bluuebunny/crossref_metadata_2025 huggingface dataset:
Brain-Derived Neurotrophic Factor, a New Predictor of Coronary Artery Calcification
Authors: Jin Hong , Ji Jing-jing , Zhu Yi , Wang Xiao-dong , Li Yi-ping , Shi Qiu-yin , Chen Yi-fei
Published: February 2021

Brain-derived neurotrophic factor (BDNF) plays a functional role in vascular endothelium homeostasis and the alleviation of atherosclerosis. Matrix gla protein (MGP) and Nε-(1-carboxymethyl)-l-lysine (CML) are both confirmed to be VC predictors. This study investigated the association between BDNF, MGP, CML and coronary artery calcification (CAC). Plasma BDNF, MGP, and CML levels were measured in 274 patients who underwent computed tomography to determine the CAC score (Agatston score). It was found that patients with CAC exhibited lower BDNF and MGP and higher CML levels than those without CAC. Plasma BDNF levels in patients with diabetes or hypertension were lower compared with the control groups. In logistic regression analysis, age, hypertension, BDNF, and MGP were independent predictors of CAC. Plasma BDNF and MGP levels were both correlated with the Agatston score even after adjustment for age, total cholesterol level, triglycerides, low-density lipoprotein level, creatinine clearance rate, and the presence of hypertension and diabetes mellitus. In 167 patients with CAC, circulating BDNF level was inversely associated with CML level and positively related to MGP level. In the receiver operating characteristic analysis for CAC, the areas under the curves for BDNF, MGP, and CML were 0.757, 0.777 and 0.653, respectively. In summary, plasma BDNF levels are associated with the Agatston score, and BDNF further predicts the occurrence of CAC.
Algebraic bound for the phase–frequency response of the commande robuste d'ordre non-entier approximation of fractional differentiators and its applications in control systems analysis
Authors: Neshat Khashayar , Tavazoei Mohammad Saleh
Published: February 2021

This article deals with analyzing the phase–frequency response of commande robuste d'ordre non-entier approximations of fractional-order differentiators. More precisely, an algebraic tight upper bound is derived for the phase of the approximations obtained from the commande robuste d'ordre non-entier method. Then, some applications for this achievement are discussed in the viewpoint of control systems analysis. These applications include usefulness of the obtained upper bound in stability preservation analysis during the commande robuste d'ordre non-entier–based approximation process and applicability of such a bound in finding necessary or sufficient conditions for test of positive realness/negative imaginariness of a fractional-order transfer function.
Deriving Compound-Specific Exposure Limits for Chemicals Used in Pharmaceutical Synthesis: Challenges in Expert Decision-Making Exemplified Through a Case Study-Based Workshop
Authors: Drewe William C. , Dobo Krista L. , Sobol Zhanna , Bercu Joel P. , Parris Patricia , Nicolette John
Published: February 2021

A workshop entitled “Deriving Compound-Specific Exposure Limits for Chemicals Used in Pharmaceutical Synthesis” was held at the 2018 Genetic Toxicology Association annual meeting. The objectives of the workshop were to provide an educational forum and use case studies and live multiple-choice polling to establish the degree of similarity/diversity in approach/opinion of the industry experts and other delegates present for some of the more challenging decision points that need to be considered when developing a compound-specific exposure limit (ie, acceptable intake or permissible or permitted daily exposure). Herein we summarize the relevant background and case study information for each decision point topic presented as well as highlight significant polling responses and discussion points. A common observation throughout was the requirement for expert judgment to be applied at each of the decision points presented which often results in different reasoning being applied by the risk assessor when deriving a compound-specific exposure limit. This supports the value of precompetitive cross-industry collaborations to develop compound-specific limits and harmonize the methodology applied, thus reducing the associated uncertainty inherent in the application of isolated expert judgment in this context. An overview of relevant precompetitive cross-industry collaborations working to achieve this goal is described.
Weight Loss and Improvement of Metabolic Alterations in Overweight and Obese Children Through the I2AO2 Family Program: A Randomized Controlled Clinical Trial
Authors: Fernández-Ruiz Virginia E. , Solé-Agustí Maria , Armero-Barranco David , Cauli Omar
Published: February 2021

Childhood obesity is a major public health concern. We wanted to evaluate the effectiveness of a multidisciplinary program based on healthy eating, exercise, cognitive-behavioral therapy, and health education to achieve weight loss and improve metabolic parameters in overweight and obese children. A randomized, controlled clinical trial with long-term follow-up (24 months) was conducted at a community care center in overweight and obese individuals aged 6–12 years. A sample of 108 children was divided into an experimental and a control group receiving a standard care program. The experimental groups received a 12-month interdisciplinary program; the results were evaluated at 4 months, the end of the intervention, and at follow-up 12 months later. Anthropometric and biological marker measurements related to metabolic alterations, dyslipidemia (based on total cholesterol), hyperglycemia, fasting glycaemia, triglycerides, low-density lipoprotein cholesterol, and high-density lipoprotein cholesterol in blood were recorded. The intervention had a significant effect ( p < 0.001) in terms of decreased body mass index, skinfolds, and waist and arm circumferences. These changes were accompanied by biochemical changes underlying an improvement in metabolic parameters, such as a significant reduction in total cholesterol, low-density lipoprotein-cholesterol, triglycerides, and hyperglycemia and a significant increase in high-density lipoprotein-cholesterol. These effects were still significant for markers of excess weight or obesity in the experimental group 12 months after the end of the intervention, suggesting that an enduring change in healthy lifestyles had been maintained period. This interdisciplinary, nurse-led program helped to reduce childhood and adolescent excess weight and obesity and had long-lasting effects.
The Effect of Unsupervised Home-Based Exercise Training on Physical Functioning Outcomes in Older Adults: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
Authors: Mahjur Mahdi , Norasteh Ali Asghar
Published: February 2021

