bluuebunny/crossref_metadata_2025 huggingface dataset:
Treatment Experiences in Adults Born With Cleft Lip and/or Palate: A Whole of Life Survey in the United Kingdom
Authors: Ardouin Kenny , Drake David , Popat Sandip , Stock Nicola Marie
Published: November 2020

Objectives:

Adults with cleft lip and/or palate (CL/P) may report dissatisfaction with aesthetic and/or functional outcomes and express desire for further treatment. Although medical intervention can improve quality of life, surgical procedures require complex decision-making and can invoke psychological distress. The aim of this study was to gain a better understanding of ongoing treatment-related support needs by examining self-reported treatment experiences of a sample of adults born with CL/P.

Design:

An online, mixed-methods survey was designed by the Cleft Lip and Palate Association in collaboration with the Centre for Appearance Research at the University of the West of England. A total of 207 eligible responses were received. Qualitative data were analyzed using inductive content analysis, while quantitative data were analyzed using descriptive statistics.

Results:

Although participants were satisfied with surgical and dental/orthodontic outcomes overall, many reported ongoing difficulties. Some stated they would seek further treatment while others felt conflicted about risks and benefits. Some had refused treatment, citing treatment fatigue, anxiety, and/or concerns that treatment would be unsuccessful. More than 40% of participants were unaware of their entitlement to cleft-related treatment provided by the National Health Service, and many others had experienced difficulties accessing care.

Conclusions:

Although advances in health care may offer opportunities for adults to improve their quality of life, treatment decisions should be weighed with the support of a clinical psychologist where available. Guidance for young adults considering future treatment is also recommended. Finally, training and resources for local practitioners may improve general awareness of CL/P services and increase access to specialist care for adults with ongoing CL/P-related concerns.
Political Ideology and Issue Importance
Authors: Rice Douglas , Schaffner Brian F. , Barney David J.
Published: November 2020

Past research has shown that issues vary significantly in their salience across citizens, explaining key outcomes in political behavior. Yet it remains unclear how individual-level differences in issue salience affect the measurement of latent constructs in public opinion, namely political ideology. In this paper, we test whether scaling approaches that fail to incorporate individual-level differences in issue salience could understate the predictive power of ideology in public opinion research. To systematically examine this assertion, we employ a series of latent variable models which incorporate both issue importance and issue position. We compare the results of these different and diverse scaling approaches to two survey data sets, investigating the implications of accounting for issue salience in constructing latent measures of ideology. Ultimately, we find that accounting for issue importance adds little information to a more basic approach that uses only issue positions, suggesting ideological signals for measurement models reside most prominently in the issue positions of individuals rather than the importance of those issues to the individual.
Diagnostic and Prognostic Value of TAT, PIC, TM, and t-PAIC in Malignant Tumor Patients With Venous Thrombosis
Authors: Zhou Kun , Zhang Jun , Zheng Zun-Rong , Zhou Yu-Zhen , Zhou Xun , Wang Li-Da , Suo Bing , Jiang Xiao-Feng , Liu Pei-Jia , Wang Dong-Hua
Published: November 2020

Background:

Venous thromboembolism (VTE) is an important complication in patients with malignant tumors. Its exact diagnosis and treatment are still lacking. We used a high-sensitive chemiluminescence method to detect thrombin–antithrombin III complex (TAT), plasmin-α2-plasmininhibitor complex (PIC), thrombomodulin (TM), and tissue plasminogen activator–inhibitor complex(t-PAIC) in combination with D-dimer and fibrin degradation product (FDP) to analyze their diagnostic and prognostic value in patients with malignant tumors.

Methods:

In total, 870 patients with confirmed malignant tumors were included, 82 of whom had diagnosed VTE; 200 healthy individuals were classified as the control group. The TAT, PIC, TM, and t-PAIC were detected using Sysmex HISCL5000 automated analyzers, whereas FDP and D-dimer were detected using Sysmex CS5100 coagulation analyzer. Receiver operating characteristic (ROC) curves were used to evaluate the diagnostic efficiency. Survival probabilities were determined using Kaplan–Meier analysis, and multivariate analyses were performed using a Cox regression model.

Results:

Compared with healthy controls, patients with malignant tumors showed significantly elevated TAT, PIC, TM, t-PAIC, D-dimer, and FDP. Similarly, compared with patients in the non-thrombosis group, those in the thrombosis group showed significantly elevated levels of the above mentioned markers. Logistic regression analysis showed that TAT, PIC, TM, t-PAIC, D-Dimer, and FDP were all associated with VTE. ROC analysis showed that “TAT+PIC+TM+t-PAIC+D-dimer+FDP”showed the highest sensitivity and specificity. Patients with elevated TAT, PIC, TM, and t-PAIC had a significantly shorter survival. Multivariate Cox survival analysis showed that TM and t-PAIC were significantly associated with poor prognosis. In addition, the incidence of VTE was significantly lower in patients with malignant tumors who were treated with low-molecular-weight heparin (LMWH), and their survival period was significantly longer than that of patients with malignant tumors who were not treated with LMWH.

