bluuebunny/crossref_metadata_2025 huggingface dataset:
Asymptomatic Hyperinsulinemic Hypoglycemia and Grade 4 Intraventricular Hemorrhage in a Late Preterm Infant
Authors: Banas Janlie L. , Viswalingam Bhavani , Rajadurai Victor Samuel , Yap Fabian , Chandran Suresh
Published: October 2021

Hyperinsulinemic hypoglycemia (HH) has the potential to cause acute neurologic dysfunction and neurodevelopmental impairment. Parieto-occipital neuronal injuries have been reported in hypoglycemic infants, but intraparenchymal hemorrhage is rare. On day 5 of life, a late preterm infant was transferred to our care with recurrent asymptomatic hypoglycemia. Prior to arrival, plasma glucose levels were at a median of 1.25 mmol/L (22.5 mg/dL) in the first 6 hours of life, and he required a glucose infusion rate (GIR) of 22.6 mg/kg/min. Hyperinsulinism was confirmed in the presence of detectable insulin, low ketones, and fatty acid when hypoglycemic. A left grade 4 intraventricular hemorrhage (IVH) was noted in the cranial ultrasound scan during the workup for sepsis on the day of admission. However, magnetic resonance imaging of the brain on day 7 of life revealed extensive bilateral IVH. On day 9, he was initiated on diazoxide, and HH resolved within 48 to 72 hours, allowing increment of feeds while weaning GIR. Ventricular drain for post-hemorrhagic ventriculomegaly was advised but not performed. At 3 months, post-hemorrhagic ventriculomegaly was stable, and there were early signs of neurodevelopmental delay. After discontinuing diazoxide at 4 months of age, he passed an 8-hour fasting study confirming the resolution of HH. Severe hypoglycemia has been associated with cerebral hyperperfusion in preterm infants and potentially could cause IVH. Close monitoring and prompt intervention in preterm infants to prevent severe hypoglycemia are paramount. In addition to long-term neurodevelopmental follow-up, infants with recurrent hypoglycemia may benefit from neuroimaging and thereby early intervention if required.
Sensorimotor Polyneuropathy in a Diabetic Patient After Rapid Overcorrection of Chronic Hyperglycemia
Authors: Broadhead Devin Y. , Devenport Stephen B.
Published: October 2021

The differential diagnosis for peripheral neuropathy of uncertain etiology is extensive, and the work-up presents a diagnostic challenge for the physician. Following initial clinical assessment, we recommend electrodiagnostic studies as the test of choice in the evaluation of peripheral neuropathy of unclear cause. Subsequent laboratory testing can then be better specified according to the results of the electrodiagnostic studies and clinical assessment. This case report presents a 66-year-old female with a history of uncontrolled type-II diabetes who developed prominent sensorimotor neuropathy after experiencing several hypoglycemic episodes. Due to difficulties with insulin titration, over the course of 4 weeks, the patient quickly and drastically lowered her chronically elevated average serum glucose concentration to the point of suffering multiple periods of hypoglycemia. Soon after, she developed paresthesia in her hands and feet, as well as significant weakness in both upper and lower extremities. Unfortunately, the patient was lost to follow-up before a definitive diagnosis could be established. Hypoglycemia and rapid correction of long-standing hyperglycemia are relatively under-recognized sources of neuropathy in diabetic patients. Physicians taking care of diabetic patients who develop peripheral neuropathy following rapidly improved glycemic control or hypoglycemia should be aware of the possibility of a diabetic neuropathy and begin prompt work-up to exclude other causes before making the diagnosis of treatment-induced diabetic neuropathy or hypoglycemic neuropathy.
Cognitive Apprenticeship in STEM Graduate Education: A Qualitative Review of the Literature
Authors: Minshew Lana M. , Olsen Amanda A. , McLaughlin Jacqueline E.
Published: October 2021

The future is dependent on the STEM graduate education system, emphasizing the importance of STEM graduate programs in producing highly trained expert researchers. The cognitive apprenticeship (CA) framework provides guidance to experts (i.e., faculty) on how to explicate their knowledge through the creation of learning opportunities that foster and support students in developing expertise in a particular discipline. This review examines the current landscape of research focused on the use of the CA framework in STEM graduate education. The research suggests the CA framework is a useful and effective model for supporting faculty in cultivating rich learning opportunities for STEM graduate students.
Public Sector Employment as a Social Welfare Policy: The “Social Contract” and Failed Job Creation for Youth in Egypt
Authors: Kawamura Yusuke
Published: October 2021

Although the IMF and the World Bank have advocated public sector reforms for market-oriented economic development, Egyptian authoritarian leaders have avoided such reforms. Egypt maintains a large public sector with a significant number of young Egyptians among its ranks. However, the public sector has shortcomings such as overstaffed government departments, deteriorating working conditions, and employee protests. This study uses the “social contract” concept to understand why Egypt’s political leaders have preserved this inefficient institution. The logic of the “social contract” works under two conditions: generous welfare as the main source of the regime’s legitimacy and a lack of accurate information concerning the extent to which people can tolerate painful reforms under authoritarian rule. Contrary to the conventional understanding, a lack of democratic institutions imposes “shackles” upon authoritarian leaders rather than giving them wide discretion regarding policymaking and the manipulation of institutions for their survival. The findings thus offer important insights into the dynamics of authoritarianism.
“The Message Is You Don’t Exist”: Exploring Lived Experiences of Rural Lesbian, Gay, Bisexual, Transgender, Queer/Questioning (LGBTQ) People Utilizing Health care Services
Authors: Henriquez Nadine R. , Ahmad Nora
Published: October 2021