Background:

Exercise training such as balance, aerobic, and resistance training is able to improve physical functioning of older adults. Delivering such exercise regimes at home without supervision may be useful for older adults because they do not have to leave their homes.

Objective:

This systematic review and meta-analysis of randomized controlled trials aimed to establish the effect of unsupervised home-based exercise training regimes on physical functioning (balance and muscle strength) in older adults.

Data sources:

PubMed, CINAHL, Medline, Google Scholar, and Scopus databases and reference lists of included investigations were searched.

Study selection:

Thirteen randomized controlled trials (RCTs) of exercise training impact on balance and upper body strength with concurrent control groups were included in the analysis.

Results:

Our analyses revealed that in older adults, unsupervised home-based various exercise training was effective in improving measures of proactive balance (mean difference (MD) = −1.37 s; 95% confidence interval (CI), −2.24, −0.51 s; p = 0.002) and balance test battery (MD: 1.80; 95% CI, 0.46, 3.14 s; p = 0.009). There were no significant differences between the experimental and control groups for upper body strength ( p > 0.05).

Conclusion:

Unsupervised home-based exercise training improves balance in older adults. Future investigations are needed to clarify the mechanisms underlying unsupervised home-based exercise training’s effect on this population’s physical functioning outcomes.
Global Pandemicity of COVID-19: Situation Report as of June 9, 2020
Authors: Sanyaolu Adekunle , Okorie Chuku , Hosein Zaheeda , Patidar Risha , Desai Priyank , Prakash Stephanie , Jaferi Urooj , Mangat Jasmine , Marinkovic Aleksandra
Published: February 2021

A novel coronavirus was identified as the cause of a cluster of pneumonia cases in Wuhan, China in December 2019. This cluster quickly spread across the globe and led the World Health Organization (WHO) to declare severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) a pandemic on March 11, 2020. It’s sudden emergence, ceaseless human-to-human transmission, and rapid spread has led to continuous pandemicity. As of June 9, 2020, there were 7 039 918 confirmed cases and 404 396 deaths globally. The rate of spread of COVID-19 is affected through respiratory droplets, most commonly when infected individuals cough or talk. The virus is released through respiratory secretions that infect individuals once contact with mucous membranes is made directly or indirectly. Our research was conducted via an electronic literature review on PubMed, Google Scholar, and MedLine Plus. Data were then collected from peer-reviewed articles that included applicable keywords and published between January 1, 2020, and June 9, 2020. This article highlights the rapid spread of SARS-CoV-2 worldwide and indicates a higher number of mortalities in the elderly and those with comorbidities. As the number of cases increases, an immediate need to “flatten the curve” is essential to avoid catastrophic overwhelming of hospital systems across the affected countries. To do so, there is an emphasis on detection, testing, isolating the infected, and organizing the healthcare response to the virus. The rapid spread of infection has impacted over 200 countries and territories to date. This report takes a closer look at the cases, fatalities, and recoveries in different regions of the world with details regarding the geographic scale of SARS-CoV-2 spread, risks, and the subsequent impact on the countries affected. Also, this report discusses some effective measures that were carried out by some countries that helped them to mitigate the pandemic and flatten the curve of COVID-19 spread as early as possible.
Systematic Review of Interventions to Reduce Operating Time in Lung Cancer Surgery
Authors: Hoefsmit Paulien C , Cerfolio Robert J , de Vries Ralph , Dahele Max , Zandbergen H Reinier
Published: February 2021

Introduction:

Operating rooms are a scarce resource but often used inefficiently. Operating room efficiency emerges as an important part of maximizing surgical capacity and productivity, minimizing delays, and optimizing lung cancer outcomes. The operative time (time between patient entering and leaving the operating room) is discrete and the one that the surgical team can most directly influence. We performed a systematic review to evaluate the literature and identify methods to improve the efficiency of the intraoperative phase of operations for lung cancer.

Methods:

A literature search (in PubMed, Embase, Cochrane, and Scopus) was performed from inception up to March 9, 2020, according to the methodology described in the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement.

Results:

We identified 3 articles relevant to the intraoperative phase of lung cancer operating room efficiency. All 3 were consistent in showing clinically relevant time reductions in the intraoperative phase or procedures relevant to this phase. The authors demonstrated that the application of various improvement methodologies resulted in a substantial reduction in operative time, which was associated with a reduction in complications, and improved staff morale.

