bluuebunny/crossref_metadata_2025 huggingface dataset:
Feasibility and initial efficacy of a high-intensity interval training program using adaptive equipment in persons with multiple sclerosis who have walking disability: study protocol for a single-group, feasibility trial
Authors: Hubbard Elizabeth A. , Motl Robert W. , Elmer David J.
Published: November 2020

Background

There is considerable evidence for the efficacy of moderate-intensity continuous exercise benefitting clinically relevant outcomes in persons with multiple sclerosis (MS). However, persons with MS who have walking disability (pwMS-wd) are severely deconditioned and may achieve superior benefits by engaging in high-intensity interval training (HIIT), especially while utilizing adaptive equipment, such as recumbent arm/leg stepping (RSTEP). The proposed study will assess the feasibility of a 12-week, RSTEP HIIT program in pwMS-wd. The secondary aim will examine changes in aerobic fitness, physical activity, ambulation, upper arm function, cognition, fatigue, and depression as clinically relevant efficacy outcomes following the 12-week, RSTEP HIIT intervention.

Methods

The study will recruit 15 pwMS-wd. Feasibility will be measured via process, resource, management, and scientific outcomes throughout the entirety of the research study. The secondary, clinically relevant outcomes will consist of a neurological exam, aerobic capacity, physical activity, ambulation, cognition, upper arm function, fatigue, and depression. Outcomes will be assessed at baseline (T1), midpoint (T2, following 6 weeks), and post-intervention (T3, following 12 weeks). The intervention will involve 12 weeks of supervised, individualized HIIT sessions two to three times per week. The individual HIIT sessions will each involve 10 cycles of 60-s intervals at the wattage associated with 90% VO2peak followed by 60 s of active recovery intervals at 15 W, totaling 20 min in length plus 5-min warm-up and cool-down periods.

Discussion

The feasibility design of the proposed study will provide experience and preliminary data for advancing towards a proof-of-concept study comparing HIIT to moderate-intensity continuous RSTEP for improving clinically relevant outcomes in a randomized control trial design. The results will be disseminated via manuscripts for publication and a report for distribution among the National Multiple Sclerosis Society.

Trial registration

ClinicalTrials.gov NCT04416243. Retrospectively registered on June 4, 2020
The A2B trial, antibiotic prophylaxis for excision-graft surgery in burn patients: a multicenter randomized double-blind study
Authors:   for the A2B trial investigators, Dépret François , Farny Boris , Jeanne Mathieu , Klouche Kada , Leclerc Thomas , Nouette-Gaulain Karine , Pantet Olivier , Rémerand Francis , Roquilly Antoine , Rousseau Anne-Françoise , Sztajnic Simon , Wiramus Sandrine , Vicaut Eric , Legrand Matthieu
Published: November 2020

Background

The indication for antibiotic prophylaxis in burn patients remains highly controversial, with no consensus having been reached. The objective of antibiotic prophylaxis is to reduce the risk of postoperative local and systemic infections. Burn surgery is associated with a high incidence of bacteremia, postoperative infections, and sepsis. However, antibiotic prophylaxis exposes patients to the risk of selecting drug-resistant pathogens as well as to the adverse effects of antibiotics (i.e., Clostridium difficile colitis). The lack of data precludes any strong international recommendations regarding perioperative prophylaxis using systemic antibiotics in this setting.

The goal of this project is therefore to determine whether perioperative systemic antibiotic prophylaxis can reduce the incidence of postoperative infections in burn patients.

Methods

The A2B trial is a multicenter (10 centers), prospective, randomized, double-blinded, placebo-controlled study. The trial will involve the recruitment of 506 adult burn patients with a total body surface area (TBSA) burn of between 5 and 40% and requiring at least one excision-graft surgery for deep burn injury. Participants will be randomized to receive antibiotic prophylaxis (antibiotic prophylaxis group) or a placebo (control group) 30 min before the incision of the first two surgeries. The primary outcome will be the occurrence of postoperative infections defined as postoperative sepsis and/or surgical site infection and/or graft lysis requiring a new graft within 7 days after surgery. Secondary outcomes will include mortality at day 90 postrandomization, skin graft lysis requiring a new graft procedure, postoperative bacteremia (within 48 h of surgery), postoperative sepsis, postoperative surgical site infection, number of hospitalizations until complete healing (> 95% TBSA), number of hospitalization days living without antibiotic therapy at day 28 and day 90, and multiresistant bacterial colonization or infection at day 28 and day 90.

Discussion

The trial aims to provide evidence on the efficacy and safety of antibiotic prophylaxis for excision-graft surgery in burn patients.

Trial registration

ClinicalTrials.gov NCT04292054. Registered on 2 March 2020
Relationship between the severity of endometriosis symptoms (dyspareunia, dysmenorrhea and chronic pelvic pain) and the spread of the disease on ultrasound
Authors: Kor Elham , Mostafavi Seyed Reza Saadat , Mazhin Zahra Ahmadian , Dadkhah Adeleh , Kor Anis , Arvanagh Shirin Habibi , Noroozi Shima Ghafourian , Sadri Ghazal
Published: November 2020

Objectives

About 10–15% of women of childbearing age have endometriosis. The present study aimed to investigate the relationship between the severity of symptoms of endometriosis and the spread as well as the stage of the disease on ultrasonography. The present cross-sectional study evaluates the relationship between the severity of endometriosis symptoms and the spread of disease on ultrasonography in patients with endometriosis.

