bluuebunny/crossref_metadata_2025 huggingface dataset:
Perceptions of Pressures to Alter or Misrepresent Time Allocation Among Clinician–Researchers With NIH Career Development Awards
Authors: Moniz Michelle H. , Griffith Kent A. , Jones Rochelle D. , Mangurian Christina , Jagsi Reshma
Published: October 2019

Purpose

National Institutes of Health career development (K) awards mandate specific allocations of effort to research and training. The authors sought to understand pressures perceived by award recipients to change or misrepresent effort, and whether these perceptions differed by gender.

Method

In 2010–2011 and 2014, the authors surveyed K08 and K23 award recipients. Questions evaluated perceived pressure to change or misrepresent time allocation. Multivariable logistic regression modeling of pressure to misrepresent effort evaluated associations with individual and basic job characteristics.

Results

Of the 1,719 faculty in the initial target population, 493 women and 573 men (1,066, 62%) responded at both time points. Most respondents reported feeling pressure to increase time spent on professional activities other than their K award-related research or career development or to decrease time on their K award-related research. The likelihood of perceiving pressure differed significantly by gender: 68% of women vs 55% of men (P < .001). A minority reported perceiving pressure to misrepresent professional time (women, 29%, vs men, 27%, P = .52). Multivariable analysis revealed that pressure to misrepresent professional time was less likely among respondents at institutions with the most extramural funding (P = .02). A significant pairwise interaction between gender and K award type suggested that female K08 awardees had higher odds than male peers of perceiving pressure to misrepresent time.

Conclusions

Most K award recipients reported feeling pressure to do more non-K award-related activities. More than a quarter reported feeling pressure to misrepresent effort. Additional research is needed to evaluate the proportion of academic medical faculty who actually misrepresent professional effort.
Bioactive Adrenomedullin, Organ Support Therapies, and Survival in the Critically Ill: Results from the French and European Outcome Registry in ICU Study
Authors: Lemasle Léa , Blet Alice , Geven Christopher , Cherifa Ményssa , Deniau Benjamin , Hollinger Alexa , Fournier Marie-Céline , Monnet Xavier , Rennuit Isabelle , Darmon Michael , Laterre Pierre-François , Struck Joachim , Hartmann Oliver , Bergmann Andreas , Mebazaa Alexandre , Gayat Etienne
Published: October 2019

Objectives:

Adrenomedullin has vascular properties and elevated plasma adrenomedullin levels were detected in sepsis. We assessed, in septic and nonseptic ICU patients, the relation between circulating adrenomedullin, the need for organ support and mortality, using an assay of bioactive adrenomedullin.

Design:

Prospective multicenter observational cohort study.

Setting:

Data from the French and euRopean Outcome reGistry in ICUs study.

Patients:

Consecutive patients admitted to intensive care with a requirement for invasive mechanical ventilation and/or vasoactive drug support for more than 24 hours following ICU admission and discharged from ICU were included.

Interventions:

Clinical and biological parameters were collected at baseline, including bioactive-adrenomedullin. Status of ICU survivors was assess until 1 year after discharge. The main outcome was the need for organ support, including renal replacement therapy and/or for inotrope(s) and/or vasopressor(s). Secondary endpoints were the ICU length of stay and the 28-day all-cause mortality.

Measurements and Main Results:

Median plasma bioactive adrenomedullin (n = 2,003) was 66.6 pg/mL (34.6–136.4 pg/mL) and the median Simplified Acute Physiology Score II score 49 (36–63). Renal replacement therapy was needed in 23% and inotropes(s) and/or vasopressor(s) in 77% of studied patients. ICU length of stay was 13 days (7–21 d) and mortality at 28 days was 22 %. Elevated bioactive adrenomedullin independently predicted 1) the need for organ support (odds ratio, 4.02; 95% CI, 3.08–5.25) in ICU patients whether admitted for septic or nonseptic causes and 2) the need for renal replacement therapy (odds ratio, 4.89; 3.83–6.28), and for inotrope(s) and/or vasopressor(s) (odds ratio, 3.64; 2.84–4.69), even in patients who were not on those supports at baseline. Elevated bioactive adrenomedullin was also associated with a prolonged length of stay (odds ratio, 1.85; 1.49–2.29) and, after adjustment for Simplified Acute Physiology Score II, with mortality (odds ratio, 2.31; 1.83–2.92).

Conclusions:

Early measurement of bioactive adrenomedullin is a strong predictor of the need of organ support and of short-term mortality in critically ill patients.
Opening the cocaine economy by providing within-session access to a cheaper source of cocaine makes demand for it more elastic
Authors: Kearns David N. , Silberberg Alan
Published: October 2019

Previous studies found that opening the cocaine economy by providing postsession access to cocaine had no effect on animals' demand for cocaine, whereas postsession access to saccharin or food made demand for these nondrug reinforcers more elastic. It is possible that there was no effect of economy type on cocaine taking in these earlier studies because of the delay to the postsession cocaine in the open economy. The present experiment tested whether forming an open economy by providing additional within-session cocaine, rather than postsession cocaine, would make rats' demand for cocaine more elastic. Saccharin was used as a nondrug comparison reinforcer. Three groups of rats pressed one lever for cocaine and one for saccharin on an ascending series of fixed ratio (FR) schedules where the number of responses required per reinforcer increased from 1 to 48 over sessions. In the open cocaine and open saccharin economy groups, rats had occasional access during the session to a third lever where cocaine or saccharin reinforcers, respectively, were always available on an FR-1 schedule. The main finding was that demand for cocaine was more elastic in the open cocaine economy group than in either of the other groups. Demand for saccharin was more elastic in the open saccharin economy group than in the open cocaine economy group. This study shows that cocaine taking is sensitive to economy type when the additional source of cocaine in an open economy is available close in time to when rats work for cocaine.
Integrating Fat Graft with Blepharoplasty to Rejuvenate the Asian Periorbita
Authors: Larsson Juan C. , Chen Tai-Yuan , Lao William W.
Published: October 2019

