bluuebunny/crossref_metadata_2025 huggingface dataset:
MET-11 Recent advances in targeted therapies and immunotherapy for metastatic brain tumors
Authors: Ando Yuichi
Published: December 2021

This presentation outlines CQ2 of Chapter 2 from the forthcoming updated version of the Clinical Practice Guidelines for Brain Tumors, edited by the Society. These guidelines discuss chemotherapy and other drug therapies for metastatic brain tumors in adult patients. First, there is no noteworthy change in the principle of prioritizing local treatment of symptomatic metastatic brain tumors or those that require local treatment in the near future. However, with recent advances in molecular-targeted drugs and/or immune checkpoint inhibitors, many physicians now consider starting systemic treatment prior to local treatment of brain metastases, even in patients with solid tumors that were once considered insensitive to chemotherapy, given that their symptoms are well-controlled and do not require urgent treatment. In the treatment of non-small cell lung cancer (NSCLC), the molecular subtypes of metastatic brain tumors with EGFR mutations and ALK fusion genes have yielded favorable responses to molecular-targeted drugs. Because small molecule drugs are well delivered to the central nervous system, systemic drug therapy with such targeted drugs is commonly selected for patients with untreated metastatic brain tumors. A recent phase II trial has shown the effectiveness of anti-PD-1 antibody pembrolizumab monotherapy for metastatic brain tumors from NSCLC. Because untreated metastatic brain tumors from renal cell carcinoma are prone to bleeding, local treatment of brain metastases should be prioritized before systemic treatment, even if the patient is asymptomatic. Regardless of BRAF mutation status, immune checkpoint inhibitors alone or in combination (nivolumab and ipilimumab) are effective against malignant melanoma with brain metastases; moreover, a combined treatment with BRAF and MEK inhibitors is effective against BRAF mutation-positive malignant melanoma with brain metastases. A novel HER2 inhibitor, tucatinib (unapproved), is expected to be effective against metastatic brain tumors from HER2-positive breast cancer.
MNG-2 Meningioma with aseptic meningitis
Authors: Nakajima Hideki , Tsuchiya Takuro , Shimizu Shigetoshi
Published: December 2021

The patient, a woman in her seventies, visited the Department of Neurology at our hospital one month ago with transient right hemiparesis, and was referred to our department because a CT scan showed a 4cm extramedullary lesion in the left convexity. She was judged to have symptomatic epilepsy associated with the lesion and was started on antiepileptic drugs. The lesion showed low signal on T1WI, equal signal on T2WI, and homogeneous contrast on Gd contrast T1WI, suggesting a meningioma, but the surrounding left frontal lobe subarachnoid space was also contrasted, suggesting the possibility of seeding or other diseases. After that, the contrast area of the subarachnoid space increased in a short period of time, and the control of epileptic seizures was poor. Preoperative spinal fluid examination showed an elevated cell count and findings of aseptic meningitis. A left parietal craniotomy was performed to remove the extramedullary tumor as much as possible. The subarachnoid space of the left frontal lobe adjacent to the tumor was covered with extensive pale yellow apparently abscess-like tissue. The pathological diagnosis of the extramedullary tumor was angiomatous meningioma (WHO Grade 1), and the pale yellow tissue that filled the subarachnoid space was necrotic tissue containing neutrophils and no tumor component. IgG4 was positive in about 10% of the tumor. The postoperative course of the patient was good, the contrast area of the left frontal lobe subarachnoid space was reduced on MRI, aseptic meningitis was improved, and she was discharged home with no neurological deficits. The patient has been under outpatient observation for 2 years without recurrence of aseptic meningitis or appearance of contrast-enhancing lesions in the subarachnoid space. This case is thought to be a possible IgG4-related disease, and we report it with a discussion of the literature.
CS-5 A case of anaplastic pleomorphic xanthoastrocytoma in the pineal region
Authors: Nakayama Noriyuki , Yamada Ryuta , Yamada Tetsuya , Iwama Toru
Published: December 2021

Tumors in the pineal gland are rare tumors that account for about 0.3% of all brain tumors and have various histological types of tumors develop with germinoma, pineocytoma, and pineoblastoma in that order. On the other hand, pleomorphic xanthoastrocytoma (PXA) is a rare tumor of less than 0.2% and frequently occurs in supratentorial cerebral surface of children and young adults.A case was a 61-year-old man whose pineal tumor was found due to visual disturbance. MRI showed a 23 mm-sized lesion with cysts and inhomogeneous enhancement in the pineal gland. Partial calcification was observed, but there was no non-communicating hydrocephalus, and no increase in HCG-β and AFP with blood sampling. A midline suboccipital craniotomy was performed in the sitting position, a head-up surgery was performed using a 4K / 3D video microscope system (ORBEYE exoscope, Olympus) by the infratentorial supracerebellar approach (ITSCA). The bridging veins and precentral cerebellar vein were dissected to expose the posterior surface of the tumor, and internal decompression was performed. For the complication of air embolism, artificial cerebrospinal fluid was sprayed, and the bilateral internal jugular veins were compressed to confirm the inflow point. There was strong adhesion to the Rt vein of Rosenthal, and the site was removed intracapsularly. Finally, subtotal resection was performed with remaining the upper part of the tumor, a blind lesion behind the Vein of Galen. Vertical gaze palsy occurred after this operation, but it gradually improved over time. Tumor showed pathologically remarkable polymorphism, poor microvascular proliferation and necrosis, but mitotic figures 4–5 / 10HPF, MIB-1 index 10%, GFAP positive, no BRAF V600E mutation. There are few reports of PXA occurring in the pineal gland, and this case is the sixth case. It is also the first report for pineal tumors using ORBEYE through ITSCA in the sitting position.
COT-13 Luminance analysis of 5-aminolevulinic acid using Image J for malignant brain tumor
Authors: Kon Takashi , Kobayashi Yusuke , Sato Yosuke , Shimizu Katsuyoshi , Mizutani Tohru
Published: December 2021

