bluuebunny/crossref_metadata_2025 huggingface dataset:
Early mechanical ventilation in patients with Guillain-Barré syndrome at high risk of respiratory failure: a randomized trial
Authors: Melone Marie-Anne , Heming Nicholas , Meng Paris , Mompoint Dominique , Aboab Jerôme , Clair Bernard , Salomon Jerôme , Sharshar Tarek , Orlikowski David , Chevret Sylvie , Annane Djillali
Published: September 2020

Introduction

About 30% of patients with Guillain-Barré syndrome become ventilator dependent, of whom roughly 75% develop pneumonia. This trial aimed at assessing the impact of early mechanical ventilation (EMV) on pneumonia occurrence in GBS patients. We hypothesize that EMV will reduce the incidence of pneumonia.

Methods

This was a single centre, open-label, randomized controlled trial performed on two parallel groups. 50 intensive care unit adults admitted for Guillain-Barré syndrome and at risk for acute respiratory failure. Patients were randomized to early mechanical ventilation via face-mask or endotracheal intubation owing to the presence or absence of impaired swallowing (experimental arm), or to conventional care (control arm). The primary outcome was the incidence of pneumonia up to intensive care unit discharge (or 90 days, pending of which occurred first).

Findings

Twenty-five patients were randomized in each group. There was no significant difference between groups for the incidence of pneumonia (10/25 (40%) vs 9/25 (36%), P = 1). There was no significant difference between groups for the time to onset of pneumonia (P = 0.50, Gray test). During follow-up, there were 16/25 (64%) mechanically ventilated patients in the control group, and 25/25 (100%) in the experimental arm (P < 000·1). The time on ventilator was non-significantly shorter in the experimental arm (14 [7; 29] versus 21.5 [17.3; 35.5], P = 0.10). There were no significant differences between groups for length of hospital stay, neurological scores, the proportion of patients who needed tracheostomy, in-hospital death, or any serious adverse events.

Conclusions

In the present study including adults with Guillain-Barré syndrome at high risk of respiratory failure, we did not observe a prevention of pneumonia with early mechanical ventilation. Trial registration: ClinicalTrials.gov under the number NCT00167622. Registered 9 September 2005, https://clinicaltrials.gov/ct2/show/NCT00167622?cond=Guillain-Barre+Syndrome&cntry=FR&draw=2&rank=1
Deep learning-based estimation of PV power plant potential under climate change: a case study of El Akarit, Tunisia
Authors: Ben Othman Afef , Ouni Ayoub , Besbes Mongi
Published: September 2020

Background

Several climatologists and experts in the renewable energy field agree that GHI and DNI calculation models must be revised because of the increasingly unpredictable and powerful climatic disturbances. The construction of analytical mathematical models for the prediction of these disturbances is almost impossible because the physical phenomena relating to the climate are often complex. We raise the question over the current and future PV system’s sustainable energy production and whether climate disturbances will be affecting this sustainability and resulting in supply decline.

Methods

In this paper, we tried to use deep learning as a tool to predict the evolution of the future production of any geographic site. This approach can allow for improvements in decision-making concerning the implantation of solar PV or CSP plants. To reach this aim, we have deployed the databases of NASA and the Tunisian National Institute of Meteorology relating to the climatic parameters of the case study region of El Akarit, Gabes, Tunisia. In spite of the colossal amount of processed data that dates back to 1985, the use of deep learning algorithms allowed for the validation of the previously made estimates of the energy potential in the studied region.

Results

The calculation results suggested an increase in production as it was confirmed by the 2019 measures. The findings obtained from the case study region were reliable and seemed to be very promising. The results obtained using deep learning algorithms were similar to those produced by conventional calculation methods. However, while conventional approaches based on measurements obtained using hardware solutions (ground sensors) are expensive and very difficult to implement, the suggested new approach is cheaper and more convenient.

Conclusions

In the existence of a protracted controversy over the hypothetical effects of climate change, making advances in artificial intelligence and using new deep learning algorithms are critical procedures to strengthening conventional assessment tools of the production sites of photovoltaic energy and CSP plants.
Impaired memory for cooperative interaction partners in borderline personality disorder
Authors: Niedtfeld Inga , Kroneisen Meike
Published: September 2020

Background

Interpersonal disturbances in Borderline Personality Disorder (BPD) have been attributed to a negativity bias in social cognition. Adding to this literature, we experimentally tested whether those with BPD show altered memory for cooperative versus non-cooperative interaction partners.

Methods

In a source memory paradigm, 51 female BPD patients and 50 healthy controls (HC) played a trust game with 40 different female target characters (trustworthy vs untrustworthy). In a subsequent surprise memory test, participants had to recognize those target individuals (vs distractor pictures), and had to recall whether they had shown cooperative behavior during the trust game. We hypothesized that BPD patients have better memory for uncooperative interaction partners as compared to cooperative interaction partners, and that a-priori expectations of untrustworthiness would influence recall.

Results

During the trust game, BPD individuals invested lower amounts of money than HC for trustworthy targets, but no differences were found for untrustworthy targets. During the memory test, BPD patients had significant difficulties to remember cooperative targets, as compared to HC. More specifically, those with BPD indicated more often than HC that they had not previously interacted with cooperative targets of the previous trust game. We did not detect any differences between BPD and HC in source memory, or with regard to the effects of trustworthiness expectations.

