bluuebunny/crossref_metadata_2025 huggingface dataset:
Risk factors for anastomotic leakage after laparoscopic low anterior resection: A single‐center retrospective study
Authors: Nagaoka Tomoyuki , Fukunaga Yosuke , Mukai Toshiki , Yamaguchi Tomohiro , Nagasaki Toshiya , Akiyoshi Takashi , Konishi Tsuyoshi , Nagayama Satoshi
Published: November 2020

Introduction

Anastomotic leakage (AL) is a serious complication affecting short‐term and long‐term outcomes in rectal cancer surgery. While laparoscopic low anterior resection is a widespread procedure, the risk factors for AL are not well established. This study aimed to evaluate risk factors for AL after laparoscopic low anterior resection with double stapling technique (DST) anastomosis.

Methods

We performed a retrospective cohort study of laparoscopic low anterior resection with DST anastomosis for rectal cancer between January 2010 and February 2019. Finally, a total of 1197 patients were eligible for the study. Twenty‐five variables were collected for univariate and multivariate analyses.

Results

AL occurred in 49 patients (4.1%). In multivariate analysis, blood loss (≥70 mL) and no defunctioning stoma were independent risk factors (odds ratio [OR] 2.23; 95% confidence interval [CI] 1.08‐4.34; P = .030 and OR 3.15; 95% CI 1.66‐6.37; P = .0003, respectively). In addition, risk factors for AL were analyzed in 601 patients without defunctioning stoma. As a result, AL occurred in 36 patients (6.0%) and multivariate analysis demonstrated that blood loss (≥70 mL) and anastomotic level from anal verge (<5 cm) were independent risk factors (OR 3.11; 95% CI 1.24‐7.44; P = .016 and OR 2.33; 95% CI 1.14‐4.69; P = .020, respectively).

Conclusion

Laparoscopic low anterior resection is feasible and safe with a low AL rate. Important factors associated with AL were blood loss and defunctioning stoma. Without defunctioning stoma, blood loss and distal anastomosis are also important factors.
Chronic obstructive pulmonary disease research by using big data
Authors: Rhee Chin Kook
Published: November 2020

As the information technology develops, large amount of data has been stored. The digitalisation of the health‐care system enables researchers to use big data easily. Big data have been utilised for valuable source for chronic obstructive pulmonary disease (COPD) research. Various sources of data are now available including nationwide claim data and primary care database. Recently, web data are also used in COPD research. Each different data source has strengths and weaknesses. Merging different data can overcome the limitation of big data research. Future direction of big data research is to integrate multiple big data.
Efficacy and safety of abobotulinumtoxinA for upper limb spasticity in children with cerebral palsy: a randomized repeat‐treatment study
Authors: Delgado Mauricio R , Tilton Ann , Carranza‐Del Río Jorge , Dursun Nigar , Bonikowski Marcin , Aydin Resa , Maciag‐Tymecka Iwona , Oleszek Joyce , Dabrowski Edward , Grandoulier Anne‐Sophie , Picaut Philippe ,   the Dysport in PUL study group
Published: November 2020

Aim

To assess the efficacy and safety of repeat abobotulinumtoxinA injections in reducing upper limb spasticity in children with cerebral palsy (CP).

Method

This was a double‐blind, repeat‐cycle study (NCT02106351) in children with CP (2–17y). Children were randomized to receive 2U/kg (control), 8U/kg, or 16U/kg abobotulinumtoxinA injections into the target muscle group (wrist or elbow flexors) and additional muscles alongside occupational therapy via a home‐exercise therapy program (HETP; minimum five 15min sessions/wk). Children received 8U/kg or 16U/kg plus HETP in cycles 2 to 4.

Results

During cycle 1, 210 children (126 males, 84 females; mean age [SD] 9y [4y 5mo], range 2–17y; n=70/group) had at least one upper limb abobotulinumtoxinA injection and 209 complied with the HETP. At week 6 of cycle 1, children in the 8U/kg or 16U/kg groups had significantly lower Modified Ashworth scale scores versus the 2U/kg group (primary outcome: treatment differences of –0.4 [p=0.012] and –0.7 [p<0.001] respectively). All groups improved on Physician Global Assessment and children in all groups achieved their treatment goals at least as expected. Therapeutic benefits were sustained during cycles 2 to 4; muscular weakness was the only treatment‐related adverse event reported in at least one child/group (4.3% and 5.7% vs 1.4% respectively).

Interpretation

Treatment with 8U/kg or 16U/kg abobotulinumtoxinA significantly reduced upper limb spasticity versus the 2U/kg control dose. Therapeutic benefits of abobotulinumtoxinA plus HETP were sustained with repeat treatment cycles.

What this paper adds

AbobotulinumtoxinA injections significantly reduced upper limb spasticity in children with cerebral palsy.

Children treated with abobotulinumtoxinA and targeted home exercises showed global improvement and goal attainment.

Benefits were sustained over 1 year with repeat cycles of abobotulinumtoxinA and home exercises.

