bluuebunny/crossref_metadata_2025 huggingface dataset:
Utility of serological tumor biomarkers for surveillance of hepatocellular carcinoma in patients undergoing dialysis
Authors: Toyoda Hidenori , Kikuchi Kan , Tsuruta Yuki , Hiraoka Atsushi , Tsuji Kunihiko , Tanaka Junko
Published: June 2020

Background

Patients undergoing dialysis are at risk of hepatocellular carcinoma (HCC) and preferably should undergo HCC surveillance. We investigated the utility of HCC tumor markers for HCC surveillance in patients undergoing dialysis.

Methods

Three serum markers specific for HCC, namely alpha-fetoprotein (AFP), Lens culinaris agglutinin A-reactive fraction of AFP (AFP-L3) and des-gamma-carboxy prothrombin (DCP), were measured in dialysis patients with and without a diagnosis of HCC (n = 60 and 507, respectively). The predictive value of each marker and that of a diagnostic score (GALAD score) based on patient age and gender as well as the same three markers were evaluated by receiver-operating characteristic (ROC) analysis, as well as sensitivity and specificity.

Results

AFP, DCP and the GALAD scores showed high predictive values for HCC, with areas under the ROC curve of >0.85. This effectiveness remained when focusing on small HCC (≤3 cm or ≤2 cm) or early-stage HCC (Stage I), as well as after propensity score matching of background characteristics of HCC and non-HCC patients. In particular, DCP and GALAD score had excellent predictive abilities for HCC.

Conclusions

Measuring serum tumor markers for HCC can serve as a complement to imaging studies in the surveillance of HCC in patients undergoing dialysis, and reduce the likelihood of advanced HCC at detection and diagnosis.
Phase I study of vinblastine in combination with nilotinib in children, adolescents, and young adults with refractory or recurrent low-grade glioma
Authors: Vairy Stephanie , Le Teuff Gwénaël , Bautista Francisco , De Carli Emilie , Bertozzi Anne-Isabelle , Pagnier Anne , Fouyssac Fanny , Nysom Karsten , Aerts Isabelle , Leblond Pierre , Millot Frederic , Berger Claire , Canale Sandra , Paci Angelo , Poinsignon Vianney , Chevance Aurelie , Ezzalfani Monia , Vidaud Dominique , Di Giannatale Angela , Hladun-Alvaro Raquel , Petit Francois M , Vassal Gilles , Geoerger Birgit , Le Deley Marie-Cécile , Grill Jacques
Published: June 2020

Background

New rescue regimens are needed for pediatric refractory/recurrent low-grade glioma. Nilotinib is a tyrosine kinase inhibitor that has potential synergistic effects with vinblastine on angiogenesis, tumor cell growth, and immunomodulation.

Methods

This phase I trial aimed to determine the recommended doses of this combination for phase II trials (RP2D) using the dual-agent Bayesian continual reassessment method. Nilotinib was given orally twice daily (BID) in combination with once-weekly vinblastine injections for a maximum of 12 cycles of 28 days (clinicaltrials.gov, NCT01884922).

Results

Thirty-five pediatric patients were enrolled across 4 dose levels. The median age was 7 years and 10 had neurofibromatosis type 1. Patients had received a median of 3 prior treatment lines and 25% had received more than 4 previous treatment lines. Dose-limiting toxicity (DLT) during cycle 1 was hematologic, dermatologic, and cardiovascular. The RP2D was identified at 3 mg/m2 weekly for vinblastine with 230 mg/m2 BID for nilotinib (estimated probability of DLT = 18%; 95% credibility interval, 7–29%). Fifteen patients completed the 12 cycles; 2 stopped therapy prematurely due to toxicity and 18 due to disease progression. Three patients achieved a partial response leading to an objective response rate of 8.8% (95% confidence interval [CI], 1.9–23.7), and the disease control rate was 85.3% (95% CI, 68.9–95.1). The 12-month progression-free survival was 37.1% (95% CI, 23.2–53.67).

Conclusions

Vinblastine and nilotinib combination was mostly limited by myelosuppression and dermatologic toxicity. The efficacy of the combination at the RP2D is currently evaluated in a randomized phase II trial comparing this regimen to vinblastine alone.
Coulomb screening correction to the Q value of the triple-alpha process in thermal plasmas
Authors: Phyu Lai Hnin , Moriya H , Horiuchi W , Iida K , Noda K , Yamashita M T
Published: June 2020

The triple-alpha reaction is key to $^{12}$C production and is expected to occur in weakly coupled thermal plasmas as encountered in normal stars. We investigate how Coulomb screening affects the structure of a system of three alpha particles in such a plasma environment by precise three-body calculations within the Debye–Hückel approximation. A three-alpha model that has the Coulomb interaction modified in the Yukawa form is employed. Precise three-body wave functions are obtained by a superposition of correlated Gaussian basis with the aid of the stochastic variational method. The energy shifts of the Hoyle state due to the Coulomb screening are obtained as a function of the Debye screening length. The results, which automatically incorporate the finite-size effect of the Hoyle state, are consistent with the conventional result based on the Coulomb correction to the chemical potentials of ions that are regarded as point charges in a weakly coupled thermal plasma. We have given a theoretical basis to the conventional point-charge approach to the Coulomb screening problem relevant for nuclear reactions in normal stars by providing the first evaluation of the Coulomb corrections to the $Q$ value of the triple-alpha process that produces a finite-size Hoyle state.
Which Learning Activities Enhance Physical Therapist Practice? Part 1: Systematic Review and Meta-analysis of Quantitative Studies
Authors: Leahy Edmund , Chipchase Lucy , Calo Marlena , Blackstock Felicity C
Published: June 2020

Objective

Following graduation from professional education, the development of clinical expertise requires career-long participation in learning activities. The purpose of this study was to evaluate which learning activities enhanced physical therapist practice.

