bluuebunny/crossref_metadata_2025 huggingface dataset:
Clinical application of drug sensitive gene detection in postoperative instillation for non-muscle invasive bladder cancer
Authors: Wang Zhenlong , Tang Hui , Xue Yuquan , Xue Li , Li Hongliang , Chong Tie
Published: October 2020

Background

Bladder cancer is the most common malignant tumor of the urinary system. One of the biological characteristics of NMIBC is the high recurrence rate after surgery. The implementation of this project aimed to investigate the role of pharmacogenomic testing-guided intravesical perfusion of chemotherapeutic agents in the postoperative perfusion therapy for non-muscle invasive bladder cancer.

Method

From January 2015 to December 2016, 298 patients with non-muscle-invasive bladder cancer were enrolled in this prospective study. These patients received chemotherapy drugs after electrotherapy. According to the presence or absence of tumor susceptibility gene detection after surgery, they were divided into two groups, including the drug sensitive group(N = 44) and the control group(N = 254). The drug sensitive group received bladder infusion therapy with sensitive chemotherapy drugs based on drug sensitivity gene detection results. The control group received intravesical instillation of pirarubicin. The preoperative general data and tumor grade of patients were recorded. Cystoscopy was performed before and every 3 months after surgery. The chest CT, upper abdomen CT, renal function, and urinary routine tests were performed. Tumor recurrence, metastasis and tumor-related death were recorded and evaluated during follow-up.

Results

The drug sensitive group, which selected high-sensitivity drugs for intravesical instillation therapy based on gene expression, has a significantly lower relapse rate (11.36% vs 37.40%, P < 0.05) and a significantly longer time to relapse (17.80 ± 7.20 month vs11.20 ± 6.10 month, P < 0.05) compared with the control group. There were no significant differences in the time of mortality and death time between two groups.

Conclusion

The pharmacogenomic testing-directed bladder instillation of chemotherapeutic drugs may be more effective than empiric drug administration in reducing the recurrence rate of non-muscle-invasive bladder cancer.
Association between surgical technique, adhesions and morbidity in women with repeat caesarean section: a retrospective study in a rural hospital in Western Tanzania
Authors: Mooij R. , Mwampagatwa I. H. , van Dillen J. , Stekelenburg J.
Published: October 2020

Background

The worldwide incidence of birth by Caesarean Section (CS) is rising. Many births after a previous CS are by repeat surgery, either by an elective CS or after a failed trial of labour. Adhesion formation is associated with increased maternal morbidity in patients with repeat CSs. In spite of large-scale studies the relation between the incidence of adhesion formation and CS surgical technique is unclear. This study aims to assess maternal and neonatal morbidity and mortality after repeat CSs in a rural hospital in a low-income country (LIC) and to analyse the effect of surgical technique on the formation of adhesions.

Methods

A cross-sectional, retrospective medical records study of all women undergoing CS in Ndala Hospital in 2011 and 2012.

Results

Of the 3966 births, 450 were by CS (11.3%), of which 321 were 1st CS, 80 2nd CS, 36 3rd CS, 12 4th and one 5th CS (71, 18, 8, 3 and 0.2% respectively). Adhesions were considered to be severe in 56% of second CSs and 64% of third CSs. In 2nd CSs, adhesions were not associated with closure of the peritoneum at 1st CS, but were associated with the prior use of a midline skin incision. There was no increase in maternal morbidity when severe adhesions were present. Adverse neonatal outcome was more prevalent when severe adhesions were present, but this was statistically non-significant (16% vs 6%).

Conclusions

Our results give insight into the practice of repeat CS in our rural hospital. Adhesions after CSs are common and occur more frequently after midline skin incision at 1st CS compared to a transverse incision. Reviewing local data is important to evaluate quality of care and to compare local outcomes to the literature.
Potential predictors for prognosis and postpartum recovery time of acute fatty liver of pregnancy
Authors: Chen Jun , Huang Ze-Bing , Fan Xue-Gong , Hu Xing-Wang , Qi Min , Liao Cheng-Jin , Long Li-Yuan , Huang Yan
Published: October 2020

Background

Acute fatty liver of pregnancy (AFLP) is a potentially lethal condition of pregnant women with a high mortality rate. Potential predictors related to postpartum recovery time and prognostic factors of AFLP are still unclear. This study aimed to evaluate potential predictors for prognosis and postpartum recovery time of AFLP.

Methods

We retrospectively analyzed the clinical data of 76 AFLP patients in our hospital from 2002 to 2017 and investigated potential predictors using univariate analysis and multivariate logistic regression analysis.

Results

Hepatic encephalopathy (HE) was found to be associated with prognosis in AFLP patients (P = 0.005, OR = 26.844). The postpartum recovery time analysis showed that AFLP patients with a age < 25 had the shortest recovery time, but no significant difference (P = 0.134, OR = 5.952). The postpartum recovery time of patients with liver failure (LF) was significantly prolonged compared to those without LF (P = 0.036, OR = 10.052). Cryoprecipitate, and plasma infusion showed no significant effect on prognosis or recovery time. Artificial liver support therapy (ALST) had no effect on prognosis, but it might affect postpartum recovery time with no statistical significance (P = 0.128, OR = 5.470).

