bluuebunny/crossref_metadata_2025 huggingface dataset:
Different limb lengths in gastric bypass surgery: study protocol for a Swiss multicenter randomized controlled trial (SLIM)
Authors: Kraljević Marko , Schneider Romano , Wölnerhanssen Bettina , Bueter Marco , Delko Tarik , Peterli Ralph
Published: May 2021

Background

Obesity and type 2 diabetes mellitus are reaching epidemic proportions. In morbidly obese patients, bariatric operations lead to sustained weight loss and relief of comorbidities in the majority of patients. Laparoscopic Roux-Y-gastric bypass (RYGB) is one of the most frequently performed operations, but it is still unknown why some patients respond better than others. Therefore, a number of variations of this operation have been introduced. Recent evidence suggests that a longer bypassed biliopancreatic limb (BPL) has the potential to be more effective compared to the standard RYGB with a shorter BPL length. This article describes the design and protocol of a randomized controlled trial comparing the outcome of a RYGB operation with a long versus short BPL.

Methods/design

The trial is designed as a multicenter, randomized, patient- and observer-blinded trial. The relevant ethics committee has approved the trial protocol. To demonstrate that long BPL RYGB is superior compared to short BPL RYGB in terms of weight loss and resolution of T2DM, the study is conducted as a superiority trial. Postoperative percent total weight loss and nutritional deficiency rate are the primary endpoints, whereas morbidity, mortality, remission of obesity-related comorbidities and quality of life are secondary endpoints. Eight hundred patients, between 18 and 65 years and with a body mass index (BMI) from 35 to 60 kg/m2 who meet the regulatory rules for bariatric surgery in Switzerland, will be randomized. The endpoints and baseline measurements will be assessed pre-, intra-, and postoperatively.

Discussion

With its high number of patients and a 5-year follow-up, this study will answer questions about effectiveness and safety of long BPL RYGB and provide level I evidence for improvement of the standard RYGB. These findings might therefore potentially influence global bariatric surgery guidelines.

Trial registration

ClinicalTrials.gov NCT04219787. Registered on 7 January 2020.
Assessment of the efficacy and safety of tocilizumab in patients over 80 years old with giant cell arteritis
Authors:   for the French Study Group for Large Vessel Vasculitis (GEFA), de Boysson Hubert , Le Besnerais Maelle , Blaison Félix , Daumas Aurélie , Jarrot Pierre-André , Perrin François , Tieulié Nathalie , Maria Alexandre , Duffau Pierre , Gombert Bruno , Samson Maxime , Espitia Olivier , Lambert Marc , Mékinian Arsène , Aouba Achille
Published: May 2021

Objective

To assess the efficacy and tolerance of tocilizumab (TCZ) in giant cell arteritis (GCA) patients over 80.

Method

GCA patients over 80 years old from the French Study Group for Large Vessel Vasculitis register who received TCZ were analyzed.

Results

Twenty-one GCA patients (median age 84 [81–90] years old, including nine over 85) received TCZ for the following nonexclusive reasons: glucocorticoid (GC)-sparing effect in 14, relapsing disease in 8, disease severity in 4, and/or failure of another immunosuppressant in 4. TCZ was introduced with GCs at diagnosis in 6 patients and at 8 [3–37] months after GC initiation in 15 others. After a median delay of 8 [2–21] months post-TCZ introduction, 14 (67%) patients were able to definitively stop GCs, including 6 who were GC-dependent before TCZ. At the last follow-up (median 20 [3–48] months), 11 (52%) patients had definitively stopped TCZ, and 2 additional patients had stopped but relapsed and resumed TCZ.

Seven (33%) patients experienced 11 adverse events: hypercholesterolemia in 4 patients; infections, i.e., pyelonephritis, bronchitis, and fatal septic shock associated with mesenteric infarction following planned surgery (GCs were stopped for 1 year and TCZ infusions for 2 months), respectively, in 3 patients; moderate thrombocytopenia and moderate neutropenia in 2 patients; and a 5-fold increase in transaminase levels in another that improved after TCZ dose reduction.

Conclusion

TCZ remains a valuable GC-sparing option in the oldest GCA patients with an interesting risk-benefit ratio. Mild-to-moderate adverse events were observed in one-third of patients.
Association of vitamin D-binding protein and vitamin D3 with insulin and homeostatic model assessment (HOMA-IR) in overweight and obese females
Authors: Setayesh Leila , Casazza Krista , Moradi Nariman , Mehranfar Sanaz , Yarizadeh Habib , Amini Abbas , Yekaninejad Mir Saeed , Mirzaei Khadijeh
Published: May 2021

Objective

Equivocal association the contribution of 25-hydroxyvitamin D (25(OH)D) and the well-accepted role of vitamin D-binding protein (VDBP) on bioavailability of 25(OH)D or its independent roles, has led to possible association of the VDBP in glucose metabolism. This study was conducted to evaluate the relationships among 25(OH)D, VDBP, glucose/insulin metabolism and homeostatic model assessment (HOMA-IR). Blood samples were collected from 236 obese and overweight women. VDBP and 25(OH)D levels, and biochemical parameters were measured using an enzyme-linked immunosorbent assay (ELISA). An impedance fat analyzer was utilized to acquire the body composition.

