bluuebunny/crossref_metadata_2025 huggingface dataset:
Resilience and Vulnerabilities of the North American Food System during the Covid‐19 Pandemic
Authors: Orden David
Published: August 2020

The coronavirus pandemic and consequent economic disruption have tested the resilience of the North American food system. The poorest Americans were put at risk of food deprivation as their incomes fell. Disruptions reverberated through the food supply chain as the pandemic escalated; meatpacking plants became disease hotspots. The Coronavirus Food Assistance Program (CFAP) provided US$ 16 billion of aid to farmers and ranchers based on falling prices. CFAP added to the counter‐cyclical safety‐net programmes legislated in 2018 and ad hoc support authorised for two years by the Trump administration. The CFAP support is reasonable in the context of the pandemic‐related economic collapse, but also raises concern about increased support tied to market conditions and current production, including support linked to unilateral US trade policies that have invoked retaliation by trading partners. As of early June, the hopeful scenario was that the worst challenges to the food system had passed. Grain and livestock inventories were relatively high and spring planting intentions were strong, but supply constraints in North America or internationally remained a risk. The pandemic has underscored the inherent fragility of an integrated world and the high stakes in the debate about globalisation that will inevitably follow.
Influence of pinhão starch and natural extracts on the performance of thermoplastic cassava starch/PBAT extruded blown films as a technological approach for bio‐based packaging material
Authors: Müller Priscila Schultz , Carpiné Danielle , Yamashita Fábio , Waszczynskyj Nina
Published: August 2020

Films were produced using the blown extrusion method from blends made with cassava and pinhão thermoplastic starch, compostable polyester (poly(butylene adipate co‐terephthalate, PBAT) and natural extracts (rosemary and green tea). The effect of the incorporation of the extracts and the type of starch added in the film properties were investigated following the mixture design (23) approach. Regression models and response surface curves were generated to predict the film properties. The effect of the cold storage (6 °C and 17% of humidity relative, for 60 days) on the film properties was also investigated in order to simulate future applications. All the properties were mainly influenced by the extract type. The incorporation of the extracts decreased the lightness parameter and the films produced with green tea extract were more opaque than those made with rosemary. Starch/rosemary blends were more flexible, while the extract type did not have a significant effect on tensile strength (TS). Film elongation (ELO) ranged from 520% to 719% and might be comparable to some synthetic polymers. The water vapor permeability was improved in approximately 14% with addition of the extracts. The storage conditions, on the one hand, increased the TS, elastic modulus, and opacity of films and, on the other hand, decreased the elongation parameter. The thermal stability of films was not modified by adding extracts or varying the starch type. The results demonstrated that pinhão/cassava/PBAT blends and the natural extracts are a good alternative matrix to produce packagings with adequate mechanical and barrier properties.

Practical Application

Extruded films produced from cassava or pinhão starch, poly(butylene adipate co‐terephthalate) (PBAT) and natural extracts show technological potential to be used as active packaging for food products. Pinhão starch is a great alternative substitute to cassava starch and the incorporation of the commercial compostable polymer (PBAT) is necessary in order to confer suitable mechanical properties to extrusion process. The extrusion blown method, a process widely used by plastic industries, allows the scale‐up of bio‐based packagings for industrial scale.
Materialization of novel composite bio‐based active edible film functionalized with essential oils on antimicrobial and antioxidative aspect of chicken nuggets during extended storage
Authors: Bharti Sanjay Kumar , Pathak Vikas , Alam Tanweer , Arya Anita , Singh Vinod Kumar , Verma Arun Kumar , Rajkumar Vincentraju
Published: August 2020

The present study was aimed to develop Manihot esculenta and Carrageenan bio‐based composite active film functionalized with anise, caraway, and nutmeg essential oils (EOs) and to assess the shelf life of chicken nuggets wrapped with the developed film at refrigeration storage. Overall, the Minimum Inhibitory Concentration (MIC) values of the three EOs ranged from 0.4 to 0.8% v/v of which nutmeg EO was found most effective. Incorporation of EOs in the film resulted in significant (P ˂ 0.05) decrease in tensile strength and water activity while elongation at break was significantly (P ˂ 0.05) increased. No significant (P ˃ 0.05) changes in thickness and Water Vapor Transmission Rate (WVTR) were observed. Based on physicomechanical and sensory evaluation, films incorporated with 0.5, 1, and 1% concentration of anise, nutmeg, and caraway EO were selected. Chicken nuggets overwrapped with aforementioned films were stored aerobically at refrigeration temperature (4 ± 1 °C) to evaluate antimicrobial, antioxidant, and sensory characteristics. The result indicated that pH, peroxide, free fatty acid (FFA), and thiobarbituric acide (TBA) value of treatments were significantly (P ˂ 0.05) lower than controls however significantly (P < 0.05) higher DPPH activity was observed in all treatments. The total plate count, psychrophilic count and, yeast and mold count were also significantly (P ˂ 0.01) lower in treatment groups and were within the permissible limits. The treated samples were well acceptable during whole storage period of 15 days. The application of composite, active edible bio‐based film was found proficient in confining product quality attributes throughout storage.

