bluuebunny/crossref_metadata_2025 huggingface dataset:
Venetoclax in combination with azacitidine in Japanese patients with acute myeloid leukaemia: phase 1 trial findings
Authors: Taniguchi Shuichi , Yamauchi Takahiro , Choi Ilseung , Fukuhara Noriko , Potluri Jalaja , Salem Ahmed Hamed , Hong Wan-Jen , Honda Hideyuki , Nishimura Yasuko , Okubo Sumiko , Usuki Kensuke
Published: March 2021

Background

Venetoclax plus azacitidine is indicated in the USA for the treatment of newly diagnosed acute myeloid leukaemia in older patients (≥75 years) or those ineligible for induction chemotherapy due to co-morbidities.

Methods

In this phase 1/2 study (NCT02265731), Japanese patients (≥60 years) with untreated (ineligible for induction chemotherapy) or relapsed/refractory acute myeloid leukaemia received oral venetoclax 400 mg/day (3-day ramp up in cycle 1) plus subcutaneous or intravenous azacitidine 75 mg/m2 on days 1–7 per 28-day cycle until disease progression or unacceptable toxicity.

Results

As of 10 December 2019, six patients were enrolled (median age: 75 years; untreated: n = 5; relapsed/refractory: n = 1); median treatment duration: 10.3 months (range, 0.7–29.4). Most common grade ≥ 3 adverse events were lymphopaenia and febrile neutropaenia (n = 4 each). Four patients reported serious adverse events; only an event of grade 3 fungal pneumonia was considered possibly related to both study drugs, requiring dose interruption of venetoclax and delay of azacitidine. Five (83%) patients had responses (complete remission: n = 3). Median time to first response of complete remission/complete remission with incomplete count recovery was 1.0 month (range, 0.8–5.5); median overall survival: 15.7 months (95% confidence interval: 6.2, not reached).

Conclusions

Venetoclax plus azacitidine was well tolerated and showed high response rates in Japanese patients with acute myeloid leukaemia.
Statistics of collision parameters computed from 2D simulations
Authors: Süli Á
Published: March 2021

There are two popular ways to speed up simulations of planet formation via increasing the collision probability: (i) confine motion to 2D, (ii) artificially enhance the physical radii of the bodies by an expansion factor. In this paper, I have performed 100 simulations each containing 104 interacting bodies and computed the collision parameters from the results of the runs. Each run was executed for a lower and a higher accuracy parameter. The main goal is to determine the probability distribution functions of the collision parameters and their dependence on the expansion factor. A simple method is devised to improve the determination of the collision parameters from the simulation data. It was shown that the distribution of the impact parameter is uniform and independent of the expansion factor. For real collisions, the impact velocity is greater than 1 mutual escape velocity, a finding that can be explained using the two-body problem. The results cast some doubts on simulations of the terrestrial planets’ final accretion that have assumed merge. Collision outcome maps were created adopting the fragmentation model of recent studies to estimate the number of different types of collisions. A detailed comparison with earlier works indicates that there are similarities as well as significant differences between the different works. The results indicate that as the planetary disc matures and the masses of the bodies differ progressively than the majority of collisions lead to mass growth either via partial accretion or via graze-and-merge collision.
Mitigation of X-ray induced DNA damages and expression of DNA-repair genes by antioxidative Potentilla fulgens root extract and its ethyl-acetate fraction in mammalian cells
Authors: Tripathy Debabrata , Upadhyay Ravi , Singh Chongtham Sovachandra , Boruah Nabamita , Mandal Nripendranath , Chatterjee Anupam
Published: March 2021

Potentilla fulgens is a medicinal plant in North-East India whose root is reported to have anti-diabetic, anticarcinogenic and antioxidant properties. The potential of hydro-alcoholic extract of P. fulgens root (PRE) for providing protection to mammalian cells exposed to ionising radiation was investigated in this study. The methanolic extract of PRE shows an enhanced radical scavenging ability in a concentration dependent manner. PRE-pre-treatment to stimulated human blood lymphocytes (HBLs) reduced the frequency of deletion and exchange aberrations induced by X-irradiation. Similar protection of chromosome aberrations was also observed in mouse bone marrow cells (BMCs) where mice were given PRE extract (1 mg extract/day/mice) ad libitum in the drinking water for 45 days before whole-body X-irradiation. Of the various extracts prepared by partitioning of the methanol extract, the ethyl-acetate (EA) fraction was found to possess better antioxidant, radical scavenging and DNA-damage reduction activities. PRE-pre-treatment also reduced the radiation-induced cell-cycle delay effectively in HBL. In HEK-293 cells, PRE reduced radiation-induced G2-block in cell kinetics. Interestingly, PRE-treatment alone increased the concentration of endogenous glutathione (GSH) in mouse BMC and in stimulated HBL along with the elevated expression of γ-glutamyl-cysteine synthetase heavy/catalytic subunit, a key determinant of GSH synthesis. Studies on expression of two DNA-repair genes revealed that there was a marked increase in the expression of GADD45 and H2AX genes after X-irradiation in stimulated HBL, and such expression was reduced significantly if PRE-treatment was given prior to radiation. The present findings show the ability of PRE to reduce radiation-induced DNA damages probably by free radical scavenging whereas modulation of expression of DNA-repair genes’ and endogenous GSH-increment emerge as effective strategies. The present study is the first report on the selected medicinal plant species that suggests it to be a potential natural radioprotector when used as root extract or its EA fraction for mitigating radiation toxicity.
Persistent post-covid symptoms in healthcare workers
Authors: Gaber T A-Z K , Ashish A , Unsworth A
Published: March 2021

Background

Recent reports suggest a higher incidence of COVID-19 infections among healthcare workers (HCW). However, information about the long-term complications affecting this population is lacking.

