bluuebunny/crossref_metadata_2025 huggingface dataset:
Prognostic significance of Ki67 during neoadjuvant chemotherapy in primary unresectable ovarian cancer
Authors: Kaya Ryusuke , Takanashi Hiroko , Nakajima Akari , Saito Ryosuke , Yamaguchi Noriko , Morimoto Keiji , Isonishi Seiji
Published: August 2021

Aim

The purpose of this study was to investigate whether the Ki67 values were associated with survival for predicting prognosis in patients with advanced ovarian cancer receiving neoadjuvant chemotherapy (NACT).

Methods

Among 17 patients treated with NACT, 13 patients were available for tissue samples from matched pre‐ and post‐therapy tissues. Ki67 scores were transformed to a logarithmic scale for the statistical analyses. The optimal cutoff values of the log‐phase Ki67 were assessed by receiver operating characteristic (ROC) analysis. Kaplan–Meier analysis, the log‐rank test, and Cox regression analysis were carried out to analyze survival.

Results

The Ki67‐decrease and post‐NACT Ki67 were the independent factors associated with relapse‐free survival (RFS) (p < 0.001 and p = 0.003). No association was observed on overall survival. The optimal cutoff values for the Ki67‐decrease and the post‐NACT Ki67 were 6.67% and 5.46 based on ROC where the area under ROC curves (AUC) were 1.00 (p < 0.001) with the 100% sensitivity and specificity. The median RFS was 537 days in patients showing Ki67‐decrease >6.66% or post‐NACT Ki67 level <5.46, while it was 224 days in those with Ki67 decrease ≤6.66% or post‐NACT Ki67 level ≥5.46 (p = 0.001).

Conclusions

The Ki67‐decrease and the lower post‐NACT Ki67 are independent factors associated with favorable RFS, indicating that they could be precise biomarker candidates for prognosis in NACT‐administered patients with advanced ovarian cancer.
Cardio‐pulmonary function among children with mild or asymptomatic COVID‐19 infection needing certification for return‐to‐play
Authors: Chicco Daniela , Rispoli Francesco , De Nardi Laura , Romano Sara , Mazzolai Michele , Bobbo Marco , Tavcar Irena , Cattarini Gilberto , Badina Laura , Barbi Egidio , Maschio Massimo
Published: August 2021

Aim

To explore the cardio‐pulmonary function of children returning to play sports after mild or asymptomatic SARS‐CoV‐2 infection.

Methods

This is a consecutive case series conducted at the Institute for Maternal and Child Health, Trieste, Italy. Paediatric patients who accessed the Institute for cardiologic and pneumological evaluation before the return‐to‐play competitive sports were recruited, according to the Italian Sports Medical Federation recommendations. Echocardiogram, electrocardiogram, treadmill ECG test and pulmonary function tests were performed.

Results

One hundred and thirty‐two patients (aged 8–17 years old, mean age 12.8 ± 2.5) were recruited. Among these, 127 children were considered for the final analysis (49.6% females). Out of 127, 84 (66.1%) had a mild symptomatic form of SARS‐CoV‐2 infection, while 43 (33.9%) were asymptomatic. The main referred symptoms were fever (n = 37, 44%), asthenia (n = 14, 16.7%), rhinitis (n = 16, 19%), ageusia (n = 19, 22.6%), anosmia (n = 24, 28.6%), sore throat (n = 3, 3.6%), cough (n = 9, 10.7%), arthralgia‐myalgia (n = 11, 13.1%), headache (n = 23, 27.4%) and gastrointestinal symptoms (n = 7, 8.3%). No child presented evidence of cardio‐pulmonary function impairment after an average time of 77.3 days (SD 35) from SARS‐CoV‐2 swab positivity and a median of 68 days (IQ1 52, IQ3 92.5).

Conclusion

This preliminary study suggests that, in the absence of specific symptoms, the diagnostic yield of cardio‐pulmonary tests before returning to play sports may be very low.
Microbiome and fermentation parameters in the rumen of dairy buffalo in response to ingestion associated with a diet supplemented with cysteamine and hemp seed oil
Authors: Zhou Xiaokang , Zhang Nanji , Zhang Jie , Gu Qichao , Dong Canjuan , Lin Bo , Zou Caixia
Published: August 2021

In this study, high‐throughput gene amplicon sequencing was used to investigate the effects of 6 treatments [2 levels of hemp seed oil (HSO) × 3 levels of cysteamine (CS)] on bacterial and fungal communities in the rumen of 30 crossbred dairy buffalo. Our results indicate that the total numbers of bacterial and fungal taxa were unaffected regardless of diet (p > 0.05), while the total number of archaea was affected (p < 0.05) by the interaction of HSO and CS. Compared with control treatment, microbial composition of archaea was strongly influenced by CS (p < 0.05), while the addition of HSO, CS or both had a weak effect on fungus and bacteria. In addition, there was a significant increase in the lactic acid content with the addition of HSO, and the addition of CS to the feed caused a significant decrease in the ratio of acetic acid to propionic acid, compared with control treatment (p < 0.05). Correlation analysis showed that Acetobacter was significantly positively correlated with the genera Pichia, Klebsiella and Acinetobacter. pH was found to have a significant effect on the methanogens, and total volatile fatty acids (VFA) had a strong correlation with Butyrivibrio. The strong influence of CS on some methanogens shows that it may have potential in the development of methane reduction interventions.
Food for thought: Does the Food—a fact of life website benefit food and nutrition teaching in the UK?
Authors: White Alex
Published: August 2021

