bluuebunny/crossref_metadata_2025 huggingface dataset:
Magnetic Resonance Spectroscopy in the Diagnosis and Prognosis of Breast Cancer
Authors: Egorov M. V. , Sinitsyn V. E. , Bakunovich A. V.
Published: November 2019

Objective. To evaluate the efficiency of magnetic resonance spectroscopy in the diagnosis and prognosis of breast cancer (BC).

Material and methods. Twenty-eight patients aged 37 to 80 years with established primary invasive BC were examined. Its grade was determined according to pathomorphological verification with immunohistochemical analysis. Breast MRI was performed using the standard protocol, by determining the measured diffusion coefficient (MDC), dynamic contrast enhancement (DCE). Proton magnetic resonance spectroscopy was carried out using the Breeze software package. The clinical and morphological findings and the results of radiation studies were compared to determine Nottingham prognostic index (NPI) scores. To identify the Spearman rank correlation coefficient between MRI findings (the type of pharmacokinetic curves, the total choline-containing (tCho) peak integral) and the values characterizing tumor size and grade.

Results. NPI calculation showed that the scoring range was 2.4 to 6.76; the expected 5-year survival rates reached 93%. The mean MDC was 0.856×10-3 mm2/sec; type II pharmacokinetic curve prevailed (n=16; 57.1%). There was a statistically significant negative correlation between the values of MDC, the type of a contrast agent accumulation curve, the levels of HER2/neu and the proliferation marker Ki-67; there was a statistically significant strong positive correlation between the presence of 1H-MPC tCho peak and the indicators determining tumor malignancy (the levels of HER2/neu and Ki-67). Statistically significant differences between the type of a pharmacokinetic curve in DCE and the level of tCho in the prognostic groups defined when calculating NPI were determined in patients with moderate (n=4; 14.2%) and poor (n=10; 35.7%) prognosis.

Conclusion. The capabilities of MR spectroscopy are superior in information content to the data obtained by determining the MDC, the nature of contrast medium accumulation in breast tumor, and are comparable with the data determining the type of a tumor (the presence of the HER2/neu gene, Ki-67 proliferation marker) in predicting BC cancer grade and 5-year survival rates.
Early Сontrast-Enhanced Multispiral Computed Tomographic Diagnosis of Septic Pulmonary Embolism and a Case of Successful Surgical Treatment
Authors: Sukhova M. B. , Medvedev А. P.
Published: November 2019

The review presents a rare clinical case of right-sided infective endocarditis (IE), a variant of early diagnosis using contrast-enhanced multispiral computed tomography (CE-MSCT), and successful surgical treatment for septic pulmonary embolism and right-sided IE. The clinical manifestation of the disease lasted about 3 weeks. The diagnosis was established according to the results of an emergency complex CE-MSCT study. At 4 hours after the patient went to the clinic, a combined operation (removal of part of the venous port and thrombectomy from the left pulmonary branch) was successfully performed. There was a complete coincidence of CE-MSCT study data and intraoperative results; staphylococcal septic focus was confirmed in a laboratory. The total length of stay in hospital was 9 days; that of full performance restoration was 3 weeks. The presented case has proven that the CE-MSCT may be the only sufficient technique for detecting septic pulmonary embolism and deciding in favor of surgical treatment, eliminating the need for a different kind of instrumental diagnosis, which significantly reduces the time of diagnosis.
Anastrozole and Levonorgrestrel-Releasing Intrauterine Device in the Treatment of Endometriosis: A Randomized Clinical Trial
Authors: Acién Pedro , Velasco Irene , Acién Maribel
Published: November 2019

Background: Effectiveness of Anastrozole and levonorgestrel-releasing intrauterine device (LNG-IUD, Mirena®) in the treatment of endometriosis. Methods: Randomized clinical trial. Elegibility criteria: Endometriomas >3×4 cm, CA-125>35 U/mL and symptoms suggestive of endometriosis. Thirty-one women were randomized to anastrozole+Mirena®+Conservative Surgery(CS) (n=8), anastrozole+Mirena®+transvaginal ultrasound-guided puncture-aspiration(TUGPA) (n=7), Mirena®+CS (n=9), or Mirena®+TUGPA (n=7). Interventions: Anastrozole 1 mg/day and/or only Mirena® for 6 months. CS or TUGPA one month after starting medical treatment. Results: A significant improvement in symptoms during the treatment (difference of 43%, 95% CI 29.9-56.2) occurred, which was maintained at 1 and 2 years. It was more significant in patients treated with anastrozole. For CA-125, the most significant decrease was observed without anastrozole. After CS for endometriosis, a reduction of findings of endometriomas and long-term recurrences occurred, with or without anastrozole, although anastrozole seems to delay recurrences. At 4,2±1,7 years, 88% of the patients who underwent CS were asymptomatic, compared to only 21% if TUGPA was performed, with or without anastrozole (p=0.019). Conclusion: Dosing anastrozole for 6 months, starting one month before CS of endometriosis, reduces more significantly the painful symptoms and delays recurrences, but has no other significant advantages over the single insertion of LNG-IUD (Mirena®) during the same time.
Novel miRNA Sponges to Specifically Modulate Gene Expression in Colon Cancer Cells
Authors: Aguilera Alejandro , Perazzoli Gloria , Cabeza Laura , Mesa Cristina , Quiñonero Francisco , García-Pinel Beatriz , Velez Celia , Rama Ana Rosa
Published: November 2019

