bluuebunny/crossref_metadata_2025 huggingface dataset:
Effects of Subsequent Systemic Anticancer Medication Following First-Line Lenvatinib: A Post Hoc Responder Analysis from the Phase 3 REFLECT Study in Unresectable Hepatocellular Carcinoma
Authors: Alsina Angel , Kudo Masatoshi , Vogel Arndt , Cheng Ann-Lii , Tak Won Young , Ryoo Baek-Yeol , Evans Thomas R. Jeffry , López López Carlos , Daniele Bruno , Misir Soamnauth , Ren Min , Izumi Namiki , Qin Shukui , Finn Richard S.
Published: December 2019

Introduction: Understanding the relationship between subsequent-line therapies and overall survival (OS) is important for maximizing OS for patients with hepatocellular carcinoma. Objective: In this post hoc analysis, we investigated OS in lenvatinib- and sorafenib-treated patients from the REFLECT study, who then received subsequent anticancer medication during the survival follow-up period. Methods: The follow-up period commenced at the first off-treatment visit after stopping the study medication and continued until study termination, withdrawal of consent, or death. OS and objective response rate were calculated for patients who did or did not receive poststudy anticancer medication for both treatment arms, as well as for the overall cohort. We investigated the subset of patients who responded to first-line treatment and subsequently received anticancer medication. Results: The OS for patients initially randomized to first-line lenvatinib (versus first-line sorafenib) and who then received any subsequent anticancer medication was 20.8 vs. 17.0 months (hazard ratio [HR] 0.87; 95% CI 0.67–1.14). The OS for patients who initially received first-line lenvatinib (versus first-line sorafenib) and who did not receive any subsequent anticancer medication was 11.5 vs. 9.1 months (HR 0.90; 95% CI 0.75–1.09). Responders to first-line lenvatinib who received subsequent medication had a median OS of 25.7 months (95% CI 18.5–34.6); responders to first line-sorafenib who received subsequent medication had a median OS of 22.3 months (95% CI 14.6–not evaluable). Conclusions: In this post hoc analysis of all patients in the REFLECT study who received subsequent anticancer medication, OS was increased compared with patients who did not receive any subsequent anticancer medication. In a subset analysis of responders who had received subsequent anticancer medication, use of first-line lenvatinib led to a slightly longer median OS; more research is needed on the benefits of using first-line lenvatinib compared with sorafenib.
Effect of Renin-Angiotensin-Aldosterone System Inhibitors on Short-Term Mortality After Sepsis
Authors: Hsu Wan-Ting , Galm Brandon Patrick , Schrank Gregory , Hsu Tzu-Chun , Lee Shih-Hao , Park James Yeongjun , Lee Chien-Chang
Published: December 2019

Antagonists of the renin-angiotensin-aldosterone system (RAAS), including ACEIs (angiotensin-converting enzyme inhibitors) and ARBs (angiotensin II receptor blockers), may prevent organ failure. We, therefore, investigated whether specific RAAS inhibitors are associated with reduced mortality in patients with sepsis.We conducted a population-based retrospective cohort study using multivariable propensity score–based regression to control for differences among patients using different RAAS inhibitors. A multivariable-adjusted Cox proportional-hazards regression model was used to determine the association between RAAS inhibitors and sepsis outcomes. To directly compare ACEI users, ARB users, and nonusers, a 3-way propensity score matching approach was performed. Results were pooled with previous evidence via a random-effects meta-analysis. A total of 52 727 patients were hospitalized with sepsis, of whom 7642 were prescribed an ACEI and 4237 were prescribed an ARB. Using propensity score–matched analyses, prior ACEI use was associated with decreased 30-day mortality (hazard ratio, 0.84 [95% CI, 0.75–0.94]) and 90-day mortality (hazard ratio, 0.83 [95% CI, 0.75–0.92]) compared with nonuse. Prior ARB use was associated with an improved 90-day survival (hazard ratio, 0.88 [95% CI, 0.83–0.94]). These results persisted in sensitivity analyses focusing on patients without cancer and patients with hypertension. By contrast, no beneficial effect was found for antecedent β-blockers exposure (hazard ratio, 0.99 [95% CI, 0.94–1.05]). The pooled estimates obtained from the meta-analysis was 0.71 (95% CI, 0.58–0.87) for prior use of ACEI/ARB.The short-term mortality after sepsis was substantially lower among those who were already established on RAAS inhibitor treatment when sepsis occurred.
Aging Impairs Renal Autoregulation in Mice
Authors: Wei Jin , Zhu Jinxiu , Zhang Jie , Jiang Shan , Qu Larry , Wang Lei , Buggs Jacentha , Tan Xuerui , Cheng Feng , Liu Ruisheng
Published: December 2019