Aims

Investigation of long-term impact of COVID-19 in HCW.

Methods

Seropositivity for SARS-CoV-2 antibodies was evaluated for the majority of HCW in an English teaching hospital 2 months following the peak of COVID-19 first wave. A questionnaire investigating the long-term complications was sent through global e-mail to HCW 4 months following the peak of the wave enquiring about the persistent health issues still affecting them at that point.

Results

Out of 3759 subjects tested for SARS-CoV-2 antibodies, 932 were positive (24%). Forty-five per cent of 138 HCW responding to the questionnaire reported persistent symptoms with 32% struggling to cope 3–4 months following the peak of the wave. Moderate-to-severe fatigue stood out as the most disabling symptom (39%) but mild-to-moderate shortness of breath, anxiety and sleep disturbance were almost universal in the subjects still struggling with symptoms. Only 16% consulted their general practitioner (GP) about their symptoms with only 2% taking sick leave after recovering from the acute illness.

Conclusions

Our data suggest that about a third of HCW who responded to the survey were still struggling to cope with the symptoms of what is now known as long covid several months after the acute COVID-19 infections. The overwhelming majority of this group seem to be reluctant to neither seek medical advice nor take sick leave.
Swing Pricing and Fragility in Open-End Mutual Funds
Authors: Jin Dunhong , Kacperczyk Marcin , Kahraman Bige , Suntheim Felix
Published: March 2021

How can fragility be averted in open-end mutual funds? In recent years, markets have observed an innovation that changed the way open-end funds are priced. Alternative pricing rules (known as swing pricing) adjust funds’ net asset values to pass on funds’ trading costs to transacting shareholders. Using unique data on investor-level transactions in U.K. corporate bond funds, we show that swing pricing eliminates the first-mover advantage arising from the traditional pricing rule and significantly reduces outflows during market stress. Swing pricing also reduces concavity in the flow-performance relationship and dilution in fund performance.
The Interplay Between Postsynaptic Striatal D2/3 Receptor Availability, Adversity Exposure and Odd Beliefs: A [11C]-Raclopride PET Study
Authors: Smigielski Lukasz , Wotruba Diana , Treyer Valerie , Rössler Julian , Papiol Sergi , Falkai Peter , Grünblatt Edna , Walitza Susanne , Rössler Wulf
Published: March 2021

Background

Between unaffected mental health and diagnosable psychiatric disorders, there is a vast continuum of functioning. The hypothesized link between striatal dopamine signaling and psychosis has guided a prolific body of research. However, it has been understudied in the context of multiple interacting factors, subclinical phenotypes, and pre-postsynaptic dynamics.

Method

This work investigated psychotic-like experiences and D2/3 dopamine postsynaptic receptor availability in the dorsal striatum, quantified by in vivo [11C]-raclopride positron emission tomography, in a sample of 24 healthy male individuals. Additional mediation and moderation effects with childhood trauma and key dopamine-regulating genes were examined.

Results

An inverse relationship between nondisplaceable binding potential and subclinical symptoms was identified. D2/3 receptor availability in the left putamen fully mediated the association between traumatic childhood experiences and odd beliefs, that is, inclinations to see meaning in randomness and unfounded interpretations. Moreover, the effect of early adversity was moderated by a DRD2 functional variant (rs1076560). The results link environmental and neurobiological influences in the striatum to the origination of psychosis spectrum symptomology, consistent with the social defeat and diathesis–stress models.

Conclusions

Adversity exposure may affect the dopamine system as in association with biases in probabilistic reasoning, attributional style, and salience processing. The inverse relationship between D2/3 availability and symptomology may be explained by endogenous dopamine occupying the receptor, postsynaptic compensatory mechanisms, and/or altered receptor sensitivity. This may also reflect a cognitively stabilizing mechanism in non-help-seeking individuals. Future research should comprehensively characterize molecular parameters of dopamine neurotransmission along the psychosis spectrum and according to subtype profiling.
Key considerations on the potential impacts of the COVID-19 pandemic on antimicrobial resistance research and surveillance
Authors: Rodríguez-Baño Jesús , Rossolini Gian Maria , Schultsz Constance , Tacconelli Evelina , Murthy Srinivas , Ohmagari Norio , Holmes Alison , Bachmann Till , Goossens Herman , Canton Rafael , Roberts Adam P , Henriques-Normark Birgitta , Clancy Cornelius J , Huttner Benedikt , Fagerstedt Patriq , Lahiri Shawon , Kaushic Charu , Hoffman Steven J , Warren Margo , Zoubiane Ghada , Essack Sabiha , Laxminarayan Ramanan , Plant Laura
Published: March 2021

