bluuebunny/crossref_metadata_2025 huggingface dataset:
Atomistic investigation of GFRP composites under chloride environment
Authors: Wang Xing Quan , Lau Denvid
Published: October 2020

Fiber reinforced polymer composites have paved the way for the evolution of the engineering materials. Glass fiber reinforced polymer (GFRP) has become one of the most promising materials among the novel composites due to its low price and high performance. Here, the GFRP composite in investigated by fill atomistic molecular dynamics, which contains the epoxy matrix and amorphous silica substrate. The degradation in chloride environment is revealed through the interfacial interactions, the structural changes of the epoxy matrix and hydrogen bonding in the composites. Compared to dry and aqueous environment, the simulation results show that chloride environment leads to the worst deterioration of interfacial adhesion, which correlates with structural and mechanical degradation of bonded interface, as indicated by the decreased epoxy density close to interface. It is indicated by examining the nano-structures of the interface during the pulling process that the chloride environment hinders the formation of intramolecular and intermolecular hydrogen bonds in the GFRP composites. These findings indicate the deterioration towards bond and matrix is critical in the presence of the chloride environment, which provides the fundamental insight for designing and predicting performance degradation of macroscopic GFRP composites in the marine application.
Structural model updating study in consideration of complex pre-stress distribution
Authors: Luyun Chen , Xichun Huang , Hong Yi
Published: October 2020

In the present work, to improve the accuracy of the numerical model, the structural model updating problem is investigated in consideration of the influence of pre-stress. In order to eliminate the influence of complex pre-stress on the calculation scale and calculation precision for the continuous structures, the structural dynamic model updating is implemented by using the structural optimization strategy. The optimization function is established, in which the residual value of natural frequency parameter between the finite element model with/without complex pre-stress distribution is defined as objective function under certain constraints. Finally, the thin cylindrical shell structure with welding residual stress distribution, for example, the structural model updating is carried out, and the numerical results verify the feasibility and effectiveness of the proposed method.
Food and Housing Insecurity for Latinx/a/o College Students: Advancing an Intersectional Research Agenda
Authors: Duran Antonio , Núñez Anne-Marie
Published: October 2020

Along with concerns about higher education’s declining affordability, attention to food and housing insecurity among postsecondary students has risen, especially with the COVID-19 pandemic. In this manuscript, the authors review how literature has examined food/housing insecurity for Latinx/a/o students before employing an intersectional lens to develop a research agenda to investigate food/housing insecurity for Latinx/a/o students. This agenda emphasizes interrogating how interrelated systems of power and oppression affect Latinx/a/o students’ access to basic needs.
Prognostic significance of the sum of the diameters of single foci in multifocal papillary thyroid cancer: the concept of new-old tumor burden
Authors: Manso Jacopo , Censi Simona , Roberti Amir , Iacobone Maurizio , Barollo Susi , Bertazza Loris , Galuppini Francesca , Vianello Federica , Albinger Nora , Scaroni Carla , Pennelli Gianmaria , Mian Caterina
Published: October 2020

Aim:

The prognostic value of multifocality (Mu) in papillary thyroid cancer (PTC) remains controversial. The present study aimed to investigate this issue and test the possible prognostic significance of the sum of the diameters of single foci (SDSF), the total number of foci (TNF), and primary tumor size (PTS) in multifocal PTC.

Methods:

We retrospectively analyzed a single-center consecutive series of 370 PTCs. For multifocal cases we analyzed bilaterality occurrence, SDSF, TNF, and PTS.

Results:

Mu was observed in 41.1% PTCs, and bilaterality in 30%. Mu was associated with an advanced T-category. In bilateral multifocal PTC, the PTS was larger, and microPTC was less frequent, while T-categories were higher. Mu and bilaterality per se had no impact on prognosis. At univariate analysis, PTS, SDSF, vascular invasion, lymph node metastases, distant metastases, T-categories, Initial Risk Stratification System score, second treatment and TERT promoter mutation correlated with persistence/recurrence or death in the multifocal PTC group. On multivariate Cox proportional hazards regression analyses, SDSF again independently predicted persistence/recurrence or death in multifocal PTCs. We found that a cut-off for SDSF less than 40 mm was able to identify multifocal PTC patients with a very low risk of persistence/recurrence (negative predictive value 96.9%). Disease-free survival was significantly shorter in patients with multifocal PTCs and SDSF ⩾40 mm.

Conclusions:

Mu and bilaterality per se were not prognostically significant. SDSF emerged as a new independent prognostic factor for persistence/recurrence of multifocal PTC. SDSF might better represent the tumor burden in multifocal PTC, with SDSF < 40 mm identifying multifocal PTC patients with a good prognosis.
Long‐term chronic intermittent hypoxia: a particular form of chronic high‐altitude pulmonary hypertension
Authors: Brito Julio , Siques Patricia , Pena Eduardo
Published: October 2020

In some subjects, high‐altitude hypobaric hypoxia leads to high‐altitude pulmonary hypertension. The threshold for the diagnosis of high‐altitude pulmonary hypertension is a mean pulmonary artery pressure of 30 mmHg, even though for general pulmonary hypertension is ≥25 mmHg. High‐altitude pulmonary hypertension has been associated with high hematocrit findings (chronic mountain sickness), and although these are two separate entities, they have a synergistic effect that should be considered. In recent years, a new condition associated with high altitude was described in South America named long‐term chronic intermittent hypoxia and has appeared in individuals who commute to work at high altitude but live and rest at sea level. In this review, we discuss the initial epidemiological pattern from the early studies done in Chile, the clinical presentation and possible molecular mechanism and a discussion of the potential management of this condition.
‘Tired, afraid, breathless … .’ An international survey of the exercise experience for people living with pulmonary hypertension
Authors: Chia Karen S.W. , Brown Karen , Kotlyar Eugene , Wong Peter K. K. , Faux Steven G. , Shiner Christine T.
Published: October 2020