Purpose: For malignant brain tumor surgery, photodynamic diagnosis (PDD) with 5-aminolevulinic acid (5-ALA) is useful for maximal removal of the tumor. Although it has the advantage of identifying the presence or absence of residual tumors during surgery, there are variations in positive rates, and the classification is limited, based on visual inspection such as Stummer’s classification (strong, vague, none). We analyzed the luminance of positive findings using software Image J for brain tumor surgery using 5-ALA, and we report the results. Materials and Methods: From April 2018 to March 2021, 31 patients with suspected malignant glioma before surgery were included. Intraoperative 5-ALA positive findings were analyzed by software Image J (Wayne Rasband: NIH), the luminance was measured with a histogram, and compared the maximum luminance titer. Results: Among the positive cases, the average maximum luminance value for malignant glioma was 101 (50–168), which consisted of 11 cases of Glioblastoma, 1 case of Oligodendroglioma, and 1 case of anaplastic astrocytoma. The average maximum brightness of metastatic brain tumors is lower than that of malignant gliomas, even if they are visually strong, 83.5 (28–121). Conclusions: Even if it is visually strong in the conventional Stummer classification, it may be possible to classify in detail by analyzing luminance with Image J. In addition, more objective index is necessary to classify the vague findings.
COT-18 Trends in Primary Brain Tumors in Kumamoto Prefecture with Declining Birthrate and Aging Population - Kumamoto Prefecture Brain Tumor Epidemiological Survey
Authors: Shinojima Naoki , Itoyama Takashi , Mukasa Akitake
Published: December 2021

Backgrounds: The demographic characteristics of Kumamoto Prefecture are that there is little population movement and the total population remains constant at about 1.8 million, but in recent years the birthrate is declining and the population is aging. We have been conducting the Kumamoto Prefecture Brain Tumor Epidemiological Survey since 1989 in cooperation with neurosurgical institutions in the prefecture. In this study, we examined whether recent demographic changes have affected the incidence of primary brain tumors (BT). Methods: Patients with primary BT were collected annually from 44 institutions in Kumamoto Prefecture (as of 2020), and the number of incidences per 100,000 population was calculated for each BT for each year, excluding patients living outside the prefecture and duplicate cases. Results: The total number of primary BT was 11441 (top 3: meningioma 40%, pituitary adenoma 17%, glioma 17%). Of 4261 men with primary BT, the top 3 were meningioma (27%), glioma (23.7%), and pituitary adenoma (18.4%)), and 7180 women (top 3: meningioma (47.7%), pituitary adenoma (16.2%), and glioma (12.9%)). The number of primary BT increased every year, and the incidence increased significantly when comparing 1989–2004 and 2005–2020 (13.6 vs. 25.0/100,000, p<0.000001). Typical brain tumors (meningioma, pituitary adenoma, glioma, schwannoma, malignant lymphoma) also increased year by year, especially asymptomatic meningioma. The median age of asymptomatic meningiomas was significantly higher than that of symptomatic meningiomas (69 vs. 65 years, p<0.0001). Gliomas increased significantly in the later stages compared with the early stages in children (0–14 years) and the elderly (65 years and older). Conclusion: Our results suggest that an increase in the number of BT such as glioblastoma, which are more common in the elderly, as well as an increase in the number of opportunities for intracranial examinations in the aging of the population may be responsible for the increased incidence of primary BT.
Viewing the American West as a Chicana in China
Authors: Montoya María E
Published: December 2021

In both scholarly work and popular imagination, the American West is the final destination of migrant from Europe and Mexico. The stories of those migrants, however, obscure the first migration (12,000 BP) from Asia into North America. That migration across the now-submerged land bridge of Beringia ended humanity’s millennia-long journey across the globe that originated in Africa more than 50,000 years earlier. Using two examples, this essay reflects on how the Asian origins of the first Americans have been transformed into myths that conceal humanity’s migratory nature. First, in Chinese Communist propaganda, those origins are transformed into the myth of Peking Man as a branch of humanity originating in China rather than Africa. Second, in the writing of Rudolfo Anaya, those Asian origins are transformed into the myth of homogenous “Brown Brothers” united against white imperialists. Rather than rely on a myth of racial unity in some original homeland, this essay urges reliance on the shared experience of migration and home-making in hostile environments as the true source of our common humanity. Anaya’s Golden Carp, symbol of the life-giving fierce of water in an arid environment, captures this common human predicament stretching from Tibet and Xinjiang to New Mexico, epitomizing the American West as the place where humanity has been reunited, the home to the last wanderers of the human race.
Prehabilitation intervention for patients undergoing elective colectomy
Authors: Taniguchi Hideki , Kamada Takaaki , Sato Tomoyuki , Ueda Tomomi , Yamamoto Tatsuo
Published: December 2021

Aim:

Patients with sarcopenia who undergo surgery for colorectal cancer have an increased incidence of postoperative complications and prolonged hospital stay, thus requiring prehabilitation. We evaluated the effectiveness of a prehabilitation intervention comprising exercise and nutritional therapy for patients undergoing colorectal resection.

