bluuebunny/crossref_metadata_2025 huggingface dataset:
Three-dimensional printing for assessment of paravalvular leak in transcatheter aortic valve implantation
Authors: Thorburn Casey , Abdel-Razek Omar , Fagan Susan , Pearce Neil , Furey Michael , Harris Scott , Bartellas Michael , Adams Corey
Published: August 2020

Background

Three-dimensional (3D) models have the unique ability to replicate individualized cardiac anatomy and may therefore provide clinical benefit. Transcatheter aortic valve implantation (TAVI) currently relies on preoperative imaging for accurate valve sizing, type of valve used, and avoidance of complications. Three-dimensional (3D) modelling may provide benefit for optimal preoperative TAVI planning. The goal of this study is to assess the utility of 3D modelling in the prediction of paravalvular leak (PVL) post TAVI.

Methods

Retrospective analysis of five patients who underwent TAVI at our center. Pre-operative cardiac gated CT images were utilized to create a 3D printed model with true size aortic root dimensions, including the coronary artery ostium location and left ventricular outflow tract. Deployment of the corresponding model and size TAVI valve into the created 3D model at a similar depth of implantation via fluoroscopy was performed for each patient. Degree of PVL was assessed using a closed system with water infusion under pressure over a duration of 5 s. Correlation was made between the volume obtained in the closed loop model during the pressurized period and the degree of PVL reported on the patients post TAVI placement on transthoracic echocardiogram.

Results

One female, and four males (age in years ranged from 68 to 87) underwent successful TAVI (0% 30-day mortality). PVL on post procedure TTE ranged from none to trivial. Successful deployment of TAVI valves inside the 3D model occurred in all cases. The average volume of water collected on three trials over 5 s ranged between 19.1–24.1 ml A multivariate linear regression showed significant association between the degree of PVL reported on post-operative transthoracic echocardiogram and the amount of volume detected in the 3D model (difference: -3.9657, 95% CI: (− 4.6761,-3.2554), p < 0.001).

Conclusions

Our experiments show that replicated 3D models have potential clinical utilization in predicting PVL in the TAVI population. Future research into the role of 3D modelling in the field of TAVI should continue to be explored.
The comparison of extraction methods of ganjiang decoction based on fingerprint, quantitative analysis and pharmacodynamics
Authors: Wei Yanyan , Jiang Ning , Liu Tuo , Liu Chang , Xiao Wen , Liang Likeng , Li Tongming , Yu Yang
Published: August 2020

Background

Ulcerative colitis (UC) is a chronic nonspecific inflammatory disease of the colon and rectum with unknown etiology, and its symptoms include bloody diarrhea, abdominal pain, and hematochezia. Traditional Chinese medicine compound has a good therapeutic, multi-target effect on UC. Ganjiang decoction (GD), which is a traditional classic prescription in China, contains Zingiberis Rhizoma, Angelicae Sinensis Radix, Coptidis Rhizoma, Phellodendri Chinensis Cortex, Sanguisorbae Radix, Granati Pericarpium, and Asini Corii Colla and could be used to treat symptoms of UC. This study aimed to conduct a preliminary study before GD colon-targeted preparation, to explore the relationship between extraction method and efficacy of GD.

Methods

High-performance liquid chromatography (HPLC) was used for the fingerprinting of five preparation methods of GD. HPLC and gas chromatography were used to quantitatively analyze the important chemical components of GD and compare their differences. Mice with UC induced by dextran sulphate sodium salt received the extracts from the five preparation methods of GD via gavage. Disease activity index (DAI) score, colonic length, relative weight of spleen, pathological analysis results, inflammatory factors, therapeutic effect of the five preparation methods of GD, and their relationship with extraction process were compared.

Results

Cluster analysis revealed that the content of the components extracted by traditional extraction methods was significantly different from the other four methods. The third and fifth preparation methods extracted Coptidis Rhizoma and Phellodendri Chinensis Cortex with 50% ethanol to obtain more alkaloids. In the fourth and fifth methods, more volatile oils were detected by adding Zingiberis Rhizoma and Angelicae Sinensis Radix fine powder. According to DAI score, colonic length, relative weight of spleen, pathological analysis results, and inflammatory factors, the third method showed a good therapeutic effect, while the fifth method had the best therapeutic effect.

Conclusions

The results showed that the difference of the five extracts of GD in the efficacy of DSS-induced UC in mice was closely related to the extraction method. Our study improved the extraction process of GD and provided a foundation for the process of enteric-soluble preparations and a new idea for traditional Chinese medicine compound preparation.
Feasibility and acceptability of a video library tool to support community health worker counseling in rural Afghan districts: a cross-sectional assessment
Authors: Dal Santo Leila C. , Rastagar Sayed Haroon , Hemat Shafiqullah , Alami Sayed Omar , Pradhan Subarna , Tharaldson Jenae , Dulli Lisa S. , Todd Catherine S.
Published: August 2020

Background

Rural Afghan populations have low skilled birth attendance rates and high maternal and infant mortality. Insecurity and armed conflict, geographic barriers, and cultural norms often hinder women’s access to facility-based reproductive, maternal, newborn, and child health (RMNCH) services. Community health workers (CHWs) are critical agents for behavioral change in this and similarly fragile settings, where RMNCH information exposure is limited by low literacy and mass media access. We assessed the feasibility and acceptability of a computer tablet-based health video library (HVL) to enhance CHW counseling on RMNCH topics in three rural Afghan districts.

