could suggest greater skeletal fragility after RYGB.
Adrenal Cushing Syndrome Diagnosed During Pregnancy: Successful Medical Management With Metyrapone
Authors: Azzola Alescia , Eastabrook Genevieve , Matsui Doreen , Berberich Amanda , Tirona Rommel G , Gray Daryl , Gallego Patricia , Van Uum Stan
Published: November 2020

Adrenal Cushing syndrome during pregnancy is rare, and there is limited information on the effect and safety of metyrapone treatment both for mother and fetus. We present a 24-year-old woman diagnosed with adrenal Cushing syndrome at the end of the second trimester. We elected treatment with metyrapone titrated to 250 mg 3 times daily, resulting in good clinical response and maternal serum and saliva cortisol levels in the upper half of the normal pregnancy range. A healthy male infant was born at 35 weeks’ gestation, with no clinical signs of adrenal insufficiency, this despite a low cortisol of 5 nmol/L on the first day of life. We measured metyrapone in maternal and umbilical cord blood samples, demonstrating fetal venous metyrapone levels similar to maternal venous concentration, and a fetal arterial cord concentration at about 60% of the fetal venous cord concentration. This case demonstrates that salivary cortisol levels may be used to monitor the effect of metyrapone on adrenal Cushing syndrome during pregnancy. We show, for the first time in humans, that metyrapone does cross the placenta and may suppress fetal cortisol production without necessarily causing clinical signs of adrenal insufficiency.
Toward an Affective Political Ecology of Obesity
Authors: Abbots Emma-Jayne , Eli Karin , Ulijaszek Stanley
Published: November 2020

This article argues for an affective approach to obesity that destabilizes the conceptual boundaries between the biological and the social aspects of food, eating, and fatness. Its approach foregrounds visceral experience, attends to food both inside and outside the body, and explores how bodies labeled “obese” consume their political, economic, and material environments. This approach is termed affective political ecology. The authors’ aim is to draw attention to how the entanglements between the physiological and social aspects of eating tend to be absented from antiobesity public health rhetoric. By exploring a range of ethnographic examples in high-income countries, they illuminate how such interventions often fail to account for the complex interplays between subjective corporeal experience and political economic relations and contend that overlooking an individual’s visceral relationship with food counterproductively augments social stigma, stresses, and painful emotions. They demonstrate, then, how an approach that draws together political economic and biomedical perspectives better reflects the lived experience of eating. In so doing, the authors aim to indicate how attending to affective political ecologies can further our understanding of the consumption practices of those in precarious and stressful social contexts, and they offer additional insight into how the entanglement of the biological and the social is experienced in everyday life.
A rapid review and meta-analysis of the asymptomatic proportion of PCR-confirmed SARS-CoV-2 infections in community settings
Authors: Beale Sarah , Hayward Andrew , Shallcross Laura , Aldridge Robert W. , Fragaszy Ellen
Published: November 2020

Background: Cross-sectional studies indicate that up to 80% of active SARS-CoV-2 infections may be asymptomatic. However, accurate estimates of the asymptomatic proportion require systematic detection and follow-up to differentiate between truly asymptomatic and pre-symptomatic cases. We conducted a rapid review and meta-analysis of the asymptomatic proportion of PCR-confirmed SARS-CoV-2 infections based on methodologically appropriate studies in community settings.

Methods: We searched Medline and EMBASE for peer-reviewed articles, and BioRxiv and MedRxiv for pre-prints published before 25/08/2020. We included studies based in community settings that involved systematic PCR testing on participants and follow-up symptom monitoring regardless of symptom status. We extracted data on study characteristics, frequencies of PCR-confirmed infections by symptom status, and (if available) cycle threshold/genome copy number values and/or duration of viral shedding by symptom status, and age of asymptomatic versus (pre)symptomatic cases. We computed estimates of the asymptomatic proportion and 95% confidence intervals for each study and overall using random effect meta-analysis. 

Results: We screened 1138 studies and included 21. The pooled asymptomatic proportion of SARS-CoV-2 infections was 23% (95% CI 16%-30%). When stratified by testing context, the asymptomatic proportion ranged from 6% (95% CI 0-17%) for household contacts to 47% (95% CI 21-75%) for non-outbreak point prevalence surveys with follow-up symptom monitoring. Estimates of viral load and duration of viral shedding appeared to be similar for asymptomatic and symptomatic cases based on available data, though detailed reporting of viral load and natural history of viral shedding by symptom status were limited. Evidence into the relationship between age and symptom status was inconclusive.

Conclusion: Asymptomatic viral shedding comprises a substantial minority of SARS-CoV-2 infections when estimated using methodologically appropriate studies. Further investigation into variation in the asymptomatic proportion by testing context, the degree and duration of infectiousness for asymptomatic infections, and demographic predictors of symptom status are warranted.
Staff Satisfaction Management
Authors: Skripnichenko L.
Published: November 2020

Dynamically changing conditions for the development of society, transformations taking place both in the internal and external environment of the organization, have a significant impact on the processes of personnel management. Each employee contributes to the end result of the enterprise. Employee satisfaction affects the competitiveness of the company, its stability in a crisis, the ability to take a leading position in changes in the market economy. Staff satisfaction is one of the key factors for the stable functioning of the company. The more employees are satisfied with their work space, functional duties, organization, nature and content of work, material and intangible incentives, advancement on the career ladder, labor collective, the more effective their work in the organization will become. Also, among the factors affecting the satisfaction of staff work, one can distinguish the qualification of an employee, his individual characteristics, gender, age, length of service.

