bluuebunny/crossref_metadata_2025 huggingface dataset:
Renal medicine and urology
Authors: Simon Chantal , Everitt Hazel , van Dorp Françoise , Hussain Nazia , Nash Emma , Peet Danielle
Published: June 2020

This chapter in the Oxford Handbook of General Practice explores renal medicine and urology in general practice. It covers laboratory tests, how to estimate renal function, presentation of renal disease, chronic kidney disease, specific kidney diseases, renal stones, and haematuria, bladder, and renal cancer. It explores urinary tract infection, incontinence of urine, aids and appliances, and urinary tract obstruction. It examines benign prostatic hypertrophy, prostate-specific antigen testing, and prostate cancer. It also reviews conditions of the penis and testicular disease.
Neurology
Authors: Simon Chantal , Everitt Hazel , van Dorp Françoise , Hussain Nazia , Nash Emma , Peet Danielle
Published: June 2020

This chapter in the Oxford Handbook of General Practice explores neurology in general practice. It covers reflexes and muscle power, cranial nerve lesions, neuropathy, polyneuropathy, walking problems, and speech problems. It explores transient loss of consciousness, migraine, headache, facial pain, raised intracranial pressure, intracranial bleeds, acute stroke, and prevention of stroke. It discusses Parkinson’s disease, multiple sclerosis, motor neurone disease, and Creutzfeldt–Jakob disease. It also examines spinal cord conditions, epilepsy, muscle disorders, neurological rehabilitation problems, and neurological assessment scales.
Haematology and immunology
Authors: Simon Chantal , Everitt Hazel , van Dorp Françoise , Hussain Nazia , Nash Emma , Peet Danielle
Published: June 2020

This chapter in the Oxford Handbook of General Practice explores haematology in general practice. It covers full blood count and erythrocyte sedimentation rate. It explores diagnosis and initial investigation of anaemia, iron deficiency anaemia, haemoglobinopathies, bleeding and clotting disorders, and anticoagulation. It examines haematological malignancy, acute leukaemia, chronic leukaemia and myeloproliferation, lymphoma, immune deficiency, and allergy.
Gynaecology
Authors: Simon Chantal , Everitt Hazel , van Dorp Françoise , Hussain Nazia , Nash Emma , Peet Danielle
Published: June 2020

This chapter in the Oxford Handbook of General Practice explores gynaecology in general practice. It covers the menstrual cycle, premenstrual syndrome, amenorrhoea, menorrhagia, the menopause, and hormone replacement therapy. It discusses pelvic pain, endometriosis and adenomyosis, prolapse, and uterine problems. It also explores ovarian disease, conditions of the cervix, cervical cancer screening, and vaginal and vulval problems.
Child health
Authors: Simon Chantal , Everitt Hazel , van Dorp Françoise , Hussain Nazia , Nash Emma , Peet Danielle
Published: June 2020

This chapter in the Oxford Handbook of General Practice explores child health in general practice. It covers child health promotion from birth, including the neonatal and 6-week check, neonatal bloodspot screening, screening for hip dysplasia, vision and hearing screening tests, birth trauma, genetic disorders, common problems of small babies, prematurity, and neonatal jaundice. It examines feeding babies, weaning, and developmental milestones. It discusses fever and acute illness in the under 5s, childhood infection, urinary tract infection, congenital heart disease, asthma, constipation, malabsorption, gut atresia, hernias, and intussusception. It explores growth disorders, endocrine problems, funny turns, febrile convulsions, epilepsy, hydrocephalus, neural tube defect, arthritis, dermatology, and cancer. It also discusses behaviour problems, sleep problems, toilet training, poor progress at school, autism, learning disability, adolescence, chronic illness, disability, safeguarding children, and child death.
Ear, nose, and throat
Authors: Simon Chantal , Everitt Hazel , van Dorp Françoise , Hussain Nazia , Nash Emma , Peet Danielle
Published: June 2020

This chapter in the Oxford Handbook of General Practice explores ear, nose, and throat (ENT) medicine in general practice. It covers dental and jaw problems, sore throat and tonsillitis, hoarseness and stridor, neck lumps, and salivary gland problems. It examines nasal problems, sinusitis, and rhinitis. It discusses ear pain and external ear problems, otitis media, deafness, tinnitus, and vertigo.
Ophthalmology
Authors: Simon Chantal , Everitt Hazel , van Dorp Françoise , Hussain Nazia , Nash Emma , Peet Danielle
Published: June 2020

This chapter in the Oxford Handbook of General Practice explores ophthalmology in general practice. It covers assessment of the eye, eye trauma, eye pain, papilloedema, and orbital disease. It examines lid disease, blepharitis, tear duct problems, red eye, conjunctivitis, and corneal, scleral and uveal disease. It discusses visual field loss and blindness, sudden loss of vision in one eye, gradual loss of vision, glaucoma, and cataract. It also explores refraction errors, squint, contact lenses, and drugs for the eye.
The SkyMapper-Gaia RVS view of the Gaia–Enceladus–Sausage  – an investigation of the metallicity and mass of the Milky Way’s last major merger
Authors: Feuillet Diane K , Feltzing Sofia , Sahlholdt Christian L , Casagrande Luca
Published: June 2020

