bluuebunny/crossref_metadata_2025 huggingface dataset:
‘Busy, Without Thimbles, at the Needlework’: Men’s Sewing and Masculinity on the Victorian Goldfields, 1851–1861
Authors: Cramer Lorinda
Published: January 2020

Australia’s gold-rush history has long been dominated by narratives of male adventure: of landscapes where men lived side by side, mateship took on increasing importance in the pursuit of gold, masculine behaviours and manners were emphasized and domesticity was shunned. In the early years of the rich discoveries of gold, men often travelled alone to the colony of Victoria in their search for wealth. This article examines a situation this unique environment created: where men unaccompanied by women – although women, too, were present on the diggings – were required to adopt practices perceived as feminine. It focuses in on needlework to explore the tensions that emerged given sewing was a defining female occupation during the nineteenth century, inhabiting a central place in the female experience. As this article highlights, sewing became an essential practice for men on the Victorian goldfields in order to keep themselves clothed, warm and dry. I consider how men approached their sewing tasks given needlework’s inextricable link with women, and the various strategies they used to frame their sewing in letters, diaries and memoirs – sometimes for close friends and family alone, and other times for wider dissemination. Drawing on sociological frameworks on constructions of gender, masculinity and manliness, I then consider how a shifting engagement with domestic practices may have strengthened rather than challenged identity on the goldfields.
Cyclic variations in the main components of the solar large-scale magnetic field
Authors: Obridko V N , Sokoloff D D , Shelting B D , Shibalova A S , Livshits I M
Published: January 2020

We consider variations of the dipole and quadrupole components of the solar large-scale magnetic field. Both axial and equatorial dipoles exhibit a systematic decrease during the past four cycles, in accordance with the general decrease of solar activity. The transition of the pole of a dipole from the polar region to the midlatitudes occurs rather quickly, so that the longitude of the pole changes little. With time, however, this inclined dipole region shifts to larger longitudes, which suggests an acceleration of dipole rotation. The mean rotation rate exceeds the Carrington velocity by 0.6 per cent. The behaviour of a quadrupole differs dramatically. Its decrease over the last four cycles was much smaller than that of the dipole moment. The ratio of the quadrupole and dipole moments has increased for four cycles more than twice, in contrast to sunspot numbers, which displayed a twofold decrease for the same time interval. Regarding quadrupole rotation, the mean longitude of the poles of one sign decreased by 600° over four cycles, which suggests that the mean rotation rate was lower than the Carrington velocity by 0.28 per cent. We do not, however, see any conclusive evidence that, in the period under discussion, a mode of quadrupole symmetry was excited in the Sun along with the dipole mode.
Nuclear envelope attachment of telomeres limits TERRA and telomeric rearrangements in quiescent fission yeast cells
Authors: Maestroni Laetitia , Reyes Céline , Vaurs Mélina , Gachet Yannick , Tournier Sylvie , Géli Vincent , Coulon Stéphane
Published: January 2020

Telomere anchoring to nuclear envelope (NE) is a key feature of nuclear genome architecture. Peripheral localization of telomeres is important for chromatin silencing, telomere replication and for the control of inappropriate recombination. Here, we report that fission yeast quiescent cells harbor predominantly a single telomeric cluster anchored to the NE. Telomere cluster association to the NE relies on Rap1–Bqt4 interaction, which is impacted by the length of telomeric sequences. In quiescent cells, reducing telomere length or deleting bqt4, both result in an increase in transcription of the telomeric repeat-containing RNA (TERRA). In the absence of Bqt4, telomere shortening leads to deep increase in TERRA level and the concomitant formation of subtelomeric rearrangements (STEEx) that accumulate massively in quiescent cells. Taken together, our data demonstrate that Rap1–Bqt4-dependent telomere association to NE preserves telomere integrity in post-mitotic cells, preventing telomeric transcription and recombination. This defines the nuclear periphery as an area where recombination is restricted, creating a safe zone for telomeres of post-mitotic cells.
Return to work advice after total hip and knee replacement
Authors: Nouri F , Coole C , Baker P , Drummond A
Published: January 2020

Background

Little is known about the information and advice on return to work received by patients undergoing total hip and knee replacement.

Aims

To investigate patients’ views and experiences of work-related advice provided by clinicians, and how this might be improved.

Methods

Semi-structured interviews with patients who had undergone total hip and knee replacement, were working prior to surgery and intended to return to work. Data were analysed thematically.

Results

Forty-five patients from three UK regions were consented. Eight themes were identified including lack of information, lack of an individualized approach and accessibility and acceptability of information dissemination methods. Patients identified their information needs and who they felt was best placed to address them.

Conclusions

Patients receive little information and advice on return to work following total hip and knee replacement, although not all patients required this. However, more focus is needed on providing this, and patients should be screened to ensure resources are best targeted with interventions being tailored to the individual.
Using the Post-Descendens Hypoglossal Nerve in Hypoglossal-Facial Anastomosis: An Anatomic and Histologic Feasibility Study
Authors: Tayebi Meybodi Ali , Moreira Leandro Borba , Zhao Xiaochun , Belykh Evgenii , Lawton Michael T , Eschbacher Jennifer M , Preul Mark C
Published: January 2020

BACKGROUND

Hypoglossal-facial anastomosis (HFA) is a popular facial reanimation technique. Mobilizing the intratemporal segment of the facial nerve and using the post-descendens hypoglossal nerve (ie, the segment distal to the take-off of descendens hypoglossi) have been proposed to improve results. However, no anatomic study has verified the feasibility of this technique.