Methods

Eight databases were searched for studies published from inception through December 2018. Articles reporting quantitative data evaluating the effectiveness of learning activities completed by qualified physical therapists were included. Study characteristics and results were extracted from the 26 randomized controlled trials that met the inclusion criteria. Clinician (knowledge, affective attributes, and behavior) and patient-related outcomes were extracted.

Results

There was limited evidence that professional development courses improved physical therapist knowledge. There was low-level evidence that peer assessment and feedback were more effective than case discussion at improving knowledge (standardized mean difference = 0.35, 95% CI = 0.09–0.62). Results were inconsistent for the effect of learning activities on affective attributes. Courses with active learning components appeared more effective at changing physical therapist behavior. The completion of courses by physical therapists did not improve patient outcomes; however, the addition of a mentored patient interaction appeared impactful.

Conclusion

Current evidence suggests active approaches, such as peer assessment and mentored patient interactions, should be used when designing learning activities for physical therapists. Further high-quality research focused on evaluating the impact of active learning interventions on physical therapist practice and patient outcomes is now needed.

Impact

This study is a first step in determining which learning activities enhance clinical expertise and practice would enable the physical therapy profession to make informed decisions about the allocation of professional development resources.
Which Learning Activities Enhance Physical Therapist Practice? Part 2: Systematic Review of Qualitative Studies and Thematic Synthesis
Authors: Leahy Edmund , Chipchase Lucy , Calo Marlena , Blackstock Felicity C
Published: June 2020

Objective

Post-professional physical therapy expertise requires career-long participation in learning activities. Understanding physical therapists’ lived experience of learning activities provides novel insight into how best to enhance physical therapist practice from the perspective of the learner. The purpose of this study was to explore qualified physical therapists’ experiences, beliefs, and perspectives with regard to learning activities and professional development.

Methods

Eight databases were searched for studies published from inception through December 2018. Study selection included mixed-methods and qualitative studies exploring physical therapists’ experiences, perspectives, beliefs, and attitudes. Thematic synthesis was performed, and the GRADE-Confidence in the Evidence from Reviews of Qualitative research was used to assess the level of confidence in the findings. A total 41 studies with 719 participants were included.

Results

The key findings include physical therapists’ perceptions that worthwhile post-professional learning requires more than attendance at professional development courses. Physical therapists perceived that worthwhile learning requires connection with others and being “taken out of one’s comfort zone.” Sufficient time and accessible, trustworthy resources were also valued.

Conclusions

Moderate- to low-level evidence suggests that the choice of professional development activities and education design for qualified physical therapists should consider the inclusion of connected activities, activities that take participants out of comfort zones, time to practice, and trustworthy resources that are easily accessible. Future research should evaluate the effectiveness of learning activities encompassing these factors, prioritizing those that minimize the barriers of time and distance.

Impact

This study adds to the profession’s understanding of physical therapists’ lived experience of learning activities, providing novel insight into how best to enhance physical therapist practice from the perspective of the learner.
Opiates and the ‘Therapeutic Revolution’ in Japan
Authors: Vitale Judith
Published: June 2020

This article argues that the widespread use of opiate-compounded medicines in late-nineteenth-century Japan was partly a result of Meiji period (1868–1912) public health policies. An overview of the status of opiates in Japan from the seventeenth to the nineteenth centuries is intended to explain possible reasons: pharmaceutical reforms in the 1870s and 1880s were based on Edo-period (1603–1868) protostructures of regulated drug manufacture; in contrast, the Meiji government failed to introduce Western clinical practice within a short span of time. As a result opiates, marketed as Western ‘modern’ medicines, were smoothly integrated into pre-existing beliefs, according to which drugs and diets maintained bodily health.
Dual UTR-A novel 5′ untranslated region design for synthetic biology applications
Authors: Balzer Le Simone , Onsager Ingerid , Lorentzen Jon Andreas , Lale Rahmi
Published: June 2020

Bacterial 5′ untranslated regions of mRNA (UTR) involve in a complex regulation of gene expression; however, the exact sequence features contributing to gene regulation are not yet fully understood. In this study, we report the design of a novel 5′ UTR, dual UTR, utilizing the transcriptional and translational characteristics of 5′ UTRs in a single expression cassette. The dual UTR consists of two 5′ UTRs, each separately leading to either increase in transcription or translation of the reporter, that are separated by a spacer region, enabling de novo translation initiation. We rationally create dual UTRs with a wide range of expression profiles and demonstrate the functionality of the novel design concept in Escherichia coli and Pseudomonas putida using different promoter systems and coding sequences. Overall, we demonstrate the application potential of dual UTR design concept in various synthetic biology applications ranging from fine-tuning of gene expression to maximization of protein production.
Supplementation with calcium salts of cottonseed oil improves performance of Bos indicus animals consuming finishing diets1
Authors: Carvalho Marcos A A , Cappellozza Bruno I , Silva Bruna , Castro Thais S , Burim Marcos Renato , Cervieri Rafael C
Published: June 2020