Conclusion:

TAT, PIC, TM, and t-PAIC combined with D-dimer and FDP were better than the application of a single marker in the diagnosis of VTE in patients with malignant tumors. TAT and PIC can be used as sensitive markers in the diagnosis of VTE but not as prognostic markers. TM and t-PAIC might be independent prognostic indicators in patients with malignant tumors, regardless of the state of thrombus.
Hemivariational continuum approach for granular solids with damage-induced anisotropy evolution
Authors: Timofeev Dmitry , Barchiesi Emilio , Misra Anil , Placidi Luca
Published: November 2020

Mechanical behavior of materials with granular microstructures is confounded by unique features of their grain-scale mechano-morphology, such as the tension–compression asymmetry of grain interactions and irregular grain structure. Continuum models, necessary for the macro-scale description of these materials, must link to the grain-scale behavior to describe the consequences of this mechano-morphology. Here, we consider the damage behavior of these materials based upon purely mechanical concepts utilizing energy and variational approach. Granular micromechanics is accounted for through Piola’s ansatz and objective kinematic descriptors obtained for grain-pair relative displacement in granular materials undergoing finite deformations. Karush–Kuhn–Tucker (KKT)-type conditions that provide the evolution equations for grain-pair damage and Euler–Lagrange equations for evolution of grain-pair relative displacement are derived based upon a non-standard (hemivariational) variational approach. The model applicability is illustrated for particular form of grain-pair elastic energy and dissipation functionals through numerical examples. Results show interesting damage-induced anisotropy evolution including the emergence of a type of chiral behavior and formation of finite localization zones.
Subcutaneous administration of triamcinolone as part of the management of feline eosinophilic keratoconjunctivitis
Authors: Lucyshyn Danica R , Good Kathryn L , Knickelbein Kelly E , Chang Maggie W , Strøm Ann R , Hollingsworth Steven R , Thomasy Sara M , Leonard Brian C , Sebbag Lionel , Wiggans K Tomo , Maggs David J
Published: November 2020

Objectives

The aim of this retrospective case-control study was to report the efficacy of subcutaneous triamcinolone as part of a regimen for feline eosinophilic keratoconjunctivitis (FEK).

Methods

Records and clinical photographs were reviewed and lesions semiquantitatively graded for cats with cytologically confirmed FEK. Clinical data were compared between a study population of nine cats (11 eyes) treated with, and a reference population of seven cats (eight eyes) treated without, a median of 0.11 mg/kg (range 0.10–0.20 mg/kg) of triamcinolone acetonide subcutaneously.

Results

Breed, sex, age and prevalence of corneal ulceration at presentation; corneal disease severity before and at the initiation of immunomodulation; and duration of antiviral treatment before immunomodulation did not differ significantly between populations ( P ⩾0.059). Corneal plaques resolved in five cats each from the study and reference populations ( P = 0.366). Median (range) time from immunomodulation to corneal plaque resolution did not significantly differ ( P = 0.246) between the study (median 14 days; range 8–38 days) and reference (median 28 days, range 14–46 days) populations. No adverse reactions were attributed to triamcinolone administration, and all corneal ulcers in the study population re-epithelialized within 14 days (range 8–38 days) following triamcinolone injection. Time to corneal ulcer re-epithelialization following triamcinolone injection varied minimally in those receiving antivirals prior to (8 or 30 days until re-epithelialization), simultaneously with (38 days) or after (14 or 24 days) triamcinolone.

Conclusions and relevance

In otherwise healthy cats with FEK, subcutaneous administration of triamcinolone appears to be well tolerated and as efficacious as conventional topical immunomodulatory therapies. It may be especially useful in ulcerated eyes where topical immunomodulation is contraindicated.
Tuned mass dampers for the drift reduction of structures with soil effects using ant colony optimization
Authors: Soheili Saeed , Zoka Hooman , Abachizadeh Mahdi
Published: November 2020

This paper probes the effects of the Tuned Mass Damper (TMD) device on the response of a 40-story building including three types of soils and experiencing 16 far-field earthquakes. The Ant Colony Optimization (ACO) method is employed to obtain the best settings for TMD values and the objective is reducing the maximum drift of the structure considering soil structure interaction (SSI) effects. The TMD effects on the displacement and acceleration response of the structure as well as its influence on the drift response are studied. Moreover, the frequency analyses of the drift responses in addition to the story locations with the highest drifts are also investigated. It is shown that the optimized design results in considerable reduction in drifts enhancing the profits of utilizing the TMD device.
Do European elections enhance satisfaction with European Union democracy?
Authors: Plescia Carolina , Daoust Jean-François , Blais André
Published: November 2020

We provide the first individual-level test of whether holding supranational elections in the European Union fosters satisfaction with European Union democracy. First, we examine whether participation at the European Parliament election fosters satisfaction with democracy and whether, among those who participated, a winner–loser gap materializes at the EU level. Second, we examine under which conditions participating and winning in the election affect satisfaction with European Union democracy, focusing on the moderating role of exclusive national identity. Our approach relies on panel data collected during the 2019 European Parliament elections in eight countries. We demonstrate that while participating and winning increase satisfaction, such positive boost does not materialize among those with exclusive national identity. These findings hold an important message: elections are no cure to deep-seated alienation.
Psychometric evaluation of the short form of the Arizona Life History Battery (K-SF-42): A revised Chinese version for emerging adults
Authors: Zhang Meng Xuan , Hui Bryant P. H. , Wu Anise M. S.
Published: November 2020

