bluuebunny/crossref_metadata_2025 huggingface dataset:
Removal of retained intracavernous needle tip using intraoperative fluoroscopy
Authors: Lazaraviciute Gabija , McKay Alastair C , Massanova Matteo , Hendry David S , Zreik Abdullah
Published: September 2020

Intracavernous injections of vasoactive drugs, such as alprostadil, are widely used as an effective treatment method for erectile dysfunction. Intracavernous breakage of the needle is a very rare complication of self-injections, with only a few case reports available in the current literature. Treatment methods described vary in the literature, ranging from immediate surgical exploration under ultrasound guidance to non-operative management with delayed needle removal once it is easily palpable. We report a case of an 82-year-old man with a retained intracavernous 1 cm 30 gauge needle tip after injection of alprostadil (Caverject; marketing authorisation number PL 00057/0942) and the innovative use of intraoperative X-ray imaging (fluoroscopy) for removal of this.

Level of evidence: level 5 (case report/technique)
Anti-JCV antibody index does not change during ocrelizumab-treatment
Authors: Rempe Torge , Carlson Aaron , Miravalle Augusto , Gyang Tirisham Victoria
Published: September 2020

Objective

To prospectively assess anti-JCV antibody index (AI) and its relationship to immunoglobulin levels in ocrelizumab-treated MS patients.

Methods

Monocentric prospective observational study over 24 months assessing anti-JCV AI and immunoglobulin levels in MS patients before and after initiation of ocrelizumab.

Results

No significant change in anti-JCV AI titers was observed 458 ± 300 days after initiation of ocrelizumab (n = 45, 0.7 ± 2.21 vs. 0.6 ± 2.06, p = 0.8). Seroconversion occurred in 1/20 initially anti-JCV seronegative patients. There was no correlation between changes in anti-JCV AI and immunoglobulins.

Conclusion

Treatment with ocrelizumab is not associated with an increase in anti-JCV AI titers.
Perception of survival and overconfidence: The case of Najib Razak (2009–2018)
Authors: Ramadhani Eryan
Published: September 2020

This article aims to examine political decision-making by focusing on how leaders’ motivation to maintain power affects their perception of political survival. Such motivation however is susceptible to judgment bias. Built on political psychology, accountability may help leaders improve their cognitive complexity or make them resort to cognitive shortcuts. Where leaders end up in the cognitive spectrum depends on the type of audiences to whom they feel accountable: core (i.e. ruling elites and loyal voters) and external (i.e. the opposition and its supporters) audiences. Preoccupation with the former may prompt leaders to downplay the latter’s challenges. Moreover, leaders’ understanding of their support base may be mistaken—that core audiences may shift their allegiance to the opposition. The result is overconfidence. Analysing Najib Razak’s leadership (2009–2018), I argue that Najib’s perception of survival stemmed from his perceived unwavering loyalty towards core audiences, invulnerability as the United Malays National Organisation (UMNO) standard-bearer and the weakness of the opposition. Unfortunately, his overconfidence resulted in Barisan Nasional’s (BN) defeat in GE14.
“Bold and Ragged”: A Cross-Cultural Case for the Aesthetics of Melodic Angularity
Authors: Carter-Ényì Aaron , Carter-Ényì Quintina
Published: September 2020

