bluuebunny/crossref_metadata_2025 huggingface dataset:
Development and evaluation of an integrated diabetes-periodontitis nutrition and health education module
Authors: Jamil Nor Aini , Chau Shin Hwa , Abdul Razak Nabihah Iman , Shamsul Kamar Iffa Izzwani , Mohd-Said Shahida , Rani Haslina , Sameeha Mohd Jamil
Published: May 2021

Background

A good understanding of the bi-directional relationship between diabetes and periodontitis is essential to ensure the successful management of both diseases. This study aimed to develop and evaluate an integrated diabetes-periodontitis nutrition and health education module.

Methods

The module was developed as an iterative and review process by five experts in nutrition and dietetics, periodontics, and dental public health. It consisted of three phases: (i) needs assessment on module contents and characteristics, (ii) module development and (iii) module evaluation by experts. Twelve healthcare professionals aged between 30 and 53 years (average 13.5 years of working experience) validated the module contents and its comprehensibility using the Patient Education Materials Assessment Tool for printable materials (PEMAT-P) and audio-visual materials (PEMAT-A/V). Scores of 0 (disagree) or 1 (agree) were given for sets of understandability and actionability statements and presented as a total percentage.

Results

Seventeen infographic-flip charts and 13 short-videos were developed in the Malay language and grouped into four topics: (i) Introduction to Diabetes and Periodontitis, (ii) Diabetes and Periodontitis Care, (iii) Lifestyle Modification, and (iv) Myths and Facts. Flip charts were rated between 76-100% for understandability and 80–100% for actionability, while videos rated between 90-100% for understandability and 100% for actionability, respectively.

Conclusion

Overall, the newly developed module ranked high median scores for understandability and actionability. This finding reflects positive acceptance of the integrated module among the various healthcare professionals involved in managing patients with diabetes and periodontitis.
Single-cell genomics unveils a canonical origin of the diverse mitochondrial genomes of euglenozoans
Authors: Záhonová Kristína , Lax Gordon , Sinha Savar D. , Leonard Guy , Richards Thomas A. , Lukeš Julius , Wideman Jeremy G.
Published: May 2021

Background

The supergroup Euglenozoa unites heterotrophic flagellates from three major clades, kinetoplastids, diplonemids, and euglenids, each of which exhibits extremely divergent mitochondrial characteristics. Mitochondrial genomes (mtDNAs) of euglenids comprise multiple linear chromosomes carrying single genes, whereas mitochondrial chromosomes are circular non-catenated in diplonemids, but circular and catenated in kinetoplastids. In diplonemids and kinetoplastids, mitochondrial mRNAs require extensive and diverse editing and/or trans-splicing to produce mature transcripts. All known euglenozoan mtDNAs exhibit extremely short mitochondrial small (rns) and large (rnl) subunit rRNA genes, and absence of tRNA genes. How these features evolved from an ancestral bacteria-like circular mitochondrial genome remains unanswered.

Results

We sequenced and assembled 20 euglenozoan single-cell amplified genomes (SAGs). In our phylogenetic and phylogenomic analyses, three SAGs were placed within kinetoplastids, 14 within diplonemids, one (EU2) within euglenids, and two SAGs with nearly identical small subunit rRNA gene (18S) sequences (EU17/18) branched as either a basal lineage of euglenids, or as a sister to all euglenozoans. Near-complete mitochondrial genomes were identified in EU2 and EU17/18. Surprisingly, both EU2 and EU17/18 mitochondrial contigs contained multiple genes and one tRNA gene. Furthermore, EU17/18 mtDNA possessed several features unique among euglenozoans including full-length rns and rnl genes, six mitoribosomal genes, and nad11, all likely on a single chromosome.

Conclusions

Our data strongly suggest that EU17/18 is an early-branching euglenozoan with numerous ancestral mitochondrial features. Collectively these data contribute to untangling the early evolution of euglenozoan mitochondria.
Characterization of the dynamics and variability of neuronal subtype responses during growth, degrowth, and regeneration of Nematostella vectensis
Authors: Havrilak Jamie A. , Al-Shaer Layla , Baban Noor , Akinci Nesli , Layden Michael J.
Published: May 2021

Background

The ability to regenerate body parts is a feature of metazoan organisms and the focus of intense research aiming to understand its basis. A number of mechanisms involved in regeneration, such as proliferation and tissue remodeling, affect whole tissues; however, little is known on how distinctively different constituent cell types respond to the dynamics of regenerating tissues. Preliminary studies suggest that a number of organisms alter neuronal numbers to scale with changes in body size. In some species with the ability of whole-body axis regeneration, it has additionally been observed that regenerates are smaller than their pre-amputated parent, but maintain the correct morphological proportionality, suggesting that scaling of tissue and neuronal numbers also occurs. However, the cell dynamics and responses of neuronal subtypes during nervous system regeneration, scaling, and whole-body axis regeneration are not well understood in any system. The cnidarian sea anemone Nematostella vectensis is capable of whole-body axis regeneration, with a number of observations suggesting the ability to alter its size in response to changes in feeding. We took advantage of Nematostella’s transparent and “simple” body plan and the NvLWamide-like mCherry fluorescent reporter transgenic line to probe the response of neuron populations to variations in body size in vivo in adult animals during body scaling and regeneration.

