bluuebunny/crossref_metadata_2025 huggingface dataset:
The effects of processing barley and maize on metabolic and digestive responses in horses
Authors: Thorringer Nana W , Weisberg Martin R , Jensen Rasmus B
Published: November 2020

The competition for customers increases the search for new grain processing methods for equine feed, but the effect on starch digestibility and metabolic responses varies. Therefore, to evaluate the effect of the processing methods, toasting and micronizing, on starch digestion and the effect on metabolic responses, the mobile bag technique (MBT) and plasma glucose and insulin concentrations in the blood were used to estimate nutrient disappearance and metabolic responses pre-cecally. Further, cecal pH, ammonium nitrogen (N), and short-chain fatty acid (SCFA) concentrations were used to estimate the metabolic response in the cecum. Four cecally cannulated horses (body weight [BW] 565 ± 35 kg) were used in a 4 × 4 Latin square design with four periods of 8 d of diet adaptation and 2 d of data collection. Diets were formulated using hay and processed grains: micronized barley (MB), toasted barley (TB), micronized maize (MM), and toasted maize (TM) and were balanced to provide 1 g starch/kg BW in the morning meal. On day 9 in each period, blood and cecal fluid samples were taken before the morning meal and hourly thereafter for 8 h. On day 10 in each period, 15 bags of either MB, TB, MM, or TM (1 × 1 × 12 cm; 15 μm pore size; 1 g feed) were placed in the stomach, respectively. The dry matter disappearance was highest for the MM at all time points compared with the other feedstuffs (P < 0.001). Maize and micronizing had the highest starch disappearance (P = 0.048) compared with barley and toasting. No treatment effect was measured for any of the glucose and insulin parameters. No feed effect was measured for the insulin parameters. Plasma glucose peaked later (P = 0.045) for maize than for barley, and TB had a larger area under the curve for glucose than MB, MM, and TM (P = 0.015). The concentration of total SCFA increased after feeding (P < 0.001), with a higher concentration for barley than for maize (P = 0.044). No treatment or feed effects were measured for ammonium N or pH, but both were affected by time (P < 0.001). In conclusion, toasting was not as efficient as micronizing to improve pre-cecal starch digestibility; therefore, the preferred processing method for both barley and maize is micronizing. Further, the amount of starch escaping enzymatical digestion in the small intestine was higher than expected.
Comparing different approaches of time-lapse seismic inversion
Authors: Rosa Daiane R , Santos Juliana M C , Souza Rafael M , Grana Dario , Schiozer Denis J , Davolio Alessandra , Wang Yanghua
Published: November 2020

Time-lapse (4D) seismic inversion aims to predict changes in elastic rock properties, such as acoustic impedance, from measured seismic amplitude variations due to hydrocarbon production. Possible approaches for 4D seismic inversion include two classes of method: sequential independent 3D inversions and joint inversion of 4D seismic differences. We compare the standard deterministic methods, such as coloured and model-based inversions, and the probabilistic inversion techniques based on a Bayesian approach. The goal is to compare the sequential independent 3D seismic inversions and the joint 4D inversion using the same type of algorithm (Bayesian method) and to benchmark the results to commonly applied algorithms in time-lapse studies. The model property of interest is the ratio of the acoustic impedances, estimated for the monitor, and base surveys at each location in the model. We apply the methods to a synthetic dataset generated based on the Namorado field (offshore southeast Brazil). Using this controlled dataset, we can evaluate properly the results as the true solution is known. The results show that the Bayesian 4D joint inversion, based on the amplitude difference between seismic surveys, provides more accurate results than sequential independent 3D inversion approaches, and these results are consistent with deterministic methods. The Bayesian 4D joint inversion is relatively easy to apply and provides a confidence interval of the predictions.
Low-Quality Patents in the Eye of the Beholder: Evidence from Multiple Examiners
Authors: de Rassenfosse Gaétan , Griffiths William E. , Jaffe Adam B. , Webster Elizabeth
Published: November 2020

A low-quality patent system threatens to slow the pace of technological progress. Concerns about low patent quality are supported by estimates from litigation studies suggesting that most US patents granted should not have been issued. We propose a new model for measuring patent quality, based on equivalent patent applications submitted to multiple offices. Our method allows us to distinguish whether low-quality patents are issued because an office implements a low standard or because it violates its own standard. The results suggest that quality in patent systems is higher than previously thought. Specifically, the percentage of granted patents that are below each office’s own standard is under 10% for all offices. The Japanese patent office has a higher percentage of granted patents below its own standard than those from Europe, the USA, Korea, and China. This result arises from the fact that Japan has a higher standard than other offices. (JEL O34, K2, L4, F42)
Intraspecific variation and taxonomy of northern pikaOchotona hyperborea(Mammalia, Lagomorpha)
Authors: Lissovsky Andrey A , Obolenskaya Ekaterina V , Dokuchaev Nikolai E , Okhlopkov Innokentiy M
Published: November 2020

