bluuebunny/crossref_metadata_2025 huggingface dataset:
Chronic fusiform extracranial vertebral artery aneurysm with recurrent posterior circulation emboli: Case report and review of the literature
Authors: Evans Katherine , Lindert Ralf-Björn , Dyde Richard , Tse George H
Published: May 2021

We report a case of a 64-year-old man with a fusiform right extracranial vertebral artery aneurysm, spanning over half the extra-cranial V2 (foraminal) segment, presenting with recurrent multi-focal posterior circulation embolic ischaemic stroke. The patient was treated with endovascular embolisation of the right vertebral artery to prevent further thrombo-embolic events. Distal and proximal occlusion of the aneurysmal vertebral artery was performed with a micro-vascular plug with partial aneurysm sack embolisation to aid thrombosis and reduce the risk of recanalisation. Two months post procedure MR angiography confirmed successful aneurysm occlusion with no post-procedural complication. The patient returned to his normal independent life. Endovascular treatment with vessel sacrifice is an effective treatment with low morbidity and we believe the MVP device to be a efficacious option in the vertebral artery.
Resilient allocentric reorientation following transfer from the inside to the outside of an arena
Authors: Holden Luke J , Whitt Emma J , Haselgrove Mark
Published: May 2021

In two virtual spatial-navigation experiments, participants were trained to find a hidden goal that was located adjacent to one of the right-angled corners of a cross-shaped virtual environment. The location of the goal was defined solely with respect to the geometry of the environmental structure. Training trials started from a single central start location (Experiment 1) or from multiple start locations over 2, 4, or 16 training trials (Experiment 2). Following training, participants were placed onto the outside of the same environment and asked to again find the hidden goal (which, unbeknown to participants, was removed) during a single test trial. The results from both experiments revealed that participants spent more time searching in regions on the outside of the environment that were closest to the location where the hidden goal was positioned during the previous training stage. In contrast, participants spent very little time searching in regions whose visual appearance matched those regions that contained the hidden goal during training. These results reproduce the findings from previous research which supports the idea of an allocentric encoding of the shape of the environment during navigation and further implies that this encoding is relatively resilient to manipulations that might be expected to undermine it.
Review of pregnancy in Crohn’s disease and ulcerative colitis
Authors: Laube Robyn , Paramsothy Sudarshan , Leong Rupert W.
Published: May 2021

Inflammatory bowel disease (IBD) frequently affects women of childbearing age and can have implications in pregnancy. Most women with IBD have comparable fertility with women in the general population. Fertility is reduced in women with active disease or previous ileal-pouch–anal anastomosis (IPAA) surgery and is temporarily reduced in men taking sulfasalazine. Women with IBD have an increased risk of preterm delivery, low birth weight, small-for-gestational-age infants and Cesarean section (CS) delivery, however, no increased risk of congenital abnormalities. These adverse outcomes are particularly prevalent for women with active IBD compared with those with quiescent disease. Conception should occur during disease remission to optimize maternal and fetal outcomes and reduce the risk of disease exacerbations during pregnancy. Pre-conception counseling is therefore pertinent to provide patient education, medication review for risk of teratogenicity and objective disease assessment. Most medications are safe during pregnancy and breastfeeding, with the exception of methotrexate, ciclosporin, allopurinol and tofacitinib. Delivery modality should be guided by obstetric factors in most cases; however, CS is recommended for women with active perianal disease and can be considered for women with inactive perianal disease or IPAA. In conclusion, most women with IBD have uncomplicated pregnancies. Active IBD is the predominant predictor of poor outcomes and disease exacerbations; therefore, maintenance of disease remission during and before pregnancy is crucial.
Teriflunomide in relapsing-remitting multiple sclerosis: outcomes by age and pre-treatment status
Authors: Kallmann Boris A. , Ries Stefan , Kullmann Jennifer S. , Quint Laura M. , Engelmann Ulrich , Chan Andrew
Published: May 2021

Background and aims:

To investigate effectiveness and safety of teriflunomide (14 mg once daily) in association with age and pre-treatment in unselected MS patients.

Methods:

Prespecified analysis of a non-interventional, prospective, real-world study in Germany.

Results:

A total of 558 (49.5%) patients were above 45 years old, and 593 patients (52.6%) had been pre-treated within 6 months prior to teriflunomide. Baseline Expanded Disability Status Scale (EDSS) was higher with older age, with lower number of relapses. Relapse rate decreased in all age groups, and in both treatment-naïve (0.82 ± 0.73 at baseline; 0.25 ± 0.55 under teriflunomide) and pre-treated (from 0.48 ± 0.76; 0.22 ± 0.50) patients after 12 months compared with the year before teriflunomide initiation. EDSS remained stable in patients of all age groups as well as in therapy-naïve and pre-treated patients over 24 months. The percentage of patients with adverse events (AEs) ranged between 29.2% (age group >25–35) and 38.9% (age group >55–65), with an increased discontinuation rate (most commonly due to diarrhoea, alopecia and nausea) in the higher age groups. AE rates were lower in pre-treated compared with treatment-naïve patients.

Conclusion:

Overall, patients of all age groups including older patients, and irrespective of pre-treatment, benefit from teriflunomide treatment in routine clinical practice.