Practical Application

The majority of films used for packaging of meat and meat products are derived from synthetic “plastic” materials. The demerits associated with plastics have eventually led to explore natural alternatives such as edible films. The composite‐active bio‐based films have a huge potential to be molded for specific film properties based on requirements of product‐specific packaging conditions.
Characterization of astragaloside I‐IV based on the separation of HPTLC from Pleurotus ostreatus cultivated with Astragalus
Authors: Li Huizhen , Zhao Yana , Yang Weimin , Zhang Zhijun
Published: August 2020

In this study, total saponins were extracted from Pleurotus ostreatus cultivated with Astragalus as one of organic culture substrates. High Performance Thin Layer Chromatography (HPTLC) assay showed total saponins could be separated effectively, and four kinds of spots were identified as AG I, AG II, AG III, and AG IV, respectively. FTIR spectra based on HPTLC separation assay showed the saponin characteristic groups including ‐OH, C‐H, C=O, and the glycoside linkaged to sapogenin group C‐O‐C, suggesting the four kinds of spots belonged to cycloartane‐type triterpene saponins. The primary mass spectra of precursor ion (HPTLC‐ESI‐MS) assay further proved the main composition of four kinds of spots was AG I‐IV, respectively. Physical properties, including the detection of specific rotation and melting point, revealed the separation of high‐purity saponin monomer by HPTLC. HPTLC‐dual wavelength spectrodensitometric method detection showed that content of astragaloside I‐IV was ranged from 0.2 to 0.5 mg/g, and the total astragalosides contents attained to 1.397 mg/g, indicating P. ostreatus could bioaccumulate astragalosides from Astragalus. These results demonstrated the characterization of astragalosides based on the separation of HPTLC was effective, and supported to consider astragalosides‐enriched P. ostreatus as functional edible fungus for food and medical applications.

Practical Application

Currently, the consumption of enriched foods has become common and continues to increase due to urgent demanding for foods with high nutritional value. Pleurotus ostreatus is a functional edible fungus, which not only can produce secondary metabolites, but can enrich bioactive ingredients. Astragalosides have a wide range of biological activities, especially currently being tested as cardioprotective agent. In this study, P. ostreatus was cultivated through adding Astragalus into culture substrates, which realized massive enrichment of astragalosides. Astragalosides‐enriched P. ostreatus as functional edible fungus could be extensively used in food and medical areas, especially for the prevention of cardiovascular diseases.
Premature onset of Sjögren's syndrome is prone to be complicated with renal tubular acidosis
Authors: Wang Qian , Dai Sheng‐Ming
Published: August 2020

Sjögren's syndrome (SS) is a common systemic autoimmune disease. SS usually occurs among middle‐aged women with a peak incidence age of approximately 50 years old. Kidney involvement is relatively uncommon in SS, which is mostly characterized as interstitial nephritis and may result in renal tubular acidosis (RTA). But premature onset of SS seems to be prone to RTA. Here we reported four cases of premature onset SS who developed into RTA at a relatively young age and three of whom suffered from severe osteomalacia. All of them shared a disease onset under age eighteen. Two of them presented hypokalemic periodic paralysis initially, one presented purpura and one endured xerophthalmia at first place. Three of them complicated with osteomalacia under age thirty. All the 4 cases didn’t receive proper medical care in time due to a prolonged delay of diagnosis. We aim to raise the alarm over misdiagnosis/underdiagnosis of the disorder among young people.
A computational framework for analyzing dynamic auctions: The market impact of information sharing
Authors: Asker John , Fershtman Chaim , Jeon Jihye , Pakes Ariel
Published: August 2020

This article develops a computational framework to analyze dynamic auctions and uses it to investigate the impact of information sharing among bidders. We show that allowing for the dynamics implicit in many auction environments enables the emergence of equilibrium states that can only be reached when firms are responding to dynamic incentives. The impact of information sharing depends on the extent of dynamics and provides support for the claim that information sharing, even of strategically important data, need not be welfare reducing. Our methodological contribution is to show how to adapt the experience‐based equilibrium concept to a dynamic auction environment and to provide an implementable boundary‐consistency condition that mitigates the extent of multiple equilibria.
Non‐denitrifier nitrous oxide reductases dominate marine biomes
Authors: Bertagnolli Anthony D. , Konstantinidis Konstantinos T. , Stewart Frank J.
Published: August 2020

Microbial enzymes often occur as distinct variants that share the same substrate but differ in substrate affinity, sensitivity to environmental conditions, or phylogenetic ancestry. Determining where variants occur in the environment helps identify thresholds that constrain microbial cycling of key chemicals, including the greenhouse gas nitrous oxide (N2O). To understand the enzymatic basis of N2O cycling in the ocean, we mined metagenomes to characterize genes encoding bacterial nitrous oxide reductase (NosZ) catalyzing N2O reduction to N2. We examined data sets from diverse biomes but focused primarily on those from oxygen minimum zones where N2O levels are often elevated. With few exceptions, marine nosZ data sets were dominated by ‘atypical’ clade II gene variants. Atypical nosZ has been associated with low oxygen, enhanced N2O affinity, and organisms lacking enzymes for complete denitrification, i.e., non‐denitrifiers. Atypical nosZ often occurred in metagenome‐assembled genomes (MAGs) with nitrate or nitrite respiration genes, although MAGs with genes for complete denitrification were rare. We identified atypical nosZ in several taxa not previously associated with N2O consumption, in addition to known N2O‐associated groups. The data suggest that marine environments generally select for high N2O‐scavenging ability across diverse taxa and have implications for how N2O concentration may affect N2O removal rates.
Metagenome assembled‐genomes reveal similar functional profiles of CPR/Patescibacteria phyla in soils
Authors: Nascimento Lemos Leandro , Manoharan Lokeshwaran , William Mendes Lucas , Monteiro Venturini Andressa , Satler Pylro Victor , Tsai Siu Mui
Published: August 2020

