bluuebunny/crossref_metadata_2025 huggingface dataset:
A new approach for diagnosing hematological malignancies using monocytosis workflow optimization and abnormal lymphocyte/blast flag of Sysmex XN series of blood count analyzers
Authors: Kocaturk Evin , Kusku Kiraz Zeynep , Uskudar Teke Hava , Demir Sukru Saygin , Alatas Ibrahim Ozkan
Published: July 2020

Introduction

Monocytosis Workflow Optimization rule set has been developed by using mono‐dysplasia‐score to determine reactive monocytosis and prevent unnecessary blood smear of these patients and for detection of chronic myelomonocytic leukemia cases during complete blood count. In our study, we aimed to examine the contribution of Monocytosis Workflow Optimization rule set.

Methods

Adult patients with monocyte count ≥1.0 103/µL and monocyte percentage ≥10% were included in our study. Blood smears were made from the samples in our laboratory. These smears were examined and patients were divided into two groups as reactive monocytosis or hematological malignancy. The groups were compared in terms of Monocytosis Workflow Optimization rule set and device flags.

Results

Twenty‐one patients had hematological malignancies of 155 patients who were included in our study. Monocytosis Workflow Optimization rule set suggested performing blood smear in 19 of the patients with hematological malignancy, and evaluated two patients as reactive monocytosis with 90.5% sensitivity and 76.9% specificity. There was an “abnormal lymphocyte/ blast” flag in 90.5% of patients with hematological malignancies and in patients whose Monocytosis Workflow Optimization rule set defined as reactive monocytosis and it was found that sensitivity and negative predictive value reached 100%.

Conclusion

Automated validation support systems and softwares developed especially for these systems make it possible to classify patients with their non‐specific findings, as a result both contributing to the reduction of laboratory workload and costs and assisting laboratory specialists and clinicians with adding value to laboratory results.
Lactic acid bacteria feeding reversed the malformed eye structures and ameliorated gut microbiota profiles of Drosophila melanogaster Alzheimer’s disease model
Authors: Liu G. , Tan F.H.-P. , Lau S.-Y.A. , Jaafar M.H. , Chung F.Y.-L. , Azzam G. , Liong M.-T. , Li Y.
Published: July 2020

Aims

To utilize transgenic GMR-Aβ42 Drosophila melanogaster as a model to evaluate potential Alzheimer’s disease (AD)-reversal effects via the administration of lactic acid bacteria (LAB) strains, and associations of LAB with changes in gut microbiota profiles.

Methods and Results

Wild-type flies (Oregon-R) were crossed with glass multimer reporter-GAL4 (GMR-GAL4) to produce GMR-OreR (Control), while UAS-Aβ42 (#33769) were crossed with GMR-GAL4 to produce transgenic Drosophila line that expressed Aβ42 (GMR-Aβ42). Feed containing seven different LAB strains (Lactobacillus paracasei 0291, Lactobacillus helveticus 1515, Lactobacillus reuteri 30242, L. reuteri 8513d, Lactobacillus fermentum 8312, Lactobacillus casei Y, Lactobacillus sakei Probio65) were given to GMR-Aβ42 respectively, while feed without LAB strains were given to control and transgenic GMR-Aβ42.nf Drosophila lines. The morphology of the eyes was viewed with scanning electron microscopy (SEM). The changes in gut microbiota profiles associated with LAB were analysed using 16s high throughput sequencing. Malformation of eye structures in transgenic GMR-Aβ42 Drosophila were reversed upon the administration of LAB strains, with more prevalent effects from L. sakei Probio65 and L. paracasei 0291. The GMR-Aβ42.nf group showed dominance of Wolbachia in the gut, a genus that was almost absent in the normal control group (P < 0·05). The administration of L. sakei Probio65 and L. paracasei 0291 reduced the abundance of Wolbachia accompanied by increased abundance of Stenotrophomonas and Acetobacter (P < 0·05), resembling the microbial profile of the control group.

Conclusions

Lactobacillus sakei Probio65 and Lactobacillus  paracasei 0291 have more prominent effects in reversing malformed eye of transgenic GMR-Aβ42 Drosophila, and reducing the abundance of Wolbachia accompanied by an increased abundance of Stenotrophomonas and Acetobacter.

Significance and Impact of the Study

Potentials of LAB to prevent and/or alleviate the onset and pathogenesis of neurodegenerative diseases such as AD, supporting brain health strategies along the gut–brain axis.
Do Supply Chain Exemplars Have More or Less Dependent Suppliers?
Authors: Schwieterman Matthew A. , Miller Jason , Knemeyer A. Michael , Croxton Keely L.
Published: July 2020

Extant literature offers differing perspectives regarding whether buying firms benefit from having highly dependent suppliers. One view is that buyers benefit from having dependent suppliers as this provides buyers the ability to dictate terms in the relationship. An alternative perspective is that buyers are worse off from having dependent suppliers in that this dependence can lead to conditions that harm value creation. In this manuscript, supply chain management theory is extended by evaluating these differing predictions. This is accomplished by analyzing a database from Bloomberg of objective, secondary data for more than 3,000 supplier relationships for 49 firms independently recognized as possessing exemplar supply chains and 530 of these firms’ largest industry rivals based on GICS industry codes. These data are utilized to develop a portfolio‐level measure of buyer–supplier dependence that incorporates the bilateral nature of dependence. The findings indicate that, relative to their industry rivals, firms with exemplar supply chains have suppliers with a lower level of dependency. These results contribute to theory, inform management practice, and suggest avenues for future research.
From short‐term blood pressure variability to atherosclerosis: Relative roles of vascular stiffness and endothelial dysfunction
Authors: Tatasciore Alfonso , Di Nicola Marta , Tommasi Roberto , Santarelli Francesco , Palombo Carlo , Parati Gianfranco , De Caterina Raffaele
Published: July 2020

