bluuebunny/crossref_metadata_2025 huggingface dataset:
Impact of Covid-19 on Stroke Code Activations, Process Metrics, and Diagnostic Error
Authors: Velez Faddi G. Saleh , Alvarado-Dyer Ronald , Brutto Victor J. Del , Carrión-Penagos Julián , Bulwa Zachary , Prabhakaran Shyam
Published: November 2020

Background and Purpose:

In a comprehensive stroke center, we analyzed the stroke code activations (SCA), assessed the impact of Covid-19, and the measures taken by the local government to lessen the spread of the disease.

Methods:

We retrospectively reviewed SCA and classified them into 2 groups: pre-pandemic activations (February 15 to March 10) and Covid-19 pandemic activations (March 11 to April 30). The primary outcome was the ratio of true positive diagnoses of stroke relative to the total number of SCA in the 2 time periods.

Results:

Among the 212 SCA, 83 (39.2%) were from the pre-pandemic period, whereas 129 (60.8%) were from the pandemic period, 147 (69.3%) in the Emergency Department (ED) versus 65 (30.7%) in the inpatient service. In the ED cohort, a rapid decrease in the number of SCA at the beginning of the pandemic was followed by a gradual increase to pre-pandemic levels and a significant increase in the number of true positive strokes over time (44.2% vs 61.1%, p = 0.037). An increase in door-to-CT time (p = 0.001) and an increase in the rate of diagnostic error in patients admitted from the ED (p = 0.016) were also seen. The in-hospital cohort had a sustained decrease in the number of SCA following the pandemic declaration, with no difference in the rate of true positive stroke.

Conclusions:

We observed a rapid decline and slow recovery in ED SCA with a shift toward increased true positive cases following the Covid-19 pandemic. Also, delays in obtaining CT and diagnostic error was increased, however, no difference in early clinical outcomes were seen between groups.
Educational Leadership Doctoral Program Evaluation: Student Voice as the Litmus Test
Authors: Paufler Noelle A. , Ezzani Miriam D. , Murakami Elizabeth T. , Viamontes Quintero Jesika , Pazey Barbara L.
Published: November 2020

This study examines students’ perceptions of an Educational Leadership Doctoral Program’s redesign, based on a multi-criteria framework that informed the program’s core values and beliefs to prepare students to: (a) lead learning organizations; (b) engage ethically with the community; (c) advocate for diversity, equity, and inclusion; and (d) develop theory-to-practice solutions. Student voices are expressed through surveys and focus group interviews. Student perceptions of the core values and beliefs were reflected in their experiences. The program evaluation was significant as a critical review of the redesign informing both faculty and students about areas still in need of continuous improvement.
Facial Stereotype Bias Is Mitigated by Training
Authors: Chua Kao-Wei , Freeman Jonathan B.
Published: November 2020

People automatically infer others’ personality (e.g., trustworthiness) based on facial appearance, and such facial stereotype biases predict real-world consequences across political, legal, and business domains. The present research tested whether these biases can be mitigated through counterstereotype training aimed at reconfiguring the associations between specific facial appearances and social traits. Across six studies and a replication, a behavioral counterstereotype training consistently reduced or eliminated facial stereotype biases for White male faces in the context of economic trust games, hiring decisions, and even automatic evaluations assessed via evaluative priming. Together, the results demonstrate a fundamental malleability in facial stereotyping related to trustworthiness, with a minimal training able to mitigate the tendency to activate and apply long-held, highly automatized facial stereotypes. These findings suggest that face impressions are more flexible than typically appreciated, and they provide a potential inroad toward combating our ingrained biases based on facial appearance.
Performing healthy ageing through images: From broadcasting to silence
Authors: Duque Marília
Published: November 2020

This article addresses the centrality of images in the definition of a new paradigm for ageing, when health (measured by autonomy) becomes a condition for freedom (associated with youth). Based on a 16-month ethnography conducted with older people (aged 50–80) in a middle-class district in São Paulo, Brazil, I found that smartphones empower older people to craft a health identity by engaging and producing content that highlights the positive aspects of ageing. In this community, health is a concept deeply associated with productivity, and social media becomes a space for participants to present themselves as busy, giving visibility to all of the activities they engage with. On WhatsApp groups, participants can also work as curators, sharing content that is in the public interest, which improves their collective experience of ageing and restores their sense of utility and dignity. I found that smartphones also allow participants to manipulate the mechanism of social comparison used to classify who is healthy and who is old. Often, when they have a condition or frailty, they confine themselves to online interactions, hiding from view the ageing body that could compromise their performance. By doing that, their declines are kept on the backstage of their social interactions, allowing participants to extend their presence within the third age, which is associated with freedom and autonomy, while the decline related to the fourth age is kept in the shadows.
Bonding Effectiveness of Contemporary Materials in Luting Glass-Ceramic to Dentine: An In Vitro Study
Authors: Mutlu Alev , Atay Ayse , Çal Ebru
Published: November 2020

Aim:

To evaluate the shear bond strength (SBS) of resin cements, flowable composites, and a preheated composite in luting glass-ceramic to dentin.