Soil microbiome is one of the most heterogeneous biological systems. State‐of‐the‐art molecular approaches such as those based on single‐amplified genomes (SAGs) and metagenome assembled‐genomes (MAGs) are now improving our capacity for disentailing soil microbial‐mediated processes. Here, we analysed publicly available datasets of soil microbial genomes and MAG's reconstructed from the Amazon's tropical soil (primary forest and pasture) and active layer of permafrost, aiming to evaluate their genome size. Our results suggest that the Candidate Phyla Radiation (CPR)/Patescibacteria phyla have genomes with an average size fourfold smaller than the mean identified in the RefSoil database, which lacks any representative of this phylum. Also, by analysing the potential metabolism of 888 soil microbial genomes, we show that CPR/Patescibacteria representatives share similar functional profiles, but different from other microbial phyla and are frequently neglected in the soil microbial surveys. Finally, we argue that the use of MAGs may be a better choice over SAGs to expand the soil microbial databases, like RefSoil.
Chronic post‐operative opioid use after open cardiac surgery: A Danish population‐based cohort study
Authors: Bonnesen Kasper , Nikolajsen Lone , Bøggild Henrik , Hostrup Nielsen Per , Jacobsen Carl‐Johan , Viemose Nielsen Dorthe
Published: August 2020

Background

Knowledge of chronic opioid use after cardiac surgery is sparse. We therefore aimed to describe the proportion of new chronic post‐operative opioid use after open cardiac surgery.

Methods

We used prospectively registered data from a national prescription registry and a clinical registry of 29 815 first‐time cardiac surgeries from three Danish university hospitals. Data collection spanned from 2003 to 2016. The main outcome was chronic post‐operative opioid use, defined as at least one opioid dispensing in the fourth post‐operative quarter. Data were assessed for patient‐level predictors of chronic post‐operative opioid use, including pre‐operative opioid use, opioid use at discharge, comorbidities, and procedural related variables.

Results

The overall proportion of post‐operative opioid use was 10.6% (95% CI: 10.2‐10.9). The proportion of new chronic post‐operative opioid use was 5.7% (95% CI: 5.5‐6.0) among pre‐operative opioid naïve patients. The corresponding proportions among patients, who pre‐operatively used low or high dose opioid (1‐500 mg or > 500 mg cumulative morphine equivalent opioid), were 68.3% (95% CI: 66.1‐70.4) and 76.3% (95% CI: 74.0‐78.5) respectively. Risk factors associated with new chronic post‐operative opioid use included: female gender, underweight and obesity, pre‐operative comorbidities, acute surgery, ICU‐time > 1 day, and post‐operative complications. Strongest predictor of chronic post‐operative opioid use was post‐discharge use of opioid within one month after surgery (odds ratio 3.3, 95% CI: 2.8‐4.0).

Conclusion

New chronic post‐operative opioid use after open cardiac surgery is common. Focus on post‐discharge opioid use may help clinicians to reduce rates of new chronic opioid users.
Effect of varenicline directly observed therapy versus varenicline self‐administered therapy on varenicline adherence and smoking cessation in methadone‐maintained smokers: a randomized controlled trial
Authors: Nahvi Shadi , Adams Tangeria R. , Ning Yuming , Zhang Chenshu , Arnsten Julia H.
Published: August 2020

Background and Aims

Level of adherence to tobacco cessation medication regimens is believed to be causally related to medication effectiveness. This study aimed to evaluate the efficacy of varenicline directly observed therapy (DOT) on varenicline adherence and smoking cessation rates among smokers with opioid use disorder (OUD) receiving methadone treatment.

Design

Multicenter, parallel‐group two‐arm randomized controlled trial.

Setting

Urban opioid treatment program (OTP) in the Bronx, New York, USA.

Participants

Daily smokers of ≥ 5 cigarettes/day, interested in quitting (ladder of change score 6–8), in methadone treatment for ≥ 3 months, attending OTP ≥ 3 days/week. Participants’ mean age was 49 years, 56% were male, 44% Latino, 30% Black, and they smoked a median of 10 cigarettes/day.

Interventions

Individual, block, random assignment to 12 weeks of varenicline, either directly observed with methadone (DOT, n = 50) or via unsupervised self‐administered treatment (SAT, n = 50).

Measurements

The primary outcome was adherence measured by pill count. The secondary outcome was 7‐day point prevalence tobacco abstinence verified by expired carbon monoxide (CO) < 8 parts per million.

Findings

Retention at 24 weeks was 92%. Mean adherence was 78.5% [95% confidence interval (CI) = 71.8–85.2%] in the DOT group versus 61.8% in the SAT group (95% CI = 55.0–68.6%); differences were driven by DOT effects in the first 6 weeks. CO‐verified abstinence did not differ between groups during the intervention (P = 0.26), but was higher in the DOT than the SAT group at intervention end (DOT = 18% versus SAT = 10%, difference = 8%, 95% CI = –13, 28); this difference was not significant (P = 0.39) and was not sustained at 24‐week follow‐up.