Conclusion

HE is a potential predictor for prognosis of AFLP. LF is a potential predictor for postpartum recovery time.
High physical activity and high sedentary behavior increased the risk of gestational diabetes mellitus among women with excessive gestational weight gain: a prospective study
Authors: Yong Heng Yaw , Mohd Shariff Zalilah , Mohd Yusof Barakatun Nisak , Rejali Zulida , Bindels Jacques , Tee Yvonne Yee Siang , van der Beek Eline M.
Published: October 2020

Background

Although physical activity (PA) in pregnancy benefits most women, not much is known about pregnancy-related changes in PA and its association with gestational diabetes mellitus (GDM) risk. The aim of this study was to identify the trajectory of PA during pregnancy and possible associations with the risk of GDM.

Methods

This was a prospective cohort study of 452 pregnant women recruited from 3 health clinics in a southern state of Peninsular Malaysia. PA levels at the first, second, and third trimester were assessed using the Pregnancy Physical Activity Questionnaire. GDM was diagnosed at 24–28 weeks of gestation following the Ministry of Health Malaysia criteria. Group-based trajectory modeling was used to identify PA trajectories. Three multivariate logistic models were used to estimate the odds of trajectory group membership and GDM.

Results

Two distinct PA trajectories were identified: low PA levels in all intensity of PA and sedentary behavior (Group 1: 61.1%, n = 276) and high PA levels in all intensity of PA as well as sedentary behavior (Group 2: 38.9%, n = 176). Moderate and high intensity PA decreased over the course of pregnancy in both groups. Women in group 2 had significantly higher risk of GDM in two of the estimated logistic models. In all models, significant associations between PA trajectories and GDM were only observed among women with excessive gestational weight gain in the second trimester.

Conclusions

Women with high sedentary behavior were significantly at higher risk of GDM despite high PA levels by intensity and this association was significant only among women with excessive GWG in the second trimester. Participation in high sedentary behavior may outweigh the benefit of engaging in high PA to mitigate the risk of GDM.
Ex-Utero Intrapartum Treatment (EXIT): indications and outcome in fetal cervical and oropharyngeal masses
Authors: García-Díaz Lutgardo , Chimenea Angel , de Agustín Juan Carlos , Pavón Antonio , Antiñolo Guillermo
Published: October 2020

Background

The “Ex-Utero Intrapartum Treatment” (EXIT) procedure allows to ensure fetal airway before completion of delivery and umbilical cord clamping while keeping uteroplacental circulation. Airway obstruction in fetal oropharyngeal and cervical masses can be life-threatening at birth. In those situations, controlled access to fetal airway performed by a trained multidisciplinary team allows safe airway management, while feto-maternal circulation is preserved. We aim to review the indications and outcome of the EXIT procedure in a case series of fetal cervical and oropharyngeal masses.

Methods

We have carried out a retrospective review of all patients with fetal cervical and oropharyngeal masses who underwent an EXIT procedure between 2008 and 2019. Variables evaluated included indication for EXIT, ultrasound and MRI findings, the need of amnioreduction, gestational age at EXIT, birth weight, complications, operative time, survival rate, pathological findings, and postnatal evolution. Five patients are included in this series. One additional case has already been published.

Results

The diagnosis were cervical teratoma (n = 1), epulis (n = 1) and lymphangioma (n = 3). Polyhydramnios was present in 2 patients, requiring amnioreduction in one of them. Mean gestational age at EXIT was 36–37 weeks (range, 34–38 weeks). Median EXIT time in placental support was 9 min (range, 3–22 min). Access to airway was successfully established in EXIT in all cases. All children born by EXIT are currently healthy and without complications.

Conclusion

The localization and characteristics of the mass, its relationship to the airway, and the presence of polyhydramnios seem to be major factors determining indications for EXIT and clinical outcome.
Modelling the lifetime cost-effectiveness of radical prostatectomy, radiotherapy and active monitoring for men with clinically localised prostate cancer from median 10-year outcomes in the ProtecT randomised trial
Authors: Sanghera S. , Mohiuddin S. , Coast J. , Garfield K. , Noble S. , Metcalfe C. , Lane J. A. , Turner E. L. , Neal D. , Hamdy F. C. , Martin R. M. , Donovan J. L. ,   for the ProtecT study group, Bollina Prasad , Doble Andrew , Doherty Alan , Gillatt David , Gnanapragasam Vincent , Hughes Owen , Kockelbergh Roger , Kynaston Howard , Paul Alan , Paez Edgar , Rowe Edward
Published: October 2020

Background

Optimal management strategies for clinically localised prostate cancer are debated. Using median 10-year data from the largest randomised controlled trial to date (ProtecT), the lifetime cost-effectiveness of three major treatments (radical radiotherapy, radical prostatectomy and active monitoring) was explored according to age and risk subgroups.

Methods

A decision-analytic (Markov) model was developed and informed by clinical input. The economic evaluation adopted a UK NHS perspective and the outcome was cost per Quality-Adjusted Life Year (QALY) gained (reported in UK£), estimated using EQ-5D-3L.

