bluuebunny/crossref_metadata_2025 huggingface dataset:
Plasma C-Reactive Protein Level and Outcome of Acute Ischemic Stroke Patients Treated by Intravenous Thrombolysis: A Systematic Review and Meta-Analysis
Authors: Jiang Jin , Tan Changhong , Zhou Wen , Peng Wuxue , Zhou Xuan , Du Juncong , Wang Hui , Mo Lijuan , Liu Xi , Chen Lifen
Published: April 2021

Introduction: The plasma C-reactive protein (CRP) level in predicting prognosis of acute ischemic stroke (AIS) patients receiving intravenous thrombolysis (IVT) is not yet established. This study is aiming to investigate the relationship between the plasma CRP level and outcome of AIS patients receiving IVT. Methods: PubMed and EMBASE were searched for relevant studies that evaluated the relationship between the CRP level and outcome of AIS patients receiving IVT. STATA 12.0 was used to pool the data for meta-analysis. Results: In total, 8 studies were included. Six studies reported a positive relationship between the high CRP level and unfavorable outcome at 3 months. Five studies associated the high plasma CRP level with high mortality at 3 months. And meta-analysis further confirmed that the high CRP level was related to unfavorable outcomes (odds ratio [OR] = 1.716, 95% CI: 1.170–2.517, p = 0.006) and mortality (OR = 2.751, 95% CI: 1.613–4.693, p < 0.001) at 3 months. However, an elevated CRP level was not found to increase the risk of symptomatic intracerebral hemorrhage. Conclusion: A high plasma CRP level was associated with a 3-month poor outcome of AIS patients treated with IVT. CRP may be used as a biomarker for the risk stratification of AIS patients as candidates receiving IVT or other alternative therapy such as mechanical thrombectomy.
Gastric Hyperplastic Polyps: A Benign Entity? Analysis of Recurrence and Neoplastic Transformation in a Cohort Study
Authors: João Mafalda , Areia Miguel , Alves Susana , Elvas Luís , Taveira Filipe , Brito Daniel , Saraiva Sandra , Teresa Cadime Ana
Published: April 2021

Introduction: Hyperplastic polyps represent 30–93% of all gastric epithelial polyps. They are generally detected as innocuous incidental findings; however, they have a risk of neoplastic transformation and recurrence. Frequency and risk factors for neoplastic transformation and recurrence are not well established and are fields of ongoing interest. This study aims to evaluate the frequency of and identify the risk factors for recurrence and neoplastic change of gastric hyperplastic polyps (GHP). Methods: A single-centre retrospective cohort study including consecutive patients who underwent endoscopic resection of GHP from January 2009 to June 2020. Demographic, endoscopic, and histopathologic data was retrieved from the electronic medical records. Results: A total of 195 patients were included (56% women; median age 67 [35–87] years). The median size of GHP was 10 (3–50) mm, 62% (n = 120) were sessile, 61% (n = 119) were located in the antrum, and 36% (n = 71) had synchronous lesions. Recurrence rate after endoscopic resection was 23% (n = 26). In multivariate analysis, antrum location was the only risk factor for recurrence (odds ratio [OR] 3.0; 95% confidence interval [CI] 1.1–8.1). Overall, 5.1% (n = 10) GHP showed neoplastic transformation, with low-grade dysplasia in 5, high-grade dysplasia in 4, and adenocarcinoma in 1. In multivariate analysis, a size >25 mm (OR 84; 95% CI 7.4–954) and the presence of intestinal metaplasia (OR 7.6; 95% CI 1.0–55) and dysplasia (OR 86; 95% CI 10–741) in adjacent mucosa were associated with an increased risk of neoplastic transformation. Recurrence was not associated with neoplastic transformation (OR 1.1; 95% CI 0.2–5.9). Discussion: Our results confirmed the risk of recurrence and neoplastic transformation of GHP. Antrum location was a predictor of recurrence. The risk of neoplastic change was increased in large lesions and with intestinal metaplasia and dysplasia in adjacent mucosa. More frequent endoscopic surveillance may be required in these subgroups of GHP.
Colorectal Endoscopic Submucosal Dissection in a Western Center: Analysis of Outcomes and Safety Profile
Authors: Santos-Antunes João , Marques Margarida , Morais Rui , Carneiro Fátima , Macedo Guilherme
Published: April 2021

Introduction: Endoscopic submucosal dissection (ESD) is a well-established endoscopic technique for the treatment of gastrointestinal lesions. Colorectal ESD outcomes are less reported in the Western literature, and Portuguese data are still very scarce. Our aim was to describe our experience on colorectal ESD regarding its outcomes and safety profile. Methods: We conducted a retrospective evaluation of recorded data on ESDs performed between 2015 and 2020. Only ESDs performed on epithelial neoplastic lesions were selected for further analysis. Results: Of a total of 167 colorectal ESDs, 153 were included. Technical success was achieved in 147 procedures (96%). The lesions were located in the colon (n = 24) and rectum (n = 123). The en bloc resection rate was 92% and 97%, the R0 resection rate was 83% and 82%, and the curative resection rate was 79% and 78% for the colon and the rectum, respectively. The need for a hybrid technique was the only risk factor for piecemeal or R1 resection. We report a perforation rate of 3.4% and a 4.1% rate of delayed bleeding; all the adverse events were manageable endoscopically, without the need of blood transfusions or surgery. Most of the lesions were laterally spreading tumours of the granular mixed type (70%), and 20% of the lesions were malignant (12% submucosal and 8% intramucosal cancer). Conclusion: Our series on colorectal ESD reports a very good efficacy and safety profile. This technique can be applied by endoscopists experienced in ESD.
Cause of Death after Traumatic Brain Injury: A Population-Based Health Record Review Analysis Referenced for Nonhead Trauma
Authors: Esterov Dmitry , Bellamkonda Erica , Mandrekar Jay , Ransom Jeanine E. , Brown Allen W.
Published: April 2021

