bluuebunny/crossref_metadata_2025 huggingface dataset:
Impact of prior antibiotics on infected pancreatic necrosis microbiology in ICU patients: a retrospective cohort study
Authors: Garret Charlotte , Canet Emmanuel , Corvec Stéphane , Boutoille David , Péron Matthieu , Archambeaud Isabelle , Le Thuaut Aurélie , Lascarrou Jean-Baptiste , Douane Frédéric , Lerhun Marc , Regenet Nicolas , Coron Emmanuel , Reignier Jean
Published: June 2020

Background

Recent guidelines advise against prophylactic antibiotics in patients with necrotizing pancreatitis, advocating instead a step-up drainage and necrosectomy strategy with antibiotics as dictated by microbiological findings. However, prompt antibiotic therapy is recommended in patients with sepsis or septic shock, a possible presentation of infected pancreatic necrosis (IPN). Consequently, in many critically ill patients with IPN, pancreatic samples are collected only after broad-spectrum antibiotic therapy initiation. Whether this prior antibiotic exposure alters the microbiological findings is unknown. The main objective was to determine whether prior antibiotic exposure sterilized the samples collected during procedures for suspected IPN in patients admitted to the intensive care unit (ICU) for acute pancreatitis with suspected IPN. We retrospectively studied 56 consecutive ICU patients admitted with suspected IPN. We collected details on the microbiological samples and antimicrobials used. A definite diagnosis of IPN was given when bacteria were identified in pancreatic samples.

Results

In all, 137 pancreatic samples were collected, including 91 (66.4%) after antibiotic therapy initiation. IPN was confirmed in 48 (86%) patients. The proportion of positive samples was 74 (81.3%) in antibiotic-exposed patients and 32/46 (69.5%) in unexposed patients (p = 0.58). Of the 74 positive samples from exposed patients, 62 (84%) had organisms susceptible to the antibiotics used. One-third of samples contained more than one organism. Among patients with IPN, 37.5% had positive blood cultures. Multidrug- or extensively drug-resistant bacteria were identified at some point in half the patients.Enterobacter cloacaecomplex was more frequent in the exposed group (p = 0.02), as were Gram-negative anaerobic bacteria (p = 0.03).

Conclusion

Antibiotic exposure before sampling did not seem to affect culture positivity of pancreatic samples to confirm IPN, but may affect microbiological findings. Our results suggest that, in patients with sepsis and suspected IPN, antibiotics should be started immediately and pancreatic samples obtained as soon as possible thereafter. In other situations, antibiotics can be withheld until the microbiological results of pancreatic samples are available, to ensure accurate targeting of the spectrum to bacterial susceptibility patterns.

ClinicalTrials.gov numberNCT03253861
On the ω-multiple Meixner polynomials of the first kind
Authors: Zorlu Oğurlu Sonuç , Elidemir İlkay
Published: June 2020

In this study, we introduce a new family of discrete multiple orthogonal polynomials, namely ω-multiple Meixner polynomials of the first kind, where ω is a positive real number. Some structural properties of this family, such as the raising operator, Rodrigue’s type formula and an explicit representation are derived. The generating function for ω-multiple Meixner polynomials of the first kind is obtained and by use of this generating function we find several consequences for these polynomials. One of them is a lowering operator which will be helpful for obtaining a difference equation. We give the proof of the lowering operator by use of new technique which is a more elementary proof than the proof of Lee in (J. Approx. Theory 150:132–152, 2008). By combining the lowering operator with the raising operator we obtain the difference equation which has the ω-multiple Meixner polynomials of the first kind as a solution. As a corollary we give a third order difference equation for the ω-multiple Meixner polynomials of the first kind. Also it is shown that, for the special case $\omega = 1$ω=1, the obtained results coincide with the existing results for multiple Meixner polynomials of the first kind. In the last section as an illustrative example we consider the special case when $\omega =1/2$ω=1/2 and, for the $1/2$1/2-multiple Meixner polynomials of the first kind, we state the corresponding result for the main theorems.
Trajectory tracking control with preview action for a class of continuous-time Lur’e-type nonlinear systems
Authors: Yu Xiao , Li Li
Published: June 2020

A novel preview control scheme is developed for the trajectory tracking problem of continuous-time Lur’e-type nonlinear systems. With the aid of the translation approach, the state augmentation technique along with some special mathematical manipulations, an augmented error system including preview information is constructed. The tracking control problem is thereby reduced to a standard $H_{\infty }$

H
∞

controller design problem. Meanwhile, the integrator is introduced to eliminate the steady-state tracking error. The controller design condition is established in terms of a linear matrix inequality (LMI). As for the original system, the tracking controller is a state feedback controller with tracking error integral plus preview action. Finally, an example is given to illustrate the tracking performance of the proposed method.
Existence results of nonlocal Robin mixed Hahn and q-difference boundary value problems
Authors: Dumrongpokaphan Thongchai , Patanarapeelert Nichaphat , Sitthiwirattham Thanin
Published: June 2020

In this paper, we aim to study a nonlocal Robin boundary value problem for fractional sequential fractional Hahn-q-equation. The existence and uniqueness results for this problem are revealed by using the Banach fixed point theorem. In addition, the existence of at least one solution is studied by using Schauder’s fixed point theorem. The theorems for existence results are obtained.
Image data model optimization method based on cloud computing
Authors: Liu Jingyu , Wu Jing , Sun Linan , Zhu Hailong
Published: June 2020

