bluuebunny/crossref_metadata_2025 huggingface dataset:
Role of placenta accreta index in prediction of morbidly adherent placenta: A reliability study
Authors: Agarwal Shubhra , Agarwal Arjit , Chandak Shruti
Published: September 2020

Objective

To estimate the level of interobserver agreement in the calculation of placenta accreta index (PAI) as well as to evaluate the accuracy of PAI in prediction of morbidly adherent placenta.

Materials and methods

This was a prospective study where 45 pregnant women (from 28 to 37 weeks of gestational age) with at least one previous Caesarean section and ultrasound-proven placenta previa were included. A known and previously published scoring system, the PAI, was evaluated independently by two radiologists and the cases were followed for the delivery and histopathology outcome. The accuracy of the PAI and the level of interrater agreement was analysed using cross-table analysis, intraclass correlation efficient and Cohen’s kappa as statistical variables.

Results

Adherent placenta was found in 15 patients accounting for 33% of cases. The PAI showed nearly 90% sensitivity, specificity and the predictive values. Interrater agreement in calculation of PAI by the two radiologists was perfect with an intraclass correlation efficient of 0.959. An easy-to-use morbid adherent placenta score was also predicted to simplify the results of PAI, which showed moderate agreement (κ = 0.746).

Conclusions

The PAI can be helpful in stratifying the individual risk of placental invasion above the baseline risk. The PAI-derived, simplified scoring system called morbid adherent placenta score can be used as a simple tool to interpret and convey the results of PAI.
Social media representation of female genital cutting: A YouTube analysis
Authors: Wondwossen Fantaye Arone , Konkle Anne TM
Published: September 2020

Introduction:

Female genital cutting is a practice that has incited controversy and conflicting discourses across the international community. There is a need to analyze social media data on the portrayal of the practice in order to gather insights and inform strategic planning and interventions design. This study aims to explore and describe the portrayal of female genital cutting in the comments section of YouTube comment posts.

Methods:

This mixed-method study employs a content analysis approach with a sequential exploratory design. A total of 150 YouTube comment posts were analyzed through qualitative content analysis and quantitative descriptive content analysis on NVivo 11 and Microsoft Excel, respectively.

Results:

Salient subthemes from the qualitative component included likening female genital cutting with male genital cutting, differentiating female genital cutting from male genital cutting, branding female genital cutting as a harmful and unethical practice, branding female genital cutting as a normal tradition, contribution of religion and culture to female genital cutting, gender inequality issues, and the need for education or cultural relativism to change or cope with the practice. The quantitative component identified neutral, positive, mixed, and neutral tones; and formal, colloquial, and mixed language types; as well as targets of stigma with patterns in the themes.

Conclusion:

The portrayal of female genital cutting in the YouTube comment posts revealed the range of perceptions, beliefs, and opinions of users with various stances on the practice. Study findings are useful for strategic planning and the development of interventions with informative goals. Study findings can also help to gage and evaluate the effectiveness of existing programs that aim to reduce misinformation about female genital cutting or aim to reduce stigmas surrounding the practice.
Leveraging Trends in Neurology Admissions for Departmental Planning During the COVID-19 Pandemic
Authors: Lau K. H. Vincent , Anand Pria , Greer David M. , Cervantes-Arslanian Anna , Phicil Sheila , Moore Jesse , Takahashi Courtney
Published: September 2020

The COVID-19 pandemic has led to shifts in healthcare utilization for patients both with and without COVID-19. We aimed to determine how trends in neurology service admissions during the pandemic may aid in departmental planning by predicting future clinician staffing and other needs. We examined all admissions to the general neurology, stroke, and neurocritical care services from January 31 to May 16, 2020 at our tertiary-care hospital using an electronic health record query, comparing these to analogous data in 2019. We trended admission rates and projected future censuses using logarithmic regression, tracked changes in length of stay (LOS), and quantified shifts in presentations of specific diagnoses. Daily rates of admissions declined sharply during the week of March 13, 2020 (the week after pandemic status was declared by the World Health Organization). On the censoring date, we projected a return to pre-pandemic censuses in the week of June 21 and used this information to make decisions regarding neurology resident schedules. There was a trend toward increased LOS for general neurology and stroke patients between March 27 and April 9, 2020 compared to in 2019, with subsequent decline coinciding with early hospital initiatives. Since March 13, 2020, there has been a trend toward reduced presentations of ischemic stroke, suggesting a need for community education on stroke awareness. Characterizing early trends in neurology admissions may allow physician administrators to plan local and community-level responses to the pandemic.
Knee Intraosseous Injections: A Systematic Review of Clinical Evidence of Different Treatment Alternatives
Authors: Di Matteo Berardo , Polignano Alberto , Onorato Francesco , La Porta Agostino , Iacono Francesco , Bonanzinga Tommaso , Raspugli Giovanni , Marcacci Maurilio , Kon Elizaveta
Published: September 2020

Objective

To systematically review the available clinical evidence regarding the safety and efficacy of knee intraosseous injections for the treatment of bone marrow lesions in patients affected by knee osteoarthritis.