Results

We utilized the previously characterized NvLWamide-like::mCherry transgenic reporter line to determine the in vivo response of neuronal subtypes during growth, degrowth, and regeneration. Nematostella alters its size in response to caloric intake, and the nervous system responds by altering neuronal number to scale as the animal changes in size. Neuronal numbers in both the endodermal and ectodermal nerve nets decreased as animals shrunk, increased as they grew, and these changes were reversible. Whole-body axis regeneration resulted in regenerates that were smaller than their pre-amputated size, and the regenerated nerve nets were reduced in neuronal number. Different neuronal subtypes had distinct responses during regeneration, including consistent, not consistent, and conditional increases in number. Conditional responses were regulated, in part, by the size of the remnant fragment and the position of the amputation site. Regenerates and adults with reduced nerve nets displayed normal behaviors, indicating that the nerve net retains functionality as it scales.

Conclusion

These data suggest that the Nematostella nerve net is dynamic, capable of scaling with changes in body size, and that neuronal subtypes display differential regenerative responses, which we propose may be linked to the scale state of the regenerating animals.
Impact of COVID-19 lockdown on the incidence and mortality of acute exacerbations of chronic obstructive pulmonary disease: national interrupted time series analyses for Scotland and Wales
Authors:   on behalf of the EAVE II Collaborators, Alsallakh Mohammad A. , Sivakumaran Shanya , Kennedy Sharon , Vasileiou Eleftheria , Lyons Ronan A. , Robertson Chris , Sheikh Aziz , Davies Gwyneth A.
Published: May 2021

Background

The COVID-19 pandemic and ensuing national lockdowns have dramatically changed the healthcare landscape. The pandemic’s impact on people with chronic obstructive pulmonary disease (COPD) remains poorly understood. We hypothesised that the UK-wide lockdown restrictions were associated with reductions in severe COPD exacerbations. We provide the first national level analyses of the impact of the COVID-19 pandemic and first lockdown on severe COPD exacerbations resulting in emergency hospital admissions and/or leading to death as well as those recorded in primary care or emergency departments.

Methods

Using data from Public Health Scotland and the Secure Anonymised Information Linkage Databank in Wales, we accessed weekly counts of emergency hospital admissions and deaths due to COPD over the first 30 weeks of 2020 and compared these to the national averages over the preceding 5 years. For both Scotland and Wales, we undertook interrupted time-series analyses to model the impact of instigating lockdown on these outcomes. Using fixed-effect meta-analysis, we derived pooled estimates of the overall changes in trends across the two nations.

Results

Lockdown was associated with 48% pooled reduction in emergency admissions for COPD in both countries (incidence rate ratio, IRR 0.52, 95% CI 0.46 to 0.58), relative to the 5-year averages. There was no statistically significant change in deaths due to COPD (pooled IRR 1.08, 95% CI 0.87 to 1.33). In Wales, lockdown was associated with 39% reduction in primary care consultations for acute exacerbation of COPD (IRR 0.61, 95% CI 0.52 to 0.71) and 46% reduction in COPD-related emergency department attendances (IRR 0.54, 95% CI 0.36 to 0.81).

Conclusions

The UK-wide lockdown was associated with the most substantial reductions in COPD exacerbations ever seen across Scotland and Wales, with no corresponding increase in COPD deaths. This may have resulted from reduced transmission of respiratory infections, reduced exposure to outdoor air pollution and/or improved COPD self-management.
First case report of a NUP98-PMX1 rearrangement in de novo acute myeloid leukemia and literature review
Authors: Fu Weijia , Huang Aijie , Cheng Hui , Luo Yanrong , Gao Lei , Tang Gusheng , Yang Jianmin , Wang Jianmin , Ni Xiong
Published: May 2021

Background

The nucleoporin 98 (NUP98)-paired related homeobox 1 (PMX1) fusion gene, which results from t(1;11)(q23;p15), is rare in patients with acute myeloid leukemia (AML). Currently, only two cases of chronic myeloid leukemia in the accelerated phase or blast crisis and three cases of therapy-related AML have been reported. Here, we first report a patient with de novo AML carrying the NUP98-PMX1 fusion gene.

Case presentation

A 49-year-old man diagnosed with AML presented the karyotype 46,XY,t(1;11)(q23;p15)[20] in bone marrow (BM) cells. Fluorescence in situ hybridization analysis using dual-color break-apart probes showed the typical signal pattern. Reverse transcription-polymerase chain reaction (RT-PCR) analysis suggested the presence of the NUP98-PMX1 fusion transcript. The patient received idarubicin and cytarabine as induction chemotherapy. After 3 weeks, the BM aspirate showed complete remission, and the RT-PCR result for the NUP98-PMX1 fusion gene was negative. Subsequently, the patient received three cycles of high-dose Ara-c as consolidation chemotherapy, after which he underwent partially matched (human leukocyte antigen–DP locus mismatch) unrelated allogeneic hematopoietic stem cell transplantation (HSCT). The follow-up period ended on September 30, 2020 (6 months after HSCT), and the patient exhibited no recurrence or transplantation-related complications.

Conclusion

This is the first report of a patient with de novo AML carrying the NUP98-PMX1 fusion gene. The reported case may contribute to a more comprehensive profile of the NUP98-PMX1 rearrangement, but mechanistic studies are warranted to fully understand the role of this fusion gene in leukemia pathogenesis.
Label-free detection of uptake, accumulation, and translocation of diesel exhaust particles in ex vivo perfused human placenta
Authors: Bongaerts Eva , Aengenheister Leonie , Dugershaw Battuja B. , Manser Pius , Roeffaers Maarten B. J. , Ameloot Marcel , Nawrot Tim S. , Bové Hannelore , Buerki-Thurnherr Tina
Published: May 2021

Background

Pregnant women and developing fetuses comprise a particularly vulnerable population as multiple studies have shown associations between prenatal air pollution exposure and adverse pregnancy outcomes. However, the mechanisms underlying the observed developmental toxicity are mostly unknown, in particular, if pollution particles can cross the human placenta to reach the fetal circulation.