Results

Using the multivariate linear regression, a reverse relationship was observed between VDBP and (HOMA-IR), such that women with higher VDBP displayed lower insulin resistance. The relationship was independent of age, body mass index, standardized energy intake and physical activity (p = 0.00). No significant relationship between 25(OH)D levels, FBS, body composition or insulin resistance were observed (p > 0.2). Current study observed that higher level of VDBP may be associated with lower levels of insulin and HOMA-IR, thus the evaluation of VDBP in diverse population groups seems to have significant clinical value in evaluating the prevalence of DM or early stage of glucose intolerance.
Association between water and sanitation and soil-transmitted helminthiases: Analysis of the Brazilian National Survey of Prevalence (2011–2015)
Authors: Mingoti Poague Kasandra Isabella Helouise , Mingoti Sueli Aparecida , Heller Léo
Published: May 2021

Background

Most of the studies conducted in Brazil assessing the relationship between water, sanitation and hygiene (WASH) and Soil-transmitted helminth (STH) infections, have focused on cases, reflecting the reality of small areas and not of a countrywide situation. In order to fill this gap, the current paper presents an epidemiological study exploring the association between water and sanitation and STHs prevalence in students from 7 to 17 years old, in all 27 Brazilian Federation Units.

Methods

Three ecological studies were carried out considering the prevalence of ascariasis, trichuriasis, and hookworm as outcome variables. The sample consisted of 197,567 students aged 7–17 years old living in 521 Brazilian municipalities. Data were retrieved from the National Survey on the Prevalence of Schistosomiasis mansoni and Soil-transmitted helminth infections (2011–2015). The Generalized Linear Model with the negative binomial distribution was used to evaluate the statistical association between outcomes and explanatory variables. Univariate and Multivariate analyses were conducted with 25 and 5 % significance levels, respectively. Data were aggregated considering municipalities as the geographical unit for analysis.

Results

Protective association was found between access to filtered water and adequate sanitation in schools with ascariasis (RR 0.989, CI 95 % 0.983–0.996; RR 0.988, CI 95 % 0.977–0.998), access to filtered water in schools with trichuriasis (RR 0.986, CI 95 % 0.979–0.993) and adequate sanitation at home with hookworm ((RR 0.989, CI 95 % 0.982–0.996). The percentage of population served with Bolsa Família Program, used as a proxy for poverty, was the only significant variable common to all models.

Conclusions

Our findings support that WASH, both in schools and homes, are essential to schoolchildren health with regard to STHs. However, sanitary interventions will not be fully effective in preventing STH infections without promoting access to quality public services, particularly for people living in poverty, the most vulnerable group.
Association of breastfeeding and risk of metabolic syndrome and its components in postmenopausal parous women: Korea national health and nutrition examination survey (2010 ~ 2016)
Authors: Lee Jusuk , Kim Taehong
Published: May 2021

Background

Understanding the relationship between breastfeeding (BF) and metabolic syndrome (Mets) is important for maternal long-term health benefits and disease prevention. This study aimed to examine the association between BF and Mets and its components among postmenopausal parous Korean women.

Methods

This cross-sectional study on 10,356 Korean women used nationally representative data from the KNHANES from 2010 to 2016. Anthropometric, laboratory data and manual BP were measured. A multivariate logistic regression analysis was conducted to examine the association of BF with Mets and its components after adjusting for potential confounding variables. A p-value < 0.05 was to be considered statistically significant.

Results

Mets was present in 42% of the study participants. The BF group had low household income and education level. The prevalence of Mets in the BF group was higher than that in the non-BF group (42.69% vs. 34.76%, p <  0.001). BF was associated with increased risk of Mets (odds ratio [OR]: 1.4, 95% confidence interval [CI]: 1.18–1.65, p <  0.001). The BF group was at higher risks for diabetes (OR: 1.5, 95%CI: 1.14–1.98), hypertension (OR: 1.32, 95%CI: 1.03–1.68), hypertriglyceridemia (OR: 1.42, 95%CI: 1.02–1.99) and low high-density lipoprotein cholesterol (OR: 1.32, 95%CI: 1.06–1.65).

Conclusion

In this study, BF did not affect decreasing the prevalence of Mets and its components.
The SEAM Barrett model: Strengths and weaknesses
Authors: Lynn Heloise , Sayers Colin M. , Roure Benjamin
Published: May 2021

The SEG Advanced Modeling (SEAM) Barrett model was designed to model typical land basins found in the North American midcontinent that host unconventional reservoirs, such as fractured shale reservoirs. This model was used recently in several studies to assess whether shale bodies could be resolved using azimuthal 3D P-P reflection seismic data. In one study, it was claimed that near-surface complexity prevents the identification of the shale bodies using azimuthal analysis and concluded that velocity variation with azimuth (VVAz) and amplitude variation with azimuth (AVAz) are not worth running in the Permian Basin. However, another study by different authors applied a different seismic processing sequence to successfully resolve the reservoir geobodies and showed promising AVAz and VVAz results. We have focused on the SEAM Barrett model itself. Despite some advantages, the limitations of the Barrett model prevent general conclusions to be drawn about the usefulness of VVAz and AVAz to characterize fractured unconventional reservoirs.
Pore characterization of the Marcellus Shale by nitrogen adsorption and prediction of its gas storage capacity
Authors: Zhu Yixuan , Carr Timothy , Zhang Zhongmin , Song Liaosha
Published: May 2021