Design

A literature search was carried out on PubMed, Embase, and Google Scholar databases in January 2020. The following inclusion criteria were adopted: (1) studies of any level of evidence, dealing with subchondral injection of bone substitute materials and/or biologic agents; (2) studies with minimum 5 patients treated; and (3) studies with at least 6 months’ follow-up evaluation. All relevant data concerning clinical outcomes, adverse events, and rate of conversion to arthroplasty were extracted.

Results

A total of 12 studies were identified: 7 dealt with calcium phosphate administration, 3 with platelet-rich plasma, and 2 with bone marrow concentrate injection. Only 2 studies were randomized controlled trials, whereas 6 studies were prospective and the remaining 4 were retrospective. Studies included a total of 459 patients treated with intraosseous injections. Overall, only a few patients experienced adverse events and clinical improvement was documented in the majority of trial. The lack of any comparative evaluation versus subchondral drilling alone is the main limitation of the available evidence.

Conclusions

Knee intraosseous injections are a minimally invasive and safe procedure to address subchondral bone damage in osteoarthritic patients. They are able to provide beneficial effects at short-term evaluation. More high-quality evidence is needed to confirm their potential and to identify the best product to adopt in clinical practice.
Does the four-glass test still have a place in microbiological evaluation of chronic prostatitis? Findings from an Indian tertiary care centre
Authors: Tiwari Punit , Choudhary Arpan
Published: September 2020

Background:

Chronic prostatitis (CP) is a bothersome disease affecting young and middle-aged men. Routine cultures often fail to localize the source of infection. Although the four-glass test is considered the gold-standard test for evaluating CP, it has found less favour in clinical practice. We re-inspected its utility in patients suffering from CP.

Methods:

Seventy cases of CP of Indian origin were enrolled. The four-glass test was conducted, and the samples were labelled as VB1, VB2, VB3 and EPS. A quantitative culture and drug sensitivity test for 16 antimicrobials was performed.

Results:

Samples from 61 patients ( Mage=36 years) were analysed. Chronic bacterial prostatitis was identified in 29 (47.5%) cases. Enterococcus spp. were the most common isolate, followed by Escherichia coli. A wide variability in positivity pattern was noted in the four-glass test. The most common pattern was for only the EPS sample to be positive (nine cases; 16.1%), followed by all four samples to be positive (seven cases; 12.5%). High susceptibility was found (94–100%) against third-generation cephalosporins, meropenem, amikacin, gentamicin and nitrofurantoin.

Conclusions:

The four-glass test is still important in the evaluation of CP. In about half of the cases examined in this study, bacterial localization could be made to the prostate.

Level of evidence:

Level IIIb.
Primary duodenal plasmacytoma with associated primary (amyloid light-chain) amyloidosis in a cat
Authors: Tamura Yu , Chambers James K , Neo Sakurako , Goto-Koshino Yuko , Takagi Satoshi , Uneyama Mizuho , Uchida Kazuyuki , Hisasue Masaharu
Published: September 2020

Case summary

A 14-year-old spayed female American Shorthair cat was presented with weight loss and a palpable abdominal mass. Abdominal ultrasound and CT revealed a duodenal mass with suspected perforation and an enlarged jejunal lymph node. Cytological evaluation from a fine-needle aspiration of the abdominal mass displayed many atypical round cells, some with a small amount of light pink material at the cellular edge. The duodenal mass was surgically removed, and was diagnosed as a plasma cell tumour immunohistochemically positive for CD79 alpha, IgA and lambda immunoglobulin light chains. In addition, amyloidosis was detected. PCR to assess the antigen receptor rearrangement of the tumour cells showed a monoclonal rearrangement of the immunoglobulin heavy chain gene. Postoperatively, the cat received chemotherapy with cyclophosphamide and prednisolone. Owing to progressive enlargement of the jejunal lymph node, different chemotherapy protocols were used sequentially, namely chlorambucil, lomustine and L-asparaginase. However, the cat died 96 days after the initial diagnosis. Post-mortem examination confirmed systemic dissemination of tumour cells. The cause of death was considered to be a result of a complication of the tumour itself and associated amyloidosis.

Relevance and novel information

This patient was diagnosed with a primary duodenal plasmacytoma, and primary (amyloid light-chain) amyloidosis. In cats, intestinal plasmacytoma is rarely reported and associated amyloidosis is an uncommon feature, when compared with humans. To our knowledge, this is the first clinical report of duodenal plasmacytoma in a cat. The present report shows that feline plasmacytomas should be included in the differential diagnosis of a duodenal mass.
Education Under Siege: Exploring How International Economic Sanctions Create Crises of Pedagogy
Authors: Hwami Munyaradzi
Published: September 2020

Purpose:

This article examines the adverse impact of international economic sanctions on pedagogy. The article considers the contemporary times as a period of misinformation, false news, and untruths. Utilizing anti-hegemonic literature, international economic sanctions are viewed as neoliberalism’s instrument of coercion, a Western weapon used to enforce Western values on those with different perceptions toward the free market system.

Design/Approach/Methods:

This article utilizes critical scholarship to unmask authoritarian neoliberalism and a scoping review of sanctioned societies. Critical analytics are deployed to interpret and make sense of the dominant educational policy framework that appears to be against diversity.