Lipid ingredients are often used into feedlot cattle diets, primarily to increase energy density and improve efficiency parameters of the herd. Therefore, this study was designed to evaluate the effects of including calcium salts of fatty acids (CSFA) and increasing levels of cottonseed byproducts into feedlot diets. On day 0 of the study, 96 Bos indicus bullocks were individually weighed twice and initial body weight (BW) was considered the average of both measurements (initial BW = 287 ± 22.4 kg). Bulls were ranked by initial BW, allocated into 1 of 12 feedlot pens (eight bulls per pen), and pens randomly assigned to one of three treatments: 1) inclusion of 15.0% [dry matter (DM) basis] of cottonseed byproducts into the finishing diet (CTS-15; n = 4), 2) inclusion of 22.0% (DM basis) of cottonseed byproducts into the finishing diet (CTS-22; n = 4), and 3) inclusion of 2.7% (DM basis) of CSFA of cottonseed oil into the finishing diet (CSFA; n = 4). The experimental period lasted 135 d and consisted of 5 d of preadaptation, 15 d of adaptation (ADP), 31 d of growing (GRO), and 84 d of finishing (FIN). Performance and carcass characteristics data were evaluated at the end of the experimental period. A treatment × period interaction was observed on total DM intake (DMI; P < 0.0001), given that no treatment differences were observed during ADP (P > 0.33), whereas CSFA-supplemented animals had a reduced DMI during GRO and FIN phases (P < 0.05). When individual mean nutrient intake was evaluated, CSFA supplementation caused a reduction in crude protein and physically effective neutral detergent fiber intake (P ≤ 0.05), and tended to reduce metabolizable energy, net energy for maintenance and gain intake (P = 0.06). Additionally, CSFA inclusion or CTS increase into the diet did not affect final BW, BW change, average daily gain (ADG), hot carcass weight, carcass ADG, and yield gain (P ≥ 0.11). On the other hand, CSFA reduced DMI as percentage of BW and improved feed efficiency (FE; P < 0.02) and also tended to improve biological conversion (BC; P = 0.07) versus CTS. Similarly, increasing CTS byproducts in the diet improved FE and BC (P = 0.02) but also tended to increase dressing percentage (DP; P = 0.08). In summary, including CSFA into feedlot diets reduced DMI but improved FE and BC of beef cattle, demonstrating the efficacy of this technology on feedlot beef cattle diets. Moreover, increasing cottonseed byproducts into the diets also benefited FE, BC, and DP of finishinw B. indicus cattle.
Impact of UV-C Radiation Applied during Plant Growth on Pre- and Postharvest Disease Sensitivity and Fruit Quality of Strawberry
Authors: Forges M. , Bardin M. , Urban L. , Aarrouf J. , Charles F.
Published: June 2020

Ultraviolet-C (UV-C) radiation is efficient in reducing the development of diseases in many species, including strawberry (Fragaria × ananassa). Several studies suggest that UV-C radiation is effective not only because of its disinfecting effect but also because it may stimulate plant defenses. In this study, the effect of preharvest UV-C radiation applied during strawberry cultivation on plant growth, fruit quality, and susceptibility to major fungal diseases such as gray mold, powdery mildew, and soft rot was evaluated. UV-C treatments had an impact on flowering initiation and fruit development. Flowering occurred earlier for UV-C-treated plants than for nontreated plants. At harvest, a larger amount of fruit was produced by treated plants despite their slight decrease in leaf area. UV-C treatment did not improve strawberry shelf life but did not alter the physical integrity of strawberry fruit. Natural infection of leaves to powdery mildew and of fruit to Rhizopus spp. strongly decreased in response to UV-C treatment.
A Genome Resource for the Apple Powdery Mildew Pathogen Podosphaera leucotricha
Authors: Gañán Lederson , White Richard Allen , Friesen Maren L. , Peever Tobin L. , Amiri Achour
Published: June 2020

Powdery mildew, caused by Podosphaera leucotricha, is an economically important disease of apple and pear trees. A single monoconidial strain (PuE-3) of this biotrophic fungus was used to extract DNA for Illumina sequencing. Data were assembled to form a draft genome of 43.8 Mb consisting of 8,921 contigs, 9,372 predicted genes, and 96.1% of complete benchmarking universal single copy orthologs (BUSCOs). This is the first reported genome sequence of P. leucotricha that will enable studies of the population biology, epidemiology, and fungicide resistance of this pathogen. Furthermore, this resource will be fundamental to uncover the genetic and molecular mechanisms of the apple−powdery mildew interaction, and support future pome fruit breeding efforts.
Evolving perspectives on stool testing for colorectal cancer: a qualitative systematic review
Authors: Chin Yip Han , Ng Cheng Han , Seah Sherlyn Hui Yu , Jain Sneha Rajiv , Law Jia Hao , Devi M. Kamala , Chong Choon Seng
Published: June 2020

Objectives

Colorectal cancer is one of the leading causes of cancer-related deaths globally. A multitude of screening methods has been devised for early diagnosis, including the faecal immunochemical test (FIT). This qualitative review aims to discover the barriers and facilitators to the utility of the FIT from the general population’s perspective.

Methods

Authors searched five electronic bases (Medline, Embase, CINAHL, PsycINFO and Web of Science) till December 2019. The search was conducted using key search terms and qualitative and mixed-method studies were included. Two independent reviewers screened articles and conducted quality appraisal. Data were synthesised thematically.

Results

A total of 11 articles that reported users’ views on FIT kits were included. Three themes were generated from the included articles: FIT kit factors, patients’ perception of colorectal cancer screening, and social health support system. The nature of the test and the supplementary information was found to affect the utilisation of the test. User’s awareness and perspectives towards cancer and screening were found to have impacted the adoption of the FIT kit. Social support and local healthcare systems were also found to have influenced the use of FIT.

