bluuebunny/crossref_metadata_2025 huggingface dataset:
Lived experience influencing law reform: insights from a collaborative research project
Authors: Flynn Eilionóir , de Bhailís Clíona , Serra María Laura
Published: June 2020

This article will explore the methodologies employed in a collaborative research project on lived experience of exercise or denial of legal capacity, known as the Voices of Individuals: Collectively Exploring Self-determination (VOICES) project. In so doing, the project’s research team will reflect on key decisions about the project’s background, design, implementation (including the recruitment and selection of participants, workshops and editing contributions) and considerations for further research.
Tai Chi exercise for psychological well-being among adults with cardiovascular disease: A systematic review and meta-analysis
Authors: Taylor-Piliae Ruth E , Finley Brooke A
Published: June 2020

Background:

Regular exercise is beneficial for adults with cardiovascular disease to improve psychological well-being. Tai Chi is a mind–body exercise thought to promote psychological well-being.

Aim:

Examine the efficacy of Tai Chi in improving psychological well-being among persons with cardiovascular disease.

Methods:

An electronic literature search of 10 databases (AMED, CINAHL, Embase, OpenGrey, PsycARTICLES, PsycINFO, PubMed, Scopus, SPORTDiscus, and Web of Science) was conducted. Clinical trials that examined one or more aspect of psychological well-being, incorporated a Tai Chi intervention among cardiovascular disease participants, and were published in English or German languages were included. Comprehensive Meta-Analysis version 2.0 software (Biostat, Inc.) was used to calculate the effect sizes (i.e. Hedges’ g) and the 95% confidence intervals using random effects models.

Results:

A total of 15 studies met the inclusion criteria, enrolling 1853 participants (mean age = 66 years old, 44% women). Outcomes included: quality of life (QOL), stress, anxiety, depression, and psychological distress. When Tai Chi was compared with controls, significantly better general QOL (Hedges’ g 0.96; p=0.02, I2=94.99%), mental health QOL (Hedges’ g=0.20; p=0.01, I2=15.93) and physical health QOL (Hedges’ g=0.40; p=0.00, I2=0%); with less depression (Hedges’ g=0.69; p=0.00, I2=86.64%) and psychological distress (Hedges’ g=0.58; p=0.00, I2=0%) were found.

Conclusions:

Few Tai Chi studies have been conducted during the past decade examining psychological well-being among older adults with cardiovascular disease. Further research is needed with more rigorous study designs, adequate Tai Chi exercise doses, and carefully chosen outcome measures that assess the mechanisms as well as the effects of Tai Chi.
Adaptive auction protocol for task assignment in wireless sensor and actuator networks
Authors: Wang Lu , Li Ming , Kou Jiaxun , Yang Kun , Jiang Chunlan
Published: June 2020

The development of wireless sensor and actuator network is leading to high complexity networks and subsequently, new challenges in task assignment for effective sensor–actuator coordination. This article proposes an adaptive auction protocol for task assignment in multi-hop wireless actuator networks, considering a scenario where all actuators are immobile and each of them can obtain the target information from sensors. Unlike existing methods that neglect the adaptive auction area required by dynamic networks, the proposed method uses an adaptive factor [Formula: see text] (reflects the adaptive auction area) that is deduced based on the relation between network characteristics and protocol performance. Simulation results show that the adaptive protocol can dynamically change the auction area during the network operation. In addition, comparison with existing methods, such as simple auction protocol, 1 hop simple auction aggregation protocol, and 1 hop simple auction aggregation protocol greedy extension, shows that the adaptive auction protocol can choose the optimal solution at a low communication cost with a high probability, irrespective of the changes in the network.
Legal Intimacies: Slavery and Marriage in Victorian Law and Literature
Authors: Sheehan Lucy
Published: June 2020

In Oliver Twist (1837), Dickens explains that Oliver’s father had been “solemnly contracted” to marry Oliver’s mother, but was already married to another woman. A “clanking bond,” this marriage becomes a metaphorical slavery. In reality, legal thinkers turned to slavery law to litigate England’s domestic future, drawing on cases that regulated enslaved people’s movements to support changing marriage policies for metropolitan English families. By reading Oliver Twist in relation to these legal intimacies, we can see how the Victorian family was legitimated through its encounters with the recent history of British slavery and enslaved families excluded from English family law.
Transparency and Reproducibility of Meta-Analyses in Psychology: A Meta-Review
Authors: Polanin Joshua R. , Hennessy Emily A. , Tsuji Sho
Published: June 2020

Systematic review and meta-analysis are possible as viable research techniques only through transparent reporting of primary research; thus, one might expect meta-analysts to demonstrate best practice in their reporting of results and have a high degree of transparency leading to reproducibility of their work. This assumption has yet to be fully tested in the psychological sciences. We therefore aimed to assess the transparency and reproducibility of psychological meta-analyses. We conducted a meta-review by sampling 150 studies from Psychological Bulletin to extract information about each review’s transparent and reproducible reporting practices. The results revealed that authors reported on average 55% of criteria and that transparent reporting practices increased over the three decades studied ( b = 1.09, SE = 0.24, t = 4.519, p < .001). Review authors consistently reported eligibility criteria, effect-size information, and synthesis techniques. Review authors, however, on average, did not report specific search results, screening and extraction procedures, and most importantly, effect-size and moderator information from each individual study. Far fewer studies provided statistical code required for complete analytical replication. We argue that the field of psychology and research synthesis in general should require review authors to report these elements in a transparent and reproducible manner.
Toward a Refined Mindfulness Model Related to Consciousness and Based on Event-Related Potentials
Authors: Verdonk Charles , Trousselard Marion , Canini Frédéric , Vialatte Francois , Ramdani Céline
Published: June 2020

