bluuebunny/crossref_metadata_2025 huggingface dataset:
Untroubling children’s identity in child protection and welfare assessment through a postconventional analytic
Authors: Flynn Susan
Published: September 2020

The sustaining argument advanced in this paper is that postconventional analysis offers a constructive theoretical lens to contemplate identity in child protection and welfare assessment. Critical application of abridged postconventionalism considers how identity and biodiversity in children and young people, operating across lines of racial, disability, gender and other identity markers, can be understood during informed assessment of needs.

Findings

In the context of transformative postmodern influences, the intention is to provide an aid to students and practitioners who are increasingly impelled to think about traditionally biological-based identity categories, across more abstract lines of social, lingual and cultural construction. Four themes for professional development are presented. First, the complex origins of identity must be appreciated. Second, criticality and openness to the meaning of identity is preferable. Third, progress lies in courteous, sensitive and inclusive practice. Fourth, practitioners should acquire knowledge competency in identity categories.

Applications

Overall, acceptance of the somewhat fluid and socially contingent nature of identity, without marked rejection of its embodied aspects, can promote more sensitive and inclusive ways of working with children and young people.
Distally Based Peroneal Artery Perforator-Plus Fasciocutaneous Flap to Reconstruct Soft Tissue Defect Combined With Chronic Osteomyelitis in the Lateral Malleolus
Authors: Luo Zhaobiao , Dong Zhonggen , Ni Jiangdong , Wei Jianwei , Peng Ping , Lv Guohua
Published: September 2020

Distally based peroneal artery perforator-plus fasciocutaneous (DPAPF) flaps are widely used to reconstruct soft tissue defects of the lower extremity. Treatment for soft tissue defect combined with chronic osteomyelitis in the lateral malleolus has rarely been reported. The aim of this study was to elaborate the superiority of the DPAPF flap and provide referential experience for using the DPAPF flap in this situation. Between June 2010 and December 2017, soft tissue defects in the setting of chronic osteomyelitis in the lateral malleolus were reconstructed with DPAPF flaps in 17 patients. After thorough debridement, the defect was repaired with the DPAPF flap, and patients subsequently followed an antibiotic regimen for 6 weeks. Follow-up periods for all patients were at least 24 months. The reconstruction outcomes and the satisfaction of the 17 patients were evaluated. Of the 17 flaps, 16 survived uneventfully, except one occurrence of partial necrosis. No infection occurred in the follow-up period. In the study, 17 patients except one were satisfied with flap appearance. All the patients were satisfied with the reconstruction outcomes. In a one-stage procedure, the use of DPAPF flaps is ideal for reconstructing soft tissue defects in the setting of chronic osteomyelitis in the lateral malleolus.
At the dawn of the transcriptomic medicine
Authors: Koks Gea , Pfaff Abigail L , Bubb Vivien J , Quinn John P , Koks Sulev
Published: September 2020

Progress in genomic analytical technologies has improved our possibilities to obtain information regarding DNA, RNA, and their dynamic changes that occur over time or in response to specific challenges. This information describes the blueprint for cells, tissues, and organisms and has fundamental importance for all living organisms. This review focuses on the technological challenges to analyze the transcriptome and what is the impact of transcriptomics on precision medicine. The transcriptome is a term that covers all RNA present in cells and a substantial part of it will never be translated into protein but is nevertheless functional in determining cell phenotype. Recent developments in transcriptomics have challenged the fundamentals of the central dogma of biology by providing evidence of pervasive transcription of the genome. Such massive transcriptional activity is challenging the definition of a gene and especially the term “pseudogene” that has now been demonstrated in many examples to be both transcribed and translated. We also review the common sources of biomaterials for transcriptomics and justify the suitability of whole blood RNA as the current optimal analyte for clinical transcriptomics. At the end of the review, a brief overview of the clinical implications of transcriptomics in clinical trial design and clinical diagnosis is given. Finally, we introduce the transcriptome as a target for modern drug development as a tool for extending our capacity for precision medicine in multiple diseases.
Beneficial Effects of Glycyrrhizin in Chronic Periodontitis Through the Inhibition of Inflammatory Response
Authors: Sun Yaru , Zhao Binghui , Li Zhaobao , Wei Jianming
Published: September 2020

Elevated inflammatory cytokines and high mobility group box 1 (HMGB1) production are associated with chronic periodontitis (CP). Glycyrrhizin is the major constituent of Glycyrrhiza glabra. L. (Fabaceae) root with anti-inflammation activities. This study evaluated the effects of glycyrrhizin on CP. TNF-α-treated human periodontal ligament stem cell (hPDLSC) model was established, and was administrated with 1, 2 or 5 mM glycyrrhizin for 24 h. After treatment, the expression of HMGB1and inflammatory cytokines was monitored. Significantly increased HMGB1 (median: 5646.4, range: 1918.2-8233.7 vs median: 204.5, range: 98.7-283.6, pg/mL), TNF-α (median: 345.5, range: 161.0-567.9 vs median: 93.5, range: 58.1-159.3, pg/mL), IL-1β (median: 2014.6, range: 209.5-4308.1 vs median: 224.5, range: 48.8-335.8, pg/mL) and IL-6 (median: 1223.6, range: 398.2-2183.8 vs median: 240.4, range: 105.2-400.5, pg/mL) were detected in gingival crevicular fluid from CP patients. Glycyrrhizin significantly prevented TNF-α-induced expression of HMGB1 (691.5 ± 136.4 vs 142.8 ± 57.3 pg/mL), IL-6 (388.1 ± 85.2 vs 189.4 ± 61.2 pg/mL) and IL-1β (176.3 ± 47.2 vs 53.9 ± 25.7 pg/mL) in hPDLSC. In CP rats, glycyrrhizin significantly decreased HMGB1 (5795.6 ± 1121.5 vs 586.4 ± 436.8 pg/mL), TNF-α (421.8 ± 93.7 vs 87.9 ± 21.6 pg/mL), IL-6 (1423.8 ± 235.2 vs 622.6 ± 176.1 pg/mL) and IL-1β (1562.8 ± 334.3 vs 733.5 ± 265.1 pg/mL) in gingival crevicular fluid. Glycyrrhizin suppresses inflammatory activities in CP rats and represents a promising molecule for controlling CP.
Derivation and validation of a prediction rule for mortality of patients with respiratory virus-related pneumonia (RV-p score)
Authors: Chen Liang , Han Xiudi , Li YanLi , Zhang Chunxiao , Xing Xiqian
Published: September 2020