Registration:

BfArM public study database number 2075.
Is timing of superior labrum anterior to posterior (SLAP) repair important? A cohort study evaluating the effect of the duration of symptoms prior to surgery on the outcomes of patients who underwent type II SLAP repair
Authors: Murphy Geoffrey T , Lam Patrick H , Murrell George AC
Published: May 2021

Background

The management of superior labrum anterior to posterior (SLAP) tears is somewhat controversial. It is unclear if the length of time between symptom onset and surgery affects SLAP repair outcomes.

Methods

Sixty-one SLAP repairs were retrospectively reviewed pre-operatively and post-operatively at 1, 6, 24 weeks, and > 2 years post-surgery. Patients were allocated to an ‘early repair’ or ‘late repair’ group based on time between symptom onset and surgery.

Results

Of the 61 patients, 22 patients had surgery within six months of symptom onset. Pre-operatively, ‘late repair’ patients played a higher level of sport than ‘early repair’ patients prior to injury. Post-operatively, both groups had similar outcomes up to six months, though at six months ‘early repair’ patients reported a higher level of work than ‘late repair’ patients (p = 0.01). At > 2 years after surgery, ‘early repair’ patients had reduced pain and difficulty with overhead activities (p = 0.002), less stiffness (p = 0.001) and were more satisfied than ‘late repair’ patients (p = 0.04).

Conclusions

Up to six months post-operatively, the time between symptom onset and surgery has limited effect on functional outcomes. However, at > 2 years after surgery, earlier repairs ( < 6 months) are interestingly associated with better functional outcomes. Further studies are required to determine if this is a causal relationship.
Erdafitinib treatment in Brazilian patients with metastatic urothelial carcinoma (mUC): real-world evidence from an Expanded Access Program
Authors: Monteiro Fernando Sabino M. , Silva Adriano Gonçalves e , Gomes Andrea Juliana P. de S. , Dutra Carolina , Ferreira Naira Oliveira , Mariano Rodrigo Coutinho , Schutz Fabio A.
Published: May 2021

Background:

Erdafitinib is the first targeted therapy approved for the treatment of patients with metastatic urothelial carcinoma (mUC). Approval was based on a phase II single-arm trial that demonstrated significant activity of erdafitinib in patients with tumors harboring FGFR2/3 alterations. In Brazil, an Expanded Access Program (EAP) provided patients with early access to erdafitinib prior to market authorization. The current report describes characteristics and outcomes of patients with mUC on erdafitinib therapy.

Methods:

Patients with mUC that failed first- and second-line systemic therapies were screened for FGFR2/3 alterations in primary or metastatic tumor tissues. Patients with FGFR2/3 alterations were selected to receive erdafitinib at the standard dosing schedule and were followed prospectively to evaluate the efficacy and safety outcomes.

Results:

From 19 April 2019, through 13 March 2020, 47 patients with mUC from 10 Brazilian centers were tested for FGFR2/3 alterations. Alterations in FGFR2/3 were found in 12 patients (25.5%) and all of them were eligible for the EAP. Four patients (33%) had partial response, while two patients (17%) had stable disease. Progressive disease, the best response, was observed in five patients (42%). At a median follow-up of 16.2 months, the median time to treatment failure (TTF) was 2.8 months. When considering only patients with objective response, the median TTF was 5.3 months. Adverse events (AEs) were reported for any grade and grade 3 or higher in 10 patients (83%) and 5 patients (42%), respectively. The most common AE was hyperphosphatemia.

Conclusion:

This first real-world evidence report of heavily treated patients with mUC confirms the efficacy and safety of erdafitinib in a disease setting with a lack of treatment options.
The Effect of Seeking Resource Diversity on Post-Alliance Innovation Outcomes
Authors: Liu Richie L , Juasrikul Sakdipon , Yim Sean
Published: May 2021

Prior research has studied the influence of R&D resource diversity, but such work only examined a single level of resource diversity. Although alliance partners engage in multiple levels of resource diversity to expand their organizational boundary, we have limited knowledge of how to utilize internal and between partners’ R&D resources. Drawing upon the perspectives of the tensions-based view and organizational boundary, we test the effects of three different levels of resource diversities, simultaneously, on post-alliance innovation outcomes. Using a dataset of 320 U.S. publicly traded firms that participated in a strategic alliance and had a patent filing between 1985 and 2010, our results reveal that internal R&D resource diversity, the R&D diversity between partners, and the similarity of industry level negatively effects innovative outcomes. However, both internal R&D resource diversity and similarity of industry level diminish the negative influence of newly acquired R&D resources from partners. We not only contribute to the existing body of work by investigating multiple levels of diversity but also provide insight to practitioners when engaging in such diversities with different levels.
Linalool Inhibits MCF-7 Tumor Growth in a Xenograft Model by Apoptosis Induction and Immune Modulation
Authors: Zhao Yunqi , Meng Xi , Zeng Yan , Wang Canbin , Chen Jiwei , She Zhennan
Published: May 2021

In this study, the anti-cancer activity of linalool was investigated in MCF-7 breast cancer-bearing mice. Natural killer (NK) and B cell populations in peripheral blood were studied by flow cytometry. The expressions of proliferating cell nuclear antigen (PCNA) and Ki-67 in xenograft tumors were evaluated by immunohistochemistry. Terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL) assay was performed to investigate apoptosis induction in an in vivo model. The results indicated that linalool possesses an inhibitory effect on breast cancer growth in the xenograft model. Linalool reduced B cell counts, but increased NK cell counts in mice peripheral blood. The immunosignals of PCNA and Ki-67 were significantly lower in the linalool treatment group than those of the control group. The TUNEL assay showed that linalool significantly induced apoptosis compared to the control group. The findings of this study provide insight and evidence on the antiproliferative activity of linalool on human breast cancer.
Determining the Number of Bariatric Beds Needed in a U.S. Acute Care Hospital
Authors: Magazine Michael , Murphy Matt , Schauer Daniel P. , Wiggermann Neal
Published: May 2021

Aim:

This project used historical hospital data to forecast demand for specialized bariatric beds. Models were evaluated that determined the relationship between the number of bariatric beds owned and service level for patients of size requiring these beds. A calculator was developed for minimizing the equipment costs of meeting demand.