Background

Lesbian, gay, bisexual, transgender, queer/questioning (LGBTQ) people experience significant health inequities with well-documented negative health impacts due to their status as a sexual and gender minority population. Insensitive or discriminatory attitudes toward LGBTQ people within the health care system have negatively impacted access to health services and the overall physical and mental health and well-being of this at risk population. Few studies of LGBTQ populations in rural areas have been conducted, with even fewer in the Canadian context. Rural areas often create greater visibility for LGBTQ persons, contain fewer supports and alternatives in the face of discrimination, and are often are less accepting of LGBTQ populations due to increased stigma and social isolation.

Objective

The purpose of this study is to examine the lived experiences of LGBTQ people utilizing health care services in rural Manitoba.

Method

12 individuals who self-identified as LGBTQ who had accessed health care services in Manitoba were recruited. Using qualitative methodology, interviews were recorded and analyzed for themes.

Results

Analysis revealed themes including stigma and discrimination, judgments and assumptions, gender identities, lack of knowledge, limited access/systemic barriers, rural considerations, and recommendations for changes to address the gaps in health care services and barriers to access.

Conclusions

This study of the LGBTQ community provides an expression of their opinions and experiences, but also provides a voice to this underserved population. The findings of this study provide a better understanding of the unique health needs and experiences of LGBTQ people in rural Manitoba, creating opportunities for meaningful change in health care delivery
A Systematic Scoping Review on Pedagogical Strategies of Interprofessional Communication for Physicians in Emergency Medicine
Authors: Ong Zhi H. , Tan Lorraine H. E. , Ghazali Haziratul Z. B. , Ong Yun T. , Koh Jeffrey W. H. , Ang Rachel Z. E. , Bok Chermaine , Chiam Min , Lee Alexia S. I. , Chin Annelissa M. C. , Zhou Jamie X. , Chan Gene W. H. , Nadarajan Gayathri D. , Krishna Lalit K. R.
Published: October 2021

Background

Interprofessional communication (IPC) is integral to interprofessional teams working in the emergency medicine (EM) setting. Yet, the coronavirus disease 2019 pandemic has laid bare gaps in IPC knowledge, skills and attitudes. These experiences underscore the need to review how IPC is taught in EM.

Purpose

A systematic scoping review is proposed to scrutinize accounts of IPC programs in EM.

Methods

Krishna's Systematic Evidence-Based Approach (SEBA) is adopted to guide this systematic scoping review. Independent searches of ninedatabases (PubMed, Embase, CINAHL, Scopus, PsycINFO, ERIC, JSTOR, Google Scholar and OpenGrey) and “negotiated consensual validation” were used to identify articles published between January 1, 2000 and December 31, 2020. Three research teams reviewed the data using concurrent content and thematic analysis and independently summarized the included articles. The findings were scrutinized using SEBA's jigsaw perspective and funneling approach to provide a more holistic picture of the data.

Results

In total

18,809 titles and abstracts were identified after removal of duplicates, 76 full-text articles reviewed, and 19 full-text articles were analyzed. In total, four themes and categories were identified, namely: (a) indications and outcomes, (2) curriculum and assessment methods, (3) barriers, and (4) enablers.

Conclusion

IPC training in EM should be longitudinal, competency- and stage-based, underlining the need for effective oversight by the host organization. It also suggests a role for portfolios and the importance of continuing support for physicians in EM as they hone their IPC skills.

Highlights

• IPC training in EM is competency-based and organized around stages. • IPC competencies build on prevailing knowledge and skills. • Longitudinal support and holistic oversight necessitates a central role for the host organization. • Longitudinal, robust, and adaptable assessment tools in the EM setting are necessary and may be supplemented by portfolio use.
Factors influencing knee valgus alignment in Crowe type IV hip dysplasia after total hip arthroplasty
Authors: Sun Jing-yang , Ma Hai-yang , Shen Jun-min , Du Yin-qiao , Dong Yu , Zhang Yan-chao , Zhou Yong-gang , Wang Yan
Published: October 2021

Background

Valgus deformity of the knee remains a complaint after total hip arthroplasty (THA) among some patients with Crowe type IV hip dysplasia. We aimed to identify the knee alignment in these patients before and after surgery, and to explore the factors contributing to postoperative knee valgus alignment.

Materials and methods

We retrospectively reviewed a series of Crowe type IV patients who received THA between February 2010 and May 2019 in our hospital. The patients’ medical data were collected from the hospital information system. On both preoperative and postoperative full limb length standing radiographs, the following parameters were measured: hip–knee–ankle angle (HKA), mechanical lateral distal femoral angle (mLDFA), medial proximal tibial angle, anatomical tibiofemoral angle, anatomical lateral distal femoral angle, femoral neck-shaft angle, pelvic obliquity, limb length, height and lateral distance of hip center, and femoral offset. Univariate and multivariate binary logistic regression were used to identify the factors influencing postoperative knee valgus alignment.

