bluuebunny/crossref_metadata_2025 huggingface dataset:
Management of extra-abdominal fibromatosis in a musculoskeletal tumour centre in Hong Kong
Authors: Yvette Lam Wei Sze , Tak Fong Sin , Lok Mak Ka
Published: February 2021

Introduction:

Fibromatosis is a benign disease yet prone to recurrence. The best treatment option remains controversial. The purpose of this study was to analyse the management approach in our musculoskeletal tumour centre.

Materials and Methods:

Thirty-four patients with extra-abdominal fibromatosis referred to our centre between 2000 to 2018 were included. Patients’ demographics, tumour location and size, year of diagnosis, treatment modalities, surgical margins, recurrence, and subsequent management were analysed.

Results:

Patients mostly presented in the second and third decade, with female predominance. Twenty-seven patients underwent excision. Other management options included ‘watchful waiting’, pharmacological treatment and radiotherapy. Recurrence rate was 51.9%. There was no statistically significant relationship between marginal status and recurrence.

Conclusion:

We report our experiences on management of fibromatosis, with strategy shifted from early excision to a conservative approach over the years. Surgical excision is still indicated in some situations. Tumour recurrence is not rare but second excision is not always necessary.
COVID-19 Impact on Exports of Services: Opportunities, Challenges and Suggestions for India
Authors: Veeramani Sivalingam , Anam
Published: February 2021

The COVID-19 outbreak has put the global economic scenario out of order. The mechanism of lockdown and social distancing has paved a grave situation for global trade in general and services in particular as they are inseparable and requires proximity between the supplier and the consumer. In view of the outstanding contribution of services in India’s foreign trade, this study examines the impact of the pandemic on aggregate, sectoral and mode-wise services exports from India. It ultimately seeks to highlight key opportunities, challenges and suggestions to protect and promote India’s services interest amid this global disruption. We review the quarterly and monthly services exports patterns from January to July 2020 based on the data obtained from the World Trade Organization and the Reserve Bank of India. The perspective on mode-wise services exports is derived from the Trade-in Services by Modes of Supply (TISMOS) data set of the WTO for 2017. The analysis highlights a severe drop in overall services exports, by over 10% during the second quarter of 2020. Travel, transport and financial services have been hit hardest. However, the decline in India’s services exports found as relatively much lower in comparison to other major services exporting economies. The comparative edge in digital or Mode 1 services offers greater opportunities for the country in the longer period if urgent policy initiatives and support are extended to potential online services sectors.
The Predictors of Hypertension in Children: Palestinian Perspective
Authors: Batran Ahmad , Fashafsheh Nawras , Ayed Ahmad , Salameh Basma
Published: February 2021

Children with high blood pressure are much more likely than children with lower blood pressure to experience hypertension in adulthood. The purpose of this study was to determine the prevalence of hypertension and predictors of hypertension in Palestinian children.

Method

Cross-sectional study was performed on five hundred and nine (10–13) year old students from governmental schools in Jenin and Tubas. Anthropometric measures consist of body mass index, hip circumference (HC), waist circumference (WC), the ratio of waist to hip (WHR), and the ratio of waist to height (WHtR) were measured. Blood pressure was assessed including systolic (SBP) and diastolic (DBP) utilizing a (Dynamap) vital signs monitor.

Results

Approximately 38.7% of participants (38.8% females and 38.63% males) were considered pre-hypertensive and 7.3% of the participants (7.4% females and 7.1% males) were hypertensive. Also, there was a weak to moderate relationship between mean blood pressure (systolic and diastolic) and the anthropometric measurements. Additionally, most predictors with significant effects on early childhood hypertension were body mass index (OR 1.16, 95% CI 1.09–1.23).

Conclusions

Hypertension and prehypertension are present in Palestinian children. Waist hip ratio is the greatest predictor of BP, followed by body mass index. Hence, weight-reduction strategies to at-risk children are crucial to minimizing the prevalence of Palestinian childhood hypertension.
Effect of sizing agent on interfacial properties of carbon fiber-reinforced PMMA composite
Authors: Jian Li
Published: February 2021

The surface treatment of carbon fibers (CFs) was carried out using a self-synthesized sizing agent. The effects of sizing agent on the surface of CFs and the interface properties of CF/polymethyl methacrylate (PMMA) composites were mainly studied. Scanning electron microscopy, Fourier transform infrared spectroscopy, X-ray photoelectron spectroscopy, and static contact angle were used to compare and study the CFs before and after the surface treatment, including surface morphology, surface chemical element composition, and wettability of the surface. The influence of sizing agent on the mechanical properties of CF/PMMA resin composite interface was investigated. The results show that after sizing treatment, the CF surface O/C value increased by 35.1% and the contact angles of CF and resin decreased by 16.2%. The interfacial shear strength and interlayer shear strength increased by 12.6%.
Sonography as a Prognostic Indicator of Breslow Depth: Primary Malignant Melanoma of the Auricular Helix
Authors: Payano-Griffin Shirly
Published: February 2021