Results

Considering different analyses, the cumulative size of posterior deep infiltrative endometriosis (DIE) (less than 1 cm) is significantly correlated with minimal severity of dyspareunia and chronic pelvic pain. The incidence of dyspareunia was more prevalent in patients with complete stenosis of Douglas pouch than those with incomplete stenosis. Furthermore, the incidence of severe and very severe pain in patients with Douglas pouch stenosis is relatively higher than that in patients without stenosis. Only dyspareunia is related to the stage of endometriosis, and patients with dyspareunia are five times more at risk of a higher stage of the disease. The severity of dyspareunia is related to the stage of endometriosis and the severity of Douglas pouch stenosis. The results showed a correlation between chronic pelvic pain and r-ASRM score (revised American Society for Reproductive Medicine score).
Emerging roles of N6-methyladenosine (m6A) modification in breast cancer
Authors: Wang Yanyan , Zhang Yujie , Du Yushen , Zhou Meiqi , Hu Yue , Zhang Suzhan
Published: November 2020

N6-Methyladenosine (m6A) is the most abundant, dynamic, and reversible epigenetic RNA modification that is found in coding and non-coding RNAs. Emerging studies have shown that m6A and its regulators affect multiple steps in RNA metabolism and play broad roles in various cancers. Worldwide, breast cancer is the most prevalent cancer in female. It is a very heterogeneous disease characterized by genetic and epigenetic variations in tumor cells. Increasing evidence has shown that the dysregulation of m6A-related effectors, as methyltransferases, demethylases, and m6A binding proteins, is pivotal in breast cancer pathogenesis. In this review, we have summarized the most up-to-date research on the biological functions of m6A modification in breast cancer and have discussed the potential clinical applications and future directions of m6A modification as a biomarker as well as a therapeutic target of breast cancer.
Fear of panoptic surveillance: using digital technology to control the COVID-19 epidemic
Authors: Keshet Yael
Published: November 2020

Background

In a bid to reduce infection rates by COVID-19 the authorities in some countries, in collaboration with medical regulators and experts, have employed digital technologies to control and regulate citizens’ behavior. Public opinion and the public’s compliance with these technologies come into play here. The objective of the present study was to examine attitudes expressed in the public discourse toward the use of digital technologies to control people’s behavior during the COVID-19 pandemic, as reflected in the media.

Methods

Qualitative analysis was performed on posts and comments submitted in response to 12 articles that appeared on the four leading Israeli news sites, on three significant occasions: first, upon the announcement of the use of surveillance technologies by the Israeli security agency (ISA); second, upon the announcement of the launch of the Health Ministry’s app that tracks contacts with COVID-19 patients; and third, following reports of petitions lodged with Israel’s supreme court challenging the use of surveillance technologies. The analysis was performed using ATLAS-Ti software for systematic analysis.

Results

A total of 2551 posts and comments referring to these 12 articles were found, 714 of which were relevant to the purpose of the study. The analysis revealed disagreement between those who supported the measures taken and opponents. Supporters regarded contact tracing by means of digital technologies as essential to the effort to protect people during the pandemic, and believed that employing the ISA’s capabilities was the correct way to combat the epidemic. Opponents of the measures rejected the use of tracking technologies, regarding this step as a move toward dictatorship and a violation of fundamental civil rights. Some proposed alternative measures that would obviate the use of such tracking.

Conclusions

The primary task of medical practice is to heal illness and alleviate suffering. The debate surrounding the employment of digital technologies during the COVID-19 pandemic highlights the complexity of the close connection between social control and care in times of pandemic. The context of this pandemic has highlighted the interrelatedness of advanced digital surveillance technologies, medical care, and social control exercised by authorities and medical regulators and experts, which raises issues of transparency, trust and mistrust among the public. These issues become all the more relevant when the number of patients grows rapidly, the authorities need to deal with the extended ongoing COVID-19 pandemic, the country has entered a second lockdown, and the public must be persuaded to comply with highly restrictive regulations. Recommendations to policy makers, practical implications, and suggestions for future research are discussed.
Stability of deficiency indices for discrete Hamiltonian systems under bounded perturbations
Authors: Liu Yan , Xu Meiru
Published: November 2020

This paper is concerned with stability of deficiency indices for discrete Hamiltonian systems under perturbations. By applying the perturbation theory of Hermitian linear relations we establish the invariance of deficiency indices for discrete Hamiltonian systems under bounded perturbations. As a consequence, we obtain the invariance of limit types for the systems under bounded perturbations. In particular, we build several criteria of the invariance of the limit circle and limit point cases for the systems. Some of these results improve and extend some previous results.
A spatio-temporal specification language and its completeness & decidability
Authors: Li Tengfei , Liu Jing , Sun Haiying , Chen Xiang , Zhang Lipeng , Sun Junfeng
Published: November 2020