In a shale gas reservoir, pore characterization is an important factor used to determine gas storage capacity. However, the nanometer (nm)-scale pore system in shale is difficult to explore by traditional optical, scanning electron microscopy, or even nuclear magnetic resonance well logging. We have investigated the pore structure and storage capacity of the Marcellus Shale through integration of petrophysical analysis from laboratory and well-logging data and nitrogen adsorption. The isotherm of Marcellus Shale is a composite isotherm, which has features of type I, type II, and type IV isotherms with type H4 of the hysteresis loop, suggesting slit-like pores developed in the Marcellus Shale. Quantitative analysis of pore volumes from the nitrogen adsorption indicates that density porosity may be more properly used to approximate the shale porosity and estimate the shale gas volume. In addition, the specific surface area, micropore, and mesopore volumes have a positive relationship with the kerogen volume and total organic content (TOC). By using the Langmuir and Brunauer-Emmet-Teller models, the simulated result indicates that the higher adsorbed quantity of the Marcellus Shale could be the result of the increase of micropore volume contributed, by the increase of kerogen or TOC content. The proposed equations rapidly compute TOC, a key parameter to predict gas storage capacity in overmature shale such as the Marcellus Shale.
Locoregional Therapies for Colorectal Cancer Liver Metastases: Options Beyond Resection
Authors: Uhlig Johannes , Lukovic Jelena , Dawson Laura A. , Patel Reema A. , Cavnar Michael J. , Kim Hyun S.
Published: May 2021

Colorectal cancer was the third most common malignancy worldwide in 2018, and most patients present with or develop distant metastases. Colorectal liver metastases are most commonly observed because of the vascular drainage of the colon and superior rectum. Current guidelines recommend surgical resection as first-line treatment; however, 80% to 90% of patients with colorectal liver metastases are ineligible for primary resection. For patients with unresectable disease, a multidisciplinary treatment approach is favored, incorporating systemic therapy and a toolbox of local ablative therapies. These treatments either aim at cytoreduction to enable a conversion to surgical resectability or control of disease progression and spread. Each of these treatments carries unique outcomes and risk profiles, thereby contributing to an individualized treatment strategy for patients with colorectal liver metastases. This review summarizes evidence on hepatic artery infusion, stereotactic body radiation therapy, thermal ablation, transarterial chemoembolization with drug-eluding beads, and transarterial radioembolization for treatment of colorectal liver metastases. Results of large-scale prospective and retrospective studies and international guidelines are discussed to provide detailed background on the current and prospective use of local ablative techniques in management of colorectal liver metastases.
Assessment Criteria and Clinical Implications of Extranodal Extension in Head and Neck Cancer
Authors: Huang Shao Hui , Chernock Rebecca , O’Sullivan Brian , Fakhry Carole
Published: May 2021

Tumor breaching the capsule of a lymph node is termed extranodal extension (ENE). It reflects aggressiveness of a tumor, creates anatomic challenges for disease clearance, and increases the risk of distant metastasis. Extranodal extension can be assessed on a pathology specimen, by radiology studies, and by clinical examination. Presence of ENE in a pathology specimen has long been considered a high-risk feature of disease progression and would ordinarily benefit from the addition of chemotherapy to adjuvant radiotherapy. Although the eighth edition of the Union for International Cancer Control/American Joint Committee on Cancer stage classification dichotomizes pathologic ENE according to its presence or absence, emerging evidence suggests that the extent of a pathologic ENE may provide additional value for risk stratification to guide adjuvant therapy. Recent data suggest that the prognostic importance of pathologic ENE is also applicable for HPV-associated head and neck squamous cell carcinoma. In addition, compelling data demonstrate that indisputable radiologic ENE is a powerful risk stratification tool to identify patients at high risk for treatment failure, especially distant metastasis, applicable for both HPV-positive and HPV-negative head and neck squamous cell carcinoma. However, the definition and taxonomy of radiologic ENE requires standardization. The goal of this review is to clarify the contemporary understanding of the prognostic implications of ENE in head and neck squamous cell carcinoma, present the nuances of what is presently known and unknown, and elucidate how to classify ENE pathologically and radiologically with an understanding of the strengths and weaknesses of each approach. Finally, with the development of several risk stratification methods, the relative role of ENE and other prognostic schema will be explored.
Strategies to Minimize Late Effects From Pelvic Radiotherapy
Authors: Dohm Ammoren , Sanchez Julian , Stotsky-Himelfarb Eden , Willingham Field F. , Hoffe Sarah
Published: May 2021