Malignant melanoma is a cellular cancer that produces pigmentation of the skin. The tendency toward melanoma may be inherited, and risk factors are increased with overexposure to the sun and ultraviolet radiation. Melanomas commonly present as a dark, asymmetrical, mole-like spot that spreads, with an irregular border. It is uncommon to find a melanoma in the auricular regions and even rarer for it to be a primary malignancy of the auricles. Utilizing sonography to evaluate melanoma lesions could serve as a prognostic indicator, regarding Breslow’s depth, an aide in staging, as well as surgical planning. However, utilizing multiple diagnostic imaging modalities is essential in the proper evaluation and staging of a melanoma. Currently there are revolutionary, effective systemic therapies available for patients with a metastatic melanoma. Current therapies are focused on immunotherapy and checkpoint inhibitors. These treatment options provide an opportunity for selected metastatic melanoma patients to achieve healthy long-term success.
Emergency Physicians Performing Point-of-Care Lung Sonography to Diagnose Pneumonia: A Prospective Multicenter Study
Authors: Zare Mohammad Amin , Mizani Mahtab , Sameti Azadeh , Bahmani Alireza , Fathi Marzieh
Published: February 2021

Objective:

There has always been some issues in the accurate diagnosis of pneumonia, a common cause of emergency department (ED) visits and revisits, which is typically made based on the patient’s clinical syndrome. This is made more difficult due to the traditional chest radiography having limited accuracy. This prospective multicenter study was conducted to determine the diagnostic accuracy of a point-of-care lung sonography performed by emergency physicians for the diagnosis of pneumonia in an acute care setting. This was compared with chest computed tomography (CT), the diagnostic gold standard.

Methods:

ED patients who presented with signs and symptoms of pneumonia were eligible to enroll in the study. After enrollment, point-of-care lung sonography was performed on patients by emergency physicians who had passed a focused teaching course on lung sonographic findings of pneumonia. All enrolled patients were followed up. Patients who underwent a chest CT during their hospital admission course were finally included and analyzed.

Results:

Emergency physicians who performed a point-of-care lung sonography had a sensitivity of 100%, specificity of 75%, positive predictive value of 88.88%, negative predictive value of 100%, and an overall accuracy of 90% in the diagnosis of pneumonia.

Conclusion:

These emergency physicians could accurately diagnose pneumonia, with a point-of-care lung sonography, after completing a focused sonography course.
Determination of the Accuracy of Supine and Prone Approaches to Sonographically Measured Kidney Dimensions
Authors: Ohagwu Christopher C. , Amogu Friday I. , Abonyi Livinus C. , Ochie Kalu , Eze Cletus U. , Ezechukwu Uchenna N.
Published: February 2021

Objective:

To determine the accuracy of supine and prone approaches to sonographically measured kidney dimensions.

Methods:

The kidney dimensions of 109 participants were sonographically determined in supine and prone patient positions. The two measurements were compared with each other using the intra-class correlation, coefficient of variation for duplicate measurements and Bland-Altman plot. The two sets of measurements were each compared with measurements from computed tomography.

Results:

There was a very strong agreement between kidney dimensions in supine and prone positions. There was also an agreement between kidney dimensions in supine and prone positions and computed tomography measurements.

Conclusion:

The kidney dimensions obtained using patient-in-supine position and patient-in-prone position approaches may be equivalent and the two approaches may be used interchangeably.
Sonographic Evaluation of Serous Cystadenofibroma With Evidence of Intermittent Torsion
Authors: Krohn Kaela A.
Published: February 2021

Serous cystadenofibromas are benign surface epithelial stromal tumors of the ovary. Many of the sonographic features of serous cystadenofibromas mimic what are traditionally considered possible characteristics of malignancy. Depending on the size of the ovarian neoplasm, there can be increased risk for ovarian torsion. Meticulous sonographic evaluation and appropriate optimization are critical for establishing the risk for malignancy and likelihood of torsion. This case describes how sonography was used to help identify a serous cystadenofibroma in a postmenopausal woman.
Prognostic Value of Initial Blood Cell Counts in Acute Myeloid Leukemia
Authors: Kirby Eric , Markert Ronald , Marinella Mark
Published: February 2021

Introduction:

Acute myeloid leukemia (AML) is an aggressive hematologic malignancy that has a poor prognosis. Not only does AML lead to mortality, but toxicity from chemotherapy can result in life-threatening complications. While the goal of treatment for some AML patients is cure, if the risks of chemotherapy are substantial, then less aggressive treatment regimens, including no treatment, should be pursued. The goal of this study was to identify risk factors for early mortality among patients with AML who receive chemotherapy.

Methods:

This study was a retrospective chart review. From January 2015 to August 2019, patients who received chemotherapy for AML were included. Demographic and clinical characteristics were gathered from when the patient was first suspected to have AML: age, sex, race, body surface area (BSA), white blood cell count (WBC), hemoglobin, platelet count, lactate dehydrogenase (LDH), and uric acid. The outcome was weeks of survival from the first day of treatment. The independent samples Mann-Whitney Test was used for dichotomous comparisons.

Results:

Forty-nine patients were included in the study. Patients aged ≤65 years old had greater median survival than those >65 years old (40.36 weeks vs. 11.50 weeks, p=0.045). Patients with a hemoglobin >8 g/dL had greater median survival than those ≤8g/dL (45.43 weeks vs. 6.57 weeks, p<0.001). Patients with a platelet count >50,000/mm3 had greater median survival than those ≤50,000/mm3 (47.72 weeks vs. 8.29 weeks, p<0.001). Sex and race were not related to survival time nor were cutoffs for BSA, WBC, LDH, and uric acid.