AbobotulinumtoxinA injections into the upper limb were well tolerated over 1 year.
Prediabetes, heart mechanics, and echocardiography: A narrative review
Authors: Davarpasand Tahereh , Hosseinsabet Ali
Published: November 2020

Prediabetes is a dysglycemic state that affects many around the world and is a known risk factor for the occurrence of type 2 diabetes mellitus in the future, accompanied by vascular complications. Evidence abounds regarding myocardial involvement in prediabetes. We herein review studies having applied tissue Doppler imaging or speckle‐tracking echocardiography to evaluate myocardial function in subjects with prediabetes to depict a picture of cardiac mechanics in individuals with prediabetes in comparison with patients suffering from diabetes mellitus and individuals in the normoglycemic state. Finally, we present the detrimental effects of prediabetes on cardiac mechanics.
Gender differences in dentistry: A qualitative study on students’ intrinsic and extrinsic motivations for entering dentistry at higher education
Authors: Kærsgaard Jens Laurs Brøndum , Christensen Mette Krogh , Søndergaard Pernille Yde , Naukkarinen Johanna
Published: November 2020

Introduction

Having a balanced gender distribution is thought to ensure the diversity of knowledge and know‐how and take better into account the different needs in society. The aim of the study is to explore and understand possible gender differences in (a) the students’ motivational spectrum to choose a dental education and (b) their prospect of a professional career in dentistry.

Methods

We conducted in‐depth interviews with male and female dental students (n = 14) followed by a theoretical reading based on Self‐Determination Theory to explore the students’ intrinsic and extrinsic motivations for entering dentistry in Denmark.

Results

Regardless gender, the dental students are motivated by role models, people orientation and strong interest in health sciences, but prefer dentistry to medicine, because of the responsibilities and working conditions. They were also motivated by the dental school's combination of theory and practice in students’ learning of craftsmanship. Moreover, students valued the prospect of job security and a good work‐life balance. However, there were markedly gender differences in motivation in relation to financial incentives as well as working life and career as a dentist, as it seemed that dental students needed gendered relatedness in relation to specialisation and employment in public versus private sector.

Conclusion

The motivational spectrum varies widely, regardless of gender. In line with the standpoint feminist theory, a balanced gender distribution in dental education helps to meet the different needs in society and labour market. Consequently, a gender‐sensitive recruitment strategy reflecting the gender differences in identities, knowledge and interests will be needed.
Comparison between students’ self‐assessment, and visual and digital assessment techniques in dental anatomy wax‐up grading
Authors: Abdalla Rowida , Bishop Susan S. , Villasante‐Tezanos Alejandro G. , Bertoli Elizangela
Published: November 2020

Introduction

Digital technology has the potential to provide a bias‐free evaluation instrument for practical examination grading. E4D Compare software was designed for teaching institutions to allow comparison between scanned models prepared by students and master models prepared by instructors. The aim of this study was to determine the tolerance value for the E4D compare software (E4D Technologies LLC, Richardson, TX, USA) that provides scores comparable with faculty grades for wax‐ups #23 and #19. Additionally, this study sought to assess the correlation between students’ self‐assessments, visual and digital grades and the reliability of the software.

Methods

Student wax‐ups (n = 112) were uploaded into the software and then compared with faculty‐generated master wax‐ups. Digital grading was performed at tolerances 200–800 μm in 50 μm increments and was repeated twice.

Results

A tolerance of 350 μm was the closest to faculty grades for #23 and 500 μm was the closest for #19. Visual and digital grades showed moderate to high correlation for both wax‐ups. Correlations between students’ self‐assessments and visual and digital grades improved with #19 versus #23. A near‐perfect correlation was found between grades at the first and second digital grading sessions.

Conclusions

The tolerance that closely matches faculty grades differs according to the tooth type. The software provided consistent grades and correlated well with faculty grades. Students’ self‐assessment skills improved as they proceeded throughout the course. Further studies are necessary to ascertain the role of the software in improving students’ self‐assessment skills.
Emergence de Ceratitis capitata (Diptera: Tephritidae) sur culture protégée de piment (Solanaceae) en zone subsaharienne (Algérie)
Authors: Mostefaoui O. , Sekour M. , Balmès V. , Ben Halima Kamel M.
Published: November 2020

En Algérie, la mouche méditerranéenne des fruits a longtemps été associée à la production fruitière des régions côtières à climat tempéré. Avec le changement climatique, en particulier avec un automne et un printemps devenus plus chauds et secs, cette mouche s’est disséminée à de nouvelles localisations et cause désormais des dommages à d’autres plantes hôtes. Elle est présente dans la zone subsaharienne du Souf (Algérie) sur culture protégée de piment (Capsicum annuum) où elle cause des dégâts importants.
Deep learning techniques for recommender systems based on collaborative filtering
Authors: Martins Guilherme Brandão , Papa João Paulo , Adeli Hojjat
Published: November 2020

In the Big Data Era, recommender systems perform a fundamental role in data management and information filtering. In this context, Collaborative Filtering (CF) persists as one of the most prominent strategies to effectively deal with large datasets and is capable of offering users interesting content in a recommendation fashion. Nevertheless, it is well‐known CF recommenders suffer from data sparsity, mainly in cold‐start scenarios, substantially reducing the quality of recommendations. In the vast literature about the aforementioned topic, there are numerous solutions, in which the state‐of‐the‐art contributions are, in some sense, conditioned or associated with traditional CF methods such as Matrix Factorization (MF), that is, they rely on linear optimization procedures to model users and items into low‐dimensional embeddings. To overcome the aforementioned challenges, there has been an increasing number of studies exploring deep learning techniques in the CF context for latent factor modelling. In this research, authors conduct a systematic review focusing on state‐of‐the‐art literature on deep learning techniques applied in collaborative filtering recommendation, and also featuring primary studies related to mitigating the cold start problem. Additionally, authors considered the diverse non‐linear modelling strategies to deal with rating data and side information, the combination of deep learning techniques with traditional CF‐based linear methods, and an overview of the most used public datasets and evaluation metrics concerning CF scenarios.
The future is how: Urbanising the Korean peninsula for imagining post‐fossil cities in East Asia
Authors: Hwang Jin‐Tae
Published: November 2020