Conclusion

This systematic review focuses on addressing and understanding the perception of FIT from first-hand accounts. Since its inception, FIT screening has increased colorectal cancer screening uptake due to its increased reliability and the simplicity of the test. However, there is a need to increase the uptake of FIT kits through increasing accessibility of the screening process and considering the holistic patient experience.
Roflumilast attenuates cognitive deficits in estrogen insufficient rats
Authors: Goyal Ahsas , Garabadu Debapriya
Published: June 2020

Estrogen replacement therapy including specific estrogen receptor alpha (ERα) agonist, 4,4′,4″-(4-propyl-[1H] pyrazole-1,3,5-triyl) trisphenol (PPT), improves cognitive function in the females with estrogen insufficiency condition. It is well suggested that the cyclic nucleotides are considered as one of the downstream mediators to ERα receptor activity and they can be hypothesized as a potential target in the management of estrogen insufficiency condition. Roflumilast, a phosphodiesterase-4 inhibitor, increases the level of cyclic adenosine monophosphate (cAMP) in most of the tissues including the brain, and is reported to have procognitive activity in the experimental animals. Hence, the present study evaluated the therapeutic effect of roflumilast with or without PPT in rats with experimentally-induced estrogen insufficiency. Estrogen insufficiency was induced in female rats through bilateral ovariectomy on day-1 (D-1) of the experimental schedule. Roflumilast (0.3 and 1.0 mg/kg; p.o.) and PPT (333µg/kg; i.p.) attenuated ovariectomy-induced cognitive deficits in the rodents during behavioral tests. Roflumilast and PPT increased the cholinergic function and cAMP level in the rat hippocampus and prefrontal cortex. Further, ovariectomy-induced decrease in the extent of phosphorylation of ERα in both the brain regions was attenuated with the monotherapy of either roflumilast or PPT. Interestingly, the combination of 1.0 mg/kg roflumilast and PPT exhibited better therapeutic effectiveness than their monotherapy. In addition, roflumilast facilitated PPT-induced increase in the level of expression of phosphorylated protein kinase-B (Akt) in both the rat brain regions. Hence, it can be assumed that the combination of roflumilast and PPT could be a therapeutic option in the management of estrogen insufficiency-induced disorders.
Anterior versus Posterior Scoring of Cartilage in Otoplasty: A Retrospective Patient-related Outcome Measurement Study
Authors: Smit Johannes A. , Coenen Dominique W. , van Amerongen Eline A. , Ruhé P. Quinten , Breugem Corstiaan C.
Published: June 2020

Background:

Various surgical techniques are applied to correct prominent ears. However, there are limited data on the effect of otoplasty on patient-related outcome measures, such as cold ears and cold intolerance. This retrospective cohort study describes the occurrence of cold intolerance in 98 patients, with a total of 196 ears in a single center during 6 years (2011–2017).

Methods:

In this study, 3 groups were identified: group I, anterior scoring of the cartilage (ie, Chong Chet); group II, posterior scoring of the cartilage and suture reposition of the cartilage; and group III, posterior approach without scoring (ie, Furnas and Mustardé). Parents of patients filled in a questionnaire with 40 questions to criticize the effect of surgery.

Results:

Symptoms of cold intolerance and pain were reported in 44.4% (n = 16) in the anterior scoring group, 48.1% (n = 26) in the posterior scoring group, and 62.5% (n = 5) in the posterior approach group without scoring of the cartilage (P = 0.68). The satisfaction rate was significantly lower in the posterior group without scoring (Likert scale of 17.44 ± 22.01 anterior scoring, 16.02 ± 18.13 posterior scoring, and 11.13 ± 25.87 posterior approach without scoring; P = 0.02).

Conclusions:

This study underscores the fact that a great part of patients after otoplasty report symptoms of cold intolerance; however, these most often resolve and did not differ between different groups. Patients should be informed about this sequela. Furthermore, overall satisfaction rate was significantly lower in the posterior group without scoring.
Effects of dapagliflozin and gliclazide on the cardiorenal axis in people with type 2 diabetes
Authors: van Bommel Erik J.M. , Smits Mark M. , Ruiter Danique , Muskiet Marcel H.A. , Kramer Mark H.H. , Nieuwdorp Max , Touw Daan J. , Heerspink Hiddo J.L. , Joles Jaap A. , van Raalte Daniël H.
Published: June 2020

Objectives:

There is a bidirectional relationship between cardiovascular and renal disease. The drug-class of SGLT2 inhibitors improves outcomes at both ends of this so called cardiorenal axis. We assessed the effects of SGLT2 inhibition and sulfonylurea treatment on systemic hemodynamic function and investigated whether SGLT2 inhibitor-induced changes in systemic hemodynamics correlate with changes in renal hemodynamics.

Methods:

Forty-four people with type 2 diabetes were randomized to 12 weeks of dapagliflozin 10 mg/day or gliclazide 30 mg/day treatment. Systemic hemodynamic function, autonomic nervous system activity, and vascular stiffness were measured noninvasively, whereas renal hemodynamics, glomerular filtration rate (GFR) and effective renal plasma flow, were assessed with gold-standard urinary clearances of inulin or iohexol and para-aminohippuric acid, respectively. Correlation analyses were performed to assess relationships between dapagliflozin-induced changes in cardiovascular and renal variables.