Background:

Failing to provide enough bariatric beds may negatively affect outcomes for patients of size and healthcare workers, whereas owning more bariatric beds than required to meet demand means unnecessary cost. With rising rates of obesity increasing care costs, minimizing equipment costs is increasingly important.

Method:

One year of hospital admissions data were used to determine arrival rates and lengths of stay for patients of size. Two subsequent years verified the consistency of these rates. Simulations modeled the flow of patients of size through the hospital and the service level associated with the number of beds owned. A minimization function determined the optimal number of bariatric beds to be provided. A simplified, generalizable model was compared to the simulation.

Results:

The simplified model produced similar results to more complex simulation. The optimization was robust, or insensitive to small changes in inputs, and identified substantial opportunity for savings if demand for beds was substantially over- or underestimated.

Conclusions:

The simplified model and cost optimization could be used in many situations to prevent costly errors in equipment planning. However, hospitals should consider customized simulation to estimate demand for high-cost equipment or unique circumstances not fitting the assumptions of these models.
Epithelioid sarcoma of the parapharyngeal space: A case report
Authors: Li Yun-Tian , Luo Wen-Guang , Zhang Hong-Yan
Published: May 2021

Epithelioid sarcoma (ES) was first described by Enzinger in 1970. It is a rare variant of soft tissue sarcoma with a 5-year overall survival (OS) rate of 50%. Here, we reported a case of epithelioid sarcoma in the parapharyngeal space of an adult, resulting in a favorable prognosis after chemotherapy and radiation therapy. A 34-year-old female who complained of pharynx pain and discomfort was suspected of having a tumor in the right parapharyngeal space by CT scan. Excision biopsy suggested epithelioid sarcoma. Clinical and radiological studies did not reveal tumor distant metastasis in the patient. After excisional biopsy, the patient underwent chemotherapy and external beam radiation treatment. She has remained alive for 2 years and 7 months without recurrence since her last treatment. In this paper, we also provide a detailed review of the role of radiotherapy in the treatment of epithelioid sarcoma in previously reported cases.
Pros and cons of eHealth: A systematic review of the literature and observations in Denmark
Authors: Svendsen Mathias T , Tiedemann Sylvia N , Andersen Klaus Ejner
Published: May 2021

Objectives:

The main objectives of this article are to systematically review the recent literature on patient safety in relation to the use of eHealth and to investigate how the Danish authorities supervise private eHealth clinics with regard to patient safety.

Methods:

Original studies reporting the association between patient safety and the use of eHealth as a means of communication between patients and healthcare providers were included. Four literature databases were searched for English-language articles reporting results from cohort studies and clinical trials, published from 2015 until March 2021. Moreover, registered private eHealth clinics in Denmark were evaluated with reference to a recent national audit of patient safety issues in eHealth.

Results:

The literature search retrieved four intervention studies. The studies did not identify any particular patient safety risks associated with the use of eHealth. Many different authorized healthcare providers (preferably, doctors) apply eHealth in various contexts. eHealth is being used as the only form of contact between the healthcare provider and the patient, as a supplement to patient visitations in an outpatient clinic, or as a tool for communicating between two or more healthcare providers. The regulation of eHealth involves patient safety issues but also has interfaces to marketing, IT systems, and infrastructure. Supervision of eHealth includes the organization of clinics, handling patient charts, prescription medicine, patient legal rights, and patient transition. However, there are many interfaces in the division of responsibilities among the various governmental players.

Conclusion:

eHealth is being used increasingly and in many settings, although recently published intervention studies investigating patient safety issues by the use of eHealth are limited. A structured and continuous governmental control and regulation of patient safety in relation to the use of eHealth is warranted.
Atopy, asthma, and risk of bladder cancer: Systematic review and meta-analysis of cohort studies
Authors: Feng Suoyi , Shao Ziqi , Ju Longzhu , Zhang Yiting
Published: May 2021

The relationship between atopic diseases and cancer at various sites has been extensively studied. Previous epidemiological studies have investigated the association between atopic diseases and bladder cancer; however, the results remain inconclusive. In this study, we performed a systematic review and meta-analysis of cohort studies published thus far to evaluate the association between atopy and the risk of bladder cancer. We conducted a systematic search in PubMed, Embase, ISI Web of Science, and Scopus to identify potentially relevant studies. The pooled risk ratio (RRs) and 95% confidence intervals (95% CIs) were calculated using a random-effect model considering the heterogeneity among studies. On the basis of our selection criteria, a total of 10 cohort studies were included in our meta-analysis involving 2,341,005 participants, of whom 1720 were patients with bladder cancer. The pooled RR of bladder cancer in the group with atopic disease versus the group without atopic disease was 1.31 (95% CI: 1.10–1.56, p < 0.01), indicating a positive association between overall atopy and bladder cancer risk. In subgroup analysis, the pooled RR of bladder cancer was 1.46 (95% CI: 1.18–1.80, p < 0.001) for asthma and 1.03 (95% CI: 0.74–1.44, p = 0.86) for allergic rhinitis. The risk of bladder cancer is positively associated with overall atopy and asthma, but is not associated with allergic rhinitis.
Defining and Measuring Meditation-Related Adverse Effects in Mindfulness-Based Programs
Authors: Britton Willoughby B. , Lindahl Jared R. , Cooper David J. , Canby Nicholas K. , Palitsky Roman
Published: May 2021