Results

Costs and QALYs extrapolated over the lifetime were mostly similar between the three randomised strategies and their subgroups, but with some important differences. Across all analyses, active monitoring was associated with higher costs, probably associated with higher rates of metastatic disease and changes to radical treatments.

When comparing the value of the strategies (QALY gains and costs) in monetary terms, for both low-risk prostate cancer subgroups, radiotherapy generated the greatest net monetary benefit (£293,446 [95% CI £282,811 to £299,451] by D’Amico and £292,736 [95% CI £284,074 to £297,719] by Grade group 1). However, the sensitivity analysis highlighted uncertainty in the finding when stratified by Grade group, as radiotherapy had 53% probability of cost-effectiveness and prostatectomy had 43%. In intermediate/high risk groups, using D’Amico and Grade group > = 2, prostatectomy generated the greatest net monetary benefit (£275,977 [95% CI £258,630 to £285,474] by D’Amico and £271,933 [95% CI £237,864 to £287,784] by Grade group). This finding was supported by the sensitivity analysis.

Prostatectomy had the greatest net benefit (£290,487 [95% CI £280,781 to £296,281]) for men younger than 65 and radical radiotherapy (£201,311 [95% CI £195,161 to £205,049]) for men older than 65, but sensitivity analysis showed considerable uncertainty in both findings.

Conclusion

Over the lifetime, extrapolating from the ProtecT trial, radical radiotherapy and prostatectomy appeared to be cost-effective for low risk prostate cancer, and radical prostatectomy for intermediate/high risk prostate cancer, but there was uncertainty in some estimates. Longer ProtecT trial follow-up is required to reduce uncertainty in the model.

Trial registration

Current Controlled Trials number, ISRCTN20141297: http://isrctn.org (14/10/2002); ClinicalTrials.gov number, NCT02044172: http://www.clinicaltrials.gov (23/01/2014).
Short-term changes in the anterior segment and retina after small incision lenticule extraction
Authors: Chen Yanwei , Liao Huaping , Sun Yue , Shen Xi
Published: October 2020

Background

To analyse short-term changes in the anterior segment and retina after small incision lenticule extraction (SMILE).

Methods

Patients with myopia scheduled for SMILE were recruited from Ruijin Hospital, Shanghai, China. Basic patient information such as age, sex, and refractive errors was recorded. Ocular measurements were taken before surgery, and 1 day and 1 week after surgery; they included axial length (AL), central corneal thickness (CCT), anterior chamber depth (ACD), lens thickness (LT), white to white (WTW), pupil diameter (PD), macular thickness (MT), ganglion cell layer thickness (GCL), retinal nerve fiber layer thickness (RNFL), choroidal thickness (CT), macular vessel density, and optic disc vessel density.

Results

Sixty-one eyes of 31 patients were selected for this study. AL, CCT, ACD, and postoperative PD were significantly reduced (p < 0.05), while LT was thickened after surgery (p < 0.05). MT at the fovea decreased 1 day and 1 week after surgery (p < 0.05). GCL showed no significant changes after surgery. RNFL was unchanged 1 day after surgery, but the inferior sector was thickened 1 week after surgery. CT was thicker at the fovea 1 day after surgery and 1.0 mm from the fovea in the nasal sector 1 week after surgery. Macular vessel density was significantly decreased 1 day after surgery and most recovered in 1 week. Optic disc vessel density decreased at the peripapillary part 1 day after surgery and recovered after 1 week. ΔACD and ΔLT showed no significant correlation 1 day after surgery. ΔACD was negatively correlated with ΔLT and sphere 1 week after surgery (r = − 0.847, p < 0.000; r = − 0.398, p = 0.002). ΔLT was positively correlated with the sphere 1 week after surgery (r = 0.256, p = 0.048).

Conclusion

The anterior segment was the most affected, while the retina also underwent changes with regard to MT, RNFL, CT, macular vessel density, and peripapillary vessel density.
A case of tractional retinal detachment associated with congenital retinal vascular hypoplasia in the superotemporal quadrant treated by vitreous surgery
Authors: Miyamoto Tomomi , Kobayashi Takatoshi , Kida Teruyo , Sato Takaki , Fukumoto Masanori , Ikeda Tsunehiko
Published: October 2020

Background

Here we report a case of traction retinal detachment (TRD) associated with congenital retinal vascular hypoplasia localized in the superotemporal quadrant that was treated with vitrectomy.

Case presentations

A 58 year-old female presented with a gradual decrease of visual acuity (VA) and distorted vision in her left eye. She had a past history of amblyopia in her left eye from early childhood, and a previous examination performed at a nearby hospital revealed that the corrected visual acuity (VA) in that eye was 0.15. Upon initial examination, no abnormal findings were observed in her right eye, yet optic-disc traction and macular rotation with a folded TRD extending superotemporally from the macular region was observed in her left eye. Fluorescein fundus angiography showed a retinal nonperfused area localized in the superotemporal quadrant surrounded by a retinal avascular area. The optic disc in her left eye was smaller than that in her right eye. Vitrectomy was performed to remove the proliferative membrane and created an artificial posterior vitreous detachment (PVD). Following surgery, the patient’s corrected VA improved from 0.04 to 0.1.

