bluuebunny/crossref_metadata_2025 huggingface dataset:
Diagnostic performance of intraoperative assessment in grade 2 endometrioid endometrial carcinoma
Authors: Bandala-Jacques Antonio , Cantú-de-León David , Pérez-Montiel Delia , Salcedo-Hernández Rosa A. , Prada Diddier , González-Enciso Aarón , Gonzalez-Valdés Arely , Barquet-Muñoz Salim Abraham
Published: October 2020

Background

Endometrial carcinoma is the most common gynecologic malignancy in developed countries. Grade 2 carcinoma is associated with pelvic lymph-node metastasis, depending on selected risk factors. Intraoperative assessment (IOA) can identify patients at risk for lymph node metastasis who should undergo staging surgery. Our objective was to establish the diagnostic precision of IOA in determining the need for surgical staging in grade 2 endometrioid endometrial carcinoma.

Methods

Two hundred twenty-two patients underwent IOA. Results were compared to the final pathology report. The accuracy of the IOA parameters was calculated. Variables were evaluated in patients with positive versus negative IOA. Overall and disease-free survivals were calculated according to IOA, lymphadenectomy, and nodal metastasis.

Results

IOA was positive in 80 patients. It showed an accuracy of 76.13% when compared with the postoperative assessment. The best individual parameter was myometrial invasion. Nodal metastasis was observed in 16 patients in the positive IOA group and 7 patients in the negative group. Patients with lymph node metastasis had a 5-year overall survival rate of 80.9%, whereas patients without metastasis had a 5-year overall survival rate of 97.9%.

Conclusions

IOA is an adequate tool to identify high-risk patients in grade 2 endometrial carcinoma. Myometrial invasion is the individual parameter that yields the highest diagnostic precision.
Impact of free maternal health care policy on maternal health care utilization and perinatal mortality in Ghana: protocol design for historical cohort study
Authors: Azaare John , Akweongo Patricia , Aryeetey Genevieve Cecilia , Dwomoh Duah
Published: October 2020

Background

Ghana introduced what has come to be known as the 'Free’ Maternal Health Care Policy (FMHCP) in 2008 via the free registration of pregnant women to the National Health Insurance Scheme to access healthcare free of charge. The policy targeted every pregnant woman in Ghana with a full benefits package covering comprehensive maternal healthcare.

Purpose

This study seeks to measure the contribution of the FMHCP to maternal healthcare utilization; antenatal care uptake, and facility delivery and determine the utilization impact on stillbirth, perinatal, and neonatal deaths using quasi-experimental methods. The study will also contextualize the findings against funding constraints and operational bottlenecks surrounding the policy operations in the Upper East Region of Ghana.

Methods

This study adopts a mixed-method design to estimate the treatment effect using variables generated from historical data of Ghana and Kenya Demographic and Health Survey data sets of 2008/2014, as treatment and comparison groups respectively. As DHS uses complex design, weighting will be applied to the data sets to cater for clustering and stratification at all stages of the analysis by setting the data in STATA and prefix Stata commands with‘svy’. Thus, the policy impact will be determined using quasi-experimental designs; propensity score matching, and difference-in-differences methods. Prevalence, mean difference, and test of association between outcome and exposure variables will be achieved using the Rao Scot Chi-square. Confounding variables will be adjusted for using Poisson and multiple logistics regression models. Statistical results will be reported in proportions, regression coefficient, and risk ratios. This study then employs intrinsic-case study technique to explore the current operations of the ‘free’ policy in Ghana, using qualitative methods to obtain primary data from the Upper East Region of Ghana for an in-depth analysis.

Discussion

The study discussions will show the contributions of the ‘free’ policy towards maternal healthcare utilization and its performance towards stillbirth, perinatal and neonatal healthcare outcomes. The discussions will also centre on policy designs and implementation in resource constraints settings showing how SDG3 can be achievement or otherwise. Effectiveness of policy proxy and gains in the context of social health insurance within a broader concept of population health and economic burden will also be conferred.

Protocol approval

This study protocol is registered for implementation by the Ghana Health Service Ethical Review Committee, number: GHS-ERC 002/04/19.
Genomic and phylogenetic characterization of ChPV2, a novel goat PV closely related to the Xi-PV1 species infecting bovines
Authors: Willemsen Anouk , van den Boom Alexander , Dietz Julienne , Bilge Dagalp Seval , Dogan Firat , Bravo Ignacio G. , Ehrhardt Anja , Ehrke-Schulz Eric
Published: October 2020

Background

Papillomaviruses (PVs) infecting artiodactyls are very diverse, and only second in number to PVs infecting primates. PVs associated to lesions in economically important ruminant species have been isolated from cattle and sheep.

Methods

Potential PV DNA from teat lesions of a Damascus goat was isolated, cloned and sequenced. The PV genome was analyzed using bioinformatics approaches to detect open reading frames and to predict potential features of encoded proteins as well as putative regulatory elements. Sequence comparison and phylogenetic analyses using the concatenated E1E2L2L1 nucleotide and amino acid alignments was used to reveal the relationship of the new PV to the known PV diversity and its closest relevants.