For the 23 of 49 patients who survived less than six months from the time they started chemotherapy, patients with a platelet count >50,000/mm3 had greater median survival than those ≤50,000/mm3 (11.29 weeks vs. 4.43 weeks, p=0.016). Also, for patients surviving less than six months, those with BSA >1.95 m2 had median survival of 10 weeks versus median survival of 4.5 weeks for BSA ≤1.95 m2 (p=0.07).

Conclusion:

For patients receiving chemotherapy for AML, we found that in addition to older age, lower hemoglobin and lower platelet count were risk factors for survival time and should be considered before embarking on an aggressive treatment regimen, as the risks may outweigh the benefits.

Figure

Disclosures

No relevant conflicts of interest to declare.
Level of Evidence for FDA Drug Approvals in Pivotal Clinical Trials of Hematological Malignancies
Authors: Al Hadidi Samer , Ramos Carlos A.
Published: February 2021

BACKGROUND

Clinical trials are integral to improve treatment outcomes for patients with hematological malignancies. Although early phase (I/II) clinical trials may provide evidence of clinical efficacy, the main goal for early phase trials is to assess safety signal. Results of phase III clinical trials provide the strongest evidence to support the use of new cancer medications. The Food and Drug Administration (FDA) is responsible to ensure appropriate control and supervision of pharmaceutical drugs.

METHODS

On the basis of publicly available study protocols and FDA reviews, the authors reviewed the level of evidence in 52 clinical trials supporting 49 drug approvals from 2016 to 2020. Data cut point was May 2020. These trials resulted in approval of medications to treat leukemia, non-Hodgkin lymphoma, Hodgkin lymphoma, myelodysplastic syndrome, myeloproliferative neoplasms and multiple myeloma.

RESULTS

A total of 52 clinical trials were assessed in the 5 years period. Phase III trials supported 61.5% while earlier phase trials supported 36.5% of subsequent FDA hematological malignancies approvals. The level of evidence to support FDA approvals improved with time with 50% of approvals in 2016 and 2017 supported by phase III clinical trials compared to 69% in 2019. Approvals were based on early phase trials in mantle cell lymphoma (100%), chronic myeloid leukemia (100%), diffuse large B cell lymphoma (100%), classic Hodgkin's lymphoma (67%) and acute myeloid leukemia (56%). Phase III trials enrolled 87% of the patients (14238 from16429 patients). Eighteen drug approvals (37% of all approvals) were based on 13% of the total number of patients in the studied period.

CONCLUSIONS

Level of evidence to support drug approvals in hematological malignancies was based on early phase trials in more than a third of the times. Although early phase studies are appropriate for safety signals, further clinical activity assessment should be done to support the use of new drugs to treat hematological malignancies. Previous successful early phase studies failed to show clinical activity in phase III studies. Despite the fact that use of new approved drugs based on early phase studies evidence may be needed, patients and healthcare providers should be aware of such possibility when using newly approved medications.

Figure

Disclosures

Ramos: Novartis: Membership on an entity's Board of Directors or advisory committees; Tessa Therapeutics: Research Funding; Kuur Therapeutics: Research Funding.
Fzr1 Preserves Hematopoietic Stem Cell Quiescence through Inhibiting Runx1
Authors: Zhou Chengfang , Kuang Mei , Chen Jieping , Hou Yu
Published: February 2021

Regulated blood production is achieved through the hierarchical organization of dormant hematopoietic stem cell (HSC) subsets that differ in self-renewal potential and division frequency, with long-term (LT)-HSCs dividing the least. FZR1, as a regulatory subunit of anaphase promoting complex/cyclosome (APC), is a master regulator of cell cycle, but little is known with regard to its role in HSC quiescence. Thus, we examined the function of Fzr1 in HSCs during steady-state hematopoiesis and under stress. We demonstrate that Fzr1 deletion led to perturbed hematopoiesis with an approximately 2-fold decrease in HSC pool size, as consequence of Fzr1 loss driving HSC from quiescence into rapid cycling (~70.1% to ~28.4%), elevating proliferation (~4.58% to ~18.5%) and apoptosis (~0.23% to ~2.86%) in HSC. As shown by serial bone marrow transplantation and competitive repopulation assays, self-renewal capacity and regenerative capacity were impaired, but differentiation of HSCs was not affected post Fzr1 deletion. Mechanistically, Fzr1 loss led to upregulation of Runx1 expression, in line with the protein expression, the ubiquitin sites of the gene was also obviouly decreased, knockdown Runx1 can rescue the Fzr1-deficient phenotype in HSC. Together, our data therefore support that Fzr1 acts a positive regulator of HSC quiescence and self-renewal capacity through inhibiting Runx1 expression.

Disclosures

No relevant conflicts of interest to declare.
Incidence and Risk Factors for 30-Day Readmission after Inpatient Chemotherapy Among Acute Lymphoblastic Leukemia Patients
Authors: Dalal Mansi , Slayton William , Tran Phuong Tan , Brown Joshua David
Published: February 2021

Background: chemotherapy for acute lymphoblastic leukemia (ALL) patients is complex and intense, resulting in their high readmission rate. Modifiable risk factors may exist to reduce their readmission.