Conclusions

The present case was likely to be TRD caused by PVD in the presence of localized congenital retinal vascular hypoplasia secondary to optic-disc hypoplasia.
A scoping review of physical activity and screen time guidelines for use in Outside School Hours Care
Authors: Virgara Rosa , Lewis Lucy , Phillips Anna , Richardson Mandy , Maher Carol
Published: October 2020

Background

Globally, millions of children attend Outside School Hours Care. Children’s activity in this setting is critical to meeting daily physical activity recommendations. Guidelines are evidence-based statements intended to optimise practice. This study aimed to identify guidelines used in Outside School Hours Care for physical activity and screen time and summarise their content and methods of development.

Methods

Outside School Hours Care guidelines for children aged 5 to 12 years were identified by systematically searching Medline, Emcare, Embase, Scopus, ERIC, Sportsdiscus, TROVE, ProQuest, UpToDate, NICE, SIGN and Google in accordance with PRISMA-ScR guidelines. The search was conducted in March 2019 and results screened independently by two authors. Data were synthesized narratively.

Results

Nine guideline documents were identified from grey literature only (n = 8 USA, n = 1 Canada). The included guidelines focused predominantly on the after school care period (n = 9 vs n = 2 for the before school period). All had recommendations for physical activity, whilst 7 included screen time recommendations. There was considerable variability across the physical activity and screen time recommendations, though taken together, they recommended 30–60 min of moderate- to- vigorous physical activity and less than 60 min of recreational screen time per session. All guidelines were developed by expert/stakeholder panels, but none followed rigorous guideline development methods.

Conclusions

Limited published guidelines for physical activity and screen time in Outside School Hours Care exist. There is a variation in duration and intensity of physical activity recommended, whilst screen time recommendations are more consistent. Guidelines designed with rigorous tools and for other world regions are warranted.
Effects of guided counseling during pregnancy on birth weight of newborns in West Gojjam Zone, Ethiopia: a cluster-randomized controlled trial
Authors: Demilew Yeshalem Mulugeta , Alene Getu Degu , Belachew Tefera
Published: October 2020

Background

The high proportion of birth weight in Ethiopia is hypothesized to be due to inadequate maternal diet which is associated with poor nutrition education during pregnancy. There was no study that evaluated the effect of nutrition education on birth weight in the study area. This study aimed to assess the effects (overall, direct and indirect effects) of guided counseling on the birth weight of neonates.

Methods

A two-arm parallel cluster randomized controlled community trial was conducted from May 1, 2018, to April 30, 2019, in West Gojjam Zone, Northwest Ethiopia. At the baseline, 346 pregnant women in the 11 intervention clusters and 348 pregnant women in the 11 control clusters were recruited. However, birth weight was measured from 258 and 272 newborns in the intervention and control groups, respectively.

In the intervention group, counseling was given monthly for four consecutive months in the participant’s homes. Besides, leaflets with key counseling messages were distributed to each woman in the intervention arm. Pregnant women who attended routine nutrition education given by the health system were recruited as control. Dietary practice, nutritional status, and birth weight were the primary, secondary and tertiary outcomes of this intervention. Data were collected using a structured data collection tool. Birth weight was measured within 48 h after birth. Independent sample t-test, linear mixed-effects model, and path analysis were fitted to assess effects of the intervention.

Results

The intra-cluster correlation coefficient was 0.095. The average birth weight of newborns in the intervention group was 0.257 kg higher compared with their counterparts in the control arm (β = 0.257, P < 0.001). The direct effect of this intervention on birth weight was 0.17 (β = 0.17, P<0.001 ) whereas the indirect effect of this intervention was 0.08 (β = 0.08, P<0.001 ).

Conclusion

Counseling using the health belief model and the theory of planned behavior has a positive effect on improving birth weight. The findings suggest the need for enhancing nutrition education of pregnant women through the application of theories to improve birth weight.

Trial registration

Clinical Trials.gov NCT03627156, “Retrospectively registered Jun, 13, 2018”.
An exploratory study investigating the effect of foot type and foot orthoses on gluteus medius muscle activity
Authors: Sadler Sean , Spink Martin , de Jonge Xanne Janse , Chuter Vivienne
Published: October 2020

Background

Abnormal gluteus medius muscle activity is associated with a number of musculoskeletal conditions. Research investigating the effect of foot type and foot orthoses on gluteus medius muscle activity is both conflicting and limited. The primary aim was to investigate the relationship between foot type and gluteus medius muscle activity during shod walking. The secondary aims of this study were to explore the effect and amount of usage of a pair of unmodified prefabricated foot orthoses on gluteus medius muscle activity during shod walking.

Methods

Foot type was determined using the foot posture index and gluteus medius muscle activity was measured with surface electromyography in 50 healthy adults during shod walking. Participants were then fitted with prefabricated foot orthoses and required to return after 4 weeks. Pearson’s correlation and one-way ANOVA were used to determine effect of foot type. Paired t-tests and ANCOVA were used to determine effect of foot orthoses.

Results

Participants with a cavus foot type demonstrated significantly more gluteus medius mean (p = 0.04) and peak amplitude (p = 0.01), and a greater range in amplitude (p = 0.01) compared to participants with a neutral foot type. Compared to a planus foot type, participants with a cavus foot type demonstrated significantly larger mean (p = 0.02) and peak amplitude (p = 0.01), and a greater range in amplitude (p = 0.01). Prefabricated foot orthoses did not change the gluteus medius muscle activity.

