bluuebunny/crossref_metadata_2025 huggingface dataset:
Nonvascularized Toe Joint Transfers to the Hand in Young Children: Technique Revisited
Authors: Trost Jeffrey G. , Kaufman Matthew , Netscher David T.
Published: August 2020

Background:

Small joint reconstruction of the hand poses a significant challenge, especially in children where both functional motion and preservation of the epiphysis are desired. Auto-transplantation of whole joints is the only way to reconstruct a functional joint that maintains growth potential. Historically, nonvascularized toe-to-finger joint transfer has been criticized for high rates of avascular necrosis and joint dissolution, while vascularized transfers seemingly resulted in increased durability of the joint space and epiphysis. However, certain populations remain poor candidates for microvascular reconstruction, such as those with congenital deformities or sequelae from trauma or infection. In our case series, we demonstrate that a simplified nonvascularized surgical technique and careful patient selection can produce stable, functional joints.

Methods:

Nonvascularized toe-to-finger joint transfer was performed in 3 children between the ages of 4 and 6. Reconstructed joints included 2 proximal interphalangeal (PIP) joints and 1 metacarpophalangeal (MCP) joint. Donor grafts consisted of second toe PIP joints harvested en bloc to include the epiphysis of the middle phalanx, collateral ligaments, volar plate, and a diamond-shaped island of extensor tendon with its central slip attachment.

Results:

Follow-up ranged from 7 to 29 months. Each patient demonstrated functional improvements in joint motion and stability. Postoperative radiographs confirmed adequate joint alignment and persistence of the joint spaces. Epiphyseal closure was observed in 1 patient as early as 25 months postoperatively.

Conclusions:

Nonvascularized joint transfer should remain a practical consideration for small joint reconstruction of the hand in certain pediatric patients.
A method for fault diagnosis in evolving environment using unlabeled data
Authors: Hu Yang , Baraldi Piero , Maio Francesco Di , Liu Jie , Zio Enrico
Published: August 2020

Industrial components and systems typically operate in an evolving environment characterized by modifications of the working conditions. Methods for diagnosing faults in components and systems must, therefore, be capable of adapting to the changings in the environment of operation. In this work, we propose a novel fault diagnostic method based on the compacted object sample extraction algorithm for fault diagnostics in an evolving environment from where unlabeled data are collected. The developed diagnostic method is shown able to correctly classify data taken from synthetic and real-world case studies.
Multi-objective optimization of job shops with automated guided vehicles: A non-dominated sorting cuckoo search algorithm
Authors: Karimi Behzad , Niaki Seyed Taghi Akhavan , Niknamfar Amir Hossein , Hassanlu Mahsa Gareh
Published: August 2020

The reliability of machinery and automated guided vehicle has been one of the most important challenges to enhance production efficiency in several manufacturing systems. Reliability improvement would result in a simultaneous reduction of both production times and transportation costs of the materials, especially in automated guided vehicles. This article aims to conduct a practical multi-objective reliability optimization model for both automated guided vehicles and the machinery involved in a job-shop manufacturing system, where different machines and the storage area through some parallel automated guided vehicles handle materials, parts, and other production needs. While similar machines in each shop are limited to failures based on either an Exponential or a Weibull distribution via a constant rate, the machines in different shops fail based on different failure rates. Meanwhile, as the model does not contain any closed-form equation to measure the machine reliability in the case of Weibull failure, a simulation approach is employed to estimate the shop reliability to be further maximized using the proposed model. Besides, the automated guided vehicles are restricted to failures according to an Exponential distribution. Furthermore, choosing the best locations of the shops is proposed among some potential places. The proposed NP-Hard problem is then solved by designing a novel non-dominated sorting cuckoo search algorithm. Furthermore, a multi-objective teaching-learning-based optimization, as well as a multi-objective invasive weed optimization are designed to validate the results obtained. Ultimately, a novel AHP-TOPSIS method is carried out to rank the algorithms in terms of six performance metrics.
Exceptional response to nivolumab of a heavily pre-treated patient with metastatic renal-cell cancer: from a case report to molecular investigation and future perspectives
Authors: Dimitrakopoulos Foteinos-Ioannis D. , Kourea Eleni , Nasioulas George , Papadopoulou Eirini , Nikolakopoulos Achilles , Spyropoulou Despoina , Kottorou Anastasia , Karatzas Andreas , Kalofonos Haralabos P. , Koutras Angelos
Published: August 2020

Immunotherapy may result in long-lasting exceptional clinical responses, the molecular background of which is inadequately understood. Here, we present the case of a 63-year-old patient with a past medical history of renal cancer who relapsed many years later. Several treatment lines were administered prior to immunotherapy, which was administered in the ninth line, achieving complete remission which had lasted for more than 3 years. Genomic alterations, tumor mutational burden (TMB), and microsatellite instability as well as PD-L1, MLH1, MSH2, MSH6, PMS2, CD3, CD8, CD20, CD138, CD1a, and FoxP3 expression were assessed in primary and metastatic tumors. Primary and metastatic tumors were microsatellite stable with high TMB, while somatic mutations in MLH1 and TP53 genes were detected, respectively. Although the primary tumor was negative for PD-L1 expression, the lung metastasis was positive. Interestingly, metastasis displayed a dramatically increased infiltration by CD1a-positive dendritic cells in addition to increased CD3+ and CD8+ cytotoxic T cells. Increased infiltration of the metastatic tumor by CD1a+ antigen presenting cells warrants further investigation to assess its potential predictive value.
Basal Testosterone Renders Individuals More Receptive to Minority Positions
Authors: Germar Markus , Mojzisch Andreas
Published: August 2020