miRNA sponges allow the selective blockade of a complete family of associated miRNAs which induce posttranscriptional gene silencing in its target through binding to 3´UTR mRNA. MiRNA-365 and miRNA-145 are down-regulated in colorectal cancer (CRC), but not in health tissues. Based on this, we constructed two vectors by inserting miRNA sponge (one for miRNA-365 and other for miRNA-145), and used EGFP (enhanced green fluorescent protein) as a 3′ UTR reporter gene to analyse the ability of each sponge to catch its respective miRNA. qPCR results corroborated that the expression levels of both miRNAs were lower in CRC cell lines than in normal colon cell line. Flow cytometry analysis revealed a decrease of the EGFP expression levels in the cell lines transfected with both sponges, being higher on the normal cell line while CRC cell lines presented a minimal decline. Also, this decrease was inversely proportional to the levels of expression of both miRNAs obtained by qPCR. These results were corroborated by fluorescence microscopy, showing a similar decrease fluorescence. We propose a new vector system to carry in a specific way the expression of genes to CRC cells without affecting healthy cells, preventing damage to healthy tissues.
Covalent Surface Functionalization of Bovine Serum Albumin to Magnesium Surface: Enhancing Robust Corrosion Inhibition and In vitro Osteo-Inductivity
Authors: Lee Seo Yeon , Shrestha Sita , Shrestha Bishnu K , Park Chan Hee , Kim Cheol Sang
Published: November 2019

Herein, we describe precisely on covalent modification of pure magnesium (Mg) surface and applied to induce in vitro osteogenic differentiation. A new concept, chemical bonding method is proposed for developing stable chemical bonds on Mg surface through serial assembly of bioactive additives including ascorbic acid (AA) and bovine serum albumin (BSA). The coating with such potential materials shows strong integrity to the Mg and could suitable for cell-interface interaction with the host tissue during implantation in bone tissue repair. The physicochemical and electrochemical properties of surface modified Mg assess how these nanoscales layered of biomolecules could demonstrate the significance improvement in chemical stability of coating. The modified Mg-OH-AA-BSA exhibits better anti-corrosion behavior with high corrosion potential (Ecorr ~ ‒ 0.96 V) and low corrosion current density (Icorr ~ 0.2 µA cm-2) as compared to pure Mg (Ecorr ~ ‒1.46 V, Icorr ~ 10.42 µA cm-2). Outer layer of BSA on Mg protects fast degradation rate of Mg which is the consequence of strong chemicals bonds between amine groups on BSA with carboxylic groups on AA. Collectively, the results suggest that surface modified Mg provides strong bio-interface and enhances the proliferation and differentiation of pre-osteoblast (MC3T3-E1) cells through protein-lipid interaction. Owing to this fact, the cost-effective and scalable covalent functionalization of Mg surface inherits biological advantage in orthopedic and dental implants with long term stability.
Sírios e libaneses no oeste paulista – décadas de 1880 a 1950
Authors: Truzzi Oswaldo
Published: November 2019

O artigo busca explorar os condicionantes e características distintivas da inserção socioeconômica de sírios e libaneses no interior paulista, entre as décadas de 1880 e 1950. Do início difícil como mascates, portadores de uma cultura distante, os sírios e libaneses lograram se firmar como comerciantes, aproveitando as oportunidades que suas redes (de parentes e conterrâneos) e a economia cafeeira em expansão ofereciam, estabelecendo-se sobretudo nos ramos de roupas, tecidos e armarinhos de secos e molhados e de gado e cereais. Tomando como fonte principal uma série de obras – acadêmicas e memorialísticas –, nas quais o imigrante sírio e libanês é retratado no interior, o artigo indica ainda as principais regiões do oeste paulista nas quais o grupo se concentrou, discute trajetórias que ilustram algumas das possibilidades de mobilidade, a formação de lideranças, o modo como as práticas religiosas se transformaram e a mobilidade acentuada – como doutores e políticos – conquistada por estratos da primeira geração nascida no Brasil.
Staged Bilateral Total Knee Arthroplasty: Increased Risk of Recurring Complications
Authors: Grace Trevor R. , Tsay Ellen L. , Roberts Heather J. , Vail Thomas P. , Ward Derek T.
Published: November 2019

Background:

As the demand for knee arthroplasty increases, risk assessment and counseling are critical for optimal patient outcomes perioperatively. The purpose of this study was to determine if specific complications occurring after unilateral knee replacement predict the risk of recurrence after a staged replacement of the contralateral knee for patients with bilateral symptomatic disease.

Methods:

Linked, nationwide data from the U.S. Hospital Cost and Utilization Project from 2005 to 2014 were used to measure the occurrence of complications after the first and second procedures in staged bilateral total knee arthroplasties (TKAs). Odds ratios (ORs) and conditional probabilities were determined to assess whether having a specific complication after the first TKA increased the chance that the same complication occurred after the second procedure.

Results:

A total of 36,278 patients who underwent staged bilateral TKAs were analyzed. All complications occurring after the first arthroplasty were associated with both a significantly increased probability and odds of recurrence following the second arthroplasty. These included myocardial infarction (OR, 56.63 [95% confidence interval (CI), 18.04 to 155.44]; p < 0.001), ischemic stroke (OR, 41.38 [95% CI, 1.98 to 275.82]; p = 0.03), other cardiac complications (OR, 7.73 [95% CI, 4.24 to 14.11]; p < 0.001), respiratory complications (OR, 8.58 [95% CI, 2.85 to 23.17]; p = 0.002), urinary complications (OR, 11.19 [95% CI, 5.44 to 22.25]; p = 0.001), hematoma (OR, 15.05 [95% CI, 7.90 to 27.27]; p < 0.001), deep vein thrombosis (OR, 7.40 [95% CI, 5.37 to 10.08]; p < 0.001), and pulmonary embolism (OR, 11.00 [95% CI, 5.01 to 23.92]; p < 0.001).