Results

Here, we investigated the accumulation and translocation of diesel exhaust particles (DEPs), as a model particle for combustion-derived pollution, in human perfused placentae using label-free detection by femtosecond pulsed laser illumination. The results do not reveal a significant particle transfer across term placentae within 6 h of perfusion. However, DEPs accumulate in placental tissue, especially in the syncytiotrophoblast layer that mediates a wealth of essential functions to support and maintain a successful pregnancy. Furthermore, DEPs are found in placental macrophages and fetal endothelial cells, showing that some particles can overcome the syncytiotrophoblasts to reach the fetal capillaries. Few particles are also observed inside fetal microvessels.

Conclusions

Overall, we show that DEPs accumulate in key cell types of the placental tissue and can cross the human placenta, although in limited amounts. These findings are crucial for risk assessment and protection of pregnant women and highlight the urgent need for further research on the direct and indirect placenta-mediated developmental toxicity of ambient particulates.
A dual electro-optical biosensor based on Chlamydomonas reinhardtii immobilised on paper-based nanomodified screen-printed electrodes for herbicide monitoring
Authors: Antonacci Amina , Attaallah Raouia , Arduini Fabiana , Amine Aziz , Giardi Maria Teresa , Scognamiglio Viviana
Published: May 2021

The indiscriminate use of herbicides in agriculture contributes to soil and water pollution, with important endangering consequences on the ecosystems. Among the available analytical systems, algal biosensors have demonstrated to be valid tools thanks to their high sensitivity, cost-effectiveness, and eco-design. Herein, we report the development of a dual electro-optical biosensor for herbicide monitoring, based on Chlamydomonas reinhardtii whole cells immobilised on paper-based screen-printed electrodes modified with carbon black nanomaterials. To this aim, a systematic study was performed for the selection and characterisation of a collection among 28 different genetic variants of the alga with difference response behaviour towards diverse herbicide classes. Thus, CC125 strain was exploited as case study for the study of the analytical parameters. The biosensor was tested in standard solutions and real samples, providing high sensitivity (detection limit in the pico/nanomolar), high repeatability (RSD of 5% with n = 100), long lasting working (10 h) and storage stability (3 weeks), any interference in the presence of heavy metals and insecticides, and low matrix effect in drinking water and moderate effect in surface one.
Alcohol use and its determinants among adults living with HIV/AIDS in Ethiopia: a systematic review and meta-analysis
Authors: Mekuriaw Birhanie , Belayneh Zelalem , Molla Alemayehu , Mehare Tsegaye
Published: May 2021

Background

Alcohol use is a common practice of almost all communities worldwide and it is more common among persons with HIV infection. Alcohol consumption among people with HIV/AIDS may result in poor treatment adherence, further immunity suppression and increase the risk of comorbid illness (diseases) which collectively diminish the anti-retroviral therapy responses. Although there are separate studies conducted regarding alcohol use among people with HIV/AIDS in Ethiopia, the finding results are highly variable and inconsistent. Therefore, conducting a systematic review and meta-analysis has a paramount importance to show the pooled prevalence of alcohol use and to identify its determinants among people with HIV/AIDS.

Methods

A systematic search of electronic databases of PubMed/Medline, Science Direct, Hinnari and Cochrane library was employed. Additionally, the grey literature was searched from Google and Google Scholar. Data were extracted using a standardized data extraction format prepared in Microsoft Excel . STATA-version 14 statistical software was used for analysis. Heterogeneity of primary studies was found as evaluated using the I2 test result. As a result, a random-effect meta-analysis model was used to estimate the pooled prevalence of alcohol use.

Results

A total of 22 primary studies which comprises 8,368 study participants were included in this systematic review and meta-analysis. The pooled prevalence of lifetime, current and hazardous alcohol use among HIV patients in Ethiopia were 36.42% [95% CI (19.96, 52.89)], 19.00% [95% CI (12.98, 25.01)] and 21.64% [95% CI (12.72, 30.55)], respectively. Khat chewing [OR = 3.53, (95% CI 1.31, 9.51)] and cigarette smoking [OR = 7.04, (95% CI 3.53, 14.04)] were found as statistically significant determinants of hazardous alcohol use among people with HIV infection.

Conclusions

The result of this review showed that alcohol drinking is highly practiced among people with HIV/AIDS in Ethiopia. The magnitude of alcohol use was highly variable based on the screening methods used to measure alcohol use. Comorbid substance use (khat and cigarette) increases the risk of alcohol consumption among HIV patients. This suggests a need for designing appropriate and culturally applicable intervention programs and policy responses.

Trial registration PROSPERO 2019, “CRD42019132524.”
Development and preliminary psychometric investigation of the German Satisfaction with Comprehensive Cancer Care (SCCC) Questionnaire
Authors: Esser Peter , Sautier Leon , Sarkar Susanne , Schilling Georgia , Bokemeyer Carsten , Koch Uwe , Friedrich Michael , Defossez Gautier , Mehnert-Theuerkauf Anja
Published: May 2021

Purpose

The assessment of patient satisfaction during treatment is essential to provide patient-centered high-quality cancer care. Nevertheless, no German instrument assesses patient satisfaction with comprehensive cancer care, which not only includes oncological treatment, but also interpersonal quality of care as well as psychosocial support services. Based on the French REPERES-60, we developed the German Patient Satisfaction with Comprehensive Cancer Care (SCCC) questionnaire.