In the past few years, significant progress has been made on spatio-temporal cyber-physical systems in achieving spatio-temporal properties on several long-standing tasks. With the broader specification of spatio-temporal properties on various applications, the concerns over their spatio-temporal logics have been raised in public, especially after the widely reported safety-critical systems involving self-driving cars, intelligent transportation system, image processing. In this paper, we present a spatio-temporal specification language, STSLPC, by combining Signal Temporal Logic (STL) with a spatial logic S4u, to characterize spatio-temporal dynamic behaviors of cyber-physical systems. This language is highly expressive: it allows the description of quantitative signals, by expressing spatio-temporal traces over real valued signals in dense time, and Boolean signals, by constraining values of spatial objects across threshold predicates. STSLPCcombines the power of temporal modalities and spatial operators, and enjoys important properties such as finite model property. We provide a Hilbert-style axiomatization for the proposed STSLPCand prove the soundness and completeness by the spatio-temporal extension of maximal consistent set and canonical model. Further, we demonstrate the decidability of STSLPCand analyze the complexity of STSLPC. Besides, we generalize STSL to the evolution of spatial objects over time, called STSLOC, and provide the proof of its axiomatization system and decidability.
Autonomic nervous system activity and the risk of nosocomial infection in critically ill patients with brain injury
Authors: Wirtz Mathijs R. , Moekotte Jiri , Balvers Kirsten , Admiraal Marjolein M. , Pittet Jean-Francois , Colombo Joe , Wagener Brant M. , Goslings J. Carel , Juffermans Nicole
Published: November 2020

Purpose

Nosocomial infection contributes to adverse outcome after brain injury. This study investigates whether autonomic nervous system activity is associated with a decreased host immune response in patients following stroke or traumatic brain injury (TBI).

Methods

A prospective study was performed in adult patients with TBI or stroke who were admitted to the Intensive Care Unit of our tertiary university hospital between 2013 and 2016. Heart rate variability (HRV) was recorded daily and assessed for autonomic nervous system activity. Outcomes were nosocomial infections and immunosuppression, which was assessed ex vivo using whole blood stimulations with plasma of patients with infections, matched non-infected patients and healthy controls.

Results

Out of 64 brain injured patients, 23 (36%) developed an infection during their hospital stay. The ability of brain injured patients to generate a host response to the bacterial endotoxin lipopolysaccharides (LPS) was diminished compared to healthy controls (p < 0.001). Patients who developed an infection yielded significantly lower TNF-α values (86 vs 192 pg/mL, p = 0.030) and a trend towards higher IL-10 values (122 vs 84 pg/mL, p = 0.071) following ex vivo whole blood stimulations when compared to patients not developing an infection. This decreased host immune response was associated with altered admission HRV values. Brain injured patients who developed an infection showed increased normalized high-frequency power compared to patients not developing an infection (0.54 vs 0.36, p = 0.033), whereas normalized low-frequency power was lower in infected patients (0.46 vs 0.64, p = 0.033).

Conclusion

Brain injured patients developing a nosocomial infection show parasympathetic predominance in the acute phase following brain injury, reflected by alterations in HRV, which parallels a decreased ability to generate an immune response to stimulation with LPS.
Role of organizations in preparedness and emergency response to flood disaster in Bangladesh
Authors: Hossain Babul
Published: November 2020

The present study is to know the role of organizations and make an assessment on their assistance regarding preparedness and emergency response of flood disaster affected people. This study has used a mixed-method approach. Flood-affected people were the respondents to evaluate the organizational role. The study reveals that before the flood in 2017 to minimize the loss and damages, the GOs play a very effective role concerning the arrangement of preparatory meetings and preparing shelter centers, and NGOs play a very useful role in making arrangements for awareness-building training. During the emergency period, the GOs played a comparatively better role in providing CI sheets, agricultural assistance and cash money as relief for establishing housing facilities and emergency support. The NGOs played relatively a better role in providing food, water, clothes, medicine, etc. This study put forward complications such as limited sanctions, disruption of communication, lack of awareness of sufferers, and overlapping. The findings of this study would be a significant for the disaster policymakers, and civil societies.
A giant pelvic solitary fibrous tumor with Doege–Potter syndrome successfully treated with transcatheter arterial embolization followed by surgical resection: a case report
Authors: Yuza Kizuki , Sakata Jun , Nagaro Hiroki , Ando Takuya , Hirose Yuki , Miura Kohei , Takizawa Kazuyasu , Kobayashi Takashi , Ichikawa Hiroshi , Hanyu Takaaki , Shimada Yoshifumi , Nagahashi Masayuki , Kosugi Shin-Ichi , Wakai Toshifumi
Published: November 2020

Background

Solitary fibrous tumor (SFT), a mesenchymal fibroblastic tumor with a hypervascular nature, rarely develops in the pelvis. Resection of a giant SFT occupying the pelvic cavity poses an increased risk of developing massive hemorrhage during resection, although surgical resection is the most effective treatment method for this tumor to achieve a potential cure. SFT rarely develops with Doege–Potter syndrome, which is known as a paraneoplastic syndrome characterized by non-islet cell tumor hypoglycemia (NICTH) secondary to SFT that secretes insulin-like growth factor-II (IGF-II). We present a case of a giant pelvic SFT with Doege–Potter syndrome, which was successfully treated with transcatheter arterial embolization (TAE) followed by surgical resection.