Rock-dwelling pikas of the genus Ochotona have fragmented montane geographical distribution presumably associated with geological and climatic events of Late Quaternary. Within this genus, the northern pika, O. hyperborea has the widest distribution. Taxonomic composition and subspecific structure of this species has been controversial during the past century. Sixteen available names were combined in different manners into a variable number of weakly overlapping subspecies by previous authors. A comparison of data sets from the entire distribution range of northern pikas is presented here for the first time, including: craniometric, bioacoustic, and multilocus genetic data. We examined 301 skulls, and the mitochondrial COI gene and two nuclear introns in 79 specimens, as well as the structure of alarm calls from 107 individuals. Our results show that the six subspecies within O. hyperborea correspond to the six genetic parapatric lineages. Five of these are hypothesized to be involved in hybridization at the edges of their distribution. Three acoustic races completely correspond with the six genetic lineages: each acoustic race consists of two lineages. Morphometric data do not display any phylogenetic signal in our study. The subspecies from the Mountains of Khabarovsk Territory, north of Amur River, is described de novo as O. h. fedoseevi ssp. n. The type locality of O. hyperborea is defined more accurately. A neotype is designated for O. h. cinereofusca to stabilize use of names of pikas from the Amur region.
Reduced Levels of Intestinal Neuropeptides and Neurotrophins in Neurotoxin-Induced Parkinson Disease Mouse Models
Authors: Choi Jin Gyu , Jeong Miran , Joo Boh Rah , Ahn Ji-Hye , Woo Jeong-Hwa , Kim Dong-Hyun , Oh Myung Sook , Choi Jung-Hye
Published: November 2020

Intestinal neuropeptides and neurotrophins as endocrine messengers play a key role in the bidirectional gut-brain interaction both in health and disease status. Their alterations in several neurological disorders have been reported, but whether a remarkable change occurs in Parkinson disease (PD) remains unexplored. In this study, we aimed to investigate the levels of 13 neuropeptides and 4 neurotrophins in the intestine of neurotoxin-induced PD mice. The PD mice were obtained by chronic injection of 1-methyl-4-phenyl-1,2,3,6 tetrahydropyridine (MPTP) or MPTP/probenecid (MPTP/p). The levels of mRNA and protein expression in mouse intestines were measured by using real-time reverse transcription polymerase chain reaction and Western blotting, respectively. We found that the mRNA expression of 2 neuropeptides (cholecystokinin [CCK] and dynorphin A [Dyn A]) and 2 neurotrophins (brain-derived neurotrophic factor [BDNF] and neurotrophin-5) was significantly decreased in the colon of MPTP group compared to the vehicle-treated group. The protein levels of CCK, Dyn A, and BDNF were reduced in the colon of MPTP- or MPTP/p-treated mice compared to those of the vehicle-treated group. These data suggest that the intestinal expression of CCK, Dyn A, and BDNF was significantly reduced in PD animal models, and may play a role in the gut-brain axis in PD.
Recent advances in radiobiology with respect to pleiotropic aspects of tissue reaction
Authors: Suzuki Keiji , Amrenova Aidana , Mitsutake Norisato
Published: November 2020

DNA double-strand breaks (DSBs) induced by ionizing radiation are the major cause of cell death, leading to tissue/organ injuries, which is a fundamental mechanism underlying the development of tissue reaction. Since unscheduled senescence, predominantly induced among epithelial tissues/organs, is one of the major modes of cell death in response to radiation exposure, its role in tissue reaction has been extensively studied, and it has become clear that senescence-mediated secretion of soluble factors is an indispensable component of the manifestation of tissue reaction. Recently, an unexpected link between cytoplasmic DSBs and innate immunity was discovered. The activation of cyclic GMP-AMP (cGAMP) synthase (cGAS) results in the stimulation of the cGAS–stimulator of interferon genes (STING) pathway, which has been shown to regulate the transactivation of a variety of secretory factors that are the same as those secreted from senescent cells. Furthermore, it has been proven that cGAS–STING pathway also mediates execution of the senescence process by itself. Hence, an autocrine/paracrine feedback loop has been discussed in previous literature in relation to its effect on the tissue microenvironment. As the tissue microenvironment plays a crucial role in cancer development, tissue reaction could be involved in the late health effects caused by radiation exposure. In this paper, the novel findings in radiation biology, which should provide a better understanding of the mechanisms underlying radiation-induced carcinogenesis, are overviewed.
Laparosacopic management with combination of fatty meal and methylen-blu for chylous leak after a left para-aortic paraganglioma excision
Authors: Cupellini Curzio , Alemanno Giovanni , Bottari Andrea , Bella Annamaria Di , Bruscino Alessandro , Martellucci Jacopo , Bergamini Carlo , Pantalone Desiree , Prosperi Paolo
Published: November 2020

We report a case of chylous leak recognized post-operatively after abdominal surgery for left para-aortic paraganglioma in a young female with a history of open botallo’s duct. Conservative measures failed to control the leak and the patient is not eligible for sclerotisation. Laparoscopic exploration with intralipidand methylen blue injection through an orogastric tube revealed the leaking area near the superior mesenteric vein behind the Traitz, and this was ligated with non-asorbable suture and placement of acrylic glue. The patient was discharged the 7th post-operative day after removal of the drainage which appeared to supply <100 cc of serum material. Outpatient control was successful and the patient is actually in good conditions.
Leading the Military Health System Transformation: From Military Treatment Facility to Market Construct
Authors: Melton John J , Quick Jeffrey W
Published: November 2020

The transition of authority to manage and administer all DoD Medical Treatment Facilities from the Military Department Services to the Defense Health Agency is an extremely complex challenge involving multiple stakeholders and systems in an effort to achieve greater force readiness while reducing cost. Womack Army Medical Center at Fort Bragg served as the U.S. Army’s sole prototype for the initial phase of the transition of authority. Starting with a foundational shift to an organizational outward mindset was essential in building effective relationships to exercise Mission Command at echelon to manage risks to mission during this period of uncertainty and ambiguity. This shift in mindset set the conditions for mobilizing Army Doctrine, elicited, and invited collaborative behaviors, and resulted in the improved organizational performance accomplished with velocity to successfully lead the transformation to Defense Health Agency.
Low birthweight is associated with lower glomerular filtration rate in middle-aged mainly healthy women
Authors: Lillås Bjørn Steinar , Tøndel Camilla , Aßmus Jörg , Vikse Bjørn Egil
Published: November 2020

Background

Low birthweight (LBW) has been shown to increase the risk of severe kidney disease. Studies have also shown associations between LBW and lower estimated glomerular filtration rate (GFR) in young adults. In this study we investigated whether LBW associates with measured GFR (mGFR) in middle-aged mainly healthy adults.