Life history (LH) strategies explain how organisms adapt to the environment and make the best use of their resources to fulfill bodily maintenance, growth, reproduction and other functions. The K-SF-42 is a short version of the 199-item Arizona Life History Battery for assessing seven different domains of LH strategies. This article aims to evaluate the psychometric properties of a Chinese version of the K-SF-42. We recruited 1,016 Chinese university students, who aged 16 to 28 years old ( M age = 19.47, SD = 1.17) to participant in an anonymous questionnaire. Results of the confirmatory factor analysis supported the second-order six-factor model (except romantic partner attachment), and the scale and subscales of such measurement displayed good internal consistencies. With the exception of religiosity, all of the subscales showed significant positive correlations with a brief unidimensional measure of LH strategies (i.e., the Mini-K). The criterion-related validity of the scale was further supported by the association between its higher score (suggesting slower LH strategies) and the lower levels of childhood harshness and unpredictability. This study provided evidence for the satisfactory applicability of the Chinese version of the K-SF-42 to a Chinese population and contributed to the further investigation of the LH strategies’ mechanisms underlying human behavior across cultures.
Is clinical expertise a conflict of interest in research?
Authors: Neill Sara , Martin Lisa , Harris Lisa
Published: November 2020

Purpose:

Doctors who research and provide abortion care have had their work characterized as a conflict of interest. We investigated whether surgeons who perform medical procedures other than abortion also routinely conduct research on that procedure and whether they disclose this as a relevant “conflict of interest.”

Method:

We conducted a two-step literature review of five medical procedures—abortion, rhinoplasty, Mohs micrographic surgery, transurethral resection of the prostate, and laminectomy. We identified articles published between June 2011 and May 2012, and we calculated the proportion of articles authored by clinicians who also perform that procedure as well as the percentage that reported clinical care as a conflict of interest. We then screened conflict of interest statements on publications on said procedures from the same journals between 2012 and 2019 and calculated the proportion of publications that reported clinical work as a conflict of interest.

Results:

We identified 135 publications that met inclusion criteria. We calculated that 100% of publications on rhinoplasty, transurethral resection of the prostate, and Mohs included a clinician who performs that procedure. Seventy-five percent of publications on laminectomy and 78% of publications on abortion included a clinician. None of the reviewed research articles included a disclosure that the authors also performed the procedure. From 2012 to 2019, there were 1,903 published articles on these procedures. None included a conflict of interest that disclosed clinical work as a conflict of interest.

Conclusion:

Although abortion providers publish as clinician-researchers at rates similar to surgeons in other areas of medicine, they alone face accusations that their clinical expertise is a potential conflict of interest. This stigmatizing practice could have wide-ranging consequences including delegitimization of the scientific method and peer review process broadly.
Addressing inactivity after stroke: The Collaborative Rehabilitation in Acute Stroke (CREATE) study
Authors: Jones Fiona , Gombert- Karolina , Honey Stephanie , Cloud Geoffrey , Harris Ruth , Macdonald Alastair , McKevitt Christopher , Robert Glenn , Clarke David
Published: November 2020

Background

Stroke patients are often inactive outside of structured therapy sessions – an enduring international challenge despite large scale organizational changes, national guidelines and performance targets. We examined whether experienced-based co-design (EBCD) – an improvement methodology – could address inactivity in stroke units.

Aims

To evaluate the feasibility and impact of patients, carers, and staff co-designing and implementing improvements to increase supervised and independent therapeutic patient activity in stroke units and to compare use of full and accelerated EBCD cycles.

Methods

Mixed-methods case comparison in four stroke units in England.

Results

Interviews were held with 156 patients, staff, and carers in total; ethnographic observations for 364 hours, behavioral mapping of 68 patients, and self-report surveys from 179 patients, pre- and post-implementation of EBCD improvement cycles. Three priority areas emerged: (1) ‘Space’ (environment); (2) ‘Activity opportunities’ and (3) ‘Communication’. More than 40 improvements were co-designed and implemented to address these priorities across participating units. Post-implementation interview and ethnographic observational data confirmed use of new social spaces and increased activity opportunities. However, staff interactions remained largely task-driven with limited focus on enabling patient activity. Behavioral mapping indicated some increases in social, cognitive, and physical activity post-implementation, but was variable across sites. Survey responses rates were low at 12–38% and inconclusive.