Conclusions:

Our systematic review found that various improvement methodologies have the potential to significantly reduce operative time for lung cancer surgery. This increases the value of lung cancer surgery. These findings are consistent with the wider literature on improving surgical efficiency.
Testing the EPDS and PHQ-9 Among Peripartum Adolescents in Nairobi, Kenya: a Mixed-Methods Study
Authors: Kumar Manasi , Huang Keng Yen , Othieno Caleb , Kagoya Martha , Nyongesa Vincent , Yator Obadia , Madeghe Beatrice , Unutzer Jurgen , Saxena Shekhar , McKay Mary
Published: February 2021

Background:

Cognitive interviewing is a well-recognised methodology to identify clinical and commonsensical relevance of mental health questionnaire items by our research participants. Depression is amongst the most common condition impacting pregnant and parenting adolescents in sub-Saharan Africa (SSA). In Kenya, studies have reported depression prevalence estimates of 12-50% in peripartum adolescents. While young people prefer using English, there has not been enough data to point to how well they respond to Kiswahili translations of the commonly used tools.

Method:

Thirty-two participants between ages 14-18 years were approached and through informed consent for them to participate. We used Edinburgh Postnatal Depression Scale (EPDS) and Patient Health Questionnaire-9 (PHQ-9) in English and Kiswahili versions to carry out the interviews and were coded along with 4 domains of comprehension, retrieval, judgement, and patient response. The interviews were discussed within the team and tables were shared between 3 raters for further consensus. The interview transcripts were analyzed manually using thematic analysis. We used the findings from the interviews to make modifications to the existing English versions of EPDS and PHQ-9 and to modify Kiswahili versions too.

Discussion:

We found that adolescents had challenges in fully understanding items in both sets of tools however, EPDS was better received than PHQ-9. Psychometrically, the EPDS English version and Kiswahili versions fared better than the PHQ-9 English and Kiswahili versions. PHQ-9 presented considerable issues with regards to semantic clarity however had simpler response options in comparison to EPDS which was more experientially appropriate, but response options were not simple. On our thematic analysis, we felt that the adolescents were significantly challenged by the new, unanticipated pregnancy or motherhood experience. Poverty, poor partner support, discord with parents and distress in the family, and traumatic end of supportive and helpful relationships were the notable problems. We believe the cultural and linguistic modifications made on these tools would make them more suitable to be validated with a sample of pregnant adolescents.

Conclusion:

While sensitive cross-cultural translations for the commonly used open access depression tools is critical, it is also pertinent to understand whether these are developmentally appropriate. Our participants had multiple psychosocial and material challenges that necessitate measures sensitive to their age, social context, and health experiences. Additionally, we felt that both the tools may not be suitable for self-administration and may need the involvement of a case worker or community health worker.
Comparing telehealth to traditional office visits for patient management in the COVID-19 pandemic: A cross-sectional study in a respiratory assessment clinic
Authors: Phillips J Cole , Lord Richard W , Davis Stephen W , Burton Amanda A , Kirk Julienne K
Published: February 2021

Introduction

The aim of this study was to examine whether telehealth is as safe and effective as traditional office visits in assessing and treating patients with symptoms consistent with COVID-19.

Methods

In this retrospective cross-sectional study, the primary outcome was any 14-day related healthcare follow-up event(s). Secondary outcomes were the type of 14-day related follow-up event including hospital admission, emergency department visit, office visit, telehealth visit and/or multiple follow-up visits. Individual visit types were identified due to the significant difference between a hospital admission and an office visit. Logistic regressions were done using the predictors of visit type, age, gender and comorbidities and the primary outcome variable of a related follow-up visit and then by follow-up type: hospital admission, emergency department visit or office visit.

Results

Of 1305 visits, median age was 42.3 years and 65.8% were female. Traditional office visits accounted for 741 (56.8%) of initial visits, while 564 (43.2%) visits occurred via telehealth. One hundred and forty-six (25.9%) of the telehealth visits resulted in a 14-day related healthcare follow-up visit versus 161 (21.7%) of the office visits (adjusted odds ratio (OR) 1.22, 95% CI 0.94–1.58).

Discussion

There was no significant difference in related follow-ups of initial telehealth visits compared to initial office visits including no significant difference in hospital admission or emergency department visits. These findings suggest that based on follow up healthcare utilization, telehealth may be a safe and effective option in assessing and treating patients with respiratory symptoms as the COVID-19 pandemic continues.
Activist memory narration on social media: Armenian genocide on Instagram
Authors: Davidjants Jaana , Tiidenberg Katrin
Published: February 2021