During the past 30 years, radiation treatment techniques have significantly improved, from conventional external-beam radiation therapy, to three-dimensional conformal radiation therapy, to current intensity-modulated radiation therapy, benefiting patients who undergo treatment of pelvic malignancies. Modern treatment options also include proton beam irradiation as well as low and high dose rate brachytherapy. Although the acute adverse effects of these modalities are well documented in clinical trials, less well known are the true incidence and optimal management of those late adverse effects that can occur months to years later. In a population of survivors of cancer that is steadily increasing, with many such patients receiving radiotherapy at some time during their disease course, these late effects can become a considerable management and quality-of-life issue. This review will examine the range of late toxicities that can occur from pelvic radiotherapy and explore strategies to prevent and mitigate them.
A Case-Based Approach to Understanding Complex Genetic Information in an Evolving Landscape
Authors: DiNardo Courtney D. , Korde Larissa A. , Yurgelun Matthew B.
Published: May 2021

The rapid integration of highly sensitive next-generation sequencing technologies into clinical oncology care has led to unparalleled progress, and yet these technological advances have also made genetic information considerably more complex. For instance, accurate interpretation of genetic testing for germline/inherited cancer predisposition syndromes and somatic/acquired pathogenic variants now requires a more nuanced understanding of the presence and incidence of clonal hematopoiesis and circulating tumor cells, with careful evaluation of pathogenic variants occurring at low variant allele frequency required. The interplay between somatic and germline pathogenic variants and awareness of distinct genotype-phenotype manifestations in various inherited cancer syndromes are now increasingly appreciated and can impact patient management. Through a case-based approach, we focus on three areas of particular relevance to the treating clinician oncologist: (1) understanding clonal hematopoiesis and somatic mosaicism, which can be detected on germline sequencing and lead to considerable confusion in clinical interpretation; (2) implications of the detection of a potentially germline pathogenic variant in a high-penetrance cancer susceptibility gene during routine tumor testing; and (3) a review of gene-specific risks and surveillance recommendations in Lynch syndrome. A discussion on the availability and difficulties often associated with direct-to-consumer genetic testing is also provided.
Adoptive Cellular Therapy for Solid Tumors
Authors: Bear Adham S. , Fraietta Joseph A. , Narayan Vivek K. , O’Hara Mark , Haas Naomi B.
Published: May 2021

Cancer immunotherapy tools include antibodies, vaccines, cytokines, oncolytic viruses, bispecific molecules, and cellular therapies. This review will focus on adoptive cellular therapy, which involves the isolation of a patient’s own immune cells followed by their ex vivo expansion and reinfusion. The majority of adoptive cellular therapy strategies utilize T cells isolated from tumor or peripheral blood, but may utilize other immune cell subsets. T-cell therapies in the form of tumor-infiltrating lymphocytes, T-cell receptor T cells, and CAR T cells may act as “living drugs” as these infused cells expand, engraft, and persist in vivo, allowing adaptability over time and enabling durable remissions in subsets of patients. Adoptive cellular therapy has been less successful in the management of solid tumors because of poor homing, proliferation, and survival of transferred cells. Strategies are discussed, including expression of transgenes to address these hurdles. Additionally, advances in gene editing using CRISPR/Cas9 and similar technologies are described, which allow for clinically translatable gene-editing strategies to enhance the antitumor activity and to surmount the hostilities advanced by the host and the tumor. Finally, the common toxicities and approaches to mitigate these are reviewed.
The Right Treatment of the Right Patient: Integrating Genetic Profiling Into Clinical Decision Making in Advanced Gastric Cancer in Asia
Authors: Nakamura Yoshiaki , Shitara Kohei , Lee Jeeyun
Published: May 2021

Gastric cancer is a major global health burden, especially when patients are diagnosed with recurrent or metastatic gastric cancer. Despite recent advances in treatment options with palliative chemotherapy, the median overall survival of patients with gastric cancer remains within 1 or 2 years after the diagnosis of metastatic disease. Gastric cancer is significantly more prevalent in eastern Asia (e.g., Japan and Korea). Next-generation sequencing is rapidly being adopted as part of clinical practice in Korea and Japan, especially in patients with gastric cancer. Approximately 10% to 15% of the patients with gastric cancer who undergo next-generation sequencing of their tumor specimen are allocated to target-matched clinical trials in Japan and Korea. In Japan and Korea, a cell-free DNA next-generation sequencing panel is also actively being investigated as an alternative next-generation sequencing test for patients with gastric cancer, which may reflect the tumor heterogeneity of gastric cancer. In Japan and Korea, multiple biomarkers, such as HER2, mismatch repair, Epstein-Barr virus, PD-L1 (combined positive score), EGFR, FGFR2, and CLDN18.2, are routinely assessed through immunohistochemistry or in situ hybridization before initiation of the first-line treatment in all patients with gastric cancer. Most tertiary cancer centers in Korea routinely perform HER2, mismatch repair, Epstein-Barr virus, and PD-L1 next-generation sequencing before palliative chemotherapy in patients with gastric cancer. Biomarker evaluation for all patients with metastatic gastric cancer enables clinicians to identify available biomarker-based clinical trials early during the course of treatment, which expands treatment opportunities while patients are medically fit for clinical trials, if available. Comprehensive genomic profiling using a tissue or circulating tumor DNA next-generation sequencing panel is considered necessary during second-line or subsequent treatment. It is hoped that a comprehensive molecular profiling strategy will facilitate greater use of precision medicine through molecularly targeted therapies for patients with gastric cancer in the near future.
Access of Patients With Lung Cancer to High Technology Radiation Therapy in Brazil
Authors: Faroni Lilian Dantonino , Rosa Arthur Accioly , Aran Veronica , Ramos Renan Serrano , Ferreira Carlos Gil
Published: May 2021

PURPOSE

Lung cancer is a global health problem, with more than 220,000 new cases and 150,000 deaths per year in the United States. Likewise, in Brazil, lung cancer is the most lethal cancer with 30,200 new cases expected in 2020. Regarding treatment types, radiation therapy (RT) represents an important approach, since 60%-70% of the patients will receive this modality of treatment during the course of their disease. However, access to RT remains challenging because of the socioeconomic inequalities in the Brazilian population, where approximately 100,000 patients/year die without access to RT. This work provides an overview on the availability of high technology RT in Brazil.

