bluuebunny/crossref_metadata_2025 huggingface dataset:
Follow-up schedule for initial recurrent hepatocellular carcinoma after ablation based on risk classification
Authors: Sun Xuqi , Li Lingling , Lyu Ning , Mu Luwen , Lai Jinfa , Zhao Ming
Published: July 2020

Background

To date, no standard follow-up guidelines exist regarding patients receiving ablation for initial recurrent hepatocellular carcinoma (HCC). We aimed to explore whether intensive follow-up could benefit these patients.

Methods

We reviewed the clinical data of patients who received complete ablation for initial HCC recurrence after curative treatments in our institution from January 2005 to June 2017. Risk factors for second recurrence of HCC were identified by univariate and multivariate analyses. Patients were classified into low- and high-risk groups according to the outcome of the classification and regression model. The patients were further categorized into short- (< 3 months) and long-interval (3–6 months) follow-up subgroups based on their surveillance in the first 2 years after complete ablation for initial recurrence. The Kaplan-Meier method with log-rank test was performed to compare the overall survival (OS) based on follow-up intervals in each risk group. We also validated our results by stratifying patients into subgroups with different numbers of risk factors and comparing the OS between patients with different follow-up intervals.

Results

A total of 361 patients were enrolled. The risk factors for secondary recurrence included the Barcelona Clinic Liver Cancer (BCLC) stage at initial recurrence and first recurrence-free survival after curative treatments for primary HCC (p < 0.001 and p = 0.002). Two risk groups (low and high) were identified. In both the low- and high-risk groups, the OS of patients was not associated with intervals of follow-up (p = 0.29 and 0.49). No significant difference was found in the rates of BCLC 0/A stage, tumor location or curative treatments for the second recurrence by different follow-up intervals in each risk group (p = 0.34 and 0.87; p = 0.69 and 0.97). The same tendency was found in subgroups with 0/1/2 risk factors for secondary recurrence during validation.

Conclusion

The long-interval follow-up did not compromise the survival of patients with complete ablation for initial recurrent HCC.
Intramuscular progesterone versus 8% Crinone vaginal gel for luteal phase support following blastocyst cryopreserved single embryo transfer: a retrospective cohort study
Authors: Bakkensen Jennifer B. , Racowsky Catherine , Thomas Ann M. , Lanes Andrea , Hornstein Mark D.
Published: July 2020

Background

The optimal route of progesterone administration for luteal support in cryopreserved embryo transfer (CET) has been the subject of much debate. While most published research has pertained to day 3 transfers, recent data on blastocyst CET has suggested that intramuscular progesterone (IMP) is superior to twice daily vaginal Endometrin suppositories for luteal phase support, resulting in significantly higher ongoing pregnancy rates. This study aimed to determine whether IMP is similarly superior to 8% Crinone vaginal gel for luteal phase support following blastocyst CET.

Methods

Autologous and donor oocyte blastocyst cryopreserved single embryo transfer (SET) cycles from January 2014–January 2019 utilizing either 50 mg IMP daily or 90 mg 8% Crinone gel twice daily for luteal support were included. The primary outcome was live birth. Secondary outcomes included biochemical pregnancy, spontaneous abortion, and clinical pregnancy. All analyses were adjusted a priori for oocyte age. Log-binomial regression analysis was performed with differences in outcomes reported as relative risk (RR) with 95% confidence intervals (CI).

Results

A total of 1710 cycles were included, of which 1594 utilized IMP and 116 utilized 8% Crinone gel. Demographic and cycles characteristics were similar between the two groups. Compared to cycles utilizing IMP, cycles utilizing Crinone gel resulted in similar rates of live birth (RR 0.91; 95% CI 0.73–1.13), biochemical pregnancy (RR 1.12, 95% CI 0.65–1.92), spontaneous abortion (RR 1.41, 95% CI 0.90–2.20), and clinical pregnancy (RR 1.00, 95% CI 0.86–1.17).

Conclusions

Compared to cryopreserved blastocyst SET cycles utilizing IMP for luteal support, cycles utilizing 8% Crinone gel resulted in similar likelihood of live birth.
Level of knowledge, attitude, and practice of family planning and associated factors among disabled persons, north-shewa zone, Amhara regional state, Ethiopia
Authors: Mekonnen Alemayehu Gonie , Bayleyegn Alebachew Demelash , Aynalem Yared Asmare , Adane Tigist Demssew , Muluneh Mikyas Arega , Asefa Meaza
Published: July 2020

Background

In Ethiopia, people with disabilities face socioeconomic disadvantages and they have a limited access to sexual and reproductive health information including family planning service. At present, however, there is a scarcity of research on the association between disability and family planning, and only limited data is available for disabled people in Ethiopia. Hence, this study assessed the level of knowledge, attitude, and practice of family planning and associated factors among disabled persons in North-shewa zone, Amhara regional state, Ethiopia.

Methods

A cross-sectional survey was conducted from June to October 2019. A total of 397 study participants were interviewed using a structured and pre-tested questionnaire. A multistage systematic sampling technique was employed to select study participants. Data were entered into Epi data and exported into Statistical Package for the Social Sciences (SPSS) version 21 for analysis. Logistic regression was performed to analyze the data. A significant association was declared at a p-value of less than 0.05.