In Maarten Hajer and his colleagues' insightful papers (Hajer & Pelzer, 2018, Energy Research and Social Science, 44, 222; Hajer & Versteeg, 2019, Territory, Politics, Governance, 7, 122) and the following sharp commentaries, we confirmed that critical scholars in the field of urban studies and energy research recognise that “the future is now” for imagining post‐fossil cities and dismantling the current unsustainable energy regime gobbling up fossil fuels. This commentary briefly shows an example of a more practical and concrete illusion that includes how to transform existing, unsustainable, fossil fuel‐based urbanisation into a more sustainable, post‐fossil future in the spatial context of East Asia, at a less abstract level. Ultimately, it emphasises that the spectre of Henry Lefebvre should be haunting more regions outside of the First World.
Reconstruction of Miocene to Pleistocene sea‐surface conditions in the eastern Indian Ocean on the basis of calcareous nannofossil assemblages from ODP Hole 757B
Authors: Imai Ryo , Sato Tokiyuki , Chiyonobu Shun , Iryu Yasufumi
Published: November 2020

We studied the calcareous nannofossil assemblages from Ocean Drilling Program Hole 757B in the eastern Indian Ocean to reconstruct the sea‐surface conditions, especially changes in thermocline/nutricline depth, from the middle Miocene to the Pleistocene. Nutrient levels at the sea surface were reconstructed from the nannofossil accumulation rate, abundance of Discoaster, and coccolith size variations in Reticulofenestra. The sea‐surface conditions were likely to have been oligotrophic with a deep thermocline/nutricline during 11.8–7.5 and 6.7–6.2 Ma. The change from oligotrophic to eutrophic conditions at 7.5–6.7 Ma was caused by an influx of nutrient‐rich terrestrial material or upwelling of nutrient‐rich water induced by intensified southeast trade winds. This conclusion is supported by a marked increase in the magnetic susceptibility of the sediment that is coincident with the change from oligotrophic to eutrophic assemblages. The diminished abundance of Discoaster after ~ 3.0 Ma indicates shallowing of the thermocline/nutricline after that time, which confirms the reduced Indonesian Throughflow resulting from tectonic restriction and intensified cooling of the Benguela upwelling system. Decreases in the modal coccolith size of Reticulofenestra, indicating eutrophic conditions, are observed in three horizons. Two of these events (at 7.5 and 5.0 Ma) correspond to biogenic blooms in the Indian Ocean at 7.6 Ma and 6.0–5.0 Ma, respectively.
Synthesis, structure, and properties of polymer‐derived, metal‐reinforced boron carbide cermet composites
Authors: Dyatkin Boris , Laskoski Matthew , Edelen William K. , Qadri Syed B. , Keller Teddy M.
Published: November 2020

We report on a novel polymer‐derived synthesis approach that yields boron carbide monoliths and metal‐reinforced B4C cermets. This single‐step approach relies on a preceramic powder blend of boron and an acetylenic resin with a high char yield. At low temperatures below 1500°C and without applied pressures, preceramic precursor reaction bond together and form nanocrystalline refractory B4C matrices. Resulting near net shape boron, carbide monoliths exhibit small crystal grain sizes, maintain chemical purity, and exhibit morphological homogeneity. We reinforce the refractory carbide with five different metals and demonstrate the influence of each on the density, hardness, oxidation stability, and electronic conductivity of resulting cermet composites. We assess the optimal synthesis and reinforcement strategies that tailor these nanostructured materials for inexpensive and high‐performing engineering applications.
“Production + procurement” outsourcing with competitive contract manufacturer's partial learning and supplier's price discrimination
Authors: Niu Baozhuang , Zeng Fanzhuo , Chen Lei
Published: November 2020

It is widely observed that many original equipment manufacturers (OEMs) have relied on contract manufacturers (CMs) for production, even if the CMs have self‐branded business. However, outsourcing “production + procurement” indicates deep cooperation between OEMs and CMs, and hence, induces the CMs to partially but legally learn the OEM's innovations. In this paper, we formulate an OEM's procurement outsourcing decisions to a competitive CM when the latter has partial learning ability. We formulate the OEM's trade‐offs between its procurement cost saving and the intensified downstream competition because of the competitive CM's improved products. We find that the OEM prefers outsourcing “production + procurement” when the competitive CM's learning ability is either low or high. The CM's high learning ability will lower the OEM's marginal revenue but the OEM can save innovation investment cost if he outsources “production + procurement”. We also study the impact of the competitive CM's improved learning ability and the OEM's license fee charged to the competitive CM.
Does talking about end of life with adults with intellectual disability cause emotional discomfort or psychological harm?
Authors: Stancliffe Roger J. , Wiese Michele Y. , Read Sue , Jeltes Gail , Barton Rebecca , Clayton Josephine M.
Published: November 2020

Background

Caregivers often avoid involving people with intellectual disability in end‐of‐life discussions and activities. One reason is fear that the person may become upset or psychologically harmed.