Both arterial blood pressure (BP) average levels and short‐term BP variability (BPV) relate to hypertension‐mediated organ damage, in particular increased carotid artery intima‐media thickness (IMT) and carotid‐femoral pulse wave velocity (PWV). Endothelial dysfunction possibly mediates such damage. The authors aimed at further investigating such role in hypertensive patients. In 189 recently diagnosed, untreated hypertensive patients the authors evaluated, in a cross‐sectional design, the relationships of BP average levels and short‐term systolic (S) BPV (standard deviation of awake SBP or of 24‐hour‐weighted SBP) with IMT and PWV, and how much these relationships are explained by endothelial function parameters—brachial artery flow‐mediated dilation (FMD) and digital reactive hyperemia index (RHI). Multivariable models assessed the strength of these relationships to derive a plausible pathogenetic sequence. Both average SBP values and our measures of SBPV were significantly related to IMT (24‐hour mean SBP: r = .156, P = .034; 24‐hour‐weighted SBPV: r = .157, P = .033) and to PWV (24‐hour mean SBP: r = .179, P = .015; 24‐hour‐weighted SBPV: r = .175; P = .018), but only poorly related to FMD or RHI (P > .05 for all). At univariable regression analysis, FMD and RHI were both related to IMT, (P < .001), but not to PWV. When FMD and RHI were added to average SBP and SBPV parameters in a multivariable model, both significantly (P < .005) contributed to predict IMT, but not PWV. Thus, endothelial dysfunction relates to IMT independently of BP parameters, but appears to play a minor role in the association between BP variability‐related variables and arterial stiffening.
A three‐tiered integrative analysis of transcriptional data reveals the shared pathways related to heart failure from different aetiologies
Authors: Jiang Zhenhong , Guo Ninghong , Hong Kui
Published: July 2020

Heart failure (HF) is the end stage of most heart disease cases and can be initiated from multiple aetiologies. However, whether the molecular basis of HF has a commonality between different aetiologies has not been elucidated. To address this lack, we performed a three‐tiered analysis by integrating transcriptional data and pathway information to explore the commonalities of HF from different aetiologies. First, through differential expression analysis, we obtained 111 genes that were frequently differentially expressed in HF from 11 different aetiologies. Several genes, such as NPPA and NPPB, are early and accurate biomarkers for HF. We also provided candidates for further experimental verification, such as SERPINA3 and STAT4. Then, using gene set enrichment analysis, we successfully identified 19 frequently dysregulated pathways. In particular, we found that pathways related to immune system signalling, the extracellular matrix and metabolism were critical in the development of HF. Finally, we successfully acquired 241 regulatory relationships between 64 transcriptional factors (TFs) and 17 frequently dysregulated pathways by integrating a regulatory network, and some of the identified TFs have already been proven to play important roles in HF. Taken together, the three‐tiered analysis of HF provided a systems biology perspective on HF and emphasized the molecular commonality of HF from different aetiologies.
Effect of icosapent ethyl on susceptibility to ventricular arrhythmias in postinfarcted rat hearts: Role of GPR120‐mediated connexin43 phosphorylation
Authors: Chen Wei‐Ting , Chen Syue‐yi , Wu De‐Wei , Lee Cheng‐Che , Lee Tsung‐Ming
Published: July 2020

The ω‐3 fatty acids exert as an antioxidant via the G protein‐coupled receptor 120 (GPR120). Icosapent ethyl, a purified eicosapentaenoic acid, showed a marked reduction in sudden cardiac death. Connexin43 is sensitive to redox status. We assessed whether icosapent ethyl attenuates fatal arrhythmias after myocardial infarction, a status of high oxidative stress, through increased connexin43 expression and whether the GPR120 signalling is involved in the protection. Male Wistar rats after ligating coronary artery were assigned to either vehicle or icosapent ethyl for 4 weeks. The postinfarction period was associated with increased oxidative‐nitrosative stress. In concert, myocardial connexin43 levels revealed a significant decrease in vehicle‐treated infarcted rats compared with sham. These changes of oxidative‐nitrosative stress and connexin43 levels were blunted after icosapent ethyl administration. Provocative arrhythmias in the infarcted rats treated with icosapent ethyl were significantly improved than vehicle. Icosapent ethyl significantly increased GPR120 compared to vehicle after infarction. The effects of icosapent ethyl on superoxide and connexin43 were similar to GPR120 agonist GW9508. Besides, the effects of icosapent ethyl on oxidative‐nitrosative stress and connexin43 phosphorylation were abolished by administering AH‐7614, an inhibitor of GPR120. SIN‐1 abolished the Cx43 phosphorylation of icosapent ethyl without affecting GPR120 levels. Taken together, chronic use of icosapent ethyl after infarction is associated with up‐regulation of connexin43 phosphorylation through a GPR120‐dependent antioxidant pathway and thus plays a beneficial effect on arrhythmogenic response to programmed electrical stimulation.
PD‐1 mRNA expression in peripheral blood mononuclear cells as a biomarker for different stages of primary gouty arthritis
Authors: Su Jing , Zhang Xuefang , Zhao Qing , Guo Zhaodi , Wu Jianxiong , Chen Guoqiang , Liang Qianxin , Chen Zhixiang , He Zhiliang , Cai Xiuping , Xie Manlin , Zheng Lei , Zhao Kewei
Published: July 2020