Methods

We invited individuals with LBW (1100–2300 g) and individuals with normal BW (NBW; 3500–4000 g) ages 41–52 years. GFR was measured using plasma clearance of iohexol. BW and BW for gestational age (BWGA) were obtained from the Medical Birth Registry of Norway and tested as main predictors. GFR was the main outcome.

Results

We included 105 individuals (57 LBW and 48 NBW). The mean GFR was 95 ± 14 mL/min/1.73 m2 in the LBW group and 100 ± 13 mL/min/1.73 m2 in the NBW group (P = 0.04). There was a significant sex difference: in women the mean GFR was 90 ± 12 versus 101 ± 14 mL/min/1.73 m2 in the LBW and NBW groups, respectively (P = 0.006), whereas corresponding values for men were 101 ± 15 versus 100 ± 11 mL/min/1.73 m2 (P = 0.7). Using linear regression, we found the GFR was 4.5 mL/min/1.73 m2 higher per 1 kg higher BW for women (P = 0.02), with a non-significant 1.2 mL/min/1.73 m2 lower GFR for men (P = 0.6). In analyses of BWGA, there was also a significant association for women, but not for men.

Conclusions

Middle-aged mainly healthy women with LBW had lower mGFR as compared with women with NBW. No such difference was found for men.
Funding Constraints and Informational Efficiency
Authors: Glebkin Sergei , Gondhi Naveen , Kuong John Chi-Fong
Published: November 2020

We analyze a tractable rational expectations equilibrium model with margin constraints. We argue that constraints affect and are affected by informational efficiency, leading to a novel amplification mechanism. A decline in wealth tightens constraints and reduces investors’ incentive to acquire information, lowering price informativeness. Lower informativeness, in turn, increases the risk borne by financiers who fund trades, leading them to further tighten constraints faced by investors. This information spiral leads to (a) significant increases in risk premium and return volatility in crises, when investors wealth declines, (b) complementarities in information acquisition in crises, and (c) complementarities in margin requirements.
Amyloid storm: acute kidney injury and massive proteinuria, rapidly progressing to end-stage kidney disease in AA amyloidosis of familial Mediterranean fever
Authors: Kukuy Olga L , Beckerman Pazit , Dinour Dganit , Ben-Zvi Ilan , Livneh Avi
Published: November 2020

Objective

Amyloid A nephropathy of FMF usually progresses over many years to end-stage renal disease (ESRD). We aim to describe an acute condition, termed here ‘amyloid storm’, typically manifesting with a rapid (≤2 weeks) increase in serum creatinine and urine protein, that has never been characterized in FMF amyloidosis.

Methods

This retrospective analysis features amyloid storm by comparing between FMF amyloidosis patients who have experienced an episode of amyloid storm (study group) and matched patients who have not (control group). The primary outcome was ESRD or death within 1 year from study entry. Featured data were retrieved from hospital files.

Results

The study and control groups, each comprising 20 patients, shared most baseline characteristics. However, they differed on the time from FMF onset to reaching serum creatinine of 1.2 mg/dl [26.5 years (s.d. 15.15) vs 41.55 (10.98), P = 0.001] and the time from the onset of proteinuria to study entry [8.8 years (s.d. 6.83) vs 15.75 (13.05), P = 0.04], culminating in younger age at study entry [39.95 years (s.d. 16.81) vs 48.9 (9.98), respectively, P = 0.05] and suggesting an accelerated progression of kidney disease in the study group. Within 1 year from study entry, 16 patients in the study and 3 in the control groups reached the primary endpoint (P = 0.000). The major triggers of amyloid storm were infections, occurring in 17 of 20 patients.

Conclusion

Amyloid storm is a complication of FMF amyloidosis, induced by infection and associated with poor prognosis and death.
Government-led Resettlement after Natural Disasters as a Durable Solution? The Case of Cyclone Idai
Authors: Jacobs Carolien , Almeida Bernardo
Published: November 2020

Thousands of people had to flee their homes when Cyclone Idai hit Mozambique in 2019. In its aftermath, the government resettled more than 80,000 people from high-risk areas to safer ground. This article analyses resettlement as a durable solution to disaster response. The question of durable resettlement due to climate-related displacement is especially pertinent in the light of ongoing climate change. Based on empirical research, we show that, although the government succeeded in providing a short-term response to the disaster, there are two major impediments to using resettlement as a durable solution: the lack of citizen participation in the decision-making process leading to resettlement; and the gap between the short-term humanitarian perspective and a longer-term development viewpoint. Resettlement can hardly be seen as a durable solution to climate-related displacement as long as key principles are not respected.
The skeletal remains of the euryhaline sclerorhynchoid †Onchopristis(Elasmobranchii) from the ‘Mid’-Cretaceous and their palaeontological implications
Authors: Villalobos-Segura Eduardo , Kriwet Jürgen , Vullo Romain , Stumpf Sebastian , Ward David J , Underwood Charlie J
Published: November 2020