Background:

Respiratory viruses are important etiologies of community-acquired pneumonia. However, current knowledge on the prognosis of respiratory virus-related pneumonia (RV-p) is limited. Thus, here we aimed to establish a clinical predictive model for mortality of patients with RV-p.

Methods:

A total of 1431 laboratory-confirmed patients with RV-p, including 1169 and 262 patients from respective derivation and validation cohorts from five teaching hospitals in China were assessed between January 2010 and December 2019. A prediction rule was established on the basis of risk factors for 30-day mortality of patients with RV-p from the derivation cohort using a multivariate logistic regression model.

Results:

The 30-day mortality of patients with RV-p was 16.8% (241/1431). The RV-p score was composed of nine predictors (including respective points of mortality risk): (a) age ⩾65 years (1 point); (b) chronic obstructive pulmonary disease (1 point); (c) mental confusion (1 point); (d) blood urea nitrogen (1 point); (e) cardiovascular disease (2 points); (f) smoking history (2 points); (g) arterial pressure of oxygen/fraction of inspiration oxygen (PaO2/FiO2) < 250 mmHg (2 points); (h) lymphocyte counts <0.8 × 109/L (2 points); (i) arterial PH < 7.35 (3 points). A total of six points was used as the cut-off value for mortality risk stratification. Our model showed a sensitivity of 0.831 and a specificity of 0.783. The area under the receiver operating characteristic curve was more prominent for RV-p scoring [0.867, 95% confidence interval (CI)0.846–0.886] when compared with both pneumonia severity index risk (0.595, 95% CI 0.566–0.624, p < 0.001) and CURB-65 scoring (0.739, 95% CI 0.713–0.765, p < 0.001).

Conclusion:

RV-p scoring was able to provide a good predictive accuracy for 30-day mortality, which accounted for a more effective stratification of patients with RV-p into relevant risk categories and, consequently, help physicians to make more rational clinical decisions. The reviews of this paper are available via the supplemental material section.
A Study of Aesthetic and Functional Outcome Following Structural Fat Grafting for Facial Scars and Contour Deformity
Authors: Rao Anantheswar Y. N. , Reddy Sudarshan Nagireddy , Chandrappa Ashok Basroor , Vasudevan Srikanth , Batth Rittu
Published: September 2020

Study Design:

This is a prospective observational study of 60 consecutive cases with facial scars and contour deformity who underwent structural fat grafting.

Objectives:

The aim of the present article is to highlight how fat grafting helps to improve aesthetic and functional outcome in facial scars and contour deformities. It also highlights the factors that need to be considered while planning autologous fat grafting to get better aesthetic results.

Methods:

This is a prospective observational study of 60 consecutive cases with facial scars and contour deformity. The study was conducted from May 2014 to April 2019 in a tertiary care hospital. All the patients were followed up for a minimum period of 1 year from the date of surgery. Assessment of post-operative aesthetic outcome, in terms of satisfaction, was done using the Visual Analogue Scale (VAS), which ranges from 1 to 10 by the patient and operative surgeon.

Results:

The mean age was 30.8 9.8 years. Out of 60 patients, 20 patients underwent additional procedure like dermabrasion and collagen dressing to improve aesthetic outcome. Among 60 patients, 24 patients had transient edema and 10 patients had bruising at the recipient site. There were no major donor site complications except pain which was managed conservatively. Mean patient satisfaction score is 7 and mean surgeon satisfaction score is 7.25.

Conclusion:

Despite the ongoing concerns about survival and longevity of fat grafts and also unpredictability of long-term outcomes, fat grafting has become a very useful surgical tool to improve the quality of facial scars and correct contour deformity. Our series shows excellent outcome both clinically as well as from the patient satisfaction. Future research is warranted in the fields of the adipocyte derived stem cells and to expand the clinical application of fat grafting.
Sclerosing Extramedullary Hematopoietic Tumor: A Case Report
Authors: Wang Dapeng , Castro Eduardo , Rao Arundhati , McPhaul Christopher Michael
Published: September 2020