Methods

The REPERES-60 was translated and the items were adapted to make it applicable to the German healthcare system and across different tumor entities. Scales of the resulting instrument were extracted via principal axis factoring (PAF). Subsequently, we investigated the reliability (Cronbach’s Alpha, CA), discriminatory power (corrected item-scale correlations) and convergent validity (pre-specified correlations of the SCCC with different outcomes).

Results

The SCCC consisted of 32 items which were subsequently tested among a sample of 333 patients across different tumor entities (response rate: 47%). Average age was 59 years (standard deviation: 14), 63% were male. PAF revealed four multi-item scales named Competence, Information, Access and Support accounting for 71% of the variance. Two single-items scales assess global satisfaction with medical and psychosocial care, respectively. CA across the multi-item scales ranged from .84 to .96. Discriminatory power was sufficiently high, with all r ≥ .5. Convergent validity was largely verified by negative associations of the four multi-item scales with depressive/anxious symptomatology (r ≥ − .18, p < .01) and fatigue/overall symptom burden (r ≥ − .14, p < .01).

Conclusion

We developed a tool to assess patient satisfaction with comprehensive cancer care in Germany. The SCCC showed satisfactory psychometric properties. Further studies are needed to verify these preliminary findings.
The emerging role of the KCTD proteins in cancer
Authors: Angrisani Annapaola , Di Fiore Annamaria , De Smaele Enrico , Moretti Marta
Published: May 2021

The human family ofPotassium (K+) Channel Tetramerization Domain(KCTD) proteins counts 25 members, and a significant number of them are still only partially characterized. While some of the KCTDs have been linked to neurological disorders or obesity, a growing tally of KCTDs are being associated with cancer hallmarks or involved in the modulation of specific oncogenic pathways. Indeed, the potential relevance of the variegate KCTD family in cancer warrants an updated picture of the current knowledge and highlights the need for further research on KCTD members as either putative therapeutic targets, or diagnostic/prognostic markers. Homology between family members, capability to participate in ubiquitination and degradation of different protein targets, ability to heterodimerize between members, role played in the main signalling pathways involved in development and cancer, are all factors that need to be considered in the search for new key players in tumorigenesis. In this review we summarize the recent published evidence on KCTD members’ involvement in cancer. Furthermore, by integrating this information with data extrapolated from public databases that suggest new potential associations with cancers, we hypothesize that the number of KCTD family members involved in tumorigenesis (either as positive or negative modulator) may be bigger than so far demonstrated.
Hanging by a thread: unusual nocturnal resting behaviour in a jumping spider
Authors: Rößler Daniela C. , De Agrò Massimo , Biundo Elia , Shamble Paul S.
Published: May 2021

Background

For diurnal animals that heavily rely on vision, a nocturnal resting strategy that offers protection when vision is compromised, is crucial. We found a population of a common European jumping spider (Evarcha arcuata) that rests at night by suspending themselves from a single silk thread attached overhead to the vegetation, a strategy categorically unlike typical retreat-based resting in this group.

Results

In a comprehensive study, we collected the first quantitative field and qualitative observation data of this surprising behaviour and provide a detailed description. We tested aspects of site fidelity and disturbance response in the field to assess potential functions of suspended resting. Spiders of both sexes and all developmental stages engage in this nocturnal resting strategy. Interestingly, individual spiders are equally able to build typical silk retreats and thus actively choose between different strategies inviting questions about what factors underlie this behavioural choice.

Conclusions

Our preliminary data hint at a potential sensory switch from visual sensing during the day to silk-borne vibration sensing at night when vision is compromised. The described behaviour potentially is an effective anti-predator strategy either by acting as an early alarm system via vibration sensing or by bringing the animal out of reach for nocturnal predators. We propose tractable hypotheses to test an adaptive function of suspended resting. Further studies will shed light on the sensory challenges that animals face during resting phases and should target the mechanisms and strategies by which such challenges are overcome.
The role of schools as an opportunity for transmission of local knowledge about useful Restinga plants: experiences in southeastern Brazil
Authors: van Luijk Nicky , Soldati Gustavo Taboada , da Fonseca-Kruel Viviane Stern
Published: May 2021

Background

The study of cultural transmission can help identify processes that influence knowledge systems dynamics and evolution, especially during childhood and youth, which are fundamental phases in acquiring survival skills. In this sense, we use the knowledge about useful restinga plants (Brazilian coastal vegetation) as an analytical model to describe, compare, and analyze cultural transmission during youth, while factoring in origin, in the Cabo Frio region, southeastern Brazil. We tested (1) whether transmission of knowledge is conservative, (2) whether immigration events define the transmission modes, (3) whether teaching is the most important social transmission cognitive process, and (4) which type of stimulus/context is most important for the knowledge transmission process.

Methods

Questionnaires and free listings were applied to 150 high school students aged between 15 and 20 to obtain information about socioeconomic characteristics, useful plant knowledge, and cultural transmission. We analyzed the distribution of knowledge according to the informant’s origin and evaluated the models, processes, and context with which this information was transmitted. The chi-square test was used to determine the association between origin, plant knowledge, and transmission as well as to reveal the most important models, modes, and processes during youth.

