bluuebunny/crossref_metadata_2025 huggingface dataset:
Rapid and spontaneous resolution of hemorrhagic macular hole retinal detachment and subretinal hemorrhages in an eye with pathologic myopia: a case report
Authors: Ito Taiju , Igarashi-Yokoi Tae , Shinohara Kosei , Yoshida Takeshi , Ohno-Matsui Kyoko
Published: September 2020

Background

To report a rare case of pathologic myopia in which a choroidal neovascularization (CNV) induced a hemorrhagic macular hole retinal detachment (MHRD), and then both the CNV and MHRD disappeared simultaneously in 5 days.

Case presentation

A 76-year-old man with pathologic myopia complained of distorted vision in his left eye of 1-week duration. The visual acuity in the left eye was 20/20 and the axial length was 31.0 mm. Ophthalmoscopic examinations of the left eye showed many retinal hemorrhages and whitish lesions on a background of severe diffuse myopic atrophy. Swept-source OCT (SS-OCT) showed multiple hyperreflective vertical finger-like projections extending into the outer retina that corresponded to the area of the botryoidal-shaped retinal hemorrhages. The SS-OCT images also showed many subretinal infiltrations adjacent to linear retinal hemorrhages with a disruption of the adjacent ellipsoid zone of the photoreceptors. Fluorescein angiography (FA) showed early hyperfluorescence and late leakages corresponding to the areas of the hemorrhages or adjacent to the linear retinal hemorrhages. These results suggested that the development of the inflammatory CNV was related to the outer retinopathy or choroiditis as in eyes with punctate inner choroidopathy or multifocal choroiditis rather than myopic CNV. We planned an intravitreal anti-vascular endothelial growth factor (anti-VEGF) injection but the patient noticed a sudden reduction of the visual acuity a few days before the anti-VEGF injection. The left fundus showed a MHRD due to the subretinal hemorrhage. Five days later, the SS-OCT images confirmed a recession of the CNV and a resolution of the MHRD.

Conclusions

Rapid and spontaneous resolution of both myopic CNV and hemorrhagic MHRD suggest that there may have been a mutual mechanism causing the MHRD and CNV. A careful follow-up before doing surgery may be a choice for hemorrhagic MHRD in eyes with pathologic myopia.
Psychotically driven aggression is associated with greater mentalizing challenges in psychotic spectrum disorders
Authors: Johansson Anette GM , Källman Malin , Högman Lennart , Kristiansson Marianne , Fischer Håkan , Bölte Sven
Published: September 2020

Background

Some aggressive acts committed by individuals with psychotic spectrum disorders (PSD) are understandable in the context of interpersonal conflict or goal attainment, yet others are unpredictable, arising from delusions or hallucinations (psychotically driven aggressive acts, PDA). It is unknown if there are underlying differences in cognitive or perceptive social cognition in relation to aggression motivation in PSD.

Method

We compared differences in social cognition performance between 49 individuals with PSD who had committed PDA with those exhibiting other types of aggression (n = 31) (non-PDA) and to community controls (n = 81) on the Swedish version of Double Movie for the Assessment of Social Cognition – Multiple Choice (DMASC-MC). Participants with PSD had more than 3 months of clinical stability and substance use abstention and stable antipsychotic medication doses. General intellectual ability was assessed with the information and matrix reasoning subtests of the Wechsler Intelligence Scales.

Results

The PSD group with a history of PDA exhibited lower total and perceptive social cognition scores on the DMASC-MC than the non-PDA group and controls. In addition, they also showed lower cognitive scores compared to typical controls. Lower total scores were associated with lower scores on Wechsler intelligence subtests information and matrix reasoning. Taking this into account, the PDA group still had lower social cognition scores. There were no associations of antipsychotic medication dosages, positive or negative symptoms with social cognition scores. Higher antipsychotic dosage at the time of DMASC-MC testing and social cognition scores predicted a past history of PDA.

Conclusions

We conclude that impaired social cognition, particularly perceptive social cognition, is associated with PDA in individuals with PSD.
Association of serum uric acid levels with suicide risk in female patients with major depressive disorder: a comparative cross-sectional study
Authors: Chen Jing-Xu , Feng Jun-Hui , Zhang Li-Gang , Liu Yan , Yang Fu-De , Wang Shao-Li , Tan Yun-Long , Su Yun-Ai
Published: September 2020

Background

Individuals with major depressive disorder (MDD) have a high suicide risk. Some evidence suggests that uric acid (UA) may be involved in the pathophysiology of MDD. The purpose of this study was to evaluate whether serum UA levels were associated with suicide risk in MDD patients.

Methods

One hundred four female patients with MDD (52 patients with suicide risk and 52 patients without suicide risk) and 52 healthy individuals were included in this study. The suicide risk was evaluated by Mini International Neuropsychiatric Interview (M.I.N.I.). Fasting serum levels of UA, as well as glucose, lipid and renal function indicators were measured.

Results

Serum UA levels in MDD patients with suicide risk (245.01 ± 55.44 μmol/L) were significantly lower than those in MDD patients without suicide risk (274.17 ± 72.65 μmol/L) (p = 0.017) and healthy controls (271.42 ± 55.25 μmol/L) (p = 0.030). There was no difference in serum UA levels between the MDD patients without suicide risk and healthy controls (p = 0.821). Binary logistic regression analysis revealed a significant relationship between suicide risk and decreased serum UA levels (OR = 0.989,p = 0.010) in MDD patients.