We characterize the Gaia–Enceladus–Sausage kinematic structure recently discovered in the Galactic halo using photometric metallicities from the SkyMapper survey, and kinematics from Gaia  radial velocities measurements. By examining the metallicity distribution functions (MDFs) of stars binned in kinematic/action spaces, we find that the $\sqrt{J_R}$ versus Lz space allows for the cleanest selection of Gaia–Enceladus–Sausage stars with minimal contamination from disc or halo stars formed in situ or in other past mergers. Stars with $30 \le \sqrt{J_R} \le 50$ (kpc km s−1)1/2 and −500 ≤ Lz ≤ 500 kpc km s−1 have a narrow MDF centred at [Fe/H] = −1.17 dex with a dispersion of 0.34 dex. This [Fe/H] estimate is more metal-rich than literature estimates by 0.1−0.3 dex. Based on the MDFs, we find that selection of Gaia–Enceladus–Sausage stars in other kinematic/action spaces without additional population information leads to contaminated samples. The clean Gaia–Enceladus–Sausage sample selected according to our criteria is slightly retrograde and lies along the blue sequence of the high VT halo colour magnitude diagram dual sequence. Using a galaxy mass–metallicity relation derived from cosmological simulations and assuming a mean stellar age of 10 Gyr, we estimate the mass of the Gaia–Enceladus–Sausage progenitor satellite to be 108.85–9.85 M⊙, which is consistent with literature estimates based on disc dynamic and simulations. Additional information on detailed abundances and ages would be needed for a more sophisticated selection of purely Gaia–Enceladus–Sausage stars.
Chromatin remodeler Ino80C acts independently of H2A.Z to evict promoter nucleosomes and stimulate transcription of highly expressed genes in yeast
Authors: Qiu Hongfang , Biernat Emily , Govind Chhabi K , Rawal Yashpal , Chereji Răzvan V , Clark David J , Hinnebusch Alan G
Published: June 2020

The chromatin remodelers SWI/SNF and RSC function in evicting promoter nucleosomes at highly expressed yeast genes, particularly those activated by transcription factor Gcn4. Ino80 remodeling complex (Ino80C) can establish nucleosome-depleted regions (NDRs) in reconstituted chromatin, and was implicated in removing histone variant H2A.Z from the −1 and +1 nucleosomes flanking NDRs; however, Ino80C’s function in transcriptional activation in vivo is not well understood. Analyzing the cohort of Gcn4-induced genes in ino80Δ mutants has uncovered a role for Ino80C on par with SWI/SNF in evicting promoter nucleosomes and transcriptional activation. Compared to SWI/SNF, Ino80C generally functions over a wider region, spanning the −1 and +1 nucleosomes, NDR and proximal genic nucleosomes, at genes highly dependent on its function. Defects in nucleosome eviction in ino80Δ cells are frequently accompanied by reduced promoter occupancies of TBP, and diminished transcription; and Ino80 is enriched at genes requiring its remodeler activity. Importantly, nuclear depletion of Ino80 impairs promoter nucleosome eviction even in a mutant lacking H2A.Z. Thus, Ino80C acts widely in the yeast genome together with RSC and SWI/SNF in evicting promoter nucleosomes and enhancing transcription, all in a manner at least partly independent of H2A.Z editing.
Forecasting Seizure Freedom After Epilepsy Surgery Assessing Concordance Between Noninvasive and StereoEEG Findings
Authors: Uribe San Martin Reinaldo , Di Giacomo Roberta , Mai Roberto , Gozzo Francesca , Pelliccia Veronica , Mariani Valeria , Cardinale Francesco , Ciampi Ethel , Onofrj Marco , Tassi Laura
Published: June 2020

BACKGROUND

Accurate localization of the probable Epileptogenic Zone (EZ) from presurgical studies is crucial for achieving good prognosis in epilepsy surgery.

OBJECTIVE

To evaluate the degree of concordance at a sublobar localization derived from noninvasive studies (video electroencephalography, EEG; magnetic resonance imaging, MRI; 18-fluorodeoxyglucose positron emission tomography FDG-PET, FDG-PET) and EZ estimated by stereoEEG, in forecasting seizure recurrence in a long-term cohort of patients with focal drug-resistant epilepsy.

METHODS

We selected patients with a full presurgical evaluation and with postsurgical outcome at least 1 yr after surgery. Multivariate Cox regression analysis for seizure freedom (Engel Ia) was performed.

RESULTS

A total of 74 patients were included, 62.2% were in Engel class Ia with a mean follow-up of 2.8 + 2.4 yr after surgery. In the multivariate analysis for Engel Ia vs >Ib, complete resection of the EZ found in stereoEEG (hazard ratio, HR: 0.24, 95%CI: 0.09-0.63, P = .004) and full concordance between FDG-PET and stereoEEG (HR: 0.11, 95%CI: 0.02-0.65, P = .015) portended a more favorable outcome. Most of our results were maintained when analyzing subgroups of patients.

CONCLUSION

The degree of concordance between noninvasive studies and stereoEEG may help to forecast the likelihood of cure before performing resective surgery, particularly using a sublobar classification and comparing the affected areas in the FDG-PET with EZ identified with stereoEEG.
Strategic environmental policy and international market share rivalry under differentiated Bertrand oligopoly
Authors: Lapan Harvey E , Sikdar Shiva
Published: June 2020

We analyse strategic environmental policies under international Bertrand oligopoly when firms in different industries, located in different countries, produce differentiated products. Under cooperation, emission prices always exceed the joint marginal damage from pollution. Under non-cooperation, internationally nontradable and tradable emission permit prices are always higher than the domestic marginal damage from emissions (the Pigovian tax); emission taxes can also exceed the Pigovian tax. The non-cooperative emission prices under all instruments can exceed the joint pollution damage. Internationally tradable permits generate outcomes closest to cooperation — they result in the lowest pollution and the highest welfare among all instruments under non-cooperation. Pollution is the highest and welfare the lowest with taxes. Our results provide support for allowing international trade in emission permits even when governments choose their permit levels non-cooperatively.
Possible Diagnostic Delays and Missed Prevention Opportunities in Pneumocystis Pneumonia Patients Without HIV: Analysis of Commercial Insurance Claims Data—United States, 2011–2015
Authors: Gold Jeremy A W , Jackson Brendan R , Benedict Kaitlin
Published: June 2020

Background

Pneumocystis pneumonia (PCP) is a life-threatening but treatable and preventable fungal infection in immunocompromised persons. Previous studies suggest that persons without HIV who develop PCP (PCPHIV-) experience more acute, severe illness than persons with HIV who develop PCP (PCPHIV+). We analyzed health insurance claims data to compare demographics, underlying conditions, symptoms, and prescriptions for PCPHIV+ and PCPHIV-.