Results

Informants provided 299 plant citations ($$ \overline{x} $$

x
¯

= 1.75; s = 1.73) related to 37 species. The categories of the most cited uses were edible (93) and medicinal (32). Statistical results showed that origin did not influence knowledge distribution and transmission. In addition, although the most relevant mode was the conservative (vertical) one, the one-to-many diffuse mode (teacher) was highlighted. The new environmental context for immigrants did not influence transmission, the main transmission process was teaching, and the learning contexts were predominantly school-related.

Conclusion

Plant knowledge in youth was related to local edible and medicinal plants, indicating adaptive knowledge linked to material demands for survival. While the initial models for cultural transmission are family (vertical), during the development phase of juveniles, other actors become models (one-to-many). In addition, the nature of the information (survival demand) and age are more relevant to cultural transmission than the socio-environmental context.
Method for accurate multi-growth-stage estimation of fractional vegetation cover using unmanned aerial vehicle remote sensing
Authors: Yue Jibo , Guo Wei , Yang Guijun , Zhou Chengquan , Feng Haikuan , Qiao Hongbo
Published: May 2021

Background

Fractional vegetation cover (FVC) is an important parameter for evaluating crop-growth status. Optical remote-sensing techniques combined with the pixel dichotomy model (PDM) are widely used to estimate cropland FVC with medium to high spatial resolution on the ground. However, PDM-based FVC estimation is limited by effects stemming from the variation of crop canopy chlorophyll content (CCC). To overcome this difficulty, we propose herein a “fan-shaped method” (FSM) that uses a CCC spectral index (SI) and a vegetation SI to create a two-dimensional scatter map in which the three vertices represent high-CCC vegetation, low-CCC vegetation, and bare soil. The FVC at each pixel is determined based on the spatial location of the pixel in the two-dimensional scatter map, which mitigates the effects of CCC on the PDM. To evaluate the accuracy of FSM estimates of the FVC, we analyze the spectra obtained from (a) the PROSAIL model and (b) a spectrometer mounted on an unmanned aerial vehicle platform. Specifically, we use both the proposed FSM and traditional remote-sensing FVC-estimation methods (both linear and nonlinear regression and PDM) to estimate soybean FVC.

Results

Field soybean CCC measurements indicate that (a) the soybean CCC increases continuously from the flowering growth stage to the later-podding growth stage, and then decreases with increasing crop growth stages, (b) the coefficient of variation of soybean CCC is very large in later growth stages (31.58–35.77%) and over all growth stages (26.14%). FVC samples with low CCC are underestimated by the PDM. Linear and nonlinear regression underestimates (overestimates) FVC samples with low (high) CCC. The proposed FSM depends less on CCC and is thus a robust method that can be used for multi-stage FVC estimation of crops with strongly varying CCC.

Conclusions

Estimates and maps of FVC based on the later growth stages and on multiple growth stages should consider the variation of crop CCC. FSM can mitigates the effect of CCC by conducting a PDM at each CCC level. The FSM is a robust method that can be used to estimate FVC based on multiple growth stages where crop CCC varies greatly.
DE-MR simulation imaging for prone radiotherapy after breast-conserving surgery: assessing its application in lumpectomy cavity delineation based on deformable image registration
Authors: Zhao Changhui , Li Jianbin , Wang Wei , Gong Guanzhong , Xu Liang , Zhang Yingjie , Li Fengxiang , Shao Qian , Wang Jinzhi , Liu Xijun , Xu Min
Published: May 2021

Background

The application of delayed-enhancement magnetic resonance (DE-MR) simulation imaging in lumpectomy cavity (LC) delineation for prone radiotherapy in patients with an invisible seroma or a low seroma clarity score (SCS) after breast-conserving surgery (BCS) based on deformable image registration (DIR) was assessed.

Methods

Twenty-six patients who were suitable for radiotherapy in prone positions after BCS were enrolled, and both computed tomography (CT) and DE-MR simulation scans were acquired. The LC delineated based on titanium surgical clips on CT images was denoted as LCCT. The LC delineated based on the signal of cavity boundaries on fat-suppressed T2-weighted imaging (T2WI) and multiphase delayed-enhancement T1-weighted imaging (DE-T1WI), which was performed at 2 min, 5 min and 10 min postinjection, were denoted as LCT2, LC2T1, LC5T1 and LC10T1, respectively. Afterwards, DIR was performed to compare the volumes and locations of the LCs with MIM software. The generalized conformity index (CIgen) of inter (intra) observer (Inter-CIgen and Intra-CIgen) was also used to explore the inter(intra) observer variation for LC delineation on each image modality.

Results

LCCT–LC10T1 provided the best conformal index (CI) and degree of inclusion (DI), increasing by 2.08% and 4.48% compared to LCCT–LCT2, 11.36% and 2.94% for LCCT–LC2T1, and 8.89% and 7.69% for LC5T1–LCCT, respectively. The center of mass (COM) of LCCT–LC10T1 decreased by 17.86%, 6.12% and 13.21% compared with that of LCCT–LCT2, LCCT–LC2T1 and LCCT–LC5T1, respectively. The agreement of LC delineation was strongest for 10th min DE-TIWI (coefficient of variation, COV = 2.30%, Inter-CIgen = 87.06%, Intra-CIgen = 92.64%).