Results

A total of 64 Crowe type IV patients (87 hips) were included in the study. Overall, HKA improved from 176.54 ± 3.52° preoperatively to 179.45 ± 4.31° at the last follow-up. Those hips were subdivided into non-valgus group (≥ 177.0°, n = 65) and valgus group (< 177.0°, n = 22) according to postoperative HKA. Only postoperative mLDFA was a significant factor in the multivariate regression model.

Conclusions

The postoperative mLDFA is a major factor related to knee valgus alignment after THA, which combines the preoperative anatomy and surgical reconstruction. Other factors previously published were found to have no significance.

Level of evidence

III.
Human impact on fluvial systems in Europe with special regard to today’s river restorations
Authors: Maaß Anna-Lisa , Schüttrumpf Holger , Lehmkuhl Frank
Published: October 2021

Climate, geology, geomorphology, soil, vegetation, geomorphology, hydrology, and human impact affect river–floodplain systems, especially their sediment load and channel morphology. Since the beginning of the Holocene, human activity is present at different scales from the catchment to the channel and has had an increasing influence on fluvial systems. Today, many river–floodplain systems are transformed in course of river restorations to “natural” hydrodynamic and morphodynamic conditions without human impacts. Information is missing for the historical or rather “natural” as well as for the present-day situation. Changes of the “natural” sediment fluxes in the last centuries result in changes of the fluvial morphology. The success of river restorations depends on substantial knowledge about historical as well as present-day fluvial morphodynamics. Therefore, it is necessary to analyze the consequences of historical impacts on fluvial morphodynamics and additionally the future implications of present-day human impacts in course of river restorations. The objective of this review is to summarize catchment impacts and river channel impacts since the beginning of the Holocene in Europe on the fluvial morphodynamics, to critically investigate their consequences on the environment, and to evaluate the possibility to return to a “natural” morphological river state.
Reference-agnostic representation and visualization of pan-genomes
Authors: Liang Qihua , Lonardi Stefano
Published: October 2021

Background

The pan-genome of a species is the union of the genes and non-coding sequences present in all individuals (cultivar, accessions, or strains) within that species.

Results

Here we introduce PGV, a reference-agnostic representation of the pan-genome of a species based on the notion of consensus ordering. Our experimental results demonstrate that PGV enables an intuitive, effective and interactive visualization of a pan-genome by providing a genome browser that can elucidate complex structural genomic variations.

Conclusions

The PGV software can be installed via conda or downloaded from https://github.com/ucrbioinfo/PGV. The companion PGV browser at http://pgv.cs.ucr.edu can be tested using example bed tracks available from the GitHub page.
Identifying piRNA targets on mRNAs in C. elegans using a deep multi-head attention network
Authors: Yang Tzu-Hsien , Shiue Sheng-Cian , Chen Kuan-Yu , Tseng Yan-Yuan , Wu Wei-Sheng
Published: October 2021

Background

Piwi-interacting RNAs (piRNAs) are the small non-coding RNAs (ncRNAs) that silence genomic transposable elements. And researchers found out that piRNA also regulates various endogenous transcripts. However, there is no systematic understanding of the piRNA binding patterns and how piRNA targets genes. While various prediction methods have been developed for other similar ncRNAs (e.g., miRNAs), piRNA holds distinctive characteristics and requires its own computational model for binding target prediction.

Results

Recently, transcriptome-wide piRNA binding events in C. elegans were probed by PRG-1 CLASH experiments. Based on the probed piRNA-messenger RNAs (mRNAs) binding pairs, in this research, we devised the first deep learning architecture based on multi-head attention to computationally identify piRNA targeting mRNA sites. In the devised deep network, the given piRNA and mRNA segment sequences are first one-hot encoded and undergo a combined operation of convolution and squeezing-extraction to unravel motif patterns. And we incorporate a novel multi-head attention sub-network to extract the hidden piRNA binding rules that can simulate the biological piRNA target recognition process. Finally, the true piRNA–mRNA binding pairs are identified by a deep fully connected sub-network. Our model obtains a supreme discriminatory power of AUC $$=$$
=
93.3% on an independent test set and successfully extracts the verified binding pattern of a synthetic piRNA. These results demonstrated that the devised model achieves high prediction performance and suggests testable potential biological piRNA binding rules.

Conclusions

In this research, we developed the first deep learning method to identify piRNA targeting sites on C. elegans mRNAs. And the developed deep learning method is demonstrated to be of high accuracy and can provide biological insights into piRNA–mRNA binding patterns. The piRNA binding target identification network can be downloaded from http://cosbi2.ee.ncku.edu.tw/data_download/piRNA_mRNA_binding.
Whole genome sequence of a non-toxigenic Corynebacterium diphtheriae strain from a hospital in southeastern China
Authors: Li Guogang , Wang Sipei , Zhao Sheng , Zhou Yangxiao , Pan Xinling
Published: October 2021

Background

Sporadic cases of infection with non-toxigenic Corynebacterium diphtheriae (C. diphtheriae) isolates have been reported in regions covered by the Diphtheria-Tetanus-Pertussis vaccine, but no information describing the whole genome of non-toxigenic strains collected in China is available. Therefore, in this work, the complete genome of a non-toxigenic strain of C. diphtheriae from a hospital located in southeastern China was performed.