METHODS

A retrospective study was performed using the Brazilian Radiotherapy Census, local public and private databases, and the current literature published in 2019.

RESULTS

The Brazilian radiotherapy network relies on approximately 363 linear accelerators and 20 cobalt machines that remain operational. Most of these machines are installed at public health facilities. Regarding high technology, intensity-modulated RT is available in 53.7% (n = 130) and volumetric modulated arc therapy in 28.5% (n = 69) of the institutions, although only 19.8% (n = 48) of those facilities are capable of performing image-guided RT using cone beam computed tomography. Considering only the public health care system, the scenario is more restricted, with 40.1% (n = 65) of the institutions offering intensity-modulated RT, 21% (n = 34) volumetric modulated arc therapy, and 14.8% (n = 24) using cone beam computed tomography. Because of these scare resources, only 16% of Radiation Departments offer stereotactic body RT.

CONCLUSION

Brazil still needs to improve and provide high and safer RT technologies to patients with lung cancer across all Brazilian regions to attend the population needs and obtain better patient outcomes.
Afirma Genomic Sequencing Classifier and Xpression Atlas Molecular Findings in Consecutive Bethesda III-VI Thyroid Nodules
Authors: Hu Mimi I , Waguespack Steven G , Dosiou Chrysoula , Ladenson Paul W , Livhits Masha J , Wirth Lori J , Sadow Peter M , Krane Jeffrey F , Stack Brendan C , Zafereo Mark E , Ali Syed Z , Weitzman Steven P , Hao Yangyang , Babiarz Joshua E , Kennedy Giulia C , Kloos Richard T
Published: May 2021

Context

Broad genomic analyses among thyroid histologies have been described from relatively small cohorts.

Objective

Investigate the molecular findings across a large, real-world cohort of thyroid fine-needle aspiration (FNA) samples.

Design

Retrospective analysis of RNA sequencing data files.

Setting

Clinical Laboratory Improvement Amendments laboratory performing Afirma Genomic Sequencing Classifier (GSC) and Xpression Atlas (XA) testing.

Participants

A total of 50 644 consecutive Bethesda III-VI nodules.

Intervention

None.

Main Outcome Measures

Molecular test results.

Results

Of 48 952 Bethesda III/IV FNAs studied, 66% were benign by Afirma GSC. The prevalence of BRAF V600E was 2% among all Bethesda III/IV FNAs and 76% among Bethesda VI FNAs. Fusions involving NTRK, RET, BRAF, and ALK were most prevalent in Bethesda V (10%), and 130 different gene partners were identified. Among small consecutive Bethesda III/IV sample cohorts with one of these fusions and available surgical pathology excision data, the positive predictive value of an NTRK or RET fusion for carcinoma or noninvasive follicular thyroid neoplasm with papillary-like nuclear features was >95%, whereas for BRAF and ALK fusions it was 81% and 67%, respectively. At least 1 genomic alteration was identified by the expanded Afirma XA panel in 70% of medullary thyroid carcinoma classifier–positive FNAs, 44% of Bethesda III or IV Afirma GSC suspicious FNAs, 64% of Bethesda V FNAs, and 87% of Bethesda VI FNAs.

Conclusions

This large study demonstrates that almost one-half of Bethesda III/IV Afirma GSC suspicious and most Bethesda V/VI nodules had at least 1 genomic variant or fusion identified, which may optimize personalized treatment decisions.
Time-Series Analysis of Continuous Glucose Monitoring Data to Predict Treatment Efficacy in Patients with T2DM
Authors: Li Li , Sun Jie , Ruan Liemin , Song Qifa
Published: May 2021

Context

There is a challenge to predict treatment effects in patients with type 2 diabetes mellitus (T2DM).

Objective

To assess and predict treatment effects in patients with T2DM through time-series analysis of continuous glucose monitoring (CGM) measurements.

Method

We extracted and clustered the trend components of CGM measurements to generate representative time-series profiles, which were used as a predictor of treatment effects in groups of patients.

Setting and Participants

We recruited 111 outpatients with T2DM at Ningbo City First Hospital, China.

Intervention

The patients underwent CGM measurement for 14 days at the beginning of glucose-lowering treatment.

Main Outcome Measures

Hemoglobin A1c (HbA1c) and fasting plasma glucose (FPG) were obtained at the beginning and after 6 months of treatment.