Social influence is an inevitable part of human social interaction. Although past research has demonstrated that testosterone has a key role in social interaction, no study has examined its role in social influence so far. Building on previous research showing that minority positions are perceived as risky options and that testosterone is positively associated with status seeking and risk-taking, we hypothesized that basal testosterone renders individuals more receptive to minority positions. In two studies, participants (total N = 250) read messages that were supported by either a numerical majority or minority. As hypothesized, individuals’ levels of basal testosterone were positively related to susceptibility to minority influence. In contrast, susceptibility to majority influence was unaffected by basal testosterone. Given the importance of minorities for innovation and change within societies, our results suggest that individuals with high levels of testosterone may play an important role as catalysts of social change.
COVID-19 and Health Code: How Digital Platforms Tackle the Pandemic in China
Authors: Liang Fan
Published: August 2020

As COVID-19 is rapidly spreading around the world, some countries have launched or plan to implement contact-tracing apps to detect exposure risks. In China, the government relies on Health Code, developed by Alipay and WeChat, for identifying people potentially exposed to COVID-19. The color-based code can determine people’s exposure risks and freedom of movement based on factors like travel history, duration of time spent in risky areas, and relationships to potential carriers. This essay discusses the rise of Health Code from a platform perspective, arguing that digital platforms are key players conducting health surveillance and mediating state–citizen relations in China. More importantly, tracing apps might become a normal practice in many countries, suggesting that platforms will be substantially adopted for health surveillance.
Assessment of Key Performance Indicators of the Primary Health Care in Oman: A Cross-Sectional Observational Study
Authors: Al Rashidi Badria , Al Wahaibi Ahmed H. , Mahomed Ozayr , Al Afifi Zainab , Al Awaidy Salah
Published: August 2020

Objective

Effective primary health care (PHC) is the key to attaining universal health coverage. The key performance indicators (KPIs), is a component of quality improvement in the PHC service sector that provides feedback to inform and better public service delivery and promoting accountability. We assessed the current performance of PHC service by using KPIs to identify the possible challenges that necessitate being confronted, highlight the lessons learnt, and propose steps towards improvements.

Methods

We conducted a cross-sectional observational study across 12 PHC centers in 6 governorates in Oman during the period of June 2017 to June 2018. Secondary data from the computerized medical records of the PHC centers on six key indicators, accessibility, workload, outcomes, timeliness, satisfaction, and safety were analysed to assess the performance of PHC service and to identify challenges confronted and propose steps towards further service improvement.

Results

The mean overall KPIs scores across the ten PHC centers were 174.5 (SD: 9.80) or 67.01%. The overall scores were normally distributed with a median score of 175 (IQR: 171-181). The lowest percentage score was obtained by Al Qabil (61.35%) with the highest mark being at Wadi Kabir (70.54%). The mean score across all KPIs was 3.84 (SD:0.94) with a median score of 3.9 (IQR: 3.43-4.5). Of the six KPI components, safety (4.85), satisfaction (4.67), timeliness (4.44), and accessibility (4.31) had the highest performance scores, whilst workload (4.15) and outcomes (3.75) lagged behind.

Conclusions

Performance across the KPIs exhibited a considerable variation between facilities, with workload and outcome performing lower than other components. The findings of this study offered a measure of internal strengths that need to be sustained, challenges that require quality improvement initiatives, and external factors such as social determinants that impact overall performance PHC.
A Systematic Review of Antibiotic Prophylaxis for Delayed Sternal Closure in Children
Authors: Kennedy John T. , DiLeonardo Olivia , Hurtado Christopher G. , Nelson Jennifer S.
Published: August 2020

Antibiotic prophylaxis following delayed sternal closure in pediatric cardiac surgery is not standardized. We systematically reviewed relevant literature published between 1990 and 2019 to aid future trial design. Patient characteristics, antimicrobial prophylaxis regimens, and postoperative incidence of infection were collected. Twenty-eight studies described 36 different regimens in over 3,000 patients. There were 11 single-drug regimens and 25 multidrug regimens. Cefazolin-only was the most common regimen (9/36, 25%). The overall incidence of surgical site infection was 7.5% (217/2,910 patients) and bloodstream infection was 7.4% (123/1,667 patients). In the 2010s, multidrug regimens were associated with a significantly lower incidence of both surgical site infections (4.6% vs. 20%, P < .001) and bloodstream infections (6.0% vs. 50%, P < .001) compared to single-drug regimens.
Reproductive Health Issues
Authors: Hunt Patricia E.
Published: August 2020

Occupational health nurses and other health professionals are at the forefront of the issues of reproductive health in the workplace. Many complexities are involved, and the best information available may be inconclusive. Thus, these issues represent a challenging area where occupational health nurses can make important contributions.