Conclusions

Among daily smokers attending opioid treatment programs, opioid treatment program‐based varenicline directly observed therapy was associated with early increases in varenicline adherence compared with self‐administered treatment, but findings were inconclusive as to whether directly observed therapy was associated with a difference in tobacco abstinence.
Use of medication reviews among older women with dementia, 2003‐2015: A longitudinal cohort study
Authors: Thapaliya Kailash , Harris Melissa L. , Byles Julie E.
Published: August 2020

Objective

To identify factors associated with incidence of medication reviews (MRs), particularly in women with dementia and in residential aged care (RAC).

Methods

Data from 10 359 women in the 1921‐1926 cohort of the Australian Longitudinal Study on Women's Health were linked to Medicare Benefits Schedule data to identify MRs for each year from 2003 to 2015.

Results

Incidence of MR increased from 2003 to 2013 (age 87‐92 years) when 37.1% of women with dementia had a MR compared to 19.8% of women without dementia. Adjusting for time and other factors, the odds of having a MR were higher for women with dementia (AOR = 1.18, 95% CI: 1.06‐1.32) and women in RAC (AOR = 3.61, 95% CI: 3.28‐3.98).

Conclusions

Although higher in women with dementia and those in RAC, utilisation of MR was modest. System‐level interventions may be required to ensure the use and benefits of MRs.
Is mode of first birth a risk factor for subsequent preterm birth?
Authors: Gugusheff Jessica , Patterson Jillian , Torvaldsen Siranda , Ibiebele Ibinabo , Nippita Tanya
Published: August 2020

Background

Previous preterm birth is a strong predictor of subsequent preterm birth, but less is known about the causes of preterm birth following a full‐term first pregnancy. Recent research has highlighted previous caesarean section as a potential risk factor.

Aim

To examine the relationship between mode of first birth and the risk of subsequent preterm birth in New South Wales (NSW), Australia.

Materials and Methods

A population‐based record‐linkage study of NSW women who had a live singleton first birth at ≥37 weeks gestation, followed by a singleton second birth between 2005 and 2017. Relative risk (RR) and 95% CI of preterm birth in the subsequent pregnancy was calculated using modified Poisson regression, with mode of first birth as the exposure. Spontaneous preterm birth and preterm prelabour caesarean were secondary outcomes.

Results

Women who had either an intrapartum (RR: 1.26, 95% CI 1.19–1.32) or prelabour caesarean (RR: 1.26, 95% CI 1.18–1.35) first birth had a higher risk of subsequent preterm birth (any birth <37 weeks gestation), than those who birthed vaginally. Women who had a previous instrumental birth (RR: 0.85, 95% CI 0.79–0.91) or prelabour caesarean (RR: 0.74, 95% CI 0.67–0.82) had lower risks of subsequent spontaneous preterm birth. However, prior prelabour caesarean also greatly increased risk of subsequent preterm prelabour caesarean (RR: 5.25, 95% CI 4.65–5.93).

Conclusions

The mode of first birth has differing effects on the risk of subsequent spontaneous preterm birth and preterm prelabour caesarean. Awareness of the risk of subsequent preterm birth following caesarean section may help inform clinical decisions around mode of first birth.
The Organizational Voter: Support for New Parties in Young Democracies
Authors: Poertner Mathias
Published: August 2020

How do voters come to support new political parties? This article contends that new types of locally organized, participant‐based societal organizations—such as neighborhood associations, informal sector unions, and indigenous movements—can play a crucial mediating role in securing electoral support for new parties. Drawing on social identity and self‐categorization theory, I argue that endorsements of new parties by such organizations sway the vote preferences of organization members and people in their larger social networks. A discrete choice experiment, presenting voters in Bolivia with campaign posters, demonstrates that organizational endorsements are highly effective in mobilizing voters, especially when voters face a new party. Endorsements can even counteract policy and ethnic differences between candidates and voters. The findings suggest an important, understudied route to partisan support in new democracies and have important implications for research on political accountability.
Are individuals from lower social classes more susceptible to conspiracy theories? An explanation from the compensatory control theory
Authors: Mao Jia‐Yan , Yang Shen‐Long , Guo Yong‐Yu
Published: August 2020

Previous research has indicated that social class is likely to be an important factor that influences individuals’ beliefs in conspiracy theories; however, the underlying psychological mechanisms between these two variables remain unclear. This study directly investigated the relationship between these two variables through questionnaires and experimental manipulation, and introduced the perspective of compensatory control theory to investigate the serial mediating role of perceived control and need for structure in the process of social class influencing individuals’ belief in conspiracy theories. The results showed that social class can significantly negatively predict individuals’ belief in conspiracy theories, and perceived control and need for structure played a serial mediating role between them. To some extent, these results reveal the psychological mechanism that causes the higher likelihood of people from lower social classes to believe in conspiracy theories, and advances the explanation from the compensatory control theory.
Overview of a novel paediatric surgical simulation‐based medical education programme in Myanmar
Authors: Nataraja Ramesh M. , Oo Yin Mar , Ljuhar Damir , Webb Nathalie R. , Pacilli Maurizio , Win Nyo Nyo , Aye Aye
Published: August 2020

Background

Simulation‐based medical education (SBME) is an integral part of undergraduate and postgraduate training in high‐income countries (HICs). Despite potential benefits to low‐ and middle‐income countries (LMICs), it has not been widely applied. Our aim was to use SBME to address some essential paediatric surgery learning needs in a LMIC.