Impaired renal autoregulation permits more transmission of disturbance in systemic blood pressure, which initiates barotrauma in intrarenal microvasculatures such as glomerular and tubulointerstitial capillaries, contributing to the development of kidney damage and deterioration in renal function, especially under the conditions with high blood pressure. Although it has been postulated that autoregulatory efficiency is attenuated in the aging kidney, direct evidence remains lacking. In the present study, we measured the autoregulation of renal blood flow, myogenic response of afferent arteriole (Af-Art), tubuloglomerular feedback in vivo with micropuncture, as well as tubuloglomerular feedback in vitro in isolated perfused juxtaglomerular apparatus in young and aged C57BL/6 mice. We found that renal blood flow was not significantly changed in response to a defined elevation of renal arterial pressure in young mice but significantly increased in aged mice. Additionally, myogenic response of Af-Art measured by microperfusion with a stepwise increase in perfusion pressure was significantly blunted in the aging kidney, which is associated with the attenuation of intraluminal pressure-induced intracellular calcium increases, as well as the reduced expression of integrin α5 (Itga5) in Af-Art. Moreover, both tubuloglomerular feedback in vivo and in vitro were nearly inactive in the aging kidney, which is associated with the significantly reduced expression of adenosine A1 receptor (A1AR) and suppressed vasoconstrictor response to adenosine in Af-Art. In conclusion, this study demonstrates that aging impairs renal autoregulation with blunted myogenic response and inhibited tubuloglomerular feedback response. The underlying mechanisms involve the downregulations of integrin α5 and A1AR in the Af-Art.
Financial Burdens and Barriers to Care Among Nonelderly Adults With Heart Disease: 2010–2015
Authors: Bernard Didem , Fang Zhengyi
Published: December 2019

Background

We examined the prevalence of high burdens and barriers to care among adults with heart disease treatment.

Methods and Results

The participants were aged 18 to 64 years from the Medical Expenditure Panel Survey–Household Component (MEPS‐HC) for 2010–2015.
High burden
is out‐of‐pocket spending on care and insurance premiums >20% of income.
Barriers to care
are forgoing and delaying care for financial reasons. Logistic regressions were used to estimate the odds of having high burdens and barriers. Adults treated for heart disease have odds ratios (ORs) of 2.18 (95%
CI
, 1.91–2.50) for having high burden, 2.51 (95%
CI
, 2.23–2.83) for forgoing care, and 3.57 (95%
CI
, 3.8–4.13) for delaying care compared with adults without any chronic condition. Among adults treated for heart disease compared with adults with private group coverage, ORs for having high burdens were significantly lower among those with public insurance (
OR
: 0.17; 95%
CI
, 0.10–0.26) or the uninsured (
OR
: 0.58; 95%
CI
, 0.36–0.92) and higher among those with private nongroup insurance (
OR
: 5.30; 95%
CI
, 3.26–8.61). Compared with adults with private group coverage, ORs for delaying care were 2.07 (95%
CI
, 1.37–3.12) for those with public insurance, 2.64; 95% CI, 1.70–4.10) for those without insurance, and 2.16 (95%
CI
, 1.24–3.76) for those with private nongroup insurance.

Conclusions

Public insurance provides protection against high burdens but not against forgoing or delaying care. Future research should investigate whether and to what extent barriers to care are associated with worse health outcomes and higher costs in the long term.
Probability Dominance
Authors: Diecidue Enrico , Levy Haim , Levy Moshe
Published: December 2019

The most commonly employed paradigms for decision making under risk are expected utility, prospect theory, and regret theory. We examine the simple heuristic of maximizing the probability of being ahead, which in some natural economic situations may be in contradiction to all three of the above fundamental paradigms. We test whether this heuristic, which we call probability dominance (PD), affects decisions under risk. We set up head-to-head situations where all preferences of a given class (expected utility, original or cumulative prospect theory, or regret theory) favor one alternative yet PD favors the other. Our experiments reveal that 49% of subjects' choices are aligned with PD in contradiction to any form of expected utility or prospect theory maximization; 73% are aligned with PD as opposed to preferences under risk aversion and under original and cumulative prospect theory preferences; and 68% to 76% are aligned with PD contradicting preferences under regret theory. We conclude that probability dominance substantially affects choices and should therefore be incorporated into decision-making models. We show that PD has significant economic consequences. The PD heuristic may have evolved through situations of winner-take-all competition.
Behavioral Impediments to Valuing Annuities: Complexity and Choice Bracketing
Authors: Brown Jeffrey R. , Kapteyn Arie , Luttmer Erzo F. P. , Mitchell Olivia S. , Samek Anya
Published: December 2019

This paper examines two behavioral factors that diminish people's ability to value a lifetime income stream or annuity, drawing on a randomized experiment with about 4,000 adults in a U.S. nationally representative sample. We find that increasing the complexity of the annuity choice reduces respondents' ability to value the annuity, measured by the difference between the sell and buy values they assign to the annuity. When we limit narrow choice bracketing by inducing people to think first about how quickly or slowly to spend down assets in retirement, their ability to value an annuity increases.
Evolutionary scenarios for the origin of an Antarctic tardigrade species based on molecular clock analyses and biogeographic data
Authors: Guidetti Roberto , McInnes Sandra J. , Cesari Michele , Rebecchi Lorena , Rota-Stabelli Omar
Published: December 2019

