bluuebunny/crossref_metadata_2025 huggingface dataset:
Asymmetrical vertebral column decancellation for the management of rigid congenital kyphoscoliosis
Authors: Hu Fanqi , Hu Wenhao , Yang Xiaoqing , Wang Chunguo , Song Kai , Zheng Guoquan , Zhang Xuesong
Published: August 2020

Background

Congenital kyphoscoliosis is a disease that often requires surgical treatment. Wedge osteotomies, such as pedicle subtraction osteotomy, are insufficient to correct this complicated rigid deformity. Vertebral column resection yields sufficient correction, but it is an exhaustively lengthy operation with a high risk of major complications. There are few effective and safe techniques for treating rigid congenital kyphoscoliosis. We aimed to investigate the technique of asymmetrical vertebral column decancellation (AVCD) for the treatment of rigid congenital kyphoscoliosis and evaluate the clinical and radiographic results of patients treated with the technique.

Methods

Between January 2013 to June 2017, the data of 31 patients with congenital kyphoscoliosis who underwent single level AVCD were reviewed. Preoperative and postoperative radiographical parameters and the visual analogue scale, Asia Spinal Injury Association, and Scoliosis Research Society-22 scores were documented. The patients were followed up for an average period of 29 months.

Results

The average operative time was 273.9 ± 46.1 min. The average volume of blood loss was 782.3 ± 162.6 ml. The main coronal curve improved from a mean of 81.4° preoperatively to 24.7° at the final follow-up, and the coronal balance improved from 28.9 to 7.6 mm. The degree of local kyphosis improved from a mean of 86.5° to 29.2°, and the sagittal balance improved from 72.3 to 16.9 mm. All clinical outcomes also improved significantly from preoperatively to the final follow-up. No permanent postoperative neurologic complications occurred.

Conclusion

The AVCD surgical procedure corrects spinal deformities in both the coronal and sagittal planes by way of a convex-sided Y shape osteotomy, achieves satisfactory realignment without additional neurological complications, and can be considered an alternative treatment for rigid congenital kyphoscoliosis.
Peer support to maintain psychological wellbeing in people with advanced cancer: findings from a feasibility study for a randomised controlled trial
Authors: Walshe Catherine , Roberts Diane , Calman Lynn , Appleton Lynda , Croft Robert , Skevington Suzanne , Lloyd-Williams Mari , Grande Gunn , Perez Algorta Guillermo
Published: August 2020

Background

Advanced cancer affects people’s lives, often causing stress, anxiety and depression. Peer mentor interventions are used to address psychosocial concerns, but their outcomes and effect are not known. Our objective was to determine the feasibility of delivering and investigating a novel peer mentor intervention to promote and maintain psychological wellbeing in people with advanced cancer.

Methods

A mixed methods design incorporating a two-armed controlled trial (random allocation ratio 1:1) of a proactive peer mentor intervention plus usual care, vs. usual care alone, and a qualitative process evaluation. Peer mentors were recruited, trained, and matched with people with advanced cancer. Quantitative data assessed quality of life, coping styles, depression, social support and use of healthcare and other supports. Qualitative interviews probed experiences of the study and intervention.

Results

Peer mentor training and numbers (n = 12) met feasibility targets. Patient participants (n = 12, from 181 eligible who received an information pack) were not recruited to feasibility targets. Those who entered the study demonstrated that intervention delivery and data collection were feasible. Outcome data must be treated with extreme caution due to small numbers, but indicate that the intervention may have a positive effect on quality of life.

Conclusions

Peer mentor interventions are worthy of further study and researchers can learn from these feasibility data in planning participant recruitment and data collection strategies. Pragmatic trials, where the effectiveness of an intervention is tested in real-world routine practice, may be most appropriate. Peer mentor interventions may have merit in enabling survivors with advanced cancer cope with their disease.

Trial Registration

The trial was prospectively registered 13.6.2016: ISRCTN10276684.
Assessment of intimate partner violence abuse ratings by recently abused and never abused women
Authors: Straus Helen E. , Guonjian Elizabeth H. , Christian Errick , Roberts Rebecca R.
Published: August 2020

Background

There are a paucity of directly reported intimate partner violence survivors’ experiences, especially in women of color. This study measures recently/currently abused women’s ratings of varied abuse events compared to ratings from never abused women.

Methods

Women in a single, urban, public hospital emergency department (ED) were screened for intimate partner violence using the Abuse Assessment Screen (AAS). Two groups were identified - women abused within 1 year by an intimate partner or family member and those who screened negative for abuse. Using a two-group longitudinal survey and interview format, women completed visual analog scale ratings (0–100) for each of 20 abuse events/types. For analysis, each abuse type was placed on the 0–100 scale according to its designated rating.

Results

Average age of participants in the abuse group (n = 30) was 33. Never abused women averaged age 50 (n = 32). The majority of participants were African-American: abused 67% and never abused 94%. Abused women rated name-calling (p < 0.02) and put-downs (p < 0.01) as more severe than never abused women. Other non-physical and physical forms of abuse such as threats, control, burns or forced sex were perceived more similarly between groups.