Results

We isolated and characterized the full-genome of novel Capra hircus papillomavirus. We identified the E6, E7, E1, E2, L2, L1 open reading frames with protein coding potential and putative active elements in the ChPV2 proteins and putative regulatory genome elements. Sequence similarities of L1 and phylogenetic analyses using concatenated E1E2L2L1 nucleotide and amino acid alignments suggest the classification as a new PV type designated ChPV2 with a phylogenetic position within the XiPV genus, basal to the XiPV1 species. ChPV2 is not closely related to ChPV1, the other known goat PV isolated from healthy skin, although both of them belong confidently into a clade composed of PVs infecting cervids and bovids. Interestingly, ChPV2 contains an E6 open reading frame whereas all closely related PVs do not

Conclusion

ChPV2 is a novel goat PV closely related to the Xi-PV1 species infecting bovines. Phylogenetic relationships and genome architecture of ChPV2 and closely related PV types suggest at least two independent E6 losses within the XiPV clade.
Correlations between weight‐bearing 3D bone architecture and dynamic plantar pressure measurements in the diabetic foot
Authors: Belvedere Claudio , Giacomozzi Claudia , Carrara Claudio , Lullini Giada , Caravaggi Paolo , Berti Lisa , Marchesini Giulio , Baccolini Luca , Durante Stefano , Leardini Alberto
Published: October 2020

Background

Measurements of plantar loading reveal foot‐to‐floor interaction during activity, but information on bone architecture cannot be derived. Recently, cone‐beam computer tomography (CBCT) has given visual access to skeletal structures in weight‐bearing. The combination of the two measures has the potential to improve clinical understanding and prevention of diabetic foot ulcers. This study explores the correlations between static 3D bone alignment and dynamic plantar loading.

Methods

Sixteen patients with diabetes were enrolled (group ALL): 15 type 1 with (N, 7) and without (D, 8) diabetic neuropathy, and 1 with latent autoimmune diabetes. CBCT foot scans were taken in single‐leg upright posture. 3D bone models were obtained by image segmentation and aligned in a foot anatomical reference frame. Absolute inclination and relative orientation angles and heights of the bones were calculated. Pressure patterns were also acquired during barefoot level walking at self‐selected speed, from which regional peak pressure and absolute and normalised pressure‐time integral were worked out at hallux and at first, central and fifth metatarsals (LOAD variables) as averaged over five trials. Correlations with 3D alignments were searched also with arch index, contact time, age, BMI, years of disease and a neuropathy‐related variable.

Results

Lateral and 3D angles showed the highest percentage of significant (p < 0.05) correlations with LOAD. These were weak‐to‐moderate in the ALL group, moderate‐to‐strong in N and D. LOAD under the central metatarsals showed moderate‐to‐strong correlation with plantarflexion of the 2nd and 3rd phalanxes in ALL and N. LOAD at the hallux increased with plantarflexion at the 3rd phalanx in ALL, at 1st phalanx in N and at 5th phalanx in D. Arch index correlated with 1st phalanx plantarflexion in ALL and D; contact time showed strong correlation with 2nd and 3rd metatarsals and with 4th phalanx dorsiflexion in D.

Conclusion

These preliminary original measures reveal that alteration of plantar dynamic loading patterns can be accounted for peculiar structural changes of foot bones. Load under the central metatarsal heads were correlated more with inclination of the corresponding phalanxes than metatarsals. Further analyses shall detect to which extent variables play a role in the many group‐specific correlations.
A cell-of-origin epigenetic tracer reveals clinically distinct subtypes of high-grade serous ovarian cancer
Authors: Lo Riso Pietro , Villa Carlo Emanuele , Gasparoni Gilles , Vingiani Andrea , Luongo Raffaele , Manfredi Anna , Jungmann Annemarie , Bertolotti Alessia , Borgo Francesca , Garbi Annalisa , Lupia Michela , Laise Pasquale , Das Vivek , Pruneri Giancarlo , Viale Giuseppe , Colombo Nicoletta , Manzo Teresa , Nezi Luigi , Cavallaro Ugo , Cacchiarelli Davide , Walter Jörn , Testa Giuseppe
Published: October 2020

Background

High-grade serous ovarian cancer (HGSOC) is a major unmet need in oncology. The remaining uncertainty on its originating tissue has hampered the discovery of molecular oncogenic pathways and the development of effective therapies.

Methods

We used an approach based on the retention in tumors of a DNA methylation trace (OriPrint) that distinguishes the two putative tissues of origin of HGSOC, the fimbrial (FI) and ovarian surface epithelia (OSE), to stratify HGSOC by several clustering methods, both linear and non-linear. The identified tumor subtypes (FI-like and OSE-like HGSOC) were investigated at the RNAseq level to stratify an in-house cohort of macrodissected HGSOC FFPE samples to derive overall and disease-free survival and identify specific transcriptional alterations of the two tumor subtypes, both by classical differential expression and weighted correlation network analysis. We translated our strategy to published datasets and verified the co-occurrence of previously described molecular classification of HGSOC. We performed cytokine analysis coupled to immune phenotyping to verify alterations in the immune compartment associated with HGSOC. We identified genes that are both differentially expressed and methylated in the two tumor subtypes, concentrating on PAX8 as abona fidemarker of FI-like HGSOC.

Results

We show that:

- OriPrint is a robust DNA methylation tracer that exposes the tissue of origin of HGSOC.

- The tissue of origin of HGSOC is the main determinant of DNA methylation variance in HGSOC.

- The tissue of origin is a prognostic factor for HGSOC patients.