A great accountability for communication about reproductive toxins falls on occupational health professionals. They must make every effort to be knowledgeable, to control workplace risks for everyone, and to educate and counsel employees on reproductive issues in the workplace.
Educating Blue Collar Workers
Authors: Pugh Nancy S.
Published: August 2020

The nurse who meets with workers to share practical information about safe work practices, health maintenance, and home safety has the privilege of working to make a difference in their lives. On each return visit to the workplace, the messages can be strengthened and reinforced by using appropriate intervention strategies.

The workplace offers a fertile field for effective health education for blue collar workers. Health education can provide useful information and develop within blue collar workers a sense of empowerment that they have the capacity to develop and use improved health behaviors. Education based on workers’ value system, interests, and strengths will be the most likely to influence lifestyle choices.
Occupational Health Nursing in Finland
Authors: Komulainen Pirkko
Published: August 2020

In Finland occupational health services are stipulated by the law. The services are primarily directed at preventive measures and the achievement of a better working environment. The coverage of occupational health services is about 90%. Occupational health nurses are public health nurses in Finland. Moreover, they have the opportunity to have 4 weeks’ complementary schooling and postgraduate education from universities or nursing colleges.

There are about 1,900 occupational health nurses in Finland. On the one hand occupational health nurses work independently; on the other hand, they work as a member of a team. Their work consists of environmental surveys and health education (based on working conditions and health habits), including first aid training, health examination, counseling, and treatment in case of illness.
Managing Time
Authors: Wachs Joy E.
Published: August 2020

Managing time puts the occupational health nurse manager in control of health services and personal goals. Articulating those goals and appropriately delegating some of the outcomes needed to meet those goals should result in accomplishing the goals in less time. Strategies to control time expenditures on a daily basis include developing a “to do” list, avoiding procrastination, time wasters, and paper shuffling, creating an environment conducive to work, and rewarding self and staff for a job well done.
Thoracic Computed Tomography Scan and Bronchoscopy Appearance of Mounier-Kuhn Syndrome: A Case Report
Authors: Fernández-Trujillo Liliana , Sangiovanni Saveria , Morales Eliana Isabel , Sua Luz Fernanda , García Carlos Alejandro
Published: August 2020

Mounier-Kuhn syndrome (MKS) is a rare congenital disease with an autosomal recessive inheritance pattern, characterized by an enlargement of the trachea and bronchi. MKS is secondary to a thinning of the muscular mucosa and atrophy of the longitudinal muscle and elastic fibers of the tracheobronchial tree. As a consequence, tracheal diverticulosis and dilatations in the posterior membranous wall appear, along with bronchiectasis that tend to be cystic in appearance. Overall, there is an impairment of mucocilliary clearance, with an ineffective cough, which predisposes the patient to recurrent lower respiratory tract infections. Clinical manifestations vary from asymptomatic to respiratory failure and death, most patients being diagnosed between the third and fourth decades of life. It is an often undiagnosed disease, with a diagnostic algorithm that includes the use of radiological techniques, alone or in combination with bronchoscopy. Specific diagnostic criteria have been developed, based on patients’ tracheal and main bronchi diameter on chest X-ray and thoracic computed tomography scan. We present the case of a 45-year-old African American man who presented with a history of multiples episodes of pneumonia that required management in the intensive care unit, on whom MKS was diagnosed.
The Impact of Bilateral Suprazygomatic Maxillary Nerve Blocks on Postoperative Pain Control in Patients Undergoing Orthognathic Surgery
Authors: Nores Gabriela D. Garcia , Cuzzone Daniel A. , Hush Stefanie E. , Pandya Kalyani , Stuart Adam , Williams Joseph K. , Brady Colin M.
Published: August 2020

Aims: The mainstay of analgesia in orthognathic interventions for maxillary hypoplasia is perioperative opioids, however, the side effect profile is broad with the potential for well-described deleterious effects. The suprazygomatic maxillary nerve block has been previously shown to be effective in decreasing pain associated with palatal surgery. To date, there have been no studies detailing the use of maxillary nerve blocks as an adjunctive pain control measure during correction of maxillary hypoplasia. Consequently, we sought to evaluate the efficacy of intra-operative, ultrasound-guided bilateral suprazygomatic maxillary nerve blockade in decreasing postoperative narcotic consumption in patients undergoing Le Fort I level surgical orthognathic correction of cleft-related maxillary hypoplasia. Methods: Between January and December 2019, patients underdoing suprazygomatic maxillary nerve blockade for orthognathic correction of maxillary hypoplasia via either Le Fort I advancement or distraction were prospectively collected and compared to controls. Patient demographics, narcotic use (represented as morphine milligram equivalents per kg; MME/kg), self-reported pain scales, operative times, length of stay (LOS), and complication rates were compared. Results: Over the 12-month interval, 40 patients met inclusion criteria (n = 19 Block; n = 21 Control). Mean ages were 15.6 and 15.9 years, respectively. The block group demonstrated a significant reduction in postoperative narcotic requirements on POD1 and POD2 when compared to controls (POD1: 0.020 mg/kg vs 0.066 mg/kg, P < .005; POD2: 0.030 mg/kg vs 0.080 mg/kg, P < .016), with a trend toward significance thereafter. Corroboratively, self-reported pain scores in the first 24 hours were significantly decreased in the block compared to control groups with a trend toward significance thereafter (POD1: 1.13 vs 2.72, P < .001; POD2: 1.72 vs 2.56, P < .08; POD3: 1.21 vs 2.07, P < .06). LOS was decreased by an average of 1 day in the block group, operative times were unchanged, and neither group evidenced perioperative complication or return to service within 30 days. Conclusion: Administration of bilateral suprazygomatic maxillary nerve blocks in patients undergoing Le Fort I maxillary osteotomy for correction of cleft-related maxillary deficiency demonstrated a significant reduction in post-operative narcotic requirements, self-reported pain scales, and LOS without increased complications, suggesting its utility as a safe and effective analgesic adjunct in this patient population.
Faculty Preferences in Clinical Education Recognition: A Survey of Faculty at 3 Institutions
Authors: Ju Connie , Becker Devra B.
Published: August 2020