Patients with pulmonary hypertension are more sedentary than the general population, but attitudes and experiences that may influence their exercise behaviour remain poorly understood. This study identified patterns of behaviour, attitudes towards exercise, barriers and enablers of exercise for people living with pulmonary hypertension. Accessibility of rehabilitation services from a patient perspective was also explored. A voluntary, international survey of people living with pulmonary hypertension was conducted, with mixed quantitative and qualitative data collection. Data from 187 participants in 19 countries were included in the analyses. In total, 52% (95/183) of people with pulmonary hypertension reported that they attempted to engage in regular physical activity. This was less than the proportion who did so prior to diagnosis (61%, 112/184, p = 0.006) and was accompanied by uncertainty and anxiety about exercise. In total, 63% (113/180) of the cohort reported experiencing previous adverse events while exercising, which was associated with a greater likelihood of ongoing exercise concerns and anxiety. Fear, frustration and uncertainty about exercise were noted as common barriers to engaging in exercise with pulmonary hypertension. Other barriers to exercise included intrinsic factors such as debilitating breathlessness and fatigue, and external factors such as cost and access to appropriate services. Most respondents (76%, 128/169) did not have access to a multi‐disciplinary rehabilitation service, although an overwhelming majority (92%, 159/172) reported that this would be helpful. Respondents rated education; a supervised, structured exercise programme; and psychology input as the most important components of a multi‐disciplinary rehabilitation service for pulmonary hypertension. Health professionals must work together with consumers to co‐design rehabilitation services that will facilitate exercise and increased activity for people living with pulmonary hypertension.
Gaining and Recording Consent: A Practical guide for the Dental Team
Authors: Holden Alexander C L
Published: October 2020

Consent is an essential part of any medical or dental treatment. Patients have a well-developed sense of autonomy and society demands that this is respected by those providing treatment. It is within living memory where the consent process was not held to be so important, with patients being happy to submit to medical and dental opinion without question. This has rapidly evolved to the point where today, even the simplest of procedures requires a solid consent process to take place. The consequences of not doing this are the potential for litigation, professional sanction and most importantly, the potential to deprive patients of the right to determination of what treatment they allow to be done to them. This article aims to illustrate the principles behind gaining consent from competent adult patients and how this might be recorded in clinical notes in a way that properly reflects the process's complexity and importance in the provision of dental treatment.
Temporomandibular Disorder for the General Dental Practitioner
Authors: Beecroft Emma , Penlington Chris , Desai Hannah , Durham Justin
Published: October 2020

Temporomandibular disorder (TMD) is the most common cause of chronic pain in the orofacial region. With prevalence in the general population reported at 10% to 15%, patients will regularly present to general dental practitioners (GDPs) with symptoms relating to TMD. Despite its relative commonality, TMD continues to pose both a diagnostic and management challenge for the general dental practitioner. This article aims to guide clinicians with regards to clinical examination, diagnosis and biopsychosocial management of TMD within primary care.
Placement of a transjugular intrahepatic portosystemic shunt in addition to recanalization of acute and chronic portomesenteric vein occlusions – a retrospective evaluation
Authors: Barbier Charlotte Ebeling , Rorsman Fredrik , Eriksson Lars-Gunnar , Sangfelt Per , Sheikhi Reza , Vessby Johan , Nyman Rickard
Published: October 2020

Background

Portomesenteric vein thrombosis may be life-threatening due to bowel ischemia caused by venous stasis, or variceal bleeding caused by portal hypertension.

Purpose

To evaluate the effectiveness and safety of recanalization combined with transjugular intrahepatic portosystemic shunt in acute and chronic portomesenteric vein thrombosis in patients with and without liver cirrhosis.

Material and Methods

21 consecutive patients (5 women, 16 men; mean 48 years) with portomesenteric vein thrombosis (8 acute, 13 chronic) treated at the Interventional Radiology department between March 2014 and September 2018 were retrospectively reviewed. The main portal vein was completely obliterated and the portomesenteric vein thrombosis extended into the superior mesenteric vein in all patients. The portomesenteric vein thromboses were recanalized transhepatically, a transjugular intrahepatic portosystemic shunt was inserted, thrombectomy was performed in acute portomesenteric vein thrombosis, and angioplasty with or without additional stenting was performed in chronic portomesenteric vein thrombosis.

Results

Recanalization was successful in 8/8 patients (100%) with acute portomesenteric vein thrombosis, and in 11/13 patients (85%) with chronic portomesenteric vein thrombosis. In 12 patients, blood flow was restored in one session. Several sessions were more frequently needed in patients with acute portomesenteric vein thrombosis compared to those with chronic portomesenteric vein thrombosis ( p = 0.003). Re-occlusion occurred and was recanalized in 10/19 patients and was more frequent in patients with chronic ( n = 8/11) than on those with acute ( n = 2/8) portomesenteric vein thrombosis ( p = 0.04). Adverse events occurred in five patients. There was no 30-day mortality.