- FI-like and OSE-like HGSOC are endowed with specific transcriptional alterations that impact patients’ prognosis.

- OSE-like tumors present a more invasive and immunomodulatory phenotype, compatible with its worse prognostic impact.

- Among genes that are differentially expressed and regulated in FI-like and OSE-like HGSOC, PAX8 is abona fidemarker of FI-like tumors.

Conclusions

Through an integrated approach, our work demonstrates that both FI and OSE are possible origins for human HGSOC, whose derived subtypes are both molecularly and clinically distinct. These results will help define a new roadmap towards rational, subtype-specific therapeutic inroads and improved patients’ care.
Autoregulation of JARID2 through PRC2 interaction with its antisense ncRNA
Authors: Al-Raawi Diaa , Kanhere Aditi
Published: October 2020

Objective

JARID2 is a member of chromatin-modifying Polycomb Repressive Complex-2 or PRC2. It plays a role in recruiting PRC2 to developmental genes and regulating its activity. JARID2 along with PRC2 is indispensable for normal development. However, it remains unclear how JARID2 expression itself is regulated. Recently a number of non-protein-coding RNAs or ncRNAs are shown to regulate transcription. An antisense ncRNA, JARID2-AS1, is expressed from the first intron of JARID2 isoform-1 but its role in regulation of JARID2 expression has not been investigated. The objective of this study was to explore the role of JARID2-AS1 in regulating JARID2 and consequently PRC2.

Results

We found that JARID2-AS1 is localised in the nucleus and shows anti-correlated expression pattern to that of JARID2 isoform-1 mRNA. More interestingly, data mining approach strongly indicates that JARID2-AS1 binds to PRC2. These are important observations that provide insights into transcriptional regulation of JARID2, especially because they indicate that JARID2-AS1 by interacting and probably recruiting PRC2 participates in an auto-regulatory loop that controls levels of JARID2. This holds importance in regulation of developmental and differentiation processes. However, to support this hypothesis, further in-depth studies are needed which can verify JARID2-AS1-PRC2 interactions.
Robust performance of a novel stool DNA test of methylated SDC2 for colorectal cancer detection: a multicenter clinical study
Authors: Wang Jianping , Liu Side , Wang Hui , Zheng Lei , Zhou Changchun , Li Guoxin , Huang Rongkang , Wang Huaiming , Li Chujun , Fan Xinjuan , Fu Xinhui , Wang Xinying , Guo Hongliang , Guan Jie , Sun Yanlai , Song Xilin , Li Zengjun , Mu Dianbin , Sun Jujie , Liu Xianglin , Qi Yan , Niu Feng , Chen Chunhua , Wu Xiaolin , Wang Xianshu , Song Xianrang , Zou Hongzhi
Published: October 2020

Background and Aims

Stool DNA testing is an emerging and attractive option for colorectal cancer (CRC) screening. We previously evaluated the feasibility of a stool DNA (sDNA) test of methylated SDC2 for CRC detection. The aim of this study was to assess its performance in a multicenter clinical trial setting.

Methods

Each participant was required to undergo a sDNA test and a reference colonoscopy. The sDNA test consists of quantitative assessment of methylation status of SDC2 promoter. Results of real-time quantitative methylation-specific PCR were dichotomized as positive and negative, and the main evaluation indexes were sensitivity, specificity, and kappa value. All sDNA tests were performed and analyzed independently of colonoscopy.

Results

Among the 1110 participants from three clinical sites analyzed, 359 and 38 were diagnosed, respectively, with CRC and advanced adenomas by colonoscopy. The sensitivity of the sDNA test was 301/359 (83.8%) for CRC, 16/38 (42.1%) for advanced adenomas, and 134/154 (87.0%) for early stage CRC (stage I–II). Detection rate did not vary significantly according to age, tumor location, differentiation, and TNM stage, except for gender. The follow-up testing of 40 postoperative patients with CRC returned negative results as their tumors had been surgically removed. The specificity of the sDNA test was 699/713 (98.0%), and unrelated cancers and diseases did not seem to interfere with the testing. The kappa value was 0.84, implying an excellent diagnostic consistency between the sDNA test and colonoscopy.

Conclusion

Noninvasive sDNA test using methylated SDC2 as the exclusive biomarker is a clinically viable and accurate CRC detection method.

Chinese Clinical Trial Registry

Chi-CTR-TRC-1900026409, retrospectively registered on October 8, 2019; http://www.chictr.org.cn/edit.aspx?pid=43888&htm=4.
Biodegradation and metabolic pathway of fenvalerate by Citrobacter freundii CD-9
Authors: Tang Jie , Lei Dan , Wu Min , Hu Qiong , Zhang Qing
Published: October 2020