Methods

Eleven SBME courses were designed, implemented and evaluated over a 4‐year period in partnership with local paediatric surgeons and the University of Medicine 1 in Yangon, Myanmar. All courses were simulation‐based and different major SBME modalities were utilized. Evaluation included pre‐ and post‐course questionnaires, other evaluation assessments including Likert scale self‐rated confidence in different domains, as well as, mixed method evaluation and Kirkpatrick's hierarchy of evaluation.

Results

Over 4 years, a multidisciplinary team consisting of surgical consultants, fellows, and educational specialists delivered 11 courses at a tertiary LMIC paediatric surgical centre. Attendance varied between 23 and 50 healthcare professionals, with some participants attending all of the educational activities. SBME modalities were utilized to meet each courses' learning objectives. All educational courses scored highly and showed statistically significant differences in all the self‐rated pre and post‐course confidence Likert scale domains. SBME was accepted and embraced by local participants and faculty, and transition to local delivery of educational content has begun. Level 4 of Kirkpatrick's hierarchy of evaluation was demonstrated.

Conclusion

SBME can be used to meet essential learning objectives of local staff in a LMIC. Through various modalities, it offers a reliable, proven and affordable means of teaching multiple aspects of paediatric surgical clinical practice. By employing innovative simulation‐based solutions, it can be adapted by local faculty to continue meeting ongoing learning needs.
Risk factors and management of primary choledocholithiasis: a systematic review
Authors: Zhang Jie , Ling Xiaofeng
Published: August 2020

Background

Primary choledocholithiasis (PC) is a common disease in biliary surgery. The treatment is always challenging due to its high recurrence. A systemic review is undertaken to determine the risk factors for recurrence and provide with the individualized management strategy.

Methods

Electronic databases PubMed (Medline), Embase and Cochrane Central Register of Controlled Studies were searched for relevant articles on risk factors for PC recurrence. Its therapeutic intervention was also collected and analysed.

Results

A total of 36 articles were eligible for inclusion. The recurrent risk factors include abnormalities of biliary anatomy (peripapillary diverticulum), dynamics (choledochal dilation, sharp angulation and stone number), metabolism (advanced age and hypothyroidism) and bacterial infection (Enterobacter and Helicobacter pylori). These factors eventually induce cholestasis and stone formation. At present, there is no guideline and expertise consensus for PC management. The treatment mainly consists of stone retrieval approaches and internal drainage surgeries. The former are minimally invasive methods: endoscopic sphincterotomy (EST), papillary balloon dilation (EPBD) and laparoscopic common bile duct exploration (LCBDE). The latter include choledochoduodenostomy (CDS) and choledochojejunostomy (CJS) with Roux‐en‐Y reconstruction. By far, the internal drainage surgeries have significantly lower recurrence than stone retrieval approaches.

Conclusion

Abnormal biliary anatomy, dynamics, metabolism and bacterial infection are the risk factors for PC. Both EST/EPBD and LCBDE can be performed as initial treatment. For recurrent PC, CDS is more suitable to the elderly, while Roux‐en‐Y CJS reserves for young patients or those in good conditions.
Local excision versus radical resection in patients with rectal neuroendocrine tumours: a propensity score match analysis
Authors: Zhao Beiqun , Hollandsworth Hannah M. , Lopez Nicole E. , Parry Lisa A. , Abbadessa Benjamin , Cosman Bard C. , Ramamoorthy Sonia L. , Eisenstein Samuel
Published: August 2020

Background

The rectum is a common site for neuroendocrine tumours of the gastrointestinal tract. Diagnosis of these tumours has been increasing in recent years, highlighting the need to better define treatment options for patients with rectal neuroendocrine tumours (rNETs).

Methods

We performed a retrospective analysis using the National Cancer Database (2004–2014) to compare overall survival (OS) between local excision (LE) and radical resection (RR). To minimize bias, we performed three propensity score‐matched comparisons stratified by tumour size: <10 mm, 10–20 mm, >20 mm. We compared OS by Kaplan–Meier analysis. We also examined margin status and postoperative outcomes for each comparison.

Results

A total of 12 996 patients underwent surgical treatment for rNET. There was no significant difference in probability of 10‐year OS between LE and RR for patients with tumours <10 mm (88.6% versus 83.8%, P = 0.631, respectively) and tumours 10‐20 mm (69.5% versus 69.3%, P = 0.226, respectively). In patients with tumours >20 mm, probability of 10‐year OS was significantly longer in the LE group (76.5% versus 37.0%, P < 0.001). For all tumour sizes <10 mm and >20 mm, RR had significantly higher rates of 30‐day readmission and negative margins. In subset analysis, there was no difference in OS for patients with positive margins after LE versus negative margins after RR for all tumour size groups.

Conclusions

Our findings suggest that LE is a reasonable treatment option in patients with rNETs, especially for patients with high perioperative risk. Limitations to this study include its retrospective nature and inability to analyse surgeon decision‐making.
Laparoscopic total mesorectal excision combined with en‐bloc seminal vesicle and prostate resection for rectal cancer after chemoradiotherapy
Authors: Zhang Xubing , Deng Xiangbing , Li Jin , Ding Yanling , Liu Sheng , Wang Ziqiang
Published: August 2020

Background

This study aimed to explore the surgical outcomes of laparoscopic total mesorectal excision (TME) combined with en‐bloc seminal vesicle resection (SVR) and partial prostate resection (PPR) for locally advanced rectal cancer (LARC) after chemoradiotherapy (CRT).