We present the first known cranial remains of the fossil batoid †Onchopristis numidus. Based on two exceptionally well-preserved specimens collected from the ‘Kem Kem Beds’ (Albian–Cenomanian), south-east Morocco, an almost complete description of the rostral and cranial portions of the genus †Onchopristis is provided, together with new observations regarding the development and arrangement of the rostral denticle series for this genus. The comparison between the rostrum length of the specimens of †O. numidus with those of extant pristids, reveals a relatively large batoid species with an estimated total length between two and four metres. Overall, the cranial morphology of †Onchopristis resembles that of other sclerorhynchoids. Its robust hypertrophied rostrum, with the characteristic wood-like mineralization covering the inner layer of tessellate cartilage at the centre of the rostrum, in addition to the thick lateral layers of densely porous cartilage on the sides of the rostral cartilages, resembles that observed in †Ischyrhiza and †Schizorhiza, and differentiates †Onchopristis from other sclerorhynchoids (e.g. †Libanopristis, †Micropristis and †Sclerorhynchus). Aiming to determinate the phylogenetic relations of †Onchopristis within sclerorhynchoids, a cladistic analysis was carried out based on the remains described here; its results suggest a new taxonomic arrangement within the sclerorhynchoids.
Grapevine Asteroid Mosaic-Associated Virus is Resident and Prevalent in Wild, Noncultivated Grapevine of New York State
Authors: Thompson Jeremy R. , Gomez Annika L. , Younas Aisha , González-Tobón Juliana , Cha Alex , Perry Keith L.
Published: November 2020

In North America, uncultivated, free-living grapevines (Vitis spp.) frequently grow alongside their cultivated counterparts, thus increasing the potential for exchange of microbiota. For this study, we used high-throughput sequencing (HTS) of small RNAs to survey for virus populations in free-living grapevines of the Finger Lakes region of New York State. Of 32 grapevines analyzed, 23 were free-living vines, while the remaining 9 were commercially grown Vitis vinifera plants from the same region. In total, 18 (78.3%) of the free-living grapevines tested were positive for grapevine asteroid mosaic-associated virus (GAMaV) infection by HTS, with detection confirmed by seminested reverse-transcription PCR and sequencing of nine isolates. Phylogenetic analyses of an ungapped alignment of the New York GAMaV sequences (length: 2,334 nucleotides) with the five known full-length or close to full-length global sequences showed that the New York isolates were broadly grouped. Of the nine cultivated plants, eight were infected with both hop stunt viroid and grapevine yellow speckle viroid 1, three were singly infected with grapevine leafroll-associated virus 3, and one harbored GAMaV. This limited survey of free-living grapevines, one of the first to use HTS, has highlighted the high incidence of a virus associated with disease in commercial V. vinifera.
Fungicide Resistance in Venturia effusa, Cause of Pecan Scab: Current Status and Practical Implications
Authors: Standish J. R. , Brenneman T. B. , Bock C. H. , Stevenson K. L.
Published: November 2020

Pecan scab, caused by Venturia effusa, is the most economically damaging disease of pecan in the southeastern United States, and annual epidemics are most effectively managed through multiple fungicide applications. The fungicide applications can be the single greatest operating cost for commercial growers and the return on that investment is impacted by fungicide resistance. V. effusa produces multiple generations of conidia per season, exhibits substantial genetic diversity, overwinters as stromata in the tree, and is under immense selection from the applied fungicides, all of which lead to a high risk for developing fungicide resistance. Since the mid-1970s, resistance or reduced sensitivity has been observed in isolates of V. effusa to the methyl benzimidazole carbamates, demethylation inhibitors, quinone outside inhibitors, organotin compounds, and the guanidines. Over the last 10 years, several studies have been conducted that have improved both scab management and fungicide resistance management in V. effusa. The aim of this review is to summarize recent developments in our understanding of fungicide resistance in V. effusa in the context of scab management in southeastern pecan orchards. The history, modes of action, general use of the labeled fungicides, and mechanisms and stability of fungicide resistance in V. effusa are discussed; conclusions and future research priorities are also presented.
Recent Advances in Population Genomics of Plant-Parasitic Nematodes
Authors: Montarry Josselin , Mimee Benjamin , Danchin Etienne G. J. , Koutsovoulos Georgios D. , Ste-Croix Dave T. , Grenier Eric
Published: November 2020

Plant-parasitic nematodes are a costly burden of crop production. Ubiquitous in nature, phytoparasitic nematodes are associated with nearly every important agricultural crop and represent a significant constraint on global food security. Population genetics is a key discipline in plant nematology to understand aspects of the life strategies of these parasites, in particular their modes of reproduction, geographic origins, evolutionary histories, and dispersion abilities. Advances in high-throughput sequencing technologies have enabled a recent but active effort in genomic analyses of plant-parasitic nematodes. Such genomic approaches applied to multiple populations are providing new insights into the molecular and evolutionary processes that underpin the establishment of these nematodes and into a better understanding of the genetic and mechanistic basis of their pathogenicity and adaptation to their host plants. In this review, we attempt to update information about genome resources and genotyping techniques useful for nematologists who are thinking about initiating population genomics or genome sequencing projects. This review is intended also to foster the development of population genomics in plant-parasitic nematodes through highlighting recent publications that illustrate the potential for this approach to identify novel molecular markers or genes of interest and improve our knowledge of the genome variability, pathogenicity, and evolutionary potential of plant-parasitic nematodes.
Prevalence of Home Births and Associated Risk Profile and Maternal Characteristics, 2016–2018
Authors: Goyal Sonal , Kortsmit Katherine , Cox Shanna , D'Angelo Denise V. , Romero Lisa , Henderson Zsakeba T. , Barfield Wanda D.
Published: November 2020

OBJECTIVE:

To estimate the prevalence of pregnancies that meet the low-risk criteria for planned home births and describe geographic and maternal characteristics of home births compared with hospital births.

