bluuebunny/crossref_metadata_2025 huggingface dataset:
Severe Fibrous Dysplasia in McCune-Albright Syndrome: A Need for Continuous Surveillance
Authors: Grob Francisca , Clark Jonathan , Zacharin Margaret
Published: December 2020

Introduction: McCune-Albright syndrome (MAS) is a rare condition, in which GNAS mutations affect multiple organs. Fibrous dysplasia (FD), affecting only one or multiple skeletal territories, may severely affect craniofacial structures. Concomitant occurrence of acromegaly aggravates skull deformity, leading to eye, ear, and posterior cranial fossa compromise. Case Presentation: A 30-year-old man diagnosed with MAS at the age of 3 developed almost all known complications of the syndrome. The craniofacial component of his polyostotic FD increased over time, aggravated by difficult to control acromegaly. Acute onset of severe headache and neurologic compromise, caused by subarachnoid haemorrhage, caused his demise. Post-mortem examination revealed a meningeal artery aneurysm caused by disruption of the intracranial vasculature by severe bone disease. Adrenal histology revealed nodular hyperplasia without clinical evidence of hypercortisolism. Discussion: The post-mortem findings described aid understanding of the multiorgan involvement of MAS, providing new insights into possible pathogenetic mechanisms underlying the systemic effects of GNAS mutations, and highlight a need for systematic surveillance for cerebrovascular changes in craniofacial FD that may be amenable to intervention to avoid catastrophic outcome.
Effect of Anacetrapib on Cholesterol Efflux Capacity: A Substudy of the DEFINE Trial
Authors: Metzinger Mark P. , Saldanha Suzanne , Gulati Jaskeerat , Patel Kershaw V. , El‐Ghazali Ayea , Deodhar Sneha , Joshi Parag H. , Ayers Colby , Rohatgi Anand
Published: December 2020

Background

Anacetrapib is the only cholesteryl ester transfer protein inhibitor proven to reduce coronary heart disease (CHD). However, its effects on reverse cholesterol transport have not been fully elucidated. Macrophage cholesterol efflux (CEC), the initial step of reverse cholesterol transport, is inversely associated with CHD and may be affected by sex as well as haptoglobin copy number variants among patients with diabetes mellitus. We investigated the effect of anacetrapib on CEC and whether this effect is modified by sex, diabetes mellitus, and haptoglobin polymorphism.

Methods and Results

A total of 574 participants with CHD were included from the DEFINE (Determining the Efficacy and Tolerability of CETP Inhibition With Anacetrapib) trial. CEC was measured at baseline and 24‐week follow‐up using J774 macrophages, boron dipyrromethene difluoride–labeled cholesterol, and apolipoprotein B–depleted plasma. Haptoglobin copy number variant was determined using an ELISA assay. Anacetrapib increased CEC, adjusted for baseline CEC, risk factors, and changes in lipids/apolipoproteins (standard β, 0.23; 95% CI, 0.05–0.41). This CEC‐raising effect was seen only in men (
P
interaction=0.002); no effect modification was seen by diabetes mellitus status. Among patients with diabetes mellitus, anacetrapib increased CEC in those with the normal 1‐1 haptoglobin genotype (standard β, 0.42; 95% CI, 0.16–0.69) but not the dysfunctional 2‐1/2‐2 genotypes (
P
interaction=0.02).

Conclusions

Among patients with CHD, anacetrapib at a dose linked to improved CHD outcomes significantly increased CEC independent of changes in high‐density lipoprotein cholesterol or other lipids, with effect modification by sex and a novel pharmacogenomic interaction by haptoglobin genotype, suggesting a putative mechanism for reduced risk requiring validation.
Distribution of sasX, qacA/B and mupA genes and determination of genetic relatedness of methicillin-resistant Staphylococcus aureus among clinical isolates and nasal swab samples from the same patients in a hospital in Malaysia
Authors: Nurhafiza NNBA , Siti Asma H , Azian H , Foo PC , Yasmin KI , Chan YY
Published: December 2020

INTRODUCTION This study determined the distribution of sasX, qacA/B and mupA genes from methicillin-resistant Staphylococcus aureus (MRSA) isolated from clinical samples and nasal swab samples of the same patients and analysed their genetic relatedness. METHODS Polymerase chain reaction was used to detect the presence of sasX, qacA/B and mupA genes from 47 paired MRSA isolates. A paired isolate was defined as one nasal swab (colonising) isolate and clinical isolate that caused infection in the same patient. 22 selected paired isolates were subjected to multilocus sequence typing (MLST). The genetic relatedness among the isolates and association between the putative genes with epidemic sequence types (STs) were investigated. RESULTS 7 (14.9%, n = 14) paired isolates were positive for the sasX gene. qacA/B genes were positive in 7.4% (n = 7) of the isolates, from three paired isolates and one clinical isolate whose paired colonising isolate was negative. The paired sample of three patients were positive for both genes. The mupA gene was not detected in all the isolates. MLST revealed two epidemic STs, ST22 and ST239, and a novel ST4649. sasX and qacA/B genes were found in ST239 in 29.5% (n = 13) and 13.6% (n = 6) of cases, respectively. Gene co-existence occurred in 13.6% (n = 6) of MRSA ST239 and 2.3% (n = 1) of MRSA ST4649. CONCLUSION sasX and qacA/B genes were present in the MRSA isolates, while the mupA gene was undetected. ST22 and ST239 were the major MRSA clones. The circulating MRSA genotypes conferred different virulence and resistance determinants in our healthcare settings.
Epidemiology of stillbirths based on different gestational thresholds at a tertiary hospital
Authors: Tan KH , Dai F , Ng MJ , Tan PL , Yeo SH , Chern B
Published: December 2020