Food education in school is compulsory in the UK and is an important means for teaching pupils’ basic food skills and about the importance of healthy eating. However, previous research has shown that UK food teachers face challenges due to time and money limitations, and value support to teach about food. Food—a fact of life (FFL) is the British Nutrition Foundation's education programme designed to help give teachers this support, with over 2000 resources online. To assess the impact of these resources, a survey was sent to UK teachers to evaluate their perceptions of the effect of using these resources on their teaching practice, classroom management, pupil learning/engagement and overall exam results. Teachers (n = 501) reported a benefit from using the FFL resources, with most respondents indicating that their use had a positive impact on their teaching practice and the learning of their pupils. This article summarises the main findings from this survey and discusses how they will be used by the British Nutrition Foundation to further improve FFL resources.
Identifying cortical plate inclination as a parameter to re‐assess transverse discrepancies in untreated adults with different vertical facial heights—A retrospective CBCT study
Authors: Ravikumar Prasanna Arvind T. , Dinesh S. P. Saravana
Published: August 2021

Objective

To determine the inclination angles of buccal, palatal cortical plates and assess its harmony with existing molar buccolingual inclination in adults with different vertical facial heights. The aim of this study was to identify the role of cortical plate inclination as a diagnostic tool for determining alveolar support in adults with transverse discrepancies.

Materials and Methods

One‐hundred and fifty seven CBCTs (50‐Hypo‐divergent, 51‐Normo‐divergent and 56‐Hyper‐divergent growth patterns) of untreated adults were utilized. Cross‐sectional slices with respect to the maxillary first molar were taken as orientation landmarks in defined reference planes. Inclination angles for the first molar, buccal and palatal cortical plate were determined with respect to the palatal plane. ANOVA and Post Hoc Tukey's HSD test were carried out to determine significant differences between groups.

Results

Molar inclination was significantly greater in hyper‐divergent groups compared to normo‐divergent and hypo‐divergent groups (P < .05). Greater variation between molar inclination and cortical plate inclination (buccal and palatal) was seen in hyper‐divergent groups (P < .05). Hypo‐divergent and normo‐divergent groups showed almost similar molar and cortical plate inclinations; however, there was a significant difference between the buccal and palatal cortical plates (P < .05).

Conclusions

Cortical plate inclination is in agreement with molar inclination in hypo‐ and normo‐divergent groups when compared to hyper‐divergent groups. In adults with decreased/normal facial heights, greater balance and harmony is observed between the dental and alveolar substructures in the posterior region. In adults with increased facial heights, a greater amount of dentoalveolar compensation is seen with respect to the molar and its surrounding bone support.
Evaluation of an online course for prevention of unwanted sexual behaviour in residential aged care services—A pilot study
Authors: Smith Daisy E. , Wright Meghan T. , Pham Tony H. , Ibrahim Joseph E.
Published: August 2021

Background

Residential aged care services (RACS) staff have substantial gaps in knowledge to prevent and manage unwanted sexual behaviour (USB) in RACS.

Objectives

This study aimed to explore the feasibility of a pilot online course (intervention) addressing USB in RACS.

Method

Development of a self‐guided e‐learning educational course was based on existing research, national and international approaches to human rights approaches to sexual assault and underwent internal and external peer review. An anonymous, online, cross‐sectional survey was conducted post‐intervention completion. RAC‐Communiqué subscribers were recruited via an e‐invitation. English speaking enrolled or registered nurses, employed in an Australian RACS, were eligible. From the 167 participants who expressed interest to enrol, 129 were eligible and 45 returned completed consent forms. Fifteen survey items regarding perceived competence and intervention satisfaction were analysed.

Results

The intervention addressed content pertaining to staffs’ legal and regulatory requirements, managing incidents and awareness of key services. Thirty‐eight of 45 eligible participants responded (84.4%). Participants reported they would recommend the intervention to a colleague (n = 36, 97.3%). Participants self‐reported (i) advanced learning post‐completion; (ii) raised awareness (n = 29, 78.4%) (iii) prompted current practice reflection (n = 35, 94.6%) and (iv) prompted improving USB workplace management (n = 34, 91.9%). Results are subjected to social desirability bias.

Conclusions

The intervention was relevant, engaging and practical. The findings contribute to a more comprehensive understanding of the specific training topics relevant and useful to RACS staff.

Implication for practice

E‐learning tools could be an effective teaching method for USB in RACS. The intervention may be a useful tool to encourage staff to reflect and change current practice.
Magnetic resonance imaging scans in patients with dorsal root ganglion stimulation
Authors: Reining Marco , Winkler Dirk , Boettcher Joachim , Meixensberger Juergen , Kretzschmar Michael
Published: August 2021

Objective

Patients fitted with a neurostimulator face a greater need to undergo magnetic resonance imaging (MRI) scans. Given the lack of literature in this regard, this study aims to review our experience with MRI examinations on patients implanted with a dorsal root ganglion stimulation (DRG‐S) system and their potential adverse events.