Introduction: Traumatic brain injury (TBI) is a leading cause of disability and is associated with decreased survival. Although it is generally accepted that TBI increases risk of death in acute and postacute periods after injury, causes of premature death after TBI in the long term are less clear. Methods: A cohort sample of Olmsted County, Minnesota, residents with confirmed TBI from January 1987 through December 1999 was identified. Each case was assigned an age- and sex-matched non-TBI referent case, called regular referent. Confirmed TBI cases with simultaneous nonhead injuries were identified, labeled special cases. These were assigned 2 age- and sex-matched special referents with nonhead injuries of similar severity. Underlying causes of death in each case were categorized using death certificates, International Classification of Diseases, Ninth Revision, International Statistical Classification of Diseases, Tenth Revision, and manual health record review. Comparisons were made over the study period and among 6-month survivors. Results: Case-regular referent pairs (n = 1,257) were identified over the study period, and 221 were special cases. In total, 237 deaths occurred among these pairs. A statistically significant difference was observed between total number of deaths among all cases (n = 139, 11%) and regular referents (n = 98, 8%) (p = 0.006) over the entire period. This outcome was not true for special cases (32/221, 14%) and special referents (61/441, 14%) (p = 0.81). A greater proportion of deaths by external cause than all other causes was observed in all cases (52/139, 37%) versus regular referents (3/98, 3%) and in special cases (13/32, 41%) versus special referents (5/61, 8%) (p < 0.001 for both). Among all case-referent pairs surviving 6 months, no difference was found between total number of deaths (p = 0.82). The underlying cause of death between these 2 groups was significantly different for external causes only (p < 0.01). For special cases surviving 6 months versus special referents, no difference was observed in total number of deaths (p = 0.24) or underlying causes of death (p = 1.00) between groups. Discussion/Conclusion: This population-based case-matched referent study showed that increased risk of death after TBI existed only during the first 6 months after injury, and the difference was due to external causes.
Gastric Adenoma: A High Incidence Rate of Developing Carcinoma and Risk of Metachronous Gastric Cancer according to Long-Term Follow-Up
Authors: Okamoto Yuki , Kanzaki Hiromitsu , Tanaka Takehiro , Sakae Hiroyuki , Abe Makoto , Iwamuro Masaya , Kawano Seiji , Kawahara Yoshiro , Okada Hiroyuki
Published: April 2021

Introduction: Gastric adenomas are histologically defined as benign epithelial tumors. While some of them remain adenomas for a long time, others progress to carcinomas. However, long-term outcomes of such cases are not entirely clear. Here, we explored the risk factors and incidence of developing carcinoma from gastric adenoma as well as metachronous gastric cancer. Methods: This study was conducted at a facility that adopted a follow-up strategy for gastric adenoma. Lesions histologically diagnosed as gastric intestinal-type adenomas between January 2004 and December 2016 were analyzed. Clinicopathological data were collected from patients’ medical records, and histological changes from adenoma to carcinoma during endoscopic follow-up and risk factors of cancer development were evaluated. Results: This study involved 409 lesions from 376 patients. The analysis of the development of gastric cancer from adenoma and metachronous gastric cancer was ultimately performed for 282 lesions from 258 patients and 269 lesions from 246 patients, respectively, due to different follow-up periods. The 5-year rate of carcinoma development was 34.0%. Risk factors for carcinoma development upon multivariate analysis were lesion size ≥15 mm and morphological depression. All cases with both factors developed gastric carcinoma, and 50.5% of those with either factor developed carcinoma within 5 years. Gastric adenoma was accompanied by metachronous gastric cancer in 1.5% of the patients annually. The only risk factor for metachronous gastric carcinoma was primary adenoma progressing to carcinoma during the follow-up period. Discussion/Conclusion: Given the high rate of carcinoma development in patients with risk factors, resection of gastric adenoma should be considered during the initial examination. Careful observation and follow-up should also be conducted to detect not only changes in the primary adenoma but also the occurrence of metachronous carcinoma, especially in cases of adenoma progressing to carcinoma.
GİRİŞİMCİ VE YENİLİKÇİ ÜNİVERSİTELERİN ETKİNLİKLERİNİN ÖLÇÜLMESİ
Authors: SELAMZADE Fuad , ÖZDEMİR Yahya
Published: April 2021