There is currently a lack of biomarkers to assist the diagnosis and prediction of primary gouty arthritis (PG). Therefore, we evaluated the clinical value of programmed cell death protein 1 (PD‐1) mRNA expression in peripheral blood mononuclear cells (PBMCs) of patients with PG. This study included 36 patients with acute phase PG (APPG), 48 with non‐acute phase PG (NAPPG), 42 with asymptomatic hyperuricemia (AH) and 79 normal controls (NCs). PD‐1 mRNA expression levels were detected by qRT‐PCR. PD‐1 mRNA expression was statistically analysed by ANOVA or t tests, while correlations between PD‐1 mRNA and clinical variables were assessed using Pearson correlation tests. Receiver operator characteristic (ROC) curve analysis was used to evaluate the diagnostic value of PD‐1 in different PG stages. PD‐1 mRNA expression was significantly lower in patients with APPG than that in NAPPG, AH and NCs (P < 0.01). Correlation analysis revealed that PD‐1 mRNA levels correlated negatively with T‐score (r = −0.209, P < 0.01). ROC curve analysis showed that serum uric acid (SUA), PD‐1 mRNA and both combined displayed higher diagnostic value in patients with PG, NAPPG and APPG compared to that in NCs and patients with non‐PG arthritis (NPG). Moreover, ROC curve analysis showed that SUA and PD‐1 mRNA had good diagnostic value in APPG, with the greatest diagnostic power when combined. PD‐1 mRNA could be a clinical auxiliary diagnostic biomarker for APPG, and the combined use of PD‐1 mRNA and SUA is better than that of SUA alone.
Estimation of time parameter proportionality ratios in large catchments: Case study of the Modder‐Riet River Catchment, South Africa
Authors: Allnutt Christopher E. , Gericke Ockert J. , Pietersen Jaco P. J.
Published: July 2020

Catchment response time parameters, for example, the time of concentration (TC), lag time (TL), and time to peak (TP) are fundamental to event‐based design flood estimation in ungauged catchments. Hydrological literature often fails to clearly differentiate between the seven different time parameter definitions interchangeably used in practice and consequently, proportionality ratios are commonly applied. This article aims to investigate and establish the suitability of the currently recommended time parameter definitions and proportionality ratios for small catchments in larger sub‐catchments exceeding 50 km2 by using an automated hyetograph–hydrograph analysis tool. The time parameter estimates proved to be highly variable, but the average time parameter proportionality ratios proved to be less significant and in all the sub‐catchments, it was confirmed that the average proportionality ratios equal unity, that is, TC ≈ TL ≈ TP. Hence, the currently recommended TC:TL proportionality ratios of 1.417 and 1.667, are respectively not applicable at larger catchment levels. The establishment of unbiased empirical time parameter equations would remain an international challenge if the misinterpretation of the different time parameter definitions and use of incorrect time parameter proportionality ratios continue; hence, the results from this study, as well as others, should be considered for further investigation and/or implementation.
Impacts of urban drainage systems on stormwater hydrology: Rocky Branch Watershed, Columbia, South Carolina
Authors: Ress Logan D. , Hung Chen‐Ling J. , James L. Allan
Published: July 2020

Increases in impervious surfaces and land‐use changes associated with urbanization have long been the focus of urban hydrological research. However, studies and calculations that consider impervious surfaces alone do not encompass all factors that influence urban hydrologic response, as alternative urban structures may have a substantial effect on stormflow. This study examines several descriptors to improve estimations of hydrologic impacts of urbanization in small watersheds. Configurations of drainage densities that include storm sewers were computed for the highly urbanized Rocky Branch Watershed. Storm sewer configurations resulted in an approximate tripling of the drainage density. In addition, rainfall and stormflow data were analyzed to compare the hydrologic response of two subcatchments with varying percentages of impervious areas and drainage densities. The subcatchment with a higher percentage of impervious area produced significantly (p < .01) higher runoff volumes with an average runoff coefficient of 0.446, while the subcatchment with higher storm sewer densities displayed significantly shorter lag times of 9 min. In this case, the percentage of impervious area increased the volume of runoff but, storm sewer densities accelerated hydrologic responses, suggesting that hydrologically relevant metrics should be considered to accurate assess flood risk alternatives.
National Geriatric Network Rapidly Addresses Trainee Telehealth Needs in Response to COVID‐19
Authors: Nearing Kathryn A. , Lum Hillary D. , Dang Stuti , Powers Becky , McLaren Jaye , Gately Megan , Hung William , Moo Lauren
Published: July 2020

BACKGROUND/OBJECTIVES

Coronavirus disease 2019 (COVID‐19) has pushed many geriatric healthcare providers to attempt video visits for the first time. Although the Veterans Health Administration (VA) is a pioneer in telemedicine, rapid shifts to nearly exclusive use of telehealth for healthcare delivery and changes regarding trainee engagement in telehealth served as the impetus for rapidly assessing telehealth training needs.

DESIGN

National needs assessment (online survey) of associated health trainees and medical fellows affiliated with Geriatric Research Education and Clinical Centers (GRECCs).

SETTING

National GRECC network ‐‐ 20 VA centers of excellence focused on supporting Veterans as they age. Each GRECC is affiliated with a school of medicine at a major university.