Materials and Methods

We conducted a retrospective analysis of the prospective treatment documentation gathered from November 2011 to October 2020. We identified 259 MRI registrations for patients with an implanted neurostimulation system; the MRI examinations were performed using a 1.5 Tesla MRI system in accordance with a structured scheme.

Results

Among the 259 MRI registrations identified in this study, 28 corresponded to patients with an implanted DRG‐S system. In 2 cases, no MRI scan was performed, and thus, only 26 MRI examinations were evaluated in detail. The DRG‐S device was approved for the requested MRI scans in only 2 of these 26 cases (7.7%). In addition, 2 minor adverse events (syncopal episode and connection problem) were identified, and only the second problem (3.8%) was related to neurostimulator operation.

Conclusions

Necessary MRI examinations in patients with DRG‐S systems are rarely covered by the European CE/US Food and Drug Administration (CE/FDA) approval. Although the manufacturer recommendations are against the use of MRI in patients with implanted DRG‐S in certain conditions, we performed these scans without causing injury to the patient or damaging the device. Given that data on safety are limited, MRIs should be conducted study related. We provide recommendations for the procedure that should be followed when an MRI is needed urgently.
Achieving equity and inclusion in pediatric dermatology research: Priorities and considerations
Authors: Huang Jennifer T. , Davies Olivia M. T. , Siegel Dawn H.
Published: August 2021

As we increase our focus and energy on equity, diversity, and inclusion (EDI)‐relevant research, we must consider the “what, why, and how” of our work. The goals of this paper are to highlight unique issues pediatric dermatologists face in providing equitable care, pose considerations when reporting data on race and ethnicity, and advocate for standardized classification of race and ethnicity in research.
Productive exposures: Vulnerability as a parallel practice of care in ethnographic and community spaces
Authors: Zizzo Gabriella , Warin Megan , Zivkovic Tanya , Maher JaneMaree
Published: August 2021

Theories of vulnerability are most often seen in the anthropology of disaster studies, where socio‐economic and political inequalities produce environmental vulnerabilities, and the people situated in these locations are positioned as vulnerable and dependent 'Others'. Rather than reproduce vulnerability as a concept denoting weakness, this paper seeks to examine the generative capacities of vulnerability practised in parallel in ethnographic and community spaces. As a form of witnessing and participating in and out of differing social worlds, anthropology engages in different vulnerabilities with and between multiple actors. This paper examines how a community program working with families identified as 'disadvantaged' in South Australia strategically uses vulnerability as a productive resource and a practice of care. In theorising vulnerability through parallel practices in both ethnographic approaches and this community program, we argue that vulnerability can be leveraged away from negative welfare discourses towards alternative politics of radical care and social change.
A survey of road feature extraction methods from raster maps
Authors: Jiao Chenjing , Heitzler Magnus , Hurni Lorenz
Published: August 2021

Maps contain abundant geospatial information, such as roads, settlements, and river networks, to name a few. The need to access this information to carry out analyses (e.g., in transportation, landscape planning, or ecology), as well as advances in software and hardware technologies, have driven the development of workflows to efficiently extract features from maps. The aim of this article is to provide a comprehensive overview of such methods to extract road features from raster maps. The methods are categorized based on the classes of techniques they employ (e.g., line extraction), as well as their subclasses (e.g., line tracing, Hough transform), the amount of user intervention required (e.g., interactive, automatic), the required data (e.g., scanned maps, contemporary vector data) and the produced results (e.g., raster‐based predictions, vector‐based results, attributes). Additionally, recent road extraction methods from overhead imagery, together with evaluation methods that will possibly benefit road extraction from raster maps, are reviewed. Furthermore, the evolution of this research field is analyzed over the past 35 years and the limitations of the current techniques, as well as possible future directions, are discussed.
An investigation into longitudinal forms of gullies within the “Grand Canyon” of Bengal, Eastern India
Authors: Patel Priyank Pravin , Dasgupta Rajarshi , Chanda Sreeparna , Mondal Sayoni
Published: August 2021

The development of gullies is intrinsically linked with the growth of their principal channels. Analysis of the longitudinal form of these channels can provide insight into both the extent of badland formation within that catchment and the nature of the substrate. In this study, we examine the longitudinal profiles of the major gullies formed within the Gangani Badlands in Paschim Medinipur district of Eastern India, which is often referred to as the “Grand Canyon” of Bengal. These are examined using a very high‐resolution digital elevation model to extract the respective main gully catchments, map the stream network and derive the required information for statistical analysis of the gully longitudinal profile forms. Stream segment gradient indices were subsequently computed and related to the hardness of the substrate that was derived using a RockSchmidt rebound hammer. The effect of the ambient lateritic hardpan is seen to markedly influence the gully channel character, with most having steeper segments in the middle portion of their course, where the initial rills and minor gullies debouch over the high duricrust escarpment present here. Since gully development within lateritic terrain is a relatively less examined phenomenon worldwide, such investigations add to the relevant knowledge base.
ERF108 from Poncirus trifoliata (L.) Raf. functions in cold tolerance by modulating raffinose synthesis through transcriptional regulation of PtrRafS
Authors: Khan Madiha , Hu Jianbing , Dahro Bachar , Ming Ruhong , Zhang Yang , Wang Yue , Alhag Ahmed , Li Chunlong , Liu Ji‐Hong
Published: August 2021