Neuroimaging, behavioral, and self-report evidence suggests that there are four main cognitive mechanisms that support mindfulness: (a) self-regulation of attention, (b) improved body awareness, (c) improved emotion regulation, and (d) change in perspective on the self. In this article, we discuss these mechanisms on the basis of the event-related potential (ERP). We reviewed the ERP literature related to mindfulness and examined a data set of 29 articles. Our findings show that the neural features of mindfulness are consistently associated with the self-regulation of attention and, in most cases, reduced reactivity to emotional stimuli and improved cognitive control. On the other hand, there appear to be no studies of body awareness. We link these electrophysiological findings to models of consciousness and introduce a unified, mechanistic mindfulness model. The main idea in this refined model is that mindfulness decreases the threshold of conscious access. We end with several working hypotheses that could direct future mindfulness research and clarify our results.
Cultural and global perspectives to relationship management in international public relations: The Sino-Chilean case study
Authors: Labarca Claudia , Ampuero Ruiz Pablo
Published: June 2020

There is still debate on whether a global public relations model may be applied in any cultural setting. This article contributes to this discussion by presenting empirical evidence about how Chilean export firms develop public relations strategies to Chinese audiences and the dual dimension – global and cultural – of their practice. Two main findings are discussed: on the one hand, Chilean companies have mostly developed a global approach to reach general audiences. On the other, the actual practice of relationship management – through their firm’s executives – is carried out by placing culture as critical for successful public relations efforts. Specifically, Chilean executives use guanxi as the main driver of their relationship management.
The role of (in)visibility in hate crime targeting transgender people
Authors: Colliver Ben , Silvestri Marisa
Published: June 2020

This article explores incidents of hate crime targeted at transgender people. Drawing on in-depth interview data, it challenges and extends established theorisations of the significance of ‘difference’ and ‘vulnerability’ in relation to victimisation. It introduces and emphasises the idea of ‘visibility’ as a more useful lens through which to understand the systematic harm caused by hate crime victimisation. Through an analysis of complex identities, the article argues that current conceptualisations of ‘visibility’ do not appreciate the complex, intersectional nature of visibility, which is key in understanding how people navigate their identities in different spaces and contexts.
Arthroscopic thermal stabilization for distal radioulnar joint instability: 3 to 19 years follow-up
Authors: Helsper Elizabeth A. , Frantz Lisa M. , Adams Jessica M. , Morris Harry A. , Hearon Bernard F.
Published: June 2020

This retrospective study investigated the clinical outcomes of patients treated for chronic distal radioulnar joint instability with arthroscopic thermal annealing of the superficial radioulnar ligaments, ulnar palmar wrist ligaments, and dorsoulnar wrist capsule using a radiofrequency probe. Sixty patients (62 wrists) were treated over an 18-year period. At mean follow-up of 10 years (range 3 to 19), 30 of 33 patients were satisfied with their surgical outcomes. There were statistically significant improvements in ulnar-sided wrist pain on a visual analogue scale and in distal radioulnar joint stability on the dorsopalmar stress test after surgery compared with preoperative status. The modified Mayo Wrist Score and Quick Disabilities of the Arm, Shoulder, and Hand score of the patients were favourable. Early failure occurred in 11 of 62 wrists. Nine of these 11 wrists needed a secondary procedure. We conclude that arthroscopic thermal shrinkage is effective for the majority of the patients with mild to moderate chronic distal radioulnar joint instability in long-term follow-up. Secondary open ligament reconstruction is an option in the case of early failure.

Level of evidence: IV
Poor stimulation of bovine dendritic cells by Mycobacterium bovis culture supernatant and surface extract is associated with decreased activation of ERK and NF-κB and higher expression of SOCS1 and 3
Authors: Ihedioha Olivia , Potter Andrew A , Chen Jeffrey M
Published: June 2020

The cell envelope of pathogenic mycobacteria interfaces with the host. As such, the interaction of bacterial products localized at or released from the cell surface with the host’s immune system can determine the fate of the bacterium in its host. In this study, the effects of three different types of Mycobacterium bovis cell envelope fractions—purified protein derivative, total cell wall lipids and culture supernatant and surface extract—on bovine dendritic cells were assessed. We found that the culture supernatant and surface extract fraction induced little to no production of the pro-inflammatory cytokines TNF-α and IL-12 in bovine dendritic cells. Moreover, this muted response was associated with poor activation of ERK and NF-κB, both of which are critical for the pro-inflammatory response. Furthermore, culture supernatant and surface extract treatment increased the expression of suppressor of cytokine signaling 1 and 3, both of which are negative regulators of pro-inflammatory signaling, in bovine dendritic cells. These observations taken together suggest the M. bovis culture supernatant and surface extract fraction contain immunomodulatory molecules that may aid in M. bovis pathogenesis.
Safeguarding children from coronavirus disease 2019: Practices of nuclear medicine units in Singapore
Authors: Cheng Lenith Tai Jit , Peh Wee Ming , Lam Winnie Wing Chuen
Published: June 2020