INTRODUCTION The stillbirth rate (SBR) is an important public health indicator. We studied the distribution of maternal and fetal characteristics and time trends of the SBR at KK Women’s and Children’s Hospital (KKH), Singapore, from 2004 to 2016 based on various definitions of stillbirth. METHODS Data was obtained from the Data Warehouse and Stillbirth Reporting System of KKH from 2004 to 2016. SBRs were calculated based on three definitions (fetal deaths at ≥ 20 weeks, 24 weeks or 28 weeks of gestation per 1,000 total births) and were described with maternal and fetal characteristics, and by year. RESULTS From 2004 to 2016, the SBR declined by 44.7%, 25.5% and 18.9% based on Definitions I, II and III, respectively. The SBR at KKH in 2016 was 5.2 (Definition I), 4.1 (Definition II) and 3.0 (Definition III) per 1,000 total births. The SBR was significantly higher in women aged ≥ 35 years, nulliparas and female fetuses. The number of live births at 24–27+6 weeks of gestation was more than four times higher than that of stillbirths (822 vs. 176). There were 104 (12.7%) neonatal deaths during this gestation period, giving a high survival rate of 87.3%. CONCLUSION The SBR in KKH is relatively lower than that in other developed countries. There is a need to consider revising our hospital and national definitions of the stillbirth lower boundary from 28 weeks to 24 weeks of gestation. This would allow us to make better comparisons with other developed countries, in line with improvements in healthcare.
The Case of “Costa del Nuuk”
Authors: Eriksen Freja C.
Published: December 2020

This chapter investigates how fifteen inhabitants of the Greenlandic capital, Nuuk, make sense of climate change and its impacts through media exposure and personal experiences. While Greenland’s melting ice sheet has long served as a backdrop to the global climate debate, local public views of climate change have largely been overlooked. This study finds that, although the media is an important source of information about climate change for the inhabitants of Nuuk, their sense-making of the phenomenon is saturated by personal experiences. Alarmist media representations, for instance, are continuously challenged by references to personal experiences of positive local impacts of climate change. The chapter identifies six distinctions underlying the inhabitants’ sense-making of climate change — natural/unnatural, certainty/uncertainty, self/other, local/global, positive/negative, and environment/economy.
Sense-Making of COP 21 among Rural and City Residents
Authors: Hoppe Imke , De Silva-Schmidt Fenja , Brüggemann Michael , Arlt Dorothee
Published: December 2020

This chapter explores the role of space in making sense of climate change coverage. The role of space is analyzed in the form of (a) (attributed) spatial distance and/or proximity to climate change, (b) personal nature and weather experiences attributed to climate change and (c) social spaces. The study compares how the United Nations’ summit COP 21, which resulted in the Paris Agreement in 2015, has been perceived and interpreted in an urban (Hamburg) and a rural setting (Otterndorf), both located in Northern Germany. In each setting, two focus group interviews were held (n = 15), one with long-term inhabitants and one with newly relocated citizens. This data was complemented by media diaries (including standardized and open questions), in which participants documented their communicative engagement with the climate summit on a daily basis. Media use in both cases is fairly similar, with participants in the rural setting using their local newspaper more intensively. Yet, local newspapers’ quality of reporting the summit was deemed as highly deficient, failing to provide a local angle to the climate summit and to the broader topic of climate change. Media, apparently, have not explained the issue well: climate change and politics are perceived as overly complex and distant. Space plays an important role: people in the rural setting—with the rising tides of the North Sea behind the dikes—felt more personally concerned by climate change than inhabitants of Hamburg. Furthermore, long-term inhabitants drew much stronger links between climate change and their region. The duration of stay in a certain setting thus turns out to be an important moderator of spatial influence on interpretations of climate change.
Extreme Weather Events and Local Impacts of Climate Change
Authors: Otto Friederike E. L.
Published: December 2020

While global and regional temperature increases are the most certain indicators of anthropogenic climate change, due to the emissions from burning fossil fuels, the damage caused by climate change is most clearly manifest in changes in seasons and extreme weather events. Recent advances in the attribution of extreme weather events, combined with newly available observations of past weather and climate, have made it possible to causally link high-impact extreme events to human-induced climate change. The level of confidence in these findings, however, varies according to the type of event and region of the world. While the increase in heatwaves can be quantified with confidence in most parts of the world, attribution assessments for droughts and hurricanes are much more uncertain.
Designing Performance Systems in Anticipation of Unintended Consequences: Experiences and Lessons From the Compstat-Based Performance Regime in NYPD
Authors: Lu Yi , Yang Kaifeng , Thomas M. Blair
Published: December 2020