Ülkelerin büyümesinde ve gelişmesinde üniversitelerin, özellikle girişimci ve yenilikçi üniversitelerin ekonomiye katkıları önem taşımaktadır. Çalışmada Türkiye`deki girişimci ve yenilikçi üniversitelerin hem girişimsel ve hem de akademik açıdan etkinliklerinin analiz edilmesi amaçlanmıştır. Bu amaca ulaşmak için iki farklı model oluşturularak Veri Zarflama Analizi kullanılmıştır. Ayrıca, etkin üniversitelerin Süper Etkinlik skorları belirlenmiştir. Çalışma bulgularında, Girişimcilik ve Yenilikçilik yönünden etkinliklerinin değerlendirildiği ölçeğe göre sabit getirili analizde üniversitelerin %18`inin, ölçeğe göre değişken getirili analizde ise %26`sının etkin olduğu görülmüştür. Bilimsel Çalışma yönünden etkinliklerinin değerlendirildiği ölçeğe göre sabit getirili analizde üniversitelerin %24`ünün, ölçeğe göre değişken getirili analizde ise %40`ının etkin olduğu tespit edilmiştir. Çalışma sonucunda Türkiye`deki girişimci ve yenilikçi üniversitelerin mevcut kaynaklarını daha etkin kullanmaları ve çıktıları artırmaları gerektiği tespit edilmiştir.
Die Chronik des Marcellinus Comes
Authors: Jakobi Rainer
Published: April 2021

The Chronicle by Marcellinus was intended as a sequel to its predecessor Jerome but demonstrates marked differences concerning the underlying historiographic and narrative ideas. The text is distinctly orthodox and emphasizes both the history of salvation and pronounced panegyrics. In his praefatio, Marcellinus voices a clearly individual concept. The summa brevitas of the chronicle is substituted by long passages and the ‘chronological present tense’ by the tenses of historical narrative. Marcellinus carefully chooses ideologically striking (hitherto unnoticed) quotations both from classical authors and the Old Testament. These intertextual signals underline the author´s interpretation of the historical facts.
Africa and the International Criminal Court: (Re)constructing the Narrative
Authors: Nimigan Sarah P.
Published: April 2021

African support for the International Criminal Court (icc) from its earliest stages of institutional development is often referenced in the international criminal justice literature with limited explanation. The aim of this article is to establish a holistic account of African support for an international criminal court in the pre-Rome period, during the Rome Diplomatic Conference, and after the establishment of the icc. This analysis uses rational choice and constructivist international relations (ir) theory to help explain levels of African commitment to the Rome Statute using Kenya and Ivory Coast as case studies. While the icc has been criticized on neocolonial bases, it is important to reconstruct the narrative to more accurately reflect African agency over the international criminal justice project, and the icc in particular. African resistance to the institutional behaviour of the icc is situated in its broader political context(s): domestically and internationally, using rational and normative factors to explain various levels of African commitment to the Rome Statute.
Heavier Inner-core Rainfall of Major Hurricanes in the North Atlantic Basin than Other Global Basins
Authors: Guzman Oscar , Jiang Haiyan
Published: April 2021

Based on 19 years of precipitation data collected by the Tropical Rainfall Measuring Mission (TRMM) and the Global Precipitation Measurement (GPM) mission, a comparison of the rainfall produced by tropical cyclones (TCs) in different global basins is presented. A total of 1789 TCs were examined in the period from 1998 to 2016 by taking advantage of more than 47,737 observations of TRMM/GPM 3B42 multi-satellite derived rainfall amounts. The axisymmetric component of the TC rainfall is analyzed in all TC-prone basins. The resulting radial profiles show that major hurricanes in the Atlantic basin exhibit significantly heavier inner-core rainfall rates than those in any other basins. To explain the possible causes of this difference, rainfall distributions for major hurricanes are stratified according to different TC intensity and environmental variables. Based on the examination of these parameters, we found that the stronger rainfall rates in the Atlantic major hurricanes are associated with higher values of convective available potential energy, drier relative humidity in the low to middle troposphere, colder air temperature at 250hPa, and stronger vertical wind shear than other basins. These results have important implications in the refining of our understanding of the mechanisms of TC rainfall.
Demographic Characteristics of Children Diagnosed with Bacterial Tracheitis
Authors: Barengo Jenna H. , Redmann Andrew J. , Kennedy Patrick , Rutter Michael J. , Smith Matthew M.
Published: April 2021

Objectives:

Examine the presentation and clinical course of patients with bacterial tracheitis (BT). Identify if socioeconomic differences exist among children who present with BT.

Methods:

This was a retrospective case series from a tertiary care pediatric medical center. The study group included patients less than 18 years old who were diagnosed with BT from January 2011 to March 2019. Patients with a tracheostomy and those who developed BT after prolonged hospitalization were excluded. Patient demographics were compared with the demographics of the counties surrounding the hospital.

Results:

33 patients with BT met inclusion criteria. The most common presenting symptoms were difficulty breathing, stridor, and sore throat (81.8% each), followed by cough (78.8%). Median length of stay was 3 days [interquartile range (IQR):2-4]. 19 patients (57.5%) were admitted to the intensive care unit. Intubation was required for 13 patients (39.4%), for a median length of 2 days [IQR:2-2]. Methicillin sensitive staphylococcus aureus was the most common bacterial etiology (33%). Mean presenting age was 8.58 years [95% confidence interval:7.3-9.9] and 14 patients were female (42.4%). 31 patients were white (93.9%), 1 was black (3%), and 1 was Hispanic (3%). BT patients were more likely to have private insurance compared to comparison (81.8% vs 63.4%, P < .001).

