bluuebunny/crossref_metadata_2025 huggingface dataset:
Multivariable non-invasive association of isocitrate dehydrogenase mutational status in World Health Organization grade II and III gliomas with advanced magnetic resonance imaging T2 mapping techniques
Authors: Kern Maike , Auer Timo A , Fehrenbach Uli , Tanyildizi Yasemin , Picht Thomas , Misch Martin , Wiener Edzard
Published: January 2020

Aim

To investigate multivariable analyses for noninvasive association of the isocitrate dehydrogenase (IDH) mutational status in grade II and III gliomas including evaluation of T2 mapping-sequences.

Methods

Magnetic resonance imaging (MRI) examinations with histopathologically proven World Health Organization grade II and III gliomas were retrospectively enrolled. Multivariate receiver operating characteristics (ROC) analyses to associate IDH mutational status were performed containing quantitative T2 mapping analyses and qualitative characteristics (sex, age, localization, heterogeneity, oedema, necrosis and diameter). Relaxation times were calculated pixelwise by means of standardized ROI analyses. Interobserver variability also was tested.

Results

Out of 32 patients (mean age: 50.7 years; range: 32–83), nine had grade II gliomas and 24 grade III, while 59.5% showed a positive IDH mutated state (IDHm) and 40.5% were wildtype (IDHw). Multivariable ROC analyses were calculated for relaxation time and range, localization and age with a cumulative 0.955 area under the curve (AUC) ( p < 0.001), while central T2-relaxation time had by far the highest single variable sensitivity (AUC: 0.873; range: 0.762; age: 0.809; localization: 0.713). Age (cut off: 49 years; p = 0.031) and localization ( p = 0.014) were the only qualitative parameters found to be significant as IDHw gliomas were older and IDHm gliomas were preferentially located fronto-temporal.

Conclusions

This is the first study evaluating quantitative T2 mapping sequences for association of the IDH mutational status in grade II and III gliomas demonstrating an association between relaxation time and mutational status. Analyses of T2 mapping relaxation times may even be suitable for predicting the correct IDH mutational state. Prognostic accuracy increases significantly in predicting the correct mutational state when combing T2 relaxation time characteristics and the qualitative MRI features age and localization.
Elevated 1-Year Mortality Rate in Males Sustaining Low-Energy Proximal Femur Fractures and Subgroup Analysis Utilizing Age-Adjusted Charlson Comorbidity Index
Authors: Schultz Kyle A. , Westcott Benjamin A. , Barber Kimberly R. , Sandrock Todd A.
Published: January 2020

Introduction:

Low-energy proximal femur fractures are common in the aging population and the ability to identify patients at increased mortality risk provides surgeons information to improve informed decision-making with patients and families. We evaluated for gender differences in 1-year mortality after sustaining low-energy proximal femur fractures with subgroup analysis to identify the impact of fracture location, age, and comorbidities on mortality.

Materials and Methods:

Patients ≥40 years of age sustaining a low-energy proximal femur fracture identified at our institution between January 1, 2014, and December 31, 2017. International Classification of Diseases, Ninth Revision and International Classification of Diseases, Tenth Revision codes were used to identify comorbidities for calculation of the age-adjusted Charlson comorbidity index (ACCI). The county clerk database was searched to identify mortality within 1 year of injury. One-year mortality rates were calculated and multiple comparisons were made between genders controlling for age, fracture location, and/or ACCI.

Results:

Women presented with low-energy proximal femur fractures at a rate of almost 3:1 to men at our institution ( P = .001). Men demonstrated a significantly increased ACCI at presentation (5.35 ± 2.55 vs 4.86 ± 1.77, P = .03). Men had an increased 1-year mortality rate for all (31.3% vs 21.5%, P = .004) and intertrochanteric (IT) fractures (36.2% vs 22.9%, P = .008). Controlling for ACCI, gender, and fracture location, men demonstrated increased mortality rate with IT fractures ( P = .002) and trended toward but did not reach significance with femoral neck fractures ( P = .07).

Discussion:

Men presenting with low-energy femur fractures are at an increased mortality risk compared to women. On average, men present with an overall worse health status as identified by ACCI, which could predispose these patients not only to fractures themselves but also impair their ability to recover from injury.

Conclusion:

Men are at an increased 1-year mortality risk after sustaining proximal femur fractures.
Edutocracy: The New West Indian Plantocracy?
Authors: Denny Stacy L.
Published: January 2020

Despite pedagogical, technological, and curricular advancements in the West Indian education system, there has been little success in constructively addressing the pervasive regional English language examination failures. I contend that most researchers address these second language acquisition failures by focusing on symptoms rather than causes. However, this study seeks a novel way of tackling the problem, by employing the WordTree design by analogy method, typically used in the engineering field, but adapted for this social science enquiry. The method is used to generate a fitting analogy for the current failing language education system to provide insights into underlying issues, which assist in better understanding and addressing this failure. This method finds that the failing system is analogous to that of the plantocratic system of colonial times based on their strikingly similar ideologies, practices, and attendant outcomes. Resultantly, I term this language education system, an edutocracy.1 This study expands on scholarly works in the advancing areas of curriculum as cultural practice and colonial imagination to provide a different, deeper perspective of this West Indian problem, while exploring the implications of the analogous relationship.
Psychometry of the Multidimensional Perceived Autonomy Support Scale in Physical Education With Spanish Secondary School Students
Authors: Burgueño Rafael , Macarro-Moreno José , Medina-Casaubón Jesús
Published: January 2020