Conclusions

Abused women perceive verbal abuse events differently compared to never abused women.
Health professionals learning qualitative research in their workplace: a focused ethnography
Authors: Ghirotto Luca , De Panfilis Ludovica , Di Leo Silvia
Published: August 2020

Background

The interest for qualitative research methodology has expanded beyond theoretical academic research on medical education, gathering interest from all healthcare professionals. Qualitative research has potentials in exploring the social, emotional, psychological aspects of care and in broadening professionals’ scientific competencies. Nonetheless, qualitative research has still not been embraced within formal and academic curricula for future professionals, preventing newer generations from appreciating the value of its epistemological and methodological aspects and from using it in the development and implementation of clinical research. The purpose of this study was to comprehend the attitudes of health professionals learning and conducting qualitative studies within a practical training program developed in their workplace.

Methods

The present work consisted of a focused ethnography, including 14 professionals during their one-year attendance training on qualitative research methodology. Strategies used for collecting data included participant observations, field notes, semi-structured interviews, and a focus group. All the data were analyzed consistently with ethnographic indications.

Results

Analyses allowed us to evidence the educational, motivational, group-related and organizational factors influencing the attitudes and skill acquisition of healthcare professionals learning and conducting qualitative research within a practical training program developed in their workplace. Prior educational background was perceived as a sort of barrier. Nonetheless, the training boosted a change in attitude both in terms of appreciation of the research approach and trainees’ emotional involvement with research participants. Doing a qualitative study in a multidisciplinary team raised in-group dynamics that hindered bringing the studies to conclusion. Trainees repeatedly lamented the difficulty in managing time to devote to research-related activities and questioned the feasibility of adopting this methodology for conducting research in their workplace.

Conclusions

Continual education training on the methodological aspects and practical implications of qualitative research may foster a renewed attitude towards one’s professional education, while making inter-professional relationship issues emerge. Nonetheless, broadening the perspectives of professionals on their clinical practice by means of learning qualitative methodology may have an evident quality improvement return. Strategies for future qualitative research methodology hands-on training addressed to health professionals in continuing education are proposed.
Assessing the benefits and usefulness of Schwartz Centre rounds in second-year medical students using clinical educator-facilitated group work session: not just “a facilitated moan”!
Authors: Smith J. , Stewart M. G. , Foggin E. , Mathews S. , Harris J. , Thomas P. , Cooney A. , Stocker C. J.
Published: August 2020

Background

An experiential curriculum exposing medical students to the clinic early has many benefits but comes with the emotional stress this environment engenders. Schwartz rounds (SR) are an effective means to combat emotional stress and increasingly used in UK and USA hospitals. Recent studies show that the SR format may also provide benefits for medical students. This study aimed to investigate whether the guidance of SR in second year medical students provides the same benefits as to healthcare professionals.

Methods

SR assessment involved 83 s year MBChB students in facilitated groupwork sessions. Topics discussed were “change and resilience” and “duty of candour”. Students completed a Likert Scale questionnaire evaluating outcomes proffered by the Point of Care Foundation in collaboration with the Schwartz Foundation, with freeform feedback.

Results

There was an 86% completion rate with 25% providing written feedback. Participants were more likely to agree than disagree that SR were beneficial. SR effectiveness in enhancing students’ working relationship awareness and skills was strongly correlated with understanding the purpose of, and engagement with, the SR (P < 0.001). Similarly, engagement with the SR was strongly correlated with self-reporting of enhanced patient-centredness (P < 0.001). Freeform feedback could be grouped into five themes that revolved around understanding of the SR and engagement with the process. Many positive comments regarded the SR as a forum not only to “learn experientially” but to so in a “safe environment”. Many negative comments stemmed from students not seeing any benefits of engagement with the SR, in that sharing experiences was “unbeneficial”, “empathy is inherent and not learnt”, or that sharing emotional problems is simply “moaning”.

Conclusion

SRs are an effective way of fostering empathy and understanding towards patients and colleagues. However, for the students to benefit fully from the SR it is necessary for them to engage and understand the process. Therefore, for the successful implementation of SR into pre-clinical medical education, it is important to help students realise that SR are not merely a “facilitated whinge”.
Consumers’ satisfaction factors mining and sentiment analysis of B2C online pharmacy reviews
Authors: Liu Jingfang , Zhou Yingyi , Jiang Xiaoyan , Zhang Wei
Published: August 2020

Background

In recent years, online pharmacies have been accepted by increasingly more consumers, and the prospects for online pharmacies are optimistic. This article explores the consumers’ satisfaction factors addressed in Business to Customer (B2C) online pharmacy reviews and analyzes the sentiments expressed in the reviews. The goal of this work is to help B2C online pharmacy enterprises identify consumers’ concerns, continuously improve the health services level.

Methods

This article was based on the Latent Dirichlet Allocation (LDA) topic model. From a third-party platform-based B2C online pharmacy and a proprietary B2C online pharmacy (JD Pharmacy and J1.COM, respectively), 136,630 pieces of over-the-counter (OTC) drug review data posted from January 1, 2015 to December 31, 2018 were selected as samples and used to explore the satisfaction factors of B2C online pharmacy consumers regarding the entire drug purchasing process. Then, the sentiments expressed in the drug reviews were analyzed with SnowNLP.