PARTICIPANTS

Trainees (n = 89) representing 12 disciplines.

RESULTS

Two‐thirds of participants had received some telehealth training. However, most had never done a video‐to‐home visit, and, regardless of telehealth experience, they reported low confidence. Based on open‐ended questions exploring training needs, educational resources were rapidly developed and disseminated.

INTERVENTION

Within 1 week of the assessment, a nuts‐and‐bolts guide regarding remote access, technology requirements, video‐conferencing platforms, and managing emergencies was sent to the national network of GRECC associate directors for education for dissemination among discipline‐specific training directors at their sites. This resource was subsequently submitted to the national VA COVID Strong Practices SharePoint site. An interdisciplinary team of geriatric specialists with extensive video‐to‐home experience also organized a national webinar that peaked at just over 700 participants. GRECC Connect, a network of geriatric specialty teams funded to improve care access for rural older veterans using telehealth and associated health training programs at each GRECC facilitated rapid development and dissemination of both resources.

CONCLUSION

We quickly identified and responded to telehealth training needs of geriatrics trainees to optimize care for rural older adults as part of a rapid response to COVID‐19. Although the webinar and nuts‐and‐bolts resources were developed within the VA context, they have demonstrated high demand and broader applicability. Results should continue to inform curriculum development efforts to address telehealth training gaps within and outside the VA.
Market Power and Patent Strategies: Evidence from Renaissance Venice
Authors: Comino Stefano , Galasso Alberto , Graziano Clara
Published: July 2020

This paper exploits the introduction of the first regularized patent system, which appeared in the Venetian Republic in 1474, to examine the factors shaping inventors’ propensity to use a new form of intellectual property. We combine detailed information on craft guilds and patents in Renaissance Venice and show a negative association between patenting activity and guild statutory norms that strongly restricted entry and price competition. Our analysis shows that the heterogeneity in patenting activity documented by the industrial organization literature is not a special feature of modern technologies, but is rather a persistent phenomenon affected by market power.
Head Repositioning during Neurointerventional Procedures to Optimize Biplanar Imaging
Authors: Dowlati Ehsan , Zhou Tianzan , Stewart Jeffrey , Felbaum Daniel R. , Liu Ai‐Hsi , Mai Jeffrey C. , Armonda Rocco A.
Published: July 2020

BACKGROUND AND PURPOSE

Head positioning is an important aspect for surgical planning in any cranial procedure. However, in neurointerventional cases, this is an afterthought due to advances in biplane imaging. We aim to present that the concept of head positioning may be applied to neurointerventional procedures to obtain optimal working projections to aide in the treatment of neurovascular pathology.

METHODS

The operative log of the senior author was reviewed between 2016 and 2019. Seventeen patients were identified who required readjustment of head position to allow for ideal working projection during treatment. The reports and imaging of these patients were reviewed and categorized based on repositioning adjustments applied.

RESULTS

Three specific head adjustments were performed to obtain working projections using biplanar angiography: head flexed position, head extended position, or extended‐tilt positioning. All patients underwent endovascular coiling treatment for a variety of intracranial aneurysms.

CONCLUSION

In select cases, ideal views of vascular pathology can be difficult to obtain due to limitations of biplane rotation or patient‐specific anatomy. Simple maneuvers in head positioning can be done to achieve better working projections for optimized endovascular treatment.
The effect of botulinum toxin A on patients with persistent idiopathic dentoalveolar pain—A systematic review
Authors: Dawson Andreas , Dawson Jenny , Ernberg Malin
Published: July 2020

Background

It has been suggested that botulinum toxin A (BONT‐A) is a safe and effective treatment in relieving pain in patients with persistent idiopathic dentoalveolar pain (PIDP).

Objectives

This study aimed to systematically evaluate all the available studies investigating the pain‐relieving effects of BONT‐A in patients with PIDP.

Methods

A systematic search with specific search terms was made in PubMed, Web of Science and Scopus. Two authors screened titles and abstracts and selected eligible studies for inclusion in the systematic review. The quality of the studies was evaluated by the 12 items Quality Assessment Tool for Observational studies (Pre‐Post) Studies with No Control Group, and the level of evidence was assessed according to GRADE.

Results

Three observational studies of 3695 identified were included (445 overlapping studies; 3247 excluded studies). All studies were uncontrolled observational studies investigating the pain‐relieving effect of BONT‐A in patients with PIDP. The included studies had a fair quality (moderate risk of bias) and insufficient level of evidence. The pain reducing effect by BONT‐A injections was in average 50% or more in two studies, in one study 3 out of 4 patients became almost pain free.

Conclusions

This systematic review shows that presently the level of scientific evidence is insufficient to evaluate the pain‐relieving effect of BONT‐A injections in patients with PIDP. There are indications that BONT‐A injections could be a possible management option for patients with PIDP that seems to be safe and with few adverse events. There is a need for well‐designed placebo‐controlled, double‐blind RCTs.
Maryland dentists' perceptions and attitudes toward dental therapy
Authors: Davis Anna L. , Zare Hossein , McCleary Rachael , Kanwar Oshin , Tolbert Elliott , Gaskin Darrell J.
Published: July 2020

Objectives

To learn dentists' perceptions, attitudes, and concerns about the problems of access to oral health care for low income and rural Marylanders and to ascertain whether the dentists believe dental therapy is a viable solution.

Methods

We conducted three focus group discussions of 27 dentists during August and September 2018 in three locations in urban and rural areas of Maryland.