Case presentation

A 46-year-old woman presented with a disorder of consciousness due to refractory hypoglycemia. Images of the pelvis showed a giant and heterogeneously hypervascular mass displacing and compressing the rectum. Endocrinological evaluation revealed low serum levels of insulin and C-peptide consistent with NICTH. Angiography identified both the inferior mesenteric artery and the bilateral internal iliac artery as the main feeders of the tumor. To avoid intraoperative massive bleeding, super-selective TAE was performed for the tumor 2 days prior to surgery. Hypoglycemia disappeared after TAE. The tumor was resected completely, with no massive hemorrhage during resection. Histologically, it was diagnosed as IGF-II-secreting SFT. Partial necrosis of the rectum in the specimen was observed due to TAE. The patient was followed up for 2 years and no evidence of disease has been reported.

Conclusions

Preoperative angiography followed by TAE is an exceedingly helpful method to reduce intraoperative hemorrhage when planning to resect SFT occupying the pelvic cavity. Complications related to ischemia should be kept in mind after TAE, which needs to be planned within 1 or 2 days before surgery. TAE for tumors may be an option in addition to medical and surgical treatment for persistent hypoglycemia in Doege–Potter syndrome.
Feasibility of an app-based parent-mediated speech production intervention for minimally verbal autistic children: development and pilot testing of a new intervention
Authors: Saul Jo , Norbury Courtenay
Published: November 2020

Background

Training speech production skills may be a valid intervention target for minimally verbal autistic children. Intervention studies have explored various approaches albeit on a small scale and with limited experimental control or power. We therefore designed a novel app-based parent-mediated intervention based on insights from the video modelling and cued articulation literature and tested its acceptability and usage.

Methods

Consultation with the autism community refined the initial design and culminated in a pilot trial (n = 19) lasting 16 weeks. Participants were randomly allocated an intervention duration in an AB phase design and undertook weekly probes during baseline and intervention via the app. We evaluated the acceptability of the intervention via feedback questionnaires and examined the usability variables such as adherence to the testing and intervention schedule, time spent on the app and trials completed during the intervention phase.

Results

High acceptability scores indicated that families liked the overall goals and features of the app. Ten participants engaged meaningfully with the app, completing 82% of the test trials and uploading data in 61% of intervention weeks; however, of these, only three met the targeted 12.5 min of intervention per week.

Conclusion

We discuss the possible reasons for variability in usage data and how barriers to participation could be surmounted in the future development of this intervention.
A virtual teaching clinic for virtual care during the COVID-19 pandemic
Authors: He Xin , Shelden Daniel , Kraftson Andrew , Else Tobias , Auchus Richard J.
Published: November 2020

The COVID-19 pandemic has prompted the rapid transition of in-person outpatient care to telemedicine, and clinical training to remote learning. The endocrinology fellows at the University of Michigan maintain their own continuity-of-care clinics and rotate in the Ann Arbor Veterans Affairs (VA) Healthcare System. For these clinics, we sought to preserve patient staffing with expert attending physicians and continue the clinical training experience in a remote setting.

We have adapted the online conferencing platform, Zoom, to integrate learners into a virtual teaching clinic environment. By using the Zoom “breakout room” feature, fellows are able to match staffing attending physicians to different patient cases, according to attending physicians’ areas of specialty. Similar to the traditional teaching clinic environment, our remote staffing strategy has ensured that fellows continue to provide excellent patient care and fulfill educational aims across our University and VA facilities.

Outpatient clinics in other University of Michigan departments and other academic centers have inquired about or have begun utilizing our method. Even beyond COVID-19, our paradigm potentially provides a convenient virtual staffing platform to serve patient populations with geographic or transportation challenges. Following implementation, stakeholders can regularly evaluate the approach to continually improve both patient care and medical education.
Shifts in the global migration order and migration transitions in Europe: the cases of Turkey and Russia
Authors: Düvell Franck
Published: November 2020

This paper takes as a premise that world economics, world politics and global labour are changing and that whilst migration is a driver as well as a consequence of change it is changing, too. For long, conventional research focussed on north-north and south-north migrations, like across the Atlantic or from agricultural and industrialising to industrial countries. This was in part inspired by the economic and political dominance of the ‘global north’, but also driven by a western and Eurocentric bias. Meanwhile, a long period of economic and political transformations and turbulences gave rise to new economic powers, diversified the sending-receiving country matrix and thus fundamentally changed the determinants for international migration. I elaborate the concepts migration order and migration transition to argue that these are useful for analysing the changes in the configuration of sending, receiving and transit states. To illustrate the argument, this article takes Russia and Turkey and developments from the early 2000s as case studies and analyses the shifts in the regional and global migration flows.
Focus on the notice: evidence of spatial skills’ effect on middle school learning from a computer simulation
Authors: Epler-Ruths Colleen M. , McDonald Scott , Pallant Amy , Lee Hee-Sun
Published: November 2020