Materials and Methods:

In total, 108 noncaries human third molar teeth embedded in acrylic blocks, grinded from the occlusal surfaces until dentin was exposed, and divided into 9 randomized groups ( n = 12). In total, 108 ceramic samples prepared in disc shape (3mm × 3mm) from IPS e. max CAD (Ivoclar Vivadent) blocks. Four adhesive resin cements: Variolink Esthetic DC (Ivoclar Vivadent), G-CEM LinkForce (GC), Panavia V5 (Kuraray Noritake), Maxcem Elite Chroma (Kerr), and three flowable composites: G-ænial Universal Flo (GC), Herculite XRV Ultra Flow (Kerr), Vertise Flow (Kerr), and one preheated composite: Enamel Plus HRI (Micerium) luted to the prepared occlusal surfaces of the teeth with total-etch, self-etch, and self-adhesive protocols. Then samples were thermocyled (5,000 cycles, 5–55°C, dwell time 20 s). SBS test was performed in a universal testing machine (at 0.5 mm/min). Failure modes were examined under a stereomicroscope at ×25 magnification. Data were analyzed using Kruskal–Wallis and Dunn–Bonferroni tests ( α = 0.05).

Results:

There were statistically significant differences among material types ( P < .05). Highest SBS values found in G-ænial Universal Flo (15.43 ± 5.67), and the lowest values obtained in Maxcem Elite Choroma (SA) (1.25 ± 1.47). There were no significant differences between self-etch (Panavia V5, Maxcem Elite Choroma [SE]) and self-adhesive (Maxcem Elite Choroma [SA], Vertise Flow) protocols ( P > .05).

Conclusion:

Flowable composites can be alternatives to resin cements when bonded with total-etch procedures. Bond strength of self-etch and self-adhesive applications is still to be developed.
A Radiographic Assessment of Dental Morbidity in Patients with Multiple Myeloma Undergoing Autologous Stem Cell Transplant: A Retrospective Study
Authors: Wazzan Taggreed , Jagtap Rohan , Mona Mahmoud , Katz Joseph
Published: November 2020

Aim:

To assess the dental and oral morbidity in multiple myeloma patients as expressed in dental radiographs before autologous stem cell transplant.

Materials and Methods:

A retrospective study involving 79 multiple myeloma patients was designed to collect data prior to their autologous stem cell transplant. Patients were seen at the oral medicine clinic at the University of Florida College of Dentistry during the years 2010–2013. Through available patient data and interpretation of radiographs, the following variables were recorded: age, gender, carious lesions, periodontal disease, and periapical radiolucency. In addition, the incidence of root fragment retention and the presence of punched-out osteolytic lesions were recorded. Cochran–Mantel–Haenszel (CMH) tests and logistic regression were performed for descriptive analysis and presentation of the data.

Results:

Seventy-nine multiple myeloma patients were recruited for this study. Ages ranged from 28 to 79 years (mean = 61, SD = 9.6), including 41 (51.9%) females and 38 (48.1%) males. The results demonstrated dental decay in 64.56% of patients, periodontal disease in 62.03%, apical rarefying osteitis in 13.92% of patients, and punched-out lesions in 24.05% of patients.

Conclusion:

Our study indicates high dental morbidity in multiple myeloma patients prior to autologous stem cell transplant. The elimination of foci of infection is highly recommended prior to autologous stem cell transplant for this high-risk population because of the potential risk of bacteremia/septicemia from oral bacteria associated with dental morbidity.
The Effects of Workplace Inclusion on Employee Assimilation Outcomes
Authors: Miller Marisa J. , Manata Brian
Published: November 2020

This study investigates the relationship between coworker inclusion and assimilation outcomes. To begin, this paper reviews components of assimilation and inclusion that are thought to co-occur in the workplace. In addition, employees of a large university in the Pacific Northwest were surveyed electronically to investigate the extent to which inclusion and assimilation outcomes are related. Finally, a discussion is offered that details the study’s findings, that is, task- and social-based aspects of inclusion are related positively to assimilation outcomes (i.e., acculturation, job competencies, coworker familiarity, supervisor familiarity, member recognition, involvement, and role negotiation). Moreover, these conclusions remained generally the same for newcomers versus old-timers, as well as for student versus non-student samples.
Quality Assurance in Long-Term Care and Development of Quality Indicators in Japan
Authors: Igarashi Ayumi , Eltaybani Sameh , Takaoka Manami , Noguchi-Watanabe Maiko , Yamamoto-Mitani Noriko
Published: November 2020

Dealing with an aging society is a global challenge, and more countries than ever before are now mobilizing their healthcare systems to provide high-quality long-term care (LTC) to older adults. This paper reviews the current situation pertaining to aging and the issues for measuring the LTC quality in Japan. It also introduces current efforts to develop quality indicators for measuring LTC quality. Assuring the quality of LTC and developing indicators to measure its quality is a challenge worldwide. Detailed systems for LTC quality measurement have been developed and managed, primarily in the US. In Japan, on the other hand, such systems do not exist; the public LTC system mostly depends on the evaluation of structural aspects, such as facility structure and staffing. Our research group has been developing quality indicators to measure LTC quality. In the future, we aim to evaluate care quality in various LTC settings using the proposed quality indicators, aiming to improve care quality across LTC settings in the community-based integrated care system.
Toothbrushing Performance and Oral Cleanliness after Brushing in 12-Year-Old Children
Authors: Weik U. , Cordes O. , Weber J. , Krämer N. , Pieper K. , Margraf-Stiksrud J. , Deinzer R.
Published: November 2020

Objectives:

Nationwide prevention programs in Germany aim to promote oral health. The group prevention program starts in kindergarten and ends when the children are about 12 y old. While in a recent study, toothbrushing behavior of 12-y-old children was analyzed, the present study’s objective was to examine the children’s ability to achieve oral cleanliness and to analyze how toothbrushing behavior and compliance with the toothbrushing recommendations taught in the group prevention programs predict oral cleanliness.