Ethylene‐responsive factors (ERFs) are plant‐specific transcription factors involved in cold stress response, and raffinose is known to accumulate in plants exposed to cold. However, it remains elusive whether ERFs function in cold tolerance by modulating raffinose synthesis. Here, we identified a cold‐responsive PtrERF108 from trifoliate orange (Poncirus trifoliata (L.) Raf.), a cold‐tolerant plant closely related to citrus. PtrERF108 is localized in the nucleus and has transcriptional activation activity. Overexpression of PtrERF108 conferred enhanced cold tolerance of transgenic lemon, whereas virus‐induced gene silencing (VIGS)‐mediated knockdown of PtrERF108 in trifoliate orange greatly elevated cold sensitivity. Transcriptome profiling showed that PtrERF108 overexpression caused extensive reprogramming of genes associated with signaling transduction, physiological processes and metabolic pathways. Among them, a raffinose synthase (RafS)‐encoding gene, PtrRafS, was confirmed as a direct target of PtrERF108. RafS activity and raffinose content were significantly increased in PtrERF108‐overexpressing transgenic plants, but prominently decreased in the VIGS plants under cold conditions. Meanwhile, exogenous replenishment of raffinose could recover the cold tolerance of PtrERF108‐silenced plants, whereas VIGS‐mediated knockdown of PtrRafS resulted in cold‐sensitive phenotype. Taken together, the current results demonstrate that PtrERF108 plays a positive role in cold tolerance by modulation of raffinose synthesis via regulating PtrRafS. Our findings reveal a new transcriptional module composed of ERF108‐RafS underlying cold‐induced raffinose accumulation in plants.
Trace element geochemistry and PGE potential of noritic bodies from Uauá block, Bahia - Brazil
Authors: Oliveira Elson Paiva de
Published: August 2021

Preliminary field relationship and incompatible trace element geochemistry on two bodies of noritic rocks from Uauá area are discussed with the aim of evaluating their metallogenic potential. The rocks show primitive mantle normalized and chondrite normalized patterns very similar to chilled margins and parental magmas to the Bushveld and Insizwa complexes (RSA) which host major platinum group elements deposits. The data suggest the Uauá noritic bodies may be potential for ore mineralisation.
O papel da matéria orgânica e dos agregados na erodibilidade dos solos
Authors: Guerra Antonio José Teixeira
Published: August 2021

The present study regards the significance of organic matter content and aggregates on soil erosion. Other soil properties, vegetation cover and erosivity are also taken into consideration. The study is carried out in Rogate, Southeast England.
Dosagem de chumbo em pequenas quantidades nos minerais
Authors: Cassedanne Jeanníne Odette , Carvalho Hamílcar Freire de
Published: August 2021

This study describes a lead volumetric titration in minerals. Complexometric accumulation titrations are used and a previous lead separation as chloride is necessary. In the range of 10 to 50 mg of metal, a precision of 0,5 to 0,04% is reached, with a good reproductibility.
A Numerical Study of Particle Migration in Porous Media During Produced Water Reinjection
Authors: Xia Tian , Feng Qihong , Wang Sen , Shu Qinglin , Zhang Yigen , Sun Yeheng
Published: August 2021

The clogging phenomenon often occurs during the reinjection of produced water due to the suspended particles, which will deteriorate the development efficiency. Many experimental and analytical methods have been introduced to solve this problem; however, few numerical approaches have been proposed to investigate the particle migration in the produced water reinjection process. Moreover, it is hard to obtain a clear understanding directly from the particle scale when the injected particles have different sizes. This paper employs a coupled lattice Boltzmann method and discrete element method (LBM-DEM) to study the aforementioned process. The method was validated by reproducing the Drafting–Kissing–Tumbling (DKT) process. Simulations of migration of injected particles with different sizes through porous media were conducted and three clogging scenarios had been identified. We investigated the impact of injected particle size distribution and porous media on particle migration and concluded the results in the polydisperse aspect. From the simulation, we can conclude that mix clogging is the scenario we should try to avoid. Besides, both critical ratio of particle diameter of porous media to median particle diameter of injected particles (D/d50) and critical standard deviation value exist. The particle size range should be as small as possible in economical limits and the D/d50 value should be larger than the critical value. Our results can provide a good guide for the produced water pretreatment, which can improve oil recovery.
Impact of trimethylaluminum exposure time on the mechanical properties of single-cycle atomic layer deposition modified cellulosic nanopaper
Authors: Li Yi , Losego Mark D.
Published: August 2021