Methods

Pre and post a 6‐month intervention about end of life, we assessed depression, anxiety, and fear of death among intervention (n = 24) and comparison (n = 20) participants with intellectual disability. End‐of‐life ‘encounters’ (conversations/activities about end of life) were monitored, including comfort ratings.

Results

Overall, 79% of encounters were rated very comfortable/somewhat comfortable. Participants initiated 69% of encounters. There was no significant pre–post change in depression or fear of death. Anxiety improved significantly.

Conclusions

This is the first controlled, longitudinal study providing robust evidence about whether discussing end of life leads to emotional discomfort or psychological harm. Data showed adults with intellectual disability can safely engage in conversations/activities about end of life. The high percentage of participant‐initiated encounters showed participants wanted to talk about end of life.
The coronary artery calcium score correlates with left atrial low‐voltage area: Sex differences
Authors: Hojo Rintaro , Fukamizu Seiji , Tokioka Sayuri , Inagaki Dai , Kimura Takashi , Takahashi Masao , Kitamura Takeshi , Sakurada Harumizu , Hiraoka Masayasu
Published: November 2020

Introduction

In patients with coronary artery disease, a high coronary artery calcium score (CACS) correlates with atrial fibrillation (AF); however, the association between left atrial (LA) remodeling progression and coronary arteriosclerosis is unclear. This study aimed to evaluate the relationship between LA remodeling progression and the CACS.

Methods

This retrospective study enrolled 148 patients with AF (paroxysmal AF, n = 94) who underwent catheter ablation. Voltage mapping for the left atrium and coronary computed tomography for CACS calculations were performed. The ratio of the LA low‐voltage area (LA‐LVA), defined by values less than 0.5 mV divided by the total LA surface without pulmonary veins, was calculated. Patients with LA‐LVA (<0.5 mV) >5% and ≤5% were classified as the LVA (n = 30) and non‐LVA (n = 118) groups, respectively. Patient characteristics and CACS values were compared between the two groups.

Results

LA volume, age, CHA2DS2VASc score, and percentage of female patients were significantly higher, and the estimated glomerular filtration rate was lower in the LVA group than in the non‐LVA group. The CACS was significantly higher in the LVA group (248.4 vs. 13.2; p = .001). Multivariate analysis identified the LA volume index and CACS as independent predictors of LA‐LVA (<0.5 mV) greater than 5%. The areas under the receiver operating characteristic curves for predicting LA‐LVA (<0.5 mV) greater than 5% with CACS were 0.695 in the entire population, 0.782 in men, and 0.587 in women.

Conclusion

Progression of LA remodeling and coronary artery calcification may occur in parallel. A high CACS may indicate advanced LA remodeling, especially in men.
Association of mean corpuscular volume with sarcopenia and visceral obesity in individuals without anemia
Authors: Tanaka Muhei , Okada Hiroshi , Hashimoto Yoshitaka , Kumagai Muneaki , Nishimura Hiromi , Fukui Michiaki
Published: November 2020

Aims/Introduction

Sarcopenia and visceral obesity are major global public health issues, and higher mean corpuscular volume (MCV) levels are related to adverse outcomes. Nevertheless, no study has determined the association between MCV and body composition. Therefore, we evaluated the association between MCV levels and trunk muscle quality, muscle quantity and visceral fat area.

Materials and Methods

In our cross‐sectional study, we investigated 702 middle‐aged Japanese individuals without anemia and with normal MCV levels who underwent physical checkups. The cross‐sectional area of skeletal muscle or visceral fat was analyzed by computed tomography.

Results

In the adjusted model, the MCV was independently associated with the visceral fat area index (β = −0.107, P = 0.0007), total skeletal muscle index (β = 0.053, P = 0.0341) and total skeletal muscle density (β = 0.099, P = 0.0012). MCV as a continuous variable was related to the prevalence of sarcopenia (odds ratios [OR] 0.93, 95% confidence intervals (CI) 0.88–0.98, per 1.0 fL increment; P = 0.0097) and visceral obesity (OR 0.91, 95% CI 0.86–0.97, per 1.0 fL increment; P = 0.0046). The highest MCV quartile was independently associated with the prevalence of sarcopenia (OR 0.48, 95% CI 0.27–0.83; P = 0.0089) and visceral obesity (OR 0.49, 95% CI 0.27–0.88; P = 0.0170), compared with the lowest quartile.

Conclusions

In individuals without anemia and with normal MCV levels, a lower MCV was associated with unfavorable body composition, including lower muscle quality, lower muscle quantity, sarcopenia and visceral obesity.
The novel peptide NbPPI1 identified from Nicotiana benthamiana triggers immune responses and enhances resistance against Phytophthora pathogens
Authors: Wen Qujiang , Sun Manli , Kong Xianglan , Yang Yang , Zhang Qiang , Huang Guiyan , Lu Wenqin , Li Wanyue , Meng Yuling , Shan Weixing
Published: November 2020