Results

Forty-six percent of study participants were knowledgeable about family planning methods. The injectable was the most known method of modern contraception (74.8%) while withdrawal (18.1%) was the least known traditional family planning method. Fifty-five percent of our study participants had a good attitude about family planning methods and one-fourth (24.5%) of disabled persons currently utilized any method of family planning. Those having a good knowledge of family planning were 1.6 times more likely to utilize family planning methods than those having poor knowledge of family planning methods (AOR = 1.61, CI = 1.27, 16.24). Moreover, participants who completed college education were 7 times more likely to have a good knowledge of family planning methods than uneducated participants (AOR = 7.23; 95% CI = 2.28, 22.06).

Conclusions

In this study, the knowledge, attitude, and practice of disabled people about family planning methods were relatively low. Due attention should be given to ensure that disabled people are well informed about family planning methods through information, education, and communication activities.
Cardiac MRI utilizing late gadolinium enhancement (LGE) and T1 mapping in the detection of radiation induced heart disease
Authors: Ricco Anthony , Slade Alexander , Canada Justin M. , Grizzard John , Dana Franklin , Rezai Gharai Leila , Neiderer Keith , Vera Armando , Abbate Antonio , Weiss Elisabeth
Published: July 2020

Background and purpose

Radiotherapy has been associated with late dose-dependent cardiovascular toxicity. In this cross-sectional pilot study, radiation dose distributions were correlated with areas of localized and diffuse myocardial fibrosis as measured by novel cardiac MRI (CMR) sequences including late gadolinium enhancement (LGE) and T1 mapping with the goal to identify early markers of myocardial damage.

Materials and methods

Twenty-eight patients with chest tumors including lung, breast, esophagus, and lymphoma underwent CMR per study protocol on average 46.4 months (range 1.7–344.5) after radiotherapy. Patients without pretreatment cardiac history were included if the volume of heart receiving 5 Gy or more was at least 10% (V5Gy ≥ 10%). The association of LGE with cardiac dosimetric factors, clinical factors (e.g., tumor type, smoking history, BMI), and T1 values was analyzed.

Results

Cardiac maximum (Dmax) and mean dose (Dmean) equivalent to doses delivered in 2 Gy fractions (EQD2) were on average 50.9 Gy (range 6.2–108.0) and 8.2 Gy (range 1.0–35.7), respectively, compared to 60.8 Gy (40.8–108.0) and 6.8 Gy (1.8–21.8) among the 9 patients with LGE. Doses were not different between patients with and without LGE (p = 0.16 and 0.56, respectively). The average T1 value of the left ventricle myocardium was 1009 ms (range 933–1117). No significant correlation was seen for heart Dmax and Dmean and T1 values (p = 0.14 and 0.58, respectively). In addition, no significant association between clinical factors and the development of LGE was identified.

Conclusions

No relation between cardiac doses, the presence of LGE or T1 values was observed. Further study is needed to determine the benefit of CMR for detecting radiotherapy-related myocardial fibrosis.
A report of three cancer patients on opioid analgesia receiving spinal anesthesia: abrupt pain elimination without respiratory depression
Authors: Nozaki-Taguchi Natsuko , Ueda Yuko , Inada Azusa , Son Kyongsuk , Isono Shiroh
Published: July 2020

Background

Complete removal of pain with regional anesthesia has been reported to cause fatal respiratory depression in opioid-dependent patients, which leads us to choose general anesthesia. We hereby report three cases of chronically opioid-treated cancer patients operated under spinal anesthesia without respiratory event.

Case presentation

Case 1: a 32-year-old female treated with high-dose morphine for her cancer pain was planned for cesarean section. Case 2: a 65-year-old female on moderate dose of oxycodone was planned for surgery of her femoral bone fracture. Case 3: a 65-year-old male on low-dose oxycodone was planned for intramedullary nailing for metastatic femoral bone tumor. In all three cases, spinal anesthesia was chosen. Continuous respiratory monitoring revealed no apnea or bradypnea.

Conclusion

Spinal anesthesia was safely performed without respiratory depression in chronic opioid users for cancer pain.
Development of an in situ simulation-based continuing professional development curriculum in pediatric emergency medicine
Authors: Leung James S. , Brar Mandeep , Eltorki Mohamed , Middleton Kevin , Patel Leanne , Doyle Meagan , Ngo Quang
Published: July 2020

Background

Continuing professional development (CPD) activities delivered by simulation to independently practicing physicians are becoming increasingly popular. At present, the educational potential of such simulations is limited by the inability to create effective curricula for the CPD audience. In contrast to medical trainees, CPD activities lack pre-defined learning expectations and, instead, emphasize self-directed learning, which may not encompass true learning needs. We hypothesize that we could generate an interprofessional CPD simulation curriculum for practicing pediatric emergency medicine (PEM) physicians in a single-center tertiary care hospital using a deliberative approach combined with Kern’s six-step method of curriculum development.

Methods

From a comprehensive core list of 94 possible PEM clinical presentations and procedures, we generated an 18-scenario CPD simulation curriculum. We conducted a comprehensive perceived and unperceived needs assessment on topics to include, incorporating opinions of faculty PEM physicians, hospital leadership, interprofessional colleagues, and expert opinion on patient benefit, simulation feasibility, and value of simulating the case for learning. To systematically rank items while balancing the needs of all stakeholders, we used a prioritization matrix to generate objective “priority scores.” These scores were used by CPD planners to deliberately determine the simulation curriculum contents.

