bluuebunny/crossref_metadata_2025 huggingface dataset:
Post-Caesarean section niche-related impaired fertility: hypothetical mechanisms
Authors: Vissers Jolijn , Hehenkamp Wouter , Lambalk Cornelis Bavo , Huirne Judith Anna
Published: April 2020

Caesarean section can result in an indentation of the myometrium at the site of the Caesarean scar, called a niche. Niches can cause symptoms of abnormal uterine blood loss, dysmenorrhoea, chronic pelvic pain and dyspareunia and are possibly related to subfertility. Various other explanations for the cause of subfertility after Caesarean section have been proposed in the literature, such as uterine pathology, intra-abdominal adhesions and women’s reproductive choices. Not all niches cause symptoms and the relation with subfertility and a niche in the uterine scar still needs further study since direct evidence is lacking so far. Based on the limited available evidence, and in combination with observations made during sonographic hysteroscopic evaluations and laparoscopic niche repair, we propose and discuss three hypothetical mechanisms: (i) the environment for sperm penetration and implantation may be detrimental; (ii) there could be a physical barrier to embryo transfer and implantation; and (iii) psychogenic factors may reduce the likelihood of pregnancy. Several innovative surgical treatments have been developed and are being implemented for niche-related problems. Promising results are reported, but more evidence is needed before further implementation in daily practice. The additional value of niche resections should be compared to expectant management or fertility therapies, such as ART, in randomized controlled trials. Therefore, our suggested hypotheses should, for the time being, not be used for justification of any specific procedures outside clinical trials.
Nurse Staffing, the Clinical Work Environment, and Burn Patient Mortality
Authors: Bettencourt Amanda P , McHugh Matthew D , Sloane Douglas M , Aiken Linda H
Published: April 2020

The complexity of modern burn care requires an integrated team of specialty providers working together to achieve the best possible outcome for each burn survivor. Nurses are central to many aspects of a burn survivor’s care, including physiologic monitoring, fluid resuscitation, pain management, infection prevention, complex wound care, and rehabilitation. Research suggests that in general, hospital nursing resources, defined as nurse staffing and the quality of the work environment, relate to patient mortality. Still, the relationship between those resources and burn mortality has not been previously examined. This study used a multivariable risk-adjusted regression model and a linked, cross-sectional claims database of more than 14,000 adults (≥18 years) thermal burn patients admitted to 653 hospitals to evaluate these relationships. Hospital nursing resources were independently reported by more than 29,000 bedside nurses working in the study hospitals. In the high burn patient-volume hospitals (≥100/y) that care for the most severe burn injuries, each additional patient added to a nurse’s workload is associated with 30% higher odds of mortality (P < .05, 95% CI: 1.02–1.94), and improving the work environment is associated with 28% lower odds of death (P < .05, 95% CI: 0.07–0.99). Nursing resources are vital in the care of burn patients and are a critical, yet previously omitted, variable in the evaluation of burn outcomes. Attention to nurse staffing and improvement to the nurse work environment is warranted to promote optimal recovery for burn survivors. Given the influence of nursing on mortality, future research evaluating burn patient outcomes should account for nursing resources.
Realized Volatility Forecasting with Neural Networks
Authors: Bucci Andrea
Published: April 2020

In the last few decades, a broad strand of literature in finance has implemented artificial neural networks as a forecasting method. The major advantage of this approach is the possibility to approximate any linear and nonlinear behaviors without knowing the structure of the data generating process. This makes it suitable for forecasting time series which exhibit long-memory and nonlinear dependencies, like conditional volatility. In this article, the predictive performance of feed-forward and recurrent neural networks (RNNs) was compared, particularly focusing on the recently developed long short-term memory (LSTM) network and nonlinear autoregressive model process with eXogenous input (NARX) network, with traditional econometric approaches. The results show that RNNs are able to outperform all the traditional econometric methods. Additionally, capturing long-range dependence through LSTM and NARX models seems to improve the forecasting accuracy also in a highly volatile period.
Linking Migration Aspirations to Integration Prospects: The Experience of Syrian Refugees in Sweden
Authors: Borselli Marco , van Meijl Toon
Published: April 2020

In this article, we examine the shifting role of aspirations in migration and integration processes by focusing on the experiences of a group of Syrian refugees settling in Sweden. We demonstrate that aspirations and capabilities may be used to study the lives of refugees (and immigrants) before, during, and after migration and that through a sequential study of aspirations it is possible to determine how refugees come to envision possible life trajectories in destination countries. Understanding the relevance of refugees’ aspirations and the effects that other actors have on these is important to recognize refugees’ active role in shaping migration and integration dynamics.
Louise Spieker Rankin’s Global Souths: An American Cookbook for India and Culinary Imperialism
Authors: Tunc Tanfer Emin
Published: April 2020