This article explores diasporic activist memory narration on social media. We analyze the multimodal content and comments on the Instagram account “Armenians in Lebanon” (AiL), Instagram’s affordances, and interview data with their social media manager to understand how memory is narrated, how specific audiences respond to it, and how Instagram as a platform shapes it. We found three temporally non-linear memory activist narratives—“Survival,” “Suffering,” and “Never Forget.” These narratives leverage Instagram’s affordances of visuality, scalability, and interactivity and combine social media branding practices with framing to recount the past so as to serve the diaspora Armenians’ present and future needs of genocide recognition and reparations. In the narrative, Armenians are positioned as both continually suffering because of, and thriving despite of Turkey, as well as committed to extending their quest for genocide recognition into the future.
Renewal model for anomalous traffic in Internet2 links
Authors: Nicholson John , Kokoszka Piotr , Lund Robert , Kiessler Peter , Sharp Julia
Published: February 2021

We propose and estimate an alternating renewal model describing the propagation of anomalies in a backbone internet network in the United States. Internet anomalies, either caused by equipment malfunction, news events or malicious attacks, have been a focus of research in network engineering since the advent of the internet over 30 years ago. This article contributes to the understanding of statistical properties of the times between the arrivals of the anomalies, their duration and stochastic structure. Anomalous, or active, time periods are modelled as periods containing clusters or 1s, where 1 indicates a presence of an anomaly. The inactive periods consisting entirely of 0s dominate the 0–1 time series in every link. Since the active periods contain 0s, a separation parameter is introduced and estimated jointly with all other parameters of the model. Our statistical analysis shows that the integer-valued separation parameter and five other non-negative, scalar parameters satisfactorily describe all statistical properties of the observed 0–1 series.
What makes It Difficult to keep an Intimate Relationship: Evidence From Greece and China
Authors: Apostolou Menelaos , Wang Yan
Published: February 2021

Keeping an intimate relationship is challenging, and there are many factors causing strain. In the current research, we employed a sample of 1,403 participants from China and Greece who were in an intimate relationship, and we classified 78 difficulties in keeping an intimate relationship in 13 factors. Among the most common ones were clinginess, long work hours, and lack of personal time and space. Clinginess was reported as a more common source of relationship strain by women, while bad sex was reported as a more common source of relationship strain by men. Fading away enthusiasm, bad sex, infidelity and children were reported as more important by older participants, while lack of personal time and space, and character issues were reported as more important by younger participants. The factor structure was similar in the Greek and in the Chinese cultural contexts, but there were also differences. In addition, there were significant interactions between the sample and the sex. For instance, for the non-monogamous factor, men gave higher scores than women in both samples, but the difference was much more pronounced in the Greek sample.
Design and development of fibrous filter media induced by structural characteristics of needle punched nonwoven
Authors: Roy Rupayan , Ishtiaque SM
Published: February 2021

This article discussed the structural changes influenced by punching parameters and their impact on the functional properties of needle punched nonwoven. Three punching parameters i.e., punch density, needle penetration depth and stroke frequency were considered as process variables. Three factors three levels Box Behnken experimental design was used for sample preparation. Newly proposed structural indices were used to evaluate the fibre orientation in X and Y direction of fabric using tracer fibre technique. It was found that measured functional properties of fabrics are well correlated with considered structural indices. The fibre coverage area inferred an increase but coefficient of fibre curliness and anisotropy of inclination angle of fibre observed a decrease, with the increase of punch density, needle penetration depth and stroke frequency. Mean flow pore size followed an initial decrease and then, increase, but filtration efficiency and pressure drop followed an initial increase and then, decrease with the increase of punch density, needle penetration depth and stroke frequency. Finally, process parameters were optimized to achieve a filter media with maximum filtration efficiency and minimum pressure drop.
Postoperative Radiotherapy Omitting Level Ⅳ for Locally Advanced Supraglottic and Glottic Laryngeal Carcinoma
Authors: Wu Yang , Zhang Longzhen , Tang Tianyou , Li Liantao , Li Liang , Yu Hongmin
Published: February 2021

Background:

Cervical lymph nodes metastases are one of the most significant prognostic factors in patients with laryngeal carcinoma, whether treatment by surgery or by radiotherapy. The current study retrospected the postoperative radiotherapy of locally advanced supraglottic and glottic laryngeal carcinoma (at a greater risk of lymph node metastasis) to determine the effect of radiotherapy excluding cervical level Ⅳ lymph nodes.

Methods:

Patients of supraglottic type and glottic type were irradiated with level Ⅳ from January 2012 to June 2013, without level Ⅳ from July 2013 to December 2014, according to physicians’ decision. Ninety-three patients were selective neck irradiation (SNI) of levels Ⅱ-Ⅳ (Group A) and 87 patients were SNI of levels Ⅱ and Ⅲ (Group B). The comparison between Group A and Group B was made with observation of clinical risk of recurrence and radiation complications, as well as overall survival (OS), progress-free survival (PFS) and regional nodal recurrence-free survival.

Results:

No remarkable difference was observed in the distribution of recurrence, levels of relapse, OS, PFS and regional nodal recurrence-free survival between the 2 groups (p > 0.05). Mean radiation dose at level Ⅳ, thyroid and cervical esophagus showed significant difference between the 2 therapeutic groups (p < 0.01). As regard radiation complications, no significant difference was found in radiation dermatitis of any grade between the 2 groups (p > 0.05). However, there was remarkable difference in clinical hypothyroidism and radiation esophagitis between Group A and Group B (p < 0.05).