Results

We describe a novel three-step CPD simulation curriculum design method involving (1) systematic and deliberate needs assessment, (2) systematic prioritization, and (3) curriculum synthesis. Of practicing PEM physicians, 17/20 responded to the perceived learning needs survey, while 6/6 leaders responded to the unperceived needs assessment. These ranked data were input to a five-variable prioritization matrix generating priority scores. Based on local needs, the highest 18 scoring clinical presentations and procedures were selected for final inclusion in a PEM CPD simulation curriculum. An interim survey of PEM physician (21/24 respondents) opinions was collected, with 90% finding educational value with the curriculum. The curriculum includes items not identified by self-directed learning that PEM physicians thought should be included.

Conclusions

We highlight a novel methodology for PEM physicians that can be adapted by other specialities when designing their own CPD simulation curriculum. This methodology objectively considers and prioritizes the needs of practicing physicians and stakeholders involved in CPD.
The need for COVID-19 research in low- and middle-income countries
Authors: Gupta Madhu , Wahl Brian , Adhikari Binita , Bar-Zeev Naor , Bhandari Sudip , Coria Alexandra , Erchick Daniel J. , Gupta Nidhi , Hariyani Shreya , Kagucia E. Wangeci , Killewo Japhet , Limaye Rupali Jayant , McCollum Eric D. , Pandey Raghukul , Pomat William S. , Rao Krishna D. , Santosham Mathuram , Sauer Molly , Wanyenze Rhoda K. , Peters David H.
Published: July 2020

In the early months of the pandemic, most reported cases and deaths due to COVID-19 occurred in high-income countries. However, insufficient testing could have led to an underestimation of true infections in many low- and middle-income countries. As confirmed cases increase, the ultimate impact of the pandemic on individuals and communities in low- and middle-income countries is uncertain. We therefore propose research in three broad areas as urgently needed to inform responses in low- and middle-income countries: transmission patterns of SARS-CoV-2, the clinical characteristics of the disease, and the impact of pandemic prevention and response measures. Answering these questions will require a multidisciplinary approach led by local investigators and in some cases additional resources. Targeted research activities should be done to help mitigate the potential burden of COVID-19 in low- and middle-income countries without diverting the limited human resources, funding, or medical supplies from response activities.
Longitudinal associations between sleep disturbance and disease severity in patients with COPD
Authors: Luyster Faith S. , Wang Juan , Sciurba Frank C. , Bon Jessica
Published: July 2020

Background

Sleep disturbance is a common complaint among patients with chronic obstructive pulmonary disease (COPD). Studies examining the associations between sleep disturbance and COPD severity have primarily been cross-sectional and produced conflicting results. We extended previous research by investigating the bidirectional longitudinal associations between sleep disturbance and indicators of COPD severity including airway obstruction, dyspnea, health status, exercise capacity, hyperinflation, and diffusing capacity of the lung (DLCO).

Methods

We used longitudinal data from the COPD Specialized Center for Clinically Oriented Research (SCCOR) prospective cohort. One hundred fifty-seven patients with COPD (54.1% male, 66.3 ± 6.4 years) completed assessments at baseline and 2-year follow-up. Primary outcomes of interest were: sleep disturbance based on a single item from the Beck Depression Inventory; airflow obstruction, defined by FEV1% predicted from spirometry; health status, as measured by the St. George’s Respiratory Questionnaire; exercise capacity, as determined by walking distance (meters) during an incremental shuttle walk test; dyspnea, as measured by the modified Medical Research Council scale; DLCO, determined by single breath carbon monoxide diffusion; and hyperinflation, defined by residual volume from body plethysmography. Linear and logistic regression analyses were conducted, correcting for baseline outcome severity.

Results

After controlling for covariates of age, sex, race, body mass index, and smoking status, sleep disturbance was associated with worse health status at baseline. Using longitudinal follow-up data, greater disease severity including airflow obstruction, dyspnea, health status, exercise capacity, and DLCO independently predicted sleep disturbance at 2-year follow-up. Baseline sleep disturbance was not associated with subsequent disease severity.

Conclusions

Disease severity predicts future sleep disturbance in COPD patients. This suggests that COPD severity may be a risk factor for the development of sleep problems, and therefore better COPD control may be a preventative strategy for sleep disturbance.
Analysis of the finiteness for the first collision time between two randomly moving particles
Authors: Alzulaibani Alaa A.
Published: July 2020

The finiteness of the collision time between two different randomly moving particles is presented by providing more useful analysis that gives stronger and finite moment. The triangular arrays and the uniform integrability conditions of the all probable positions non-stationary random sequence are used. In addition, an important property of Marcinkiewicz laws of large numbers and Hoffman-Jorgensen inequality are presented in this analysis. All of them are deriving to provide the sufficient conditions that give more stronger moments of the first meeting time in the probability space.
Seventh order hybrid block method for solution of first order stiff systems of initial value problems
Authors: Akinfenwa O. A. , Abdulganiy R. I. , Akinnukawe B. I. , Okunuga S. A.
Published: July 2020