Conclusion

It was feasible to implement EBCD in stroke units. This resulted in multiple improvements in stroke unit environments and increased activity opportunities but minimal change in recorded activity levels. There was no discernible difference in experience or outcome between full and accelerated EBCD; this methodology could be used across hospital stroke units to assist staff and other stakeholders to co-design and implement improvement plans.
Urological issues in cyclists
Authors: Peacock J , Cobley J , Patel B
Published: November 2020

Cycle use has grown rapidly over the last few years in the UK. British Cycling membership has increased threefold since the 2012 Olympic and Paralympic Games, and this is likely to rise in the wake of the Coronavirus pandemic. As urologists, day-to-day encounters with cyclists are commonplace, who may present with acute traumatic injuries or chronic overuse injuries. The aim of this literature review was to evaluate the effect of cycling on conditions presenting to the urology clinic, in particular those of raised prostate-specific antigen (PSA), haematuria and soft-tissue lesions (‘cyclist nodules’). Furthermore, the review aimed to summarize the relationship between cycling and pudendal nerve entrapment (PNE) syndromes. A PubMed search of the literature on cycling and genitourinary disorders was performed. The literature suggests no significant change in PSA levels after a bout of cycling. Age appears to have no effect on the change in PSA experienced following a bout of cycling, in particular when comparing those <50 years of age to those >50 years of age. Haematuria appears to be rare with cycling but has been described, even with stationary bike riding. It is imperative to exclude coexisting urinary-tract pathological conditions, and cycling-induced haematuria should always be considered a diagnosis of exclusion. Perineal nodular induration (‘cyclist nodules’) is a rare condition, related to pressure and repetitive micro-trauma between the perineum and saddle. Pudendal Nerve Entrapment (PNE) represents the most common bicycling-associated urogenital complaint. Numbness in the perineum, penis, scrotum or buttocks—‘genital numbness’—is the most common and most recognized symptom of pudendal compression. Despite several studies demonstrating a link between elite cyclists and erectile dysfunction, for the average cyclist riding may actually have a protective effect on sexual function.
Benzodiazepine Withdrawal Catatonia, Delirium, and Seizures in a Patient With Schizoaffective Disorder
Authors: Mader Edward C. , Rathore Sunil H. , England John D. , Branch Lionel A. , Copeland Brian J.
Published: November 2020

Benzodiazepine withdrawal symptoms vary from mild anxiety to life-threatening delirium or seizures. In susceptible individuals, such as those with mood disorders, benzodiazepine withdrawal may also precipitate catatonia. A 26-year-old man with schizoaffective disorder (depressed type with catatonia) ran out of lorazepam and presented with catatonia, delirium, and seizures. He was taking olanzapine, venlafaxine, and trazodone for schizoaffective disorder. Lorazepam 2 mg twice daily kept him free of catatonia for 6 months. Besides catatonia and delirium, lorazepam withdrawal also triggered convulsive seizures and nonconvulsive status epilepticus. He was admitted to the intensive care unit where he underwent continuous video-EEG monitoring. Catatonia resolved with lorazepam on day 2. Seizures stopped with levetiracetam, lacosamide, and propofol on day 4. His mental status was normal when he was discharged on day 6. If not immediately recognized and treated, catatonia and delirium can lead to significant morbidity or mortality. Unfortunately, physicians tend to overlook catatonia and delirium, especially if both syndromes are present. At first, we suspected that our patient had ictal catatonia, but video-EEG showed no clear-cut correlation between catatonia, seizures, and epileptiform activity. As with prior observations, the patient’s catatonia was more sensitive to benzodiazepine withdrawal and treatment than his seizures. The efficacy of benzodiazepines in aborting catatonia, seizures, and mixed delirium-catatonia syndromes suggests a key pathogenetic role of abnormal GABA neurotransmission in these brain disorders.
Factors Associated with the Death of Preterm Babies Admitted to Neonatal Intensive Care Units in Ethiopia: A Prospective, Cross-sectional, and Observational Study
Authors: Mekasha Amha , Tazu Zelalem , Muhe Lulu , Abayneh Mahlet , Gebreyesus Goitom , Girma Abayneh , Berhane Melkamu , McClure Elizabeth M. , Goldenberg Robert L. , Nigussie Assaye K.
Published: November 2020

Aim. To determine the risk factors for death among preterm neonates. Methods and materials. The data set used was derived from a prospective, multi-center, observational clinical study conducted in 5 tertiary hospitals in Ethiopia from July, 2016 to May, 2018. Subjects were infants admitted into neonatal intensive care unit. Results. Risk factors were determined using statistical model developed for this study. The mean gestational age was 32.87 (SD ± 2.42) weeks with a range of 20 to 36 weeks. There were 2667 (70.69%) survivors and 1106 (29.31%) deaths. The significant risk factors for preterm death were low gestational age, low birth weight, being female, feeding problem, no antenatal care visits and vaginal delivery among mothers with higher educational level. Conclusions. The study identified several risk factors for death among preterm neonates. Most of the risk factors are preventable. Thus, it is important to address neonatal and maternal factors identified in this study through appropriate ANC and optimum infant medical care and feeding practices to decrease the high rate of preterm death.
Estimation of fastener pull-through resistance of composite laminates based on generalized regression neural network
Authors: Mingjian Sheng , Puhui Chen , Cheng Chen
Published: November 2020