Methods

Patients receiving TME combined with en‐bloc SVR and PPR for LARC after CRT from 2014 to 2019 were enrolled retrospectively. Patients' characteristics and surgical outcomes were collected and analysed.

Results

A total of six male patients were enrolled in this study. Among them, four patients proved to be T4b stage including three Denonvilliers fascia invasion and one seminal vesicle invasion. R0 resection was achieved in all patients. With a median follow‐up time of 24 months, no local recurrence was observed.

Conclusion

It is safe and feasible to perform laparoscopic TME combined with en‐bloc SVR and PPR in selected LARC patients after neoadjuvant CRT. It can provide a safe circumferential resection margin and R0 resection. More studies are warranted to improve the diagnostic accuracy for T4b stage after CRT and avoid unnecessary extended resection.
Diagnostic approaches for pancreatic cystic lesions
Authors: Kanani Trisha , Isherwood John , Chung Wen Yuan , Dennison Ashley
Published: August 2020

Background

Cystic lesions of the pancreas (PCLs) may be inflammatory or proliferative and making an accurate and timely pre‐operative diagnosis remains a significant clinical challenge. This is principally due to the heterogeneity of the pathological processes involved. PCLs constitute an entity with diverse histology and although infrequent, the possible potential for malignant transformation of these lesions and the opportunity for curative surgery mandates that our diagnostic approaches are up to date and evidence based. In addition, improved diagnostic accuracy is crucial to prevent unnecessary surgical procedures with the inevitable associated morbidity.

Methods

This narrative review examines the current diagnostic benchmarks and identifies novel diagnostic techniques that warrant further consideration, a number of which are beginning to be included in routine clinical practice when these PCLs are being investigated. A computerized search was made of MEDLINE, EMBASE and PubMed using the search words ‘diagnostic approaches to pancreatic cystic lesions’. All relevant articles in English language or with an English abstract were retrieved and additionally cross referenced.

Conclusion

The increasing accuracy of available imaging techniques together with the wider availability of endoluminal ultrasound and the development of additional novel methods to assess PCLs presents an opportunity to significantly improve the pre‐operative diagnosis rate. This is essential to classify the type of PCL and hence guide the management particularly with lesions where there is a likelihood of progression to more serious pathology. We have highlighted the need for a comprehensive and standardized algorithm for the diagnosis and management of PCLs.
The handicap for enhanced solidarity across advanced economies: The greater the economic openness higher the unequal distribution of income
Authors: Özdemir Onur
Published: August 2020

Perspectives on degree of economic openness have been discussed by different paradigms resulting in concluding remarks which differ widely from each other. However, the existing literature has passed over the importance of the relationship between economic openness and income distribution in relation to the bargaining framework and thus its effect on social solidarity. In this paper, the rationale is based on the argument that an increase in the degree of economic openness has a significant impact on the distribution of income through the channels of trade and financial account. The empirical results show that a more open economic environment leads to an unequal distribution of income, both reducing labor's share and increasing income inequality, through the collapse of bargaining power of labor in favor of capital across advanced economies over the 1996–2014 period. However, the results also suggest that the trade channel is a more effective influence on income distribution than the finance channel. Additionally, other globalization measures, including economic, social and political factors, also have negative effects on income distribution by way of reducing the bargaining power of labor, which results in the collapse of social solidarity and cohesion over time.
Quality and use of unlicensed vitamin D preparations in primary care in England: Retrospective review of national prescription data and laboratory analysis
Authors: Wan Mandy , Patel Anish , Patel Jignesh P. , Rait Greta , Jones Stuart A. , Shroff Rukshana
Published: August 2020

Aim

To evaluate the type (licensed vs unlicensed) and cost of preparations used to fulfil vitamin D prescriptions in England over time, and to compare measured vitamin D content of selected vitamin D preparations against labelled claim.

Methods

Retrospective analysis of vitamin D prescription data in primary care in England (2008‐2018). Laboratory analysis of 13 selected vitamin D preparations.

Results

Alongside a rise in the number of oral licensed colecalciferol preparations from 0 to 27 between 2012 and 2018, the proportion of vitamin D prescriptions in which licensed vitamin D preparations were supplied increased from 11.8 to 54.2%. However, the use of unlicensed food supplements (dose strength 400‐50 000 IU) remained high, accounting for 39.7% of vitamin D prescriptions in 2018. The two licensed preparations showed mean (±SD) vitamin D content of 90.9 ± 0.7% and 90.5 ± 3.9% of the labelled claimed amount, meeting the British Pharmacopeia specification for licensed medicines (90‐125% of labelled claim). The 11 food supplements showed vitamin D content ranging from 41.2 ± 10.6% to 165.3 ± 17.8% of the labelled claim, with eight of the preparations failing to comply with the food supplement specification (80‐150% of labelled claim).