Methods:

Twelve-year-old randomly selected children ( N = 174) were asked to brush their teeth to the best of their abilities, and simultaneously a video was recorded for behavioral analyses. Plaque levels were measured before and immediately after toothbrushing. In addition, dental status and gingival bleeding were assessed.

Results:

After brushing to the best of their abilities, there was plaque on 50% (±24.72%) of all measured sites at the gingival margin (Marginal Plaque Index). Regression analyses revealed approximately 22% of the variance of marginal plaque on the outer surfaces to be explained by the time brushed by circular movements (β = −0.41; P < 0.001) and the number of sextants brushed for at least 7.5 s (β = −0.171; P < 0.05). Circular movements explained most additional variance (Δ R2 = 0.113; P < 0.001). With respect to inner surfaces, none of the behavioral aspects explained any variance of oral cleanliness.

Conclusion:

Despite regular group prevention measures, 12-y-old children show limited skills to clean their teeth adequately. Furthermore, none of the recommended behaviors relates to oral cleanliness after toothbrushing at inner surfaces. As a consequence, it is necessary to explore further which behavioral sequences effectively improve oral cleanliness.

Knowledge Transfer Statement:

This study illustrates that children’s compliance to toothbrushing recommendations is not necessarily related to toothbrushing effectiveness. Clinicians should therefore assess the effectivity of recommendations individually and provide individual guidance for improvement.
Map-based assessment of older adults’ life space: validity and reliability
Authors: Hinrichs Timo , Zanda Adriana , Fillekes Michelle P. , Bereuter Pia , Portegijs Erja , Rantanen Taina , Schmidt-Trucksäss Arno , Zeller Andreas W. , Weibel Robert
Published: November 2020

Background

Map-based tools have recently found their way into health-related research. They can potentially be used to quantify older adults’ life-space. This study aimed to evaluate the validity (vs. GPS) and the test-retest reliability of a map-based life-space assessment (MBA).

Methods

Life-space of one full week was assessed by GPS and by MBA. MBA was repeated after approximately 3 weeks. Distance-related (mean and maximum distance from home) and area-related (convex hull, standard deviational ellipse) life-space indicators were calculated. Intraclass correlations (MBA vs. GPS and test-retest) were calculated in addition to Bland-Altman analyses (MBA vs. GPS).

Results

Fifty-eight older adults (mean age 74, standard deviation 5.5 years; 39.7% women) participated in the study. Bland-Altman analyses showed the highest agreement between methods for the maximum distance from home. Intraclass correlation coefficients ranged between 0.19 (95% confidence interval 0 to 0.47) for convex hull and 0.72 (95% confidence interval 0.52 to 0.84) for maximum distance from home. Intraclass correlation coefficients for test-retest reliability ranged between 0.04 (95% confidence interval 0 to 0.30) for convex hull and 0.43 (95% confidence interval 0.19 to 0.62) for mean distance from home.

Conclusions

While acceptable validity and reliability were found for the distance-related life-space parameters, MBA cannot be recommended for the assessment of area-related life-space parameters.
Increasing system-wide implementation of opioid prescribing guidelines in primary care: findings from a non-randomized stepped-wedge quality improvement project
Authors: Zgierska Aleksandra E. , Robinson James M. , Lennon Robert P. , Smith Paul D. , Nisbet Kate , Ales Mary W. , Boss Deanne , Tuan Wen-Jan , Vidaver Regina M. , Hahn David L.
Published: November 2020

Background

Clinician utilization of practice guidelines can reduce inappropriate opioid prescribing and harm in chronic non-cancer pain; yet, implementation of “opioid guidelines” is subpar. We hypothesized that a multi-component quality improvement (QI) augmentation of “routine” system-level implementation efforts would increase clinician adherence to the opioid guideline-driven policy recommendations.

Methods

Opioid policy was implemented system-wide in 26 primary care clinics. A convenience sample of 9 clinics received the QI augmentation (one-hour academic detailing; 2 online educational modules; 4–6 monthly one-hour practice facilitation sessions) in this non-randomized stepped-wedge QI project. The QI participants were volunteer clinic staff. The target patient population was adults with chronic non-cancer pain treated with long-term opioids. The outcomes included the clinic-level percentage of target patients with a current treatment agreement (primary outcome), rates of opioid-benzodiazepine co-prescribing, urine drug testing, depression and opioid misuse risk screening, and prescription drug monitoring database check; additional measures included daily morphine-equivalent dose (MED), and the percentages of all target patients and patients prescribed ≥90 mg/day MED. T-test, mixed-regression and stepped-wedge-based analyses evaluated the QI impact, with significance and effect size assessed with two-tailedp < 0.05, 95% confidence intervals and/or Cohen’sd.

Results

Two-hundred-fifteen QI participants, a subset of clinical staff, received at least one QI component; 1255 patients in the QI and 1632 patients in the 17 comparison clinics were prescribed long-term opioids. At baseline, more QI than comparison clinic patients were screened for depression (8.1% vs 1.1%,p = 0.019) and prescribed ≥90 mg/day MED (23.0% vs 15.5%,p = 0.038). The stepped-wedge analysis did not show statistically significant changes in outcomes in the QI clinics, when accounting for the comparison clinics’ trends. The Cohen’sdvalues favored the QI clinics in all outcomes except opioid-benzodiazepine co-prescribing. Subgroup analysis showed that patients prescribed ≥90 mg/day MED in the QI compared to comparison clinics improved urine drug screening rates (38.8% vs 19.1%,p = 0.02), but not other outcomes (p ≥ 0.05).