Conclusion:

Children who presented with BT were more likely to be privately insured than a comparison population.
Study on flow field and measurement characteristics of a small-bore ultrasonic gas flow meter
Authors: Chen Desheng , Cao Haibin , Cui Baoling
Published: April 2021

A new structure is proposed for a DN25-type ultrasonic gas flow meter with a V-shape double sound channel arrangement. The flow field characteristics are analyzed including velocity curves for the four channel lines, velocity profiles for different cross-sections of the flow meter, and streamlines of the transducer channel sections. The metering characteristics of the flowmeter are measured using a Venturi nozzle device. When the pipeline flow rate is less than 2.26 m/s, the pipe installation does not have a significant effect on the velocity profile and the velocity in the channel lines. However, the error in the low-flow region is large, and the flow distortion directly affects the measurement accuracy. When an ultrasonic gas flow meter with an accuracy class of 1.5 is used with pipes containing a single or double bend upstream, the linear error doubles, low-flow error becomes a negative deviation, and reference error in the low-flow region becomes approximately 700%–949%. The installation structure of the first pair of transducers also affects the signal propagation of the transducers behind it. Therefore, it is critical to process the ultrasonic signal according to the flow field distribution and adopt different weighted algorithms to obtain accurate pipeline flow rates to improve the measurement accuracy of the ultrasonic flow meter.
Determinants of Facebook use among students and its impact on collaborative learning
Authors: Alwreikat Asma , Zaid Mohammed Khair Abu , Shehata Ahmed
Published: April 2021

The purpose of this study is to investigate the determinants of Facebook use among university students in Jordanian universities, and its impact on collaborative learning. The study compares Facebook use between students of social sciences disciplines and students of sciences disciplines. The study used a quantitative research approach. The research instrument used is a questionnaire. The results of the study showed that the relationship between Facebook use and collaborative learning is above average, which means that the more time spent on Facebook, the better academic performance students achieve through collaborative learning. Additionally, the study revealed that Facebook use was posited to affect collaborative learning, though the level of effect varies between social sciences and science disciplines. The study proposes a model that describes the relation between collaborative learning and Facebook use, which bridges a gap in the Arabic context that lacks models showing this type of relationship.
Postcolonial social drama: The case of Brazilian dentists in Portugal
Authors: Torresan Angela
Published: April 2021

By the late 1990s, when I was conducting ethnographic fieldwork research in Lisbon, the ‘dentists’ case’ had become a familiar trope for the presence of Brazilian immigrants in Portugal. Although it involved a small group of Brazilian and Portuguese professionals, it gained visibility in the media of both countries, escalating into a political and diplomatic quarrel, and culminating in the amendment of the 1966 Cultural Accord. I use Victor Turner’s concept of social drama to address the case as a chapter in the cyclical pattern of connection and disconnection of postcolonial Luso-Brazilian relationships. Drawing from a recent discussion on the concept of cosmopolitanism in migration studies, I employ the idea of postcolonial sociabilities to help explore the seemingly inherent ambiguities in the relationship between Brazilians and Portuguese.
Iatrogenic uvular injury related to airway instrumentation: A report of 13 cases from the webAIRS database and a review of uvular necrosis following inadvertent uvular injury
Authors: Bright Matthew R , Concha Blamey Sandra I , Beckmann Linda A , Culwick Martin D
Published: April 2021

Published reports of uvular necrosis are uncommon and it is possibly an under-reported complication of oropharyngeal manipulation. Uvular necrosis is thought to develop due to ischaemia secondary to mechanical compression of the uvula from oropharyngeal devices. Patients typically present with symptoms of a sore throat within 48 hours postoperatively. It is unclear whether there are any preventable factors, or any specific management strategies that might reduce this complication. Treatment is most commonly conservative management, including observation and simple analgesia. We present 13 cases of uvular injury that were reported to a web-based anaesthesia incident reporting system (webAIRS), a voluntary de-identified anaesthesia incident reporting system in Australia and New Zealand. While the postoperative findings varied, sore throat was the most frequent symptom. Most of the cases resolved spontaneously; the remainder with supportive treatment only. The findings suggest that patients who sustain a uvular injury can be reassured, but they should be advised to seek review early if sore throat persists or any difficulty with breathing develops.
Zonotopic Kalman filtering for stability augmentation and flight envelope estimation
Authors: Harno Hendra G , Kim Yoonsoo , Moon Jun , Bang Hyochoong
Published: April 2021

This article introduces a novel methodology based on zonotopic Kalman filtering for stabilizing attitude dynamics and estimating flight envelopes of an unmanned helicopter via an observer-based (output) feedback control law and a reachability analysis, respectively. The helicopter dynamics is represented by a linear state-space model, based on which the feedback control law is designed. Since not all state variables are measurable, state information is acquired by applying a zonotopic Kalman filter to yield sets of state-variable estimates of the helicopter in terms of zonotopes. Not only are the resulting zonotopes used for the observer-based feedback control, but also for estimating the flight envelopes of the helicopter based on the reachability analysis. This approach is useful for enhancing pilot’s awareness about dynamic responses of the helicopter, which may undergo unsafe flight conditions due to actuator faults triggered by undesirable perturbations. The efficacy of the proposed methodology is demonstrated via an example, where we also expose the benefits of applying the zonotopic Kalman filter as compared with an ordinary stochastic Kalman filter.
Mediation analysis for mixture Cox proportional hazards cure models
Authors: Zhou Xiaoxiao , Song Xinyuan
Published: April 2021