Findings:

Neoliberalism has caused a crisis in pedagogy. Education is under siege as academics and scientific evidence are being disregarded. The call is for pedagogues from all over the world to continue to avail evidence to power by practicing critical education. Literature is utilized to propose critical pedagogy when scientific evidence is disputed, and non-Western epistemologies are considered anachronous.

Originality/Value:

Linking sanctions and neoliberalism is relatively novel, as is the contribution of the same lenses to authoritarian neoliberalism. The assault on divergent epistemologies is critical, and the defense of critical scholarship is every academic’s duty. The article joins conversations on the neoliberal assault on education and society.
A Bottom-Up Approach Addressing Patient Care and Differential Diagnosis Amidst the Covid-19 Response
Authors: Zolnikov Tessa , Zolnikov Tara Rava
Published: September 2020

Patient care often refers to the broad spectrum of care, prevention, and treatment that a provider delivers, while the point of a differential diagnosis is to make a distinction between 2 or more conditions that share similar signs or symptoms. A broad differential should be considered for every single patient who is currently ill (eg, all patients with respiratory illnesses); without it, there will likely be an increase of misdiagnosis, unnecessary patient suffering, and an influx of patients to the emergency department. The COVID-19 response has forced many of these basic medical values aside, like providing differential diagnosis or practicing bedside manner through social interaction, while physicians struggle to continue care for patients. As a result, newly formed hospital and clinical policies may have dangerously traded everyday diagnosis and treatment of patients for the pandemic and quarantine recommendations. This type of assumptive medicine is based on a singular differential that can be detrimental to patients, who are more likely affected with more common illnesses, like bronchitis or pneumonia—or perhaps, even more threatening illnesses, like a pulmonary embolism, COPD exacerbation, congestive heart failure and even lung cancer. Although these new policies and reactions to COVID-19 are proactive, these actions could be at the cost of providing quality patient care for people who have not contracted COVID-19.
Angiotensin-converting enzyme 2, the SARS-CoV-2 cellular receptor, is widely expressed in human myometrium and uterine leiomyoma
Authors: Racilan Alexon M , Assis Wiviane A , Casalechi Maíra , Spagnolo-Souza Ananda , Pascoal-Xavier Marcelo A , Simões-e-Silva Ana C , Del Puerto Helen L , Reis Fernando M
Published: September 2020

Objective:

Angiotensin-converting-enzyme 2 (ACE2), the cell surface receptor for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is found in a variety of reproductive tissues. The present study evaluated whether uterine fibroids and normal myometrium express ACE2 and, if so, at which tissue compartments.

Methods:

We included 13 premenopausal women (age range 33–50 years, median 40 years) with uterine fibroids undergoing elective hysterectomy or myomectomy. Samples of leiomyoma ( n = 12) and normal myometrial tissue ( n = 8) were analyzed by immunohistochemistry for protein localization or by real time PCR for mRNA detection.

Results:

In normal myometrium, ACE2 immunoreactivity was localized in smooth muscle fibers, arteriolar walls, and endothelial cells. In uterine leiomyoma, ACE2 staining was more intense in smooth muscle cells than in the extracellular matrix, and was also present in vascular endothelium. ACE2 mRNA was detected in myometrium as well as in fibroid samples.

Conclusion:

Human myometrium and uterine leiomyoma express ACE2 mRNA and have abundant distribution of ACE2 protein in their smooth muscle cells and microvasculature.
Scenes of emergency: Dis/re-assembling the promise of the UK emergency state
Authors: Anderson Ben
Published: September 2020

The paper traces the development of UK ‘state of emergency’ legislation through three ‘scenes of emergency’: the introduction of the Emergency Powers Act in 1920, a revision to the Act in 1964, and discussion within government departments about possible changes to emergency powers in 1973. Through these scenes, and contra to existing work on the state of emergency as an occasion for the intensification of sovereignty, I show how the introduction of and revision to ‘state of emergency’ legislation were occasions for a double concern – with the excessiveness of the state, as per Foucault’s analysis of liberalism, but also for the excessiveness of events. In ‘scenes of emergency’ a specific ‘state effect’ was dis/re-assembled: the promise of the providential state that protected life through control of events. As emergency legislation was subject to deliberation and contestation, other versions of the state surfaced: beginning with the interested, classed, state and the tyrannical state as emergency powers were introduced and ending with the anxious state that loses faith in the efficacy of emergency powers in a world of changing events. As well as arguing that work on governing emergencies should be orientated to ‘scenes of emergency’ in which that which governs relates to excess, the paper suggests that assemblage approaches to the state should be concerned with dis/re-assembly.
Electromyography of the Shoulder Musculature during Passive Rehabilitation Exercises
Authors: Cross Janelle A , deVries John , Mocarski Mason , Ketchum Nicholas C , Compty Eileen , Krimmer Matthew , Fritz Jessica M , Vetter Carole S
Published: September 2020

Background

Medical professionals remain conflicted about the best rehabilitation protocol a patient should perform after rotator cuff repair surgery. Exercises deemed passive may be activating the shoulder muscles to a moderate level, thus putting the surgical repair construct at risk for re-injury. The purpose of this study was to measure the activation of the rotator cuff and surrounding musculature during exercises used in physical therapy following rotator cuff repair surgery using electromyography (EMG).