Conclusion

Recanalization and insertion of a transjugular intrahepatic portosystemic shunt is safe and effective in patients with acute and chronic portomesenteric vein thrombosis with or without cirrhosis. Recanalization was more likely to stay patent in acute compared with chronic portomesenteric vein thrombosis.
Relationship of the Musculocutaneous Nerve and Its Twigs to the Coracoid Process: An Operative Exposure
Authors: Singh Hardeep , Yang Justin S. , Wiley Taylor , Judson Christopher , Arciero Robert A. , Mazzocca Augustus D. , Voss Andreas
Published: October 2020

Background:

A musculocutaneous nerve (MCN) injury is a rare complication of the Latarjet procedure. Most of these injuries are neurapraxias and resolve with time; however, permanent injuries can occur. Understanding the anatomy and relationship of the MCN to the coracoid process is essential to prevent injuries.

Purpose:

To provide realistic, in situ–referenced measurements for the Latarjet procedure.

Study Design:

Descriptive laboratory study.

Methods:

A total of 12 matched-pair cadaveric specimens (24 fresh-frozen shoulders) were dissected. Coracoid osteotomy was performed, and the MCN and its respective twigs were identified. Measurements were made from the coracoid process to the entry site of the nerve twigs and trunk into the coracobrachialis muscle.

Results:

Overall, 70.8% of specimens had twigs; however, there was a discrepancy in the presence (41.7%) and number (75.0%) of twigs in the paired specimens. The most proximal twigs were, on average, 33.5 ± 8.1 mm (range, 21.9-47.6 mm) from the coracoid process. The main trunk was, on average, 51.1 ± 14.4 mm (range, 16.7-71.9 mm) from the coracoid process. In 33.3% of specimens, the nerve entered the coracobrachialis at a distance shorter than 5 cm below the coracoid process, and this increased to 91.7% when the twigs were accounted for.

Conclusion:

The previously described safe zone of 5 cm below the coracoid process may not be reliable to protect the MCN or its twigs. Using 3 cm would decrease the chances of damaging a twig or the main trunk. In 33.3% of the specimens, the nerve entered the coracobrachialis at a distance shorter than 5 cm below the coracoid process, and this increased to 91.7% when twigs were accounted for.

Clinical Relevance:

As the Latarjet procedure is an emerging technique, it is essential to be aware of the anatomic structures and the relation between different neural structures to anatomic points of reference. Therefore, the results of this study add significant information for a safe surgical procedure for the majority of patients suffering from shoulder instability.
Sumatriptan as abortive treatment in cyclic vomiting syndrome: A cross-sectional study
Authors: Lin Bixuan , Zhou Zhipeng , Venkatesan Thangam
Published: October 2020

Cyclic vomiting syndrome (CVS) is characterized by episodic vomiting and shares similarities with migraine headache. Guidelines recommend using triptans as abortive therapy in CVS, but there are limited data on its efficacy. Methods: We thus sought to characterize sumatriptan use and performed a cross-sectional study of adults with CVS episodes within the previous 6 months. Questionnaires about demographics, clinical characteristics, and response to sumatriptan (defined as >50% reduction in symptoms) were administered via e-mail. We investigated differences between responders and nonresponders, using χ 2 and Student’s t test. Results: Of 101 participants (age 41 ± 15 years, 74% female, 83% Caucasian), 39 (38%) used sumatriptan during their last CVS attack. Most reported an improvement in nausea (55%), vomiting (59%), and abdominal pain (43%) within 2 h and at 24 h (67%, 73%, and 67%) respectively. Eighteen (46%) reported that sumatriptan helped them avoid emergency department visits and 20 (51%) avoided being hospitalized. Nonresponse to sumatriptan was associated with depression ( p = 0.01), current cannabis use ( p = 0.02), use of benzodiazepines ( p = 0.04), and opioids (0.02) during an episode. No serious side effects were noted. Conclusions: Sumatriptan use reduced symptoms of CVS but did not abort them. Prospective studies to determine its independent effects are needed.
Midostaurin in patients with acute myeloid leukemia and FLT3-TKD mutations: a subanalysis from the RATIFY trial
Authors: Voso Maria Teresa , Larson Richard A. , Jones Dan , Marcucci Guido , Prior Thomas , Krauter Jürgen , Heuser Michael , Lavorgna Serena , Nomdedeu Josep , Geyer Susan M. , Walker Alison , Wei Andrew H. , Sierra Jorge , Sanz Miguel A. , Brandwein Joseph M. , de Witte Theo M. , Jansen Joop H. , Niederwieser Dietger , Appelbaum Frederick R. , Medeiros Bruno C. , Tallman Martin S. , Schlenk Richard F. , Ganser Arnold , Amadori Sergio , Cheng Yuan , Chen YinMiao , Pallaud Celine , Du Ling , Piciocchi Alfonso , Ehninger Gerhard , Byrd John , Thiede Christian , Döhner Konstanze , Stone Richard M. , Döhner Hartmut , Bloomfield Clara D. , Lo-Coco Francesco
Published: October 2020