The coronavirus disease 2019 outbreak has been designated a public-health emergency in major cities around the globe. Major health-care institutions are scrambling to implement effective infection control measures to ensure the safety of patients and visitors while minimising disruptions to the provision of quality health care. We describe the measures taken by the nuclear medicine units in the major health-care institutions within Singapore to ensure optimal delivery of care to our paediatric patients and their caregivers.
“I love weather more than anybody”: A digital ethnography of The Weather Channel’s fan community
Authors: Shermak Jeremy L , Whipple Kelsey N
Published: June 2020

We Love Weather is the fan community of The Weather Channel. Launched in 2016, We Love Weather aims to serve so-called “weather geeks” by providing exclusive and specialized weather content, as well as participatory and communal elements. This study proposes that We Love Weather is an “affinity space” where participants create, procure, and develop content and knowledge. It exemplifies the power and capability of a high-functioning, efficient online information hub. Using digital ethnographic analysis of We Love Weather’s discussion forums and user-generated content, we found that We Love Weather promotes teaching and learning of weather information through sharing and community maintenance that establishes the site as an affinity space. It is an example of a positive, helpful, and deliberative online space.
A global hybrid VS30 map with a topographic slope–based default and regional map insets
Authors: Heath David C , Wald David J , Worden C Bruce , Thompson Eric M , Smoczyk Gregory M
Published: June 2020

Time-averaged shear wave velocity over the upper 30 m of the earth’s surface ( V S30) is a key parameter for estimating ground motion amplification as both a predictive and a diagnostic tool for earthquake hazards. The first-order approximation of V S30 is commonly obtained through a topographic slope–based or terrain proxy due to the widely available nature of digital elevation models. However, better-constrained V S30 maps have been developed in many regions. Such maps preferentially employ various combinations of V S30 measurements, higher-resolution elevation models, lithologic, geologic, geomorphic, and other proxies and often utilize refined interpolation schemes. We develop a new hybrid global V S30 map database that defaults to the global slope-based V S30 map, but smoothly inserts regional V S30 maps where available. In addition, we present comparisons of the default slope-based proxy maps against the new hybrid version in terms of V S30 and amplification ratio maps, and uncertainties in assigned V S30 values.
Reduction in inequalities in health insurance coverage and healthcare utilization among older adults in the Philippines after mandatory national health insurance coverage: trend analysis for 2003–2017
Authors: Siongco Kathryn Lizbeth Lucena , Nakamura Keiko , Seino Kaoruko
Published: June 2020

Background

Health policies in the Philippines have evolved in response to increasing health demands of older adults. However, there is a lack of research on equity among the ageing population in low-middle income countries. The objective of this study was to identify the trends in National Health Insurance Program (NHIP) coverage and healthcare utilization among older adults in the Philippines for the period from 2003 to 2017, during which NHIP expansion policies were implemented, focusing on reductions in socio-economic inequalities.

Methods

A literature search of policies for older adults and an analysis of four Philippine National Demographic and Health Surveys (2003, 2008, 2013, and 2017) with data from 25,217 older adults who were 60 years or older were performed. The major outcome variables were NHIP coverage, self-reported illness, outpatient healthcare utilization, and inpatient healthcare utilization. Inequalities in NHIP coverage and healthcare utilization according to wealth were evaluated by calculating the concentration index for individual years, followed by a regression-based decomposition analysis.

Results

NHIP coverage among older adults increased from 9.4 (2003) to 87.6% (2017). Although inequalities according to wealth quintile were observed in all four surveys (all P < 0.001), the concentration index declined from 0.3000 (2003) to 0.0247 (2017), showing reduced inequalities in NHIP coverage over time as observed for self-reported illness and healthcare utilization. NHIP coverage expansion for older adults in 2014 enabled equal opportunity for access to healthcare.

Conclusion

The passage of mandatory NHIP coverage for older Filipino adults in 2014 was followed by a reduction in inequality in NHIP coverage and healthcare utilization according to wealth.
Substitution Mapping of the Major Quantitative Trait Loci Controlling Stigma Exsertion Rate from Oryza glumaepatula
Authors: Tan Quanya , Zou Tuo , Zheng Mingmin , Ni Yuerong , Luan Xin , Li Xiaohui , Yang Weifeng , Yang Zifeng , Zhu Haitao , Zeng Ruizhen , Liu Guifu , Wang Shaokui , Fu Xuelin , Zhang Guiquan
Published: June 2020

Background

Stigma exsertion rate (SER) is a key determinant for the outcrossing ability of male sterility lines (MSLs) in hybrid rice seed production. In the process of domestication, the outcrossing ability of cultivated rice varieties decreased, while that of wild Oryza species kept strong. Here, we detected the quantitative trait loci (QTLs) controlling SER using a set of single-segment substitution lines (SSSLs) derived from O. glumaepatula, a wild Oryza species.

Results

Seven QTLs for SER were located on 5 chromosomes. qSER-1a and qSER-1b were located on chromosome 1. qSER-3a and qSER-3b were mapped on chromosome 3, and qSER-3b was further located at an estimated interval of 898.8 kb by secondary substitution mapping. qSER-5, qSER-9 and qSER-10 were identified on chromosomes 5, 9 and 10, respectively, and qSER-9 was delimited to an estimated region of 551.9 kb by secondary substitution mapping. The additive effects of the 7 QTLs ranged from 10.6% to 14.8%, which were higher than those of most loci for SER reported previously.