The fastener pull-through resistance is a key performance index of composite laminates used for engineering application, and increasing research attention is being paid to developing methods for its calculation or estimation. The currently available research methods mainly focus on the standard test and the finite element analysis for determining the pull-through resistance of composite laminates suffering transverse load by the fasteners. Based on the results of the fastener pull-through resistance experiment performed on X850 composite laminates, a model for estimating the maximum affordable load of composite laminates for the fastener pull-through resistance is proposed, using generalized regression neural network technology. The inputs of this model are simplified to six parameters: the proportion of the ±45° layer of the laminates, the number of the layers, the thickness of the laminates, the bolt head shape, whether the bolt has a washer or not, and the nominal diameter of the bolt; the Gauss function is used as the hidden layer function. The model uses a large portion of the experimental data to train for finding the optimal smoothness factor, which is used to reconstruct the model, and simulation is performed with the remainder of the experimental data. The comparison between the estimated results using the model and the experimental results shows that the generalization ability of the proposed model can meet the estimation requirements. Moreover, the pull-through resistance of composite laminates under transverse load from a fastener can be estimated with high accuracy after some standard fastener pull-through resistance tests of the composite laminates.
The nuclear receptor 4A family members: mediators in human disease and autophagy
Authors: Chen Liqun , Fan Fengtian , Wu Lingjuan , Zhao Yiyi
Published: November 2020

The Nuclear receptor 4A (NR4A) subfamily, which belongs to the nuclear receptor (NR) superfamily, has three members: NR4A1 (Nur77), NR4A2 (Nurr1) and NR4A3 (Nor1). They are gene regulators with broad involvement in various signaling pathways and human disease responses, including autophagy. Here, we provide a concise overview of the current understanding of the role of the NR4A subfamily members in human diseases and review the research into their regulation of cell autophagy. A deeper understanding of these mechanisms has potential to improve drug development processes and disease therapy.
Fragmentation and propulsive effect of shock wave lithotripsy in treatment of small renal calculi
Authors: Abid Ammar Fadil , Hussein Nasser Sabah
Published: November 2020

Background

Small renal calculi are frequently observed in clinical practice, and chemo-lytic therapy has limited effects. The purpose of the study is to evaluate the effectiveness of extracorporeal shock wave lithotripsy (ESWL) in the treatment of small renal calculi.

Methods

We studied 60 patients with small renal stones from March 2017 to March 2019. After excluding eight patients with incomplete data, the remaining 52 patients were evaluated. Patients with symptomatic single or multiple stones of 6–8 mm in diameter or asymptomatic on ultrasound and kidney-ureter-bladder radiograph were eligible for inclusion. Small stones were treated by ESWL. The data were analyzed using the Statistical Packages for Social Sciences - version 25 (IBM Corporation).

Results

The mean age of the 52 patients was 34.5 ± 9.5 years. Forty-one (78.8%) patients were symptomatic, while 11 (21.2%) were asymptomatic. Forty-seven (90.4%) had single small renal stones, while four patients had two stones (7.7%) and only one patient had three stones (1.9%). Forty-five stones were successfully treated by ESWL, while 13 stones failed to respond.

Conclusion

ESWL is a useful tool for treating small renal calculi; it works either by fragmenting the stones or by acting as a pushing force. However, further large prospective studies are needed to corroborate the above conclusions.
Role of microsurgical varicocelectomy in the management of non-obstructive azoospermia with varicocele: our tertiary care centre experience
Authors: Thakur Avinash P. S. , Sadasivan Darsan , Sharma Vivek , Ramasamy Vasantharaja , Parol Subeesh , Singh Sangeeta , Soni Jatin
Published: November 2020

Background

Varicocele is an abnormal dilation and tortuosity of the internal spermatic veins within the pampiniform plexus of the spermatic cord. Varicocele is associated with progressive testicular damage and infertility. Azoospermia is associated with a varicocele in approximately 4–14% cases. For men with azoospermia or severe oligoasthenospermia, varicocele repair may result in modest improvement in semen quality which may have a significant advantage on couple’s fertility options. The aim of the study was to evaluate the role of microsurgical varicocelectomy in the men of non-obstructive azoospermia (NOA) with clinical varicocele.

Methods

This was a retrospective study conducted between August 2012 and January 2017, a backward review of 104 patients with the diagnosis of infertility and NOA with palpable varicocele that underwent microsurgical varicocelectomy at our institution was performed. In addition, microdissection testicular sperm extraction (MDTESE) results of these post-varicoceletomy patients were compared with the patients of NOA without varicocele.

Results

A total of 104 patients underwent varicocelectomy; out of these, 19 patients (18.26%) had sperm on sperm analysis post-operatively. Two of them had spontaneous pregnancy (10.5%), and 3 had children by intracytoplasmic sperm injection (15.78%). Out of the 85 patients who had MDTESE, 29 patients (34.11%) had sperms in their testis. The fertilization rate was 89.65%. Sperm retrieval rate (SRR) in NOA men with varicocele was 34.11% which was higher from those who had NOA without varicocele (24.03%). Live birth rate was 31.03% in NOA men who had varicocelectomy which was more in comparison to NOA men without varicocele (24%).

