bluuebunny/crossref_metadata_2025 huggingface dataset:
Healing pattern classification for thoracolumbar burst fractures after posterior short-segment fixation
Authors: Liang Changxiang , Liu Guihua , Liang Guoyan , Zheng Xiaoqing , Yin Dong , Xiao Dan , Zeng Shixing , Cai Honghua , Chang Yunbing
Published: June 2020

Background

Thoracolumbar burst fractures can be treated with posterior short-segment fixation. However, no classification can help to estimate whether the healed vertebral body will have sufficient stability after implant removal. We aimed to develop a Healing Pattern Classification (HPC) to evaluate the stability of the healed vertebra based on cavity size and location.

Methods

Fifty-two thoracolumbar burst fracture patients treated with posterior short-segmental fixation without fusion and followed up for an average of 3.2 years were retrospectively studied. The HPC was divided into 4 types: type I - no cavity; type II - a small cavity with or without the violation of one endplate; type III - a large cavity with or without the violation of one endplate; and type IV - a burst cavity with the violation of both endplates or the lateral cortical shell. The intraobserver and interobserver intraclass correlation coefficients (ICCs) of the HPC were assessed. The demographic characteristics and clinical outcomes of the cohort were compared between the stable group (types I and II) and the unstable group (types III and IV). Logistic regression was conducted to evaluate risk factors for unstable healing.

Results

The intraobserver and interobserver ICCs of the HPC were 0.86 (95% CI = 0.74–0.90) and 0.77 (95% CI = 0.59–0.86), respectively. While the unstable healing group (types III and IV) accounted for 59.6% of the patients, most of these patients were asymptomatic. The preoperative Load Sharing Classification (LSC) comminution score may predict the occurrence of unstable healing (OR = 8.4, 95% CI = 2.4–29.7).

Conclusions

A reliable classification for assessing the stability of a healed vertebra was developed. With type I and II healing, the vertebra is considered stable, and the implant can be removed. With type III healing, the vertebra may have healing potential, but the implant should not be removed unless type II healing is achieved. With type IV healing, the vertebra is considered extremely unstable, and instrumentation should be maintained. Assessing the LSC comminution score preoperatively may help to predict unstable healing after surgery.
Gynecological hysterectomy in Northern Tanzania: a cross- sectional study on the outcomes and correlation between clinical and histological diagnoses
Authors: Michael Daniel , Mremi Alex , Swai Patricia , Shayo Benjamin C. , Mchome Bariki
Published: June 2020

Background

Hysterectomy is one of the most common gynaecological procedures performed worldwide. The magnitude of the complications related to hysterectomy and their risk factors are bound to differ based on locations, availability of resources and level of surgical training. Documented complications rates and their correlates are reported from high income countries while data from low- and middle-income countries including Tanzania is scare.

Methods

This was a hospital based cross-sectional study conducted at a tertiary facility in northern Tanzania where 178 women who underwent elective gynecological hysterectomies in the department of obstetrics and gynecology within the study period were enrolled. Logistic regression was performed to determine the association between risk factors and occurrence of surgical complication where p-value of < 0.05 was considered statistically significant. The degree of correlation between pre-operative clinical and histological diagnosis was determined by kappa correlation test.

Results

A total of 75 (42%) of women had surgical complications within 10 days of surgery. Blood transfusion and intra-operative bleeding were the most common complications observed in 34 (19.1%) and 17 (9.6%) women respectively. Independent risk factors for complications included obesity (OR 3.9; 95% CI 1.44–10.46), previous abdominal operations (OR 8.44; 95% CI 2.52–28.26) and longer duration of operation (> 2 h) (OR 5.02; 95% CI 2.18–11.5). Both uterine fibroid and adenomyosis had good correlation of clinical and histological diagnosis (p-value < 0.001).

Conclusion

Bleeding and blood transfusion were the most common complications observed in this study. Obesity, previous abdominal operation and prolonged duration of operation were the most significant risk factors for the complications. Local tailored interventions to reduce surgical complications of hysterectomy are thus pivotal. Clinicians in this locality should have resources at their disposal to enhance definitive diagnosis attainment before surgical interventions.
Barriers to seeking consultation for abnormal uterine bleeding: systematic review of qualitative research
Authors: Henry Claire , Ekeroma Alec , Filoche Sara
Published: June 2020

Background

Although Abnormal Uterine Bleeding (AUB) can have serious medical consequences and significantly impacts daily life, the overall trend is that most women do not seek care for these symptoms. The objective of this review was to synthesise factors impeding women’s access care for AUB.

Methods

Systematic literature review of qualitative studies (interview and focus group) regarding the lived in experiences of women with abnormal menstrual symptoms, followed by a thematic analysis of these studies. We screened CINAHL, SCOPUS, ProQuest, OVID and Pubmed for qualitative studies. Studies were assessed using the Clinical Appraisal Skills Programme checklist and thematic synthesis was used to develop themes from the findings of the studies.

Results

The review yielded 12 studies that satisfied the inclusion criteria. Three themes were developed that described barriers for women seeking care for AUB: health literacy (understanding of normal periods, role of cervical Pap smears and lack of access to appropriate information), taboo/normalisation (fear and embarrassment of symptoms, prioritising others) and health care provider (lack of accessible and trusted female GPs and poor experiences with GPs).