OBJECTIVE

To assess the anatomic feasibility of HFA and the structural compatibility between the 2 nerves when the intratemporal facial and post-descendens hypoglossal nerves are used.

METHODS

The facial and hypoglossal nerves were exposed bilaterally in 10 sides of 5 cadaveric heads. The feasibility of a side-to-end (ie, partial end-to-end) HFA with partial sectioning of the post-descendens hypoglossal nerve and the mobilized intratemporal facial nerve was assessed. The axonal count and cross-sectional area of the facial and hypoglossal nerves at the point of anastomosis were assessed.

RESULTS

The HFA was feasible in all specimens with a mean (standard deviation) 9.3 (5.5) mm of extra length on the facial nerve. The axonal counts and cross-sectional areas of the hypoglossal and facial nerves matched well. Considering the reduction in the facial nerve cross-sectional area after paralysis, the post-descendens hypoglossal nerve can provide adequate axonal count and area to accommodate the facial nerve stump.

CONCLUSION

Using the post-descendens hypoglossal nerve for side-to-end anastomosis with the mobilized intratemporal facial nerve is anatomically feasible and provides adequate axonal count for facial reanimation. When compared with use of the pre-descendens hypoglossal nerve, this technique preserves C1 fibers and has a potential to reduce glottic complications.
The Sensor Technology and Rehabilitative Timing (START) Protocol: A Randomized Controlled Trial for the Rehabilitation of Mild Traumatic Brain Injury
Authors: Parrington Lucy , Jehu Deborah A , Fino Peter C , Stuart Samuel , Wilhelm Jennifer , Pettigrew Natalie , Murchison Charles F , El-Gohary Mahmoud , VanDerwalker Jess , Pearson Sean , Hullar Timothy , Chesnutt James C , Peterka Robert J , Horak Fay B , King Laurie A
Published: January 2020

Background

Clinical practice for rehabilitation after mild traumatic brain injury (mTBI) is variable, and guidance on when to initiate physical therapy is lacking. Wearable sensor technology may aid clinical assessment, performance monitoring, and exercise adherence, potentially improving rehabilitation outcomes during unsupervised home exercise programs.

Objective

The objectives of this study were to: (1) determine whether initiating rehabilitation earlier than typical will improve outcomes after mTBI, and (2) examine whether using wearable sensors during a home-exercise program will improve outcomes in participants with mTBI.

Design

This was a randomized controlled trial.

Setting

This study will take place within an academic hospital setting at Oregon Health & Science University and Veterans Affairs Portland Health Care System, and in the home environment.

Participants

This study will include 160 individuals with mTBI.

Intervention

The early intervention group (n = 80) will receive one-on-one physical therapy 8 times over 6 weeks and complete daily home exercises. The standard care group (n = 80) will complete the same intervention after a 6- to 8-week wait period. One-half of each group will receive wearable sensors for therapist monitoring of patient adherence and quality of movements during their home exercise program.

Measurements

The primary outcome measure will be the Dizziness Handicap Inventory score. Secondary outcome measures will include symptomatology, static and dynamic postural control, central sensorimotor integration posturography, and vestibular-ocular-motor function.

Limitations

Potential limitations include variable onset of care, a wide range of ages, possible low adherence and/or withdrawal from the study in the standard of care group, and low Dizziness Handicap Inventory scores effecting ceiling for change after rehabilitation.

Conclusions

If initiating rehabilitation earlier improves primary and secondary outcomes post-mTBI, this could help shape current clinical care guidelines for rehabilitation. Additionally, using wearable sensors to monitor performance and adherence may improve home exercise outcomes.
DIAGNOSTIC IMAGING AND IONIZING RADIATION EXPOSURE IN A LEVEL 1 TRAUMA CENTRE POPULATION MET WITH TRAUMA TEAM ACTIVATION: A ONE-YEAR PATIENT RECORD AUDIT
Authors: Bågenholm Anna , Løvhaugen Pål , Sundset Rune , Ingebrigtsen Tor
Published: January 2020

This audit describes ionizing and non-ionizing diagnostic imaging at a regional trauma centre. All 144 patients (males 79.2%, median age 31 years) met with trauma team activation from 1 January 2015 to 31 December 2015 were included. We used data from electronic health records to identify all diagnostic imaging and report radiation exposure as dose area product (DAP) for conventional radiography (X-ray) and dose length product (DLP) and effective dose for CT. During hospitalization, 134 (93.1%) underwent X-ray, 122 (84.7%) CT, 92 (63.9%) focused assessment with sonography for trauma (FAST), 14 (9.7%) ultrasound (FAST excluded) and 32 (22.2%) magnetic resonance imaging. One hundred and sixteen (80.5%) underwent CT examinations during trauma admissions, and 73 of 144 (50.7%) standardized whole body CT (SWBCT). DAP values were below national reference levels. Median DLP and effective dose were 2396 mGycm and 20.42 mSv for all CT examinations, and 2461 mGycm (national diagnostic reference level 2400) and 22.29 mSv for a SWBCT.
Adult Zebrafish Model for Screening Drug-Induced Kidney Injury
Authors: Kato Yuki , Tonomura Yutaka , Hanafusa Hiroyuki , Nishimura Kyohei , Fukushima Tamio , Ueno Motonobu
Published: January 2020