Methods

We used the IBM MarketScan Research Databases to identify patients diagnosed with PCP during 2011–2015. We analyzed claims 1 year before to 3 months after diagnosis to compare PCPHIV+ and PCPHIV-.

Results

Among 3938 patients, 70.4% were PCPHIV-. Compared with PCPHIV+, PCPHIV- were more likely to be older (median, 60 vs 45 years; P < .0001), female (51.5% vs 20.2%; P < .0001), hypoxemic (13.5% vs 7.1%; P < .0001), and to die within 90 days (6.6% vs 4.2%; P < .0001). The most common underlying conditions among PCPHIV- included chronic pulmonary diseases (54.6%), solid tumors (35.1%), hematologic malignancies (20.1%), and rheumatologic conditions (14.0%). The median time between the first visit for PCP-related symptoms and PCP diagnosis was longer for PCPHIV- than PCPHIV+ (25 vs 16 days; P < .0001). In the 3 months before PCP diagnosis, PCPHIV- were less likely to have an outpatient prescription for PCP prophylaxis than PCPHIV+ (6.9% vs 10.6%; P = .0001).

Conclusions

PCPHIV- may experience a prolonged illness course and diagnostic delays compared with PCPHIV+. Clinicians should maintain a high index of suspicion for PCP in immunocompromised patients with compatible symptoms, regardless of HIV status.
The United Kingdom’s Statutory Constitution
Authors: Psygkas Athanasios
Published: June 2020

The emergence of the UK’s statutory constitution has challenged the old Diceyan adage that ‘neither the Act of Union with Scotland nor the Dentists Act 1878 has more claim than the other to be considered supreme law’. This article reconceptualises constitutional statutes, offering a three-pronged approach to identifying such legislation. This new model examines the content of the statute, the history of enacting the constitutional statute (the ‘life of the Bill’), and the post-enactment history (the ‘life of the statute’). The proposed framework reflects a historical approach to constitutionalism and gives weight not only to judicial practice, but also to the interactions between other constitutional actors and to popular endorsement. Four case studies of statutes demonstrate how the new model adds layers to, and diverges from, the current judicial approach. Finally, the article describes the implications of taking constitutional statutes seriously under the proposed approach.
Syncope in a hypertrophic heart at a wedding party: can happiness break a thick heart? Takotsubo cardiomyopathy complicated with left ventricular outflow tract obstruction in a hypertrophic heart
Authors: Orphanou Nicoletta , Eftychiou Christos , Papasavvas Elias , Ioannides Marios , Avraamides Panayiotis
Published: June 2020

A 70-year-old woman with known history of hypertension presented because of a syncopal episode during dinner at a wedding party, followed by chest pain. On physical examination a systolic murmur was noted, and her electrocardiogram showed ST segment elevation in anterior leads. She had elevated troponin levels while echocardiography showed a hypertrophic interventricular septum with dyskinetic apex and left ventricular outflow (LVOT) obstruction. Emergency coronary angiography excluded obstructive coronary artery disease and confirmed the presence of LVOT obstruction with a gradient of 90 mm Hg. A left ventriculography showed hypercontractility of the basal and mid segments with apical wall dyskinesia indicating Takotsubo cardiomyopathy. Patient was discharged after 6 days of hospitalization with normalization of left ventricular function and regression of the LVOT obstruction. This is an interesting case of Takotsubo cardiomyopathy complicated with severe LVOT obstruction in a patient with hypertensive heart disease and a sigmoid septum hypertrophy.
Conformational selection of allergen-antibody complexes—surface plasticity of paratopes and epitopes
Authors: Fernández-Quintero Monica L , Loeffler Johannes R , Waibl Franz , Kamenik Anna S , Hofer Florian , Liedl Klaus R
Published: June 2020

Antibodies have the ability to bind various types of antigens and to recognize different antibody-binding sites (epitopes) of the same antigen with different binding affinities. Due to the conserved structural framework of antibodies, their specificity to antigens is mainly determined by their antigen-binding site (paratope). Therefore, characterization of epitopes in combination with describing the involved conformational changes of the paratope upon binding is crucial in understanding and predicting antibody-antigen binding. Using molecular dynamics simulations complemented with strong experimental structural information, we investigated the underlying binding mechanism and the resulting local and global surface plasticity in the binding interfaces of distinct antibody-antigen complexes. In all studied allergen-antibody complexes, we clearly observe that experimentally suggested epitopes reveal less plasticity, while non-epitope regions show high surface plasticity. Surprisingly, the paratope shows higher conformational diversity reflected in substantially higher surface plasticity, compared to the epitope. This work allows a visualization and characterization of antibody-antigen interfaces and might have strong implications for antibody-antigen docking and in the area of epitope prediction.
Mitogenomics of the endangered Mediterranean monk seal (Monachus monachus) reveals dramatic loss of diversity and supports historical gene-flow between Atlantic and eastern Mediterranean populations
Authors: Rey-Iglesia Alba , Gaubert Philippe , Espregueira Themudo Gonçalo , Pires Rosa , de la Fuente Constanza , Freitas Luís , Aguilar Alex , Borrell Asunción , Krakhmalnaya Tatiana , Vasconcelos Raquel , Campos Paula F
Published: June 2020

The Mediterranean monk seal Monachus monachus is one of the most threatened marine mammals, with only 600–700 individuals restricted to three populations off the coast of Western Sahara and Madeira (North Atlantic) and between Greece and Turkey (eastern Mediterranean). Its original range was from the Black Sea (eastern Mediterranean) to Gambia (western African coast), but was drastically reduced by commercial hunting and human persecution since the early stages of marine exploitation.