Conclusions:

Radiotherapy after surgery omitting level Ⅳ may improve the quality of life in patients with locally advanced supraglottic and glottic laryngeal carcinoma, won’t worsen the prognosis as well.
The Effect of Kiwifruit Therapeutics in the Treatment of Diabetic Foot Ulcer
Authors: Kardoust Moein , Salehi Hossein , Taghipour Zahra , Sayadi Ahmadreza
Published: February 2021

Diabetes mellitus is considered a silent disease with possible late chronic complications such as diabetic foot ulcer. This condition is managed by surgical debridement. To improve surgical outcome, some surgeons use proteolytic agents after surgery. Kiwifruit contains a type of proteolytic enzyme called actinidin that may play a role in the treatment of such complication. In the current study, we evaluate the role of kiwifruit extract in the treatment of diabetic foot ulcer. Eighteen diabetic foot ulcer patients were included in a randomized, double-blind clinical trial. The patients were divided randomly to control and experimental groups. Patients in the control group underwent daily wound dressing using base ointment (Eucerin). In the experimental group, we added kiwifruit extract to the standard wound dressing. Clinical data including general appearance of wound (according to recorded photographs before and after medical intervention) were analyzed using SPSS version 22. The mean wound area of the experimental group was significantly less than in the control group ( P = .005) after 4 weeks of treatment. Comparison of the average of size difference, before and after the treatment in the experimental group and the control group, shows that kiwifruit can have a good impact on wound healing ( P = .0001). In patients with diabetic foot ulcer, wound dressing using kiwifruit extract may help reduce time of treatment and may replace surgical debridement for some selected cases.
Surgical Diabetic Foot Infections: Is Osteomyelitis Associated With a Worse Prognosis?
Authors: Aragón-Sánchez Javier , Víquez-Molina Gerardo , López-Valverde María Eugenia , Rojas-Bonilla José María , Murillo-Vargas Christian
Published: February 2021

It has been reported that patients with diabetes and foot ulcers complicated with osteomyelitis (OM) have a worse prognosis than those complicated with soft tissue infections (STI). Our study aimed to determine whether OM is associated with a worse prognosis in cases of moderate and severe diabetic foot infections requiring surgery. A retrospective series consisted of 150 patients who underwent surgery for diabetic foot infections. We studied the differences between OM versus STI. Furthermore, diabetic foot infections were reclassified into four groups: moderate STI (M-STI), moderate OM (M-OM), severe STI (S-STI), and severe OM (S-OM). The variables associated with prognosis were limb loss, length of hospital stay, duration of antibiotic treatment, recurrence of the infection, and time to healing (both the initial ulcer and the postoperative wound). No differences in limb salvage, hospital stay, duration of antibiotic treatment, recurrence of the infection, and time to healing were found when comparing OM with STI. Patients with M-O had a higher rate of recurrences after initial treatment and a longer time to healing when comparing with M-STI. We didn’t find any differences between severe infections with or without OM. In conclusion, we have found in our surgical series of diabetic foot infections that OM is not associated with worse prognosis when comparing with STI regarding limb loss rate, length of hospital stays, duration of antibiotic treatment, recurrence of the infection, and time to healing. The results of the present series should further be confirmed by other authors.
The Mandala Model of Transformative Learning
Authors: Chang Ching-Wen
Published: February 2021

Transformative learning theory has provided a sound theoretical base for adult education’s Western and Eastern academic field. This article aims to introduce the mandala model of transformative learning by transferring Mezirow’s theory of perspective transformation onto a mandala map. In the mandala model, the learning agent exercises two capabilities—knowledgeability and reflexivity—to solve and pose problems in learning contexts. The learners accomplish the circle of transformative learning through the four phases of acquiring knowledge, taking actions to praxes, and generating wisdom; they are on the way to fulfill transformative learning. The theoretical model of transformative learning postulates to implement learners’ capabilities and manifest the dynamics of generative mechanisms. Moreover, it postulates to integrate knowledge into personal life and societal situations through actions and praxes and elucidate wisdom and beneficial outcomes in the intrapersonal and interpersonal contexts.
Diagnostic accuracy of automated occlusion detection in CT angiography using e-CTA
Authors: Seker Fatih , Pfaff Johannes Alex Rolf , Mokli Yahia , Berberich Anne , Namias Rafael , Gerry Steven , Nagel Simon , Bendszus Martin , Herweh Christian
Published: February 2021

Background and aim

The aim of this study was to assess the diagnostic accuracy of e-CTA (product name) (Brainomix) in the automatic detection of large vessel occlusions in anterior circulation stroke.

Methods

Of 487 CT angiographies from patients with large vessel occlusions stroke, 327 were used to train the algorithm while the remaining cases together with 140 negative CT angiographies were used to validate its performance against ground truth. Of these 301 cases, 144 were randomly selected and used for an additional comparative analysis against 4 raters. Sensitivity, specificity, positive and negative predictive value (PPV and NPV), accuracy and level of agreement with ground truth (Cohen’s Kappa) were determined and compared to the performance of a neuroradiologist, a radiology resident, and two neurology residents.