Result

Categorization of the 12 factors identified by LDA showed that 5 factors were related to logistics; these 5 factors, which also included the most drug reviews, made up 38.5% of the reviews. The number of factors related to drug prices was second, with 3 factors, and reviews of drug prices made up 25.5% of the reviews. Customer service and drug effects each had two related factors, and a smaller percentage of these reviews (13.95%) were related to drug effects. Consumers still maintain positive opinions of JD Pharmacy and J1.COM. However, some opinions on logistics and drug prices are expressed.

Conclusion

The most important task for online pharmacies is to improve logistics. It is better to develop self-built logistics. Both types of B2C online pharmacies can improve consumer viscosity by implementing marketing strategies. With regard to customer service, focusing on improving employees’ service attitudes is necessary.
Factors facilitating trained NIMART nurses’ adherence to treatment guidelines: a vital matter in the management of TB/HIV treatment in South Africa
Authors: Makhado Lufuno , Davhana-Maselesele Mashudu , Lebese Rachel Tsakani , Maputle Sonto Maria
Published: August 2020

Background

Globally, the burden of tuberculosis or human immunodeficiency virus (TB/HIV) is at 24% and this alarming rate compelled the World Health Organization (WHO) to declare the African region as a critical workforce shortage area. To facilitate adherence to treatment guidelines, WHO recommended a strategy of task shifting for countries with high health workforce shortages. The strategy aimed at the redistribution of health care tasks to available workers. The study aimed to determine the factors facilitating nurse-initiated management of antiretroviral therapy (NIMART) trained nurses’ adherence to TB/HIV treatment guidelines.

Methods

The study employed an exploratory-descriptive design. The study was conducted in Ugu and Ngaka Modiri Molema Districts of KwaZulu-Natal (KZN) and North West (NW) Provinces of South Africa. The population comprised of 24 participants who were purposively selected. The in-depth focus group discussions were conducted and ATLAS T.I. was used for data analysis following the basic steps of notice-collect-think (NCT) analysis. Trustworthiness and adherence to ethics were ensured.

Results

The singular theme of factors facilitating NIMART trained nurses’ adherence to treatment guidelines which included positive attitudinal needs and positive behavioural change emerged from raw data.

Conclusion

Continuous training, support supervision, and improved relationships with colleagues need to be enhanced to enable NIMART trained nurses to adhere to treatment guidelines.
Acute neurological care in north-east Germany with telemedicine support (ANNOTeM): protocol of a multi-center, controlled, open-label, two-arm intervention study
Authors: Weber J. E. , Angermaier A. , Bollweg K. , Erdur H. , Ernst S. , Flöel A. , Gorski C. , Kandil F. I. , Kinze S. , Kleinsteuber K. , Kurth T. , Schmehl I. , Theen S. , Endres M. , Audebert H. J. ,   for the ANNOTeM-consortium
Published: August 2020

Background

Both diagnosis and treatment of neurological emergencies require neurological expertise and are time-sensitive. The lack of fast neurological expertise in regions with underserved infrastructure poses a major barrier for state-of-the-art care of patients with acute neurological diseases and leads to disparity in provision of health care. The main purpose of ANNOTeM (acute neurological care in North East Germany with telemedicine support) is to establish effective and sustainable support structures for evidence based treatments for stroke and other neurological emergencies and to improve outcome for acute neurological diseases in these rural regions.

Methods

A “hub-and-spoke” network structure was implemented connecting three academic neurological centres (“hubs”) and rural hospitals (“spokes”) caring for neurological emergencies. The network structure includes (1) the establishment of a 24/7 telemedicine consultation service, (2) the implementation of standardized operating procedures (SOPs) in the network hospitals, (3) a multiprofessional training scheme, and (4) a quality management program. Data from three major health insurance companies as well as data from the quality management program are being collected and evaluated. Primary outcome is the composite of first time of receiving paid outpatient nursing care, first time of receiving care in a nursing home, or death within 90 days after hospital admission.

Discussion

Beyond stroke only few studies have assessed the effects of telemedically supported networks on diagnosis and outcome of neurological emergencies. ANNOTeM will provide information whether this approach leads to improved outcome. In addition, a health economic analysis will be performed.

Study registration

German Clinical Trials Register DRKS00013067, date of registration: November 16 th, 2017, URL: http://www.drks.de/DRKS00013068
Outcome measures for airway clearance techniques in children with chronic obstructive lung diseases: a systematic review
Authors: Lauwers Eline , Ides Kris , Van Hoorenbeeck Kim , Verhulst Stijn
Published: August 2020

Background

Airway clearance techniques (ACTs) are an important aspect of the treatment of children with chronic obstructive lung diseases. Unfortunately, a sound evidence base is lacking and airway clearance strategies are largely based on clinical expertise. One of the reasons for the limited evidence is the lack of appropriate outcome measures specifically related to the effectiveness of ACTs. This review discusses all outcome measures applied in previous research in the pediatric population to provide a baseline for future studies.

Data sources

A systematic literature search was performed in PubMed, Web of Science and EMBASE databases. Search terms included chronic obstructive lung diseases and ACTs.

Study selection

Studies were independently selected by the investigators according to the eligibility criteria. After screening, 49 articles remained for further analysis.