Research on the adverse effects of mindfulness-based programs (MBPs) has been sparse and hindered by methodological imprecision. The 44-item Meditation Experiences Interview (MedEx-I) was used by an independent assessor to measure meditation-related side effects (MRSEs) following three variants of an 8-week program of mindfulness-based cognitive therapy ( n = 96). Each item was queried for occurrence, causal link to mindfulness meditation practice, duration, valence, and impact on functioning. Eighty-three percent of the MBP sample reported at least one MRSE. Meditation-related adverse effects with negative valences or negative impacts on functioning occurred in 58% and 37% of the sample, respectively. Lasting bad effects occurred in 6% to 14% of the sample and were associated with signs of dysregulated arousal (hyperarousal and dissociation). Meditation practice in MBPs is associated with transient distress and negative impacts at similar rates to other psychological treatments.
Expert Consensus on Clinical Application of Lateral Lumbar Interbody Fusion: Results From a Modified Delphi Study
Authors: Hai Yong , Liu Jingwei , Liu Yuzeng , Liu Tie , Zhang Xinuo , Pan Aixing , Zhang Yiqi , Ding Hongtao , Wu Yuxuan , Han Bo , Tang Xinli
Published: May 2021

Study Design:

Modified Delphi study.

Objective:

The objective of this study was to establish expert consensus on the application of lateral lumbar interbody fusion (LLIF) by using the modified Delphi study.

Methods:

From June 2019 to March 2020, Members of the Chinese Study Group for Lateral Lumbar Spine Surgery were selected to collect expert feedback using the modified Delphi method where 65 spine surgeons from all over China agreed to participate. Four rounds were performed: 1 face-to-face meeting and 3 subsequent survey rounds. The consensus was achieved with ≥a 70.0% agreement for each question. The recommendation of grade A was defined as ≥90.0% of the agreement for each question. The recommendation of grade B was defined as 80.0-89.9% of the agreement for each question. The recommendation of grade C was defined as 70.0-79.9% of the agreement for each question.

Results:

A total of 65 experts formed a panelist group, and the number of questionnaires collected was 63, 59, and 62 in the 3 rounds. In total, 5 sections, 71 questions, and 382 items achieved consensus after the Delphi rounds including summary; preoperative evaluation; application at the lumbar spinal stenosis, lumbar disc herniation, lumbar spondylolisthesis, adult degenerative scoliosis, postoperative adjacent segmental degeneration, and revision surgery; complications; and postoperative follow-up evaluation of LLIF.

Conclusion:

The modified Delphi method was utilized to ascertain an expert consensus from the Chinese Study Group for Lateral Lumbar Spine Surgery to inform clinical decision-making in the application of LLIF. The salient grade A recommendations of the survey are enumerated.
Effect of Irrigants and Irrigating Devices on Disinfection of Root Canal System: A Systematic Review
Authors: Attavar Shruthi H. , Hegde Mithra N.
Published: May 2021

Aim:

The effective delivery of irrigants into the inaccessible areas of the root canal system is the prerequisite for a proper disinfection of the root canal system. Numerous activation devices that can provide effective delivery of the irrigant and aid in the success of the root canal treatment are available. The activation of irrigants has claimed to be effective in in vitro and clinical trials. Hence, the present systematic review aims to analyze the effect of irrigants and irrigating devices in disinfecting the root canal system.

Materials and Methods:

A literature search was undertaken in PubMed, Cochrane, Web of Science, and Scopus databases. The inclusion criteria included clinical trials, both in vivo and ex vivo. The exclusion criteria included animal studies, textbooks, review articles, and case reports. The patients who required endodontic treatment along with the activation of irrigants were chosen as participants for the review.

Result:

The search strategy screened around 132 articles, out of which only 10 were selected for the present systematic review. The risk of bias was calculated based on the following scores: 3, high; 2, moderate; and 1, low. In the present systematic review, four articles were categorized into low-risk bias, three articles were classified as moderate risk, and three articles belonged to the high-risk category.

Conclusion:

The present systematic review concluded that the use of a mechanical activation device along with the irrigant will help in better removal of the smear layer and debris from the root canal system, improving the cleanliness and helping achieve more successful endodontic treatment.
The fantasmatic narrative of ‘sustainable development’. A political analysis of the 2030 Global Development Agenda
Authors: Telleria Juan , Garcia-Arias Jorge
Published: May 2021

The article offers a critical analysis of the United Nations 2030 Global Development Agenda, whose stated aim is to "transform the world" in such a way that no one is left behind. Drawing on post-Marxist theory, we argue that the 2030 Global Development Agenda is a fantasmatic narrative seeking to conceal the conflictual causes and the antagonistic origins of global development and sustainability issues. Within this fantasmatic narrative, ‘sustainable development’ is the empty signifier that articulates and sustains the agenda’s discourse. Our analysis of the ontological assumptions underpinning the documents that frame the agenda shows that, rather than transforming, the agenda naturalizes and consolidates the existing status quo: a status quo that has created (and continues to perpetuate) the global problems that the agenda aims to solve.
Constructing captive ecology at the aquarium: Hierarchy, care, violence, and the limits of control
Authors: Holmberg Mollie
Published: May 2021