This article represents the findings from the qualitative portion of a mixed methods study that investigated the impact of middle school students’ spatial skills on their plate tectonics learning while using a computer visualization. Higher spatial skills have been linked to higher STEM achievement, while use of computer visualizations has mixed results for helping various students with different spatial levels. This study endeavors to better understand the difference between what high and low spatial-skilled middle school students notice and interpret while using a plate tectonic computer visualization. Also, we examine the differences in the quantity and quality of students’ spatial language. The collected data include student spatial scores, student interviews, screencasts, and online artifacts. The artifacts were students’ answers to questions inserted in an online curriculum (GEODE) with the embedded computer visualization (Seismic Explorer). Students were asked what they “noticed” during interviews and in the curriculum. Typed student answers and interviews were analyzed for types and quantity of spatial words. Analysis of typed answers and interviews indicated that there are differences in the number and types of spatial words used by high or low spatial students. Additionally, high spatial learners talk about depth, notice patterns in data and are more likely to make a hypothesis to explain what they see on the screen. Findings suggest that students go through an iterative cycle of noticing and interpreting when using a scientific model. Overall, results show a significant positive relationship between spatial skills and what students notice while learning plate tectonics. An explanation for the increased gain in plate tectonics comprehension is that students with higher spatial skills notice more, so they are able to interpret more details of the model. This finding implies that students with low spatial skills do not benefit as much from use of a computer visualization and will need more scaffolding in order to interpret details in the computer visualization.
Effects of cutting and sowing seeds of native species on giant ragweed invasion and plant diversity in a field experiment
Authors: Byun Chaeho , Choi Ho , Kang Hojeong
Published: November 2020

Background

Ambrosia trifidais a highly invasive annual plant, but effective control methods have not been proposed. Among various eradication methods, cutting is a simple measure to control invasive plants, and sowing seeds of native plants may effectively increase biotic resistance to invasion. In this study, we conducted a field experiment with two treatments: cutting and sowing seeds of six native or naturalized plants.

Results

We found a significantly lowerA. trifidaabundance after cutting than in the control (77% decrease). Sowing seeds of native species did not provide any additional benefit for the control ofA. trifida, but increased the importance values and diversity of other native vegetation. The abundance ofA. trifidawas negatively correlated with that of other plant taxa based on plant cover, biomass, and density. However, biotic resistance of sown plants was not effective to control invasion becauseA. trifidawas so competitive.

Conclusions

We concluded that cutting is an effective measure to controlAmbrosia trifidawhile sowing seeds of native plants can increase native plant diversity.
COVID-19 infection: epidemiological, clinical, and radiological expression among adult population
Authors: Ragab Eman , Mahrous Asrar Helal , El Sheikh Ghadeer Maher
Published: November 2020

Background

High-resolution computed tomography (HRCT) has proved to be an important diagnostic tool throughout the COVID-19 pandemic outbreaks. Increasing number of the infected personnel and shortage of real-time transcriptase polymerase chain reaction (RT-PCR) as well as its lower sensitivity made the CT a backbone in diagnosis, assessment of severity, and follow-up of the cases.

Results

Two hundred forty patients were evaluated retrospectively for clinical, laboratory, and radiological expression in COVID-19 infection. One hundred eighty-six non-severe cases with home isolation and outpatient treatment and 54 severe cases needed hospitalization and oxygen support. Significant difference between both groups was encountered regarding the age, male gender, > 38° fever, dyspnea, chest pain, hypertension, ≤ 93 oxygen saturation, intensive care unit (ICU) admission, elevated D-dimer, high serum ferritin and troponin levels, and high CT-severity score (CT-SS) of the severe group. CT-SS showed a negative correlation with O2 saturation and patients’ outcome (r − 0.73/p 0.001 and r − 0.56/p 0.001, respectively). Bilateral peripherally distributed ground glass opacities (GGOs) were the commonest imaging feature similar to the literature.

Conclusion

Older age, male gender, smoking, hypertension, low O2 saturation, increased CT score, high serum ferritin, and high D-dimer level are the most significant risk factors for severe COVID-19 pneumonia. Follow-up of the recovered severe cases is recommended to depict possible post COVID-19 lung fibrosis.
Central Nervous System Lymphomas
Authors: Grommes Christian
Published: November 2020

PURPOSE OF REVIEW

Primary central nervous system (CNS) lymphoma is a rare, aggressive extranodal non-Hodgkin lymphoma confined to the brain, eyes, CSF, or spinal cord without systemic, non-CNS involvement. This article reviews the clinical presentation, imaging characteristics, diagnostic workup, novel pathophysiologic insights, and treatment of immunocompetent patients with primary CNS lymphoma.