Objectives: To identify the incidence, causes, and risk factors of readmission following inpatient chemotherapy among ALL patients.

Design: A retrospective cohort using the 2016 National Readmission Database.

Subjects: ALL children and adults receiving inpatient chemotherapy.

Measurements: We applied three different definitions of 30-day readmission: (1) nonelective readmission based on readmission type reported by hospitals, (2) unplanned readmission defined by the algorithm developed by the Center for Medicare and Medicaid Services, and (3) unintentional readmission, combining of (1) and (2). We used a weighted survey procedure to calculate incidence and unweighted, multivariable Poisson regression with robust variance estimates for risk factors analysis, including patient-, hospital- and admission-related characteristics.

Results: Percentage for nonelective, unplanned, and unintentional readmission were 33.3%, 22.4%, and 18.5%, respectively. Top three causes for unplanned readmissions were neutropenia/agranulocytosis (27.8%), septicemia (15.3%) and pancytopenia (11.5%). Risk ratios for unintentional readmission were 1.21 (1.08-1.36) for nonelective vs elective admission, 1.19 (1.06-1.33) for public vs private insurance enrollees, 0.96 (0.95-0.98) for each day of hospital stay, 0.77 (0.62-0.95) for large, teaching, and 0.87 (0.70-1.08) for small teaching vs non-teaching hospitals.

Conclusions: Possible strategies to reduce readmission among ALL patients could be shortening the gap in quality of care among teaching vs non-teaching hospitals, understanding the difference of privately vs publicly insured patients, and avoiding aggressive discharge after chemotherapy.

Disclosures

No relevant conflicts of interest to declare.
Weakness Ranking Method for Subsystems of Heavy-Duty Machine Tools Based on FMECA Information
Authors: Yang Zhaojun , Guo Jinyan , Tian Hailong , Chen Chuanhai , Zhu Yongfu , Liu Jia
Published: February 2021

Heavy-duty machine tools are composed of many subsystems with different functions, and their reliability is governed by the reliabilities of these subsystems. It is important to rank the weaknesses of subsystems and identify the weakest subsystem to optimize products and improve their reliabilities. However, traditional ranking methods based on failure mode effect and critical analysis (FMECA) does not consider the complex maintenance of products. Herein, a weakness ranking method for the subsystems of heavy-duty machine tools is proposed based on generalized FMECA information. In this method, eight reliability indexes, including maintainability and maintenance cost, are considered in the generalized FMECA information. Subsequently, the cognition best worst method is used to calculate the weight of each screened index, and the weaknesses of the subsystems are ranked using a technique for order preference by similarity to an ideal solution. Finally, based on the failure data collected from certain domestic heavy-duty horizontal lathes, the weakness ranking result of the subsystems is obtained to verify the effectiveness of the proposed method. An improved weakness ranking method that can comprehensively analyze and identify weak subsystems is proposed herein for designing and improving the reliability of complex electromechanical products.
Coupled mixed model for joint genetic analysis of complex disorders with two independently collected data sets
Authors: Wang Haohan , Pei Fen , Vanyukov Michael M. , Bahar Ivet , Wu Wei , Xing Eric P.
Published: February 2021

Background

In the last decade, Genome-wide Association studies (GWASs) have contributed to decoding the human genome by uncovering many genetic variations associated with various diseases. Many follow-up investigations involvejoint analysisof multiple independently generated GWAS data sets. While most of the computational approaches developed for joint analysis are based on summary statistics, the joint analysis based on individual-level data with consideration of confounding factors remains to be a challenge.

Results

In this study, we propose a method, called Coupled Mixed Model (CMM), that enables a joint GWAS analysis on two independently collected sets of GWAS data with different phenotypes. The CMM method does not require the data sets to have the same phenotypes as it aims to infer the unknown phenotypes using a set of multivariate sparse mixed models. Moreover, CMM addresses the confounding variables due to population stratification, family structures, and cryptic relatedness, as well as those arising during data collection such as batch effects that frequently appear in joint genetic studies. We evaluate the performance of CMM using simulation experiments. In real data analysis, we illustrate the utility of CMM by an application to evaluating common genetic associations for Alzheimer’s disease and substance use disorder using datasets independently collected for the two complex human disorders. Comparison of the results with those from previous experiments and analyses supports the utility of our method and provides new insights into the diseases. The software is available athttps://github.com/HaohanWang/CMM.
Comparative transcriptome analysis reveals novel insights into transcriptional responses to phosphorus starvation in oil palm (Elaeis guineensis) root
Authors: Kong Sze-Ling , Abdullah Siti Nor Akmar , Ho Chai-Ling , Musa Mohamed Hanafi bin , Yeap Wan-Chin
Published: February 2021

Background

Phosphorus (P), in its orthophosphate form (Pi) is an essential macronutrient for oil palm early growth development in which Pi deficiency could later on be reflected in lower biomass production. Application of phosphate rock, a non-renewable resource has been the common practice to increase Pi accessibility and maintain crop productivity in Malaysia. However, high fixation rate of Pi in the native acidic tropical soils has led to excessive utilization of P fertilizers. This has caused serious environmental pollutions and cost increment. Even so, the Pi deficiency response mechanism in oil palm as one of the basic prerequisites for crop improvement remains largely unknown.