Drug-induced kidney injury is a serious safety issue in drug development. In this study, we evaluated the usefulness of adult zebrafish as a small in vivo system for detecting drug-induced kidney injury. We first investigated the effects of typical nephrotoxicants, gentamicin and doxorubicin, on adult zebrafish. We found that gentamicin induced renal tubular necrosis with increased lysosome and myeloid bodies, and doxorubicin caused foot process fusion of glomerular podocytes. These findings were similar to those seen in mammals, suggesting a common pathogenesis. Second, to further evaluate the performance of the model in detecting drug-induced kidney injury, adult zebrafish were treated with 28 nephrotoxicants or 14 nonnephrotoxicants for up to 4 days, euthanized 24 h after the final treatment, and examined histopathologically. Sixteen of the 28 nephrotoxicants and none of the 14 nonnephrotoxicants caused drug-induced kidney injury in zebrafish (sensitivity, 57%; specificity, 100%; positive predictive value, 100%; negative predictive value, 54%). Finally, we explored genomic biomarker candidates using kidneys isolated from gentamicin- and cisplatin-treated zebrafish using microarray analysis and identified 3 candidate genes, egr1, atf3, and fos based on increased expression levels and biological implications. The expression of these genes was upregulated dose dependently in cisplatin-treated groups and was > 25-fold higher in gentamicin-treated than in the control group. In conclusion, these results suggest that the adult zebrafish has (1) similar nephrotoxic response to those of mammals, (2) considerable feasibility as an experimental model for toxicity studies, and (3) applicability to pathological examination and genomic biomarker evaluation in drug-induced kidney injury.
Axial changes in wood functional traits have limited net effects on stem biomass increment in European beech (Fagus sylvatica)
Authors: Peters Richard L , von Arx Georg , Nievergelt Daniel , Ibrom Andreas , Stillhard Jonas , Trotsiuk Volodymyr , Mazurkiewicz Aleksandra , Babst Flurin
Published: January 2020

During the growing season, trees allocate photoassimilates to increase their aboveground woody biomass in the stem (ABIstem). This ‘carbon allocation’ to structural growth is a dynamic process influenced by internal and external (e.g., climatic) drivers. While radial variability in wood formation and its resulting structure have been intensively studied, their variability along tree stems and subsequent impacts on ABIstem remain poorly understood. We collected wood cores from mature trees within a fixed plot in a well-studied temperate Fagus sylvatica L. forest. For a subset of trees, we performed regular interval sampling along the stem to elucidate axial variability in ring width (RW) and wood density (ρ), and the resulting effects on tree- and plot-level ABIstem. Moreover, we measured wood anatomical traits to understand the anatomical basis of ρ and the coupling between changes in RW and ρ during drought. We found no significant axial variability in ρ because an increase in the vessel-to-fiber ratio with smaller RW compensated for vessel tapering towards the apex. By contrast, temporal variability in RW varied significantly along the stem axis, depending on the growing conditions. Drought caused a more severe growth decrease, and wetter summers caused a disproportionate growth increase at the stem base compared with the top. Discarding this axial variability resulted in a significant overestimation of tree-level ABIstem in wetter and cooler summers, but this bias was reduced to ~2% when scaling ABIstem to the plot level. These results suggest that F. sylvatica prioritizes structural carbon sinks close to the canopy when conditions are unfavorable. The different axial variability in RW and ρ thereby indicates some independence of the processes that drive volume growth and wood structure along the stem. This refines our knowledge of carbon allocation dynamics in temperate diffuse-porous species and contributes to reducing uncertainties in determining forest carbon fixation.
Mentors’ Beliefs About Their Roles in Health Care Education: A Qualitative Study of Mentors’ Personal Interpretative Framework
Authors: Loosveld Lianne M. , Van Gerven Pascal W.M. , Vanassche Eline , Driessen Erik W.
Published: January 2020

Purpose

How mentors shape their mentoring is strongly influenced by their personal beliefs about the goals and purpose of mentoring, the possible activities associated with it, who decides on the focus of the mentoring relationship, and the strategies mentors choose to enact these beliefs in practice. In accordance with the personal interpretative framework, the authors operationalized mentors’ beliefs as professional self-understanding (the what) and subjective educational theory (the how) of teaching and sought to identify different mentoring positions.

Method

Using a qualitative approach, the authors conducted semistructured interviews between December 2017 and January 2018 with 18 undergraduate mentors from Maastricht University in Maastricht, the Netherlands. The aim of the interviews was to reconstruct their personal interpretative framework. Before building a general pattern of explanation in a cross-case analysis, the authors performed a within-case analysis of the data, analyzing individual mentors.

Results

This approach resulted in the identification and description of 4 mentoring positions: the (1) facilitator (service providing and responsive), (2) coach (development supporting and responsive), (3) monitor (signaling and collaborative), and (4) exemplar (service providing or development supporting and directive). Each position represents a coherent pattern of normative beliefs about oneself as a mentor (professional self-understanding) and how to enact these beliefs in practice (subjective educational theory).