Methods

Muscle activation was recorded in fourteen participants performing sixteen exercises. Four fine wire electrodes (supraspinatus, infraspinatus, subscapularis, teres minor) and six surface electrodes (upper and middle division of the trapezius, anterior, medial and posterior head of the deltoid, biceps brachii) were utilized. EMG activity values for each muscle were normalized to the maximum voluntary isometric contraction and activation levels were assessed.

Results

Twelve of the sixteen exercises tested were moderately active in the subscapularis muscle. The results show the subscapularis muscle was activated in all three planes of motion.

Discussion

Most exercises were found to have low activation levels for the supraspinatus, infraspinatus and teres minor muscles. While the exercises examined in this study appear to be safe for the more commonly repaired supraspinatus, caution should be used when administering exercises to individuals with repairs involving the subscapularis.
Erenumab for chronic cluster headache: A case report
Authors: Riederer Franz , Wenner Allyson M
Published: September 2020

The preventive treatment for cluster headache is often limited by a lack of efficacy or side effects. Calcitonin gene-related peptide (CGRP) has been implicated in the pathophysiology of cluster headache. Galcanezumab, a monoclonal antibody against calcitonin gene-related peptide (CGRP), significantly reduced the frequency of episodic cluster headache attacks. We report the case of a 38-year-old woman with chronic refractory cluster headache and comorbid migraine who received erenumab in 4 repeated doses of 70 mg subcutaneously over 25 weeks. Attack frequency decreased from three attacks per day to several attacks per week. Erenumab seemed to be highly effective in the prevention of cluster headache attacks in this patient. We suggest that randomized control trials should be performed.
Systems-based hematology: highlighting successes and next steps
Authors: May Jori E. , Irelan Patrick C. , Boedeker Kailee , Cahill Emily , Fein Steven , Garcia David A. , Hicks Lisa K. , Lawson Janice , Lim Ming Y. , Morton Colleen T. , Rajasekhar Anita , Shanbhag Satish , Zumberg Marc S. , Plovnick Robert M. , Connell Nathan T.
Published: September 2020

Systems-based hematology is dedicated to improving care delivery for patients with blood disorders. First defined by the American Society of Hematology in 2015, the idea of a systems-based hematologist arose from evolving pressures in the health care system and increasing recognition of opportunities to optimize the quality and cost effectiveness of hematologic care. In this review, we begin with a proposed framework to formalize the discussion of the range of initiatives within systems-based hematology. Classification by 2 criteria, project scope and method of intervention, facilitates comparison between initiatives and supports dialogue for future efforts. Next, we present published examples of successful systems-based initiatives in the field of hematology, including efforts to improve stewardship in the diagnosis and management of complex hematologic disorders (eg, heparin-induced thrombocytopenia and thrombophilias), the development of programs to promote appropriate use of hematologic therapies (eg, blood products, inferior vena cava filters, and anticoagulation), changes in care delivery infrastructure to improve access to hematologic expertise (eg, electronic consultation and disorder-specific care pathways), and others. The range of projects illustrates the broad potential for interventions and highlights different metrics used to quantify improvements in care delivery. We conclude with a discussion about future directions for the field of systems-based hematology, including extension to malignant disorders and the need to define, expand, and support career pathways.
Surface Morphology Analysis of Knit Structure-Based Triboelectric Nanogenerator for Enhancing the Transfer Charge
Authors: Niu Li , Miao Xuhong , Li Yutian , Xie Xinkai , Wen Zhen , Jiang Gaoming
Published: September 2020

Harvesting waste biomechanical energy has provided a promising approach to improve the power supplement of wearable devices for extending usage life. Surface morphology is a significant factor for enhancing output performance of triboelectric nanogenerator; however, there is a limitation for evaluating the morphology of the surface and its impact on power generation. To evaluate the relationship between the surface morphology and transfer charge, there is a mathematical theory that is the fractal geometry theory that has been proposed to analyze the characteristic of irregular surface morphology. This theory provided a good understanding of the contact area and roughness of the surface. We have designed three categories of knit structures with cord appearance by using a flat knitting machine and analyzed their surface characteristics. Meanwhile, the geometric structures can be demonstrated through the fractal dimension for evaluating the generated output performance during contacting and separation. The present research exhibits that, with the increasing number of knitted units, the triboelectric power-generation performance continued to reduce due to the available contact area decreasing. After calculating the fractal dimension of different knit structures, the m*n rib structures show the high transfer charge when the fractal dimension is close to number one, especially the fractal dimension of the 1*1 rib structure that can reach 0.99. The fractal theory can be further used as an approach to evaluate the influence on the output performance of irregular surface morphology, unrelated to the uniform convex unit distraction. The result of this research also demonstrated the feasibility of a knitted-based triboelectric nanogenerator in scavenging biomechanical energy for powering portable electronics integrated into garments.
Carbon Dots as New Generation Materials for Nanothermometer: Review
Authors: Mohammed Lazo Jazaa , Omer Khalid M.
Published: September 2020