Background:

Contemporary periorbital rejuvenation is undergoing a paradigm shift to an approach that prioritizes volume preservation and/or augmentation. However, the technical difficulties of using traditional fat grafting techniques in this area and the distinct ethnic features make periorbital rejuvenation in Asians especially challenging. Here, the authors present their approach to enhance the periorbita and outcomes.

Methods:

A retrospective chart review was performed for 33 consecutive patients who underwent microautologous fat transplantation (MAFT) to the periorbita using the MAFT gun device combined with excisional blepharoplasty. Additionally, preoperative and postoperative photographs were analyzed by external evaluators to grade the aesthetic outcomes and fat resorption rates.

Results:

Three months after surgery, patients looked on average 5.4 ± 3.4 years younger, and the aesthetic result was graded 7.4 ± 2 in a one-to-ten scale. The fat resorption rate was 19.6% ± 3.5% at 3 months and 32.2% ± 3.9% after 12 months (range: 12–24 months; P = 0.007). The overall morbidity rate was 12% (4 patients), including 1 visible lump (3%), an overcorrection case (3%) in the lower eyelid, and 2 palpable lumps in the upper eyelid (6%) which were not visible. One case of lower eyelid hollowness required secondary fat grafting.

Conclusions:

Traditional blepharoplasty procedures can be combined with fat grafting techniques to address volume loss and tissue descend while keeping ethnic identity. A fat injection device like the MAFT gun is safe and effective and provides long-term predictable outcomes for fat grafting around the periorbital thin skin.
Prolonged Antiretroviral Therapy in Adolescents With Vertical HIV Infection Leads to Different Cytokine Profiles Depending on Viremia Persistence
Authors: Munhoz Luiz Gustavo Cano , Garcia Spina Fernanda , Machado Daisy Maria , Gouvea Aída , Succi Regina Célia De Menezes , Diaz Ricardo Sobhie , De Moraes-Pinto Maria Isabel
Published: October 2019

Background:

We investigated immune activation, exhaustion markers and cytokine expression upon stimulation in adolescents with vertical HIV infection.

Methods:

Thirty adolescents receiving antiretroviral therapy (ART) for vertical HIV infection, including 12 with detectable viral load (HIV/DET), 18 with undetectable viral load (HIV/UND) and 30 control adolescents without HIV infection (CONTROL), were evaluated for immune activation and programmed cell death protein-1 expression by flow cytometry, and 21 cytokines by Luminex Multiple Analyte Profiling technology after in vitro peripheral blood phytohemagglutinin stimulation.

Results:

Lower CD4+ T cells and higher T cell activation and exhaustion markers were noted on CD4+ T and on CD8+ T cells and memory subsets from HIV/DET group, who also produced lower in vitro IFN-gamma, IL-10, IL-13, IL-17A, IL-5 and IL-6 than HIV/UND group. HIV/UND were comparable with CONTROL group in respect to CD4+ T cell counts and T cell activation and exhaustion markers, but with higher in vitro production of ITAC (a chemokine with leukocyte recruitment function), IL-4 and IL-23. An inverse correlation between cytokine production and programmed cell death protein-1 expression on CD4+ T and CD8+ T subsets was detected.

Conclusions:

Persistent viremia despite ART leads to T cell activation and immune exhaustion with low cytokine production, whereas viral suppression by ART leads to parameters similar to CONTROL, although a different cytokine profile is observed, indicating residual HIV impact despite absence of detectable viremia.
Immunogenicity and Safety of the 13-Valent Pneumococcal Conjugate Vaccine Administered in a 3 + 1 versus 2 + 1 Dose Schedule Among Infants in China
Authors: Zhu Fengcai , Hu Yuemei , Li Jingxin , Ye Qiang , Young Mariano M. , Liang John Z. , Gruber William C. , Giardina Peter C. , Scott Daniel A.
Published: October 2019

Background:

13-valent pneumococcal conjugate vaccine (PCV13) was licensed in China based on immunologic noninferiority to 7-valent PCV (PCV7). As part of the noninferiority study, immunogenicity and safety of PCV13 administered as a 3- or 2-dose infant series followed by a toddler dose were examined in healthy Chinese infants.

Methods:

Infants (42- to 77-days-old) were randomized to a 3-dose PCV13 or PCV7 infant series administered double-blind at 3, 4 and 5 months or PCV13 administered open-label at 2, 4 and 6 months and a 2-dose open-label series at 3 and 5 months; all subjects received a toddler dose (12 months). Serotype-specific immunoglobulin G (IgG) concentrations were measured 1 month after the infant series and before and after the toddler dose. Opsonophagocytic activity (OPA) was measured in a subset of subjects at each time point. Safety was evaluated.