Conclusions

For 20 years women have consistently reported poor experiences in accessing care for AUB. The findings from our review indicate that drivers to impeding access are multiple; therefore any approaches to improve access will need to be multi-level – from comprising local sociocultural considerations to improved GP training.
Challenges of managing diabetes in Iran: meta-synthesis of qualitative studies
Authors: Mohseni Mohammad , Shams Ghoreishi Tahereh , Houshmandi Sousan , Moosavi Ahmad , Azami-Aghdash Saber , Asgarlou Zoleykha
Published: June 2020

Background

Although several diabetes management and control programmes are introduced in Iran, many patients do not achieve diabetes-related clinical goals as recommended. The aim of this study was to identify the qualitative evidence for the challenges regarding diabetes management.

Methods

A systematic review of qualitative studies following PRISMA guidelines was undertaken. Scopus, PubMed, Science Direct, and Web of Knowledge were searched as well as Persian databases including Magiran, Irandoc and SID from inception to August 2019. The included Studies were either in English- or Persian-language qualitative studies reporting the perspectives of patients, their relatives, or healthcare service providers. Content of the findings were analysed and organized according to Chronic Care Model framework.

Results

Twelve studies met the inclusion criteria. Six main themes were identified including holistic understanding of patients, leadership and governance difficulties, service delivery, workforce, financing, and information and research.

Conclusion

Challenges regarding the management of diabetes in Iran is multifaceted. Reforming the health care system or developing complementary strategies is essential to improve suitable health care model for patients with chronic conditions such as diabetic patients.
Home care clients: a research protocol for studying their pathways
Authors: Keefe Janice M. , Funk Laura , Knight Lucy , Lobchuk Michelle , Macdonald Marilyn , Mitchell Lori , Rempel Julie , Warner Grace , Stevens Susan
Published: June 2020

Background

Enhancing non-clinical home care supports and services for older adults to live well is a strategic priority in developed countries, including Canada. Underpinning these supports and services are structures of care that are reflected in home care policies, programs and practices within jurisdictions. These approaches to care exist at multiple levels and inform interactions, perceptions, and care assessment, planning and provision, ultimately shaping the supports that are delivered. Jurisdictional differences in approaches to care mean that pathways through home care systems may differ, depending on where one lives. The goal of this study is to understand how approaches to care shape the pathways of older adult home care clients with chronic and long term conditions in two Canadian health jurisdictions.

Methods

This longitudinal mixed-methods study has three interrelated research streams informed by aspects of the socio-ecological framework. We will examine client pathways using a retrospective analysis of home care assessment data (Resident Assessment Instrument- Home Care) in two health authorities (Client/Service Data Stream). We will analyze interview data from older adult home care clients and a cluster of each client’s family or friend caregiver(s), home support worker(s), care/case coordinator(s) and potentially other professionals at up to three points over 18 months using a prospective qualitative comparative case study design (Constellation Data Stream). We will review home care policies relevant to both health authorities and interview key informants regarding the creation and implementation of policies (Policy Stream). Our study will apply an integrated knowledge translation (iKT) approach that engages knowledge users in research design, analysis and interpretation to facilitate relevancy of results.

Discussion

Applying a mixed-method research design to understand approaches to care within and between two jurisdictions will contribute to the evidence base on older adult home care client pathways. Study results will identify how potential differences are experienced by clients and their families. An understanding of the policies will help to contextualize these findings. The iKT model will ensure that findings are useful for strategic planning and decision-making, and supporting changes in care practice.
Antibiotic dry buffalo therapy: effect of intramammary administration of benzathine cloxacillin against Staphylococcus aureus mastitis in dairy water buffalo
Authors: Guccione Jacopo , D’Andrea Luigi , Pesce Antonella , Toni Fausto , Borriello Giuliano , Salzano Caterina , Diuccio Francesco , Pascale Massimo , Ciaramella Paolo
Published: June 2020

Background

Mastitis is one of the most costly diseases in Mediterranean buffalo (MB). At present, just a few specific antibiotics registered for this dairy specie have been synthetized. Efficacy of an antibiotic dry buffalo therapy (aDBT) againstStaphylococcus aureus(S. aureus) mastitis, based on intra-quarter administration of 600 mg of benzathine cloxacillin, have been evaluated for the first time. Eighty MB’s quarters received a drying-off therapy (aDBT-group) and 80 were left untreated (no-aDBT-group). They were sampled at drying-off (pre-treatment) and at the resumption of milking [< 10 days in milk (DIM)].Fresh calver mastitis rate,dry period new mastitis rate,dry period cure rate, andpersistent mastitis ratewere calculated for clinical monitoring. Overall proportion of positive quarters/animals, quarters affected by mastitis or intramammary infections (IMI), effects on somatic cell count (SCC) and milk yield were also assessed.

Results

An inter-group difference (aDBT vs. no-aDBT) was recorded for all the indexes considered. An intra-group (drying-off vs. < 10 DIM) difference was detected in aDBT-group regarding the proportion of positive-cultured quarters and animals. Concerning the latter, an inter-groups difference was also recorded at second sampling. No clinical mastitis due to theS. aureuswas observed. Regarding the subclinical ones, a higher intra-group difference was observed in aDBT than no-aDBT group, while an inter-group difference was recorded at second sampling. No protective effect was observed against IMI. SCC showed an inter-group difference at second sampling, while none difference was instead detected for milk yield.