Results

Focus group participants felt that problems with access to dental care for low income and rural Marylander were not due to a shortage of dental providers. They believed there are more than enough dentists in the state. Access problems in Maryland are due in large part to inadequate insurance coverage and low oral health literacy. With the exception of one participant, the dentists would not use dental therapists in their practices to expand access.

Conclusions

Maryland dentists in our focus group strongly oppose the use of dental therapists to address the state's unmet oral health care needs. Any effort to expand the state's dental workforce using dental therapists must address Maryland dentists' concerns and opinions.
Treatment outcomes in hepatitis C virus genotype 1a infected patients with and without baseline NS5A resistance‐associated substitutions
Authors: Dietz Julia , Vermehren Johannes , Matschenz Katrin , Buggisch Peter , Klinker Hartwig , Schulze zur Wiesch Julian , Hinrichsen Holger , Peiffer Kai‐Henrik , Graf Christiana , Discher Thomas , Trauth Janina , Schattenberg Jörn M. , Piecha Felix , Mauss Stefan , Niederau Claus , Müller Tobias , Neumann‐Haefelin Christoph , Berg Christoph P. , Zeuzem Stefan , Sarrazin Christoph ,   European HCV Resistance Study Group
Published: July 2020

Background & Aims

The presence of baseline resistance‐associated substitutions (RASs) reduced sustained virologic response (SVR) rates in chronic hepatitis C virus (HCV) genotype 1a infected patients treated with Elbasvir/Grazoprevir (EBR/GZR). This study aimed to evaluate the frequency of NS5A RASs and treatment outcomes in patients for whom EBR/GZR was intended.

Methods

We sequenced NS5A in 832 samples from German genotype1a‐infected DAA‐naïve patients population‐based, which were collected in the European Resistance Database. Treatment outcomes and clinical parameters were evaluated in 519 of such patients retrospectively.

Results

Overall, 6.5% of patients harboured EBR‐specific NS5A RASs at baseline, including Q30H/R (3.3%), L31M (1.8%), Y93H (1.6%) and other individual variants. Antiviral treatment, including EBR/GZR, was initiated in 88% of the patients. In the absence of RASs, the majority of patients received EBR/GZR for 12 weeks (57%) and the SVR rate was 97% compared to 99% SVR achieved using other DAA regimens (LDV/SOF ± RBV, G/P, PrOD + RBV, VEL/SOF). Various regimens were used in the presence of RASs and SVR rates were high following treatment with LDV/SOF (100%), G/P (83%), PrOD/RBV (100%), VEL/SOF (100%), SMV/SOF (100%) and EBR/GZR + RBV for 16 weeks (100%). However, two patients received EBR/GZR for 16 weeks without RBV and one relapsed.

Conclusions

EBR/GZR treatment with or without RBV for 12 or 16 weeks according to a baseline RAS analysis was highly effective with ≥97% SVR in patients with genotype 1a. EBR/GZR without RBV should be avoided in patients with RASs. High SVR rates were also achieved using other 8‐ or 12‐week DAA regimens.
Breastfeeding promotion on Twitter: A social network and content analysis approach
Authors: Moukarzel Sara , Rehm Martin , Daly Alan J.
Published: July 2020

The importance of breastfeeding for maternal and infant health is well‐established, yet complex and intertwined sociocultural barriers contribute to suboptimal breastfeeding rates in most countries. Large‐scale campaigns for evidence dissemination and promotion through targeted interventions on social media may help overcome some of these barriers. To date, most breastfeeding research on social media only focuses on content analysis, and there remains limited knowledge about the social networks of online communities (who interacts with whom), influencers in the breastfeeding space and the diffusion of evidence‐based knowledge. This study, grounded in social network theory, aims to better understand the breastfeeding communication landscape on Twitter including determining the presence of a breastfeeding network, communities and key influencers. Further, we characterize influencer interactions, roles and the content being shared. The study revealed an overall breastfeeding social network of 3,798 unique individuals (users) and 3,972 tweets with commonly used hashtags (e.g., #breastfeeding and #normalizebreastfeeding). Around one third of users (n = 1,324, 34%) exchanged pornographic content (PC) that sexualized breastfeeding. The non‐PC network (n = 2,474 users) formed 144 unique communities, and content flowing within the network was disproportionately influenced by 59 key influencers. However, these influencers had mostly inward‐oriented interaction (% composition, E‐I index: 47% professionals, −0.18; 41% interested citizens, −0.67; 12% companies, −0.18), limiting opportunities for evidence‐based dissemination to the lay public. Although more tweets about peer‐reviewed research findings were sent compared with tweets about nonevidence‐based lay recommendations, our findings suggest that it is the lay public who often communicated findings, which may be overcome through a targeted social network‐based intervention.
Overexpression of RRM2 is related to poor prognosis in oral squamous cell carcinoma
Authors: Wang Shuo , Wang Xiao‐Long , Wu Zhi‐Zhong , Yang Qi‐Chao , Xiong Hong‐Gang , Xiao Yao , Li Hao , Sun Zhi‐Jun
Published: July 2020

Objectives

Ribonucleotide reductase M2 (RRM2) is a rate‐limiting enzyme involved in DNA repair and synthesis. This study aimed to investigate the expression level, clinicopathological significance, and prognostic value of RRM2 in oral squamous cell carcinoma (OSCC).