Results:

Dapagliflozin reduced stroke volume by 4%, cardiac output by 5%, vascular stiffness by 11%, and mean arterial pressure by 5% from baseline, without increasing heart rate or sympathetic activity, while simultaneously lowering glomerular filtration rate by 8%. Despite similar improvements in glycemic control by dapagliflozin and gliclazide (−0.5 ± 0.5 versus−0.7 ± 0.5%; P = 0.12), gliclazide did not affect any of these measurements. There was no clear association between the dapagliflozin-induced changes in cardiovascular and renal physiology.

Conclusion:

Dapagliflozin seemingly influences systemic and renal hemodynamics independently and beyond glucose lowering in people with type 2 diabetes.

This clinical trial was registered at https://clinicalTrials.gov (ID: NCT02682563).
Genetics of renovascular hypertension in children
Authors: Viering Daan H.H.M. , Chan Melanie M.Y. , Hoogenboom Lieke , Iancu Daniela , de Baaij Jeroen H.F. , Tullus Kjell , Kleta Robert , Bockenhauer Detlef
Published: June 2020

Objective:

In most cases of renovascular hypertension in children, the cause is unclear. The aim of this study was to investigate genetic variation as a factor in the development of renovascular hypertension in children.

Methods:

In a cohort of 37 unrelated children from a single tertiary referral center, exome sequencing was performed. We assessed variants in recognized and suspected disease genes and searched for novel ones with a gene-based variant-burden analysis.

Results:

In the majority of patients, exome sequencing could not identify causative variants. We found a pathogenic variant in a recognized associated disease gene in five patients (three pathogenic variants in NF1, one in ELN and a deletion of chromosome 7q11.23, consistent with Williams syndrome). In two other patients, (likely) pathogenic variants were found in putative renovascular hypertension genes (SMAD6 and GLA), with clinical implications for both. Ten additional patients carried variants of uncertain significance (VUS) in known (n = 4) or putative (n = 6) renovascular hypertension disease genes. Rare variant burden analysis yielded no further candidate genes.

Conclusion:

Genetic contributors, such as germline mutations in NF1, ELN, 7q11.23del were present in only 5 out of 37 (14%) children with renovascular hypertension. Twelve other children (32%) had potentially causal variants identified, including a pathogenic variant in SMAD6; a vasculopathy gene hitherto unknown to link with renovascular hypertension. Most importantly, our data show that exome sequencing can rarely identify the cause of renovascular hypertension in nonsyndromic children. We suggest that nongenetic factors or somatic genetic variation will play a more important role.
Anosmia and Ageusia: Not an Uncommon Presentation of COVID-19 Infection in Children and Adolescents
Authors: Mak Phoebe Qiaozhen , Chung Ka-Shing , Wong Joshua Sung-Chih , Shek Chi-Chiu , Kwan Mike Yat-Wah
Published: June 2020

Since the emergence of a cluster of viral pneumonia cases in Wuhan, Hubei Province, People’s Republic of China, at the end of December 2019, caused by severe acute respiratory syndrome coronavirus (SARS-CoV-2), a novel coronavirus also known as “coronavirus disease 2019 (COVID-19),” as of 7 April 2020, more than 1,214,466 cases of COVID-19 have been reported in more than 200 countries and territories, resulting in more than 67,767 deaths. The disease was recognized by World Health Organization (WHO) as a pandemic on 11 March 2020. Published reports of adult patients with COVID-19 infection described symptoms including fever, cough, fatigue, sputum production, headache, dyspnea and diarrhea. Children usually showed milder respiratory symptoms or were asymptomatic, while loss of taste or sensation of smell were seldom reported. In this paper, we report three cases of pediatric patients with COVID-19 infection who presented with anosmia and/or ageusia.
Peroral endoscopic myotomy versus pneumatic dilation for achalasia: a systematic review and meta-analysis
Authors: Zhong Chunyu , Tan Shali , Huang Shu , Lü Muhan , Peng Yan , Fu Xiangsheng , Tang Xiaowei
Published: June 2020

Presently, the primary endoscopic options for the treatment of achalasia are peroral endoscopic myotomy (POEM) and pneumatic dilation. But the clinical outcomes of POEM and pneumatic dilation for achalasia have not yet to be fully evaluated. So, we aimed to compare the clinical outcomes between the two treatment modalities. We searched all the relevant studies published up to September 2019 examining the comparative efficacy between POEM and pneumatic dilation. Outcomes included success rate, Eckardt score, lower esophageal sphincter pressure and adverse events. Outcomes were documented by pooled risk ratios and mean difference with 95% confidence interval (CI) using Review Manager 5.3. Seven studies with a total of 619 patients were identified. There were 298 patients underwent POEM treatment and 321 patients underwent pneumatic dilation treatment. The clinical success rate was higher in the POEM group than that in the pneumatic dilation group at 6, 12 and 24 months’ follow-up, with a risk ratio of 1.14 (95% CI, 1.06–1.22, P = 0.0002, I
2 = 0%), 1.34 (95% CI, 1.24–1.45, P < 0.00001, I
2 = 17%) and 1.35 (95% CI, 1.10–1.65, P = 0.004, I
2 = 70%), respectively. The change of Eckardt scores was more obvious in the POEM group than in the pneumatic dilation group, with a mean difference of 1.19 (95% CI, 0.78–1.60, P < 0.00001, I
2 = 70%). The rate of gastroesophageal reflux and other complications for POEM was significantly higher than for pneumatic dilation, with a risk ratio of 4.17 (95% CI, 1.52–11.45, P = 0.006, I
2 = 61%) and 3.78 (95% CI, 1.41–10.16, P = 0.008, I
2 = 0%). Our current evidence suggests that the long-term efficacy of POEM was superior to that of pneumatic dilation, but accompanied by higher complications.
COVID-19 epidemic in the Seine-Saint-Denis Department of Greater Paris: one month and three waves for a tsunami
Authors: Lapostolle Frédéric , Goix Laurent , Vianu Isabelle , Chanzy Erick , De Stefano Carla , Gorlicki Judith , Petrovic Tomislav , Adnet Frédéric
Published: June 2020

Introduction

Worldwide, the COVID-19 epidemic has put health systems to the test. The excess mortality is partly due to the influx of patients requiring hospitalization and intensive care. We propose that the chronology of epidemic spread gives a window of time in which hospitals can act to prevent reaching capacity.