Methods:

This prospective study included 44 patients undergoing colorectal resection between August 2018 and July 2019. Patients’ mean age and body mass index were 71.6 ± 10.8 years and 21.4 ± 3.4 kg/m2, respectively; 57% of the patients were female. Prehabilitation intervention comprised ≥2000 walking steps and handgrip training as exercise therapy and a postexercise 125 mL L-leucine-enriched beverage (160 kcal, 11.0 g protein, 2300 mg L-leucine) as nutritional therapy. This routine was performed preoperatively, twice a day for 10.2 ± 2.5 (7–20) consecutive days. The primary endpoint was increased skeletal mass index. The secondary endpoints were increased handgrip strength, body weight, skeletal muscle mass, body fat, and serum transthyretin concentrations. We compared patients with and without sarcopenia (sarcopenia group [SG] vs nonsarcopenia group).

Results:

The skeletal muscle index (before vs after intervention: 6.2 ± 1.0 vs 6.4 ± 1.0 kg/m2, P < .001), body weight (52.8 ± 11.4 vs 53.5 ± 11.4 kg, P < .001), skeletal muscle mass (21.1 ± 4.9 vs 21.5 ± 4.9 kg, P < .001), and serum transthyretin concentration (24.6 ± 6.7 vs 26.7 ± 6.7 mg/dL, P < .0001) increased after the intervention. Sub-analysis results (SG: n = 13, nonsarcopenia group: n = 30) indicated an additional increase in skeletal muscle index (P = .02) and handgrip strength (P = .02) and a further decrease in body fat ratio (P = .03) in the SG.

Conclusions:

Short-term prehabilitation intervention using a leucine-enriched beverage was effective in patients with sarcopenia undergoing colorectal resection.

Clinical trial registry:

This study was registered with the Center for Clinical Trials, Japan Medical Association at https://dbcentre3.jmacct.med.or.jp/jmactr/App/JMACTRE02_04/JMACTRE02_04.aspx?kbn=3&seqno=7436 (registration no.: JMA-IIA00321).
Satisfaction With Expectations-Based Education in Women Undergoing Breast Reconstruction
Authors: Tedesco Deborah , Makarem Gasan , Mayo James , Loerzel Victoria
Published: December 2021

Women undergoing breast reconstruction sometimes have unrealistic or unformed expectations regarding the reconstructive process and outcomes. The objectives of this study were to assess preoperative expectations in women undergoing mastectomy and initial breast reconstruction, provide expectations-based education, and evaluate satisfaction with education. Fifty-one women undergoing mastectomy and breast tissue expander placement participated in this study. At a preoperative education appointment, participants completed a questionnaire to determine whether their expectations were realistic, unrealistic, or unformed. A nurse practitioner reviewed the results and provided patient-centered, expectations-based education to modify expectations from unrealistic to realistic or to set expectations from unformed to realistic. Four to 6 weeks after surgery, a second questionnaire was provided to assess perceived satisfaction with education. Unrealistic and unformed expectations were identified related to complications, pain, scarring, sensation, symmetry, and aesthetic results. After receiving patient-centered, expectations-based preoperative education, participants agreed they had received the appropriate amount of information and felt well prepared for their surgery and recovery. Most participants reported they were aware of possible complications, had effective tools to manage their pain, and had received adequate information about scarring and sensation changes. Some participants continued to have unrealistic or unformed expectations related to aesthetic results. Women undergoing breast reconstruction often have unrealistic or unformed expectations before surgery. Identifying these expectations and proving expectations-based education resulted in satisfaction with information provided.
Agrobacterium leguminum sp. nov., isolated from nodules of Phaseolus vulgaris in Spain
Authors: Castellano-Hinojosa Antonio , Correa-Galeote David , Ramírez-Bahena Martha-Helena , Tortosa Germán , González-López Jesús , Bedmar Eulogio J. , Peix Álvaro
Published: December 2021

Two endophytic strains, coded MOVP5Tand MOPV6, were isolated from nodules ofPhaseolus vulgarisplants grown on agricultural soil in Southeastern Spain, and were characterized through a polyphasic taxonomy approach. Their 16S rRNA gene sequences showed 99.3 and 99.4 %, 98.9 and 99.6 %, and 99.0 and 98.7% similarity to ‘A. deltaense’ YIC 4121T,A. radiobacterLGM 140T, andA. pusenseNRCPB10T, respectively. Multilocus sequence analysis based on sequences ofrecAandatpDgenes suggested that these two strains could represent a newAgrobacteriumspecies with less than 96.5 % similarity to their closest relatives. PCR amplification of thetelAgene, involved in synthesis of protelomerase, confirmed the affiliation of strains MOPV5Tand MOPV6 to the genusAgrobacterium. Whole genome average nucleotide identity and digital DNA–DNA hybridization average values were less than 95.1 and 66.7 %, respectively, with respect to its closest related species. Major fatty acids in strain MOPV5Twere C18 : 1 ω7c/C18 : 1 ω6cin summed feature 8, C19 : 0cyclo ω8c, C16 : 0and C16 : 03-OH. Colonies were small to medium, pearl-white coloured on YMA at 28 °C and growth was observed at 10–42 °C, pH 5.0–10.0 and with 0.0–0.5 % (w/v) NaCl. The DNA G+C content was 59.9 mol%. These two strains differ from all other genomovars ofAgrobacteriumfound so far, including those that have not yet given a Latin name. The combined genotypic, phenotypic and chemotaxonomic data support the classification of strain MOPV5Tas representing a novel species ofAgrobacterium, for which the nameAgrobacterium leguminumsp. nov. is proposed. The type strain is MOPV5T(=CECT 30096T=LMG 31779T).
SARS-CoV-2 genetic variations associated with COVID-19 pathogenicity
Authors: Aiewsakun Pakorn , Nilplub Patrawee , Wongtrakoongate Patompon , Hongeng Suradej , Thitithanyanont Arunee
Published: December 2021