Conclusions

Awareness of their mentoring position can help mentors understand why they act the way they do in certain situations and how this behavior affects their mentees’ learning and development. It can also help mentors identify personal learning needs and, consequently, provide opportunities for faculty development.
Nalmefene in the Treatment of Internet Pornography Addiction – A Case Report and Review of Literature
Authors: Yazdi Kurosch , Fuchs-Leitner Isabella , Gerstgrasser Nikolas W.
Published: January 2020

The mu-opioid antagonist nalmefene (18 mg per day) was administered in the treatment of a heterosexual male with internet pornography addiction. The patient had no other co-addictions or psychiatric comorbidities, allowing a direct measurement for the effectiveness of nalmefene on internet pornography addiction. Over a period of 72 weeks and an assessment frequency between 1 and 18 weeks, self-monitoring assessments of craving and pornography consumption were collected on different craving and obsessive-compulsive scales. Results indicate that nalmefene impressively decreased addictive symptoms. Importantly, the patient-induced discontinuation of nalmefene led to an immediate increase of craving scores and addictive behavior, which dropped again after restarting the medication. The patient has been in complete remission of symptoms for over a year under our supervision, and for further 2 years after that according to his account. Therefore, nalmefene seems to be a useful adjunction for patients with internet pornography addiction.
Pharmacokinetics and Pharmacodynamics of Remimazolam (CNS 7056) after Continuous Infusion in Healthy Male Volunteers
Authors: Eisenried Andreas , Schüttler Jürgen , Lerch Marco , Ihmsen Harald , Jeleazcov Christian
Published: January 2020

Background

Remimazolam (CNS 7056) is a new ultra-short acting benzodiazepine for IV sedation. This study aimed to investigate the electroencephalogram (EEG) pharmacodynamics of remimazolam infusion.

Methods

Twenty healthy male volunteers received remimazolam as continuous IV infusion of 5 mg/min for 5 min, 3 mg/min for the next 15 min, and 1 mg/min for further 15 min. Continuous EEG monitoring was performed by a neurophysiologic system with electrodes placed at F3, F4, C3, C4, O1, O2, Cz, and Fp1 (10/20 system) and using the Narcotrend Index. Sedation was assessed clinically by using the Modified Observer’s Assessment of Alertness and Sedation scale. Pharmacodynamic models were developed for selected EEG variables and Narcotrend Index.

Results

EEG changes during remimazolam infusion were characterized by an initial increase in beta frequency band and a late increase in delta frequency band. The EEG beta ratio showed a prediction probability of Modified Observer’s Assessment of Alertness and Sedation score of 0.79, and could be modeled successfully using a standard sigmoid Emax model. Narcotrend Index showed a prediction probability of Modified Observer’s Assessment of Alertness and Sedation score of 0.74. The time course of Narcotrend Index was described by an extended sigmoid Emax model with two sigmoid terms and different plasma–effect equilibration times.

Conclusions

Beta ratio was identified as a suitable EEG variable for monitoring remimazolam sedation. Narcotrend Index appeared less suitable than the beta ratio for monitoring the sedative effect if remimazolam is administered alone.

Editor’s Perspective

What We Already Know about This Topic

What This Article Tells Us That Is New
Socioeconomic Status and Days Alive and Out of Hospital after Major Elective Noncardiac Surgery
Authors: Jerath Angela , Austin Peter C. , Ko Dennis T. , Wijeysundera Harindra C. , Fremes Stephen , McCormack Daniel , Wijeysundera Duminda N.
Published: January 2020

Background

Socioeconomic status is an important but understudied determinant of preoperative health status and postoperative outcomes. Previous work has focused on the impact of socioeconomic status on mortality, hospital stay, or complications. However, individuals with low socioeconomic status are also likely to have fewer supports to facilitate them remaining at home after hospital discharge. Thus, such patients may be less likely to return home over the short and intermediate term after major surgery. The newly validated outcome, days alive and out of hospital, may be highly suited to evaluating the impact of socioeconomic status on this postdischarge period. The study aimed to determine the association of socioeconomic status with short and intermediate term postoperative recovery as measured by days alive and out of hospital.

Methods

The authors evaluated data from 724,459 adult patients who had one of 13 elective major noncardiac surgical procedures between 2006 and 2017. Socioeconomic status was measured by median neighborhood household income (categorized into quintiles). Primary outcome was days alive and out of hospital at 30 days, while secondary outcomes included days alive and out of hospital at 90 and 180 days, and 30-day mortality.

Results

Compared to the highest income quintile, individuals in the lowest quintile had higher unadjusted risks of postoperative complications (6,049 of 121,099 [5%] vs. 6,216 of 160,495 [3.9%]) and 30-day mortality (731 of 121,099 [0.6%] vs. 701 of 160,495 [0.4%]) and longer mean postoperative length of stay (4.9 vs. 4.4 days). From lowest to highest income quintile, the mean adjusted days alive and out of hospital at 30 days after surgery varied between 24.5 to 24.9 days.

Conclusions

Low socioeconomic status is associated with fewer days alive and out of hospital after surgery. Further research is needed to examine the underlying mechanisms and develop posthospital interventions to improve postoperative recovery in patients with fewer socioeconomic resources.

Editor’s Perspective

What We Already Know about This Topic

What This Article Tells Us That Is New
Smoking Is Associated With Longer Intensive Care Unit Stays in Spine Trauma Patients
Authors: Du Jerry Y. , Weinberg Douglas S. , Moore Timothy A. , Vallier Heather A.
Published: January 2020

Objective:

To determine the impact of smoking on intensive care unit (ICU) outcomes in patients who underwent operative fixation for spine trauma.

Design:

Retrospective cohort study.

Setting:

Single academic level I trauma center.

Patients:

One hundred eighty-one consecutive surgical spine trauma patients from January 2010 to December 2014 requiring ICU stay.

Intervention:

Patients with smoking history compared to patients with no previous smoking history.

Main Outcome Measurements:

ICU length of stay, postoperative complications.