METHODS:

Data from the 2016–2018 Pregnancy Risk Assessment Monitoring System (PRAMS), a survey among women with recent live births, and linked birth certificate variables were used to calculate the prevalence of home births that were considered low-risk. We defined low-risk pregnancy as a term (between 37 and 42 weeks of gestation), singleton gestation with a birth weight within the 10th–90th percentile mean for gestational age (as a proxy for estimated fetal size appropriate for gestational age), without prepregnancy or gestational diabetes or hypertension, and no vaginal birth after cesarean (VBAC). We also calculated the prevalence of home and hospital births by site and maternal characteristics. Weighted prevalence estimates are presented with 95% CIs to identify differences.

RESULTS:

The prevalence of home births was 1.1% (unweighted n=1,034), ranging from 0.1% (Alabama) to 2.6% (Montana); 64.9% of the pregnancies were low-risk. Among the 35.1% high-risk home births, 39.5% of neonates were large for gestational age, 20.5% of neonates were small for gestational age, 17.1% of the women had diabetes, 16.9% of the women had hypertension, 10.6% of the deliveries were VBACs, and 10.1% of the deliveries were preterm. A significantly higher percentage of women with home births than hospital births were non-Hispanic White (83.9% vs 56.5%), aged 35 years or older (24.0% vs 18.1%), with less than a high school-level of education (24.6% vs 12.2%), and reported no health insurance (27.0% vs 1.9%). A significantly lower percentage of women with home births than hospital births initiated prenatal visits in the first trimester (66.9% vs 87.1%), attended a postpartum visit (80.1% vs 90.0%), and most often laid their infants on their backs for sleep (59.3% vs 79.5%).

CONCLUSIONS:

Understanding the risk profile, geographic distribution, and characteristics of women with home births can guide efforts around safe birthing practices.
Complications of Pelvic Organ Prolapse Surgery in the 2015 Finnish Pelvic Organ Prolapse Surgery Survey Study
Authors: Wihersaari Olga , Karjalainen Päivi , Tolppanen Anna-Maija , Mattsson Nina , Jalkanen Jyrki , Nieminen Kari
Published: November 2020

OBJECTIVE:

To describe the major complications of pelvic organ prolapse (POP) surgery in Finland.

METHODS:

The Finnish Pelvic Organ Prolapse Surgery Survey 2015 study is a prospective cohort of POP surgeries performed in Finland in 2015. Perioperative, postoperative, and late complications during 1 year of follow-up were compared among native tissue repair, transvaginal mesh, and abdominal mesh surgery. Major complications were assessed using the Clavien-Dindo grading system. Predictive factors for major complications were studied with logistic regression analysis.

RESULTS:

Within 1 year after POP surgery, 396 (11.2%) of 3,515 women had at least one complication: 10.9% after native tissue, 11.7% after transvaginal mesh, and 13.5% after abdominal mesh repair. The majority of complications occurred within 2 months after surgery and postoperative infection (4.3%) and bleeding or hematoma (2.6%) were the most frequent. The incidence of organ injuries was low. Mesh-augmented surgery was associated with significantly higher rates of bladder and bowel injuries than native tissue surgery. Complication-related reoperations occurred significantly more often after abdominal mesh repair than native tissue surgery (5.2% vs 1.8%, P=.001). Mesh-related complications were diagnosed more often after transvaginal mesh repair. The overall rate of major complications (Clavien-Dindo grades III–V) was 3.3%. Abdominal mesh surgery was associated with the highest rate of major adverse events (8.8% vs native tissue repair 2.6% and transvaginal mesh 4.9%). The incidence of Clavien-Dindo grade IV or V complications was rare (less than 0.6%). Mesh surgery (transvaginal mesh adjusted odds ratio [aOR] 2.23, 95% CI 1.31–3.80, and abdominal mesh aOR 3.02, 95% CI 1.67–5.46), longer operating time (aOR 2.84, 95% CI 1.78–4.53), prior POP surgery (aOR 1.68, 95% CI 1.00–2.81) and difficult surgery (aOR 2.75, 95% CI 1.63–4.62) were associated with an increased risk for occurrence of major complications.

CONCLUSION:

Serious adverse events were rare regardless of the operative approach. However, mesh-augmented surgery was associated with higher risk for major complications.
Rethinking Prenatal Screening for Anomalies of Placental and Umbilical Cord Implantation
Authors: Jauniaux Eric , Silver Robert M.
Published: November 2020

The most common anomalies of implantation of the placenta and umbilical cord include placenta previa, placenta accreta spectrum, and vasa previa, and are associated with considerable perinatal and maternal morbidity and mortality. There is moderate quality evidence that prenatal diagnosis of these conditions improves perinatal outcomes and the performance of ultrasound imaging in diagnosing them is considered excellent. The epidemiology of placenta previa is well known, and it is standard clinical practice to assess placental location at the routine screening second-trimester detailed fetal anatomy ultrasound examination. In contrast, the prevalence of placenta accreta spectrum and vasa previa in the general population is more difficult to evaluate because detailed confirmatory histopathologic data are not available in most studies. The sensitivity and specificity of ultrasonography for the diagnosis of these anomalies is also difficult to assess. Recent epidemiologic studies show an increase in the incidence of placental and umbilical cord implantation anomalies, which may be the result of increased use of assisted reproductive technology and cesarean delivery. There is good evidence to support targeted standardized protocols for women at high risk and that screening and diagnosing placenta accreta spectrum and vasa previa should be integrated into obstetric ultrasound training programs.
Intrascleral 4-flanged technique for in-the-bag intraocular lens subluxation
Authors: Mahler Ori S. , Biron Roy , Hecht Idan , Pras Eran , Einan-Lifshitz Adi
Published: November 2020

Purpose:

To present a series of cases in which the 4-flanged technique was used in the management of in-the-bag intraocular lens (IOL) subluxation.