In this study, we performed genome-wide association analyses on SARS-CoV-2 genomes to identify genetic mutations associated with pre-symptomatic/asymptomatic COVID-19 cases. Various potential covariates and confounding factors of COVID-19 severity, including patient age, gender and country, as well as virus phylogenetic relatedness were adjusted for. In total, 3021 full-length genomes of SARS-CoV-2 generated from original clinical samples and whose patient status could be determined conclusively as either ‘pre-symptomatic/asymptomatic’ or ‘symptomatic’ were retrieved from the GISAID database. We found that the mutation 11 083G>T, located in the coding region of non-structural protein 6, is significantly associated with asymptomatic COVID-19. Patient age is positively correlated with symptomatic infection, while gender is not significantly correlated with the development of the disease. We also found that the effects of the mutation, patient age and gender do not vary significantly among countries, although each country appears to have varying baseline chances of COVID-19 symptom development.
On the state independency and log-linearity of error propagation for discrete group affine systems with application to attitude estimation
Authors: Wang Jiaolong , Zhang Chengxi , Wu Jin
Published: December 2021

Purpose

This paper aims to propose a general and rigorous study on the propagation property of invariant errors for the model conversion of state estimation problems with discrete group affine systems.

Design/methodology/approach

The evolution and operation properties of error propagation model of discrete group affine physical systems are investigated in detail. The general expressions of the propagation properties are proposed together with the rigorous proof and analysis which provide a deeper insight and are beneficial to the control and estimation of discrete group affine systems.

Findings

The investigation on the state independency and log-linearity of invariant errors for discrete group affine systems are presented in this work, and it is pivotal for the convergence and stability of estimation and control of physical systems in engineering practice. The general expressions of the propagation properties are proposed together with the rigorous proof and analysis.

Practical implications

An example application to the attitude dynamics of a rigid body together with the attitude estimation problem is used to illustrate the theoretical results.

Originality/value

The mathematical proof and analysis of the state independency and log-linearity property are the unique and original contributions of this work.
“This article is interesting, however”: exploring the language use in the peer review comment of articles published in the BMJ
Authors: Zhang Guangyao , Wang Licheng , Xie Weixi , Shang Furong , Xia Xinlu , Jiang Chunlin , Wang Xianwen
Published: December 2021

Purpose

The purpose of this paper is to reveal a symbol – “however” that authors are very interested in, but few research studies pay attention to the existing literature. The authors aim to further insight its function.

Design/methodology/approach

In this research, the authors selected 3,329 valid comments on articles published in the British Medical Journal (BMJ) from 2015 to 2020 as the research objects. The authors showed the length distribution of reviewers' comments. In what follows, the authors analyzed the general distribution of words in comments and reviewer comments’ position to understand reviewers' comments qualitatively in word dimension. Specially, the authors analyzed functions of “however” and “but”, words that authors are most concerned with. In addition, the authors also discussed some factors, which may be related to “however,” that reflect reviewers' praise through regression analysis.

Findings

The authors found that there are marked differences in the length of reviewers' comments under different review rounds. By mapping the reviewers' comments to different sections, the authors found that reviewers are deeply concerned to methods section. Adjectives and adverbs in comments written in different sections of the manuscripts also have different characteristics. The authors tried to interpret the turning function of “however” in scientific communication. Its frequency of use is related to reviewers' identities, specifically academic status. More precisely, junior researchers use “however” in praise more frequently than senior researchers do.

Research limitations/implications

The linguistic feature and function of “however” and “but” in the reviewers' comments of the rejected manuscripts may be different from accepted papers and also worth exploring. Regrettably, the authors cannot obtain the peer review comments of rejected manuscripts. This point may limit the conclusion of the investigation of this article.

Originality/value

Overall, the survey results revealed some language features of reviewers' comments, which could provide a basis of future endeavors for many reviewers in open peer review (OPR) field. Specially, the authors also put forward an interesting symbol to examine the review comments, “however”, for the first time.
Translocate, to fund or not to fund: challenges in funding an emerging market start-up
Authors: De Jesus Carlos , Ker-Fox Jason , Senyatsi Phuti
Published: December 2021

Subject area:

Financial management – Specifically start-up valuations.

Study level/applicability:

Honours or masters level (professional or academic).

Case overview:

The case is around a tech start-up in the informal transport market in South Africa, that has obtained some government funding and developed a working SaaS. However, requires funding to expand and grow. Informal transport is significant in emerging and developing markets and the product is portable internationally. In South Africa, two listed companies (US and SA) were started with similar concepts in Logistics and private client market and are now global in 124 and 24 countries. Management of the venture capital firm are senior and experienced and have invested years and funding into this company, and while willing to offer equity had quite a high value in mind, the venture capital company (with an impact mandate) needs to decide whether to fund the start-up and negotiate a value.