Conclusion

Decreased serum UA levels were associated with suicide risk in MDD patients. Purinergic system dysfunction may be involved in the neurobiological basis of suicide risk in these patients.
Lung cancer awareness and palliative care interventions implemented in low-and middle-income countries: a scoping review
Authors: Nwagbara Ugochinyere I. , Ginindza Themba G. , Hlongwana Khumbulani W.
Published: September 2020

Background

Lung cancer is the most diagnosed cancer worldwide. In low- and middle-income countries (LMICs), lung cancer is often diagnosed at a late stage due to poor knowledge and awareness of its signs and symptoms. Increasing lung cancer awareness is likely to reduce the diagnosis and treatment delays. The implementation of early palliative care has also been reported to improve a patient’s quality of life, and even survival. The aim of this scoping review was to map evidence on lung cancer awareness and palliative care interventions implemented in sub-Saharan Africa (SSA) and other LMICs.

Methods

This scoping review was guided by Arksey and O’Malley’s framework. Databases such as the EBSCOhost, PubMed, Science Direct, Google Scholar, World Health Organization (WHO) library and grey literature were used to perform systematic searches of relevant articles. The methodological quality assessment of included primary studies was assessed using the Mixed Method Appraisal Tool (MMAT). NVivo version 10 software was used to perform the thematic content analysis of the included studies.

Results

A total number of screened articles was 2886, with 236 meeting the eligibility criteria and 167 further excluded following abstract screening. Sixty-nine (69) articles qualified for full-article screening and 9 were selected for detailed data extraction and methodological quality assessment. Of the included nine studies, eight described at least one lung cancer warning signs and symptoms, while one described the effectiveness of palliative care for lung cancer. Eight articles recognized the level of lung cancer knowledge, risk factors awareness of warning signs and symptoms in LMICs, mostly Africa and Asia.

Conclusions

Most of the participants were aware of tobacco use as the major risk factor for lung cancer but lacked knowledge on the other pre-disposing risk factors. Evidence on palliative care is scarce, therefore, awareness interventions packaged with evidence on the value of timely access to palliative care services in improving the quality of life of the lung cancer patients and their families, are required.
A case of anti- pityriasis versicolor therapy that preserves healthy mycobiome
Authors: Dyląg Mariusz , Leniak Ewa , Gnat Sebastian , Szepietowski Jacek C. , Kozubowski Lukasz
Published: September 2020

Background

The impact of Malassezia yeasts on skin mycobiome and health has received considerable attention recently. Pityriasis versicolor (PV), a common dermatosis caused by Malassezia genus worldwide, is a manifestation of dysbiosis. PV can be associated with hyper- and/or hypopigmented skin lesions. This disease entity is characterized by high percentage of relapses, which demands a proper antifungal therapy that is based on unambiguous species identification and drug susceptibility testing.

Case presentation

Comprehensive analysis of PV case in man presenting simultaneously hyper- and hypopigmented skin lesions was performed. Conventional and molecular diagnostic procedures revealed Malassezia furfur and Malassezia sympodialis, respectively as etiological agents of skin lesions observed. Susceptibility tests showed significantly lowered sensitivity of M. furfur cells to fluconazole. Based on susceptibility profiles local antifungal therapy with drugs characterized by entirely different mechanism of action was included.

Conclusions

Our study indicates that cases of PV represented by two types of skin lesions in one patient may be associated with distinct Malassezia species. Moreover, as observed in this case, each of the isolated etiological agents of PV may differ significantly in susceptibility to antifungals. This can significantly complicate the treatment of dermatosis, which by definition is associated with a significant percentage of relapses. In the presented case localized topical treatment was sufficient and successful while allowing maintaining the physiological mycobiome.
In vitro propagation of three mosaic disease resistant cassava cultivars
Authors: Sessou Amitchihoué Franck , Kahia Jane W. , Houngue Jerome Anani , Ateka Elijah Miinda , Dadjo Colombe , Ahanhanzo Corneille
Published: September 2020

Background

Cassava is a staple food for over 800 million people globally providing a cheap source of carbohydrate. However, the cultivation of cassava in the country is facing to viral diseases, particularly cassava mosaic disease (CMD) which can cause up to 95% yield losses. With aim to supply farmers demand for clean planting materials, there is need to accelerate the production of the elite cultivars by use of tissue culture in order to cope with the demand.

Methods

Nodal explants harvested from the greenhouse grown plants were sterilised using different concentrations of a commercial bleach JIK (3.85% NaOCl) and varying time intervals. Microshoots induction was evaluated using thidiazuron (TDZ), benzyl amino purine (BAP), and kinetin. Rooting was evaluated using different auxins (Naphthalene acetic acid NAA and Indole-3-butyricacid IBA). PCR-based SSR and SCAR markers were used to verify the presence ofCMD2gene in the regenerated plantlets.

Results

The highest level of sterility in explants (90%) was obtained when 20% Jik was used for 15 min. The best cytokinin for microshoots regeneration was found to be kinetin with optimum concentrations of 5, 10 and 20 μM for Agric-rouge, Atinwewe, and Agblehoundo respectively. Medium without growth regulators was the best for rooting the three cultivars. A survival rate of 100, 98, and 98% was recorded in the greenhouse for Agric-rouge, Atinwewe, and Agblehoundo respectively and the plantlets appeared to be morphologically normal. The SSR and SCAR analysis of micropropagated plants showed a profile similar to that of the mother plants indicating that the regenerated plantlets retained theCMD2gene after passing through in vitro culture, as expected with micropropagation.