A hybrid second derivative three-step method of order 7 is proposed for solving first order stiff differential equations. The complementary and main methods are generated from a single continuous scheme through interpolation and collocation procedures. The continuous scheme makes it easy to interpolate at off-grid and grid points. The consistency, stability, and convergence properties of the block formula are presented. The hybrid second derivative block backward differentiation formula is concurrently applied to the first order stiff systems to generate the numerical solution that do not coincide in time over a given interval. The numerical results show that the new method compares favorably with some known methods in the literature.
FISH-based sperm aneuploidy screening in male partner of women with a history of recurrent pregnancy loss
Authors: Pourfahraji Fakhrabadi Marjan , Kalantar Seyed Mahdi , Montazeri Fatemeh , Dehghani Ashkezari Mahmood , Pourfahraji Fakhrabadi Majid , Sabbagh Nejad Yazd Samira
Published: July 2020

Background

Recurrent pregnancy loss is defined as having the experience of three or more repeated pregnancy losses. Despite numerous studies, RPL etiology remains unclear; in this respect, many etiological factors have been thoroughly investigated. However, the contribution of male factors in RPL at the sperm aneuploidy has rarely been examined. The aim of the current study is to assess the existence of autosome and sex chromosome aneuploidy in sperm of men with history of recurrent pregnancy loss. In this prospective study, 50 men with a history of recurrent pregnancy loss were included as case group and 15 men with normal sperm analysis, without abortion history and with at least one child were included as control group. Two- and three-color fluorescence in situ hybridization technique was used for screening aneuploidy in 13, 18, 21, X, and Y chromosomes.

Results

Overall, the comparison of sperm aneuploidies in sex and autosome chromosomes (13, 21, 18) between case and control groups showed that chromosomal abnormality was significantly increased in men with RPL than men without history of RPL. Among all examined cells, about 18.28% nullisomy, 6.48% disomy, and 0.06% trisomy were observed. As well, two cells with XXYY and one cell with XXXY karyotype were observed. Among the analyzed chromosomes, the prevalence of nullisomy of chromosome 13 was higher than other studied chromosomes.

Conclusion

The results suggest the implication of sperm chromosomal abnormalities in recurrent pregnancy loss. Clinical application of FISH-based screening test is recommended for investigating sperm aneuploidy in RPL cases to counsel couples for making informed decision.
Cognitive emotion regulation, anxiety, and depression in infertile women: a cross-sectional study
Authors: Foroudifard Fatemeh , Amini Payam , Navid Behnaz , Omani-Samani Reza , Sepidarkish Mahdi , Maroufizadeh Saman
Published: July 2020

Background

Cognitive strategies play an important role in the prevention of psychological disorders. The aim of this study was to examine the relationships of cognitive emotion regulation with anxiety and depression symptoms in a sample of infertile women in Iran.

Results

According to correlation analysis, all adaptive strategies (i.e., acceptance, positive refocusing, refocus on planning, positive reappraisal, and putting into perspective), except for Acceptance strategy, were indirectly related to both anxiety and depression symptoms. Conversely, four maladaptive strategies (i.e., self-blame, rumination, catastrophizing, and other-blame) were positively related to anxiety and depression symptoms. After controlling for demographic/infertility information, hierarchical regression analyses indicated that acceptance, rumination, and positive refocusing subscales were significantly associated with anxiety; and refocus of planning was related to depression.

Conclusion

In sum, cognitive emotion regulation strategies appeared to be related to anxiety and depression symptoms in women suffering from infertility. These results suggest the use of cognitive therapy to reduce the anxiety and depression in these women.
Impact of preoperative SYNTAX Scores on short-term outcome following coronary artery bypass grafting surgery in the patients with multi-vessels coronary artery disease
Authors: Ramadan Bassem Adel , Zaki Mohamed Ahmed , Etman Wahid Gamal El Din , Agha Mohamed Mostafa , Sobhy Mohamed Ahmed , Hassanein Wael Mahmoud
Published: July 2020

Background

SYNTAX Scores I (SSI) assesses the complexity of CAD; SYNTAX Score II (SSII) uses both SSI and other clinical variables, in estimation of 4 years mortality following both coronary artery bypass grafting surgery (CABG) and percutaneous coronary intervention (PCI) and gives recommendations for the best revascularization strategy in a specific patient. Our aim is to investigate the impact of both SYNTAX Scores on short-term outcome following CABG.

Results

Prospectively, we studied 150 patients with multi-vessels coronary artery disease, referred to perform, elective primary isolated CABG. All cases performed on pump CABG with aortic cross clamping, then followed up for 90 days postoperatively, for onset of mortality from all causes, myocardial infarction (MI), stroke, mediastinitis, and need for renal replacement therapy (RRT).

SSI showed a statistically significant association with in-hospital and 90 days mortality, MI, and mediastinitis (P = < 0.001, 0.015, 0.045 respectively); SSII showed a statistically significant association with in-hospital mortality and 90 days mortality and need for renal replacement therapy (P = 0.007, 0.043, 0.012 respectively); SSI is independent risk factor for overall mortality (OR 1.192, 95% CI 1.018–1.396) (P = 0.029) and MI (OR 1.182, 95% CI 1.016–1.375).