Results

This non-toxigenic isolate belonged to the belfanti biotype and possessed a unique ST (assigned as ST799 in pubMLST). ErmX was present in the genome sequence and this isolate owned the resistance to erythromycin and clindamycin. Genes coding for virulence factors involved in adherence, iron-uptake and regulation of diphtheria toxin were also found. Two genes were involved in the interaction between pathogen and host. The phylogenetic analysis revealed that this newly isolated strain was similar to the strain NCTC10838, CMCNS703 and CHUV2995.

Conclusion

Non-toxigenic C. diphtheriae strain contained virulence factors, thus it is able to cause an infectious disease, aspect that could be clarified by performing the whole genome sequencing analysis.
Technical advance in silico and in vitro development of a new bipolar radiofrequency ablation device for renal denervation
Authors: Pérez Noel , Muffly Karl , Saddow Stephen E.
Published: October 2021

Background

Renal denervation with radiofrequency ablation has become an accepted treatment for drug-resistant hypertension. However, there is a continuing need to develop new catheters for high-accuracy, targeted ablation. We therefore developed a radiofrequency bipolar electrode for controlled, targeted ablation through Joule heating induction between 60 and 100 °C. The bipolar design can easily be assembled into a basket catheter for deployment inside the renal artery.

Methods

Finite element modeling was used to determine the optimum catheter design to deliver a minimum ablation zone of 4 mm (W) × 10 mm (L) × 4 mm (H) within 60 s with a 500 kHz, 60 Vp-p signal, and 3 W maximum. The in silico model was validated with in vitro experiments using a thermochromic phantom tissue prepared with polyacrylamide gel and a thermochromic ink additive that permanently changes from pink to magenta when heated over 60 °C.

Results

The in vitro ablation zone closely matched the size and shape of the simulated area. The new electrode design directs the current density towards the artery walls and tissue, reducing unwanted blood temperature increases by focusing energy on the ablation zone. In contrast, the basket catheter design does not block renal flow during renal denervation.

Conclusions

This computational model of radiofrequency ablation can be used to estimate renal artery ablation zones for highly targeted renal denervation in patients with resistant hypertension. Furthermore, this innovative catheter has short ablation times and is one of the lowest power requirements of existing designs to perform the ablation.
Prediction of all-cause mortality in coronary artery disease patients with atrial fibrillation based on machine learning models
Authors: Liu Xinyun , Jiang Jicheng , Wei Lili , Xing Wenlu , Shang Hailong , Liu Guangan , Liu Feng
Published: October 2021

Background

Machine learning (ML) can include more diverse and more complex variables to construct models. This study aimed to develop models based on ML methods to predict the all-cause mortality in coronary artery disease (CAD) patients with atrial fibrillation (AF).

Methods

A total of 2037 CAD patients with AF were included in this study. Three ML methods were used, including the regularization logistic regression, random forest, and support vector machines. The fivefold cross-validation was used to evaluate model performance. The performance was quantified by calculating the area under the curve (AUC) with 95% confidence intervals (CI), sensitivity, specificity, and accuracy.

Results

After univariate analysis, 24 variables with statistical differences were included into the models. The AUC of regularization logistic regression model, random forest model, and support vector machines model was 0.732 (95% CI 0.649–0.816), 0.728 (95% CI 0.642–0.813), and 0.712 (95% CI 0.630–0.794), respectively. The regularization logistic regression model presented the highest AUC value (0.732 vs 0.728 vs 0.712), specificity (0.699 vs 0.663 vs 0.668), and accuracy (0.936 vs 0.935 vs 0.935) among the three models. However, no statistical differences were observed in the receiver operating characteristic (ROC) curve of the three models (all P > 0.05).

Conclusion

Combining the performance of all aspects of the models, the regularization logistic regression model was recommended to be used in clinical practice.
Predicting the expression level of Ki-67 in breast cancer using multi-modal ultrasound parameters
Authors: Cheng Chen , Zhao Hongyan , Tian Wei , Hu Chunhong , Zhao Haitao
Published: October 2021

Objective

This study investigated the feasibility of predicting the expression levels of Ki-67 in breast cancer using ultrasonographic findings and clinical features.

Methods

Fifty-eight breast cancer patients, with 82 lesions confirmed by surgical pathology, were selected retrospectively for this study. Conventional ultrasound examination and elastography examination were performed before surgery. Clinical features (age, estrogen receptor (ER), progesterone receptor, and human epidermal growth factor receptor-2 expression levels), ultrasonographic findings, and elastography scores, including the maximum size, location, number, margin, borderline, blood flow, and elastography score of the mass, were collected. The expression of Ki-67 was recorded using immunohistochemical staining, and the patients were divided into a high (≥ 20%) expression group and a low (< 20%) expression group. SPSS 23.0 software was used for statistical analysis. An independent sample t-test was used for measurement data, and a χ2 test was used for enumeration data. Logistic regression analysis was performed for meaningful indicators, and the receiver operating characteristic curve was used to calculate the best diagnostic cut-off point.

Results

Monofactorial analysis showed that there was a statistically significant difference (p < 0.05) between the high expression of Ki-67 and the maximum diameter of the mass, the margin of the mass, the color Doppler flow imaging of the blood flow, and the resistance index of the blood flow. There were no significant differences in age, mass location, number, morphology, borderline, microcalcification, and elastography score (p > 0.05). Multiple factor regression analysis showed that a large mass and a mass with a rich blood flow had an independent predictive value for Ki-67. When the diameter was > 21.5 mm, the diagnostic sensitivity and specificity were 91.9% and 71.3%, respectively. The expression level of Ki-67 was negatively correlated with that of ER.