Results

Using total RNA extracted from young roots as template, we performed a comparative transcriptome analysis on oil palm responding to 14d and 28d of Pi deprivation treatment and under adequate Pi supply. By using Illumina HiSeq4000 platform, RNA-Seq analysis was successfully conducted on 12 paired-end RNA-Seq libraries and generated more than 1.2 billion of clean reads in total. Transcript abundance estimated by fragments per kilobase per million fragments (FPKM) and differential expression analysis revealed 36 and 252 genes that are differentially regulated in Pi-starved roots at 14d and 28d, respectively. Genes possibly involved in regulating Pi homeostasis, nutrient uptake and transport, hormonal signaling and gene transcription were found among the differentially expressed genes.

Conclusions

Our results showed that the molecular response mechanism underlying Pi starvation in oil palm is complexed and involved multilevel regulation of various sensing and signaling components. This contribution would generate valuable genomic resources in the effort to develop oil palm planting materials that possess Pi-use efficient trait through molecular manipulation and breeding programs.
Screening the elite chemotypes of Gloriosa superba L. in India for the production of anticancer colchicine: simultaneous microwave-assisted extraction and HPTLC studies
Authors: Pandey Devendra Kumar , Kaur Prabhjot , Kumar Vijay , Banik R. M. , Malik Tabarak , Dey Abhijit
Published: February 2021

Background

Gloriosa superba L. (Colchicaceae) is a high-value medicinal plant indigenous to Africa and Southeast Asia. Its therapeutic benefits are well-established in traditional medicines including Ayurveda. It is well known for its natural bioactive compound colchicine which exhibits a wide range of pharmacological activities i.e. rheumatism, gout and was also introduced into clinical practices. The increasing demand as well as its illegal harvesting has brought this valuable plant under threatened category.

Methods

The present investigation describes a microwave assisted extraction (MAE) strategy coupled with a densitometric-high performance thin layer chromatographic (HPTLC) methodology for the analysis of colchicine from 32 different populations of G. superba. A Box-Behnken statistical design (3 level factor) has been employed to optimize MAE, in which power of microwave, time of irradiation, aqueous ethanol and pH were used as independent variables whereas colchicine was used as the dependent variables. Chromatography was carried out on Silica gel 60 F254 TLC plates with toluene: methanol, 85:15 (v/v) being used as solvent system. Densitometric measurement was performed at λ=254 nm following post-derivatization (10% methanolic sulphuric acid).

Results

Optimal conditions for extraction to obtain the maximum colchicine yield was found to be 7.51 mg g− 1 which was very close to be predicted response 7.48 mg g− 1 by maintaining microwave power (460 W), irradiation time (6.4 min), aqueous ethanol-30, pH -3. Colchicine content ranged between 2.12–7.58 mg g− 1 among 32 G. superba populations in which only three chemotypes viz. GS- 1, GS- 3, and GS- 2 collected from West Bengal and Sikkim, respectively exhibited maximum yield of colchicine.

Conclusion

Therefore, this newly developed optimized MAE coupled with HPTLC densitometry methodology not only quantifies colchicine in order to identify elite chemotypes of G. superba, but it also encourages in selecting high yielding populations of the plants for industrial use and economic boost for the farmers. This validated, simple and reproducible HPTLC protocol is being used for the first time to estimate colchicine from natural populations of G. superba obtained from 32 different geographical regions of India.

Graphical abstract
Complex chronic patients as an emergent group with high risk of intracerebral haemorrhage: an observational cohort study
Authors:   on behalf Ebrictus Research Group, Lorman-Carbó Blanca , Clua-Espuny Josep Lluís , Muria-Subirats Eulàlia , Ballesta-Ors Juan , González-Henares Maria Antònia , Fernández-Sáez José , Martín-Luján Francisco M.
Published: February 2021

Background

Demographic aging is a generalised event and the proportion of older adults is increasing rapidly worldwide with chronic pathologies, disability, and complexity of health needs. The intracerebral haemorrhage (ICH) has devastating consequences in high risk people. This study aims to quantify the incidence of ICH in complex chronic patients (CCP).

Methods

This is a multicentre, retrospective and community-based cohort study of 3594 CCPs followed up from 01/01/2013 to 31/12/2017 in primary care without a history of previous ICH episode. The cases were identified from clinical records encoded with ICD-10 (10th version of the International Classification of Diseases) in the e-SAP database of the Catalan Health Institute. The main variable was the ICH episode during the study period. Demographic, clinical, functional, cognitive and pharmacological variables were included. Descriptive and logistic regression analyses were carried out to identify the variables associated with suffering an ICH. The independent risk factors were obtained from logistic regression models, ruling out the variables included in the HAS-BLED score, to avoid duplication effects. Results are presented as odds ratio (OR) and 95% confidence interval (CI). The analysis with the resulting model was also stratified by sex.