Cellulosic nanomaterials can improve the performance of various products and can be renewably sourced. In this study, nanocellulosic paper (nanopapers) is chemically and physically altered with simple gas-phase processing to achieve enhanced mechanical performance. Cellulosic nanofibril paper is exposed to single cycles of trimethylaluminum (TMA) and water to modify the surface and subsurface chemistry with small quantities of aluminum oxide. Precursor exposure times are found to significantly influence the amount of inorganic deposited within the cellulosic structure and its crystallinity. This result differs from the common assumption that exposing cellulose to TMA will lead to an “atomic layer deposition (ALD)” type of process in which self-limited surface saturation is quickly achieved. These results suggest that with extended exposure times, the TMA precursor finds new pathways to chemically or physically alter the cellulosic material. Through the x-ray photoelectron spectroscopy analysis, we find that cellulose undergoes a decomposition process during the TMA exposure and/or subsequent reaction with H2O, creating at least one additional pathway to inorganic uptake. Interestingly, uniaxial tensile strength measurements reveal that longer TMA exposure times significantly increase the nanopaper's elongation at break and ultimate tensile strength, with only a modest loss in Young's modulus. While similar inorganic loading can be achieved with multiple ALD cycles, mechanical toughness exhibits significantly less change than for the increased TMA exposure times. X-ray diffraction suggests that the TMA exposures are transforming crystalline portions of the nanocellulose into amorphous structures. These amorphous regions lead to crazing, which increases the strain to break and toughness of the nanopaper.
The Abundance and Organization of
Salmonella
Extracellular Polymeric Substances in Gallbladder-Mimicking Environments and
In Vivo
Authors: Hahn Mark M. , González Juan F. , Hitt Regan , Tucker Lauren , Gunn John S.
Published: August 2021

Salmonella enterica
serovar Typhi causes chronic infections by establishing biofilms on cholesterol gallstones. The production of extracellular polymeric substances (EPSs) is key to biofilm development, and biofilm architecture depends on which EPSs are made.
Use of the DBM Model to the Predict of Arrival of Coronal Mass Ejections to the Earth
Authors: Kaportseva K. B. , Shugay Yu. S.
Published: August 2021

This paper analyzes the results of modeling coronal mass ejection (CME) propagation in 2010–2011 obtained using input data from different sources: CME catalogs SEEDS and CACTus, and predictions of the velocity of quasi-stationary solar wind fluxes, as an environment, through which CMEs propagate. As the model of quasi-stationary solar wind fluxes, the model for predicting the velocity of the solar wind of the Space Weather Forecast Center of the Skobeltsyn Institute of Nuclear Physics of Moscow State University, operating online, is used. The CME prediction is carried out using the Simple Drag-Based Model. A comparison was performed between the ICME arrival time and their velocities obtained when modeling with data from the open ICME catalogs: the Richardson and Cane ICME catalog and the GMU CME List. Based on the comparison, it was concluded that a more accurate prediction for the growth phase of the 24th solar activity cycle was obtained using data on CME parameters from the CACTus database. The obtained errors in predicting the ICME parameters are comparable with the errors of other existing models.
Coexistence of serotonin syndrome and neuroleptic malignant syndrome: does it exist?
Authors: Prakash Sanjay , Lodha Deepali , Rawat Kalu Singh
Published: August 2021

We report a 21-year-old man with bipolar disorder who was on a stable dose of escitalopram and risperidone. Tramadol and cough syrup (dextromethorphan) were added for his recent attack of upper respiratory tract infection. However, he developed various neurological symptoms. Haloperidol and ondansetron were added after hospitalisation. However, his condition deteriorated. A diagnosis of serotonin syndrome (SS) was made, and cyproheptadine was started. Cyproheptadine provided relief in most of the symptoms within 48 hours except for the presence of fever and rigidity. The addition of bromocriptine provided a complete resolution of the symptoms. We considered the presence of both SS and neuroleptic malignant syndrome (NMS) in this case. There are four similar cases in the literature. We discussed a diagnostic and therapeutic approach for patients who are on both serotonergic agents and neuroleptics and develop SS-like or NMS-like clinical features.
Extraosseous odontogenic fibroma with a clear cells component: a 5-year follow-up
Authors: Retama-Carranza Estefanía , Padilla-Rosas Miguel , Zepeda-Nuño José Sergio , Nava-Villalba Mario
Published: August 2021

The extraosseous/peripheral odontogenic fibroma (E/POF) is a benign mesenchymal odontogenic tumour found on the gingival surface with clinical characteristics identical to those of reactive lesions. A histopathological analysis is the only method for determining the difference between reactive lesions and these neoplastic lesions, whose recurrence potential varies between 38.9% and 50%, highlighting the importance of correct diagnosis. The following report describes an E/POF case with a clear cells component, as well as a long-term follow-up treatment, which we emphasise due to its potential for recurrence.
Intriguing aural foreign body and algorithm of management of foreign body
Authors: Ponnuvelu Komalar , Saniasiaya Jeyasakthy , Abdul Gani Norhaslinda
Published: August 2021

Foreign body (FB) in the external auditory canal is more common among the paediatric age group compared with adult patients and it may be deposited in various ways. An accidental animate aural FB is reported to be commonly encountered in adults whereas inanimate FBs are likely to be found among adult patients with learning disability. An elderly man presented with accidental penetration of rattan tree stem into his ear while gardening. Removal of a FB from the external auditory canal requires expertise as deep penetration of a FB into the middle and inner ear may lead grave complications, especially when overzealous removal is attempted by nonear, nose and throat (ENT) personnel. This case emphasises on the importance of awareness of meticulous removal of a FB under proper visualisation so as to avoid unnecessary complications. Additionally, we propose an algorithm for proper removal of aural FB in an acute care setting.
Diagnosis and management of cold agglutinin disease associated with low-grade B-cell lymphoma in a patient receiving pembrolizumab for lung cancer
Authors: Karki Nabin Raj , McElhone Peyton , Savage Natasha , Abdel Karim Nagla
Published: August 2021