In plants, recognition of small secreted peptides, such as damage/danger‐associated molecular patterns (DAMPs), regulates diverse processes, including stress and immune responses. Here, we identified an SGPS (Ser‐Gly‐Pro‐Ser) motif‐containing peptide, Nicotiana tabacum NtPROPPI, and its two homologs in Nicotiana benthamiana, NbPROPPI1 and NbPROPPI2. Phytophthora parasitica infection and salicylic acid (SA) treatment induced NbPROPPI1/2 expression. Moreover, SignalP predicted that the 89‐amino acid NtPROPPI includes a 24‐amino acid N‐terminal signal peptide and NbPROPPI1/2‐GFP fusion proteins were mainly localized to the periplasm. Transient expression of NbPROPPI1/2 inhibited P. parasitica colonization, and NbPROPPI1/2 knockdown rendered plants more susceptible to P. parasitica. An eight‐amino‐acid segment in the NbPROPPI1 C‐terminus was essential for its immune function and a synthetic 20‐residue peptide, NbPPI1, derived from the C‐terminus of NbPROPPI1 provoked significant immune responses in N. benthamiana. These responses led to enhanced accumulation of reactive oxygen species, activation of mitogen‐activated protein kinases, and up‐regulation of the defense genes Flg22‐induced receptor‐like kinase (FRK) and WRKY DNA‐binding protein 33 (WRKY33). The NbPPI1‐induced defense responses require Brassinosteroid insensitive 1‐associated receptor kinase 1 (BAK1). These results suggest that NbPPI1 functions as a DAMP in N. benthamiana; this novel DAMP provides a potentially useful target for improving plant resistance to Pytophthora pathogens.
Transcranial direct‐current stimulation enhances implicit motor sequence learning in persons with Parkinson's disease with mild cognitive impairment
Authors: Firouzi Mahyar , Van Herk Karlijn , Kerckhofs Eric , Swinnen Eva , Baeken Chris , Van Overwalle Frank , Deroost Natacha
Published: November 2020

Implicit motor sequence learning (IMSL) is affected in Parkinson's disease (PD). Research in healthy young participants shows the potential for transcranial direct‐current stimulation (tDCS) over the primary motor cortex (M1) to enhance IMSL. In PD, only null effects have been reported to date. We determined concurrent, short‐term, and long‐term effects of anodal tDCS over M1 on IMSL, as measured by the serial reaction time (SRT) task, in persons with PD with mild cognitive impairment (MCI). Concurrent (anodal/sham tDCS intervention during the SRT task), short‐term (5 min post‐intervention), and long‐term (1 week post‐intervention) effects on IMSL were evaluated in persons with idiopathic PD (Hoehn and Yahr stage II‐III) with MCI. Results of 11 persons with PD (8 men and 3 women; mean age = 77.1 years; mean disease duration = 7.7 years) showed significant IMSL in the anodal (p = .016), but not in the sham tDCS condition (p = .937). Post‐hoc analyses showed that IMSL reached statistical significance at 1 week post‐intervention (p < .001). Anodal tDCS over M1 exerted beneficial effects on IMSL in persons with PD with MCI, in particular one week post‐intervention. Our study is the first to report a positive effect of tDCS on IMSL in PD. Further research should include a larger, more cognitively diverse sample and additional follow‐up periods.
“Invisible Voices”: A Critical Incident Study of Family Caregivers’ Experience of Nursing Homes After Their Elder Relative’s Death
Authors: Aschieri Filippo , Barello Serena , Durosini Ilaria
Published: November 2020

Purpose

The literature provides few examples of family caregivers’ retrospective evaluation of nursing home services. This study aimed at analyzing narratives of Italian family caregivers of elders who experienced nursing home placement.

Design and Methods

Data were gathered through in‐depth interviews with family members after their relatives’ death. The interviews were based on the Critical Incident Technique, which allowed the categorization of the most memorable positive and negative events from the perspective of family members of elders deceased in nursing homes. Interviews were interpreted with a phenomenologically inspired thematic analysis approach. Participants were screened for complicated grief disorder as a confounding variable in relatives’ accounts of the treatment.

Results

Results suggested that positive long‐term recollection of the nursing home was associated with different themes emerging from the interviews: medical reliability and expertise, active demonstrations of care that extend beyond the contract with the facility, individualized attention, responsiveness, openness to dialog with family members about routines, management of the first impression, and family engagement. Lack of professionals’ expertise and medical failures, lack of care for patients’ personal goods, lack of family involvement, lack of individualized attention, lack of responsiveness, poor patient surveillance, and structural limits of the facilities were the themes that were more frequently negatively associated with the nursing home experience.

Implications for Practice

Focusing on the key dimensions connected to the quality of the experience of family members can enrich the quality of existing nursing home services and allow healthcare policymakers and managers to design better facilities for the patients.
Intravascular papillary endothelial hyperplasia in the oral mucosa and jawbones: A collaborative study of 20 cases and a systematic review
Authors: Vieira Carolina Clasen , Gomes Ana Paula Neutzling , Galdino dos Santos Laylla , de Almeida Douglas Silva , Hildebrand Laura Campos , Flores Isadora Luana , dos Santos Jean Nunes , Schuch Lauren Frenzel , Vasconcelos Ana Carolina Uchoa
Published: November 2020

Background

Intravascular papillary endothelial hyperplasia is an unusual vascular lesion characterized by the proliferation of endothelial cells. The aim of this study was to determine the frequency and general features of this lesion.

Methods

Biopsy records of three oral pathology services were reviewed for intravascular papillary endothelial hyperplasia cases from 1959 to 2020. In addition, a systematic review of case reports and case series was carried out in eight electronic databases.