Conclusions

Augmenting routine policy implementation with targeted QI intervention, delivered to volunteer clinic staff, did not additionally improve clinic-level, opioid guideline-concordant care metrics. However, the observed effect sizes suggested this approach may be effective, especially in higher-risk patients, if broadly implemented.

Trial registration

Not applicable.
Value of Galectin-3 assay in children with heart failure secondary to congenital heart diseases: a prospective study
Authors: Saleh Nagwan , Khattab Ahmed , Rizk Mohamed , Salem Sherif , Abo-Haded Hany
Published: November 2020

Background

Galectin-3 is a new biomarker, which plays an important role in tissue inflammation, cardiac remodeling, and fibrosis. It can be readily measured in the circulation to detect early heart failure (HF). This study aimed to assess the value of galectin-3 assay in early diagnosis of children with heart failure secondary to congenital heart disease (CHD) and correlate it with the patients’ outcome.

Methods

This prospective cohort study included 75 children diagnosed to have CHD; {Group A: 45 CHD children with HF symptoms and reduced ejection fraction (REF) and Group B: 30 CHD children with no HF symptoms and normal ejection fraction (NEF)}. They were compared to 40 age- and sex-matched controls (Group C). Children with CHD undergone history taking, Ross HF classification, Echocardiographic assessment and laboratory investigations including serum galactin-3 level.

Results

Galectin-3 serum level increased in CHD children, and it showed significant increase in (Gp A) compared to Gp B or Gp C (p = ≤ 0.001). In addition, serum level of Galactin-3 was correlated positively with Ross classification (r = 0.68, p = 0.018) and negatively correlated to EF% (r= -0.61, p ≤ 0.001). Galactin-3 showed better diagnostic value than Ross HF classification in early diagnosis of HF in CHD children with a cut point (≥ 10.4), significantly had 96.7% sensitivity, 90% specificity, 91% positive predictive value, 93.2% negative predictive value, with area under the curve (AUC = 0.96) and 93% accuracy. While there was a significant correlation between Ross HF classification and HF outcome in (Gp A) children (p = 0.05), we did not find any significant correlation between serum galectin-3 level and HF mortality in same group (p = 0.08).

Conclusions

Galectin-3 assay is a promising marker for early diagnosis of HF in children with CHD; but it has no role in detecting HF mortality.
Effectiveness of Alberta Family Integrated Care on infant length of stay in level II neonatal intensive care units: a cluster randomized controlled trial
Authors:   the Alberta FICare Level II NICU Study Team, Benzies Karen M. , Aziz Khalid , Shah Vibhuti , Faris Peter , Isaranuwatchai Wanrudee , Scotland Jeanne , Larocque Jill , Mrklas Kelly J. , Naugler Christopher , Stelfox H. Thomas , Chari Radha , Soraisham Amuchou Singh , Akierman Albert Richard , Phillipos Ernest , Amin Harish , Hoch Jeffrey S. , Zanoni Pilar , Kurilova Jana , Lodha Abhay
Published: November 2020

Background

Parents of infants in neonatal intensive care units (NICUs) are often unintentionally marginalized in pursuit of optimal clinical care. Family Integrated Care (FICare) was developed to support families as part of their infants’ care team in level III NICUs. We adapted the model for level II NICUs in Alberta, Canada, and evaluated whether the new Alberta FICare™ model decreased hospital length of stay (LOS) in preterm infants without concomitant increases in readmissions and emergency department visits.

Methods

In this pragmatic cluster randomized controlled trial conducted between December 15, 2015 and July 28, 2018, 10 level II NICUs were randomized to provide Alberta FICare™ (n = 5) or standard care (n = 5). Alberta FICare™ is a psychoeducational intervention with 3 components: Relational Communication, Parent Education, and Parent Support. We enrolled mothers and their singleton or twin infants born between 32 0/7 and 34 6/7 weeks gestation. The primary outcome was infant hospital LOS. We used a linear regression model to conduct weighted site-level analysis comparing adjusted mean LOS between groups, accounting for site geographic area (urban/regional) and infant risk factors. Secondary outcomes included proportions of infants with readmissions and emergency department visits to 2 months corrected age, type of feeding at discharge, and maternal psychosocial distress and parenting self-efficacy at discharge.

Results

We enrolled 654 mothers and 765 infants (543 singletons/111 twin cases). Intention to treat analysis included 353 infants/308 mothers in the Alberta FICare™ group and 365 infants/306 mothers in the standard care group. The unadjusted difference between groups in infant hospital LOS (1.96 days) was not statistically significant. Accounting for site geographic area and infant risk factors, infant hospital LOS was 2.55 days shorter (95% CI, − 4.44 to − 0.66) in the Alberta FICare™ group than standard care group, P = .02. Secondary outcomes were not significantly different between groups.

Conclusions

Alberta FICare™ is effective in reducing preterm infant LOS in level II NICUs, without concomitant increases in readmissions or emergency department visits. A small number of sites in a single jurisdiction and select group infants limit generalizability of findings.

Trial registration

ClinicalTrials.gov Identifier NCT02879799, retrospectively registered August 26, 2016.
Antibiotic therapy alone does not have a high success rate in cases of unexpected positive cultures in intraoperative samples from hip and knee prosthesis revision
Authors: Fink Bernd , Schlumberger Michael
Published: November 2020

Background

Unexpectedly positive bacterial cultures during prosthesis revision surgery still occur on occasion despite good preoperative diagnostics. In such cases a six-week antibiotic therapy without further surgical intervention is recommended. The aim of this study was to find out how successful this procedure is.