Results:

One month after the infant series, serotype-specific immune responses (IgG ≥ 0.35 µg/mL) were similar for the 2- versus 3-dose schedules, except for serotype 6B, which was significantly lower in the 2-dose group [70.1% in the PCV13 (3, 5 + 12 mo) group vs. 93.2% in the PCV13 (3, 4, 5 + 12 mo) group and 94.7% in the PCV13 (2, 4, 6 + 12 mo) group]. IgG geometric mean concentrations and OPA geometric mean titers trended numerically higher with 3- versus 2-dose schedules. No significant differences in immunogenicity were observed between the 3- versus 2-dose schedules after the toddler dose. PCV13 was well-tolerated across all schedules.

Conclusions:

PCV13 administered as a 3- or 2-dose infant series followed by a toddler dose was immunogenic and well tolerated in healthy Chinese infants and likely protective against PCV13 serotypes; immune responses with a 2-dose schedule were lower for some serotypes.
Instruments for the assessment of patient adherence to oral anticoagulation with warfarin protocol for a systematic review
Authors: da Silva Praxedes Marcus Fernando , Sousa Vianna Mayara , Freitas Nunes de Sousa Waleska Jaclyn , Bartolazzi Frederico , de Araújo Vânia Eloisa , Parreiras Martins Maria Auxiliadora
Published: October 2019

Background:

Non-adherence can be highlighted as one of the main contributors to the occurrence of adverse events in patients treated with warfarin. The usefulness of self-reporting measures of drug adherence could be improved by following psychometric properties in the development of the measurement scales. Thus, we aimed to describe the protocol of a systematic literature review designed to investigate and describe validated instruments used to assess adherence to warfarin therapy.

Methods:

We will perform a systematic review will include observational and experimental studies involving the use of validated instruments to assess adherence to warfarin therapy. Dimensions of adherence raised by the selected studies will be extracted to be compared. We will systematically search electronic databases including MEDLINE, LILACS, EMBASE, and Cochrane Library using a comprehensive strategy from inception to June 31, 2019. Two reviewers will revise the literature independently using a standardized form and assess the potential bias. After the comparison of results, discrepancies will be solved after the analysis of a third reviewer.

Result:

The development of the present systematic will help to summarize and evaluate the validated instruments that have been previously published to assess adherence to warfarin therapy.

Conclusion:

This review will substantiate the discussion of relevant topics that should be assessed while providing care to patients taking warfarin. This knowledge will enable a comprehensive approach for healthcare professionals to improve treatment outcomes and the design of future investigations.

Registration:

The systematic review is registered in the PROSPERO international prospective register of systematic review (PROSPERO# CRD42019128324).
Plasma miR-32 levels in non-small cell lung cancer patients receiving platinum-based chemotherapy can predict the effectiveness and prognosis of chemotherapy
Authors: Xu Shuyuan , Li Jing , Chen Ling , Guo Li , Ye Mei , Wu Yuanyuan , Ji Quanjiang
Published: October 2019

Background:

Previous studies have shown that microRNA-32 (miRNA-32) is an exosome microRNA that affects the proliferation and metastasis of non-small cell lung cancer (NSCLC) cells. In this study, our goal was to assess the expression of plasma microRNA-32 and its potential as a biomarker to predict the tumor response and survival of patients with NSCLC undergoing platinum-based chemotherapy.

Methods:

Plasma microRNA-32 levels before and after 1 cycle of platinum-based chemotherapy in 43 patients with NSCLC were measured using a quantitative real-time polymerase chain reaction assay (qPCR). In addition, the demographic and survival data of the patients were collected for analysis.

Results:

A significant correlation was observed between the changes in microRNA-32 levels before and after 1 chemotherapy cycle and the treatment response (P = .035). In addition, Kaplan–Meier analysis showed that the level of microRNA-32 after 1 chemotherapy cycle was significantly correlated with the prognosis of patients. The median progression-free survival (P = .025) and overall survival (P = .015) of patients with high microRNA-32 levels (≥7.73) after 1 chemotherapy cycle was 9 and 21 months, respectively. In contrast, the median survival of patients with low microRNA-32 levels (<7.73) was 5 and 10 months, respectively.

Conclusions:

The plasma levels of microRNA-32 correlated with the efficacy of platinum-based chemotherapy and survival, indicating that microRNA-32 may be useful for predicting the effectiveness of platinum-based chemotherapy and prognosis in NSCLC.
Giant paravertebral schwannoma near the lumbar nerve roots with bone destruction
Authors: Chen Hangjun , Xu Qiang , Zhan Ping , Liu Yuan , Dai Min , Zhang Bin
Published: October 2019

Rationale:

Schwannomas grow slowly, originating from the Schwann cells of the nerve sheath. Schwannomas of cranial origin have the highest incidence, followed by intraspinal schwannomas. However, paravertebral schwannoma is rare, and to our knowledge, giant paravertebral schwannomas near the lumbar nerve roots with bone destruction are extremely rare.

Patient concerns:

A 47-year-old Chinese woman complained of lower back soreness and a sensation of a bulging lumbar disc with no obvious cause for the past 3 years.

Diagnosis:

Lumbar magnetic resonance imaging showed a large mass with uneven density, 17 × 12 × 15 cm in size, located to the right of the 4th lumbar with obvious bony destruction. Histopathology and immunohistochemistry confirmed that this mass was a benign schwannoma.

Interventions:

Complete resection of the tumor (measuring about 17 × 12 × 15 cm in size) and vertebral reconstruction using internal fixation were performed.

Outcomes:

The patient was discharged without complications after surgery. The 3-year follow-up revealed that the patient recovered well with no evidence of recurrence.