Results and conclusions

Data are summarized according to the type of outcome measure. 48 (98%) studies performed pulmonary function tests, 19 (39%) assessed expectorated sputum, 10 (20%) parameters related to disease exacerbation, 8 (16%) oxygenation, 8 (16%) patient-reported outcomes, 5 (10%) exercise capacity and 5 (10%) applied imaging techniques. The synthesis of results showed a high discrepancy between studies due to differences in study design, population and the application of techniques. Since no ‘gold standard’ method could be identified, a combination of different outcome measures is recommended to gain a better understanding and to identify the potential effects of ACTs. An overview of important considerations has been provided to assist researchers in their choice of outcomes in future studies.
RelB sustains endocrine resistant malignancy: an insight of noncanonical NF-κB pathway into breast Cancer progression
Authors: Wang Mei , Zhang Yanyan , Xu Zhi , Qian Peipei , Sun Wenbo , Wang Xiumei , Jian Zhang , Xia Tiansong , Xu Yong , Tang Jinhai
Published: August 2020

Background

The activation of the NF-κB pathway plays a crucial role in the progression of breast cancer (BCa) and also involved in endocrine therapy resistance. On the contrary to the canonical NF-κB pathway, the effect of the noncanonical NF-κB pathway in BCa progression remains elusive.

Methods

BCa tumor tissues and the corresponding cell lines were examined to determine the correlation between RelB and the aggressiveness of BCa. RelB was manipulated in BCa cells to examine whether RelB promotes cell proliferation and motility by quantitation of apoptosis, cell cycle, migration, and invasion. RNA-Seq was performed to identify the critical RelB-regulated genes involved in BCa metastasis. Particularly, RelB-regulated MMP1 transcription was verified using luciferase reporter and ChIP assay. Subsequently, the effect of RelB on BCa progression was further validated using BCa mice xenograft models.

Results

RelB uniquely expresses at a high level in aggressive BCa tissues, particularly in triple-negative breast cancer (TNBC). RelB promotes BCa cell proliferation through increasing G1/S transition and/or decreasing apoptosis by upregulation of Cyclin D1 and Bcl-2. Additionally, RelB enhances cell mobility by activating EMT. Importantly, RelB upregulates bone metastatic protein MMP1 expression through binding to an NF-κB enhancer element located at the 5′-flanking region. Accordingly, in vivo functional validation confirmed that RelB deficiency impairs tumor growth in nude mice and inhibits lung metastasis in SCID mice.
Association between the 21-gene recurrence score and isolated locoregional recurrence in stage I-II, hormone receptor-positive breast cancer
Authors: Yang David D. , Buscariollo Daniela L. , Cronin Angel M. , Weng Shicheng , Hughes Melissa E. , Bleicher Richard J. , Cohen Adam L. , Javid Sara H. , Edge Stephen B. , Moy Beverly , Niland Joyce C. , Wolff Antonio C. , Hassett Michael J. , Punglia Rinaa S.
Published: August 2020

Background

Although the 21-gene recurrence score (RS) assay is widely used to predict distant recurrence risk and benefit from adjuvant chemotherapy among women with hormone receptor-positive (HR+) breast cancer, the relationship between the RS and isolated locoregional recurrence (iLRR) remains poorly understood. Therefore, we examined the association between the RS and risk of iLRR for women with stage I-II, HR+ breast cancer.

Methods

We identified 1758 women captured in the national prospective Breast Cancer-Collaborative Outcomes Research Database who were diagnosed with stage I-II, HR+ breast cancer from 2006 to 2012, treated with mastectomy or breast-conserving surgery, and received RS testing. Women who received neoadjuvant therapy were excluded. The association between the RS and risk of iLRR was examined using competing risks regression.

Results

Overall, 19% of the cohort (n = 329) had a RS ≥25. At median follow-up of 29 months, only 22 iLRR events were observed. Having a RS ≥25 was not associated with a significantly higher risk of iLRR compared to a RS < 25 (hazard ratio 1.14, 95% confidence interval 0.39–3.36, P = 0.81). When limited to women who received adjuvant endocrine therapy without chemotherapy (n = 1199; 68% of the cohort), having a RS ≥25 (n = 74) was significantly associated with a higher risk of iLRR compared to a RS < 25 (hazard ratio 3.66, 95% confidence interval 1.07–12.5, P = 0.04). In this group, increasing RS was associated with greater risk of iLRR (compared to RS < 18, hazard ratio of 1.66, 3.59, and 7.06, respectively, for RS 18–24, 25–30, and ≥ 31; Ptrend = 0.02).

Conclusions

The RS was significantly associated with risk of iLRR in patients who did not receive adjuvant chemotherapy. The utility of the RS in identifying patients who have a low risk of iLRR should be further studied.
Pelvic injury prognosis is more closely related to vascular injury severity than anatomical fracture complexity: the WSES classification for pelvic trauma makes sense
Authors: Wu Yu-Tung , Cheng Chi-Tung , Tee Yu-San , Fu Chih-Yuan , Liao Chien-Hung , Hsieh Chi-Hsun
Published: August 2020

Background

The most common cause of death in cases of pelvic trauma is exsanguination caused by associated injuries, not the pelvic injury itself. For patients with relatively isolated pelvic trauma, the impact of vascular injury severity on outcome remains unclear. We hypothesized that the severity of the pelvic vascular injury plays a more decisive role in outcome than fracture pattern complexity.