We here analyse 42 mitogenomes of Mediterranean monk seals, from across their present and historical geographic ranges to assess the species population dynamics over time. Our data show a decrease in genetic diversity in the last 200 years. Extant individuals presented an almost four-fold reduction in genetic diversity when compared to historical specimens. We also detect, for the first time, a clear segregation between the two North Atlantic populations, Madeira and Cabo Blanco, regardless of their geographical proximity. Moreover, we show the presence of historical gene-flow between the two water basins, the Atlantic Ocean and the Mediterranean Sea, and the presence of at least one extinct maternal lineage in the Mediterranean. Our work demonstrates the advantages of using full mitogenomes in phylogeographic and conservation genomic studies of threatened species.
Morphological and Molecular Characterization of Alternaria Species Causing Leaf Blight on Watermelon in China
Authors: Ma Guoping , Bao Shuwen , Zhao Juan , Sui Yuan , Wu Xuehong
Published: June 2020

Watermelon is an economically important crop in China and is commonly affected by Alternaria-like leaf blight that can result in significant economic losses. In this study, 830 Alternaria isolates, recovered from symptomatic watermelon leaves, were identified based on morphological traits, pathogenicity, and multilocus sequence analyses of glyceraldehyde-3-phosphate dehydrogenase (GAPDH), histone 3 (HIS3), the internal transcribed spacer of ribosomal DNA (rDNA ITS), and the RNA polymerase II second largest subunit (RPB2). Watermelon isolates grouped to five Alternaria species and one unclassified Alternaria species. They were A. tenuissima, A. alternata, A. cucumerina, A. infectoria, A. gaisen, and Alternaria sp. Notably, A. tenuissima was the most prevalent (73.5%) of the six isolated species, followed by A. alternata (25.0%), A. cucumerina (1.1%), Alternaria sp. (0.2%), A. infectoria (0.1%), and A. gaisen (0.1%). Pathogenicity tests demonstrated that all six Alternaria species could produce brown necrotic lesions on detached leaves of watermelon. The average disease incidence (75.1%) and average disease index (60.8) of watermelon resulting from inoculation of leaves with A. cucumerina were significantly higher than levels resulting from A. alternata (52.9% and 37.2) and A. tenuissima (47.5% and 30.8). Inoculation with Alternaria sp. resulted in a disease incidence (70.0%) and disease index (51.5), which were lower than those of A. cucumerina. The disease incidence and disease index in watermelon leaves inoculated with the one isolate of A. infectoria and the one isolate of A. gaisen present in the inoculated leaves were 28.9% and 16.4, and 48.9% and 31.4, respectively. Results of the study indicate that Alternaria species associated with watermelon leaf blight in China are more diverse than that has been previously reported. This is the first report globally of A. infectoria, A. gaisen, and an unclassified Alternaria species as causal agents of leaf blight on watermelon.
Sepsis secondary to multifocal Enterococcus faecium infection
Authors: Huang Xiao-qing , Qiu Jun-ke , Wang Cai-hong , Pan Lei , Xu Jie-kun , Pan Xiao-hong , Ji Xiao-bo , Mao Min-jie
Published: June 2020

Introduction:

Nosocomial Enterococcus faecium (E faecium) infections are common among immunocompromised patients; however, sepsis caused by E faecium is rarely encountered in the clinical setting.

Patient concerns:

A 69-year-old woman with a previous history of tuberculosis (TB), developed symptoms of recurrent fever, paroxysmal cough, and exertional dyspnea for over 2 months before she presented to the hospital.

Diagnosis:

The patient was initially misdiagnosed with recurrent TB, and did not respond to anti-TB therapy. Culture results of blood, endotracheal necrotic tissue, and urine confirmed a diagnosis of multifocal E faecium infection.

Interventions:

On definitive diagnosis, the patient received intensive antimicrobial combination treatment with linezolid, teicoplanin, caspofungin, and voriconazole on the basis of antimicrobial susceptibility results.

Outcomes:

After transient improvement, the patient's condition deteriorated due to secondary infections, and the patient died after discharge against medical advice.

Conclusion:

E faecium bacteremia may cause sepsis in immunocompromised patients, and has a high mortality rate. Careful pathogen detection and early initiation of treatment is crucial to good patient outcome.
Effectiveness of a primary care clinical ultrasound classroom for family physicians as a formative intervention system, a quasi-experimental trial
Authors: Diego-Domínguez Fernando , Torrecilla-García Miguel , Casado-Huerga Jesús , Paule-Sánchez Maria Ángeles , Soria-López Clara Isabel , Iglesias-Clemente José Manuel , de Dios-Hernández José María , Diego-Mangas Natalia , Cubillo-Jiménez María , Pérez-Escanilla Fernando
Published: June 2020

Introduction:

Clinical ultrasound is a technique that increases diagnostic capacity and facilitates clinical decision making. The objective is to develop and validate an ultrasound training methodology oriented to the clinical practice of the family physician.