Conclusions

qSER-1a and qSER-1b are novel loci for SER on chromosome 1. All of the 7 QTLs have major effects on SER. The major QTLs of SER will help to develop MSLs with strong outcrossing ability.
Effects of high temperature stress during anthesis and grain filling periods on photosynthesis, lipids and grain yield in wheat
Authors: Djanaguiraman M. , Narayanan S. , Erdayani E. , Prasad P. V. V.
Published: June 2020

Background

Short episodes of high temperature (HT) stress during reproductive stages of development cause significant yield losses in wheat (Triticum aestivum L.). Two independent experiments were conducted to quantify the effects of HT during anthesis and grain filling periods on photosynthesis, leaf lipidome, and yield traits in wheat. In experiment I, wheat genotype Seri82 was exposed to optimum temperature (OT; 22/14 °C; day/night) or HT (32/22 °C) for 14 d during anthesis stage. In experiment II, the plants were exposed to OT or HT for 14 d during the grain filling stage. During the HT stress, chlorophyll index, thylakoid membrane damage, stomatal conductance, photosynthetic rate and leaf lipid composition were measured. At maturity, grain yield and its components were quantified.

Results

HT stress during anthesis or grain filling stage decreased photosynthetic rate (17 and 25%, respectively) and grain yield plant− 1 (29 and 44%, respectively), and increased thylakoid membrane damage (61 and 68%, respectively) compared to their respective control (OT). HT stress during anthesis or grain filling stage increased the molar percentage of less unsaturated lipid species [36:5- monogalactosyldiacylglycerol (MGDG) and digalactosyldiacylglycerol (DGDG)]. However, at grain filling stage, HT stress decreased the molar percentage of more unsaturated lipid species (36:6- MGDG and DGDG). There was a significant positive relationship between photosynthetic rate and grain yield plant− 1, and a negative relationship between thylakoid membrane damage and photosynthetic rate.

Conclusions

The study suggests that maintaining thylakoid membrane stability, and seed-set per cent and individual grain weight under HT stress can improve the photosynthetic rate and grain yield, respectively.
Risk of rebleeding from gastroesophageal varices after initial treatment with cyanoacrylate; a systematic review and pooled analysis
Authors: Hu Zixuan , Zhang Decai , Swai Joel , Liu Tao , Liu Shaojun
Published: June 2020

Background

Cyanoacrylate alone or in combination with other interventions, can be used to achieve variable rates of success in preventing rebleeding. Our study aims to assess the pooled risk of gastric and esophageal varices rebleeding after an initial treatment with cyanoacrylate alone and/or in combination with other treatments, by a systematic review of the literature and pooled analysis.

Methods

PubMed, EMBASE, SCOPUS, and the Cochrane library were searched for studies that reported the risk of rebleeding during the follow-up period after treatment of gastric or esophageal varices with either cyanoacrylate alone or in combination with other treatments. Standard error, upper and lower confidence intervals at 95% confidence interval for the risk were obtained using STATA Version 15 which was also used to generate forest plots for pooled analysis. The random or fixed effect model was applied depending on the heterogeneity (I2).

Results

A total of 39 studies were found to report treatment of either gastric or esophageal varices with either cyanoacrylate alone or in combination with other treatments. When gastric varices are treated with cyanoacrylate alone, the risk of rebleeding during the follow-up period is 0.15(Confidence Interval: 0.11–0.18). When combined with lipiodol; polidocanol or sclerotherapy the rebleeding risks are 0.13 (CI:0.03–0.22), 0.10(CI:0.02–0.19), and 0.10(CI:0.05–0.18), respectively. When combined with percutaneous transhepatic variceal embolization; percutaneous transhepatic variceal embolization; endoscopic ultrasound guided coils; or with ethanolamine, the rebleeding risk are 0.10(CI:0.03–0.17), 0.10(CI:0.03–0.17), 0.07(CI:0.03–0.11) and 0.08(CI:0.02–0.14), respectively.

When esophageal varices are treated with cyanoacrylate alone, the risk of rebleeding is 0.29(CI:0.11–0.47). When combined with percutaneous transhepatic variceal embolization; sclerotherapy; or band ligation, the risks of rebleeding are 0.16(CI:0.10–0.22), 0.12(CI:0.04–0.20) and 0.10(CI:0.04–0.24), respectively. When combined with a transjugular intrahepatic portosystemic shunt; or ethanolamine, the risks of rebleeding are 0.06(CI: − 0.01-0.12) and 0.02 (CI: − 0.02-0.05), respectively.

Conclusion

In treating both gastric and esophageal varices, cyanoacrylate produces better results in terms of lower risk of rebleeding when combined with other treatments than when used alone. The combination of cyanoacrylate with ethanolamine or with endoscopic ultrasound guided coils produces the lowest risk of rebleeding in esophageal and gastric varices, respectively. We call upon randomized trials to test these hypotheses.
Discrimination of benign from malignant breast lesions in dense breasts with model-based analysis of regions-of-interest using directional diffusion-weighted images
Authors: Penn Alan I. , Medved Milica , Dialani Vandana , Pisano Etta D. , Cole Elodia B. , Brousseau David , Karczmar Gregory S. , Gao Guimin , Reich Barry D. , Abe Hiroyuki
Published: June 2020

Background

There is an increasing interest in non-contrast-enhanced magnetic resonance imaging (MRI) for detecting and evaluating breast lesions. We present a methodology utilizing lesion core and periphery region of interest (ROI) features derived from directional diffusion-weighted imaging (DWI) data to evaluate performance in discriminating benign from malignant lesions in dense breasts.