A 65-year-old with non-small cell lung cancer developed autoimmune haemolytic anaemia while receiving pembrolizumab containing chemoimmunotherapy. Initially thought to be due to pembrolizumab induced haemolysis, he was treated with steroids, and pembrolizumab was held. Haemolysis was refractory to steroids and blood was observed to agglutinate in cold room temperatures. Cold agglutinins in high titre and monoclonal serum IgM kappa protein were detected. Bone marrow biopsy showed marginal zone lymphoma confirming low grade B-cell lymphoma causing cold agglutinin disease. B-cell depletion by rituximab stopped haemolysis, and pembrolizumab was safely continued for lung cancer.
Isolated juxtapapillary retinal capillary haemangioblastoma and exudative maculopathy in an elderly patient without von Hippel-Lindau syndrome: combined proton beam radiotherapy and intravitreal anti-VEGF
Authors: Adan Ahmed , Carine Luke , Heimann Heinrich , Ugarte Marta
Published: August 2021

A 71-year-old Caucasian man presented with an isolated juxtapapillary retinal capillary haemangioblastoma on the superior and temporal left optic disc with active exudation resulting in macular intraretinal and subretinal fluid, reduced vision, scotoma and distortion with progression over 6 weeks. He did not have von Hippel-Lindau syndrome. After proton beam radiotherapy (PBR), the tumour size remained unchanged, but did not stop the exudation. Three anti-vascular endothelial growth factor (VEGF) (ie, bevacizumab) injections at monthly intervals resulted in reduced macular oedema. Combined therapy with PBR and anti-VEGF injections sustained our patient’s vision at 12 months follow-up.
Unusual cause of recalcitrant epistaxis
Authors: Khatri Gaurav , Singh Anup , Mahajan Anshu , Handa Kumud Kumar
Published: August 2021

Nosebleeds are among the most familiar presentations to the emergency department as well as otorhinolaryngologic outpatient services. Bleeding from nasal septal branches of the anterior ethmoid artery (AEA) is common and can be effectively controlled endoscopically. However, the bleeding from a pseudoaneurysm involving the nasal septal branches of AEA is extremely rare and can be troublesome to control using endoscopic methods. We report an adult patient presenting with profuse nasal bleeding postroad traffic accident due to the formation of AEA septal branch pseudoaneurysm. The patient required repeated nasal packing, and the diagnosis was revealed using digital subtraction angiography. Since profuse active bleeding precluded endoscopic visualisation, an external approach had to be adopted to ligate the AEA to control the bleeding. We discuss the management options and nuances for this rare cause of the troublesome nasal bleeding.
100 years on: the impact of the discovery of insulin on clinical outcomes
Authors: Buse John B , Davies Melanie J , Frier Brian M , Philis-Tsimikas Athena
Published: August 2021

Throughout history, up to the early part of the 20th century, diabetes has been a devastating disorder, particularly when diagnosed in childhood when it was usually fatal. Consequently, the successful pancreatic extraction of insulin in 1921 was a miraculous, life-changing advance. In this review, the truly transformative effect that insulin has had on the lives of people with type 1 diabetes and on those with type 2 diabetes who are also dependent on insulin is described, from the time of its first successful use to the present day. We have highlighted in turn how each of the many facets of improvements over the last century, from advancements in the properties of insulin and its formulations to the evolution of different methods of delivery, have led to continued improvement in clinical outcomes, through the use of illustrative stories from history and from our own clinical experiences. This review concludes with a brief look at the current challenges and where the next century of technological innovation in insulin therapy may take us.
Exploring patients’ perceptions and experiences of treatments for the prevention of variceal bleeding: a qualitative study
Authors: Poyner Chris , Tripathi Dhiraj , Mathers Jonathan
Published: August 2021

Background

The most common fatal complication of liver cirrhosis is haemorrhaging caused by variceal rupture. The prevention of the first variceal bleed is, therefore, an important clinical goal. Little is known about patients’ experience of treatments geared towards this, or of their perceptions of treatments prior to being exposed to them.

Aims

To explore the factors impacting patient preference for, and actual experience of carvedilol and variceal band ligation.

Methods

Semistructured interviews were conducted with 30 patients from across the UK at baseline, prior to random allocation to either carvedilol or variceal band ligation. Twenty patients were interviewed a second time at 6-month follow-up. Five patients who declined the trial were also interviewed. Data were analysed using thematic analysis.

Results

There was no clear preference for either treatment pathway at baseline. Key factors reported by patients to influence their treatment preference included: negative experiences with key treatment processes; how long-term or short-term treatment was perceived to be; treatment misconceptions; concerns around polypharmacy and worries around treatment adherence. Patient treatment experience was influenced by their perceptions of treatment effectiveness; clinical surveillance; clinician interaction and communication, or lack thereof. Carvedilol-specific experience was also influenced by the manifestation of side effects and patient dosage routine. Variceal band ligation-specific experience was positively influenced by the use of sedation, and negatively influenced by the procedure recovery period.