Methods

In a study of 508 patients, who required revision surgery of total hip (THA, n = 231) or knee arthroplasties (TKA, n = 277) because of component loosening, biopsy was carried out before their surgery. The collected tissue samples (5) from the biopsy and the revision surgery procedure itself were analyzed according the criteria of the International Consensus Meeting (ICM). Tests revealed 11 patients (7 THA, 4 TKA) with unexpectedly positive bacterial cultures from tissue samples obtained during the revision surgery due to false negative preoperative diagnostic results. These 11 patients were treated with 6 weeks antibiotic therapy and examined with a follow-up of at least 2 years (42.2 ± 16.5 months).

Results

Five patients (2 TKA, 3 THA) became reinfected, resulting in a success rate of 54.5%.

Conclusion

Antibiotic therapy alone of an unexpected positive intraoperative bacterial culture in prosthesis revision surgery seems to be less successful than previously assumed.
Is the Apert foot an overlooked aspect of this rare genetic disease? Clinical findings and treatment options for foot deformities in Apert syndrome
Authors: Stauffer Alexandra , Farr Sebastian
Published: November 2020

Background

Apert syndrome is characterised by the presence of craniosynostosis, midface retrusion and syndactyly of hands and feet, thus, synonymously referred to as acrocephalosyndactyly type I. Considering these multidisciplinary issues, frequently requiring surgical interventions at an early age, deformities of the feet have often been neglected and seem to be underestimated in the management of Apert syndrome. Typical Apert foot features range from complete fusion of the toes and a central nail mass to syndactyly of the second to fifth toe with a medially deviated great toe; however, no clear treatment algorithms were presented so far. This article reviews the current existing literature regarding the treatment approach of foot deformities in Apert syndrome.

State-of-the-art topic review

Overall, the main focus in the literature seems to be on the surgical approach to syndactyly separation of the toes and the management of the great toe deformity (hallux varus). Although the functional benefit of syndactyly separation in the foot has yet to be determined, some authors perform syndactyly separation usually in a staged procedure. Realignment of the great toe and first ray can be performed by multiple means including but not limited to second ray deletion, resection of the proximal phalanx delta bone on one side, corrective open wedge osteotomy, osteotomy of the osseous fusion between metatarsals I and II, and metatarsal I lengthening using gradual osteodistraction. Tarsal fusions and other anatomical variants may be present and have to be corrected on an individual basis. Shoe fitting problems are frequently mentioned as indication for surgery while insole support may be helpful to alleviate abnormal plantar pressures.

Conclusion

There is a particular need for multicenter studies to better elaborate surgical indications and treatment plans for this rare entity. Plantar pressure measurements using pedobarography should be enforced in order to document the biomechanical foot development and abnormalities during growth, and to help with indication setting. Treatment options may include conservative means (i.e. insoles, orthopedic shoes) or surgery to improve biomechanics and normalize plantar pressures.

Level of evidence

Level V.
Head and neck cutaneous melanoma: 5-year survival analysis in a Serbian university center
Authors: Višnjić Aleksandar , Kovačević Predrag , Veličkov Asen , Stojanović Mariola , Mladenović Stefan
Published: November 2020

Background

Head and neck melanoma (HNM) is specific from the anatomical and etiopathogenetic aspects. In addition to morphopathological parameters, rich vascularization and lymphatic drainage of the head and neck affect the occurrence of lymphogenic and hematogenous metastases, as well as the metastases on both sides of the neck.

Methods

A retrospective cross-sectional study included cutaneous melanoma patients who underwent surgery at a clinical center over a 10-year period. The clinical follow-up was at least 60 months. The Kaplan-Meier method was used for the survival analysis. The predictor effect of certain independent variables on a given dichotomous dependent variable (survival) was measured by the Cox regression analysis.

Results

The analysis of demographic and clinical characteristics of 116 patients with HNM revealed that there was no statistically significant difference in age and gender in the total sample. Thirty-three (28.45%) patients were already in stage III or IV of the disease at the first examination, which affected the overall survival rate. The overall 5-year survival was 30.2%. No statistically significant difference in 5-year survival was found in relation to age and location. The period without melanoma progression decreased progressively in the advanced stage. Forty-nine patients (42%) underwent surgery for lymphogenic metastases in the parotid region and/or neck during the follow-up.

Conclusions

Patients with HNM included in this study frequently presented an advanced stage of the disease at the first examination, which is reflected in a low rate of 5-year survival. Early diagnosis and adequate primary treatment can ensure longer survival.
Statistical stopping criteria for automated screening in systematic reviews
Authors: Callaghan Max W , Müller-Hansen Finn
Published: November 2020

Active learning for systematic review screening promises to reduce the human effort required to identify relevant documents for a systematic review. Machines and humans work together, with humans providing training data, and the machine optimising the documents that the humans screen. This enables the identification of all relevant documents after viewing only a fraction of the total documents. However, current approaches lack robust stopping criteria, so that reviewers do not know when they have seen all or a certain proportion of relevant documents. This means that such systems are hard to implement in live reviews. This paper introduces a workflow with flexible statistical stopping criteria, which offer real work reductions on the basis of rejecting a hypothesis of having missed a given recall target with a given level of confidence. The stopping criteria are shown on test datasets to achieve a reliable level of recall, while still providing work reductions of on average 17%. Other methods proposed previously are shown to provide inconsistent recall and work reductions across datasets.
Integrated analytical approach to unveil the secrets of the recently discovered “Sphinx Room”: a new piece of Domus Aurea puzzle
Authors: Caggiani Maria Cristina , Coccato Alessia , Mazzoleni Paolo , D’Alessio Alessandro , Russo Alfonsina , Barone Germana
Published: November 2020