Fenvalerate is a pyrethroid insecticide with rapid action, strong targeting, broad spectrum, and high efficiency. However, continued use of fenvalerate has resulted in its widespread presence as a pollutant in surface streams and soils, causing serious environmental pollution. Pesticide residues in the soil are closely related to food safety, yet little is known regarding the kinetics and metabolic behaviors of fenvalerate. In this study, a fenvalerate-degrading microbial strain, CD-9, isolated from factory sludge, was identified as Citrobacter freundii based on morphological, physio-biochemical, and 16S rRNA sequence analysis. Response surface methodology analysis showed that the optimum conditions for fenvalerate degradation by CD-9 were pH 6.3, substrate concentration 77 mg/L, and inoculum amount 6% (v/v). Under these conditions, approximately 88% of fenvalerate present was degraded within 72 h of culture. Based on high-performance liquid chromatography and gas chromatography-mass spectrometry analysis, ten metabolites were confirmed after the degradation of fenvalerate by strain CD-9. Among them, o-phthalaldehyde is a new metabolite for fenvalerate degradation. Based on the identified metabolites, a possible degradation pathway of fenvalerate by C. freundii CD-9 was proposed. Furthermore, the enzyme localization method was used to study CD-9 bacteria and determine that its degrading enzyme is an intracellular enzyme. The degradation rate of fenvalerate by a crude enzyme solution for over 30 min was 73.87%. These results showed that strain CD-9 may be a suitable organism to eliminate environmental pollution by pyrethroid insecticides and provide a future reference for the preparation of microbial degradation agents and environmental remediation.
Uncovering the genomic potential of the Amazon River microbiome to degrade rainforest organic matter
Authors: Santos-Júnior Célio Dias , Sarmento Hugo , de Miranda Fernando Pellon , Henrique-Silva Flávio , Logares Ramiro
Published: October 2020

Background

The Amazon River is one of the largest in the world and receives huge amounts of terrestrial organic matter (TeOM) from the surrounding rainforest. Despite this TeOM is typically recalcitrant (i.e. resistant to degradation), only a small fraction of it reaches the ocean, pointing to a substantial TeOM degradation by the river microbiome. Yet, microbial genes involved in TeOM degradation in the Amazon River were barely known. Here, we examined the Amazon River microbiome by analysing 106 metagenomes from 30 sampling points distributed along the river.

Results

We constructed theAmazon River basin Microbial non-redundant Gene Catalogue(AMnrGC) that includes ~ 3.7 million non-redundant genes, affiliating mostly to bacteria. We found that the Amazon River microbiome contains a substantial gene-novelty compared to other relevant known environments (rivers and rainforest soil). Genes encoding for proteins potentially involved in lignin degradation pathways were correlated to tripartite tricarboxylates transporters and hemicellulose degradation machinery, pointing to a possiblepriming effect. Based on this, we propose a model on how the degradation of recalcitrant TeOM could be modulated by labile compounds in the Amazon River waters. Our results also suggest changes of the microbial community and its genomic potential along the river course.

Conclusions

Our work contributes to expand significantly our comprehension of the world’s largest river microbiome and its potential metabolism related to TeOM degradation. Furthermore, the produced gene catalogue (AMnrGC) represents an important resource for future research in tropical rivers.
Expanding magnetic organelle biogenesis in the domain Bacteria
Authors: Lin Wei , Zhang Wensi , Paterson Greig A. , Zhu Qiyun , Zhao Xiang , Knight Rob , Bazylinski Dennis A. , Roberts Andrew P. , Pan Yongxin
Published: October 2020

Background

The discovery of membrane-enclosed, metabolically functional organelles inBacteriahas transformed our understanding of the subcellular complexity of prokaryotic cells. Biomineralization of magnetic nanoparticles within magnetosomes by magnetotactic bacteria (MTB) is a fascinating example of prokaryotic organelles. Magnetosomes, as nano-sized magnetic sensors in MTB, facilitate cell navigation along the local geomagnetic field, a behaviour referred to as magnetotaxis or microbial magnetoreception. Recent discovery of novel MTB outside the traditionally recognized taxonomic lineages suggests that MTB diversity across the domainBacteriaare considerably underestimated, which limits understanding of the taxonomic distribution and evolutionary origin of magnetosome organelle biogenesis.

Results

Here, we perform the most comprehensive metagenomic analysis available of MTB communities and reconstruct metagenome-assembled MTB genomes from diverse ecosystems. Discovery of MTB in acidic peatland soils suggests widespread MTB occurrence in waterlogged soils in addition to subaqueous sediments and water bodies. A total of 168 MTB draft genomes have been reconstructed, which represent nearly a 3-fold increase over the number currently available and more than double the known MTB species at the genome level. Phylogenomic analysis reveals that these genomes belong to 13 Bacterial phyla, six of which were previously not known to include MTB. These findings indicate a much wider taxonomic distribution of magnetosome organelle biogenesis across the domainBacteriathan previously thought. Comparative genome analysis reveals a vast diversity of magnetosome gene clusters involved in magnetosomal biogenesis in terms of gene content and synteny residing in distinct taxonomic lineages. Phylogenetic analyses of core magnetosome proteins in this largest available and taxonomically diverse dataset support an unexpectedly early evolutionary origin of magnetosome biomineralization, likely ancestral to the origin of the domainBacteria.