This research aimed to adapt and psychometrically examine the Multidimensional Perceived Autonomy Support Scale in Physical Education in the Spanish context. The participants were 560 (264 men and 296 women; Mage = 14.49, SDage = 1.05) physical education secondary school students. The results underpinned a 15-item three-factor correlated model, which was invariant across gender and age. The reliability analysis reflected an acceptable level of internal consistency and temporal stability for each factor. The structural equation modeling showed that perceived cognitive, procedural, and organizational autonomy support predicted positively and significantly basic psychological need satisfaction. The Multidimensional Perceived Autonomy Support Scale in Physical Education is a valid and reliable instrument to multidimensionally measure the secondary school students’ perception of autonomy support from physical education teachers in the Spanish context.
Low levels of HIV-1 drug resistance mutations in patients who achieved viral re-suppression without regimen switch: a retrospective study
Authors: Onwuamah Chika K. , Okpokwu Jonathan , Audu Rosemary , Imade Godwin , Meloni Seema T. , Okwuraiwe Azuka , Chebu Philippe , Musa Adesola Z. , Chaplin Beth , Dalhatu Ibrahim , Agbaji Oche , Samuels Jay , Ezechi Oliver , Ahmed Mukhtar , Odaibo Georgina , Olaleye David O. , Okonkwo Prosper , Salako Babatunde Lawal , Raizes Elliot , Yang Chunfu , Kanki Phyllis J. , Idigbe Emmanuel O.
Published: January 2020

Background

We identified a HIV-positive cohort in virologic failure (VF) who re-suppressed without drug switch. We characterized their drug resistance mutations (DRM) and adherence profiles to learn how to better manage HIV drug resistance.

A retrospective cohort study utilizing clinical data and stored samples. Patients received ART at three Nigerian treatment centres. Plasma samples stored when they were in VF were genotyped.

Result

Of 126 patients with samples available, 57 were successfully genotyped. From ART initiation, the proportion of patients with adherence ≥90% increased steadily from 54% at first high viral load (VL) to 67% at confirmed VF, and 81% at time of re-suppressed VL. Sixteen (28%) patients had at least one DRM. Forty-six (81%) patients had full susceptibility to the three drugs in their first-line (1 L) regimen. Thirteen (23%) were resistant to at least one antiretroviral drug but three were resistant to drugs not used in Nigeria. Ten patients had resistance to their 1 L drug(s) and six were fully susceptible to the three drugs in the recommended second-line regimen.

Conclusion

This cohort had little drug resistance mutations. We conclude that if adherence is not assured, patients could exhibit virologic failure without having developed mutations associated with drug resistance.
Differential expression of IDA (INFLORESCENCE DEFICIENT IN ABSCISSION)-like genes in Nicotiana benthamiana during corolla abscission, stem growth and water stress
Authors: Ventimilla Daniel , Domingo Concha , González-Ibeas Daniel , Talon Manuel , Tadeo Francisco R.
Published: January 2020

Background

IDA (INFLORESCENCE DEFICIENT IN ABSCISSION)-like signaling peptides and the associated HAE (HAESA)-like family of receptor kinases were originally reported in the model plantArabidopsis thaliana(Arabidopsis) to be deeply involved in the regulation of abscission. Actually, IDA peptides, as cell-to-cell communication elements, appear to be implicated in many developmental processes that rely on cell separation events, and even in the responses to abiotic stresses. However, the knowledge related to the molecular machinery regulating abscission in economically important crops is scarce. In this work, we determined the conservation and phylogeny of theIDA-like andHAE-like gene families in relevant species of the Solanaceae family and analyzed the expression of these genes in the allopolyploidNicotiana benthamiana,in order to identify members involved in abscission, stem growth and in the response to drought conditions.

Results

The phylogenetic relationships among theIDA-like members of the Solanaceae studied, grouped the two pairs of NbenIDA1 and NbenIDA2 protein homeologs with the Arabidopsis prepropeptides related to abscission. Analysis of promoter regions searching for regulatory elements showed that these two pairs of homeologs contained both hormonal and drought response elements, althoughNbenIDA2Alacked the hormonal regulatory elements. Expression analyses showed that the pair ofNbenIDA1homeologs were upregulated during corolla abscission.NbenIDA1andNbenIDA2pairs showed tissue differential expression under water stress conditions, sinceNbenIDA1homeologs were highly expressed in stressed leaves whileNbenIDA2homeologs, especiallyNbenIDA2B, were highly expressed in stressed roots. In non-stressed active growing plants, nodes and internodes were the tissues with the highest expression levels of all members of theIDA-like family and their putativeHAE-like receptors.