Conclusion

For patients with a low SCS (SCS ≤ 2) after BCS, it is feasible to contour the LC based on prone DE-MR simulation images. Furthermore, the LC derived from prone DE-T1WI at 10 min was found to be most similar to that derived from prone CT simulation scans using titanium surgical clips regardless of the volume and location of the LC. Inter (intra) variability was minimal for the delineation of the LC based on 10th min DE-TIWI.
High dose simultaneous integrated boost for node positive cervical cancer
Authors: Jayatilakebanda Iresha , Tsang Yat Man , Hoskin Peter
Published: May 2021

Introduction

Lymph node metastases presenting with locally advanced cervical cancer are poor prognostic features. Modern radiotherapy approaches enable dose escalation to radiologically abnormal nodes. This study reports the results of a policy of a simultaneous integrated boost (SIB) in terms of treatment outcomes.

Materials and methods

Patients treated with radical chemoradiation with weekly cisplatin for locally advanced cervical cancer including an SIB to radiologically abnormal lymph nodes were analysed. All patients received a dose of 45 Gy in 25 fractions and a SIB dose of 60 Gy in 25 fractions using intensity modulated radiotherapy/volumetric modulated arc therapy, followed by high dose rate brachytherapy of 28 Gy in 4 fractions. A control cohort with radiologically negative lymph nodes was used to compare impact of the SIB in node positive patients. Treatment outcomes were measured by overall survival (OS), post treatment tumour response and toxicities. The tumour response was based on cross sectional imaging at 3 and 12 months and recorded as local recurrence free survival (LRFS), regional recurrence free survival (RRFS) and distant recurrence free survival (DRFS).

Results

In between January 2015 and June 2017, a total of 69 patients with a median follow up of 30.9 months (23 SIB patients and 46 control patients) were identified. The complete response rate at 3 months was 100% in the primary tumour and 83% in the nodal volume receiving SIB. The OS, LRFS, RRFS and DRFS at 3 years of the SIB cohort were 69%, 91%, 79% and 77% respectively. High doses can be delivered to regional pelvic lymph nodes using SIB without excessive toxicity.

Conclusion

Using a SIB, a total dose of 60 Gy in 25 fractions chemoradiation can be delivered to radiologically abnormal pelvic nodes with no increase in toxicity compared to node negative patients. The adverse impact of positive nodal status may be negated by high dose deposition using SIB, but larger prospective studies are required to confirm this observation.
Percutaneous, PMMA-augmented, pedicle screw instrumentation of thoracolumbar ankylotic spine fractures
Authors: Buxbaum Rina E. , Shani Adi , Mulla Hani , Rod Alon , Rahamimov Nimrod
Published: May 2021

Introduction

Fractures in the ankylotic spine may have an insidious presentation but are prone to displace with devastating consequences. The long lever arm of ankylosed spine fragments may lead to pulmonary and great vessel injury and is difficult to adequately immobilize. Conservative treatment will produce in many cases poor outcomes with high morbidity and mortality. Open surgical treatment is also fraught with technical difficulties and can lead to major blood loss and prolonged operative times.

In recent years, percutaneous instrumentation of non-ankylotic spine fractures has gained popularity, producing similar outcomes to open surgery with shorter operative times and reduced blood loss and hospital length of stay. We describe our experience implementing these techniques in ankylotic spine patients.

Methods

We retrospectively retrieved from our hospital’s electronic health records all patients treated for thoracolumbar spine fractures between 2008 and 2015 with a diagnosis of ankylosing spondylitis (AS) or diffuse idiopathic skeletal hyperostosis (DISH). Operative and postoperative data, results, and complications were tabulated, and radiographic parameters were evaluated.

Results

Twenty-four patients with ankylotic spine disease underwent percutaneous augmented instrumentation between 2008 and 2015. The mean age was 76. All patients had at least one comorbidity. The mean number of ankylosed levels was 14. Mean operative time was 131 min. The average postoperative hemoglobin decrease was 1.21 gr/%, with only 4 patients requiring blood transfusion.

45.8% of the patients had postoperative medical complications. One patient (4.2%) had a superficial postoperative infection, and one patient died in hospital. The average hospital length of stay was 14.55 days.

All patients retained their preoperative ASIA grades, and 3 improved one grade. All patients united their fractures without losing reduction.

Conclusions

PMMA-augmented percutaneous instrumentation is an attractive surgical option for this difficult patient subset, especially when compared to other available current alternatives.
Anterior positioning screw in proximal femoral plating restricts posterior tilt of retroverted femoral neck fractures: a retrospective cohort study
Authors: Nie Sheng-Bo , Liu Jun-Feng , Zhu Jiang-Hua , Zhou Zi-Fei , Zhang Lei , Zheng Long-Po
Published: May 2021

Background

Preoperative posterior tilt is a risk factor for fixation failure in femoral neck fractures. This study aimed to evaluate the configuration of anterior positioning screw in proximal femoral plating in the treatment of retroverted femoral neck fractures in terms of resisting posterior tilt.

Methods

We retrospectively analyzed patients with retroverted femoral neck fractures who were fixed by proximal femoral plating from January 2014 to August 2019. All patients were divided into two groups according to screw configuration: anterior long-threaded screw (ALTS, n = 36) and normally short-threaded screws (NTS, n = 46). Baseline characteristics were reviewed and radiological and clinical outcomes were analyzed. Logistic regression analysis was used to identify risk factors for developing posterior tilt.