Results

111 patients each had 960 to 1344 CGM measurements for 14 days at 96 measurements per day. The patients were classified into 3 groups according to the profiles of trend components of CGM observed values by time-series clustering method, including decreasing (47 patients), increasing (26 patients), and unchanged (38 patients) profiles. After 6 months of glucose-lowering treatment, FPG declined from 10.2 to 6.8 mmol/L (a decline of 3.4 mmol/L) in the decreasing group, from 8.9 to 9.2 mmol/L (a rise of 0.3 mmol/L) in the increasing group, and from 8.4 to 7.5 mmol/L (a decline of 0.9 mmol/L) in the unchanged group. The changes of HbA1c were 2.3%, 0.2%, and 0.9% for the 3 groups (P < 0.01), respectively.

Conclusions

Clustering of the trend components of CGM data generates representative CGM profiles that are predictive of 6-month therapeutic effects for T2DM.
Osteogenesis Imperfecta: Mechanisms and Signaling Pathways Connecting Classical and Rare OI Types
Authors: Jovanovic Milena , Guterman-Ram Gali , Marini Joan C
Published: May 2021

Osteogenesis imperfecta (OI) is a phenotypically and genetically heterogeneous skeletal dysplasia characterized by bone fragility, growth deficiency, and skeletal deformity. Previously known to be caused by defects in type I collagen, the major protein of extracellular matrix, it is now also understood to be a collagen-related disorder caused by defects in collagen folding, posttranslational modification and processing, bone mineralization, and osteoblast differentiation, with inheritance of OI types spanning autosomal dominant and recessive as well as X-linked recessive. This review provides the latest updates on OI, encompassing both classical OI and rare forms, their mechanism, and the signaling pathways involved in their pathophysiology. There is a special emphasis on mutations in type I procollagen C-propeptide structure and processing, the later causing OI with strikingly high bone mass. Types V and VI OI, while notably different, are shown to be interrelated by the interferon-induced transmembrane protein 5 p.S40L mutation that reveals the connection between the bone-restricted interferon-induced transmembrane protein-like protein and pigment epithelium-derived factor pathways. The function of regulated intramembrane proteolysis has been extended beyond cholesterol metabolism to bone formation by defects in regulated membrane proteolysis components site-2 protease and old astrocyte specifically induced-substance. Several recently proposed candidate genes for new types of OI are also presented. Discoveries of new OI genes add complexity to already-challenging OI management; current and potential approaches are summarized.
Data extraction methods for systematic review (semi)automation: A living systematic review
Authors: Schmidt Lena , Olorisade Babatunde K. , McGuinness Luke A. , Thomas James , Higgins Julian P. T.
Published: May 2021

Background: The reliable and usable (semi)automation of data extraction can support the field of systematic review by reducing the workload required to gather information about the conduct and results of the included studies. This living systematic review examines published approaches for data extraction from reports of clinical studies.

Methods: We systematically and continually search MEDLINE, Institute of Electrical and Electronics Engineers (IEEE), arXiv, and the dblp computer science bibliography databases. Full text screening and data extraction are conducted within an open-source living systematic review application created for the purpose of this review. This iteration of the living review includes publications up to a cut-off date of 22 April 2020.

Results: In total, 53 publications are included in this version of our review. Of these, 41 (77%) of the publications addressed extraction of data from abstracts, while 14 (26%) used full texts. A total of 48 (90%) publications developed and evaluated classifiers that used randomised controlled trials as the main target texts. Over 30 entities were extracted, with PICOs (population, intervention, comparator, outcome) being the most frequently extracted. A description of their datasets was provided by 49 publications (94%), but only seven (13%) made the data publicly available. Code was made available by 10 (19%) publications, and five (9%) implemented publicly available tools.

Conclusions: This living systematic review presents an overview of (semi)automated data-extraction literature of interest to different types of systematic review. We identified a broad evidence base of publications describing data extraction for interventional reviews and a small number of publications extracting epidemiological or diagnostic accuracy data. The lack of publicly available gold-standard data for evaluation, and lack of application thereof, makes it difficult to draw conclusions on which is the best-performing system for each data extraction target. With this living review we aim to review the literature continually.
Traducción y seguridad ciudadana
Authors: Balbuena Torezano María del Carmen
Published: May 2021

Este trabajo presenta las principales características un futuro proyecto de investigación interdisciplinar sobre fraseología, terminología y textos relacionados con los fenómenos relativos a los movimientos migratorios, la integración y la violencia global, cuyo objetivo fundamental es la elaboración de un sistema de información sobre el dominio del terrorismo global. En dicho sistema de información los conceptos están vinculados a una ontología, que a su vez constituye el vínculo entre términos en distintas lenguas (inglés, francés, alemán, árabe, español).
El sexto sentido de M. Night Shyamalan. ¿Algo más que su sorprendente final?
Authors: Maldonado Parra Mireia
Published: May 2021

De El sexto sentido de M. Night Shyamalan se destaca habitualmente el giro o “plot twist” que supone su sorprendente final. Sin embargo, como demostrará el presente artículo, el final de la cinta cuenta con numerosos antecedentes en el mundo del cine, incluso no reciente, y su verdadero valor ha de situarse más bien en la multiplicidad de interpretaciones que ofrece. El presente artículo pretende mostrar parte de esta diversidad presentando interpretaciones y análisis de críticos que saben encontrar en la película su capacidad de abordar cuestiones existenciales muy profundas.
The Use of Video as an Aid for the Construction of CLIL Pre-service Teachers’ Identity1
Authors: Gómez Parra Mª Elena , Díaz Martín Cristina
Published: May 2021