Methods

We accrued 55 dense-breast cases with 69 lesions (31 benign; 38 cancer) at a single institution in a prospective study; cases with ROIs exceeding 7.50 cm2 were excluded, resulting in analysis of 50 cases with 63 lesions (29 benign, 34 cancers). Spin-echo echo-planar imaging DWI was acquired at 1.5 T and 3 T. Data from three diffusion encoding gradient directions were exported and processed independently. Lesion ROIs were hand-drawn on DWI images by two radiologists. A region growing algorithm generated 3D lesion models on augmented apparent-diffusion coefficient (ADC) maps and defined lesion core and lesion periphery sub-ROIs. A lesion-core and a lesion-periphery feature were defined and combined into an overall classifier whose performance was compared to that of mean ADC using receiver operating characteristic (ROC) analysis. Inter-observer variability in ROI definition was measured using Dice Similarity Coefficient (DSC).

Results

The region-growing algorithm for 3D lesion model generation improved inter-observer variability over hand drawn ROIs (DSC: 0.66 vs 0.56 (p < 0.001) with substantial agreement (DSC > 0.8) in 46% vs 13% of cases, respectively (p < 0.001)). The overall classifier improved discrimination over mean ADC, (ROC- area under the curve (AUC): 0.85 vs 0.75 and 0.83 vs 0.74 respectively for the two readers).

Conclusions

A classifier generated from directional DWI information using lesion core and lesion periphery information separately can improve lesion discrimination in dense breasts over mean ADC and should be considered for inclusion in computer-aided diagnosis algorithms. Our model-based ROIs could facilitate standardization of breast MRI computer-aided diagnostics (CADx).
Diffusion tensor imaging and electrophysiology as robust assays to evaluate the severity of acute spinal cord injury in rats
Authors: Chen Beike , Tan Qiang , Zhao Weikang , Yang Qiming , Zhang Hongyan , Gao Fabao , Liu Xin , Feng Hua , Jiang Dianming
Published: June 2020

Background

Diffusion tensor imaging (DTI) is an effective method to identify subtle changes to normal-appearing white matter (WM). Here we analyzed the DTI data with other examinations, including motor evoked potentials (MEPs), histopathological images, and behavioral results, to reflect the lesion development in different degrees of spinal cord injury (SCI) in acute and subacute stages.

Method

Except for 2 Sprague -Dawley rats which died from the anesthesia accident, the rest 42 female rats were randomized into 3 groups: control group (n = 6), moderate group (n = 18), and severe group (n = 18). Moderate (a 50-g aneurysm clip with 0.4-mm thickness spacer) or severe (a 50-g aneurysm clip with no spacer) contusion SCI at T8 vertebrae was induced. Then the electrophysiological assessments via MEPs, behavioral deterioration via the Basso, Beattie, and Bresnaha (BBB) scores, DTI data, and histopathology examination were analyzed.

Results

In this study, we found that the damage of WM myelin, MEPs amplitude, BBB scores and the decreases in the values of fractional anisotropy (FA) and axial diffusivity (AD) were more obvious in the severe injury group than those of the moderate group. Additionally, the FA and AD values could identify the extent of SCI in subacute and early acute SCI respectively, which was reflected in a robust correlations with MEPs and BBB scores. While the values of radial diffusivity (RD) showed no significant changes.

Conclusions

Our data confirmed that DTI was a valuable in ex vivo imaging tool to identify damaged white matter tracts after graded SCI in rat, which may provide useful information for the early identification of the severity of SCI.
The impact of neoadjuvant and adjuvant immunotherapy on the survival of pancreatic cancer patients: a retrospective analysis
Authors: Amin Saber , Baine Michael , Meza Jane , Lin Chi
Published: June 2020

Background

Immunotherapy has become an essential part of cancer treatment after showing great efficacy in various malignancies. However, its effectiveness in pancreatic ductal adenocarcinoma (PDAC), especially in resectable pancreatic cancer, has not been studied. The primary objective of this study is to compare the OS impact of immunotherapy between PDAC patients who receive neoadjuvant immunotherapy and patients who receive adjuvant immunotherapy. The secondary objective is to investigate the impact of neoadjuvant and adjuvant immunotherapy in combination with chemotherapy and chemoradiation by performing subset analyses of these two groups.

Methods

Patients diagnosed with PDAC between 2004 and 2016 were identified from the National Cancer Database (NCDB). Multivariable Cox proportional hazard analysis was performed to examine the effect of neoadjuvant and adjuvant immunotherapy in combination with chemotherapy and chemoradiation on the OS of the patients. The multivariable analysis was adjusted for essential factors such as the age at diagnosis, sex, race, education, income, place of living insurance status, hospital type, comorbidity score, and year of diagnosis.