Results

e-CTA had a sensitivity and specificity of 0.84 (0.77–0.89) and 0.96 (0.91–0.98) respectively for the detection of any large vessel occlusions on the correct side in the whole validation cohort. This performance was identical in the comparative analysis subgroup and was within the range of physicians at different levels of expertise: 0.86–0.97 and 0.91–1.00, respectively. For the detection of proximal occlusions, it was 0.92 (0.84–0.96) and 0.98 (0.94–1.00) for the whole cohort and 0.93 (0.80–0.98) and 1.00 (0.95–1.00) for the comparative analysis, respectively for e-CTA. The range was 0.8–0.97 for sensitivity and 0.97–1.00 for specificity for the four physicians.

Conclusions

The performance of e-CTA in detecting any large vessel occlusions is comparable to less experienced physicians but is similar to experienced physicians for detecting proximal large vessel occlusions.
Update on systemic treatment in early triple negative breast cancer
Authors: Núñez Abad Martín , Calabuig-Fariñas Silvia , Lobo de Mena Miriam , José Godes Sanz de Bremond María , García González Clara , Torres Martínez Susana , García-García José Ángel , Iranzo González-Cruz Vega , Camps Herrero Carlos
Published: February 2021

Triple negative breast cancer (TNBC) is a heterogeneous disease representing about 15% of all breast cancers. TNBC are usually high-grade histological tumors, and are generally more aggressive and difficult to treat due to the lack of targeted therapies available, and chemotherapy remains the standard treatment. There is a close relationship between pathological complete response after chemotherapy treatment and higher rates of disease-free survival and overall survival. In this review of systemic treatment in early triple negative breast cancer, our purpose is to analyze and compare different therapies, as well as to highlight the novelties of treatment in this breast cancer subtype.
A finite element analysis engineering solution to short riveted connections under dynamic loadings
Authors: Hill Aaron Thomas , Williamson Eric
Published: February 2021

The research presented in this manuscript focuses on the development of an LS-DYNA finite element model to predict the dynamic shear strength of short riveted lap-spliced specimens. Using data collected from experimental testing at the U.S. Army Engineer Research and Development Center (ERDC), a finite element model was developed to replicate the behavior of A502 Grade short riveted connections under quasi-static loading. Subsequent analyses used published Cowper-Symonds constitutive model coefficients to replicate the behavior of these connections under dynamic loading. Computed results were then compared with available test data from ERDC. Given the challenges involved in creating physical models with riveted connections and the abundance of historical bridges constructed with rivets, the developed finite element analysis engineering solution can serve as a critical tool for researchers interested in predicting the response of short riveted connections to dynamic loading and those interested in developing strategies to mitigate against this loading.
Long‐term outcomes of pregnant women with pulmonary hypertension diagnosed by echocardiography: a retrospective cohort study in a single center from China
Authors: Lai Weisi , Ding Yiling , Wen Lieming
Published: February 2021

Recent studies suggest that pregnancy may not be absolutely contraindicated in women with moderate pulmonary hypertension. We aimed to evaluate the long‐term outcomes of pregnant women with pulmonary hypertension diagnosed by echocardiography in our clinical department. Pregnant women with pulmonary hypertension, diagnosed by a pulmonary systolic arterial pressure > 30 mmHg via echocardiography, who were admitted in our department for termination of pregnancy or delivery between 2004 and 2016 were included in this retrospective cohort study. Demographic characteristics, clinical histories, perinatal outcomes, and follow‐up outcomes after discharge were reported. The primary outcome was survival of the pregnant women after discharge. A total of 88 pregnant women with pulmonary hypertension were included in this cohort study. The women were categorized into severe and moderate pulmonary hypertension groups according to their pulmonary systolic arterial pressure at admission. Women with severe pulmonary hypertension were significantly more likely to have deteriorated cardiac function and higher incidence of neonatal complications during the perinatal periods (p < 0.05). During a median follow‐up of 26 months, the mortality rate was significantly higher in women with severe pulmonary hypertension (p < 0.05). However, the accumulated survival rate was >90% for women with moderate pulmonary hypertension within the follow‐up period. Multivariate Cox regression analyses showed that poor cardiac function before pregnancy, irregular antenatal care, and hyperuricemia were independent mortality risk factors for women with pulmonary hypertension after discharge. In conclusion, the long‐term survival of pregnant women with moderate pulmonary hypertension diagnosed by echocardiography was considered acceptable in this cohort. Our findings suggest that pregnancy might not be absolutely contraindicated in women with moderate pulmonary hypertension.
Deficiency of antioxidants and increased oxidative stress in COVID-19 patients: A cross-sectional comparative study in Jigawa, Northwestern Nigeria
Authors: Muhammad Yahaya , Kani Yamuna Aminu , Iliya Sani , Muhammad Jafaru Bunza , Binji Abubakar , El-Fulaty Ahmad Abdurrahman , Kabir Muhd Bashir , Umar Bindawa Kabir , Ahmed Armaya’u
Published: February 2021

Introduction:

The COVID-19 is a pandemic caused by SARS-CoV-2 which has infected over 74 million people, killing more than 1,600,000 million people around the world as of 17th December 2020. Accumulation of free radicals coupled by weakened antioxidant system leads to oxidative stress, which will further worsen respiratory diseases, COVID-19 inclusive. This study aimed to examine the levels of some antioxidants and oxidative stress markers in COVID-19 patients.