The recent discovery of the Sphinx Room, belonging to the Domus Aurea Esquiline wing, thanks to the framework given by the project “Non-destructive analytical studies at Parco Archeologico del Colosseo (Rome, Italy)”, allowed to perform an analytical campaign, both in situ and on micro-fragments. The first aim was to contribute to the overall comprehension of the Domus Aurea complex and to contextualize the newly-discovered room inside this extraordinary imperial architecture by means of an archaeometrical characterisation of the painting materials. The palette, composed of Egyptian blue, green earths, iron- and lead-based red, orange and yellow, calcite, carbon-based black, allowed to compare the Sphinx Room to Corridor 92 and Room 114 of Domus Aurea and to other sites in Rome. Furthermore, the employ of an organic binder in some spots can be put forward based on spectroscopic results, which does not exclude a wider use of the a fresco. Furthermore, a complementary methodological strategy was designed, in order to achieve a complete characterization of the materials. In addition to the well-known combination of portable X-ray fluorescence and portable/laboratory Raman analyses, Infrared Fourier Transform Spectroscopy was used, both in situ (Diffuse Reflectance) and in the lab (Attenuated Total Reflectance). The results confirm the suitability of this approach for the characterization of Roman wall paintings, where both inorganic and organic materials are simultaneously present.
Clinical, Cellular, and Molecular Evidence of the Additive Antitumor Effects of Biguanides and Statins in Prostate Cancer
Authors: Jiménez-Vacas Juan M , Herrero-Aguayo Vicente , Montero-Hidalgo Antonio J , Sáez-Martínez Prudencio , Gómez-Gómez Enrique , León-González Antonio J , Fuentes-Fayos Antonio C , Yubero-Serrano Elena M , Requena-Tapia María J , López Miguel , Castaño Justo P , Gahete Manuel D , Luque Raúl M
Published: November 2020

Context

Prostate cancer (PCa) is one of the leading causes of cancer-related death among the male population worldwide. Unfortunately, current medical treatments fail to prevent PCa progression in a high percentage of cases; therefore, new therapeutic tools to tackle PCa are urgently needed. Biguanides and statins have emerged as antitumor agents for several endocrine-related cancers.

Objective

To evaluate: (1) the putative in vivo association between metformin and/or statins treatment and key tumor and clinical parameters and (2) the direct effects of different biguanides (metformin/buformin/phenformin), statins (atorvastatin/simvastatin/lovastatin), and their combination, on key functional endpoints and associated signalling mechanisms.

Methods

An exploratory/observational retrospective cohort of patients with PCa (n = 75) was analyzed. Moreover, normal and tumor prostate cells (normal [RWPE-cells/primary prostate cell cultures]; tumor [LNCaP/22RV1/PC3/DU145 cell lines]) were used to measure proliferation/migration/tumorsphere-formation/signalling pathways.

Results

The combination of metformin+statins in vivo was associated to lower Gleason score and longer biochemical recurrence-free survival. Moreover, biguanides and statins exerted strong antitumor actions (ie, inhibition of proliferation/migration/tumorsphere formation) on PCa cells, and that their combination further decreased; in addition, these functional parameters compared with the individual treatments. These actions were mediated through modulation of key oncogenic and metabolic signalling pathways (ie, AR/mTOR/AMPK/AKT/ERK) and molecular mediators (MKI67/cMYC/androgen receptor/cell-cycle inhibitors).

Conclusions

Biguanides and statins significantly reduced tumor aggressiveness in PCa, with this effect being more potent (in vitro and in vivo) when both compounds are combined. Therefore, given the demonstrated clinical safety of biguanides and statins, our results suggest a potential therapeutic role of these compounds, especially their combination, for the treatment of PCa.
Sarcopenia Is Associated With Reduced Function on Admission to Rehabilitation in Patients With Diabetes
Authors: Churilov Irina , Churilov Leonid , Brock Kim , Murphy David , MacIsaac Richard J , Ekinci Elif I
Published: November 2020

Objective

This work aims to estimate the prevalence of sarcopenia and to investigate the association between sarcopenia and functional performance in patients with and without diabetes admitted for inpatient rehabilitation.

Materials and Methods

Consecutive patients admitted to the subacute inpatient rehabilitation unit at St Vincent’s Hospital Melbourne, Australia (November 2016 to March 2020) were prospectively recruited into this cross-sectional study. Sarcopenia was diagnosed using the European Working Group on Sarcopenia in Older People 2018 algorithm. Participants’ functional performance was measured by the total Functional Independence Measure, motor Functional Independence Measure, and the Short Physical Performance Battery. The association between sarcopenia and functional performance was investigated using quantile regression.

Results

Of 300 participants, 49 (16%) had a history of diabetes and 44 (14.7%) were diagnosed with sarcopenia. No significant difference in the prevalence of sarcopenia between patients with or without diabetes was identified (11/49, 22.5% vs 33/251, 13.2%, P = .12). In patients with diabetes, those with sarcopenia had significantly reduced functional performance compared to those without sarcopenia on Functional Independence Measure, motor Functional Independence Measure, and the Short Physical Performance Battery, whereas in patients without diabetes no significant difference between patients with and without sarcopenia were identified for either functional performance measure (all P values for interaction < .005).