Conclusions

These data do not support a view that the patient experience of beta-blockade for prevention of variceal bleeds is likely to be superior to variceal band ligation.
Factors associated with treatment and control of hypertension among elderly adults in Shenzhen, China: a large-scale cross-sectional study
Authors: Ni Wenqing , Yuan Xueli , Zhang Jia , Li Ping , Zhang Hong Min , Zhang Yan , Xu Jian
Published: August 2021

Objective

Hypertension has become the leading cause of death worldwide. Data on hypertension management among Shenzhen elderly are sparse. Our study aims to investigate treated and controlled hypertension in Shenzhen elderly, and identify relevant predictors.

Design

A cross-sectional study.

Setting

Communities in Shenzhen, Guangdong, China.

Participants

A cross-sectional study was conducted. We employed a convenience sampling method to select participants; 124 007 participants aged 65 years and older were recruited from January to December 2018 at local community health centres in Shenzhen.

Main outcome measures

Data on treatment, control and influencing factors of hypertension were obtained from a standard questionnaire, physical measurements and biochemical analyses.

Results

Prevalence of hypertension was 55.8% among the sample population. Among this group of hypertensive patients, those undergoing hypertension treatment and those with hypertension under control were 54.4% and 32.3%, respectively. Employing multivariate analysis, significant associations were found between treatment and older age, junior high school education and above (OR=1.25, p＜0.05), being widowed rather than being married or cohabiting (OR=1.28, p＜0.05), engaging in physical activity (OR=1.14, p＜0.05), ex-smoker (OR=1.19, p＜0.05), habitual drinker (OR=0.72, p＜0.05), history of cardiovascular disease (CVD) (OR=2.20, p＜0.05) and comorbidities, with a higher probability for those with obesity (OR=1.89, p＜0.05), central obesity (OR=1.10, p＜0.05), diabetes (OR=1.49, p＜0.05) or dyslipidaemia (OR=1.20, p＜0.05). Male sex (OR=0.91, p＜0.05), junior high school education and above (OR=1.28, p＜0.05), engaging in physical activity (OR=1.06, p＜0.05), history of CVD (OR=1.82, p＜0.05) and individuals who had diabetes (OR=1.52, p＜0.05) or dyslipidaemia (OR=1.05, p＜0.05) were associated with increased likelihood of control. Aged 80 years and older (OR=0.93, p＜0.05), habitual drinker (OR=0.73, p＜0.05) and central obesity (OR=0.94, p＜0.05) were negatively associated with control of hypertension.

Conclusions

We found a high prevalence of hypertension, but a low prevalence of treatment and control among Shenzhen elderly.
Cohort study of hospitalists’ procedural skills: baseline competence and durability after simulation-based training
Authors: Hale Caleb , Crocker Jonathan , Vanka Anita , Ricotta Daniel N , McSparron Jakob I , Huang Grace C
Published: August 2021

Objectives

Hospitalists are expected to be competent in performing bedside procedures, which are associated with significant morbidity and mortality. A national decline in procedures performed by hospitalists has prompted questions about their procedural competency. Additionally, though simulation-based mastery learning (SBML) has been shown to be effective among trainees whether this approach has enduring benefits for independent practitioners who already have experience is unknown. We aimed to assess the baseline procedural skill of hospitalists already credentialed to perform procedures. We hypothesised that simulation-based training of hospitalists would result in durable skill gains after several months.

Design

Prospective cohort study with pretraining and post-training measurements.

Setting

Single, large, urban academic medical centre in the USA.

Participants

Twenty-two out of 38 eligible participants defined as hospitalists working on teaching services where they would supervise trainees performing procedures.

Interventions

One-on-one, 60 min SBML of lumbar puncture (LP) and abdominal paracentesis (AP).

Primary and secondary outcome measures

Our primary outcome was the percentage of hospitalists obtaining minimum passing scores (MPS) on LP and AP checklists; our secondary outcomes were average checklist scores and self-reported confidence.

Results

At baseline, only 16% hospitalists met or exceeded the MPS for LP and 32% for AP. Immediately after SBML, 100% of hospitalists reached this threshold. Reassessment an average of 7 months later revealed that only 40% of hospitalists achieved the MPS. Confidence increased initially after training but declined over time.

Conclusions

Hospitalists may be performing invasive bedside procedures without demonstration of adequate skill. A single evidence-based training intervention was insufficient to sustain skills for the majority of hospitalists over a short period of time. More stringent practices for certifying hospitalists who perform risky procedures are warranted, as well as mechanisms to support skill maintenance, such as periodic simulation-based training and assessment.
Effectiveness of virtual and augmented reality for improving knowledge and skills in medical students: protocol for a systematic review
Authors: Hussain Zain , Ng Dominic Mark , Alnafisee Nouf , Sheikh Zakariya , Ng Nathan , Khan Ateeb , Hussain Amir , Aitken Debbie , Sheikh Aziz
Published: August 2021

Introduction

Virtual reality (VR) and augmented reality (AR) technologies are increasingly being used in undergraduate medical education. We aim to evaluate the effectiveness of VR and AR technologies for improving knowledge and skills in medical students.