Conclusions

SYNTAX Scores are good predictors of short-term outcome after CABG; increased SSI was associated with increased mortalities (in-hospital and total 90 days), MI and mediastinitis, increased SSII associated with increased mortalities (in-hospital and total 90 days), and need for RRT; SSI is independent risk factor for mortality and MI.
Association of vitamin C status in diabetes mellitus: prevalence and predictors of vitamin C deficiency
Authors: D Praveen , Puvvada Ranadheer Chowdary , M Vijey Aanandhi
Published: July 2020

Background

Vitamin C is one of the most important micronutrient required for various physiological roles in the human system. Evidences suggest that there is an inadequate status of vitamin C in diabetes mellitus. The objectives of this study is to understand the prevalence of vitamin C deficiency in established type II diabetes mellitus patients and to study the correlation between various variables of diabetes mellitus with serum vitamin C levels.

Methods

A prospective cross-sectional study to assess the prevalence of vitamin C deficiency was carried out in diabetes patients. Fasting blood sugar levels, glycated hemoglobin, serum malondialdehyde levels, and lipid profile levels were correlated with serum vitamin C levels.

Results

The prevalence rate of hypovitaminosis C is found to be 55.13% among the enrolled patients. There is a significant increase in the systolic blood pressure levels in patients with inadequate as well as deficient vitamin C levels (p < 0.05). Inverse relationship exists between fasting blood sugar and vitamin C levels (p < 0.001). Similarly total cholesterol levels were also inversely related to the vitamin C levels (p = 0.0031). Body mass index, glycated hemoglobin, and fasting blood sugar levels are important predictors of vitamin C deficiencies.

Conclusion

Vitamin C deficiency is well established among diabetes mellitus patients. Deficiency of vitamin C levels has an impact on the serum malondialdehyde levels suggesting increased oxidative stress. The higher oxidative stress would have led to increase in glycated hemoglobin. Further research must be carried out to understand the beneficial effects of vitamin C supplementation in diabetes mellitus.
Lymphatic sparing laparoscopic varicocelectomy with or without testicular artery preservation: is there a difference?
Authors: Yehya Abdelaziz , Abdalrazek Mohamed , Gamaan Ibrahim , Fathy Ahmed , Batal Wael El
Published: July 2020

Background

Lymphatic sparing laparoscopic Palomo varicocelectomy is a safe and reliable technique for varicocele treatment in adolescents and children. The purpose of this study was to compare the outcomes of lymphatic sparing laparoscopic varicocelectomy with and without testicular artery preservation. The prospective random allocation of selected patients was done at Al-Azhar University Hospital, Pediatric Surgery Department from February 2010 till January 2015. All patients underwent lymphatic sparing laparoscopic varicocelectomy and they were divided into two equal groups, group A underwent laparoscopic Palomo without testicular artery sparing and group B underwent the procedure with testicular artery sparing. The main outcome included operative time, postoperative hydrocele, and persistence of varicocele, together with catch-up testicular growth or testicular atrophy.

Results

One hundred and sixty male patients presented with left-sided primary varicocele that was diagnosed clinically and affirmed by color Doppler ultrasonography. The mean age was 14.25 ± 1.6 years (ranged 13-16 years). There was one case of persistent varicocele in group A, compared to 8 cases in group B with a statistically significant difference (p = 0.016). A significant difference had been found in the operative time (p = 0.001) between both groups. No hydrocele or testicular atrophy had been detected in both groups. No significant inter-group differences were seen in aspects of age, varicocele grade, and catch-up testicular growth. The mean follow-up period was 42 months (24-60 months).

Conclusion

Lymphatic sparing laparoscopic Palomo varicocelectomy was superior to that with testicular artery preservation as regard varicocele persistence and operative time and hence is preferable for the management of primary pediatric varicocele.
Medication adherence to disease-modifying anti-rheumatic drugs among patients with rheumatoid arthritis at Assiut University Hospital, Egypt
Authors: Mahran Safaa A. , Khedr Tayser Mohamed , Mohammed Esraa Moustafa , El-Hakeim Eman Mohamed Hussein
Published: July 2020

Background

Rheumatoid arthritis is a chronic disabling autoimmune disease with predilection to synovial joints and many extraarticular manifestations. Disease-modifying anti-rheumatic drugs are the cornerstone and initial therapy in rheumatoid arthritis. Although medication adherence is crucial for successful therapy, non-adherence is a substantial problem in some. This study aimed to determine the adherence rate of treatment with disease-modifying anti-rheumatic drugs among patients with rheumatoid arthritis in an Egyptian university hospital. In this study, seventy-three adult rheumatoid arthritis patients who are on disease-modifying anti-rheumatic drugs treatment for at least 6 months were included in this study. After full history and clinical examination, assessment of the adherence rate to disease-modifying anti-rheumatic drugs was done using the Clinician Rating Scale. Measuring the quality of life using the Health Assessment Questionnaire Disability Index and screening for depression and anxiety using the Hospital Anxiety and Depression Scale were done. The socio-economic level of the patients was assessed by socio-economic status scale.

Results

In the current study, 65.1% of the patients were highly adherent to their disease-modifying anti-rheumatic drug (DMARD) medications, while 26% showed middle level of adherence. There was a significant difference between medication adherence and anxiety, but not with other demographic data, clinical data, disease activity, or socio-economic level.