Conclusion

The nodal explants was established to be 20% of Jik (3.85% NaOCl) with an exposure time of 15 min. Kinetin was proved to be the best cytokinins for microshoot formation with the optimum concentration of 5, 10 and 20 μM for Agric-rouge, Atinwewe, and Agblehoundo respectively. The protocol developed during this study will be useful for mass propagation of the elite cassava cultivars.
Psychiatric, cognitive functioning and socio-cultural views of menstrual psychosis in Oman: an idiographic approach
Authors: Al-Sibani Nasser , Al-Maqbali Mandhar , Mahadevan Sangeetha , Al-Huseini Salim , Al-Muzeni Muna , Al-Adawi Samir
Published: September 2020

Background

Most documented cases of menstrual psychosis have been from Euro-American populations with reports from cross-cultural populations being only a few. A primary aim was to determine whether the cyclical/episodic nature of menstrual psychosis among case series observed at a tertiary care unit in Oman fulfills the diagnostic criteria of the International Classification of Diseases (ICD-10) and diverge into Brockington’s sub-types (World Psychiatry. 2005;4(1):9–17). Related aims were to solicit measures of psychometric functioning of those with menstrual psychosis and associated idioms of distress.

Methods

A series of consecutive patients seeking psychiatric consultation from January 2016 to December 2017 were screened via structured interview—Composite-International Diagnostic Interview (CIDI) and Brockington’s sub-types. The identified patients (n = 4) also underwent psychometric evaluation including examination of affective functioning, intellectual capacity and neuropsychological functioning (i.e.attention and concentration, learning and remembering, executive function, processing speed and speech and language). The analysis of outcome measures was via an idiographic approach.

Results

The spectrum of distress among people with menstrual psychosis does not fit existing psychiatric nosology. Evaluations revealed that a majority of the participants displayed something akin to morbid phenomena relating to manic and psychotic symptoms. In the parlance of traditional Omani society, this would be termed “spirit possession”. In terms of classification by timing within the menstrual cycle as expounded by Brockington, the present case series in Oman fulfilled the definition of catamenial psychosis and paramenstrual psychosis. With regard to psychometric function, all participants performed adequately on indices of intellectual functioning but appeared to have impairments in neuropsychological functioning, including the dimensions of processing speed, episodic memory, and executive functioning. Within the given society, the periodicity of mind alteration has been attributed to spirit possession.

Conclusions

This is one of the first case series of its kind in the country elucidating whether the manifestation of menstrual psychosis among individuals in Oman fulfills the subtypes postulated by Brockington. The present case series suggests that menstrual psychosis is marked with neuropsychological impairments that were previously observed in other phasic manic episodes or brief psychotic disorders.
Hydroalcoholic extract and seed of Foeniculum vulgare improve folliculogenesis and total antioxidant capacity level in F1 female mice offspring
Authors: Pourjafari Fahimeh , Haghpanah Tahereh , Nematollahi-Mahani Seyed Noreddin , Pourjafari Fariba , Ezzatabadipour Massood
Published: September 2020

Background

Foeniculum vulgare (fennel) is traditionally suggested for the fertility improvement in Iranian lore due to its antioxidant and phytoestrogen compounds. The present study aimed to investigate the effects of fennel seed and its hydroalcoholic extract on the serum total antioxidant capacity (TAC) and folliculogenesis in offspring exposed to either of the treatments in utero and 56 days after birth (PND 56).

Methods

Pregnant NMRI mice were randomly divided into 5 groups of 7: extract-treated groups received 500 and 1000 mg/kg/day fennel extract (FE), seed-treated groups received 500 and 1000 mg/kg/day fennel seed (FS), and the control group (CTL) received no treatment. The treatments started from pregnancy day 1 and continued until PND 56. Body and right ovary weights and ovary dimensions were recorded. Hematoxylin and eosin stained ovary sections were prepared to calculate the proportion of different follicles. The level of TAC in the serums was also measured by fluorescence recovery after photo bleaching.

Results

A marked rise in the body and ovary weights of treated mice was observed compared to the CTL group. The mean number of primordial, primary, pre-antral, and pre-ovulatory follicles as well as corpus luteum size in the treated offspring was significantly higher compared to those of CTL offspring. The atretic follicle number was nonsignificantly lower in either of the treatment groups compared with that in the CTL. However, treatment of animals with 500 mg/kg FE showed a more pronounced effect. Animals in FS500, FE500 and FE1000 groups had a significantly higher level of serum TAC compared to the CTL group.

Conclusions

Fennel extract and seed administration in pregnancy and lactation period improve offspring’s folliculogenesis. Higher level of TAC in the serum of offspring might have positively altered the folliculogenesis milieu.
Identification of quality gaps in healthcare services using the SERVQUAL instrument and importance-performance analysis in medical intensive care: a prospective study at a medical center in Taiwan
Authors: Lu Shu-Ju , Kao Hsiu-O , Chang Bao-Lin , Gong Shu-Ing , Liu Shu-Mei , Ku Shih-Chi , Jerng Jih-Shuin
Published: September 2020

Background

Assessing patients’ expectations and perceptions of health service delivery is challenging. To understand the service quality in intensive care units (ICUs), we investigated the expected and perceived service quality of ICU care.

Methods

We conducted this study at an ICU of a university-affiliated medical center in Taiwan from April to September 2019. Admitted patients or their family members responded to a questionnaire survey adopted from the SERVQUAL instrument consisting of 22 items in five dimensions. The questionnaire was provided on ICU admission for expectation and before ICU discharge for perception. We analyzed the quality gaps between the surveys and applied important-performance analysis (IPA).