Conclusion

Our results suggest that the pair ofNbenIDA1homeologs are involved in the natural process of corolla abscission while both pairs ofNbenIDA1andNbenIDA2homeologs are implicated in the response to water stress. The data also suggest that IDA peptides may be important during stem growth and development. These results provide additional evidence that the functional module formed by IDA peptides and its receptor kinases, as defined in Arabidopsis, may also be conserved in Solanaceae.
Anesthetic management of a patient with a continuous-flow left ventricular assist device for video-assisted thoracoscopic surgery: a case report
Authors: Iwata Shihoko , Yokokawa Sumire , Sato Mihoshi , Ozaki Makoto
Published: January 2020

Background

As patients with left ventricular assist device (LVAD) have long expected survival, the incidence of noncardiac surgery in this patient population is increasing. Here, we present the anesthetic management of a patient with a continuous-flow LVAD who underwent video-assisted thoracic surgery (VATS).

Case presentation

A 37-year-old man with LVAD was scheduled to undergo VATS because of repeated spontaneous pneumothorax. Generally, patients with these devices have marginal right heart function; therefore, it is important to avoid factors that worsen pulmonary vascular resistance (PVR). However, VATS requires one-lung ventilation (OLV) and it tends to cause increase in PVR, leading to right heart failure.

In the present case, when the patient was set in a lateral decubitus position and progressive hypoxia was observed during OLV, transesophageal echocardiography demonstrated a dilated right ventricle and a temporally flattened interventricular septum, and the central venous pressure increased to approximately 20 mmHg. Because we anticipated deterioration of right heart function, dobutamine and milrinone were administered and/or respirator settings were changed to decrease PVR for maintaining LVAD performance. Finally, resection of a bulla was completed, and the patient was discharged in stable condition on postoperative day 37.

Conclusions

The anesthetic management of a patient with LVAD during VATS is challenging because the possible hemodynamic changes induced by hypoxia associated with OLV affect LVAD performance and right heart function. In our experience, VATS that requires OLV will be well tolerated in a patient with LVAD with preserved right heart function, and a multidisciplinary approach to maintain right heart function will be needed.
The prognostic role of platelet-to-lymphocyte ratio on overall survival in gastric cancer: a systematic review and meta-analysis
Authors: Cao Weijuan , Yao Xiaomin , Cen Danwei , Zhi Yajun , Zhu Ningwei , Xu Liyong
Published: January 2020

Background

This study aimed to summarize the previously published literature on the role of platelet-to-lymphocyte ratio (PLR) on overall survival (OS) in patients with gastric cancer.

Methods

We systematically searched PubMed, EmBase, and the Cochrane library to identify eligible studies to review. Pooled hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated using the random-effects model. Sensitivity and subgroup analyses were performed, and publication bias was assessed.

Results

A total of 28 studies comprising 15,617 patients with gastric cancer were included in this meta-analysis. The pooled results indicated that elevated PLR was associated with poor OS (HR: 1.37; 95% CI: 1.24–1.51; P < 0.001). A significant publication bias was observed (Egger test, P = 0.036; Begg test, P = 0.017). After adjusting for publication bias using the trim and fill method, an adjusted pooled HR of 1.19 (95% CI: 1.08–1.33; P = 0.001) was observed. Subgroup analyses indicated an elevated PLR in retrospective studies. Studies conducted in Turkey, the UK, the USA, and Costa Rica; studies with a sample size of < 1000, with < 70% male patients, and with patients treated with chemotherapy; studies with PLR cutoff value of ≥200; and studies with lower quality as determined by the Newcastle-Ottawa Scale all showed greater harmful effects on OS than their corresponding subsets (P < 0.05).

Conclusions

An elevated PLR was associated with poor OS in patients with gastric cancer. These results might differ between studies due to differences in design, country of origin, sample size, sex proportion, treatment strategy, PLR cutoff value, and study quality.
Analysis of the relationship between MIR155HG variants and gastric Cancer susceptibility
Authors: Zou Wenjing , Li Xu , Li Cheng , Liu Dan , Lv Yanyan , Yang Ying , Ye Nan , Guo Dan , He Shuixiang
Published: January 2020

Background

Gastric cancer is one of the most common cancers in the world and a major cause of cancer-related death. This study aims to determine whether genetic variations in MIR155HG could be associated with gastric cancer risk.

Materials & methods

A total of 506 gastric cancer patients and 500 healthy controls were enrolled in this study. Genotypes were examined with the MassARRAY platform and data management and analysis were conducted with the Typer Software. Odds ratios (OR) and 95% confidence intervals (CIs) were calculated with logistic regression adjusting for age and gender to evaluate the associations between SNPs with gastric cancer in genetic model analysis.

Results

The “CC” genotype of rs4143370 decreased the risk of gastric cancer in genotype model (p = 0.020) and recessive model (p = 0.018). Inversely, the “CC” genotype of rs1893650 increased the risk of gastric cancer in genotype model (p = 0.023) and recessive model (p = 0.014). Stratified analysis showed that rs11911469 was associated with an increased risk of gastric cancer only among the male group in the dominant model (p = 0.039) and additive model (p = 0.030). The haplotype analysis showed a strong linkage disequilibrium among these six SNPs (rs4143370, rs77699734, rs11911469, rs1893650, rs34904192 and rs928883).