Conclusions:

Medical complications that occur postoperatively after TKA are associated with a significantly increased risk of recurrence of these complications after staged replacement of the contralateral knee. Although overall complication rates remain low, patients who develop these medical complications after the first replacement should be counseled on their increased risk profile prior to the contralateral surgical procedure.

Level of Evidence:

Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
Bilateral Girdlestone Procedure as a Treatment Modality in a Case of Complicated Adult-Onset Osteopetrosis
Authors: Agrawal Aniruddh , Maniar Adit , Maniar Rajesh
Published: November 2019

Case:

We describe a nonambulatory 39-year-old man who presented with a diagnosis of osteopetrosis and ankyloses, having experienced bilateral fractures of his proximal femora, undergone unsuccessful conventional surgical interventions, and having developed chronic osteomyelitis of his right proximal femur. Bilateral Girdlestone procedures were performed. Postoperative range of hip motion and Harris hip scores improved, and he became ambulatory, achieving optimal function considering the circumstances at 12 months postoperatively.

Conclusions:

Although the indications of the bilateral Girdlestone procedure remain undefined, these procedures may constitute acceptable treatment in patients with osteopetrosis with ankylosis and chronic osteomyelitis of the proximal femur.
Isolated Rupture of the Short Head of the Biceps at the Proximal Musculotendinous Junction
Authors: Kozak Thomas Augustyn , Kozak Tomasz Konstanty Walenty
Published: November 2019

Case:

Two men aged 19 and 21 years sustained wakeboarding injuries where the towrope was forced against the anterior region of the arm. Physical examination revealed bruising and tenderness over the biceps with weakness in elbow flexion. Magnetic resonance imaging demonstrated complete musculotendinous rupture of their short head of biceps. Surgical repair followed by cast immobilization led to an excellent outcome in both cases.

Conclusions:

This is a unique series of complete musculotendinous rupture of the short head of the biceps occurring in wakeboarding accidents, with the mechanism of injury resisted shoulder adduction and flexion.
Subacute High-Energy Traumatic Knee Dislocation in an Ambulatory Patient
Authors: Britt Elise , Covey D.C.
Published: November 2019

Case:

A 62-year-old man presented with a posterolateral knee dislocation sustained in a motorcycle collision initially managed nonsurgically. His treatment was complicated by recurrent dislocation from noncompliance with bracing and weight-bearing restrictions and by comorbidities including peripheral artery disease, type 2 diabetes, and heavy smoking and drinking. He was treated with a multiplanar knee-spanning external fixator and patellar tendon repair without further ligamentous reconstruction. This treatment provided a stable, functional knee with minimal pain.

Conclusions:

In this complex, noncompliant patient with a subacute knee dislocation, knee-spanning biplanar external fixation and patellar tendon repair without ligament reconstruction were crucial in achieving a satisfactory outcome.
Epidural Abscess Caused by Gas-Producing Clostridium Septicum
Authors: Money Adam J. , Molloy Seth , Grabowski Gregory
Published: November 2019

Case:

Few cases have reported Clostridium species of bacteria as a source for vertebral osteomyelitis and epidural abscesses. The subspecies of Clostridium septicum has not been described as a cause. This case describes a 69-year-old man who hematogenously spread C. septicum without associated malignancy, subsequently failed conservative management in the form of intravenous antibiotics, and was definitively treated with surgical intervention through a minimally invasive approach.

Conclusions:

An epidural abscess occurring in a surgically naive patient is a rare phenomenon. An epidural abscess caused by C. septicum is even rarer. Appropriate imaging, early recognition, and surgical debridement can lead to a favorable outcome.
Analisis Kesediaan Membayar (Willingness to Pay) Masyarakat Terhadap Pertanian Organik Buah Naga
Authors: Ningsih Kustiawati , Sakdiyah Halimatus , Felani Herman , Dwiastuti Rini , Asmara Rosihan
Published: November 2019

Pertanian organik merupakan jawaban atas revolusi hijau yang digalakkan pada tahun 1960-an yang menyebabkan (a) Berkurangnya kesuburan tanah dan (b) Kerusakan lingkungan akibat pemakaian pupuk dan pestisida kimia yang tidak terkendali. Gagalnya revolusi hijau menyebabkan masyarakat semakin sadar akan pentingnya mengembangkan sistem pertanian yang berwawasan lingkungan dan berkelanjutan. Program “Go Organik 2010” merupakan implementasi dukungan pemerintah terhadap sistem pertanian organik. Sehingga pertanian organik mulai berkembang di Indonesia umumnya dan di Kabupaten Pamekasan, khususnya. Pertanian organik buah naga merupakan pertanian organik yang sedang berkembang di Kabupaten Pamekasan. Sebagai implementasi untuk mewujudkan kelestarian pertanian organik buah naga, maka dibutuhkan analisis tentang kesediaan membayar masyarakat terhadap nilai keberadaan (Existence Value) dan nilai penggunaan alternatif (Option Value) pertanian Organik Buah Naga. Penelitian ini menggunakan metode CVM (Contingent Valuation Method) untuk mengestimasi biaya yang akan dikeluarkan masyarakat. Hasil penelitian menunjukkan bahwa besarnya estimasi WTP (Willingness To Pay) masyarakat terhadap nilai keberadaan pertanian organik buah naga adalah sebesar Rp. 42.060.403,89 / hektar per tahun. Sedangkan besarnya estimasi WTP (Willingness To Pay) masyarakat terhadap nilai penggunaan alternatif pertanian organik buah naga sebesar Rp. 41.633.017,67 / hektar per tahun.
Gambaran Krisis Petani Muda Indonesia
Authors: Arvianti Eri Yusnita , Masyhuri Masyhuri , Waluyati Lestari Rahayu , Darwanto Dwijono Hadi
Published: November 2019