Conclusions

In NOA men with varicocele microsurgical varicocelectomy may have favourable effects which results in recovery of motile sperms in the post-operative ejaculate and also on spontaneous or assisted pregnancies, but it appears that this effect was more remarkable on MDTESE results when following successful intracytoplasmic sperm injection. Importantly, Sperm retrieval rate, pregnancy rate and subsequent live birth rate were higher in these patients in comparison to patients affected by NOA alone. In patients with NOA and coexisting varicocele, varicocelectomy can be considered to be essential to the overall reproductive outcome in these patients.
Multiple waves of freshwater colonization of the three-spined stickleback in the Japanese Archipelago
Authors: Kakioka Ryo , Mori Seiichi , Kokita Tomoyuki , Hosoki Takuya K. , Nagano Atsushi J. , Ishikawa Asano , Kume Manabu , Toyoda Atsushi , Kitano Jun
Published: November 2020

Background

The three-spined stickleback (Gasterosteus aculeatus) is a remarkable system to study the genetic mechanisms underlying parallel evolution during the transition from marine to freshwater habitats. Although the majority of previous studies on the parallel evolution of sticklebacks have mainly focused on postglacial freshwater populations in the Pacific Northwest of North America and northern Europe, we recently use Japanese stickleback populations for investigating shared and unique features of adaptation and speciation between geographically distant populations. However, we currently lack a comprehensive phylogeny of the Japanese three-spined sticklebacks, despite the fact that a good phylogeny is essential for any evolutionary and ecological studies. Here, we conducted a phylogenomic analysis of the three-spined stickleback in the Japanese Archipelago.

Results

We found that freshwater colonization occurred in multiple waves, each of which may reflect different interglacial isolations. Some of the oldest freshwater populations from the central regions of the mainland of Japan (hariyo populations) were estimated to colonize freshwater approximately 170,000 years ago. The next wave of colonization likely occurred approximately 100,000 years ago. The inferred origins of several human-introduced populations showed that introduction occurred mainly from nearby habitats. We also found a new habitat of the three-spined stickleback sympatric with the Japan Sea stickleback (Gasterosteus nipponicus).

Conclusions

These Japanese stickleback systems differ from those in the Pacific Northwest of North America and northern Europe in terms of divergence time and history. Stickleback populations in the Japanese Archipelago offer valuable opportunities to study diverse evolutionary processes in historical and contemporary timescales.
Usefulness of sialic acid for diagnosis of sepsis in critically ill patients: a retrospective study
Authors: Yao Bo , Liu Wen-juan , Liu Di , Xing Jin-yan , Zhang Li-juan
Published: November 2020

Background

Early diagnosis of sepsis is very important. It is necessary to find effective and adequate biomarkers in order to diagnose sepsis. In this study, we compared the value of sialic acid and procalcitonin for diagnosing sepsis.

Methods

Newly admitted intensive care unit patients were enrolled from January 2019 to June 2019. We retrospectively collected patient data, including presence of sepsis or not, procalcitonin level and sialic acid level. Receiver operating characteristic curves for the ability of sialic acid, procalcitonin and combination of sialic acid and procalcitonin to diagnose sepsis were carried out.

Results

A total of 644 patients were admitted to our department from January 2019 to June 2019. The incomplete data were found in 147 patients. Finally, 497 patients data were analyzed. The sensitivity, specificity and area under the curve for the diagnosis of sepsis with sialic acid, procalcitonin and combination of sialic acid and procalcitonin were 64.2, 78.3%, 0.763; 67.9, 84.0%, 0.816 and 75.2, 84.6%, 0.854. Moreover, sialic acid had good values for diagnosing septic patients with viral infection, with 87.5% sensitivity, 82.2% specificity, and 0.882 the area under the curve.

Conclusions

Compared to procalcitonin, sialic acid had a lower diagnostic efficacy for diagnosing sepsis in critically ill patients. However, the combination of sialic acid and procalcitonin had a higher diagnostic efficacy for sepsis. Moreover, sialic acid had good value for diagnosing virus-induced sepsis.
Resolution of post-anaesthesia aortic regurgitation by repair of a ruptured sinus of Valsalva aneurysm: 5 case reports
Authors: Xue Qian , Yang Chun , Han Xiu
Published: November 2020

Background

Ruptured sinus of Valsalva aneurysm (SVA) is a rare cardiovascular disease in which some patients exhibit aortic valve insufficiency. SVA repair and valve replacement are usually required for treatment. Here, we report 5 cases of ruptured SVA with severe post-anaesthesia aortic regurgitation (AR). To the best of our knowledge, this is the first report of ruptured SVA with severe post-anaesthesia AR.

Case presentation:

From 2018 to 2020, there were 5 cases of ruptured SVA with severe AR after anaesthesia in our hospital. The main symptoms were palpitation and shortness of breath. Transthoracic echocardiography (TTE) with colour-flow Doppler showed ruptured aortic sinus aneurysms without AR. Post-anaesthesia echocardiography showed severe AR. Direct patch closure of the ruptured aneurysm resolved the left-to-right shunt and AR, and the aortic valve was not replaced.

Conclusions

Post-anaesthesia AR without obvious structural defects may occur in patients with ruptured SVAs. Valve replacement may not be necessary.
Cross-sectoral inter-rater reliability of the clinical frailty scale – a Danish translation and validation study
Authors: Nissen Søren Kabell , Fournaise Anders , Lauridsen Jørgen T. , Ryg Jesper , Nickel Christian H. , Gudex Claire , Brabrand Mikkel , Andersen-Ranberg Karen
Published: November 2020

Background

Focus on frailty status has become increasingly important when determining care plans within and across health care sectors. A standardized frailty measure applicable for both primary and secondary health care sectors is needed to provide a common reference point. The aim of this study was to translate the Clinical Frailty Scale (CFS) into Danish (CFS-DK) and test inter-rater reliability for key health care professionals in the primary and secondary sectors using the CFS-DK.