Scholars have long documented the unintended consequences of performance systems, but insufficient attention is paid to the drivers of such consequences and the ways of mitigating them. This article contributes to this line of inquiry by analyzing New York Police Department’s (NYPD) experience with its signature performance system and its affiliated policies. With multiple data sources, it finds three main drivers of the unintended consequences, including the excessive performance pressure, the bureaucracy-public expectation mismatch, and the ambiguity concerning government performance. The article makes six suggestions regarding the design of performance management systems so that their potential unintended consequences can be better identified and mitigated.
Influence of metabolic syndrome on post-stroke outcome, angiogenesis and vascular function in old rats determined by dynamic contrast enhanced MRI
Authors: Pradillo Jesús M , Hernández-Jiménez Macarena , Fernández-Valle María E , Medina Violeta , Ortuño Juan E , Allan Stuart M , Proctor Spencer D , Garcia-Segura Juan M , Ledesma-Carbayo María J , Santos Andrés , Moro María A , Lizasoain Ignacio
Published: December 2020

Stroke affects primarily aged and co-morbid people, aspects not properly considered to date. Since angiogenesis/vasculogenesis are key processes for stroke recovery, we purposed to determine how different co-morbidities affect the outcome and angiogenesis/vasculogenesis, using a rodent model of metabolic syndrome, and by dynamic enhanced-contrast imaging (DCE-MRI) to assess its non-invasive potential to determine these processes. Twenty/twenty-two month-old corpulent (JCR:LA-Cp/Cp), a model of metabolic syndrome and lean rats were used. After inducing the experimental ischemia by transient MCAO, angiogenesis was analyzed by histology, vasculogenesis by determination of endothelial progenitor cells in peripheral blood by flow cytometry and evaluating their pro-angiogenic properties in culture and the vascular function by DCE-MRI at 3, 7 and 28 days after tMCAO. Our results show an increased infarct volume, BBB damage and an impaired outcome in corpulent rats compared with their lean counterparts. Corpulent rats also displayed worse post-stroke angiogenesis/vasculogenesis, outcome that translated in an impaired vascular function determined by DCE-MRI. These data confirm that outcome and angiogenesis/vasculogenesis induced by stroke in old rats are negatively affected by the co-morbidities present in the corpulent genotype and also that DCE-MRI might be a technique useful for the non-invasive evaluation of vascular function and angiogenesis processes.
Modal Mismatch and Accessibility Gap in Dhaka using a Time of Day Based Approach
Authors: Nakshi Paromita , Kishore Debnath Anindya
Published: December 2020

Transport accessibility is an area of growing global attention among transportation planners and policymakers. This paper aims to portray spatiotemporal variations of car and public bus accessibility in the context of a city in a developing country: Dhaka, Bangladesh. The public bus system in Dhaka is characterized by a semi-formal arrangement which means there is a lack of available data, for example, General Transit Feed Specification, which poses great difficulties in the study of accessibility. Given these limitations, we have presented the concept of major destinations to analyze spatiotemporal accessibility based on the simple understanding that trip purposes, time of day, and trip destinations are interlinked in an urban area, and different locations would attract a different number of trips based on the time of day. Using a spatial autocorrelation approach, we identified the statistically significant destination clusters in Dhaka by peak and off-peak hours. We measured accessibility to the major destinations using a cumulative opportunity-based metric followed by estimation of the Modal Accessibility Gap (MAG). The findings indicated that, regardless of the trip origins and time of day, dependence on public transport puts the users in a substantially disadvantageous position. From the policy perspective, we have suggested the introduction of a formal public transport system in Dhaka, particularly targeting the traffic analysis zones with higher MAG. Such an approach would lead to better resource usage while providing enhanced public transport services for both peak and off-peak hours and limiting dependence on cars.
Bankart Repair Versus Latarjet Procedure for Recurrent Anterior Shoulder Instability: A Systematic Review and Meta-analysis of 3275 Shoulders
Authors: Imam Mohamed A. , Shehata Mohamed S.A. , Martin Alexander , Attia Hamdy , Sinokrot Muhammad , Bahbah Eshak I. , Gwilym Stephen , Jacob Joshua , Narvani A. Ali , Meyer Dominik C.
Published: December 2020

Background:

Little consensus is available regarding the standard treatment for recurrent anterior instability of the shoulder. Typically, treatment selection has been based on training and tradition rather than the available evidence.

Purpose:

This study aimed to compare the clinical outcomes between arthroscopic Bankart procedure and the Latarjet procedure in the treatment of recurrent anterior shoulder instability with emphasis on follow-up time.

Study Design:

Systematic review and meta-analysis.

Methods:

We searched PubMed, Cochrane Central Register of Controlled Trials, Scopus, Ovid, and Web of Science up to January 2018 and included studies that compared arthroscopic Bankart versus Latarjet for treatment of anterior shoulder instability. Continuous data, such as operative time and patient-reported outcomes, were pooled as mean differences (MDs), whereas dichotomous data, such as recurrence, revision, redislocation, arthropathy, infection, and hematoma, were pooled as risk ratios (RRs), with 95% CIs.