Mediation analysis aims to decompose a total effect into specific pathways and investigate the underlying causal mechanism. Although existing methods have been developed to conduct mediation analysis in the context of survival models, none of these methods accommodates the existence of a substantial proportion of subjects who never experience the event of interest, even if the follow-up is sufficiently long. In this study, we consider mediation analysis for the mixture of Cox proportional hazards cure models that cope with the cure fraction problem. Path-specific effects on restricted mean survival time and survival probability are assessed by introducing a partially latent group indicator and applying the mediation formula approach in a three-stage mediation framework. A Bayesian approach with P-splines for approximating the baseline hazard function is developed to conduct analysis. The satisfactory performance of the proposed method is verified through simulation studies. An application of the Alzheimer’s disease (AD) neuroimaging initiative dataset investigates the causal effects of APOE-[Formula: see text] allele on AD progression.
Understanding mental distress in Arcahaie, Haiti: Heterogeneous uses of idioms of distress in communicating psychological suffering
Authors: Lichtenberg Alexander A. , Shi Mengxi , Joseph Kenol , Kaiser Bonnie N. , Katz Craig L.
Published: April 2021

Research on mental health in specific communities requires careful attention to cultural context and language. Studies on global mental health have increasingly analyzed idioms of distress, or culturally situated ways of conceptualizing, experiencing, and expressing distress. This study examines how idioms of distress are used and understood in Arcahaie, Haiti. The goal was to enrich current understanding of mental health conceptualization and communication by exploring the heterogeneity of common idioms of distress. Interviews with community members ( N = 47) explored meanings and perceived causations of 13 idioms of distress. Major themes included pervasiveness of poverty, ruminative thinking, effects of Vodou and Christian belief systems, embodied distress, and the behavior of “crazy” people ( moun fou). The findings suggest some specific pathways for potential community engagement projects, including training lay-leaders in cognitive behavioral therapy using existing socioreligious infrastructure and expanding access to social engagement activities. This research contributes to a small but growing body of literature on mental illness in Haiti and to methods for studying idioms of distress.
The correlation between obesity and prostate volume in patients with benign prostatic hyperplasia at Charlotte Maxeke Johannesburg Academic Hospital
Authors: Mampa Eshely , Haffejee Mohamed , Fru Pascaline
Published: April 2021

Background

Benign prostatic hyperplasia (BPH) is on the increase placing a substantial burden on health care systems. Recent studies have shown that men with high body mass index (BMI) and central obesity, as denoted by waist circumference (WC) have bigger prostate volumes (PV) with subsequent increase in lower urinary tract symptoms (LUTS) than men with normal BMI. The purpose of this research was to investigate the correlation between Obesity and PV in patients with BPH.

Methods

The study included 178 men aged between 50 and 75 years with BPH seen at Charlotte Maxeke Johannesburg academic hospital (CMJAH) Urology Outpatient Department between September 2018 and February 2019. Weight and height measurements were obtained to calculate BMI. Furthermore, WC was measured using a measuring tape, while a transrectal ultrasound (TRUS) was used to measure PV. Patient demographics, clinical characteristics such as hypertension, diabetes, smoking and prostate specific antigen (PSA) were also noted.

Results

Patients in the study had a mean age of 64.87 ± 6.526 years and the mean BMI was 27.31 ± 3.933 kg/m2. The mean PV of each BMI group were 52.92 ± 38.49, 61.00 ± 33.10 and 64.86 ± 37.46 cm3for normal, overweight and obese groups, respectively, and the average PV score was 59.36 ± 36.507 cm3. The mean PSA score was 4.30 ± 3.126 with a range of 1.3–6.4, while the mean WC was 98.67 cm. There was no correlation between BMI and PV (pvalue = 0.195) as well as between PV and WC, hypertension, diabetes or smoking. The results revealed that the relationship between PV with PSA level as well as age was significant (pvalue = 0.001,pvalue = 0.009, respectively).

Conclusion

The results showed no correlation between BMI and PV. Diabetes and hypertension as well had no positive correlation with PV. A follow-up study may be indicated to look at the correlation between obesity, LUTS and urinary flow rates to establish whether aggressive management of obesity would have significant impact on the management of BPH.
Blood flow response to orthostatic challenge identifies signatures of the failure of static cerebral autoregulation in patients with cerebrovascular disease
Authors: Gregori-Pla Clara , Mesquita Rickson C. , Favilla Christopher G. , Busch David R. , Blanco Igor , Zirak Peyman , Frisk Lisa Kobayashi , Avtzi Stella , Maruccia Federica , Giacalone Giacomo , Cotta Gianluca , Camps-Renom Pol , Mullen Michael T. , Martí-Fàbregas Joan , Prats-Sánchez Luís , Martínez-Domeño Alejandro , Kasner Scott E. , Greenberg Joel H. , Zhou Chao , Edlow Brian L. , Putt Mary E. , Detre John A. , Yodh Arjun G. , Durduran Turgut , Delgado-Mederos Raquel
Published: April 2021

Background

The cortical microvascular cerebral blood flow response (CBF) to different changes in head-of-bed (HOB) position has been shown to be altered in acute ischemic stroke (AIS) by diffuse correlation spectroscopy (DCS) technique. However, the relationship between these relative ΔCBF changes and associated systemic blood pressure changes has not been studied, even though blood pressure is a major driver of cerebral blood flow.

Methods

Transcranial DCS data from four studies measuring bilateral frontal microvascular cerebral blood flow in healthy controls (n = 15), patients with asymptomatic severe internal carotid artery stenosis (ICA, n = 27), and patients with acute ischemic stroke (AIS, n = 72) were aggregated. DCS-measured CBF was measured in response to a short head-of-bed (HOB) position manipulation protocol (supine/elevated/supine, 5 min at each position). In a sub-group (AIS, n = 26; ICA, n = 14; control, n = 15), mean arterial pressure (MAP) was measured dynamically during the protocol.