RECENT FINDINGS

The prognosis of primary CNS lymphoma has significantly improved over the past few decades because of the introduction of and widespread use of high-dose methotrexate, which is now the backbone of all first-line combination chemotherapy treatments. Despite this progress, durable remission is still observed in only approximately 50% of patients. Novel insights into the pathophysiology of primary CNS lymphoma have identified the B-cell receptor pathway as well as the suppressed tumor immune microenvironment and immune evasion as key mechanisms in the pathogenesis of primary CNS lymphoma. Novel, small molecules and agents targeting these aberrant pathways have been introduced into clinical trials of recurrent/refractory primary CNS lymphomas. Agents such as the Bruton tyrosine kinase (BTK) inhibitor ibrutinib or immunomodulatory drugs such as lenalidomide and pomalidomide have shown promising response rates in the relapsed setting.

Diagnosis of primary CNS lymphoma requires a high level of suspicion because clinical signs and deficits can vary and depend on the involved CNS compartments. Rapid initiation of therapy is essential for recovery and prognosis. The optimal treatment regimen has not been defined, but methotrexate-based chemotherapy regimens are considered the standard treatment approach for induction treatment. Novel, targeted agents have recently been introduced into the therapeutic arsenal.
Nonopioid GTS-21 Mitigates Burn Injury Pain in Rats by Decreasing Spinal Cord Inflammatory Responses
Authors: Zhou Yinhui , Leung-Pitt Yiuka , Deng Hao , Ren Yang , You Zerong , Kem William R. , Shen Shiqian , Zhang Wei , Mao Jianren , Martyn J. A. Jeevendra
Published: November 2020

Background:

Burn injury (BI) pain consists of inflammatory and neuropathic components and activates microglia. Nicotinic alpha 7 acetylcholine receptors (α7AChRs) expressed in microglia exhibit immunomodulatory activity during agonist stimulation. Efficacy of selective α7AChR agonist GTS-21 to mitigate BI pain and spinal pain-mediators was tested.

METHODS:

Anesthetized rats after hind-paw BI received intraperitoneal GTS-21 or saline daily. Allodynia and hyperalgesia were tested on BI and contralateral paw for 21 days. Another group after BI receiving GTS-21 or saline had lumbar spinal cord segments harvested (day 7 or 14) to quantify spinal inflammatory-pain transducers or microglia activation using fluorescent marker, ionized calcium-binding adaptor protein (Iba1).

RESULTS:

BI significantly decreased allodynia withdrawal threshold from baseline of ~9–10 to ~0.5–1 g, and hyperalgesia latency from ~16–17 to ~5–6 seconds by day 1. Both doses of GTS-21 (4 or 8 mg/kg) mitigated burn-induced allodynia from ~0.5–1 to ~2–3 g threshold (P = .089 and P = .010), and hyperalgesia from ~5–6 to 8–9 seconds (P < .001 and P < .001) by day 1. The GTS-21 group recovered to baseline pain threshold by day 15–17 compared to saline-treated, where the exaggerated nociception persisted beyond 15–17 days. BI significantly (P < .01) increased spinal cord microgliosis (identified by fluorescent Iba1 staining), microglia activation (evidenced by the increased inflammatory cytokine), and pain-transducer (protein and/or messenger RNA [mRNA]) expression (tumor necrosis factor-α [TNF-α], interleukin-1β [IL-1β], nuclear factor-kappa B [NF-κB], interleukin-6 [IL-6], Janus-associated kinase signal transducer and activator of transcription 3 [JAK-STAT3], and/or N-methyl-d-aspartate receptor [NMDAR]). GTS-21 mitigated pain-transducer changes. The α7AChR antagonist methyllycaconitine nullified the beneficial effects of GTS-21 on both increased nociception and pain-biomarker expression.

CONCLUSIONS:

Nonopioid, α7AChR agonist GTS-21 elicits antinociceptive effects at least in part by decreased activation spinal-cord pain-inducers. The α7AChR agonist GTS-21 holds promise as potential therapeutic adjunct to decrease BI pain by attenuating both microglia changes and expression of exaggerated pain transducers.
Development and Evaluation of a Risk-Adjusted Measure of Intraoperative Hypotension in Patients Having Nonemergent, Noncardiac Surgery
Authors: Christensen Anna L. , Jacobs Ethan , Maheshwari Kamal , Xing Fei , Zhao Xiaohong , Simon Samuel E. , Domino Karen B. , Posner Karen L. , Stewart Alvin F. , Sanford Joseph A. , Sessler Daniel I.
Published: November 2020

BACKGROUND:

Intraoperative hypotension is common and associated with organ injury and death, although randomized data showing a causal relationship remain sparse. A risk-adjusted measure of intraoperative hypotension may therefore contribute to quality improvement efforts.

METHODS:

The measure we developed defines hypotension as a mean arterial pressure <65 mm Hg sustained for at least 15 cumulative minutes. Comparisons are based on whether clinicians have more or fewer cases of hypotension than expected over 12 months, given their patient mix. The measure was developed and evaluated with data from 225,389 surgeries in 5 hospitals. We assessed discrimination and calibration of the risk adjustment model, then calculated the distribution of clinician-level measure scores, and finally estimated the signal-to-noise reliability and predictive validity of the measure.