In the current age of data explosion, the amount of data has reached incredible proportions. Digital image data constitute most of these data. With the development of science and technology, the demand for networked work and life continues to grow. Cloud computing technology plays an increasingly important role in life and work. This paper studies the optimization methods for cloud computing image data recognition models. The parallelization and task scheduling of the remote-sensing image classification model SCSRC based on spatial correlation regularization and sparse representation are studied in a cloud computing platform. First, cloud detection technology, combined with the dynamic features of the edge overlap region, is implemented in cloud computing mode. For image edge overlap region detection, the SCSRC method is implemented on a single machine, and the time performance of the method is analysed experimentally, which provides a basis for parallelization research under the cloud computing platform. Finally, the speedup and expansion ratio of the SK-SCSRC algorithm are determined by experiment, and MR-SCSRC and SK-SCSRC are compared. The simulation results show that, compared to previous methods, the method of image edge overlap detection is more accurate and the image fusion is better, which improves the image recognition ability in the overlap region and demonstrates the performance improvement of the MR-SCSRC algorithm under scheduling. This method addresses the shortcomings of Hadoop’s existing scheduler and can be integrated into remote-sensing cloud computing systems in the future.
Innovative use of data sources: a cross-sectional study of data linkage and artificial intelligence practices across European countries
Authors: Haneef Romana , Delnord Marie , Vernay Michel , Bauchet Emmanuelle , Gaidelyte Rita , Van Oyen Herman , Or Zeynep , Pérez-Gómez Beatriz , Palmieri Luigi , Achterberg Peter , Tijhuis Mariken , Zaletel Metka , Mathis-Edenhofer Stefan , Májek Ondřej , Haaheim Håkon , Tolonen Hanna , Gallay Anne
Published: June 2020

Background

The availability of data generated from different sources is increasing with the possibility to link these data sources with each other. However, linked administrative data can be complex to use and may require advanced expertise and skills in statistical analysis. The main objectives of this study were to describe the current use of data linkage at the individual level and artificial intelligence (AI) in routine public health activities, to identify the related estimated health indicators (i.e., outcome and intervention indicators) and health determinants of non-communicable diseases and the obstacles to linking different data sources.

Method

We performed a survey across European countries to explore the current practices applied by national institutes of public health, health information and statistics for innovative use of data sources (i.e., the use of data linkage and/or AI).

Results

The use of data linkage and AI at national institutes of public health, health information and statistics in Europe varies. The majority of European countries use data linkage in routine by applying a deterministic method or a combination of two types of linkages (i.e., deterministic & probabilistic) for public health surveillance and research purposes. The use of AI to estimate health indicators is not frequent at national institutes of public health, health information and statistics. Using linked data, 46 health outcome indicators, 34 health determinants and 23 health intervention indicators were estimated in routine. The complex data regulation laws, lack of human resources, skills and problems with data governance, were reported by European countries as obstacles to routine data linkage for public health surveillance and research.

Conclusions

Our results highlight that the majority of European countries have integrated data linkage in their routine public health activities but only a few use AI. A sustainable national health information system and a robust data governance framework allowing to link different data sources are essential to support evidence-informed health policy development. Building analytical capacity and raising awareness of the added value of data linkage in national institutes is necessary for improving the use of linked data in order to improve the quality of public health surveillance and monitoring activities.
Prevention of severe infectious complications after colorectal surgery using oral non-absorbable antimicrobial prophylaxis: results of a multicenter randomized placebo-controlled clinical trial
Authors: Mulder Tessa , Kluytmans-van den Bergh Marjolein , Vlaminckx Bart , Roos Daphne , de Smet Anne Marie , de Vos tot Nederveen Cappel Robert , Verheijen Paul , Brandt Alexandra , Smits Anke , van der Vorm Eric , Bathoorn Erik , van Etten Boudewijn , Veenemans Jacobien , Weersink Annemarie , Vos Margreet , van ’t Veer Nils , Nikolakopoulos Stavros , Bonten Marc , Kluytmans Jan
Published: June 2020

Background

Surgical site infections (SSIs) are common complications after colorectal surgery. Oral non-absorbable antibiotic prophylaxis (OAP) can be administered preoperatively to reduce the risk of SSIs. Its efficacy without simultaneous mechanical cleaning is unknown.

Methods

The Precaution trial was a double-blind, placebo-controlled randomized clinical trial conducted in six Dutch hospitals. Adult patients who underwent elective colorectal surgery were randomized to receive either a three-day course of preoperative OAP with tobramycin and colistin or placebo. The primary composite endpoint was the incidence of deep SSI or mortality within 30 days after surgery. Secondary endpoints included both infectious and non-infectious complications at 30 days and six months after surgery.

Results

The study was prematurely ended due to the loss of clinical equipoise. At that time, 39 patients had been randomized to active OAP and 39 to placebo, which reflected 8.1% of the initially pursued sample size. Nine (11.5%) patients developed the primary outcome, of whom four had been randomized to OAP (4/39; 10.3%) and five to placebo (5/39; 12.8%). This corresponds to a risk ratio in the intention-to-treat analysis of 0.80 (95% confidence interval (CI) 0.23–2.78). In the per-protocol analysis, the relative risk was 0.64 (95% CI 0.12–3.46).