Conclusions

The observed tendency to forget cooperative interaction partners in BPD is possibly caused by dysfunctional cognitive schemas. At the same time, it might also corroborate patients’ assumptions that others are untrustworthy, thereby fuelling interpersonal disturbances in BPD.
The reconfiguration of biobanks in Europe under the BBMRI-ERIC framework: towards global sharing nodes?
Authors: Argudo-Portal Violeta , Domènech Miquel
Published: September 2020

Freezers with biospecimen deposits became biobanks and later were networked at the pan-European level in 2013 under the Biobanking and BioMolecular Resources Research Infrastructure—European Research Infrastructure Consortium (BBMRI-ERIC). Drawing on document analysis about the BBMRI-ERIC and multi-sited fieldwork with biobankers in Spain from a science and technology studies approach, we explore what biobanks are expected to do and become under the BBMRI-ERIC framework, and how infrastructural transitions promote particular transformations in biobanking practices. The primary purpose of biobanks in Europe is presented as being to become mediators in contemporary biomedical research (global sharing nodes) distribution, and distributed nodes of samples and their associated data. We argue that infrastructural transitions are complicated and heterogeneous, giving rise to unattended local concerns on adjusting their practices to fit into the BBMRI-ERIC framework, even for non-members, as the case of Spain illustrates, where “old practices” of collection and storage are questioned. In this article, we aim to encourage qualitative studies to explore the lags between pan-European policies and prospects, different contextual interpretations, and biobanking reconfigurations as an opportunity to explore what that lag is made of (e.g. tensions with “old practices,” unresolved conflicts with the national agendas, reservations on a possible centralization of the biobanking practices by regional biobanks, lack of funding, etc.). Such research could enrich not only policy guidance, but also the understanding of technoscientific infrastructures’ scalability.
Efficacy of baloxavir marboxil on household transmission of influenza infection
Authors: Umemura Takumi , Mutoh Yoshikazu , Kawamura Takato , Saito Masayuki , Mizuno Takahito , Ota Aiko , Kozaki Koji , Yamada Tetsuya , Ikeda Yoshiaki , Ichihara Toshihiko
Published: September 2020

Background

Baloxavir marboxil (baloxavir) is a new anti-influenza virus agent that is comparable to oseltamivir phosphate (oseltamivir). Since the efficacy of baloxavir in preventing household transmission of influenza is not well established, we compared the secondary household influenza virus transmission rates between patients on baloxavir vs oseltamivir.

Methods

Between October 2018 and March 2019, we enrolled index patients (diagnosed with influenza and treated with baloxavir or oseltamivir) and household members. The secondary attack rate of household members was compared between index patients treated with baloxavir vs oseltamivir. Risk factors of household transmission were determined using multivariate logistic analyses.

Results

In total, 169 index patients with influenza type A were enrolled. The median age was 27.0 (interquartile range; 11–57) years. The number of index patients treated with baloxavir and oseltamivir was 49 and 120, respectively. The secondary attack rate was 9.0% (95% confidence interval [CI]: 4.6–15.6) in the baloxavir group and 13.5% (95% CI: 9.8–17.9) in the oseltamivir group. In the multivariate analysis, independent risk factors were 0–6 years of age (odds ratio [OR] 2.78, 95% CI: 1.33–5.82, p < 0.01) and not being on baloxavir treatment. (OR: 0.63, 95% CI: 0.30–1.32, p = 0.22).

Conclusion

The household secondary attack rate of influenza was comparable in patients treated with baloxavir vs oseltamivir. Therefore, baloxavir can be used as an alternative therapy to oseltamivir in reducing household transmission of influenza.

Trial registration

Patients in this study were retrospectively registered. https://www.tosei.or.jp/clinical/pdf/2_influenza.pdf.
Laparoscopic cholecystectomy for a cholelithiasis patient with an aberrant biliary duct of B5: a case report
Authors: Suzuki Takuto , Asahi Yoh , Sawada Akifumi , Umemoto Kohei , Kina Masaya , Shinohara Masahiro , Yokoyama Kazunori , Masuko Hiroyuki
Published: September 2020

Background

An aberrant biliary duct of segment 5 (B5) is a rare anomaly of the biliary tract. All anatomical anomalies of the biliary tract are risk factors for bile duct injury during surgery. We report a case of cholelithiasis with an aberrant B5 that was detected during a detailed preoperative imaging examination and treated with laparoscopic cholecystectomy.

Case presentation

A 69-year-old woman was admitted to the emergency room of our hospital with abdominal pain. She was diagnosed with cholelithiasis, and an aberrant B5 branching off the hepatic duct was suggested during preoperative imaging. Laparoscopic cholecystectomy was performed at our surgical department. There were no intra- or postoperative complications, and the patient was discharged on the fourth day after surgery.

Conclusions

Laparoscopic cholecystectomy can be safely performed without intra- or postoperative complications in patients with cholelithiasis and an aberrant B5 if it is accurately diagnosed preoperatively.
Surgical resection of a middle mediastinal paraganglioma that caused diabetes
Authors: Miura Kentaro , Kobayashi Nobutaka , Satomi Hidetoshi
Published: September 2020

Background

Paragangliomas are rare neuroendocrine tumors originating from chromaffin cells of extra-adrenal origin. Ninety percent of adrenergic tumors originate in the adrenal medulla and are known as pheochromocytomas; the remaining 10% are extra-adrenal and are called paragangliomas. Mediastinum paragangliomas is rare and commonly originate from the posterior mediastinum, while those originating from the middle posterior are quite rare. Some paragangliomas secrete catecholamines, leading to symptoms such as hypertension, tachycardia, and diabetes.