Results:

There were 297 spine trauma patients identified, of which 181 had an ICU stay (61%). There were 96 patients in the smoker cohort (53%) and 85 in the nonsmoker cohort (47%). On univariate analysis, the smoking cohort had a significantly longer ICU length of stay (11.0 ± 12.0 days vs. 8.01 ± 7.98 days, P = 0.046). Adjusting for confounders, smoking (beta: 3.99, P = 0.023), age ≥65 years (beta: 7.61, P = 0.001), body mass index ≥30 (beta: 4.47, P = 0.010), and American Spinal Injury Association Impairment Scale (beta: −1.39, P = 0.013) were independently associated with increased ICU length of stay. Smoking was not significantly associated with pneumonia (P = 0.238) or adult respiratory distress syndrome (P = 0.387) on multivariate analysis.

Conclusions:

A history of smoking, older age, obesity, and increasing American Spinal Injury Association Impairment Scale was independently associated with increased ICU length of stay in patients with surgical spine trauma. This study highlights the health care burden of smoking in the trauma population and may help physicians triage scarce ICU resources.

Level of Evidence:

Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
Capecitabine, Oxaliplatin, Irinotecan, and Bevacizumab Combination Followed by Pazopanib Plus Capecitabine Maintenance for High-Grade Gastrointestinal Neuroendocrine Carcinomas
Authors: Alifieris Constantinos E. , Griniatsos John , Delis Spiros G. , Nikolaou Michail , Avgoustou Constantinos , Panagiotidis Mihalis I. , Souferi-Chronopoulou Eleni , Trafalis Dimitrios T.
Published: January 2020

Objectives:

Gastrointestinal neuroendocrine carcinoma (NEC) is a lethal, uncommon, and understudied neoplasm. We present the efficacy and safety of first-line capecitabine (CP), oxaliplatin, irinotecan, and bevacizumab (CAPOXIRI-BEV) combination followed by pazopanib plus CP maintenance therapy in patients with advanced high-grade poorly differentiated gastrointestinal NEC.

Methods:

This was a two-stage phase II study conducted at multiple institutions. Patients were consecutively enrolled and had advanced NEC of the colon or small bowel. Patients received irinotecan 125 mg/m2, oxaliplatin 80 mg/m2 on day 1, CP 1000 mg/m2 twice daily on days 1 to 14, plus bevacizumab 8 mg/kg on day 1 for six 21-day cycles. Maintenance therapy was given to those who responded (complete response/partial response) or had stable disease after 6 cycles with CAPOXIRI-BEV with pazopanib 800 mg daily plus CP 1600 mg/m2 daily on days 1 to 14 every 3 weeks until disease progression or unacceptable toxicity. Patients who progressed on CAPOXIRI-BEV received standard etoposide-carboplatin. The primary endpoint was overall response rate.

Results:

Twenty-two patients were enrolled of whom 19 were evaluable. The median age was 60 years. The overall response rate (3 complete response/6 partial response) was 47.4% (95% confidence interval: 29.5-76.1), the overall disease control rate was 78.9% (95% confidence interval: 62.6-99.6), and, at median 30 (11 to 41 mo) months’ follow-up, 5 patients (26.3%) were still alive. Median progression-free survival was 13 months, and the 1-year progression-free survival rate was 52.6%. The median overall survival was 29 months. The median overall survival of the 9 patients who responded versus those with stable disease/progressive disease was 30.5 versus 14 months, respectively. The median duration of response was 16 months. Predictable toxicity was observed.

Conclusions:

First-line CAPOXIRI-BEV followed by pazopanib plus CP maintenance therapy for advanced NEC demonstrates promising efficacy and predictable toxicity. Further investigation is warranted.
Vulvar Pigmented Epithelioid Melanocytoma With a Novel HTT-PKN1 Fusion: A Case Report
Authors: Donati Michele , Kastnerova Liubov , Cempírková Dana , Vaněček Tomáš , Michal Michal , Kazakov Dmitry V.
Published: January 2020

Pigmented epithelioid melanocytoma is a highly pigmented, predominantly dermal melanocytic neoplasm composed by epithelioid and spindled melanocytes. It is characterized by a limited number of specific genomic alterations principally involving protein kinase A regulatory subunit alpha (PRKAR1A) and fusion of protein kinase C alpha isoform (PRKCA). However, in some of these neoplasms, no genetic aberrations have been detected. We performed genomic analysis of a nodular heavily pigmented intradermal proliferation composed of monomorphic epithelioid melanocytes with slight cytologic atypia consisting with pigmented epithelioid melanocytoma occurring on the vulva of a 24-year-old woman. A novel fusion transcript HTT-PKN1 and an ATM (Val410Ala) missense mutation were found. No other mutations including TERT-promoter hotspot mutation analysis were detected. The data expand the spectrum of molecular alterations in pigmented epithelioid melanocytoma.
Inhibitory concentration of propofol in combination with dexmedetomidine during microelectrode recording for deep brain stimulator insertion surgeries under general anesthesia
Authors: Lin Yu-Shan , Liu Kang-Du , Chang Chi , Yang Huai-Zhe , Tsou Mei-Yung , Chu Ya-Chun
Published: January 2020

Background:

Microelectrode recording (MER) for target refinement is widely used in deep brain stimulator insertion for Parkinson disease. Signals may be influenced by anesthetics when patients receive general anesthesia (GA). This study determined the inhibitory concentration (IC) of propofol on MER signals when it was coadministered with dexmedetomidine.

Methods:

Patients were anesthetized with dexmedetomidine (0.5 μg·kg−1 loading, followed by infusion at 0.4 μg·kg−1h−1) and propofol through target-controlled infusion for GA with tracheal intubation. The surgeon conducted the online scoring of the background signals, spiking frequency, amplitude, and pattern of single-unit activities by using a 0–10 verbal numerical rating scale (NRS; 0, maximal suppression; 10, minimal suppression), and responses were grouped into suppression (NRS ≤ 6) and nonsuppression (NRS > 6). The median inhibitory concentration (IC50) of propofol (as target effect-site concentrations: Ceprop) was determined using modified Dixon’s up-and-down method. Probit regression analysis was further used to obtain the dose–response relationship, and IC05 and IC95 were calculated.