Conclusions

These findings expand the taxonomic and phylogenetic diversity of MTB across the domainBacteriaand shed new light on the origin and evolution of microbial magnetoreception. Potential biogenesis of the magnetosome organelle in the close descendants of the last bacterial common ancestor has important implications for our understanding of the evolutionary history of bacterial cellular complexity and emphasizes the biological significance of the magnetosome organelle.
Post-normal times: re-thinking the futures of the EU-Africa relationship
Authors: Bourgeois Robin , Mattheis Frank , Kotsopoulos John
Published: October 2020

The nature of the relationship between the European Union (EU) and Africa is in permanent evolution. Historically, the EU mostly dominated the relationship while Africa developed adaptive/reactive strategies. With the establishment of new powers as well as efforts to decolonise the thought and practise of North-South interactions, it is crucial to understand what the future of the relationship could be. The purpose of this paper is to draw lessons from the “Broadening the debate on EU-Africa relations” workshop whose aim was to advance perspectives on EU-Africa relations from the point of view of African scholars. The process consisted of identifying major influential factors in the relationship and assessing what role they played in the past and what role they could play in the future. The results indicate a decline of the importance of EU-dominated factors and the emergence of African agency related factors. We interpret these results as a transformation of this relationship, using the concept “post-normal” to highlight indeterminacy, insolvability and irreversibility as the new context. Implications are discussed regarding the type of research that needs to be developed in order to further investigate this transformation, particularly the meaning of a shifting focus from (normal times) EU-Africa relationship to (post-normal times) Africa-EU relationships.
Error estimation and adaptivity for PGD based on complementary solutions applied to a simple 1D problem
Authors: Reis Jonatha , Moitinho de Almeida José Paulo , Díez Pedro , Zlotnik Sergio
Published: October 2020

Reduced order methods are powerful tools for the design and analysis of sophisticated systems, reducing computational costs and speeding up the development process. Among these reduced order methods, the Proper Generalized Decomposition is a well-established one, commonly used to deal with multi-dimensional problems that often suffer from thecurse of dimensionality. Although the PGD method has been around for some time now, it still lacks mechanisms to assess the quality of the solutions obtained. This paper explores the dual error analysis in the scope of the PGD, using complementary solutions to compute error bounds and drive an adaptivity process, applied to a simple 1D problem. The energy of the error obtained from the dual analysis is used to determine the quality of the PGD approximations. We define a new adaptivity indicator based on the energy of the error and use it to drive parametric h- and p- adaptivity processes. The results are positive, with the indicator accurately capturing the parameter that will lead to lowest errors.
Adding a modified Lemaire procedure to ACLR in knees with severe rotational knee instability does not compromise isokinetic muscle recovery at the time of return-to-play
Authors: Joseph Leopold , Demey Guillaume , Chamu Thomas , Schmidt Axel , Germain Alexandre , van Rooij Floris , Saffarini Mo , Dejour David
Published: October 2020

Purpose

To determine whether isokinetic muscle recovery following ACLR using a hamstring tendon (HT) would be equivalent (non-inferior) in knees that had high-grade pivot-shift and adjuvant modified Lemaire procedure versus knees that had minimal pivot-shift and no adjuvant modified Lemaire procedure.

Methods

We evaluated 96 consecutive patients that underwent primary ACLR. Nine were excluded because of contralateral knee injury, and of the remaining 87, ACLR was performed stand-alone in 52 (Reference group), and with a Lemaire procedure in 35 (Lemaire group) who had high-grade pivot-shift, age < 18, or genu recurvatum > 20°. At 6 months, isokinetic tests were performed at 240°/s and 90°/s to calculate strength deficits of hamstrings (H) and quadriceps (Q). At 8 months, patients were evaluated using IKDC, Lysholm, and Tegner scores.

Results

Compared to the Reference group, the Lemaire group were younger (23.0 ± 2.5 vs 34.2 ± 10.5,p = 0.021) with a greater proportion of males (80% vs 56%,p < 0.001). The Lemaire group had no complications, but the Reference group had one graft failure and one cyclops syndrome. Strength deficits at 240°/s and at 90°/s were similar in both groups, but mixed H/Q ratios were lower for the Lemaire group (1.02 ± 0.19 vs 1.14 ± 0.24,p = 0.011). IKDC and Lysholm scores were similar in both groups, but Tegner scores were higher in the Lemaire group (median, 6.5 vs 6.0,p = 0.024).

Conclusions

ACLR with a modified Lemaire procedure for knees with rotational instability grants equivalent isokinetic muscle recovery as stand-alone ACLR in knees with no rotational instability. For ACL-deficient knees with high-grade pivot-shift, a Lemaire procedure restores rotational stability without compromising isokinetic muscle recovery.

Study design

Level III, comparative study.
Intersecting social structures and human actors: Ganfoso refugees’ settling experiences and impact on children’s education
Authors: Akua-Sakyiwah Beatrice
Published: October 2020

The myth that Ghana is stable and peaceful, cause many refugees from across Africa and elsewhere, escaping wars from their countries to flee there. Whilst here, refugees face transitional problems in acculturation and settlement, stemming from a lack of education, as many have not had formal education before coming to Ghana. The problem is worsened by an immigration system and a social structure that delays responding to refugees’ needs. With a lack of viable employment to support parents’ settlement needs, these cumulatively function to affect refugee children’s educational attainment. Using ideas from Giddens’ structuration theory as a conceptual framework, the research seeks to understand how immigration rules and other mediated rules at the Ganfoso Refugee Camp, interlacing refugee parents’ acculturation/settlement experiences, impact children’s educational lives. The article uses narratives from teachers/head-teachers, refugee camp management, and a cross-section of community members to highlight how social structures, policy regulation and implementation, combined with issues of refugees’ agency (personal experiences and responses to situation), impact upon their settlement and affect their children’s education.