Expected learning outcomes:

Characteristics of a successful start-up are formulating an appropriate discount rate, using real world data; performing a DCF and relative valuations given limited information; scenario analysis and sensitivity analysis; and the importance of negotiating (understanding managements side).

Supplementary materials

Teaching notes are available for educators only.

Complexity academic level

This case was written for use in financial management classes in either an academic full-time student (final year undergraduate/bachelor) or a postgraduate program with working students/professional (MBA) program level.

Subject code

CSS: 1: Accounting and finance.
Does membership of local Chambers of Commerce networks enhance rural SME performance?: An empirical analysis
Authors: Tiwasing Pattanapong , Sawang Sukanlaya
Published: December 2021

Purpose

Local Chambers of Commerce networks provide small- and medium-sized enterprises (SMEs) with an opportunity to access essential information and networking with other businesses, resulting in improved business performance. However, rural SMEs are less likely to participate in these networks and often possess lower performance. This paper aims to examine the relationship between being members of local Chambers of Commerce networks and rural SMEs’ performance by comparing business performance between rural SMEs who are members and non-members of local Chambers of Commerce networks. This paper also further explores difference in business growth plans between rural SMEs members and non-members.

Design/methodology/approach

The empirical analysis draws on cross-sectional data of 3,769 rural SMEs in England and Wales from the UK's Government Longitudinal Small Business Survey 2015. Propensity score matching (PSM) is applied to control for selection bias and variations in business characteristics before comparing business performance, measured in terms of annual turnover, sale growth and profitability, between rural SMEs that are members and non-members of local Chambers of Commerce networks.

Findings

Our results show that rural SME members of local Chambers of Commerce networks are more likely to grow their sales than non-members. However, they perform as good as non-members in terms of turnover and profitability. The results also emphasise that local Chambers of Commerce networks are crucial for rural SMEs to develop the skills of the workforce and leadership capability of managers, new product/service development and new working practices. Therefore, to enhance rural SMEs' performance, tailoring the services of local Chambers of Commerce to support rural businesses' needs and encouraging rural SMEs to make use of business networks are recommended.

Practical implications

The paper unpacks the relationships between being local Chamber of Commerce membership and business performance, offering lessons for rural SMEs to boost their business performance and growth through participating in local business association networks.

Originality/value

This paper is the first study that explores the comparative analysis of business performance and growth plans between rural SMEs that are members and non-members of the local Chamber of Commerce networks. We provide an empirical evidence-based analysis to existing literature regarding the advantages of being local Chamber of Commerce memberships to enhance business performance in rural areas.
Institutional pressure and open innovation: the moderating effect of digital knowledge and experience-based knowledge
Authors: Jiao Hao , Yang Jifeng , Cui Yu
Published: December 2021

Purpose

When considering the influence of external social, technical and political environments on organizations’ open innovation behavior, especially in emerging markets, institutional theory is especially salient. This study aims to answer the question of how to integrate organizations’ external institutional pressures and internal knowledge structure to mitigate the challenges in the open innovation process.

Design/methodology/approach

This study uses a sample of 2,126 observations from the 2012 World Bank Enterprise Survey. A multivariate regression model is designed to explore the impact of external institutional pressure (i.e. coercive pressure, mimetic pressure and normative pressure) on open innovation, as well as the moderating effect of digital knowledge and experience-based knowledge.

Findings

The results show that institutional pressure has a positive role in promoting open innovation; digital knowledge weakens the positive relationship between institutional pressure and open innovation; experience-based knowledge strengthens the positive relationship between institutional pressure (especially coercive pressure) and open innovation.

Originality/value

This study combines institutional theory and knowledge management to enriches insights into open innovation in emerging markets. Beyond recognizing the inherent multidimensionality of the concept of institutional pressure, this study creates an integrated path for the legitimacy acquiring of enterprises through the knowledge structure design (i.e. digital knowledge and experience-based knowledge). It also deepens the institutional pressure to enable the implementation of digital knowledge to manage open innovation processes.
Hospital‐level variation in outcomes after in‐hospital cardiac arrest in Denmark
Authors: Stankovic Nikola , Andersen Lars W. , Granfeldt Asger , Holmberg Mathias J.
Published: December 2021

Background

We investigated hospital‐level variation in outcomes after in‐hospital cardiac arrest (IHCA) in Denmark, and assessed whether variation in outcomes could be explained by differences in patient characteristics.

Methods

Adult patients (≥18 years old) with IHCA in 2017 and 2018 were included from the Danish IHCA Registry (DANARREST). Data on patient characteristics and outcomes were obtained from population‐based registries. Predicted probabilities, likelihood ratio tests, intraclass correlation coefficients (ICCs), and median odds ratios (ORs) were calculated for return of spontaneous circulation (ROSC), survival to 30 days, and survival to 1 year.

Results

A total of 3340 patients with IHCA from 24 hospitals were included. We found that hospital‐level variation in outcomes after IHCA existed across all measures of variation. The unadjusted median OR for ROSC, survival to 30 days, and survival to 1 year were 1.28 (95% confidence interval [CI]: 1.24, 1.45), 1.38 (95% CI: 1.33, 1.60), and 1.44 (95% CI: 1.39, 1.70), respectively. The unadjusted ICC suggest that 2.0% (95%: 1.6%, 4.4%), 3.3% (95%: 2.7%, 6.8%), and 4.3% (95%: 3.5%, 8.6%) of the total individual variation in ROSC, survival to 30 days, and survival to 1 year was attributable to hospital‐level variation. These results decreased but persisted in the analyses adjusted for select patient characteristics.