Antibiotic use in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) patients during the COVID-19 pandemic has exceeded the incidence of bacterial coinfections and secondary infections, suggesting inappropriate and excessive prescribing. Even in settings with established antimicrobial stewardship (AMS) programmes, there were weaknesses exposed regarding appropriate antibiotic use in the context of the pandemic. Moreover, antimicrobial resistance (AMR) surveillance and AMS have been deprioritised with diversion of health system resources to the pandemic response. This experience highlights deficiencies in AMR containment and mitigation strategies that require urgent attention from clinical and scientific communities. These include the need to implement diagnostic stewardship to assess the global incidence of coinfections and secondary infections in COVID-19 patients, including those by multidrug-resistant pathogens, to identify patients most likely to benefit from antibiotic treatment and identify when antibiotics can be safely withheld, de-escalated or discontinued. Long-term global surveillance of clinical and societal antibiotic use and resistance trends is required to prepare for subsequent changes in AMR epidemiology, while ensuring uninterrupted supply chains and preventing drug shortages and stock outs. These interventions present implementation challenges in resource-constrained settings, making a case for implementation research on AMR. Knowledge and support for these practices will come from internationally coordinated, targeted research on AMR, supporting the preparation for future challenges from emerging AMR in the context of the current COVID-19 pandemic or future pandemics.
Laboratory-based diagnosis of scabies: a review of the current status
Authors: Siddig Emmanuel Edwar , Hay Roderick
Published: March 2021

Scabies is a neglected tropical disease (NTD) of the skin that is caused by the mite Sarcoptes scabiei. It is considered to be an important public health problem in many regions. The disease is at its most prevalent in low-resource countries where there are overcrowded living conditions coupled with poor hygiene. In some regions, mass drug administration using ivermectin is a key population-based approach to the control of scabies. Before starting a patient on specific treatment, confirming the diagnosis by accurate and rapid identification of the organism is critical. Different laboratory-based techniques for scabies have been developed in the last few decades. These include direct microscopy and histopathology. More recently, serological testing, dermoscopy and different molecular techniques have been developed as diagnostic methods for scabies. To date, none of these, apart from microscopy and dermoscopy, has been translated into routine clinical laboratory practice. A simple point-of-care or laboratory test would provide a rapid and confirmed diagnosis and early institution of effective treatment. In this review we present an update on the laboratory techniques currently in use for the identification of scabies.
Ancient gene duplications in RNA viruses revealed by protein tertiary structure comparisons
Authors: Cisneros-Martínez Alejandro Miguel , Becerra Arturo , Lazcano Antonio
Published: March 2021

To date only a handful of duplicated genes have been described in RNA viruses. This shortage can be attributed to different factors, including the RNA viruses with high mutation rate that would make a large genome more prone to acquire deleterious mutations. This may explain why sequence-based approaches have only found duplications in their most recent evolutionary history. To detect earlier duplications, we performed protein tertiary structure comparisons for every RNA virus family represented in the Protein Data Bank. We present a list of thirty pairs of possible paralogs with <30 per cent sequence identity. It is argued that these pairs are the outcome of six duplication events. These include the α and β subunits of the fungal toxin KP6 present in the dsRNA Ustilago maydis virus (family Totiviridae), the SARS-CoV (Coronaviridae) nsp3 domains SUD-N, SUD-M and X-domain, the Picornavirales (families Picornaviridae, Dicistroviridae, Iflaviridae and Secoviridae) capsid proteins VP1, VP2 and VP3, and the Enterovirus (family Picornaviridae) 3C and 2A cysteine-proteases. Protein tertiary structure comparisons may reveal more duplication events as more three-dimensional protein structures are determined and suggests that, although still rare, gene duplications may be more frequent in RNA viruses than previously thought.

Keywords: gene duplications; RNA viruses.
Utilization of an Online Education Module and Standardized Patient Simulation Experience to Improve Nursing Student Learning Outcomes With Heart Failure Patients
Authors: De Silva Sriyani Ramyalatha , Gates Michael G. , Waczek Allison D.
Published: March 2021

The aim of this experimental study was to examine whether nursing students’ participation in an online comprehensive heart failure educational module enhances their knowledge and ability to apply heart failure education skills in a simulated standardized nurse-patient interaction. Findings suggest that students who received a heart failure educational module scored significantly higher on both an exam of heart failure knowledge and a simulated nurse-patient interaction. The results suggest that large gains can be made in nursing education by using innovative teaching strategies that move beyond normal classroom/lecture teaching techniques.
Effectiveness of a Home-Based Exercise Intervention in the Fitness Profile of Hispanic Survivors of Breast Cancer
Authors: Ortiz Alexis , Hughes Daniel C. , Mama Scherezade K. , Tirado-Gomez Maribel , Liao Yue , Song JaeJoon , Gonzalez Velda , Basen-Engquist Karen
Published: March 2021

Background:

Home-based exercise interventions might be a desirable long-term option for breast cancer survivors to enhance compliance and long-term health benefits.

Purpose:

To assess the effectiveness of a home-based intervention aimed at helping survivors of breast cancer meet the physical activity guidelines of the American College of Sports Medicine.

Methods:

Eighty-nine women (age: 55.4 ± 10 years; body mass index: 31 ± 6.5 kg/m2) from 2 cancer centers serving Hispanic women participated in this study. Women underwent a baseline assessment of cardiorespiratory fitness, muscle endurance and strength, flexibility, range of motion, and extremity disability. After baseline measures, women were randomized into a control or exercise group. The exercise intervention consisted of a walking program, elastic band strengthening, and flexibility exercises performed at home. The outcome measures were reassessed 16 weeks after baseline measures.