In a time of accelerating ecological crises, captive care performed by zoos and aquariums increasingly plays a central and controversial role in attempts to resuscitate species and ecosystems rapidly disappearing from the planet. Here I use the Giant Pacific octopus ( Enteroctopus dofleini) exhibit at the Vancouver Aquarium to examine practices involved in capture and captive care at a prominent Canadian institution. As I trace how octopuses come to the Aquarium and how people work to keep them alive and healthy in this environment, I examine the complex ways violence and domination interact with care practices. Centering octopuses and their material relations in this analysis thus allows me to connect everyday care practices to systems of governance and extraction that support captive ecologies and also generate the categories used in care. Through this investigation, I find that pastoral power organizes care practices at the Vancouver Aquarium and maintains anthropocentric order in this space. Slow violence here results from the imperfect replacement of lifegiving relations, and the nature of this harm is shaped by different beings’ relationships to anthropocentric order. Hierarchical categorizations structure care practices here, and when care directed at keeping animals healthy fails, slow violence often becomes acute. Elusiveness best characterizes how octopuses confound attempts to know and care for them within this anthropocentric power structure. The theoretical lens and language I offer seeks to describe moments of rupture in anthropocentric power without romanticizing animal endangerment as liberation or (conversely) accepting the logic that harm in captivity can only diminish if care improves. Through this work, I showcase both the violence and possibilities embedded in different ways of living and relating with ecological others amidst crisis.
Secondary cytogenetic abnormalities in core-binding factor AML harboring inv(16) vs t(8;21)
Authors: Han Se young , Mrózek Krzysztof , Voutsinas Jenna , Wu Qian , Morgan Elizabeth A. , Vestergaard Hanne , Ohgami Robert , Kluin Philip M. , Kristensen Thomas Kielsgaard , Pullarkat Sheeja , Møller Michael Boe , Schiefer Ana-Iris , Baughn Linda B. , Kim Young , Czuchlewski David , Hilberink Jacobien R. , Horny Hans-Peter , George Tracy I. , Dolan Michelle , Ku Nam K. , Arana Yi Cecilia , Pullarkat Vinod , Kohlschmidt Jessica , Salhotra Amandeep , Soma Lori , Bloomfield Clara D. , Chen Dong , Sperr Wolfgang R. , Marcucci Guido , Cho Christina , Akin Cem , Gotlib Jason , Broesby-Olsen Sigurd , Larson Melissa , Linden Michael A. , Deeg H. Joachim , Hoermann Gregor , Perales Miguel-Angel , Hornick Jason L. , Litzow Mark R. , Nakamura Ryotaro , Weisdorf Daniel , Borthakur Gautam , Huls Gerwin , Valent Peter , Ustun Celalettin , Yeung Cecilia C. S.
Published: May 2021

Patients with core-binding factor (CBF) acute myeloid leukemia (AML), caused by either t(8;21)(q22;q22) or inv(16)(p13q22)/t(16;16)(p13;q22), have higher complete remission rates and longer survival than patients with other subtypes of AML. However, ∼40% of patients relapse, and the literature suggests that patients with inv(16) fare differently from those with t(8;21). We retrospectively analyzed 537 patients with CBF-AML, focusing on additional cytogenetic aberrations to examine their impact on clinical outcomes. Trisomies of chromosomes 8, 21, or 22 were significantly more common in patients with inv(16)/t(16;16): 16% vs 7%, 6% vs 0%, and 17% vs 0%, respectively. In contrast, del(9q) and loss of a sex chromosome were more frequent in patients with t(8;21): 15% vs 0.4% for del(9q), 37% vs 0% for loss of X in females, and 44% vs 5% for loss of Y in males. Hyperdiploidy was more frequent in patients with inv(16) (25% vs 9%, whereas hypodiploidy was more frequent in patients with t(8;21) (37% vs 3%. In multivariable analyses (adjusted for age, white blood counts at diagnosis, and KIT mutation status), trisomy 8 was associated with improved overall survival (OS) in inv(16), whereas the presence of other chromosomal abnormalities (not trisomy 8) was associated with decreased OS. In patients with t(8;21), hypodiploidy was associated with improved disease-free survival; hyperdiploidy and del(9q) were associated with improved OS. KIT mutation (either positive or not tested, compared with negative) conferred poor prognoses in univariate analysis only in patients with t(8;21).
Burden and attitude to resistant and refractory migraine: a survey from the European Headache Federation with the endorsement of the European Migraine & Headache Alliance
Authors:   On behalf of the Burden and Attitude to Resistant and Refractory (BARR) Study Group, Sacco Simona , Lampl Christian , Maassen van den Brink Antoinette , Caponnetto Valeria , Braschinsky Mark , Ducros Anne , Little Patrick , Pozo-Rosich Patricia , Reuter Uwe , Ruiz de la Torre Elena , Sanchez Del Rio Margarita , Sinclair Alexandra J. , Martelletti Paolo , Katsarava Zaza
Published: May 2021

Background

New treatments are currently offering new opportunities and challenges in clinical management and research in the migraine field. There is the need of homogenous criteria to identify candidates for treatment escalation as well as of reliable criteria to identify refractoriness to treatment. To overcome those issues, the European Headache Federation (EHF) issued a Consensus document to propose criteria to approach difficult-to-treat migraine patients in a standardized way. The Consensus proposed well-defined criteria for resistant migraine (i.e., patients who do not respond to some treatment but who have residual therapeutic opportunities) and refractory migraine (i.e., patients who still have debilitating migraine despite maximal treatment efforts).