Case presentation

A 76-year-old woman visited our hospital for the treatment and further evaluation of diabetes. Her hemoglobin A1c levels had risen to 11.0%. To investigate the cause of her diabetes, a contrast-enhanced chest computed tomography scan was performed, revealing a ring-enhancing tumor (30 × 30 mm) in the middle mediastinum. The surgical resection was performed via video-assisted thoracic surgery. Surgery was performed using a vessel-sealing device; however, bleeding was persistent from the surrounding tissue. Total bleeding was 400 g. Blood pressure fluctuations and arrhythmia did not occur during the operation. The patient’s uncontrolled diabetes was cured after the surgery, and the tumor was diagnosed as a functional paraganglioma.

Conclusions

We encountered a rare case of functional paraganglioma located in the middle mediastinum. Functional paragangliomas should be considered as a potential cause of uncontrolled diabetes, and a whole-body CT scan should be performed to investigate this possible cause.
Narrow band imaging for thoracic endometriosis
Authors: Yamamoto Takehiro , Fujikawa Ryo , Arai Yoshifumi , Nakamura Toru
Published: September 2020

Background

The thoracic cavity is the most frequent site of extrapelvic endometriosis. It exhibits a wide variety of clinical manifestations, such as chest pain, cough, and respiratory distress, and is frequently associated with pelvic endometriosis. Although histological confirmation is the gold standard for a definitive diagnosis, endoscopic identification of the affected area is often difficult. Narrow band imaging (NBI) is an imaging technique that emphasizes vascular structures and is reported to be useful in the diagnosis of pelvic endometriosis.

Case presentations

A 31-year-old woman and 39-year-old woman developed a recurrent right pneumothorax during their menstruation cycles. They both had no medical history suggesting pelvic endometriosis. We planned an elective video-assisted thoracoscopic surgery for the suspicion of thoracic endometriosis. In addition to white light alone, an NBI observation enhanced the microvasculature of the suspected lesions and allowed us to identify the affected area more clearly. Partial resections of the diaphragm were performed. Histopathological and immunohistochemical studies of each specimen confirmed the diagnosis of extrapelvic endometriosis.

Conclusions

NBI may improve the diagnostic accuracy for thoracic endometriosis, especially in clinically suspected patients but without a history of pelvic endometriosis.
Vestibular rehabilitation for persons with stroke and concomitant dizziness—a pilot study
Authors: Ekvall Hansson Eva , Pessah-Rasmussen Hélène , Bring Annika , Vahlberg Birgit , Persson Liselott
Published: September 2020

Background

Dizziness is common among patients with first time stroke. It affects self-perceived health and is a risk factor for falls. Vestibular rehabilitation (VR) is effective for treating dizziness among various conditions, but the effect of dizziness with origin in the central nervous system is poorly studied.

This pilot study of a randomized controlled trial aimed at investigating a vestibular rehabilitation programme among patients with first time stroke and concomitant dizziness. A second aim was to study the feasibility of performing the randomized controlled trial.

Methods

The participants were computer generated randomized to either an intervention or a control group. The intervention comprised of four different vestibular rehabilitation exercises, adapted for each patient and usual rehabilitation. The control group received usual rehabilitation without the vestibular rehabilitation exercises. Outcome measures used were The Activities-specific Balance Confidence Scale, the Berg Balance Scale, the Functional Gait Assessment Scale and the EuroQol-5D. Feasibility was studied in terms of recruitment, adherence and retention rates, also as the ability to collect primary and secondary outcomes as well as to find indications of treatment differences.

Results

Self-rated health improved for all participants. No other differences between baseline and follow-up were detected neither within nor between groups. Recruitment rate was 23%, adherence to the intervention 90%, retention rate 69% and ability to collect outcome measures 90%. No adverse events occurred.

Conclusion

Both the intervention and the control groups improved in self-perceived health. The measures of feasibility were satisfactory in this study, apart from a low recruitment rate.
How does an individual’s default behavior on an online peer-to-peer lending platform influence an observer’s default intention?
Authors: Tang Mingfeng , Mei Mei , Li Cuiwen , Lv Xingyang , Li Xushuang , Wang Lihao
Published: September 2020

Previous studies indicate that individuals’ default behaviors on online peer-to-peer (P2P) lending platforms greatly influence other borrowers’ default intentions. However, the mechanism of this impact is not clear. Moreover, there is scarce research in regard to which factors influence the relationship between an individual’s default behavior and an observer’s default intention. These important questions are yet to be resolved; hence, we conducted two experiments using the scenario-based research method, focusing on Chinese online P2P lending platforms. Our results indicate that an individual’s default behavior can trigger an observer’s default intention as a result of the imperfect punitive measures as they currently exist on Chinese online P2P lending platforms. Both the observer’s moral disengagement level and pragmatic self-activation level serve as mediating variables. In situations where an observer knows an individual’s default behavior, the level of intimacy between the defaulter and observer positively affects the relationship between their default behavior and intention. The intimacy level also positively influences the relationship between the individual’s default behavior and the two mediator variables. Based on the findings, we provide management suggestions in the context of online P2P lending. Our study sets a foundation for future research to utilize other methods to extend the present research findings to other regions and domains.
Correction to: Brief Montreal-Toulouse Language Assessment Battery: adaptation and content validity
Authors: Altmann Raira Fernanda , Ortiz Karin Zazo , Benfica Tainá Rossato , Oliveira Eduarda Pinheiro , Pagliarin Karina Carlesso
Published: September 2020