Methods

Medical records of patients with pelvic fracture at a single center between January 2016 and December 2017 were retrospectively reviewed. Those with an abbreviated injury scale (AIS) score ≥ 3 in areas other than the pelvis were excluded. Lateral compression (LC) type 1 fractures and anteroposterior compression (APC) type 1 fractures according to the Young-Burgess classification and ischial fractures were defined as simple pelvic fractures, while other fracture types were considered complicated pelvic fractures. Based on CT, vascular injury severity was defined as minor (fracture with or without hematoma) or severe (hematoma with contrast pooling/extravasation). Patient demographics, clinical parameters, and outcome measures were compared between the groups.

Results

Severe vascular injuries occurred in 26 of the 155 patients and were associated with poorer hemodynamics, a higher injury severity score (ISS), more blood transfusions, and a longer ICU stay (3.81 vs. 0.86 days, p = 0.000) and total hospital stay (20.7 vs. 10.1 days, p = 0.002) compared with minor vascular injuries. By contrast, those with complicated pelvic fractures (LC II/III, APC II/III, vertical shear, and combined type fracture) required a similar number of transfusions and had a similar length of ICU stay as those with simple pelvic fractures (LC I, APC I, and ischium fracture) but had a longer total hospital stay (13.6 vs. 10.3 days, p = 0.034). These findings were similar even if only patients with ISS ≥ 16 were considered.

Conclusions

Our results indicate that even in patients with relatively isolated pelvic injuries, vascular injury severity is more closely correlated to the outcome than the type of anatomical fracture. Therefore, a more balanced classification of pelvic injury that takes both the fracture pattern and hemodynamic status into consideration, such as the WSES classification, seems to have better utility for clinical practice.
Endovascular treatment with in-vitro fenestration and sac filling technique for ruptured thoracoabdominal aortic aneurysm with Behcet’s disease
Authors: Xia Shibo , Song Chao , Zhang Lei , Hu Wenping , Li Haiyan , Shen Yu , Lu Qingsheng
Published: August 2020

Purpose

We provided an endovascular strategy of treating ruptured aortic aneurysm with Behcet’s Disease.

Case report

A 25-year-old man was diagnosed ruptured thoracoabdominal aortic aneurysm with Behcet’s Disease according to his eye damage history, high level of ESR and C-reactive protein and the imaging result. We used in-vitro fenestration of the stent-graft combined with in-stent technique to occlude the ruptured aortic aneurysm and preserve the blood supply from the aorta for visceral arteries in emergency. Sac filling technique was used to treat the endoleak to quickly prevent bleeding. The patient kept post-operative immunotherapy for 1 year.

Conclusion

The patient had a good prognosis in the reduction of the cavity of aortic aneurysm to the normal size without any complications in a year follow-up.
A novel culture method that sustains ERα signaling in human breast cancer tissue microstructures
Authors: Cartaxo Ana Luísa , Estrada Marta F. , Domenici Giacomo , Roque Ruben , Silva Fernanda , Gualda Emilio J. , Loza-Alvarez Pablo , Sflomos George , Brisken Cathrin , Alves Paula M. , André Saudade , Brito Catarina
Published: August 2020

Background

Estrogen receptor α (ERα) signaling is a defining and driving event in most breast cancers; ERα is detected in malignant epithelial cells of 75% of all breast cancers (classified as ER-positive breast cancer) and, in these cases, ERα targeting is the main therapeutic strategy. However, the biological determinants of ERα heterogeneity and the mechanisms underlying therapeutic resistance are still elusive, hampered by the challenges in developing experimental models recapitulative of intra-tumoral heterogeneity and in which ERα signaling is sustained. Ex vivo cultures of human breast cancer tissue have been proposed to retain the original tissue architecture, epithelial and stromal cell components and ERα. However, loss of cellularity, viability and ERα expression are well-known culture-related phenomena.

Methods

BC samples were collected and brought to the laboratory. Then they were minced, enzymatically digested, entrapped in alginate and cultured for 1 month. The histological architecture, cellular composition and cell proliferation of tissue microstructures were assessed by immunohistochemistry. Cell viability was assessed by measurement of cell metabolic activity and histological evaluation. The presence of ERα was accessed by immunohistochemistry and RT-qPCR and its functionality evaluated by challenge with 17-β-estradiol and fulvestrant.

Results

We describe a strategy based on entrapment of breast cancer tissue microstructures in alginate capsules and their long-term culture under agitation, successfully applied to tissue obtained from 63 breast cancer patients. After 1 month in culture, the architectural features of the encapsulated tissue microstructures were similar to the original patient tumors: epithelial, stromal and endothelial compartments were maintained, with an average of 97% of cell viability compared to day 0. In ERα-positive cases, fibers of collagen, the main extracellular matrix component in vivo, were preserved. ERα expression was at least partially retained at gene and protein levels and response to ERα stimulation and inhibition was observed at the level of downstream targets, demonstrating active ER signaling.