Methods:

Quasi-experimental study, with a before/after design, a control group, and 1 year of follow-up. Twenty family physicians working in primary care health centers with a list of over 800 patients will be included, as well as a control group of family physicians with similar characteristics in terms of age, sex, and patient list. A structured training process oriented to the clinical practice of the family physician, primary care clinical ultrasound classroom (AECAP), will be carried out, and the improvement of knowledge and skills of the participants will be evaluated, as well as the improvement of the quality of care based on clinical indicators.

Discussion:

The family physician is in a privileged situation allows increasing the performance of ultrasound in frequent clinical situations and reducing care hours. We hope that the results obtained in this study demonstrate the effectiveness of the structured training method (AECAP) and support the generalization of ultrasound in primary health care.

Ethics and dissemination:

The study was approved by the Medical Research Ethics Committee of Salamanca on December 17, 2018 (cod 2018 11 134). The trial was registered in ClinicalTrials.gov provided by the US National Library of Medicine-number: NCT04283383.
Sertoli-Leydig cell tumor in two siblings with DICER1 syndrome
Authors: Zhang Ying , Ren Meng , Hong Yazhen , Zhong Yanping , Cong Xiaofeng , Chen Chen , Liu Ziling , Man Yu , Yang Lei
Published: June 2020

Rationale:

DICER1 syndrome is an autosomal-dominant tumor predisposition syndrome associated with numerous cancerous and noncancerous conditions. The most common sex cord-stromal tumor associated with DICER1 syndrome is Sertoli-Leydig cell tumor of the ovary (SLCT), which is extremely unusual and accounts for < 0.5% of all ovarian neoplasms. SLCT predominantly affects adolescents and young female adults. To date, there are only a few case reports of ovarian SLCT with underlying germline DICER1 mutations. The diagnosis and treatment of this rare malignancy remains challenging in the clinic mainly due to its rarity and varied presentation.

Patient concerns:

A 21-year-old Chinese girl (proband) was admitted in hospital for experiencing a lower abdominal pain and irregular vaginal bleeding for half a year. She was initially diagnosed with abdominal cavity mass prior to surgical operation. The other 20-year-old patient is the younger sister of the proband, who was diagnosed with ovarian cysts and had irregular menstruation and amenorrhea for 4 months. The elder sister underwent an uncomplicated bilateral ovarian tumor resection. Given a high degree of malignancy, comprehensive staged fertility-preserving surgery, including left adnexectomy, omentectomy, pelvic, and para-aortic lymphadenectomy, was performed. Since the other patient requested to maintain her fertility, tumor resection was only conducted in the right ovary.

Diagnoses:

The elder sister was diagnosed as poorly differentiated SLCT accompanied with heterologous stage IC rhabdomyosarcoma (RMS) based on its typical pathology features and molecular characteristics from immunohistochemistry (IHC) staining. The younger sister was diagnosed as poorly differentiated SLCT. Targeted next-generation sequencing (NGS) detected DICER1 mutation in the plasma samples and postoperative tumor tissues of both patients.

Interventions:

Both patients underwent surgical tumor resection, followed by combination chemotherapy with bleomycin, etoposide, and cisplatin for 4 cycles.

Outcomes:

Patients received the above clinical interventions but eventually died from disease recurrence. The elder sister died from disease relapse after one and a half years postsurgery. The younger sister had a relapse of the disease 1 year later, but she refused the comprehensive staged surgery and died from disease relapse quickly.

Lessons:

Ovarian SLCT patients with DICER1 mutations and a family history have a high degree of malignancy and are associated with a poor prognosis. With ongoing research efforts on DICER1 mutations, genetic screening and counselling on a regular basis is recommended for predicting potential future cancer risk of individuals with DICER1 syndrome family history.
Occurrence of the S230R integrase strand inhibitor mutation in a treatment-naïve individual case report
Authors: Gudipati Smitha , Brar Indira , Golembieski Alicia , Hanna Zachary , Markowitz Norman
Published: June 2020

Rationale:

Transmitted resistance to integrase strand inhibitors (INSTI) has been uncommon, but is slowly becoming more prevalent among those living with HIV. In an era with 2-drug regimens for antiretroviral therapy, transmitted resistance for INSTI is alarming.

Patient concerns:

A 28-year-old African American female was recently diagnosed with HIV during a 30-week prenatal visit.

Diagnosis:

HIV 4th generation test was positive as well as confirmation. Genotype was performed using next generation sequencing.

Interventions:

Patient was initially rapidly started on a dolutegravir based regimen and changed to a protease inhibitor regimen once her genotype reported an S230R mutation.

Outcomes:

Patient became virally suppressed on antiretroviral therapy and delivered an HIV negative baby.

Lessons:

INSTI resistance testing should be done for treatment-naïve and INSTI-naïve persons, particularly when considering 2 drug INSTI based regimens.
Dab2 gene variant is associated with increased coronary artery disease risk in Chinese Han population
Authors: Wang Yinghong , Wang Yongtao , Adi Dilare , He XiaoDong , Liu Fen , Abudesimu Asiya , Fu Zhenyan , Ma Yitong
Published: June 2020

Disabled-2 (Dab2) is a clathrin and cargo-binding endocytic adaptor protein that plays a role in cellular trafficking of low-density lipoprotein receptor (LDLR). However, little is known about its involvement in coronary artery disease (CAD). Here, we aimed to investigate the association between Dab2 single-nucleotide polymorphisms (SNPs) and CAD in Chinese Han and Uyghur populations.

We performed a case-control study in CAD group that consisted of 621 Han and 346 Uygurs, and the age and gender matched control group consisted of 611 Han and 405 Uygurs. The clinicopathological characteristics of these subjects were analyzed. Genotyping of 4 SNPs (rs1050903, rs2855512, rs11959928, and rs2255280) of the Dab2 gene was performed in all subjects with an improved multiplex ligase detection reaction method.