Conclusions

The effects againstS. aureusmastitis of benzathine cloxacillin administration at drying-off were assessed for the first time in MB. Its use shows encouraging results in reducing the proportion of mastitis and positive animals at the resumption of the lactation.
Evaluation of treatment with a combination of mycophenolate mofetil and prednisolone in dogs with meningoencephalomyelitis of unknown etiology: a retrospective study of 86 cases (2009–2017)
Authors: Song Joong-Hyun , Yu Do-Hyeon , Lee Hee-Chun , Hwang Tae-Sung , Kim Young Joo , An Su-Jin , Jung Dong-In
Published: June 2020

Background

Combination therapy with glucocorticoids and adjunctive immunomodulating drugs has been generally accepted as a standard treatment regimen for meningoencephalomyelitis of unknown etiology (MUE). We hypothesized that treatment with MMF as an adjunctive agent along with glucocorticoids would be effective and well-tolerated protocol in dogs with MUE. Eighty-six dogs with MUE between May 2009 and June 2017 were included (59 females and 27 males; mean age of 5.93 years; mean body weight of 3.83 kg). The medical records of dogs with MUE treated with prednisolone and MMF were retrospectively evaluated to determine the therapeutic response, survival time, and treatment-related adverse effects.

Results

A partial or complete response (CR) was recorded for 75 dogs. The overall median survival time from the initiation of treatment was 558 days. Dogs that showed CR with no relapse over the treatment period (from diagnosis to death) had significantly longer median survival times. A significantly higher mortality hazard ratio of 4.546 was recorded in dogs that failed to achieve CR. The interval between the onset of clinical signs and the clinical presentation was not significantly associated with CR, relapse rate, and survival time. Adverse effects included gastrointestinal upsets in 26 dogs (30.23%), sporadic infections in 17 dogs (19.77%), and pancreatitis in seven dogs (8.14%).

Conclusions

The results suggest that adjunctive MMF treatment for MUE is safe and comparable to other immunosuppressive protocols. The treatment should focus on the achievement of CR and preventing relapse for successful management.
UBE2I promotes metastasis and correlates with poor prognosis in hepatocellular carcinoma
Authors: Yang Hao , Gao Shan , Chen Jing , Lou Weiyang
Published: June 2020

Background

A comprehensive investigation of ubiquitin-conjugating enzyme E2I (UBE2I) in cancer is still insufficiency. In this study, we aimed to analyze its role and mechanism in cancer by combination of bioinformatic analysis and experimental validation.

Methods

The expression profile of UBE2I in human cancers were obtained using GEPIA. Kaplan–Meier plotter was used to assess the prognostic values of UBE2I in diverse types of cancer. ROC curve analysis was employed to determine the diagnostic role of UBE2I in hepatocellular carcinoma (HCC). The expression differences based on various clinicopathological features was evaluated by UALCAN. Wound healing assay and transwell invasion assay were used to detected the effects of UBE2I on migration and invasion of HCC cells, respectively. The miRNA regulatory mechanism of UBE2I was successively investigated by binding prediction, expression analysis, survival analysis and dual-luciferase reporter assay. The correlation of UBE2I mRNA expression and UBE2I promoter methylation level was assessed using cBioPortal. STRING was finally introduced to perform co-expression analysis and enrichment analysis for UBE2I.

Results

UBE2I was upregulated in HCC, correlated with cancer progression and poor prognosis of HCC. We also found a significant diagnostic value of UBE2I in HCC. Functional experiments revealed that knockdown of UBE2I significantly inhibited HCC migration and invasion. Further research on mechanism suggested that loss of inhibition of hsa-miR-195-3p and dysregulation of UBE2I promoter methylation might account for UBE2I overexpression in HCC. Analysis of UBE2I-invovled regulatory network identified six key genes (NSMCE2, SAE1, UBA2, RANGAP1, SUMO1 and SUMO2) whose expression linked to poor prognosis in HCC.

Conclusions

In conclusion, UBE2I may be a promising therapeutic target and biomarker in cancer, especially HCC.
Kinesin superfamily protein 21B acts as an oncogene in non-small cell lung cancer
Authors: Sun Zhi-Gang , Pan Feng , Shao Jing-Bo , Yan Qian-Qian , Lu Lu , Zhang Nan
Published: June 2020

Background

Kinesin superfamily proteins (KIFs) serve as microtubule-dependent molecular motors, and are involved in the progression of many malignant tumors. In this study, we aimed to investigate the expression pattern and precise role of kinesin family member 21B (KIF21B) in non-small cell lung cancer (NSCLC).

Methods

KIF21B expression in 72 cases of NSCLC tissues was measured by immunohistochemical staining (IHC). We used shRNA-KIF21B interference to silence KIF21B in NSCLC H1299 and A549 cells and normal lung epithelial bronchus BEAS-2B cells. The biological roles of KIF21B in the growth and metastasis abilities of NSCLC cells were measured by Cell Counting Kit-8 (CCK8), colony formation and Hoechst 33342/PI, wound-healing, and Transwell assays, respectively. Expression of apoptosis-related proteins was determined using western blot. The effect of KIF21B on tumor growth in vivo was examined using nude mice model.