Conclusion

This study confirmed the relationship between SNPs of MIR155HG and the gastric cancer risk among the Chinese Han population. Our data may provide a new perspective to understand the aetiology of gastric cancer.
High-normal PaCO2 values might be associated with worse outcome in patients with subarachnoid hemorrhage – a retrospective cohort study
Authors: Reiff Tilman , Barthel Oliver , Schönenberger Silvia , Mundiyanapurath Sibu
Published: January 2020

Background

While both hypercapnia and hypocapnia are harmful in patients with subarachnoid hemorrhage (SAH), it is unknown whether high-normal PaCO2 values are better than low-normal values. We hypothesized that high-normal PaCO2 values have more detrimental than beneficial effects on outcome.

Methods

Consecutive patients with aneurysmal subarachnoid hemorrhage (aSAH) requiring mechanical ventilation treated in a tertiary care university hospital were retrospectively analyzed regarding the influence of PaCO2 on favorable outcome, defined as modified Rankin scale score < 3 at discharge. Primary endpoint was the difference in the proportion of PaCO2 values above 40 mmHg in relation to all measured PaCO2 values between patients with favorable and unfavorable outcome.

Results

150 patients were included. Median age was 57 years (p25:50, p75:64), median Hunt-Hess score was 4 (p25:3, p75:5). PaCO2 values were mainly within normal range (median 39.0, p25:37.5, p75:41.4). Patients with favorable outcome had a lower proportion of high-normal PaCO2 values above 40 mmHg compared to patients with unfavorable outcome (0.21 (p25:0.13, p75:0.50) vs. 0.4 (p25:0.29, p75:0.59)) resulting in a lower chance for favorable outcome (OR 0.04, 95% CI 0.00–0.55, p = 0.017). In multivariable analysis adjusted for Hunt-Hess score, pneumonia and length of stay, elevated PaCO2 remained an independent predictor of outcome (OR 0.05, 95% CI 0.00–0.81, p = 0.035).

Conclusions

A higher proportion of PaCO2 values above 40 mmHg was an independent predictor of outcome in patients with aSAH in our study. The results need to be confirmed in a prospective trial.
Nomogram for prediction of gestational diabetes mellitus in urban, Chinese, pregnant women
Authors: Guo Fei , Yang Shuai , Zhang Yong , Yang Xi , Zhang Chen , Fan Jianxia
Published: January 2020

Background

This study sought to develop and validate a nomogram for prediction of gestational diabetes mellitus (GDM) in an urban, Chinese, antenatal population.

Methods

Age, pre-pregnancy body mass index (BMI), fasting plasma glucose (FPG) in the first trimester and diabetes in first degree relatives were incorporated as validated risk factors. A prediction model (nomogram) for GDM was developed using multiple logistic regression analysis, from a retrospective study conducted on 3956 women who underwent their first antenatal visit during 2015 in Shanghai. Performance of the nomogram was assessed through discrimination and calibration. We refined the predicting model with t-distributed stochastic neighbor embedding (t-SNE) to distinguish GDM from non-GDM. The results were validated using bootstrap resampling and a prospective cohort of 6572 women during 2016 at the same institution.

Results

Advanced age, pre-pregnancy BMI, high first-trimester, fasting, plasma glucose, and, a family history of diabetes were positively correlated with the development of GDM. This model had an area under the receiver operating characteristic (ROC) curve of 0.69 [95% CI:0.67–0.72, p < 0.0001]. The calibration curve for probability of GDM showed good consistency between nomogram prediction and actual observation. In the validation cohort, the ROC curve was 0.70 [95% CI: 0.68–0.72, p < 0.0001] and the calibration plot was well calibrated. In exploratory and validation cohorts, the distinct regions of GDM and non-GDM were distinctly separated in the t-SNE, generating transitional boundaries in the image by color difference. Decision curve analysis showed that the model had a positive net benefit at threshold between 0.05 and 0.78.

Conclusions

This study demonstrates the ability of our model to predict the development of GDM in women, during early stage of pregnancy.
Childbirth care in Egypt: a repeat cross-sectional analysis using Demographic and Health Surveys between 1995 and 2014 examining use of care, provider mix and immediate postpartum care content
Authors: Pugliese-Garcia Miguel , Radovich Emma , Campbell Oona M. R. , Hassanein Nevine , Khalil Karima , Benova Lenka
Published: January 2020

Background

Egypt has achieved important reductions in maternal and neonatal mortality and experienced increases in the proportion of births attended by skilled professionals. However, substandard care has been highlighted as one of the avoidable causes behind persisting maternal deaths. This paper describes changes over time in the use of childbirth care in Egypt, focusing on location and sector of provision (public versus private) and the content of immediate postpartum care.

Methods

We used five Demographic and Health Surveys conducted in Egypt between 1995 and 2014 to explore national and regional trends in childbirth care. To assess content of care in 2014, we calculated the caesarean section rate and the percentage of women delivering in a facility who reported receiving four components of immediate postpartum care for themselves and their newborn.

Results

Between 1995 and 2014, the percentage of women delivering in health facilities increased from 35 to 87% and women delivering with a skilled birth attendant from 49 to 92%. The percentage of women delivering in a private facility nearly quadrupled from 16 to 63%. In 2010–2014, fewer than 2% of women delivering in public or private facilities received all four immediate postpartum care components measured.