Results

After elevated positioning, DCS CBF returned to baseline supine values in controls (p = 0.890) but not in patients with AIS (9.6% [6.0,13.3], mean 95% CI, p < 0.001) or ICA stenosis (8.6% [3.1,14.0], p = 0.003)). MAP in AIS patients did not return to baseline values (2.6 mmHg [0.5, 4.7], p = 0.018), but in ICA stenosis patients and controls did. Instead ipsilesional but not contralesional CBF was correlated with MAP (AIS 6.0%/mmHg [− 2.4,14.3], p = 0.038; ICA stenosis 11.0%/mmHg [2.4,19.5], p < 0.001).

Conclusions

The observed associations between ipsilateral CBF and MAP suggest that short HOB position changes may elicit deficits in cerebral autoregulation in cerebrovascular disorders. Additional research is required to further characterize this phenomenon.
Challenges experienced by midwives working in rural communities in the Upper East Region of Ghana: a qualitative study
Authors: Adatara Peter , Amooba Philemon Adoliwine , Afaya Agani , Salia Solomon Mohammed , Avane Mabel Apaanye , Kuug Anthony , Maalman Raymond Saa-Eru , Atakro Confidence Alorse , Attachie Irene Torshie , Atachie Constancia
Published: April 2021

Background

In 2017, a total of 295,000 women lost their lives due to pregnancy and childbirth across the globe, with sub-Saharan Africa and South Asia accounting for approximately 86 % of all maternal deaths. The maternal mortality ratio in Ghana is exceptionally high, with approximately 308 deaths/100,000 live births in 2017. Most of these maternal deaths occur in rural areas than in urban areas. Thus, we aimed to explore and gain insights into midwives’ experiences of working and providing women-centred care in rural northern Ghana.

Methods

A qualitative descriptive exploratory design was used to explore the challenges midwives face in delivering women-centred midwifery care in low-resource, rural areas. A total of 30 midwives practicing in the Upper East Region of Ghana were purposefully selected. Data were collected using individual semistructured interviews and analysed through qualitative content analysis.

Results

Five main themes emerged from the data analysis. These themes included were: inadequate infrastructure (lack of bed and physical space), shortage of midwifery staff, logistical challenges, lack of motivation, and limited in-service training opportunities.

Conclusions

Midwives experience myriad challenges in providing sufficient women-centred care in rural Ghana. To overcome these challenges, measures such as providing adequate beds and physical space, making more equipment available, and increasing midwifery staff strength to reduce individual workload, coupled with motivation from facility managers, are needed.
Laparoscopic versus open pancreatic resection for ductal adenocarcinoma: separate propensity score matching analyses of distal pancreatectomy and pancreaticoduodenectomy
Authors: Chen Ke , Pan Yu , Huang Chao-jie , Chen Qi-long , Zhang Ren-chao , Zhang Miao-zun , Wang Guan-yu , Wang Xian-fa , Mou Yi-ping , Yan Jia-fei
Published: April 2021

Background

Pancreatic ductal adenocarcinoma (PDAC) is a leading causes of cancer mortality worldwide. Currently, laparoscopic pancreatic resection (LPR) is extensively applied to treat benign and low-grade diseases related to the pancreas. The viability and safety of LPR for PDAC needs to be understood better. Laparoscopic distal pancreatectomy (LDP) and pancreaticoduodenectomy (LPD) are the two main surgical approaches for PDAC. We performed separate propensity score matching (PSM) analyses to assess the surgical and oncological outcomes of LPR for PDAC by comparing LDP with open distal pancreatectomy (ODP) as well as LPD with open pancreaticoduodenectomy (OPD).

Methods

We assessed the data of patients who underwent distal pancreatectomy (DP) and pancreaticoduodenectomy (PD) for PDAC between January 2004 and February 2020 at our hospital. A one-to-one PSM was applied to prevent selection bias by accounting for factors such as age, sex, body mass index, and tumour size. The DP group included 86 LDP patients and 86 ODP patients, whereas the PD group included 101 LPD patients and 101 OPD patients. Baseline characteristics, intraoperative effects, postoperative recovery, and survival outcomes were compared.

Results

Compared to ODP, LDP was associated with shorter operative time, lesser blood loss, and similar overall morbidity. Of the 101 patients who underwent LPD, 10 patients (9.9%) required conversion to laparotomy. The short-term surgical advantage of LPD is not as apparent as that of LDP due to conversions. Compared with OPD, LPD was associated with longer operative time, lesser blood loss, and similar overall morbidity. For oncological and survival outcomes, there were no significant differences in tumour size, R0 resection rate, and tumour stage in both the DP and PD subgroups. However, laparoscopic procedures appear to have an advantage over open surgery in terms of retrieved lymph nodes (DP subgroup: 14.4 ± 5.2 vs. 11.7 ± 5.1, p = 0.03; PD subgroup 21.9 ± 6.6 vs. 18.9 ± 5.4, p = 0.07). These two groups did not show a significant difference in the pattern of recurrence and overall survival rate.

Conclusions

Laparoscopic DP and PD are feasible and oncologically safe procedures for PDAC, with similar postoperative outcomes and long-term survival among patients who underwent open surgery.
Application of preoperative computed tomographic lymphography for precise sentinel lymph node biopsy in breast cancer patients
Authors: Wen Shishuai , Liang Yiran , Kong Xiaoli , Liu Baofeng , Ma Tingting , Zhou Yeqing , Jiang Liyu , Li Xiaoyan , Yang Qifeng
Published: April 2021

Background

In light of the extensive application of sentinel lymph node biopsy (SLNB) in clinically node-negative breast cancer patients and the recently investigated failure of SLNB after lumpectomy, it has become important to explore methods for preoperative mapping of sentinel lymph nodes (SLNs) and their lymphatics to direct precise SLNB and improve the identification rate of SLNs.