Methods

The Clinical Frailty Scale was translated into Danish using the ISPOR principles for translation and cultural adaptation that included forward and back translation, review by the original developer, and cognitive debriefing. For the validation exercise, 40 participants were asked to rate 15 clinical case vignettes using the CFS-DK. The raters were distributed across several health care professions: primary care physicians (n = 10), community nurses (n = 10), hospital doctors from internal medicine (n = 10) and intensive care (n = 10). Inter-rater reliability was assessed using intraclass correlation coefficients (ICC), and sensitivity analysis was performed using multilevel random effects linear regression.

Results

The Clinical Frailty Scale was translated and culturally adapted into Danish and is presented in this paper in its final form. Inter-rater reliability in the four professional groups ranged from ICC 0.81 to 0.90. Sensitivity analysis showed no significant impact of professional group or length of clinical experience. The health care professionals considered the CFS-DK to be relevant for their own area of work and for cross-sectoral collaboration.

Conclusion

The Clinical Frailty Scale was translated and culturally adapted into Danish. The inter-rater reliability was high in all four groups of health care professionals involved in cross-sectoral collaborations. However, the use of case vignettes may reduce the generalizability of the reliability findings to real-life settings. The CFS has the potential to serve as a common reference tool when treating and rehabilitating older patients.
Significance of urinary fatty acid-binding protein 4 level as a possible biomarker for the identification of minimal change disease in patents with nephrotic-range proteinuria
Authors: Tanaka Marenao , Furuhashi Masato , Moniwa Norihito , Maeda Takuto , Takizawa Hideki , Matsumoto Megumi , Sakai Akiko , Higashiura Yukimura , Gocho Yufu , Koyama Masayuki , Ogawa Yayoi , Miura Tetsuji
Published: November 2020

Background

Fatty acid-binding protein 4 (FABP4), but not FABP1 (liver-type FABP), is ectopically induced in injured glomerular endothelial cells, and urinary FABP4 (U-FABP4) level is associated with proteinuria and renal dysfunction in a general population.

Methods

The clinical significance of U-FABP4 was investigated in 81 patients (male/female: 43/38, age: 57 ± 17 years) who underwent kidney biopsy.

Results

U-FABP4 was negatively correlated with estimated glomerular filtration rate (eGFR) (r = − 0.56, P < 0.01) and was positively correlated with age, blood pressure, triglycerides, proteinuria (r = 0.58, P < 0.01), plasma FABP4 and urinary FABP1 (U-FABP1) (r = 0.52, P < 0.01). Multivariable regression analysis showed that eGFR, proteinuria and U-FABP1 were independent predictors of U-FABP4. The level of U-FABP4, but not that of proteinuria, eGFR or U-FABP1, in minimal change nephrotic syndrome (MCNS) was significantly lower than the level in membranous nephropathy (MN) and that in diabetic nephropathy. Receiver operating characteristic curve analysis indicated that U-FABP4 level ≤ 0.78 μg/gCr predicted MCNS in patients who had nephrotic-range proteinuria with a high level of accuracy. When divided by the median value of U-FABP4 at baseline in 33 of the 81 patients who could be followed up, the yearly change (post–pre) in eGFR in the low U-FABP4 group was significantly greater than that in the high U-FABP4 group (median: 11.0 vs. -5.0 mL/min/1.73m2/year).

Conclusions

U-FABP4 level is independently associated with proteinuria and renal dysfunction in patients with glomerular kidney disease. A low U-FABP4 level may predict MCNS in patients with nephrotic syndrome and would be a useful biomarker for differential diagnosis of MCNS and MN, which are common causes of nephrotic syndrome.
Cervical myelopathy due to neurovascular compression syndrome caused by persistent first intersegmental artery: a case report
Authors: Endo Takuro , Sugawara Taku , Higashiyama Naoki
Published: November 2020

Background

Persistent first intersegmental artery (PFIA) is a rare anatomical variation of vertebral arteries and is an asymptomatic finding in most cases. Here we report a rare case of cervical myelopathy caused by spinal cord compression by the PFIA.

Case presentation

The patient was a 52-year-old man who complained of numbness and burning sensation around the neck and left shoulder area, partial weakness in the left deltoid muscle, right side thermal hypoalgesia, and disturbance of deep sensation since the past 1 year, and the symptoms had gradually worsened. Magnetic resonance imaging (MRI) and computed tomography (CT) showed spinal cord compression by the left PFIA at the C1/C2 level. Because conservative treatment was ineffective, microvascular decompression (MVD) of the PFIA was performed. The left PFIA was laterally transposed using polytetrafluoroethylene (PTFE) bands and anchored to the dura mater using three PTFE bands. To achieve adequate transposition, the small blood vessels bridging the spinal cord and PFIA and the dorsal root nerve had to be sacrificed. Postoperative T2-weighted MRI showed a small hyperintense region in the lateral funiculus of the spinal cord, but no new neurological deficits were identified. In the early postoperative stage, the patient’s deep sensory impairment and motor dysfunction were improved. His numbness and burning sensation almost disappeared, but slight thermal hypoalgesia remained in the lower limb.