Highly sensitive non-contact mode temperature sensing is substantial for studying fundamental chemical reactions, biological processes, and applications in medical diagnostics. Nanoscale-based thermometers are guaranteeing non-invasive probes for sensitive and precise temperature sensing with subcellular resolution. Fluorescence-based temperature sensors have shown great capacity since they operate as “non-contact” mode and offer the dual functions of cellular imaging and sensing the temperature at the molecular level. Advancements in nanomaterials and nanotechnology have led to the development of novel sensors, such as nanothermometers (novel temperature-sensing materials with a high spatial resolution at the nanoscale). Such nanothermometers have been developed using different platforms such as fluorescent proteins, organic compounds, metal nanoparticles, rare-earth-doped nanoparticles, and semiconductor quantum dots. Carbon dots (CDs) have attracted interest in many research fields because of outstanding properties such as strong fluorescence, photobleaching resistance, chemical stability, low-cost precursors, low toxicity, and biocompatibility. Recent reports showed the thermal-sensing behavior of some CDs that make them an alternative to other nanomaterials-based thermometers. This kind of luminescent-based thermometer is promising for nanocavity temperature sensing and thermal mapping to grasp a better understanding of biological processes. With CDs still in its early stages as nanoscale-based material for thermal sensing, in this review, we provide a comprehensive understanding of this novel nanothermometer, methods of functionalization to enhance thermal sensitivity and resolution, and mechanism of the thermal sensing behavior.
Habitat disturbance influences the skin microbiome of a rediscovered neotropical-montane frog
Authors: Jiménez Randall R. , Alvarado Gilbert , Sandoval José , Sommer Simone
Published: September 2020

Background

The skin microbiome serves as a first line defense against pathogens in vertebrates. In amphibians, it has the potential to protect against the chytrid fungus Batrachochytrium dendrobatis (Bd), a likely agent of amphibian declines. Alteration of the microbiome associated with unfavorable environmental changes produced by anthropogenic activities may make the host more susceptible to pathogens. Some amphibian species that were thought to be “extinct” have been rediscovered years after population declines in the late 1980s probably due to evolved Bd-resistance and are now threatened by anthropogenic land-use changes. Understanding the effects of habitat disturbance on the host skin microbiome is relevant for understanding the health of these species, along with its susceptibility to pathogens such as Bd. Here, we investigate the influence of habitat alteration on the skin bacterial communities as well as specifically the putative Bd-inhibitory bacterial communities of the montane frog Lithobates vibicarius. This species, after years of not being observed, was rediscovered in small populations inhabiting undisturbed and disturbed landscapes, and with continuous presence of Bd.

Results

We found that cutaneous bacterial communities of tadpoles and adults differed between undisturbed and disturbed habitats. The adults from disturbed habitats exhibited greater community dispersion than those from undisturbed habitats. We observed a higher richness of putative Bd-inhibitory bacterial strains in adults from disturbed habitats than in those from undisturbed habitats, as well as a greater number of these potential protective bacteria with a high relative abundance.

Conclusions

Our findings support the microbial “Anna Karenina principle”, in which disturbance is hypothesized to cause greater microbial dispersion in communities, a so-called dysbiosis, which is a response of animal microbiomes to stress factors that decrease the ability of the host or its microbiome to regulate community composition. On the positive side, the high richness and relative abundance of putative Bd-inhibitory bacteria may indicate the development of a defense mechanism that enhances Bd-protection, attributed to a co-occurrence of more than 30-years of host and pathogen in these disturbed habitats. Our results provide important insight into the influence of human-modified landscapes on the skin microbiome and health implications of Bd-survivor species.
Associated factors of pregnancy spacing among women of reproductive age Group in South of Iran: cross-sectional study
Authors: Dehesh Tania , Salarpour Elaheh , Malekmohammadi Neda , Kermani Sepideh Arjomand
Published: September 2020

Background

Optimal pregnancy spacing is an important incidence in reproductive women’s health. Short or long pregnancy spacing leads to the greatest health, social and economic problems such as increase in maternal and infant mortality and morbidity, and adverse pregnancy outcomes. The aim of this study is to assess the mean of pregnancy spacing and associated factors of pregnancy spacing among women of reproductive age group with recurrent event analysis.

Methods

The fertility history of 1350 women aged 15–49 years was collected in this cross-sectional study. The women were selected through multistage random sampling method from a list of clinics in 2018. Some predictors were collected from their records and others were collected by face-to-face interview. The recurrent event survival analysis was used to explore the effect of predictors on pregnancy spacing. The R software program was used for analysis.

Results

There were nine predictors that had significant effect on pregnancy spacing. These predictors included the age of mother at marriage, mother’s BMI, contraception use, breast feeding duration of the previous child, the education level of husband, the sex preference of the mother, presence of abortion or stillbirth in the preceding pregnancies, income sufficiency, and mother’s awareness of optimum pregnancy interval. The most influential predictors; contraception use (HR = 2.34, 95%CI = 1.23 to 2.76, P < 0.001) and income sufficiency (HR = 2.046, 95%CI = 1.61 to 3.02, P = 0.018) lead to longer and son preference of mother (HR = 2.231, 95%CI = 1.24 to 2.81, P = 0.023) lead to shorter pregnancy spacing.