The results from the RATIFY trial (ClinicalTrials.gov: NCT00651261; CALGB 10603) showed that midostaurin combined with standard chemotherapy significantly improved outcomes in patients with FMS-like tyrosine kinase 3 (FLT3)–mutated acute myeloid leukemia (AML), compared with placebo. In this post hoc subgroup analysis from the trial, we evaluated the impact of midostaurin in 163 patients with FLT3-tyrosine kinase domain (TKD) mutations. At a median follow-up of 60.7 months (95% CI, 55.0-70.8), the 5-year event-free survival (EFS) rate was significantly higher in patients treated with midostaurin than in those treated with placebo (45.2% vs 30.1%; P = .044). A trend toward improved disease-free survival was also observed with midostaurin (67.3% vs 53.4%; P = .089), whereas overall survival (OS) was similar in the 2 groups. Patients with AML and NPM1mut/FLT3-TKDmut or core binding factor (CBF)–rearranged/FLT3-TKDmut genotypes had significantly prolonged OS with or without censoring at hematopoietic cell transplantation (HCT), compared with NPM1WT/CBF-negative AMLs. The multivariable model for OS and EFS adjusted for allogeneic HCT in first complete remission as a time-dependent covariable, revealed NPM1 mutations and CBF rearrangements as significant favorable factors. These data show that NPM1 mutations or CBF rearrangements identify favorable prognostic groups in patients with FLT3-TKD AMLs, independent of other factors, also in the context of midostaurin treatment.
Bronchoscopically delivered microwave ablation in anin vivoporcine lung model
Authors: Sebek Jan , Kramer Steve , Rocha Rob , Yu Kun-Chang , Bortel Radoslav , Beard Warren L. , Biller David S. , Hodgson David S. , Ganta Charan K. , Wibowo Henky , Yee John , Myers Renelle , Lam Stephen , Prakash Punit
Published: October 2020

Background

Percutaneous microwave ablation is clinically used for inoperable lung tumour treatment. Delivery of microwave ablation applicators to tumour sites within lung parenchyma under virtual bronchoscopy guidance may enable ablation with reduced risk of pneumothorax, providing a minimally invasive treatment of early-stage tumours, which are increasingly detected with computed tomography (CT) screening. The objective of this study was to integrate a custom microwave ablation platform, incorporating a flexible applicator, with a clinically established virtual bronchoscopy guidance system, and to assess technical feasibility for safely creating localised thermal ablations in porcine lungsin vivo.

Methods

Pre-ablation CTs of normal pigs were acquired to create a virtual model of the lungs, including airways and significant blood vessels. Virtual bronchoscopy-guided microwave ablation procedures were performed with 24–32 W power (at the applicator distal tip) delivered for 5–10 mins. A total of eight ablations were performed in three pigs. Post-treatment CT images were acquired to assess the extent of damage and ablation zones were further evaluated with viability stains and histopathologic analysis.

Results

The flexible microwave applicators were delivered to ablation sites within lung parenchyma 5–24 mm from the airway wallviaa tunnel created under virtual bronchoscopy guidance. No pneumothorax or significant airway bleeding was observed. The ablation short axis observed on gross pathology ranged 16.5–23.5 mm and 14–26 mm on CT imaging.

Conclusion

We have demonstrated the technical feasibility for safely delivering microwave ablation in the lung parenchyma under virtual bronchoscopic guidance in anin vivoporcine lung model.
Microbial succession from a subsequent secondary death event following mass mortality
Authors: Harrison Lindsay , Kooienga Emilia , Speights Cori , Tomberlin Jeffery , Lashley Marcus , Barton Brandon , Jordan Heather
Published: October 2020

Background

Each death event can be characterized by its associated microbes – a living community of bacteria composed of carcass, soil, and insect-introduced bacterial species – a necrobiome. With the possibility for close succession of these death events, it may be beneficial to characterize how the magnitude of an initial death event may impact the decomposition and necrobiomes of subsequent death events in close proximity. In this paper we hope to characterize the microbial communities associated with a proximate subsequent death event, and distinguish any changes within those communities based on the magnitude of an initial death event and the biomass of preexisting carcass (es) undergoing decomposition. For this experiment, 6 feral swine carcasses in containers were placed in the vicinity of preexisting and ongoing carcass decomposition at sites of three different scales of decomposing carcass biomass. Swab samples were collected from the skin and eye sockets of the container pigs and subjected to 16 s rRNA sequencing and OTU assignment.

Results

PERMANOVA analysis of the bacterial taxa showed that there was no significant difference in the bacterial communities based on initial mortality event biomass size, but we did see a change in the bacterial communities over time, and slight differences between the skin and ocular cavity communities. Even without soil input, necrobiome communities can change rapidly. Further characterization of the bacterial necrobiome included utilization of the Random Forest algorithm to identify the most important predictors for time of decomposition. Sample sets were also scanned for notable human and swine-associated pathogens.

Conclusions

The applications from this study are many, ranging from establishing the environmental impacts of mass mortality events to understanding the importance of scavenger, and scavenger microbial community input on decomposition.
Molecular epidemiology of clinical Mycobacterium tuberculosis complex isolates in South Omo, Southern Ethiopia
Authors: Wondale Biniam , Keehwan Kwon , Medhin Girmay , Teklu Takele , Mohammed Temesgen , Tolosa Samuel , Zewude Aboma , Amsalu Friehiwot , Pieper Rembert , Ameni Gobena
Published: October 2020

Background

Tuberculosis (TB) is caused byMycobacterium tuberculosiscomplex (MTBC). Mapping the genetic diversity of MTBC in high TB burden country like Ethiopia is important to understand principles of the disease transmission and to strengthen the regional TB control program. The aim of this study was to investigate the genetic diversity ofMycobacterium tuberculosiscomplex (MTBC) isolates circulating in the South Omo, southern Ethiopia.