Conclusions

In this study, we found that outcomes after IHCA varied across hospitals in Denmark. However, only about 2%–4% of the total individual variation in outcomes after IHCA was attributable to differences between hospitals, suggesting that most of the individual variation in outcomes was attributable to patient‐level variation.
Anaesthetic considerations in posterior instrumentation of scoliosis due to spinal muscular atrophy: Case series of 56 operated patients
Authors: Förster Johannes G. , Schlenzka Dietrich , Österman Heikki , Pitkänen Mikko
Published: December 2021

Background

Spinal muscular atrophy (SMA) is a rare illness that often leads to severe kyphoscoliosis. This case series adds to the heretofore sparse information as regards the anaesthetic management of SMA scoliosis patients.

Methods

This retrospective study reviewed the charts of 79 SMA patients (type II n = 34 and type III n = 45) presenting for possible scoliosis surgery during the time period 2007–2019. Special attention focused on preoperative assessment and clearance requirements, anaesthesia protocol and postoperative handling.

Results

Out of 79 patients, 17 did not receive clearance for the procedure mostly due to grave respiratory insufficiency. Out of 62 patients with clearance for both surgery and anaesthesia, 56 patients [44 females, 12 males; age mean ± SD (range) 22 ± 7.3 (10–40) years] underwent the procedure. Their forced vital capacity and forced expiratory volume in 1 s were mean ± SD (range) 1.41 ± 0.53 (0.61–2.65) L and 1.26 ± 0.47 (0.52–2.27) L, respectively. Intubation difficulties and their resolution, e.g. with the help of fibreoptic technique and video laryngoscopy, are described. All 56 patients were extubated in the operating room postoperativley. Patients stayed at the postanaesthesia care unit for one (n = 48) or two (n = 8) nights. A considerable amount of the patients (19/56) developed hypokalaemia postoperatively.

Conclusion

This analysis is one of the bigger series of its kind and adds insight into the preoperative clearance process, the anaesthetic protocol and some of the postoperative complications, e.g. the tendency for developing postoperative hypokalaemia which has not been reported previously.
Glucose management team significantly improves glycaemic care and commitment to in‐hospital guidelines within arthroplastic patients
Authors: Ylikoski Marianne , Immonen Heidi , Tiihonen Raine , Kauppi Markku J. , Huhtala Heini , Jokinen Janne J. , Lahtela Jorma
Published: December 2021

Background

Perioperative dysglycaemias are a risk for harm but guidelines to improve glucose management are poorly adhered to.

Aim

To determine whether a specialized team and diabetes education improves the implementation of guidelines and glucose values.

Methods

We conducted a prospective study of 611 nonselected, consecutive patients attending for elective hip or knee arthroplasty. The first 209 patients received conventional care and the following 402 patients received intervention (Acute Glucose Service, AGS) in two chronological groups; either perioperatively (AGS1) or also preoperatively (AGS2). The AGS‐team provided diabetes education, identified the patients with diabetes risk and adjusted the medication when needed. Capillary plasma glucose (CPG) was repeatedly measured and glycated haemoglobin (HbA1c) obtained before and after the surgery. The study objectives were to evaluate the staff actions when hyperglycaemia was severe (CPG >10 mmol/L), and to assess improvement of the glycaemic values and the complication rate within 3 months.

Results

None of the severely hyperglycaemic events in the reference group were treated according to guidelines. In the AGS 1 group, 50% and in the AGS2 group, 53% were appropriately managed (p < .001). The events of hyperglycaemia (CPG >7.8 mmol/L at least twice) and of severe hyperglycaemia (CPG >10 mmol/L) decreased in all patient groups. The medians of the highest, mean and variability of CPG values improved. The mean HbA1c improved significantly within AGS 2. There was no association between improved glycaemic care and early complications.

Conclusions

AGS intervention significantly improves adherence to guidelines and glucose values.
Comparative study of functional outcomes between ultra‐low anterior resection and inter‐sphincteric resection: a propensity matched analysis
Authors: Gori Jayesh , Kazi Mufaddal , Rajkumar Barath , Bhuta Prajesh , Ankathi Suman Kumar , Desouza Ashwin , Saklani Avanish
Published: December 2021

Background

Comparative bowel functional outcomes between ultralow anterior resections (ULAR) and inter‐sphincteric resection (ISR) for similar tumour and patient characteristics is not known.

Methods

Single centre study of low rectal caners (<5cm from anal verge) with 1:1 propensity matching of age, sex, body mass index, prior radiation, and surgical approach (open vs. minimally invasive) was performed for the ULAR and ISR groups. Primary outcome measure was Wexner Incontinence scores and Low Anterior Resection Syndrome (LARS) score at a single time point after stoma reversal.

Results

Seventy‐two matched patients were included. Median Wexner scores were five and eight for the ULAR and ISR cohorts (p = 0.006). Major incontinence (Wexner >11) was found in 5.6% versus 33% after ULAR and ISR, respectively. Major LARS (score > 29) was demonstrated in 11% versus 25% in ULAR versus ISR (p = 0.293). Majority in both groups has no LARS (score < 20), that is, 72.2% versus 63.9% in ULAR against ISR. Besides these, stool fragmentation (p < 0.001), nocturnal defecation (p < 0.001) and use of anti‐diarrhoeal medications (p = 0.023) were significantly more after ISR.