Through qualitative interviews with 69 participants, the article highlight discussions on the effect of institutional barriers to refugees’ experiences, and impact on educational access of refugee children in Ghana.
Postoperative tetraplegia due to conversion disorder upon emergence from general anesthesia
Authors: Ito Asuka , Nakamoto Tatsuo , Ohira Sayaka , Kamibayashi Takahiko
Published: October 2020

Background

Acute neurological deficit upon emergence from general anesthesia is a serious emergency. Conversion disorder, previously known as hysteria, is a somatoform disorder that causes neurological deficits without anatomical or physiological explanations. It is particularly rare after general anesthesia.

Case presentation

A 28-year-old healthy Japanese woman presented tetraplegia with normal sensory function upon waking from general anesthesia. She was evaluated for the causes of tetraplegia. There were no abnormal findings, and her symptoms were inconsistent with any anatomical or neurological pathology. Although she could not flex her knee actively, she could maintain the passive flexed position, suggesting that her paralysis was nonorganic. The most likely diagnosis was conversion disorder. After a 12-h observation, the patient fully recovered.

Conclusions

In patients with neurological deficits not correlating with neurological findings after general anesthesia, the presence of somatic disorders, such as conversion disorder, should be considered.
Outcome measures and treatment effectiveness in late onset myasthenia gravis
Authors: Pasqualin Francesca , Guidoni Silvia V. , Ermani Mario , Pegoraro Elena , Bonifati Domenico M.
Published: October 2020

Background

Recently different subtypes of myasthenia gravis (MG) have been described. They differ for clinical features and pathogenesis but the prognosis and response to treatment is less clear. The aim of the study was to evaluate outcome and treatment effectiveness including side effects in late onset MG (LOMG) compared with early onset MG (EOMG).

Methods

We analysed retrospectively 208 MG patients. Clinical features were recorded as well as treatment and side effects. Outcome at the last follow-up was evaluated with MGSTI and MGPIS scales.

Results

The 208 patients included were classified as follow: 36 ocular MG, 40 EOMG, 72 LOMG, 25 thymoma-associated, 14 anti-MuSK and 21 double seronegative. Similar positive outcome was achieved in either early and late onset subgroup. We found pharmacological remission and minimal manifestations at the MGFA-PIS in the 95% and 94,4% of EOMG and LOMG respectively but in LOMG a lower dose of immunosuppressors (MGSTI< 2) was required compared to EOMG (p = 0,048). Severe side effects were present in a small percentage of patients in both group but diabetes was more frequent in LOMG vs EOMG (2,2% vs 5%, p = 0.017).

Conclusions

Despite LOMG has more comorbidities that might interfere with treatment and outcome, therapeutic management does not seem to differ between EOMG and LOMG. A similar positive outcome was seen in both subgroups but LOMG group seems to require lower doses of medication to control symptoms.
Cognitive dysfunction among inpatients and outpatients with schizophrenia: relationship to positive and negative symptoms
Authors: Okasha Tarek Ahmed , Hussein Hanan , Shorub Eman , Nagi Hamed , Moustafa Ahmed A. , El-Serafi Doha
Published: October 2020

Background

Cognitive impairment is an established feature of schizophrenia and is a strong predictor of eventual social and functional outcome. Few studies have investigated cognitive impairment in hospital long-stay patients with schizophrenia. This study evaluates and compares cognitive function among a sample of patients with schizophrenia in both inpatient and outpatient departments in order to determine the relationship between cognitive impairment and clinical variables.

A cross-sectional comparative study based on a semi-structured interview investigating 100 inpatients with schizophrenia recruited from El-Abassia Mental Health Hospital departments compared to 100 patients with schizophrenia selected from the outpatients’ clinic matched with cases. The assessment tools included SCID-I, the Adult Wechsler Intelligence Scale, the computerized version of Wisconsin Card Sorting Test (WCST), Mini-Mental State Examination (MMSE), and Positive and Negative Syndrome Scale (PANSS).

Results

Patients with schizophrenia showed significant deficits on cognitive function with no statistically significant difference between the inpatient and outpatient groups. Executive function was significantly correlated with verbal, non-verbal, and total IQ. Executive function was negatively correlated with the positive and general symptoms of PANSS and not correlated with its negative symptoms. In addition, we did not find any statistically significant relationship between cognitive functions and the duration of illness.

Conclusion

The study provides evidence that institutionalization is not an influential factor on cognitive impairment patients with schizophrenia. However, the psychopathological aspects of the disorder are one of the crucial factors affecting the cognitive function in schizophrenia.
A comparative cross-sectional analysis on prevalence of depression and associated risk factors among medical students and doctors of Karachi, Pakistan
Authors: Qureshi Muhammad Fazal Hussain , Mohammad Danish , Sadiq Sara , Abubaker Zain Jawed , Kumari Ujalla , Devnani Joti , Dawani Nakeeta , Soleja Fahad Khalid , Haroon Ayesha
Published: October 2020

Background

It has been noted that there is high prevalence of depression among medical personnel whether it is a student or an on-duty doctor. However, no study has been done to highlight these two vulnerable groups. Accordingly, the objective of current study is to compare the prevalence of depression among medical students and doctors working in hospitals, and its correlation with demographic variables, associated symptoms and history of any recent trauma. A descriptive cross-sectional study design was selected for this study. PHQ-9 was used as study tool.