Results

A total of 117 patients were included (62.4% males, average age: 65.9 years, average length of stay: 10.1 days, and 76.9% survival to ICU discharge). The overall weighted mean scores for the surveys were similar (4.57 ± 0.81 and 4.58 ± 0.52, respectively). The ‘tangibles’ dimension had a higher perception than expectation (3.99 ± 0.55 and 4.31 ± 0.63 for expectation and perception, respectively, p < 0.001). IPA showed that most of the items in ‘reliability,’ ‘responsiveness’ and ‘assurance’ were located in the quadrant of high expectation and high perception, whereas most of the items in ‘tangibles’ and ‘empathy’ were located in the quadrant of low expectation and low perception. One item (item 1 for ‘tangibles’) was found in the quadrant of high expectation and low perception.

Conclusions

The SERVQUAL approach and IPA might provide useful information regarding the feedback by patients and their families for ICU service quality. In most aspects, the performance of the ICU satisfactorily matched the needs perceived by the patients and their families.
Development and psychometric evaluation of the women shift workers’ reproductive health questionnaire: a sequential exploratory mixed-method study
Authors: Nikpour Maryam , Tirgar Aram , Ghaffari Fatemeh , Ebadi Abbas , Sharif Nia Hamid , Nasiri-Amiri Fatemeh
Published: September 2020

Background

There is no standard and comprehensive questionnaire for reproductive health assessment among women shift workers. This study aimed at the development and psychometric evaluation of the Women Shift Workers’ Reproductive Health Questionnaire.

Methods

This sequential exploratory mixed-method study was conducted in a qualitative (item generation) and a quantitative (psychometric evaluation) phase. In the qualitative phase, the primary item pool of the questionnaire was generated based on the findings of the qualitative content analysis of 21 interviews held with 21 women shift workers as well as the findings of a literature review. In the quantitative phase, the face, content, construct, convergent, and discriminant validity and the reliability of the questionnaire were assessed. For construct validity assessment through exploratory and confirmatory factor analyses, 620 women shift workers were conveniently selected to fill out the questionnaire. Reliability assessment was done through assessing internal consistency, stability, and composite reliability.

Results

The primary item pool contained 88 items. During face and content validity, item number was reduced to 55. Construct validity assessment through factor analysis revealed that 56.50% of the total variance was explained by five factors with 34 items. The factors were named motherhood, general health, sexual relationships, menstruation, and delivery. Confirmatory factor analysis confirmed the fit of the five-factor model. The Cronbach’s alpha and the composite reliability value of the questionnaire were more than 0.7.

Conclusion

The Women Shift Workers’ Reproductive Health Questionnaire is a valid and reliable instrument and can be used for reproductive health assessment among women shift workers.
Efficacy and safety of CyberKnife radiosurgery in elderly patients with brain metastases: a retrospective clinical evaluation
Authors: Acker Gueliz , Hashemi Seyed-Morteza , Fuellhase Josch , Kluge Anne , Conti Alfredo , Kufeld Markus , Kreimeier Anita , Loebel Franziska , Kord Melina , Sladek Diana , Stromberger Carmen , Budach Volker , Vajkoczy Peter , Senger Carolin
Published: September 2020

Background

Stereotactic radiosurgery (SRS) has been increasingly applied for up to 10 brain metastases instead of whole brain radiation therapy (WBRT) to achieve local tumor control while reducing neurotoxicity. Furthermore, brain-metastasis incidence is rising due to the increasing survival of patients with cancer. Our aim was to analyze the efficacy and safety of CyberKnife (CK) radiosurgery for elderly patients.

Methods

We retrospectively identified all patients with brain metastases ≥ 65 years old treated with CK-SRS at our institution since 2011 and analyzed data of primary diseases, multimodality treatments, and local therapy effect based on imaging follow-up and treatment safety. Kaplan–Meier analysis for local progression-free interval and overall survival were performed.

Results

We identified 97 patients (233 lesions) fulfilling the criteria at the first CK-SRS. The mean age was 73.2 ± 5.8 (range: 65.0–87.0) years. Overall, 13.4% of the patients were > 80 years old. The three most frequent primary cancers were lung (40.2%), kidney (22.7%), and malignant melanoma (15.5%). In 38.5% (47/122 treatments) multiple brain metastases were treated with the CK-SRS, with up to eight lesions in one session. The median planning target volume (PTV) was 1.05 (range: 0.01–19.80) cm3. A single fraction was applied in 92.3% of the lesions with a median prescription dose of 19 (range: 12–21) Gy. The estimated overall survivals at 3-, 6-, and 12 months after SRS were 79, 55, and 23%, respectively. The estimated local tumor progression-free intervals at 6-, 12-, 24-, 36-, and 72 months after SRS were 99.2, 89.0, 67.2, 64.6, and 64.6%, respectively. Older age and female sex were predictive factors of local progression. The Karnofsky performance score remained stable in 97.9% of the patients; only one patient developed a neurological deficit after SRS of a cerebellar lesion (ataxia, CTCAE Grade 2).