Results:

Twenty-three adult patients participated in this study. Under the concomitant infusion of dexmedetomidine, the predicted IC50 value (95% CI) of Ceprop for neuronal suppression during MER was 1.29 (1.24–1.34) μg·mL−1 as calculated using modified Dixon’s up-and-down method. Using probit analysis, the estimated IC05, IC50, and IC95 values (95% CIs) were 1.17 (0.87–1.23), 1.28 (1.21–1.34), and 1.40 (1.33–1.85) μg·mL−1, respectively.

Conclusion:

Our data provided reference values of propofol for dosage adjustment to avoid interference on MER under GA when anesthetics have to be continuously infused during recording.
Localized Scleroderma in the Pediatric Population
Authors: Nicpon Jennifer J. , Udlis Kimberly A.
Published: January 2020

Localized scleroderma is an uncommon condition that affects the skin and underlying tissues. Although the pathogenesis is not well understood, lesions of localized scleroderma develop from an initial inflammatory reaction that results in collagen deposition, fibrosis, and atrophy. Healthcare providers need to be alert for skin discolorations or atypical ecchymosis appearances that do not resolve. Prompt diagnosis and treatment, particularly in pediatric patients, are necessary to reduce the risk of growth disturbance, extremity length differences, permanent damage to the skin, accessory structures, joints, and facial atrophy (Careta & Romiti, 2015). Delayed treatment is associated with worse outcomes (Martini et al., 2018). Consensus-based recommendations provide effective treatment options; however, more studies are required in the pediatric population as, to date, there is only one randomized controlled trial in this population (Constantin et al., 2018).
Diagnostic value of various liquid biopsy methods for pancreatic cancer
Authors: Zhu Yuzhou , Zhang Hao , Chen Nan , Hao Jianqi , Jin Hongyu , Ma Xuelei
Published: January 2020

Background:

Liquid biopsy is a novel method for cancer diagnosis, which has been applied in lung and breast cancers, demonstrating high diagnostic value. However, clinical value of it in pancreatic cancer (PC) remains to be verified. The aim of this meta-analysis was to evaluate overall diagnostic value of various liquid biopsy methods (circulating tumor DNA, circulating tumor cells and exosomes) in detecting PC.

Methods:

We comprehensively searched relevant studies in PubMed, Medline, Embase, and Web of Science without time limitation according to PRISMA. Data necessary for reconstructing a 2 × 2 table was calculated from the original articles. The methodological quality of included studies was evaluated by QUADAS-2. Statistical analysis including was performed by the software Meta-Disc version 1.4, and STATA 14.2.

Results:

A total of 19 studies including 1872 individuals were included in this meta-analysis. In which, 7 were studies about ctDNA, 7 were on CTCs and 6 were about exosomes (Sefrioui D1, studied diagnostic accuracy of both ctDNA and CTCs, with no common patients in these 2 groups). The pooled sensitivity estimates for ctDNA, CTCs and exosomes in detecting PC with their 95% confidential intervals (95% CI) were 0.64 (95%CI 0.58–0.70), 0.74 (95%CI 0.68–0.79) and 0.93 (95%CI 0.90–0.95), respectively. The pooled specificity estimates were 0.92(95%CI 0.88–0.95), 0.83 (95%CI 0.78–0.88) and 0.92 (95%CI 0.88–0.95), respectively. The area under curve (AUC) of the sROC for ctDNA, CTCs and exosomes in detecting PC were 0.9478, 0.8166, and 0.9819, respectively. The overall sensitivity, specificity and AUC of the sROC curve for overall liquid biopsy in detecting PC were 0.80 (95%CI 0.77–0.82), 0.89 (95%CI 0.87–0.91) and 0.9478, respectively.

Conclusion:

This meta-analysis confirmed that liquid biopsy had high diagnostic value in detecting PC. In ctDNA, CTCs and exosomes these 3 subgroups, exosomes showed highest sensitivity and specificity.
Association of 4-limb systolic blood pressure heterogeneity with peripheral artery disease and left ventricular mass index
Authors: Chang Ching-Tang , Lee Wen-Hsien , Hsu Po-Chao , Chen Ying-Chih , Lee Meng-Kuang , Tsai Wei-Chung , Chu Chun-Yuan , Lee Chee-Siong , Lin Tsung-Hsien , Voon Wen-Chol , Su Ho-Ming
Published: January 2020

A large interarm and interleg systolic blood pressure (SBP) difference and ankle-brachial index (ABI) <0.9 were associated with peripheral artery disease and left ventricular hypertrophy. These 3 parameters were derived from 4-limb SBP data. However, there is no study to assess clinical significance of SBP heterogeneity in 4 limbs. The aim of this study was to evaluate the association of 4-limb SBP standard deviation (SD) with peripheral vascular parameters and echocardiographic data in patients with or without clinical findings of peripheral artery disease.

A total of 1240 patients were included, of whom 1020 had no clinical evidence of overt peripheral artery disease. The 4-limb blood pressures, brachial-ankle pulse wave velocity, and ABI were measured simultaneously by an ABI-form device.