Purpose:

Innovative studies have created proposals for measuring productivity using Relative Value Unit (RVU) or Educational Value Unit (EVU) systems, but little attention has been given to faculty preferences for rewarding educational activity. This study assesses perceptions of educational value and reward preferences for educational involvement of faculty at 3 different hospital systems affiliated with 1 medical school.

Method:

A 25-question electronic survey was sent to clinical faculty across 3 distinct hospital systems affiliated with a Midwestern medical school in spring 2015. Results were analyzed using the Kruskal-Wallis test and free text comments were reviewed for common themes.

Results:

A total of 4325 surveys were distributed and 361/467 (77%) of the surveys opened were completed for an overall response rate of 8%. Of the respondents 55% were employed by the primary affiliate hospital. Most respondents believed some method of recognition for educational activities should be in place at their institution. Overall, clinical faculty believed their own hospital systems valued education less than the school of medicine and their departments did. Most faculty gave highest preference for academic recognition, reduction in RVU requirements, or an adoption of an EVU system.

Conclusion:

Most faculty preferred reduced RVU requirements, adoption of an EVU system, or some method of academic recognition to reward educational activity. Differences in results between hospital systems suggest institutional climate may influence faculty preferences.
Genetic variants modulate gene expression statin response in human lymphoblastoid cell lines
Authors: Theusch Elizabeth , Chen Yii-Der I. , Rotter Jerome I. , Krauss Ronald M. , Medina Marisa W.
Published: August 2020

Background

Statins are widely prescribed to lower plasma low-density lipoprotein cholesterol levels. Though statins reduce cardiovascular disease risk overall, statin efficacy varies, and some people experience adverse side effects while on statin treatment. Statins also have pleiotropic effects not directly related to their cholesterol-lowering properties, but the mechanisms are not well understood. To identify potential genetic modulators of clinical statin response, we looked for genetic variants associated with statin-induced changes in gene expression (differential eQTLs or deQTLs) in lymphoblastoid cell lines (LCLs) derived from participants of the Cholesterol and Pharmacogenetics (CAP) 40 mg/day 6-week simvastatin clinical trial. We exposed CAP LCLs to 2 μM simvastatin or control buffer for 24 h and performed polyA-selected, strand-specific RNA-seq. Statin-induced changes in gene expression from 259 European ancestry or 153 African American ancestry LCLs were adjusted for potential confounders prior to association with genotyped and imputed genetic variants within 1 Mb of each gene’s transcription start site.

Results

From the deQTL meta-analysis of the two ancestral populations, we identified significant cis-deQTLs for 15 genes (TBC1D4, MDGA1, CHI3L2, OAS1, GATM, ASNSD1, GLUL, TDRD12, PPIP5K2, OAS3, SERPINB1, ANKDD1A, DTD1, CYFIP2, and GSDME), eight of which were significant in at least one of the ancestry subsets alone. We also conducted eQTL analyses of the endogenous (control-treated), statin-treated, and average of endogenous and statin-treated LCL gene expression levels. We identified eQTLs for approximately 6000 genes in each of the three (endogenous, statin-treated, and average) eQTL meta-analyses, with smaller numbers identified in the ancestral subsets alone.

Conclusions

Several of the genes in which we identified deQTLs have functions in human health and disease, such as defense from viruses, glucose regulation, and response to chemotherapy drugs. This suggests that DNA variation may play a role in statin effects on various health outcomes. These findings could prove useful to future studies aiming to assess benefit versus risk of statin treatment using individual genetic profiles.
Multidrug resistant and extensively drug resistant Acinetobacter baumannii hospital infection associated with high mortality: a retrospective study in the pediatric intensive care unit
Authors: Shi Jingyi , Sun Ting , Cui Yun , Wang Chunxia , Wang Fei , Zhou Yiping , Miao Huijie , Shan Yijun , Zhang Yucai
Published: August 2020

Background

Multidrug resistant (MDR) and extensively drug resistant (XDR)Acinetobacter baumanniipresents challenges for clinical treatment and causes high mortality in children. We aimed to assess the risk factors and overall mortality for MDR/XDRAcinetobacter baumanniiinfected pediatric patients.

Methods

This retrospective study included 102 pediatric patients who developed MDR/XDRAcinetobacter baumanniiinfection in the pediatric intensive care unit (PICU) of Shanghai Children’s Hospital in China from December 2014 to May 2018.