Conclusions

The diagnosis of sarcopenia was associated with a reduced functional performance on admission to inpatient rehabilitation in patients with diabetes, but not in those without diabetes. Further investigation is needed into the progress of patients with dual diagnoses of diabetes and sarcopenia in inpatient rehabilitation.
New Anti-Müllerian Hormone Target Genes Involved in Granulosa Cell Survival in Women With Polycystic Ovary Syndrome
Authors: Racine Chrystèle , Genêt Carine , Bourgneuf Camille , Dupont Charlotte , Plisson-Petit Florence , Sarry Julien , Hennequet-Antier Christelle , Vigouroux Corinne , Mathieu d’Argent Emmanuelle , Pierre Alice , Monniaux Danielle , Fabre Stéphane , di Clemente Nathalie
Published: November 2020

Purpose

A protective effect of anti-Müllerian hormone (AMH) on follicle atresia was recently demonstrated using long-term treatments, but this effect has never been supported by mechanistic studies. This work aimed to gain an insight into the mechanism of action of AMH on follicle atresia and on how this could account for the increased follicle pool observed in women with polycystic ovary syndrome (PCOS).

Methods

In vivo and in vitro experiments were performed to study the effects of AMH on follicle atresia and on the proliferation and apoptosis of granulosa cells (GCs). RNA-sequencing was carried out to identify new AMH target genes in GCs. The expression of some of these genes in GCs from control and PCOS women was compared using microfluidic real time quantitative RT-PCR.

Results

A short-term AMH treatment prevented follicle atresia in prepubertal mice. Consistent with this result, AMH inhibited apoptosis and promoted proliferation of different models of GCs. Moreover, integrative biology analyses of 965 AMH target genes identified in 1 of these GC models, confirmed that AMH had initiated a gene expression program favoring cell survival and proliferation. Finally, on 43 genes selected among the most up- and down-regulated AMH targets, 8 were up-regulated in GCs isolated from PCOS women, of which 5 are involved in cell survival.

Main conclusions

Our results provide for the first time cellular and molecular evidence that AMH protects follicles from atresia by controlling GC survival and suggest that AMH could participate in the increased follicle pool of PCOS patients.
Effect of Initial Treatment Choice on 2-year Quality of Life in Patients with Low-risk Papillary Thyroid Microcarcinoma
Authors: Moon Jae Hoon , Ryu Chang Hwan , Cho Sun Wook , Choi June Young , Chung Eun-Jae , Hah Jeong Hun , Hwangbo Yul , Jeong Woo-Jin , Jung Yuh-Seog , Kim Ji-hoon , Kim Min Joo , Kim Su-jin , Kim Yeo Koon , Lee Chang Yoon , Lee Eun Kyung , Lee Ji Ye , Lee Kyu Eun , Lee You Jin , Lee Yumi , Yu Hyeong Won , Park Do Joon , Ryu Junsun , Park Young Joo
Published: November 2020

Context

The long-term quality of life (QoL) in patients with low-risk papillary thyroid microcarcinoma (PTMC) underwent active surveillance (AS) and immediate surgery is unclear.

Objective

The aim of this study was to investigate the effect of initial treatment choice on 2-year QoL in patients with low-risk PTMC

Design, Setting, and Participants

We analyzed 2652 QoL surveys from 1055 subjects enrolled in ongoing multicenter prospective cohort study on active surveillance of PTMC, in which the median follow-up duration was 24.4 months.

Major Outcome Measure

We evaluated QoL of patients with low-risk PTMC according to their treatment modality using generalized estimating equation.

Results

Six hundred and seventy-four subjects (male = 161; mean age = 48.8 ± 11.9 years) with low-risk PTMC chose AS while 381 subjects (male = 75; mean age = 45.7 ± 10.4 years) chose immediate surgery, including lobectomy/isthmusectomy (L/I) and total thyroidectomy (TT). Among the 817 subjects who completed baseline QoL surveys, 2-year QoL was good in order of AS (n = 500), L/I (n = 238), and TT (n = 79) groups after adjustment for age, sex, baseline tumor size, and baseline QoL scores. Among the 101 subjects who changed their treatment from AS to surgery during the follow-up period, 35 subjects who changed treatment due to disease progression had better QoL than 66 subjects who had no disease progression.

Conclusions

This study identified QoL as a major issue in choosing an initial treatment of low-risk PTMC and highlighted the possibility of using AS as the primary treatment.
Insight on the Intracrinology of Menopause: Androgen Production within the Human Vagina
Authors: Cellai Ilaria , Di Stasi Vincenza , Comeglio Paolo , Maseroli Elisa , Todisco Tommaso , Corno Chiara , Filippi Sandra , Cipriani Sarah , Sorbi Flavia , Fambrini Massimiliano , Petraglia Felice , Scavello Irene , Rastrelli Giulia , Acciai Gabriele , Villanelli Fabio , Danza Giovanna , Sarchielli Erica , Guarnieri Giulia , Morelli Annamaria , Maggi Mario , Vignozzi Linda
Published: November 2020

In this study, we investigated steroidogenic gene mRNA expression in human vaginas and verified the ability of human vagina smooth muscle cells (hvSMCs) to synthesize androgens from upstream precursor dehydroepiandrosterone (DHEA). As a readout for androgen receptor (AR) activation, we evaluated the mRNA expression of various androgen-dependent markers. hvSMCs were isolated from vagina tissues of women undergoing surgery for benign gynecological diseases. In these cells, we evaluated mRNA expression of several steroidogenic enzymes and sex steroid receptors using real time reverse transcription-polymerase chain reaction. Androgen production was quantified with liquid chromatography tandem-mass spectrometry (LC-MS/MS).