In 1933, Louise Spieker Rankin published the first edition of An American Cookbook for India, a recipe and household manual for American women who, like herself, found themselves living as expatriates in India with little or no prior knowledge of domestic life in subcontinental Asia. While Rankin’s cookbook builds upon the preexisting body of Anglo-Indian colonial cookbooks produced by the women of the British Raj, what renders the second edition of An American Cookbook for India (published in 1944) worthy of examination is how it connects one global south—Rankin’s homeland of the American South—to another, South Asia. In Rankin’s network of global souths, the troubling legacy of American slavery and domestic servitude by people of color are superimposed onto India through an extension of U.S. imperialism—in this case, through a complicated form of culinary imperialism in which male Indian cooks continue the work of the "mammies" of the “Old South” by replicating nostalgic southern recipes and perpetuating white supremacy. As I contend, a significant part of this gendered, racist, imperialist project is also the elision, or at best selective representation, of two wars—the American Civil War and World War II—which are eclipsed by the mythmaking that accompanies An American Cookbook for India.
MRI image analysis methods and applications: an algorithmic perspective using brain tumors as an exemplar
Authors: Vadmal Vachan , Junno Grant , Badve Chaitra , Huang William , Waite Kristin A , Barnholtz-Sloan Jill S
Published: April 2020

The use of magnetic resonance imaging (MRI) in healthcare and the emergence of radiology as a practice are both relatively new compared with the classical specialties in medicine. Having its naissance in the 1970s and later adoption in the 1980s, the use of MRI has grown exponentially, consequently engendering exciting new areas of research. One such development is the use of computational techniques to analyze MRI images much like the way a radiologist would. With the advent of affordable, powerful computing hardware and parallel developments in computer vision, MRI image analysis has also witnessed unprecedented growth. Due to the interdisciplinary and complex nature of this subfield, it is important to survey the current landscape and examine the current approaches for analysis and trend trends moving forward.
Liberal Relativism’s Challenge to Conscience Rights
Authors: Finegan Thomas
Published: April 2020

I argue that within contemporary liberal theory and case law is a relativistic conception of conscience, a conception which has the effect of obscuring the significance of conscience and downplaying the importance of conscience rights. The article focuses in particular on the right to conscientious objection. After outlining a representative cohort of cases from within contemporary liberalism concerning conscientious objection I analyse Cardinal Ratzinger’s (Pope Emeritus Benedict XVI) ‘dictatorship of relativism’ critique for its cogency as a response to these cases. I contend that although the ‘dictatorship of relativism’ critique is almost always understood in a univocal manner it is in fact comprised of two logically distinct arguments. One of these is found fundamentally flawed while the other is deemed promising yet in need of supplementation and defence. This I attempt via an analysis of the understanding of conscience present within contemporary liberal case law and theory. I go on to claim that contemporary liberalism, in part due to its problematic understanding of conscience, is often insufficiently respectful of an important principle of conscience rights protection when it dismisses claims of conscientious objection. The final part of the article is an attempt at explaining the paradox of a liberalism which readily justifies significant restrictions on conscience rights. I end by concluding that one version of the ‘dictatorship of relativism’ critique, suitably clarified and supplemented, is basically sound and poses a very serious challenge to contemporary liberalism.
A building concern? The health needs of families in temporary accommodation
Authors: Croft Laura Austin , Marossy Agnes , Wilson Tracey , Atabong Alice
Published: April 2020

Background

The number of families living in temporary accommodation in the UK is increasing. International evidence suggests that family homelessness contributes to poor mental health outcomes for both child and parent/carer, yet there is no routine way of understanding these health impacts at a local area level.

Methods

A homeless health needs audit was adapted to include questions about family health and completed in survey form by 33 people living in temporary accommodation in the London Borough of Bromley. Data were supplemented through an engagement event with 23 health and community care practitioners.

Results

The small population sample surveyed showed high levels of poor mental health in addition to behaviours that increase the risk of physical ill health (such as smoking) and a high use of secondary healthcare services. Engagement with practitioners showed awareness of poor health amongst this population group and challenges with regard to providing appropriate support.

Conclusions

There needs to be a sustainable and representative way of understanding the health needs of this population group including a comparison of the health needs of people placed in temporary accommodation in and out of their resident area.
Coparenting Supports in Mitigating the Effects of Family Conflict on Infant and Young Child Development
Authors: Negrini Lisa S
Published: April 2020

Family conflict has a profound impact on infants and young children’s social–emotional and behavioral development. In work with infants and young children, it is critical to understand the ways in which conflict between coparents infiltrates the family system, creating less than optimum environments for young children. Current research suggests that children who are surrounded by family conflict lag behind in the development of social, emotional, and regulatory skills. Developing a clear understanding of the ways in which children need to be supported through solid coparental relationships is essential because young children’s sense of safety and security enables them to optimize their developmental capacities. This report and analysis of supports for coparenting also reviews the literature on the effects of coparental conflict on children. Considering the mother–father–child triangle and the benefits of coparenting to the young child, particularly in families in which conflict exists, enhances our work with families. An exploration of the opportunities for integrating coparenting supports into services for families is discussed, and a case for incorporating these strategies into treatment protocols is made. Recommendations for further research on the use of coparenting supports to buffer the effects of family conflict on infants and young children are proposed.
UAE private foundations—an overview
Authors: Mrazek Yann
Published: April 2020

Most Middle Eastern entrepreneurial families are familiar with foreign offshore trusts and foundations and have been using these tools to ensure wealth preservation and inter-generational continuity for several generations. In that context, the United Arab Emirates (UAE) now counts three foundation regimes (in the Abu Dhabi Global Market, the Dubai International Financial Centre and the Ras Al Khaimah International Corporate Centre) and provides a local solution to wealth management and preservation, family succession planning, corporate structuring and asset protection. The purpose of this article is to present the context, mechanisms and interests in relation to UAE private foundations.
Duties and remedies in the Principles of International Commercial Contracts (PICC) and the Principles of Reinsurance Contract Law (PRICL): notes for a comparison
Authors: Cerini Diana
Published: April 2020