Permasalahan utama mengenai ketenagakerjaan pertanian kita yaitu terjadinya perubahan struktur demografi yang kurang menguntungkan bagi sektor pertanian yang mengarah pada penuaan petani. Petani berusia tua (lebih dari 55 tahun) jumlahnya semakin meningkat, akan tetapi tenaga kerja berusia muda semakin berkurang. Semakin tingginya tingkat pendidikan pemuda di perdesaan, maka mereka semakin selektif dalam memilih pekerjaan. Mereka enggan untuk bekerja di pedesaan karena adanya ketidakcocokan antara ketrampilan dan tingkat pendidikan yang dimiliki dengan ketersediaan pekerjaan di perdesaan. Padahal Indonesia membutuhkan petani-petani yang produktif untuk memaksimalkan produksi pangan. Tujuan makalah ini adalah menjelaskan perubahan struktural tenaga kerja pertanian dilihat dari fenomena aging farmer dan menurunnya jumlah tenaga kerja usia muda sektor pertanian di Indonesia , menjelaskan berbagai faktor penyebab perubahan struktural tenaga kerja pertanian dan keengganan tenaga kerja usia muda masuk ke sektor pertanian, menjelaskan kebijakan yang diperlukan untuk mendukung tenaga kerja muda masuk ke sektor pertanian. Metode yang digunakan adalah studi literatur dan deskriptif. Hasilnya adalah masalah krisis petani muda harus segera ditanggulangi supaya tidak mengancam ketahanan pangan di Indonesia.
Beef Cattle Large Commodity Chain: Market Structure And Performance Analysis
Authors: Sunyigono Andrie Kisroh
Published: November 2019

Industri sapi potong masih didominasi oleh peternak kecil (98%) sedangkan sisanya adalah kontribusi dari peternak besar. Sehingga belum mampu memenuhi kebutuhan nasional. Meskipun kecil, peran peternak besar cukup signifikan terutama dalam memenuhi kebutuhan daging berkualitas tinggi. Oleh karena kajian terhadap peran peternak besar sangat dibutuhkan. Tujuan dari kajian ini adalah menganalisis struktur pasar dan kinerja peternak besar sapi potong di Jawa Timur yang merupakan lumbung daging nasional. Metode analisis yang digunakan adalah analisis Rasio Konsentrasi, Gini Koefisien dan Hambatan masuk dan keluar pasar. Hasil kajian menunjukkan bahwa: 1. Struktur pasar sapi bakalan dan jagal adalah oligopoli lemah sedangkan struktur pasar peternak dan pedagang adalah oligopoli kuat; 2) Analisis kinerja rantai komoditas sapi potong di tingkat penyedia bakalan, peternak, pedagang dan jagal adalah menguntungkan dan efisien; 3) Terdapat hubungan antara struktur pasar dan kinerja usaha sapi potong yaitu semakin tinggi tingkat konsentrasi pasar maka semakin tinggi pula tingkat keuntungan dan efisiensinya.
A STUDY ON AFFECTING FACTORS OF WHITE-NEST SWIFTLET (COLLOCALIA FUCIPHAGA) FARMING PERFORMANCE IN HAURGEULIS DISTRICT, INDRAMAYU REGENCY
Authors: Wahyudi Dodo , Suwarto Suwarto , Irianto Heru
Published: November 2019

Indonesia is a major supplier of Edible-nest swiftlet to China, reaching 102 million USD in 2017. Products of Edible-nest swiftlet, containing very high glycoproteins, are exported to China by Indonesia which come  from Java, included Haurgeulis District, Indramayu Regency. White-nest businesses in that area have been developed since 1950s although the productivity subsequently decline in the rate of deforestation of the concession area nowadays. These problems are henceforth set as the focus of the study, based on the inference Malcom Baldrige Criteria for Performance Excellence (MBCfPE). The purpose of this study is to recognize the association white-nest business performance. Some internal factors, observed as the endogenous-predictor factors of business performance, include achievement-motivation factor, strategic planning, technical aspects and technologies, guanxi (personal relationship), and leadership. Surveillance activities is undertaken by using simple random sampling with questionnaire method for collecting the data, followed by using path analysis method for testing the hypothesis of the association. The test results show that all of internal factor have significant effect on the performance of the white-nest business by the leadership intervening. The leadership factor is the largest influence for managing white-nest swiftlet (Collocalia fuciphaga) farming performance which has the straight influence to business performance. The association of each internal factors and the white-nest business performance described by a structural model.
Effect of Self-Regulated Learning for Improving Dietary Management and Quality of Life in Patients with Type-2 Diabetes Mellitus at Dr. Ramelan Naval Hospital, Surabaya, Indonesia
Authors: Estuningsih Yayuk , Rochmah Thinni Nurul , Andriani Merryana , Mahmudiono Trias
Published: November 2019