Lessons:

Here, we emphasize the importance of careful radiological examination and reflect on the difficulty of tumor resection. Furthermore, understanding the treatment and diagnosis of lumbar paravertebral schwannoma is critical for plastic surgeons and radiologists when encountering similar cases.
Acupotomy by an ultrasound-guided technique
Authors: Qiu Zuyun , Jia Yan , Shen Yifeng , Zhou Qiaoyin , Sun Xiaojie , Zhu Xinyue , Li Shiliang
Published: October 2019

Background:

Acupotomy is a miniature surgery instrument. It can cut and detach the abnormal, cicatricial, and contractured tissues by causing only microtrauma. Acupotomy has been widely used clinically with a satisfactory efficacy. With the development of ultrasound technology, ultrasound-guided acupotomy has shown great value in clinical practice. But it is not yet clear that ultrasound-guided acupotomy is very effective and safe. Therefore, it is important to re-evaluate the available evidence to reach a relatively convincing conclusion that acupotomy by ultrasound-guided technique is a better choice than traditional acupotomy. The purpose of this systematic review is to provide a method for evaluating the effectiveness and safety of acupotomy by ultrasound-guided technique.

Methods:

This systematic review will be performed by searching relevant randomized controlled trials (RCTs) without any language or publication status restriction from inception to December 2019 by 2 researchers in nine databases (PubMed, Medline, Embase, Cochrane Library, Chinese literature databases, Chinese Biomedical Literature Database [CBM], China National Knowledge Infrastructure [CNKI], China Science and Journal Database [CSJD], and Wanfang Database). All RCTs evaluating acupotomy by the ultrasound-guided technique will be included in this study. Visual analog scale (VAS) and change of symptom will be assessed as the primary outcomes. The change in the ultrasound image, safety and adverse events, and acceptability will be assessed as secondary outcomes. The selection of study, data collection and analysis, and assessment of the study quality will be completed independently by 2 researchers. RevMan v.5.3 will be used for meta-analysis if no significant heterogeneity is detected. Continuous outcomes will be presented as the mean difference (MD) or standardized MD, while dichotomous data will be expressed as the relative risk.

Results:

This study will provide a high-quality synthesis of QL and AR to assess the effectiveness and safety of acupotomy by ultrasound-guided technique.

Conclusion:

This systematic review will provide evidence to judge whether acupotomy by ultrasound-guided technique is an effective the efficacy and safety intervention.

PROSPERO registration number:

CRD42018109070.
Acupotomy for patients with trigger finger
Authors: Jia Yan , Qiu Zuyun , Sun Xiaojie , Shen Yifeng , Zhou Qiaoyin , Li Shiliang
Published: October 2019

Background:

Trigger finger is thought to be caused by aseptic inflammation of the A1 pulley and subsequent thickening and narrowing of the fibrous sheath. Acupotomy has been an important treatment for trigger finger. But an updated systematic review about this issue has not yet been released. This systematic review protocol is aimed at providing a higher quality method used to evaluate the efficacy and safety of acupotomy treatment for trigger finger.

Methods:

The following databases will be searched from the study inception to July 2019: the Cochrane Central Register of Controlled Trials (Cochrane Library), MEDLINE, EMBASE, PubMed, China National Knowledge Infrastructure, Wan-Fang Data, and Chinese Biomedical Literature Database. All English or Chinese randomized controlled trials related to acupotomy for trigger finger will be included. Two reviewers will independently perform the processes of study inclusion, data extraction, and quality assessment. The primary outcome will be assessed by improvement of the pain symptoms and finger activity. Secondary outcomes will be assessed through Safety assessment. Meta-analysis will be completed by RevMan V.5.3 software.

Results:

This systematic review will provide an assessment of the current state of acupotomy for trigger finger, aiming to show the efficacy and safety of treatment.

Conclusion:

This systematic review will re-evaluate a higher-quality systematic review to obtain a relatively convincing conclusion that finds acupotomy to be a better choice for trigger finger patients.

PROSPERO registration number:

CRD42018118663
Comparison of International Consensus Conference guidelines and WIND classification for weaning from mechanical ventilation in Brazilian critically ill patients
Authors: Lago Alessandra Fabiane , Gastaldi Ada Clarice , Mazzoni Amanda Alves Silva , Tanaka Vanessa Braz , Siansi Vivian Caroline , Reis Isabella Scutti , Basile-Filho Anibal
Published: October 2019

The knowledge of weaning ventilation period is fundamental to understand the causes and consequences of prolonged weaning. In 2007, an International Consensus Conference (ICC) defined a classification of weaning used worldwide. However, a new definition and classification of weaning (WIND) were suggested in 2017. The objective of this study was to compare the incidence and clinical relevance of weaning according to ICC and WIND classification in an intensive care unit (ICU) and establish which of the classifications fit better for severely ill patients. This study was a retrospective cohort study in an ICU in a tertiary University Hospital. Patient data, such as population characteristics, mechanical ventilation (MV) duration, weaning classification, mortality, SAPS 3, and death probability, were obtained from a medical records database of all patients, who were admitted to ICU between January 2016 and July 2017. Three hundred twenty-seven mechanically ventilated patients were analyzed. Using the ICC classification, 82% of the patients could not be classified, while 10%, 5%, and 3% were allocated in simple, difficult, and prolonged weaning, respectively. When WIND was used, 11%, 6%, 26%, and 57% of the patients were classified into short, difficult, prolonged, and no weaning groups, respectively. Patients without classification were sicker than those that could be classified by ICC. Using WIND, an increase in death probability, MV days, and tracheostomy rate was observed according to weaning difficult. Our results were able to find the clinical relevance of WIND classification, mainly in prolonged, no weaning, and severely ill patients. All mechanically ill patients were classified, even those sicker with tracheostomy and those that could not finish weaning, thereby enabling comparisons among different ICUs. Finally, it seems that the new classification fits better in the ICU routine, especially for more severe and prolonged weaning patients.
Ilioinguinal/iliohypogastric nerve block versus transversus abdominis plane block for pain management following inguinal hernia repair surgery
Authors: Zhou Youfa , Chen Minmin , Zhang Yanting , Zhou Haiyan , Yu Xin , Chen Gang
Published: October 2019