An amendment to this paper has been published and can be accessed via the original article.
3D printing in critical care: a narrative review
Authors: Boshra Mina , Godbout Justin , Perry Jeffrey J. , Pan Andy
Published: September 2020

Background

3D printing (3DP) has gained interest in many fields of medicine including cardiology, plastic surgery, and urology due to its versatility, convenience, and low cost. However, critical care medicine, which is abundant with high acuity yet infrequent procedures, has not embraced 3DP as much as others. The discrepancy between the possible training or therapeutic uses of 3DP in critical care and what is currently utilized in other fields needs to be addressed.

Objective

This narrative literature review describes the uses of 3DP in critical care that have been documented. It also discusses possible future directions based on recent technological advances.

Methods

A literature search on PubMed was performed using keywords and Mesh terms for 3DP, critical care, and critical care skills.

Results

Our search found that 3DP use in critical care fell under the major categories of medical education (23 papers), patient care (4 papers) and clinical equipment modification (4 papers). Medical education showed the use of 3DP in bronchoscopy, congenital heart disease, cricothyroidotomy, and medical imaging. On the other hand, patient care papers discussed 3DP use in wound care, personalized splints, and patient monitoring. Clinical equipment modification papers reported the use of 3DP to modify stethoscopes and laryngoscopes to improve their performance. Notably, we found that only 13 of the 31 papers were directly produced or studied by critical care physicians.

Conclusion

The papers discussed provide examples of the possible utilities of 3DP in critical care. The relative scarcity of papers produced by critical care physicians may indicate barriers to 3DP implementation. However, technological advances such as point-of-care 3DP tools and the increased demand for 3DP during the recent COVID-19 pandemic may change 3DP implementation across the critical care field.
Serum protein biomarkers for juvenile dermatomyositis: a pilot study
Authors: Tawalbeh Shefa M. , Marin Wilfredo , Morgan Gabrielle A. , Dang Utkarsh J. , Hathout Yetrib , Pachman Lauren M.
Published: September 2020

Background

Blood accessible biomarkers to assess disease activity and their response to therapies in Juvenile Dermatomyositis (JDM) are urgently needed. This pilot study aims to identify serum protein biomarkers associated with clinical disease activity in untreated JDM and their response to medical therapy.

Methods

SomaScan® technology screened JDM patients for 1305 proteins at three points: 1) before start of treatment, 2) while on therapy, and 3) after treatment tapering when patients were clinically inactive. To define disease associated biomarkers, SomaScan® data from untreated JDM patients (n = 8) were compared to SomaScan® data from an independent age-matched healthy control group (n = 12). Longitudinal analysis defined treatment responsive proteins at three time points: untreated (7 samples), treated (7 samples), and clinically inactive (6 samples). To confirm the SomaScan® data, a subset of nine candidate proteins (CXCL11, IL-17B, IL-17D, IL-22, CXCL10, MCP-1, ANGPT2, MIF, IL-23) weretested by ELISA after adding 2 JDM (one untreated, one clinically inactive) serum samples to the same group of JDM girls (8 untreated, 7 treated; 7 clinically inactive) as well as with 17 age, gender, matched healthy controls.

Results

Comparison of untreated JDM versus healthy controls identified 202 elevated and 49 decreased serum proteins in JDM patients with an adjustedp-value < 0.001. Only 82 out of 251 identified biomarker candidates responded to treatment while 12 out of these 82 proteins returned to their original untreated disease levels upon therapy tapering. The ELISA testing of the untreated samples for nine candidate proteins confirmed previously known biomarkers (CXCL10 or IP-10, CXCL11 or I-TAC and MCP-1) and identified novel biomarkers including IL-22, Angiopoetin-2, and IL-17B in a cross-sectional analysis comparing 8 untreated JDM and 17 age/gender matched controls. The subsequent longitudinal data by ELISA were not concordant for some biomarkers (IL-22 and IL-17B), but the other biomarkers either normalized or rebounded concordantly.

Conclusions

Blood accessible protein biomarkers reflecting JDM pathophysiology were identified; some of them rebounded after therapy was tapered. Further studies bridging these biomarkers to specific clinical features of JDM are required to confirm the clinical utility of these serum protein biomarkers.
Low-grade oncocytic tumour of kidney (CD117-negative, cytokeratin 7-positive)
Authors: de Andrade Melo Cláudio Galeno Ramalho , Xavier Marcus Vinicius Nunes , Pimenta Isabela Soares , Athanazio Daniel Abensur
Published: September 2020

Background

The term low-grade oncocytic tumour of kidney is an emerging entity describing CD117-negative and cytokeratin 7-positive indolent tumors with overlapping morphological features between oncocytic tumors.

Case presentation

We present herein the case of a 77-year-old female with a 3.2-cm nodule in mid pole of the left kidney. The tumor was uniformly oncocytic with solid, compact nested and trabecular growth patterns. There was common areas of transition to central zones of stromal edema with marked tumor hypocellularity and growth in cords. Some of these areas had adjacent fresh hemorrhage. Immunohistochemistry showed strong and diffuse expression of cytokeratin 7 and negativity for cKIT/CD117.