Conclusion

In this study, no significant difference was found between medication adherence and demographic, clinical, or socio-economic data. However, anxiety was significantly related to DMARD adherence in the studied group. Age and HAQ-DI were found to be strong predictors to medication adherence in our RA patients. Further studies should be conducted on a large number of patients with rheumatoid arthritis to become generalizable to a broader population.
Lowering dementia risk and slowing progression of disease: the role of cognitive reserve and cognitive training
Authors: Scherrer Jeffrey F. , Morley John E.
Published: July 2020

Almeida-Meza et al found an inverse correlation between cognitive reserve (associated with educational level, complexity of occupations and leisure activities) and dementia incidence. We suggest clarifying studies using their data-set and consider what can be done to modify socioeconomic inequalities that affect cognitive reserve or to slow early dementia.
A Cautionary Tale: Quantitative LC-HRMS Analytical Procedures for the Analysis of N-Nitrosodimethylamine in Metformin
Authors: Yang Jingyue , Marzan Tim Andres , Ye Wei , Sommers Cynthia D. , Rodriguez Jason D. , Keire David A.
Published: July 2020

A private testing laboratory reported in a Citizen Petition (CP) to FDA that 16 of 38 metformin drug products they tested had N-nitrosodimethyl amine (NDMA) amounts above the allowable intake (AI) of 96 ng/day. Because the FDA had been monitoring drugs for nitrosamines, orthogonal analytical procedures had been developed, validated and applied to detect the following nitrosamines in metformin drug products (if present): (i) NDMA (with a dedicated method) or (ii) NDMA (with a second confirmatory method), N-nitroso-diethylamine (NDEA), N-ethyl-N-nitroso-2-propanamine (NEIPA), N-nitroso-diisopropylamine (NDIPA), N-nitroso-di-n-propylamine (NDPA), N-nitroso-methylphenylamine (NMPA), N-nitroso-di-n-butylamine (NDBA) and N-nitroso-N-methyl-4-aminobutyric acid (NMBA). In contrast to the private laboratory results, FDA testing on the same set of 38 samples with orthogonal procedures observed amounts over the AI in only 8 of the 38 products and generally observed lower values than reported by the private testing laboratory. As described here, the investigation into the cause of the discrepancy revealed that N,N-dimethylformamide (DMF) can interfere with NDMA measurements. The data showed that the use of sufficient mass accuracy in the data acquisition and appropriate mass tolerance setting in the data processing to assure the selectivity of mass spectrometry measurements of NDMA in the presence of co-eluting DMF was necessary to prevent overestimation of the level of NDMA in metformin drug products. Overall, care should be taken to assure the necessary specificity in analytical procedures for adequate assessment of the nitrosamine level in drug products that also contain DMF or other potential interfering substances.
Lack of AR in LepRb Cells Disrupts Ambulatory Activity and Neuroendocrine Axes in a Sex-Specific Manner in Mice
Authors: Cara Alexandra L , Myers Martin G , Elias Carol F
Published: July 2020

Disorders of androgen imbalance, such as hyperandrogenism in females or hypoandrogenism in males, increase risk of visceral adiposity, type 2 diabetes, and infertility. Androgens act upon androgen receptors (AR) which are expressed in many tissues. In the brain, AR are abundant in hypothalamic nuclei involved in regulation of reproduction and energy homeostasis, yet the role of androgens acting via AR in specific neuronal populations has not been fully elucidated. Leptin receptor (LepRb)–expressing neurons coexpress AR predominantly in hypothalamic arcuate and ventral premammillary nuclei (ARH and PMv, respectively), with low colocalization in other LepRb neuronal populations, and very low colocalization in the pituitary gland and gonads. Deletion of AR from LepRb-expressing cells (LepRbΔAR) has no effect on body weight, energy expenditure, and glucose homeostasis in male and female mice. However, LepRbΔAR female mice show increased body length later in life, whereas male LepRbΔAR mice show an increase in spontaneous ambulatory activity. LepRbΔAR mice display typical pubertal timing, estrous cycles, and fertility, but increased testosterone levels in males. Removal of sex steroid negative feedback action induced an exaggerated rise in luteinizing hormone in LepRbΔAR males and follicle-stimulating hormone in LepRbΔAR females. Our findings show that AR can directly affect a subset of ARH and PMv neurons in a sex-specific manner and demonstrate specific androgenic actions in the neuroendocrine hypothalamus.
Recurrent requirement for the m6A-ECT2/ECT3/ECT4 axis in the control of cell proliferation during plant organogenesis
Authors: Arribas-Hernández Laura , Simonini Sara , Hansen Mathias Henning , Paredes Esther Botterweg , Bressendorff Simon , Dong Yang , Østergaard Lars , Brodersen Peter
Published: July 2020

mRNA methylation at the N6-position of adenosine (m6A) enables multiple layers of post-transcriptional gene control, often via RNA-binding proteins that use a YT521-B homology (YTH) domain for specific m6A recognition. In Arabidopsis, normal leaf morphogenesis and rate of leaf formation require m6A and the YTH-domain proteins ECT2, ECT3 and ECT4. In this study, we show that ect2/ect3 and ect2/ect3/ect4 mutants also exhibit slow root and stem growth, slow flower formation, defective directionality of root growth, and aberrant flower and fruit morphology. In all cases, the m6A-binding site of ECT proteins is required for in vivo function. We also demonstrate that both m6A methyltransferase mutants and ect2/ect3/ect4 exhibit aberrant floral phyllotaxis. Consistent with the delayed organogenesis phenotypes, we observe particularly high expression of ECT2, ECT3 and ECT4 in rapidly dividing cells of organ primordia. Accordingly, ect2/ect3/ect4 mutants exhibit decreased rates of cell division in leaf and vascular primordia. Thus, the m6A-ECT2/ECT3/ECT4 axis is employed as a recurrent module to stimulate plant organogenesis, at least in part by enabling rapid cellular proliferation.
Extra-gastric expression of the proton pump H+/K+ -ATPase in the gills and kidney of the teleost Oreochromis niloticus
Authors: Barnawi Ebtesam Ali , Doherty Justine E. , Ferreira Patrícia Gomes , Wilson Jonathan M.
Published: July 2020