Conclusions

SRS is a safe and efficient option for the treatment of elderly patients with brain metastases with good local control rates without the side effects of WBRT. Older age and female sex seem to be predictive factors of local progression. Prospective studies are warranted to clarify the role of SRS treatment for elderly patients.
Fanconi–Bickel syndrome in a Ugandan child – diagnostic challenges in resource-limited settings: a case report
Authors: Piloya Thereza , Ssematala Hawa , Dramani Lydia Paparu , Nalikka Oliva , Baluka Miriam , Musiime Victor
Published: September 2020

Background

Fanconi–Bickel syndrome is an autosomal recessive disorder of glucose metabolism. It is an extremely rare disorder. Most cases have been reported in consanguineous communities. None of the cases have been reported in Black Africans in sub-Saharan Africa. This case was diagnosed 3 years after initial presentation due to diagnostic challenges and limited awareness of similar metabolic syndromes in our setting.

Case presentation

We report the case of a 4-year-old boy, born to non-consanguineous Black African parents, who presented with failure to thrive and rachitic features in infancy. Clinical, laboratory, and radiological features were indicative of Fanconi–Bickel syndrome. No genetic testing was done. The diagnosis was made 3 years after the initial presentation due to diagnostic challenges. He showed clinical improvement with the institution of a galactose-free diet.

Conclusion

Fanconi–Bickel syndrome occurs even in non-consanguineous Black African populations. Therefore, clinicians in resource-poor settings should raise their index of suspicion for such metabolic disorders in settings with a high prevalence of failure to thrive among children.
Phloretin ameliorates hepatic steatosis through regulation of lipogenesis and Sirt1/AMPK signaling in obese mice
Authors: Liou Chian-Jiun , Wu Shu-Ju , Shen Szu-Chuan , Chen Li-Chen , Chen Ya-Ling , Huang Wen-Chung
Published: September 2020

Background

Phloretin is isolated from apple trees and could increase lipolysis in 3T3-L1 adipocytes. Previous studies have found that phloretin could prevent obesity in mice. In this study, we investigated whether phloretin ameliorates non-alcoholic fatty liver disease (NAFLD) in high-fat diet (HFD)-induced obese mice, and evaluated the regulation of lipid metabolism in hepatocytes.

Methods

HepG2 cells were treated with 0.5 mM oleic acid to induce lipid accumulation, and then treated with phloretin to evaluate the molecular mechanism of lipogenesis. In another experiment, male C57BL/6 mice were fed normal diet or HFD (60% fat, w/w) for 16 weeks. After the fourth week, mice were treated with or without phloretin by intraperitoneal injection for 12 weeks.

Results

Phloretin significantly reduced excessive lipid accumulation and decreased sterol regulatory element-binding protein 1c, blocking the expression of fatty acid synthase in oleic acid-induced HepG2 cells. Phloretin increased Sirt1, and phosphorylation of AMP activated protein kinase to suppress acetyl-CoA carboxylase expression, reducing fatty acid synthesis in hepatocytes. Phloretin also reduced body weight and fat weight compared to untreated HFD-fed mice. Phloretin also reduced liver weight and liver lipid accumulation and improved hepatocyte steatosis in obese mice. In liver tissue from obese mice, phloretin suppressed transcription factors of lipogenesis and fatty acid synthase, and increased lipolysis and fatty acid β-oxidation. Furthermore, phloretin regulated serum leptin, adiponectin, triglyceride, low-density lipoprotein, and free fatty acid levels in obese mice.

Conclusions

These findings suggest that phloretin improves hepatic steatosis by regulating lipogenesis and the Sirt-1/AMPK pathway in the liver.
Physiological effects of adding ECCO2R to invasive mechanical ventilation for COPD exacerbations
Authors: Diehl J.-L. , Piquilloud L. , Vimpere D. , Aissaoui N. , Guerot E. , Augy J. L. , Pierrot M. , Hourton D. , Arnoux A. , Richard C. , Mancebo J. , Mercat A.
Published: September 2020

Background

Extracorporeal CO2 removal (ECCO2R) could be a valuable additional modality for invasive mechanical ventilation (IMV) in COPD patients suffering from severe acute exacerbation (AE). We aimed to evaluate in such patients the effects of a low-to-middle extracorporeal blood flow device on both gas exchanges and dynamic hyperinflation, as well as on work of breathing (WOB) during the IMV weaning process.

Study design and methods

Open prospective interventional study in 12 deeply sedated IMV AE-COPD patients studied before and after ECCO2R initiation. Gas exchange and dynamic hyperinflation were compared after stabilization without and with ECCO2R (Hemolung, Alung, Pittsburgh, USA) combined with a specific adjustment algorithm of the respiratory rate (RR) designed to improve arterial pH. When possible, WOB with and without ECCO2R was measured at the end of the weaning process. Due to study size, results are expressed as median (IQR) and a non-parametric approach was adopted.

Results

An improvement in PaCO2, from 68 (63; 76) to 49 (46; 55) mmHg, p = 0.0005, and in pH, from 7.25 (7.23; 7.29) to 7.35 (7.32; 7.40), p = 0.0005, was observed after ECCO2R initiation and adjustment of respiratory rate, while intrinsic PEEP and Functional Residual Capacity remained unchanged, from 9.0 (7.0; 10.0) to 8.0 (5.0; 9.0) cmH2O and from 3604 (2631; 4850) to 3338 (2633; 4848) mL, p = 0.1191 and p = 0.3013, respectively. WOB measurements were possible in 5 patients, indicating near-significant higher values after stopping ECCO2R: 11.7 (7.5; 15.0) versus 22.6 (13.9; 34.7) Joules/min., p = 0.0625 and 1.1 (0.8; 1.4) versus 1.5 (0.9; 2.8) Joules/L, p = 0.0625. Three patients died in-ICU. Other patients were successfully hospital-discharged.