Results

KIF21B was up-regulated in NSCLC tissues, and correlated with pathological lymph node and pTNM stage, its high expression was predicted a poor prognosis of patients with NSCLC. Silencing of KIF21B mediated by lentivirus-delivered shRNA significantly inhibited the proliferation ability of H1299 and A549 cells. KIF21B knockdown increased apoptosis in H1299 and A549 cells, down-regulated the expression of Bcl-2 and up-regulated the expression of Bax and active Caspase 3. Moreover, KIF21B knockdown decreased the level of phosphorylated form of Akt (p-Akt) and Cyclin D1 expression in H1299 and A549 cells. In addition, silencing of KIF21B impeded the migration and invasion of H1299 and A549 cells. Further, silencing of KIF 21B dramatically inhibited xenograft growth in BALB/c nude mice. However, silencing of KIF21B did not affect the proliferation, migration and invasion of BEAS-2B cells.

Conclusions

These results reveal that KIF21B is up-regulated in NSCLC and acts as an oncogene in the growth and metastasis of NSCLC, which may function as a potential therapeutic target and a prognostic biomarker for NSCLC.
A novel patient-derived organoids-based xenografts model for preclinical drug response testing in patients with colorectal liver metastases
Authors: Jian Mi , Ren Li , He Guodong , Lin Qi , Tang Wentao , Chen Yijiao , Chen Jingwen , Liu Tianyu , Ji Meiling , Wei Ye , Chang Wenju , Xu Jianmin
Published: June 2020

Backgrounds

Cancer-related mortality in patients with colorectal cancer (CRC) is predominantly caused by development of colorectal liver metastases (CLMs). How to screen the sensitive chemotherapy and targeted therapy is the key element to improve the prognosis of CLMs patients. The study aims to develop patient-derived organoids-based xenografted liver metastases (PDOX-LM) model of CRC, to recapitulate the clinical drug response.

Methods

We transplanted human CRC primary tumor derived organoids in murine spleen to obtain xenografted liver metastases in murine liver. Immunohistochemistry (IHC) staining, whole-exome and RNA sequencing, and drug response testing were utilized to identify the homogeneity in biological and genetic characteristics, and drug response between the PDOX-LM models and donor liver metastases.

Results

We successfully established PDOX-LM models from patients with CLMs. IHC staining showed that positive expression of CEA, Ki67, VEGF, FGFR2 in donor liver metastases were also well preserved in matched xenografted liver metastases. Whole-exon sequencing and transcriptome analysis showed that both xenografted and donor liver metastases were highly concordant in somatic variants (≥ 0.90 frequency of concordance) and co-expression of driver genes (Pearson’s correlation coefficient reach up to 0.99, P = 0.001). Furthermore, drug response testing showed that the PDOX-LM models can closely recapitulated the clinical response to mFOLFOX6 regiments.

Conclusions

This PDOX-LM model provides a more convenient and informative platform for preclinical testing of individual tumors by retaining the histologic and genetic features of donor liver metastases. This technology holds great promise to predict treatment sensitivity for patients with CLMs undergoing chemotherapy.
The impact of regional astrocyte interferon-γ signaling during chronic autoimmunity: a novel role for the immunoproteasome
Authors: Smith Brandon C. , Sinyuk Maksim , Jenkins Julius E. , Psenicka Morgan W. , Williams Jessica L.
Published: June 2020

Background

In early autoimmune neuroinflammation, interferon (IFN)γ and its upregulation of the immunoproteasome (iP) is pathologic. However, during chronic multiple sclerosis (MS), IFNγ has protective properties. Although dysregulation of the iP has been implicated in neurodegeneration, its function remains to be fully elucidated. Here, we demonstrate that IFNγ signaling in regional astrocytes induces the iP and promotes protection of the CNS during chronic autoimmunity.

Methods

In a multiple sclerosis (MS) brain, we evaluated mRNA expression and labeled postmortem MS brainstem and spinal cord for iP subunits and indicators of oxidative stress. Primary regional human astrocytes were analyzed for iP regulation and function by quantitative reverse transcription-polymerase chain reaction (qRT-PCR), Western blot, OxyBlot, and reactive oxygen species and caspase activity detection assays. Following immunization with myelin oligodendrocyte glycoprotein (MOG)35-55, the role of IFNγ signaling and the iP during chronic experimental autoimmune encephalomyelitis (EAE) were assessed using pharmacologic inhibition of the iP and genetic interruption of IFNγ signaling specifically in astrocytes. Central nervous system (CNS) tissues were analyzed by immunohistochemistry (IHC) and immunofluorescence, and cell-specific colocalization was quantified.

Results

In MS tissue, iP expression was enhanced in the spinal cord compared to brainstem lesions, which correlated with a decrease in oxidative stress. In vitro, IFNγ stimulation enhanced iP expression, reduced reactive oxygen species burden, and decreased oxidatively damaged and poly-ubiquitinated protein accumulation preferentially in human spinal cord astrocytes, which was abrogated with the use of the iP inhibitor, ONX 0914. During the chronic phase of an MS animal model, EAE, ONX 0914 treatment exacerbated the disease and led to increased oxidative stress and poly-ubiquitinated protein buildup. Finally, mice with astrocyte-specific loss of the IFNγ receptor exhibited worsened chronic EAE associated with reduced iP expression, enhanced lesion size and oxidative stress, and poly-ubiquitinated protein accumulation in astrocytes.