In the multivariable linear regression analysis, increased left ventricular mass index (LVMI), ABI < 0.9, interarm SBP difference >10 mm Hg, and interleg SBP difference >15 mm Hg (P ≤ .030) were associated with increased 4-limb SBP SD. Additionally, a subgroup multivariable linear regression analysis in 1020 patients without ABI < 0.9, interarm SBP difference >10 mm Hg, and interleg SBP difference >15 mm Hg found 4-limb SBP SD still had a positive correlation with LVMI (P < .001).

In addition to significant association with ABI < 0.9, interarm SBP difference >10 mm Hg, and interleg SBP difference >15 mm Hg, 4-limb SBP SD was positively correlated with LVMI in the multivariable linear regression analysis in all study patients. Furthermore, in the subgroup of patients without clinical evidence of peripheral artery disease, 4-limb SBP SD still had a positive correlation with LVMI. Hence, assessment of 4-limb SBP heterogeneity is useful in identification of high-risk group of peripheral artery disease and/or increased LVMI, irrespective of the presence of overt peripheral artery disease.
Stretta procedure versus proton pump inhibitors for the treatment of nonerosive reflux disease
Authors: He Suyu , Xu Fei , Xiong Xin , Wang Hui , Cao Lipeng , Liang Ninglin , Wang Hanmei , Jing Xiaojuan , Liu Tianyu
Published: January 2020

To compare the Stretta procedure with proton pump inhibitors for the treatment of nonerosive reflux disease (NERD).

From July 2018 to April 2019, patients diagnosed with NERD and referred for treatment were enrolled. They were treated with either Stretta procedure or proton pump inhibitor (PPI) medication and followed-up for 6 months. The symptom control, quality of life, lower esophageal sphincter (LES) pressure, 24-hour pH parameters, PPI usage and satisfaction rate were evaluated. The complications were assessed. The outcomes of the 2 groups were analyzed and compared.

Twenty-eight patients in the Stretta group and 21 patients in the PPI group completed the 6-month follow-up. No severe adverse events occurred in both groups. Both interventions were effective in improvement of symptom and quality of life. The symptom score improvement was significantly superior in the Stretta group compared to the PPI group (6.3 ± 3.4 vs 8.5 ± 4.1, P = .03). LES pressure increased significantly in the Stretta group compared to the PPI group (14.2 ± 4.4 mm Hg vs 10.0 ± 4.0 mm Hg, P < .01). Although both interventions improved 24-hour pH parameters, including number of acid episodes (P = .27), acid exposure time (P = .39), and DeMeester score (P = .28), no difference was found between the 2 groups. Complete PPI cessation rate (82% vs 52%, P = .03) as well as satisfaction rate (89% vs 57%, P = .02) was much higher in Stretta group than those in the PPI group

The Stretta procedure was safe and effective in the short term for the management of NERD. The Stretta procedure resulted in higher LES pressure and achieved better improvement of symptom control and PPI cessation than did PPI in the short term.
Surgical treatments for post-intubation laryngotracheal stenosis in patients with central nervous system injuries
Authors: Tsai Stella Chin-Shaw , Lin Frank Cheau-Feng
Published: January 2020

Post-intubation laryngotracheal stenosis is a complication commonly encountered in patients with central nervous system (CNS) injuries, often preventing decannulation. To date, no data is available in the literature focusing on this issue. Our objective was to describe surgical treatments for laryngotracheal stenosis and discuss factors associated with successful decannulation in this group of patients.

Medical records of patients with CNS injury who received tracheal surgeries at our institution between 2009 and 2016 were retrospectively collected and analyzed.

Data on 124 surgeries in 62 patients with CNS injury were collected. The total complication rate was 20.9% with no surgical mortality. The decannulation success rate was 85.5%. Argon laser surgeries (48), diode laser surgeries (22), tracheal resection and reconstructions (R&R) (9), and tracheal T-tube placements (67) were performed. The average times from the first bronchoscopy check up to surgery and surgery to decannulation were 0.7 and 8.2 months, accordingly. The mean post-decannulation follow-up time was 13.5 months. A shift from the use of rigid bronchoscopy in the initial surgeries to laryngeal mask in the latter surgeries yielded an average decrease of 3 days in hospital length of stay (LOS). A change from initial rigid bronchoscopic core out procedures and argon laser to interventional flexible bronchoscopic resections with diode laser also decreased LOS significantly.

Surgical treatments for patients with CNS injury and laryngotracheal stenosis can be safely performed with low mortality, acceptable complications, and a high decannulation success rate. The majority of patients with laryngotracheal stenosis can be managed with laser endoscopic surgeries, though tracheal R&R might still be required in selected cases. The use of laryngeal mask to secure the airway and diode laser in the intra-luminal resections improved the surgical outcome and was therefore recommended for these patients suffering from post-intubation laryngotracheal stenosis.
The prevalence of first-onset temporomandibular disorder in low back pain and associated risk factors
Authors: Lee Kuei-Chen , Wu Yung-Tsan , Chien Wu-Chien , Chung Chi-Hsiang , Chen Liang-Cheng , Shieh Yi-Shing
Published: January 2020

The coexistence of low back pain (LBP) and temporomandibular disorder (TMD) has often been noted clinically. However, studies of the association between these two conditions involving a large population with longitudinal evidences are lacking. Therefore, the study aimed to investigate the association between LBP and TMD in a nationwide-matched cohort population with a 15-year follow-up.

Data of 65,121 patients newly diagnosed with LBP were analyzed, along with those of 195,363 (1:3) sex- and age-matched controls. Multivariate Cox regression analysis was used to determine TMD risk between the LBP and non-LBP groups. Kaplan-Meier method was used for determining the cumulative risk of first-onset TMD between groups, with a 15-year follow-up.