Acinetobacter baumanniiclinical isolates were recovered from different specimens including blood, sputum, bronchoalveolar lavage fluid, cerebrospinal fluid, ascites, hydrothorax, and urine. Antibiotic susceptibility test was determined according to the Clinical and Laboratory Standards Institute interpretive criteria. Clinical and biological data were obtained from the patients’ medical records.

Results

102 patients withAcinetobacter baumanniiinfection were enrolled. The median age was 36 (9.6, 98.8) months, and there were 63 male in the case group. The overall mortality rate was 29.4%, while theAcinetobacter baumannii-associated mortality rate was 16.7% (17/102, 12 bloodstream infections, 4 meningitis and 1 intra-abdominal infection). Bloodstream infections occurred in 28 patients (27.5%), and 10 patients (9.8%) among them had central line-associated bloodstream infections (6 central venous catheters, 2 PICCs, 1 venous infusion port and 1 arterial catheter). Cerebrospinal fluid (CSF) cultures were positive in 4(3.9%) patients. 14(13.7%) patients got positive cultures in ascites and hydrothorax. Lower respiratory isolates (56/102) accounted for 54.9% of all patients. Non-survival patients appeared to have a lower NK cell activity (6.2% ± 3.61% vs. 9.15% ± 6.21%,P = 0.029), higher CD4+ T cell ratio (39.67% ± 12.18% vs. 32.66% ± 11.44%,P = 0.039),and a higher serum level of interlukin-8 (IL-8, 15.25 (1.62, 47.22)pg/mL vs. 0.1 (0.1, 22.99)pg/mL,P = 0.01) whenAcinetobacter baumanniiinfection developed. Multivariate logistic analysis indicated that high serum level of Cr (RR, 0.934, 95%CI, 0.890–0.981;P = 0.007) and high BUN/ALB level (RR, 107.893, 95%CI, 1.425–870.574;p = 0.005) were associated with high risk of mortality in MDR/XDRAcinetobacter baumanniiinfected patients.

Conclusion

MDR/XDRAcinetobacter baumanniiinfection is a serious concern in pediatric patients with high mortality. Bloodstream and central nervous system infection accounted for high risk of death. Acute kidney injury is associated with high risk of mortality.
The role of MRI and clinicopathologic features in predicting the invasive component of biopsy-confirmed ductal carcinoma in situ
Authors: Yoon Ga Young , Choi Woo Jung , Cha Joo Hee , Shin Hee Jung , Chae Eun Young , Kim Hak Hee
Published: August 2020

Background

The upgrade rate of biopsy-confirmed ductal carcinoma in situ (DCIS) to invasive carcinoma is up to 50% on final pathology. We investigated MRI and clinicopathologic predictors of the invasive components of DCIS diagnosed by preoperative biopsy and then compared MRI features between patients with DCIS, microinvasive ductal carcinoma (mIDC), and invasive ductal carcinoma (IDC) diagnosed on final pathology.

Methods

Two hundred and one patients with 206 biopsy-confirmed DCIS lesions were enrolled. MRI and clinicopathologic features were used to predict either mIDC or IDC via a cumulative logistic regression analysis. For the lesions detected on MRI, morphologic and kinetic analyses were performed using the Chi-square, Fisher’s exact, and Kruskal-Wallis tests.

Results

Of all the lesions, 112 (54.4%) were diagnosed as DCIS, 50 (24.3%) were upgraded to mIDC, and 44 (21.4%) to IDC. The detection on MRI as mass (Odds ratio (OR) = 8.84, 95% confidence interval (CI) = 1.05–74.04, P = 0.045) or non-mass enhancement (NME; OR = 11.17, 95% CI = 1.35–92.36, P = 0.025), negative progesterone receptor (PR; OR = 2.40, 95% CI = 1.29–4.44, P = 0.006), and high Ki-67 level (OR = 2.42, 95% CI = 1.30–4.50, P = 0.005) were significant independent predictors of histologic upgrade. On MRI, 87 (42.2%) lesions appeared as mass and 107 (51.9%) as NME. Irregularly shaped, not-circumscribed, heterogeneous, or rim-enhancing masses with intratumoral high signal intensity or peritumoral edema, clumped or clustered ring-enhancing NMEs, and high peak enhancement were significantly associated with histologic upgrade (P < 0.001).

Conclusion

MRI detection, negative PR, and high Ki-67 levels are associated with a histologic upgrade in patients with biopsy-confirmed DCIS. Suspicious MRI features are more frequent in such patients.
Premature mortality of gastrointestinal cancer in Iran: trends and projections 2001–2030
Authors: Shadmani Fatemeh Khosravi , Farzadfar Farshad , Yoosefi Moein , Mansori Kamyar , Shadman Reza Khosravi , Haghdoost Aliakbar
Published: August 2020

Background

The present study was conducted to determine the trend and projection of premature mortality from gastrointestinal cancers (GI cancers) at national and subnational levels in Iran.

Methods

Employing the data obtained from Iranian Death Registry System (DRS) and population data from census, the mortality rates of GI cancers was calculated among 30–70 age groups. The trends of esophageal, colon and rectum, gallbladder, pancreases, stomach, and liver cancer premature mortalities were estimated and projected at the national and subnational levels from 2001 to 2030. Then, Spatio-temporal model was used to project spatial and temporal correlations.