Self-regulated learning is a process of learning how to manage and regulate oneself to obtain skills and knowledge without depending on others. It is expected that diabetes patients can manage their diabetes by themselves. This study aimed to analyze the effect of self-regulated learning-based educational intervention on quality of life for patients with type-2 diabetes mellitus (DM) at Dr. Ramelan Naval Hospital, Surabaya. This was a quasi-experimental study in the form of pretest and posttest with a control group design. A total of 20 patients with DM were randomly divided into intervention and control groups to undergo a 4-week intervention. The intervention group received dietary education with self-regulated learning, while the control group received standard education. The results revealed differences in variables such as dietary obedience, food intake at home, fasting blood sugar, diastolic blood pressure, and quality of life. The intervention group experienced a positive impact on the quality of life and resulted in better dietary obedience than that of the control group. In conclusion, the implementation of self-regulated learning-based dietary education can improve dietary obedience, knowledge, intention, family support, social support, physical activity, and quality of life for patients with type 2 diabetes.
Confessionário/Armário, o Altar/Sala de Aula
Authors: Vieira de Sousa Vinicius
Published: November 2019

Relato de experiência apresentado ao ProfEPT. Este é o perurso de um filósofo errante que viveu no confessionário/armário, que sonhou com o altar, mas que encontrou de fato a sua alegria na sala de aula.
“Simple” Well Spacing Calculations are Inaccurate and Costly
Authors: Jacobs Trent
Published: November 2019

The distance between horizontal wells in the North American shale patch is almost always reported as a single measurement, often in clean round numbers, e.g. 450 ft or 600 ft. The problem with accepting such figures as the whole picture is that they are too simplistic, which can lead shale producers to make multimillion-dollar mistakes when it comes to drafting up the next drilling campaign.

This is the conclusion reached by Enverus (formerly Drilling Info), which says in a recently published report on well spacing that it has adopted a new method to determine the distance between horizontal wells and analyze the impact that distance has on production. The analytics and business intelligence firm points out that it had been using “simple” spacing calculations that it now considers to be “inaccurate.”

The traditional method, used not just by Enverus but others across the shale sector, relies on a single parameter known as a midpoint measurement between wells. The new method presented by Enverus uses 300 different inputs to come up with a better answer.

“Well spacing is complex and incredibly important in today’s current free-cash-flow era,” said Sarp Ozkan, the energy analysis director at Enverus. In a press release he compared trying to understand the issue with “peeling back an onion.”

Some of the layers Enverus is using to better assess well spacing and its impact on production include taking into account that wellbore separation can vary all along the laterals. Horizontal distances represent the conventional way to look at well spacing, but Enverus says vertical separation must also be considered, which is especially relevant to stacked formations. When an operator’s directional drilling data is not avail-able, the company is modeling “synthetic” well trajectories.

This enhanced analysis is all part of a well-spacing toolkit Enverus has rolled out in recent months. Its arrival comes as capital markets are hitting the brakes on funding the US shale sector due to disappointing well results and difficulties in establishing free cash flow.•

As a result, many producers have pivoted their focus from production growth to drilling lower-cost wells that have stronger rates of return. However, this shift has not necessarily delivered all the answers on how far apart to drill infill wells to avoid fracture interference and excessive crosswell communication.

Midpoint Malaise

Enverus used several case studies in its report to show that misjudging optimal well spacing has led shale producers to over drill their assets. The result of landing just one or two unneeded wells is a severe downgrade in a drilling section’s net present value.
Laryngeal mask airway reduces incidence of post-operative sore throat after thyroid surgery compared with endotracheal tube: a single-blinded randomized controlled trial
Authors: Gong Yahong , Xu Xiaohan , Wang Jin , Che Lu , Wang Weijia , Yi Jie
Published: November 2019

Background: Sore throat is a remarkable complication after thyroid surgery with endotracheal tube (ETT). Many studies revealed that laryngeal mask airway (LMA) might reduce the incidence and severity of postoperative sore throat. However, little is known about the use of a flexible reinforced LMA (FLMA) in thyroid surgery. The purpose of this study was to explore the potential benefits of FLMA compared with ETT on postoperative sore throat. Methods:In thisprospective, single-blinded, randomized, controlled trial, ninety-six patients aged 20-80 years, scheduled for elective radical thyroidectomy under general anesthesia were enrolled. They were randomly divided into ETT group and FLMA group. All the included patients received total intravenous anesthesia (with propofol, fentanyl and rocuronium) and controlled mechanical ventilation during the surgery. Cuff pressure of ETT and FLMA were strictly controlled. Incidence and severity of postoperative sore throat, numbness and hoarseness at 1, 24, and 48 h after surgery was evaluated and compared between the two groups. Incidence and severity of buckling during extubation and the hemodynamic profile during intubation were also recorded and compared. Results:The incidence of sore throat and hoarseness was significantly lower in FLMA group than those in ETT group at 1h, 24h and 48h postoperatively, as well as the severity of sore throat. Compared to ETT group, there was a significantly lower incidence of buckling during extubation and less fluctuation of HR and BP at 1min and 3min after intubation in FLMA group. Conclusions:Patients undergoing thyroid surgery with FLMA had less postoperative laryngopharyngeal symptoms when compared with ETT. The use of FLMA also achieved less buckling during extubation and better hemodynamic profiles during intubation. Trial registration:The research was registered in Chinese Clinical Trial Registry (ChiCTR-IOR-15006602) on May 23th, 2015.
The levels of urinary joining chain containing IgG immune complexes are associated with disease severity in IgA nephropathy
Authors: Li Guanhong , Yue Cai , Fan Xiaohong , Wen Yubing , Chen Gang , Qin Yan , Gao Ruitong , Li Xuemei
Published: November 2019