Conclusions

Despite the increasing availability of quality assured licensed preparations, food supplements continued to be used interchangeably with licensed preparations to fulfil vitamin D prescriptions. Food supplements, manufactured under less stringent quality standards, showed wide variations between measured and declared vitamin D content, which could lead to the risk of under‐ and over‐dosing.
Evaluation of designs for renal drug studies based on the European Medicines Agency and Food and Drug Administration guidelines for drugs that are predominantly secreted
Authors: Pradhan Sudeep , Wright Daniel F.B. , Duffull Stephen B.
Published: August 2020

Aims

Dose adjustment for drugs eliminated by the kidneys generally assume a linear relationship between renal drug clearance (CLR) and glomerular filtration rate (GFR). This assumption may not hold for drugs that undergo extensive tubular secretion where nonlinearity in drug handling is expected. The aim of this study is to determine if renal drug study designs recommended by the European Medicines Agency (EMA) and Food and Drug Administration (FDA) could distinguish linear from nonlinear renal drug handling.

Methods

In this simulation and estimation study, the study designs based on the EMA and FDA guidelines for Phase I renal drug studies were evaluated for their ability to discriminate a linear from a nonlinear relationship between CLR and GFR. The number of subjects for each simulated study ranged from 4 to 960. Power, relative standard error and bias were calculated.

Results

Study designs under the EMA and FDA guidelines required ≥8 and ≥48 subjects, respectively, to achieve ≥80% power to discriminate a linear from nonlinear relationship between CLR and GFR. The relative standard error of estimated parameters were 13–37 and 17–44% for the designs with 24 subjects under the EMA and FDA guidelines, respectively. The bias in parameter estimates under the EMA designs were not evident, however, they were biased (13–21%) under the FDA designs.

Conclusion

The EMA design was found to require fewer subjects (n = 8) compared to the FDA (n = 48) to discriminate linear from nonlinear drug renal handling at ≥80% study power while both the designs perform poorly for the parameter precision.
TERT promoter mutations in primary and secondary WHO grade III meningioma
Authors: Maier Andrea Daniela , Stenman Adam , Svahn Fredrika , Mirian Christian , Bartek Jiri , Juhler Marianne , Zedenius Jan , Broholm Helle , Mathiesen Tiit
Published: August 2020

Purpose: TERT promoter mutation (TERTpMut) has a strong association to recurrence and has been suggested to act as a driver mutation for malignant transformation of WHO grade I and II meningiomas. TERTpMut has been investigated in selected high‐grade meningioma samples. The existence of TERTpMut across recurrent tumors in a population‐based cohort needs to be investigated in order to identify when TERTpMut emerges across recurrent samples and to validate prognostic impact among WHO grade III tumors. Methods: We gathered material from a consecutive single‐center cohort of 40 patients with malignant meningioma (WHO grade III) treated between 2000 and 2018, including specimens from primary and secondary malignant meningiomas with the corresponding earlier benign specimens and later malignant recurrences. In total 107 tumor samples were studied by Sanger sequencing for TERT promoter mutational status. Results: Seven of 40 patients (17.5%) harbored TERTpMut thus validating the incidence of TERTpMut in previous non‐population‐based cohorts. In 6/7 patients, the TERTpMut was present at initial surgery (WHO grade I–III) while in one patient the TERTpMut was found de novo when the meningioma became malignant. The incidences were 2/1.000.000/year for TERTpMut WHO grade III meningioma and 8/1.000.000/year for TERTpwt WHO grade III meningioma in our catchment area. We found a 1.7 times higher recurrence rate (CI 95% 0.65–4.44) and a 2.5 higher mortality rate per 10 person‐years (CI 95% 1.01–6.19) for TERTpMut compared to TERTpwt. Conclusion: TERTpMut can occur independently of malignant progression in meningioma and was most often present from the first tumor sample across recurring tumors. TERTpMut in WHO grade III may represent a marker of an aggressive subset of tumors.
Spectroscopic study of in situ‐formed metallocomplexes of proton pump inhibitors in water
Authors: Abramenko Nikita , Kejík Zdeněk , Kaplánek Robert , Tatar Ameneh , Brogyányi Tereza , Pajková Martina , Sýkora David , Veselá Kateřina , Antonyová Veronika , Dytrych Petr , Ikeda‐Saito Masao , Martásek Pavel , Jakubek Milan
Published: August 2020

Proton pump inhibitors, such as omeprazole, pantoprazole and lansoprazole, are an important group of clinically used drugs. Generally, they are considered safe without direct toxicity. Nevertheless, their long‐term use can be associated with a higher risk of some serious pathological states (e.g. amnesia and oncological and neurodegenerative states). It is well known that dysregulation of the metabolism of transition metals (especially iron ions) plays a significant role in these pathological states and that the above drugs can form complexes with metal ions. However, to the best of our knowledge, this phenomenon has not yet been described in water systems. Therefore, we studied the interaction between these drugs and transition metal ions in the surrounding water environment (water/DMSO, 99:1, v/v) by absorption spectroscopy. In the presence of Fe(III), a strong redshift was observed, and more importantly, the affinities of the drugs (represented as binding constants) were strong enough, especially in the case of omeprazole, so that the formation of a metallocomplex cannot be excluded during the explanation of their side effects.
Factors determining COVID-19 pneumonia severity in a country with routine BCG vaccination
Authors: Aksu K , Naziroğlu T , Özkan P
Published: August 2020

Background

The impact of countries’ bacillus Calmette–Guérin (BCG) vaccination policies on the course of coronavirus disease (COVID-19) outbreak is a curiosity. In this study, the relationship between BCG vaccination status and severity of COVID-19 pneumonia and the factors affecting disease severity were investigated.