Methods

The out-of-hospital SAMU Emergency Medical System in an entry point into the French health care system. We recorded the number of patients managed, of patients transferred to emergency departments (ED), and of mobile intensive care units (MICUs) dispatched. Each criterion was compared to the mean of the same criterion over the previous 5 years. The alert threshold which indicated a public health crisis was defined as a 20% increase compared to the 5-year mean.

Results

The reference period, from January 2015 to December 2019, included 3 381 611 calls, and 1 137 856 patients. The study period, from 17 February to 28 March 2020, included 166 888 calls, and 56 708 patients. The daily numbers of patients managed crossed the threshold on February 25, and increased until the end of the study period. The daily number of patients transferred to ED crossed the threshold on March 16, and increased until the end of the period. The daily number of MICUs dispatched crossed the threshold on March 15, and increased until the end of the period.

Conclusion

The COVID-19 epidemic reached our department in three consecutive waves which overwhelmed the health care system. The first wave preceded by 30 days the massive arrival of critical patients. Health care systems must take advantage of this delay to prepare for the third wave.
Discussing Drug Use With Health Care Providers Is Associated With Perceived Need and Receipt of Drug Treatment Among Adults in the United States
Authors: Mauro Pia M. , Samples Hillary , Klein Kathryn S. , Martins Silvia S.
Published: June 2020

Background:

Drug treatment utilization is low despite a high public health burden of drug use disorders (DUDs). Engaging people at risk for DUDs across a broader range of health care settings may improve uptake of drug treatment.

Objectives:

To estimate the prevalence of drug use screening/discussions between health care providers and individuals with past-year drug use, and to assess the associations between drug use screening/discussions and perceived need and use of drug treatment.

Methods:

We analyzed representative cross-sectional data from the 2015 to 2017 National Surveys on Drug Use and Health. The sample included adults aged 18 years and above reporting past-year drug use and ≥1 health care visit. We measured correlates of drug use screening/discussions using multinomial logistic regression. Overall and among adults meeting DUD criteria, we used logistic regression to estimate associations between drug use screening/discussions and (1) past-year drug treatment and (2) perceived need for treatment.

Results:

In the full sample (n=21,505), 34.50% reported no screening/discussions, 44.50% reported screening only, and 21.00% reported discussions with providers. Discussions were associated with significantly higher odds of receiving any drug treatment [adjusted odds ratio (aOR)=3.52 (2.66–4.65)], specialty drug treatment [aOR=4.13 (2.92–5.82)], and perceived treatment need [aOR=2.08 (1.21–3.59)]. Among people with DUD (n=3,834; 15.69%), discussions were associated with treatment use, but not with perceived need.

Conclusions:

Discussing drug use with providers may impact people’s perceptions of drug treatment need and use, indicating potential opportunities to engage people in addiction treatment. Addressing barriers to discussing drug use across care settings could increase treatment use, particularly among people with DUD.
Adverse Events and Burnout
Authors: Vogus Timothy J. , Ramanujam Rangaraj , Novikov Zhanna , Venkataramani Vijaya , Tangirala Subrahmaniam
Published: June 2020

Background:

Prior research has found that adverse events have significant negative consequences for the patients (first victim) and caregivers (second victim) involved such as burnout. However, research has yet to examine the consequences of adverse events on members of caregiving units. We also lack research on the effects of the personal and job resources that shape the context of how adverse events are experienced.

Objectives:

We test the relationship between job demands (the number of adverse events on a hospital nursing unit) and nurses’ experience of burnout. We further explore the ways in which personal (workgroup identification) and job (safety climate) resources amplify or dampen this relationship. Specifically, we examine whether, and the conditions under which, adverse events affect nurse burnout.

Research Design:

Cross-sectional analyses of survey data on nurse burnout linked to hospital incident reporting system data on adverse event rates for the year before survey administration and survey data on workgroup identification and safety climate.

Subjects:

Six hundred three registered nurses from 30 nursing units in a large, urban hospital in the Midwest completed questionnaires.

Results:

Multilevel regression analysis indicated that adverse events were positively associated with nurse burnout. The effects of adverse events on nurse burnout were amplified when nurses exhibited high levels of workgroup identification and attenuated when safety climate perceptions were higher.

Conclusions:

Adverse events have broader negative consequences than previously thought, widely affecting nurse burnout on caregiving units, especially when nurses strongly identify with their workgroup. These effects are mitigated when leaders cultivate safety climate.
Enhancing capacity and synthesis of [68Ga]68-Ga-PSMA-HBED-CC with the lyophilized ready-to-use kit for nuclear pharmacy applications
Authors: Golan Haim , Esa Moad , Moshkoviz Keren , Feldhaim Asher , Hoch Baruch , Shalom Eli
Published: June 2020

Introduction

The authors describe the newly proposed synthesis technique for the gallium-68 (Ga-68)-labeled tracer ([68Ga]Ga-PSMA-HBED-CC) for imaging expression of the prostate-specific membrane antigen (PSMA). An effort was applied to design the lyophilized cold kit (isoPROtrace-11) as a time-saving technique resulting in increased radiochemical yields.