Setting:

Shamir Medical Center, Israel.

Design:

Retrospective cohort analysis.

Methods:

Included were consecutive cases with secondary IOL subluxation that underwent scleral fixation with the 4-flanged technique using 6-0 polypropylene and low temperature cautery. Surgeries were performed during September 2019 to April 2020. Postoperative IOL angle tilt was evaluated using high-resolution ocular coherence tomography.

Results:

Eleven eyes of 11 patients were included. The mean age was 82.7 ± 5.5 years, and 60% were men. Pseudoexfoliation was noted in 82% of patients, and only 1 case was related to trauma. The mean corrected distance visual acuity (CDVA) postoperatively was within 1 line of the original presubluxation CDVA (0.55 ± 0.41 vs 0.54 ± 0.6 logMAR, P = .965). The mean postoperative IOL tilt was 5.78 ± 3.85 degrees. Surgery duration decreased from 70 ± 14 minutes to 39 ± 15 minutes (first to last operations). No intraoperative complications were reported. Postoperatively, transient intraocular pressure elevation, which resolved at 1 week, was recorded in 45% of cases. Cystoid macular edema, which resolved within a few months under topical treatment, was seen in 2 patients.

Conclusions:

Among a cohort of patients with secondary in-the-bag IOL subluxation, the 4-flanged technique was safe and resulted in satisfactory visual outcomes and a stable IOL position, with a short learning curve.
Key Activities of Caregivers for Individuals With Parkinson Disease: A Secondary Analysis
Authors: Shin Ju Young , Habermann Barbara
Published: November 2020

BACKGROUND: Individuals with Parkinson disease (PD) require support from family caregivers because of decreased functional levels in a later stage. Much of the research with PD caregivers has been limited by relatively homogenous samples of primarily White and largely spousal caregivers. METHODS: This secondary analysis aimed to describe a national sample of caregivers of individuals with PD in the Caregiving in the U.S. 2015 data set and their activities, including activities of daily living (ADLs), instrumental ADLs (IADLs), and key activities they performed for individuals with PD. RESULTS: Fifty-four caregivers (32 women) were included. The mean (SD) age was 57.7 (16.9) years, and the sample included 57% White, 9% Black, 15% Asian, and 17% Hispanic caregivers. Relationships to care recipient were 32% spouses, 20% mothers, and 11% fathers, with the remaining being a variety of relationships. The number of ADLs and IADLs performed by the caregiver was 2.85 (SD, 2.18) and 4.72 (SD, 2.08), respectively. The most frequent ADLs were getting in and out of beds and chairs, getting dressed, getting to and from the toilet, and bathing/showering. The most frequent IADLs were transportation, shopping, managing finances, giving medicine, preparing meals, and housework. CONCLUSION: This study shows the number of ADLs and IADLs performed by a diverse group of PD caregivers and indicates the need to acknowledge the extensive work performed by caregivers.
Effects of Xingnaojing on serum high-sensitivity C-reactive protein and neuron-specific enolase in patients with acute cerebral hemorrhage
Authors: Zhou Zhe-ren , Zhao Yun-hua , Sun Rong , Zhang Yu-rong
Published: November 2020

Background:

This study will systematically explore the effects of Xingnaojing (XNJ) on serum high-sensitivity C-reactive protein (hs-CRP) and neuron-specific enolase (NSE) in patients with acute cerebral hemorrhage (ACH).

Methods:

We will comprehensively search the following electronic databases (MEDLINE, EMBASE, Cochrane Library, Allied and Complementary Medicine Database, and China National Knowledge Infrastructure) from inception to the March 1, 2020. There are no limitations related to the language and publication status. Two authors will independently perform all citation identification, information extraction, and study quality. All potential conflicts will be solved through discussion with the help of a third author. RevMan 5.3 software will be used for data synthesis and statistical analysis.

Results:

This study will summarize the present evidence to investigate the effects of XNJ on serum hs-CRP and NSE in patients with ACH.

Conclusion:

This study may provide an impressive understanding of perspective from scientific basis for effects of XNJ on serum hs-CRP and NSE in patients with ACH.

Study registration:

PROSPERO CRD42020171648.
Melanotic neuroectodermal tumor of infancy successfully treated with metformin
Authors: Liang Yu , Tian Ruicheng , Wang Jing , Shan Yuhua , Gao Hongxiang , Xie Chenjie , Li Jingjing , Zhang Lei , Xu Min , Gu Song
Published: November 2020

Rationale:

Melanotic neuroectodermal tumor of infancy (MNTI) is a rare tumor originated from neural crest cells with the potential for recurrence and metastasis. The peak age for the disease is during the first year after birth. The current therapy is primarily surgery. The patient reported here is the first case of MNTI treated with metformin.

Patient concerns:

A case of a 4-month-old infant with a history of swelling in the mouth for 1 month.

Diagnosis:

The tumor was diagnosed using radiology, pathology, and immunohistochemistry, and it was performed with complete surgical resection. Unfortunately, the tumor recurred 3 months after surgery.