Results:

Pooling data from 7 cohort studies (3275 patients) showed that arthroscopic Bankart was associated with a higher risk of redislocation (RR, 2.74; 95% CI, 1.48-5.06; P = .03), a higher risk of recurrence (RR, 2.87; 95% CI, 1.91-4.30; P < .0001), and a lower risk of infection (RR, 0.16; 95% CI, 0.06-0.43; P = .0002) compared with Latarjet, while the effect size did not favor arthroscopic Bankart or Latarjet in terms of Rowe score (MD, 0.22; 95% CI, –5.64 to 6.08; P = .94), revision (RR, 0.34; 95% CI, 0.08-1.39; P = .13), and hematoma (RR, 0.20; 95% CI, 0.03-1.19; P = .07). The effect estimate showed a pronounced advantage for Latarjet from 6 to 10 years postoperatively in terms of recurrence and redislocation (RR, 3.00; 95% CI, 1.98-4.56 and RR, 2.85; 95% CI, 1.51-5.38, respectively).

Conclusion:

Our results showed that Latarjet had less risk of recurrence and redislocation with longer follow-up time. Both procedures were comparable in terms of Rowe score, the need for revision, and postoperative hematoma formation, whereas Bankart repair was associated with a lower risk of infection.
General causality orientations in self-determination theory: Meta-analysis and test of a process model
Authors: Hagger Martin S , Hamilton Kyra
Published: December 2020

Causality orientations theory, a key sub-theory of self-determination theory, identifies three distinct causality orientations: autonomy, control, and impersonal orientation. The theory proposes generalized effects of the orientations on motivation and behavior. We meta-analyzed studies ( k = 83) testing relations between causality orientations, forms of motivation from self-determination theory, and behavior. Pooled data were used to test a process model in which autonomous and controlled forms of motivation mediated relations between causality orientations and behavior. Results revealed that autonomy and control orientations were positively correlated with autonomous and controlled forms of motivation, respectively. Impersonal orientation was correlated negatively with autonomy orientation and autonomous forms of motivation, and positively with control orientation and controlled forms of motivation. Process model tests revealed total effects of autonomy orientation on behavior, comprising direct and indirect effects through autonomous motivation, and a positive direct effect of control orientation on behavior and a negative indirect effect through controlled motivation, resulting in a zero total effect. Analysis of age, gender, behavior type, study design, and study quality revealed few moderator effects on model relations. Findings support effects of autonomy orientation on motivation and behavior, and the processes involved, and identify constructs that could be targeted, or circumvented, in behavioral interventions.
Self–other agreement in personality development in romantic couples
Authors: Lenhausen Madeline R , van Scheppingen Manon A , Bleidorn Wiebke
Published: December 2020

A large body of evidence indicates that personality traits show high rank-order stability and substantial mean-level changes across the lifespan. However, the majority of longitudinal research on personality development has relied on repeated assessments of self-reports, providing a narrow empirical base from which to draw conclusions and develop theory. Here, we (1) tested whether self- and informant-reports provided by couples show similar patterns of rank-order stability and mean-level change and (2) assessed self–other agreement in personality development. We charted the Big Five personality trajectories of 255 couples ( N = 510; M age = 27.01 years) who provided both self- and partner-reports at four assessments across 1.5 years. Results indicated similar rank-order stabilities in self- and partner-report data. Latent growth curve models indicated no significant differences between self- and partner-reported personality trajectories, with exceptions to extraversion and agreeableness. We further found strong cross-sectional agreement across all Big Five traits and assessment waves as well as moderate self–other agreement in personality change in emotional stability and agreeableness. These findings highlight the relevance of multi-method assessments in personality development, while providing information about personality stability and change. Discussion focuses on the theoretical implications and future directions for multi-method assessments in longitudinal personality research.
Atypical periprosthetic femoral fractures of the hip: characterisation of three cases
Authors: Toro Giuseppe , Di Fino Ciro , De Cicco Annalisa , Toro Gabriella , Paoletta Marco , Toro Antonio , Tarantino Umberto , Iolascon Giovanni , Panni Alfredo Schiavone
Published: December 2020

Introduction:

Long-term use of bisphosphonates (BPs) has been associated with a specific type of tensile side femoral stress fracture known as Atypical Femoral Fracture (AFF). Theoretically periprosthetic femoral fractures (PFF) should be excluded from the diagnosis of AFF. However, emerging evidence correlates prolonged BPs use with the occurrence of a type of PFF with an atypical pattern (atypical PFF, APFF). The aim of the present study is to report 3 cases of APFF treated at a single centre.

Methods:

Clinical and radiographic records of PFF that occurred between January 2016 and August 2018 were retrospectively reviewed. All patients meeting the American Society for Bone and Mineral Research (ASBMR) criteria for definition of PFF were included. Management strategies for APFF and patient outcomes, including fracture healing and hip function (assessed by the Oxford Hip Score [OHS]) were collected.

Results:

3 patients in the study period were identified as APFF (1 incomplete, 2 complete). All patients were females with a mean age of 83.3 years. All patients were treated with lateral plating. The application of a contralateral strut allograft resulted in fracture healing in cases of complete fractures. Mean OHS at final follow-up was 34.3.