Conclusions

Observational data emerging during the study provided new evidence for the effectiveness of OAP that changed both the clinical and medical ethical landscape for infection prevention in colorectal surgery. We therefore consider it unethical to continue randomizing patients to placebo. We recommend the implementation of OAP in clinical practice and continuing monitoring of infection rates and antibiotic susceptibilities.

Trial registration

The PreCaution trial is registered in the Netherlands Trial Register under NL5932 (previously: NTR6113) as well as in the EudraCT register under 2015–005736-17.
RDGN-based predictive model for the prognosis of breast cancer
Authors: Dong Bing , Yi Ming , Luo Suxia , Li Anping , Wu Kongming
Published: June 2020

Background

Breast cancer is the most diagnosed malignancy in females in the United States. The members of retinal determination gene network (RDGN) including DACH, EYA, as well as SIX families participate in the proliferation, apoptosis, and metastasis of multiple tumors including breast cancer. A comprehensive predictive model of RDGN might be helpful to herald the prognosis of breast cancer patients.

Methods

In this study, the Gene Expression Ominibus (GEO) and Gene Set Expression Analysis (GSEA) algorithm were used to investigate the effect of RDGN members on downstream signaling pathways. Besides, based on The Cancer Genome Atlas (TCGA) database, we explored the expression patterns of RDGN members in tumors, normal tissues, and different breast cancer subtypes. Moreover, we estimated the relationship between RDGN members and the outcomes of breast cancer patients. Lastly, we constructed a RDGN-based predictive model by Cox proportional hazard regression and verified the model in two separate GEO datasets.

Results

The results of GSEA showed that the expression of DACH1 was negatively correlated with cell cycle and DNA replication pathways. On the contrary, the levels of EYA2 and SIX1 were significantly positively correlated with DNA replication, mTOR, and Wnt pathways. Further investigation in TCGA database indicated that DACH1 expression was lower in breast cancers especially basal-like subtype. In the meanwhile, SIX1 was remarkably upregulated in breast cancers while EYA2 level was increased in Basal-like and Her-2 enriched subtypes. Survival analyses demonstrated that DACH1 was a favorable factor while EYA2 and SIX1 were risk factors for breast cancer patients. Given the results of Cox proportional hazard regression analysis, two members of RDGN were involved in the present predictive model and patients with high model index had poorer outcomes.

Conclusion

This study showed that aberrant RDGN expression was an unfavorable factor for breast cancer. This RDGN-based comprehensively framework was meaningful for predicting the prognosis of breast cancer patients.
Evaluation of morbidity in Schistosoma mansoni-positive primary and secondary school children after four years of mass drug administration of praziquantel in western Kenya
Authors: Abudho Bernard O. , Guyah Bernard , Ondigo Bartholomew N. , Ndombi Eric M. , Ireri Edmund , Carter Jennifer M. , Riner Diana K. , Kittur Nupur , Karanja Diana M. S. , Colley Daniel G.
Published: June 2020

Background

World Health Organization guidelines recommend preventive chemotherapy with praziquantel to control morbidity due to schistosomiasis. The primary aim of this cross-sectional study was to determine if 4 years of annual mass drug administration (MDA) in primary and secondary schools lowered potential markers of morbidity in infected children 1 year after the final MDA compared to infected children prior to initial MDA intervention.

Methods

Between 2012 and 2016 all students in two primary and three secondary schools within three kilometers of Lake Victoria in western Kenya received annual mass praziquantel administration. To evaluate potential changes in morbidity we measured height, weight, mid-upper arm circumference, hemoglobin levels, abdominal ultrasound, and quality of life in children in these schools. This study compared two cross-sectional samples of Schistosoma mansoni egg-positive children: one at baseline and one at year five, 1 year after the fourth annual MDA. Data were analyzed for all ages (6–18 years old) and stratified by primary (6–12 years old) and secondary (12–18 years old) school groups.

Results

The prevalence of multiple potential morbidity markers did not differ significantly between the egg-positive participants at baseline and those at 5 years by Mann Whitney nonparametric analysis and Fisher’s exact test for continuous and categorical data, respectively. There was a small but significantly higher score in school-related quality of life assessment by year five compared to baseline by Mann Whitney analysis (P = 0.048) in 13–18 year olds where malaria-negative. However, anemia was not positively impacted by four annual rounds of MDA, but registered a significant negative outcome.