Interventions:

We prescribed metformin for the infant.

Outcomes:

Currently, after 9 months of treatment, the tumor is well controlled without apparent side effects.

Lessons:

The case presented suggested that metformin may be an underlying therapy for MNTI.
Novel peroral cholangioscopy-directed lithotripsy using an ultraslim upper endoscope for refractory Mirizzi syndrome
Authors: Li Jian , Guo Shao-Ju , Zhang Jing-Chao , Wang Hong-Yan , Li Kai , Xu Cheng-Shan , Wang Xue-Fang
Published: November 2020

Rationale:

Mirizzi syndrome (MS) is an uncommon condition characterized by common hepatic duct (CHD) compression by an impacted gallbladder or cystic duct stones or adjacent inflammation. To date, a standardized therapeutic strategy for MS has not been established yet, owing to its complex clinical presentation. Thus, researchers still have to develop new optimized approaches to solve this problem. Herein, we describe a patient with refractory MS who underwent a successful treatment by novel hybrid anchoring balloon-guided direct peroral cholangioscopy (POC) using an ultraslim endoscope.

Patient concerns:

A 56-year-old man with a history of biliary stone was referred to our hospital for complaints of discomfort in the right upper quadrant of the abdomen and obstructive jaundice. Endoscopic retrograde cholangiopancreatography showed an 18-mm impacted stone at the level of the cystic duct, which compressed the CHD. The CHD had local stricture, with its upstream and intrahepatic bile duct dilation.

Diagnoses:

He was diagnosed with type I MS.

Interventions:

Initially, the patient received an endoscopic major sphincterotomy. However, conventional stone extraction, including mechanical lithotripsy, was unsuccessful. Then, after signing the informed consent form for further treatment, he was successfully treated with novel hybrid anchoring balloon-guided direct POC.

Outcomes:

The patient had no operative complications and was discharged with cleared ducts. At the 3-year follow-up, he was asymptomatic.

Lessons:

Our novel hybrid anchoring balloon-guided direct POC may be an effective alternative treatment approach for difficult gallbladder cases, such as refractory MS.
Percutaneous endoscopic cervical foraminotomy as a new treatment for cervical radiculopathy
Authors: Zhang Yangyang , Ouyang Zhihua , Wang Wenjun
Published: November 2020

Background:

Anterior cervical discectomy and fusion (ACDF) is the gold standard treatment for this cervical radiculopathy. Posterior endoscopic cervical foraminotomy (PECF), an effective alternative to ACDF, is becoming widely used by an increasing number of surgeons. However, comparisons of the clinical outcomes of ACDF and PECF remain poorly explored. The purpose of this study was to evaluate and compare visual analog scale (VAS)-arm scores, VAS-neck scores, neck disability index (NDI) scores, reoperation, and complications in PECF and ACDF.

Materials and Methods:

We comprehensively searched electronic databases or platforms, including PubMed, Web of Science, EMBASE, and the Cochrane Controlled Trial Center, using the PRISMA guidelines. The required information, including VAS-arm scores, VAS-neck scores, NDI scores, reoperation, and complications, was extracted from qualified studies and independently tested and compared by 2 researchers. The methodological index for nonrandomized studies was used to evaluate study quality.

Results:

Nine studies consisting of 230 males and 256 females were included. The mean age of the included patients was 49.6 years, and the mean follow-up time was 20.6 months. The VAS-arm scores were significantly higher, and VAS-neck scores and NDI scores of PECF showed greater improvement trends for PECF than ACDF. The complication proportion of patients with PECF was lower, while the proportion of reoperation was similar between PECF and ACDF. ACDF was the most common revision surgery. The most common complication of PECF was transient paresthesia.

Conclusion:

Compared with ACDF, PECF is safe and effective in patients with unilateral cervical radiculopathy without myelopathy, and PECF does not increase the probability of reoperation and complications.
Dasatinib associated lymphadenopathy in a chronic myeloid leukemia patient
Authors: Pilalas Dimitrios , Koletsa Triantafyllia , Arsos Georgios , Panselinas Grigorios , Exadaktylou Paraskevi , Polychronopoulos George , Savopoulos Christos , Kaiafa Georgia D.
Published: November 2020

Rationale:

Dasatinib associated lymphadenopathy (DAL) is a rare adverse event in chronic myeloid leukemia patients (CML). A case of voluminous lymphadenopathy in the context of DAL is presented.

Patient concerns:

A 40-year-old male patient was diagnosed with BCR-ABL1 positive chronic stage CML 2 years ago and achieved complete molecular response on nilotinib, which was switched to dasatinib due to nilotinib intolerance. After 5 months on dasatinib, the patient presented with a large mass in the axillary region.

Diagnosis:

Common infectious and autoimmune etiologies of lymphadenopathy were ruled out. The positron emission tomography/computed tomography (PET/CT) demonstrated a hypermetabolic lymphadenopathy highly suspicious of lymphoma. The subsequent biopsy excluded lymphoma or extramedullary blastic transformation of CML and revealed reactive lymphadenopathy with mixed (cortical and paracortical) pattern. Clinical history and clinicopathological correlation suggested the diagnosis of DAL.

Intervention:

Dasatinib was discontinued and the patient remained in close follow-up. TKI treatment with nilotinib was reinitiated.

Outcomes:

Lymphadenopathy resolved clinically at 4 weeks and normalization of PET/CT findings was documented at 9 weeks after cessation of the drug. TKI treatment with nilotinib was reinitiated with good tolerance.