Sclerosing extramedullary hematopoietic tumor (SEMHT) is a rare disease that was originally named fibrous hematopoietic tumor or myelosclerosis. The process typically occurs in patients with a history of chronic myeloproliferative disorders and may afflict the skin, lung, breast, gastrointestinal tract, breast, kidney, lymph node, and thyroid gland. In this article, we report the case of a 37-year-old female with more than 5 years history of acute B-cell lymphoblastic leukemia who presented with right upper quadrant pain and tenderness. Computed tomography scan showed multiple new ring-enhancing low-density lesions within the right and left hepatic lobes. A computed tomography–guided liver core biopsy was performed on one of the new liver lesions and showed extramedullary hematopoiesis with atypical megakaryocytes and sinusoidal capillarization with associated fibroblastic proliferation. Numerous atypical megakaryocytes were scattered in the background of haphazard collagen deposition. No significant blasts or a leukemic process were identified. Bone marrow aspiration and biopsy showed extensive reticulin fibrosis (MF-3), trilineage dysplasia, increased blasts (10% to 19%), and hypercellularity (close to 100%), which was consistent with MDS-EB-2. Cytogenetics was reported as follows: 44~46,XX,-3,add(3)(p13),-5,-6,-7,17,del(17)(p12),+1~5mar[cp9]/46,XX. Molecular analysis was negative for both JAK2 V617F and CALR exon 9 activating mutations. In summary, we contributed a new case of SEMHT diagnosis in a synchronous presentation with poor clinical evolution associated chromosome 7 deletion and intact JAK2 and CALR exon 9. Care should be taken when diagnosing intraabdominal and retroperitoneal soft tissue masses with the history of hematological disorders.
Integrating iPads into Team-Based Learning in the Pediatrics Clerkship: Do They Provide Any Value?
Authors: Chitkara Maribeth B , Pongvitayapanu Richard , Lu Wei-Hsin
Published: September 2020

Background:

Team-Based Learning (TBL) is an instructional strategy that embraces the concept of a flipped classroom. At our institution, the Clerkship in Pediatrics utilizes TBL sessions to deliver curricular content rather than lecture format. In 2016, matriculating medical students were given iPads for the purpose of transitioning to electronic delivery of curricular materials in the pre-clinical phase of their study. In 2017, the Clerkship in Pediatrics was tasked with investigating methods to integrate iPad use into clinical education.

Activity:

We employed the web-based platform Examplify to deliver test questions for TBL sessions over the span of 1 academic year (2018-2019). Curricular content was converted to Examplify for half of the TBL sessions and team performance for the sessions was compared to those administered traditionally. Students participating in the course were surveyed regarding their satisfaction with the 2 formats using a 15-item survey with a 4-point rating scale and open-ended questions.

Results and discussion:

Integration of technology into TBL sessions was met with mixed results. Performance on the eTBL sessions was significantly higher for 2 of the 6 sessions: the Abdominal Pain (90.2% vs 84.1%, P = .04) and the Toxicology (85.6% vs 79.4%, P = .03) sessions. A majority of students felt that the eTBL sessions facilitated multiple learning styles, promoted discussions, and nurtured different learning styles. However, students also felt that the electronic sessions were more cumbersome and difficult to navigate. Future research comparing the 2 modalities using a more comprehensive integration of media content, such as video and audio files, will further inform the success of this endeavor.
Perifoveal exudative vascular anomalous complex in a highly myopic eye
Authors: Sacconi Riccardo , Borrelli Enrico , Bandello Francesco , Querques Giuseppe
Published: September 2020

‘Perifoveal Exudative Vascular Anomalous Complex’ (PEVAC) is a perifoveal, unilateral, isolated, perifoveal aneurysm, in otherwise healthy patients. Here, we report a case of PEVAC in a highly myopic eye of a 86-year-old woman affected by a visual decline in the right eye (best-corrected visual acuity of 20/100). She had no other relevant past conditions and/or ocular impairment. Fundus examination in the right eye showed myopic chorioretinal degeneration with a concomitant PEVAC. Structural optical coherence tomography (OCT) showed a round lesion with a hyperreflective wall associated with intraretinal cystic spaces. OCT-angiography nicely disclosed an isolated large aneurysmal retinal dilation featuring the PEVAC with detectable flow in superficial capillary plexus, deep capillary plexus, and avascular slab. This case highlights the importance of discerning between different vascular disorders of the macula, in order to be able to offer the right treatment and/or follow-up to the patient.
Increasing Naloxone Knowledge and Use Through Direct-to-Patient Education
Authors: Litten Kathryn , Hill Lucas G. , Garza Aida , Srinivasa Maaya
Published: September 2020

Background: In the United States, opioid overdoses account for 130 deaths daily. Barriers to obtaining naloxone, the drug-of-choice for opioid overdose reversal, include limited education, access, and perceptions of provider judgement. Objectives: This study aimed to assess the efficacy of mailed education about naloxone, with or without a live teaching seminar, to patients at risk for opioid overdose. Methods: This observational study was conducted in a federally qualified health system. A phone presurvey was administered to patients on long-term opioid therapy or with a diagnosis of opioid use disorder to assess opioid overdose-related knowledge. Subjects were mailed a handout about naloxone and an invitation to receive naloxone at no cost at a seminar. Three-month phone postsurveys were conducted. The primary outcome was change in mean knowledge score from presurvey to postsurvey. Secondary outcomes included scores on individual survey items, naloxone prescriptions provided, and overdose reversals reported. Results: Ninety-four patients received mailed education. Sixty-two subjects took presurveys and 23 took 3-month follow-up surveys. Five subjects attended the live seminar. The mean cumulative knowledge score improved by 8.7% from the presurvey to the postsurvey. During the study period, one new naloxone prescription was written and one overdose reversal was reported. Conclusion: Direct-to-patient mailed education slightly improved knowledge regarding naloxone and opioid overdose response, and it may have led to one successful overdose reversal. Mailing education to a larger population of patients at risk for opioid overdose may be necessary to observe a substantial clinical impact.
ACVR1/JAK1/JAK2 inhibitor momelotinib reverses transfusion dependency and suppresses hepcidin in myelofibrosis phase 2 trial
Authors: Oh Stephen T. , Talpaz Moshe , Gerds Aaron T. , Gupta Vikas , Verstovsek Srdan , Mesa Ruben , Miller Carole B. , Rivera Candido E. , Fleischman Angela G. , Goel Swati , Heaney Mark L. , O’Connell Casey , Arcasoy Murat O. , Zhang Yafeng , Kawashima Jun , Ganz Tomas , Kowalski Mark , Brachmann Carrie Baker
Published: September 2020