Conclusions

The proposed model system is a new methodology to study ex vivo breast cancer biology, in particular ERα signaling. It is suitable for interrogating the long-term effects of anti-endocrine drugs in a set-up that closely resembles the original tumor microenvironment, with potential application in pre- and co-clinical assays of ERα-positive breast cancer.
Initial ovarian sensitivity index predicts embryo quality and pregnancy potential in the first days of controlled ovarian stimulation
Authors: Camargo-Mattos David , García Uziel , Camargo-Diaz Felipe , Ortiz Ginna , Madrazo Ivan , Lopez-Bayghen Esther
Published: August 2020

Background

To determine if a modified ovarian sensitivity index (MOSI), based on initial follicular measurements and the initial follicle-stimulating hormone (FSH) dose, can predict the production of high-quality embryos for successful implantation during in vitro fertilization (IVF).

Methods

This study consisted of two phases: 1) a retrospective study and 2) a prospective observational study. For the first phase, 363 patients charts were reviewed, of which 283 had embryos transferred. All women underwent a standardized antagonist-based IVF protocol. At the first follow-up (Day 3/4), the number and size of the follicles were determined. MOSI was calculated as ln (number follicles (≥6 mm) × 1000 / FSH initial dose). Afterward, the number and quality of the ova, embryo development, and the number and quality of the blastocysts were determined. Embryo implantation was confirmed by β-hCG. For the second phase, 337 IVF cycles were followed to determine MOSI’s accuracy.

Results

MOSI could predict the production of ≥4 high-quality embryos by Day 2 (AUC = 0.69, 95%CI:0.63–0.75), ≥2 blastocysts (AUC = 0.74, 95%CI:0.68–0.79), and ≥ 35% rate of blastocyst formation (AUC = 0.65, 95%CI:0.58–0.72). Using linear regression, MOSI was highly associated with the number of ova captured (β = 5.15), MII oocytes (β = 4.31), embryos produced (β = 2.90), high-quality embryos (β = 0.98), and the blastocyst formation rate (β = 0.06, p < 0.01). Using logistic regression, MOSI was highly associated with achieving ≥4 high-quality embryos (odds ratio = 2.80, 95%CI:1.90–4.13), ≥2 blastocysts (odds ratio = 3.40, 95%CI:2.33–4.95), and ≥ 35% blastocysts formation rate (odds ratio = 1.96, 95%CI:1.31–2.92). This effect was independent of age, BMI, and antral follicle count. For implantation, MOSI was significantly associated with successful implantation (odds ratio = 1.79, 95%CI:1.25–2.57). For the prospective study, MOSI was highly accurate at predicting ≥6 high-quality embryos on Day 2 (accuracy = 68.5%), ≥6 blastocysts (accuracy = 68.0%), and a blastocyst formation rate of ≥35% (accuracy = 61.4%).

Conclusion

MOSI was highly correlated with key IVF parameters that are associated with achieved pregnancy. Using this index with antagonist cycles, clinicians may opt to stop an IVF cycle, under the assumption that the cycle will fail to produce good blastocysts, preventing wasting the patient’s resources and time.
Pre-hospital triage performance and emergency medical services nurse’s field assessment in an unselected patient population attended to by the emergency medical services: a prospective observational study
Authors: Magnusson Carl , Herlitz Johan , Axelsson Christer
Published: August 2020

Background

In Sweden, the rapid emergency triage and treatment system (RETTS-A) is used in the pre-hospital setting. With RETTS-A, patients triaged to the lowest level could safely be referred to a lower level of care. The national early warning score (NEWS) has also shown promising results internationally. However, a knowledge gap in optimal triage in the pre-hospital setting persists. This study aimed to evaluate RETTS-A performance, compare RETTS-A with NEWS and NEWS 2, and evaluate the emergency medical service (EMS) nurse’s field assessment with the physician’s final hospital diagnosis.

Methods

A prospective, observational study including patients (≥16 years old) transported to hospital by the Gothenburg EMS in 2016. Three comparisons were made: 1) Combined RETTS-A levels orange and red (high acuity) compared to a predefined reference emergency, 2) RETTS-A high acuity compared to NEWS and NEWS 2 score ≥ 5, and 3) Classification of pre-hospital nurse’s field assessment compared to hospital physician’s diagnosis. Outcomes of the time-sensitive conditions, mortality and hospitalisation were examined. The statistical tests included Mann–Whitney U test and Fisher’s exact test, and several binary classification tests were determined.

Results

Overall, 4465 patients were included (median age 69 years; 52% women). High acuity RETTS-A triage showed a sensitivity of 81% in prediction of the reference patient with a specificity of 64%. Sensitivity in detecting a time-sensitive condition was highest with RETTS-A (73%), compared with NEWS (37%) and NEWS 2 (35%), and specificity was highest with NEWS 2 (83%) when compared with RETTS-A (54%). The negative predictive value was higher in RETTS-A (94%) compared to NEWS (91%) and NEWS 2 (92%). Eleven per cent of the final diagnoses were classified as time-sensitive while the nurse’s field assessment was appropriate in 84% of these cases.