Conclusions

Bowel continence was relatively inferior after ISR as compared to an ULAR for low rectal cancers in matched cohorts. Major LARS in ISR was twice as prevalent without statistical differences.
Risk of complications in the late vs early days of the 42nd week of pregnancy: A nationwide cohort study
Authors: Andersson Charlotte Brix , Petersen Jesper Padkaer , Johnsen Søren Paaske , Jensen Martin , Kesmodel Ulrik Schiøler
Published: December 2021

Introduction

Uncertainty remains about the most appropriate timing of induction of labor in late‐term pregnancies. To address this issue, this study aimed to compare the risk of neonatal morbidity and pregnancy‐ and birth‐related complications between gestational age (GA) 41+4–42+0 and GA 41+0–41+3 weeks.

Material and methods

This nationwide registry‐based cohort study included singleton births without major congenital malformations, with registered GA, and with intended vaginal delivery at GA 41+0– 42+0 weeks between 2009 and 2018 in Denmark. Logistic regression models were used to estimate the crude risk ratio and adjusted risk ratio (RRA) of neonatal and obstetric adverse outcomes in births at GA 41+4– 42+0 weeks compared with GA 41+0– 41+3 weeks. The results were adjusted for relevant confounders, including induction of labor.

Results

A higher incidence of neonatal morbidity and birth complications was observed in births at GA 41+4–42+0 weeks than in births at GA 41+0–41+3 weeks. Neonatal morbidities included an increased risk of low Apgar score (Apgar 0–6 after 5 min; RRA 1.17, 95% confidence interval [CI] 1.01–1.34), meconium aspiration (RRA 1.25, 95% CI 1.06–1.48), need for respiratory support (continuous positive airway pressure; RRA 1.09, 95% CI 1.03–1.15), and a composite outcome of need for comprehensive treatment at a neonatal department or neonatal death (RRA 1.65, 95% CI 1.29–2.11). Birth complications included emergency cesarean section (RRA 1.17, 95% CI 1.14–1.21), severe lacerations (RRA 1.11, 95% Cl 1.04–1.17), and increased blood loss after birth (RRA 1.13, 95% CI 1.06–1.21).

Conclusions

Births at GA 41+4–42+0 weeks were associated with an increased risk of neonatal morbidity and birth complications compared with births at GA 41+0–41+3 weeks. The results of this study may aid clinicians in deciding when to recommend induction of labor in late‐term pregnancies.
Role of ascorbic acid infusion in critically ill patients with transfusion‐related acute lung injury
Authors: Kassem Amira B. , Ahmed Islam , Omran Gamal , Megahed Mohamed , Habib Tamer
Published: December 2021

Introduction

In critically ill patients, transfusion‐related acute lung injury (TRALI) remains the leading cause of transfusion‐related fatalities in critical care settings and is associated with inflammation and oxidative stress state. Recent research raised the potential efficacy of high‐dose intravenous ascorbic acid (VC) in critically ill patients.

Objective

The aim of this trial was to investigate the effect of high‐dose intravenous VC as a targeted therapy for TRALI in terms of serum proinflammatory (interleukin [IL]‐8, IL‐1β, C‐reactive protein), anti‐inflammatory (IL‐10), oxidative stress (superoxide dismutase, malondialdehyde) markers, and plasma VC levels. Secondary outcomes were oxygenation (PaO2/FiO2 ratio), vasopressor use, duration of mechanical ventilation, ICU length of stay, 7‐day mortality and 28‐day mortality.

Methods

Eighty critically ill patients with TRALI (n = 80) were randomized to receive 2.5 g/6 h intravenous vitamin C for 96 hours (ASTRALI group) or placebo. Patients were followed up to measure the outcomes initially (T0) and at the end of treatment (T96).

Results

When compared to the control group, the ASTRALI group at T96 showed significantly higher median of IL‐10 (31.6 ± 25.8 vs 17.7 ± 12.0 pg/mL, P < .0001) levels and superoxide dismutase (12 876 ± 4627 U/L vs 5895 ± 6632 U/L, P < .0001) activities, and lower median C‐reactive protein (76 ± 50 vs 89 ± 56 mg/L, P = .033), IL‐8 (11.8 ± 7.3 vs 35.5 ± 19.8 pg/mL, P < .0001) and malondialdehyde (0.197 ± 0.034 vs 0.234 ± 0.074 μM/L, P = .002) levels.

Conclusion

High‐dose ascorbic acid was associated with significantly reduced oxidative stress, reduced pro‐inflammatory markers except IL‐1β, elevated anti‐inflammatory marker and elevated plasma VC levels.
Long‐term efficacy of first‐line ibrutinib treatment for chronic lymphocytic leukaemia in patients with TP53 aberrations: a pooled analysis from four clinical trials
Authors: Allan John N. , Shanafelt Tait , Wiestner Adrian , Moreno Carol , O’Brien Susan M. , Li Jianling , Krigsfeld Gabriel , Dean James P. , Ahn Inhye E.
Published: December 2021