Results

Of the 65 205 retrieved cases, 20 (0.03%) were diagnosed as intravascular papillary endothelial hyperplasia. Mean patient age was 46.55 years, and females (12 cases/60%) were more affected. The lower lip (9 cases/47.36%) was the most commonly affected site, and the lesions were generally asymptomatic (7 cases/63.63%). Clinically, 90% of the lesions presented (18 cases) as a nodule, with a mean size of 1.13 cm. The clinical diagnostic hypotheses most frequently raised were mucocele (6 cases/37.50%) and hemangioma (5 cases/31.25%). An excisional biopsy was chosen in all cases for treatment. Forty‐nine studies of the systematic review were included, yielding 105 cases. The literature showed similarity in all variables.

Conclusion

Despite the uncommon frequency, clinicians and oral pathologists should familiarize themselves with the similarities between intravascular papillary endothelial hyperplasia and some other lesions in terms of clinical and histological features.
Paying for expertise: The effect of experience on insurance demand
Authors: Anand Vaibhav , Tyler Leverty James , Wunder Kenny
Published: November 2020

This paper investigates whether corporations purchase insurance for the real services that insurers provide. We examine the real‐service efficiency hypothesis in the insurance industry by exploiting within firm‐year variation in reinsurance usage and experience at the line of business level. Our results show that insurers purchase reinsurance to access reinsurers’ expertise and specialized knowledge. We find that, within the same year, the average multi‐line insurer purchases 2.4%–3.3% points more reinsurance for new lines relative to existing lines. The demand for reinsurance declines by 0.55%–0.80% points with each additional year of experience. The size of these effects differs by the line of business, indicating that the development of internal expertise and specialized knowledge varies by line.
Construction and validation of a Brazilian educational comic book for pediatric perioperative care
Authors: Vasques Marcela C. M. Z. , Silva Brenda B. , de Avila Marla A. G.
Published: November 2020

Purpose

Educational material can facilitate familiarization with the hospital and surgical contexts for children and guardians and minimize potential difficulties experienced during hospitalization. This study aimed to construct and validate a comic book for guiding children in perioperative care.

Design and Methods

A descriptive study was conducted at a pediatric ward in a university hospital in Brazil. A content validity index with a concordance of 0.8 was used for validation.

Results

The content was validated with the participation of 19 content judges (nurses, anesthesiologists, and surgeons); face validity was achieved with the participation of 22 parents and their respective children aged 7–12 years old. The contents of the comic book included perioperative care (hospitalization, fasting, surgical team, operating room, and anesthesia). Universal content validity indices of 0.89 and 0.99 were obtained for content and face validity, respectively. Free Portuguese educational material titled “Getting to know the Surgery Center” was created in the form of a 19‐page comic book in print and digital formats. The comic book was face and content validated and considered relevant for children in perioperative care. The suggestions of the healthcare professional and families who participated contributed toward the final version of this educational comic book.

Practice Implications

This study aimed to further the development of educational materials that help alleviate stress, fear, and anxiety among children awaiting surgery, as well as their parents/guardians. As such, it offers a positive and appropriate contribution to perioperative nursing. The study further contributes to a discussion on pediatric nursing, which goes beyond clinical care and procedure. In the context of pediatric surgery and the children themselves, the results indicate that the family must be included in the surgical process and that the language employed must be appropriate to the target audience. Our comic book can be used by nurses to develop similar resources for diverse needs.
Pattern of progression in advanced hepatocellular carcinoma treated with ramucirumab
Authors: Reig Maria , Galle Peter R. , Kudo Masatoshi , Finn Richard , Llovet Josep M. , Metti Andrea L. , Schelman William R. , Liang Kun , Wang Chunxiao , Widau Ryan C. , Abada Paolo , Zhu Andrew X.
Published: November 2020

Background & Aims

Radiological progression patterns to first‐line sorafenib have been associated with post‐progression and overall survival in advanced hepatocellular carcinoma, but these associations remain unknown for therapies in second‐ and later‐line settings. This post hoc analysis of REACH and REACH‐2 examined outcomes by radiological progression patterns in the second‐line setting of patients with advanced hepatocellular carcinoma treated with ramucirumab or placebo.

Methods

Patients with advanced hepatocellular carcinoma, Child‐Pugh A and Eastern Cooperative Oncology Group Performance Status 0 or 1 with prior sorafenib were randomized to receive ramucirumab 8mg/kg or placebo every 2 weeks. Among 625 patients with ≥1 progression pattern (new extrahepatic lesion [including new macrovascular invasion], new intrahepatic lesion, extrahepatic growth or intrahepatic growth), data were analysed by trial and for pooled individual patient data for REACH‐2 and REACH (alpha‐fetoprotein ≥400 ng/mL). Cox models evaluated prognostic implications of progression patterns on overall and post‐progression survival.

Results

Post‐progression survival was worse among those with new extrahepatic lesions in REACH (HR 2.33, 95% CI 1.51‐3.60), REACH‐2 (HR 1.49, 95% CI 0.72‐3.08) and the pooled population (HR 1.75, 95% CI 1.12‐2.74) compared to other progression patterns. Overall survival was also significantly reduced in those with new extrahepatic lesions across studies. Ramucirumab provided an overall survival benefit across progression patterns, including patients with new extrahepatic lesions (HR 0.56, 95% CI 0.39‐0.80) in the pooled population.