Conclusions

In the pre-hospital triage of EMS patients, RETTS-A showed sensitivity that was twice as high as that of both NEWS and NEWS 2 in detecting time-sensitive conditions, at the expense of lower specificity. However, the proportion of correctly classified low risk triaged patients (green/yellow) was higher in RETTS-A. The nurse’s field assessment of time-sensitive conditions was appropriate in the majority of cases.
Neurological outcome after extracorporeal cardiopulmonary resuscitation for in-hospital cardiac arrest: a systematic review and meta-analysis
Authors: Gravesteijn Benjamin Yaël , Schluep Marc , Disli Maksud , Garkhail Prakriti , Dos Reis Miranda Dinis , Stolker Robert-Jan , Endeman Henrik , Hoeks Sanne Elisabeth
Published: August 2020

Background

In-hospital cardiac arrest (IHCA) is a major adverse event with a high mortality rate if not treated appropriately. Extracorporeal cardiopulmonary resuscitation (ECPR), as adjunct to conventional cardiopulmonary resuscitation (CCPR), is a promising technique for IHCA treatment. Evidence pertaining to neurological outcomes after ECPR is still scarce.

Methods

We performed a comprehensive systematic search of all studies up to December 20, 2019. Our primary outcome was neurological outcome after ECPR at any moment after hospital discharge, defined by the Cerebral Performance Category (CPC) score. A score of 1 or 2 was defined as favourable outcome. Our secondary outcome was post-discharge mortality. A fixed-effects meta-analysis was performed.

Results

Our search yielded 1215 results, of which 19 studies were included in this systematic review. The average survival rate was 30% (95% CI 28–33%,I2 = 0%,p = 0.24). In the surviving patients, the pooled percentage of favourable neurological outcome was 84% (95% CI 80–88%,I2 = 24%,p = 0.90).

Conclusion

ECPR as treatment for in-hospital cardiac arrest is associated with a large proportion of patients with good neurological outcome. The large proportion of favourable outcome could potentially be explained by the selection of patients for treatment using ECPR. Moreover, survival is higher than described in the conventional CPR literature. As indications for ECPR might extend to older or more fragile patient populations in the future, research should focus on increasing survival, while maintaining optimal neurological outcome.
DiMSum: an error model and pipeline for analyzing deep mutational scanning data and diagnosing common experimental pathologies
Authors: Faure Andre J. , Schmiedel Jörn M. , Baeza-Centurion Pablo , Lehner Ben
Published: August 2020

Deep mutational scanning (DMS) enables multiplexed measurement of the effects of thousands of variants of proteins, RNAs, and regulatory elements. Here, we present a customizable pipeline, DiMSum, that represents an end-to-end solution for obtaining variant fitness and error estimates from raw sequencing data. A key innovation of DiMSum is the use of an interpretable error model that captures the main sources of variability arising in DMS workflows, outperforming previous methods. DiMSum is available as an R/Bioconda package and provides summary reports to help researchers diagnose common DMS pathologies and take remedial steps in their analyses.
A multi-centre open-label two-arm randomised superiority clinical trial of azithromycin versus usual care in ambulatory COVID-19: study protocol for the ATOMIC2 trial
Authors: Hinks Timothy S. C. , Barber Vicki S. , Black Joanna , Dutton Susan J. , Jabeen Maisha , Melhorn James , Rahman Najib M , Richards Duncan , Lasserson Daniel , Pavord Ian D. , Bafadhel Mona
Published: August 2020

Background

Azithromycin is an orally active synthetic macrolide antibiotic with a wide range of anti-bacterial, anti-inflammatory and antiviral properties. It is a safe, inexpensive, generic licenced drug available worldwide and manufactured to scale and is a potential candidate therapy for pandemic coronavirus disease 2019 (COVID-19). Azithromycin was widely used to treat severe SARS-CoV and MERS-CoV, but to date, no randomised data are available in any coronavirus infections.

Other ongoing trials are exploring short courses of azithromycin either in early disease, within the first 7 days of symptoms, when azithromycin’s antiviral properties may be important, or late in disease when anti-bacterial properties may reduce the risk of secondary bacterial infection. However, the molecule’s anti-inflammatory properties, including suppression of pulmonary macrophage-derived pro-inflammatory cytokines such as interleukins-1β, -6, -8, and -18 and cytokines G-CSF and GM-CSF may provide a distinct therapeutic benefit if given in as a prolonged course during the period of progression from moderate to severe disease.

Methods

ATOMIC2 is a phase II/III, multi-centre, prospective, open-label, two-arm randomised superiority clinical trial of azithromycin versus standard care for adults presenting to hospital with COVID-19 symptoms who are not admitted at initial presentation. We will enrol adults, ≥ 18 years of age assessed in acute hospitals in the UK with clinical diagnosis of COVID-19 infection where management on an ambulatory care pathway is deemed appropriate. Participants will be randomised in a 1:1 ratio to usual care or to azithromycin 500 mg orally daily for 14 days with telephone follow-up at days 14 and 28. The primary objective is to compare the proportion with either death or respiratory failure requiring invasive or non-invasive mechanical ventilation over 28 days from randomisation. Secondary objectives include mortality/respiratory failure in those with a PCR-confirmed diagnosis; all-cause mortality; progression to pneumonia; progression to severe pneumonia; peak severity of illness and mechanistic analysis of blood and nasal biomarkers.