Results:

The intervention showed a strong effect of time on muscle strength and shoulder range of motion, and time and group for self-reported disability. There were no differences in sedentary behavior, physical fitness, and disability measures across intervention groups, including both exercise groups combined and changes over time between intervention groups.

Conclusion:

It appears that a home-based intervention affects only upper-body strength and related disability, indicating that other components might need closer monitoring for significant changes to occur across time.
Supportive care practice: do we need guidelines?
Authors: Olver Ian
Published: March 2021

Purpose of review

To review the role of evidence-based clinical practice guidelines in promoting the quality and consistency of supportive care in oncology to meet the needs of practitioners and patients.

Recent findings

To maintain quality, guidelines must be regularly updated in terms of content as new treatment modalities like immunotherapy are introduced, adapted to new methodologies such as the application of artificial intelligence, adoption of multiple symptoms or orphan symptoms and capture new endpoints such a patient-reported outcomes. This helps prevent a major barrier to implementation; negative attitudes of practitioners towards guidelines. Digital guidelines provide greater opportunities for dissemination, ease of updating and can be linked to education modules. The quality must be assured by critically appraising the literature and then grading the level of evidence of the guidelines. The benefits of supportive care guidelines include guidance for clinical decision-making in a changing field, continuing professional development of practitioners, a source of information for patients and in highlighting the gaps where further research is necessary.

The implications are that guidelines are required for supportive care in cancer but they must be constantly updated and evolve in their structure, the rigour of appraisal and content to promote quality care.
Cannabis Use in Older Adults: A Perspective
Authors: Solomon Haley V. , Greenstein Aaron P. , DeLisi Lynn E.
Published: March 2021

The prevalence of cannabis use among older adults (aged 65 and above) for both recreational and medicinal purposes has significantly increased in recent years. Information regarding the safety of cannabis in this population is important since aging is associated with metabolic changes, multiple morbidities, increases in prescription medication use, and an overall decline in functioning. In this Perspectives article, we review special considerations pertinent to older adults—specifically, the impact of cannabis on cognition and on falls and injuries, its drug interactions, and its potential medicinal applications for treating the behavioral and psychological symptoms of dementia. Knowledge about the role of cannabis in brain health, injury risk, and drug interactions remains limited since the available evidence stems primarily from adolescent and young adult cohorts, plus a limited number of small observational studies with older adults. In terms of utilizing certain cannabinoids to treat the behavioral and psychological symptoms of dementia, some studies have found promising results, but because of the lack of consistency in the literature, it is premature to draw conclusions. Controlled research trials specifically with geriatric participants are needed to understand the effects of cannabis use in this vulnerable population.
Metabolic Regulation of the NLRP3 Inflammasome
Authors: Ye Qizhen , Chen Sheng , Wang Di
Published: March 2021

The progression of many diseases is accompanied by inflammation, in which inflammasomes play an important role. Inflammasomes are large multimolecular complexes present in the cytosol of stimulated immune cells, which mediate the activation of caspase-1 and the secretion of cytokines, leading to cellular pyroptosis. During this process, metabolic regulation of the inflammasome is gaining increasing attention in this field. This review focuses on a major inflammasome, NOD-, LRR- and pyrin domain-containing protein 3 (NLRP3), and discusses the role and significance of its metabolic regulation.
Macrophage-Mediated Defensive Mechanisms Involving Zinc Homeostasis in Bacterial Infection
Authors: Na-Phatthalung Pinanong , Min Junxia , Wang Fudi
Published: March 2021

Zinc homeostasis in macrophages is essential for maintaining their antimicrobial functions, and a growing body of evidence indicates that both zinc depletion and excess zinc in myeloid cells decrease bacterial survival. In macrophages, maintaining intracellular and extracellular zinc levels via zinc transporter proteins, including Slc30a and Slc39a family members, plays an important role in the response to immunological signals and infection. Recently, studies have found that macrophages utilize a variety of zinc-modulating mechanisms, thus expanding our knowledge regarding the role that zinc plays in response to bacterial infection. Here, we review recent progress with respect to altered zinc metabolism in macrophages and the consequences with respect to fighting invading pathogens.
Maternal Mental Disorders and Pediatric Infectious Diseases
Authors: Auger Nathalie , Monnier Maëva , Low Nancy , Lee Ga Eun , Bilodeau-Bertrand Marianne , Luu Thuy Mai
Published: March 2021

Background:

Maternal stress and depression are associated with infections in offspring, but there is a paucity of data for other mental disorders.

Methods:

We conducted a retrospective cohort study of 832,290 children born between 2006 and 2016 in hospitals of Quebec, Canada. We identified maternal mental disorders before and during pregnancy, and admissions for otitis media, pneumonia, infectious enteritis and other infections in children before 13 years of age. We used Cox proportional hazards regression to estimate hazard ratios (HRs) with 95% confidence intervals (CI) for the association between maternal mental disorders and the risk of pediatric infectious diseases, adjusted for maternal age, comorbidity, socioeconomic disadvantage, and other confounders.

Results:

The incidence of pediatric infection hospitalization was higher for maternal mental disorders compared with no disorder (66.1 vs. 41.1 cases per 1000 person-years). Maternal mental disorders were associated with 1.38 times the risk of otitis media (95% CI: 1.35–1.42), 1.89 times the risk of bronchitis (95% CI: 1.68–2.12), and 1.65 times the risk of infectious enteritis in offspring (95% CI: 1.57–1.74). Stress and anxiety disorders (HR 1.49, 95% CI: 1.46–1.53) and personality disorders (HR 1.55, 95% CI: 1.49–1.61) were more strongly associated with the risk of pediatric infection hospitalization than other maternal mental disorders. Associations were prominent in the first year of life and weakened with age.