Momelotinib (MMB) is a JAK1/2 and ACVR1 inhibitor with demonstrated clinical activity in all 3 hallmarks of myelofibrosis (MF): anemia, constitutional symptoms, and splenomegaly. In this phase 2 open-label translational biology study (NCT02515630) of 41 transfusion-dependent patients with MF, we explored mechanisms underlying the favorable activity of MMB on MF-associated iron-restricted anemia, including its impact on serum hepcidin levels, and markers of iron storage and availability, erythropoiesis, and inflammation. A transfusion-independent response (TI-R), defined as red blood cell transfusion independence (TI) ≥12 weeks at any time on study, occurred in 17 patients (41%; 95% confidence interval [CI], 26%-58%), including 14 patients (34%; 95% CI, 20%-51%) who achieved TI-R by week 24. In addition, 78% of TI nonresponse (TI-NR) patients achieved a ≥50% decrease in transfusion requirement for ≥8 weeks. Adverse events (AEs) were consistent with previous studies of MMB in MF, with cough, diarrhea, and nausea as the most common. Twenty-one patients experienced grade ≥3 AEs, most commonly anemia and neutropenia. Consistent with preclinical data, daily MMB treatment led to an acute and persistent decrease in blood hepcidin associated with increased iron availability and markers of erythropoiesis. Baseline characteristics associated with TI-R were lower inflammation and hepcidin as well as increased markers of erythropoiesis and bone marrow function. Overall, the study demonstrates that MMB treatment decreases hepcidin in conjunction with improving iron metabolism and erythropoiesis, suggesting a mechanistic explanation for the reduced transfusion dependency observed in transfusion-dependent MF patients treated with MMB, thereby addressing the key unmet medical need in the MF population.
Drag-reducing polymers improve hepatic vaso-occlusion in SCD mice
Authors: Crompton Dan , Vats Ravi , Pradhan-Sundd Tirthadipa , Sundd Prithu , Kameneva Marina V.
Published: September 2020

Key Points

Nanomolar concentrations of drag-reducing polymer (DRP) reduce vaso-occlusion in the liver of sickle cell disease (SCD) mice. The potential for DRP as a rheology-based treatment/therapy for SCD warrants further study.
The expansion of the TRB and TRG genes in domestic goats (Capra hircus) is characteristic of the ruminant species
Authors: Giannico Francesco , Massari Serafina , Caputi Jambrenghi Anna , Soriano Adriano , Pala Angela , Linguiti Giovanna , Ciccarese Salvatrice , Antonacci Rachele
Published: September 2020

Background

Goats (Capra hircus), one of the first domesticated species, are economically important for milk and meat production, and their broad geographical distribution reflects their successful adaptation to diverse environmental conditions. Despite the relevance of this species, the genetic research on the goat traits is limited compared to other domestic species. Thanks to the latest goat reference genomic sequence (ARS1), which is considered to be one of the most continuous assemblies in livestock, we deduced the genomic structure of the T cell receptor beta (TRB) and gamma (TRG) loci in this ruminant species.

Results

Our analyses revealed that although the organization of the goat TRB locus is broadly similar to that of the other artiodactyl species, with three in-tandem D-J-C clusters located at the 3′ end, a complex and extensive series of duplications have occurred in theVgenes at the 5′ end, leading to a marked expansion in the number of theTRBVgenes. This phenomenon appears to be a feature of the ruminant lineage since similar gene expansions have also occurred in sheep and cattle.

Likewise, the general organization of the goatTRGgenes is typical of ruminant species studied so far, with two paralogous TRG loci, TRG1 and TRG2, located in two distinct and distant positions on the same chromosome as result of a split in the ancestral locus. Each TRG locus consists of reiterated V-J-J-C cassettes, with the goat TRG2 containing an additional cassette relative to the corresponding sheep and cattle loci.

Conclusions

Taken together, these findings demonstrate that strong evolutionary pressures in the ruminant lineage have selected for the development of enlarged sets ofTRBandTRGgenes that contribute to a diverse T cell receptor repertoire. However, differences observed among the goat, sheep and cattleTRBandTRGgenes indicate that distinct evolutionary histories, with independent expansions and/or contractions, have also affected each ruminant species.
Developmentally regulated activation of defense allows for rapid inhibition of infection in age-related resistance to Phytophthora capsici in cucumber fruit
Authors: Mansfeld Ben N. , Colle Marivi , Zhang Chunqiu , Lin Ying-Chen , Grumet Rebecca
Published: September 2020

Background

Age-related resistance (ARR) is a developmentally regulated phenomenon conferring resistance to pathogens or pests. Although ARR has been observed in several host-pathogen systems, the underlying mechanisms are largely uncharacterized. In cucumber, rapidly growing fruit are highly susceptible to Phytophthora capsici but become resistant as they complete exponential growth. We previously demonstrated that ARR is associated with the fruit peel and identified gene expression and metabolomic changes potentially functioning as preformed defenses.