The aim of this study was to better understand the perceived impact of resistant and refractory migraine and the attitude of physicians involved in migraine care toward those conditions.

Methods

We conducted a web-questionnaire-based cross-sectional international study involving physicians with interest in headache care.

Results

There were 277 questionnaires available for analysis. A relevant proportion of participants reported that patients with resistant and refractory migraine were frequently seen in their clinical practice (49.5% for resistant and 28.9% for refractory migraine); percentages were higher when considering only those working in specialized headache centers (75% and 46% respectively). However, many physicians reported low or moderate confidence in managing resistant (8.1% and 43.3%, respectively) and refractory (20.7% and 48.4%, respectively) migraine patients; confidence in treating resistant and refractory migraine patients was different according to the level of care and to the number of patients visited per week. Patients with resistant and refractory migraine were infrequently referred to more specialized centers (12% and 19%, respectively); also in this case, figures were different according to the level of care.

Conclusions

This report highlights the clinical relevance of difficult-to-treat migraine and the presence of unmet needs in this field. There is the need of more evidence regarding the management of those patients and clear guidance referring to the organization of care and available opportunities.
ClearSight™ finger cuff versus invasive arterial pressure measurement in patients with body mass index above 45 kg/m2
Authors: Eley Victoria , Christensen Rebecca , Guy Louis , Wyssusek Kerstin , Pelecanos Anita , Dodd Benjamin , Stowasser Michael , van Zundert Andre
Published: May 2021

Background

Measuring blood pressure in patients with obesity is challenging. The ClearSight™ finger cuff (FC) uses the vascular unloading technique to provide continuous non-invasive blood pressure measurements. We aimed to test the agreement of the FC with invasive radial arterial monitoring (INV) in patients with obesity.

Methods

Participants had a body mass index (BMI) ≥45 kg/m2 and underwent laparoscopic bariatric surgery. FC and INV measurements were obtained simultaneously every 5 min on each patient, following induction of anesthesia. Agreement over time was assessed using modified Bland-Altman plots and error grid analysis permitted clinical interpretation of the results. Four-quadrant plots allowed assessment of concordance in blood pressure changes.

Results

The 30 participants had a median (IQR) BMI of 50.2 kg/m2 (IQR 48.3–55.3). The observed bias (SD, 95% limits of agreement) for systolic blood pressure (SBP) was 14.3 mmHg (14.1, -13.4 – 42.0), 5.2 mmHg (10.9, -16.0 – 26.5) for mean arterial pressure (MAP) and 2.6 mmHg (10.8, -18.6 – 23.8) for diastolic blood pressure (DBP). Error grid analysis showed that the proportion of readings in risk zones A-E were 90.8, 6.5, 2.7, 0 and 0% for SBP and 91.4, 4.3, 4.3, 0 and 0% for MAP, respectively. Discordance occurred in ≤8% of pairs for consecutive change in SBP, MAP and DBP.

Conclusions

The vascular unloading technique was not adequately in agreement with radial arterial monitoring. Evaluation in a larger sample is required before recommending this technique for intraoperative monitoring of patients with BMI ≥45 kg/m2.
Systemic immune-inflammation index predicts prognosis of sequential therapy with sorafenib and regorafenib in hepatocellular carcinoma
Authors: Hong Young Mi , Yoon K. T. , Cho Mong
Published: May 2021

Background

Regorafenib has shown promising results as a second-line therapy for patients with hepatocellular carcinoma (HCC) who progressed on sorafenib. Although there have been several data regarding the efficacy of sequential therapy with sorafenib and that of regorafenib in real-life, specific inflammation markers for predicting the prognosis have not been studied. This study aimed to investigate prognostic value of systemic inflammatory markers in patients with HCC who received sorafenib-regorafenib sequential therapy.

Methods

We retrospectively analyzed medical data of patients who received regorafenib for the treatment of HCC after sorafenib failure. Progression free survival (PFS) and overall survival (OS) were assessed using the Kaplan–Meier survival curves. Univariate and multivariate analyses were performed to analyze the factors associated with survival.

Results

A total of 58 patients who received at least one dose of regroafenib and fulfilled the eligibility criteria, good performance status (Eastern Cooperative Oncology Group [ECOG] 0–1) and preserved liver function (Child-Pugh-A), were included in the analysis. The median PFS was 3 months (95% confidence interval [CI] = 0.981–5.019) and the median OS was 8 months (95% CI = 5.761–10.239). Elevated systemic immune-inflammation index (SII ≥340) was independently associated with poor OS. In multivariate analysis, the SII (hazard ratio [HR] = 2.211, 95% CI = 1.089–4.489, P = 0.028) and alpha-fetoprotein (AFP) (HR = 2.750, 95% CI = 1.259–6.010, P = 0.011) were independent predictors of OS.