The origin of the Antarctic continental extant fauna is a highly debated topic, complicated by the paucity of organisms for which we have clear biogeographic distributions and understanding of their evolutionary timescale. To shed new light on this topic, we coupled molecular clock analyses with biogeographic studies on the heterotardigrade genus Mopsechiniscus. This taxon includes species with endemic distributions in Antarctica and other regions of the southern hemisphere. Molecular dating using different models and calibration priors retrieved similar divergence time for the split between the Antarctic and South American Mopsechiniscus lineages (32–48 Mya) and the estimated age of the Drake Passage opening that led to the separation of Antarctica and South America. Our divergence estimates are congruent with other independent studies in dating Gondwanan geological events. Although different analyses retrieved similar results for the internal relationships within the Heterotardigrada, our results indicated that the molecular dating of tardigrades using genes coding for ribosomal RNA (18S and 28S rDNA) is a complex task, revealed by a very wide range of posterior density and a relative difficulty in discriminating between competing models. Overall, our study indicates that Mopsechiniscus is an ancient genus with a clear Gondwanan distribution, in which speciation was probably directed by a cooccurrence of vicariance and glacial events.
An enlarged map-reduce using 2logmean-PSO optimization for unstructured data
Authors: Kanimozhi KV , Krishnan Rajakumar , Venkatesan M
Published: December 2019

Text clustering system is a proper technique which mainly segments large measure of textual documents into clusters. The size of the material influences the clustering of text by reducing its performance. In this manner, the textual document comprises sparse and uninformative features, and thus raises the computational time and decreases the execution of primary clustering process. Feature selection is a crucial system to choose another subset of instructive text feature to enhance text clustering execution and diminish computational time. The implemented model proposes a 2logmean-particle swarm optimization algorithm for the unstructured text clustering. In this newly proposed technique, all the texts are initially converted into ASCII value, and then by using the particle swarm optimization, the document text is clustered. The outcomes display that clustering accuracy of the implemented method is high compared to the existing K-means algorithm. Furthermore, performances of newly implemented techniques are evaluated concerning scalability, less computation speed with colossal dimensionality reduction.
Computerizing NIAAA’s Best Practices for Youth Screening and Brief Intervention: A Proof-of-Concept Pilot Study of an Automated Alcohol Screening and Intervention Resource Tool
Authors: Carswell Steven B. , Mitchell Shannon G. , Gryczynski Jan , Lertch Elizabeth
Published: December 2019

This article reports findings from formative research on translating key elements of the National Institute on Alcohol Abuse and Alcoholism (NIAAA) and American Academy of Pediatrics Practitioner’s Guide for pediatric alcohol misuse to a computerized web- and mobile-compatible format with patient risk screening and tailored decision support content. Five practitioners at an urban primary care center used a prototype computerized version of the NIAAA/American Academy of Pediatrics Practitioner’s Guide with 80 adolescent patients during routine health-care visits. Practitioners reported a high level of practitioner and adolescent patient engagement and satisfaction with the prototype. Study findings indicate that computerization of the NIAAA Practitioner’s Guide is feasible and well accepted by providers and adolescent patients and could be useful for addressing alcohol misuse in primary care settings.
Compatibilization of natural rubber–polypropylene thermoplastic elastomer blend
Authors: Belhaoues Abderrahmane , Benmesli Samia , Riahi Farid
Published: December 2019

The effects of the addition of epoxidized natural rubber/maleic anhydride-grafted polypropylene blend as a compatibilizing agent (CA) on the properties of natural rubber (NR)/polypropylene (PP) thermoplastic elastomer blend were studied. The blends were prepared in the molten state at 180°C using a Brabender Plasticorder at a rotor speed of 60 r min−1. Evidence of compatibilization was obtained from the Brabender plastograms and from the mechanical properties results as well as the morphological analysis. It was found that the addition of the CA at different contents resulted in an increase of the tensile strength and Young’s modulus and a decrease of the elongation at break. It was also found that the melting temperature remained unchanged, the % crystallinity decreased, but the thermal stability was not affected. The morphology revealed a more homogeneous distribution of the dispersed PP phase for the CA-containing systems compared to the control NR/PP blend. These effects were attributed to the interactions that developed with the blend constituents through the functional groups of the CA.
A 10-Year Follow-Up of a Randomized Prospective Study of 2 Treatments for Chronic Rhinosinusitis Without Nasal Polyps and Investigation of the Impact of Gastroeosophageal Reflux Disease in the Resistance to Treatment
Authors: Lechien Jerome R. , Debie Gersende , Mahillon Virginie , Thill Marie-Paule , Rodriguez Alexandra , Horoi Mihaela , Kampouridis Stelianos , Muls Vinciane , Saussez Sven
Published: December 2019

Objectives:

To compare the 2 long-term medical strategies in chronic rhinosinusitis without nasal polyps (CRSnNP) and to identify the role of gastroesophageal reflux disease (GERD) and Helicobacter pylori as factors of treatment failure.

Material and Methods:

Fifty-seven patients with CRSnNP were randomized into 2 therapeutic groups. The first group was treated with 4 weeks of amoxicillin/clavulanate and a short course of oral steroids. The second group received 8 weeks of clarithromycin. Sinonasal Outcome Test-20 (SNOT-20) and Lund and Mackay scores were assessed at baseline and after treatment, and GERD Health-Related Quality of Life (GERD-HRQL) questionnaire was evaluated in all patients. Patients with a GERD-HRQL score >8 received esogastroscopy and H pylori detection. Patients were followed during a 10-year period for clinical course and GERD evolution. The 10-year evolution of patients was described in terms of recurrence, medical, and surgical treatments.