Conclusions:

Maternal mental disorders are risk factors for infectious disease hospitalization in offspring. Women with mental disorders may benefit from psychosocial support to reduce the risk of serious infections in their children.
Primary Pyomyositis in Children is No More a Rare Condition: Presentation of 2 Clinical Cases
Authors: Pedoto Deianira , Diana Alfredo , Pennacchio Maria Laura , Paciello Francesca , Quarantiello Flavio , Della Casa Roberto
Published: March 2021

Primary pyomyositis is a bacterial muscle infection which may lead to abscess formation and severe complications. Although this condition has long been considered “tropical” and rare, mostly affecting immunocompromised patients, cases of pyomyositis have recently raised significantly among healthy children in temperate climates. With these 2 cases we highlight the importance of an early recognition of this condition, allowing an immediate treatment and reducing complications.
The association of polymorphism in PHACTR1 rs9349379 and rs12526453 with coronary artery atherosclerosis or coronary artery calcification. A systematic review
Authors: Koitsopoulos Pavlos G. , Rabkin Simon W.
Published: March 2021

Objective

There is a need to identify genetic factors that may produce coronary artery atherosclerotic disease (CAD) that are not involved in the usual risk factors leading to CAD. Previous studies have often equated coronary artery calcification (CAC) with CAD with coronary stenosis or its sequelae. The objective of this study was to examine the relationship between phosphatase and actin regulator 1 (PHACTR1) single nucleotide polymorphisms (SNPs) and the type of coronary artery disease CAD versus CAC.

Method

A systematic review of the literature was conducted to answer the question of whether PHACTR1 gene polymorphisms are associated with coronary artery disease expressed as coronary artery atherosclerosis or CAC.

Results

Eighteen studies spanning seven PHACTR1 SNPs were identified and evaluated for the relationship between PHACTR1 and coronary artery disease. There were significant relationships between rs9349379, rs12526453, and CAD with odds ratios (ORs) (confidence interval) of, respectively, 1.15 (1.13–1.17), 1.13 (1.09–1.17) but not for rs2026458, 1.03 (0.88–1.19). The OR for CAC was 1.22 (1.18–1.26) for rs9349379 and 1.28 (1.21–1.38) for rs12526453.

Conclusions

Several PHACTR1 specifically rs9349379 and rs12526453 polymorphisms but not rs2026458, are associated with CAD. There are differences in the association of PHACTR1 SNPs with CAC. PHACTR1 warrants more attention and study for the prevention and treatment of CAD.
18F-choline PET-computed tomography for the prediction of early treatment responses to transarterial radioembolization in patients with hepatocellular carcinoma
Authors: Aujay Godefroy , Debordeaux Frédéric , Blanc Jean-Frederic , Lapuyade Bruno , Papadopoulos Panteleimon , Bordenave Laurence , Trillaud Hervé , Pinaquy Jean-Baptiste
Published: March 2021

Background

Transarterial radioembolization (TARE) is widely used for the treatment of hepatocellular carcinoma (HCC), but early treatment response can be very difficult to assess. The aim was to evaluate 18F-fluorocholine PET/computed tomography (CT) to assess the treatment response in patients with intermediate or locally advanced HCC.

Methods

Between March 2019 and July 2020, nine HCC patients treated with TARE, who underwent PET/CT at baseline and 1 month after treatment, were enrolled. The maximum, mean (SUVmean), and peak (SUVpeak) standardized uptake value (SUV), SUV normalized by lean body mass (SUL), and total lesion glycolysis (TLG) were measured. Statistical analysis used the Mann–Whitney test to evaluate the differences in parameters between responders (partial and complete response) and nonresponders (stable or progressive disease) at the 6-month follow-up, according to the modified Response Evaluation Criteria in Solid Tumors.

Results

Three patients were nonresponders (progressive disease and stable disease) and six were responders. Delta SUVmean, delta SUL, and delta TLG could predict an early response (P = 0.02, P = 0.04, and P = 0.02, respectively). None of the pre-therapeutic parameters were correlated with the response. Post-therapeutic SUL, SUVmean, TLG, and SUVpeak were also predictive of the response.

Conclusions

Our preliminary results showed that changes in certain metabolic parameters (from baseline PET to 1-month PET) are predictive of the response to TARE in HCC (Delta SUVmean, delta TLG, and delta SUL). The absence of post-treatment inflammation could lead to a better prediction than MRI evaluation. This study suggests that 1-month 18F-choline PET/CT could modify the clinical management predicting responders.