The LBP group was more likely to develop first-onset TMD (adjusted hazards ratio (HR) = 1.561, P < .001), after adjusting for demographic variables and comorbidities. The risk factors for TMD were LBP, young age, higher insured premium, and osteoporosis. In the subgroup analysis, the LBP group had a higher risk of TMD than the non-LBP group in all stratifications.

LBP is the risk factor contributing to the development of first-onset TMD. Therefore, clinicians should be reminded to manage LBP disorders concurrently when treating TMD.
The association between Helicobacter pylori infection with overweight/obesity
Authors: Chen Jialiang , Ma Jie , Liu Xinyuan , Duan Shaojie , Liang Ning , Yao Shukun
Published: January 2020

Background:

Obesity has become a serious public health issue. The role of Helicobacter pylori (H. pylori) infection in overweight or obesity is inconsistent and controversial. It is very necessary to conduct a systematic review and meta-analysis for determining whether H. pylori infection was associated with risk of overweight/obesity.

Methods:

Four databases (PubMed, Web of Science, The Cochrane Library, and EMBASE) will be searched from the inception to January 15, 2019. All observational studies (including cross-sectional, case-control or longitudinal studies) reporting the association between H. pylori infection and overweight/obesity will be included. The primary outcome was the presence and incidence of overweight/obesity in conjunction with H. pylori infection. Study selection, data extraction, and assessment of quality will be conducted independently by 2 reviewers. RevMan 5.3 and STATA 14.0 software will be used for data synthesis.

Results:

The results of this study will provide a better understanding of the role of H. pylori infection in overweight/obesity among overall population.

Conclusion:

This systematic review and meta-analysis will generate evidence of the association between H. pylori infection and overweight/obesity, and the findings of this study will be published in a peer-reviewed journal.

PROSPERO registration number: CRD42019121939
To evaluate the efficacy and safety of different kinds of PDE5-Is with tamsulosin as a medical therapy for LUTS secondary to benign prostatic hyperplasia
Authors: Ma Chengquan , Zhang Jianzhong , Cai Zhonglin , Li Hongjun
Published: January 2020

Background:

Drug therapy for lower urinary tract symptoms (LUTS) secondary to benign prostate hyperplasia (BPH) is a major and popular method. However, the therapeutic strategy is still not clear enough up to now. The purpose of this study was to compare the relative safety and efficacy of different types of phosphodiesterase type 5 inhibitors (PDE5-Is) with tamsulosin for the treatment of LUTS secondary to BPH.

Methods:

Databases including PubMed, OpenGrey, Embase, Cochrane Library, and Web of Science will be searched to identify qualified studies. We will use the Stata version 13.0 to conduct the network meta-analysis (NMA) with a random or fixed effects model of Bayesian framework. International prostate symptom score (IPSS), maximum urinary flow fate (Qmax) and their credible intervals (CI) will be used to compare every medical intervention with the efficacy and safety, including sildenafil plus tamsulosin, tadalafil plus tamsulosin, vardenafil plus tamsulosin. And the ranking of probability of different interventions will be estimated by comparing the surface under the cumulative ranking curve (SUCRA).

Results:

A high quality-synthesis of the current evidence for comparing with different doses or types of PDE5-Is combined with tamsulosin to the treatment of LUTS secondary to BPH will be provided.

Conclusions:

This NMA and systematic review will generate evidence to help choose the best combination for treatment of LUTS secondary to BPH.

PROSPERO registration number: PROSPERO CRD 42019139062
Fully covered self-expandable metal stent with an anti-migration system vs plastic stent for distal biliary obstruction caused by borderline resectable pancreatic cancer
Authors: Tamura Takashi , Yamaue Hiroki , Itonaga Masahiro , Kawaji Yuki , Nuta Junya , Hatamaru Keiichi , Yamashita Yasunobu , Kitahata Yuji , Miyazawa Motoki , Hirono Seiko , Okada Ken-ichi , Kawai Manabu , Shimokawa Toshio , Kitano Masayuki
Published: January 2020

Background and aim:

Biliary obstruction can impair the effectiveness of neo-adjuvant chemotherapy. This study was designed to compare biliary stenting with covered self-expandable metal stents (FCSEMS) and plastic stents (PS) in patients with biliary obstruction caused by borderline resectable pancreatic cancer (BRPC) who were undergoing neo-adjuvant chemotherapy during preoperative biliary drainage.

Methods:

This single-center, comparative, randomized, superiority study was designed to compare FCSEMS with PS for drainage of biliary obstruction of BRPC. Twenty two eligible patients providing informed consent will be randomized 1:1 by computer to either FCSEMS or PS for endoscopic retrograde biliary drainage (ERBD). All subsequent clinical interventions, including crossover to alternative procedures, will be at the discretion of the treating physician based on standard clinical care. The primary outcomes will be the rates and causes of stent dysfunction during preoperative biliary drainage. Other outcomes include time required for ERBD, adverse events related to ERBD, period from ERBD to surgery, percentage of patients able to undergo surgery, operation time, intraoperative bleeding volume, postoperative adverse events, and postoperative hospitalization. Subjects, treating clinicians, and outcome assessors will not be blinded to assignment.

Discussion:

This study is intended to determine whether FCSEMS or PS is the better biliary stent for ERBD for management of patients with biliary obstruction of BRPC, a common clinical dilemma that has not yet been investigated in randomized trials.

Trials registration:

UMIN-CTR, Identifier: UMIN000030473. Registered July 10, 2017, Wakayama Medical University Hospital.