Results:

Thirty-seven patients completed the study; SNOT-20 and Lund and Mackay scores similarly improved in both groups. Amoxicillin/clavulanate group had significantly more adverse reactions than the clarithromycin group (P = .03). After the therapeutic course, 35% (amoxicillin/clavulanate) and 41% (clarithromycin) of patients needed functional endoscopic sinus surgery (FESS). During the long-term follow-up, 54% (amoxicillin/clavulanate) and 40% (clarithromycin) of patients had late CRSnNP recurrence; FESS was performed in less than 15% of cases of recurrence. Gastroesophageal reflux disease complaint’s severity was associated with late recurrence of CRSnNP.

Conclusion:

Amoxicillin/clavulanate and clarithromycin would be competitive treatments for CRSnNP. Gastroesophageal reflux disease seems to be a negative factor for treatment response and recurrence.
Rehabilitation of Severe to Profound Sensorineural Hearing Loss in Adults: Audiological Outcomes
Authors: Ciorba Andrea , Guidi Maria Paola , Skarżyński Piotr H. , Bianchini Chiara , Rosignoli Monica , Mazzoli Manuela , Pelucchi Stefano , Hatzopoulos Stavros
Published: December 2019

The aim of this article is to describe the audiological patterns of 71 adult patients presenting severe to profound sensorineural hearing loss, who were rehabilitated by cochlear implants (CIs) and hearing aids. This is a retrospective study in a university setting, where the clinical records of 71 adult patients were reviewed and processed. Speech intelligibility was evaluated at one aided ear (CI) or at both aided ears (double CI or a combination of CI and hearing aid [HA]). Patients with a bilateral CI or with a bimodal hearing setup (CI and HA) performed better than those with a single CI; data from the phonetic matrices test showed that there was a statistically significant difference among patients aided by a single CI versus binaural setup (double CI or CI + HA). In particular, patients aided by a bilateral CI, or by a CI and HA, showed an improvement in the functional results of the speech tests, compared to patients using a single CI. Binaural hearing (either with a bilateral CI or bimodal) allows an improvement in the functional results at the speech tests, compared to the use of a CI only.
Evaluation and Prognostic Significance of Galectin-3 Expression in Oral Squamous Cell Carcinoma
Authors: Tokmak Serdar , Arık Deniz , Pınarbaşlı Özgür , Gürbüz Melek Kezban , Açıkalın Mustafa Fuat
Published: December 2019

Introduction:

In squamous cell carcinomas of the oral cavity, factors that can predict prognosis are being studied. However, new prognostic factors are needed to provide information on the biological properties of tumors. Galectin-3 is known to be involved in many biological events such as cell adhesion and differentiation, angiogenesis, apoptosis, tumorigenesis, and metastasis. In our study, the prognostic role of galectin-3 expression in squamous cell carcinomas of the oral cavity was investigated.

Materials and Methods:

The study included 60 patients with a diagnosis of squamous cell carcinoma of the oral cavity. The demographic characteristics of the patients were compiled from the patient files. Galectin-3 expression was studied immunohistochemically. Cytoplasmic and nuclear expressions of galectin-3 were evaluated separately. In addition, the total expression score was calculated by multiplying the percentage and intensity scores for each cases. The critical expression score was determined according to the median value of the total scores.

Results:

Among 60 cases, 28 tumors were located on the lip, 21 on the tongue, 4 on the floor of the mouth, 3 on the orobuccal mucosa, 3 on the retromolar trigone, and 1 on the gingivobuccal junction. There was no statistically significant relationship between prognosis and nuclear or cytoplasmic galectin-3 expression. Tumor grade and invasion pattern were found to be associated with the galectin-3 total expression score.

Conclusion:

Although galectin-3 total expression score was correlated with the tumor grade and invasion pattern, it is not associated with overall survival or recurrence rates. However, there is a need for a large series of cases in which methods are standardized in order to clarify the prognostic role of galectin-3 expression in oral squamous cell carcinomas.
Algorithmic Capitalism and the Digital Divide in Sub-Saharan Africa
Authors: Karar Haytham
Published: December 2019

Digitalization generates new opportunities for employment and earnings, but also entails a plethora of uncertainties and challenges. This article highlights the implications of algorithmic capitalism and how it relates to the digital divide in sub-Saharan Africa by discussing specific examples (Ghana and Kenya), considering the existing structure of social inequality. Both case studies refute the World Bank’s argument that economic liberalization and deregulation are sufficient approaches to improve material access to Internet services in the Global South. The article concludes that the digital divide is an extension of the global phenomenon of inequality. Although algorithmic capitalism has increased the number of Internet users in the region, it has failed to bridge the digital divide, particularly the urban–rural division. This article also suggests that privately owned mobile phone service providers can contribute to Internet usage and to bridging the digital divide in sub-Saharan Africa.
The Relevance of In Silico, In Vitro and Non-human Primate Based Approaches to Clinical Research on Major Depressive Disorder
Authors: Carvalho Constança , Varela Susana A.M. , Bastos Luísa Ferreira , Orfão Inês , Beja Vanda , Sapage Manuel , Marques Tiago A. , Knight Andrew , Vicente Luís
Published: December 2019