Materials and methods

Human OSCC tissue microarrays were used to detect the expression of RRM2, cancer stem cell (CSC) markers CD44 and aldehyde dehydrogenase 1 (ALDH1), and the epithelial–mesenchymal transition (EMT) marker Slug. The correlation of RRM2 expression with clinicopathological parameters was evaluated. The effects of RRM2 on cell proliferation, migration, and apoptosis were investigated.

Results

Compared with normal and dysplastic tissues, the expression of RRM2 in human primary OSCC was significantly increased, and its overexpression was correlated with advanced pathological grade. The overall survival rate of patients with high RRM2 expression was lower than that of patients with low RRM2 expression. The overexpression of RRM2 was significantly associated with OSCC recurrence, and its overexpression was correlated with the CSC markers CD44 and ALDH1 and the EMT marker Slug. The expression of RRM2 promotes the proliferation and migration of human OSCC cells and inhibits apoptosis.

Conclusion

Ribonucleotide reductase M2 may be a novel target in the diagnosis, prognosis, and therapy of OSCC.
Percutaneous Vertebroplasty with Side‐Opening Cannula or Front‐Opening Cannula in the Treatment of Kummell Disease?
Authors: Wu Xi‐fa , Ping Yong , Zeng Xiang‐qin , Feng Yong , Wang Zhen , Li Tao , Wu Dong‐jin
Published: July 2020

Objective

To explore the effect of bone cement distribution, cement leakage, and clinical outcomes with side‐opening cannula for bone cement injection in percutaneous vertebroplasty (PVP) in treatment of Kummell disease.

Methods

A prospective study of patients with Kummell disease undergoing PVP was conducted from April 2012 to September 2017. In total, 43 patients (11 males, 32 females) with Kummell disease who received bilateral PVP were included in the study. The patients were divided into front‐opening cannulas (FOC) group with front‐opening cannulas and side‐opening cannulas (SOC) group with side‐opening cannulas. All patients were followed up for 6 months. The patient general information such as gender, age, bone density, compression ratio, operative time, and location of fracture vertebrae were recorded. Visual analogue scale (VAS), Oswestry Disability Index (ODI), bone cement distribution, radiation exposure time, bone cement leakage rate and vertebral height, and kyphosis angle were measured and compared for two groups before surgery, 1 day and 6 months after surgery.

Results

A total of 43 patients were enrolled, including 11 males and 32 females, aged 61–84 years. The bone density (T value) was 2.5 ± 0.6 in FOC group and 2.4 ± 0.6 in SOC group (P > 0.05). The compression ratio and operative time were 36.1% ± 13.0%, 39.3 ± 7.9 min in FOC group and 35.2% ± 13.7%, 40.0 ± 10.7 min in SOC group (P > 0.05). There was no significance between FOC and SOC groups in the location of fracture vertebrae. All patients underwent at least 6 months of follow‐up. At 6 months postoperatively, the VAS and ODI were significantly higher in the FOC group (3.0 ± 0.8, 35.7% ± 2.1%) than in the SOC group (1.3 ± 0.4, 18.6% ± 2.4%) (P < 0.05). The cement leakage rate of the SOC group was 4.8%, which was lower than that of the FOC group (31.8%, P < 0.05), and the bone cement distribution ratio was higher than that of the FOC group (63.1% ± 7.9% vs 40.5% ± 8.6%, P < 0.05). At 6 months after operation, the height of the anterior and posterior vertebral bodies of the patients in the SOC group restored better than the FOC group (anterior SOC: FOC 5.1 ± 0.5 mm vs 4.5 ± 0.5 mm; posterior SOC: FOC 0.6 ± 0.1 mm vs 0.3 ± 0.1 mm, P < 0.05), and the kyphosis correction was more obvious than patients in FOC group (SOC: FOC 8.5° ± 1.4° vs 4.6° ± 0.8°, P < 0.05).

Conclusion

Percutaneous vertebroplasty with side‐opening cannula is safe and effective in avoiding bone cement leakage, improving bone cement distribution, and restoring vertebral height.
Differentiation between left bundle branch block (LBBB) preceded dilated cardiomyopathy and dilated cardiomyopathy preceded LBBB by cardiac magnetic resonance imaging
Authors: Wang Hui , He Yi , Du Xin , Yao Rui , Chang Sanshuai , Guo Fei , Bai Zhongle , Lv Qiang , Liu Xiaohui , Dong Jianzeng , Ma Changsheng
Published: July 2020

Background

Dilated cardiomyopathy (DCM) may be a result of or the cause of left bundle branch block (LBBB) in patients with DCM and LBBB. It is almost impossible from the history alone to know which came first in clinical work.

Methods

Patients with LBBB and DCM who had cardiac magnetic resonance (CMR) examination were analyzed. Occurrence sequence of DCM and LBBB was determined by chart reviewing. Diastolic lateral/septal wall thickness ratio (DLSWTR) and lateral wall thickening (LWT) were compared between patients with different time sequences. Response to CRT was analyzed according to medical history and CMR manifestation.

Results

Sixty‐three patients were divided into two groups by cluster analysis. DLSWTR and LWT were significantly higher in group 1 (preserved lateral wall thickness and function), compared to those in group 2 (reduced lateral wall thickness and function) (1.06 ± 0.13 vs. 0.8 ± 0.12, 34.57 ± 11.48% vs. 11.18 ± 5.56%, respectively, both P < .001). Occurrence sequence was clear in 14 patients and further analyzed. In group 1, seven patients were clearly having no evidence of DCM when LBBB was first diagnosed (defined as LBBB‐precede‐DCM) and in group 2, seven patients did not have LBBB when DCM was diagnosed (defined as DCM‐precede‐LBBB). Among 10 patients who received CRT therapy, all seven patients in group 1 responded well whereas none of three patients in group 2 responded well.