Result

Mean age of students was 21 ± 1.83 while the mean age of the doctors included in study was 31 ± 7.8. A multivariate analysis model (MANOVA) was applied where male doctor and students were found to have a significantly high association (p = < 0.001) with depression scores as compared to their counterpart and students. Positive association was observed among sector and symptom of hopelessness, sleep changes and appetite/weight changes. The most common symptom among both groups was sleep changes while the least common symptom among doctors was concentration problem and among students was feeling of helplessness. It was also found that 26% of the students were having suicidal thoughts while only 16% of the doctors were having suicidal intentions.

Conclusion

It is concluded that depression is highly prevalent among medical students when comparing with on-duty doctors, so they should be screened with regular intervals and good counselling sessions to prepare them for a better health care system.
A structured mixed method process evaluation of a randomized controlled trial of Individual Placement and Support (IPS)
Authors: Fyhn Tonje , Ludvigsen Kari , Reme Silje E. , Schaafsma Frederieke
Published: October 2020

Background

Individual Placement and Support (IPS) is an evidence-based work rehabilitation program helping people with moderate to severe mental illness to obtain ordinary employment. Although IPS has proven superior to other work rehabilitation programs, in many studies, the majority of the participants remain unemployed. Structured process evaluations of IPS that use mixed methods are scarce, although they could identify implementation aspects that may enhance its effect. The aim of the current study is to assess reach, fidelity, and identify barriers and facilitators to implement IPS.

Methods

The process evaluation was conducted alongside a randomized controlled trial including six IPS centers, comparing IPS with treatment as usual in a population of patients in treatment for moderate to severe mental illness. Mixed methods were used in the process evaluation, including focus group interviews with service providers, individual interviews and survey data from participants, and fidelity reviews using the validated IPS Fidelity Scale.

Results

The intervention reached the intended target group. All centers reached fair to good fidelity according to the IPS Fidelity Scale within the project period (range 97–109, SD 8.1) (see Table 5). Certain fidelity items indicated implementation issues related to employer contact, community-based services, and integration with health services. Survey data showed that less than half of the participants regarded their illness as a barrier for participating in IPS and that freedom of disclosure was important. Participant interviews gave further insight into the role of the IPS specialist, emphasizing their availability and consistent job focus.

Conclusions

Indications of implementation challenges across centers during the first year suggest special attention should be given to these aspects in an early phase to ensure higher fidelity from the start and thus enhance the effectiveness of IPS. The IPS specialist played an important role for participants and was described as positive, pushing in a positive way, and encouraging. More knowledge on the characteristics of successful IPS specialists could further enhance the effectiveness of the intervention.

Trial registration

The study was registered on clinicaltrials.gov prior to the inclusion period (reg.no: NCT01964092, registered 17/07/2013).
Imaging of metastatic cervical nodes: is CT helpful in differentiation of squamous cell carcinoma (SCC) from non-SCC groups?
Authors: Eissa Lamya A. , Mehanna Ahmed Mohamed
Published: October 2020

Background

Cervical node metastasis is frequently encountered in CT neck of patients with squamous cell carcinoma (SCC) and non-(SCC). Differentiation between both entities carries its value on prognosis and choice of treatment plans. The purpose of the study was to compare between the SCC and non-SCC metastatic cervical adenopathies according to different imaging parameters with the use of comparative statistical analysis of any of these criteria. This was made by retrospectively studying 157 patients. Imaging analyzed the following parameters: nodal size, laterality, nodal levels, “grouping” of nodes, nodal shape, and “periphery,” as well as the presence or absence of nodal “necrosis.” Statistics are made to show significant differences between both groups.

Results

The criterion of necrosis had statistical significance, being more prevalent among the SCC groups. Involvement of levels I, II, and supra clavicular was more prevalent among SCC patients. Age and sex had also some statistical significance.

Conclusions

The combination of different imaging parameters could distinguish SCC from non-SCC. Nodal “necrosis”—(excluding “cystic”)—combined with involvement of nodal levels II and being in older-aged men were statistically significant in the SCC compared to non-SCC.
Pneumoparotid: a rare but well-documented cause of parotid gland swelling
Authors: Aljeaid Dhaifallah , Mubarak Ali , Imarli Yasser , Alotaibi Ohoud
Published: October 2020

Background

Pneumoparotid is a rare cause of parotid gland swelling. It is due to reflux of air through Stensen’s duct into the parenchyma of the parotid gland.

Case presentation

A case of self-induced pneumoparotid in a 12-year-old boy is reported. The diagnosis was primarily considered after careful history taking with special attention on the patient’s habits, and it was confirmed by computed tomography.

Conclusion

Pneumoparotid is a rare but well-documented clinical entity. It should be included in the differential diagnosis of parotid gland swelling.
Correction to: The relationship between level of the red cell distribution width and the outcomes of patients who acquired pneumonia from community
Authors: Ahmed Yousef , Mahmoud Manal A.
Published: October 2020

An amendment to this paper has been published and can be accessed via the original article.
A geomechanical correction for time-lapse amplitude variation with offset
Authors: MacBeth Colin , Bachkheti Samarth
Published: October 2020