Conclusions

Using a formalized protocol of RR adjustment, ECCO2R permitted to effectively improve pH and diminish PaCO2 at the early phase of IMV in 12 AE-COPD patients, but not to diminish dynamic hyperinflation in the whole group. A trend toward a decrease in WOB was also observed during the weaning process.

Trial registration ClinicalTrials.gov: Identifier: NCT02586948.
An exact expression of positive periodic solution for a first-order singular equation
Authors: Xin Yun , Cui Xiaoxiao , Liu Jie
Published: September 2020

The main purpose of this paper is to obtain an exact expression of the positive periodic solution for a first-order differential equation with attractive and repulsive singularities. Moreover, we prove the existence of at least one positive periodic solution for this equation with an indefinite singularity by applications of topological degree theorem, and give the upper and lower bounds of the positive periodic solution.
Adenocarcinoma originating from long-segment Barrett's esophagus over 15 cm: a series of 3 cases
Authors: Kuwayama Naoki , Hoshino Isamu , Gunji Hisashi , Tonooka Toru , Soda Hiroaki , Eto Ryotaro , Takiguchi Nobuhiro , Nabeya Yoshihiro
Published: September 2020

Background

Barrett's esophagus (BE) is characterized by presence of columnar epithelium in the lower esophageal mucosa, which originally comprises stratified squamous epithelium. Gastroesophageal reflux disease causes BE and BE adenocarcinoma (BEAC); further, the incidence of BEAC is increasing, especially in developed countries. Long-segment BE (LSBE) has a particularly high carcinogenic potential and necessitates treatment, surveillance, and prevention.

Case presentation

Herein, we report three cases of BEAC originating from LSBE larger than 15 cm. All three patients underwent surgery for the diagnosis of BEAC. A 66-year-old man with advanced esophageal cancer underwent neoadjuvant chemotherapy and subsequent subtotal esophagectomy. The postoperative pathological diagnosis was of poorly differentiated adenocarcinoma with lymph node metastasis (pT3 pN3 pM0 pStage III based on the Union for International Cancer Control TNM Classification 8th edition). Two years after the operation, the patient was diagnosed with recurrence around the celiac artery and underwent chemotherapy. An 83-year-old woman with advanced esophageal cancer underwent subtotal esophagectomy. The postoperative pathological diagnosis was of well-differentiated adenocarcinoma with supraclavicular lymph node metastasis (pT3 pN3 pM1 pStage IV). Two months after the operation, the patient was diagnosed with recurrence in the neck lymph nodes and underwent chemotherapy; however, she died. A 66-year-old man with early-stage esophageal cancer underwent subtotal esophagectomy. A superficial early cancerous lesion was seen over BE. The postoperative pathological diagnosis was of well-differentiated adenocarcinoma without lymph node metastasis (pT1a pN0 pM0 pStage 0). The patient was found to be alive and recurrence-free 3 months after the operation.

Conclusions

BEAC might show good prognosis if detected and treated early. Extremely LSBE is associated with a high incidence of BEAC; therefore, early detection and treatment with close surveillance is essential.
Combined resection of the hepatic artery without reconstruction in pancreaticoduodenectomy: a case report of pancreatic cancer with an aberrant hepatic artery
Authors: Kuribara Tadao , Ichikawa Tatsuo , Osa Kiyoshi , Inoue Takeshi , Ono Satoshi , Asanuma Kozo , Kaneko Shiori , Sano Takayuki , Shigeyoshi Itaru , Matsubara Kouta , Irie Naoko , Iai Akira , Shinobi Tetsuya , Ishizu Hideki , Miura Katsuhiro
Published: September 2020

Background

Pancreaticoduodenectomy (PD) is rarely performed for pancreatic cancer with hepatic arterial invasion owing to its poor prognosis and high surgical risks. Although there has been a recent increase in the reports of PD combined with hepatic arterial resection due to improvements in disease prognosis and operative safety, PD with major arterial resection and reconstruction is still considered a challenging treatment.

Case presentation

A 61-year-old man with back pain was diagnosed with pancreatic head and body cancer. Although distant metastasis was not confirmed, the tumor had extensively invaded the hepatic artery; therefore, we diagnosed the patient with locally advanced unresectable pancreatic cancer. After gemcitabine plus nab-paclitaxel (GnP) therapy, the tumor considerably decreased in size from 35 to 20 mm. Magnetic resonance imaging revealed a gap between the tumor and the hepatic artery. Tumor marker levels returned to their normal range, and we decided to perform conversion surgery. In this case, an artery of liver segment 2 (A2) had branched from the left gastric artery; therefore, we decided to preserve A2 and perform PD combined with hepatic arterial resection without reconstruction. After four cycles of GnP therapy, we performed hepatic arterial embolization to prevent postoperative ischemic complications prior to surgery. Immediately after embolization, collateral arterial blood flow to the liver was observed. Operation was performed 19 days after embolization. Although there was a temporary increase in liver enzyme levels and an ischemic region was found near the surface of segment 8 of the liver after surgery, no liver abscess developed. The postoperative course was uneventful, and S-1 was administered for a year as adjuvant chemotherapy. The patient is currently alive without any ischemic liver events and cholangitis and has not experienced recurrence in the past 4 years since the surgery.