Results

161 (4.4%) participants suffered an ICH episode. Mean age 87 ± 9 years; 55.9% women. The ICH incidence density was 151/10000 person-years [95%CI 127–174], without differences by sex. Related to subjects without ICH, presented a higher prevalence of arterial hypertension (83.2% vs. 74.9%; p = 0.02), hypercholesterolemia (55.3% vs. 47.4%, p = 0.05), cardiovascular disease (36.6% vs. 28.9%; p = 0.03), and use of antiplatelet drugs (64.0% vs. 52.9%; p = 0.006). 93.2% had a HAS-BLED score ≥ 3. The independent risk factors for ICH were identified: HAS-BLED ≥3 [OR 3.54; 95%CI 1.88–6.68], hypercholesterolemia [OR 1.62; 95%CI 1.11–2.35], and cardiovascular disease [OR 1.48 IC95% 1.05–2.09]. The HAS_BLED ≥3 score showed a high sensitivity [0.93 CI95% 0.89–0.97] and negative predictive value [0.98 (CI95% 0.83–1.12)].

Conclusions

In the CCP subgroup the incidence density of ICH was 5–60 times higher than that observed in elder and general population. The use of bleeding risk score as the HAS-BLED scale could improve the preventive approach of those with higher risk of ICH.

Trial registration

This study was retrospectively registered in ClinicalTrials.gov (NCT03247049) on August 11/2017.
Effect of balanced crystalloids versus saline on urinary biomarkers of acute kidney injury in critically ill adults
Authors:   for the SMART Investigators, Funke Blake E. ,   the Pragmatic Critical Care Research Group, Jackson Karen E. , Self Wesley H. , Collins Sean P. , Saunders Christina T. , Wang Li , Blume Jeffrey D. , Wickersham Nancy , Brown Ryan M. , Casey Jonathan D. , Bernard Gordon R. , Rice Todd W. , Siew Edward D. , Semler Matthew W.
Published: February 2021

Background

Recent trials have suggested use of balanced crystalloids may decrease the incidence of major adverse kidney events compared to saline in critically ill adults. The effect of crystalloid composition on biomarkers of early acute kidney injury remains unknown.

Methods

From February 15 to July 15, 2016, we conducted an ancillary study to the Isotonic Solutions and Major Adverse Renal Events Trial (SMART) comparing the effect of balanced crystalloids versus saline on urinary levels of neutrophil gelatinase-associated lipocalin (NGAL) and kidney injury molecule-1 (KIM-1) among 261 consecutively-enrolled critically ill adults admitted from the emergency department to the medical ICU. After informed consent, we collected urine 36 ± 12 h after hospital admission and measured NGAL and KIM-1 levels using commercially available ELISAs. Levels of NGAL and KIM-1 at 36 ± 12 h were compared between patients assigned to balanced crystalloids versus saline using a Mann-Whitney U test.

Results

The 131 patients (50.2%) assigned to the balanced crystalloid group and the 130 patients (49.8%) assigned to the saline group were similar at baseline. Urinary NGAL levels were significantly lower in the balanced crystalloid group (median, 39.4 ng/mg [IQR 9.9 to 133.2]) compared with the saline group (median, 64.4 ng/mg [IQR 27.6 to 339.9]) (P < 0.001). Urinary KIM-1 levels did not significantly differ between the balanced crystalloid group (median, 2.7 ng/mg [IQR 1.5 to 4.9]) and the saline group (median, 2.4 ng/mg [IQR 1.3 to 5.0]) (P = 0.36).

Conclusions

In this ancillary analysis of a clinical trial comparing balanced crystalloids to saline among critically ill adults, balanced crystalloids were associated with lower urinary concentrations of NGAL and similar urinary concentrations of KIM-1, compared with saline. These results suggest only a modest reduction in early biomarkers of acute kidney injury with use of balanced crystalloids compared with saline.

Trial registration

ClinicalTrials.gov number: NCT02444988. Date registered: May 15, 2015.
Safety and efficacy of Hypofractionated stereotactic radiosurgery for high-grade Gliomas at first recurrence: a single-center experience
Authors: Guan Yun , Xiong Ji , Pan Mingyuan , Shi Wenyin , Li Jing , Zhu Huaguang , Gong Xiu , Li Chao , Mei Guanghai , Liu Xiaoxia , Pan Li , Dai Jiazhong , Wang Yang , Wang Enmin , Wang Xin
Published: February 2021

Background

The optimal treatment for recurrent high-grade gliomas (rHGGs) remains uncertain. This study aimed to investigate the efficacy and safety of hypofractionated stereotactic radiosurgery (HSRS) as a first-line salvage treatment for in-field recurrence of high-grade gliomas.

Methods

Between January 2016 and October 2019, 70 patients with rHGG who underwent HSRS were retrospectively analysed. The primary endpoint was overall survival (OS), and secondary endpoints included both progression-free survival (PFS) and adverse events, which were assessed according to Common Toxicity Criteria Adverse Events (CTCAE) version 5. The prognostic value of key clinical features (age, performance status, planning target volume, dose, use of bevacizumab) was evaluated.

Results

A total of 70 patients were included in the study. Forty patients were male and 30 were female. Forty-nine had an initial diagnosis of glioblastoma (GBM), and the rest (21) were confirmed to be WHO grade 3 gliomas. The median planning target volume (PTV) was 16.68 cm3 (0.81–121.96 cm3). The median prescribed dose was 24 Gy (12–30 Gy) in 4 fractions (2–6 fractions). The median baseline of Karnofsky Performance Status (KPS) was 70 (40–90). With a median follow-up of 12.1 months, the median overall survival after salvage treatment was 17.6 months (19.5 and 14.6 months for grade 3 and 4 gliomas, respectively; p = .039). No grade 3 or higher toxicities was recorded. Multivariate analysis showed that concurrent bevacizumab with radiosurgery and KPS > 70 were favourable prognostic factors for grade 4 patients with HGG.