Conclusion

The tumor size and blood flow of breast cancer is correlated with the expression level of Ki-67 and, thus, it could be used to predict the expression level of Ki-67 in ultrasound diagnosis. The margin condition and the expression level of ER of an ultrasonic mass could also indirectly reflect the Ki-67 expression level of the mass.
A longitudinal study of cardiac structure and function using echocardiography in patients undergoing peritoneal dialysis
Authors: Zhu Yunyun , Zhang Difei , Hu Xiaoxuan , Liu Hui , Xu Yuan , Hou Haijing , Peng Yu , Lu Ying , Liu Xusheng , Lu Fuhua
Published: October 2021

Background

Peritoneal dialysis (PD) can be associated with abnormal cardiac structure and function and increased mortality risk. Therefore, in this study, we analyzed the cardiac structure and function dynamic changes using echocardiography during the first 2 years of PD therapy. We also assessed its associations with all-cause mortality risk after 2 years of follow-up.

Methods

End-stage renal disease (ESRD) patients that have started PD from 2011 to 2017, and had echocardiography at baseline and years 1 and 2, were included in this study. Echocardiographic parameters were compared between baseline and year 2. Multivariable Cox models were used to estimate the association between echocardiographic parameters changes and all-cause mortality risk.

Results

We finally enrolled 72 PD patients in this study. The mean right ventricular diameter (RVD) increased from baseline (18.31 mm) to year 1 (18.75 mm) and year 2 (19.65 mm). We also observed a significant decrease in cardiac output (CO) between baseline and year 2. Additionally, a slight decrease trend in ejection fraction (EF) was observed. Finally, every 1 % increase in RVD was associated with a 68.2 % higher mortality risk after dialysis (HR, 1.682; 95 % CI, 1.017–2.783).

Conclusions

Our results demonstrated a susceptibility for deteriorated right cardiac structure and function during the first 2 years of PD treatment. Also, higher all-cause mortality risk was observed after 2 years of PD. Altogether, these results highlighted the need for additional focus on regular echocardiographic examinations during long-term PD management.

Trial registration

The PD-CRISC cohort, registered with the Chinese Clinical Trial Registry (ChiCTR1900023565).
The quality of life in women with cervical cancer and precancerous lesions of Han and ethnic minorities in Southwest China
Authors: Zhao Min , Pu Xin , Yan Yi Jun , Zhang Shao , Long Xue , Luo Lei , Li Zheng
Published: October 2021

Background

As patients with cervical cancer and precancerous lesions can be diagnosed at early stage and live longer, it is imperative to understand their health-related quality of life so that better cancer-related policies could be promoted and reasonable distribution of limited resources could be implemented. We conducted a cross-sectional study in the Third Affiliated Hospital of Kunming Medical University to assess the health-related quality of life in our targeted population. Due to the characteristics of Yunnan nationality, our study population includes both Han people and ethnic minorities.

Methods

A cross-sectional study was conducted from January 2019 to December 2020, and 300 patients were selected, who were initially diagnosed with cervical cancer and cervical intraepithelial neoplasia (CIN) pathologically. EQ-5D questionnaire was used to evaluate their quality of life.

Results

Patients in Han and ethnic minorities showed good comparability. EQ-5D VAS score was statistically significant between Han and ethnic minorities (mean, 85.42 vs. 81.01; P<0.05). EQ-5D utility score was slightly different but without statistical significance between the two groups (mean, 0.959 vs. 0.932; P>0.05). Nationality, economic trouble, menopause status and participation of China National Cervical Cancer Screening Program (CNCCSP) are influencing factors of HRQoL among women with cervical cancer and precancerous lesions. Besides, we also found low awareness in the CNCCSP and human papilloma virus vaccine, as well as low participation in the national screening program.

Conclusion

The results of our study imply that the difference of HRQoL does exist between Han people and ethnic minorities with cervical cancer and precancerous lesions. Health providers and health-related departments need to invest more health and financial resources to expand the awareness and participation of the screening project. More efforts should be made in underdeveloped minority areas to assure the accessibility of health resources and interventions. To mitigate economic trouble caused by the diseases, more equal insurance reimbursement should be suggested and implemented in people with or without employee insurance.
Pooled analysis of combination antiemetic therapy for chemotherapy-induced nausea and vomiting in patients with colorectal cancer treated with oxaliplatin-based chemotherapy of moderate emetic risk
Authors: Shimokawa Mototsugu , Hayashi Toshinobu , Nishimura Junichi , Satoh Taroh , Fukunaga Mutsumi , Matsui Reiko , Tsuji Yasushi , Mizuki Fumitaka , Kogawa Takahiro
Published: October 2021

Background

Among patients with colorectal cancer (CRC) treated with oxaliplatin (L-OHP)-based chemotherapy, delayed chemotherapy-induced nausea and vomiting (CINV) have not been well controlled.

Methods

We pooled data from two prospective observational studies in Japan and one phase III clinical trial to assess whether delayed CINV could be controlled with a combination of three antiemetics adding a neurokinin-1 receptor antagonist and identified individual risk factors, using an inverse probability treatment-weighted analysis.