Conclusion

When assessing healthy adults with a cavus foot type, clinicians and researchers should be aware that these participants may display higher levels of gluteus medius muscle activity during gait compared to neutral and planus type feet. Additionally, clinicians and researchers should be aware that the type of prefabricated foot orthoses used did not change gluteus medius muscle activity over 4 weeks. Future research should aim to explore this relationship between foot type and gluteus medius muscle activity in larger sample sizes, consider the potential role of other lower extremity muscles and biomechanical variables, and investigate if these findings also occur in people with pathology.
Two-component surface replacement implants compared with perichondrium transplantation for restoration of Metacarpophalangeal and proximal Interphalangeal joints: a retrospective cohort study with a mean follow-up time of 6 respectively 26 years
Authors: Muder Daniel , Hailer Nils P. , Vedung Torbjörn
Published: October 2020

Background

The aim of our study was to compare the long-term outcome after perichondrium transplantation and two-component surface replacement (SR) implants to the metacarpophalangeal (MCP) and the proximal interphalangeal (PIP) joints.

Methods

We evaluated 163 joints in 124 patients, divided into 138 SR implants in 102 patients and 25 perichondrium transplantations in 22 patients. Our primary outcome was any revision surgery of the index joint.

Results

The median follow-up time was 6 years (0–21) for the SR implants and 26 years (1–37) for the perichondrium transplants. Median age at index surgery was 64 years (24–82) for SR implants and 45 years (18–61) for perichondium transplants. MCP joint survival was slightly better in the perichondrium group (86.7%; 95% confidence interval [CI]: 69.4–100.0) than in the SR implant group (75%; CI 53.8–96.1), but not statistically significantly so (p = 0.4). PIP joint survival was also slightly better in the perichondrium group (80%; CI 55–100) than in the SR implant group (74.7%; CI 66.6–82.7), but below the threshold of statistical significance (p = 0.8).

Conclusion

In conclusion, resurfacing of finger joints using transplanted perichondrium is a technique worth considering since the method has low revision rates in the medium term and compares favorable to SR implants.

Level of evidence

III (Therapeutic).
Comparison of robot-assisted retroperitoneal laparoscopic adrenalectomy versus retroperitoneal laparoscopic adrenalectomy for large pheochromocytoma: a single-centre retrospective study
Authors: Fu Sheng-Qiang , Zhuang Chang-Shui , Yang Xiao-Rong , Xie Wen-Jie , Gong Bin-Bin , Liu Yi-Fu , Liu Ji , Sun Ting , Ma Ming
Published: October 2020

Background

To evaluate the feasibility and safety of robot-assisted retroperitoneal laparoscopic adrenalectomy (RARLA) for large pheochromocytomas (PHEOs; size≥6 cm) compared with retroperitoneal laparoscopic adrenalectomy (RLA).

Methods

Fifty-one patients who underwent adrenalectomy for large PHEOs between March 2016 and January 2019 were enrolled and divided into two groups, including 32 RLA cases and 19 RARLA cases. We compared the perioperative efficacy and long-term follow-up results between the two groups.

Results

Preoperative data, including demographics, comorbidities and tumour characteristics, were similar between the groups. Intraoperatively, the RARLA group had a lower incidence of haemodynamic instability (26.3% vs. 56.2%, P = 0.038) and less intraoperative blood loss (100 ml vs. Two hundred milliliter, P = 0.042) than the RLA group. The groups showed no significant differences in operative time or transfusion rates. Postoperatively, the time to diet resumption, time to ambulation, time to drainage removal and postoperative hospital stay were shorter in the RARLA group than in the RLA group (1 d vs. 2 d, P = 0.027; 1 d vs. 2 d, P = 0.034; 3 d vs. 5 d, P = 0.002; 5 d vs. 6 d, P = 0.02, respectively). The groups exhibited no significant differences in the duration of anaesthetic use, complications, or long-term follow-up results for the blood pressure (BP) improvement rate.

Conclusions

Compared with RLA, RARLA is a safe, feasible and even optimized procedure for large PHEOs.
Robotic adrenalectomy in the pediatric population: initial experience case series from a tertiary center
Authors: Mitra Anirban P. , Vasquez Evalynn , Kokorowski Paul , Chang Andy Y.
Published: October 2020

Background

Laparoscopic resection is the most well described minimally-invasive approach for adrenalectomy. While it allows for improved cosmesis, faster recovery and decreased length of hospital stay compared with the open approach, instrument articulation limitations can hamper surgical dexterity in pediatric patients. Use of robotic assistance can greatly enhance operative field visualization and instrument control, and is in the early stages of adoption in academic centers for pediatric populations.

Case presentation

We present a single-institution series of pediatric adrenalectomy cases. The da Vinci Xi surgical system was used to perform adrenalectomies on three consecutive patients (ages, 2–13 years) at our center. Final pathology revealed ganglioneuroblastoma (n = 2) and pheochromocytoma (n = 1). Median operating time was 244 min (range, 244–265 min); median blood loss was estimated at 100 ml (range, 15–175 ml). Specimens were delivered intact and all margins were negative. Median post-operative hospital stay was 2 days (range, 1–6 days). All patients remain disease-free at median follow-up of 19 months (range, 12–30 months).