Methods

The HVL was introduced by trained CHWs in 10 pilot communities within one rural district in each of Balkh, Herat, and Kandahar provinces. We used a mixed-methods study design to assess exposure to and perception of the HVL 6 months post-introduction. We surveyed married women (n = 473) and men (n = 468) with at least one child under 5 years and conducted in-depth interviews with CHWs and community leaders (shurasand Family Health Action groups) within pilot communities (n = 80). Program improvement needs were summarized using quantitative and qualitative data.

Results

Higher proportions of women in Balkh (60.3%) and Herat (67.3%) reported viewing at least one HVL video compared to women in Kandahar (15%), while male HVL exposure was low (8–17%) across all districts. Most HVL-exposed clients (85–93% of women and 74–92% of men) reported post-video counseling by CHWs. Nearly all (94–96% of women and 85–92% of men) were very interested in watching videos on other health topics in the future. Participants recommended increasing the number of videos and range of topics, using tablets with larger screens, and translating videos into additional local languages to improve the HVL program.

Conclusion

The HVL was a highly acceptable tool for relaying health information, but coverage of female audiences in Kandahar and male audiences broadly was low. The HVL should better engage men and other key influencers to engineer local solutions that directly facilitate male HVL exposure, indirectly improve women’s HVL access, and support collaborative spousal health decision-making. A larger efficacy trial is warranted to measure the HVL’s effect on knowledge and health-related behavioral outcomes.
Predictive accuracy of biomarkers for survival among cardiac arrest patients with hypothermia: a prospective observational cohort study in Japan
Authors: Okada Yohei , Kiguchi Takeyuki , Irisawa Taro , Yoshiya Kazuhisa , Yamada Tomoki , Hayakawa Koichi , Noguchi Kazuo , Nishimura Tetsuro , Ishibe Takuya , Yagi Yoshiki , Kishimoto Masafumi , Shintani Hiroshi , Hayashi Yasuyuki , Sogabe Taku , Morooka Takaya , Sakamoto Haruko , Suzuki Keitaro , Nakamura Fumiko , Nishioka Norihiro , Matsuyama Tasuku , Matsui Satoshi , Shimazu Takeshi , Koike Kaoru , Kawamura Takashi , Kitamura Tetsuhisa , Iwami Taku
Published: August 2020

Background

There is limited information on the predictive accuracy of commonly used predictors, such as lactate, pH or serum potassium for the survival among out-of-hospital cardiac arrest (OHCA) patients with hypothermia. This study aimed to identify the predictive accuracy of these biomarkers for survival among OHCA patients with hypothermia.

Methods

In this retrospective analysis, we analyzed the data from a multicenter, prospective nationwide registry among OHCA patients transported to emergency departments in Japan (the JAAM-OHCA Registry). We included all adult (≥18 years) OHCA patients with hypothermia (≤32.0 °C) who were registered from June 2014 to December 2017 and whose blood test results on hospital arrival were recorded. We calculated the predictive accuracy of pH, lactate, and potassium for 1-month survival.

Results

Of the 34,754 patients in the JAAM-OHCA database, we included 754 patients from 66 hospitals. The 1-month survival was 5.8% (44/754). The areas under the curve of the predictors and 95% confidence interval were as follows: pH 0.829 [0.767–0.877] and lactate 0.843 [0.793–0.882]. On setting the cutoff points of 6.9 in pH and 120 mg/dL (13.3 mmol/L) in lactate, the predictors had a high sensitivity (lactate: 0.91; pH 0.91) and a low negative likelihood ratio (lactate: 0.14; pH 0.13), which are suitable to exclude survival to 1 month. Furthermore, in additional analysis that included only the patients with potassium values available, a cutoff point of 7.0 (mmol/L) for serum potassium had high sensitivity (0.96) and a low negative likelihood ratio (0.09).

Conclusion

This study indicated the predictive accuracy of serum lactate, pH, and potassium for 1-month survival among adult OHCA patients with hypothermia. These biomarkers may help define a more appropriate resuscitation strategy.
Re-assessment of re-warming for out-of-hospital births
Authors: Jones Peter , Joly Camille , Vivien Benoît
Published: August 2020

Therapeutic controlled cooling is routinely practiced on neonates with core temperatures of 33–34 °C attained during cooling for birth related hypoxic-ischaemia encephalopathy (HIE). Rewarming after therapeutic cooling in clinical trials for HIE takes place at 0.25–0.5 °C/h over 6–12 h. Javaudin et al. looked at four methods for re-warming infants born out-of-hospital. The incubator group had a 0.8 °C median increase in body temperature for a median transfer time of 38 min (IQR-31-49 min); equating to 1.3 °C/h. In contrast, the group plastic bag+skin-to-skin+cap had a median temperature rise of 0.2 °C (median transport time 43 min [IQR-33-61 min]); equating to 0.28 °C/h, which is closer to therapeutic controlled methods. Javaudin et al. proposed incubator re-warming for out-of-hopital births whereas we consider that an alternative interpretation of the article’s results leads to the different conclusion that plastic bag+skin-to-skin+cap, rather than an incubator, is the preferable method due to the more progressive re-warming and lower frequency of hyperthermia.
DNA methylation in Hepatoblastoma-a literature review
Authors: Shen Gang , Shen Hongyu , Zhang Jing , Yan Qingtao , Liu Huixian
Published: August 2020