Conclusions

The emergence of new extrahepatic lesions in the second‐line setting is a poor prognostic factor for post‐progression survival. The benefit of ramucirumab for overall survival was consistent across progression patterns.
A new subspecies of Ornithogalum malatyanum (Asparagaceae: Scilloideae) from eastern Anatolia, Turkey
Authors: Yapar Yakup , Behçet Lütfi
Published: November 2020

Ornithogalum malatyanum subsp. aricakense is a new subspecies from Elazığ province in eastern Turkey, differing from the typical subspecies in its flat, broader leaves and longer inflorescence of slightly larger flower. A description, photographs, ecology, distribution and conservation status of the new taxon are presented.
Investigating apoptotic, inflammatory, and growth markers in poor responders undergoing natural in vitro fertilization cycles: a pilot study
Authors: Sfakianoudis Konstantinos , Tsioulou Petroula , Maziotis Evangelos , Grigoriadis Sokratis , Glava Argyro , Nitsos Nikolaos , Giannelou Polina , Makrakis Evangelos , Pantou Agni , Rapani Anna , Koutsilieris Michael , Mastorakos George , Pantos Konstantinos , Simopoulou Mara
Published: November 2020

This study investigates follicular fluid (FF) from patients with poor and normal ovarian response undergoing natural assisted reproductive technology cycles. We report about (1) cell‐free DNA (cfDNA), which reflects apoptosis; (2) corticotropin‐releasing hormone (CRH); (3) interleukin (IL)‐15, which reflects inflammation; (4) granulocyte colony–stimulating factor (G‐CSF); (5) vascular endothelial growth factor (VEGF); and (6) insulin‐like growth factor I (IGF‐I), which reflects follicular growth. Forty‐four poor responders and 44 normal responders—according to the Bologna criteria—were recruited. FF samples were prepared for cfDNA quantification employing Q‐PCR and for CRH, IL‐15, G‐CSF, VEGF, and IGF‐I quantification employing ELISA. Statistically nonsignificant different levels of FF cfDNA, CRH, IL‐15, VEGF, and IGF‐I were observed. Interestingly, statistically significant higher G‐CSF levels were observed in normal responders (302.48 ± 474.36 versus 200.10 ± 426.79 pg/mL, P = 0.003). Lower cfDNA integrity was observed in cycles resulting in clinical pregnancy for both groups (normal: 0.07 ± 0.04 versus 0.25 ± 0.17 ng/μL, P < 0.001; poor: 0.10 ± 0.06 versus 0.26 ± 0.12 ng/μL, P < 0.001). The results predominantly showcase similarities between normal and poor responders pertaining to inflammatory, apoptotic, and growth factors. This may be attributed to the employment of natural cycles in order to exclude controlled ovarian stimulation as a factor—indicating its detrimental effect. As G‐CSF levels presented significantly higher in normal responders, its vital role in understanding a compromised ovarian response is highlighted.
The role of osteopontin in oral cancer: A brief review with emphasis on clinical applications
Authors: dos Santos Erison Santana , Ramos Joab Cabral , Roza Ana Luiza Oliveira Corrêa , Mariz Bruno Augusto Linhares Almeida , Paes Leme Adriana Franco
Published: November 2020

Osteopontin (OPN) is a calcium‐binding glycol‐phosphoprotein present in many physiologic and pathological processes. This protein can control bone cell adhesion, osteoclastic activity, and bone matrix mineralization. However, its participation in pathological processes such as atherosclerosis, sarcoidosis, tuberculosis, and cancer have been described. Some studies have shown that OPN may participate in the development and progression of oral cancer. Although the role of OPN in oral cancer is not fully understood, some studies have suggested that this protein may induce malignant phenotype of cells by activation of PI3K/AKT/mTOR pathway, which favors cell proliferation, invasion, metastasis, angiogenesis, and failure of treatment. This review discusses the possible mechanism of involvement of OPN in oral cancer and its potential clinical application in diagnosis and prognosis.
Comparison of postoperative cytokine and hormone between endoscopically assisted and open parotid tumor resection
Authors: Zhao Luodan , Ye Yushan , Jiao Jiuyang , Liao Junkun , Lin Zhaoyu , Zhong Jianglong , Wu Jialing , Fang Zezhen , Kontos Filippos , Chen Weiliang , Huang Xiaoming , Dias‐Ribeiro Eduardo , Yang Zhaohui , Li Jinsong , Fan Song
Published: November 2020

Objective

Endoscopically assisted extracapsular dissection through a single incision along the cephaloauricular furrow has been adapted as a method of access for operating on benign parotid gland tumors. However, no study has compared the immune and stress responses after surgery between the endoscopic procedure and conventional open surgery.

Methods

Through a randomized method, 50 patients with benign parotid gland tumors were assigned to undergo either endoscopically assisted extracapsular dissection or open parotidectomy. The postoperative inflammatory changes and hormonal response in the patients were analyzed at serum level during the preoperative period and at 12, 24, and 72 hr after either surgery.

Results

Twenty‐three patients received an endoscopic procedure, while 27 underwent open surgery. The size of the incision, amount of intraoperative bleeding, volume of drainage, postoperative pain score, and satisfaction with appearance were all improved in the endoscopic procedure group. Additionally, the serum levels of C‐reactive protein, interleukin (IL)‐6, IL‐10, and cortisol were significantly lower in the endoscopy group in comparison with those in the open surgery group.