Results

The overall mortality rate of GI cancers was higher in males than in females, indicating 6.1, 3.9 and 3.9% per 100,000 individuals among males in 2001, 2015 and 2030 respectively and 3.8, 3.1 and 3.7 per 100,000 individuals among females in the same time-frame. The overall mortality rate of GI cancers in males was decreasing until 2015 and will remain stationary into 2030; however, the rate will be increasing among females in both time-frames. Also, there was a considerable variation in the mortality trends of different cancers. Pancreatic, gallbladder, and liver cancers were shown to have an increasing trend while a drop was observed in the mortality rates of stomach, colon and rectum, and esophageal cancers.

Conclusion

Variation of GI cancers patterns and trends around the country indicated that a more comprehensive control plan is needed to include the predicted variations.
Response to correspondence from Koerner and colleagues concerning our paper entitled: The effect of diluting povidone-iodine on bacterial growth associated with speech
Authors: Gnanasekaran Sivashanth , Rogers Sophie , Wickremasinghe Sanj , Sandhu Sukhpal S.
Published: August 2020

Clinicians adopt varying strategies for antisepsis with PI, which to this day remains efficient, economical and effective. Clinicians should prudently consider effective PI application, and we thank Koerner and Grzybowski for encouraging debate and raising the profile of this issue.
Females with ADHD: An expert consensus statement taking a lifespan approach providing guidance for the identification and treatment of attention-deficit/ hyperactivity disorder in girls and women
Authors: Young Susan , Adamo Nicoletta , Ásgeirsdóttir Bryndís Björk , Branney Polly , Beckett Michelle , Colley William , Cubbin Sally , Deeley Quinton , Farrag Emad , Gudjonsson Gisli , Hill Peter , Hollingdale Jack , Kilic Ozge , Lloyd Tony , Mason Peter , Paliokosta Eleni , Perecherla Sri , Sedgwick Jane , Skirrow Caroline , Tierney Kevin , van Rensburg Kobus , Woodhouse Emma
Published: August 2020

Background

There is evidence to suggest that the broad discrepancy in the ratio of males to females with diagnosed ADHD is due, at least in part, to lack of recognition and/or referral bias in females. Studies suggest that females with ADHD present with differences in their profile of symptoms, comorbidity and associated functioning compared with males. This consensus aims to provide a better understanding of females with ADHD in order to improve recognition and referral. Comprehensive assessment and appropriate treatment is hoped to enhance longer-term clinical outcomes and patient wellbeing for females with ADHD.

Methods

The United Kingdom ADHD Partnership hosted a meeting of experts to discuss symptom presentation, triggers for referral, assessment, treatment and multi-agency liaison for females with ADHD across the lifespan.

Results

A consensus was reached offering practical guidance to support medical and mental health practitioners working with females with ADHD. The potential challenges of working with this patient group were identified, as well as specific barriers that may hinder recognition. These included symptomatic differences, gender biases, comorbidities and the compensatory strategies that may mask or overshadow underlying symptoms of ADHD. Furthermore, we determined the broader needs of these patients and considered how multi-agency liaison may provide the support to meet them.

Conclusions

This practical approach based upon expert consensus will inform effective identification, treatment and support of girls and women with ADHD. It is important to move away from the prevalent perspective that ADHD is a behavioural disorder and attend to the more subtle and/or internalised presentation that is common in females. It is essential to adopt a lifespan model of care to support the complex transitions experienced by females that occur in parallel to change in clinical presentation and social circumstances. Treatment with pharmacological and psychological interventions is expected to have a positive impact leading to increased productivity, decreased resource utilization and most importantly, improved long-term outcomes for girls and women.
Persistence and remission of depressive symptoms and psycho-social correlates in Chinese early adolescents
Authors: Chi Xinli , Becker Benjamin , Yu Qian , Hossain Md Mahhub , Lin Jingyaun , Yeung Albert , Seiler-Ramadas Radhika , Grabovac Igor , Bu He , Xie Fei , Zou Liye
Published: August 2020

Background

This study aimed to investigate a one-year course of persistent/remitted depressive symptoms and associated demographic and psychosocial factors that predict persistent/remitted depressive symptoms in Chinese high school students.

Methods

One thousand five hundred forty-four Grade 7 students provided data for the first wave. Of the initially recruited students, 483 who were classified as depressed (CESD score ≥ 16) at baseline were then tracked and invited to fill in the questionnaire for a second time (Grade 8) after 1 year. Finally, 435 of them were successfully matched.

Results

Two hundred two (46.4%) of the subset categorized as depressed in the first survey (N = 435) remained with depressive symptoms, while 233 (53.6%) recovered from depression 1 year later. Having siblings, a lower level of positive youth development, non-intact family status, and poor family functioning at baseline significantly predicted a higher likelihood of persistent depression, while those with fathers having higher educational qualifications (bachelor’s degree or higher) at baseline showed a significantly higher probability of remitting from depression.