Hepatoblastoma (HB) is the most common malignant liver tumor in children. Abnormal activation of the Wnt/β-catenin signaling pathway plays an important role in the formation and development of HB. Genes in HB show a global hypomethylation change, accompanied by hypermethylation of specific tumor suppressor genes (TSGs). This article reviews the hypermethylation changes in several TSGs, such as RASSF1A, SOCS1, APC, HHIP, and P16, and analyzes the pathways and mechanisms of TSGs regulating gene expression. The role of the methylation-regulating enzymes DNA methyltransferases (DNMTs) and ten-eleven translocation (TET) family members enzymes in the methylation changes of HB was analyzed, and it was speculated that the occurrence of HB is partly due to the obstruction of liver differentiation in the early stage of differentiation. The origin cells may be incompletely differentiated hepatocytes remaining in the liver of children after birth. Therefore, further studying the role of methylation regulating enzymes in methylation changes in HB is a promising future research direction.
EFFECT: a randomized phase II study of efficacy and impact on function of two doses of nab-paclitaxel as first-line treatment in older women with advanced breast cancer
Authors: Biganzoli Laura , Cinieri Saverio , Berardi Rossana , Pedersini Rebecca , McCartney Amelia , Minisini Alessandro Marco , Caremoli Elena Rota , Spazzapan Simon , Magnolfi Emanuela , Brunello Antonella , Risi Emanuela , Palumbo Raffaella , Leo Silvana , Colleoni Marco , Donati Sara , De Placido Sabino , Orlando Laura , Pistelli Mirco , Parolin Veronica , Mislang Anna , Becheri Dimitri , Puglisi Fabio , Sanna Giuseppina , Zafarana Elena , Boni Luca , Mottino Giuseppe
Published: August 2020

Background

Limited data are available regarding the use of nab-paclitaxel in older patients with breast cancer. A weekly schedule is recommended, but there is a paucity of evidence regarding the optimal dose. We evaluated the efficacy of two different doses of weekly nab-paclitaxel, with a specific focus on their corresponding impact on patient function, in order to address the lack of data specifically relating to the older population.

Methods

EFFECT is an open-label, phase II trial wherein 160 women with advanced breast cancer aged ≥ 65 years were enrolled from 15 institutions within Italy. Patients were randomly assigned 1:1 to receive nab-paclitaxel 100 mg/m2 (arm A) or 125 mg/m2 (arm B) on days 1, 8, and 15 on a 28-day cycle, as first-line treatment for advanced disease. The primary endpoint was event-free survival (EFS), wherein an event was defined as disease progression (PD), functional decline (FD), or death. In each arm, the null hypothesis that the median EFS would be ≤ 7 months was tested against a one-sided alternative according to the Brookmeyer Crowley test. Secondary endpoints included objective response rate (ORR), clinical benefit rate (CBR), progression-free survival (PFS), overall survival (OS), and safety.

Results

After a median follow-up of 32.6 months, 140 events were observed in 158 evaluable patients. Median EFS was 8.2 months (90% CI, 5.9–8.9; p = 0.188) in arm A vs 8.3 months (90% CI, 6.2–9.7, p = 0.078) in arm B. Progression-free survival, overall survival, and response rates were similar in both groups. A higher percentage of dose reductions and discontinuations due to adverse events (AEs) was noted in arm B. The most frequently reported non-haematological AEs were fatigue (grade [G] 2–3 toxicity occurrence in arm A vs B, 43% and 51%, respectively) and peripheral neuropathy (G2–3 arm A vs B, 19% and 38%, respectively).

Conclusion

Pre-specified outcomes were similar in both treatment arms. However, 100 mg/m2 was significantly better tolerated with fewer neurotoxicity-related events, representing a more feasible dose to be recommended for older patients with advanced disease.

Trial registration

EudraCT, 2012-002707-18. Registered on June 4, 2012. NIH ClinicalTrials.gov, NCT02783222. Retrospectively registered on May 26, 2016.
Loss of AA13 LPMOs impairs degradation of resistant starch and reduces the growth of Aspergillus nidulans
Authors: Haddad Momeni Majid , Leth Maria Louise , Sternberg Claus , Schoof Erwin , Nielsen Maike Wennekers , Holck Jesper , Workman Christopher T. , Hoof Jakob Blæsbjerg , Abou Hachem Maher
Published: August 2020

Background

Lytic polysaccharide monooxygenases (LPMOs) are often studied in simple models involving activity measurements of a single LPMO or a blend thereof with hydrolytic enzymes towards an insoluble substrate. However, the contribution of LPMOs to polysaccharide breakdown in complex cocktails of hydrolytic and oxidative enzymes, similar to fungal secretomes, remains elusive. Typically, two starch-specific AA13 LPMOs are encoded by mainly Ascomycota genomes. Here, we investigate the impact of LPMO loss on the growth and degradation of starches of varying resistance to amylolytic hydrolases by Aspergillus nidulans.

Results

Deletion of the genes encoding AnAA13A that possesses a CBM20 starch-binding module, AnAA13B (lacking a CBM20) or both AA13 genes resulted in reduced growth on solid media with resistant, but not soluble processed potato starch. Larger size and amount of residual starch granules were observed for the AA13-deficient strains as compared to the reference and the impairment of starch degradation was more severe for the strain lacking AnAA13A based on a microscopic analysis. After 5 days of growth on raw potato starch in liquid media, the mount of residual starch was about fivefold higher for the AA13 gene deletion strains compared to the reference, which underscores the importance of LPMOs for degradation of especially resistant starches. Proteomic analyses revealed substantial changes in the secretomes of the double AA13 gene deletion, followed by the AnAA13A-deficient strain, whereas only a single protein was significantly different in the proteome of the AnAA13B-deficient strain as compared to the reference.