Conclusion

The proper use of this new diagnostic category avoids labeling such tumors as unclassified renal cell carcinoma – a broad category with different morphologic features and heterogenous prognosis.
Barriers and facilitators in implementing a pilot, pragmatic, telemedicine-delivered healthy lifestyle program for obesity management in a rural, academic obesity clinic
Authors: Batsis John A. , McClure Auden C. , Weintraub Aaron B. , Sette Diane , Rotenberg Sivan , Stevens Courtney J. , Gilbert-Diamond Diane , Kotz David F. , Bartels Stephen J. , Cook Summer B. , Rothstein Richard I.
Published: September 2020

Purpose

Few evidence-based strategies are specifically tailored for disparity populations such as rural adults. Two-way video-conferencing using telemedicine can potentially surmount geographic barriers that impede participation in high-intensity treatment programs offering frequent visits to clinic facilities. We aimed to understand barriers and facilitators of implementing a telemedicine-delivered tertiary-care, rural academic weight-loss program for the management of obesity.

Methods

A single-arm study of a 16-week, weight-loss pilot evaluated barriers and facilitators to program participation and exploratory measures of program adoption and staff confidence in implementation and intervention delivery. A program was delivered using video-conferencing within an existing clinical infrastructure. Elements of Consolidated Framework for Implementation Research (CFIR) provided a basis for assessing intervention characteristics, inner and outer settings, and individual characteristics using surveys and semi-structured interviews. We evaluated elements of the RE-AIM model (reach, adoption) to assess staff barriers to success for future scalability.

Findings

There were 27 patients and 8 staff completing measures. Using CFIR, the intervention was valuable from a patient participant standpoint; staff equally had positive feelings about using telemedicine as useful for patient care. The RE-AIM framework demonstrated limited reach but willingness to adopt was above average. A significant barrier limiting sustainability was physical space for intervention delivery and privacy and dedicated resources for staff. Scheduling stressors were also a challenge in its implementation.

Conclusions

The need to engage staff, enhance organizational culture, and increase reach are major factors for rural health obesity clinics to enhance sustainability of using telemedicine for the management of obesity.

Trial registration

Clinicaltrials.gov NCT03309787. Registered on 16 October 2017.
The posterior urethral valves revisited: embryological correlation, clinical classification, and risk stratification of the spectrum
Authors: Sarma Vivek Parameswara
Published: September 2020

Background

The diagnosis of posterior urethral valves (PUV) encompasses a vast spectrum of disease with variable severity and clinical features. It is vital to understand the extent of developmental insult and to define the different distinct entities grouped together under the diagnostic umbrella of PUV. This would help to determine the severity of the disease, enable better prognostication, and optimize therapy. The objective of this study is to analyze the variable features of PUV and correlate the different manifestations with the embryological development of the urinary system. The possible developmental basis of anomalies in PUV is analyzed, as recognition of the underlying defect would help to determine the severity of the disease. A clinical classification and a risk stratification approach encompassing the spectrum of PUV is proposed, to help define diagnosis and guide prognosis. A combined retrospective and prospective analysis of cases diagnosed as PUV at the tertiary teaching institute over a 5-year period from July 2014 to July 2019 was done. The outcome of selected cases was analyzed, based on the risk group stratification.

Results

The incidence of major complications during follow-up in each risk group was assessed individually and found to be highest in the high-risk group (92%), which was significantly higher than the other groups. The intermediate risk group was found to have a complication rate of 38%, while the low-risk group had only 12.5% complication rate. The three key concepts addressed in this study pertain to the embryological basis of PUV, the necessity of a clinical subdivision of patients, and the possibility of risk stratification based on clinical criteria. The limited review of institutional series is added to highlight the method of risk stratification and its probable utility.

Conclusions

The most critical factors to be accounted for in the diagnosis and management of PUV are the definition of disease severity, recognition of systemic complications, and identification of children at risk of progression to ESRD. The proposed developmental defect analysis, description of PUV sequence, clinical classification, and risk stratification approach are only the means to this end of segregating patient groups within the diagnostic spectrum.
Five-Year Outcomes With Nivolumab in Patients With Wild-Type BRAF Advanced Melanoma
Authors: Robert Caroline , Long Georgina V. , Brady Benjamin , Dutriaux Caroline , Di Giacomo Anna Maria , Mortier Laurent , Rutkowski Piotr , Hassel Jessica C. , McNeil Catriona M. , Kalinka Ewa Anna , Lebbé Céleste , Charles Julie , Hernberg Micaela M. , Savage Kerry J. , Chiarion-Sileni Vanna , Mihalcioiu Catalin , Mauch Cornelia , Arance Ana , Cognetti Francesco , Ny Lars , Schmidt Henrik , Schadendorf Dirk , Gogas Helen , Zoco Jesús , Re Sandra , Ascierto Paolo A. , Atkinson Victoria
Published: September 2020

PURPOSE

The CheckMate 066 trial investigated nivolumab monotherapy as first-line treatment for patients with previously untreated BRAF wild-type advanced melanoma. Five-year results are presented herein.