Conclusions:

Despite occurring around a hip stem like PFF, APFF had peculiar clinical and radiographic features, making them more similar to AFF. Therefore, the orthopaedic surgeon should also consider the natural history and healing problems associated with AFF prior in order to choose the most appropriate management for APFF.
Knowledge and perceptions regarding triage among human papillomavirus–tested women: A qualitative study of perspectives of low-income women in Argentina
Authors: Victoria Sánchez Antelo , Racquel E Kohler , Lucila Szwarc , Melisa Paolino , Viswanath Kasisomayajula , Silvina Arrossi
Published: December 2020

Objectives:

Among cancer prevention studies, little is known about knowledge, attitudes, and beliefs toward triage adherence in the context of the human papillomavirus self-collection test. This formative research aims to identify knowledge, attitudes, and beliefs related to human papillomavirus and cervical cancer prevention specifically about adherence to Pap triage among women residing in a low-income province in Argentina.

Methods:

We conducted six focus groups, stratified by residence and age. All participants were aged 30 or older and had performed human papillomavirus self-collection. Data collection and thematic analysis were carried out using constructs from the Health Belief Model.

Results:

Misinformation regarding human papillomavirus and cervical cancer was common and was a source of distress. Women could not distinguish Pap screening from triage; human papillomavirus risk perception was limited but cervical cancer was perceived as a threatening disease. Women were willing to follow-up after receiving an abnormal screening result. Negative views about clinician-collected screening/triage were common, defined as painful and shameful, and comes with an economic cost (transport/time). Lack of help from family/friends was an obstacle to adhering to triage. Health issues in the family’s records and a physician’s recommendation were a cue to adhere to triage.

Conclusion:

Lack of knowledge or misinformation of the causes of cervical cancer, human papillomavirus, and the multi-step screening and triage process are barriers to follow-up adherence. Interventions to improve communication between women and health providers about screening results and follow-up are needed. Also, health services should be organized to respond to women’s needs and reduce access barriers to follow-up.
Ethical, social and legal implications of genomics for primary care
Authors: Spicer John , Papanikitas Andrew
Published: December 2020

The technical advances of genomic medicine have been well described in recent years, in the medical as well as public media. The social aspects of these advances have significant implications for primary care. GPs have previously ‘done genomics’ simply by the act of taking a family history from a patient and interpreting that history as part of ordinary care. Even at the level of a family history, genomic practice inevitably involves people other than that patient, and from that fact all the social and moral complexities arise. The scientific progress in current genomic research is creating a sphere of knowledge and information that GPs will need to be increasingly familiar with now and in the future. These advances offer opportunities and challenges for the health of communities and the learning needs of all GPs [see Box 1].
Single rotation CTA of extracranial carotids integrated with cerebral CTP provides sufficient quality for decision making in patients with ischaemic stroke
Authors: Wong Siong Chuong , Hausegger Klaus A , De Paoli Luca
Published: December 2020

Purpose

Large volume computed tomography scanners with 16 cm Z-axis single rotation coverage enable joggle-mode scanning of cerebral computed tomography perfusion and single rotation computed tomography angiography of cervical arteries. Our study aims to evaluate the feasibility of scanning cervical arteries, acquired with single rotation computed tomography angiography during computed tomography perfusion in ischaemic stroke patients.

Materials and methods

A total of 143 patients were scanned with a single contrast medium injection of 60 ml. Hounsfield units of the cervical arteries and veins were objectively measured and carotid bifurcations were subjectively reviewed. The incidence of artefacts and supra-aortic vessel coverage was recorded.

Results

Single rotation computed tomography angiography of the neck demonstrated supra-aortic vessels to their origins in 58 (40.6%) patients. Ninety-nine per cent (1140/1152) of arterial segments were adequately opacified (≥150 Hounsfield units). Arteries were adequately contrasted compared to veins in 81.3% (915/1126) of segments. However, the opacification was reversed in 14.0% (158/1126) of segments, indicating a delayed timing of acquisition; 95.5% (273/286) of carotid bifurcations were of good image quality. Measurement of internal carotid artery stenosis in single rotation computed tomography angiography according to the North American Symptomatic Carotid Endarterectomy Trial correlated well with digital subtraction angiography ( R=0.87, P<0.05). Significant artefacts resulted from metal/dental implants (10.5%), contrast in central veins (7.7%) and the shoulder region (4.9%).

Conclusion

Single rotation computed tomography angiography of the neck incorporated into cerebral computed tomography perfusion with single contrast medium administration revealed adequate image quality for further decision-making in our patient sample. The main drawbacks were inadequate coverage of supra-aortic arteries and possible delay in timing of the joggle.
Prostate adenocarcinoma of secretory type with wide expression of p63 and negativity of the basal marker Ck5/6: Rare subtype of adenocarcinoma of secretory origin and to be differentiated from basal cell carcinoma. Review of literature
Authors: Abbas Mahmoud , Habibian Borzo , Bettendorf Olaf
Published: December 2020

We report a case of prostate carcinoma with wide nuclear expression for p63. These cases are rare and show atypical cytoplasmic/membrane expression of Ck5/6, alpha-methylacyl coenzyme A racemase and high-molecular-weight cytokeratin. It is rare to find this type of carcinoma with negativity for Ck5/6. We would like to present this case to avoid a diagnostic pitfall and with review of literature to understand the origin of this rare subtype.
Diversity of mangrove root-dwelling sponges in a tropical coastal ecosystem in the southern Gulf of Mexico region
Authors: Castellanos-Pérez Pedro de Jesús , Vázquez-Maldonado Laura Elena , Ávila Enrique , Cruz-Barraza José Antonio , Canales-Delgadillo Julio César
Published: December 2020