Conclusions

Occurrence sequence of DCM and LBBB can be discriminated by CMR. Preserved lateral wall morphology and function in CMR suggested LBBB preceded to DCM. Such features may be predictors of good response to CRT.
The Compassionate Kitbag: A creative and integrative approach to compassion‐focused therapy
Authors: Lucre Katherine , Clapton Neil
Published: July 2020

Purpose

This paper outlines the concept of the ‘Compassionate Kitbag’, a novel multi‐sensory‐based means of helping draw together the various elements of compassionate mind training and processes within compassion‐focused therapy (CFT), to help clients cultivate and facilitate their capacities for compassion. Building on the work of Lucre and Corten (2013,Psychology and Psychotherapy: Theory, Research and Practice, 86, 387), this is the first published work exploring this concept and the theoretical underpinnings, with a specific focus on how this can be used to support people with attachment and relational trauma.

Methods

A narrative review of the literature on multi‐sensory stimulation in facilitating people's capacities for compassion was conducted, coupled with a review of the literature of the use of non‐human and transitional objects as explained by attachment theory and the broader scientific research underpinning the CFT model.

Results

Clinical examples of how to use the Compassionate Kitbag to help stimulate compassionate therapeutic processes demonstrate the benefits of and how to begin utilizing this approach in compassion‐focused work with clients with complex needs.

Conclusions

The Compassionate Kitbag's potential therapeutic value lies in offering multifarious creative and tangible means of accessing compassion to a wide range of individuals whom are typically fearful of, blocked, and/or resistant to compassion. Further research into the wider application of the concept of the Compassionate Kitbag is needed.

Practitioner points

Many patients with ruptured and/or traumatized early attachment relationships can find more traditional talking therapies difficult to access.

Compassion‐focused therapy (CFT) can offer an evolutionary‐based understanding of interpersonal difficulties which can be helpful for such patients.

Creatively harnessing and utilizing multi‐sensory and non‐linguistic social signals in CFT is key to exercising the care‐giving and care‐receiving social mentalities that facilitate compassionate flow.

There is considerable evidence to support the use of a multi‐sensory component to the therapeutic work to help patients cultivate and facilitate their capacities for compassion.

The Compassionate Kitbag can be a way of supporting patients to create concrete representations of compassion in the context of the compassionate mind training component of the therapeutic work. Some of these objects can become transitional objects which can aid the therapeutic work.
Vascular lesions in genital lichen sclerosus in pediatric patients
Authors: Friedland Rivka , Ben‐Amitai Dan , Didkovsky Elena , Feinmesser Meora , Zvulunov Alex
Published: July 2020

Background/Objectives

Lichen sclerosus is a rare, pruritic, mucocutaneous disease affecting mostly the anogenital area. Reports have occasionally associated lichen sclerosus with overlapping vascular lesions. This study explores this association in children.

Methods

A retrospective study was conducted in the dermatology unit of a pediatric tertiary care medical center. Electronic medical records were searched for patients diagnosed with lichen sclerosus from 2006 to 2019. Review of the cases was performed to identify overlapping vascular lesions and review the clinical course of overlap cases.

Results

Of 74 children diagnosed with lichen sclerosus during the study period, five (6.75%) had overlapping vascular lesions and genital lichen sclerosus. Four patients presented with reticular telangiectatic macules and patches (n = 4, 5.4%) that appeared at or shortly after disease onset; resolution occurred a few months after treatment initiation. The fifth patient presented with telangiectases that appeared more than 2 years after the onset of the first symptoms of lichen sclerosus (n = 1, 1.3%).

Conclusion

Vascular lesions in children with genital lichen sclerosus are common and have variable clinical manifestations. Early appearance of reticular macules, patches, and papules is a variant of the disease and is followed by prompt resolution of these lesions. Pathogenesis is attributed to structural changes and repositioning of the papillary vascular plexus. These changes may be alarming to parents and therefore must be recognized by physicians to prevent unnecessary concern and investigations.
A microchip flow‐chamber assay screens congenital primary hemostasis disorders
Authors: Nakajima Yuto , Yada Koji , Ogiwara Kenichi , Furukawa Shoko , Shimonishi Naruto , Shima Midori , Nogami Keiji
Published: July 2020

Background

Von Willebrand disease (VWD) and platelet function disorders (PFDs) are congenital bleeding disorders caused by primary hemostasis defects. Platelet function tests are time‐consuming and require considerable amounts of blood sample, and there have been no easy‐to‐use assays for assessing platelet function quickly and sensitively. We report the usefulness of a microchip flow‐chamber system (T‐TAS®) for detecting and/or predicting clinical severity in patients with VWD type 1 and type 2N and platelet storage pool disease. Here, we developed an application of a screening assay for primary hemostasis disorders.

Methods

Microchips coated with collagen (PL‐chip) and collagen/thromboplastin (AR‐chip) were utilized to evaluate platelet thrombus formation (PTF) at high shear and fibrin‐rich PTF at low shear, respectively, in whole blood samples from 22 patients with VWD (16 type 2A, four type 2B, two type 3) and four patients with PFDs (two BSS, two Glanzmann thrombasthenia). The time‐to‐increase by 10 kPa (T10) was calculated from flow pressure curves. Also, whole blood‐induced platelet aggregation was assessed using Multiplate® analysis.