RESULTS:

The risk adjustment model showed acceptable calibration and discrimination (area under the curve was 0.72 and 0.73 in different validation samples). Clinician-level, risk-adjusted scores varied widely, and 36% of clinicians had significantly more cases of intraoperative hypotension than predicted. Clinician-level score distributions differed across hospitals, indicating substantial hospital-level variation. The mean signal-to-noise reliability estimate was 0.87 among all clinicians and 0.94 among clinicians with >30 cases during the 12-month measurement period. Kidney injury and in-hospital mortality were most common in patients whose anesthesia providers had worse scores. However, a sensitivity analysis in 1 hospital showed that score distributions differed markedly between anesthesiology fellows and attending anesthesiologists or certified registered nurse anesthetists; score distributions also varied as a function of the fraction of cases that were inpatients.

CONCLUSIONS:

Intraoperative hypotension was common and was associated with acute kidney injury and in-hospital mortality. There were substantial variations in clinician-level scores, and the measure score distribution suggests that there may be opportunity to reduce hypotension which may improve patient safety and outcomes. However, sensitivity analyses suggest that some portion of the variation results from limitations of risk adjustment. Future versions of the measure should risk adjust for important patient and procedural factors including comorbidities and surgical complexity, although this will require more consistent structured data capture in anesthesia information management systems. Including structured data on additional risk factors may improve hypotension risk prediction which is integral to the measure’s validity.
A Feminist Still
Authors: Padmanabhan Lakshmi
Published: November 2020

What can photographic form teach us about feminist historiography? Through close readings of photographs by visual artist and documentary photographer Sheba Chhachhi, who documented the struggle for women’s rights in India from the 1980s onward, this article outlines the political stakes of documentary photography’s formal conventions. First, it analyzes candid snapshots of recent protests for women’s rights in India, focusing on an iconic photograph by Chhachhi of Satyarani Chadha, a community organizer and women’s rights activist, at a rally in New Delhi in 1980. It attends to the way in which such photographs turn personal scenes of mourning into collective memorials to militancy, even as they embalm their subjects in a state of temporal paralysis and strip them of their individual history. It contrasts these snapshots to Chhachhi’s collaborative portrait of Chadha from 1990, a “feminist still” that deploys formal conventions of stillness to stage temporal encounters between potential histories and unrealized futures. Throughout, the article returns to the untimeliness of Chhachhi’s photography, both in the multiple temporalities opened up within the image and in its avant-garde critique of feminist politics through experiments with photographic form.
When Are You Going to Catch Up with Me?
Authors: Cheang Shu Lea , Juhasz Alexandra
Published: November 2020

“Digital nomad” Shu Lea Cheang and friend and critic Alexandra Juhasz consider the reasons for and implications of the censorship of Cheang’s 2017 film FLUIDØ, particularly as it connects to their shared concerns in AIDS activism, feminism, pornography, and queer media. They consider changing norms, politics, and film practices in relation to technology and the body. They debate how we might know, and what we might need, from feminist-queer pornography given feminist-queer engagements with our bodies and ever more common cyborgian existences. Their informal chat opens a window onto the interconnections and adaptations that live between friends, sex, technology, illness, feminism, and representation.
Efficient Continuous-Flow H–D Exchange Reaction of Aromatic Nuclei in D2O/2-PrOH Mixed Solvent in a Catalyst Cartridge Packed with Platinum on Carbon Beads
Authors: Park Kwihwan , Ito Naoya , Yamada Tsuyoshi , Sajiki Hironao
Published: November 2020

Herein, a continuous-flow deuteration methodology for various aromatic compounds is developed based on heterogeneous platinum-catalyzed hydrogen-deuterium exchange. The reaction entails the transfer of a substrate dissolved in a mixed solvent of 2-propanol and deuterium oxide into a catalyst cartridge packed with platinum on carbon beads (Pt/CB). Pt/CB could be continuously used without significant deterioration of catalyst activity for at least 24 h. Deuteration proceeded within 60 s of the substrate solutions being passed through the Pt/CB layer in the Pt/CB-packed cartridge.
Could anaesthesia be a key factor for the good outcome of bone ablation procedures? A retrospective analysis of a musculoskeletal interventional centre
Authors: Arrigoni Francesco , Izzo Antonio , Bruno Federico , Zugaro Luigi , Arrigoni Giovanni , Vacca Francesco , Barile Antonio , Masciocchi Carlo
Published: November 2020

Objective:

To choose the best anaesthetic approach through the retrospective review of different bone ablation procedures.

Methods and materials:

We retrospectively evaluated 118 ablation procedures carried out in our institute over the last 30 months. Three different anaesthetic approaches were used: general anaesthesia, i.v. sedation/analgesia and loco-regional anaesthesia (brachial plexus block, spinal anaesthesia). The outcomes were evaluated based on three parameters: technical success, patient comfort (Scale 1–5) and operator comfort (Scale 1–5).

Results:

The 118 interventional procedures were carried out on 62 benign and 56 malignant bone lesions. The overall procedural success rate was 100%. Three cases were treated under general anaesthesia: patient comfort was 5/5 in all cases; operator comfort was 5/5 in one case, and 4/5 in two cases. Twenty-one patients underwent sedation/analgesia: in three patients with benign bone lesions, patient comfort was 1/5 and operator comfort 3/5; in two patients with malignant bone lesions, patient comfort was 3/5 and operator comfort 4/5. Ninety-four patients underwent loco-regional anaesthesia: patient and operator comfort was 5/5 in all cases.