Conclusions

This study shows that the loss of AA13, especially the starch-binding AnAA13A, impairs degradation of resistant potato starch, but has limited impact on less-resistant wheat starch and no impact on processed solubilized starch. The effects of LPMO loss are more pronounced at the later stages of fungal growth, likely due to the accumulation of the less-accessible regions of the substrate. The striking impairment in granular starch degradation due to the loss of a single LPMO from the secretome offers insight into the crucial role played by AA13 in the breakdown of resistant starch and presents a methodological framework to analyse the contribution of distinct LPMOs towards semi-crystalline polysaccharides under in vivo conditions.
The effect of ecological environmental changes and mollusciciding on snail intermediate host of Schistosoma in Qianjiang city of China from 1985 to 2015
Authors: Qiu Juan , Li Rendong , Zhu Hong , Xia Jing , Xiao Ying , Huang Duan , Wang Yong
Published: August 2020

Background

Schistosomiasis remains prevalent in Africa, Asia and South America with an estimated burden of 1.9 million disability-adjusted life years in 2016. Targeting snails as a key to success for schistosomiasis control has been widely approved, but the long-term quantitative effects of interventions on snail control that would inform and improve future control programmes are unclear. Over the last six decades, schistosomiasis in China had been brought largely under control, and snail control as supplementary methods or part of integrated multisectoral approaches in different historical periods has played an essential role.

Methods

Ecological environment factors, prevalence and control data on Oncomelania hupensis between 1985 and 2015 at 5-year intervals in Qianjiang city, China, were collected. A multilevel growth model approach was used to examine the long-term effects of ecological environmental changes and mollusciciding on snail-infested area (SIA) and living snail density (LSD) during the 30 years.

Results

The variation of SIA was 68.4% in spatial distribution, while the variation of LSD was 68.4% in temporal distribution. Continuous mollusciciding could result in significant LSD reduction, but may not lead to significant SIA reduction. The normalized difference vegetation index (NDVI), patch size coefficient of variation (PSCoV) and mean patch size (MPS) reduction, slightly due to eco-environmental changes decreased SIA, while mean perimeter-area ratio (MPAR) and dry farm-land proportion (DFLP) reduction might increase SIA. Only NDVI and MPAR reduction led to a lower LSD.

Conclusions

Mollusciciding was more effective in reducing snail density, but it is not easy to eliminate snails completely. Environmental modifications could completely change the snail breeding environment and reduce its infestation area. Due to difficulty of scaling-up the current environmental modifications in waterway network regions, more effective snail control methods are needed. The experience in China could thereby provide guidance for other schistosomiasis endemic areas with a high snail prevalence.
Estimates of certain paraxial diffraction integral operator and its generalized properties
Authors: Al-Omari Shrideh , Araci Serkan , Al-Smadi Mohammed , Gumah Ghaleb , Alrabaiah Hussam
Published: August 2020

This paper aims to discuss a generalization of certain paraxial diffraction integral operator in a class of generalized functions. At the start of this paper, we propose a convolution formula and establish certain convolution theorem. Then, with the addition to the convolution theorem, we consider a set of approximating identities and substantially employ our results in generating sets of integrable and locally integrable Boehmians. The said generalized integral operator is tested and declared to be one-to-one and onto mapping. Continuity of the generalized operator with respect to the convergence of the Boehmian spaces is obtained. Over and above, an inversion formula and consistency results are also counted.
Hyers–Ulam stability of linear fractional differential equations with variable coefficients
Authors: Liu Hui , Li Yongjin
Published: August 2020

Motivated by Shen et al., we apply the Gronwall’s inequality to establish the Hyers–Ulam stability of two types (Riemann–Liouville and Caputo) of linear fractional differential equations with variable coefficients under certain conditions.
On existence and stability results to a class of boundary value problems under Mittag-Leffler power law
Authors: Ali Gauhar , Shah Kamal , Abdeljawad Thabet , Khan Hasib , Ur Rahman Ghaus , Khan Aziz
Published: August 2020

Some essential conditions for existence theory and stability analysis to a class of boundary value problems of fractional delay differential equations involving Atangana–Baleanu-Caputo derivative are established. The deserted results are derived by using the Banach contraction and Krasnoselskii’s fixed point theorems. Moreover, different kinds of stability theory including Hyers–Ulam, generalized Hyers–Ulam, Hyers–Ulam-Rassias and generalized Hyers–Ulam–Rassias stability are also developed for the problem under consideration. Appropriate examples are given for illustrative purposes.
Preoperative exercise in patients undergoing total knee arthroplasty: a pilot randomized controlled trial
Authors: Gränicher Pascale , Stöggl Thomas , Fucentese Sandro F. , Adelsberger Rolf , Swanenburg Jaap
Published: August 2020

Background

The purpose of this study was to assess the effect of preoperative physiotherapy (PT) on functional, subjective and socio-economic parameters after total knee arthroplasty (TKA).