Conclusions

Taken together, our data reveal a protective role for IFNγ in chronic neuroinflammation and identify a novel function of the iP in astrocytes during CNS autoimmunity.
IL-15 deficiency alleviates steroid-induced osteonecrosis of the femoral head by impact osteoclasts via RANKL-RANK-OPG system
Authors: Zhou Zubin , Lin Yiwei , Pan Chenhao , Wang Nan , Zhou Lihui , Shan Haojie , Gao Youshui , Yu Xiaowei
Published: June 2020

Background

Whether IL-15 is involved in the development of steroid-induced osteonecrosis of the femoral head (ONFH) is investigated.

Methods

C57BL/6 J and l15−/−mice were injected with methylprednisolone to induce wide type osteonecrosis (WT ON) and IL-15 deficiency osteonecrosis (IL-15−/−ON). Hematoxylin-Eosin (H&E) staining and micro-computed tomography (micro-CT) scanning was used to detect the microstructure. The differentiation and formation of osteoclasts were determined with colony-forming unit-granulocyte macrophages (CFU-GM), colony-forming unit-macrophage/mononuclear (CFU-M) per tibia, and tartrate-resistant acid phosphatase (TRACP or TRAP) positive cells. Serum interleukin (IL)-15, osteocalcin, bone alkaline phosphatase (BAP), bone Gla protein (BGP), and TRACP were assayed with enzyme-linked immunosorbent assay (ELISA). The receptor activator of nuclear factor-κB (RANK), RANK ligand (RANKL), and osteoprotegerin (OPG) in the femoral heads were detected by Western blot. CD34 staining was performed to detect microvascular density.

Results

IL-15 secretion was increased in the femoral heads and the serum of steroid-induced ONFH mice. IL-15 deficiency may lead to up-regulated vessel remodeling, improved microstructure, and up-regulated serum osteocalcin, BAP, and BGP secretion. Both the expression of RANKL/RANK/OPG and osteoclast differentiation and formation can be down-regulated by IL-15 deficiency.

Conclusion

IL-15 deficiency alleviates steroid-induced ONFH by impact osteoclasts via RANKL-RANK-OPG system.
Analysis and comprehensive comparison of PacBio and nanopore-based RNA sequencing of the Arabidopsis transcriptome
Authors: Cui Jiawen , shen Nan , Lu Zhaogeng , Xu Guolu , Wang Yuyao , Jin Biao
Published: June 2020

Background

The number of studies using third-generation sequencing utilising Pacific Biosciences (PacBio) and Oxford Nanopore Technologies (ONT) is rapidly increasing in many different research areas. Among them, plant full-length single-molecule transcriptome studies have mostly used PacBio sequencing, whereas ONT is rarely used. Therefore, in this study, we examined ONT RNA sequencing methods in plants. We performed a detailed evaluation of reads from PacBio, Nanopore direct cDNA (ONT Dc), and Nanopore PCR cDNA (ONT Pc) sequencing including characteristics of raw data and identification of transcripts. In addition, matched Illumina data were generated for comparison.

Results

ONT Pc showed overall better raw data quality, whereas PacBio generated longer read lengths. In the transcriptome analysis, PacBio and ONT Pc performed similarly in transcript identification, simple sequence repeat analysis, and long non-coding RNA prediction. PacBio was superior in identifying alternative splicing events, whereas ONT Pc could estimate transcript expression levels.

Conclusions

This paper made a comprehensive comparison of PacBio and nanopore-based RNA sequencing of the Arabidopsis transcriptome, the results indicate that ONT Pc is more cost-effective for generating extremely long reads and can characterise the transcriptome as well as quantify transcript expression. Therefore, ONT Pc is a new cost-effective and worthwhile method for full-length single-molecule transcriptome analysis in plants.
Sudden cardiac arrest during Nuss procedure for pectus excavatum
Authors: Kim Do Yeon , Jeong Jin Yong
Published: June 2020

Cardiac arrest during the Nuss procedure is the most serious complication and is related to cardiac injury by the surgical instruments and pectus bars. To avoid the cardiac injury, there are several techniques with various devices, including crane and wire suture, lifting hook, the Kent or Langenbeck retractor, and the Vacuum Bell device. However, a case of cardiac arrest without direct cardiac injury during the Nuss procedure has been reported in the pectus excavatum patient with coronary-to-pulmonary arterial shunts. Recently, we encountered a case of cardiac arrest without cardiac abnormalities in preoperative studies and cardiac injury during the Nuss procedure.
Efficacy and mechanisms of a single-session behavioral medicine class among patients with chronic pain taking prescription opioids: study protocol for a randomized controlled trial
Authors: Ziadni Maisa S. , Chen Abby L. , Winslow Tyler , Mackey Sean C. , Darnall Beth D.
Published: June 2020

Background

Independent of pain intensity, pain-specific distress is highly predictive of pain treatment needs, including the need for prescription opioids. Given the inherently distressing nature of chronic pain, there is a need to equip individuals with pain education and self-regulatory skills that are shown to improve adaptation and improve their response to medical treatments. Brief, targeted behavioral medicine interventions may efficiently address the key individual factors, improve self-regulation in the context of pain, and reduce the need for opioid therapy. This highlights the critical need for targeted, cost-effective interventions that efficiently address the key psychological factors that can amplify the need for opioids and increased risk for misuse. In this trial, the primary goal is to test the comparative efficacy of a single-session skills-based pain management class to a health education active control group among patients with chronic pain who are taking opioids.