Conclusion

MVD is an effective treatment for spinal cord compression caused by the PFIA, but further studies are necessary to help address technical difficulties and avoid complications.
Vitrectomy combined with intravitreal antifungal therapy for posttraumatic fungal endophthalmitis in eastern China
Authors: Zhuang Hong , Ding Xinyi , Zhang Ting , Chang Qing , Xu Gezhi
Published: November 2020

Background

To evaluate the effect and prognostic factors of vitrectomy combined with intravitreal antifungal therapy for posttraumatic fungal endophthalmitis in Eastern China.

Methods

We retrospectively reviewed the medical records of patients who developed fungal endophthalmitis after penetrating ocular trauma at an ophthalmic center in Eastern China. All patients underwent vitrectomy and intravitreal injection of antifungal drugs.

Results

Thirty-five patients (35 eyes) were included. Twelve eyes suffered plant trauma, 17 eyes metal trauma, and 6 eyes other trauma. The culture results for all 35 eyes showed filamentous fungi, including Aspergillus in 26 eyes (74.3%). Twenty-three eyes underwent vitrectomy once and 12 eyes were treated twice. Four eyes were iridectomized because of a fungal lesion behind the iris. Fungal endophthalmitis was effectively controlled in 33 eyes (94.3%), whereas 2 eyes were ultimately enucleated. Visual acuity was significantly better after treatment than before treatment (P = 0.0006). According to the preoperative vision, the affected eyes were divided into two groups: group 1A (light perception) and group 1B (better than light perception). The final visual acuity in group 1B was significantly better than that in group 1A (P = 0.0289).

Conclusions

Vitrectomy combined with intravitreal antifungal therapy is an effective treatment for posttraumatic fungal endophthalmitis. Preoperative visual acuity is a significant factor affecting the prognosis of visual acuity.
Using geo-spatial analysis for assessing the risk of hospital admissions due to community-acquired pneumonia in under-5 children and its association with socially vulnerable areas (Brazil)
Authors: Pina Juliana Coelho , Alves Luana Seles , Arroyo Luiz Henrique , Arcêncio Ricardo Alexandre , Gondim Ellen Cristina , Furtado Maria Cândida de Carvalho , de Mello Débora Falleiros
Published: November 2020

Background

The concentration of under-5 child morbidity and mortality due to pneumonia in developing countries reflects the social inequities. This study aimed to map and assess the spatial risk for hospitalization due to Community-Acquired Pneumonia in children under 5 years of age and its association with vulnerable areas.

Methods

Ecological study in the city of Ribeirão Preto, state of São Paulo, Brazil. The study population consisted of hospitalized under-5 children, diagnosed with community-acquired pneumonia, in Ribeirão Preto-São Paulo-Brazil, from 2012 to 2013. Data were collected in different databases, by a trained team, between March 2012 and August 2013 and from the 2010 Demographic Census of the Brazilian Institute of Geography and Statistics. The 956 urban census tracts were considered as the units of analysis. The incidence of cases per 10,000 inhabitants was calculated by census tracts during the study period. For the identification of the spatial risk clusters, the Kernel density estimator and the Getis-Ord Gi* technique were performed. Generalized additive models were used to verify the association between areas with social vulnerability and the occurrence of childhood pneumonia.

Results

The study included 265 children under the age of five, hospitalized due to community-acquired pneumonia. A concentration of cases was identified in the regions with greater social vulnerability (low income, poor housing conditions and homelessness), as well as a lower occurrence of cases in the most developed and economically privileged area of the city. The majority of the children lived in territories served by traditional primary healthcare units, in which the health surveillance and family and community focus are limited. It is important to highlight that the tracts with the highest degrees of vulnerability, such as those identified as high vulnerability (urban) and very high vulnerability (subnormal urban clusters).

Conclusions

The results contribute to the comprehension of the social factors involved in child hospitalization due to pneumonia, based on the analysis of the spatial distribution. This approach revealed a strategic tool for diagnosing the disparities as well presenting evidences for the planning in health and strength health care system in achieving equity, welfare and social protection of children.
Sharing whilst caring: solidarity and public trust in a data-driven healthcare system
Authors: Horn Ruth , Kerasidou Angeliki
Published: November 2020

Background

In the UK, the solidaristic character of the NHS makes it one of the most trusted public institutions. In recent years, the introduction of data-driven technologies in healthcare has opened up the space for collaborations with private digital companies seeking access to patient data. However, these collaborations appear to challenge the public’s trust in the.

Main text

In this paper we explore how the opening of the healthcare sector to private digital companies challenges the existing social contract and the NHS’s solidaristic character, and impacts on public trust. We start by critically discussing different examples of partnerships between the NHS and private companies that collect and use data. We then analyse the relationship between trust and solidarity, and investigate how this relationship changes in the context of digital companies entering the healthcare system. Finally, we show ways for the NHS to maintain public trust by putting in place a solidarity grounded partnership model with companies seeking to access patient data. Such a model would need to serve collective interests through, for example, securing preferential access to goods and services, providing health benefits, and monitoring data access.

Conclusion

A solidarity grounded partnership model will help establish a social contract or licence that responds to the public’s expectations and to principles of a

solidaristic healthcare system.