Background: Circulating levels of aberrantly glycosylated IgA1 and its immune complexes (IgA/IgG-IC) are elevated and correlated with disease severity in IgA nephropathy (IgAN). The pathologic IgA containing immune complexes deposits in the kidney were found to be in dimeric or polymeric forms, suggesting that those deposited IgA immune complexes contain joining chain, which is critical for the multimerization and transportation of IgA. Both the dimeric IgA and polymeric IgA can cause renal damage by inducing the release of cytokines from mesangial cells. We aimed to investigate the urinary J chain containing IgG immune complexes/creatinine ratio (UJGCR) and analyze its relationship with disease severity in IgAN. Methods: The UJGCR were measured by sandwich enzyme linked immunosorbent assay in 26 patients with IgAN, 31 patients with other kidney diseases and 32 healthy volunteers. Results: The levels of UJGCR were higher in patients with IgAN than that in non-IgAN patients ( P =0.006) and healthy volunteers ( P <0.0001). Importantly, receiver operating characteristics curve analysis confirmed that UJGCR had good discrimination between non-IgAN patients and IgAN patients. The levels of UJGCR positively correlated with 24-hour urinary protein excretion (r=0.63, P =0.0006), serum creatinine (r=0.55, P =0.003), and negatively correlated with estimated glomerular filtration rate (r= -0.61, P =0.0008) in IgAN. Furthermore, the levels of UJGCR were higher in IgAN patients with IgA mesangial deposition of (+/++) than patients with (+++/++++). And IgAN patients with tubular atrophy/interstitial fibrosis showed higher levels of UJGCR than that without ( P =0.03). Similarly, the levels of urinary IgA-IgG/creatinine ratio (UAGCR) were also found to be elevated and associated with clinical and pathological parameters as UJGCR in IgAN. Besides, significant correlation between the levels of UJGCR and UAGCR was shown, suggesting UJGCR was mainly composed of J-IgA-IgG. Conclusions: The levels of UJGCR are associated with disease severity in IgAN. UJGCR is a potential biomarker for both glomerular and tubulointerstitial lesions in IgAN.
Musculoskeletal consequences in cyber-addicted students - Is it really a matter of health? A ROC curve analysis for prioritizing risk factors
Authors: Moghadam Rashid Heidari , Babamiri Mohammad , Ghasemi Fakhradin , Ghaffari Mohammad Ebrahim , Razie Mahdi , Bandehelahi Khadijeh , Mortezapour Alireza
Published: November 2019

Background The high prevalence and also multiple consequences of addiction to various online content, including online games and social networks, have become a major challenge. The ability to predict musculoskeletal disorders from this addiction can help reveal in students' health status in the near future. The aim of this study was to determine the prevalence of this addiction and the ability to predict neck pain from this matter in students.Methods This study was carried out among 665 students. Data collection was performed through three questionnaires on problematic use of online games, social networking addiction, and Nordic musculoskeletal disorders. Data were compared with Chi-square and independent T-test, and the logistic regression model was then presented at a significant level of 0.05. Finally, the area under the receiver operating characteristic (ROC) curve and Discriminant analysis with SPSS and STATA software were conducted to clarify associations.Results The prevalence of Internet-related content addiction was 32.8%. The results showed that addiction to social networks and online games can increase the risk of neck disorder. Also 0.58 area under ROC curve depicted the ability to predict neck pain from this addiction.Conclusions In students with internet - related content addiction, neck disorder can be predicted. Given the high prevalence of internet addiction in students, it is essential to take immediate and appropriate interventions to avoid the associated adverse effects such as neck problems.
Are we equipped with serving the right care? Implications for program responses regarding gender-based violence
Authors: Tin Khaing Nwe , Oung Myitzu Tin , Yin Su Su , Htet Kyaw Ko Ko , Hein Kyaw Thu , Einda Hla Mya Thway , Than Kyu Kyu
Published: November 2019

Background Globally, 35% of women have experienced gender-based violence (GBV) which seriously affects all aspects of women’s health. While health sector must play a key role in response, there are many barriers for GBV survivors to access health services, especially in developing countries including Myanmar. Limitations of health sector in provision of quality services to GBV survivors, healthcare providers’ knowledge, attitude, experience and service availability and readiness, should be explored as an initial step for the improvement of health care response to GBV survivors.Methods This study was a cross-sectional descriptive study conducted in four purposively selected townships with higher number GBV cases. Face-to-face interviews were done to all health care providers (n=233) from public health facilities using a structured questionnaire. The findings were described as frequency and percentage for categorical data and mean and standard deviation for continuous data.Results Lady Health Visitors and Midwives were mainly involved (88.0%). About two-thirds had heard GBV without probing. Types of violence they mostly described were physical (81.1%) and sexual violence (8.5%). One-third wanted women to be patient to their partners’ violence to maintain family ties. Nearly two-third assumed conflict between husband and wife was not a matter that someone should involve. About 70% had given care to GBV survivors and they provided only injury treatment (76.1%). A quarter of them experienced sexual violence cases, but only 4.9% and 1.2% provided emergency contraception and Sexually Transmitted Infection treatment. Although nearly two third mentioned about psychological counseling in GBV management, only 20% provided counseling services to survivors. Absence of standard GBV management guideline, trained and skilled staff for GBV and counseling room at health facilities were issues mostly stated by the respondents.Conclusions Inadequate knowledge, misconceptions and unfavorable attitudes of GBV among health care providers might deter the effectiveness of GBV management at the health sector. In addition, poor management practice together with no standard management guideline, limited skilled staff, inadequate drug supplies and absence of counseling facilities indicated insufficient readiness to provide quality health care responses to GBV surviours in Myanmar.
Factors associated with Trifluridine/Tipiracil (TAS-102) effectiveness in patients with refractory metastatic colorectal cancer: real-life data from the Czech Republic.
Authors: Grell Peter , Dvorak Josef , Vocka Michal , John Stanislav , Pitauerova Helena , Buchler Tomas , Selingerova Iveta , Borilova Simona , Petruzelka Lubos , Vyzula Rostislav , Kiss Igor , Obermannova Radka
Published: November 2019