Methods

20 patients (mean ± SD: age 67 ± 7 years) scheduled for TKA at Balgrist University Hospital between July 2016 and March 2017 were randomly assigned to a control (CG) or intervention (IG) group. 3 to 4 weeks prior to surgery the IG completed 5 to 9 sessions of PT containing proprioceptive neuromuscular facilitation (PNF) techniques, endurance training and individually indicated interventions. Measurements were executed at baseline, preoperative and 3 months after TKA. The primary outcome measure was the Stair Climbing Test (SCT), secondary outcome measures were the knee range of motion (ROM) and the level of physical activity using Lysholm Score (LS) and Tegner Activity Scale (TAS). The subjective and socio-economic parameters were the Patients’ Global Impression of Change (PGIC) scale, inpatient rehabilitation time, preoperative pain levels and metabolic equivalent (MET), postoperative intake of analgesics and overall costs.

Results

No difference between IG and CG was found for SCT (F (2/36) = 0.016,p = 0.984, η2 = 0.004). An interaction between group and time was shown for TAS (F (18/1) = 13.890) with an increase in the IG (p = 0.002, η2 = 0.536). The sub-item “pain” within the LS presented a higher pain-level in CG (F (18/1) = 4.490,p = 0.048, η2 = 0.974), while IG showed a higher preoperative MET compared to CG (p = 0.035). There were no other significant changes. The CG produced 21.4% higher overall costs, took more analgesics and showed higher preoperative pain levels than the IG.

Conclusions

Findings show that preoperative therapy improved the level of physical activity before and after TKA and resulted in a clinically relevant gain in TAS.

Trial registration

ClinicalTrials.govIdentifier;NCT03160534. Registered 19 May 2017
Clinical Spectrum of congenital heart defects (CHD) detected at the child health Clinic in a Tertiary Health Facility in Ghana: a retrospective analysis
Authors: Thomford Nicholas Ekow , Biney Robert Peter , Okai Emmanuel , Anyanful Akwasi , Nsiah Paul , Frimpong Prosperity G. , Boakye Dominic O. , Adongo Charles A. , Kruszka Paul , Wonkam Ambroise
Published: August 2020

Background

Congenital heart defects (CHD) are the singular most common congenital anomalies and account for a significant fraction of childhood mortality and morbidity. CHD occurs in ~ 1% of livebirths globally and often requires surgical interventions to improve quality of life and survival of patients. The prevalence and clinical presentations of CHD within specific populations provide a clearer overview of the burden of CHD and informs appropriate interventions. However, there is limited data on clinical presentation and occurrence of CHD in African countries such as Ghana where most cases are either diagnosed late or missed entirely resulting in increased mortality. In this retrospective study, we assessed the clinical presentations, associated comorbidities, and prescription patterns of diagnosed CHD in a tertiary facility in Ghana.

Method

This retrospective study utilized data from electronic health records (EHR) from the child health clinic of the Cape Coast Teaching Hospital - a tertiary health facility in Ghana from January 2018 to October 2019. All suspected or provisionally diagnosed cases including those confirmed with echocardiography were included in our analysis.

Results

Over 10, 000 records were reviewed, CHD was diagnosed in 79 cases, and 51 cases had complete clinical records including the type of CHD and clinical presentation. Male to female ratio was approximately 1:1 and 77.2% of the diagnoses were in children below 5 years. Acyanotic congenital heart defects were most commonly diagnosed with ventricular septal defects (VSD) and patent ductus arteriosus (PDA) being the simplest singular CHD. Tetralogy of Fallot, was the most common complex CHD accounting for 25.5% (13) of cases. Bronchopneumonia, upper respiratory infections and pneumonia were the most commonly diagnosed comorbidities accounting for over 35% of non-cardiac sequalae based on antibiotic and diuretic use.

Conclusion

Our study showed that over 75% of CHD cases were diagnosed under 5 years with VSD and TOF being the most commonly diagnosed acyanotic and cyanotic lesions, respectively. This study presents preliminary data that give an overview of CHD burden in Ghana that will inform future research and appropriate interventions.
Estimated influence of a novel biocompatible dialysis membrane on vascular events in dialysis patients with diabetic nephropathy: a prospective randomized controlled pilot study
Authors: Kubo Mitsuru , Nakazawa Ryoichi , Akiyama Kazuhiro , Tsunoda Yoshiho , Kimura Kazumasa , Koide Kenji , Matsushima Yasuhisa , Hasegawa Shinji , Ikeda Koichi , Azuma Nakanobu
Published: August 2020

Background

Polysulfone (PS) dialyzers are most frequently used worldwide for chronic renal failure patients and they are produced by several manufacturers. Despite using the same materials, differences in biocompatibility among PS dialyzers have been reported. TORAYLIGHT NV (NV) is a PS dialyzer that was reported to have superior biocompatibility compared with other PS membranes (conventional PS membranes). Therefore, we examined whether biocompatibility of PS membranes would affect the occurrence of cardiovascular events in hemodialysis patients with diabetic nephropathy (DN).

Methods

Fifty hemodialysis patients with DN were enrolled. They were randomly divided into NV and PS groups and then followed up for 3 years. The number of patients who developed cardiovascular events and clinical data including laboratory tests and blood pressure was recorded.