Background:

Controversy still exists regarding the efficiency and safety of ilioinguinal/iliohypogastric nerve (II/IH) block versus transversus abdominis plane (TAP) block for pain management after inguinal hernia repair. The purpose of the current meta-analysis was to perform a relatively credible and comprehensive assessment to compare the efficiency and safety of II/IH versus TAP for pain management after inguinal hernia repair.

Methods:

The PUBMED, CENTRAL, and EMBASE were systematically searched. Studies comparing II/IH versus TAP for pain management in adult patients undergoing inguinal herniorrhaphy were included. The results of this study are synthesized and reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement.

Results:

Six studies with 632 patients were included in this study. No statistically significant difference was observed between the II/IH and TAP groups in postoperative opioid use, the time to first request for rescue analgesia, the incidence of postoperative nausea and vomiting (PONV), incidence of complication related with nerve blocks and patient satisfaction. The TAP group had a significantly higher pain score at 6 and 8 hours postoperatively (6 hours: mean difference [MD] = 0.94, 95% confidence interval [CI] 0.67–1.22, I
2 = 0%, P < .01; 8 hours: MD = 1.02, 95% CI 0.3–1.74, I
2 = 59%, P < .01). However, no statistically significant difference was observed at 1, 2, 4, 12, 24, 48 hours, and 6 months postoperatively.

Conclusions:

In general, this meta-analysis revealed that both approaches have similar postoperative opioid consumption and no significant difference in postoperative complication and patient satisfaction. The II/IH block provides excellent analgesic effects at 6 and 8 hours after inguinal herniorrhaphy in compared with the TAP block. However, more high-quality randomized controlled trials with long-term follow-up are still required to make the conclusion.
Accelerated perineural invasion in colitis-associated cancer
Authors: Nozawa Hiroaki , Hata Keisuke , Ushiku Tetsuo , Kawai Kazushige , Tanaka Toshiaki , Shuno Yasutaka , Nishikawa Takeshi , Sasaki Kazuhito , Emoto Shigenobu , Kaneko Manabu , Murono Koji , Sonoda Hirofumi , Ishihara Soichiro
Published: October 2019

Perineural invasion (PNI) is a prognostic factor in patients with colorectal cancer. Neurotrophic factors, molecular determinants of PNI, are altered in their expression levels in patients with ulcerative colitis. In this study, we evaluated the frequency of PNI in colitis-associated cancer (CAC) and sporadic cancer.

We retrospectively reviewed 778 colorectal cancers with pathological T3-T4 in 761 patients all of whom were surgically resected without preoperative treatment. The lesions were classified into either CAC or sporadic cancer based on the clinical information. Clinicopathological findings including PNI were compared between CACs and sporadic cancers. Moreover, we analyzed the risk factors for positive PNI by multivariate analysis using a logistic regression model.

Ten of the cancers (1.3%) were diagnosed as CACs, and the remaining 768 as sporadic cancers. CACs were characterized by being nonobstructive and predominantly located in the rectum. The CACs had a larger size and more frequent undifferentiated histology than sporadic cancers. PNI was observed more frequently in CACs (90%) than in sporadic cancers without obstruction (45%, P = .007). On multivariate analysis, CAC was one of the significant factors associated with PNI (odds ratio: 9.05, P = .040).

Our results suggest that CAC was more likely to exhibit PNI than sporadic colorectal cancer.
Investigation of burnout syndrome among electrical and building technology undergraduate students in Nigeria
Authors: Bakare Jimoh , Omeje Hyginus Osita , Yisa Mukaila Abiodun , Orji Chibueze Tobias , Onyechi Kay C. N. , Eseadi Chiedu , Nwajiuba Chinyere Augusta , Anyaegbunam Emenike N.
Published: October 2019

Background:

The investigation of burnout among undergraduate students is yet to receive the same amount of attention as burnout in employees. Despite the negative effects of burnout among students, there is dearth of literature on burnout problem among electrical and building technology undergraduate students. Therefore, this study aimed to determine the burnout levels and the effect of rational-emotive behavior therapy (REBT) on symptoms of burnout among electrical and building technology undergraduate students in South–East zone of Nigeria.

Method:

A group randomized trial design involving a treatment group versus no-treatment group was adopted for this study. One hundred fifty four undergraduate students of electrical and building technology who met the study's inclusion criteria were selected from public universities in the South–East zone of Nigeria. The intervention consisted of 10 weeks of REBT treatment and 8 weeks of follow-up meetings conducted at 4 months. A self-report questionnaire was used for data collection. Repeated-measures analysis of variance, paired sample t test, and Chi-Squared were used for data analysis.

Results:

The outcome indicated that the levels of burnout syndrome among the students are high and REBT had a significant effect on the symptoms of burnout syndrome among the electrical and building technology students in the treatment group compared to their counterparts in the no-treatment group. Finally, the positive gains were significantly maintained by the treatment group at follow-up.