Methods

MTBC isolates (N = 156) were genetically analyzed using spacer oligotyping (spoligotyping) and mycobacterial interspersed repetitive unit-variable number of tandem repeat (MIRU-VNTR) typing. Major lineages and lineages were identified using MTBC databases. Logistic regression was used to correlate patient characteristics with strain clustering.

Results

The study identified Euro-American (EA), East-African-Indian (EAI), Indo-Oceanic (IO), Lineage_7/Aethiops vertus,Mycobacterium bovisandMycobacterium africanummajor lineages in proportions of 67.3% (105/156), 22.4% (35/156), 6.4% (10/156), 1.9% (3/156), 1.3% (2/156) and 0.6% (1/156), respectively. Lineages identified were Delhi/CAS 23.9% (37/155), Ethiopia_2 20.6% (32/155), Haarlem 14.2% (22/155), URAL 14.2%(22/155), Ethiopia_3 8.4% (13/155), TUR 6.5% (10/155), Lineage_7/Aethiops vertus 1.9% (3/155), Bovis 1.3% (2/155), LAM 1.3% (2/155), EAI 0.6% (1/155), X 0.6% (1/155) and Ethiopia H37Rv-like strain 0.6% (1/155). Of the genotyped isolates 5.8% (9/155) remained unassigned. The recent transmission index (RTI) was 3.9%. Orphan strains compared to shared types (AOR: 0.09, 95% CI: 0.04–0.25) were associated with reduced odds of clustering. The dominant TB lineage in pastoral areas was EAI and in non-pastoral areas was EA.

Conclusion

The epidemiological data, highly diverse MTBC strains and a low RTI in South Omo, provide information contributing to the TB Control Program of the country.
Characteristics of recovered COVID-19 patients with recurrent positive RT-PCR findings in Wuhan, China: a retrospective study
Authors: Shui Tie-Jun , Li Chao , Liu Hong-bing , Chen Xiaohua , Zhang Bi-ke
Published: October 2020

Background

Two months after the outbreak of coronavirus disease 2019 (COVID-19) in Wuhan, China, tens of thousands of hospitalized patients had recovered, and little is known about the follow-up of the recovered patients.

Methods

The clinical characteristics, reverse transcriptase-polymerase chain reaction (RT-PCR) results from throat swab specimens and the results of serological COVID-19 rapid diagnostic test (RDT) for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) were retrospectively reviewed for a total of 758 recovered patients who were previously hospitalized in 17 hospitals and quarantined at 32 rehabilitation stations in Wuhan, China.

Results

In total, 59 patients (7.78%) had recurrent positive findings for COVID-19 on RT-PCR from throat swabs. With regard to antibody detection, 50/59 (84.75%) and 4/59 (6.78%) patients had positive IgG or dual positive IgG/IgM RDT results, respectively.

Conclusions

Some patients who had been quarantined and had subsequently recovered from COVID-19 had recurrent positive RT-PCR results for SARS-CoV-2, and the possibility of transmission of the virus by recovered patients needs further investigation.

Trial registration

Current Controlled Trials ChiCTR2000033580, Jun 6th 2020. Retrospectively registered.
Cost-effectiveness of brentuximab vedotin in advanced stage Hodgkin’s lymphoma: a probabilistic analysis
Authors: Raymakers A. J. N. , Costa S. , Cameron D. , Regier D. A.
Published: October 2020

Background

Treatment with ABVD (doxorubicin, bleomycin, vinblastine, and dacarbazine) is a well-established therapy for advanced Hodgkin’s lymphoma (HL). However, the recently completed ECHELON-1 trial showed potential net clinical benefit for brentuximab vedotin (BREN+AVD) compared to ABVD as frontline therapy in patients with advanced Hodgkin’s lymphoma. The objective of this analysis is to determine whether, on current evidence, BREN+AVD is cost-effective relative to ABVD as frontline therapy in patients with advanced HL.

Methods

We constructed a probabilistic Markov model with two arms and six mutually exclusive health states, using six-month cycle lengths, and a 15-year time horizon. Time-dependent transition probabilities were calculated from ‘real-world’ data collected by the BC Cancer’s Centre for Lymphoid Cancer database or from the literature for ABVD. Time-dependent transition probabilities for BREN+AVD were taken from the ECHELON-1 trial. We estimated the incremental cost and effects per patient of each therapy and calculated the incremental cost-effectiveness ratio (ICER). Costs were measured in 2018 Canadian dollars and effects measured in quality-adjusted life years (QALYs). A probabilistic analysis was used to generate a cost-effectiveness acceptability curve (CEAC).

Results

The incremental cost between standard therapy with ABVD and therapy with BREN+AVD was estimated to be $192,336. The regimen of BREN+AVD resulted in a small benefit in terms of QALYs (0.46 QALYs). The estimated ICER was $418,122 per QALY gained. The probabilistic analysis suggests very few (8%) simulations fall below $100,000 per QALY. Even at a threshold of $200,000 per QALY gained, there was only a 24% chance that BREN+AVD would be considered cost-effective. Sensitivity analyses evaluating price reductions for brentuximab showed that these reductions needed to be in excess of 70% for this regimen to be cost-effective at a threshold of $100,000 per QALY.