Major depressive disorder (MDD) is the most severe form of depression and the leading cause of disability worldwide. When considering research approaches aimed at understanding MDD, it is important that their effectiveness is evaluated. Here, we assessed the effectiveness of original studies on MDD by rating their contributions to subsequent medical papers on the subject, and we compared the respective contribution of findings from non-human primate (NHP) studies and from human-based in vitro or in silico research approaches. For each publication, we conducted a quantitative citation analysis and a systematic qualitative analysis of the citations. In the majority of cases, human-based research approaches (both in silico and in vitro) received more citations in subsequent human research papers than did NHP studies. In addition, the human-based approaches were considered to be more relevant to the hypotheses and/or to the methods featured in the citing papers. The results of this study suggest that studies based on in silico and in vitro approaches are taken into account by medical researchers more often than are NHP-based approaches. In addition, these human-based approaches are usually cheaper and less ethically contentious than NHP studies. Therefore, we suggest that the traditional animal-based approach for testing medical hypotheses should be revised, and more opportunities created for further developing human-relevant innovative techniques.
Feasibility of extremely reduced-dose CT of the thoracic spine in human cadavers
Authors: Weinrich Julius Matthias , Warncke Malte , Wiese Nis , Regier Marc , Tahir Enver , Heinemann Axel , Sehner Susanne , Püschel Klaus , Adam Gerhard , Laqmani Azien
Published: December 2019

Background

According to the as low as reasonably achievable (ALARA) principle, radiation exposure in computed tomography (CT) should be minimized while maintaining adequate image quality. Dedicated CT protocols combined with iterative reconstruction (IR) can reduce radiation dose and/or improve image quality.

Purpose

To investigate the feasibility of extremely reduced-dose (RD) CT of the thoracic spine in human cadavers using a standard-dose (SD) and three different RDCT protocols reconstructed with filtered back projection (FBP) and IR.

Material and Methods

The thoracic spines of 11 cadavers were examined using different RDCT protocols with decreasing reference tube currents (RDCT-1: 50 mAs; RDCT-2: 30 mAs; RDCT-3: 10 mAs) at 140 kV. A clinical SDCT (70 mAs, 140 kV) served as reference. Raw data were reconstructed using FBP and two increasing levels of IR (IRL4 and IRL6). Images were evaluated for image quality, diagnostic acceptability, and visibility of anatomical structures according to a 5-point-scale.

Results

Regardless of the reconstruction technique, image quality was rated as diagnostically acceptable for all cadavers in SDCT and RDCT-1. Image quality of reconstructions with FBP were generally rated lower. Application of IR improved image quality ratings in SDCT and RDCT. RDCT-2 with IR was the most reduced-dose CT protocol which enabled diagnostically acceptable image quality in all cadavers. Compared to SDCT, RDCT protocols resulted in significantly reduced effective radiation doses (SDCT: 4.1 ± 1.5 mSv; RDCT-1: 2.9 ± 1.1 mSv; 2:1.7 ± 0.6 mSv; 3:0.6 ± 0.1 mSv; P = 0.001).

Conclusion

Diagnostically acceptable RDCT of the thoracic spine with 1.7 mSv is feasible using IR.
Effect of eating habits on obesity in adolescents: a study among Chinese college students
Authors: Xie Qi , Hao Meng-lei , Meng Ling-bing , Zuo Xiao-qin , Guo Peng , Qiu Yong , Wang Qiang , Zhang Na , Lei Min
Published: December 2019

Objective

Obesity has been linked to cardiovascular disease, diabetes, and osteoarthritis. Obesity and overweight pose a serious threat to human health, with an estimated 190 million overweight and obese people worldwide. Thus, we investigated the influence of certain eating habits on weight among Chinese college students.

Methods

We conducted a cross-sectional survey of 536 college students in Shijiazhuang, China. The survey included questions about eating habits. We analyzed the relationship between participants’ responses and obesity.

Results

Sex, residence, speed of eating, number of meals eaten per day, and a diet high in sugar were found to be correlated with obesity. Our results suggest that increasing the number of meals per day, slowing down the pace of eating, and reducing the intake of high-sugar foods have potential benefits for reducing obesity among college students.

Conclusions

In the present study, we found that some dietary habits are related to the occurrence of obesity among college-aged individuals.
IgA nephropathy suspected to be combined with Fabry disease or Alport syndrome: a case report
Authors: Hao Wen , Ao Lina , Zhang Chenli , Zhu Lei , Xie Deqiong
Published: December 2019

Immunoglobulin A (IgA) nephropathy is the most common glomerular disease, and it often manifests as persistent microscopic hematuria or gross hematuria. Fabry disease and Alport syndrome are hereditary diseases caused by mutation of genes, and these diseases are rare in China. At present, patients can be diagnosed with IgA nephropathy by clinical manifestations and laboratory examinations, but there is still controversy about the simultaneous diagnosis of Alport syndrome and Fabry disease in patients with IgA nephropathy. The present case was a 17-year-old girl with hematuria and proteinuria who underwent a renal biopsy. Light microscopy and immunofluorescence showed that IgA was deposited in the mesangium. Under electron microscopy, zebra bodies with a lamellated structure were detected. A gene test showed a COL4A3 gene mutation. The patient was administered prednisone 40 mg once a day and dispersible tablets of mycophenolate mofetil 0.75 g two times a day. The patient’s condition showed a trend of remission. The findings in our case emphasize the importance of renal biopsy and gene detection in hereditary kidney disease, especially for Fabry disease and its rare coexistence with Alport syndrome.
Food Insecurity Among Older Adults: A Multilevel Analysis of State-Level Interventions
Authors: Gaitán-Rossi Pablo , García-Appendini Ida Caterina , Félix-Beltrán Lucía , Vilar-Compte Mireya
Published: December 2019