Conclusions

In PD for pancreatic cancer with hepatic arterial invasion, if a part of the hepatic artery is aberrant and can be preserved, combined resection of the common and proper hepatic artery without reconstruction might be feasible for both curability and safety.
Laparoscopic-assisted distal gastrectomy and central pancreatectomy for gastric and perigastric lymph node metastases and pancreatic invasion from melanoma: a case report
Authors: Okawa Yuki , Ebihara Yuma , Tanaka Kimitaka , Nakanishi Yoshitsugu , Asano Toshimichi , Noji Takehiro , Kurashima Yo , Murakami Soichi , Nakamura Toru , Tsuchikawa Takahiro , Okamura Keisuke , Shichinohe Toshiaki , Hirano Satoshi
Published: September 2020

Background

In melanoma, completely resectable metastases are surgically resected to expect to prolong relapse-free survival and overall survival. However, distant metastases of melanoma are rarely indicated for surgery because multiple metastases are often observed at diagnosis. We report a case of a man in his 50s who underwent laparoscopic-assisted distal gastrectomy and central pancreatectomy for gastric metastases, lymph node metastases, and pancreatic invasion that could be completely resected.

Case presentation

A 50-year-old man was diagnosed with malignant melanoma of the left parietal region. After diagnosis, tumor resection and left cervical lymph node dissection were performed, and interferon-β treatment was added as adjuvant therapy. Seventeen months after adjuvant therapy, metastasis of stomach and abdominal lymph nodes from melanoma was diagnosed. And the pancreatic invasion of lymph nodes was suspected. Laparoscopic-assisted distal gastrectomy and the central pancreatectomy were performed because pancreatic invasion of melanoma was intraoperatively found. After 9 months of relapse-free survival, abdominal recurrence was observed. Nivolumab and ipilimumab were administered, and recurrent lesions are currently controlled. The patient has survived more than 3 years since metastasis resection.

Conclusion

In conclusion, laparoscopic-assisted distal gastrectomy and the central pancreatectomy were performed for gastric and perigastric lymph node metastases and pancreatic invasion due to malignant melanoma, and the negative surgical margin was achieved. Although patient selection is required, the central pancreatectomy was a good indication for maintaining exocrine and endocrine function. The development of immune checkpoint inhibitors and molecular-targeted agents may increase gastrointestinal surgery for metastatic melanoma in the future.
Lamellar macular holes: evolving concepts and propensity for progression to full thickness macular hole
Authors: Asaad Salim Zafar
Published: September 2020

Currently the term lamellar macular hole (LMH) alludes to a wide spectrum of macular conditions including distinct clinical entities with different pathomorphologies. Classifications into subtypes, tractional and degenerative or based on the associated preretinal tissue had been proposed. Recent insights suggest that only lesions with tissue loss should be considered ‘true’ LMH and not those morphological changes caused by tractional forces. Inclusion of lesions with foveoschisis with contractile epiretinal membrane (ERM) in earlier studies on LMHs has resulted in imprecise information about its clinical course. This review provides an overview of the evolving concepts of LMHs and analyses its natural history from study cases in previously published literature.
A new tool for the remote sensing of groundwater tables: satellite images of pastoral wells
Authors: Collignon Bernard
Published: September 2020

In the Sahara and the Sahel, groundwater is a limited and indispensable resource for pastoral livestock farming. The daily life and work of the herders are organised around the location of the wells and the depth of the water table. To ensure the sustainable development of these regions, it is therefore essential to develop accurate piezometric maps, even in the areas that are most difficult to access.

Thanks to high-resolution satellite images, the tracks made by cattle, goats and camels in the Sahara and Sahel could become a key indicator of the depth of the water table.

In the northern Sahel, pastoralists water their livestock from deep wells. To draw water, they hitch oxen or camels to a rope whose length is an accurate measure of the depth of the piezometric surface of the water table. When pulling on this rope, the animals leave deep tracks on the ground that can be observed and measured on satellite images.

We have developed a remote sensing technique that allows us to (a) identify pastoral wells, (b) isolate the tracks left by the animals used to draw water, and (c) use these animal tracks to estimate the water depth.

After carefully calibrating the method, we were able to use open data (Landsat) and satellites images freely accessible data thanks to Google Earth Pro (SPOT and Worldview) to draw up, in just a few weeks, the piezometric map of a large aquifer (200,000km2) that is not easily accessible by other means due to the prevailing insecurity that has persisted in this part of the Sahel region for several years. This same method was then subsequently tested and validated on two other aquifers, one in Nigeria and one in Niger.
The sim must go on: adapting resident education to the COVID-19 pandemic using telesimulation
Authors: Patel Shivani M. , Miller Christina R. , Schiavi Adam , Toy Serkan , Schwengel Deborah A.
Published: September 2020