Procedures

The initial material for labeling was obtained from a 68Ge/68Ga-generator. For labeling with the lyophilized cold kit isoPROtrace-11, 2.5 ml 0.1 M HCl of the middle Ga-68 elution fraction were added to the kit, shook for dissolving the vial’s contents and kept for 5 minutes at room temperature. A systematic comparison was carried out between results obtained with the cold kit technique and with previously used Modular-Lab module concerning the radiochemical yield, purity, and the time of producing.

Results

Automated module-involved synthesis of [68Ga]Ga-PSMA-HBED- CC resulted in a radiochemical yield of 84.2 ± 6.3% and purity of >95% after 25 minutes. The room temperature cold kit gave a radiochemical yield of >98% and purity of >95% after 5 minutes.

Conclusion

Using the kit method reduced the labeling time. The cold kit method increased production efficiency because less of the eluted Ga-68 was wasted.
Retroperitoneal Sclerosing Lipogranuloma in an Adolescent With Congenital Atresia of the Inferior Vena Cava: Case Report and Literature Review
Authors: Lamoshi Abdulraouf , Rothstein David H. , Ham Phillip Benson , Khan Abdur , Cheney Richard , Williot Pierre , Twist Clare , Schaefer Beverly
Published: June 2020

Sclerosing lipogranuloma (SLG) in children is a rare, benign disease of unknown etiology suspected to be due to abnormal fatty tissue reaction. A 13-year-old girl presented with progressively worsening back pain. Cross-sectional imaging identified a retroperitoneal mass compressing the left ureter as well as infrarenal inferior vena cava atresia with extensive venous collaterals and chronic partially occlusive thromboses of the iliac veins. Surgical biopsy was consistent with SLG and it resolved spontaneously. SLG is typically a disease of adulthood but may be seen in children. The association between inferior vena cava atresia with venous thrombosis and development of SLG has not been reported previously.
Prediction of Acute Kidney Injury on Admission to Pediatric Intensive Care
Authors: Raman Sainath , Tai Chian Wern , Le Marsney Renate , Schibler Andreas , Gibbons Kristen , Schlapbach Luregn J.
Published: June 2020

Objectives:

Up to 37% of children admitted to the PICU develop acute kidney injury as defined by Kidney Disease: Improving Global Outcomes criteria. We describe the prevalence of acute kidney injury in a mixed pediatric intensive care cohort using this criteria. As tools to stratify patients at risk of acute kidney injury on PICU admission are lacking, we explored the variables at admission and day 1 that might predict the development of acute kidney injury.

Design:

Single-center retrospective observational study.

Setting:

Thirty-six–bed surgical/medical tertiary PICU.

Patients:

Children from birth to less than or equal to 16 years old admitted between 2015 and 2018.

Interventions:

None.

Measurements and Main Results:

Clinical data were extracted from the PICU clinical information system. Patients with baseline creatinine at admission greater than 20 micromol/L above the calculated normal creatinine level were classified as “high risk of acute kidney injury.” Models were created to predict acute kidney injury at admission and on day 1. Out of the 7,505 children admitted during the study period, 738 patients (9.8%) were classified as high risk of acute kidney injury at admission and 690 (9.2%) developed acute kidney injury during PICU admission. Compared to Kidney Disease: Improving Global Outcomes criteria as the reference standard, high risk of acute kidney injury had a lower sensitivity and higher specificity compared with renal angina index greater than or equal to 8 on day 1. For the admission model, the adjusted odds ratio of developing acute kidney injury for high risk of acute kidney injury was 4.2 (95% CI, 3.3–5.2). The adjusted odds ratio in the noncardiac cohort for high risk of acute kidney injury was 7.3 (95% CI, 5.5–9.7). For the day 1 model, odds ratios for high risk of acute kidney injury and renal angina index greater than or equal to 8 were 3.3 (95% CI, 2.6–4.2) and 3.1 (95% CI, 2.4–3.8), respectively.

Conclusions:

The relationship between high risk of acute kidney injury and acute kidney injury needs further evaluation. High risk of acute kidney injury performed better in the noncardiac cohort.
First-line HIV treatment outcomes following the introduction of integrase inhibitors in UK guidelines
Authors: El Bouzidi Kate , Jose Sophie , Phillips Andrew N. , Pozniak Anton , Ustianowski Andrew , Gompels Mark , Winston Alan , Schaap Ab , Dunn David T. , Sabin Caroline A.
Published: June 2020

Objective:

To investigate the characteristics and outcomes of people who initiated different antiretroviral therapy (ART) regimens during the era of integrase strand transfer inhibitors (INSTIs).

Design:

UK-based observational cohort study.

Methods:

UK Collaborative HIV Cohort study participants were included if they had started ART between 1 January 2012 and 30 June 2017. Virological failure was defined as the first of two consecutive plasma HIV RNA more than 50 copies/ml, at least 6 months after starting ART. Follow-up was censored at ART discontinuation, class switch or death. The risk of virological failure among those on INSTI, protease inhibitor or nonnucleoside reverse transcriptase inhibitor (NNRTI) regimens was compared using Kaplan–Meier and Cox regression methods.