Results

Here, we compare the response to infection in fruit at resistant and susceptible ages using microscopy, quantitative bioassays, and weighted gene co-expression analyses. We observed strong transcriptional changes unique to resistant aged fruit 2–4 h post inoculation (hpi). Microscopy and bioassays confirmed this early response, with evidence of pathogen death and infection failure as early as 4 hpi and cessation of pathogen growth by 8–10 hpi. Expression analyses identified candidate genes involved in conferring the rapid response including those encoding transcription factors, hormone signaling pathways, and defenses such as reactive oxygen species metabolism and phenylpropanoid biosynthesis.

Conclusion

The early pathogen death and rapid defense response in resistant-aged fruit provide insight into potential mechanisms for ARR, implicating both pre-formed biochemical defenses and developmentally regulated capacity for pathogen recognition as key factors shaping age-related resistance.
Semi-urgent pulmonary vein isolation using cryoballoon for haemodynamically unstable atrial fibrillation storm in a patient with low cardiac output syndrome: a case report
Authors: Koike Toshiharu , Mori Fumiaki , Maeda Ryozo , Kobayashi Ken , Sakai Masayuki , Oyabu Kenjiro , Matsui Yuko , Yoshikawa Masafumi , Sugiyama Kou , Ajiro Yoichi , Iwade Kazunori
Published: September 2020

Background

Atrial fibrillation and heart failure are common coexisting conditions requiring hospitalisation for heart failure and death. Pulmonary vein isolation is a well-established option for symptomatic atrial fibrillation and for atrial fibrillation concomitant with heart failure with reduced left ventricular ejection fraction. Recently, pulmonary vein isolation using cryoballoon showed non-inferiority to radiofrequency ablation with respect to the treatment of patients with drug-refractory paroxysmal atrial fibrillation. However, the effectiveness of acute-phase rhythm control by semi-urgent pulmonary vein isolation using cryoballoon in patients with haemodynamically unstable atrial fibrillation storm accompanied with low cardiac output syndrome is unclear. Herein, we present a case in which semi-urgent pulmonary vein isolation using cryoballoon was effective for acute-phase rhythm control against drug-resistant and haemodynamically unstable repetitive atrial fibrillation tachycardia accompanied with low cardiac output syndrome.

Case presentation

A 57-year-old man was hospitalised for New York Heart Association functional class 4 heart failure with atrial fibrillation tachycardia and reduced left ventricular ejection fraction of 20% accompanied with low cardiac output syndrome-induced liver damage. The haemodynamics collapsed during atrial fibrillation tachycardia, which had become resistant to intravenous amiodarone and repeated electrical cardioversions. In addition to atrial fibrillation, atrial tachycardia and common-type atrial flutter appeared on day 3. Multiple organ failure progressed gradually due to haemodynamically unstable atrial fibrillation tachycardia storm accompanied with low cardiac output syndrome. On day 4, to focus on treatment of heart failure and multiple organ failure, semi-urgent rescue pulmonary vein isolation using cryoballoon to atrial fibrillation and cavotricuspid isthmus ablation to common-type atrial flutter were performed for acute-phase rhythm control. Soon after the ablation procedure, atrial fibrillation and common-type atrial flutter were lessened, and sinus rhythm was restored. A stable haemodynamics was successfully achieved with the improvement of hepatorenal function. The patient was discharged on day 77 without complications.

Conclusions

This case demonstrates that acute-phase rhythm control by semi-urgent pulmonary vein isolation using cryoballoon could be a treatment option in patients with haemodynamically unstable atrial fibrillation tachycardia storm accompanied with low cardiac output syndrome, which is refractory to cardioversion and drug therapy.
Early changes in ambulatory electrocardiography after transcatheter closure in patients with atrial septal defect and factors affecting heart rate variability
Authors: Su Zhenyang , Cao Qing , Zhang Hao , Sun Wei , Zhang Haifeng , Sheng Yanhui , Yang Rong , Kong Xiangqing
Published: September 2020

Background

Factors affecting heart rate variability (HRV) in patients with atrial septal defect (ASD) have not been clarified. This study sought to identify those factors and establish a preliminary risk model.

Methods

A total of 154 patients with ASD who underwent transcatheter closure and met the study requirements were analyzed in this study. Moreover, 26 patients with patent foramen ovale (PFO) were enrolled in our study as a control group. All patients underwent echocardiography and ambulatory electrocardiography before and one day after the procedure.

Results

The standard deviation of all normal-to-normal (NN) intervals (SDNN) and the standard deviation of the averages of the NN intervals in all 5 min segments of the entire recording (SDANN) were significantly higher and the heart rate was lower after closure than before closure in patients with ASD (SDNN: 6.08, 95% CI 3.00 to 9.15, p < 0.001; SDANN: 7.57, 95% CI 4.50 to 10.64, p < 0.001; heart rate: -1.17, 95% CI − 2.86 to − 0.48, p = 0.006). Multiple regression analyses indicated that age, sex, defect diameter, heart rate and diabetes were significantly associated with HRV indices (SDNN: R2 = 0.415; P < 0.001). SDNN and SDANN had obvious correlations with right ventricular systolic pressure (SDNN: R = − 0.370, p < 0.001; SDANN: R = − 0.360, p < 0.001).