Conclusions

The findings indicated that the prevalence of persistent depressive symptoms was generally high, and promoting aspects of positive youth development and family functioning for adolescents could be promising in preventing or reducing these symptoms.
Robotic assisted treatment of flank hernias: case series
Authors: Di Giuseppe Matteo , Mongelli Francesco , Marcantonio Maria , La Regina Davide , Pini Ramon
Published: August 2020

Background

Flank hernias are uncommon, surgical treatment is challenging and the minimally-invasive approach not always feasible. The aim of this study was to report the safety and feasibility of the robotic-assisted repair.

Methods

The study was approved by the local ethic committee (2019–01132 CE3495). A retrospective search on a prospectively collected dataset including demographic and clinical records on robotic surgery at our institution was performed to identify patients treated for a flank hernia. Patients were followed-up 6 months.

Results

From January 2018 to December 2019, out of 190 patients who underwent robotic-assisted hernia surgery, seven with incisional flank hernia were included. Median age was 69.0 years (IQR 63.2–78.0), BMI was 27.3 kg/m2 (IQR 25.8–32.3) and two patients were male (29%). All patients were referred to surgery because of pain, whereas one of them described recurrent episodes of small bowel obstruction.

The median hernia defect measured 25 mm ((IQR 21–40), median mesh diameter was 10 cm (IQR 10–12.5) and median operative time was 137 min (IQR 133–174). No intraoperative complication occurred.

Postoperatively, one patient developed a pneumonia, which required antibiotics. Length of hospital stay was 4.0 days (IQR 3.0–7.7). Six months after surgery, neither recurrence nor chronic pain were recorded.

Conclusions

Robotics in abdominal wall hernia surgery remains a matter of debate, despite a growing interest from the surgical community. In our reported experience with flank hernias, we found the robotic-assisted approach to be safe and feasible for the treatment of this uncommon clinical entity.
The effects of thylakoid-rich spinach extract and aqueous extract of caraway (Carum carvi L.) in letrozole-induced polycystic ovarian syndrome rats
Authors: Sherafatmanesh Saeed , Ekramzadeh Maryam , Tanideh Nader , Golmakani Mohammad-Taghi , Koohpeyma Farhad
Published: August 2020

Background

Polycystic ovary syndrome (PCOS) is a common endocrine disorder. The aim of the present study was to evaluate the effects of the oral administration of thylakoid-rich spinach extract and the caraway aqueous extract in letrozole-induced polycystic ovary syndrome rats.

Methods

Sixty female Sprague-Dawley rats were randomly divided into five groups of 12 animals each. Letrozole (1 mg/kg) was administered orally for a period of 28 days to induce PCOS. Sham and PCOS control rats received 1 mL/day of distilled water, and the three groups of PCOS rats were given 150 mg/kg of metformin, 3 g/kg of caraway, and thylakoid at a dose of 6 mg chlorophyll/gr food intake/day by oral gavage for 8 weeks. Finally, blood samples were collected and the right ovary of rats was removed, weighed, and fixed in 4% buffered formalin to determine the biochemical and stereological parameters.

Results

Compared to the PCOS control group, consuming metformin, thylakoid, and caraway extracts significantly improved the fasting blood sugar (FBS), tumor necrosis factor-alpha (TNF-α), malondialdehyde (MDA), luteinizing hormone (LH), insulin resistance, and body weight, increased the volume of the corpus luteum, and reduced the number of atretic follicles after 8 weeks (푃< 0.05). Although caraway treatment caused a significant increase in the HDL-C (High-density lipoprotein cholesterol) level (P < 0.001), no significant change was observed in terms of HDL-C in the thylakoid and metformin groups compared to the PCOS control group.

Conclusion

Our data showed that the consumption of thylakoid and caraway extracts for 8 weeks may have beneficial effects on the biochemical and stereological factors in PCOS-induced rats.
Risk factors for poor health and performance in European broiler production systems
Authors: Van Limbergen Tommy , Sarrazin Steven , Chantziaras Ilias , Dewulf Jeroen , Ducatelle Richard , Kyriazakis Ilias , McMullin Paul , Méndez Jesús , Niemi Jarkko K. , Papasolomontos Sotiris , Szeleszczuk Piotr , Van Erum Johan , Maes Dominiek ,   on behalf of the PROHEALTH consortium
Published: August 2020

Background

Conventional broilers are currently one of the most efficient protein converters. Although decades of progress in genetic selection and feed formulation have lead to high standards of efficient broiler production, still a lot of variability is found between farms and between successive flocks. The aim of this study was to investigate risk- and/or protective factors for poor health and performance in conventional broiler-farms in Europe by developing eight multivariable linear mixed models. Three different models were used to investigate mortality (overall, first week, after first week), three models for performance variables (growth, feed conversion, European production index) and two models were related to slaughterhouse data (i.e. dead on arrival and condemnation rate).

Results

Several factors related to management and housing were significantly associated with health and performance of broilers. The following factors were associated with increased mortality: floor quality, neonatal septicemia, ventilation type and other professional activities of the farmer. The factors associated with performance were chick sex, coccidiosis infections, necrotic enteritis, dysbacteriosis, light intensity adaptations, ventilation type, comparing daily flock results with previous flock results by farmer, daily check of feed and water system and type of feed. For dead on arrival three risk factors were identified i.e. daily growth, type of light adaptation and type of drinkers system. For condemnation rate seven risk factors were found, i.e. type of drinking system, daily growth, feed withdrawal time, type of ventilation, house size, septicemia after seven days and type of feed.