Methods and analysis

Using Best Evidence in Medical Education (BEME) collaboration guidelines, we will search MEDLINE (via PubMed), Education Resources Information Center, PsycINFO, Web of Knowledge, Embase and the Cochrane Central Register of Controlled Trials for English-language records, from January 1990 to March 2021. Randomised trials that studied the use of VR or AR devices for teaching medical students will be included. Studies that assessed other healthcare professionals, or did not have a comparator group, will be excluded. The primary outcome measures relate to medical students’ knowledge and clinical skills. Two reviewers will independently screen studies and assess eligibility based on our prespecified eligibility criteria, and then extract data from each eligible study using a modified BEME coding form. Any disagreements will be resolved by discussion or, if necessary, the involvement of a third reviewer. The BEME Quality Indicators checklist and the Cochrane Risk of Bias Tool will be used to assess the quality of the body of evidence. Where data are of sufficient homogeneity, a meta-analysis using a random-effects model will be conducted. Otherwise, a narrative synthesis approach will be taken and studies will be evaluated based on Kirkpatrick’s levels of educational outcomes and the Synthesis Without Meta-analysis guidelines.

Ethics and dissemination

Ethical approval is not required for this systematic review as no primary data are being collected. We will disseminate the findings of this review through scientific conferences and through publication in a peer-reviewed journal.
Temporal trends of COVID-19 mortality and hospitalisation rates: an observational cohort study from the US Department of Veterans Affairs
Authors: Cai Miao , Bowe Benjamin , Xie Yan , Al-Aly Ziyad
Published: August 2021

Objectives

To investigate the temporal trends of 30-day mortality and hospitalisation in US Veterans with COVID-19 and 30-day mortality in hospitalised veterans with COVID-19 and to decompose the contribution of changes in the underlying characteristics of affected populations to these temporal changes.

Design

Observational cohort study.

Setting

US Department of Veterans Affairs.

Participants

49 238 US veterans with a positive COVID-19 test between 20 March 2020 and 19 September 2020; and 9428 US veterans hospitalised with a positive COVID-19 test during the same period.

Outcome measures

30-day mortality rate and hospitalisation rate.

Results

Between 20 March 2020 and 19 September 2020 and in COVID-19 positive individuals, 30-day mortality rate dropped by 9.2% from 13.6% to 4.4%; hospitalisation rate dropped by 16.8% from 33.8% to 17.0%. In hospitalised COVID-19 individuals, 30-day mortality rate dropped by 12.7% from 23.5% to 10.8%. Among COVID-19 positive individuals, decomposition analyses suggested that changes in demographic, health and contextual characteristics, COVID-19 testing capacity, and hospital occupancy rates accounted for 40.2% and 33.3% of the decline in 30-day mortality and hospitalisation, respectively. Changes in the underlying characteristics of hospitalised COVID-19 individuals accounted for 29.9% of the decline in 30-day mortality.

Conclusion

Between March and September 2020, changes in demographic and health characteristics of people infected with COVID-19 contributed measurably to the substantial decline in 30-day mortality and hospitalisation.
Comparison of a preventive or curative strategy of fluid removal on the weaning of mechanical ventilation: a study protocol for a multicentre randomised open-label parallel-group trial
Authors: Dres Martin , Estellat Candice , Baudel Jean-Luc , Beloncle François , Cousty Julien , Galbois Arnaud , Guérin Laurent , Labbe Vincent , Labro Guylaine , Lebut Jordane , Mira Jean-Paul , Prat Gwenael , Quenot Jean-Pierre , Dessap Armand Mekontso
Published: August 2021

Introduction

Fluid overload is associated with a poor prognosis in the critically ill patients, especially at the time of weaning from mechanical ventilation as it may promote weaning failure from cardiac origin. Some data suggest that early administration of diuretics would shorten the duration of mechanical ventilation. However, this strategy may expose patients to a higher risk of haemodynamic and metabolic complications. Currently, there is no recommendation for the use of diuretics during weaning and there is an equipoise on the timing of their initiation in this context.

Methods and analysis

This study is a multicentre randomised controlled trial comparing two strategies of fluid removal during weaning in 13 French intensive care units (ICU). The preventive strategy is initiated systematically when the fluid balance or weight change is positive and the patients have criteria for clinical stability; the curative strategy is initiated only in case of weaning failure documented as of cardiac origin. Four hundred and ten patients will be randomised with a 1:1 ratio. The primary outcome is the duration of weaning from mechanical ventilation, defined as the number of days between randomisation and successful extubation (alive without reintubation nor tracheostomy within the 7 days after extubation) at day 28. Secondary outcomes include daily and cumulated fluid balance, metabolic and haemodynamic complications, ventilator-associated pneumonia, weaning complications, number of ventilator-free days, total duration of mechanical ventilation, the length of stay in ICU and mortality in ICU, in hospital and, at day 28. A subgroup analysis for the primary outcome is planned in patients with kidney injury (Kidney Disease: Improving Global Outcomes class 2 or more) at the time of randomisation.

Ethics and dissemination

The study has been approved by the ethics committee (Comité de Protection des Personnes Paris 1) and patients will be included after informed consent. The results will be submitted for publication in peer-reviewed journals.

Trial registration number

NCT04050007.

Protocol version

V.1; 12 March 2019.