Methods/design

Our study is a randomized, double-blind clinical trial testing the superiority of our 2-h, single-session skills-based pain management class against a 2-h health education class. We will enroll 136 adult patients with mixed-etiology chronic pain who are taking opioid prescription medication and randomize 1:1 to one of the two treatment arms. We hypothesize superiority for the skills-based pain class for pain control, self-regulation of pain-specific distress, and reduced opioid use measured by daily morphine equivalent. Team researchers masked to treatment assignment will assess outcomes up to 12 months post treatment.

Discussion

This study aims to test the utility of a single-session, 2-h skills-based pain management class to improve self-regulation of pain and reduce opioid use. Findings from our project have the potential to shift current research and clinical paradigms by testing a brief and scalable intervention that could reduce the need for opioids and prevent misuse effectively, efficiently, and economically. Further, elucidation of the mechanisms of opioid use can facilitate refinement of more targeted future treatments.

Trial registration

ClinicalTrials.gov, ID: NCT03950791. Registered on 10 May 2019.
Ropivacaine 75 mg versus placebo in perineal infiltration for analgesic efficacy at mid- and long-term for episiotomy repair in postpartum women – the ROPISIO study: a two-center, randomized, double-blind, placebo-controlled trials
Authors: Cardaillac Claire , Ploteau Stéphane , Le Thuaut Aurélie , Dochez Vincent , Winer Norbert , Ducarme Guillaume
Published: June 2020

Background

Perineal pain due to episiotomy is commonly reported and can be severe enough to disturb the mother–infant dyad during the postpartum period. Its incidence at day 7 postpartum varies from 63% to 74%. Recent studies have investigated the analgesic efficacy of perineal infiltration of ropivacaine after episiotomy but have only focused on the immediate postpartum period (at 24 and 48 h after birth). Large, adequately powered, multicenter, randomized controlled trials are required to evaluate the impact of ropivacaine infiltration on perineal pain and mid- and long-term quality of life before the widespread use of ropivacaine to prevent perineal pain after episiotomy can be recommended.

Methods/design

The ROPISIO study is a two-center, randomized, double-blind, placebo-controlled trial being conducted in La Roche sur Yon and Nantes, France. It will involve 272 women with vaginal singleton delivery and mediolateral episiotomy at term (≥ 37 weeks). Perineal infiltration (ropivacaine 75 mg or placebo) will be administrated just after vaginal birth and before episiotomy repair. The primary outcome will be the analgesic efficacy at day 7 postpartum (midterm), defined by the Numeric Pain Rating Scale (NPRS) strictly superior to 3/10 on the perineal repair area. Secondary outcomes will be the analgesic efficacy (NPRS) and the impact of pain on daily behavior, on the quality of life (36-item Short Form Health Survey), on the occurrence of symptoms of postpartum depression (Edinburgh Postnatal Depression Scale), and on sexual health (Female Sexual Function Index) at 3 and 6 months (long-term) using validated online questionnaires. This study will have 90% power to show approximately 30% relative risk reduction in the incidence of perineal pain at day 7, from 70.0% to 50.0%.

Discussion

Ropivacaine is a promising candidate drug, inexpensive, and easy to administer, and it would be suitable to include in the routine management of deliveries in labor ward. This study will investigate if perineal ropivacaine infiltration just after birth can reduce mid- and long-term postpartum pain and increase quality of life in women with mediolateral episiotomy.

Trial registration

ClinicalTrials.gov, NCT03084549. Registered on 14 April 2017.
Invasion of the thoracic duct by postlaryngectomy stomal recurrence: a case report
Authors: Zhu Weiyu , Yang Xinming , Wei Minghui , Wang Shuang
Published: June 2020

Background

Postlaryngectomy stomal recurrence can infiltrate the adjacent tissues of tracheal stoma. However, to the best of our knowledge, there is no report about postlaryngectomy stomal recurrence invading the thoracic duct with intra-mass accumulation of chylous fluid.

Case presentation

Our patient was a 52-year-old Han man who presented with a cystic-solid mass on the left side of the tracheal stoma after total laryngectomy. A diagnosis of postlaryngectomy stomal recurrence was confirmed by fine-needle aspiration and surgical dissection of the parastomal mass.

Conclusions

In the case of parastomal masses in a total laryngectomized patient, the rare differential diagnosis of postlaryngectomy stomal recurrence invading the thoracic duct with intra-mass accumulation of chylous fluid should be considered a possibility.
Maternal inflammatory markers for chorioamnionitis in preterm prelabour rupture of membranes: a systematic review and meta-analysis of diagnostic test accuracy studies
Authors: Etyang Angela Koech , Omuse Geoffrey , Mukaindo Abraham Mwaniki , Temmerman Marleen
Published: June 2020

Background

There is no consensus on the role of inflammatory markers in identifying chorioamnionitis in preterm prelabour rupture of membranes (PPROM). We set out to evaluate the accuracy of maternal blood C-reactive protein (CRP), procalcitonin and interleukin 6 (IL6) in diagnosis of histological chorioamnionitis and/or funisitis (HCA/Funisitis) in PPROM.

Methods

We searched MEDLINE, EMBASE and The Cochrane Library from inception to January 2020 for studies where maternal blood CRP, procalcitonin or IL6 was assessed against a reference standard of HCA/Funisitis in PPROM. The Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2) tool was used to assess methodological quality. Hierarchical summary receiver operating characteristic (SROC) models were used to construct summary curves. Bivariate models were used to obtain summary estimates for studies with the same cut-off.