Conclusion

Elevated SII is associated with poor OS in patients with HCC who received sequential therapy with sorafenib and regorafenib. In addition, when selecting a treatment strategy, the SII can be used in combination with the AFP level as a promising prognostic tool for HCC.
Development of a nomogram model to predict survival outcomes in patients with primary hepatic neuroendocrine tumors based on SEER database
Authors: Zhang Ziteng , Zhao Xin , Li Zhiyan , Wu Youchun , Liu Yao , Li Zhiwei , Li Guobao
Published: May 2021

Background

Primary hepatic neuroendocrine tumors (PH-NETs) are extremely rare and unknown. Because of its rarity, its prognosis features and influencing factors are not well established.

Methods

Data of 140 patients with PH-NETs diagnosed in the SEER database from 1975 to 2016 were collected. The demographics and clinic-pathological features were described. By using propensity-score matching (PSM) analysis, three associated cohorts were selected to describe the malignancy of PH-NETs and univariate analysis was conducted. Then, multivariate Cox analyses were performed and a predicting nomograph was constructed. C-index, receiver operating characteristic (ROC) curve and calibration curves were used to evaluate the predictive value of nomogram.

Results

The overall survival outcomes of PH-NETs were superior to hepatocellular carcinoma (HCC) with a mean survival time 30.64 vs 25.11 months (p = 0.052), but inferior to gastrointestinal tract neuroendocrine tumors in situ (GI-NETs in situ) with a mean survival time 30.64 vs 41.62 months (p = 0.017). With reference to gastrointestinal neuroendocrine tumors with liver metastasis (GI-NETs-LM), GI-NETs-LM had better outcomes in short time (1-year survival rate: 64.75% vs 56.43%) but was worse in long time (5-year survival rate: 8. 63% vs 18.57%). Multivariate Cox analyses showed that tumor grade and surgery were two independent factors for prognosis of the patients (p < 0.00). Tumor grade and surgery were used to construct the predicting nomogram. The C-index was 0.79 (95%CI = 0.75–0.83). The area under curve (AUC) values in ROC were 0.868 in 1-year and 0.917 in 3-year survival and the calibration curves showed good consistency.

Conclusions

The overall prognosis PH-NETs is generally favorable, better than HCC and GI-NETs-LM in long term. Preoperative biopsy and complete pathological diagnosis were recommended. Radical surgical intervention including transplantation was the first choice in PH-NETs therapy.
Medication-related osteonecrosis of the jaw (MRONJ) and eNOS Polymorphisms in multiple myeloma patients: a single center experience
Authors: Taş Ozyurtseven Betul , Serin Istemi , Nursal Ayse Feyda , Pehlivan Sacide , Pehlivan Mustafa
Published: May 2021

Background

Multiple myeloma (MM) constitutes approximately 10% of hematological malignancies. Bisphosphonates have established themselves in solid organ metastasis and multiple myeloma lytic bone lesions by inhibiting osteoclast activation. Medication-related osteonecrosis of the jaw (MRONJ) emerges as an important complication. Investigating host-based factors, and developing personal risk factors gain importance in the development mechanism of MRONJ. We aimed to reveal the different genotype polymorphisms, and clinical effects of eNOS in patients with a diagnosis of MRONJ in MM patients.

Methods

Medical records and blood samples were collected from 60 MRONJ patients with MM and 60 healthy controls. Inclusion criteria was having an exposed maxillofacial bone for more than eight weeks, a history of bisphosphonates, and no history of radiation therapy for the jaws. eNOS G894T and intron 4 VNTR were calculated by polymerase chain reaction and/or restriction fragment length polymorphism.

Results

eNOS G894T and VNTR genotypes and alleles were compared statistically with the healthy control group. There was no significant difference between the two groups. In comparison between G894T and clinical parameters, aphthous stomatitis was more common in TT genotype, while DMFT > 3 was more common in TG-GG genotype (p = 0.035, 0.023).

Conclusions

eNOS induces osteogenesis in bone metabolism, with its regulatory effects on bone remodeling and also NO induced angiogenesis takes place indirectly with its protective effect on endothelial functions. We see that these polymorphisms affecting the entire process of bone remodeling and angiogenesis, especially mucosal damage, which is the triggering factor of MRONJ pathology, have been revealed in the MM patient group. Considering the MRONJ initiating factors, it is necessary to emphasize the importance of our study results. It should be seen as an important step for new studies towards MRONJ and its treatment.
The combination of psychosocial working conditions, occupational balance and sociodemographic characteristics and their associations with no or negligible stress symptoms among Swedish occupational therapists – a cross-sectional study
Authors: Håkansson Carita , Lexén Annika
Published: May 2021

Background

The numbers of people who are on sick leave due to mental health problems, such as exhaustion disorder, are increasing in Sweden. One of the most affected groups is healthcare professionals. In order to develop preventive strategies to promote a sustainable working life for occupational therapists, there is a need to understand the associations between psychosocial working conditions, occupational balance and no or negligible stress symptoms. To the best of our knowledge, neither the combination of these factors nor the salutogenic perspective, have been taken into consideration when exploring factors associated with stress symptoms among occupational therapists in previous research.

Methods

Purposeful sampling was used. All currently working members of the Swedish Association of Occupational Therapists were invited to take part in the present study in 2018. The final sample was 3658 (48% response rate). A web-survey with questions about signs of exhaustion, psychosocial working conditions, occupational balance and sociodemographic characteristics was used. Logistic regression analyses were used in order to calculate associations between psychosocial working conditions, occupational balance, sociodemographic characteristics and no or negligible signs of exhaustion.