Conclusions

There may be a clinical benefit associated with BREN+AVD, but on current evidence the benefit is not adequately substantive compared to ABVD therapy given the cost of brentuximab vedotin. Agencies responsible for making decisions about BREN+AVD as frontline therapy for patients with advanced HL should consider whether they are willing to implement this treatment given the current uncertainty and cost-benefit profile, or negotiate substantial price-reductions from the manufacturer should they choose to reimburse.
Knowledge, attitudes, anxiety, and preventive behaviours towards COVID-19 among health care providers in Yemen: an online cross-sectional survey
Authors: Alrubaiee Gamil Ghaleb , Al-Qalah Talal Ali Hussein , Al-Aawar Mohammed Sadeg A.
Published: October 2020

Background

The growing incidence of coronavirus (COVID-19) continues to cause fear, anxiety, and panic amongst the community, especially for healthcare providers (HCPs), as the most vulnerable group at risk of contracting this new SARS-CoV-2 infection. To protect and enhance the ability of HCPs to perform their role in responding to COVID-19, healthcare authorities must help to alleviate the level of stress and anxiety amongst HCPs and the community. This will improve the knowledge, attitude and practice towards COVID-19, especially for HCPs. In addition, authorities need to comply in treating this virus by implementing control measures and other precautions. This study explores the knowledge, attitude, anxiety, and preventive behaviours among Yemeni HCPs towards COVID-19.

Methods

A descriptive, web-based-cross-sectional study was conducted among 1231 Yemeni HCPs. The COVID-19 related questionnaire was designed using Google forms where the responses were coded and analysed using the Statistical Package for the Social Sciences software package (IBM SPSS), version 22.0. Descriptive statistics and Pearson’s correlation coefficient test were also employed in this study. A p-value of < 0.05 with a 95% confidence interval was considered as statistically significant. The data collection phase commenced on 22nd April 2020, at 6 pm and finished on 26th April 2020 at 11 am.

Results

The results indicated that from the 1231 HCPs participating in this study, 61.6% were male, and 67% were aged between 20 and 30 years with a mean age of 29.29 ± 6.75. Most (86%) held a bachelor’s degree or above having at least 10 years of work experience or less (88.1%). However, while 57.1% of the respondents obtained their information via social networks and news media, a further 60.0% had never attended lectures/discussions about COVID-19. The results further revealed that the majority of respondents had adequate knowledge, optimistic attitude, moderate level of anxiety, and high-performance in preventive behaviours, 69.8, 85.10%, 51.0 and 87.70%, respectively, towards COVID-19.

Conclusion

Although the Yemeni HCPs exhibited an adequate level of knowledge, optimistic attitude, moderate level of anxiety, and high-performance in preventive behaviours toward COVID-19, the results highlighted gaps, particularly in their knowledge and attitude towards COVID-19.
Prevalence of temporomandibular disorder in children and adolescents with juvenile idiopathic arthritis – a Norwegian cross- sectional multicentre study
Authors: Fischer J. , Skeie M. S. , Rosendahl K. , Tylleskär K. , Lie S. , Shi X.-Q. , Gil E. Grut , Cetrelli L. , Halbig J. , von Wangenheim Marti L. , Rygg M. , Frid P. , Stoustrup P. , Rosèn A.
Published: October 2020

Background

Children and adolescents with juvenile idiopathic arthritis (JIA) may suffer pain from temporomandibular disorder (TMD). Still, routines for the assessment of temporomandibular joint (TMJ) pain in health and dental care are lacking. The aims of this study were to examine the prevalence of TMD in children and adolescents with JIA compared to their healthy peers and to investigate potential associations between JIA and TMD.

Methods

This comparative cross-sectional study is part of a longitudinal multicentre study performed during 2015–2020, including 228 children and adolescents aged 4–16 years with a diagnosis of JIA according to the ILAR criteria. This particular substudy draws on a subset of data from the first study visit, including assessments of TMD as part of a broader oral health examination. Children and adolescents with JIA were matched with healthy controls according to gender, age, and centre site. Five calibrated examiners performed the clinical oral examinations according to a standardised protocol, including shortened versions of the diagnostic criteria for TMD (DC/TMD) and the TMJaw Recommendations for Clinical TMJ Assessment in Patients Diagnosed with JIA. Symptoms were recorded and followed by a clinical examination assessing the masticatory muscles and TMJs.

Results

In our cohort of 221 participants with JIA and 221 healthy controls, 88 (39.8%) participants with JIA and 25 (11.3%) healthy controls presented with TMD based on symptoms and clinical signs. Painful TMD during the last 30 days was reported in 59 (26.7%) participants with JIA vs. 10 (5.0%) of the healthy controls (p <  0.001). Vertical unassisted jaw movement was lower in participants with JIA than in controls, with means of 46.2 mm vs. 49.0 mm, respectively (p <  0.001). Among participants with JIA, a higher proportion of those using synthetic disease-modifying antirheumatic-drugs and biologic disease-modifying antirheumatic-drugs presented with painful masticatory muscles and TMJs at palpation.