I. Reinsurance in the global landscape: risks of legal uncertainty and the case for an optional law; II. Relation between the Principles of International Commercial Contracts (PICC) and the Principles of Reinsurance Contract Law (PRICL); III. Contractual duties in the PICC and PRICL; IV. Remedies; V. Conclusion.
Disc Hemorrhages Are Associated With the Presence and Progression of Glaucomatous Central Visual Field Defects
Authors: Shukla Aakriti G. , Sirinek Portia E. , De Moraes C. Gustavo , Blumberg Dana M. , Cioffi George A. , Skaat Alon , Girkin Christopher A. , Weinreb Robert N. , Zangwill Linda M. , Hood Donald C. , Liebmann Jeffrey M.
Published: April 2020

Precis:

In this prospective cohort study, disc hemorrhages were associated with more severe central damage on 24-2 and 10-2 visual fields (VFs), and faster progression globally on 24-2 VFs and centrally on 10-2 VFs.

Purpose:

To study the relationship between disc hemorrhage (DH) and the presence and progression of glaucomatous central VF damage.

Methods:

Cross-sectional and longitudinal analyses were performed on data from the African Descent and Glaucoma Evaluation Study (ADAGES) cohort. Two masked investigators reviewed disc photographs for the presence and location of DH. 24-2 central VF damage was based on the number of test locations within the central 10 degrees of the 24-2 field pattern deviation and their mean total deviation (MTD). 10-2 central VF damage was based on pattern deviation and MTD. Main outcome measures were the association between DH and presence of central VF damage and between DH and worsening of VF.

Results:

DH was detected in 21 of 335 eyes (6.2%). In the cross-sectional analysis, DH was significantly associated with more severe central damage on 24-2 [incidence rate ratio=1.47; 95% confidence interval (CI)=1.02-2.12; P=0.035] and 10-2 VFs (incidence rate ratio=1.81; 95% CI=1.26-2.60; P=0.001). In the longitudinal analysis, DH eyes progressed faster than non-DH eyes based on 24-2 global MTD rates (difference in slopes, β=−0.06; 95% CI=−0.11 to −0.01; P=0.009) and 10-2 MTD rates (β=−0.10; 95% CI=−0.14 to −0.06; P< 0.001), but not 24-2 central MTD rates (β=−0.02; 95% CI=−0.078 to 0.026; P=0.338).

Conclusion:

DH was associated with the presence and progression of central VF defects. DH identification should prompt intensive central VF monitoring and surveillance with 10-2 fields to detect progression.
The Effect of Physical and Cognitive Impairments on Caregiving
Authors: Jutkowitz Eric , Gozalo Pedro , Trivedi Amal , Mitchell Lauren , Gaugler Joseph E.
Published: April 2020

Background:

Many older adults receive caregiving; however, less is known about how a change in a care recipient’s functional activity limitations [instrumental activities of daily living (IADL) and basic activities of daily living (ADL)] as well as their cognitive impairment influence the amount of caregiving received.

Methods:

Using the Health and Retirement Study (2002–2014) we identified community-dwelling respondents with Alzheimer disease and related dementias (ADRD; n=674), cognitive impairment no dementia (CIND; n=530), and no cognitive impairment (n=6126). We estimated a series of two-part regression models to identify the association between care recipients’ level of cognitive impairment, change in total number of IADL/ADL limitations and amount of caregiving received.

Results:

Persons with ADRD received 235.8 (SD=265.6) monthly hours of care compared with 26.0 (SD=92.6) and 6.0 (SD=40.7) for persons with CIND and no cognitive impairment, respectively. An increase in one IADL/ADL limitation resulted in persons with ADRD and CIND receiving 4.90 (95% confidence interval: 3.40–6.39) and 1.43 (95% confidence interval: 0.17–2.69) more hours of caregiving than persons with no cognitive impairment. Increases in total IADL/ADL limitations were associated with persons with ADRD, but not CIND, receiving more days of caregiving and having more caregivers than persons with no cognitive impairment.

Conclusions:

Compared with persons with no cognitive impairment, increases in IADL/ADL limitations disproportionally increases the caregiving received for persons with ADRD. Policies and programs must pay attention to functional impairments among those living with ADRD.
The Effect of the Inflammatory Bowel Disease Classroom in Nature on the Quality of Life of Patients With Inflammatory Bowel Disease
Authors: Navas‐López Víctor M. , Martel Laura Camacho , Martín‐Masot Rafael , Rubio María Navalón , Santana Natalia Ruiz , López Marta Herrador , Frías Arjona Almudena , Merino Valero Víctor M. , Ortega Doltz Verónica , Ramos‐Cózar Sara N. , Alcaín Martínez Guillermo
Published: April 2020