Video Abstract: http://links.lww.com/NMC/A193
Oral Care Experiences of Palliative Care Patients, Their Relatives, and Health Care Professionals
Authors: Bernardes Delgado Maria , Latour Jos , Neilens Helen , Griffiths Sarah
Published: March 2021

Oral symptoms in a growing number of palliative care patients are often neglected. Dental professionals are not always involved in palliative care. Oral care is often inadequately delivered to palliative care patients, while oral problems can affect the quality of life. A qualitative study was conducted to explore oral care experiences of palliative care patients, their relatives, and health care professionals (HCPs). Four patients, 4 relatives, and 4 HCPs were interviewed in a hospice. Transcripts were analyzed using thematic analysis and revealed 3 themes. Patients who were capable of performing oral care mainly brushed their teeth and looked after their dentures. Other care tended to be carried out by relatives and HCPs, adapted based on a person's level of consciousness. When describing the effects on oral health, relatives and HCPs tended to focus on xerostomia, whereas patients provided detailed accounts denoting the psychological and social impact of oral symptoms. Perceptions of enablers and barriers to oral care differed between groups. Patients reported lack of access to professional dental care and patients' fatigue were the main barriers to oral care. Nevertheless, there is great scope for further research into good oral care practices identified in this study and possible implementation in other settings.
The Quality of Dying and Death of Advanced Cancer Patients in Palliative Care and Its Association With Place of Death and Quality of Care
Authors: Gutiérrez-Sánchez Daniel , Gómez-García Rafael , Roselló María Luisa Martín , Cuesta-Vargas Antonio I.
Published: March 2021

The quality of dying and death is currently considered an objective to achieve at the end of life. The aim of this study is to analyze the quality of dying and death of advanced cancer patients in palliative care and its association with place of death and quality of care from the perspective of family caregivers. This is a cross-sectional study. The study sample included 72 family caregivers of advanced cancer patients in palliative care. For the evaluation of the quality of dying and death, the Spanish version of the Quality of Dying and Death Questionnaire was used. Quality of care was evaluated with the Palliative Care Outcome Scale. The mean (SD) total score on the Spanish version of the Quality of Dying and Death Questionnaire was 64.56 (20.97). The quality of dying and death was higher when the patients died at home, 70.45 (19.70), and it was positively correlated with quality of care (r = 0.61). Palliative care contributes to achieving a satisfactory quality of dying and death in Spanish advanced cancer patients. Further studies that evaluate interventions for improving the quality of dying and death in the advanced cancer population are needed.
“I Feel All Alone Out Here”
Authors: Tay Djin L. , Thompson Casidee , Jones Miranda , Gettens Caroline , Cloyes Kristin G. , Reblin Maija , Thomas Hebdon Megan C. , Beck Anna C. , Mooney Kathleen , Ellington Lee
Published: March 2021

The COVID-19 pandemic has dramatically changed social life. This secondary qualitative analysis aimed to better understand the impact of the pandemic on bereaved hospice family caregivers' experiences of social connection and isolation in a time of social distancing and general anxiety. Six caregivers in 3 states recorded audio diaries (N = 59) between March 13 and May 15, 2020. Caregivers were, on average, 56.80 years old (SD, 14.22; range, 32-67 years old) and consisted of spouses (n = 2), adult children (n = 3), and a sibling (n = 1). Using NVIVO 12, caregiver diaries were coded for (1) “social connection” (n = 23), defined as being able to access or seeking informal or formal social support networks; (2) “isolation” (n = 17), defined as being unable or reluctant to access informal or formal social support networks, or feeling alone; and (3) “bereavement processes” (n = 147), informed by the dual process model of bereavement (restoration and loss-oriented stressors). Content analysis revealed that caregivers were able to connect with others despite physical distancing expectations, expressed loneliness and grief while in isolation, and described moving on in the face of uncertainty. Findings provide insight into how caregivers experienced bereavement during the initial period of the pandemic and highlight implications for hospice bereavement services.
HIV Preexposure Prophylaxis and Sexual Satisfaction Among Men Who Have Sex With Men
Authors: Marcus Julia L. , Sewell Whitney C. , Powell Victoria E. , Ochoa Aileen , Mayer Kenneth H. , Krakower Douglas S.
Published: March 2021

In this large online survey of primarily men who have sex with men, those who used preexposure prophylaxis reported greater sexual satisfaction than did nonusers, including sexual sensations, sexual presence/awareness, and sexual exchange. Person-centered care and messaging may require acknowledging that some people use preexposure prophylaxis for reasons beyond HIV prevention.
Crohn Disease Prognostication With Semiautomatic Dual-Energy Computed Tomography Enterography–Derived Iodine Density
Authors: Dane Bari , Garada Ahmad , O'Donnell Thomas , Chang Shannon , Megibow Alec
Published: March 2021

Objective

The objective of this study was to determine if dual-energy computed tomography enterography (DECTE)–obtained iodine density can predict medical management change or surgery in Crohn disease patients.

Methods

The most active-appearing bowel segment on DECTE in 21 Crohn disease patients was retrospectively interrogated with prototype software determining the percentage of bowel wall (I) in specified ranges. Patients were categorized into 3 groups after DECTE: (1) no management change, (2) outpatient medication change, and (3) inpatient admission or surgery. Crohn's disease activity index was calculated. Group 3's percentage iodine density of >3 mg/mL and Crohn's disease activity index were compared with group 1/2. Crohn's disease activity index and percentage iodine density of >2 mg/mL were compared for groups 2/3 versus group 1 patients.

Results

There were 5 group 1, 6 group 2, and 10 group 3 patients. Group 3 patients had higher frequency of iodine density >3 mg/mL (27%) compared with groups 1/2 patients (12.6%) (P < 0.05). Crohn's disease activity index was similar (P = 0.98). Groups 2/3 patients had 60.5% iodine density of >2 mg/mL, whereas group 1 patients had 31.7% iodine density of >2 mg/mL (P < 0.05). Crohn's disease activity index was similar (P = 0.12).