Objective: To analyze whether state-level social programs for older adults (OAs) in Mexico are associated with a reduction: (a) in the prevalence of severe food insecurity (SFI) and (b) in the magnitude of the effect of municipal marginalization on SFI. Method: Cross-sectional study based on urban OAs (65–100 years) from the 2010 census. Three-level logistic multilevel regression models were estimated to explain SFI. Results: Controlling for individual and municipal characteristics, states with social programs for OAs are generally associated with lower SFI prevalences (odds ratio [OR] = 0.68 [0.48, 0.95]) and mitigate the effect of marginalization on SFI when compared with states with no programs. Compared with in-kind food programs and voucher-based programs, monetary transfers are associated with a significant reduction in SFI prevalence (OR = 0.68 [0.46, 0.99]). Conclusion: States with programs for OAs, mainly monetary transfers, are associated with lower SFI prevalences.
An Environmental Scan of Caregiver Support Resources Provided by Hospice Organizations
Authors: Gyapay Julia , Freeman Shannon , Flood Donna
Published: December 2019

Background:

Informal caregiver support programs offered by hospice organizations support the health and wellbeing of clients and caregivers. However, an understanding of the best practices for informal caregiver support programs currently undertaken across Canada remains unknown, particularly across the province of British Columbia.

Aim:

The aim of the present study was to describe what existing resources and supports are provided by hospice organizations for informal caregivers of persons who are nearing end of life or who are recently bereaved in British Columbia, Canada.

Methods:

In this descriptive study, two thirds of hospice organizations (N = 42/66; 26 urban, 16 rural) participated in a semi-structured telephone interview focused on informal caregiver support programs. All interviews were recorded, transcribed and analyzed thematically and descriptive statistics were employed.

Findings:

While no one-size-fit-all caregiver support program emerged as a gold standard across all hospice organizations, nearly two thirds (n = 26/42) offered one or more informal caregiver support programs. Four categories of caregiver support programs emerged from the data analysis, including companioning, bereavement and grief supports, education and service supports, and respite for caregivers.

Conclusion:

Caregiver support programs are a valuable service provided by some but not all hospice organizations across British Columbia, Canada. Future studies are needed to determine best methods for hospice organizations to formally assess caregivers’ needs and to determine the success and effectiveness of such programs in support of program expansion and evaluation.
Comparison of Sleep Disturbances Between Older Nursing Home Residents in High- and Low-Altitude Areas
Authors: Liu Shou , Chow Ines H. I. , Lu Li , Ren Yan-Ming , Yang Hui-Lian , Jian Sheng-Yan , Ng Chee H. , Ungvari Gabor S. , Wang Fei , Xiang Yu-Tao
Published: December 2019

Background and Objective:

This study compared sleep disturbances between older adults living in nursing home located in high- and low-altitude areas and explored the association between sleep disturbances and quality of life (QoL).

Method:

In total, 207 participants living in a high-altitude area and 437 participants in a low-altitude area were included. Sleep disturbances (ie, difficulty in initiating sleep, difficulty in maintaining sleep, and early morning awakening) were measured using standardized questions. The independent demographic and clinical correlates of sleep disturbances in high-altitude area were examined using multiple logistic regression analyses. Each type of sleep disturbance was entered as the dependent variable separately, while those with significant group differences in the univariate analyses (ie, male gender, married status, age and depressive symptoms) were entered as independent variables.

Results:

The prevalence of any type of sleep disturbances in the whole sample was 26.09%, with 41.54% in the high-altitude area and 18.76% in the low-altitude area. Physical, psychological, social, and environmental QoL domains were negatively associated with sleep disturbances in high-altitude area. Multiple logistic regression analyses revealed that male gender and married status were less likely to have sleep disturbances, while those with more severe depressive symptoms were more likely to have sleep disturbances in high-altitude area.

Conclusion:

Sleep disturbance is common among older nursing home residents in high-altitude areas. Considering the negative impact of sleep disturbance on QoL, regular screening and treatment strategies need to be developed directly for this population.
The treatment outcome of chronic HBV infection among HBV/HIV co-infected and HBV mono-infected patients
Authors: Karić Uroš , Milošević Ivana , Pešić-Pavlović Ivana , Salemović Dubravka , Stojković Milan , Jevtović Djordje
Published: December 2019