“The IBD Classroom in Nature” is an initiative that combines training and leisure activities in an ideal environment where families and patients can interact with each other. The objective of the present study was to quantify the effect that “The IBD Classroom in Nature” had on the health‐related quality‐of‐life of patients with Inflammatory bowel disease (IBD). We conducted a prospective, analytical study with a pre‐post design to demonstrate the impact on health‐related quality‐of‐life (measured with the IMPACT‐III questionnaire) of 3 days together in the context of The IBD Classroom in Nature. The study included 13 patients with IBD with a mean age of 12.3 years (interquartile range 11.9–14.5). After “The IBD Classroom in Nature” there was an improvement in the IMPACT‐III score with significant improvements in the emotional functioning and body image domains. The present study objectively shows the beneficial effect of group activities focused on the most diverse aspects of their disease.
Risk of Patient Harm Related to Unnecessary Dilution of Ready-to-Administer Prefilled Syringes
Authors: Degnan Daniel D. , Bullard Tacia N. , Davis Mary Beth Hovda
Published: April 2020

Unnecessary dilution of ready-to-administer (RTA) syringes could increase the risk of patient harm attributed to errors related to incorrect dose, improper labeling, and the potential for microbial contamination. Although published guidelines endorse the use of commercially available RTA syringes, recent surveys indicate that best practices are not always implemented. The purpose of this article is to review the existing literature and to assess the incidence and nature of errors related to the unnecessary dilution of RTA intravenous (IV) push medications in the inpatient clinical setting. The PubMed database was searched to identify studies of errors related to the use of RTA syringes for IV push medications within the last 10 years. An additional search was conducted using other search engines to identify relevant articles in the grey literature. This literature review concludes that unnecessary dilution of IV push medication in RTA syringes is an unsafe practice that occurs routinely. This practice increases the risk of patient harm through errors related to incorrect dose, improper labeling of syringes, and the potential for microbial contamination of the product. Greater awareness of the risks associated with unnecessary dilution of RTA syringes is still needed to eliminate this unsafe IV push medication administration practice and to thereby further improve outcomes.
A Scoring Method for Immunohistochemical Staining on Ki67
Authors: Guo Rui , Ma Li , Bai Xiomei , Miao Li , Li Zongfang , Yang Jun
Published: April 2020

An accurate interpretation of immunohistochemistry (IHC) staining results is crucial for precise disease diagnosis. In this study, we present a novel scoring method for interpreting and reporting of IHC staining assay results for the nuclear-type molecule. On the basis of the histologic characteristics, the samples were subdivided into 3 basic structural units and tissue subtypes including covered, mosaic, and mesenchymal subtypes. A cut-off of moderate-positive (2+) cells and 10% as the differential expression were applied to stratify the results into 11 grade scoring system (0 to X level). The observer can directly identify and count the number and percentage of positive cells from IHC staining data. Furthermore, Ki67 staining results in 88 carcinoma specimens were re-evaluated to determine the ease, reliability, reproducibility, and variance among different observers. The results indicated the consistency ratio of 68.0% for the mosaic subtype and 80% for the mesenchymal subtype, and 68.2% for the covered subtype by 5 experienced pathologists independently. Using 10% as the cut-off threshold, the consistency ratio of 92.5%, 96.8%, and 92.9% was noted for mosaic, mesenchymal, and covered subtypes, respectively. Besides, the correlation of counts revealed excellent agreement among the 5 independent pathologists. Overall, the proposed IHC scoring method is a novel, simple, reliable, and reproducible grading system for accurate interpretation of IHC staining data. Furthermore, the presented practical grading approach has the potential to improve the clinical evaluation of the IHC staining data for personalized therapy.
The Combination of Transient Receptor Potential Vanilloid Type 1 (TRPV1) and Phosphatase and Tension Homolog (PTEN) is an Effective Prognostic Biomarker in Cervical Cancer
Authors: Han Gwan Hee , Chay Doo Byung , Nam Sanghee , Cho Hanbyoul , Chung Joon-Yong , Kim Jae-Hoon
Published: April 2020

Transient receptor potential vanilloid type 1 (TRPV1) has been reported to play an important role in human cancers. However, the knowledge about TRPV1 in cervical cancer is sparse. Therefore, we evaluated the expression and clinical significance of TRPV1 in cervical cancer. Immunohistochemical analyses were performed for TRPV1 and phosphatase and tension homolog (PTEN) to delineate clinical significance using 150 cervical cancers, 230 cervical intraepithelial neoplasias, and 312 normal cervical epithelial tissues in a tissue microarray. Furthermore, the role of TRPV1 in cell growth was assessed in a cervical cancer cell line. The TRPV1 expression was significantly higher in cervical cancer tissues than in cervical intraepithelial neoplasias, and normal epithelial tissues (P<0.001). In cervical cancer tissues, TRPV1 expression negatively correlated with PTEN expression (Spearman ρ=−0.121, P=0.009). Multivariate survival analysis revealed high TRPV1 expression (hazard ratio=3.41, 95% confidence interval: 1.25–9.27, P=0.016) as an independent prognostic factor for overall survival. Notably. the high TRPV1/low PTEN expression showed the highest hazard ratio (5.87; 95% confidence interval: 2.18–15.82, P<0.001) for overall survival. In vitro results demonstrated that the overexpression of TRPV1 was associated with increased cell viability and colony formation. Overexpression of TRPV1 could be a good biomarker for the prediction of chemoradiation response. Our result suggested promising potential of high TRPV1/low PTEN as prognostic and survival makers. The possible link between the biologic function of TRPV1 and PTEN in cervical cancer warrants further studies.
Cancer risk following lymphoid malignancies among HIV-infected people
Authors: Mahale Parag , Ugoji Chinenye , Engels Eric A. , Shiels Meredith S. , Peprah Sally , Morton Lindsay M.
Published: April 2020

Objective(s):

HIV-infected people have increased cancer risk. Lymphoma survivors have an increased risk of certain second primary cancers in the general population, but second cancer risk among HIV-infected people is poorly understood. Herein, we characterized the risk of cancers following lymphoid malignancies among HIV-infected people.