Conclusion:

The current study suggests that an REBT program can be effective for dealing with burnout syndrome among the population of undergraduate students of electrical and building technology in Nigeria.
The association between progression of coronary artery calcium and colorectal adenoma
Authors: Lee Yun Jeong , Baik Su Jung , Park Hyojin , Park Jae Jun , Han Donghee , Lee Hye Sun , Lee Byoung Kwon
Published: October 2019

The potential relationship between coronary artery calcium (CAC) and colorectal adenoma has been widely indicated. This study aimed to investigate the relationship between the risk of colorectal adenoma and CAC progression in asymptomatic Korean adults who underwent serial assessments by colonoscopy and CAC scan.

A total of 754 asymptomatic participants, who had undergone serial CAC scans and colonoscopies for screening, were enrolled. Changes in CAC were assessed according to the absolute change between baseline and follow-up results. CAC progression was defined using Multi-Ethnic Study of Atherosclerosis method. Risk for adenoma at follow-up colonoscopy was determined using hazard ratio (HR) by Cox regression. The area under the receiver operating characteristic (ROC) curve was measured.

The mean follow-up duration was 3.4 ± 2.5 years. CAC progression was found in 215 participants (28.5%). Participants with adenoma at index colonoscopy showed a higher rate of CAC progression than those without (38.8% vs 23.6%, P < .01). In participants with adenoma at index colonoscopy, CAC progression significantly increased the cumulative risk for adenoma at follow-up colonoscopy (HR = 1.48, 95% confidence interval [CI] 1.06–2.06, log-rank P = .021). In multivariate analysis, male sex (HR = 2.57, 95% CI 1.22–5.42, P = .013), ≥3 adenomas at index colonoscopy (HR = 2.60, 95% CI 1.16–5.85, P = .021), and CAC progression (HR = 2.74, 95% CI 1.48–5.08, P = .001) increased the risk of adenoma at follow-up colonoscopy. In participants without adenoma at index colonoscopy, neither baseline CAC presence nor CAC progression increased the risk of adenoma at follow-up colonoscopy. The interaction between CAC progression and adenoma at index colonoscopy was significant in multivariable model (P = .005). In the ROC analysis, AUC of CAC progression for adenoma at follow-up colonoscopy was 0.625 (95% CI 0.567–0.684, P < .001) in participants with adenoma at index colonoscopy.

Participants with CAC progression, who are at high risk of coronary atherosclerosis, may need to be considered for follow-up evaluation of colorectal adenoma, especially those with adenoma at index colonoscopy.
The long-term impact of tumor burden in pT3N0M0 esophageal squamous cell carcinoma
Authors: Li Tingting , Fu Xiaobin , Xiao Lihua , Su Liyu , Dai Yaqing , Yao Qiwei , Li Jiancheng
Published: October 2019

The purpose of this study was to assess the impact of tumor burden on the survival of patients with pathologic T3N0M0 (pT3N0M0) esophageal squamous cell carcinoma (ESCC).

A total of 84 patients with pathologic T3N0M0 ESCC treated with radical esophagectomy and 3-field lymphadenectomy (3-FL) from January 2008 to December 2009 in our center were analyzed. Receiver-operating characteristic (ROC) curve analysis was performed to calculate the optimal cutoff value. The Kaplan–Meier method and log-rank test were used to assess the overall survival (OS) differences between groups. A regression model was applied to identify prognostic factors for OS. Propensity score matching (PSM) was performed to adjust for the imbalance and indication biases in the 2 groups.

The median follow-up time was 62 months (range, 1–84 months), and the 5-year OS rate was 62% (95% confidence interval, 52.2–71.8%). According to the ROC curve analysis, the optimal cutoff values for the maximal esophageal wall thickness, tumor length, and tumor volume were 1.3 cm, 5.9 cm, and 18.6 cc, respectively. Univariate analysis revealed that maximal esophageal wall thickness >1.3 cm (P = .014), tumor volume >18.6 cc (P < .001), and vascular invasion (P < .001) were significantly associated with OS. The multivariate Cox regression model identified tumor volume and vascular invasion as factors affecting OS. After propensity matching, patients with a tumor volume ≤18.6 cc had a better OS than those with a tumor volume >18.6 cc (5-year OS, 85% vs 50%, P = .008).

Tumor volume may serve as a good prognostic factor for patients with pT3N0M0 ESCC treated with radical esophagectomy and 3-FL. Larger-scale studies are warranted to validate these findings.
Incidence and outcomes of cricothyrotomy in the “cannot intubate, cannot oxygenate” situation
Authors: Kwon Young Suk , Lee Choung Ah , Park Sunghoon , Ha Sang Ook , Sim Yun Su , Baek Moon Seong
Published: October 2019

Few data are available regarding factors that impact cricothyrotomy use and outcome in general hospital setting. The aim of the present study was to determine the incidence and outcomes of the patients underwent cricothyrotomy in a “cannot intubate, cannot oxygenate” (CICO) situation at university hospitals in Korea.

This was a retrospective review of the electronic medical records of consecutive patients who underwent cricothyrotomy during a CICO situation between March, 2007, and October, 2018, at 2 university hospitals in Korea. Data regarding patient characteristics and outcomes were analyzed using descriptive statistics.