Results

PL‐chip T10 values ≥10 min successfully distinguished patients with all types of VWD and PFDs from healthy controls, irrespective of age, bleeding scores, and von Willebrand factor levels. However, AR‐chip assay incompletely distinguished between type 2A patients and healthy ones. Multiplate analysis permitted screening of PFDs and type 3 VWD, but values in type 2A partially overlapped with those in controls. PL‐chip assay did not reflect the clinical severity in these patients.

Conclusions

T‐TAS with PL‐chip could be a quick screening tool for congenital primary hemostasis disorder, VWD, and PFDs.
Multi‐organism gastrointestinal polymerase chain reaction positivity among pediatric transplant vs non‐transplant populations: A single‐center experience
Authors: Stone John M. , Savage Andrew , Hudspeth Michelle , Twombley Katherine , Kasi Nagraj , Quiros Jose Antonio , Arbizu Ricardo A. , Curry Scott
Published: July 2020

Background

Diarrhea is a common problem in the pediatric post‐solid organ transplant and post‐hematopoietic stem cell transplant populations. Infectious etiology incidences are poorly defined, and the possibility of multi‐organism positivity is often uninvestigated. The aim of this study is to utilize stool multiplex GIP assays to compare the PTP and NTP regarding the incidence and profiles of single‐organism and multi‐organism infectious diarrhea.

Methods

A single‐center retrospective review was conducted, investigating stool multiplex GIP panel results over a more than 3‐year period, for pediatric patients. Assays test for 23 viral, bacterial, and protozoal organisms.

Results

Positive assays in the PTP and NTP were 70/101 (69.3%) and 962/1716 (56.1%), respectively (P = .009). Thirty‐two percent (32/101) of assays within the PTP were multi‐organism positive, significantly more than 14.8% (254/1716) in the NTP (P < .00001). There was no significant difference in the incidence of single‐organism positives, 37.6% (38/101) in PTP and 41.3% (708/1716) in the NTP. The PTP demonstrated a statistically significantly higher incidence of the following organisms within multi‐agent positive GIPs (P < .05 for each): Clostridioides difficile, Cryptosporidium, EPEC, norovirus, and sapovirus.

Conclusions

The pediatric PTP demonstrates higher incidence of positive GIPs, higher rate of multi‐organism positivity, and unique infectious organism incidence profiles. These data can provide a framework for understanding organism‐specific pathogenicity factors, assessing the clinical impact of enteric co‐infection, and understanding the utility of this testing modality in this unique population.
Pathological aspects of mucinous cholangiocarcinoma: A single‐center experience and systematic review
Authors: Laohawetwanit Thiyaphat , Klaikaew Naruemon
Published: July 2020

Cholangiocarcinoma is a malignant neoplasm originating from the biliary epithelium. Its incidence is highest in Southeast Asia, especially in Thailand. Mucinous intrahepatic cholangiocarcinoma (mucinous iCCA), characterized by an abundant extracellular mucin pool accounting for at least 50% of total tumor volume, is an extremely rare variant of such malignancy and is notorious for rapid progression and dismal prognosis. We conducted an 11‐year retrospective analysis of resected mucinous iCCAs from our institution with a systematic review on mucinous iCCAs and combined hepatocellular‐mucinous cholangiocarcinoma (cHCC‐mCCA). There were four resected mucinous iCCA specimens at our institution (prevalence = 0.5%). Most of the patients were male. The clinicopathological characteristics were variable. The diagnosis of mucinous iCCAs could not be rendered without pathological evaluation. Either intraductal papillary neoplasm or biliary intraepithelial neoplasia was present in three out of four cases. One patient passed away at 11 months following liver resection. A total of 19 mucinous iCCAs and four cHCC‐mCCAs from previously published literature were analyzed. The 1‐year mortality rate of mucinous iCCAs from our series and published literature is 35%. The present study confirmed that mucinous iCCA is an exceedingly uncommon variant of iCCA. The differential diagnoses include metastatic carcinoma with mucinous component and cHCC‐mCCA.
External Reference Pricing and Parallel Imports of Pharmaceuticals: A Policy Comparison
Authors: Iravani Foad , Mamani Hamed , Nategh Emisa
Published: July 2020

Governments across the world constantly use a variety of measures to contain drug costs in order to increase patient access to critical medications. External Reference Pricing (ERP), or international price comparison, is a commonly employed policy to control prices of pharmaceuticals. External Reference Pricing uses the price(s) of a medicinal product in one or several countries in order to derive a benchmark or reference price for the purposes of setting the price of the product in a given country. Despite potential drawbacks, empirical studies show ERP has been successful in reducing drug prices. Another strategy that can reduce drug prices is legalizing parallel imports of drugs from low‐price countries. Motivated by the differences between government policies and the absence of national price management policies in the Unites States, in this study we compare the effects of implementing ERP or authorizing parallel imports on firm profit and different social welfare measures. We find that authorizing parallel imports can result in higher firm profit and/or social welfare than using ERP. We also examine, in a decentralized supply chain, two variations of ERP that are used in practice, the ex‐factory‐based ERP and the pharmacy purchase price (PPP)‐based ERP. We show that despite the ex‐factory‐based ERP being more common, PPP‐based ERP can increase both firm profits and social welfare. Therefore, governments should consider using PPP‐based ERP policies. Our findings help generate insights for ongoing policy discussions around measures for controlling drug prices in the United States.