Results

Experiencing high occupational balance, low workload, high control, high sense of community and high justice, were associated with no or negligible stress symptoms. Furthermore, a satisfying financial situation, having children living at home, being married and long professional experience were significant in this model.

Conclusions

It seems important to consider not only psychosocial working conditions, but also occupational balance to prevent exhaustion disorder among occupational therapists in Sweden. Organisational programmes, which reduce the workload, strengthen the control and sense of community and facilitate occupational balance, seem to be important areas for health promotion in this group.
An alternative model in the provision of CPAP in sleep apnea: a comparative cost analysis
Authors: Gonzalez-Vergara Demetrio , Marquez-Pelaez Sergio , Alfonso-Arias Jose David , Perez-Ramos Julia , Rojas-Box Jose Luis , Aumesquet-Nosea Manuel
Published: May 2021

Background

To conduct a pilot study on an alternative model for the provision of respiratory therapies in sleep apnea-hypopnea syndrome (SAHS) by internalizing the service with the purchase, monitoring and control of continuous positive airway pressure (CPAP) equipment by the hospital.

Methods

An observational, prospective pilot study of comparative cost analysis by internalizing the service to include all patients up to a budget limit of 5000 euros. The cost of internalizing the service included the acquisition of CPAP equipment and all the necessary accessories in addition to the nursing days necessary to track the patients. Patient satisfaction was assessed by a survey of the hospital service.

Results

Twenty-one patients with 23,046 patient-days of follow-up were included. The cost of the internalized system was 6825.11 €. The cost of the outsourced system over the same period would have been 22,781.18 €; thus, the direct saving was 15,956.07 €. The cost per device per day of the internalized system was 0.30 € versus the 0.99 € that the outsourced system would have cost during the study period. In the satisfaction survey, 12 (70.6%) patients indicated that they preferred the service of the hospital over that of the external company. No patient preferred the outsourced system.

Conclusions

The internalization of CPAP service represents significant cost savings from a hospital perspective and an improvement in patients’ perceptions of the quality of service.
An updated overview of e-cigarette impact on human health
Authors: Marques Patrice , Piqueras Laura , Sanz Maria-Jesus
Published: May 2021

The electronic cigarette (e-cigarette), for many considered as a safe alternative to conventional cigarettes, has revolutionised the tobacco industry in the last decades. In e-cigarettes, tobacco combustion is replaced by e-liquid heating, leading some manufacturers to propose that e-cigarettes have less harmful respiratory effects than tobacco consumption. Other innovative features such as the adjustment of nicotine content and the choice of pleasant flavours have won over many users. Nevertheless, the safety of e-cigarette consumption and its potential as a smoking cessation method remain controversial due to limited evidence. Moreover, it has been reported that the heating process itself can lead to the formation of new decomposition compounds of questionable toxicity. Numerous in vivo and in vitro studies have been performed to better understand the impact of these new inhalable compounds on human health. Results of toxicological analyses suggest that e-cigarettes can be safer than conventional cigarettes, although harmful effects from short-term e-cigarette use have been described. Worryingly, the potential long-term effects of e-cigarette consumption have been scarcely investigated. In this review, we take stock of the main findings in this field and their consequences for human health including coronavirus disease 2019 (COVID-19).
KDM6A-ARHGDIB axis blocks metastasis of bladder cancer by inhibiting Rac1
Authors: Liu Lei , Cui Jianfeng , Zhao Yajing , Liu Xiaochen , Chen Lipeng , Xia Yangyang , Wang Yong , Chen Shouzhen , Sun Shuna , Shi Benkang , Zou Yongxin
Published: May 2021

Background

KDM6A, a histone demethylase, is frequently mutated in bladder cancer (BCa). However, the role and detailed molecular mechanism of KDM6A involved in bladder cancer progression remains unknown.

Methods

Tissue specimens were used to determine the expression levels and prognostic values of KDM6A and ARHGDIB. The MTT, colony formation, wound healing and Transwell migration and invasion assays were employed to detect the BCa cell proliferation, migration and invasion, respectively. Chemotaxis of macrophages was used to evaluate the ability of KDM6A to recruit macrophages. A subcutaneous tumour model and tail vein tumour injection in nude mice were used to assess the role of KDM6A in vivo. RNA sequencing, qPCR, Western blot, ChIP and phalloidin staining assay were performed to investigate the molecular functions of KDM6A. Dual-luciferase reporter assay was used to determine the effects of KDM6A and FOXA1 on the promoters of the ARHGDIB and KDM6A.

Results

We showed that the KDM6A inhibited the motility and invasiveness of the BCa cells. Mechanistically, KDM6A promotes the transcription of ARHGDIB by demethylating histone H3 lysine di/trimethylation (H3K27me2/3) and consequently leads to inhibition of Rac1. EZH2, which catalyses the methylation of H3K27, functions to silence ARHGDIB expression, and an EZH2 inhibitor can neutralize the metastatic effect caused by KDM6A deficiency. Furthermore, we demonstrated that FOXA1 directly binds to the KDM6A promoter and thus transactivates KDM6A, leading to diminished metastatic potential.

Conclusion

Our findings establish the critical role of the FOXA1-KDM6A-ARHGDIB axis in restraining the malignancy of BCa and identify KDM6A and EZH2 as potential therapeutic targets in the management of BCa.