Conclusions

We did not detect differences in morbidity markers measured in a population of those infected or re-infected after multiple MDA. This could have been due to their relative insensitivity or a failure of MDA to prevent morbidity among those who remain infected. High malaria transmission in this area and/or a lack of suitable methods to measure the more subtle functional morbidities caused by schistosomiasis could be a factor. Further research is needed to identify and develop well-defined, easily quantifiable S. mansoni morbidity markers for this age group.
Soil releasing as key to rethink water spaces in urban planning
Authors: Adobati Fulvio , Garda Emanuele
Published: June 2020

Soil sealing processes that involved European cities in the twentieth century have reduced the quantity and quality of permeable soils (open land for agricultural and leisure resources). These processes have also weakened the ability of urban areas to manage natural events, of all evidence regarding the water cycle. This intense phase was supported by a cycle of growth that showed signs of an irreversible crisis only in the last decade, starting a new and unprecedented season. However, soil sealing development constitutes the most intense form of land degradation and affects all ecosystem services (Tobias et al. in Land Degrad 29:2015–2024, 2018). This is particularly true for spaces and territories along main rivers where the presence of sealed areas and concrete channels (riverbed and riverbanks) represents a problem regarding hydrogeological, ecological, and landscaping aspects. To safeguard urban systems, by restoring “landscape river” (and its surroundings), increasing green areas and more efficient management of the rainwater, it is fundamental to enhance the “removing sealing layers” (EU 2012) according to a holistic approach. This paper explores the de-sealing concept and highlights some international and Italian cases, in particular the River Contracts experience promoted in the Lombardy Region, including actions proposed by public policies and urban planning tools. All these experiences have proposed de-sealing processes of river environments and urban systems ensuring a new integration between urban areas and “water landscapes”. To underline some characteristics this exploration allowed: to highlight different de-sealing approaches, between direct or indirect conditioning; to recognize river elements and “environments” in which these initiatives are activated; to recognize in these initiatives a multi-scale attitude both the expected effects and the type of involved institutional subject involved; to identify the main subjects, with specific roles and responsibilities, in this type of process; to recognize limits and critical issues. River restoration, combined with de-sealing actions inside the urban structures, shall be performed by answering to several needs: increasing the green open space quantity and ecosystem services recovery; contributing to biodiversity by restoring ecosystems and ecological processes; balancing the soil-sealing negative externalities; improving the flood-risk mitigation and management in urban areas. In particular, the voluntary instrument of the River Contract includes a territorial area that is adequate for the treatment of the phenomenon but is struggling to be codified in the local planning instruments with cogency. The assumption of different spaces and the recognition of the same in the spatial devices of urban planning instruments could define more clearly the need to face the water-city relationship effectively, for the benefit of urban security and the quality of the inhabitants’ living environment.
How do the digital competences of students in vocational schools differ from those of students in cooperative higher education institutions in Germany?
Authors: Wild Steffen , Schulze Heuling Lydia
Published: June 2020

Digital skills are thought to be a key competence of the twenty-first century. With the rapid growth of internet and communication tool (ICT) usage among both students and teachers, cooperative (co-op) education programmes, like other educational institutions, face the challenge of integrating and supporting digital skill development. However, little is known about how these skills are developed prior to entering cooperative education programmes. Against this background, a sample of 893 freshers, ranging from vocational students to co-op students, were tested according to their digital skills. The analysis shows that co-op students have a higher level of competence than vocational students. In addition, we found that in our sample social background has no impact on digital competences. The results are discussed and classified in the context of the current state of research.
Variations of rhizospheric soil microbial communities in response to continuous Andrographis paniculata cropping practices
Authors: Li Junren , Chen Xiuzhen , Li Simin , Zuo Zimei , Zhan Ruoting , He Rui
Published: June 2020

Background

Changes of soil microbial communities are one of the main factors of continuous cropping problem. Andrographis paniculata has been reported to have replant problem in cultivation. However, little is known about the variations of rhizosphere soil microbial communities of A. paniculata under a continuous cropping system. Here, Illumina MiSeq was used to investigate the shifts of rhizospheric bacterial and fungal communities after continuous cropping of A. paniculata.

Results

The bacterial diversity increased whereas the fungal diversity decreased in rhizosphere soil after consecutive A. paniculata monoculture; and the soil microbial community structure differed between newly plant soil and continuous cropped soil. Taxonomic analyses further revealed that the bacterial phyla Proteobacteria, Acidobacteria and Bacteroidetes and the fungal phyla Zygomycota, Ascomycota and Cercozoa were the dominant phyla across all soil samples. The relative abundance of phyla Acidobacteria and Zygomycota were significantly increased after continuous cropping. Additionally, the most abundant bacterial genus Pseudolabrys significantly decreased, while the predominant fungal genus Mortierella increased considerably in abundance after continuous cropping.

Conclusions

Our results revealed the changes on diversity and composition of bacterial and fungal communities in rhizospheric soil under continuous cropping of A. paniculata. These data contributed to the understanding of soil micro-ecological environments in the rhizosphere of A. paniculata.
Save the ICU and save lives during the COVID-19 pandemic
Authors:   Japan ECMOnet for COVID-19, Abe Ryuzo , Bunya Naofumi , Endo Tomoyuki , Fujino Yuji , Fujita Kensuke , Fujizuka Kenji , Hagiwara Yoshihiro , Hamaguchi Jun , Hara Yoshitaka , Hashiba Eiji , Hashimoto Satoru , Hattori Noriyuki , Hoshino Kota , Ijuin Shinichi , Ikeyama Takanari , Ichiba Shingo , Iwanaga Wataru , Iwashita Yoshiaki , Kanamoto Masafumi , Kaneko Hitoshi , Kawamae Kaneyuki , Kotani Toru , Koyama Yasuaki , Liu Keibun , Masuno Tomohiko , Morimura Naoto , Nakamura Tomoyuki , Nakane Masaki , Nasu Michitaka , Nishida Osamu , Nishimura Masaji , Ochiai Kanae , Ogura Takayuki , Ohshimo Shinichiro , Oyama Keisuke , Sasaki Junichi , Seo Ryutaro , Shimazu Takeshi , Shime Nobuaki , Shimizu Keiki , Suzuki Hiroyuki , Takauji Shuhei , Takeda Shinhiro , Takeuchi Ichiro , Takita Mumon , Taniguchi Hayato , Shime Nobuaki
Published: June 2020