The use of video as an aid technique can help pre-service teachers to observe their teaching practice as well as to foster discussion among colleagues (though studies focusing on video within a CLIL context can scarcely be found in the literature). Nevertheless, the way pre-service teachers build their professional identity and whether or not they feel ‘as a CLIL teacher’ remains unclear. This aspect could be important for teachers not only in order to build their identity as CLIL teachers, but also to improve their teaching practice if it is used as feedback to improve classroom techniques. Therefore, video could stand as a professional tool to reflect on teaching practice as well as on the building of their professional identity as CLIL teachers. In sum, video is presented as a potential powerful tool to enhance CLIL teaching practice by means of the observation and reflection about teachers’ lectures. In addition, video can assist on the analysis of CLIL teaching in order to improve the praxis of this approach.
La creación de elementos ficcionales o irrealia en The Lord of the Rings: los procedimientos de formación de nuevas palabras en las traducciones al francés
Authors: Moreno Paz María del Carmen
Published: May 2021

Entre los retos de traducción que plantean los textos ficcionales, cabe destacar la traducción de los particulares ficcionales o irrealia, es decir, aquellas unidades léxicas que designan conceptos ficcionales. Esto se debe, por un lado, a su inexistencia material y a su falta de referencia a objetos del mundo real, lo que dificulta además la labor de documentación y búsqueda terminológica y condiciona la comprensión del texto ficcional. Por otra parte, la traducción de este tipo de unidades exige una habilidad creativa al traductor, que debe crear nuevas palabras para denominar los irrealia empleando los procedimientos de formación de nuevas palabras existentes en la lengua meta. En este sentido, cabe preguntarse si los irrealia pueden considerarse como un tipo particular de neologismo y, en tal caso, si recurren a los mismos procedimientos de creación. Para dar respuesta a estas preguntas, este trabajo tiene como objetivo el análisis de los procedimientos lingüísticos de formación de nuevas palabras utilizadas en las dos traducciones al francés de The Lord of the Rings, de J. R. R. Tolkien (1954-1955), publicadas por Christian Bourgois como Le Seigneur des Anneaux en ambos casos y que corresponden a los traductores Francis Ledoux (1972-1973) y Daniel Lauzon (2014-2016). Finalmente, esto nos permitirá establecer conclusiones sobre la naturaleza lingüística de estos elementos y su relación con los neologismos, así como sobre la relación entre un determinado procedimiento y la estrategia global de traducción.
Opinión de los docentes sobre el empleo de los dispositivos móviles en las actividades escolares considerando la ciencia de datos.
Authors: Salas-Rueda Ricardo-Adán , Castañeda-Martínez Ricardo
Published: May 2021

Hoy en día, los dispositivos móviles permiten la planeación, organización y realización de nuevas actividades escolares en cualquier lugar y momento. De hecho, los docentes emplean el teléfono inteligente para mejorar el proceso de enseñanza-aprendizaje. Esta investigación mixta analiza la opinión de los docentes sobre el empleo de los dispositivos móviles en las actividades escolares considerando la ciencia de datos y el aprendizaje automático (regresión lineal). La muestra está conformada por 106 docentes de la Universidad Nacional Autónoma de México (UNAM). Los resultados del aprendizaje automático indican que la realización de actividades escolares en los dispositivos móviles influye positivamente el aprendizaje, la participación y la motivación de los estudiantes. La ciencia de datos identifica 3 modelos predictivos sobre el empleo de los dispositivos móviles en las actividades escolares por medio de la técnica árbol de decisión. La información sobre el perfil del docente (sexo y experiencia docente) y el uso de la tecnología en el campo educativo permiten la construcción de estos modelos predictivos. El teléfono inteligente tiene un papel fundamental en el contexto educativo debido a que los docentes utilizan este dispositivo móvil para ingresar a las plataformas educativas, buscar la información, revisar el correo electrónico y emplear las aplicaciones tecnológicas en cualquier momento y lugar. Por último, los dispositivos móviles permiten transformar el proceso educativo, mejorar las condiciones de enseñanza-aprendizaje y actualizar las actividades escolares.
La democracia en los centros educativos españoles: concepciones de docentes y estudiantes.
Authors: Belav Guillermina , Flores-Sánchez Carlos , Guiral Claudia , Türk Yasin
Published: May 2021