Lessons:

DAL may present with voluminous lymphadenopathy consistent with malignancy in clinical and imaging workup. We describe the spectrum of lesions associated with DAL and identify common features with drug-induced lymphadenopathy.
Impact of right ventricular systolic pressure in elderly patients admitted to intensive care unit after femur fracture surgery
Authors: Lee Su Hwan , Han Yeji , Kim Soo Jung , Lee Seok Jeong , Ryu Yon Ju
Published: November 2020

The number of femoral fractures is expected to continue to increase as the size of the older population rapidly grows. However, old age is accompanied by various comorbidities and is an important postoperative risk factor in itself, meaning that patients who undergo surgery for a femur fracture may require admission to an ICU. We investigated pulmonary complications in patients over the age of 65 admitted to the ICU after femur fracture surgery.

In this single-center retrospective observational study, 289 patients over 65 years who admitted to the ICU after femur fracture surgery between June 2008 and December 2016 were investigated.

Pulmonary complications occurred in 97 of these patients (33.6%) after surgery. Mean hospitalization days (34.1 ± 25.7 vs 23.1 ± 15.7, P < .001) and mean ICU length of stay (8.4 ± 16.1 vs 2.5 ± 1.1, P = .001) were significantly longer for patients with pulmonary complications than for patients without pulmonary complications after femur fracture surgery. Patients with pulmonary complications were significantly more likely to have pulmonary disease (19.6% vs 8.9%, P = .009) and exhibit sequelae on preoperative chest X-rays (9.3% vs 3.6%, P = .048) than were patients without pulmonary complications. In addition, significant differences were observed in the right ventricular systolic pressure (RVSP) measured during preoperative echocardiography (37.4 ± 10.9 mm Hg vs 40.7 ± 9.3 mm Hg for patients without and with pulmonary complications, P = .010) and in the proportion of each group that had an RVSP of >35 mm Hg, which is a marker for pulmonary hypertension (55.2% vs 76.3% for patients without and with pulmonary complications, P < .001). In multivariate analysis, an RVSP of >35 mm Hg during preoperative echocardiography was associated with pulmonary complications after femur fracture surgery (OR, 2.6; 95% CI, 1.45–4.53).

In conclusion, Pulmonary complications in older patients admitted to the ICU after femur fracture surgery was associated with longer hospitalization and ICU stays. Preoperative RVSP measurement could identify those older patients with a high risk of pulmonary complications following transferal to the ICU after femur fracture surgery.
Risk factors associated with disease aggravation among 126 hospitalized patients with COVID-19 in different places in China
Authors: Shao Shuai , Zhao Zhiling , Wang Feng , Chang Dandan , Liu Yong , Liu Shi , Xu Xiaoguang , Li Xuyan , Jiang Chunguo , Tang Ziren
Published: November 2020

Coronavirus disease 2019 (COVID-19) has rapidly spread on a global scale. Therefore, it is urgent to identify risk factors that could be associated with severe type of COVID-19 from common type.

For this retrospective study, we recruited patients with COVID-19 in Wuhan and Zhoukou. Patients were classified into a severe group and common group based on guidelines after admission. Clinical manifestations and laboratory tests were compared, and univariate binary logistic regression and multivariate regression analyses were applied to assess potential risk factors.

A total of 126 patients were recruited from January 23 to March 23, 2020. Ninety cases were identified as the common type and 36 as the severe type. The average age in the severe group was significantly older than that in the common group (P = .008). Patients with severe COVID-19 exhibited higher proportions of dyspnea (P = .001), weakness (P = .023), and diarrhea (P = .046). Moreover, there were more patients with hypertension (P = .01) or coinfection (P = .001) in the severe group than in the common group. Additionally, severe COVID-19 was associated with increased neutrophil counts (P < .001), C-reactive protein (P < .001), procalcitonin (P = .024) and decreased lymphocyte counts (P = .001), hemoglobin (P < .001), total protein (TP) (P < .001), and albumin (ALB) (P < .001). Based on logistic regression analysis, dyspnea (P < .001), TP (P = .042), and ALB (P = .003) were independent risk factors for severe disease.

Patients with lower TP, ALB, and dyspnea should be carefully monitored, and early intervention should be implemented to prevent the development of severe disease.
Risk factors for Coronavirus disease 2019 pneumonia after admission outside Wuhan, China
Authors: Jie Li Shao , Yu Yuan , Ping Zeng Jian , Dong Xiang Xu , Ping Chai Xiang , Chao Hu , Li Yang , Jing Yang , Ling Tan Yan , Yan Jiang Ming , Peng Ling
Published: November 2020

Coronavirus disease 2019 (COVID-19) has spread worldwide, causing significant stress on the medical system. We explored the risk factors for condition changes in COVID-19 pneumonia patients after admission.

The patients diagnosed with COVID-19 pneumonia at 2 medical centers in Hunan Province were studied, and those whose conditions changed after admission were compared. Their clinical characteristics and experimental indicators were compared using SPSS software and R language to build a disease risk prediction model.

Patients with condition changes after admission were older and had more blood cell abnormalities and impaired organ function (decreased albumin, elevated D-dimer) than normal patients. We found that age, neutrophil ratio, D-dimer, chest Computed tomograpgy (CT) changes, and glucocorticoid use were risk factors for COVID-19 pneumonia after admission.

Elderly patients are more susceptible to disease changes after COVID-19 pneumonia; COVID-19 pneumonia patients who develop disease changes after admission have higher neutrophil ratios, increased D-dimer levels, chest imaging changes, and glucocorticoid usage. Additional research is needed.