Appropriate critical care delivery for Coronavirus disease 2019 (COVID-19) is a cornerstone in saving lives. Earlier publications worldwide demonstrate higher mortality among patients receiving mechanical ventilation in intensive care units during “surges” in the number of cases. In contrast, lower mortality outcomes are evident in Japan using CRISIS [CRoss Icu Searchable Information System] data by the national registry, Japan ECMOnet for COVID-19. This highlights the need for scientific analysis of the medical factors contributing to high survival rates and social factors associated with low case “surges,” to gain insight into protective strategies for possible coming waves in the COVID-19 pandemic.
Hematite (α-Fe2O3) quantification in sedimentary magnetism: limitations of existing proxies and ways forward
Authors: Roberts Andrew P. , Zhao Xiang , Heslop David , Abrajevitch Alexandra , Chen Yen-Hua , Hu Pengxiang , Jiang Zhaoxia , Liu Qingsong , Pillans Brad J.
Published: June 2020

Determination of hematite contributions to sedimentary magnetizations is an important but difficult task in quantitative environmental studies. The poorly crystalline and fine-grained nature of hematite nanoparticles makes quantification of their concentrations in natural environments challenging using mineralogical and spectroscopic methods, while the weak magnetization of hematite and often significant superparamagnetic nanoparticle concentrations make quantification difficult using magnetic remanence measurements. We demonstrate here that much-used magnetic parameters, such as the S-ratio and ‘hard’ isothermal remanent magnetization (HIRM), tend to significantly underestimate relative and absolute hematite contents, respectively. Unmixing of isothermal remanent magnetization (IRM) acquisition curves is among the more suitable approaches for defining magnetic mineral contributions, although it has under-appreciated uncertainties that limit hematite quantification. Diffuse reflectance spectroscopy and other methods can enable relative hematite and goethite content quantification under some conditions. Combined use of magnetic, mineralogical, and spectroscopic approaches provides valuable cross-checks on estimated hematite contents; such an integrated approach is recommended here. Further work is also needed to rise to the challenge of developing improved methods for hematite quantification.
Pancreaticoduodenectomy for preservation of fat-replaced pancreatic body and tail tissue in a patient with solid pseudopapillary neoplasm: a case report
Authors: Sakurai Toru , Nagakawa Yuichi , Takishita Chie , Osakabe Hiroaki , Nishino Hitoe , Akashi Masanori , Okazaki Naoto , Suzuki Kenta , Katsumata Kenji , Tsuchida Akihiko
Published: June 2020

Background

There is no standard surgical method for treating pancreatic head tumors with fat replacement of the pancreatic body and tail. Total pancreatectomy procedures are usually performed to excise pancreatic head tumors and lead to endocrine function loss and subsequent development of diabetes. We present a rare case where the adipose tissue was preserved during pancreaticoduodenectomy in a patient with a solid pseudopapillary neoplasm and fat-replaced pancreatic body and tail.

Case presentation

Contrast-enhanced computed tomography scans of a 43-year-old man revealed a tumor measuring approximately 3 cm in size with calcification in the pancreatic head. Magnetic resonance cholangiopancreatography showed that the pancreatic ducts in the body and tail were completely disrupted. Furthermore, endoscopic ultrasonography showed no pancreatic parenchyma in the body and tail of the pancreas, with disruption in the main pancreatic duct. Endoscopic ultrasonography-guided fine-needle aspiration led to the final pathological diagnosis of a solid pseudopapillary neoplasm, and laparoscopic total pancreatectomy was performed. However, intraoperative findings indicated that the tumor was located in the pancreatic head. Pancreatic parenchyma was not observed in the pancreatic body or tail, as it had been completely replaced with adipose tissue. Nevertheless, the shape of the pancreas was identifiable. Therefore, pancreaticoduodenectomy was performed to transect parenchyma at the pancreatic neck, while preserving the adipose tissue present in the pancreatic body. The main pancreatic duct could not be identified at the cut surface. Therefore, we performed modified Blumgart-style pancreaticojejunostomy to cover the cut end instead of reconstructing the pancreatic duct. The patient was discharged on postoperative day 12 without complications and is being followed-up as an outpatient. His fasting blood sugar and hemoglobin A1c levels according to the National Glycohemoglobin Standardization Program reports were within normal limits, indicating that the endocrine function (insulin secretion ability) was preserved during the 1.5 years following surgery.

Conclusions

In patients with pancreatic head tumors, pancreaticoduodenectomy that preserves fat-replaced pancreatic body and tail tissues can preserve postoperative endocrine function.
A slowly-growing solitary skip lymph nodule of occult gastric cancer above the neck of pancreas: a case report
Authors: Tang Yuhao , Sun Xiaowei , Xu Li
Published: June 2020

Background

Skip lymphatic metastasis (SK) is an exceptional and characteristic pattern of lymph node metastasis in gastric cancer (GC) with infrequent incidence. This is an extremely rare report of occult gastric cancer with solitary skip lymphatic metastasis as the initial and primary observation.