During the study period, a total of 10,187 tracheal intubations were attempted and 23 patients received cricothyrotomy. Hospitalwide incidence of cricothyrotomy was 2.3 per 1000 tracheal intubations (0.23%). The majority of cricothyrotomy procedures (22 cases, 95.7%) were performed in the emergency department (ED); 1 cricothyrotomy was attempted in the endoscopy room. In the ED, 5663 intubations were attempted and the incidence of cricothyrotomy was 3.9 per 1000 tracheal intubations (0.39%). Survival rate at hospital discharge was 47.8% (11 of 23 cases). Except for cardiac arrest at admission, survival rate was 62.5% (10 of 16 cases). Successful cricothyrotomy was performed in 17 patients (73.9%) and 9 patients (52.9%) were survived. Among 6 patients of failed cricothyrotomy (26.1%), 2 patients (33.3%) were survived. After failure of cricothyrotomy, various methods of securing airway were established: 3 tracheal intubations, 1 nasotracheal intubation, and 1 tracheostomy.

The success rate of cricothyrotomy and survival rate in the CICO situation were not high. After failure of cricothyrotomy, various methods of securing airway were performed.
Development and validation of a revised trauma-specific quality of life instrument
Authors: Herrera-Escobar Juan Pablo , deRoon-Cassini Terri , Brasel Karen , Nehra Deepika , Al Rafai Syeda Sanam , Toppo Alexander , Kasotakis George , Velmahos George , Salim Ali , Haider Adil Hussain
Published: October 2019

BACKGROUND

The National Academies of Science has called for routine collection of long-term outcomes after injury. One of the main barriers for this is the lack of practical trauma-specific tools to collect such outcomes. The only trauma-specific long-term outcomes measure that applies a biopsychosocial view of patient care, the Trauma Quality-of-Life (T-QoL), has not been adopted because of its length, lack of composite scores, and unknown validity. Our objective was to develop a shorter version of the T-QoL measure that is reliable, valid, specific, and generalizable to all trauma populations.

METHODS

We used two random samples selected from a prospective registry developed to follow long-term outcomes of adult trauma survivors (Injury Severity Score ≥9) admitted to three level I trauma centers. First, we validated the original T-QoL instrument using the 12-Item Short-Form Health Survey (SF-12) version 2.0 and Breslau post-traumatic stress disorder screening (B-PTSD) tools. Second, we conducted a confirmatory factor analysis to reduce the length of the original T-QoL instrument, and using a different sample, we scored and performed internal consistency and validity assessments of the revised T-QoL (RT-QoL) components.

RESULTS

All components of the original T-QoL were significantly correlated negatively with the B-PTSD and positively with the SF-12 mental and physical composite scores. After confirmatory factor analysis, a three-component structure using 18 items (six items/component) most appropriately represented the data. Each component in the revised instrument demonstrated a high level of internal consistency (Cronbach's α ≥0.8) and correlated negatively with the B-PTSD and positively with the SF-12, demonstrating concurrent validity. In addition, each of the RT-QoL components was able to distinguish between individuals based on their work status, with those who have returned to work reporting better health.

CONCLUSION

This more practical RT-QoL measure greatly increases the ability to evaluate long-term outcomes in trauma more efficiently and meaningfully, without sacrificing the validity and psychometric properties of the original instrument.

LEVEL OF EVIDENCE

Prognostic and epidemiological, level III.
AzeR, a transcriptional regulator that responds to azelaic acid in Pseudomonas nitroreducens
Authors: Bez Cristina , Javvadi Sree Gowrinadh , Bertani Iris , Devescovi Giulia , Guarnaccia Corrado , Studholme David J. , Geller Alexander M. , Levy Asaf , Venturi Vittorio
Published: October 2019

Azelaic acid is a dicarboxylic acid that has recently been shown to play a role in plant-bacteria signalling and also occurs naturally in several cereals. Several bacteria have been reported to be able to utilize azelaic acid as a unique source of carbon and energy, including

Pseudomonas nitroreducens

. In this study, we utilize

P. nitroreducens

as a model organism to study bacterial degradation of and response to azelaic acid. We report genetic evidence of azelaic acid degradation and the identification of a transcriptional regulator that responds to azelaic acid in

P. nitroreducens

DSM 9128. Three mutants possessing transposons in genes of an acyl-CoA ligase, an acyl-CoA dehydrogenase and an isocitrate lyase display a deficient ability in growing in azelaic acid. Studies on transcriptional regulation of these genes resulted in the identification of an IclR family repressor that we designated as AzeR, which specifically responds to azelaic acid. A bioinformatics survey reveals that AzeR is confined to a few proteobacterial genera that are likely to be able to degrade and utilize azelaic acid as the sole source of carbon and energy.
Mindfulness meditators show enhanced working memory performance concurrent with different brain region engagement patterns during recall
Authors: Bailey NW , Freedman G , Raj K , Spierings KN , Piccoli LR , Sullivan CM , Chung SW , Hill AT , Rogasch NC , Fitzgerald PB
Published: October 2019

Mindfulness meditation has been shown to improve working memory (WM). However, the altered brain activity underpinning these improvements is underexplored. In non-meditating individuals, modulation of theta and alpha oscillations and 1/f aperiodic activity during WM has been found to be related to WM performance. Resting theta and alpha oscillations have been found to differ in meditators, but WM related oscillation changes and 1/f aperiodic activity have not yet been examined. Additionally, WM event-related-potentials (ERPs) are modulated by attention, which is also enhanced by meditation, so these neural measures are candidates for exploring neural activity underpinning WM improvement in meditators. We recorded EEG from 29 controls and 29 meditators during a modified Sternberg WM task and compared theta, alpha, and 1/f aperiodic activity during the WM delay, and ERPs time-locked to the WM probe. Meditators responded more accurately (p = 0.008, Cohen’s d = 0.688). Meditators also showed different ERP distributions with earlier left-temporal activation and more frontal distribution of activity (FDR-p = 0.0186, η2 = 0.0903), as well as a reduction in overall neural response strength (FDR-p = 0.0098, η2 = 0.1251). While a higher proportion of meditators showed theta oscillations during the WM delay, no other differences in theta, alpha or 1/f aperiodic activity were present. These results suggest that increased WM performance in meditators might not be the result of higher amplitudes of typical WM activity, but instead due to an alternative neural strategy during WM decision making, which may allow more accurate responses with less neural activation.