The person in the organization acts as the most important resource in which it is necessary to invest a special type of investment in the form of remuneration, providing opportunities for the development and improvement of professional skills, creating comfortable working conditions. The need to understand the mechanisms that drive a person, affect his satisfaction with labor and then encourage him to develop and have led to this study.
Using Polygraph Screening As a Tool of the Company’s Personnel Security
Authors: Myasischeva E. , Konovalova O. , Konovalova Valeriya
Published: November 2020

Based on the generalization of domestic and foreign studies, the article analyzes the possibilities and prospects of using the psychophysiological study of polygraph personnel to solve the problem of personnel security in an organization. The main schools of using the polygraph and modern spheres of its application are highlighted, including in commercial organizations. It is shown that the use of a polygraph is a tool for obtaining the necessary additional information when hiring an employee, as well as a tool for preventing his deviant behavior (in particular, the polygraph allows identifying employees who use the company's property for personal purposes, who ignore their job responsibilities, violate business processes that communicate rudely with the company's customers, various thefts, thefts, taking bribes from suppliers, embezzlement of money, forgery of financial and reporting documents and other hidden violations). The technique of using a polygraph in the recruitment process is presented. The article discusses the limitations of using the results of printing research, which must be taken into account in practice, including the following: the results are probabilistic in nature, are indirect evidence of involvement in the identified violations, can be used as a vector for further research, and also as an additional source of data in cases of asymmetry information (for example, when hiring), the verification procedure can be used as a measure to prevent future corporate offenses or other damage to the company due to the low competence of the hired employee.
Video Cartoons and Task-Induced Involvement: Effects to Pupils’ L2 Incidental Literacy Acquisition
Authors: Arabiana Elaiza Flor S. , Malifer Dayvin Adrian Ember A. , Betonio Helen Ranoco
Published: November 2020

While most studies that explored children’s incidental literacy acquisition focused on input from written text, this quantitative-qualitative study investigated the effects of using audio-visual input through close-captioned Aesop’s Fables cartoons from PinkFong and Task-Induced Involvement (n=6 eight-year old pupils). Wilcoxon Signed Rank Test reveals that there is a significant difference in the pretest, immediate posttest and delayed posttests scores after the intervention as shown in the 90%-95% confidence level. This study also examines quantitatively the interconnectedness of the four areas of children’s literacy skills: vocabulary, oral vocabulary and pronunciation, orthographic skill and comprehension after watching cartoons and engaging in tasks. Findings reveal a high correlation between the four literacy skills reflected as 95% confidence intervals. These findings reveal that incidental literacy acquisition is approached holistictically: the acquisition of one skill leads to the acquisition of the other literacy skills.
Small animal Review
Authors: Tennant Bryn
Published: November 2020

Introduction: In this month's Small Animal Review we consider three recently published papers from other veterinary journals. The papers summarised focus on antimicrobials in reptiles, a novel polyneuropathy in huskies and clinical signs in dogs presenting with hyperaesthesia.
REVIEWS
Authors: Davis Emma
Published: November 2020

Professional books are enjoying a new premium as early years practitioners demonstrate their thirst for knowledge and guidance to help them navigate a world changed by Covid.
The show must go on
Authors: Hart Karen
Published: November 2020

As a performance storyteller for children of all ages, Craig Jenkins had to shift his performances online when coronavirus struck. He tells Karen Hart how these sessions swiftly sold out and how this has fuelled his plans for the future.
Sounding it out
Authors: Hewson Claire
Published: November 2020

Encourage children to use their senses to describe the animals and the noises they make in the book Polar Bear, Polar Bear, What Do You Hear? and observe how this helps them to develop their phonological awareness and early reading.
ANALYSIS OF THE LONGITUDINAL DISTRIBUTION OF TOMATO SEEDLINGS TRANSPLANTED AS A FUNCTION OF OPERATIONAL SPEED
Authors: Machado Túlio de Almeida , De Medeiros Hiago Henrique Moreira , Da Silva Ricardo Pereira , Santos Fábio Lúcio , Cunha João Paulo Barreto
Published: November 2020

The semi-mechanized transplanting of industrial tomato seedlings has become a viable alternative for the farmers. The aim of this work was to evaluate the influence of operating speed in the transplanting process of tomato seedlings. The work was conducted in a commercial area with 58 ha irrigated by a center pivot. The operating speeds evaluated were of 1.62; 3.15 and 4.00 km h-1, being the measurement of the distribution and the number of transplanted seedlings carried out after the passage of the mechanized set. The means of the distances between seedlings determined at each operating speed, before and after the passing on, were analyzed by Tukey test at 5% probability. For lower operating speeds of transplanting, it was observed a greater distance between the seedlings.
Eye-box extended retinal projection type near-eye display with multiple
independent viewpoints [Invited]
Authors: Jo Youngjin , Yoo Chanhyung , Bang Kiseung , Lee Byounghyo , Lee Byoungho
Published: November 2020

We introduce an approach to expand the eye-box in a
retinal-projection-based near-eye display. The retinal projection
display has the advantage of providing clear images in a wide depth
range; however, it has difficulty in practical use with a narrow
eye-box. Here, we propose a method to enhance the eye-box of the
retinal projection display by generating multiple independent
viewpoints, maintaining a wide depth of field. The method prevents
images projected from multiple viewpoints from overlapping one other
in the retina. As a result, our proposed system can provide a
continuous image over a wide viewing angle without an eye tracker or
image update. We discuss the optical design for the proposed method
and verify its feasibility through simulation and experiment.