Results

A total of 661 patients were evaluable in this study (median age: 64 years; 391 male, and 270 female). 3 antiemetics controlled delayed nausea (33.18% vs. 42.25%; p = 0.0510) and vomiting (4.15% vs. 16.08%; p < 0.0001) better than with 2 antiemetics. Female and 2 antiemetics were risk factors for both delayed nausea (female—odds ratio [OR]: 1.918; 95% confidence interval [CI]: 1.292–2.848; p = 0.0012; 2 antiemetics—OR: 1.485; 95% CI: 1.000–2.204; p = 0.0498) and delayed vomiting (female—OR: 2.735; 95% CI: 1.410–5.304; p = 0.0029; 2 antiemetics—OR: 4.551; 95% CI: 2.116–9.785; p = 0.0001).

Conclusions

Identifying individual risk factors can facilitate personalized treatments for delayed CINV. We recommend a 3-antiemetic combination prophylaxis for CRC patients treated with L-OHP-based chemotherapy, especially for female patients.
A comparison of clinical outcomes and optical performance between monofocal and new monofocal with enhanced intermediate function intraocular lenses: a case-control study
Authors: Huh Jungah , Eom Youngsub , Yang Seul Ki , Choi Young , Kim Hyo Myung , Song Jong Suk
Published: October 2021

Background

To compare clinical outcomes and optical performance of a new monofocal with enhanced intermediate function intraocular lenses (IOLs) with that of conventional monofocal IOLs.

Methods

Sixty eyes of 30 patients who underwent phacoemulsification with bilateral implantation of the ICB00 (15 patients) or ZCB00 (15 patients) IOLs were enrolled. Binocular corrected distance visual acuity (CDVA), distance corrected near visual acuity (DCNVA), and distance corrected intermediate visual acuity (DCIVA) were measured at 4 weeks after surgery. Patient satisfaction for overall, near, intermediate, and distance vision were assessed. The binocular defocus curves were measured. The root mean square of modulation transfer function (MTFRMS) was measured in the optical bench study.

Results

The mean binocular DCIVA was significantly better in the ICB00 group (0.01 logMAR) compared to the ZCB00 group (0.13 logMAR), but CDVA and DCNVA were not. The patient satisfaction for near and intermediate vision was significantly higher in the ICB00 group compared to the ZCB00. However, there was no difference in patient satisfaction for overall and distance vision between two groups. The defocus curves showed that mean visual acuity of the ICB00 group was significantly better than that of the ZCB00 group at between − 1.00 D to − 3.00 D of defocus. The ICB00 IOL had higher MTFRMS values at between − 0.50 D to − 2.00 D of defocus compared to the ZCB00 IOL.

Conclusions

The ICB00 IOL provides better binocular intermediate vision and higher satisfaction for near and intermediate vision than the ZCB00 IOL while maintaining excellent distance vision.
Severe protein C deficiency in a newborn caused by a homozygous pathogenic variant in the PROC gene: a case report
Authors: Song Uisook , Ryu Young Hye , Hong Kiteak , Shim So-Yeon , Park Seongyeol , Lee Jeong Seok , Ju Young Seok , Shin Seung Han , Lee Soyoung
Published: October 2021

Background

Severe protein C deficiency is a rare and inherited cause of thrombophilia in neonates. Protein C acts as an anticoagulant, and its deficiency results in vascular thrombosis. Herein, we report a case of protein C deficiency with a homozygous pathogenic variant in a term neonate, with good outcomes after proper treatment.

Case presentation

A four-day-old male newborn was transferred to the Seoul National University Hospital on account of dark red to black skin lesions. He was born full-term with an average birth weight without perinatal problems. There were no abnormal findings in the prenatal tests, including intrauterine sonography. The first skin lesion was observed on his right toes and rapidly progressed to proximal areas, such as the lower legs, left arm, and buttock. Under the impression of thromboembolism or vasculitis, we performed a coagulopathy workup, which revealed a high D-dimer level of 23.05 μg/ml. A skin biopsy showed fibrin clots in most capillaries, and his protein C activity level was below 10%, from which we diagnosed protein C deficiency. On postnatal day 6, he experienced an apnea event with desaturation and an abnormal right pupillary light reflex. Brain computed tomography showed multifocal patchy intracranial hemorrhage and intraventricular hemorrhage with an old ischemic lesion. Ophthalmic examination revealed bilateral retinal traction detachments with retinal folds. Protein C concentrate replacement therapy was added to previous treatments including steroids, prostaglandin E1, and anticoagulation. After replacement therapy, there were no new skin lesions, and the previous lesions recovered with scarring. Although there were no new brain hemorrhagic infarctions, there was ongoing ischemic tissue loss, which required further rehabilitation. Ophthalmic surgical interventions were performed to treat the bilateral retinal traction detachments with retinal folds. Molecular analysis revealed a homozygous pathogenic variant in the PROC gene.

Conclusion

Severe protein C deficiency can manifest as a fatal coagulopathy in any organ. Early diagnosis and proper treatment, including protein C concentrate replacement, may improve outcomes without serious sequelae.
The impact of equity factors on receipt of timely appropriate care for children with suspected malaria in eastern Uganda
Authors: Humphreys David , Kalyango Joan Nakayaga , Alfvén Tobias
Published: October 2021

Introduction

Malaria accounts for more than one-tenth of sub-Saharan Africa’s 2.8 million annual childhood deaths, and remains a leading cause of post-neonatal child mortality in Uganda. Despite increased community-based treatment in Uganda, children continue to die because services fail to reach those most at risk. This study explores the influence of two key equity factors, socioeconomic position and rurality, on whether children with fever in eastern Uganda receive timely access to appropriate treatment for suspected malaria.