Design:

Population-based linkage of HIV and cancer registries.

Methods:

We used data from the US HIV/AIDS Cancer Match Study (1996–2015) and evaluated the risk of first nonlymphoid malignancy in Cox regression models, with first lymphoid malignancy diagnosis as a time-dependent variable.

Results:

Among 531 460 HIV-infected people included in our study, 6513 first lymphoid and 18 944 first nonlymphoid malignancies were diagnosed. Risk of nonlymphoid cancer following a lymphoid malignancy was increased overall [adjusted hazard ratio (aHR) = 2.7; 95% confidence interval (CI) = 2.3--3.2], and specifically for cancers of the oral cavity (aHR = 2.6; 95% CI = 1.2–5.5), colon (2.4; 1.1–5.0), rectum (3.6; 1.9–6.7), anus (3.6; 2.5–5.1), liver (2.0; 1.2–3.5), lung (1.6; 1.1–2.4), vagina/vulva (6.1; 2.3–16.3), and central nervous system (5.0; 1.6–15.6), Kaposi sarcoma (4.6; 3.4–6.2), and myeloid malignancies (9.7; 6.1–15.4). After additional adjustment for prior AIDS diagnosis and time since HIV diagnosis, aHRs were attenuated overall (aHR = 1.7; 95% CI = 1.5–2.0) and remained significant for cancers of the rectum, anus, and vagina/vulva, Kaposi sarcoma, and myeloid malignancies.

Conclusion:

HIV–infected people with lymphoid malignancies have an increased risk of subsequent non–lymphoid cancers. As risks remained significant after adjustment for time since HIV diagnosis and prior AIDS diagnosis, it suggests that immunosuppression may explain some, but not all, of these risks.
Performing rapid autopsy for the interrogation of HIV reservoirs
Authors: Rawlings Stephen A. , Layman Laura , Smith Davey , Scott Brianna , Ignacio Caroline , Porrachia Magali , Concha-Garcia Susanna , Hendrickx Steven , Kaytes Andy , Taylor Jeff , Gianella Sara
Published: April 2020

Rapid autopsy at the end of life in people with HIV (PWH) permits the preservation of valuable tissue specimens for subsequent study of HIV reservoirs. At our institution, we have developed a cohort of PWH who consent to a rapid autopsy to gather a wide range of fluids and tissues with the goal of advancing HIV cure research. The protocol for successfully performing these autopsies has required careful thought and development over months and years. We have now successfully performed six rapid autopsies and detail here our steps to build the study cohort, train and staff a team of more than a dozen personnel, and process and preserve hundreds of samples from each autopsy.
Efficacy and Safety of Short-type Single Balloon Enteroscopy-assisted Peroral Direct Cholangioscopy Using an Ultra-slim Endoscope in Patients With Surgically Altered Anatomy
Authors: Mandai Koichiro , Uno Koji , Yasuda Kenjiro
Published: April 2020

Background:

The efficacy and safety of peroral direct cholangioscopy (PDCS) in patients with surgically altered anatomy (SAA) are unclear. The present study aimed to evaluate the efficacy and safety of short-type single balloon enteroscope (s-SBE)-assisted PDCS using an ultra-slim endoscope in patients with SAA.

Materials and Methods:

We retrospectively analyzed 12 sessions of PDCS performed in 8 patients with surgically altered gastrointestinal or pancreatobiliary anatomy between November 2017 and September 2019 at our institution. Endoscopic retrograde cholangiopancreatography using s-SBE was initially performed. Subsequently, the s-SBE was exchanged for an ultra-slim endoscope through an overtube with an inflated balloon to perform PDCS. We analyzed the success rates and adverse events resulting from the procedure.

Results:

Six patients had biliary stones and 2 had biliary strictures. The types of reconstruction were Roux-en-Y choledochojejunostomy (n=5), Billroth II gastrectomy (n=2), and Roux-en-Y gastrectomy (n=1). Biliary insertion of the ultra-slim endoscope was successful in all 12 sessions. Biliary interventions included electronic hydraulic lithotripsy in 5 sessions, stone removal using basket catheter in 3 sessions, biopsy in 2 sessions, and diagnosis of no residual stones in 2 sessions. Complete stone removal was finally achieved in all 6 patients with biliary stones. Biliary strictures in 2 patients were diagnosed as adenocarcinoma following a biopsy. The adverse events were cholangitis of mild severity in 3 sessions.