Conclusions

Egypt achieved large increases in the percentage of women delivering in facilities and with skilled birth attendants. However, most women and newborns did not receive essential elements of high quality immediate postpartum care. The large shift to private facilities may highlight failures of public providers to meet women’s expectations. Additionally, the content (quality) of childbirth care needs to improve in both sectors. Immediate action is required to understand and address the drivers of poor quality, including insufficient resources, perverse incentives, poor compliance and enforcement of existing standards, and providers’ behaviours moving between private and public sectors. Otherwise, Egypt risks undermining the benefits of high coverage because of substandard quality childbirth care.
Identification of dissociation factors in pancreatic Cancer using a mass spectrometry-based proteomic approach
Authors: Liu Peng , Kong Lingming , Liang Keke , Wu Yunhao , Jin Haoyi , Song Bing , Tan Xiaodong
Published: January 2020

Backgroud

Pancreatic cancer is a highly malignant tumor of the digestive system. This secretome of pancreatic cancer is key to its progression and metastasis. But different methods of protein extraction affect the final results. In other words, the real secretion of proteins in cancer cells has been changed. Based on mass spectrometry, we analyze the secretome from the serum-containing and serum-free medium, using different protein pretreatment methods. This study aims to identify dissociation factors in pancreatic cancer.

Methods

In this study, pancreatic cancer cells were cultured in serum-containing or serum-free medium, and the corresponding supernatants were extracted as samples. Subsequently, the above samples were separated by size exclusion chromatography (SEC), and peptide segments were identified by LC-MS/MS. The final results were identified via the hamster secreted protein database and a public database.

Results

Although the number of identified proteins in the serum-free medium group was high, the real secretion of proteins in pancreatic cancer cells was changed. There were six significant secreted proteins in the serum-containing medium group. Survival analysis via the TCGA database suggested that patients with higher expression levels of YWHAG showed a worse overall survival rate than those with lower YWHAG expression.

Conclusions

Our study demonstrated the results in the serum-containing medium group were more similar to the real secretome of pancreatic cancer cells. YWHAG could be used as a prognostic indicator for pancreatic cancer.
Space-time clustering of childhood leukemia in Colombia: a nationwide study
Authors: Rodriguez-Villamizar Laura Andrea , Rojas Díaz Marcela Pilar , Acuña Merchán Lizbeth Alexandra , Moreno-Corzo Feisar Enrique , Ramírez-Barbosa Paula
Published: January 2020

Background

Leukemia is the most common cancer in childhood. The estimated incidence rate of childhood leukemia in Colombia is one of the highest in America and little is known about its spatial distribution.

Purpose

To explore the presence of space-time clustering of childhood leukemia in Colombia.

Methods

We included children less than 15 years of age with confirmed diagnosis of acute leukemia reported to the national surveillance system for cancer between 2009 and 2017. Kulldorff’s spatio-temporal scan statistics were used with municipality and year of diagnosis as units for spatial and temporal analysis.

Results

There were 3846 cases of childhood leukemia between 2009 and 2017 with a specific mean incidence rate of 33 cases per million person-years in children aged 0–14 years. We identified five spatial clusters of childhood leukemia in different regions of the country and specific time clustering during the study period.

Conclusion

Childhood leukemia seems to cluster in space and time in some regions of Colombia suggesting a common etiologic factor or conditions to be studied.
Pathological complete response due to a prolonged time interval between preoperative chemoradiation and surgery in locally advanced rectal cancer: analysis from the German StuDoQ|Rectalcarcinoma registry
Authors: Lichthardt Sven , Wagner Johanna , Löb Stefan , Matthes Niels , Kastner Caroline , Anger Friedrich , Germer Christoph-Thomas , Wiegering Armin
Published: January 2020

Background

Preoperative chemoradiotherapy is the recommended standard of care for patients with local advanced rectal cancer. However, it remains unclear, whether a prolonged time interval to surgery results in an increased perioperative morbidity, reduced TME quality or better pathological response. Aim of this study was to determine the time interval for best pathological response and perioperative outcome compared to current recommended interval of 6 to 8 weeks.

Methods

This is a retrospective analysis of the German StuDoQ|Rectalcarcinoma registry. Patients were grouped for the time intervals of “less than 6 weeks”, “6 to 8 weeks”, “8 to 10 weeks” and “more than 10 weeks”. Primary endpoint was pathological response, secondary endpoint TME quality and complications according to Clavien-Dindo classification.

Results

Due to our inclusion criteria (preoperative chemoradiation, surgery in curative intention, M0), 1.809 of 9.560 patients were suitable for analysis. We observed a trend for increased rates of pathological complete response (pCR: ypT0ypN0) and pathological good response (pGR: ypT0-1ypN0) for groups with a prolonged time interval which was not significant. Ultimately, it led to a steady state of pCR (16.5%) and pGR (22.6%) in “8 to 10” and “more than 10” weeks. We were not able to observe any differences between the subgroups in perioperative morbidity, proportion of rectal extirpation (for cancer of the lower third) or difference in TME quality.