Results

There were 13 and 14 patients who developed cardiovascular events during the 3-year follow-up of the NV and PS groups, respectively. There was no significant difference between the groups. There were no significant differences in most of the clinical data between the two groups. However, serum pentosidine concentrations in the PS group significantly increased throughout this study, while those in the NV group did not change. Additionally, the width of the systolic blood pressure drop, which was shown to be the difference between before and after dialysis session, in the PS group showed no change, while that in the NV group tended to decrease.

Conclusions

The superiority of using NV membrane compared with conventional PS membranes in reducing cardiovascular events in hemodialysis patients with DN remains unclear. However, our results suggested that PS membranes with superior biocompatibility would slow the progression of atherosclerosis and reduce the occurrence of intradialytic hypotension.

Trial registration

This study was retrospectively registered with the Clinical Trials Registry at the University Hospital Medical Information Network (UMIN-CTR) on March 17, 2017 (registration ID, UMIN 000026339).https://upload.umin.ac.jp/cgi-open-bin/ctr/ctr.cgi?function=brows&action=brows&recptno=R000030259&type=summary&language=J
Development of a clinical prediction rule for sepsis in primary care: protocol for the TeSD-IT study
Authors: Loots Feike J. , Hopstaken Rogier , Jenniskens Kevin , Frederix Geert W. J. , van de Pol Alma C. , Van den Bruel Ann , Oosterheert Jan Jelrik , van Zanten Arthur R. H. , Smits Marleen , Verheij Theo J. M.
Published: August 2020

Background

Early recognition and treatment of sepsis is crucial to prevent detrimental outcomes. General practitioners (GPs) are often the first healthcare providers to encounter seriously ill patients. The aim of this study is to assess the value of clinical information and additional tests to develop a clinical prediction rule to support early diagnosis and management of sepsis by GPs.

Methods

We will perform a diagnostic study in the setting of out-of-hours home visits in four GP cooperatives in the Netherlands. Acutely ill adult patients suspected of a serious infection will be screened for eligibility by the GP. The following candidate predictors will be prospectively recorded: (1) age, (2) body temperature, (3) systolic blood pressure, (4) heart rate, (5) respiratory rate, (6) peripheral oxygen saturation, (7) mental status, (8) history of rigors, and (9) rate of progression. After clinical assessment by the GP, blood samples will be collected in all patients to measure C-reactive protein, lactate, and procalcitonin. All patients will receive care as usual. The primary outcome is the presence or absence of sepsis within 72 h after inclusion, according to an expert panel. The need for hospital treatment for any indication will be assessed by the expert panel as a secondary outcome. Multivariable logistic regression will be used to design an optimal prediction model first and subsequently derive a simplified clinical prediction rule that enhances feasibility of using the model in daily clinical practice. Bootstrapping will be performed for internal validation of both the optimal model and simplified prediction rule. Performance of both models will be compared to existing clinical prediction rules for sepsis.

Discussion

This study will enable us to develop a clinical prediction rule for the recognition of sepsis in a high-risk primary care setting to aid in the decision which patients have to be immediately referred to a hospital and who can be safely treated at home. As clinical signs and blood samples will be obtained prospectively, near-complete data will be available for analyses. External validation will be needed before implementation in routine care and to determine in which pre-hospital settings care can be improved using the prediction rule.

Trial registration

The study is registered in the Netherlands Trial Registry (registration number NTR7026).
Antibiofilm potential of Psidium guajava and Passiflora edulis pulp extracts against Staphylococcus aureus, cytotoxicity, and interference on the activity of antimicrobial drugs
Authors: dos Santos Renan Martins , Costa Gustavo , Cerávolo Isabela Pena , Dias-Souza Marcus Vinícius
Published: August 2020

Background

Pathogenic strains ofStaphylococcus aureuscan cause several diseases including septicemia and endocarditis, in spite of being a commensal species of the human microbiota. The current drug resistance ofS. aureusraises the need for new antimicrobials, and natural products represent a feasible source for prospection of such compounds, due to features including the diversity of structures and mechanisms of action. Here, we provide evidence of the antimicrobial activity of methanolic ofPsidium guajavaandPassiflora edulispulps against planktonic cells and biofilms of clinical isolates ofS. aureus.

Results

The extracts were effective against the strains in concentrations up to 7.81 and 250 μg/mL for planktonic cells and biofilms, respectively. Antagonistic interactions of the extracts to antimicrobial drugs were observed. The pulps caused no cytotoxic effects on BGM cells. GC-MS analysis found relevant molecules, and UPLC analysis suggested the presence of flavonoids. To the best of our knowledge, this is the first antibiofilm evidence of such extracts.

Conclusion

The extracts seem to be safe and effective enough for more studies aiming at exploring isolated antimicrobial molecules using in vivo models for the treatment of staphylococcal diseases.
Structure of direct and indirect umbilical hernia and the implication on surgical repair in children
Authors: Mostafa Mohamed Saber , AbdElrahman Mohamed , Elsherbeny Mohammed , El-Safoury Hesham
Published: August 2020

Background

Umbilical hernia (UH) is one of the most common problems seen by paediatric surgeons. The recurrence rate after surgical repair is 1–2%. In this study, we examined the ring of umbilical hernia histologically to detect differences between the two types of umbilical hernia and the relation between this histologic difference and the technique of surgical repair.