Potassium regulation is essential for the proper functioning of excitable tissues in vertebrates. The H+/ K+-ATPase (HKA), which is comprised of the HKα1 (gene: atp4a) and HKβ (gene: atp4b) subunits, has an established role in potassium and acid-base regulation in mammals and is well known for its role in gastric acidification. However, the role of the HKA in extra-gastric organs such as the gill and kidney is less clear, especially in fishes. In the present study in Nile tilapia Oreochromis niloticus uptake of the K+ surrogate flux marker rubidium (Rb+) has been demonstrated in vivo; however, this uptake was not inhibited with omeprazole, a potent inhibitor of the gastric HKA. This contrasts with gill and kidney ex vivo preparations where tissue Rb+ uptake was significantly inhibited by omeprazole and SCH28080, another gastric HKA inhibitor. The cellular localization of this pump in both gills and kidney was demonstrated using immunohistochemical techniques using custom made antibodies specific for Atp4a and Atp4b. Antibodies against both subunits showed the same apical ionocyte distribution pattern in gill and collecting tubules/ducts in kidney. Atp4a antibody specificity was confirmed by Western blotting. RT-PCT was used to confirm the expression of both subunits in gill and kidney. Taken together these results indicate for the first time K+ (Rb+) uptake in O. niloticus and that the HKA can be implicated by the ex vivo uptake inhibition by omeprazole and SCH28080, verifying a role for HKA in K+ absorption in the gill's ionocytes and collecting tubule/duct segments of the kidney.
Use of temporal and colour cueing in a symbolic delayed matching task by honey bees
Authors: Ng Leslie , Garcia Jair E. , Dyer Adrian G.
Published: July 2020

Honey bees (Apis mellifera Linnaeus) are known for their capacity to learn arbitrary relations between colours, odours, and even numbers. However, it is not known whether bees can use temporal signals as cueing stimuli in a similar way during symbolic delayed matching-to-sample tasks. Honey bees potentially process temporal signals during foraging activities, but the extent to which they can use such information is unclear. Here we investigated if free-flying honey bees could use either illumination colour, or illumination duration, as potential context-setting cues to enable their subsequent decisions for a symbolic delayed matching-to-sample task. We found that bees could use the changing colour context of the illumination to complete the subsequent spatial vision task at a level significant from chance expectation, but could not use the duration of either a 1s or 3s light as a cueing stimulus. These findings suggest that bees cannot use temporal information as a cueing stimulus as efficiently as other signals such as colour, and is consistent with previous field observations suggesting a limited interval timing capacity in honey bees.
On the Computational Aspects of a Symmetric Multidomain Boundary Element Method Approach for Elastoplastic Analysis
Authors: Zito L , Parlavecchio E , Panzeca T
Published: July 2020

The symmetric boundary element method (SBEM) is applied to the elasto-plastic analysis of bodies subdivided into substructures. This methodology is based on the use of: a multidomain SBEM approach, for the evaluation of the elastic predictor; a return mapping algorithm based on the extremal paths theory, for the evaluation of inelastic quantities characterizing the plastic behaviour of each substructure; and a transformation of the domain inelastic integrals of each substructure into corresponding boundary integrals. The elastic analysis is performed by using the SBEM displacement approach, which has the advantage of creating system equations that only consist of nodal kinematical unknowns at the interface boundary among substructures. The elasto-plastic solution utilizes a strain-driven strategy that is characterized by the evaluation of the elastic predictor that is a function of the initial conditions and the load increment. The predictor phase is followed by the use of a return mapping algorithm defined by introducing the extremal paths theory to remove the time integration. Then the computed plastic strains are considered to be constant inelastic actions imposed inside the substructure in a step-by-step procedure. Their presence involves domain integrals with singular kernels. These integrals are considered as Cauchy principal values with which the related free term is associated. In order to compute these domain integrals, the radial integral method is applied to remove the strong singularity.
Occupational therapy: The key to unlocking locked-up occupations during the COVID-19 pandemic
Authors: Kamalakannan Sureshkumar , Chakraborty Stuti
Published: July 2020

Occupations refer to the everyday activities that people do as individuals, in families and with communities to occupy time and bring meaning and purpose to life. It is not always limited to just paid employment. Occupations of the global population have been adversely affected in one way or the other because of this COVID-19 pandemic. Four different key sects of occupations were majorly affected. These are the occupations of those who are or were COVID-positive, occupations of healthy individuals affected by COVID-19/lockdown, occupations of the population highly susceptible and vulnerable of contracting COVID-19 and occupations having a direct impact on global market, supply chain or economy. These occupations were locked up due to the pandemic lockdown.