Discussion

This trial will determine the clinical utility of azithromycin in patients with moderately severe, clinically diagnosed COVID-19 and could be rapidly applicable worldwide.

Trial registration

ClinicalTrials.gov NCT04381962. Registered on 11 May 2020. EudraCT identifier 2020-001740-26. Opened for accrual on 29 May 2020.
A recognition algorithm of VGPO jamming based on discrete chirp-Fourier transform
Authors: Wu Chuanzhang , Chen Baixiao
Published: August 2020

This paper addresses the recognition problem of velocity gate pull-off (VGPO) jamming from the target echo signal for the velocity-based tracking system. The discrete chirp-Fourier transform (DCFT) is studied in this paper to jointly estimate the chirp rates and frequencies of the target and jamming signals. Firstly, the scaling characteristic of the DCFT algorithm is explored. Then, we focus on the quantitative effect of the VGPO jamming signal by analyzing the jointly estimated results in each pulse. The quantitative effect indicates that, as long as the estimated frequency is unchanged, the relationship between the estimated chirp rate and the pulse numbers is similar to the relationship between the frequency offset of VGPO jamming and the time. Finally, by utilizing the joint estimated results in each pulse repetition interval and calculating the mean square to variance ratio (MSVR) of the normalized estimated chirp rate, the VGPO jamming can be recognized. Simulation results show that the jamming signal and the target echo become distinguishable with the proposed feature. Comparing to the existing works, the proposed method can correctly recognize the jamming signal with lower jamming-to-noise ratio (JNR) 5 dB with less data needed, which means it can work effectively in the early stage of interference implementation and shows great potential in practical applications.
The best statistical model to estimate predictors of under-five mortality in Ethiopia
Authors: Fenta Setegn Muche , Fenta Haile Mekonnen , Ayenew Girum Meseret
Published: August 2020

The under-five mortality rate is one of the most important indicators of the socio-economic wellbeing and public health conditions of a country. Under-five death in Ethiopia has reduced, but the rate is still higher than the sustainable development goal target of 20 deaths per 1000 live births. This study aimed to identify the best statistical model to estimate predictors of under-five mortality in Ethiopia. Ethiopian demography and health survey of 2016 data were accessed and used for the analysis. A total of 14,370 women were included. Various count models (Poisson, Negative Binomial, Zero-Inflated Poisson, Zero-Inflated Negative Binomial, Hurdle Poisson, and Hurdle Negative Binomial) were considered to identify risk factors associated with the death of under-five in Ethiopia. The mean number of under-five death was 0.9 and its variance was 1. 697. The hurdle negative binomial model had the smallest AIC, Deviance, and BIC, suggesting the best goodness of fit. Besides, the predictive value and probabilities for many counts in the hurdle negative binomial model fitted the observed counts best. The result of hurdle negative binomial model showed that region, mother’s age, educational level of the father, education level of the mother, father’s occupation, family size, age of mother at first birth, vaccination of child, contraceptive use, birth order, preceding birth interval, twin children, place of delivery, antenatal visit predict under-five death in Ethiopia. The rate of Under-five death remains high. Concerned governmental organizations should work properly to reduce under-five mortality through encouraging child vaccinations and antenatal care visits. Attention should also be provided to multiple births and the spacing among order of birth. The Hurdle negative binomial model provided a better fit for the data. It is argued the Hurdle negative binomial model for count data with excess zeros of unknown sources such as the number of under-five death should be fitted.
Air-stable and ultrasensitive solution-cast SWIR photodetectors utilizing modified core/shell colloidal quantum dots
Authors: Kwon Jin-Beom , Kim Sae-Wan , Kang Byoung-Ho , Yeom Se-Hyuk , Lee Wang-Hoon , Kwon Dae-Hyuk , Lee Jae-Sung , Kang Shin-Won
Published: August 2020

InGaAs-based photodetectors have been generally used for detection in the short-wave infrared (SWIR) region. However, the epitaxial process used to grow these materials is expensive; therefore, InGaAs-based photodetectors are limited to space exploration and military applications. Many researchers have expended considerable efforts to address the problem of SWIR photodetector development using lead sulfide (PbS) quantum dots (QDs). Along with their cost-efficient solution processability and flexible substrate compatibility, PbS QDs are highly interesting for the quantum-size-effect tunability of their bandgaps, spectral sensitivities, and wide absorption ranges. However, the performance of PbS QD-based SWIR photodetectors is limited owing to inefficient carrier transfer and low photo and thermal stabilities. In this study, a simple method is proposed to overcome these problems by incorporating CdS in PbS QD shells to provide efficient carrier transfer and enhance the long-term stability of SWIR photodetectors against oxidation. The SWIR photodetectors fabricated using thick-shell PbS/CdS QDs exhibited a high on/off (light/dark) ratio of 11.25 and a high detectivity of 4.0 × 1012 Jones, which represents a greater than 10 times improvement in these properties relative to those of PbS QDs. Moreover, the lifetimes of thick-shell PbS/CdS QD-based SWIR photodetectors were significantly improved owing to the self-passivation of QD surfaces.