Results

Fifty paediatric patients of both sexes with clinically diagnosed direct and indirect (oblique) umbilical hernia were collected from the paediatric surgery department in the period between March 2016 and February 2018. Age ranged between 2 and 5 years. Biopsies (5 mm) were taken from the upper, lower, right and left borders of the ring in both types and processed for histological examination. Classification of umbilical hernia was based on Chang-Seok et al.’s classification, which classified the umbilical hernia into three types (direct, oblique and hernia into umbilical cord) which depend on the presence of a hole in the ring and whether the ring is covered by ligamentum teres or not. Histological sections were examined by light microscopy, and data was analysed using chi-square test to detect predominance of one type of collagen fibre over the other in each sample. Transverse collagen fibres were predominant in the upper border of the ring in 15 patients (75%) and the lower border in 14 patients (70%) of direct umbilical hernia. Transverse collagen fibres were also predominant in the right border of the ring in 21 patients (70%) and the left border in 21 patients (70%) of indirect umbilical hernia. This predominance in both cases was found to be statistically significant.

Conclusions

Predominance of transverse collagen fibres in the upper and lower borders of the ring in direct umbilical hernia and predominance in the right and left borders of the ring in oblique umbilical hernia encouraged us to suggest that wound will be more stable if closed in a transverse manner in direct umbilical hernia and a longitudinal manner in oblique umbilical hernia especially in recurrent cases.
MicroRNA genetic signature in non-small cell lung cancer (NSCLC) Egyptian patients
Authors: Mansour Samar A. , Farhat Amgad A. , Abd El-Zaher Ayman H. , Bediwy Adel S. , Abdou Said M. , Al Saka Ayman A. , Zidan Abdel Aziz A.
Published: August 2020

Background

Cancer development is associated with deregulated microRNA (miRNA) in body fluids including serum, plasma, and bronchoalveolar lavage (BAL). Early diagnosis and early treatment of lung cancer improve survival and response to treatment. So, finding an easy detectable biomarker is crucially important to improve the disease outcome. So, we analyzed the differential expression of miRNA using microarray both in serum and BAL of 37 non-small cell lung cancer (NSCLC) patients and 30 healthy control subjects (15 non-smokers and 15 smokers).

Results

A total of 32 miRNAs were significantly differentially expressed in serum of NSCLC patients versus controls (13 up-regulated and 19 down-regulated), whereas 14 miRNAs were significantly differentially expressed in BAL of NSCLC patients relative to control (12 upregulated and 2 downregulated). The accuracy of MiRNAs to detect lung cancer patients versus control was 94.3% with a specificity of 97.8% and a sensitivity of 92.3%.

Conclusions

Expression of miRNAs is specific in both serum and BAL of NSCLC patients, indicating that they might be considered easy diagnostic biomarkers for early lung cancer detection.
Natural Language Processing to Ascertain Cancer Outcomes From Medical Oncologist Notes
Authors: Kehl Kenneth L. , Xu Wenxin , Lepisto Eva , Elmarakeby Haitham , Hassett Michael J. , Van Allen Eliezer M. , Johnson Bruce E. , Schrag Deborah
Published: August 2020

PURPOSE

Cancer research using electronic health records and genomic data sets requires clinical outcomes data, which may be recorded only in unstructured text by treating oncologists. Natural language processing (NLP) could substantially accelerate extraction of this information.

METHODS

Patients with lung cancer who had tumor sequencing as part of a single-institution precision oncology study from 2013 to 2018 were identified. Medical oncologists’ progress notes for these patients were reviewed. For each note, curators recorded whether the assessment/plan indicated any cancer, progression/worsening of disease, and/or response to therapy or improving disease. Next, a recurrent neural network was trained using unlabeled notes to extract the assessment/plan from each note. Finally, convolutional neural networks were trained on labeled assessments/plans to predict the probability that each curated outcome was present. Model performance was evaluated using the area under the receiver operating characteristic curve (AUROC) among a held-out test set of 10% of patients. Associations between curated response or progression end points and overall survival were measured using Cox models among patients receiving palliative-intent systemic therapy.

RESULTS

Medical oncologist notes (n = 7,597) were manually curated for 919 patients. In the 10% test set, NLP models replicated human curation with AUROCs of 0.94 for the any-cancer outcome, 0.86 for the progression outcome, and 0.90 for the response outcome. Progression/worsening events identified using NLP models were associated with shortened survival (hazard ratio [HR] for mortality, 2.49; 95% CI, 2.00 to 3.09); response/improvement events were associated with improved survival (HR, 0.45; 95% CI, 0.30 to 0.67).

CONCLUSION

NLP models based on neural networks can extract meaningful outcomes from oncologist notes at scale. Such models may facilitate identification of clinical and genomic features associated with response to cancer treatment.
Survey of the Impact of COVID-19 on Oncologists’ Decision Making in Cancer
Authors: Ürün Yüksel , Hussain Syed A. , Bakouny Ziad , Castellano Daniel , Kılıçkap Saadettin , Morgan Gilberto , Mckay Rana R. , Pels Kevin , Schmidt Andrew , Doroshow Deborah B. , Schütz Fábio , Albiges Laurence , Lopes Gilberto , Catto James W. F. , Peters Solange , Choueiri Toni K.
Published: August 2020

PURPOSE

To understand readiness measures taken by oncologists to protect patients and health care workers from the novel coronavirus (COVID-19) and how their clinical decision making was influenced by the pandemic.

METHODS

An online survey was conducted between March 24 and April 29, 2020.