Background: Trifluridine/tipiracil (TAS-102) is effective in refractory metastatic colorectal cancer (mCRC). Currently, no predictive biomarkers are established and used in clinical practice. Methods: We analyzed data of 160 patients treated with TAS-102 in real clinical practice in the Czech Republic. Different factors associated with progression-free survival (PFS) and overall survival (OS) were evaluated. Results: Median PFS was 3.3 months, and median OS 10.2 months. Factors significantly associated with PFS and/or OS were: ECOG performance status (PS), time from diagnosis of mCRC > 24 months, initiation of treatment > 3 months from last fluoropyrimidine, number of metastatic sites, baseline CRP level, WBC count, neutrophils count, monocytes count, neutrophil to lymphocyte ratio, development of neutropenia, thrombocytopenia, diarrhea, required dose reduction and cycle delay. We developed a scoring system TAScore from factors available at the beginning of treatment. One point each was assigned to the following factors (PS, diagnosis of mCRC > 24 months, initiation of TAS-102 > 3 months from fluoropyrimidine, baseline CRP, WBC, monocytes count < 0.5 × 10 9 /L) and patients were divided into 3 groups: high risk group (0 to 1 point), intermediate (2 to 3), favorable with 4 or more points. OS according to risk group was: 5.7 months for high risk, 8.7 for intermediate, 12.8 for favorable (P < 0.001). TAScore was also associated with PFS (P < 0.001). Conclusions : TAS-102 is effective in patients with refractory mCRC. We propose simple scoring system TAScore to help with precise patient selection at the beginning of TAS-102 treatment.
Practice and its associated factors of evidence-based care during second and third stage of labour at tertiary teaching hospital in the Philippines, a descriptive mixed methods study
Authors: Masuda Chisato , Ferolin Shirley Kristine , Masuda Ken , Smith Chris , Matsui Mitsuaki
Published: November 2019

Background Evidence-based practice is one of key components of quality maternal care. However, previous studies have identified gaps between evidence and actual practices at maternity in the Philippines. This study aims to describe practice of evidence-base intrapartum care and its associated factors in a tertiary teaching hospital.Methods A mix-methods study was conducted, which consists of direct observation of intrapartum practices during the second and third stages; semi-structured interviews and focus group discussions with care providers to confirm the reasons to perform episiotomy or fundal pressure and their perception. Descriptive statistics, and univariate and multivariate logistic regressions were used to analyse the relationship between observed practices and maternal, neonatal and environmental factors. Qualitative data was extracted and categorised to identify themes on the decision-making process of practices.Results A total of 170 deliveries were included. Recommended care, such as prophylactic use of oxytocin and controlled cord traction in the third stage, were applied in almost all the cases. However, harmful practices, such as intramuscular or intravenous oxytocin use in the second stage (14.1%) and lack of foetal heart rate monitoring (57.1%) were also observed. 92.0% of primiparas received episiotomy and 31.2% of all deliveries received fundal pressure. Following factors were associated with implementation of episiotomy; primipara (adjusted Odds Ratio 62.3 [16.3-237.1]), duration of the second stage more than 30 minutes (aOR 4.6 [1.2-17.7]) and assisted vaginal delivery (aOR 15.0 [1.2-192.0]). Factors associated with fundal pressure were; primipara (aOR 3.0 [1.4-6.7]), augmentation with oxytocin (aOR 3.3 [1.5-7.0]) and assisted vaginal delivery (aOR 4.8 [1.3-18.0]). Healthcare providers believe these practices can prevent laceration or proceed delivery. 17.1% of women got OASIS in this study. Assisted vaginal delivery (aOR 6.0 [1.6-22.4]), baby’s weight more than 3500g (aOR 7.8 [1.7-36.6]), episiotomy (aOR 26.4 [2.3-299.0]) and fundal pressure (aOR 6.2 [2.1-18.2]) were associated with OASIS.Conclusions Our study found potentially harmful practices were still conducted and they contributed to the occurrence of OASIS. The perception of these practices was divergent with the current evidence, empirical knowledge had more influence. Scientific evidence and its underlying knowledge should be understood among providers to improve practices.
Effectiveness of sodium fluoride varnish to prevent dental caries in school children between age of 6 and 7 years: A randomised controlled trial in a low resource setting
Authors: Jayasinghe Rasika Manori , Senanayake Sameera , Kularatna Sanjeewa
Published: November 2019

Background
Dental caries among children is a significant public health problem world over with multiple factors playing a major role as risk factors in initiation and contnuation of the disease. Fluoride varnish application is an effective intervent in preventing dental caries. Objective of this study was to evaluate the effectiveness of six monthly application of sodium fluoride varnish in prevention of dental caries in deciduous teeth, permanent incisors and molars in children between six and seven years in a low resource setting, Sri Lanka.