Results

Age, gender, Garden classification, posterior comminution, and reduction quality showed no significant difference between the groups. Increased posterior tilt was lower in the ALTS group (3.2°, 2.1–4.3°) than that in the NTS group (5.3°, 4.2–8.3°) (p < 0.001), and the percentage of people with > 5° of posterior tilt was also lower in the ALTS group (5, 13.9% vs. 24, 52.2%; p < 0.001). Femoral neck shortening (FNS) was lower in the ALTS group (3.1 (2.1–4.7) mm vs. 4.3 (3.1–6.3) mm, p = 0.003), though not statistically significant when using 5 mm as the cut-off value. Harris Hip Score in the ALTS group was higher than that in the NTS group (87.0, 84.0–90.0 vs. 82.0, 76.0–84.5; p < 0.001). Postoperative complications including delayed union, nonunion, and avascular necrosis were comparable between the groups. Multivariable analysis identified posterior comminution (OR 15.9, 95% CI 3.6–70.3, p < 0.001), suboptimal reduction quality (OR 12.0, 95% CI 2.6–56.1, p = 0.002), and NTS configuration (reference: ALTS configuration) (OR 21.9, 95% CI 4.1–116.4, p < 0.001) as risk factors for developing posterior tilt.

Conclusions

Configuration of anterior positioning screw in proximal femoral plating provides better resistance against posterior tilt in the fixation of retroverted femoral neck fractures. Also, posterior comminution, suboptimal reduction, and NTS configuration (reference: ALTS) are risk factors for developing posterior tilt.

Trial registration

The trial registration number was ChiCTR2000039482.
Medium term outcome of Lancaster cortical window technique for extraction of femoral stem in revision hip arthroplasty
Authors: Singh Amit , Mukherjee Sunirmal , Patel Kuntal , Herlekar Deepak , Gandavaram Srikant , Charalambous Nicholas
Published: May 2021

Background

The extraction of a femoral stem during the revision hip arthroplasty can be a daunting task and can lead to catastrophic complications for the patient. A sound technique employed intraoperatively helps in the speedy recovery of the patient and reduces the risk of future surgical interventions. In this study, we present a medium-term outcome of our novel Lancaster cortical window technique which can be used for the removal of cemented or uncemented femoral stems.

Methods

The study was conducted at a specialist centre in the north-west of the UK from January 2014 to May 2019. This is a retrospective case series where patients were treated surgically using the Lancaster cortical window technique for removal of the femoral implant during a revision hip arthroplasty. Patient’s electronic notes and radiographs were used to evaluate the functional and radiological outcome.

Results

In this study, 18 patients were managed surgically using the novel Lancaster window technique. The mean age of all the patients was 81.5 years, and the male to female ratio was 10:8. Fifteen patients underwent revision surgery for aseptic loosening of the femoral and acetabular components. The rest of the three patients had revision surgery for a broken femoral stem, intraoperative femoral canal perforation while implanting a total hip replacement femoral stem and infection. Twelve femurs were replanted with uncemented long femoral stems and six with long cemented stems. The cortical window osteotomy united in all the patients in 4.2 months (mean). The mean follow-up of these patients is 20.9 months, and none of them had any implant subsidence or loosening at the time of their last follow-up.

Conclusion

We believe Lancaster cortical window technique can be safely used for the removal of cemented stems during revision hip arthroplasty without the need for expensive equipment.
Surgery in congenital lung malformations: the evolution from thoracotomy to VATS, 10-year experience in a single center
Authors: Ceylan Kenan C. , Batihan Güntuğ , Üçvet Ahmet , Gürsoy Soner
Published: May 2021

Background

Congenital lung malformation is an umbrella term and consist of various kind of parenchymal and mediastinal pathologies. Surgical resection is often required for diagnosis and curative treatment.

We aimed to review our experience in surgical treatment for congenital lung disease and present the role of minimally invasive surgery.

Methods

Surgical resections performed for benign lesions of the lung and mediastinum between January 2009 and May 2019 were retrospectively analyzed. Patients who were found to have congenital lung malformation as a result of pathological examination were included in our study. Distribution characteristics of the patients according to congenital lung malformation subtypes, differences in surgical approach and postoperative results were investigated.

Results

A total of 94 patients who underwent surgical resection and were diagnosed with the bronchogenic cyst, sequestration, bronchial atresia, congenital cystic adenomatoid malformation (CCAM), or enteric cyst as a result of pathological examination were included the study. There were no significant differences between pathological subtypes in the postoperative length of hospital stay and drainage duration however, perioperative complication rate was higher in the sequestration group. In addition, in the first three days postoperatively, the mean pain score was found to be lower in the VATS group compared to thoracotomy.

Conclusions

Congenital lung malformations consist of a heterogeneous group of diseases and the surgical treatment in these patients can range from a simple cyst excision to pneumonectomy. Video-assisted thoracoscopic surgery should be considered as the first choice in the surgical treatment of these patients in experienced centers.
Advantages of intraoperative implantation of Impella 5.5 SmartAssist in the Management of Acute Post-Infarction Ventricular Septal Defect with cardiogenic shock
Authors: Madjarov Jeko M. , Katz Michael G. , Madzharov Svetozar , Fazal Shahood , Robicsek Francis
Published: May 2021

Background

Despite advances in surgical techniques and aggressive therapy of post-infarction ventricular septal defect (VSD) with cardiogenic shock, the overall morbidity and mortality is frustratingly high. The Impella 5.5 SmartAssist (Abiomed, Danvers, MA) is a surgically implanted temporary device, recently approved by the FDA (https://www.businesswire.com/news/home/20190925005454/en/) for treatment of patients in cardiogenic shock, and may fill a technological gap for patients who require acute circulatory support after VSD closure.