The aim of this study was to analyze the treatment response of hepatitis B virus (HBV) to lamivudine and tenofovir disoproxil fumarate in HBV/HIV co-infected patients in comparison to HBV mono-infected patients. This study was conducted at the University Hospital for Infectious and Tropical Diseases in Belgrade from January 2000 until December 2017 and included all patients with chronic hepatitis B who received antiviral therapy. All patients initially treated with lamivudine were switched to tenofovir if lamivudine failure occurred. A patient was considered to have achieved a full treatment response if the level of HBV DNA was lower than 20 IU/ml or undetectable. HBs and HBe antigen loss and HBs seroconversion were also monitored. After a mean duration of lamivudine-containing antiretroviral therapy (ART) of 4.87 ± 3.48 years and lamivudine mono-therapy of 4 ± 2.52 years, failure was recorded in 82.1% and 79.3% of patients, respectively. HBV viral loads were 20 ± 32 IU/ml and 3 ± 13 IU/ml after 2.49 ± 1.56 years of tenofovir-containing ART and 1.9 ± 1.13 years of tenofovir mono-therapy, respectively. Overall mean treatment duration, taking both lamivudine- and tenofovir-based regimens into account, was 4.18 ± 2.72 and 6.17 ± 3.63 years in the mono- and co-infected patients, respectively ( p = 0.02).
Present and Future Perspectives of Using Human-Induced Pluripotent Stem Cells and Organoid Against Liver Failure
Authors: Kuse Yoshiki , Taniguchi Hideki
Published: December 2019

Organ failure manifests severe symptoms affecting the whole body that may cause death. However, the number of organ donors is not enough for patients requiring transplantation worldwide. Illegal transplantation is also sometimes conducted. To help address this concern, primary hepatocytes are clinically transplanted in the liver. However, donor shortage and host rejection via instant blood-mediated inflammatory reactions are worrisome. Induced pluripotent stem cell-derived hepatocyte-like cells have been developed as an alternative treatment. Recently, organoid technology has been developed to investigate the pathology and mechanism of organoids in cultures. Organoids can be transplanted with vascularization and connected to host blood vessels, and functionally mature better in vivo than in vitro. Hepatic organoids improve pathology in liver disease models. In this review, we introduce induced pluripotent stem cell- and organoid-based therapies against liver diseases considering present and future perspectives.
A Systematic Review of Workplace Violence Against Emergency Medical Services Responders
Authors: Murray Regan M. , Davis Andrea L. , Shepler Lauren J. , Moore-Merrell Lori , Troup William J. , Allen Joseph A. , Taylor Jennifer A.
Published: December 2019

Emergency Medical Service (EMS) responders deliver patient care in high-risk, high-stress, and highly variable scenarios. This unpredictable work environment exposes EMS responders to many risks, one of which is violence. The primary goals of this systematic literature review were to (1) define the issue of violence experienced by EMS responders and (2) identify the risk factors of violence associated with the EMS profession. An innovative inclusion of industrial literature with traditional peer-reviewed literature was performed. Of 387 articles retrieved, 104 articles were assessed and reviewed. Career exposure for EMS responders to at least one instance of verbal and/or physical violence was between 57 and 93 percent. There is a great need for rigorously designed, nationally representative examinations of occupational exposures in order to better understand the temporal associations of violence, cumulative occupational stressors, and the outcomes of physical and psychosocial injuries that are occurring as a result of exposures to violence.
Deep Vein Thrombosis in Europe—Health-Related Quality of Life and Mortality
Authors: Monreal M. , Agnelli G. , Chuang L. H. , Cohen A. T. , Gumbs P. D. , Bauersachs R. , Mismetti P. , Gitt A. K. , Kroep S. , Willich S. N. , Van Hout B.
Published: December 2019

Objectives:

Deep vein thrombosis (DVT) is a major health-care burden in Europe, but exact estimates are lacking. This study reports results from the PREFER venous thromboembolism (VTE) study concerning health-related quality of life (HrQoL) and mortality of patients with DVT.

Methods:

PREFER VTE was a prospective, observational study, conducted in 7 European countries, designed to provide data concerning treatment patterns, resource utilization, mortality, and QoL. First-time or recurrent patients with DVT were followed at 1, 3, 6, and 12 months. Health-related QoL—as measured by the EuroQoL 5-Dimension 5-Level instrument ( EQ-5D-5L)—was analyzed using Tobit regression with repeated measures, assessing the impact of baseline characteristics stratified by cancer activity. Mortality was analyzed using logistic regression.

Results:

At baseline, patients with DVT had a 0.14 lower EQ-5D-5L index score (0.72 for total sample) compared to the reference UK population (0.85). The EQ-5D-5L index score improved from baseline to 12 months in patients with active cancer (from 0.70 to 0.79) and those without (0.72-0.87); 7.3% died within a year, a 5.2% excess mortality compared to the age- and gender-adfjusted general population. The 12-month mortality rate of DVT varied between 2.9% in the pooled data from Germany, Switzerland, or Austria and 15.4% in Italy. Furthermore, the mortality rate differed between patients with active cancer and those without (42.9% vs 4.7%).

Conclusions:

Deep vein thrombosis is associated with a substantial burden of illness in terms of HrQoL at baseline, which following treatment normalizes after 12 months and has a significant mortality rate. In addition, active cancer has a significant impact on mortality and the HrQoL of patients with DVT.
Elevated beta human chorionic gonadotropin in a non-pregnant female diagnosed with anal squamous cell carcinoma
Authors: Pokharel Khageshwor , Gilbar Peter J , Mansfield Scott K , Nair Lekshmi M , So Albertina
Published: December 2019

Introduction

Elevated serum beta human chorionic gonadotrophin (β-hCG) in a female normally indicates pregnancy or possibly, gestational trophoblastic disease or ovarian germ cell tumours. Expression of β-hCG has been demonstrated in cervical and endometrial carcinoma and other non-germ cell tumours of the ovary, vulva, breast, prostate, lung, colon, oral/facial tissue and stomach.