Methods

A retrospective cross-sectional study was conducted between March and June 2020 in patients diagnosed with COVID-19 pneumonia, confirmed by severe acute respiratory syndrome coronavirus-2 polymerase chain reaction positivity in a nasopharyngeal sample and pulmonary infiltrates in computed chest tomography, in a state hospital in Istanbul, Turkey. Socio-demographic features, body mass index, smoking status, concomitant diseases, income rates and BCG vaccination status of subjects were analyzed.

Result

The study population comprised 123 adults with COVID-19 pneumonia [mean age = 49·7 years, standard deviation = 13·3 years; 82 (66·7%) male]. While the rate of cases vaccinated with BCG is lower (68·5 versus 88·2%, P = 0·026), mean age (54·0 ± 11·5 years versus 38·3 ± 10·7 years; P < 0·001), diabetes (32·6 versus 5·9%, P = 0·002) and low income (84·3 versus 52·9%, P < 0·001) are higher in patients with severe disease compared to those with mild disease. According to multivariate analysis increasing age [odds ratio (OR) = 1·119; 95% confidence interval (CI) = 1·062–1·178, P < 0·001] and low income (OR = 3·209; 95% CI = 1·008–10·222, P = 0·049) are associated with severe disease in COVID-19 pneumonia.

Conclusion

This study reveals that BCG vaccination is not associated with disease severity in COVID-19 pneumonia. Age and low income are the main determinants of severe COVID-19 pneumonia.
Significance of aldosterone gradient within left adrenal vein in diagnosing unilateral subtype of primary aldosteronism
Authors: Ogata Masatoshi , Umakoshi Hironobu , Fukumoto Tazuru , Matsuda Yayoi , Yokomoto‐Umakoshi Maki , Nagata Hiromi , Wada Norio , Miyazawa Takashi , Sakamoto Ryuichi , Ogawa Yoshihiro ,   the Q‐AND‐A Study Group
Published: August 2020

Context

The success rate of cannulation of the right adrenal vein is limited. The aldosterone gradient within the same adrenal vein branch is specific for aldosterone‐producing adenoma.

Objective

This study was performed to investigate whether the absolute aldosterone gradient within the left adrenal vein (left‐AV absolute aldosterone gradient) indicates unilateral excess aldosterone.

Design and setting

A retrospective cross‐sectional study in a single referral centre.

Patients and methods

In total, 123 consecutive patients with primary aldosteronism who had successful adrenal vein sampling (AVS) data were examined. The left‐AV absolute aldosterone gradient was considered significant when a gradient of >4:1 in the aldosterone‐to‐cortisol ratio between the common trunk vein and central vein was found.

Main outcome measure

The prevalence of the unilateral subtype in patients with a significant left‐AV absolute aldosterone gradient.

Results

The prevalence of the unilateral subtype was higher in patients with than without a significant left‐AV absolute aldosterone gradient (88.2% [15/17] vs 21.7% [23/106], P < .001). Of 60 patients with spontaneous hypokalemia, left unilateral disease on computed tomography, or both, a significant left‐AV absolute aldosterone gradient was present only in patients with the unilateral subtype on AVS (42.9% [15/35]), but not in those with the bilateral subtype (0.0% [0/25]). These data were validated in an external cohort.

Conclusion

The presence of a significant left‐AV absolute aldosterone gradient can be used to diagnose the left unilateral subtype of primary aldosteronism on AVS in patients with spontaneous hypokalemia, left unilateral disease on computed tomography or both.
Systematic review on the management of ileoanal pouch–vaginal fistulas after restorative proctocolectomy in the treatment of ulcerative colitis
Authors: Machin M. , Younan H.‐C. , Slesser A. A. P. , Mohsen Y.
Published: August 2020

Aim

Ileoanal pouch–vaginal fistula (PVF) is a relatively common complication of restorative proctocolectomy with ileal pouch–anal anastomosis. There are several operative approaches in the management of PVF. There is currently no consensus as to which approach is the most effective or which should be attempted first.

Method

A systematic review was undertaken following a publicly available protocol registered with PROSPERO (CRD42019133750) in accordance with PRISMA guidelines. Online searches of databases MEDLINE and Embase, Cochrane Library, ClinicalTrials.gov, EU Clinical Trials and ISRCTN registry were performed.

Results

Twenty‐seven articles met the criteria for inclusion in the study: 13 retrospective cohort studies, two prospective cohort studies, eight case series, three case reports and a case–control study. A narrative synthesis was performed due to heterogeneity between included articles. Our study included 577 PVFs, and the incidence rate was 2.1%–17.1%. Both local and abdominal approaches were used in the management of PVF. The overall success of local and abdominal procedures was 44.9% and 60.2% respectively. ROBINS‐I assessment revealed a critical risk of bias. GRADE assessment indicated a very low certainty in effect size and evidence quality.

Conclusion

Local interventions and abdominal approaches have a high failure rate. The results of this review will aid the counselling of patients with this condition. Furthermore, we provide an algorithm for discussion on the management of PVF based on experience at our local centre. The studies available on the management of PVF are low quality; a large prospective registry and Delphi consensus are required to further this area of research.