Methods

This was a cross-sectional study in which data were collected from 1094 caregivers of children aged 6–59 months on: illness and care-seeking during the previous two weeks, treatment received, and treatment dosing schedule. Additional data on rurality and household socioeconomic position were extracted from the Iganga-Mayuge Health and Demographic Surveillance Site (HDSS) database. A child was considered to have received prompt and appropriate care for symptoms of malaria if they received the recommended drug in the recommended dosing schedule on the day of symptom onset or the next day. Unadjusted and adjusted logistic regression models were developed to explore associations of the two equity factors with the outcome. The STROBE checklist for observational studies guided reporting.

Results

Seventy-four percent of children had symptoms of illness in the preceding two weeks, of which fever was the most common. Children from rural households were statistically more likely to receive prompt and appropriate treatment with artemisinin-combination therapy than their semi-urban counterparts (OR 2.32, CI 1.17–4.59, p = 0.016). This association remained significant following application of an adjusted regression model that included the age of the child, caregiver relationship, and household wealth index (OR 2.4, p = 0.036). Wealth index in its own right did not exert a significant effect for children with reported fever (OR for wealthiest quintile = 1.02, CI 0.48–2.15, p = 0.958).

Conclusions

The findings from this study help to identify the role and importance of two key equity determinants on care seeking and treatment receipt for fever in children. Whilst results should be interpreted within the limitations of data and context, further studies have the potential to assist policy makers to target inequitable social and spatial variations in health outcomes as a key strategy in ending preventable child morbidity and mortality.
A mixed methods analysis of environmental and household chaos: considerations for early-childhood obesity research
Authors: Krupsky Kathryn L. , Parrott Andria , Andridge Rebecca , Zvara Bharathi J. , Keim Sarah A. , Anderson Sarah E.
Published: October 2021

Background

Chaos has implications for child health that may extend to childhood obesity. Yet, results from studies describing associations between chaos and childhood obesity are mixed. New approaches to studying the environments of young children may help to clarify chaos-obesity relationships.

Methods

We conducted a concurrent mixed methods analysis of quantitative and qualitative data describing home and neighborhood chaos among a diverse cohort of 283 caregiver-toddlers dyads from Ohio. We examined the underlying structure of environmental and household chaos using exploratory factor analysis then sought to validate the structure using qualitative field notes. We generated total scores for factors of chaos and described their distributions overall and according to cohort characteristics. Additionally, we conducted a thematic content analysis of brief ethnographies to provide preliminary construct validity for our indicators of chaos.

Results

Dyads varied according to household composition, income, education, and race/ethnicity. We found evidence for a multi-factor structure for chaos, which included disorganization and neighborhood noise. Household disorganization scores ranged from 0 to 7.3 and were on average 2.1 (SD = 1.8). Neighborhood noise scores ranged from 0 to 4 and were on average 1.1 (SD = 1.1). Both disorganization and neighborhood noise were associated with indicators of socioeconomic disadvantage, such as lower educational attainment and household income. Qualitative data from households with high and low scores on the two identified factors were aligned in ways that were supportive of construct validity and further contextualized the social and material environments in which chaos occurred.

Conclusions

Chaos represents a complex construct with implications spanning various disciplines, including childhood obesity research. Previous studies suggest challenges associated with measuring chaos may limit the conclusions that can be drawn about which aspect of chaos (if any) matter most of early childhood weight development. We advance the literature by demonstrating chaos may be comprised of conceptually distinct subdomains. Future childhood obesity prevention research may benefit from more contemporary measure of chaos, such as those relying on direct observations that account for a multifaceted underlying structure.
Implementation of an organizational intervention to improve low-wage food service workers’ safety, health and wellbeing: findings from the Workplace Organizational Health Study
Authors: Sorensen Glorian , Peters Susan E. , Nielsen Karina , Stelson Elisabeth , Wallace Lorraine M. , Burke Lisa , Nagler Eve M. , Roodbari Hamid , Karapanos Melissa , Wagner Gregory R.
Published: October 2021

Background

Many organizational interventions aim to improve working conditions to promote and protect worker safety, health, and well-being. The Workplace Organizational Health Study used process evaluation to examine factors influencing implementation of an organizational intervention. This paper examines the extent to which the intervention was implemented as planned, the dose of intervention implemented, and ways the organizational context hindered or facilitated the implementation of the intervention.

Methods

This proof-of-concept trial was conducted with a large, multinational company that provides food service through contractual arrangements with corporate clients. The 13-month intervention was launched in five intervention sites in October 2018. We report findings on intervention implementation based on process tracking and qualitative data. Qualitative data from 25 post-intervention interviews and 89 process tracking documents were coded and thematically analyzed.