The COVID-19 pandemic and social distancing rules necessitated the suspension of all in-person learning activities at our institution. Consequently, distance learning became essential. We adapted a high-fidelity immersive case-based simulation scenario for telesimulation by using the virtual meeting platform Zoom® to meet our curricular needs. The use of telesimulation to teach a complex case-based scenario is novel. Two cohorts of anesthesiology residents participated 2 weeks apart. All learners were located at home. Four faculty members conducted the telesimulation from different locations within our simulation center in the roles of director, simulation operator, confederate anesthesiologist, and confederate surgeon. The anesthesiologist performed tasks as directed by learners. The scenario was divided into four scenes to permit reflection on interventions/actions by the participants based on the clinical events as the scenario progressed, to facilitate intermittent debriefing and learner engagement. All residents were given a medical knowledge pretest before the telesimulation and a posttest and learner satisfaction survey at the conclusion. The scenario was authentic and immersive, represented an actual case, and provided the opportunity to practice lessons that could be applied in the clinical setting. Participants rated telesimulation a reasonable substitution for in-person learning and expressed gratitude for continuation of their simulation-based education in this format during the pandemic. Participants in the second cohort reported feeling more engaged (p = 0.008) and stimulated to think critically (p = 0.003). Audio quality was the most frequently noted limitation. Fifty-three residents completed both pre- and posttests. The two cohorts did not differ in knowledge pretest scores (62% vs 60%, p = 0.80) or posttest scores (78% vs. 77%, p = 0.87). Overall, knowledge scores improved with the telesimulation intervention (pretest mean = 61% [SD = 14%]; posttest mean = 78% [SD = 12%]; t (41) = − 7.89, p < 0.001). Thus, using a Zoom format, we demonstrated the feasibility of adapting a complex case for telesimulation and effective knowledge gain. Furthermore, we improved our process in real time based on participant feedback. Participants were satisfied with their learning experience, suggesting that this format may be used in other distance learning situations.
Prevalence of Enterobius vermicularis infections and associated risk factors among schoolchildren in Nakhon Si Thammarat, Thailand
Authors: Laoraksawong Pokkamol , Pansuwan Pimyada , Krongchon Supakrit , Pongpanitanont Pongphan , Janwan Penchom
Published: September 2020

Background

Enterobius vermicularis infection is an important public health problem worldwide, especially among schoolchildren in tropical and subtropical countries. The prevalence of E. vermicularis infections varies in each region of Thailand; however, its status remains unknown among children who live in rural areas of the southern region. This study aimed to evaluate the current prevalence of E. vermicularis infections and to identify the risk factors for infection among schoolchildren who live in rural communities in Nakhon Si Thammarat, Southern Thailand.

Results

The overall prevalence of E. vermicularis infections was 5.79% (23 of 397). According to a multivariate analysis, the following were found to be risk factors associated with E. vermicularis infections (P < 0.05): those of the male sex (AOR = 4.03, 95% CI 1.22–13.29), those in the 3–6 year age group (AOR = 4.85, 95% CI 1.51–15.59), those who have a mother with a primary school education level (AOR = 11.22, 95% CI 1.75–71.77), those who have older sibling(s) (AOR = 6.25, 95% CI 1.83–21.26), those who have younger sibling(s) (AOR = 6.24, 95% CI 2.00–19.44), those who sometimes wash their hands after using the toilet (AOR = 5.25, 95% CI 1.24–22.21), those who keep their fingernails long (AOR = 29.97, 95% CI 6.16–145.85), and those who suck their fingers (AOR = 3.59, 95% CI 1.21–10.66).

Conclusions

This was the first report that revealed the prevalence of E. vermicularis infections among children who live in rural areas of Southern Thailand through detection using the Scotch tape technique. This study demonstrated that the high prevalence of E. vermicularis infections in schoolchildren with siblings was a significant independent predictor and that the transmission of this infection may occur in the family through their school-age siblings. In addition, children who have poor personal hygiene have a high prevalence of E. vermicularis infections. Therefore, maintaining good handwashing habits, keeping one’s fingernails short, and avoiding sucking one’s fingers should be important preventive measures against infection. Moreover, health literacy or health education, especially for parents or the principal caretakers of children, should be implemented to reduce E. vermicularis infections.
Metabolic resistance mechanism in Aedes aegypti from Lagos State, Nigeria
Authors: Fagbohun Ifeoluwa Kayode , Idowu Emmanuel Taiwo , Olakiigbe Abiodun Kanmi , Oyeniyi Amos Tolulope , Otubanjo Olubunmi Adetoro , Awolola Taiwo Samson
Published: September 2020

Background

Aedes aegypti transmits several arboviral diseases of global public health threat such as dengue, zika, and yellow fever. Recently, a series of yellow fever outbreaks have been reported in different parts of the country. Globally, the control of mosquito-borne diseases has relied heavily on insecticides based vector control efforts. Therefore, we assessed the susceptibility status to three different classes of WHO approved insecticides and evaluated the importance of detoxifying enzymes on insecticides resistance in Aedes aegypti collected from Lagos State, Nigeria. Aedes aegypti immature stages were collected from suitable habitats in peri-domestic areas of Alimosho, Kosofe, Badagry, and Ibeju-Lekki Local Government Areas (LGAs) of Lagos State, 2–5 days old glucose-fed adult female mosquitoes were exposed to discriminating doses of DDT, permethrin, bendiocarb, and PBO synergist using WHO standard procedure and kits. Identification was through morphological means only.

Results

Resistance to DDT and permethrin was recorded in all the LGAs, suspected resistance to bendiocarb was recorded in Aedes aegypti from Alimosho while full susceptibility was recorded in other LGAs. PBO synergist significantly increases the 24 h mortality of DDT and permethrin-resistant Aedes aegypti in all the LGAs. The activities of both GSTs and cytochrome P450s increase with decreasing mortality for Aedes aegypti, regression value (R2) ranges from 0.8889 to 0.6224 for GSTs and 0.4379 to 0.616 for cytochrome P450s.

Conclusions

Aedes aegypti population from Lagos State, Nigeria, have developed resistance to DDT and permethrin, the activities of P450s and GST were implicated in DDT and permethrin resistance in this study. Therefore, a need for regular insecticides monitoring and PBO should be incorporated into Aedes aegypti insecticides control strategies to forestall development of resistance to DDT and pyrethriods.