Conclusions

Factors affecting HRV in patients with ASD include age, sex, heart rate, defect size and diabetes. Furthermore, right ventricular systolic pressure plays an important role in the change in HRV.
Correction to: Two-stage Bayesian hierarchical modeling for blinded and unblinded safety monitoring in randomized clinical trials
Authors: Liu Junhao , Wick Jo , Martin Renee’ H. , Meinzer Caitlyn , Roy Dooti , Gajewski Byron
Published: September 2020

An amendment to this paper has been published and can be accessed via the original article.
A rare hepatic mass in an Italian resident
Authors: Borro Matteo , Murdaca Giuseppe , Greco Monica , Negrini Simone , Setti Maurizio
Published: September 2020

Background

Amebiasis is a rare condition in developed countries but epidemiologically growing. Clinical manifestation may range from asymptomatic to invasive disease, amoebic liver abscess being the most common manifestation. We report a peculiar case of left hepatic amoebic liver abscess in a patient without a well-known source of infection and presenting with left portal vein thrombosis.

Case presentation

Patient, working as longshoreman, presented with complaints of remittent-intermittent fever lasting from 2 weeks. Physical examination was normal. Blood tests showed mild anemia, neutrophilic leukocytosis and elevated inflammation markers. Chest x-rays was normal. Abdominal ultrasound showed multiple hypoechoic liver masses. CT-scan of abdomen showed enlarged left liver lobe due to the presence of large abscess cavity along with thrombosis of left portal vein. The indirect hemagglutination test for the detection of antibodies to Entamoeba histolytica (Eh) was positive. Ultrasound-guided percutaneous drainage revealed “anchovy sauce” pus. Metronidazole and a follow up imaging at 3 months showed resolution of abscess cavity.

Conclusion

This case shows that amoebic liver abscess is possible even in first world country patients without travel history. Left sided abscess and portal vein thrombosis are rare and hence reported.
Increased cardiovascular mortality in females with the a/a genotype of the SNPs rs1478604 and rs2228262 of thrombospondin-1
Authors: Alehagen Urban , Shamoun Levar , Wågsäter Dick
Published: September 2020

Background

Cardiovascular diseases are still the major cause of death in the Western world, with different outcomes between the two genders. Efforts to identify those at risk are therefore given priority in the handling of health resources. Thrombospondins (TSP) are extracellular matrix proteins associated with cardiovascular diseases. The aim of this study was to investigate variations in single nucleotide polymorphisms (SNPs) of TSP-1 and plasma expression, and associations with mortality from a gender perspective.

Methods

A population of 470 community-living persons were invited to participate. The participants were followed for 7.9 years and underwent a clinical examination and blood sampling. SNP analyses of TSP-1 rs1478604 and rs2228262 using allelic discrimination and plasma measurement of TSP-1 using ELISA were performed,

Results

During the follow-up period, 135 (28.7%) all-cause and 83 (17.7%) cardiovascular deaths were registered.

In the female population, the A/A genotype of rs2228262 and the T/T genotype of rs1478604 exhibited significantly more cardiovascular deaths compared with the A/G and G/G, or the T/C and C/C genotypes amalgamated (rs2228262: 13.7% vs 2.0%; Χ2:5.29; P = 0.02; rs1478604:17.7% vs 4.7%; Χ2:9.50; P = 0.002). Applied in a risk evaluation, the A/A, or T/T genotypes exhibited an increased risk of cardiovascular mortality (rs2228262: HR: 7.1; 95%CI 1.11–45.8; P = 0.04; rs1478604: HR: 3.18; 95%CI 1.35–7.50; p = 0.008). No differences among the three genotypes could be seen in the male group.

Conclusion

In this study the female group having the A/A genotype of rs2228262, or the T/T genotype of rs1478604 of TSP-1 exhibited higher cardiovascular mortality after a follow-up of almost 8 years. No corresponding genotype differences could be found in the male group. Genotype evaluations should be considered as one of the options to identify individuals at risk. However, this study should be regarded as hypothesis-generating, and more research in the field is needed.
A prospective cohort study investigating contributors to mild cognitive impairment in adults with spinal cord injury: study protocol
Authors: Sandalic Danielle , Craig Ashley , Arora Mohit , Pozzato Ilaria , Simpson Grahame , Gopinath Bamini , Kaur Jasbeer , Shetty Sachin , Weber Gerard , Cameron Ian , Tran Yvonne , Middleton James
Published: September 2020

Background

Studies report rates of mild cognitive impairment (MCI) in spinal cord injury (SCI) range between 10 and 60%. This broad estimate of MCI in SCI is most likely a result of: (i) inconsistent operationalization of MCI; (ii) heterogeneity among individuals with SCI; (iii) failure to account for MCI subtypes, thereby adding to the heterogeneity of samples; and, (iv) poor control for traumatic brain injury (TBI) that obscures differentiation of MCI attributable to TBI versus other factors. There is a paucity of longitudinal studies following the course of MCI in SCI, and none that account for multiple predictors of MCI, including interactions among predictors.

Methods

An inception cohort longitudinal study will assess approximately 100 individuals aged 17–80 years with acute SCI, with measures taken at three timepoints (baseline, 3 months post-baseline, and 12 months post-injury). Data relevant to medical care received within the first 24–48 h of presentation to the emergency department will be analysed, as will measures of cognition, injury characteristics, medical history, personal factors, psychological status, psychosocial functioning, and quality of life. Latent class mixture modelling will determine trajectories for the primary outcome of interest, cognitive functioning and its subtypes, and secondary outcomes of interest such as depression. Multiple regression analyses will identify predictors of MCI and its subtypes.

Discussion

The prospective design will reveal change in cognitive functioning across time and unveil different outcome trajectories; thus addressing the lack of knowledge on trajectories of MCI and MCI subtypes in SCI. Through subtyping MCI, we hope to yield groups of cognitively impaired individuals with SCI that are potentially more homogenous and thereby stable and predictable. This is the first study to capture emergency department and acute care diagnostic evidence of mild TBI, which has been poorly controlled in previous studies. Our study will also be the first to distinguish the contribution of TBI from other factors to the development of MCI in individuals with SCI.