Highlights

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Long term mindfulness meditators showed improved working memory (WM) accuracy

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This was concurrent with earlier left temporal activation following probe stimuli

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As well as a more frontal distribution and reduced overall neural response strength

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No oscillation differences were present in the working memory delay period

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Improved WM from altered neural strategy rather than increased neural activity
Less is more! Rapid increase in plant species richness after reduced mowing of urban grasslands
Authors: Sehrt Melissa , Bossdorf Oliver , Freitag Martin , Bucharova Anna
Published: October 2019

Urban lawns provide space for recreation in cities, and they are an important part of urban green infrastructures. However, most lawns are intensively managed. As only few plant species can survive the frequent mowing, urban lawns typically harbor only a limited number of plant species. To improve the biodiversity of urban lawns, it is often suggested to reduce the mowing frequency. Here, we studied the plant diversity of urban grasslands that have recently undergone management changes from mowing every few weeks to mowing only once or twice per season and compared them to intensively managed lawns. Within six years after the management changes, the grasslands with reduced mowing frequency indeed hosted 30% more plant species than intensively managed lawns, and they were more heterogeneous both within and between grasslands. Additionally, the species composition of less frequently mown grasslands shifted from common mowing-tolerant lawn species to typical meadow species. Our study thus shows that the reduction of mowing is a simple and effective tool for increasing the biodiversity in urban grasslands.
Parallel Factor Analysis for multidimensional decomposition of fNIRS data
Authors: Hüsser Alejandra M. , Caron-Desrochers Laura , Tremblay Julie , Vannasing Phetsamone , Martínez-Montes Eduardo , Gallagher Anne
Published: October 2019

Significance

Current techniques for data analysis in functional near-infrared spectroscopy (fNIRS), such as artifact correction, do not allow to integrate the information originating from both wavelengths, considering only temporal and spatial dimensions of the signal’s structure. Parallel factor analysis (PARAFAC) has previously been validated as a multidimensional decomposition technique in other neuroimaging fields.

Aim

We aimed to introduce and validate the use of PARAFAC for the analysis of fNIRS data, which is inherently multidimensional (time, space, wavelength).

Approach

We used data acquired in 17 healthy adults during a verbal fluency task to compare the efficacy of PARAFAC for motion artifact correction to traditional 2D decomposition techniques, i.e. target principal (tPCA) and independent component analysis (ICA). Correction performance was further evaluated under controlled conditions with simulated artifacts and hemodynamic response functions.

Results

PARAFAC achieved significantly higher improvement in data quality as compared to tPCA and ICA. Correction in several simulated signals further validated its use and promoted it as a robust method independent of the artifact’s characteristics.

Conclusions

This study describes the first implementation of PARAFAC in fNIRS and provides validation for its use to correct artifacts. PARAFAC is a promising data-driven alternative for multidimensional data analyses in fNIRS and this study paves the way for further applications.
Biased M1positive allosteric modulators reveal novel role of phospholipase D in M1-dependent rodent cortical plasticity
Authors: Moran Sean P. , Xiang Zixiu , Doyle Catherine A. , Maksymetz James , Lv Xiaohui , Faltin Sehr , Niswender Colleen M. , Rook Jerri M. , Lindsley Craig W. , Jeffrey Conn P.
Published: October 2019

Highly selective positive allosteric modulators (PAMs) of the M1subtype of muscarinic acetylcholine receptor have emerged as an exciting new approach for the potential improvement of cognitive function in patients suffering from Alzheimer’s disease and schizophrenia. M1PAM discovery programs have produced a structurally diverse range of M1PAMs with distinct pharmacological properties, including different levels of agonist activity and differences in signal bias. This includes the recent discovery of novel biased M1PAMs that can potentiate coupling of M1to activation of phospholipase C but not phospholipase D (PLD). However, little is known about the role of PLD in M1signaling in native systems and it is not clear whether biased M1PAMs will display differences in modulating M1-mediated responses in native tissue. We now report a series of studies using novel PLD inhibitors and PLD knockout mice to show that PLD is necessary for the induction of M1-dependent long-term depression (LTD) in the prefrontal cortex (PFC). Importantly, biased M1PAMs that do not couple to PLD not only fail to potentiate orthosteric agonist-induced LTD but also block M1-dependent LTD in the PFC. In contrast, biased and non-biased M1PAMs act similarly in potentiating M1-dependent electrophysiological responses that are PLD-independent. These findings demonstrate that PLD plays a critical role in the ability of M1PAMs to modulate certain CNS functions and that biased M1PAMs function differently in brain regions implicated in cognition.

We demonstrate a novel role of phospholipase D in M1-dependent rodent cortical plasticity and M1PAMs that do not couple to phospholipase D have functionally distinct effects on cortical plasticity than non-biased M1PAMs.