Conclusions

These results imply that a multifactorial approach is required with adaptations involving both improvements in management, housing, health programs and an increasing level of professionalism of the farmer in order to improve broiler performance and health.
Ex vivo comparison of sliding knot ligatures vs. haemostatic clips for equine small intestinal mesenteric vessel occlusion
Authors: Giusto Gessica , Gandini Marco
Published: August 2020

Background

In equine abdominal surgery, resection and anastomosis of strangulated intestine is a commonly performed procedure. To date, ligatures, vessel sealing devices and the ligate-divide stapler have been described for this use in horses. The objective of this study was to compare the application of haemostatic clips and ligatures to occlude equine mesenteric vessels.

Portions of jejunum with ten associated mesenteric vessels were collected from 12 horses at a local abattoir and divided into two groups. Portions of intestine were divided into two sections comprising five vessels each and assigned to Group A or Group B. Each vessel was occluded with a triple ligature. In Group A, vessels were ligated with three circumferential ligatures tied with a sliding knot with two overthrows. In Group B, vessels were occluded with application of three haemoclips. The procedures were performed by the same experienced surgeon. Intestinal length, construction time and vessel leaking pressure were measured and compared between groups.

Results

The intestinal length (mean ± SD) was 3.78 ± 0.43 m in Group A and 3.04 ± 0.83 m in Group B. The difference was not significant (p = 0.297).

The construction time (mean ± SD) was 7.03 ± 0.34 min in Group A and 2.40 ± 0.43 min in Group B. The difference was significant (p < 0.0001).

The leaking pressure was 1000 (750–1050) mmHg (median, IQ range) in Group A and 1050 (800–1050) mmHg (median, IQ range) in Group B. The difference was not significant (p = 0.225).

Conclusions

Haemoclip application is comparable in terms of leaking pressure but quicker than sliding knots to apply.
The significance of FMR1 CGG repeats in Chinese women with premature ovarian insufficiency and diminished ovarian reserve
Authors: Tang Ruiyi , Yu Qi
Published: August 2020

Background

Previous studies have shown that there is an association between FMR1 CGG repeats and ovarian dysfunction. The aim of this study is to assess the association between the number of CGG repeats in FMR1 in Chinese patients with premature ovarian insufficiency (POI) and diminished ovarian reserve (DOR).

Methods

This is a cross-sectional, case-control study, which enrolled 124 patients with POI, 57 patients with DOR and 111 normal menopausal controls. The demographic details along with other clinical data were recorded. The FMR1 CGG repeats were analyzed by polymerase chain reaction and microfluidic capillary electrophoresis.

Results

We could detect two premutation carriers in the POI group (1.6%) and one in the control group (0.9%). No premutation carriers were identified in the DOR group. The frequency of FMR1 premutations was not different between POI or DOR and controls. The most common CGG repeat was 29 and 30, and the repeat length for allele 2 had a secondary peak around 36–39 repeats. The CGG repeats were divided into groups of five consecutive values, and the distribution of allele 1 in the POI group was different from that in the control group (P < 0.001). No statistically significant differences were found for allele 1 between DOR group vs. controls, and for allele 2 between three groups (P > 0.05).

Conclusions

The study shows that the frequency of FMR1 premutations is relatively low (1.6%) in Chinese women with POI. The distribution of allele 1 CGG repeat in patients with POI showed difference from that in healthy women.
Exploring how to sustain ‘place-based’ rural health academic research for informing rural health systems: a qualitative investigation
Authors: O’Sullivan Belinda , Cairns Alice , Gurney Tiana
Published: August 2020

Background

The field of rural health research is critical for informing health improvement in rural places but it involves researching in small teams and distributed sites that may have specific sustainability challenges. We aimed to evaluate this to inform how to sustain the field of rural health research.

Methods

We conducted In-depth semi-structured interviews of 50-70 minutes with 17 rural early career researchers who were from different research sites across rural Australia. Data were thematically coded.

Results

Seven sustainability challenges were noted, namely recognition, workload, networks, funding and strategic grants, organisational culture, job security, and career progression options. Rural researchers were poorly recognised for their work and researchers were not extended the same opportunities enjoyed by staff at main campuses. Unpredictable and high workloads stemmed from community demand and limited staff. Strategic grant opportunities failed to target the generalist, complex research in this field and the limited time researchers had for grant writing due to their demands within small academic teams. Limited collaboration with other sites increased dissatisfaction. In the face of strong commitment to rural ‘places’ and their enthusiasm for improving rural health, fixed-term contracts and limited career progression options were problematic for researchers and their families in continuing in these roles.

Conclusion

A comprehensive set of strategies is needed to address the sustainability of this field, recognising its value for rural self-determination and health equity. Hubs and networks could enable more cohesively planned, collaborative research, skills sharing, senior academic supervision and career development. Targeted funding, fit to the context and purpose of this field, is urgent. Inaction may fuel regular turnover, starting after a researcher’s first years, losing rich academic theoretical and contextual knowledge that is essential to address the health of rural populations.