Conclusion

The up to date contraception tool should be at hand for couples to manage their pregnancy intervals. The unfavorable economic situation of a family leads to long pregnancy spacing. Despite the relative equality of the status of girls and boys in today’s societies, the desire to have a son child is still an important factor in shorter pregnancy spacing. The benefit of optimal pregnancy spacing should be more announced.
World Health Organization grading classification for pancreatic neuroendocrine neoplasms: a comprehensive analysis from a large Chinese institution
Authors: Yang Min , Zeng Lin , Ke Neng-wen , Tan Chun-lu , Tian Bo-le , Liu Xu-bao , Xiang Bo , Zhang Yi
Published: September 2020

Background

Pancreatic neuroendocrine neoplasms (p-NENs) are a group of highly heterogeneous tumors with distinct clinicopathological features and long-term prognosis. In 2017, in order to better stratify patients into prognostic groups and predicting their outcomes, World Health Organization (WHO) officially updated its grading system for p-NENs which distinguished these neoplasms among Grading 1 (G1) pancreatic neuroendocrine tumors (p-NETs), G2 p-NETs, G3 p-NETs and G3 pancreatic neuroendocrine carcinomas (p-NECs). However, this new grading classification for p-NENs has not yet been rigorously validated.

Methods

Data of patients who were surgically treated and histopathologically diagnosed as p-NENs at West China Hospital of Sichuan University from January 2002 to December 2018 were retrospectively collected and analyzed according the novel WHO 2017 grading classification.

Results

We eventually enrolled 480 eligible patients with p-NENs in our present study, in which 150 patients with WHO 2017 G1 p-NETs, 158 with G2 p-NETs, 64 with G3 p-NETs and 108 with G3 p-NECs were identified. The estimated 5-year overall survival for patients with G1 p-NETs, G2 p-NETs, G3 p-NETs and G3 p-NECs was 75.8, 58.4, 35.1 and 11.1%, with a median survival time of 85.3mons, 67.4mons, 51.3mons and 26.8mons, respectively. Patients with G2 p-NETs present notably worse survival than those with G1 p-NETs (P = 0.03). Survival of G3 p-NETs were significantly worse than that of G1 p-NETs or G2 p-NETs (P < 0.001, P = 0.023, respectively), as well as that when comparing G3 p-NECs with G1 p-NETs or G2 p-NETs (P < 0.001, P < 0.001, respectively). Patients with G3 p-NECs showed statistically shorter survival than those with G3 p-NETs (P < 0.001). Both WHO 2017 and 2010 grading criteria could be independent predictor for the OS of p-NENs (P = 0.016, P = 0.022; respectively). The 95% confidence intervals of WHO 2017 grading classification (0.983–9.454) was slightly smaller than that of WHO 2010 criteria (0.201–13.374), indicating a relatively more accurate predicting ability for the prognosis of p-NENs.

Conclusion

The WHO 2017 grading classification for p-NENs could successfully allocate patients into four groups with distinct clinical features and significant survival differences, which might be superior to the WHO 2010 criteria for its better prognostic stratification and more accurate predicting ability.
Multiple endo bronchial lipoma: a rare case report
Authors: Zhao Shunjin , Shui Yuexiang , Dai Zhong
Published: September 2020

Background

Endobronchial lipoma is an extremely rare benign tumor, which is generally located in the first three subdivisions of the tracheobronchial tree. According to the existing literature, all endobronchial lipomas are single (one per patient). Here, we report a rare case in which the patient presented with two endobronchial lipomas in the same patient, and underwent a bronchoscopic tumor resection in the left main bronchus and the left lower bronchus. Both tumors were pathologically confirmed as endobronchial lipoma.

Case presentation

A 52-year-old Chinese man presented at the clinic reporting a mild cough with yellow color sputum and exertional dyspnea for 2 weeks. He was a heavy smoker (45 pack-years). Chest auscultation demonstrated faint wheezing in left lower lobe. Computed tomography (CT) revealed two low-density endobronchial masses located in the middle segment of the left main bronchus and the posterior basilar segmental bronchus of the left lower lobe. The neoplasms measured a CT-attenuation value of -70HU, −98HU in density with air trapping and atelectasis in the segmental bronchus of the left lower lobe. The patient underwent interventional bronchoscopic management to remove the neoplasms by using an electrosurgical snare, cryotherapy, and electrocautery. The locations of the neoplasms were confirmed at the left main bronchus and the superior segment of the left lower lobe during bronchoscopic intervention. Histopathological examination confirmed that both tissues were consistent with lipomas. After 18 months of follow-up, the patient was free of symptoms and CT revealed that bronchiectasia remained in the superior segment of the left lower lobe; however, no mass lesion was present in the left bronchus.

Conclusions

This case suggests that an endobronchial lipoma can present as multiple lesions, and both proximal and distal types can simultaneously occur in the same patient. Thus, these findings help us further understand the biology of endobronchial lipomas.
Application of a classroom-based positive psychology education course for Chinese medical students to increase their psychological well-being: a pilot study
Authors: Zhang Xiao-Qin , Zhang Bao-Shuai , Wang Meng-Die
Published: September 2020

Background

Anxiety and depression have been increasing among Chinese medical students. The psychological well-being of Chinese medical students has become a critical focus of attention for the medical education community. Increasing evidence shows that positive psychology interventions can be effective in the enhancement of psychological well-being, and may help to prevent depressive symptoms in university students. In the present study, we aimed to explore the potential effect of positive psychology education on improving the mental health of Chinese medical students.