RESULTS

A total of 343 oncologists from 28 countries participated. The median age was 43 years (range, 29-68 years), and the majority were male (62%). At the time of the survey, nearly all participants self-reported an outbreak in their country (99.7%). Personal protective equipment was available to all participants, of which surgical mask was the most common (n = 308; 90%). Telemedicine, in the form of phone or video encounters, was common and implemented by 80% (n = 273). Testing patients with cancer for COVID-19 via reverse transcriptase polymerase chain reaction before systemic treatment was not routinely implemented: 58% reported no routine testing, 39% performed testing in selected patients, and 3% performed systematic testing in all patients. The most significant factors influencing an oncologist’s decision making regarding choice of systemic therapy included patient age and comorbidities (81% and 92%, respectively). Although hormonal treatments and tyrosine kinase inhibitors were considered to be relatively safe, cytotoxic chemotherapy and immune therapies were perceived as being less safe or unsafe by participants. The vast majority of participants stated that during the pandemic they would use less chemotherapy, immune checkpoint inhibitors, and steroids. Although treatment in neoadjuvant, adjuvant, and first-line metastatic disease was less affected, most of the participants stated that they would be more hesitant to recommend second- or third-line therapies in metastatic disease.

CONCLUSION

Decision making by oncologists has been significantly influenced by the ongoing COVID-19 pandemic.
The Tambourine Army
Authors: Roper Danielle , Wint Traci-Ann
Published: August 2020

In 2017 the radical women’s rights group known as the Tambourine Army emerged in response to gender-based violence, sexual abuse, and structures of impunity in Jamaica. The group used hashtags, organized marches, and teach-ins to encourage women to speak out against their abusers, to break the silence surrounding sexual abuse, and to advocate for survivors. Situating the Tambourine Army within traditions of women’s protest and contemporary forms of cyberactivism in the Caribbean, this essay examines the ways the group enacted a sonic disruption to the public and cyber spheres. It chronicles the rise of the movement, explores the centrality of the digital in the members’ activism, and assesses the methods deployed in the group’s contestation of postcolonial ideals of respectability.
Dark Finance, Dark People
Authors: Plummer Brenda Gayle
Published: August 2020

This discussion of Peter James Hudson’s Bankers and Empire: How Wall Street Colonized the Caribbean focuses on the way transnational banks are revealed to be players of multiple roles in the development of past and present Caribbean economies. The banks were hardly mere stalking horses for imperialism, and their considerable autonomy and self-interest were sometimes at odds with the objectives of both host governments and metropoles. They acquired a cosmopolitan character that allowed them to bypass particular national identities when convenient. Caribbean markets lay at the epicenter of their financial projects, which employed racism as a technology to banking interests, and racial capitalism grafted itself onto existing hierarchical systems. Hudson has shown the banks to be heirs to a long history of Caribbean commerce that tracks the shadowy line between the legal and the illicit and the piracy and smuggling of the past to the money laundering, tax evasion, and drug smuggling of the present.
Study on Proton-Coupled Electron Transfer in Transition Metal Complexes
Authors: Kojima Takahiko
Published: August 2020

In this award account are described our achievements in proton-coupled electron transfer reactions performed by transition metal complexes. Topics include formation and reactivity of RuIV-oxo and RuIII-oxyl complexes, and hydrogen-atom transfer from substrates to RuIII-pterin complexes. Based on kinetic analysis of the reactions, mechanistic insights into those reactions are gained to shed light on the reactivity of metal complexes as hydrogen-atom acceptors. In addition, we present our efforts in artificial photosynthesis concerning efficient and photocatalytic water oxidation by a dinuclear CoIII complex as well as selective CO2 reduction by NiII complexes.
Description of the MRI and ultrasound imaging features of giant epidermal cysts
Authors: Pressney Ian , Khoo Michael , Hargunani Rikin , Saifuddin Asif
Published: August 2020

Objectives:

Guidelines suggest that lesions over 5 cm in dimension should be referred to a specialist sarcoma centre due to the possibility of malignancy. Few epidermal cysts (ECs) reach or exceed this size and are termed giant ECs (GECs). The purpose of this study is to report on a large series of GECs.

Methods:

Retrospective review of histologically proven GECs over an 8-year period. Patient demographics with MRI and ultrasound (US) appearances were evaluated.

Results:

A total of 14 cases were included with eight males and six females. Mean age was 51 years. 11 lesions were oval and three bi-lobed in shape, while 12 demonstrated dermal apposition. All were hyperintense on water-sensitive sequences and isointense to slightly hypointense on T1W imaging. Internal clefts were seen in 13 cases and 11 demonstrated chemical shift artefact (CSA) on MRI. On US, 12 showed well-defined linear hypoechoic clefts, with 66.6% having dis-organised compared with 33.3% peripherally located clefts. One ‘pseudo testis’ pattern and one showing irregular striped echogenicity termed novel ‘pseudo muscle’ appearance. No cases demonstrated internal vascularity on Doppler US.

Conclusions:

MRI signal findings of GECs are often characteristic with hyperintensity on water-sensitive sequences, dermal apposition, CSA and internal clefts while US features of disorganised or clumped hypoechoic clefts and absence of neovascularity were commonly seen. Recognition of combinations of both US and MRI features of GECs should reduce the requirement for pre-excisional needle biopsy to confirm the diagnosis.

Advances in knowledge:

1. Identification of common imaging features of GECs should avoid unnecessary pre-excisional biopsy despite their large size in the appropriate MDT setting.

2. A novel ‘pseudo-muscle’ appearance is described on MRI and US.