Sponges are one of the most conspicuous groups of epibionts in mangrove prop root habitats. However, with the exception of the Caribbean and the Indo-Pacific regions, studies focused on species diversity are lacking in other locations that have high mangrove coverage and are relatively distant from coral reef environments. Because mangrove-root epibiont communities, in general, have been understudied worldwide, this research contributes to filling this knowledge gap. In this study, a total of 30 sponge species (belonging to three subclasses, 14 families and 19 genera) were recorded as epibionts on prop roots of the red mangrove Rhizophora mangle in a tropical coastal ecosystem of the Southern Gulf of Mexico. Of these, five were new records for the Gulf of Mexico, 14 were new for the Mexican coasts of the gulf and 25 were new for the study area. Moreover, a similarity analysis based on presence/absence data of mangrove-associated sponges reported throughout the Western Central Atlantic region revealed that the sponge assemblage from the study area was more similar to those documented in most of the Caribbean locations (Jamaica, Cuba, Martinique, Panama, Venezuela, Belize and Colombia) rather than with those of the Northeast of the Gulf of Mexico, Guadeloupe and Trinidad. This relative intra-regional dissimilarity in the structure of mangrove-associated sponge assemblages may be related to differences in environmental conditions as well as taxonomic effort. The study area, unlike most of the Caribbean locations, is characterized by estuarine conditions and high productivity throughout the year. The inter-site variability recorded in the composition of mangrove-associated sponges was influenced by a set of factors such as salinity, dissolved oxygen and hydrodynamism. This study shows the importance of exploring the mangrove-associated sponge assemblages from different regions of the world as it furthers knowledge of the biodiversity and global distribution of this group.
Prevalence and factors associated with erectile dysfunction among adult men in Moshi municipal, Tanzania: community-based study
Authors: Nyalile Kenan B. , Mushi Emmanuel H. P. , Moshi Epiphania , Leyaro Beatrice J. , Msuya Sia E. , Mbwambo Orgeness
Published: December 2020

Background

Erectile dysfunction (ED) has a negative impact on ones’ relationships with poor quality of life as inevitable result. The effects of ED maybe worse in developing countries setting like Tanzania because men’s sexual health has been forgotten. Men’s sexual and reproductive health needs are not in the national reproductive health strategic. This study aimed to determine the prevalence and factors associated with erectile dysfunction among adult men in Moshi municipality, northern Tanzania.

Results

The mean age of the 381 men was 39.6 (SD ±16.8) years. The overall prevalence of ED on this study was 29.7%. The severity of ED among study participants was; 13.4% (51), 9.7% (37), 3.7% (14), 2.9% (11) had mild, mild to moderate, moderate and severe erectile dysfunction respectively. Age 40–54 years (Adjusted OR 5.0, 95% CI 2.5–9.9),>55 years (aOR 11.7, 95% CI 5.8–23.7) and hypertension (aOR 2.6, 95% CI 1.1–6.4) were independent predictors of ED respectively.

Conclusion

The prevalence of ED is high among men in Moshi municipal as 1 out of 3 men have ED. Age and hypertension were independent predictors of ED. These results point to the need of community awareness and education programs to raise awareness among men about existence of ED problem, its consequence and where they can get advice and care in this setting. Further, health providers taking care of hypertensive and men with DM should be equipped with knowledge and skills on early detection for ED and how to counsel and where to refer patients for help.
Metabolomic and transcriptomic analyses of mutant yellow leaves provide insights into pigment synthesis and metabolism in Ginkgo biloba
Authors: Wu Yaqiong , Guo Jing , Wang Tongli , Cao Fuliang , Wang Guibin
Published: December 2020

Background

Ginkgo (Ginkgo biloba L.) is an excellent landscape species. Its yellow-green leaf mutants are ideal materials for research on pigment synthesis, but the regulatory mechanism of leaf coloration in these ginkgo mutants remains unclear.

Results

We compared the metabolomes and transcriptomes of green and mutant yellow leaves of ginkgo over the same period in this study. The results showed that the chlorophyll content of normal green leaves was significantly higher than that of mutant yellow leaves of ginkgo. We obtained 931.52M clean reads from different color leaves of ginkgo. A total of 283 substances in the metabolic profiles were finally detected, including 50 significantly differentially expressed metabolites (DEMs). We identified these DEMs and 1361 differentially expressed genes (DEGs), with 37, 4, 3 and 13 DEGs involved in the photosynthesis, chlorophyll, carotenoid, and flavonoid biosynthesis pathways, respectively. Moreover, integrative analysis of the metabolomes and transcriptomes revealed that the flavonoid pathway contained the upregulated DEM (−)-epicatechin. Fourteen DEGs from the photosynthesis pathway were positively or negatively correlated with the DEMs.