Methods

Twenty-seven patients with suspected breast cancer based on the results of the clinical examination and imaging were enrolled in the study. Computed tomographic lymphography (CTLG) followed by CT three-dimensional reconstruction was performed to determine the localization of SLNs and lymphatics on the body surface preoperatively. Intraoperatively combined staining with methylene blue and indocyanine green was used to evaluate the accuracy and feasibility of CTLG.

Results

SLNs and lymphatics from the breast were identified using CTLG in all patients, and preoperative SLNs and lymphatics localization on the body surface showed a significant role in the selection of operative incision and injection points. The accuracy rate of SLN and lymphatic detection by CTLG was 92.6% compared with intraoperatively combined staining. Moreover, preoperative CTLG performed well in SLN number detection, and the accuracy rate was 95.2%.

Conclusion

We evaluate the procedure and application of preoperative CTLG in the superficial localization of SLNs and lymphatics, which may lead to a decreased incidence of cutting off the lymphatics of SLNs and consequently more rapid and accurate SLN detection. This method promotes personalized SLN mapping, providing detailed information about the number and anatomical location of SLNs and lymphatics for adequate surgical planning for breast cancer patients.
11p11.12p12 duplication in a family with intellectual disability and craniofacial anomalies
Authors: Chen Xuejiao , Xu Huihui , Shi Weiwu , Wang Feng , Xu Fenfen , Zhang Yang , Gan Jun , Tian Xiong , Chen Baojun , Dai Meizhen
Published: April 2021

Background

Potocki–Shaffer syndrome (PSS) is a rare contiguous gene deletion syndrome marked by haploinsufficiency of genes in chromosomal region 11p11.2p12. Approximately 50 cases of PSS have been reported; however, a syndrome with a PSS-like clinical phenotype caused by 11p11.12p12 duplication has not yet been reported.

Methods

11p11.12p12 duplication syndrome was identified and evaluated using a multidisciplinary protocol. Diagnostic studies included intelligence testing, thorough physical examination, electroencephalography (EEG), magnetic resonance imaging (MRI) of the brain, ultrasonography, biochemical tests and karyotype analysis. Next-generation sequencing analysis clarified the location of the chromosomal variations, which was confirmed by chromosome microarray analysis (CMA). Whole-exome sequencing (WES) was performed to exclude single nucleotide variations (SNVs). A wider literature search was performed to evaluate the correlation between the genes contained in the chromosomal region and clinical phenotypes.

Results

The proband was a 36-year-old mother with intellectual disability (ID) and craniofacial anomalies (CFA). She and her older son, who had a similar clinical phenotype, both carried the same 11p11.12p12 duplication with a copy number increase of approximately 10.5 Mb (chr11:40231033_50762504, GRCh37/hg19) in chromosome bands 11p11.12p12. In addition, she gave birth to a child with a normal phenotype who did not carry the 11p11.12p12 duplication. By literature research and DECIPHER, we identified some shared and some distinct features between this duplication syndrome and PSS. One or more of ALX4, SLC35C1, PHF21A and MAPK8IP1 may be responsible for 11p11.12p12 duplication syndrome.

Conclusions

We present the first report of 11p11.12p12 duplication syndrome. It is an interesting case worth reporting. The identification of clinical phenotypes will facilitate genetic counselling. A molecular cytogenetic approach was helpful in identifying the genetic aetiology of the patients and potential candidate genes with triplosensitive effects involved in 11p11.12p12 duplication.
Gametocyte carriage of Plasmodium falciparum (pfs25) and Plasmodium vivax (pvs25) during mass screening and treatment in West Timor, Indonesia: a longitudinal prospective study
Authors: Kosasih Ayleen , Koepfli Cristian , Dahlan M. Sopiyudin , Hawley William A. , Baird J. Kevin , Mueller Ivo , Lobo Neil F. , Sutanto Inge
Published: April 2021

Background

A goal of malaria epidemiological interventions is the detection and treatment of parasite reservoirs in endemic areas—an activity that is expected to reduce local transmission. Since the gametocyte is the only transmissible stage from human host to mosquito vector, this study evaluated the pre and post presence of gametocytes during a mass screening and treatment (MST) intervention conducted during 2013 in East Nusa Tenggara, Indonesia.

Methods

RT-qPCR targeting pfs25 and pvs25 transcripts—gametocyte molecular markers for Plasmodium falciparum and Plasmodium vivax, respectively, was performed to detect and quantify gametocytes in blood samples of P. falciparum and P. vivax-infected subjects over the course of the MST study. The presence of both asexual and sexual parasites in microscopic and submicroscopic infections was compared from the start and end of the MST, using proportion tests as well as parametric and non-parametric tests.