PATIENTS AND METHODS

In this multicenter, double-blind, phase III study, 418 patients with previously untreated, unresectable, stage III/IV, wild-type BRAF melanoma were randomly assigned 1:1 to receive nivolumab 3 mg/kg every 2 weeks or dacarbazine 1,000 mg/m2 every 3 weeks. The primary end point was overall survival (OS), and secondary end points included progression-free survival (PFS), objective response rate (ORR), and safety.

RESULTS

Patients were followed for a minimum of 60 months from the last patient randomly assigned (median follow-up, 32.0 months for nivolumab and 10.9 months for dacarbazine). Five-year OS rates were 39% with nivolumab and 17% with dacarbazine; PFS rates were 28% and 3%, respectively. Five-year OS was 38% in patients randomly assigned to dacarbazine who had subsequent therapy, including nivolumab (n = 37). ORR was 42% with nivolumab and 14% with dacarbazine; among patients alive at 5 years, ORR was 81% and 39%, respectively. Of 42 patients treated with nivolumab who had a complete response (20%), 88% (37 of 42) were alive as of the 5-year analysis. Among 75 nivolumab-treated patients alive and evaluable at the 5-year analysis, 83% had not received subsequent therapy; 23% were still on study treatment, and 60% were treatment free. Safety analyses were similar to the 3-year report.

CONCLUSION

Results from this 5-year analysis confirm the significant benefit of nivolumab over dacarbazine for all end points and add to the growing body of evidence supporting long-term survival with nivolumab mono-therapy. Survival is strongly associated with achieving a durable response, which can be maintained after treatment discontinuation, even without subsequent systemic therapies.
Neuromuscular Blockade Monitoring in Acute Respiratory Distress Syndrome: Randomized Controlled Trial of Clinical Assessment Alone or With Peripheral Nerve Stimulation
Authors: Rezaiguia-Delclaux Saïda , Laverdure Florent , Genty Thibaut , Imbert Audrey , Pilorge Catherine , Amaru Priscilla , Sarfati Céline , Stéphan François
Published: September 2020

BACKGROUND:

Whether train-of-four (TOF) monitoring is more effective than clinical monitoring to guide neuromuscular blockade (NMB) in patients with acute respiratory distress syndrome (ARDS) is unclear. We compared clinical monitoring alone or with TOF monitoring to guide atracurium dosage adjustment with respect to drug dose and respiratory parameters.

METHODS:

From 2015 to 2016, we conducted a randomized controlled trial comparing clinical assessments every 2 hours with or without corrugator supercilii TOF monitoring every 4 hours in patients who developed ARDS (Pao
2/Fio
2 <150 mm Hg) in a cardiothoracic intensive care unit. The primary outcome was the cumulative atracurium dose (mg/kg/h). Secondary outcomes included respiratory parameters during the neuromuscular blockade.

RESULTS:

A total of 38 patients in the clinical + TOF (C + TOF) group and 39 patients in the clinical (C) group were included in an intention-to-treat (ITT) analysis. The cumulative atracurium dose was higher in the C + TOF group (1.06 [0.75–1.30] vs 0.65 [0.60–0.89] mg/kg/h in the C group; P < .001) compared to C group, as well as the atracurium daily dose (C + TOF − C group mean difference = 0.256 mg/kg/h [95% confidence interval {CI}, 0.099–0.416], P = .026). Driving pressures during neuromuscular blocking agent (NMBA) administration did not differ between groups (P = .653). Intensive care unit (ICU) mortality was 22% in the C group and 27% in the C + TOF group (P = .786). Days on ventilation were 17 (8–26) in the C group and 16 (10–35) in the C + TOF group.

CONCLUSIONS:

In patients with ARDS, adding TOF to clinical monitoring of neuromuscular blockade did not change ICU mortality or days on mechanical ventilation (MV) but did increase atracurium consumption when compared to clinical assessment alone. TOF monitoring may not be needed in all patients who receive neuromuscular blockade for ARDS.
Decontamination and Reuse of N95 Filtering Facepiece Respirators: Where Do We Stand?
Authors: Cassorla Lydia
Published: September 2020

The coronavirus disease 2019 (COVID-19) pandemic created an extraordinary demand for N95 and similarly rated filtering facepiece respirators (FFR) that remains unmet due to limited stock, production constraints, and logistics. Interest in decontamination and reuse of FFR, a product class designed for single use in health care settings, has undergone a parallel surge due to shortages. A worthwhile decontamination method must provide effective inactivation of the targeted pathogen(s), and preserve particle filtration, mask fit, and safety for a subsequent user. This discussion reviews the background of the current shortage, classification, structure, and functional aspects of FFR, and potentially effective decontamination methods along with reference websites for those seeking updated information and guidance. The most promising techniques utilize heat, hydrogen peroxide, microwave-generated steam, or ultraviolet light. Many require special or repurposed equipment and a detailed operational roadmap specific to each setting. While limited, research is growing. There is significant variation between models with regard to the ability to withstand decontamination yet remain protective. The number of times an individual respirator can be reused is often limited by its ability to maintain a tight fit after multiple uses rather than by the decontamination method itself. There is no single solution for all settings; each individual or institution must choose according to their need, capability, and available resources. As the current pandemic is expected to continue for months to years, and the possibility of future airborne biologic threats persists, the need for plentiful, effective respiratory protection is stimulating research and innovation.
Breathing New Life into Nonalternant Hydrocarbon Chemistry: Syntheses and Properties of Polycyclic Hydrocarbons Containing Azulene, Pentalene, and Heptalene Frameworks
Authors: Konishi Akihito , Yasuda Makoto
Published: September 2020