Trial registration

The study was prospectively registered with the Australian and New Zealand Clinical Trial Registry (ACTRN12619001702101) on 3rd December 2019.
Prevalence and factors associated with antenatal care utilization in Ethiopia: an evidence from demographic health survey 2016
Authors: Tsegaye Berhan , Ayalew Mohammed
Published: September 2020

Background

Ethiopia is one of the sub-Saharan African country with high maternal mortality ratio (MMR). According to Ethiopian demographic health survey (EDHS) 2016 report, MMR is 420 among 100,000 live births. Antenatal care utilization is a key intervention to reduce these deaths through problem detection and treatment, promotion of health seeking behavior, and preparing pregnant women for birth. Therefore, this study aimed to assess prevalence and factors associated with antenatal care service utilization in Ethiopia in 2016.

Methods

Secondary data analysis was done on EDHS 2016. It was a stratified, two-stage, and cluster sampling design. Analysis has been restricted to antenatal care utilization among women who delivered at least one time in the past five years. Data were weighted to correct sampling bias. Moreover, complex data analysis was done. Bi-variate and multivariable logistic regression analyses were carried out. Adjusted odds ratio with 95% confidence interval was computed and P-value less than 0.05 considered as a statistically significance level for identification of association.

Results

Prevalence of antenatal care utilization was 62.8% [95%CI: 60.9, 64.6] in this study. Maternal educational status of primary school (AOR = 1.8,95%CI:1.2, 2.6), maternal educational status of secondary school (AOR = 4.4,95%CI: 1.1, 17.3), women who listen radio less than 1 per week (AOR = 1.9,95%CI:1.12,3.34), women who listen radio at least 1 per week (AOR = 2.6,95%CI:1.4,4.8), women in rich wealth quintile (AOR = 1.9,95%CI: 1.1, 3.2) were factors positively associated with antenatal care utilization. However, women who had traditional belief (AOR = 0.1,95%CI:0.02,0.49), and women who had five children and above (AOR = 0.6,95%CI: 0.3, 0.9) were factors associated negatively with antenatal care utilization.

Conclusions

Prevalence of antenatal care utilization is still low in Ethiopia in 2016. Maternal higher maternal educational status, frequent radio listening, higher wealth quintile, traditional belief, and greater number of children were found to be associated significantly with antenatal care utilization. Consequently, socio-economic status should be enhanced, information should be accessed by women about antenatal care utilization and family planning service through mass media. Furthermore, intensive community education program should be designed for traditional believers to increase uptake of antenatal care by stakeholders.
Microperimetry as a diagnostic tool for the detection of early, subclinical retinal damage and visual impairment in multiple sclerosis
Authors: Rohowetz Landon J. , Vu Qui , Ablabutyan Lilit , Gratton Sean M. , Kunjukunju Nancy , Wallace Billi S. , Koulen Peter
Published: September 2020

Background

A majority of multiple sclerosis patients experience visual impairment, often as the initial presenting symptom of the disease. While structural changes in the retinal nerve fiber layer and optic nerve have demonstrated correlations with brain atrophy in multiple sclerosis using magnetic resonance imaging, a non-invasive, cost-effective, and clinically efficacious modality to identify early damage and facilitate prompt therapeutic intervention to slow the progression of multiple sclerosis and its ocular manifestations, is still urgently needed. In this study, we sought to determine the role of macular sensitivity measured by microperimetry in the detection of subclinical multiple sclerosis-related retinal damage and visual dysfunction.

Methods

This cross-sectional observational case-control study involved population-based samples of multiple sclerosis patients and age-, race-, and gender-matched healthy control subjects. Among the key criteria for the multiple sclerosis patients were diagnosis by the McDonald criteria, visual acuity greater than 20/25, and no history of optic neuritis. Macular sensitivity and average macular thickness were measured in all subjects using microperimetry and spectral-domain optical coherence tomography, respectively. Pearson correlation coefficients were measured using bivariate correlations. Sample means, mean differences, and 95% confidence intervals were calculated using independent sample t-tests.

Results

Twenty-eight eyes from 14 MS patients and 18 eyes from 9 control subjects were included. Mean macular sensitivity of control subjects and multiple sclerosis patients in decibels was 18.2 ± 0.4 and 16.5 ± 0.4, respectively, corresponding to a mean difference of 1.7 (95% CI, 1.1–2.4; P < 0.001). Macular sensitivity was positively correlated with macular thickness in multiple sclerosis patients (r = 0.49, P = 0.01) but not control subjects (r = 0.15, P = 0.55).

Conclusions

Macular sensitivity as measured by microperimetry was decreased in multiple sclerosis patients with normal visual acuity and no history of optic neuritis. Furthermore, macular sensitivity demonstrated a positive correlation with macular thickness as measured by optical coherence tomography. As such, microperimetry may represent a non-invasive and efficient method to identify signs of subclinical visual dysfunction that correspond with early macular architectural changes characteristic of multiple sclerosis.
Regional emphysema score is associated with tumor location and poor prognosis in completely resected NSCLC patients
Authors: Heo Jung Won , Kang Hye Seon , Park Chan Kwon , Kim Sung Kyoung , Kim Ju Sang , Kim Jin Woo , Kim Seung Joon , Lee Sang Haak , Yeo Chang Dong
Published: September 2020

Background

Lung cancer is a frequent comorbidity of chronic obstructive pulmonary disease (COPD). However, the local risk of developing lung cancer related to regional emphysema distribution and clinical outcome has not been investigated. Our aim was to evaluate the impact of regional emphysema score (RES) on tumor location and prognosis in non-small cell lung cancer (NSCLC) patients.