Conclusions

Salvage HSRS showed a favourable outcome and acceptable toxicity for rHGG. A prospective phase II study (NCT04197492) is ongoing to further investigate the value of hypofractionated stereotactic radiosurgery (HSRS) in rHGG.
Life-conditions and anthropometric variables as risk factors for oral health in children in Ladakh, a cross-sectional survey
Authors: Cagetti Maria Grazia , Cocco Fabio , Calzavara Ezio , Augello Davide , Zangpoo Phunchok , Campus Guglielmo
Published: February 2021

Background

The aim of this survey was to evaluate the severity of dental caries among children living in Zanskar Valley (Ladakh, India) and its association with anthropometric and background variables.

Methods

This cross‐sectional survey was conducted on schoolchildren divided into four age groups (< 6, ≥ 6 < 11, ≥ 11 < 14 and > 14 years of age). A total of 1474 schoolchildren (607 males, 41.2%) were examined. Actual caries prevalence (dt/DT) and gingival bleeding were recorded by four calibrated dentists. An ad hoc questionnaire evaluated general health, eating habits, oral hygiene and the self-perception of oral conditions. Height, weight, waist circumference, heart-rate and oxygen-saturation were also collected directly by examiners. Responses to questionnaire items were treated as categorical or ordinal variables. The relationship between children’s caries data, gingival bleeding, gender, Body Mass Index (BMI) following the International Obesity Task Force, waist circumference and questionnaire items was assessed using the Kruskal–Wallis test and Pearson correlation. Conditional ordinal logistic regression was used to analyse associations among caries severity, gender, BMI, waist circumference, oxygen saturation and questionnaire items. A forward stepwise logistic regression procedure was also carried-out to estimate the ORs of gingival bleeding prevalence and the covariates derived from examination or questionnaire.

Results

Caries was almost ubiquitarian with only 10.0% of caries-free children (dt/DT = 0). Caries severity, in both primary and permanent dentitions, was statistically significantly related to gender, waist circumference, BMI, oral hygiene frequency and self-reported chewing problems (p < 0.01 in both dentitions). An increasing relative risk for caries in permanent dentition compared to caries-free subjects was observed in children with a low BMI (RRR = 1.67, 95%CI = 1.54/2.83 for subjects with 1–3 caries lesions and RRR = 1.52, 95%CI = 1.36/1.74 for subjects with > 3 caries lesions); also, children with reduced waist circumference had a higher relative risk to have 1–3 caries lesions (RRR = 2.16, 95%CI = 1.84/2.53) and an even higher risk to have more than 3 caries lesions (RRR = 4.22, 95%CI = 3.33/5.34).

Conclusions

A significant impact of untreated caries lesions was observed in Ladakh schoolchildren; low BMI values and reduced waist circumference showed to be the main caries risk predictors. Preventive and intervention programmes should be implemented to improve children's oral health.
Physicians’ attitudes to disability pension – impact of diagnosis: an experimental study
Authors: McAllister Ashley , Milner Allison , Engblom Monika , Corrigan Patrick , Burström Bo
Published: February 2021

Background

The purpose of this study is to increase understanding of physicians’ attitudes towards disability pension applicants, and the impact of diagnosis. We hypothesize that physicians are more likely to think that patients with physical illnesses should get a disability pension than those with mental illness or alcohol dependence. Disability pension is an important source of income for those unable to work because of a disability and type of diagnosis should not impact accessing these benefits.

Methods

We conducted an experiment with a 2 by 3 factorial structure in Sweden. Each physician was randomly assigned one of six patient vignettes, with the same background description but with a different diagnosis. Each vignette had a diagnosis of either depression, alcohol dependence or low back pain, and was about a man or a woman. Logistic regression was used to examine the odds of a physician reporting that a patient should get a disability pension. Effects are reported in terms of odds ratios (ORs).

Results

1414 Swedish registered physicians in psychiatry or general practice (24% response rate) completed the survey. Physicians assigned the alcohol dependent vignette had OR 0.45 (95% CI: 0.34 to 0.60) for perceiving that a patient should get a disability pension compared to physicians assigned the low back pain vignette. Physicians assigned the depression vignette had OR 1.89 (95% CI: 1.42 to 2.50) for perceiving that a patient should get a disability pension compared to physicians assigned the low back pain vignette.