Conclusions

Our findings suggest a complex metabolic network in mutant yellow leaves. This study will provide a basis for studies of leaf color variation and regulation.
Mapping and understanding the decision-making process for providing nutrition and hydration to people living with dementia: a systematic review
Authors: Anantapong Kanthee , Davies Nathan , Chan Justin , McInnerney Daisy , Sampson Elizabeth L.
Published: December 2020

Background

This systematic review aimed to explore the process of decision-making for nutrition and hydration for people living with dementia from the perspectives and experiences of all involved.

Methods

We searched CINAHL, the Cochrane Library, EMBASE, MEDLINE and PsycINFO databases. Search terms were related to dementia, decision-making, nutrition and hydration. Qualitative, quantitative and case studies that focused on decision-making about nutrition and hydration for people living with dementia were included. The CASP and Murad tools were used to appraise the quality of included studies. Data extraction was guided by the Interprofessional Shared Decision Making (IP-SDM) model. We conducted a narrative synthesis using thematic analysis. PROSPERO registration number CRD42019131497.

Results

Forty-five studies were included (20 qualitative, 15 quantitative and 10 case studies), comprising data from 17 countries and 6020 patients, family caregivers and practitioners. The studies covered a range of decisions from managing oral feeding to the use of tube feeding. We found that decisions about nutrition and hydration for people living with dementia were generally too complex to be mapped onto the precise linear steps of the existing decision-making model. Decision-making processes around feeding for people living with dementia were largely influenced by medical evidence, personal values, cultures and organizational routine. Although the process involved multiple people, family caregivers and non-physician practitioners were often excluded in making a final decision. Upon disagreement, nutrition interventions were sometimes delivered with conflicting feelings concealed by family caregivers or practitioners. Most conflicts and negative feelings were resolved by good relationship, honest communication, multidisciplinary team meetings and renegotiation.

Conclusions

The decision-making process regarding nutrition and hydration for people living with dementia does not follow a linear process. It needs an informed, value-sensitive, and collaborative process. However, it often characterized by unclear procedures and with a lack of support. Decisional support is needed and should be approached in a shared and stepwise manner.
Cancer of unknown primary with EGFR mutation successfully treated with targeted therapy directed by clinical next-generation sequencing: a case report
Authors: Mitani Yosuke , Kanai Masashi , Kou Tadayuki , Kataoka Shigeki , Doi Keitaro , Matsubara Junichi , Ohashi Shinya , Matsumoto Shigemi , Muto Manabu
Published: December 2020

Background

Cancer of unknown primary (CUP) is usually treated with nonselective and empirical chemotherapy; however, its prognosis is generally poor, with a median survival of less than a year. Thus, clinicians eagerly await the development of more effective treatment strategies. In recent years, advances in next-generation sequencing (NGS) have made it possible to analyze comprehensively the genome of individual cancers. NGS has identified many genomic alterations, some of which are potential molecular targets of specific agents. We report a case of CUP that was successfully treated with targeted therapy directed by the genomic data obtained from an NGS-based multiplex assay.

Case presentation

A 52-year-old Asian woman with right hip joint pain underwent fluorodeoxyglucose-positron emission tomography/computed tomography, which showed multiple metastatic tumors in her right hip joint, thyroid gland, lung, and vertebrae. Brain magnetic resonance imaging showed multiple cerebral metastases. Additional tests, including pathology examination and conventional epidermal growth factor receptor (EGFR) gene mutation analysis (single-strand conformation polymorphism assay), could not identify the primary origin of the tumors, so the patient was diagnosed with CUP. After empirical chemotherapy for CUP, an NGS-based multiplex assay performed using a resected specimen of thyroid tumor detected the EGFR mutation c.2573 T > G p.Leu858Arg (L858R). Her treatment was changed to erlotinib, an EGFR tyrosine-kinase inhibiter, which dramatically shrank the tumors and decreased her serum carcinoembryonic antigen level. She achieved long-term disease control and survived for 2 years and 9 months from the first diagnosis.

Conclusion

This case might support the strategy that NGS-based multiplex assays could identify actionable molecular targets for individual patients with CUP.
“It brought hope and peace in my heart:” Caregivers perceptions on kangaroo mother care services in Malawi
Authors: Nyondo-Mipando Alinane Linda , Kinshella Mai-Lei Woo , Salimu Sangwani , Chiwaya Brandina , Chikoti Felix , Chirambo Lusungu , Mwaungulu Ephrida , Banda Mwai , Newberry Laura , Njirammadzi Jenala , Hiwa Tamanda , Vidler Marianne , Dube Queen , Molyneux Elizabeth , Mfutso-Bengo Joseph , Goldfarb David M. , Kawaza Kondwani
Published: December 2020

Background

Kangaroo mother care (KMC) is an effective intervention for preterm and low birth weight infants. Effective implementation of KMC relies on a multidisciplinary team centering on the newborn’s caregiver, who delivers care with support from health care workers. This study explored the experiences of caregivers on the implementation of KMC.

Methods

We conducted a descriptive qualitative study in the phenomenological tradition, an interpretative approach to describe the caregivers’ lived experience with KMC at four health facilities in Malawi from April and June 2019 through 10 non-participatory observations and 24 face-to-face interviews. We drew a purposive sample of 14 mothers, six fathers, three grandmothers, and one grandfather of infants receiving KMC in three secondary and one tertiary level hospitals. Data were analyzed following a thematic approach.