The distribution of the genotype, dominant model (AA vs. AC + CC), as well as allele frequencies of both rs2855512 and rs2255280, was significantly different between CAD patients and control subjects in Han population but not in Uyghur population. AA genotype may be a risk factor for CAD. For Han population, statistical significant correlation between dominant model for both SNPs (AA) and CAD was found after multivariate adjustment. After multivariate adjustment in the Han population, we speculate that rs285512 A allele and rs2255280 A allele may be potentially associated with the onset of coronary heart disease. Individuals with the AA genotype had an OR of 1.44 (95% CI: 1.10–1.88, P = .01, rs2855512) and 1.41 (95% CI: 1.08–1.85, P = .01, rs2255280) for CAD compared with individuals with the AC or CC genotype, respectively.

Our data indicates that the AA genotype of rs2855512 and rs2255280 in the Dab2 gene may be a genetic marker of CAD risk in Chinese Han population.
Multiple screws versus sliding hip screws in femoral neck fractures
Authors: Zhao Yu , Yin Kun , Zhao Huiling , Peng Zeli
Published: June 2020

Background:

There has been a paucity of cohort trials directly comparing multiple cannulated screws (MCS) and sliding hip screws (SHS) in femoral neck fractures at any level. Thus, a well-conducted clinical trial with an adequate sample size is urgently needed. We undertake a retrospective study to compare outcomes in patients who undertake MCS or SHS fixation for femoral neck fractures.

Methods:

A retrospective review of femoral neck fractures performed with SHS or MCS between February 2016 and June 2018 was conducted with Institutional Review Board approval in the First Affiliated Hospital of Dali University of Orthopedic Trauma. All cases were performed by a single surgeon. Of these, we included 180 patients (90 hips) that were performed surgery in treatment of femoral neck fractures. All patients received the same standardized postoperative multimodal pain protocol and the same postoperative rehabilitation program. The primary endpoint was Harris Hip Score. Secondary outcome measures include operation time, length of hospital stay, incision length, patient satisfaction, and postoperative complications. Multivariate linear and regression analyses was used to identify independent predictors of outcome. A P-value of <.05 was defined as statistical significance.

Results:

We hypothesize that both treatments provide comparable outcomes.

Trial registration:

This study protocol was registered in Research Registry (researchregistry5638).
Cerebral carbon dioxide embolism after kidney cancer laparoscopic surgery with full neurological recovery
Authors: Li Yuan , Zhang Enlong , Yuan Huishu
Published: June 2020

Rationale:

Cerebral carbon dioxide embolism (CCDE) is a rare cause of stroke and is a recognized life-threatening complication.CCDE may result from direct intravascular CO2 insufflation during surgery. Due to the lack of typical clinical manifestations, the disease is often missed or mistaken for another condition. The clinical signs and symptoms depend on the speed and volume of embolized gas entering the blood and the patient's condition. In particular, patent foramen ovale has been found to be associated, in rare cases, with the intraoperative entry of gas into the arterial system.

Patient concerns:

In this report, we present the case of a 35-year-old woman with kidney cancer who underwent laparoscopic right partial nephrectomy.

Diagnosis:

After the laparoscopic surgery, the patient was initially diagnosed with acute cerebral infarction.

Interventions:

The patient was treated according to the standard method for treatment of acute cerebrovascular disease.

Outcomes:

Three days after the laparoscopic procedure, the patient gained consciousness, and she was discharged without any neurologic sequelae on postoperative day 12.

Lessons subsections as per style:

Due to the low incidence and sudden occurrence of CCDE, there is a strong likelihood of missed diagnosis or misdiagnosis, and it is; therefore, important to be aware of the risk. The findings from this report would be highly useful as a reference to clinicians in the future.
Alectinib in the treatment of ocular metastases of ALK rearranged non small cell lung cancer
Authors: Gozzi Elisa , Angelini Francesco , Rossi Luigi , Leoni Valentina , Trenta Patrizia , Cimino Giuseppe , Tomao Silverio
Published: June 2020

Rationale:

Choroidal metastasis is a rare metastatic location although the most common intraocular neoplasm. In general, choroidal metastases respond favorably to systemic therapy targeted toward the primary neoplasm. In patients with choroidal metastasis of ALK rearranged non small cell lung cancer (NSCLC), targeted therapy using Alk inhibitors gradually replaced radiotherapy as the best treatment. Alectinib is a second-generation ALK inhibitors. Here we describe 2 clinical cases of patients with choroidal metastasis of ALK rearranged NSCLC who received Alectinib as first-line therapy achieving disease control and quality of life improvement.

Patients concerns:

In case report 1, 62-year-old man presented with scintillated scotomas at the level of the right eye; in case report 2, 69-year-old man presented with respiratory distress, persistent cough resistant to medical therapy, pain, and blurred vision.

Diagnoses:

In case report 1, fundus and ultrasonographic examination showed circumscribed choroid thickening with dome-like appearance compatible with repetitive lesion. Computed tomographic/y (CT) showed multiple bilateral pulmonary nodular formations and adenocarcinoma of the lung was diagnosed by a transbronchial biopsy.

In case report 2, CT showed a primary lesion of 36 × 27 mm in the middle lobe with bilateral lung metastases and lymphadenopathies. Multiple hepatic metastases and minor suspicious bone repetitions. A liver biopsy made a diagnosis of adenocarcinoma compatible with pulmonary primitiveness. An ocular fluoroangiography evidenced a left choroidal metastasis.

Interventions:

Case report 1, 2, medical treatment with Alectinib 1200 mg/day was initiated.