Case presentation

A 61-year-old woman, who complained of epigastric discomfort for several years, presented a solitary nodule upon pancreas neck examination by CT without performance on the primary lesion, even gastroscopy. During the preoperative 4-month follow-up, the nodule stayed stable without any therapy. The postoperative pathological examination confirmed the consistent diagnosis of gastric adenocarcinoma between the nodule and the stomach lesion, which was found by preoperative random biopsy of the mucosa.

Conclusions

This case highlights the concentration on vigilance to the SK of GC and a closer observation for intra-abdominal nodules, even radiological suspicion of a benign lesion.
Measuring adult romantic attachment: psychometric properties of the brief Spanish version of the experiences in close relationships
Authors: Guzmán-González Mónica , Rivera-Ottenberger Diana , Brassard Audrey , Spencer Rosario , Lafontaine Marie-France
Published: June 2020

The Experiences in Close Relationships (Brennan et al, Attachment theory and close relationships, 1998) questionnaire is one of the most widely used measures of adult romantic attachment. Despite the advantages of the ECR, the length of this measure may discourage its use in clinical and research contexts. Consequently, the goal of this study was to develop a brief Spanish version of the ECR questionnaire and to examine its psychometric properties when administered to six different Spanish-speaking samples from Chile. Confirmatory factor analyses replicated the two-dimensional structure of the ECR and its invariance across gender. Results also supported the reliability and concurrent validity of our brief Spanish version of the ECR (i.e., Spanish ECR-12), by its association with measures of emotion regulation, dyadic empathy, psychological distress and well-being, and relationship satisfaction. The Spanish ECR-12 can be used by researchers and clinical professionals as an abridged measure of adult attachment.
The eco-city and its core environmental dimension of sustainability: green energy technologies and their integration with data-driven smart solutions
Authors: Bibri Simon Elias
Published: June 2020

Ecological urbanism is seen today as one of the keys towards unlocking the quest for a low-carbon or fossil fuel–free society. Global and local policies promote and advocate the eco–city as the most environmentally sound model of sustainable urbanism. It is argued that the eco–city strategies and solutions are expected to deliver positive outcomes in terms of minimal demand on energy resources and thus minimal environmental impacts. Moreover, it has recently been suggested that the eco-city needs to embrace and leverage what advanced ICT has to offer, particularly with regard to sustainable energy systems, so as to improve and advance its contribution to the goals of environmental sustainability. This paper examines how the eco–city especially its core environmental dimension is practiced and justified in urban planning and development with respect to sustainable energy systems and their integration with data-driven smart technologies at the district level. To illuminate this urban phenomenon accordingly, a descriptive case study is adopted as a qualitative research methodology where the empirical basis is formed by urban planning and development documents combined with secondary data and scientific literature. To provide a theoretical foundation and produce a rationale for this study, this paper first provides a state–of–the–art review of the field of ecological urbanism in terms of its foundations, models, strategies, research issues, as well as data–driven smart technological trends. This study shows that the Eco-city District of Stockholm Royal Seaport uses green energy and data-driven smart technologies as the key strategies and solutions for achieving the environmental objectives of sustainable development in terms of lowering energy consumption and mitigating pollution. This entails conserving and decreasing the demand for energy through renewable resources (i.e., sun, wind, and water), bio–fuelled Combined Heat Power system, large-scale smart grid system, energy management, sustainable waste management, and passive solar houses. This research enhances the scholarly community’s current understanding of the emerging phenomenon of the smart eco-city with respect to the synergic potential of the integration of its sustainable energy strategies with data-driven technology solutions for advancing environmental sustainability.
Quantitative T2 mapping of glenohumeral joint osteoarthritis: a case-control study
Authors: Abou Khadrah Rania Sobhy , Reda Alaa Mohamed
Published: June 2020

Background

T2 relaxometry is a highly sensitive technique used to assess morphological changes in the cartilage prior to anatomical changes; it provides the quantification of the disparate components of cartilage such as water, proteoglycans, and collagen. This study aims to assess T2 values of glenohumeral joint cartilage using 1.5 T magnetic resonance imaging (MRI) and comparing T2 relaxation time values between two groups—the control group and the group of patients with osteoarthritis (OA). The study was conducted among 35 OA patients (27 females and eight males; median age, 60 years; age range, 43–69 years). This group was divided into primary OA (n = 15) and secondary OA (n = 20). The control group had 30 patients (25 females and five males; median age, 46 years; age range, 30–56 years). All patients were assessed using plain radiography to determine the grade of osteoarthritis followed by a multi-echo spin pulse sequence (T2 mapping) of the coronal plane. Three areas were considered to evaluate the cartilage-humeral zone, glenoid zone, and central zones by manually drawing the region of interest (ROI). The values were compared statistically by using Mann-Whitney U tests.

Results

Median T2 values differed significantly between the control group (43.4 ms [interquartile ranges, 41.54-45.33 ms]) and the OA patients for grades I (59.2 ms [interquartile ranges, 57.54-63.33 ms]), II (64.7 ms [interquartile ranges, 62.54-67.39 ms]), and III (61.9 ms, [interquartile ranges, 57.54-64.53 ms]). Mean T2 values were significantly higher in the different zones when comparing the OA patients whatever the cause primary or secondary (p value < 0.05) with the control group; no significant difference was noticed between the primary and secondary OA (p value > 0.05).