Methods:

This was a cross-sectional comparative study in which 50 COVID-19 symptomatic patients who were on admission at the COVID-19 isolation center in Jigawa, Northwestern Nigeria, were recruited. Twenty one (21) apparently healthy individuals were included as controls. Levels of antioxidant trace elements (Se, Zn, Mg, Cu and Cr), 8-isoprostaglandin F2 alpha and malondialdehyde in the plasma and erythrocytes activity of glutathione, glutathione peroxidase, superoxide dismutase and catalase were determined.

Results:

The plasma concentrations of vitamins A, C and E were significantly lower ( p < 0.001) in COVID-19 patients than controls. Activities of glutathione, glutathione peroxidase, catalase and superoxide dismutase were lower in COVID-19 subjects than controls ( p < 0.001). The concentrations of Se, Zn, Mg and Cu were significantly lower ( p < 0.001; p = 0.039; p < 0.001; and p < 0.001), respectively, in COVID-19 patients than controls, while chromium showed no significant difference ( p = 0.605). Oxidative stress marker, 8-isoprostaglandin F2 alpha, was significantly higher ( p = 0.049), while malondialdehyde was lower ( p < 0.001) in COVID-19 patients than controls.

Conclusion:

In conclusion, COVID-19 patients are prone to depleted levels of antioxidant substances due to their increase utilization in counterbalancing the negative effect of free radicals. Furthermore, COVID-19 infection with other comorbidities, such as malaria, hypertension and diabetes, are at higher risk of developing oxidative stress.
Late-onset cytomegalovirus pneumonitis successfully treated by cytomegalovirus immunoglobulin in heart transplant patient with renal failure
Authors: Jaksic Jurinjak Sandra , Hulak Vanja , Udovicic Mario
Published: February 2021

Cytomegalovirus infection is one of the most serious pathogens affecting solid organ transplant recipients. Cytomegalovirus has been identified as a risk factor for graft rejection, cardiac allograft vasculopathy and is associated with increased morbidity and mortality. Viral clearance is not achieved in all patients despite standard antiviral therapy; therefore, there is great interest in prevention and treatment strategies, as use of specific cytomegalovirus immunoglobulin, to avoid progression to organ involvement. Dose regimen of specific cytomegalovirus immunoglobulin is not well studied, especially in cytomegalovirus disease. We present the case of late onset of tissue invasive disease, pneumonitis, in young female patient after heart transplantation with acute renal failure, successfully treated with frequent intermittent cytomegalovirus immunoglobulin followed by renal dosed ganciclovir.
An unusual case of abdominal pain and splenomegaly in a paediatric patient
Authors: Eckbo Eric J , Mijovic Hana , Tam Jennifer , Goldfarb David M , Kollmann Tobias R
Published: February 2021

Fusobacterium species are members of the oral microbiota and have been found to cause a wide spectrum of opportunistic infections. We describe the case of a previously healthy teenager with a large splenic abscess secondary to Fusobacterium nucleatum, successfully managed with percutaneous drainage and intravenous antibiotics. Identification of the organism was achieved using anaerobic culture of the aspirated fluid and matrix-assisted laser desorption/ionization time of flight, later confirmed by 16S ribosomal RNA metagenomic sequencing of the fluid. Fusobacteria are typically associated with oropharyngeal infections but are very rarely implicated in splenic abscesses. Aerobic and anaerobic blood cultures should be drawn when an intra-abdominal infection is suspected in a paediatric patient, and empiric antimicrobial therapy should be administered with coverage for gram-positive, gram-negative, and anaerobic bacteria.
The Implementation of a Stress Management Program for Health Care Workers Through a Rural Occupational Health Clinic
Authors: White Crystal H. , Meier Niessa , Swint Charlotte
Published: February 2021

Background:

Stress affects U.S. healthcare workers (HCWs) and costs US$191 billion annually. About 30% to 50% of healthcare providers report burnout. Based on an assessment of a U.S. rural hospital system, 94% of workers experienced negative health consequences. We conducted a quality improvement (QI) project for the purpose of implementing a stress management program for HCWs in a hospital system.

Methods:

A total of 500 HCWs were informed of the program through hospital communication channels. Using the Plan–Do–Study–Act (PDSA) process, we screened workers presenting to the occupational health clinic for care. Project team members recruited other workers for stress screening throughout the organization. Interventions included contacting workers with elevated scores on the Perceived Stress Survey (PSS; N = 213). The nurse practitioner scheduled them for a shared-decision-making (SDM) appointment ( N = 33) where workers were informed of and encouraged to participate in stress reduction activities. Surveys were used to assess effectiveness of SDM appointments and the stress reduction activities. After each 2-week PDSA cycle, interventions were adjusted.