Methods

An 8-week classroom-based positive psychology intervention workshop, which was established as an elective course embedded in the regular school curriculum, was conducted at the School of Medicine, South China University of Technology (SCUT), China. Undergraduate medical students of the institute in year-2 or year-3 of academic study participated in this training course voluntarily. The participants’ self-reported data on the hope scale, life satisfaction scale, subjective happiness scale, and depression and anxiety scale were collected and analyzed at pre-course (n = 61) and post-course (n = 49) times. The investigation was also validated with an independent cohort of students who enrolled in the course in the year following the preliminary study.

Results

The analyses showed that the psychological well-being of the participants were improved after the intervention. Their mean scores on the hope scale, life satisfaction scale and subjective happiness scale were significantly improved (P < 0.05), while their symptom levels of depression and anxiety were significantly reduced (P < 0.01). A similar trend was observed in the validation cohort.

Conclusions

These preliminary findings suggest that positive psychology education holds promise for improving psychological well-being among Chinese medical students. Further investigations with larger and well-controlled sample cohorts may yield more convincing and reliable results.
Decreased costs and retained QoL due to the ‘PACE Steps to Success’ intervention in LTCFs: cost-effectiveness analysis of a randomized controlled trial
Authors: Wichmann Anne B. , Adang Eddy M. M. , Vissers Kris C. P. , Szczerbińska Katarzyna , Kylänen Marika , Payne Sheila , Gambassi Giovanni , Onwuteaka-Philipsen Bregje D. , Smets Tinne , Van den Block Lieve , Deliens Luc , Vernooij-Dassen Myrra J. F. J. , Engels Yvonne ,   on behalf of the PACE trial group, Andreasen Paula , Barańska Ilona , Bassal Catherine , Moore Danni Collingridge , Finne-Soveri Harriet , Froggatt Katherine , Hammar Teija , Heikkilä Rauha , Hockley Jo , Honinx Elisabeth , van Hout Hein , Kijowska Violetta , Ten Koppel Maud , Kuitunen-Kaija Outi , Leppäaho Suvi , Mammarella Federica , Mercuri Martina , Miranda Rose , de Paula Emilie Morgan , Van Den Noortgate Nele , Oosterveld-Vlug Mariska , Pac Agnieszka , Pasman H. Roeline W. , Pautex Sophie , Payne Sheila , Piers Ruth , Pivodic Lara , Rossi Paola , Szczerbińska Katarzyna , Segat Ivan , van der Steen Jenny T. , Stodolska Agata , Tanghe Marc
Published: September 2020

Background

The number of residents in long-term care facilities (LTCFs) in need of palliative care is growing in the Western world. Therefore, it is foreseen that significantly higher percentages of budgets will be spent on palliative care. However, cost-effectiveness analyses of palliative care interventions in these settings are lacking. Therefore, the objective of this paper was to assess the cost-effectiveness of the ‘PACE Steps to Success’ intervention. PACE (Palliative Care for Older People) is a 1-year palliative care programme aiming at integrating general palliative care into day-to-day routines in LTCFs, throughout seven EU countries.

Methods

A cluster RCT was conducted. LTCFs were randomly assigned to intervention or usual care. LTCFs reported deaths of residents, about whom questionnaires were filled in retrospectively about resource use and quality of the last month of life. A health care perspective was adopted. Direct medical costs, QALYs based on the EQ-5D-5L and costs per quality increase measured with the QOD-LTC were outcome measures.

Results

Although outcomes on the EQ-5D-5L remained the same, a significant increase on the QOD-LTC (3.19 points, p value 0.00) and significant cost-savings were achieved in the intervention group (€983.28, p value 0.020). The cost reduction mainly resulted from decreased hospitalization-related costs (€919.51, p value 0.018).

Conclusions

Costs decreased and QoL was retained due to the PACE Steps to Success intervention. Significant cost savings and improvement in quality of end of life (care) as measured with the QOD-LTC were achieved. A clinically relevant difference of almost 3 nights shorter hospitalizations in favour of the intervention group was found. This indicates that timely palliative care in the LTCF setting can prevent lengthy hospitalizations while retaining QoL. In line with earlier findings, we conclude that integrating general palliative care into daily routine in LTCFs can be cost-effective.

Trial registration

ISRCTN14741671.
Echocardiographic reference intervals with allometric scaling of 823 clinically healthy rhesus macaques (Macaca mulatta)
Authors: Ueda Yu , Duler Laetitia M. M. , Elliot Kami J. , Sosa Paul-Michael D. , Roberts Jeffrey A. , Stern Joshua A.
Published: September 2020

Background

Echocardiography is commonly used for assessing cardiac structure and function in various species including non-human primates. A few previous studies reported normal echocardiographic reference intervals of clinically healthy rhesus macaques under sedation. However, these studies were under-powered, and the techniques were not standardized. In addition, body weight, age, and sex matched reference intervals should be established as echocardiographic measurements are commonly influenced by these variables. The purpose of this study was to establish reference intervals for complete echocardiographic parameters based on a large cohort of clinically healthy rhesus macaques with wide ranges of weight and age distributions using allometric scaling.