Results

We included 23 studies reporting HCA/Funisitis in 902 of 1717 women, median prevalence 50% (inter-quartile range 38–57). Of these studies, 20 were prospective cohort design and 3 were retrospective cohort. Eleven studies reported the index test against a reference standard of HCA and/or funisitis, 10 reported HCA alone and 2 reported funisitis alone. Many studies had high risk of bias scores on the QUADAS-2 assessment but low concerns for applicability. Sensitivity and specificity for CRP ≥ 20 mg/L (5 studies, 252 participants) was 59% (95% CI 48–69) and 83% (95% CI 74–89) respectively. SROC curves are provided for each index test. At selected specificity of 80%, the sensitivities for CRP (all cut-offs, 17 studies, 1404 participants), PCT ( all cut-offs, 6 studies, 231 participants) and IL6 (all cut-offs, 5 studies, 299 participants) were 59%(95% CI 52–68), 56%(95% CI 50–69) and 52% (95% CI 50–86) respectively.

Conclusions

There is insufficient evidence to support use of CRP, procalcitonin or IL6 in maternal blood for diagnosis of HCA/Funisitis in PPROM. This review followed recommended methodology and data analytic methods that made the most of the data regardless of the different cut-offs used. However, the evidence is based on few studies with generally small sample sizes, poor-quality scores and substantial heterogeneity. There is a need for good-quality diagnostic accuracy studies to better assess the role of these biomarkers in PPROM.

Systematic review registration

PROSPERO registration number: CRD42015023899, registered on 8 October 2015.
On some Schwarz type inequalities
Authors: Mateljević Miodrag , Khalfallah Adel
Published: June 2020

First, we establish some Schwarz type inequalities for mappings with bounded Laplacian, then we obtain boundary versions of the Schwarz lemma.
An iterative algorithm for robust simulation of the Sylvester matrix differential equations
Authors: Nouri Kazem , Beik Samaneh Panjeh Ali , Torkzadeh Leila , Baleanu Dumitru
Published: June 2020

This paper proposes a new effective pseudo-spectral approximation to solve the Sylvester and Lyapunov matrix differential equations. The properties of the Chebyshev basis operational matrix of derivative are applied to convert the main equation to the matrix equations. Afterwards, an iterative algorithm is examined for solving the obtained equations. Also, the error analysis of the propounded method is presented, which reveals the spectral rate of convergence. To illustrate the effectiveness of the proposed framework, several numerical examples are given.
Surgical implantation of electronic tags does not induce medium-term effect: insights from growth and stress physiological profile in two marine fish species
Authors: Alfonso Sébastien , Zupa Walter , Manfrin Amedeo , Fiocchi Eleonora , Dioguardi Maria , Dara Mariano , Lembo Giuseppe , Carbonara Pierluigi , Cammarata Matteo
Published: June 2020

Background

Telemetry applied to aquatic organisms has recently developed greatly. Physiological sensors have been increasingly used as tools for fish welfare monitoring. However, for the technology to be used as a reliable welfare indicator, it is important that the tagging procedure does not disrupt fish physiology, behaviour and performance. In this communication, we share our medium-term data on stress physiological profile and growth performance after surgical tag implantation in two important marine fish species for European aquaculture, the sea bream (Sparus aurata) and the European sea bass (Dicentrarchus labrax).

Results

Blood samples after surgical tag implantation (46 days for the sea bream and 95 days for the sea bass) revealed no differences between tagged and untagged fish in cortisol, glucose and lactate levels, suggesting that the tag implantation does not induce prolonged stress in these species. Moreover, the specific growth rates were similar in the tagged and untagged fish of both species.

Conclusion

Surgical tag implantation does not have medium-term consequences for the stress physiology and growth performance of these two marine fish species in a controlled environment. These observations support the use of accelerometer tags as valuable tools for welfare monitoring in aquaculture conditions. This study also shows that tagged fish can be sampled during experiments and considered a representative portion of the population, as they display growth and physiological parameters comparable to those of untagged fish.
Adverse childhood experiences: a retrospective study to understand their associations with lifetime mental health diagnosis, self-harm or suicide attempt, and current low mental wellbeing in a male Welsh prison population
Authors: Ford Kat , Bellis Mark A. , Hughes Karen , Barton Emma R. , Newbury Annemarie
Published: June 2020

Background

Prisoners are at increased risk of poor mental health and self-harming behaviours, with suicide being the leading cause of death in custody. Adverse childhood experiences (ACEs) such as child maltreatment are strong predictors of poor mental health and wellbeing yet despite high levels of ACEs in offender populations, relatively few studies have explored the relationships between ACEs and prisoners’ mental health and wellbeing. We conducted an ACE survey with 468 male adult prisoners in a Welsh prison who were not currently considered to be at risk of self-harm and suicide and explored relationships between ACEs, lifetime mental illness diagnosis, self-harm (lifetime and lifetime in prison) or suicide attempt (lifetime and lifetime in prison), and current low mental wellbeing.