Conclusion

A prolonged time interval between neoadjuvant chemoradiation can be performed, as the rate of pCR seems to be increased without influencing perioperative morbidity.
Widely metastatic glioblastoma with BRCA1 and ARID1A mutations: a case report
Authors: Umphlett Melissa , Shea Stephanie , Tome-Garcia Jessica , Zhang Yizhou , Hormigo Adilia , Fowkes Mary , Tsankova Nadejda M. , Yong Raymund L.
Published: January 2020

Background

Glioblastoma (GBM) is a highly malignant brain neoplasm with poor survival. Despite its aggressive nature, metastatic spread of GBM is identified only rarely. While the molecular alterations associated with GBM and its subtypes are well-described, there remains a gap in understanding which alterations may predispose towards metastasis. In this report, we present a case of GBM with multi-organ metastases and discuss its genomic alterations.

Case presentation

A 74-year-old woman was diagnosed with left occipital glioblastoma (IDH-wildtype, MGMT-unmethylated), for which she underwent resection, standard chemoradiation, and then stereotactic radiosurgery (SRS) for local recurrence. One month after SRS, work-up for a pathologic hip fracture revealed a left breast mass, lytic lesions involving pelvic bones, and multiple pulmonary and hepatic lesions. Biopsies of the breast and bone lesions both demonstrated metastatic IDH-wildtype GBM. For worsening neurologic symptoms, the patient underwent debulking of a large right temporal lobe recurrence and expired shortly thereafter. Autopsy confirmed metastatic GBM in multiple systemic sites, including bilateral lungs, heart, liver, thyroid, left breast, small bowel, omentum, peritoneal surfaces, visceral surfaces, left pelvic bone, and hilar lymph nodes. Targeted sequencing was performed on tissue samples obtained pre- and postmortem, as well as on cell cultures and an orthotopic mouse xenograft derived from premortem surgical specimens. A BRCA1 mutation (p.I571T) was the only variant found in common among the primary, recurrence, and metastatic specimens, suggesting its likely status as an early driver mutation. Multiple subclonal ARID1A mutations, which promote genomic instability through impairment of DNA mismatch repair, were identified only in the recurrence. Mutational spectrum analysis demonstrated a high percentage of C:G to T:A transitions in the post-treatment samples but not in the primary tumor.

Conclusion

This case report examines a rare case of widely metastatic IDH-wildtype GBM with a clonal somatic mutation in BRCA1. Post-treatment recurrent tumor in the brain and in multiple systemic organs exhibited evidence of acquired DNA mismatch repair deficiency, which may be explained by functional loss of ARID1A. We identify a potential role for immune checkpoint and PARP inhibitors in the treatment of metastatic GBM.
Factors associated with myopia in Korean children: Korea National Health and nutrition examination survey 2016–2017 (KNHANES VII)
Authors: Kim Hyuna , Seo Jin Seok , Yoo Woong-Sun , Kim Gyu-Nam , Kim Rock Bum , Chae Jae Eun , Chung Inyoung , Seo Seong-Wook , Kim Seong Jae
Published: January 2020

Background

To evaluate the prevalence and risk factors associated with myopia and high myopia in children in South Korea.

Methods

A total of 983 children 5–18 years of age who participated in the Korean National Health and Nutrition Examination Survey 2016–2017 (KNHANES VII), a nationwide population-based cross-sectional study, were evaluated. Myopia and high myopia were defined as a spherical equivalent (SE) ≤ − 0.5 diopters (D) and SE ≤ --6.0 D. The association between refractive errors and potential risk factors for myopia was analyzed.

Results

The prevalence of myopia and high myopia was 65.4 and 6.9%, respectively. Older age and parental myopia were significantly associated with both myopia and high myopia, while higher body mass index (BMI) was associated with high myopia only. Although the proportion of subjects who spent more time on near work activities (≥4 h/day) was sequentially increased with increased refractive error, this tendency was not statistically significant by multivariable logistic regression.

Conclusions

Korean children had a high prevalence of myopia and high myopia. In this age group, the risk of myopia increased with aging and parental myopia. Higher BMI may be associated with high myopia.
Association between pre-and postnatal growth and longitudinal trends in serum uric acid levels and blood pressure in children aged 3 to 7 years
Authors: Park Bomi , Park Bohyun , Lee Hye Ah , Lee Seonhwa , Han Hyejin , Park Eunae , Cho Su Jin , Kim Hae Soon , Kim Young Ju , Ha Eun-Hee , Park Hyesook
Published: January 2020

Background

Uric acid has been identified as an important factor in the development of hypertension. If low birth weight (LBW) combined with catch-up growth (CUG) is associated with continuously elevated serum uric acid levels (SUA) level trajectories, LBW children who experience CUG may have an increased risk of hypertension later in life. Therefore, this cohort study analyzed longitudinal trends in SUA levels and changes in blood pressure in relation to pre- and postnatal growth over an extended follow-up period.

Methods

This prospective cohort study of 364 children from the Ewha Birth and Growth Cohort assessed the effects of pre- and postnatal growth status on SUA at 3, 5, and 7 years of age using a linear mixed model and the change in blood pressure over the 7-year follow-up period using a generalized linear model (analysis of covariance). CUG was defined as a change in weight (between birth and age 3) with a z-score > 0.67 for LBW subjects. The multivariate model considered sex, gestational age, and uric acid, height, and weight at 3 years of age.