Conclusion

Symptoms and clinical signs of TMD were seen in approximately half of the JIA patients compared to about one fourth of their healthy peers. Painful palpation to masticatory muscles and decreased vertical unassisted jaw movement were more frequent in participants with JIA than among healthy controls and should be part of both medical and dental routine examinations in patients with JIA.
Assessment of knowledge and practice of dentists towards Coronavirus Disease (COVID-19): a cross-sectional survey from Lebanon
Authors: Nasser Zeina , Fares Youssef , Daoud Rama , Abou-Abbas Linda
Published: October 2020

Background

Coronavirus Disease (COVID-19) epidemic is a public health emergency of international concern. Dentists are exposed to the enormous risk of COVID-19 infection during this epidemic. This study aims to assess the knowledge and practice of dentists toward the COVID-19 epidemic in Lebanon.

Methods

We conducted an online survey using the snowball-sampling technique. Information on socio-demographic data, knowledge, practice, and additional information required concerning COVID-19 were collected.

Results

Our results showed that the majority of the Lebanese dentists had good knowledge (91.3%), and nearly half of the respondents had a good practice (58.7%) regarding COVID-19. The most common information source was the World Health Organization (73.7%). Multiple linear regression showed that specialist dentists who completed training on COVID-19 with a high level of knowledge had better practice.

Conclusions

Lebanese dentists revealed good knowledge regarding COVID-19. However, dentists had limited comprehension of the extra precautionary measures that protect the dental staff and patients from this virus. Our findings have important implications for the development of strategies suitable for improving the level of practice among dentists and enhance prevention programs.
Clinicopathologic characteristics and prognosis of upper tract urothelial carcinoma complicated with aristolochic acid nephropathy after radical nephroureterectomy
Authors: Shan Hongli , Tian Wen , Hong Yazhao , Xu Bo , Wang Chunxi , Yu Bing , Wang Xiaoqing
Published: October 2020

Background

The purpose of this study was to identify the clinicopathologic characteristics and prognosis of upper tract urothelial carcinoma (UTUC) patients complicated with aristolochic acid nephropathy(AAN) after radical nephroureterectomy (RNU).

Methods

The clinical data of 42 UTUC patients with AAN (AAN group) and 238 UTUC patients without AAN (Non-AAN group) were retrospectively reviewed. All patients received a RNU with excision of bladder cuff. Demographic and clinical data, including preoperative indexes, intraoperative indexes and surgical outcomes were compared.

Results

There were no significant differences in age, tumor location, surgery approach, tumor pathologic grade, stage, the mean operative time and estimated blood loss between the two groups (all p > 0.05). There were more female patients in the AAN group (p < 0.001), and 57.1% were high grade tumors. The AAN group showed a higher complications rate (p = 0.003). The median follow-up time was 43.2 months. The AAN group showed a worse estimated 5-year overall survival rate (35.1% vs. 63.0%, p = 0.014), however, no significant difference was found between the two groups with regard to disease specific survival (63.5% vs. 81.5%, p = 0.091). Multivariate binary logistic regression analysis showed that AAN was an independent factor related with overall and disease specific survival. 38.9% of all patients experienced any types of recurrence, and the estimated 5-year recurrence-free survival rate was lower in the AAN group (37.1% vs. 63.7%, p = 0.001). In the comparison of subgroups stratified by recurrence type, the AAN group had a higher intravesical (p = 0.030) and contralateral recurrence rate (p = 0.040).

Conclusion

UTUC with AAN occurred more frequently in female patients who were more likely to develop high-grade tumors. However, these patients showed a worse overall survival and a lower recurrence-free survival rate than the other patients. AA-related UTUC might be associate with an increased risk of intravesical and contralateral recurrence after RUN.
Short- and long-term outcomes after colonic self-expandable metal stent placement for malignant large-bowel obstruction as a bridge to surgery focus on the feasibility of the laparoscopic approach: a retrospective, single center study
Authors: Tajima Jesse Yu , Matsuhashi Nobuhisa , Takahashi Takao , Mizutani Chika , Iwata Yoshinori , Kiyama Shigeru , Kubota Masaya , Ibuka Takashi , Araki Hiroshi , Shimizu Masahito , Doi Kiyoshi , Yoshida Kazuhiro
Published: October 2020

Purpose

Malignant large-bowel obstruction (MLBO) is a highly urgent condition in colorectal cancer with high complication rates. Self-expandable metal stent (SEMS) placement in MLBO is a new decompression treatment in Japan. Preoperative stent placement (bridge to surgery: BTS) avoids emergency surgery, but oncological influences of stent placement and post-BTS surgical approach remain unclear. We examined short- and long-term results of surgery for MLBO after SEMS placement in our hospital.

Methods

We retrospectively reviewed 75 patients with MLBO who underwent resection after SEMS placement at our hospital from June 2013 to December 2018. Postoperative morbidity and mortality were evaluated by comparison with the surgical approach.

Results

Tumor location was significantly higher in the left-side colon and rectum (n = 59, 78.7%) than right-side colon (n = 16, 21.3%). Technical and clinical success rates for SEMS placement were 97.3% and 96.0%, respectively. Laparoscopic surgery was performed in 54 patients (69.0%), and one-stage anastomosis was performed in 73 (97.3%). Postoperative complications were similar in the open surgery (open) group (n = 5, 23.8%) and laparoscopic surgery (lap) group (n = 7, 13.0%), with no severe complications requiring reoperation. Three-year overall survival (OS) and relapse-free survival (RFS) rates were not significantly different in the lap vs open group (67.5% vs 66.4%; 82.2% vs 62.5%).