Occupational therapists can scientifically analyse occupations and help formulate exit strategies for the lockdown. They are experts who understand and study the different ways of measuring participation in occupation to develop innovative strategies and therapeutic interventions to facilitate individuals’ engagement in occupations. They can unravel the pragmatic strategies for preventing transmission (physical distancing, hand hygiene, personal protective equipment usage and decontamination) despite engaging in occupations safely and effectively. Nourishing this niche and essential science is pertinent, not just in this pandemic context but also against a backdrop of health and social care research, policy, practice and education for the future.
Distal interlocking for short trochanteric nails: static, dynamic or no locking? Review of the literature and decision algorithm
Authors: Buruian Alexei , Silva Gomes Francisco , Roseiro Tiago , Vale Claudia , Carvalho André , Seiça Emanuel , Mendes Antonio , Pereira Carlos
Published: July 2020

Pertrochanteric hip fractures are among the most common and the use of short cephalomedullary nails as the treatment of choice is increasing. A systematic review regarding distal locking options for short cephalomedullary nails was undertaken using Medline/PubMed®, Embase® and Cochrane Library® in order to evaluate current indications, associated complications and to provide treatment recommendations. The results seem to support the use of distal static locking for unstable fractures, dynamic locking for length stable/rotational unstable fractures and no locking for stable fractures. Complications associated with distal locking include iatrogenic fractures, thigh pain, delayed union and nonunion, implant failure, screw loosening and breaking, drill bit breaking, soft tissue irritation, femoral artery branch injury, intramuscular haematoma and compartment syndrome. It is also associated with longer operative time and radiation exposure. In unlocked constructs, dorsomedial comminution and nail/medullary canal mismatch contribute to peri-implant fractures. Anterior cortical impingement is associated with cut-out and nonunion. Most studies comparing distally locked and unlocked nails report a short follow-up. Distal locking mode should be based on the fracture’s stability.

Cite this article: EFORT Open Rev 2020;5:421-429. DOI: 10.1302/2058-5241.5.190045
Kinematic alignment in total knee arthroplasty
Authors: Nisar Sohail , Palan Jeya , Rivière Charles , Emerton Mark , Pandit Hemant
Published: July 2020

Kinematic alignment (KA) is an alternative philosophy for aligning a total knee replacement (TKR) which aims to restore all three kinematic axes of the native knee. Many of the studies on KA have actually described non-KA techniques, which has led to much confusion about what actually fits the definition of KA. Alignment should only be measured using three-dimensional cross-sectional imaging. Many of the studies looking at the influence of implants/limb alignment on total knee arthroplasty outcomes are of limited value because of the use of two-dimensional imaging to measure alignment, potentially leading to inaccuracy. No studies have shown KA to be associated with higher complication rates or with worse implant survival; and the clinical outcomes following KA tend to be at least as good as mechanical alignment. Further high-quality multi-centre randomized controlled trials are needed to establish whether KA provides better function and without adversely impacting implant survival.

Cite this article: EFORT Open Rev 2020;5:380-390. DOI: 10.1302/2058-5241.5.200010
The globalised supply chain of the suture: industry and healthcare organisations' responsibility to sustainable healthcare
Authors: Horwood J , Brennan F , Morris D , Torkington J
Published: July 2020

From production to stitching: working collaboratively to reduce the carbon footprint of sutures.
Using surgical sustainability principles to improve planetary health and optimise surgical services following the COVID-19 pandemic
Authors: Rizan C , Reed M , Mortimer F , Jones A , Stancliffe R , Bhutta MF
Published: July 2020

As the world faces crises instigated by environmental disruption, demands on healthcare require sustainable solutions.
Sustainability in surgery
Authors: Vig S , Pegna V
Published: July 2020

Facing the future: how the RCS is embedding sustainable approaches into surgical and dental practice.
Stability of Variables Derived From Measures of Multisensory Function in Children With Autism Spectrum Disorder
Authors: Dunham Kacie , Feldman Jacob I. , Liu Yupeng , Cassidy Margaret , Conrad Julie G. , Santapuram Pooja , Suzman Evan , Tu Alexander , Butera Iliza , Simon David M. , Broderick Neill , Wallace Mark T. , Lewkowicz David , Woynaroski Tiffany G.
Published: July 2020

Children with autism spectrum disorder (ASD) display differences in multisensory function as quantified by several different measures. This study estimated the stability of variables derived from commonly used measures of multisensory function in school-aged children with ASD. Participants completed: a simultaneity judgment task for audiovisual speech, tasks designed to elicit the McGurk effect, listening-in-noise tasks, electroencephalographic recordings, and eye-tracking tasks. Results indicate the stability of indices derived from tasks tapping multisensory processing is variable. These findings have important implications for measurement in future research. Averaging scores across repeated observations will often be required to obtain acceptably stable estimates and, thus, to increase the likelihood of detecting effects of interest, as it relates to multisensory processing in children with ASD.
Clear sky blinks
Authors: Lynch David K. , Richtsmeier Steven C.
Published: July 2020

Ice blinks and water skies are brightness variations on the undersides of overcasts that allow ground-based observers to judge the nature of distant surfaces such as water (dark) or ice (bright). The clear sky should also scatter light from distant surfaces that might be visually detectable. We demonstrate that clear sky blinks do occur, can be visually discerned, and can be successfully photographed. We also model them theoretically using Monte Carlo simulations. The presence of atmospheric aerosols significantly enhances clear sky blinks.