Azulene 1, pentalene 2, and heptalene 3 are classical nonalternant hydrocarbons. Their fascinating π-frameworks, consecutive arrangements of odd-membered carbocycles, have engaged chemists’ attention for some time. In this review, we describe the salient revivals of these nonalternant hydrocarbons that are incorporated into polycyclic π-systems. Historical landmarks, recent studies, and fundamental properties, as well as potential applications to functional organic materials, are documented.
Curative effect of Omeprazole under different treatment courses in treatment of children with PU and HP infection and its influence on inflammatory factors
Authors: Zhang Shaohui , Zhang Yuan-da , Dong Qing-wei , Gu Fang
Published: September 2020

Objective: To compare curative effect and safety of omeprazole under different treatment courses in treatment of children with peptic ulcer (PU, diameter ≤1.0cm) and helicobacter pylori (HP) infection and its influence on inflammatory cytokines.

Methods: The study was a randomized controlled study and conducted at Baoding children’s hospital from June 2015 to June 2018. In this study 100 PU children with positive HP were chosen and classified into two groups at random. The 58 cases in the observation group were given omeprazole + amoxicillin + clarithromycin, and the antibiotics were not used two weeks later. Then, omeprazole was used to treat for two weeks. 42 cases in the control group were given omeprazole + amoxicillin + clarithromycin for two weeks. Curative effect, HP eradication rate, clinical symptoms, incidence of adverse reactions, level of serum inflammatory cytokine interleukin-6 (IL-6) and level of tumor necrosis factor-a (TNF-a) in two groups were compared.

Results: Total effective rate, HP eradication rate and clinical symptom relief of observation group were better than those of control group, and the differences showed statistical significance (P<0.05). The differences of two groups in the incidence of adverse reactions had no statistical significance (P<0.05). Serum IL-6 level and TNF-a level of observation group were significantly lower than those of control group and before the treatment, and the differences had statistical significance (P<0.05).

Conclusion: The application of omeprazole in treatment of PU patients with positive HP for four weeks can significantly improve PU cure rate and HP eradication rate, relieve clinical symptoms and reduce inflammatory response, so it deserves to be promoted clinically.

doi: https://doi.org/10.12669/pjms.36.7.3048

How to cite this:Zhang S, Zhang Y, Dong Q, Gu F. Curative effect of Omeprazole under different treatment courses in treatment of children with PU and HP infection and its influence on inflammatory factors. Pak J Med Sci. 2020;36(7):1623-1627.   doi: https://doi.org/10.12669/pjms.36.7.3048

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Igneous Rock Associations 26. Lamproites, Exotic Potassic Alkaline Rocks: A Review of their Nomenclature, Characterization and Origins
Authors: Mitchell Roger H.
Published: September 2020

Lamproite is a rare ultrapotassic alkaline rock of petrological importance as it is considered to be derived from metasomatized lithospheric mantle, and of economic significance, being the host of major diamond deposits. A review of the nomenclature of lamproite results in the recommendation that members of the lamproite petrological clan be named using mineralogical-genetic classifications to distinguish them from other genetically unrelated potassic alkaline rocks, kimberlite, and diverse lamprophyres. The names “Group 2 kimberlite” and “orangeite” must be abandoned as these rock types are varieties of bona fide lamproite restricted to the Kaapvaal Craton. Lamproites exhibit extreme diversity in their mineralogy which ranges from olivine phlogopite lamproite, through phlogopite leucite lamproite and potassic titanian richterite-diopside lamproite, to leucite sanidine lamproite. Diamondiferous olivine lamproites are hybrid rocks extensively contaminated by mantle-derived xenocrystic olivine. Currently, lamproites are divided into cratonic (e.g. Leucite Hills, USA; Baifen, China) and orogenic (Mediterranean) varieties (e.g. Murcia-Almeria, Spain; Afyon, Turkey; Xungba, Tibet). Each cratonic and orogenic lamproite province differs significantly in tectonic setting and Sr–Nd–Pb–Hf isotopic compositions. Isotopic compositions indicate derivation from enriched mantle sources, having long-term low Sm/Nd and high Rb/Sr ratios, relative to bulk earth and depleted asthenospheric mantle. All lamproites are considered, on the basis of their geochemistry, to be derived from ancient mineralogically complex K–Ti–Ba–REE-rich veins, or metasomes, in the lithospheric mantle with, or without, subsequent contributions from recent asthenospheric or subducted components at the time of genesis. Lamproite primary magmas are considered to be relatively silica-rich (~50–60 wt.% SiO2), MgO-poor (3–12 wt.%), and ultrapotassic (~8–12 wt.% K2O) as exemplified by hyalo-phlogopite lamproites from the Leucite Hills (Wyoming) or Smoky Butte (Montana). Brief descriptions are given of the most important phreatomagmatic diamondiferous lamproite vents. The tectonic processes which lead to partial melting of metasomes, and/or initiation of magmatism, are described for examples of cratonic and orogenic lamproites. As each lamproite province differs with respect to its mineralogy, geochemical evolution, and tectonic setting there is no simple or common petrogenetic model for their genesis. Each province must be considered as the unique expression of the times and vagaries of ancient mantle metasomatism, coupled with diverse and complex partial melting processes, together with mixing of younger asthenospheric and lithospheric material, and, in the case of many orogenic lamproites, with Paleogene to Recent subducted material.
DIAGNÓSTICO DE AÇÕES COLETIVAS RURAIS NO DISTRITO FEDERAL: um estudo logístico
Authors: De Carvalho Vanessa Silva , Gaban Filippi Amanda Cristina , Guarnieri Patricia
Published: September 2020