Results

Overall, 526 patients received immunotherapy. Among whom, 408/526 (77.57%) received neoadjuvant immunotherapy, and the remaining 118/526 (22.43%) received adjuvant immunotherapy. There was no significant difference in OS between neoadjuvant and adjuvant immunotherapy (HR: 1.06, CI: 0.79–1.41; p < 0.714) in the multivariable analysis. In the univariate neoadjuvant treatment subset analysis, immunotherapy was associated with significantly improved OS compared to no immunotherapy (HR: 0.88, CI: 0.78–0.98; p < 0.026). This benefit disappeared in the multivariable analysis. However, after patients were stratified by educational level, the multivariable Cox regression analysis revealed that neoadjuvant immunotherapy was associated with significantly improved OS (HR: 0.86, CI: 0.74–0.99; p < 0.04) compared to no immunotherapy only in patients with high-level of education, but not in patients with low-level of education.

Conclusion

In this study, no difference in the OS between patients who received neoadjuvant immunotherapy and patients who received adjuvant immunotherapy was noticed. Future studies comparing neoadjuvant adjuvant immunotherapy combined with chemotherapy, radiation therapy, and chemoradiation are needed.
Adjuvant VACcination against HPV in surgical treatment of Cervical Intra-epithelial Neoplasia (VACCIN study) a study protocol for a randomised controlled trial
Authors: van de Laar R. L. O. , Hofhuis W. , Duijnhoven R. G. , Polinder S. , Melchers W. J. G. , van Kemenade F. J. , Bekkers R. L. M. , Van Beekhuizen H. J.
Published: June 2020

Background

Cervical cancer is caused by Human Papilloma viruses (HPV) and is preceded by precursor stages: Cervical Intraepithelial Neoplasia (CIN). CIN is mostly found in women in their reproductive age and treated with a Loop Electrosurgical Excision Procedure (LEEP). The recurrence or residual disease rate after treatment is up to 17%. These women have a lifelong increased risk of recurrent CIN, cervical cancer and other HPV related malignancies. Furthermore, LEEP treatments are associated with complications such as premature birth. Limited data show that prophylactic HPV vaccination at the time of LEEP reduces recurrence rates, therefore leading to a reduction in repeated surgical interventions and side effect like preterm birth.

The primary study objective is to evaluate the efficacy of the nonavalent HPV vaccination in women with a CIN II-III (high-grade squamous intraepithelial lesion (HSIL) lesion who will undergo a LEEP in preventing recurrent CIN II-III after 24 months.

Methods

This study is a randomised, double blinded, placebo controlled trial in 750 patients without prior HPV vaccination or prior treatment for CIN and with histologically proven CIN II-III (independent of their hrHPV status) for whom a LEEP is planned. Included patients will be randomised to receive either three injections with nonavalent (9 HPV types) HPV vaccine or placebo injections (NaCL 0.9%) as a comparator. Treatment and follow-up will be according the current Dutch guidelines. Primary outcome is recurrence of a CIN II or CIN III lesion at 24 months. A normal PAP smear with negative hrHPV test serves as surrogate for absence of CIN. At the start and throughout the study HPV typing, quality of life and cost effectiveness will be tested.

Discussion

Although prophylactic HPV vaccines are highly effective, little is known about the effectivity of HPV vaccines on women with CIN. Multiple LEEP treatments are associated with complications. We would like to evaluate the efficacy of HPV vaccination in addition to LEEP treatment to prevent residual or recurrent cervical dysplasia and decrease risks of repeated surgical treatment.

Trial registration

Medical Ethical Committee approval number: NL66775.078.18. Affiliation: Erasmus Medical Centre. Dutch trial register: NL 7938. Date of registration 2019-08-05.
Scleral concave pool trabeculectomy combined phacoemulsification in primary open-angle glaucoma with cataract
Authors: Ye Xiangxiang , Qi Yongjun , Deng Jianhua , Yang Yang , Mo Ting , Xu Mao , Liu Wanjun
Published: June 2020

Background

To investigate the safety and efficacy of scleral concave pool trabeculectomy (SCPT) combined phacoemulsification for eyes with coexisting cataract and primary open-angle glaucoma (POAG).

Methods

This was a retrospective, controlled, interventional pilot case series. Thirty patients (30 eyes) were diagnosed with coexisting cataract and POAG between May 2015 and April 2018. Fourteen eyes underwent SCPT combined phacoemulsification were set as the study group, and 16 eyes received conventional phacotrabeculectomy were set as the control group. All patients were followed up for at least 6 months. The preoperative to postoperative changes in IOP, glaucoma medication requirements, BCVA, blebs functions, and adverse events were recorded.

Results

The groups were matched for baseline age, BCVA, IOP and types of IOP-lowering medications (all P > 0.05). At 6-month visit, there were no significant difference between control and study group in the improvement of BCVA (0.22 ± 0.24 versus 0.18 ± 0.26, P = 0.718), reduction of IOP (− 11.21 ± 8.61 mmHg versus − 9.19 ± 9.18 mmHg, P = 0.540) and the number of eyes that needed IOP-lowering medications (2 versus 3, P = 0.743). At the last visit, the rate of forming functioning blebs was significantly different between the study and control groups, (92.9% versus 68.7% respectively, P = 0.007). In the study group, 5 eyes developed hypotony, and 1 eye showed limited choroidal detachment, whereas in the control group 1 eye developed malignant glaucoma. All adverse events were successfully managed.