Methods

We enrolled 457 patients who underwent curative surgery for NSCLC at seven hospitals at The Catholic University of Korea from 2014 to 2018. Emphysema was visually assessed for each lobe, with the lingula as a separate lobe. Semi-quantitative emphysema scoring was classified as follows: 0 = none, 0.5 = 1 to 10%, 1 = 11 to 25%, 2 = 26 to 50%, 3 = 51 to 75%, and 4 = 76 to 100%. An RES was given to each of the six lung zone: the upper, middle, and lower lobes in the right and left lungs.

Results

There were 145 patients in the high RES (≥ 3) group and 312 in the low RES (< 3) group. The mean RES in each lobe with cancer was significantly higher than that in other lobes without cancer (0.51 vs. 0.37, P <  0.001). This group showed significantly shorter disease-free survival (P <  0.001), in addition, presence of COPD, low diffusing capacity of the lung for carbon monoxide (< 80), smoking status, and poor differentiation were more frequent in this group. Also, cancer in a lobe with a higher RES (odds ratio (OR) = 1.56; 95% confidence interval (CI:1.01–2.42; P = 0.04), pathologic stage ≥ III (OR = 2.23; 95% CI: 1.28–3.89; P <  0.001), and poor differentiation (OR = 1.99; 95% CI: 1.22–3.21; P <  0.001) were independent factors for tumor recurrence.

Conclusions

The regional severity of emphysema by visual qualification was associated with the location of lung cancer, and was an independently poor prognostic factor for tumor recurrence in completely resected NSCLC patients.
Favourable long-term survival of patients with esophageal cancer treated with extended transhiatal esophagectomy combined with en bloc lymphadenectomy: results from a retrospective observational cohort study
Authors: Kröll Dino , Borbély Yves Michael , Dislich Bastian , Haltmeier Tobias , Malinka Thomas , Biebl Matthias , Langer Rupert , Candinas Daniel , Seiler Christian
Published: September 2020

Background

Although considered complex and challenging, esophagectomy remains the best potentially curable treatment option for resectable esophageal and esophagogastric junction (AEG) carcinomas. The optimal surgical approach and technique as well as the extent of lymphadenectomy, particularly regarding quality of life and short- and long-term outcomes, are still a matter of debate. To lower perioperative morbidity, we combined the advantages of a one-cavity approach with extended lymph node dissection (usually achieved by only a two-cavity approach) and developed a modified single-cavity transhiatal approach for esophagectomy.

Methods

The aim of this study was to evaluate the outcome of an extended transhiatal esophageal resection with radical bilateral mediastinal en bloc lymphadenectomy (eTHE). A prospective database of 166 patients with resectable cancers of the esophagus (including adenocarcinomas of the AEG types I and II) were analyzed. Patients were treated between 2001 and 2017 with eTHE at a tertiary care university center. Relevant patient characteristics and outcome parameters were collected and analyzed. The primary endpoint was 5-year overall survival. Secondary outcomes included short-term morbidity, mortality, radicalness of en bloc resection and oncologic efficacy.

Results

The overall survival rates at 1, 3 and 5 years were 84, 70, and 61.0%, respectively. The in-hospital mortality rate after eTHE was 1.2%. Complications with a Clavien-Dindo score of III/IV occurred in 31 cases (18.6%). A total of 25 patients (15.1%) had a major pulmonary complication. The median hospital stay was 17 days (interquartile range (IQR) 12). Most patients (n = 144; 86.7%) received neoadjuvant treatment. The median number of lymph nodes resected was 25 (IQR 17). The R0 resection rate was 97%.

Conclusion

In patients with esophageal cancer, eTHE without thoracotomy resulted in excellent long-term survival, an above average number of resected lymph nodes and an acceptable postoperative morbidity and mortality.
Factors associated with conducting planning for secondary oral health care services in Brazil
Authors: de Lucena Edson Hilan Gomes , da Silva Rênnis Oliveira , de Lucena Carolina Dantas Rocha Xavier , Mepatia Amalia Issufo , Cavalcanti Yuri Wanderley , de Goes Paulo Savio Angeiras , de Sousa Maria Fátima
Published: September 2020

Background

Planning in health services specifically aims to improve the health status of a given population, guaranteeing access with equity and justice, as well as streamlining the response of the health system to the needs perceived by the community. This research aims to identify the factors associated with planning Specialized Dental Clinics (SDCs).

Methods

Secondary data were used from the external evaluation of the database of the first National Program for Access and Quality Improvement of SDCs (NPAQI–SDCs) and the informed Outpatient Information System of the Unified Health System (OIS/UHS), which contains data on the specialized dental procedures performed at SDCs. It consisted of a quantitative study in which Pearson chi-square statistical tests (p < 0.05) and a multivariate logistic regression were applied with odds ratio (OR) estimate.

Results

The results indicated that the realization of planning in SDCs was associated with lower coverage of the Oral Health Team of the Familiy Health Strategy in a municipality (OR = 1.4; 95% CI: 1.0–1.9, p = 0.049), additional training for managers (p = 0.038), the practice of self-assessment (OR = 8.2; 95% CI: 5.8–11.6; p = 0.000) and meeting service production targets (OR = 1.9; 95% CI: 1.2–3.2; p = 0.011).

Conclusion

The results indicate that the work processes of the SDCs, especially with regard to service management, are essential to the proper functioning of the service and the practice of planning is linked to the technical capacity and commitment of service managers.