Results

Over the 13-month intervention, research team representatives met with site managers monthly to provide consultation and technical assistance on safety and ergonomics, work intensity, and job enrichment. Approximately two-thirds of the planned in-person or phone contacts occurred. We tailored the intervention to each site as we learned more about context, work demands, and relationships. The research team additionally met regularly with senior leadership and district managers, who provided corporate resources and guidance. By assessing the context of the food service setting in which the intervention was situated, we explored factors hindering and facilitating the implementation of the intervention. The financial pressures, competing priorities and the fast-paced work environment placed constraints on site managers’ availability and limited the full implementation of the intervention.

Conclusions

Despite strong support from corporate senior leadership, we encountered barriers in the implementation of the planned intervention at the worksite and district levels. These included financial demands that drove work intensity; turnover of site and district managers disrupting continuity in the implementation of the intervention; and staffing constraints that further increased the work load and pace. Findings underscore the need for ongoing commitment and support from both the parent employer and the host client.

Trial registration

This study was retrospectively registered with the Clinical Trials. Gov Protocol and Results System on June 2, 2021 with assigned registration numberNCT04913168.
Metal stent for the ureteral stricture after surgery and/or radiation treatment for malignancy
Authors: Wang Wei , Gao Xiaoshuai , Chen Jixiang , Liu Zhenghuan , Peng Liao , Wei Xin
Published: October 2021

Background

To assess the efficacy and safety of self-expanding metal ureteral stent for the stricture following surgery and/or radiation for malignancy.

Methods

We performed 36 metal ureteral stent insertion procedures (32 patients) between May 2019 and June 2020. The main inclusion criterion was the patients with ureteral stricture due to surgery and/or radiation treatment for malignancy. The diagnosis of stricture was ascertained by history and radiographic imaging. The etiologies underlying the strictures were: surgery and/or radiation therapy for cervical and rectal cancer, surgery for ovarian cancer. The primary outcome was the stent patency rate, and the secondary outcomes were the postoperative complications and glomerular filtration rate (GFR). Stent patency was defined as stent in situ without evident migration, unanticipated stent exchange or recurrent ureteral obstruction. Cost analysis was calculated from stent cost, anesthesia cost and operating room fee.

Results

The pre-metallic stent GFR was 22.53 ± 6.55 mL/min/1.73 m2. Eight patients were on double-J stents before insertion of metallic stents. The total annual cost of per patient in our study was $10,600.2 US dollars (range $9394.4–$33,527.4 US dollars). During a median follow-up time of 16 months (range 8–21 months), 27 cases (31 sides, 84%) remained stent patency. Twelve patients died from their primary malignancy carrying a patency stent. Stent migration was observed in 4 patients within 10 months after insertion. Ectopic stents were endoscopically removed and replaced successfully. Three stents were occluded, and no encrustation was seen in our study. Three and four patients had postoperative fever and gross hematuria, respectively. Infection was observed in 2 cases, mandating antibiotics therapy. In addition, postoperative volume of hydronephrosis postoperatively was significantly reduced compared with preoperation (54.18 ± 15.42 vs 23.92 ± 8.3, P = 0.019). However, no statistically significant differences regarding GFR, creatinine levels, blood urea nitrogen and hemoglobin existed between preoperation and last follow-up.

Conclusions

The current study demonstrated that metal ureteral stent is effective and safe in the treatment of stricture following surgery and/or radiation therapy for malignant cancer. Patients hydronephrosis could be improved by the stent placement.
Comparison of the canal transportation of ProTaper GOLD, WaveOne GOLD, and TruNatomy in simulated double-curved canals
Authors: Kim HyeWon , Jeon Su-Jin , Seo Min-Seock
Published: October 2021

Background

In root canal preparations, it is important to maintain the original canal shape. However, it is difficult to accomplish this, especially due to the complex canal anatomy. This study aimed to compare the shaping ability of the ProTaper GOLD, WaveOne GOLD, and newly developed TruNatomy in simulated S-shaped canals.

Methods

The root canals of 60 S-shaped resin blocks were dyed using ink and photographed. The blocks were then randomly divided into three groups: group ProTaper GOLD (n = 20), WaveOne GOLD (n = 20), and TruNatomy (n = 20). The simulated canals were instrumented according to the NiTi file system and photographed again after being dyed with red ink. The pre- and post-preparation images were superimposed, and the amount of resin removed from both the mesial and distal sides of the canal measured up to 9 mm from the apical terminus, with a 1 mm increment. The preparation time was also calculated. A paired t-test was used to determine the degree of deviation at different levels within the groups. To compare the degree of transportation at different levels between the groups, one-way ANOVA and Kruskal–Wallis tests were performed according to the normality.

Results

TruNatomy showed a significant deviation between the mesial and distal sides of the canal only in the coronal area at 6, 7, 8, and 9 mm levels of the canal (p < 0.05). When comparing the amount of transportation in the 3 groups at 9 different levels, TruNatomy showed significantly less canal transportation than the other groups at the 3-and 5-mm levels of the canal (p < 0.05), while ProTaper GOLD showed the largest amount of transportation in the apical curved area at the 2 and 3 mm levels (p < 0.05). TruNatomy removed less resin than other groups in all sections (p < 0.05), while ProTaper GOLD removed slightly more resin than WaveOne GOLD; however, there was no significant difference (p = 0.043). Shaping time was the least for TruNatomy, followed by the WaveOne GOLD and ProTaper GOLD (p < 0.05).

Conclusions

TruNatomy maintained the original apical canal curvature in S-shaped curved canals better than ProTaper GOLD and WaveOne GOLD.