Conclusion:

Based on our experience, loco-regional anaesthesia is probably the best anaesthetic approach during bone ablation procedures. Benign bone lesions ablation are the more painful procedures.

Advances in knowledge:

This is the first paper that systematically investigates about the best anaesthesiological support for IR procedures.
Continuous research monitoring improves the quality of research conduct and compliance among research trainees: internal evaluation of a monitoring programme
Authors: Akello Mirriam , Coutinho Sarah , N-Mboowa Mary Gorrethy , Bukirwa Victoria D , Natukunda Agnes , Lubyayi Lawrence , Nabakooza Grace , Cose Stephen , Elliott Alison M.
Published: November 2020

Background: Research site monitoring (RSM) is an effective way to ensure compliance with Good Clinical Practice (GCP). However, RSM is not offered to trainees (investigators) at African Institutions routinely. The Makerere University/Uganda Virus Research Institute Centre of Excellence in Infection and Immunity Research and Training (MUII-Plus) introduced internal monitoring to promote the quality of trainees’ research projects. Here, we share our monitoring model, experiences and achievements, and challenges encountered.

Methods: We analysed investigators’ project reports from monitoring visits undertaken from April 2017 to December 2019. Monitors followed a standard checklist to review investigator site files and record forms, and toured site facilities. We planned four monitoring visits for each trainee: one at site initiation, two interim, and a closeout monitoring visit. A team of two monitors conducted the visits.

Results: We monitored 25 out of the 26 research projects in progress between April 2017 and December 2019. Compliance with protocols, standard operating procedures, GCP, and GCLP improved with each monitoring visit. Median (IQR) compliance rate was 43% (31%, 44%) at site initiation visit for different monitoring items, 70% (54%, 90%) at the 1st interim monitoring visit, 100% (92%, 100%) at 2nd interim monitoring visit and all projects achieved 100% compliance at site closeout.  All investigators had good work ethics and practice, and appropriate facilities. Initially, some investigators’ files lacked essential documents, and informed consent processes needed to be improved. We realized that non-compliant investigators had not received prior training in GCP/GCLP, so we offered them this training.

Conclusions: Routine monitoring helps identify non-compliance early and improves the quality of research. We recommend continuous internal monitoring for all research studies. Investigators conducting research involving human subjects should receive GCP/GCLP training before commencing their projects. Institutional higher degrees and research ethics committees should enforce this as a requirement for project approvals.
ReStOre@Home: Feasibility study of a virtually delivered 12-week multidisciplinary rehabilitation programme for survivors of upper gastrointestinal (UGI) cancer - study protocol
Authors: O'Neill Linda , Guinan Emer , Doyle Suzanne L. , O'Connor Louise , Sheill Grainne , Smyth Emily , Fairman Ciaran M. , Segurado Ricardo , Connolly Deirdre , O'Sullivan Jacintha , Reynolds John V. , Hussey Juliette
Published: November 2020

Background: Exercise rehabilitation programmes, traditionally involving supervised exercise sessions, have had to rapidly adapt to virtual delivery in response to the coronavirus disease 2019 (COVID-19) pandemic to minimise patient contacts. In the absence of an effective vaccine, the pandemic is likely to persist in the medium term and during this time it is important that the feasibility and effectiveness of remote solutions is considered.  We have previously established the feasibility of the Rehabilitation Strategies following Oesophago-gastric Cancer (ReStOre) intervention - a face to face multidisciplinary rehabilitation programme for upper gastrointestinal (UGI) cancer survivors. This study will examine the feasibility of a virtually delivered 12-week multi-component ReStOre@Home programme.

Methods: This single arm feasibility study will recruit 12 patients who have completed curative treatment for oesophago-gastric cancer. Participants will complete the 12-week ReStOre@Home programme consisting of exercise (aerobic and resistance training), 1:1 dietary counselling and group education sessions through virtual delivery. Underpinned by the Medical Research Council (MRC) Framework, feasibility will be determined by recruitment rates, adherence, retention, incidents, and acceptability. Acceptability will be assessed qualitatively through post-intervention interview and the Telehealth Usability Questionnaire. Secondary outcomes will be assessed pre and post-intervention and will include measures of physical performance (cardiopulmonary exercise test, short physical performance battery, hand grip strength, Godin Leisure Time Questionnaire, and body composition), health related quality of life (European Organisation for Research and Treatment of Cancer Core Quality of Life Questionnaire (EORTC-QLQ-C30) and oesophago-gastric cancer specific subscale (EORTC-QLQ-OG25), fatigue (Multidimensional Fatigue Inventory (MFI-20), and venous blood samples will be collected for the UGI Cancer Survivorship Biobank.

Discussion: The ReStOre@Home feasibility study will provide important data regarding the amenability of a multidisciplinary programme designed for UGI cancer survivors to virtual delivery.

Trial registration: ClinicalTrials.gov NCT04603339 (26/10/2020)