Conclusion

Preoperative stent treatment avoids stoma construction but allows anastomosis. One-time surgery was performed safely contributing to minimally invasive treatment and acceptable short- and long-term results.
Making change last? Exploring the value of sustainability approaches in healthcare: a scoping review
Authors: Lennox L. , Linwood-Amor A. , Maher L. , Reed J.
Published: October 2020

Background

Numerous models, tools and frameworks have been produced to improve the sustainability of evidence-based interventions. Due to the vast number available, choosing the most appropriate one is increasingly difficult for researchers and practitioners. To understand the value of such approaches, evidence warranting their use is needed. However, there is limited understanding of how sustainability approaches have been used and how they have impacted research or practice. This review aims to consolidate evidence on the application and impact of sustainability approaches in healthcare settings.

Methods

A systematic scoping review was designed to search for peer-reviewed publications detailing the use of sustainability approaches in practice. A 5-stage framework for scoping reviews directed the search strategy, and quality assessment was performed using the Mixed Method Appraisal Tool. Searches were performed through electronic citation tracking and snowballing of references. Articles were obtained through Web of Science, PubMed and Google Scholar. Six outcome variables for sustainability were explored to ascertain impact of approaches.

Results

This review includes 68 articles demonstrating the application of sustainability approaches in practice. Results show an increase in the use of sustainability approaches in peer-reviewed studies. Approaches have been applied across a range of healthcare settings, including primary, secondary, tertiary and community healthcare. Approaches are used for five main purposes, namely analysis, evaluation, guidance, assessment and planning. Results outline benefits (e.g. improved conceptualisation of sustainability constructs and improved ability to interpret sustainability data) and challenges (e.g. issues with approach constructs and difficulty in application) associated with using a sustainability approach in practice. Few articles (14/68) reported the sustainability outcome variables explored; therefore, the impact of approaches on sustainability remains unclear. Additional sustainability outcome variables reported in retrieved articles are discussed.

Conclusions

This review provides practitioners and researchers with a consolidated evidence base on sustainability approaches. Findings highlight the remaining gaps in the literature and emphasise the need for improved rigour and reporting of sustainability approaches in research studies. To guide future assessment and study of sustainability in healthcare settings an updated list of sustainability outcome variables is proposed.

Trial Registration

This review was registered on the PROSPERO database CRD 42016040081 in June 2016.
The use of evaluation methods for the overall assessment of health policy: potential and limitations
Authors: Kaczmarek Krzysztof , Romaniuk Piotr
Published: October 2020

Background

The implementation of public policies requires special attention from public authorities to ensure their transparency, effectiveness and efficiency. For this reason, efforts to evaluate the abovementioned politics gained attention and importance. Similar processes, by their very nature, are also noticeable in the area of health policy, however, the nature of the solutions used raises questions about the extent to which they allow to capture the assessed phenomenon in a holistic way. The current approach to the problem of evaluating health policy shows a tendency to break down this phenomenon into components including policies, programs or projects. The purpose of this publication was to assess the main methodological approaches used in evaluation studies in terms of their usefulness and limitations in conducting overall assessment of health policy.

Main body

The publication divides evaluation methods based on three main criteria identified in the literature—time, purpose and scope of evaluation. Methodological approaches to evaluation activities detailed on this basis are discussed from the point of view of their characteristics, usefulness and limitations in the creation of comprehensive health policy assessments. The growing awareness of the need for a different approach to evaluation, which was confirmed by the course of the discourse on evaluation in public health, was also pointed out.

Conclusion

Given the complexity of the matter making up the health policy, attempts aimed at its overall assessment should be based on an approach integrating many approaches, while ensuring coordination of evaluation activities that should be subject to common assumptions.
Clinicopathological features of 214 maxillary sinus pathologies. A ten-year single-centre retrospective clinical study
Authors: Pérez-Sayáns Mario , Suárez Peñaranda José M. , Quintanilla Juan Antonio Suárez , Chamorro Petronacci Cintia M. , García Abel García , Carrión Andrés Blanco , Vila Pilar Gándara , Sánchez Yolanda Guerrero
Published: October 2020

Background

Diagnosis of maxillary sinus pathology must include the clinical radiological study (CRS) and histopathological analysis. The aim of this study is 1) to describe the clinicopathological features of maxillary sinus lesions, obtained successively in a single medical centre over the last 10 years and 2) to determine the sensitivity and specificity for the diagnosis of malignant lesions based exclusively on the CRS.

Methods

It is a single-centre observational retrospective clinical study on patients who attended the University Hospital Complex of Santiago de Compostela (CHUS) with sinus pathologies during the period of 2009–2019.

Results

The sample consisted of 133 men (62.1%) and 81 women (37.9%), with an average age of 46.9 years (SD = 18.8). In terms of frequency, the most frequent pathology was the unspecified sinusitis (44.4%), followed by polyps (18.2%), malignant tumours (9.8%), inverting papilloma (7.5%), fungal sinusitis (4.7%), cysts (3.7%), benign tumours (2.3%), mucocele (2.3%) and other lesions (1.9%). Cysts and benign tumours were diagnosed earliest Vs malignant tumours (65.2 years (SD = 16.1)) were diagnosed the latest (p < 0.001). Based only on the CRS for malignancies, diagnostic indexes were 71.4% sensitivity and 97.9% specificity, with a Kappa value of 0.68 with (p < 0.001).

Conclusion

Maxillary sinus pathology is very varied with therapeutic and prognostic repercussions. CRS is sometimes insufficient and histopathological confirmation is essential.