Conclusion

Endoscopically assisted extracapsular dissection on patients with benign parotid gland tumors is associated with lower inflammatory changes and hormone responses than open surgery, thereby reducing perioperative pathophysiological disturbance and enhancing recovery after surgery.
Meta‐analysis of catheter ablation in patients with post‐infarct cardiomyopathy undergoing defibrillator implantation
Authors: Kheiri Babikir , Simpson Timothy F. , Nazer Babak
Published: November 2020

Background

Patients with post‐infarct cardiomyopathy and ventricular arrhythmias (VT) necessitating implantable cardioverter defibrillators (ICD) are at risk of recurrent shocks with increased morbidity.

Methods

A comprehensive search of electronic databases for all randomized clinical trials that evaluated the role of catheter ablation as a preventive strategy at the time of secondary prevention ICD implantation was performed. We calculated hazard ratios (HR) and 95% confidence intervals (CI) using random‐effects model.

Results

Four trials were identified with a total of 505 patients (average age 66.4 ± 9.0 years; 87.7% were male). Preventive ablation was associated with a significant reduction in appropriate device therapies (shocks and/or anti‐tachycardia therapy) (HR = 0.62; 95% CI = 0.46‐0.82; P < .01), sustained VT (HR = 0.74; 95% CI = 0.55‐0.99; P = .04) compared to control. There were no differences in inappropriate device shocks (HR = 0.80; 95% CI = 0.38‐1.71), all‐cause death (HR = 0.93; 95% CI = 0.53‐1.64), cardiac death (HR = 0.63; 95% CI = 0.29‐1.36), arrhythmic death (HR = 0.26; 95% CI = 0.05‐1.31), or cardiac hospitalization (HR = 0.79; 95% CI = 0.57‐1.11) between strategies. Preventive ablation was associated with improved SF‐36 physical component (mean difference = 2.81; 95% CI‐0.53‐5.10; P = .02), but not the mental component (mean difference = 1.30; 95% CI = ‐2.06‐4.66).

Conclusion

Among patients with post‐infarct cardiomyopathy and VT, preventive catheter ablation at the time of ICD implantation is associated with a significant reduction of appropriate ICD therapy and sustained VT, and improvement in the physical component of quality‐of‐life, but no reduction in mortality.
Trends in obesity and blood lipid abnormalities in school‐age children in Japan
Authors: Tanaka Hisako , Morisaki Naho , Piedvache Aurelie , Harada Shohei , Urayama Kevin Y.
Published: November 2020

Background

Obesity in children is a public health concern in Japan. To evaluate the current state of the obesity problem and inform future directions, we aimed to provide an updated account of secular trends in the percentage of overweight (POW) children by gender and school grade, and evaluate changes in POW after participation in the obesity health screening.

Methods

The current study utilized aggregated data from the Setagaya Ward, Tokyo, public elementary and middle school populations from 2009 to 2018. Data on the percentage of overweight ≥ 30% (POW‐30) and percentage of abnormal blood test results were examined by year, gender, and school grade level. Individual‐level data from 2015 to 2017 in children who participated in a follow‐up obesity health screening were evaluated for changes in median POW.

Results

A decreasing trend in students with a POW‐30 was observed from 2009 to 2011, with rates stabilizing thereafter. The highest proportions of POW‐30 were observed in 2010 (4.8% in middle school boys; 2.8% in middle school girls). From third grade, the difference in percentage by gender appeared to get increasingly larger until the beginning of middle school. Among obesity health screening participants, abnormal blood tests for total cholesterol and triglycerides showed a slightly increasing trend over time, and changes in POW after screening were greatest for middle school students.

Conclusions

Increases in obesity were not observed in Setagaya Ward public school students since 2010, but disparities exist by gender and grade level, suggesting that tailored intervention strategies may be useful to optimize aspects of the obesity health screening program.
Fluorographic findings of diaphragmatic paralysis with spontaneous recovery
Authors: Hosokawa Takahiro , Shibuki Saki , Tanami Yutaka , Sato Yumiko , Ko Yoshihiro , Nomura Koji , Oguma Eiji
Published: November 2020

Background

Postoperative diaphragmatic paralysis is an unavoidable complication of cardiovascular surgery. Although diaphragmatic plication, as a surgical treatment, can be performed, spontaneous recovery is possible. We aimed to identify differences in fluorographic findings of diaphragmatic paralysis between pediatric patients with and without spontaneous recovery within 1 year of intrathoracic surgery.

Methods

Ten children, who had been followed‐up for at least 1 year post‐surgery and who had not received diaphragmatic plication were included and classified into those with or without spontaneous recovery. The presence or absence of the paradoxical movement of the diaphragm and mediastinum was evaluated based on fluorographic findings. Fisher’s exact test was used to compare the presence or absence of paradoxical movement between the groups.

Results

Eight patients experienced spontaneous recovery. The mean ± standard deviation time to spontaneous recovery was 150 ± 114 days (range, 18–338 days). In the spontaneous recovery group, no patient had paradoxical movement of the mediastinum, and a significant between‐group difference was observed in the presence of the paradoxical movement of the mediastinum (present/absent in patients with vs. without spontaneous recovery: 0/8 vs. 2/0, P = 0.02). There was no significant between‐group difference in paradoxical movement of the diaphragm (present/absent in patients with vs. without spontaneous recovery: 1/7 vs. 2/0, P = 0.07). Pediatric patients without paradoxical movement of the mediastinum spontaneously recovered within 1 year of intrathoracic surgery.

Conclusions

Pediatric patients without paradoxical movement of the mediastinum, based on fluorography findings, spontaneously recovered within 1 year of surgery. The timing of spontaneous recovery varied between cases.