Results

A total of 823 rhesus macaques (ages 6 months to 31 years old; body weights 1.4 to 22.6 kg) were enrolled. Of these rhesus macaques, 421 were males and 402 were females. They were assessed with a complete echocardiographic examination including structural and functional evaluation under sedation with ketamine hydrochloride. The reference intervals of the key echocardiographic parameters were indexed to weight, age, and sex by calculating the coefficients of the allometric eq. Y = aMb. On correlation matrix, body weight, age, sex, and heart rate were significantly correlated with various echocardiographic parameters and some of the parameters were strongly correlated with body weight and age. Multiple regression analysis revealed that heart rate and body weight statistically significantly predicted several echocardiographic parameters. Valve regurgitation including tricuspid, aortic, pulmonic, and mitral regurgitations without other cardiac structural and functional abnormalities are common in clinically healthy rhesus macaques under ketamine sedation.

Conclusions

In this study, the reference intervals of echocardiographic parameters were established by performing complete echocardiographic examinations on a large number of clinical healthy rhesus macaques. In addition, allometric scaling was performed based on their weight, and further indexed to age and sex. These allometrically scaled reference intervals can be used to accurately evaluate echocardiographic data in rhesus macaques and diagnose structural and functional evidence of cardiac disease.
Efficacy and safety of CHF6001, a novel inhaled PDE4 inhibitor in COPD: the PIONEER study
Authors: Singh Dave , Emirova Aida , Francisco Catherine , Santoro Debora , Govoni Mirco , Nandeuil Marie Anna
Published: September 2020

Background

This study evaluated the efficacy, safety and tolerability of the novel inhaled phosphodiesterase-4 inhibitor CHF6001 added-on to formoterol in patients with chronic obstructive pulmonary disease (COPD).

Methods

Randomised, double-blind, placebo- and active-controlled, parallel-group study. Eligible patients had symptomatic COPD, post-bronchodilator forced expiratory volume in 1 s (FEV1) 30–70% predicted, and history of ≥1 moderate/severe exacerbation. Patients were randomised to extrafine CHF6001 400, 800, 1200 or 1600 μg twice daily (BID), budesonide, or placebo for 24 weeks. Primary objectives: To investigate CHF6001 dose-response for pre-dose FEV1 after 12 weeks, and to identify the optimal dose. Moderate-to-severe exacerbations were a secondary endpoint.

Results

Of 1130 patients randomised, 91.9% completed. Changes from baseline in pre-dose FEV1 at Week 12 were small in all groups (including budesonide), with no CHF6001 dose-response, and no significant treatment–placebo differences. For moderate-to-severe exacerbations, CHF6001 rate reductions versus placebo were 13–28% (non-significant). In post-hoc analyses, CHF6001 effects were larger in patients with a chronic bronchitis phenotype (rate reductions versus placebo 24–37%; non-significant), and were further increased in patients with chronic bronchitis and eosinophil count ≥150 cells/μL (49–73%, statistically significant for CHF6001 800 and 1600 μg BID). CHF6001 was well tolerated with no safety signal (including in terms of gastrointestinal adverse events).

Conclusions

CHF6001 had no effect in the primary lung function analysis, although was well-tolerated with no gastrointestinal adverse event signal. Post-hoc analyses focused on exacerbation risk indicate specific patient subgroups who may receive particular benefit from CHF6001.

Trial registration

ClinicalTrials.gov (NCT02986321). Registered 8 Dec 2016.
Garden-based interventions and early childhood health: an umbrella review
Authors: Skelton Kara R. , Lowe Chenery , Zaltz Daniel A. , Benjamin-Neelon Sara E.
Published: September 2020

Background

Garden-based interventions show promise for improving not only child nutrition, but other indicators of child health. Yet, existing systematic reviews of garden-based interventions often focus on one particular health outcome or setting, creating a need to holistically summarize review-level evidence on the role of garden-based interventions in early childhood. To fill this gap, we performed an umbrella review of garden-based interventions to examine their role in early childhood health promotion for children ages 6 years and younger, examining effective components of garden-based interventions and critically evaluating existing evidence.

Methods

We searched the following databases: PubMed, PubMed, PsycINFO, ERIC, CINAHL, Embase, Scopus, OVID-Agricola, and CAB Direct, limiting to reviews published from 1990 to August 2019. Of the 9457 references identified, we included a total of 16 unique reviews for analysis.

Results

Across reviews, garden based-interventions were most effective at improving nutrition-related outcomes for children, including nutritional status and fruit and vegetable consumption. Few reviews examined child health outcomes of garden-based interventions that were not nutrition related, such as physical activity, or academic performance. Across settings, there was the most evidence in support of garden-based interventions conducted in home gardens, compared to evidence from early care and education or community settings. We were unable to report on most effective components of garden-based interventions due to limitations of included reviews.

Conclusions

Existing evidence is difficult to interpret due to methodological limitations at both the review and primary study level. Therefore, the lack of evidence for certain child health outcomes should not necessarily be interpreted as an absence of an effect of garden-based interventions for specific outcomes, but as a product of these limitations. Given the breadth of evidence for garden-based interventions to improve a number of dimensions of health with older children and adult populations, we highlight areas of future research to address evidence gaps identified in this umbrella review. Further research on the role of garden-based interventions, including their impact on non-nutrition early childhood health outcomes and how effectiveness differs by setting type is necessary to fully understand their role in early childhood health promotion.

PROSPERO registration

CRD42019106848.