Conclusion

T2 relaxometry is a reliable, quantitative method for the assessment of the glenohumeral cartilage for significant differences in T2 values between the control group and the OA patients.
Integrating stem cell-based experiments in clinical research
Authors: Karmacharya Rakesh , Kieling Christian , Mondelli Valeria
Published: June 2020

With the seminal discovery of somatic cell reprogramming with defined genetic factors, it is now a routine laboratory procedure to reprogram somatic cells to generate patient-specific induced pluripotent stem cells (iPSCs) [1] Patient-specific iPSCs can be differentiated to generate mature neurons as well as three-dimensional brain organoids that show appropriate functional activity in electrophysiological studies [2,3]. However, there is a significant gap in the thoughtful incorporation of patient-derived neuronal cells in clinical studies addressing disease risk.
Time-Driven Activity-Based Costing Comparison of CT-Guided Versus MR-Guided SBRT
Authors: Parikh Neil R. , Lee Percy P. , Raman Steven S. , Cao Minsong , Lamb James , Tyran Marguerite , Chin Walter , Gilchrist Travis , Agazaryan Nzhde , Mittauer Kathryn , Steinberg Michael L. , Raldow Ann C.
Published: June 2020

PURPOSE:

Magnetic resonance–guided radiation therapy (MRgRT) has recently become commercially available, offering the opportunity to accurately image and target moving tumors as compared with computed tomography-guided radiation therapy (CTgRT) systems. However, the costs of delivering care with these 2 modalities remain poorly described. With localized unresectable hepatocellular carcinoma as an example, we were able to use time-driven activity-based costing to determine the cost of treatment on linear accelerators with CTgRT compared with MRgRT.

MATERIALS AND METHODS:

Process maps, informed via interviews with departmental personnel, were created for each phase of the care cycle. Stereotactic body radiation therapy was delivered at 50 Gy in 5 fractions, either with CTgRT using fiducial placement, deep inspiration breath-hold (DIBH) with real-time position management, and volumetric-modulated arc therapy, or with MRgRT using real-time tumor gating, DIBH, and static-gantry intensity-modulated radiation therapy.

RESULTS:

Direct clinical costs were $7,306 for CTgRT and $8,622 for MRgRT comprising personnel costs ($3,752 v $3,603), space and equipment costs ($2,912 v $4,769), and materials costs ($642 v $250). Increased MRgRT costs may be mitigated by forgoing CT simulation ($322 saved) or shortening treatment to 3 fractions ($1,815 saved). Conversely, adaptive treatment with MRgRT would result in an increase in cost of $529 per adaptive treatment.

CONCLUSION:

MRgRT offers real-time image guidance, avoidance of fiducial placement, and ability to use adaptive treatments; however, it is 18% more expensive than CTgRT under baseline assumptions. Future studies that elucidate the magnitude of potential clinical benefits of MRgRT are warranted to clarify the value of using this technology.
Effect of Surgical Oncologist Turnover on Hospital Volume and Treatment Outcomes Among Patients With Upper GI Malignancies
Authors: Franko Jan , Frankova Daniela
Published: June 2020

PURPOSE:

Lack of surgical expertise may affect cancer care delivery. Here, we examined the impact of surgical oncologist vacancy and turnover in a community cancer center serving a mixed urban and rural population.

METHODS:

Survival outcomes of patients with potentially resectable esophageal, gastric, and pancreatic carcinomas treated in the index hospital (n = 519) were compared with those of a then-contemporary control group derived from the state-specific SEER registry (n = 3,340). The onboarding period (ie, the period without a surgical oncologist) and early and late periods with a surgical oncologist were defined.

RESULTS:

At the state level, there was a steady trend of patients who were annually referred (290.4 ± 34.3 patients per year; P < .001) and underwent operation (158.7 ± 18.7 patients per year; P < .001). We observed the absence of an analogous trend in the index hospital ( P = .141). The index hospital diagnosed 12.2% of state cancers of interest during the years with surgical oncologists but only 6.7% of cancers when surgical oncologists were absent ( P = .031). The survival model adjusted for age, stage, and primary disease site comparing the early and late periods demonstrated that being treated in the index hospital did not result in inferior survival (hazard ratio, 1.067; P = .265).