Conclusions

Iodine density from DECTE may predict medical or surgical Crohn disease management.
Accuracy of Diastolic Function by Cardiac Computed Tomography Relative to Echo-Doppler: Additive Clinical and Prognostic Value
Authors: van der Veen Hayley-Ann , Lessick Jonathan , Abadi Sobhi , Mutlak Diab
Published: March 2021

Objectives

We aimed to assess the agreement between cardiac computed tomography (CT) and echo for diagnosing advanced diastolic dysfunction (DD) and to assess the prognostic value of CT-based parameters.

Methods

One hundred one consecutive patients who had both CT and echo-Doppler within 1 month were included. Diastolic function was assessed by CT using a previously validated method, based on left atrial volume changes, and compared with echocardiography grades 0 to 3. Patients were followed up for a combined outcome of cardiac death and hospitalization for heart failure.

Results

By operating characteristic curve analysis, the best CT-based parameter for predicting advanced DD based on echo was left atrial total emptying fraction. Left atrial total emptying fraction <36% had sensitivity/specificity of 76%/86%. Agreement between echo and CT for detecting advanced (grades 2/3) DD was substantial (κ = 0.62, P < 0.0001). By Cox multivariate analysis, left atrial total emptying fraction was a powerful independent predictor of outcome at 3 years (hazard ratio, 8.0 [2.2–28.4]; P < 0.0001).

Conclusions

Computed tomography–based assessment of DD has a good agreement with echo-Doppler–based results. Left atrial total emptying fraction seems to have a strong prognostic value.
Comparison of Anaerobic Exercise Capacity in Children With Familial Mediterranean Fever and Healthy Controls
Authors: Turkucar Serkan , Bayraktar Deniz , Manci Egemen , Adiguzel Dundar Hatice , Makay Balahan , Bediz Cem Seref , Savci Sema , Unsal Erbil
Published: March 2021

Background/Objective

Anaerobic exercise capacity is an important component of performing daily activities during childhood. However, diminished anaerobic exercise capacity has been reported in children with chronic conditions. Therefore, the aim of this study was to compare anaerobic exercise capacities between children with familial Mediterranean fever (FMF) and healthy peers.

Methods

Twenty-one children with FMF (FMF group) and 21 physically matched healthy controls (control group) were included. Peak power, peak power/kg, average power, and average power were evaluated using the Wingate Anaerobic Test.

Results

The peak power (FMF group: 254.8 W [IQR 25/75: 216.4/293.0 W] vs control group: 333.7 W [IQR 25/75: 241.3/570.5 W], p = 0.009), peak power/kg (FMF group: 6.3 W/kg [IQR 25/75: 5.2/7.0 W/kg] vs control group: 7.0 W/kg [IQR 25/75: 6.1/8.6 W/kg], p = 0.046), average power (FMF group: 186.0 W [IQR 25/75: 164.3/211.2 W] vs control group: 231.8 W [IQR 25/75: 181.8/338.1 W], p = 0.006), and average power/kg (FMF group: 4.5 W/kg [IQR 25/75: 3.8/5.0 W/kg] vs control group: 5.1 W/kg [IQR 25/75: 4.2/5.9 W/kg], p = 0.040) were found significantly higher in the control group compared with FMF group.

Conclusions

Children with FMF seems to have diminished anaerobic exercise capacity compared with their healthy peers.
Exercise Training Attenuates Ubiquitin-Proteasome Pathway and Increases the Genes Related to Autophagy on the Skeletal Muscle of Patients With Inflammatory Myopathies
Authors: Borges Isabela Bruna Pires , de Oliveira Diego Sales , Marie Suely Kazue Nagahashi , Lenario Antonio Marcondes , Oba-Shinjo Sueli Mieko , Shinjo Samuel Katsuyuki
Published: March 2021

Background/Objective

The aim of this study was to evaluate the effects of exercise training on the ubiquitin-proteasome system (UPS) and genes related to autophagy on the skeletal muscle of patients with dermatomyositis (DM) and immune-mediated necrotizing myopathies (IMNMs).

Methods

Seven DM patients and 6 IMNM patients were treated for 12 weeks with a twice-weekly aerobic and resistance training exercise program. Aerobic capacity, muscle strength, and expression of genes in the skeletal muscle related to UPS and to autophagy were evaluated at the baseline and after the intervention. Moreover, only at the baseline, 10 healthy control individuals were also evaluated.

Results

The age of DM and IMNM patients was 49.8 and 58.5 years, respectively. Genes related to UPS were upregulated, whereas genes related to autophagy and antioxidative systems were downregulated only in the DM group when compared with control group. After completion of the exercise training program, several genes related to UPS were downregulated, whereas genes related to autophagy, mitochondrial pathways, and antioxidative systems were upregulated in both the DM and IMNM groups.