Method
This was a double-blind, randomized controlled trial (NCT02877888). The study population was school children aged six to seven years, living in a district of Sri Lanka. Recruited children were randomly assigned to either a treatment (n=161) or to control group (n=162) using block randomization. Children in the treatment group received fluoride varnish professionally applied every 6 months combined with counselling on maintenance of oral hygiene and diet for a period of 2 years. The control group was only subjected to counselling on maintenance of oral hygiene and diet. Caries examinations were conducted using the International Caries Detection and Assessment System (ICDAS). The primary outcome studied was the number of new caries in the two study groups.

Results
At the baseline assessment, the propotion of students with dental caries was higher in the intervention groupl (80.9%) compared to the control group (48.4%). Similarly the mean number of teeth with dental caries in a student was higher in the intervention group (1.35). At each time interval, the mean number of new dental caries was significantly lower in the intervention group. When independent effect of the intervention on development of new dental caries was assessed, application of fluoride varnish every 6 months for a period of 2 years was significantly associated with less number of new dental caries compared to controls.

Conclusion
Implementation of fluoride varnish application in a low resource setting is an effective method of preventing dental caries among children. A national level programme would contribute to the reduction of prevalence of dental caries in this age group.
Trial registration: NCT02877888
Changes in children’s oral-health-related quality of life following dental treatment under general anesthesia in the United Arab Emirates
Authors: Alantali Kholoud , Halabi Manal Al , Hussein Iyad , Hassan Amar , El-Tatari Ahmed , Kowash M.B.
Published: November 2019

Background Early Childhood Caries (ECC) is the most common childhood disease in preschool children which often require dental treatment under Dental General Anaesthesia (DGA). Aim: To assess the effect of DGA on United Arab Emirates (UAE) children and their families’ Oral Health Related Quality of Life (OHRQoL). Design: A cross sectional study, using a DGA pre-and post-survey to evaluate changes in OHRQoL. A total of 173 parents completed Early Childhood Oral Health Impact Scale (ECOHIS) before and after their children (mean age 4.6 years) underwent DGA by a pediatric dentist in Al-Ain, UAE from 1st March 2017 to 28th February 2018. The ECOHIS and its effect size (ES) served to evaluate children's OHRQoL, the Wilcoxon signed-rank and the Kruskal-Wallis tests were used for statistical analyses. Results: The mean dmft of the children prior to the treatment was 13.8+3.07. Children’s pain and eating problems and parents feeling upset and guilty were the most frequently reported impacts at baseline. The ECOHIS scores decreased significantly (p < 0.001) after DGA, revealing a large ES for the child (2.19) and family (2.79) sections of the ECOHIS. Conclusions: DGA treatment resulted in significant improvement in all child and family physical, psychological and social aspects of OHRQoL.
Data Quality of Request Forms for Lumbar Spine Radiography in a Tertiary Care Hospital in Sri Lanka
Authors: Wettasinghe Mihiri Chami , Rosairo Shanthini , Wickramasinghe Nuwan Darshana
Published: November 2019

Objective: To assess the data quality of request forms for lumbar spine X-ray received by a tertiary care hospital in the Central Province, Sri Lanka.
Results: A total number of 185 lumbar spine X-ray request forms received by the Department of Radiology were analysed. Data quality was assessed on the aspects of completeness, accuracy and legibility.
Completeness was assessed for different sections separately and altogether eight sections in the request forms were analyzed. Out of the 185 request forms, 138 (74.5%) had complete entries for all the eight sections. Thirteen (7.0%) requests failed to provide the clinical history. Five request forms (2.7%) failed to provide the sex and the age of the patient. Thirty two (17.3%) did not provide details on the region of examination.
Accuracy was assessed in relation to the clinical history and region of examination. In the 172 requests, which gave a clinical history, 167 (97.1%) provided relevant clinical histories for requesting lumbar spine X-rays. Five requests (2.9%) provided irrelevant history and five (2.9%) requests contained non-standard abbreviations.
Five (2.7%) referrals were not readable by the radiologists.
Hence, the data quality of lumbar spine X-ray request forms received by the Department of Radiology needs further improvement.
The correlation between MRI findings and clinical prognosis in children with purulent meningitis
Authors: Kong Lei , Li Di , Guo Xin , Liu Linlin , Liu Gang , Liu Yue
Published: November 2019

Background: To explore the correlation between magnetic resonance imaging (MRI) findings and clinical prognosis in children with purulent meningitis.
Methods : Forty-nine cases of children with purulent meningitiswere collected from January 2016 to December 2018 in Beijing Children's Hospital. According to the Glasgow Outcome Scale（GOS), there were 35 patients with good prognosis and 14 patients with poor prognosis. All patients were scanned by MRI. We used Chi-square test and Logistic regression to analyse the correlation between MRI features and clinical prognosis in children with purulent meningitis.
Results : Among the two groups, the poor prognosis group had the worst imaging performance, while the good prognosis group had the lighter imaging performance. Chi-square test showed that the imaging signs of cerebral edema, cerebral hemorrhage, subdural effusion, hydrocephalus, venous sinus thrombosis, cerebral hernia had statistical significance between the two groups (P < 0.05). Multivariate logistic regression analysis showed that the signs of cerebral edema, subdural effusion were risk factor for poor prognosis (P < 0.001).
Conclusion : There are many complications and sequelae in children with purulent meningitis. The MRI findings of cerebral edema, cerebral hemorrhage, subdural effusion, hydrocephalus, venous sinus thrombosis, cerebral hernia suggest poor prognosis. It is instructive to clinical treatment and prognosis.