Conclusion

The SCPT combined phacoemulsification seems to be a safe and effective alternative to conventional phacotrabeculectomy for patients with POAG and visually significant cataract in the short-term.
Treatment outcomes and prognostic factors for non- malignancy associated secondary hemophagocytic lymphohistiocytosis in children
Authors: Pan Hua , Wang Gaoyan , Guan Enben , Song Liang , Song Aiqin , Liu Xiaodan , Yi Zhi , Sun Li-rong
Published: June 2020

Background

Secondary hemophagocytic lymphohistiocytosis (HLH) is a rare hyperinflammatory syndrome that requires prompt diagnosis and appropriate treatment. A risk-stratification model that could be used to identify high-risk pediatric patients with HLH who should be considered for second-line therapies, including salvage regimens and allogeneic hematopoietic cell transplantation (HCT), was developed.

Methods

The medical records of 88 pediatric patients (median age 1.4 years, range 0.2–15 years) with non-malignancy associated secondary HLH were retrospectively reviewed. Treatment strategies included dexamethasone, etoposide, and cyclosporine.

Results

Survival analysis showed HLH patients with infections other than Epstein-Barr virus (EBV) and unknown causes experienced better 5-year overall survival (OS) than patients with HLH due to autoimmune disease, EBV or immunodeficiency (76% vs. 65, 33.3, 11%, p < 0.001). On multivariate analysis, among all patients, non-response at 8 weeks was the most powerful predictor of poor OS. When treatment response was excluded, hemoglobin < 60 g/L and albumin < 25 g/L at diagnosis were associated with poor OS. In patients with EBV-HLH, hemoglobin < 60 g/L at diagnosis was associated with poor OS. A prognostic risk score was established and weighted based on hazard ratios calculated for three parameters measured at diagnosis: hemoglobin < 60 g/L (2 points), platelets < 30 × 109/L (1 point), albumin < 25 g/L (2 points). Five-year OS of low-risk (score 0–1), intermediate-risk (score 2), and poor-risk (score ≥ 3) patients were 88, 38, and 22%, respectively (p < 0.001).

Conclusions

These findings indicate that clinicians should be aware of predictive factors at diagnosis and consider 8-week treatment response to identify patients with high-risk of disease progression and the need for second-line therapy and allogeneic HCT.
Enablers of psychosocial recovery in pediatric burns: perspectives from the children, parents and burn recovery support staff
Authors: Van Niekerk Ashley , Jacobs Roxanne , Hornsby Nancy , Singh-Adriaanse Robyn , Sengoelge Mathilde , Laflamme Lucie
Published: June 2020

Background

Pediatric burn injuries are a major cause of death and injury, occurring mainly in resource poor environments. Recovery from burns is widely reported to be constrained by physical, psychological, relationship and reintegration challenges. These challenges have been widely described, but not the enablers of psychosocial recovery. This is especially true in pediatric burn research, with few multi- perspective studies on the recovery process.

Methods

This qualitative study involved 8 focus group discussions (four with 15 children post-burn injury, four with 15 caregivers) and 12 individual interviews with staff working in pediatric burns that explored the psychosocial needs of children after a burn and the enablers of their recovery. Purposive sampling was utilized and recruitment of all three categories of participants was done primarily through the only hospital burns unit in the Western Cape, South Africa. The interviews focused on factors that supported the child’s recovery and were sequentially facilitated from the child and the family’s experiences during hospitalization, to the return home to family and friends, followed by re-entry into school. Thematic analysis was used to analyze verbatim interview transcripts.

Results

The recovery enablers that emerged included: (i) Presence and reassurance; indicating the comfort and practical help provided by family and close friends in the hospital and throughout the recovery process; (ii) Normalizing interactions and acceptance; where children were treated the same as before the injury to promote the acceptance of self and by others especially once the child returned home; and (iii) Sensitization of others and protection; signifying how persons around the child had assisted the children to deal with issues in the reintegration process including the re-entry to school.

Conclusions

This study indicates that the psychosocial recovery process of children hospitalized for burns is enabled by the supportive relationships from family members, close friends and burn staff, present during hospitalization, the return home, and school re-entry. Support included comfort and physical presence of trusted others and emotional support; affirmation of the child’s identity and belonging despite appearance changes; and the advocacy and protection for the re-entry back into the school, and more generally the community.
A case report of acute hypothermia during initial inpatient clozapine titration with review of current literature on clozapine-induced temperature dysregulations
Authors: Burk Bradley G. , Ward Alex H. , Clark Brooke
Published: June 2020

Background

Here we describe a unique case of clozapine-associated hypothermia during initial titration of this medication in an acute inpatient psychiatry setting. Only a handful of cases on this topic have been published. We discuss possible pharmacologic mechanisms supporting or refuting the propensity of clozapine to induce hypothermia, as well as risk factors for clozapine-induced hypothermia, and a comparison to clozapine-induced hyperthermia.

Case presentation

A 70 year-old African American female with treatment-refractory schizoaffective disorder developed hypothermia with a nadir temperature of 89 °F (31.7 °C) after 7 days on clozapine, on a total dose of 50 mg twice daily. Accompanying symptoms included bradycardia, hypotension, QTc prolongation, tachypnea, hypoxemia, and an absence of shivering. The patient was transferred to the ICU, and rewarmed within 10 h with the discontinuation of her clozapine, ziprasidone, and carvedilol. Broad spectrum antibiotics were initiated, but discontinued shortly after, as the patient had no leukocytosis, and blood cultures were negative.