Results

Children with LBW and CUG had higher SUA for the first 7 years of life compared to the normal birth weight group. This trend was particularly evident when comparing LBW children at term to children with normal birth weight. Within the group with LBW at term, children with greater CUG had higher SUA than children with normal birth weight, and this difference increased with age. Changes in the systolic blood pressure between 3 and 7 years of age were higher by 7.9 mmHg in children who experienced LBW and CUG compared with those who had a normal birth weight after adjusting for sex, gestational age, and height, weight, and uric acid at 3 years of age (p-value = 0.08).

Conclusions

The uric acid levels and changes in systolic blood pressure were consistently higher among LBW children who experienced CUG compared with NBW children for the first 7 years of life. LBW children who experienced greater weight gain from birth to age 3 had even higher uric acid levels compared with NBW children.
Tonsillar hypertrophy and prolapse in a child – is epiglottitis a predisposing factor for sudden unexpected death?
Authors: Nieuwoudt I. , Goussard P. , Verster J. , Dempers J.
Published: January 2020

Background

Tonsillitis, with associated tonsillar hypertrophy, is a common disease of childhood, yet it is rarely associated with sudden death due to airway obstruction. Lethal complications involving the inflamed tonsils include haemorrhage, retropharyngeal abscess and disseminated sepsis.

Case presentation

We report on a case of sudden and unexpected death in an 8-year-old female who was diagnosed with and treated for tonsillitis. The child was diagnosed with acute tonsillitis 2 days prior to her collapse and was placed on a course of oral antibiotics. There were no signs of upper or lower airway obstruction. She was found to be unresponsive by her caregiver and gasping for air in her bed in the early hours of the second morning after the start of treatment. Autopsy showed massive and symmetrically enlarged palatine tonsils. The tonsils filled the pharynx almost completely. The epiglottis and laryngeal mucosa at the base of the epiglottis in the vicinity of the aryepiglottic membrane and the superior aspect of the larynx displayed red-purple discoloration, with mucosal swelling and edema. Histological examination of the palatine tonsils revealed prominent lymphoid hyperplasia, but no evidence of acute inflammation.

Conclusion

Palatine tonsillar hypertrophy in infants is a common feature of both viral and bacterial tonsillitis and has been postulated as a possible risk factor for Sudden and Unexplained Death in Infancy (SUDI), based on the theory of mechanical impediment of breathing by narrowing of the upper airway. The rounded shape of the tonsils may facilitate some airflow past the enlarged structures and hence protect against asphyxial death when the enlarged tonsils fill the laryngo-pharynx. Epiglottal and proximal laryngeal edema may play a more significant role in asphyxial unexpected deaths in cases of tonsillitis with tonsillar hypertrophy than previously suspected. This focusses the importance of careful examination of the epiglottis and proximal laryngeal mucosa, as part of a thorough examination of the laryngo-pharynx in cases of sudden death associated with tonsillar hypertrophy.
Trends in burden and risk factors associated with childhood stunting in Rwanda from 2000 to 2015: policy and program implications
Authors: Binagwaho Agnes , Rukundo Alphonse , Powers Samuel , Donahoe Kateri B. , Agbonyitor Mawuena , Ngabo Fidel , Karema Corine , Scott Kirstin Woody , Smith Fawzi Mary C.
Published: January 2020

Background

Rwanda has made substantial economic progress over the past two decades. However, evidence suggests that malnutrition among children remains high in spite of this progress. This study aims to examine trends and potential risk factors associated with childhood stunting from 2000 to 2015 in Rwanda.

Methods

Data for this study come from the 2000 to 2015 Rwanda’s Demographic and Health Surveys (DHS), a cross-sectional, population-based survey that is conducted every 5 years. Following prior work, we define stunting based on age and weight as reported in the DHS. We assess the overall prevalence of stunting among children under the age of 5 in Rwanda and then conduct bivariate analyses across a range of policy-relevant demographic, socioeconomic, and health variables. We then incorporate key variables in a multivariable analysis to identify those factors that are independently associated with stunting.

Results

The prevalence of stunting among children under the age of 5 in Rwanda declined from 2000 (47.4%) to 2015 (38.3%), though rates were relatively stagnant between 2000 and 2010. Factors associated with higher rates of stunting included living in the lowest wealth quintile, having a mother with limited education, having a mother that smoked, being of the male sex, and being of low-birth weight.

Conclusions

Though overall stunting rates have improved nationally, these gains have been uneven. Furthering ongoing national policies to address these disparities while also working to reduce the overall risk of malnutrition will be necessary for Rwanda to reach its overall economic and health equity goals.
Evaluation of smartphone APP-based case-management services among antiretroviral treatment-naïve HIV-positive men who have sex with men: a randomized controlled trial protocol
Authors: Fan Xiaoyan , She Rui , Liu Cong , Zhong Haidan , Lau Joseph T. F. , Hao Chun , Li Jinghua , Hao Yuantao , Li Linghua , Gu Jing
Published: January 2020

Background

Men who have sex with men (MSM) are disproportionally affected by HIV in China. ‘Treatment as Prevention’ is a promising strategy for HIV prevention but requires adequate adherence. Mobile health (mHealth) may be an acceptable and feasible approach for service delivery, but there is little evidence supporting mHealth intervention for improving antiretroviral treatment adherence among HIV-infected MSM in low- and middle-income countries, including China. This study will aim to develop a smartphone application-based case-management service and compare its efficacy to standard care with regards to adherence, CD4, HIV viral load and psychosocial outcomes among MSM patients in Guangzhou, China.