CONCLUSION:

Loss of surgical oncologists was associated with referral decline and likely out-migration of patients, whereas prompt restoration of surgical oncology services reinstated volumes and preserved survival outcomes.
Mitf-family transcription factor function is required within cranial neural crest cells to promote choroid fissure closure
Authors: Sinagoga Katie L. , Larimer-Picciani Alessandra M. , George Stephanie M. , Spencer Samantha A. , Lister James A. , Gross Jeffrey M.
Published: June 2020

A critical step in eye development is closure of the choroid fissure (CF), a transient structure in the ventral optic cup through which vasculature enters the eye and ganglion cell axons exit. While many factors have been identified that function during CF closure, the molecular and cellular mechanisms mediating this process remain poorly understood. Failure of CF closure results in colobomas. Recently, MITF was shown to be mutated in a subset of human coloboma patients, but how MITF functions during CF closure is unknown. To address this question, zebrafish with mutations in mitfa and tfec, two members of the Mitf-family of transcription factors, were analyzed and their functions during CF closure determined. mitfa;tfec mutants possess severe colobomas and our data demonstrate that Mitf activity is required within cranial neural crest cells (cNCCs) during CF closure. In the absence of Mitf function, cNCC migration and localization in the optic cup are perturbed. These data shed light on the cellular mechanisms underlying colobomas in patients with MITF mutations and identify a novel role for Mitf function in cNCCs during CF closure.
Placental gene editing via trophectoderm-specific Tat-Cre/loxP recombination
Authors: Ozguldez Hatice O. , Fan Rui , Bedzhov Ivan
Published: June 2020

The ways in which placental defects affect embryonic development are largely overlooked because of the lack of a trophoblast-specific approach for conditional gene ablation. To tackle this, here we established a simple, fast and efficient method for trophectodermal Tat-Cre/loxP recombination. We used the natural permeability barrier in mouse blastocysts in combination with off-the-shelf Tat-Cre recombinase to achieve editing of conditional alleles in the trophoblast lineage. This direct approach enables gene function analysis during implantation and placentation in mice, thereby critically helping to broaden our understanding of human reproduction and development.
Evaluation of genitourinary fistulas in pelvic malignancies with etiopathologic correlation: role of cross sectional imaging in detection and management
Authors: Mandava Anitha , Koppula Veeraiah , Sharma Gaurav , Kandati Meghana , Raju K.V.V.N. , Subramanyeshwar Rao T.
Published: June 2020

Objective:

Genitourinary fistulas in pelvic malignancies are abnormal communications occurring due to either locally advanced tumours invading the surrounding organs or post-therapeutic complications of malignancies. In this article we review and describe the role of cross-sectional imaging findings in the management of genitourinary fistulas in pelvic malignancies.

Methods:

A retrospective study, for the period January 2012 to December 2018, was undertaken in patients with pelvic malignancies having genitourinary fistulas. The cross-sectional (CT and MRI) imaging findings in various types of fistulas were reviewed and correlated with the primary malignancy and the underlying etiopathology.

Results:

Genitourinary fistulas were observed in 71 patients (6 males, 65 females). 11 types of fistulas were identified in carcinomas of cervix, rectum, ovary, urinary bladder, sigmoid colon, vault, endometrium and prostate. The commonest were rectovaginal and vesicovaginal fistulas. 13 patients had multiple fistulas. The sensitivity, specificity, positive and negative predictive values of CT and MRI are 98%, 100%, 66%, 98% and 95%, 25%, 88% and 50% respectively. Contrast-enhanced CT with oral and rectal contrast is more sensitive and specific than MRI in the evaluation of genitourinary fistulas.

Conclusion:

Imaging findings significantly influence the management and outcome of genitourinary fistulas in pelvic malignancies. Contrast-enhanced CT is the imaging modality of choice in the evaluation of pelvic fistulas associated with malignancies and MRI is complimentary to it.

Advances in knowledge:

To our knowledge, this study is the first of its kind wherein the mean duration of occurrence of fistulas in pelvic malignancies is correlated with the underlying etiopathology.
HEP-Net opinion on the management of ascites and its complications in the setting of decompensated cirrhosis in the resource constrained environment of Pakistan
Authors: Ali Bushra , Salim Adnan , Alam Altaf , Zuberi Bader Faiyaz , Junejo Zeeshan Ali , Azam Zahid , Kamani Lubna , Farooqi Javed Iqbal , Salih Muhammed , Nawaz Arif Amir , Choudhry Asad Ali , Hashmi Zahid Yasin , Saddiq Masood
Published: June 2020

Approximately one half of patients develop ascites within 10 years of diagnosis of compensated cirrhosis. It is a poor prognostic indicator, with only 50% surviving beyond two years. Mortality worsens significantly to 20% to 50% at one year if the ascites becomes refractory to medical therapy. Pakistan has one of the highest prevalence of viral hepatitis in the world and patients with ascites secondary to liver cirrhosis make a major percentage of both inpatient and outpatient burden. Studies indicate that over 80% of patients admitted with ascites have liver cirrhosis as the cause. This expert opinion suggests proper assessment of patients with ascites in the presence of underlying cirrhosis. This expert opinion includes appropriate diagnosis and management of uncomplicated ascites, refractory ascites and complicated ascites (including spontaneous bacterial peritonitis (SBP) ascites, hepatorenal syndrome (HRS) and hyponatremia. The purpose behind this expert opinion is to help consultants, postgraduate trainees, medical officers and primary care physicians optimally manage their patients with cirrhosis and ascites in a resource constrained setting as is often encountered in a developing country like Pakistan.

doi: https://doi.org/10.12669/pjms.36.5.2407

How to cite this:Ali B, Salim A, Alam A, Zuberi BF, Ali Z, Azam Z, et al. HEP-Net opinion on the management of ascites and its complications in the setting of decompensated cirrhosis in the resource constrained environment of Pakistan. Pak J Med Sci. 2020;36(5):1117-1132.  doi: https://doi.org/10.12669/pjms.36.5.2407

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