Results:

Of 12 585 participants, 45.6% started a NNRTI, 29.0% a protease inhibitor and 25.4% an INSTI regimen. Over a median follow-up of 20.3 months (interquartile range 7.9–38.9), 7.5% of participants experienced virological failure. Compared with those starting an NNRTI regimen, people receiving INSTIs or protease inhibitors were more likely to experience virological failure: INSTI group adjusted hazard ratio 1.52, 95% confidence interval 1.19–1.95, P = 0.0009; protease inhibitor group adjusted hazard ratio 2.70, 95% confidence interval 2.27–3.21, P less than 0.0001, likelihood ratio test P less than 0.0001.

Conclusion:

First-line INSTI regimens were associated with a lower risk of virological failure than protease inhibitor regimens but both groups were more likely to experience virological failure than those initiating treatment with a NNRTI. There is likely to be residual channelling bias resulting from selected use of INSTIs and protease inhibitors in specific clinical contexts, including in those with a perceived risk of poor adherence.
Use of Point-of-Care Nucleic Acid Tests Beyond Early Infant Diagnosis of HIV: A Retrospective Case Review in Lesotho
Authors: Macneal Kenneth , Tukei Vincent , Sacks Emma , Mokone Mafusi , Makoti Lehlohonolo , Tumbare Esther , Samosamo Tebello , Mots'oane Tsietso , Lemaire Jean-Francois , Cohn Jennifer
Published: June 2020

Background:

Rapid diagnostic tests (RDTs) for HIV antibodies remain the primary method of diagnosis of HIV in individuals over age 18 months in Lesotho. Although antibody tests have high sensitivity and specificity, up to 2.3% of serial two-test algorithms can have discrepant results between RDTs. In the case of inconclusive RDT results, Lesotho guidelines at the time of this study recommended either repeat testing with the same RDT algorithm after 14 days or immediately collect a blood sample to be sent for laboratory-based polymerase chain reaction testing. Point-of-care qualitative nucleic acid tests (POC qual NAT) may have benefits in rapidly resolving these inconclusive results, particularly when compared with repeating RDTs later or conventional polymerase chain reaction testing at the National Reference Laboratory.

Setting:

Hospitals and clinics at 29 locations throughout Lesotho that had access to point-of-care nucleic acid testing.

Methods:

Retrospective case review.

Results:

We identified 100 testing records where POC qual NAT was used to resolve inconclusive RDTs per Lesotho guidelines. Eighty-nine percent of patients received their results in a median of one day from their inconclusive RDT result (interquartile range 0–7 days). Sixty-eight patients (68%) were determined to be HIV positive based on POC nucleic acid tests (NATs), of which 54 (79%) were started on antiretroviral therapy (ART). Median time from inconclusive RDT result to initiation of ART therapy was 2 days (interquartile range 0–14 days). Three patients in this review were pregnant at the time of testing; one was HIV positive by POC qual NAT and was started on ART therapy the same day.

Conclusion:

As the availability of POC qual NAT platforms increases, they may serve as feasible options for rapid resolution of inconclusive results and initiation of ART, particularly in populations with high risk of imminent transmission.
Orbital Decompression for Exorbitism and Exophthalmos in a Patient With Thyroid Eye Disease
Authors: Kakutani Satoshi , Ito Makoto , Kakizaki Hirohiko , Takahashi Yasuhiro
Published: June 2020

A 34-year-old man with Basedow disease consulted us to treat disfiguring proptosis. On examination, the patient showed right lower eyelid retraction and right inferior rectus muscle enlargement, which were consistent with thyroid eye disease. Hertel's exophthalmometric examination demonstrated proptosis of 25.5 and 24.0 mm on the right and left sides, respectively. Computed tomography (CT) images revealed absence of the sphenoid door jamb. To correct both exorbitism and exophthalmos, the patient underwent bilateral “shallow” decompression of the lateral and medial orbital walls with orbital fat removal under general anesthesia. The authors removed 2.5 and 1.0 mL of orbital fat from the inferolateral quadrant of the right and left orbits, respectively. At 3 months postoperatively, based on the measurements of the axial globe position on sagittal CT images, postoperative proptosis reductions of 7.5 and 6.5 mm were observed on the right and left sides, respectively.
Effectiveness of Blepharoptosis Surgery in Patients With Deepening of the Upper Eyelid Sulcus
Authors: Yamazaki Hitoshi , Yunoki Tatsuya , Tojo Naoki , Hayashi Atsushi
Published: June 2020

The purpose of this retrospective study was to evaluate the effectiveness of blepharoptosis surgery in patients with deepening of the upper eyelid sulcus (DUES). This case series included 10 consecutive patients (19 eyes) with DUES associated with use of a prostaglandin analog for glaucoma. Patients who had used bimatoprost and developed DUES were changed to an alternative prostaglandin analog and observed for ≥3 months. If there was no improvement, they underwent levator resection for blepharoptosis and were followed up for ≥6 months postoperatively. Improvement in margin reflex distance-1 and surgical complications was evaluated. After discontinuation of bimatoprost in 3 cases (6 eyes), mild subjective and objective improvement in DUES was seen in 2 cases (4 eyes) but without improvement in blepharoptosis. The prostaglandin analog used before surgery was travoprost in 4 eyes (21.0%), tafluprost in 7 eyes (36.9%; including 4 eyes switched from bimatoprost), and latanoprost in 8 eyes (42.1%; including 2 eyes switched from bimatoprost). The mean margin reflex distance-1 value was 1.11 ± 0.96 mm before surgery and 3.72 ± 0.81 mm at the final postoperative follow-up; the difference was significant (P = 3.32 × −10). There were no intraoperative or postoperative complications. Levator resection is a useful and safe procedure for blepharoptosis with DUES.