In vaginal tissues, AR mRNA was significantly less expressed than estrogen receptor α, whereas in hvSMCs, its mRNA expression was higher than progestin and both estrogen receptors. In hvSMCs and in vaginal tissue, when compared to ovaries, the mRNA expression of proandrogenic steroidogenic enzymes (HSD3β1/β2, HSD17β3/β5), along with 5α-reductase isoforms and sulfotransferase, resulted as being more abundant. In addition, enzymes involved in androgen inactivation were less expressed than in the ovaries. The LC-MS/MS analysis revealed that, in hvSMCs, short-term DHEA supplementation increased Δ4-androstenedione levels in spent medium, while increasing testosterone and DHT secretion after longer incubation. Finally, androgenic signaling activation was evaluated through AR-dependent marker mRNA expression, after DHEA and T stimulation.

This study confirmed that the human vagina is an androgen-target organ with the ability to synthesize androgens, thus providing support for the use of androgens for local symptoms of genitourinary syndrome in menopause.
Effect of Extending the Original CROSS Criteria on Tumor Response to Neoadjuvant Chemoradiotherapy in Esophageal Cancer Patients: A National Multicenter Cohort Analysis
Authors: Wang Helena Hong , de Heer Ellen C. , Hulshoff Jan Binne , Kats-Ugurlu Gursah , Burgerhof Johannes G. M. , van Etten Boudewijn , Plukker John Th. M. , Hospers Geke A. P. ,   the Dutch Upper Gastrointestinal Cancer Audit (DUCA) Group
Published: November 2020

Background

Extending the original criteria of the Chemoradiotherapy for Oesophageal Cancer followed by Surgery Study (CROSS) in daily practice may increase the treatment outcome of esophageal cancer (EC) patients. This retrospective national cohort study assessed the impact on the pathologic complete response (pCR) rate and surgical outcome.

Patients and Methods

Data from EC patients treated between 2009 and 2017 were collected from the national Dutch Upper Gastrointestinal Cancer Audit database. Patients had locally advanced EC (cT1/N+ or cT2-4a/N0-3/M0) and were treated according to the CROSS regimen. CROSS (n = 1942) and the extended CROSS (e-CROSS; n = 1359) represent patients fulfilling the original or extended CROSS criteria, respectively. The primary outcome was total pCR (ypT0N0), while secondary outcomes were local esophageal pCR (ypT0), surgical radicality, and postoperative morbidity and mortality.

Results

Overall, CROSS and e-CROSS did not differ in total or local pCR rate, although a trend was observed (23.2% vs. 20.4%, p = 0.052; and 26.7% vs. 23.8%, p = 0.061). When stratifying by histology, the pCR rate was higher in the CROSS group compared with e-CROSS in squamous cell carcinomas (48.2% vs. 33.3%, p = 0.000) but not in adenocarcinomas (16.8% vs. 16.9%, p = 0.908). Surgical radicality did not differ between groups. Postoperative mortality (3.2% vs. 4.6%, p = 0.037) and morbidity (58.3% vs. 61.8%, p = 0.048) were higher in e-CROSS.

Conclusion

Extending the CROSS inclusion criteria for neoadjuvant chemoradiotherapy in routine clinical practice of EC patients had no impact on the pCR rate and on radicality, but was associated with increased postoperative mortality and morbidity. Importantly, effects differed between histological subtypes. Hence, in future studies, we should carefully reconsider who will benefit most in the real-world setting.
Looking at the impact of lockdown on eating habits
Authors: Lepkowska Dorothy
Published: November 2020

Lockdown has affected families' eating habits in different ways, with snacking increasing in some families while others have been further entrenched into food poverty. Dorothy Lepkowska explains
Never more relevant, never more needed
Authors: White Sharon
Published: November 2020

School and public health nurses have never been more relevant and more needed than now. While there is still a dearth of resources and funding for school nursing services, other funding sources might be accessible, Sharon White explains.
Topical cream containing nanoparticles with vitamin E to prevent radiodermatitis in women with breast cancer: a clinical trial protocol
Authors: Schmidt Fernanda Mateus Queiróz , González Carol V. Serna , Mattar Rodrigo Calixto , Lopes Luciana Biagini , Santos Marinilce Fagundes dos , de Gouveia Santos Vera L.C.
Published: November 2020

Objective:

Little is known about the efficacy of products aiming to prevent radiodermatitis, which affects between 90–95% of women with breast cancer. The use of antioxidants is promising, however, there is a lack of evidenceon their effectiveness. Here, the authors present a clinical trial protocol to evaluate the effects of applying a cream containing nanoparticles with vitamin E to prevent radiodermatitis in patients with breast cancer.

Method:

The protocol recommends that 108 women with breast cancer, receiving radiotherapy, are included in this triple-blinded, randomized, controlled study at an oncology hospital. Patients will be divided in three groups of 36 individuals each: group A will receive a cream with lipid nanoparticles and vitamin E, group B will receive a cream without nanoparticles nor vitamin E, and group C will receive a cream with nanoparticles without vitamin E. The primary endpoints will evaluate the incidence, degree, and time of onset of radiodermatitis. The secondary endpoints will focus on the quality of life, symptoms, and local temperature. Patients will be assessed three times a week, from the start of their radiotherapy treatment to two weeks after the last session. This protocol was approved by the research ethics committee of the institutions involved and registered on an international trials database.