Conclusion:

S-SBE-assisted PDCS using an ultra-slim endoscope was useful and safe in patients with SAA, although care should be taken to avoid adverse events.
Damage to red blood cells during whole blood storage
Authors: Oh Joo-Yeun , Marques Marisa B. , Xu Xin , Li Jindong , Genschmer Kristopher , Gaggar Amit , Jansen Jan O. , Holcomb John B. , Pittet Jean-Francois , Patel Rakesh P.
Published: April 2020

BACKGROUND

Transfusion with stored whole blood (WB) is increasingly routine practice to resuscitate bleeding trauma patients. Storage of packed red blood cells (pRBC) results in multiple biochemical, structural, and metabolic changes, referred to as to the storage lesion that may mediate adverse effects associated with transfusion of older RBC units. These include increased hemolysis, oxidative stress, and accelerated scavenging of nitric oxide (NO). Whether similar changes occur to stored WB is unclear and are characterized in this study.

METHODS

Ten WB units, in citrate-phosphate-dextrose, were purchased from the American Red Cross and changes in hemolysis (increased free hemoglobin, heme, and microparticles), oxidative stress indexed by redox cycling of peroxiredoxin-2 (Prx-2) and NO-scavenging kinetics were determined at different storage times until expiration.

RESULTS

Microparticle number and free hemoglobin, but not heme, increased in a storage time-dependent manner. When normalized to the initial number of RBCs in stored WB units, hemolysis rates were similar to those reported for pRBCs. Prx-2 recycling kinetics were slower at expiration compared with earlier storage times. Rates of NO dioxygenation did not change with storage, but were decreased compared with freshly isolated RBCs.

CONCLUSION

Storage of WB results in changes associated with the pRBC storage lesion but not for all parameters tested. The relative rate of hemolysis (indexed by free hemoglobin and microparticles) and oxidative stress was similar to that of pRBCs. However, the absolute level of hemolysis products were lower due to lower hematocrit of stored WB units. The clinical significance of these findings requires further investigation.
Efficacy of resuscitation with fibrinogen concentrate and platelets in traumatic hemorrhage swine model
Authors: Martini Wenjun Z. , Rodriguez Cassandra M. , Cap Andrew P. , Dubick Michael A.
Published: April 2020

BACKGROUND

This study compared the resuscitation effects of platelets and fibrinogen concentrate (FC) on coagulation and hemodynamics in pigs with traumatic hemorrhage and reduced platelet counts.

METHODS

Thirty pigs (40 ± 3 kg) were anesthetized and catheterized with an apheresis catheter to remove platelets using the Haemonetics 9000 (Haemonetics, Braintree, MA). Afterward, a femur fracture was induced, followed by hemorrhage of 35% the estimated blood volume. Pigs were then randomized to be resuscitated with 5% human albumin (12.5 mL/kg), FC (250 mg/kg, 12.5 mL/kg), or platelets collected from apheresis (11.0 ± 0.5 mL/kg). Animals were monitored for 2 hours or until death. Blood samples were collected before (baseline [BL]) and after apheresis, after hemorrhage, and after resuscitation to assess changes in hemodynamics and coagulation using Rotem.

RESULTS

No change in mean arterial pressure (MAP) or heart rate (HR) was observed by platelet apheresis. Hemorrhage reduced MAP to 57% ± 5% and elevated HR to 212% ± 20% of BL (both p < 0.05). Resuscitation with albumin, FC, or platelets did not revert MAP or HR to BL. Platelet counts were reduced by apheresis from BL 383 ± 20 × 103/μL to 141 ± 14 × 103/μL and were reduced further after resuscitation with albumin (88 ± 18 × 103/μL) or FC (97 ± 13 × 103/μL, all p < 0.05), but improved with platelet resuscitation (307 ± 24 × 103/μL). Fibrinogen concentration was reduced by apheresis from BL 225 ± 9 mg/dL to 194 ± 8 mg/dL, fell after albumin infusion (134 ± 11 mg/dL), increased to 269 ± 10 mg/dL after FC resuscitation (all p < 0.05), and was not affected by platelet resuscitation. Rotem α-angle decreased from 79 ± 2 degrees to 69 ± 1 degrees by apheresis and hemorrhage (p < 0.05), and recovered similarly by resuscitation with FC (87 ± 1 degrees) or platelets (78 ± 2 degrees), but not by albumin (63 ± 3 degrees). Similar responses were observed in Rotem maximum clot firmness.

CONCLUSION

In this traumatic hemorrhage swine model, low-volume resuscitation with FC or platelets was similarly effective in restoring coagulation.
Are all trauma centers created equal? Level 1 to level 1 trauma center patient transfers in the setting of rapid trauma center proliferation
Authors: Jones Mike D. , Kalamchi Louay D. , Schlinkert Andrew B. , Chapple Kristina M. , Jacobs Jordan V. , Bogert James N. , Soe-Lin Hahn , Weinberg Jordan A.
Published: April 2020

BACKGROUND

Level 1 trauma centers should provide definitive care for every aspect of injury. However, in environments that have experienced trauma center proliferation, not all level 1 centers may have the resources or expertise needed for every patient, necessitating transfer to another trauma center. The purpose of this study was to assess the incidence of such transfers and associated impact on patient outcome and burden on the receiving level 1 center.

METHODS

In a metropolitan area experiencing trauma center proliferation, we performed a 5.5-year review of patient transfers to an established level 1 (index center) from other state designated level 1 centers. American College of Surgeons verification level was identified for each facility. Comparisons were performed between the cohort of transferred patients and patients with similar demographics, injury patterns, and severity managed at the index center using propensity score matching.