Results

Most participants (84.2%) had suffered at least one ACE and 45.5% had suffered ≥4 ACEs. Prevalence of lifetime mental illness diagnosis, self-harm (lifetime and lifetime in prison) or suicide attempt (lifetime and lifetime in prison), and current low mental wellbeing increased with exposure to ACEs. For example, 2.7% of those with no ACEs reported lifetime self-harm or suicide attempt in prison compared with 31.0% (self-harm in prison) and 18.3% (suicide attempt in prison) of those with ≥4 ACEs. Compared with participants with no ACEs, those with ≥4 ACEs were four times more likely to report lifetime mental illness diagnosis and suicide attempt, and over 10 times more likely to report lifetime self-harm than those with no ACEs. Independent of lifetime mental illness diagnosis, self-harm or suicide attempt, participants with ≥4 ACEs were almost three times more likely to have current low mental wellbeing than those with no ACEs.

Conclusions

Male prisoners that have suffered multiple ACEs are substantially more likely to have lifetime mental illness diagnosis, self-harm or suicide attempt, and to have current low mental wellbeing whilst in prison. Findings suggest that trauma-informed approaches are needed in prisons to support prisoner mental health and wellbeing.
Lysyl oxidase expression is associated with inferior outcome and Extramedullary disease of acute myeloid leukemia
Authors: Kunadt Desiree , Kramer Michael , Dill Claudia , Altmann Heidi , Wagenführ Lisa , Mohr Brigitte , Thiede Christian , Röllig Christoph , Schetelig Johannes , Bornhäuser Martin , Schaich Markus , Stölzel Friedrich
Published: June 2020

Background

Lysyl oxidase (LOX) has been described as necessary for premetastatic niche formation in epithelium-derived malignancies and its expression level therefore correlates with risk of metastatic disease and overall survival. However, its role in acute myeloid leukemia (AML) has not been sufficiently analyzed.

Methods

We investigated LOX plasma expression in 683 AML patients (age 17–60 years) treated within the prospective AML2003 trial (NCT00180102). The optimal cut-off LOX value was determined using a minimal-p-value method dichotomizing patients into a LOX-high group (> 109 ng/mL, n = 272, 40%) and a LOX-low group (≤ 109 ng/mL, n = 411, 60%).

Results

Higher LOX expression was associated with lower peripheral white blood cells, lower serum LDH, and a lower frequency of FLT3-ITD and NPM1 mutations at diagnosis. Higher LOX expression was found significantly more frequently in patients with secondary AML and therapy-related AML, in patients with French-American-British M5 subtypes, and in patients with adverse-risk cytogenetics. Comparing patients in the LOX-high group and the LOX-low group revealed a 3-year overall survival (OS) of 47 and 53% (p = 0.022) and 3-year event-free survival (EFS) of 27 and 35% (p = 0.005), respectively. In the LOX-high group significantly more patients had extramedullary AML compared to the LOX-low group (p = 0.037). Combining extramedullary AML and LOX as interacting factors in a multivariate analysis resulted in an independent impact on survival for the LOX-high-extramedullary interaction for OS (HR = 2.25, p = 0.025) and EFS (HR = 2.48, p = 0.008). Furthermore, in patients with extramedullary disease (n = 59) the LOX level predicted survival. Patients within the LOX-low group had an OS of 43% and EFS of 36% as compared to the LOX-high group with an OS of 13% and EFS of 6% (p = 0.002 and p = 0.008, respectively).

Conclusion

We hypothesize LOX expression to be a new potential biomarker to predict outcome in AML, specifically in AML subgroups such as the prognostic heterogeneous group of AML patients with extramedullary disease.

Trial registration

This retrospective study was performed with patient samples registered within the prospective AML2003 trial (NCT00180102). Patients were enrolled between December 2003 and November 2009.
Learners' approaches, motivation and patterns of problem-solving on lines and angles in geometry using augmented reality
Authors: Sarkar Pratiti , Kadam Kapil , Pillai Jayesh S.
Published: June 2020

There are several concepts in 2D Geometry that require understanding their application in the real practical world. However, in classrooms, such concepts are often taught without the analysis of the learners’ realization and interpretation of the existing concepts around them, in their surroundings. For this purpose, an Augmented Reality (AR) based module for the 7th and 8th grade syllabus has been designed to encourage the active participation of the learners in the classroom while learning the concept of Lines and Angles. It comprises three AR learning activities that enable the participants to recall, visualize, and identify the type of angle and then mark it by drawing on the augmented 3D house. Before conducting the main studies, a pilot study was conducted with 6 students of 8th grade. This helped in validating the data instruments, timing, and execution of the research study. The first study was conducted with 21 students of 8th grade where 12 participants performed the AR learning activities in dyads and 9 participants performed individually. Their perspectives, approaches, and motivation in performing the AR learning activities have been reported. Findings from the study showed that the majority i.e. 90.4% participants preferred to perform the AR learning activities in dyads than individually. Though the usability score was higher for the participants who performed the AR learning activities individually (M = 70.28) as compared to dyads (M = 65.23), there was no significant difference in the motivation scores between the participants of the two groups. In the second study, 28 students of 7th grade were divided into dyads and their behavior patterns of performing the AR learning activities have been reported. Using Lag Sequential Analysis, significant sequences were obtained based on the behaviors belonging to three categories of peer involvement, teacher prompts and AR interactions. It was found that the designed AR learning activities encouraged the participants to discuss the concepts with peers, enhanced their immersive experience as they together moved around and inside the house to find and identify the angles.