Conclusion

Our experience continues to evolve, and suggests that robotic surgery is safe, feasible and oncologically effective for resection of adrenal masses in well-selected pediatric patients.
Dynamics of forage and land cover changes in Teltele district of Borana rangelands, southern Ethiopia: using geospatial and field survey data
Authors: Fenetahun Yeneayehu , Yong-dong Wang , You Yuan , Xinwen Xu
Published: October 2020

Background

The gradual conversion of rangelands into other land use types is one of the main challenges affecting the sustainable management of rangelands in Teltele. This study aimed to examine the changes, drivers, trends in land use and land cover (LULC), to determine the link between the Normalized Difference Vegetation Index (NDVI) and forage biomass and the associated impacts of forage biomass production dynamics on the Teltele rangelands in Southern Ethiopia. A Combination of remote sensing data, field interviews, discussion and observations data were used to examine the dynamics of LULC between 1992 and 2019 and forage biomass production.

Results

The result indicate that there is a marked increase in farm land (35.3%), bare land (13.8%) and shrub land (4.8%), while the reduction found in grass land (54.5%), wet land (69.3%) and forest land (10.5%). The larger change in land observed in both grassland and wetland part was observed during the period from 1995–2000 and 2015–2019, this is due to climate change impact (El-Niño) happened in Teltele rangeland during the year 1999 and 2016 respectively. The quantity of forage in different land use/cover types, grass land had the highest average amount of forage biomass of 2092.3 kg/ha, followed by wetland with 1231 kg/ha, forest land with 1191.3 kg/ha, shrub land with 180 kg/ha, agricultural land with 139.5 kg/ha and bare land with 58.1 kg/ha.

Conclusions

The significant linkage observed between NDVI and LULC change types (when a high NDVI value, the LULC changes also shows positive value or an increasing trend). In addition, NDVI value directly related to the greenness status of vegetation occurred on each LULC change types and its value directly linkage forage biomass production pattern with grassland land use types. 64.8% (grass land), 43.3% (agricultural land), 75.1% (forest land), 50.6% (shrub land), 80.5% (bare land) and 75.5% (wet land) more or higher dry biomass production in the wet season compared to the dry season.
Reference letters for subspecialty medicine residency positions: are they valuable for decision-making? Results from a Canadian study
Authors: Chopra Deepti , Joneja Mala , Sandhu Gurjit , Smith Christopher A. , Spagnuolo Catherine M. , Hookey Lawrence
Published: October 2020

Background

The letter of recommendation is currently an integral part of applicant selection for residency programs. Internal medicine residents will spend much time and expense completing sub-specialty away electives to obtain a letter of recommendation. The purpose of this study was 1) to examine a large sample of reference letters in order to define essential components of a high-quality letter, and 2) to elucidate the relationship between quality of reference letter and the letter writer.

Methods

We conducted a two-phase study. In phase one, a large sample of letters of recommendation was examined using an audit tool as a coding framework. A 5-point composite endpoint of high-quality letter components was subsequently developed. In phase two, program director letters were compared to non-program director home institution and non-home institution elective letters based on inclusion of components of the 5-point composite endpoint using Chi square testing.

Results

715 letters were examined (398 non-program director home institution letters, 201 program director letters, and 116 non-home institution elective letters). High-quality letter components were: nature of relationship, duration of relationship, In Training Evaluation Report information, research involvement and comments on areas for improvement. Program director letters had a significantly higher proportion (10.4%) of all 5 high-quality components, compared to 0% in both non-program director home institution letters and elective letters (p < 0.001). A significantly higher proportion of program director letters had 4–5 high-quality components (62.5%) compared to 2% of non-program director home institution letters and 0% of elective letters (p < 0.0001).

Conclusions

Letters of recommendation from elective rotations are of the poorest quality and such rotations should not be pursued for the sole purpose of obtaining a letter. The low quality of elective letters leads to the recommendation that writers should decline to write them, programs should not require them and trainees should not request them. Program directors write the highest quality letters and should be a resource for faculty development. Clinical supervisors can use the 5-point composite endpoint as a guide when writing letters for applicants.
Towards developing a secure medical image sharing system based on zero trust principles and blockchain technology
Authors: Sultana Maliha , Hossain Afrida , Laila Fabiha , Taher Kazi Abu , Islam Muhammad Nazrul
Published: October 2020

Background

Data security has been a critical topic of research and discussion since the onset of data sharing in e-health systems. Although digitalization of data has increased efficiency and speed, it has also made data vulnerable to cyber attacks. Medical records in particular seem to be the regular victims of hackers. Several data breach incidents throughout history have warranted the invention of security measures against these threats. Although various security procedures like firewalls, virtual private networks, encryption, etc are present, a mix of these approaches are required for maximum security in medical image and data sharing.

Methods

Relatively new, blockchain has become an effective tool for safeguarding sensitive information. However, to ensure overall protection of medical data (images), security measures have to be taken at each step, from the beginning, during and even after transmission of medical images which is ensured by zero trust security model. In this research, a number of studies that deal with these two concepts were studied and a decentralized and trustless framework was proposed by combining these two concepts for secured medical data and image transfer and storage.