Discussion

While hypoglycemia, hypothyroidism, sepsis, and stroke were effectively ruled out, alternative drug-disease (including chronic kidney disease), and drug-drug interactions were considered possible contributing features. Benzodiazepines, valproic acid, ziprasidone, and the numerous antihypertensive agents the patient was taking were considered as either primary or compounding factors for hypothermia. After exclusion or inclusion of these alternative causes, we calculated a score of 4 (possible) for clozapine-induced hypothermia on the Naranjo Scale.

Conclusions

Clozapine-induced hypothermia may occur more commonly than clinicians believe. Practitioners should be cognizant of this potentially fatal phenomenon, and monitor for temperature dysregulations while on clozapine, especially during initial titration, in those with multiple comorbid factors, and on additional medications that may contribute to hypothermia.
Idiopathic cocoon abdomen with congenital colon malrotation: a case report and review of the literature
Authors: Zhou Hui , Xu Jinling , Xie Xingwang , Han Jiantao
Published: June 2020

Background

Cocoon abdomen is a relatively rare abdominal disease characterized by the total or partial encasement of the small intestinal by a dense fibro-collagenous membrane.

Case presentation

We reported an unusual case of idiopathic cocoon abdomen with congenital colon malrotation. Laparotomy and sac release were performed on the patient. The patient was no recurrence 6 months after operation. A literature review was also performed.

Conclusion

Preoperative diagnosis of abdominal cocoon is difficult. A careful history, physical examination and appropriate radiology may be helpful in making a definitive diagnosis. If conservative treatment can’t relieve symptoms effectively, surgery is currently considered to be important in the management of this disease.
Correction to: High normal TSH is associated with lower mannan-binding lectin in women of childbearing age
Authors: Karbownik-Lewinska Malgorzata , Stepniak Jan , Marcinkowska Magdalena , Krygier Adrian , Lewinski Andrzej
Published: June 2020

An amendment to this paper has been published and can be accessed via the original article.
Role of 18F-fluorodeoxyglucose (FDG) and 18F-2-fluorodeoxy sorbitol (FDS) in autoimmune hypophysitis: a case report
Authors: Kong Ziren , Wang Yu , Ma Wenbin , Cheng Xin
Published: June 2020

Background

Autoimmune hypophysitis is a rare disease characterized by the infiltration of lymphocytic cells into the pituitary gland. 18F-fluorodeoxyglucose (FDG) and 18F-2-fluorodeoxy sorbitol (FDS) positron emission tomography (PET) are well-established and emerging techniques, respectively, which may aid in the diagnosis and classification of autoimmune hypophysitis.

Case presentation

Here, we report a 40-year-old female diagnosed with central diabetes insipidus and multiple pituitary hormone deficiencies, and MRI revealed homogeneous signals in the pituitary gland as well as thickened in the pituitary stalk. FDG PET localized the pituitary and pituitary stalk lesions and displayed an SUVmax of 5.5. FDS, a sensitive radiotracer for bacterial infections but remains unproven under aseptic inflammation, also demonstrated elevated radioactivity, with an SUVmax of 1.1 at 30 min and 0.73 at 120 min. Transnasal biopsy suggested a diagnosis of autoimmune hypophysitis, and the patient displayed radiological and clinical improvement after treatment with glucocorticoids and hormone replacement.

Conclusions

Autoimmune hypophysitis can display elevated FDG uptake, which aids in the localization of the lesions. In addition to revealing bacterial infection specifically, FDS can also accumulate under autoimmune conditions, suggesting that it could serve as a potential radiotracer for both bacterial and aseptic inflammation.

Trial registration

The patient was enrolled in study NCT02450942 (clinicaltrials.gov, Registered May 21, 2015).
Content validation of the EORTC QLQ-C15-PAL with advanced cancer patients and health care professionals from palliative care services in Chile
Authors: Rojas-Concha Leslye , Hansen Maiken Bang , Petersen Morten Aagaard , Groenvold Mogens
Published: June 2020

Background

The assessment of patients’ quality of life (QOL) is essential when evaluating the outcome of palliative care; however, no instruments have been validated for measuring symptoms and QOL in patients receiving palliative care in Chile. We aimed to investigate the content validity of the EORTC Quality of Life Questionnaire Core 15 Palliative Care (QLQ-C15-PAL), replicating the methods used previously to shorten the EORTC Quality of Life Questionnaire Core 30 (QLQ-C30) for use among patients in palliative care.

Methods

This cross-sectional study was conducted from October to November 2017 in four palliative care services. Patients with advanced cancer and health care professionals (HCPs) were invited to individual interviews to determine the relevance, appropriateness and relative importance of the 30 items of the QLQ-C30 for evaluating the outcome of palliative care, and whether relevant additional issues should be included.

Results

A total of 48 patients and 35 HCPs participated. The most important dimensions selected were pain, physical functioning, sleeping difficulties, emotional functioning, nausea/vomiting, fatigue, social functioning, lack of appetite, role functioning and constipation. Qualitative data identified important additional issues not covered by the questionnaire such as satisfaction with care, emotions and psychological support, as well as linguistic issues in the dyspnea and constipation items.

Conclusions

The EORTC QLQ-C15-PAL showed good content validity in the assessment of symptoms and QOL of advanced cancer patients; therefore, we recommend the use of this questionnaire in palliative care in Chile. Dyspnea and constipation items were revised by the EORTC group. More research is needed to add a social dimension for a comprehensive assessment of patients’ QOL.