Case presentation

We report our initial experience for two patients with post myocardial infarction VSD in the setting of cardiogenic shock supported with trans-aortic implantation Impella 5.5 SmartAssist. First patient had a posterior VSD with a left to right shunt (Qp/Qs ratio of 3.3), blood pressure 80/35 mmHg, right ventricle dysfunction, severe pulmonary arterial hypertension (an estimated systolic pulmonary artery pressure of 45 mmHg), and severe mitral valve regurgitation. Second patient was admitted for massive MI with large anterior VSD (Qp/Qs ratio of 2.8). Under cardiopulmonary bypass with cardioplegic arrest both patients underwent urgent VSD closure with trans-aortic implantation of the Impella. Minimal postoperative support was required. Patients were discharged on postoperative day 10 and 14 and remained well 3 months later. Follow-up echocardiogram showed no residual shunt.

Conclusions

Early surgical implantation of Impella 5.5 SmartAssist can prevent multiorgan dysfunction and stabilize the patients in cardiogenic shock with post-myocardial infarction VSD.
Analysis of risk factors of low cardiac output syndrome after congenital heart disease operation: what can we do
Authors: Song Bangrong , Dang Haiming , Dong Ran
Published: May 2021

Background

It’s necessary to analyze the related risk factors and complications of low cardiac output syndrome (LCOS) after operation in children with congenital heart disease (CHD), to elucidate the management strategy of LCOS.

Methods

CHD children admitted to the department of cardiology in our hospital from January 15, 2019 to October 31, 2020 were included. The personal and clinical data of CHD children with LCOS and without LCOS were collected and compared. Logistic regression analyses were conducted to identify the risk factors of postoperative LCOS. Besides, the complication and mortality of LCOS and no LCOS patients were compared.

Results

A total of 283 CHD patients were included, the incidence of postoperative LCOS in CHD patients was 12.37%. There were significant differences in the age, preoperative oxygen saturation, two-way ventricular shunt, duration of CPB and postoperative residual shunt between two groups (all p < 0.05). Logistic regression analyses indicated that age ≤ 4y(OR2.426, 95%CI1.044 ~ 4.149), preoperative oxygen saturation ≤ 93%(OR2.175, 95%CI1.182 ~ 5.033), two-way ventricular shunt (OR3.994, 95%CI1.247 ~ 6.797), duration of CPB ≥ 60 min(OR2.172, 95%CI1.002 ~ 4.309), postoperative residual shunt (OR1.487, 95%CI1.093 ~ 2.383) were the independent risk factors of LCOS in patients with CHD (all p < 0.05). There were significant differences in the acute liver injury, acute kidney injury, pulmonary infection, tracheotomy, duration of mechanical ventilation, length of ICU stay and mortality (all p < 0.05), no significant difference in the 24 h drainage was found(p = 0.095).

Conclusion

LCOS after CHD is common, more attentions should be paid to those patients with age ≤ 4y, preoperative oxygen saturation ≤ 93%, two-way ventricular shunt, duration of CPB ≥ 60 min, postoperative residual shunt to improve the prognosis of CHD patients.
C4OH is a potential newborn screening marker—a multicenter retrospective study of patients with beta-ketothiolase deficiency in China
Authors: Lin Yiming , Yang Zhantao , Yang Chiju , Hu Haili , He Haiyan , Niu Tingting , Liu Mingfang , Wang Dongjuan , Sun Yun , Shen Yuyan , Li Xiaole , Yan Huiming , Kong Yuanyuan , Huang Xinwen
Published: May 2021

Background

Beta-ketothiolase deficiency (BKTD) is an autosomal recessive disorder caused by biallelic mutation of ACAT1 that affects both isoleucine catabolism and ketolysis. There is little information available regarding the incidence, newborn screening (NBS), and mutational spectrum of BKTD in China.

Results

We collected NBS, biochemical, clinical, and ACAT1 mutation data from 18 provinces or municipalities in China between January 2009 and May 2020, and systematically assessed all available published data from Chinese BKTD patients. A total of 16,088,190 newborns were screened and 14 patients were identified through NBS, with an estimated incidence of 1 per 1 million newborns in China. In total, twenty-nine patients were genetically diagnosed with BKTD, 12 of which were newly identified. Most patients exhibited typical blood acylcarnitine and urinary organic acid profiles. Interestingly, almost all patients (15/16, 94%) showed elevated 3-hydroxybutyrylcarnitine (C4OH) levels. Eighteen patients presented with acute metabolic decompensations and displayed variable clinical symptoms. The acute episodes of nine patients were triggered by infections, diarrhea, or an inflammatory response to vaccination. Approximately two-thirds of patients had favorable outcomes, one showed a developmental delay and three died. Twenty-seven distinct variants were identified in ACAT1, among which five were found to be novel.

Conclusion

This study presented the largest series of BKTD cohorts in China. Our results indicated that C4OH is a useful marker for the detection of BKTD. The performance of BKTD NBS could be improved by the addition of C4OH to the current panel of 3-hydroxyisovalerylcarnitine and tiglylcarnitine markers in NBS. The mutational spectrum and molecular profiles of ACAT1 in the Chinese population were expanded with five newly identified variants.