Conclusions

Exercise training can increase genes related to autophagy, mitophagy, and lysosomal biogenesis in the skeletal muscle of patients. These results suggest an increase in the recycling of damaged proteins and organelles, which may also contribute to the performance and endurance of skeletal muscles in these patients. Furthermore, in patients with myositis, exercise training led to a decrease in genes related to UPS and an increase in genes related to antioxidative capacity. Therefore, this may also contribute to an attenuation of skeletal muscle loss and of the deleterious effects of oxidative stress on the skeletal muscle of these patients.
The Examination of a TPMT Gene Before Administration of Azathioprine in Rheumatology Practice and Identification of a Novel Variant p.W29R
Authors: Pavelcova Katerina , Hanova Petra , Ciferska Hana , Hasikova Lenka , Stiburkova Blanka
Published: March 2021

Background

In individuals with reduced thiopurine S-methyltransferase activity, undesirable adverse effects can occur during treatment with azathioprine (AZA). This condition affects approximately 11% of the European population, and it is genetically determined by variants in the TPMT gene. Approximately 0.3% of those of European origin have dysfunctional TPMT variants, which puts them at risk of developing life-threatening bone marrow toxicity. Our goal was to estimate the prevalence of TPMT gene mutations in Czech patients with rheumatic diseases and to assess the adverse effects associated with AZA therapy in these patients.

Methods

Two-hundred patients were assessed for the presence of genetic allelic variants using PCR amplification and direct sequencing.

Results

In 19 patients, we detected genetic allelic variants affecting TPMT activity; in 1 case, it was an unpublished heterozygous variant c.85T>C (p.W29R); of those, 15 patients were switched from AZA to a different medication, and 1 patient was prescribed a reduced dose of AZA.

Conclusions

Our findings show the importance of testing for variants of the TPMT gene before the administration of AZA in clinical rheumatology practice. Patients with documented episodes of leukopenia or elevated liver biochemical tests while on AZA should undergo TPMT genotype testing and/or TPMT enzyme activity testing.
The Cancer Risk Profile of Systemic Lupus Erythematosus Patients
Authors: Hardenbergh Dylan , Naik Rakhi , Manno Rebecca , Azar Antoine , Monroy Trujillo Jose Manuel , Adler Brittany , Haque Uzma , Timlin Homa
Published: March 2021

Systemic lupus erythematosus (SLE) patients have a well-established increased risk for cancer. Research from the past 2 decades has identified the specific malignancies that afflict SLE patients at disproportionate rates. Systemic lupus erythematosus patients are at heightened risk for several hematologic malignancies as well as for certain solid tumors, including lung, thyroid, and hepatobiliary cancers. They are at decreased risk for several cancers as well, including prostate and melanoma. Improved understanding of the unique cancer risk profile of SLE patients has led some professional societies to recommend specialized cancer screening and prevention measures for these patients and has enabled clinicians to better serve the SLE patient population.
Sacral Insufficiency Fracture on 68Ga-DOTATATE PET/CT
Authors: Filizoglu Nuh , Bugdayci Onur , Ozguven Salih
Published: March 2021

68Ga-DOTATATE PET/CT is an important tool for imaging neuroendocrine tumors, including skeletal metastases. However, false-positive results can occur in inflammatory pathologies such as sacral insufficiency fracture. We report the case of a 47-year-old man who was diagnosed with a neuroendocrine tumor of the pancreas. 68Ga-DOTATATE PET/CT showed 68Ga-DOTATATE uptake at the right side of the sacrum. Afterward, MRI made the diagnosis of sacral insufficiency fracture.
Detection of Adult Pancreatoblastoma by 18F-FDG and 68Ga-DOTATATE PET/MR
Authors: Zhou Jinxin , Xie Jing , Pan Yu , Zhang Yifan
Published: March 2021

A 36-year-old asymptomatic woman was incidentally found to have a huge mass in the pancreas by ultrasound during routine health screening. The mass was suspected of neuroendocrine tumor or solid pseudopapillary tumor by subsequent abdominal CT. 18F-FDG and 68Ga-DOTATATE PET/MR were acquired for presurgical assessment of the tumor invasion and malignant potential, which revealed intense FDG uptake and mild DOTATATE uptake. The tumor was completely resected, and postsurgical pathology demonstrated pancreatoblastoma with neuroendocrine manifestations. This case showed the metabolic and biological features of pancreatoblastoma on the 18F-FDG and 68Ga-DOTATATE PET/MR.
Unsuspected Bladder Diverticulum Resulted in False-Positive 68Ga-DOTATATE Uptake
Authors: Deng Ying , Deng Yan , He Limeng , Zhang Wei
Published: March 2021

A 67-year-old woman with medullary thyroid cancer was referred for a68Ga-DOTATATE PET/CT scan for staging. The images showed abnormal activity in the left thyroid gland and the left cervical lymph nodes. Surprisingly, increased activity was also noted in the posterolateral aspect of the urinary bladder without corresponding anatomical abnormality. This activity disappeared after urination, suggesting false-positive uptake due to bladder diverticulum.
Paraganglioma From Vaginal Wall Revealed by 131I-MIBG Scan
Authors: Zheng Kun , Zhu Shikun , Chen Libo , Li Fang , Jing Hongli
Published: March 2021

Vaginal paraganglioma is very rare. Most patients first presented irregular heavy menses and abnormal vaginal bleeding. The accurate diagnosis can only be made pathologically. Here we report a case of paraganglioma arising from vaginal wall in a 44-year-old woman who only presented catecholamine-related symptoms. The lesion had negative 99mTc-HYNIC-TOC (hydrazinonicotinyl-Tyr3-octreotide) activity but positive on 131I MIBG scan. Paraganglioma was highly suspected, which was confirmed by pathological and immunohistochemical findings after surgical resection of the lesion.