Outcomes:

In case report 1, a few days after beginning the treatment, both systemic symptoms like respiratory distress and low vision were palliated. Reassessment by CT confirmed treatment response. In case report 2, clinically, visus disorders had already improved 2 weeks after beginning treatment. CT showed pulmonary, nodal, and hepatic response. Stability of bone metastases occurred after 2 months. In addition, ocular ultrasonography documented the regression of previously reported lesions confirmed treatment response.

Lessons:

Alectinib works very well in intracranial metastases and is assumed to be so on the ocular ones as well, with benefit for the patient in quality of life.
Effect of advanced nursing care on psychological disorder in patients with COVID-19
Authors: Fan Wen-juan , Liu Xiao-ling
Published: June 2020

Background:

This study will explore the effect of advanced nursing care (ANC) on psychological disorder (PD) in patients with Coronavirus Disease 2019 (COVID-19).

Methods:

This study will search the following electronic databases up to June 30, 2020: Cochrane Library, PUBMED, EMBASE, PsycINFO, Web of Science, OpenGrey, Cumulative Index to Nursing and Allied Health Literature, CNKI, and WANGFANG. We will not impose any language limitations. Two authors will independently identify titles/abstracts and full-text of all potential studies, and will collect data from eligible studies. Additionally, study quality will be assessed by Cochrane risk of bias. If necessary, we will conduct meta-analysis if sufficient trials are included.

Results:

This study will explore the effect of ANC on PD in patients with COVID-19 through outcome indicators.

Conclusion:

The findings of this study may supply summarized evidence of ANC for the management of PD in COVID-19.

PROSPERO registration number:

PROSPERO CRD42020187610.
Brucea javanica oil emulsion injection (BJOEI) as an adjunctive therapy for patients with advanced colorectal carcinoma
Authors: Xu Chunhong , Guo Xinxin , Zhou Changhui , Zhang Hualing
Published: June 2020

Background:

Brucea javanica oil emulsion injection (BJOEI) has been widely applied as a promising adjunctive drug for colorectal carcinoma (CRC). However, the exact effects and safety of BJOEI remains controversial. In this study, we aimed to summarize the efficacy and safety of BJOEI for the treatment of advanced CRC through the meta-analysis, in order to provide scientific reference for the design of future clinical trials.

Methods:

Eligible prospective controlled clinical trials were searched from PubMed, Cochrane Library, Google Scholar, Medline, Web of Science (WOS), Excerpt Medica Database (Embase), Chinese BioMedical Database (CBM), China Scientific Journal Database (VIP), China National Knowledge Infrastructure (CNKI) and Wanfang Database. Papers in English or Chinese published from January 2000 to May 2020 will be included without any restrictions. The clinical outcomes including therapeutic effects, quality of life (QoL), immune function and adverse events, were systematically evaluated.

Study selection and data extraction will be performed independently by 2 reviewers. Review Manager 5.3 and Stata 14.0 were used for data analysis, and a fixed or random-effect model will be used depending upon the heterogeneity observed between trials. Subgroup and meta-regression analysis will be carried out depending on the availability of sufficient data.

Results:

The results of this systematic review will be published in a peer-reviewed journal.

Conclusion:

Our study will draw an objective conclusion of the effects and safety of BJOEI for advanced CRC, and provide a helpful evidence for clinicians to formulate the best postoperative adjuvant treatment strategy for CRC patients.

INPLASY registration number: INPLASY202060014.
Retransplantation After Living Donor Liver Transplantation: Data from the Adult to Adult Living Donor Liver Transplantation Study
Authors: Braun Hillary J. , Grab Joshua D. , Dodge Jennifer L. , Syed Shareef M. , Roll Garrett R. , Schwab Marisa P. , Liu Iris H. , Glencer Alexa C. , Freise Chris E. , Roberts John P. , Ascher Nancy L.
Published: June 2020

Background.

The use of living donor liver transplantation (LDLT) for primary liver transplantation (LT) may quell concerns about allocating deceased donor organs if the need for retransplantation (re-LT) arises because the primary LT did not draw from the limited organ pool. However, outcomes of re-LT after LDLT are poorly studied. The purpose of this study was to analyze the Adult to Adult Living Donor Liver Transplantation Study (A2ALL) data to report outcomes of re-LT after LDLT, with a focus on long-term survival after re-LT.

Methods.

A retrospective review of A2ALL data collected between 1998 and 2014 was performed. Patients were excluded if they received a deceased donor LT. Demographic data, postoperative outcomes and complications, graft and patient survival, and predictors of re-LT and patient survival were assessed.

Results.

Of the 1065 patients who underwent LDLT during the study time period, 110 recipients (10.3%) required re-LT. In multivariable analyses, hepatitis C virus, longer length of stay at LDLT, hepatic artery thrombosis, biliary stricture, infection, and disease recurrence were associated with an increased risk of re-LT. Patient survival among re-LT patients was significantly inferior to those who underwent primary transplant only at 1 (86% versus 92%), 5 (64% versus 82%), and 10 years (44% versus 68%).

Conclusions.

Approximately 10% of A2ALL patients who underwent primary LDLT required re-LT. Compared with patients who underwent primary LT, survival among re-LT recipients was worse at 1, 5, and 10 years after LT, and re-LT was associated with a significantly increased risk of death in multivariable modeling (hazard ratios, 2.29; P < 0.001).
Early Outcomes With the Liver-kidney Safety Net
Authors: Cannon Robert M. , Goldberg David S. , Eckhoff Devin E. , Anderson Douglas J. , Orandi Babak J. , Locke Jayme E.
Published: June 2020

Background.