Results

Research output suggested blockchain technology ensures data integrity by maintaining an audit trail of every transaction while zero trust principles make sure the medical data is encrypted and only authenticated users and devices interact with the network. Thus the proposed model solves a lot of vulnerabilities related to data security.

Conclusions

A system to combat medical/health data vulnerabilities has been proposed. The system makes use of the immutability of blockchain, the additional security of zero trust principles, and the scalability of off chain data storage using Inter Planetary File Systems (IPFS). The adoption of this system suggests to enhance the security of medical or health data transmission.
Health facility readiness and provider knowledge as correlates of adequate diagnosis and management of pre-eclampsia in Kinshasa, Democratic Republic of Congo
Authors: Nkamba Dalau Mukadi , Vangu Roland , Elongi Moyene , Magee Laura A. , Wembodinga Gilbert , Bernard Pierre , Ditekemena John , Robert Annie
Published: October 2020

Background

Hypertensive disorders in pregnancy are the second most common cause of maternal mortality in the Democratic Republic of Congo (DRC), accounting for 23% of maternal deaths. This study aimed to assess facility readiness, and providers’ knowledge to prevent, diagnose, and treat pre-eclampsia.

Methods

A facility-based cross-sectional study was conducted in 30 primary health centres (PHCs) and 28 referral facilities (hospitals) randomly selected in Kinshasa, DRC. In each facility, all midwives and physicians involved in maternal care provision (n = 197) were included. Data on facility infrastructure and providers’ knowledge about pre-eclampsia were collected using facility checklists and a knowledge questionnaire. Facility readiness score was defined as the sum of 13 health commodities needed to manage pre-eclampsia. A knowledge score was defined as the sum of 24 items about the diagnosis, management, and prevention of pre-eclampsia. The score ranges from 0 to 24, with higher values reflecting a better knowledge. The Mann-Witney U test was used to compare median readiness scores by facility type and ownership; and median knowledge scores between midwives in hospitals and in PHCs, and between physicians in hospitals and in PHCs.

Results

Overall, health facilities had 7 of the 13 commodities, yielding a median readiness score of 53.8%(IQR: 46.2 to 69.2%). Although all provider groups had significant knowledge gaps about pre-eclampsia, providers in hospitals demonstrated slightly more knowledge than those in PHCs. Midwives in public facilities scored higher than those in private facilities (median(IQR): 8(5 to 12) vs 7(4 to 8), p = 0.03). Of the 197 providers, 91.4% correctly diagnosed severe pre-eclampsia. However, 43.9 and 82.2% would administer magnesium sulfate and anti-hypertensive drugs to manage severe pre-eclampsia, respectively. Merely 14.2 and 7.1% of providers were aware of prophylactic use of aspirin and calcium to prevent pre-eclampsia, respectively.

Conclusion

Our study showed poor availability of supplies to diagnose, prevent and treat pre-eclampsia in Kinshasa. While providers demonstrated good knowledge regarding the diagnosis of pre-eclampsia, they have poor knowledge regarding its prevention and management. The study highlights the need for strengthening knowledge of providers toward the prevention and management of pre-eclampsia, and enhancing the availability of supplies needed to address this disease.
A complex histopathological challenge: suspicion of an osteoblastoma-like osteosarcoma arising from the second thoracic vertebra in a cat
Authors: Giebels Felix , Forterre Franck , Vincenti Simona , Geissbuehler Urs , Welle Monika M. , Pool Roy , Soldati Sabina , Maiolini Arianna
Published: October 2020

Background

Reports of osteoblastic tumours are limited to a few case reports in veterinary medicine. Osteoblastoma-like osteosarcoma has been accepted by the World Health Organization as an intermediate form between an osteosarcoma and osteoblastoma. This type of tumour indicates an osteosarcoma, that may resemble osteoblastoma clinically, histologically, and radiologically and have the capability for metastasis. Osteoblastoma-like osteosarcoma has not been described in veterinary medicine so far.

Case presentation

An eight-year old cat was presented due to progressive ataxia and paraparesis of the pelvic limbs. Imaging confirmed a well-defined, extradural mass originating from the spinous process of the second thoracic vertebra (T2) leading to severe compression of the spinal cord. Decompressive cytoreduction was achieved by removal of the mass after dorsal laminectomy of T1. After recovering from an acute worsening 3.5 weeks after surgery, the cat had an improved neurological status and the dorsal compression was resolved at follow-up 8 months later. A focal contrast enhancing lesion was still evident at the base of T2 spinous process and lung metastasis was additionally suspected. Based on histopathological, radiographic, and clinical features, an “osteoblastoma-like osteosarcoma” was suspected.