Findings:

Of the 42% ( N = 213) of workers who were screened for stress, 24% ( n = 52) had elevated scores. Fifty percent ( n = 26) completed an SDM appointment. Participants reported an 86% assurance level that they would use personalized stress management plans. Participants utilizing the interventions ( n = 271) reported 25% to 72% reduced stress levels.

Conclusions/Application to Practice:

This successful project, in a rural setting, included workers across job classifications. Team engagement, PSS screening, SDM opportunities, and stress management activities were project strengths. This low-cost project can be replicated.
A Discussion on the Criteria for Surgical Decision-Making in Elderly Patients With Metastatic Spinal Cord Compression
Authors: Gao Xin , Wu Zheyu , Wang Tao , Cao Jiashi , Bai Guangjian , Xin Baoquan , Cao Shuang , Jia Qi , Liu Tielong , Xiao Jianru
Published: February 2021

Study Design:

Retrospective study.

Objectives:

Although the role of surgery in the management of metastatic spinal cord compression (MSCC) has been well established, elderly patients may still be denied surgery because of higher risk of complications and shorter life expectancy. The purpose of this study was to determine whether elderly patients with MSCC could benefit from surgery and discuss the criteria for surgical decision-making in such patients.

Methods:

Enrolled in this study were 55 consecutive patients aged 75 years or older who were surgically treated for MSCC in our center. Prognostic factors predicting overall survival (OS) were explored by the Kaplan-Meier method and Cox regression model. The quality of life (QoL) of the patients was evaluated by the SOSGOQ and compared using Student’s t test. Risk factors for postoperative complications were identified by Chi-square test and multiple logistic regression analysis.

Results:

Surgical treatment for MSCC substantially improved the neurological function in 55.8% patients and QoL in 88.5% patients with acceptable rates of postoperative complications (16.4%), reoperation (9.1%), and 30-day mortality (1.8%). Postoperative ECOG-PS of 1-2, total en-bloc spondylectomy (TES), and postoperative chemotherapy were favorable prognostic factors for OS, while a high Charlson Comorbidity Index (CCI) and a long operation time were risk factors for postoperative complications.

Conclusions:

Surgery should be encouraged for elderly patients with MSCC 1) who are compromised by the current or potential neurological dysfunction; 2) with radioresistant tumors; 3) with spinal instability; and 4) with no comorbidity, ECOG-PS of 0-2, and systemic treatment adherence. In addition, surgery should be performed by a skilled and experienced surgical team.
Clinical Outcomes for Isolated Subscapularis Tears With Advanced Fatty Infiltration: Nonoperative Treatment Versus Arthroscopic Single-Row Repair
Authors: Yoon Tae-Hwan , Kim Sung-Jae , Choi Yun-Rak , Keum Ho-Sung , Chun Yong-Min
Published: February 2021

Background:

No study has investigated the treatment outcomes of isolated subscapularis tears with advanced fatty infiltration and tear progression to the supraspinatus tendon.

Purpose:

To assess the natural progression of isolated subscapularis tears with advanced fatty infiltration and compare clinical outcomes between nonoperative and operative treatment.

Study Design:

Cohort study; Level of evidence, 3.

Methods:

This study included 52 patients who received either operative (group A) or nonoperative (group B) treatment at our institution for isolated subscapularis full-thickness tears with grade 3 or 4 advanced fatty infiltration. All study patients had a minimum 2-year follow-up. The following 4 functional measures were used: visual analog scale for pain, Subjective Shoulder Value, American Shoulder and Elbow Surgeons score, and University of California Los Angeles score. The modified belly-press test was used to assess subscapularis muscle strength. In group A, structural integrity was evaluated using magnetic resonance imaging at 6 months after surgery. In addition, ultrasonographic evaluation was performed on both groups during the follow-up period to assess tear progression into the supraspinatus tendon.

Results:

At initial presentation, all functional assessment scores were significantly worse in group A versus group B ( P ≤ .05 for all 4 scores). When we compared the mean change in scores before treatment versus after treatment, the group A patients were found to have significantly greater improvement than group B patients ( P < .001 for all 4 scores); however, no significant difference was seen in final outcome scores between the groups. Although a high retear rate of 78.6% (22/28) was identified in group A, both groups showed no further tear progression to the supraspinatus tendon at the final ultrasonographic evaluation.

Conclusion:

For isolated subscapularis tears with advanced fatty infiltration, clinical improvement was seen with both nonoperative and operative treatment. Although the operatively treated group started with lower baseline scores, there were no significant differences in outcomes at final follow-up. Considering the high retear rate even after repair, surgical treatment of these lesions may not be warranted. Early detection and prompt repair of subscapularis tears, before the lesion becomes advanced with grade 3 or 4 fatty infiltration, are important for better outcomes.