Accurate inversion of time-lapse amplitude variation with offset (AVO) to reservoir pressure change requires knowledge of strain/stress changes in the reservoir and overburden. These geomechanical effects have not been taken into account in previous studies. We have determined that there are three contributions of importance that must be included in the AVO equations: a density term in the reservoir, the seismic anisotropy generated by the reservoir deformations, and the impact of the changing overburden properties. To calculate the error in neglecting these contributions, we derived analytic expressions for the 4D intercept and gradient as functions of the strains developed in the reservoir and overburden during production. The 4D AVO behavior is found to be controlled by three [Formula: see text]-factors that relate to time-lapse variations in P- and S-wave velocities. These factors can be estimated from rock-physics measurements in the laboratory or calibrated to field data measurements of time shifts via the well-known Hatchell-Bourne-Røste [Formula: see text]-factor. Numerical computation indicates that the error in not accounting for the anisotropic contribution to the P-P reflectivity is 50%–300% for the 4D zero-offset intercept and 62%–155% for the 4D gradient. Thus, in most applications, the time-lapse anisotropy in the reservoir and the overburden cannot be neglected when estimating pressure changes using 4D AVO.
Adjunctive benzodiazepines in depression: a clinical dilemma with no recent answers from research
Authors: de Cates Angharad N. , De Giorgi Riccardo
Published: October 2020

Comorbid anxiety symptoms are common in depression, and adding benzodiazepines to antidepressant treatment may seem a rational clinical solution. Benzodiazepines also have potential to reduce the initial anxiety that may be caused by early antidepressant treatment (owing to their inhibitory effect via GABAA receptor binding). This month's Cochrane Corner review examines the evidence behind combination treatment versus antidepressants alone in major depressive disorder, in terms of both the clinical and neuroscientific context. The review provides evidence that, in the first 4 weeks of treatment, additional medication with a benzodiazepine may lead to greater improvements than antidepressant alone on ratings of severity, response rates and remission rates for depression, but not on measures of anxiety.
Financial Distress Among Older Adults With Cancer
Authors: Giri Smith , Clark Deanna , Al-Obaidi Mustafa , Varnado Will , Kumar Seema , Paluri Ravi , Gbolahan Olumide , Bhatia Smita , Williams Grant R.
Published: October 2020

PURPOSE:

Financial distress (FD) among older adults with cancer is not well studied. We sought to characterize prevalence and factors associated with FD among older adults with cancer and the association of FD with geriatric assessment (GA) –identified deficits.

PATIENTS AND METHODS:

We included adults age ≥ 60 years with cancer in the University of Alabama at Birmingham Cancer and Aging Resilience Evaluation Registry who underwent GA during initial consultation with a medical oncologist before starting systemic therapy. We captured FD using a single-item question: “Do you have to pay for more medical care than you can afford?” We built multivariable models to study the impact of sociodemographic/clinical factors on FD as well as the association of FD with GA impairments.

RESULTS:

We identified 447 older adults with a median age of 69 years; 60% were men, 75% were White, and colorectal (26%) and pancreatic (19%) cancers were the most common. Overall, 27% (n = 121) reported having FD. Factors associated with FD included being Black (v White; odds ratio [OR], 2.26; 95% CI, 1.35 to 3.81; P = .002), being disabled/unemployed (v employed; OR, 2.60; 95% CI, 1.17 to 5.76; P = .019), and having an advanced degree ( v less than high school; OR, 0.13; 95% CI, 0.03 to 0.65; P = .012). Patients with FD were more likely to report several GA impairments, including depression (OR, 2.10; 95% CI, 1.06 to 4.18; P = .034) and impaired health-related quality of life in physical (β = −2.82; P = .014) and mental health domains (β = −3.31; P = .002).

CONCLUSION:

More than a quarter of older adults with cancer reported FD at the time of initial presentation to an oncologist. Several demographic factors and GA impairments were associated with FD.
Recurrence Rate of Sporadic Pheochromocytomas After Curative Adrenalectomy: A Systematic Review and Meta-analysis
Authors: Holscher Isabelle , van den Berg Tijs J , Dreijerink Koen M A , Engelsman Anton F , Nieveen van Dijkum Els J M
Published: October 2020

Background

Evidence on follow-up duration for patients with sporadic pheochromocytomas is absent, and current guidelines of the European Society of Endocrinology, American Association of Clinical Endocrinologists and Endocrine Surgeons, and the Endocrine Society are ambiguous about the appropriate duration of follow-up. The aim of this systematic review and meta-analysis is to evaluate the recurrence rate of sporadic pheochromocytomas after curative adrenalectomy.

Materials and Methods

A literature search in PubMed, Embase, and the Cochrane Library was performed. A study was eligible if it included a clear report on the number of sporadic patients, recurrence rate, and follow-up duration. Studies with an inclusion period before 1990, <2 years of follow-up, <10 patients, and unclear data on the sporadic nature of pheochromocytomas were excluded. A meta-analysis on recurrence was performed provided that the heterogeneity was low (I2 < 25%) or intermediate (I2 26–75%). Hozo’s method was used to calculate weighted mean follow-up duration and weighted time to recurrence with combined standard deviations (SDs).

Results

A total of 13 studies, including 430 patients, were included in the synthesis. The meta-analysis results describe a pooled recurrence rate after curative surgery of 3% (95% confidence interval: 2–6%, I2 = 0%), with a weighted mean time to recurrence of 49.4 months (SD = 30.7) and a weighted mean follow-up period of 77.3 months (SD = 32.2).

Conclusions

This meta-analysis shows a very low recurrence rate of 3%. Prospective studies, including economical and health effects of limited follow-up strategies for patients with truly sporadic pheochromocytomas should be considered.