A safety net policy was implemented in August 2017 giving liver transplant alone (LTA) recipients with significant renal dysfunction posttransplant priority for subsequent kidney transplantation (KT). This study was undertaken to evaluate early outcomes under this policy.

Methods.

Adults undergoing LTA after implementation of the safety net policy and were subsequently listed for KT between 60 and 365 days after liver transplantation contained in United Network for Organ Sharing data were examined. Outcomes of interest were receipt of a kidney transplant and postliver transplant survival. Safety net patients were compared with LTA recipients not subsequently listed for KT as well as to patients listed for simultaneous liver-kidney (SLK) transplant yet underwent LTA and were not subsequently listed for KT.

Results.

There were 100 patients listed for safety net KT versus 9458 patients undergoing LTA without subsequent KT listing. The cumulative incidence of KT following listing was 32.5% at 180 days. The safety net patients had similar 1-year unadjusted patient survival (96.4% versus 93.4%; P = 0.234) but superior adjusted survival (hazard ratio0.133, 0.3570.960; P = 0.041) versus LTA recipients not subsequently listed for KT. Safety net patients had superior 1-year unadjusted (96.4% versus 75.0%; P < 0.001) and adjusted (hazard ratio0.039, 0.1260.406; P < 0.001) survival versus SLK listed patients undergoing LTA without subsequent KT listing.

Conclusions.

The safety net appears to provide rapid access to KT with good early survival for those able to take advantage of it. Survival of patients unable to qualify for KT listing after LTA needs to be better understood before further limitation of SLK, however.
The therapeutic effectiveness of Convalescent plasma therapy on treating COVID-19 patients residing in respiratory care units in Baghdad, Iraq
Authors: Rasheed Anwar M. , Fatak Dhurgham F , Hashim Hashim A. , Maulood Mohammed F , Kabah Khulood K , Almusawi Yaqoob A. , Abdulamir Ahmed S
Published: June 2020

Objectives

The current COVID-19 pandemic needs unconventional therapies to tackle the resulted high morbidity and mortality. Convalescent plasma is one of the therapeutic approaches that might be of benefit.

Methods

Forty nine early-stage critically-ill COVID-19 patients residing in RCU of three hospitals in Baghdad, Iraq were included, 21 received convalescent plasma while 28 did not receive, namely control group. Recovery or death, length of stay in hospital, and improvement in the clinical course of the disease were monitored clinically along with laboratory monitoring through SARS-CoV-2 RNA detection via PCR, and SARS-CoV-2 IgG and IgM serological monitoring.

Results

Patients received convalescent plasma showed reduced duration of infection in about 4 days, and showed less death rate, 1/21 versus 8/28 in control group. In, addition, all of the patients received convalescent plasma showed high levels of SARS-CoV-2 IgG and IgM 3 days after plasma transfusion. Plasma from donors with high levels of SARS-CoV-2 IgG and donors with positive SRAS-CoV-2 IgM showed better therapeutic results than other donors.

Conclusions

Convalescent plasma therapy is an effective mode of therapy if donors with high level of SARS-Cov2 antibodies are selected and if recipients were at their early stage of critical illness, being no more than 3 days in RCU.
Electrocardiographic safety of daily Hydroxychloroquine 400mg plus Azithromycin 250mg as an ambulatory treatment for COVID-19 patients in Cameroon
Authors: Mfeukeu-Kuate Liliane , Ngatchou William , Temgoua Mazou Ngou , Kouanfack Charles , Lemogoum Daniel , Tochie Joel Noutakdie , Zemsi Armel , Fomete Lauriane , Lekelem Skinner , Zemsi Sylvain , Sobngwi Joelle , Ntandzi Thierry , Ouankou Christian Ngongang , Wasnyo Yves , Assiga Antoinette Ntsama , Nkeck Jan René , Jingi Ahmadou Musa , Guewo Magellan , Pefura Yone Eric Walter , Omgba Charlotte Moussi , Etoundi Paul Owono , Yombi Jean Cyr , Menanga Alain , Kingue Samuel , Minkande Jacqueline Ze , Mbanya Jean Claude , Zogo Pierre Ongolo , Fouda Pierre Joseph , Sobngwi Eugène
Published: June 2020

Objective

To determine the early electrocardiographic changes in a cohort of ambulatory cameroonian COVID-19 patients treated with hydroxychloroquine and Azithromycin.

Design

Prospective study.

Setting

Treatment centres of the city of Yaounde, Cameroon, from May 7th to 24th 2020.

Participants

We enrolled 51 consecutive confirmed COVID-19 on RT-PCR who having mild forms of COVID-19 and treated by hydroxychloroquine 200mg twice daily during seven days plus Azithromycin 500 mg the first day and 250 mg the remaining 4 days as per national standard.

Main outcomes measures

The primary end-point was the change in QTc interval between day 0 (D0), day 3 (D3) and day 7 (D7). Secondary endpoints were changes in all other cardiac electrical conductivity patterns and the occurrence of clinical arrhythmic events during the course of treatment.

Results

The population (29 men and 22 women) was aged 39 ± 11 years (range 17 to 61 years). Mean Tisdale score was 3.35±0.48. No significant change from baseline (D0) of QTc was observed at D7 (429±27 ms at D0 versus 396±26 ms at D7; p=0.27). A reduction of heart rate was observed between the D0 and D7 (75±13 bpm versus 70±13 bpm, p = 0.02) with increased QRS duration between D0 and D7 (95±10 ms versus 102±17 ms, p = 0.004). No symptomatic arrhythmic events occurred during the treatment course.

Conclusions

No life-threatening modifications of the QT interval was observed in non-severe COVID-19 patients treated ambulatory with hydroxychloroquine and azithromycin. Studies are needed in critical-ill and older patients.