Methods

A non-blinded 1:1 parallel-group randomised controlled trial will be conducted in Guangzhou Eighth People’s Hospital, with 300 MSM enrolled in each arm. Eligible MSM who are newly initiating ART will be randomly assigned to an intervention group (standard-of-care case management plus mHealth intervention) or a control group (standard-of-care case management). The development of the mHealth intervention will be based on the information–motivation–behavioural skills theory of ART adherence, and comprise four components: educational articles, one-to-one online communication with case managers, support-service information and hospital-visit reminders. Outcome measures will be collected at baseline and at months 1, 3, 6, and 12. The primary outcomes will be ART adherence and CD4 count at month 6. Secondary outcomes include HIV RNA, sexual behaviours, mental health status, illness perceptions, and quality of life. χ2 test and t-test will be used for between-group comparisons. Intervention effects will be evaluated using General estimating equation performed by SAS 9.0, on the principle of intention-to-treat. Structural equation modelling will be used to test potential mechanisms of intervention effect.

Discussion

This study is the first to explore the efficacy of mHealth intervention in the case management services targeted at HIV-infected MSM in low-and middle-income countries. Once proven effective, the innovative mHealth service could be integrated into the routine case management of PLWH. as well as be tailored to the patient management service for other chronic conditions.

Trial registration

ClinicalTrial.gov: NCT03860116; Registered on 1 March 2019.
Effects of social health insurance on access and utilization of obstetric health services: results from HIV+ pregnant women in Kenya
Authors: Were Lawrence P. O. , Were Edwin , Wamai Richard , Hogan Joseph , Galarraga Omar
Published: January 2020

Background

Reducing maternal morbidity and mortality remains a top global health agenda especially in high HIV/AIDS endemic locations where there is increased likelihood of mother to child transmission (MTCT) of HIV. Social health insurance (SHI) has emerged as a viable option to improve population access to health services, while improving outcomes for disenfranchised populations, particularly HIV+ women. However, the effect of SHI on healthcare access for HIV+ persons in limited resource settings is yet to undergo rigorous empirical evaluation. This study analyzes the effect of health insurance on obstetric healthcare access including institutional delivery and skilled birth attendants for HIV+ pregnant women in Kenya.

Methods

We analyzed cross-sectional data from HIV+ pregnant women (ages 15–49 years) who had a delivery (full term, preterm, miscarriage) between 2008 and 2013 with their insurance enrollment status available in the electronic medical records database of a HIV healthcare system in Kenya. We estimated linear and logistic regression models and implemented matching and inverse probability weighting (IPW) to improve balance on observable individual characteristics. Additionally, we estimated heterogeneous effects stratified by HIV disease severity (CD4 < 350 as “Severe HIV disease”, and CD4 > 350 otherwise).

Findings

Health Insurance enrollment is associated with improved obstetric health services utilization among HIV+ pregnant women in Kenya. Specifically, HIV+ pregnant women covered by NHIF have greater access to institutional delivery (12.5-percentage points difference) and skilled birth attendants (19-percentage points difference) compared to uninsured. Notably, the effect of NHIF on obstetric health service use is much greater for those who are sicker (CD4 < 350) – 20 percentage points difference.

Conclusion

This study confirms conceptual and practical considerations around health insurance and healthcare access for HIV+ persons. Further, it helps to inform relevant policy development for health insurance and HIV financing and delivery in Kenya and in similar countries in sub-Saharan Africa in the universal health coverage (UHC) era.
School suspension predicts trichomoniasis five years later in a matched sample
Authors: Rosenbaum Janet E.
Published: January 2020

Background

Young adults who were suspended from school during adolescence are more likely than matched non-suspended youth to be arrested, on probation, or not graduate from high school, which are STI risk factors. This study evaluates whether suspension is a marker for STI risk among young adults who avoid subsequent negative effects.

Methods

This study evaluated whether suspension predicts a positive test for chlamydia, gonorrhea, or trichomoniasis in a urine sample using matched sampling in the National Longitudinal Study of Adolescent and Adult Health (Add Health), and evaluated potential mediators between suspension and STI status using causal mediation analysis. We used Mahalanobis and exact matched sampling within propensity score calipers to compare 381 youth suspended for the first time in a 1-year period with 980 non-suspended youth. The suspended and non-suspended youth were similar on 67 pre-suspension variables. We evaluated STI outcomes 5 years after suspension.

Results

Before matching, suspended youth were more likely to test positive for trichomoniasis and gonorrhea, but not chlamydia, than non-suspended youth. Suspended youth were more likely to test positive for trichomoniasis 5 years after suspension than matched non-suspended youth (OR = 2.87 (1.40, 5.99)). Below-median household income before suspension explained 9% of the suspension-trichomoniasis association (p = 0.02), but criminal justice involvement and educational attainment were not statistically significantly mediators.

Conclusions

School suspension is a marker for STI risk. Punishing adolescents for initial deviance may cause them to associate with riskier sexual networks even if they graduate high school and avoid criminal justice system involvement. Suspension may compound disadvantages for youth from below-median-income families, who have fewer resources for recovering from setbacks.