TP53 aberrations [del(17p) or TP53 mutation] predict poor survival with chemoimmunotherapy in patients with chronic lymphocytic leukaemia (CLL). We evaluated long‐term efficacy and safety of first‐line ibrutinib‐based therapy in patients with CLL bearing TP53 aberrations in a pooled analysis across four studies: PCYC‐1122e, RESONATE‐2 (PCYC‐1115/16), iLLUMINATE (PCYC‐1130) and ECOG‐ACRIN E1912. The pooled analysis included 89 patients with TP53 aberrations receiving first‐line treatment with single‐agent ibrutinib (n = 45) or ibrutinib in combination with an anti‐CD20 antibody (n = 44). All 89 patients had del(17p) (53% of 89 patients) and/or TP53 mutation (91% of 58 patients with TP53 sequencing results available). With a median follow‐up of 49·8 months (range, 0·1–95·9), median progression‐free survival was not reached. Progression‐free survival rate and overall survival rate estimates at four years were 79% and 88%, respectively. Overall response rate was 93%, including complete response in 39% of patients. No new safety signals were identified in this analysis. Forty‐six percent of patients remained on ibrutinib treatment at last follow‐up. With median follow‐up of four years (up to eight years), results from this large, pooled, multi‐study data set suggest promising long‐term outcomes of first‐line ibrutinib‐based therapy in patients with TP53 aberrations.

Registered at ClinicalTrials.gov (NCT01500733, NCT01722487, NCT02264574 and NCT02048813).
The evolution of the loss of life expectancy in patients with chronic myeloid leukaemia: a population‐based study in the Netherlands, 1989–2018
Authors: Maas Carolien C. H. M. , van Klaveren David , Ector Geneviève I. C. G. , Posthuma Eduardus F. M. , Visser Otto , Westerweel Peter E. , Janssen Jeroen J. W. M. , Blijlevens Nicole M. A. , Dinmohamed Avinash G.
Published: December 2021

Studies on the conditional life expectancy of patients with chronic myeloid leukaemia (CML) are lacking. Using data from the Netherlands Cancer Registry, we examined the life expectancy of patients with CML in the Netherlands diagnosed during 1989–2018. As of the early 2010s, the life expectancy of patients with CML who survived several years after diagnosis came narrowly close to the general population’s life expectancy, regardless of age. This finding can essentially be ascribed to the introduction and broader application of tyrosine kinase inhibitors (TKIs) and provide optimism to patients with CML who can look forward to a near‐normal life expectancy in a modern TKI era.
Psychological distress among care leavers during the transition to adulthood: Risk and protective factors throughout their life course
Authors: Sulimani‐Aidan Yafit , Achdut Netta , Zeira Anat , Benbenishty Rami
Published: December 2021

The transition period from care to independent living is a vulnerable time for care leavers who may experience increased mental health problems. This study explored risk and protective factors contributing to and predicting their psychological distress as emerging adults. The study is based on an extensive set of longitudinal administrative records combined with structured phone interviews among a representative sample of 2295 alumni of educational residential care in Israel (24–31 years old). Results indicated the importance of social support from peers and staff while in and after care in predicting lower psychological distress among the young adults. Participating in skills acquisition activities while in care and integration in post‐secondary education also predicted lower psychological distress. In contrast, post‐care material deprivation and lower life satisfaction in the area of finance and work were associated with greater psychological distress. Both the subjective experiences and the objective conditions thus contribute to care leavers' mental health. Our results indicate the importance for policy and practice of approaching mental health issues in a holistic manner.
A homozygous ABHD16A variant causes a complex hereditary spastic paraplegia with developmental delay, absent speech, and characteristic face
Authors: Miyake Noriko , Silva Sebastián , Troncoso Mónica , Okamoto Nobuhiko , Andachi Yoshiki , Kato Mitsuhiro , Iwabuchi Chisato , Hirose Mio , Fujita Atsushi , Uchiyama Yuri , Matsumoto Naomichi
Published: December 2021

Hereditary spastic paraplegia (HSP) is a genetically and clinically heterogeneous genetic disease characterized by progressive weakness and spasticity predominantly affecting the lower limbs. Complex HSP is a subset of HSP presenting with additional neuronal and/or non‐neuronal phenotypes. Here, we identify a homozygous ABHD16A nonsense variant in two affected children in a Chilean family. Very recently, two groups reported patients with biallelic ABHD16A whose clinical presentation was similar to that of our patients. By reviewing the clinical features of these reports and our patients, ABHD16A‐related HSP can be characterized by early childhood onset, developmental delay, intellectual disability, speech disturbance, extrapyramidal signs, psychiatric features, no sphincter control, skeletal involvement, thin corpus callosum, and high‐intensity signals in white matter on T2‐weighted brain MRI. In addition, our affected siblings showed a characteristic face, sleep disturbance, and nodular and hyperpigmented skin lesions, which have not previously been reported in this condition.
Supporting languages: The socio‐educational integration of migrant and refugee children and young people
Authors: Horgan Deirdre , Martin Shirley , O’Riordan Jacqui , Maier Reana
Published: December 2021

Recent unprecedented levels of migration, while adding cultural and linguistic diversity, places increased pressure on host countries to develop strategies for effectively integrating new arrivals into society. This article draws on data from IMMERSE which uses participatory and co‐creation methodologies with children, parents, educators and policy‐makers to examine and develop key indicators of migrant children's socio‐educational integration. It discusses Irish findings related to language and migrant children's participation and belonging in school, highlighting children's concerns over the lack of a diverse language culture and low value placed on preserving heritage language in Ireland and across all six EU partner countries.