Case report

We report a 43-year-old premenopausal woman with p16 positive squamous cell anal cancer. Pre-treatment urinary screening was positive for β-hCG (218 IU/L), which was confirmed on serum and expressed in the tumour. Pelvic ultrasound ruled out pregnancy. Cervical cytology detected human papilloma virus p16 infection and a potential squamous intraepithelial lesion. Management and outcome: She received definitive chemoradiation (Mitomycin/5-fluorouracil) for six weeks. β-hCG, taken four weeks post completion, had returned to normal levels (<2 IU/L).

Discussion

Cases of elevated serum β-hCG are documented in different cancers including breast, gastric, lung, ovarian and renal cell. In our case, the elevated β-hCG is probably ectopic excretion by the squamous cell carcinoma tumour in the anus. While this has never been reported previously in the anus, it is likely due to the documented risk of development of precancerous as well as cancerous anal and cervical lesions through human papilloma virus infection. Raised levels of β-hCG have been reported in cervical cancers. Other possible causes of β-hCG elevation were excluded. Following treatment, her β-hCG level returned to normal strengthening the hypothesis that β-hCG elevation was due to the anal carcinoma. In conclusion, unexplained ectopic secretion of β-hCG may be the first sign of a primary malignancy.
Linear theory for the mechanics of third-gradient continua reinforced with fibers resistance to flexure
Authors: Seyed Bolouri Seyed Ehsan , Kim Chun IL , Yang Seunghwa
Published: December 2019

A linear model, framed in the setting of the second strain gradient theory, is presented for the mechanics of an elastic solid reinforced with fibers resistant to flexure. The kinematics and bending resistance of the fibers are formulated via the second and third gradient of the continuum deformation. The corresponding Euler equations and admissible boundary conditions are then obtained by means of iterated integration by parts and variational principles arising in the third gradient of virtual displacement. In particular, within the prescription of superposed incremental deformations, we derive a compatible linear model from which a complete analytical solution describing the deformations of fiber composites is obtained. The proposed linear model predicts smooth and dilatational shear angle distributions over the domain of interest, which are also aligned with the results obtained from the corresponding nonlinear theory.
The environmental needs of many Australian pet cats are not being met
Authors: Lawson Gabrielle T , Langford Fritha M , Harvey Andrea M
Published: December 2019

Objectives

The aim of this study was to investigate whether Australian cat owners are effectively meeting their cats’ environmental needs and to identify areas of deficiency that may have an impact on the cats’ health and welfare.

Methods

An online survey investigating lifestyle factors and provision of environmental resources was distributed to Australian cat owners.

Results

In total, 12,010 respondents, representing cat-owning households, completed the survey. Altogether, 45.5% were single-cat households and 54.5% were multi-cat households, with a mean number of two cats per household. In total, 46.3% of households contained indoor cats, 51.8% contained indoor–outdoor cats and 1.8% had mostly outdoor cats. Dry food was the predominant food type in 59% of households and few respondents fed their cats in a manner that stimulates natural predatory behaviours. Altogether, 17.1% of households reported cats with urinary problems such as haematuria or urethral obstruction, and 19.8% reported inappropriate urination outside of the litter tray. The incidence of urinary problems was found to be significantly increased in multi-cat households, those with a low number of litter trays, less frequent cleaning of the trays of faeces and the use of crystal type litter. The veterinary clinic was the most common place to obtain advice about feeding and toileting management.

Conclusions and relevance

An increased number of Australian households now contain multiple cats that live restricted or indoor lifestyles. Despite the majority of respondents claiming to have a lot of knowledge about cats and obtaining veterinary advice, deficiencies were identified in toileting facilities and feeding practices, which raises significant welfare concerns. Urinary tract disorders are an important cause of morbidity, mortality and relinquishment and its presence was associated with inadequate toileting facilities. Ongoing education of cat owners and an increased effort by veterinarians to include basic husbandry in preventative care consultations is critical to improving the welfare of pet cats.
Newly arrived refugee parents in Sweden and their experience of the resettlement process: A qualitative study
Authors: Mangrio Elisabeth , Carlson Elisabeth , Zdravkovic Slobodan
Published: December 2019

Aims: The Swedish public support system for the integration and establishment of newly arrived refugees includes an individualized introduction plan, containing language, civic and health information classes. As the plan requires active involvement, the simultaneous establishment of childcare and school start for children risks creating additional challenges and frustrations. The aim of the study was to explore the experience of adjustment among newly arrived refugee parents in the resettlement process, so as to understand how this risk may be mitigated. Methods: This paper presents findings from a qualitative study conducted with 24 Syrian refugee parents participating in the resettlement process and having received asylum status. Results: Parents experienced stress due to long waiting times for residence permits and the struggle to find stable housing. The parents established themselves by enrolling in language studies and looking for employment. They also faced challenges adjusting socially since they were mainly meeting people from their own country and, therefore, felt excluded from the Swedish society. Conclusions: The parents describe the experiences of having escaped from a war-torn country and arrived in new surroundings as mainly challenging for their current situation. Feelings of uncertainty arise as families struggle with daily life while waiting for residence permits, finding stable housing, learning a language and adjusting to new social circumstances. Having this in mind, we conclude that this group of refugees is exposed to health risks in the near future and, as such, is in need of additional support.