RESULTS

A total of 104 patients were received from other state level 1 centers (39% American College of Surgeons level 2, 61% American College of Surgeons level 1). Nearly 70% of patients were transferred for definitive evaluation and/or management of brain, spine, or cerebrovascular injury. For 76% of this subgroup, specialty consultation was available, but the injury was deemed beyond their capability. Comparison of the transfer cohort propensity score matched to the control cohort (93 vs. 558 patients) demonstrated increased length of stay (6.5 days vs. 4.6 days, p = 0.001) and cost (US $36,027 vs. US $30,654, p = 0.033) associated with the transfer cohort, with similar mortality (12.1% vs. 9.7%, p = 0.492).

CONCLUSION

The number of level 1 to level 1 transfers observed imply a disparity in resources and capability among level 1 trauma centers in the region. The majority of transfers were for neurosurgical care, suggestive of a deficit of adequate neurosurgical coverage in the setting of trauma center proliferation. Both patients and established trauma centers bear the burden for these transfers with respect to increased cost and length of stay.

LEVEL OF EVIDENCE

Care management, level IV.
Why is cancer not more common? A changing microenvironment may help to explain why, and suggests strategies for anti-cancer therapy
Authors: Jiang Xiaowei , Tomlinson Ian P. M.
Published: April 2020

One of the great unsolved puzzles in cancer biology is not why cancers occur, but rather explaining why so few cancers occur compared with the theoretical number that could occur, given the number of progenitor cells in the body and the normal mutation rate. We hypothesized that a contributory explanation is that the tumour microenvironment (TME) is not fixed due to factors such as immune cell infiltration, and that this could impair the ability of neoplastic cells to retain a high enough fitness to become a cancer. The TME has implicitly been assumed to be static in most cancer evolution models, and we therefore developed a mathematical model of spatial cancer evolution assuming that the TME, and thus the optimum cancer phenotype, changes over time. Based on simulations, we show how cancer cell populations adapt to diverse changing TME conditions and fitness landscapes. Compared with static TMEs, which generate neutral dynamics, changing TMEs lead to complex adaptations with characteristic spatio-temporal heterogeneity involving variable fitness effects of driver mutations, subclonal mixing, subclonal competition and phylogeny patterns. In many cases, cancer cell populations fail to grow or undergo spontaneous regression, and even extinction. Our analyses predict that cancer evolution in a changing TME is challenging, and can help to explain why cancer is neither inevitable nor as common as expected. Should cancer driver mutations with effects dependent of the TME exist, they are likely to be selected. Anti-cancer prevention and treatment strategies based on changing the TME are feasible and potentially effective.
Pulmonary radiological change of COVID-19 patients with 99mTc-MDP treatment
Authors: Yuan Xiaolin , Yi Wanrong , Liu Baoyi , Tian Simiao , Cao Fang , Wang Ruoyu , Qi Baiwen , Lu Faqiang , Fang Meiyun , Pei Fuyang , Chen Ming , Zhang Lichuan , Zhang Yong , Zhang Xiuzhi , Pan Zhenyu , Zhao Dewei , Yu Aixi
Published: April 2020

Background

As increasing cases of COVID-19 around world, urgent need for effective COVID-19-specific therapeutic drugs is necessary; therefore, we conducted a pilot randomized-controlled study to evaluate the efficacy of 99mTc-MDP for COVID-19 therapeutic treatment.

Methods

A total of 21 mild patients with COVID-19 were enrolled in this pilot RCT from February 2020 through March 2020, and then were assigned, in a 1:1 ratio, into control (11 patients) and 99mTc-MDP group (10 patients). Patients in the control group received routine treatment and patients assigned to the 99mTc-MDP group received a combination of routine treatment and an administration of 99mTc-MDP injection of 5ml/day. Both of the patients in the control and 99mTc-MDP groups were treated for 7 days with the primary end point of CT-based radiological pulmonary changes during 7-day follow-up.

Findings

From baseline to the day 7, 8 (80%) of 10 mild patients in the 99mTc-MDP group had a significant radiological improvement in lung and a decline in inflammatory infiltration, whereas only 1 (9.1%) of 11 patients in the control group had a radiological improvement in lung. None of the patients in the 99mTc-MDP group had disease progression from mild to severe, as well as an inflammatory cytokine storm, and 2 mild patients (18.2%) in the control group developed severe. During days 7 through 14, the number of patients with radiological improvement in the 99mTc-MDP group remained consistent, and only 1 additional case (22%) in the control group were reported.

Conclusion

In this randomized pilot study, 99mTc-MDP had an effective inhibitory effect on the inflammatory disease progression for the therapy of COVID-19, and it can accelerate the absorption of pulmonary inflammation in a short period of time during the process of treatment.
Meeting radiation dosimetry capacity requirements of population-scale exposures by geostatistical sampling
Authors: Rogan Peter K. , Mucaki Eliseos J. , Lu Ruipeng , Shirley Ben C. , Waller Edward , Knoll Joan H.M.
Published: April 2020

Background

Accurate radiation dose estimates are critical for determining eligibility for therapies by timely triaging of exposed individuals after large-scale radiation events. However, the universal assessment of a large population subjected to a nuclear spill incident or detonation is not feasible. Even with high-throughput dosimetry analysis, test volumes far exceed the capacities of first responders to measure radiation exposures directly, or to acquire and process samples for follow-on biodosimetry testing.