Conclusions

To the best of our knowledge, this is the first description of this tumour in veterinary medicine. In addition, this case report highlights the difficulty in the diagnosis and definition of osseous neoplasia in cats and provides a literature review.
Analysis of candidate genes expected to be essential for melanoma surviving
Authors: Krivosheeva Irina A. , Filatova Alexandra Yu. , Moshkovskii Sergei A. , Baranova Ancha V. , Skoblov Mikhail Yu.
Published: October 2020

Introduction

Cancers may be treated by selective targeting of the genes vital for their survival. A number of attempts have led to discovery of several genes essential for surviving of tumor cells of different types. In this work, we tried to analyze genes that were previously predicted to be essential for melanoma surviving. Here we present the results of transient siRNA-mediated knockdown of the four of such genes, namely, UNC45A, STK11IP, RHPN2 and ZNFX1, in melanoma cell line A375, then assayed the cells for their viability, proliferation and ability to migrate in vitro. In our study, the knockdown of the genes predicted as essential for melanoma survival does not lead to statistically significant changes in cell viability. On the other hand, for each of the studied genes, mobility assays showed that the knockdown of each of the target genes accelerates the speed of cells migrating. Possible explanation for such counterintuitive results may include insufficiency of the predicting computational models or the necessity of a multiplex knockdown of the genes.

Aims

To examine the hypothesis of essentiality of hypomutated genes for melanoma surviving we have performed knockdown of several genes in melanoma cell line and analyzed cell viability and their ability to migrate.

Methods

Knockdown was performed by siRNAs transfected by Metafectene PRO. The levels of mRNAs before and after knockdown were evaluated by RT-qPCR analysis. Cell viability and proliferation were assessed by MTT assay. Cell migration was assessed by wound healing assay.

Results

The knockdown of the genes predicted as essential for melanoma survival does not lead to statistically significant changes in cell viability. On the other hand, for each of the studied genes, mobility assays showed that the knockdown of each of the target genes accelerates the speed of cells migrating.

Conclusion

Our results do not confirm initial hypothesis that the genes predicted essential for melanoma survival as a matter of fact support the survival of melanoma cells.
History of malaria control in Rwanda: implications for future elimination in Rwanda and other malaria-endemic countries
Authors: Karema Corine , Wen Shawn , Sidibe Abigail , Smith Jennifer L. , Gosling Roly , Hakizimana Emmanuel , Tanner Marcel , Noor Abdisalan M. , Tatarsky Allison
Published: October 2020

Background

Malaria was first reported in Rwanda in the early 1900s with significant heterogeneity and volatility in transmission over subsequent decades. Here, a comprehensive literature review of malaria transmission patterns and control strategies in Rwanda between 1900 and 2018 is presented to provide insight into successes and challenges in the country and to inform the future of malaria control in Rwanda.

Methods

A systematic literature search of peer-reviewed publications (Web of Knowledge, PubMed, Google Scholar, and the World Health Organization Library (WHOLIS) and grey literature on malaria control in Rwanda between 1900 and 2019 was conducted with the following search terms: “malaria”“, “Rwanda”, “epidemiology”, “control”, “treatment”, and/or “prevention.” Reports and other relevant documents were also obtained from the Rwanda National Malaria Control Programme (NMCP). To inform this literature review and evidence synthesis, epidemiologic and intervention data were collated from NMCP and partner reports, the national routine surveillance system, and population surveys.

Results

Two hundred sixty-eight peer-reviewed publications and 56 grey literature items were reviewed, and information was extracted. The history of malaria control in Rwanda is thematically described here according to five phases: 1900 to 1954 before the launch of the Global Malaria Eradication Programme (GMEP); (2) Implementation of the GMEP from 1955 to 1969; (3) Post- GMEP to 1994 Genocide; (4) the re-establishment of malaria control from 1995 to 2005, and (5) current malaria control efforts from 2006 to 2018. The review shows that Rwanda was an early adopter of tools and approaches in the early 2000s, putting the country ahead of the curve and health systems reforms created an enabling environment for an effective malaria control programme. The last two decades have seen unprecedented investments in malaria in Rwanda, resulting in significant declines in disease burden from 2000 to 2011. However, in recent years, these gains appear to have reversed with increasing cases since 2012 although the country is starting to make progress again.

Conclusion

The review shows the impact and fragility of gains against malaria, even in the context of sustained health system development. Also, as shown in Rwanda, country malaria control programmes should be dynamic and adaptive to respond and address changing settings.
Three-dimensional printing for cardiovascular diseases: from anatomical modeling to dynamic functionality
Authors: Wang Hao , Song Hongning , Yang Yuanting , Cao Quan , Hu Yugang , Chen Jinling , Guo Juan , Wang Yijia , Jia Dan , Cao Sheng , Zhou Qing
Published: October 2020

Three-dimensional (3D) printing is widely used in medicine. Most research remains focused on forming rigid anatomical models, but moving from static models to dynamic functionality could greatly aid preoperative surgical planning. This work reviews literature on dynamic 3D heart models made of flexible materials for use with a mock circulatory system. Such models allow simulation of surgical procedures under mock physiological conditions, and are; therefore, potentially very useful to clinical practice. For example, anatomical models of mitral regurgitation could provide a better display of lesion area, while dynamic 3D models could further simulate in vitro hemodynamics. Dynamic 3D models could also be used in setting standards for certain parameters for function evaluation, such as flow reserve fraction in coronary heart disease. As a bridge between medical image and clinical aid, 3D printing is now gradually changing the traditional pattern of diagnosis and treatment.