Results

Parasite prevalence remained unchanged for P. falciparum (6% = 52/811 versus 7% = 50/740, p = 0.838), and decreased slightly for P. vivax (24% = 192/811 versus 19% = 142/740, p = 0.035) between the MST baseline and endpoint. No significant difference was observed in gametocyte prevalence for either P. falciparum (2% = 19/803 versus 3% = 23/729, p = 0.353, OR = 1.34, 95%CI = 0.69–2.63), or P. vivax (7% = 49/744 versus 5% = 39/704, p = 0.442, OR = 0.83, 95%CI = 0.52–1.31). Even though there was an insignificant difference between the two time points, the majority of parasite positive subjects at the endpoint had been negative at baseline (P. falciparum: 66% = 29/44, P. vivax: 60% = 80/134). This was similarly demonstrated for the transmissible stage—where the majority of gametocyte positive subjects at the endpoint were negative at baseline (P. falciparum: 95% = 20/21, P. vivax: 94% = 30/32). These results were independent of treatment provided during MST activities. No difference was demonstrated in parasite and gametocyte density between both time points either in P. falciparum or P. vivax.

Conclusion

In this study area, similar prevalence rates of P. falciparum and P. vivax parasites and gametocytes before and after MST, although in different individuals, points to a negligible impact on the parasite reservoir. Treatment administration based on parasite positivity as implemented in the MST should be reevaluated for the elimination strategy in the community.

Trial registration Clinical trials registration NCT01878357. Registered 14 June 2013, https://www.clinicaltrials.gov/ct2/show/NCT01878357.
Cross-cultural adaptation of the Perceived Risk of HIV Scale in Brazilian Portuguese
Authors: Torres Thiago S. , Luz Paula M. , Marins Luana M. S. , Bezerra Daniel R. B. , Almeida-Brasil Celline C. , Veloso Valdilea G. , Grinsztejn Beatriz , Harel Daphna , Thombs Brett D.
Published: April 2021

Background

Valid and reliable instruments are needed to measure the multiple dimensions of perceived risk. The Perceived Risk of HIV Scale is an 8-item measure that assesses how people think and feel about their risk of infection. We set out to perform a cross-cultural adaptation of the scale to Brazilian Portuguese among key populations (gay, bisexual and other men who have sex with men and transgender/non-binary) and other populations (cisgender heterosexual men and cisgender women).

Methods

Methodological study with cross-sectional design conducted online during October/2019 (key populations [sample 1] and other populations) and February–March/2020 (key populations not on pre-exposure prophylaxis [sample 2]). Cross-cultural adaptation of the Perceived Risk of HIV Scale followed Beaton et al. 2000 guidelines and included confirmatory factor analysis, differential item functioning (DIF) using the Multiple-Indicator Multiple-Cause model, and concurrent validity to verify if younger individuals, those ever testing for HIV, and engaging in high-risk behaviors had higher scores on the scale.

Results

4342 participants from key populations (sample 1 = 235; sample 2 = 4107) and 155 participants from other populations completed the measure. We confirmed the single-factor structure of the original measure (fit indices for sample 1 plus other populations: CFI = 0.98, TLI = 0.98, RMSEA = 0.07; sample 2 plus other populations: CFI = 0.97, TLI = 0.95, RMSEA = 0.09). For the comparisons between key populations and other populations, three items (item 2: “I worry about getting infected with HIV”, item 4: “I am sure I will not get infected with HIV”, and item 8: “Getting HIV is something I have”) exhibited statistically significant DIF. Items 2 and 8 were endorsed at higher levels by key populations and item 4 by other populations. However, the effect of DIF on overall scores was negligible (0.10 and 0.02 standard deviations for the models with other populations plus sample 1 and 2, respectively). Those ever testing for HIV scored higher than those who never tested (p < .001); among key populations, those engaging in high-risk behaviors scored higher than those reporting low-risk.

Conclusion

The Perceived Risk of HIV Scale can be used among key populations and other populations from Brazil.
Comprehensive analyses of correlation and survival reveal informative lncRNA prognostic signatures in colon cancer
Authors: Gao Meihong , Guo Yang , Xiao Yifu , Shang Xuequn
Published: April 2021

Background

Colon cancer is a commonly worldwide cancer with high morbidity and mortality. Long non-coding RNAs (lncRNAs) are involved in many biological processes and are closely related to the occurrence of colon cancer. Identification of the prognostic signatures of lncRNAs in colon cancer has great significance for its treatment.

Methods

We first identified the colon cancer-related mRNAs and lncRNAs according to the differential analysis methods using the expression data in TCGA. Then, we performed correlation analysis between the identified mRNAs and lncRNAs by integrating their expression values and secondary structure information to estimate the co-regulatory relationships between the cancer-related mRNAs and lncRNAs. Besides, the competing endogenous RNA regulation network based on co-regulatory relationships was constructed to reveal cancer-related regulatory patterns. Meanwhile, we used traditional regression analysis (univariate Cox analysis, random survival forest analysis, and lasso regression analysis) to screen the cancer-related lncRNAs. Finally, by combining the identified colon cancer-related lncRNAs according to the above analyses, we constructed a risk prognosis model for colon cancer through multivariate Cox analysis and also validated the model in the colon cancer dataset in TCGA cohorts.

Results

Six lncRNAs were found highly correlated with the overall survival of colon cancer patients, and a risk prognosis model based on them was constructed to predict the overall survival of colon cancer patients. In particular, EVX1-AS, ZNF667-AS1, CTC-428G20.6, and CTC-297N7.9 were first reported to be related to colon cancer by using our model, among which EVX1-AS and ZNF667-AS1 have been predicted to be related to colon cancer in LncRNADisease database.

Conclusions

This study identified the potential regulatory relationships between lncRNAs and mRNAs by integrating their expression values and secondary structure information and presented a significant 6-lncRNA risk prognosis model to predict the overall survival of colon cancer patients.