A disponibilidade para o armazenamento se torna cada vez mais importante no Agronegócio brasileiro, juntamente a mudanças organizações recentes entre os atores do campo, que se refletem em ações coletivas, como é o caso dos Condomínios de Armazéns Rurais. Esse trabalho objetiva analisar que tipos de ações coletivas rurais existem no Distrito Federal e entorno, e a relação delas com os Condomínios de Armazéns Rurais, através de uma revisão sistemática de literatura e estudo de caso, e analisados pela Análise de Conteúdo. Os principais resultados mostram que as ações coletivas rurais são caracterizadas em sua maioria por Associações ou Cooperativas no Distrito Federal e entorno de Goiás, e que aparentemente não existem Condomínios de Armazéns Rurais na região. Além disso, a região apresenta déficit de armazenagem e a maior parte das estruturas de armazenagem não são próprias, potencializando a criação de novos armazéns e desenvolvimento de Condomínios de Armazéns Rurais.
RESPONSABILIDADE AMBIENTAL CORPORATIVA: um panorama das publicações internacionais para a identificação de temáticas emergentes
Authors: Silva Pablo Marlon Medeiros da , Castro Ahiram Brunni Cartaxo de , Rocha Herica Kalianny Lopes Figueiredo , El-Aouar Walid Abbas , Câmara Júnior Sueldo Lopes
Published: September 2020

O objetivo desse estudo foi fazer um levantamento bibliométrico acerca das publicações sobre a Responsabilidade Ambiental no contexto organizacional no período de 2008 a 2017 utilizando-se da base de dados Scopus. A metodologia utilizou-se a pesquisa descritiva, com abordagem quantitativa, adotando-se a bibliometria como técnica de coleta para o levantamento de publicações na área da Administração entre os periódicos indexados à plataforma Scopus. Os resultados da busca apontaram para um número de 71 artigos, constatando-se uma crescente nos registros de publicações a partir de 2013. Os Gaps de pesquisa identificados estão sobre o compromisso social e ambiental que empresas mundiais têm com seus fornecedores das economias em países emergentes e a possibilidade de examinar a responsabilidade ambiental corporativa além de suas fronteiras, como em alianças estratégicas, arranjos produtivos, dentre outros. Portanto, o artigo traz importantes contribuições para a disseminação do conhecimento sobre o tema, levantando temáticas emergentes que fomentarão pesquisas futuras.
For behold, darkness shall cover the earth
Authors: Mortensen Neil
Published: September 2020

In anticipation, we await the moment for our Hallelujah chorus.
After the pandemic
Authors: Dean E
Published: September 2020

Surgeons across England are facing huge backlogs of elective surgery due to shutdowns and changes in services caused by the COVID-19 pandemic. The challenges that need to be overcome to resume surgery safely and tackle long waiting lists, including developing surgical pathways that are clear of COVID, more time needed to allow for personal protective equipment and extra cleaning of facilities and the disruption to surgical training, are discussed. But opportunities and innovations made possible by the extreme circumstances may help solve some of these problems.

While COVID-19 has highlighted shortcomings of the healthcare system, Erin Dean investigates the plans for resumption of elective services.
COVID-19: You can teach young dogs new tricks!
Authors: Eley C , Powell-Chandler A , James OP , Kokelaar R , Baumer T
Published: September 2020

With Newport establishing itself as the early 'hotspot' of the COVID-19 pandemic in Wales, rapid expansion of critical care capacity into alternative ward areas was essential. This huge surge in demand saw an urgent need for additional support and with that, four Royal Gwent Hospital higher surgical trainees offered their help amongst other healthcare professionals: gaining some additional critical care experience in return. This (hopefully) unique experience was undoubtedly challenging but made achievable in the team-working environment, crucially caring for patients and each other.

Four higher surgical trainees describe their unexpected change of role and sudden immersion into the realm of critical care amidst the COVID-19 pandemic.
Optical single-channel cryptosystem based on the discrete wavelet
transform and the chaotic standard map for multi-image
Authors: Shen Yuxin , Tang Chen , Zhou Lixiang , Lei Zhenkun
Published: September 2020

In this paper, an optical single-channel asymmetric cryptosystem based
on the inverse discrete wavelet transform (IDWT) and chaotic standard
map for multi-image in cyan-magenta-yellow-black (CMYK) mode is
proposed. To the best of our knowledge, this is the first time that
the color image in CMYK format is encoded into a real-valued
two-dimensional (2D) format by the IDWT; thus, our scheme can be
implemented in a single-channel step. In addition, we propose to
generate the random phase mask based on the chaotic standard map. Due
to the large key space and high efficiency of the chaotic standard
map, the security level of the proposed scheme can be improved. The
chaotic standard map is employed to generate the chaotic standard
phase mask (CSPM). Then the encoded 2D image can be encrypted in the
linear canonical transform domain based on the CSPM. Numerical
simulation results are shown to verify the feasibility and
effectiveness of our cryptosystem. In addition, our approach
outperforms other relevant cryptosystems and can be extended to
encrypt multiple color images directly.