Las concepciones de docentes y estudiantes sobre la democracia influyen en las actitudes, las expectativas y las posibilidades de esta forma de gobierno, por ello resulta fundamental conocerlas. El objetivo de esta investigación es describir las concepciones de democracia en el centro educativo que tienen docentes y estudiantes en España. Para ello se realizó una investigación fenomenográfica cuyos participantes fueron 15 profesores y 15 alumnos de centros educativos españoles. Los resultados sugieren tres concepciones sobre la democracia en el centro escolar, aunque con ligeras diferencias entre ambos grupos. En primer lugar, una concepción elitista que reduce la democracia a la libre competencia y elección de centro por parte de las familias, cuyos discursos jerarquizados resultan afines a la filosofía neoliberal. Una representativa que enfatiza el voto como mecanismo de decisión. Las principales diferencias entre docentes y estudiantes se encuentran bajo esta concepción, ya que mientras el profesorado tiende a desestimar el poder real del estudiantado, el alumnado llega a reclamar injerencia en decisiones trascendentales del centro. Finalmente, una concepción participativa que se caracteriza por la horizontalidad y la toma de decisiones consensuada. Promover esta concepción participativa resulta fundamental para fomentar el pensamiento crítico y la intervención de todas las personas en los asuntos comunes, avanzando así hacia sociedades más justas y equitativas.
The cost of treating inflammatory bowel disease: step-up vs step-down, therapeutic drug monitoring and personalised medicine
Authors: Avery Pearl
Published: May 2021

Inflammatory bowel disease (IBD) is a group of lifelong immune-mediated diseases, including Crohn's disease and ulcerative colitis. IBD is traditionally treated with drugs, including 5-aminosalicylates, steroids and immunosuppressants. However, the treatment landscape is changing, owing to a number of factors of significance to the IBD clinical nurse specialist. The recent introduction of novel biologic and biosimilar medications has affected the efficacy and cost of treatment. The established step-up treatment paradigm, where patients are started on simpler, cheaper therapies, is shifting toward a step-down approach, where biologics are the first-line treatment. Meanwhile, nurse-led pro-active therapeutic drug monitoring, including patient-reported outcome measures (PROMs), is helping ensure the efficacy and safety of treatment and allows for adjustments. In the near future, personalised medicine may offer genetic testing to predict a patient's reaction to different drugs and identify the most appropriate therapies. At the author's hospital, some of these factors may have contributed to a 50% reduction in emergency surgical rates for ulcerative colitis. This clinical review examines these issues in light of real-world experience from the author's hospital.
Prehospital unfractionated heparin and primary percutaneous coronary intervention
Authors: Sealy Madison , Stuart Olivia , Ross Nathan , Ebbs Phillip
Published: May 2021

Unfractionated heparin (UFH) is an anticoagulant used by some, but not all, ambulance services in the treatment of patients who will undergo primary percutaneous coronary intervention (PPCI) due to ST-elevation myocardial infarction (STEMI). This study reviews the effectiveness and safety of prehospital unfractionated heparin administration to STEMI patients prior to PPCI, and considers whether it should be used more widely for these purposes across international ambulance services. A literature search was conducted to identify articles relevant to prehospital UFH administration prior to PPCI. The reviewed literature unequivocally demonstrates that early anticoagulant administration is safe, effective and highly appropriate for STEMI patients who subsequently undergo PPCI. This study find that anticoagulants such as UFH or, in some jurisdictions, enoxaparin—should be strongly considered as a standard feature of prehospital treatment regimens for STEMI patients who will subsequently undergo PPCI.
The Potential Influence of To-Be-Forgotten Information on Educational Judgments
Authors: Scholz Sebastian , Dutke Stephan
Published: May 2021

Teachers often face complex educational judgments and research has shown that teachers are prone to be influenced by unrelated information in their judgments and decisions. To investigate the influence of potential misinformation we employed a list-method directed forgetting paradigm and investigated a simulated judgment scenario, in which participants were asked to recommend a higher or lower school track for a fictitious elementary school child. Previous research using list-method directed forgetting revealed that participants can intentionally forget information but this information might still influence further judgments. In two experiments, data on recall performance, school track recommendation, and the evaluative impression of the target were analyzed to investigate whether participants were able to intentionally forget information and whether the to-be-forgotten information influenced later judgments. To-be-forgotten information was either presented before (Experiment 1) or following (Experiment 2) information instructed to be remembered. Both experiments revealed that participants did not forget information instructed to be forgotten and their judgments were not influenced by this information. Bayes factors spoke in favor of the null hypotheses, indicating that the influence of to-be-forgotten information on simulated school track recommendations is questionable. Our results revealed important boundary conditions of directed forgetting in applied contexts.
DECISION MAKING IN DYNAMIC ENVIRONMENTS AN APPLICATION OF MACHINE LEARNING TO THE ANALYTICAL HIERARCHY PROCESS
Authors: Jassemi-Zargani Rahim , Kamps Caelum
Published: May 2021

The purpose of this work is to propose a method of algorithmic decision making that builds on the Analytical Hierarchy Process by applying reinforcement learning. Decision making in dynamic environments requires adaptability as new information becomes available. The Analytical Hierarchy Process (AHP) provides a method for comparative decision making but is insufficient to handle information that becomes available over time. Using the opinions of one or many subject matter experts and the AHP, the relative importance of evidence can be quantified. However, the ability to explicitly measure the interdependencies is more challenging. The interdependency between the different evidence can be exploited to improve the model accuracy, particularly when information is missing or uncertain. To establish this ability within a decision-making tool, the AHP method can be optimized through a stochastic gradient descent algorithm. To illustrate the effectiveness of the proposed method, an experiment was conducted on air target threat classification in time series developing scenarios.