Results

Caregivers had limited information on KMC before admission with most of the information learned from peers rather than medical professionals. Stories of positive outcomes following KMC contributed to a shift in perceptions of premature babies and acceptability of KMC as an effective intervention. Unintended consequences resulting from admission due to KMC disrupts responsibilities around the home and disrupts economic activities. Gender division of roles exists with the implementation of KMC and a mother’s support networks are crucial.

Conclusion

Kangaroo mother care is feasible and acceptable among caregivers. KMC babies are described more positively with the potential to grow into strong and healthy children. KMC remains focused on the mother, which undervalues the important roles of her support network. A change in the nomenclature from kangaroo mother care to kangaroo care would include fathers and others delivering care.
Bronchoscopist's perception of the quality of the single-use bronchoscope (Ambu aScope4™) in selected bronchoscopies: a multicenter study in 21 Spanish pulmonology services
Authors: Flandes Javier , Giraldo-Cadavid Luis Fernando , Alfayate Javier , Fernández-Navamuel Iker , Agusti Carlos , Lucena Carmen M. , Rosell Antoni , Andreo Felipe , Centeno Carmen , Montero Carmen , Vidal Iria , García-Alfonso Lucía , Bango Antonio , Ariza Miguel , Gallego Rocío , Orta Marta , Bello Salvador , Mincholé Elisa , Torrego Alfons , Pajares Virginia , González Héctor , Wangüemert Aurelio Luis , Pérez-Izquierdo Julio , Disdier Carlos , de Vega Sanchez Blanca , Cordovilla Rosa , Cascón Juan , Cruz Antonio , García-López J. Javier , Puente Luis , Benedetti Paola , García-Gallo Cristina L. , Díaz Nuevo Gema , Aguado Silvia , Partida Concepción , Díaz-Agero Prudencio , Luque Crespo Estefanía , Pavón María , Páez Francisco , Cases Enrique , Martínez Raquel , Briones Andrés , Fernández Cleofe , Martín Serrano Concepción , Uribe-Hernández Ana Maria , Robles Jose
Published: December 2020

Background

The disposable bronchoscope is an excellent alternative to face the problem of SARS-CoV-2 and other cross infections, but the bronchoscopist's perception of its quality has not been evaluated.

Methods

To evaluate the quality of the Ambu-aScope4 disposable bronchoscope, we carried out a cross-sectional study in 21 Spanish pulmonology services. We use a standardized questionnaire completed by the bronchoscopists at the end of each bronchoscopy. The variables were described with absolute and relative frequencies, measures of central tendency and dispersion depending on their nature. The existence of learning curves was evaluated by CUSUM analysis.

Results

The most frequent indications in 300 included bronchoscopies was bronchial aspiration in 69.3% and the median duration of these was 9.1 min. The route of entry was nasal in 47.2% and oral in 34.1%. The average score for ease of use, image, and aspiration quality was 80/100. All the planned techniques were performed in 94.9% and the bronchoscopist was satisfied in 96.6% of the bronchoscopies. They highlighted the portability and immediacy of the aScope4TM to start the procedure in 99.3%, the possibility of taking and storing images in 99.3%. The CUSUM analysis showed average scores > 70/100 from the first procedure and from the 9th procedure more than 80% of the scores exceeded the 80/100 score.

Conclusions

The aScope4™ scored well for ease of use, imaging, and aspiration. We found a learning curve with excellent scores from the 9th procedure. Bronchoscopists highlighted its portability, immediacy of use and the possibility of taking and storing images.
Local and global analysis of a nonlinear duopoly game with heterogeneous firms
Authors: Askar Sameh
Published: December 2020

In this paper, we introduce a nonlinear duopoly game whose players are heterogeneous and their inverse demand functions are derived from a more general isoelastic demand. The game is modeled by a discrete time dynamic system whose Nash equilibrium point is unique. The conditions of local stability of Nash point are calculated. It becomes unstable via two types of bifurcations: flip and Neimark–Sacker. Some local and global numerical investigations are performed to show the dynamic behavior of game’s system. We show that the system is noninvertible and belongs to$Z_{2}-Z_{0}$Z2−Z0type. We also show some multistability aspects of the system including basins of attraction and regions known as lobes.
Risk management in the era of recovery and rights
Authors: Carroll Andrew , McSherry Bernadette
Published: December 2020

Clinical decision-making in psychiatry is affected by many factors, including how best to reduce risks of harm while promoting autonomy and personal recovery. This article proposes guidance for clinical decision-making that is consistent with civil liability law. It emphasises collaboration, clarification of the available information and communication of decisions as a basis for recovery-oriented risk management.
Maternal mental health services in Sri Lanka: challenges and solutions
Authors: Hapangama Aruni , Kuruppuarachchi K.A.L.A.
Published: December 2020

Sri Lanka boasts of making significant strides in the indicators of maternal healthcare during the past few decades. However, these indicators mostly look only at the physical well-being of women. Lack of awareness regarding maternal mental health problems among grass-root level healthcare workers, poor integration of services, and the culture and stigma regarding perinatal mental disorders are barriers to improving services in maternal mental healthcare in Sri Lanka.