Conclusion

The patient diagnosis was associated with the physicians’ response regarding if the patient should get a disability pension. A physician’s perception is likely to impact a patient’s access to disability pension.
Can biomarkers of extracellular matrix remodelling and wound healing be used to identify high risk patients infected with SARS-CoV-2?: lessons learned from pulmonary fibrosis
Authors: Leeming D. J. , Genovese F. , Sand J. M. B. , Rasmussen D. G. K. , Christiansen C. , Jenkins G. , Maher T. M. , Vestbo J. , Karsdal M. A.
Published: February 2021

Pulmonary fibrosis has been identified as a main factor leading to pulmonary dysfunction and poor quality of life in post-recovery Severe Acute Respiratory Syndrome (SARS) survivor’s consequent to SARS-Cov-2 infection. Thus there is an urgent medical need for identification of readily available biomarkers that in patients with SARS-Cov-2 infection are able to; (1) identify patients in most need of medical care prior to admittance to an intensive care unit (ICU), and; (2) identify patients post-infection at risk of developing persistent fibrosis of lungs with subsequent impaired quality of life and increased morbidity and mortality. An intense amount of research have focused on wound healing and Extracellular Matrix (ECM) remodelling of the lungs related to lung function decline in pulmonary fibrosis (PF). A range of non-invasive serological biomarkers, reflecting tissue remodelling, and fibrosis have been shown to predict risk of acute exacerbations, lung function decline and mortality in PF and other interstitial lung diseases (Sand et al. in Respir Res 19:82, 2018). We suggest that lessons learned from such PF studies of the pathological processes leading to lung function decline could be used to better identify patients infected with SARS-Co-V2 at most risk of acute deterioration or persistent fibrotic damage of the lung and could consequently be used to guide treatment decisions.
Epicardial adipose tissue volume and coronary calcification among people living with diabetes: a cross-sectional study
Authors: Cosson Emmanuel , Nguyen Minh Tuan , Rezgani Imen , Tatulashvili Sopio , Sal Meriem , Berkane Narimane , Allard Lucie , Brillet Pierre-Yves , Bihan Hélène
Published: February 2021

Background

Epicardial adipose tissue (EAT) has anatomic and functional proximity to the heart and is considered a novel diagnostic marker and therapeutic target in cardiometabolic diseases. The aim of this study was to evaluate whether EAT volume was associated with coronary artery calcification (CAC) in people living with diabetes, independently of confounding factors.

Methods

We included all consecutive patients with diabetes whose EAT volume and CAC score were measured using computed tomography between January 1, 2019 and September 30, 2020 in the Department of Diabetology-Endocrinology-Nutrition at Avicenne Hospital, France. Determinants of EAT volume and a CAC score ≥ 100 Agatston units (AU) were evaluated.

Results

The study population comprised 409 patients (218 men). Mean (± standard deviation) age was 57 ± 12 years, and 318, 56 and 35 had type 2 (T2D), type 1 (T1D), or another type of diabetes, respectively. Mean body mass index (BMI) was 29 ± 6 kg/m2, mean AET volume 93 ± 38 cm3. EAT volume was positively correlated with age, BMI, pack-year smoking history and triglyceridaemia, but negatively correlated with HDL-cholesterol level. Furthermore, it was lower in people with retinopathy, but higher in men, in Caucasian people, in patients on antihypertensive and lipid-lowering medication, in people with nephropathy, and finally in individuals with a CAC ≥ 100 AU (CAC < 100 vs CAC ≥ 100: 89 ± 35 vs 109 ± 41 cm3, respectively, p < 0.05). In addition to EAT volume, other determinants of CAC ≥ 100 AU (n = 89, 22%) were age, T2D, ethnicity, antihypertensive and lipid-lowering medication, cumulative tobacco consumption, retinopathy, macular edema and macrovascular disease. Multivariable analysis considering all these determinants as well as gender and BMI showed that EAT volume was independently associated with CAC ≥ 100 AU (per 10 cm3 increase: OR 1.11 [1.02–1.20]).

Conclusions

EAT volume was independently associated with CAC. As it may play a role in coronary atherosclerosis in patients with diabetes, reducing EAT volume through physical exercise, improved diet and pharmaceutical interventions may improve future cardiovascular risk outcomes in this population.
The cancer metabolic reprogramming and immune response
Authors: Xia Longzheng , Oyang Linda , Lin Jinguan , Tan Shiming , Han Yaqian , Wu Nayiyuan , Yi Pin , Tang Lu , Pan Qing , Rao Shan , Liang Jiaxin , Tang Yanyan , Su Min , Luo Xia , Yang Yiqing , Shi Yingrui , Wang Hui , Zhou Yujuan , Liao Qianjin
Published: February 2021

The overlapping metabolic reprogramming of cancer and immune cells is a putative determinant of the antitumor immune response in cancer. Increased evidence suggests that cancer metabolism not only plays a crucial role in cancer signaling for sustaining tumorigenesis and survival, but also has wider implications in the regulation of antitumor immune response through both the release of metabolites and affecting the expression of immune molecules, such as lactate, PGE2, arginine, etc. Actually, this energetic interplay between tumor and immune cells leads to metabolic competition in the tumor ecosystem, limiting nutrient availability and leading to microenvironmental acidosis, which hinders immune cell function. More interestingly, metabolic reprogramming is also indispensable in the process of maintaining self and body homeostasis by various types of immune cells. At present, more and more studies pointed out that immune cell would undergo metabolic reprogramming during the process of proliferation, differentiation, and execution of effector functions, which is essential to the immune response. Herein, we discuss how metabolic reprogramming of cancer cells and immune cells regulate antitumor immune response and the possible approaches to targeting metabolic pathways in the context of anticancer immunotherapy. We also describe hypothetical combination treatments between immunotherapy and metabolic intervening that could be used to better unleash the potential of anticancer therapies.