Aim

To significantly reduce data acquisition and processing requirements for triaging of treatment-eligible exposures in population-scale radiation incidents.

Methods

Physical radiation plumes modelled nuclear detonation scenarios of simulated exposures at 22 US locations. Models assumed only location of the epicenter and historical, prevailing wind directions/speeds. The spatial boundaries of graduated radiation exposures were determined by targeted, multistep geostatistical analysis of small population samples. Initially, locations proximate to these sites were randomly sampled (generally 0.1% of population). Empirical Bayesian kriging established radiation dose contour levels circumscribing these sites. Densification of each plume identified critical locations for additional sampling. After repeated kriging and densification, overlapping grids between each pair of contours of successive plumes were compared based on their diagonal Bray-Curtis distances and root-mean-square deviations, which provided criteria (<10% difference) to discontinue sampling.

Results/Conclusions

We modeled 30 scenarios, including 22 urban/high-density and 2 rural/low-density scenarios under various weather conditions. Multiple (3-10) rounds of sampling and kriging were required for the dosimetry maps to converge, requiring between 58 and 347 samples for different scenarios. On average, 70±10% of locations where populations are expected to receive an exposure ≥2Gy were identified. Under sub-optimal sampling conditions, the number of iterations and samples were increased and accuracy was reduced. Geostatistical mapping limits the number of required dose assessments, the time required, and radiation exposure to first responders. Geostatistical analysis will expedite triaging of acute radiation exposure in population-scale nuclear events.
The Epidemiological Implications of Jails for Community, Corrections Officer, and Incarcerated Population Risks from COVID-19
Authors: Lofgren Eric , Lum Kristian , Horowitz Aaron , Madubuonwu Brooke , Myers Kellen , Fefferman Nina H.
Published: April 2020

COVID-19 is challenging many societal institutions, including our criminal justice systems. Some have proposed or enacted (e.g. the State of New Jersey) reductions in the jail and/or prison populations. We present a mathematical model to explore the epidemiological impact of such interventions in jails and contrast them with the consequences of maintaining unaltered practices. We consider infection risk and likely in-custody deaths, and estimate how within-jail dynamics lead to spill-over risks, not only affecting incarcerated people, but increasing exposure, infection, and death rates for both corrections officers, and the broader community beyond the justice system. We show that, given a typical jail-community dynamic, operating in a business-as-usual way will result in significant and rapid loss of life. Large scale reductions in arrest and speeding of releases are likely to save the lives of incarcerated people, jail staff, and the community at large.
Results of intensified source finding efforts among community-acquired cases of Legionnaires’ disease – first results of the German LeTriWa study; Berlin, 2016−2019
Authors: Buchholz U. , Jahn H. J. , Brodhun B. , Lehfeld A-S. , Lewandowsky M. , Reber F. , Adler K. , Bochmann J. , Förster C. , Koch M. , Schreiner Y. , Stemmler F. , Gagell C. , Harbich E. , Haas W. , Schaefer B. , Lück C.
Published: April 2020

Introduction

Sources of infection of most cases of community-acquired Legionnaires’ disease (CALD) are unknown.

Objective

Identification of sources of infection of CALD.

Setting

Berlin; December 2016–May 2019.

Participants

Adult cases of CALD reported to district health authorities and consenting to the study; age and hospital matched controls.

Main outcome measure

Percentage of cases of CALD with identified source of infection.

Methods

Analysis of secondary patient samples for monoclonal antibody (MAb) type (and sequence type); questionnaire-based interviews, analysis of standard household water samples for Legionella concentration followed by MAb (and sequence) typing of Legionella pneumophila serogroup 1 (Lp1) isolates; among cases taking of additional water samples to identify the infectious source as appropriate; recruitment of control persons for comparison of exposure history and contents of standard household water samples. For each case an appraisal matrix was filled in to attribute any of three source types (external (non-residence) source, residential non-drinking water (RnDW) source, residential drinking water (RDW) as source) using three evidence types (microbiological results, cluster evidence, analytical-comparative evidence (using added information from controls)).

Results

Inclusion of 111 study cases and 202 controls. Median age of cases was 67 years (range 25– 93 years), 74 (67 %) were male. Among 65 patients with urine typable for MAb type we found a MAb 3/1-positive strain in all of them.

Compared to controls being a case was not associated with a higher Legionella concentration in standard household water samples, however, the presence of a MAb 3/1-positive strain was significantly associated (OR = 4.9, 95 % confidence interval (CI) 1.7 to 11). Thus, a source was attributed by microbiological evidence if it contained a MAb 3/1-positive strain, by cluster evidence if at least two cases were exposed to it and by analytical-comparative evidence if a case was exposed to it and the type of source was statistically significantly associated with being a case. We identified an infectious source in 53 (48 %) of 111 cases: in 16 (14 %) an external source, in 9 (8 %) a RnDW source, and in 28 (25 %) we attributed RDW. We attributed 9 cases to RnDW because cases were associated with wearing not regularly disinfected dentures (OR = 3.2, 95 % CI 1.3 to 7.8).

Conclusion

Using the appraisal matrix we attributed almost half of all cases of CALD to an infectious source, predominantly RDW. Risk for LD seems to be conferred primarily by the type of Legionella rather than the amount. Dentures as a new infectious source needs further, in particular, integrated microbiological, molecular and epidemiological confirmation.