Smaller corpora and individual pieces are compared to a large corpus of 2,447 hymns using two measures of melodic angularity: mean interval size and pivot frequency. European art music and West African melodies may exhibit extreme angularity. We argue in the latter that angularity is motivated by linguistic features of tone-level languages. We also found the mean interval sizes of African-American Spirituals and Southern Harmony exceed contemporary hymnody of the 19th century, with levels similar to Nigerian traditional music (Yorùbá oríkì and story songs from eastern Nigeria). This is consistent with the account of W. E. B. Du Bois, who argued that African melody was a primary source for the development of American music. The development of the American spiritual coincides with increasing interval size in 19th-century American hymnody at large, surpassing the same measure applied to earlier European hymns. Based on these findings, we recommend techniques of melodic construction taught by music theorists, especially preference rules for step-wise motion and gap-fill after leaps, be tempered with counterexamples that reflect broader musical aesthetics. This may be achieved by introducing popular music, African and African Diaspora music, and other non-Western music that may or may not be consistent with voice leading principles. There are also many examples from the European canon that are highly angular, like Händel’s “Hallelujah” and Schönberg’s Pierrot Lunaire. Although the tendency of textbooks is to reinforce melodic and part-writing prescriptions with conducive examples from the literature, new perspectives will better equip performers and educators for current music practice.
The Incidence, Risk Factors, and Complications Associated With Surgical Delay in Multilevel Fusion for Adult Spinal Deformity
Authors: Wade Sean M. , Fredericks Donald R. , Elsenbeck Michael J. , Morrissey Patrick B. , Sebastian Arjun S. , Kaye I. David , Butler Joseph S. , Wagner Scott C.
Published: September 2020

Study Design:

Retrospective database review.

Objectives:

The incidence and risk factors for surgical delay of multilevel spine fusion for adult spinal deformity (ASD), and the complications corresponding therewith, remain unknown. The objectives of this study are to assess the incidence and risk factors for unexpected delay of elective multilevel spinal fusions on the date of surgery as well as the postoperative complications associated with these delays.

Methods:

We conducted a retrospective review of the ACS-NSQIP database on patients undergoing elective spinal instrumentation of greater than 7 levels for ASD between the years 2005 and 2015. Preoperative risk factors for delay and postoperative complications were compared between the cohorts of patients with and without surgical delays.

Results:

Multivariate analysis of 1570 (15.6%) patients identified advanced age, male sex, American Society of Anesthesiologists (ASA) Class 4, and history of smoking as independent risk factors for delay. Patients experiencing surgical delay demonstrated longer operative times, increased intraoperative bleeding, longer hospitalizations, and significantly higher rates of postoperative complications. Patients experiencing delay demonstrated an almost 7-fold increase in mortality rate (3.4% vs 0.5%, P < .001).

Conclusions:

Delays in elective surgical care for spinal deformity are negatively related to patient outcomes. Advanced age, male sex, increased ASA class, and a history of smoking cigarettes place patients at risk for surgical delay of multilevel spinal fusion. Patients experiencing surgical delay are at higher risk for postoperative complications, including a 7-fold increase in mortality. These findings suggest that ASD surgery should be postponed in patients experiencing a delay, until modifiable risk factors can be medically optimized, and perhaps postponed indefinitely in those with nonmodifiable risk factors.
Supine Imaging Is a Superior Predictor of Long-Term Alignment Following Adult Spinal Deformity Surgery
Authors: Elysee Jonathan Charles , Lovecchio Francis , Lafage Renaud , Ang Bryan , Huang Alex , Bannwarth Mathieu , Kim Han Jo , Schwab Frank , Lafage Virginie
Published: September 2020

Study Design:

Retrospective cohort study.

Objective:

To investigate correlations between preoperative supine imaging and postoperative alignment.

Methods:

A retrospective review was conducted of a single-institution database of patients with adult spinal deformity (ASD). Patients were stratified by fusion location in the lumbar or thoracic spine. Outcomes of interest were postoperative lumbar lordosis (LL) and thoracic kyphosis (TK). Sagittal alignment parameters were compared and correlation analyses were performed. Multilinear stepwise regression was conducted to identify independent predictors of postoperative LL or TK. Regression analyses were repeated within the lumbar and thoracic fusion cohorts.

Results:

A total of 99 patients were included (mean age 63.2 years, 83.1% female, mean body mass index 27.3 kg/m2). Scoliosis Research Society classification demonstrated moderate to severe sagittal and/or coronal deformity (pelvic tile modifier, 18.2% ++; sagittal vertical axis, 27.3% ++, pelvic incidence minus lumbar lordosis mismatch, 29.3% ++, SRS type, 29.3% N type curve and 68.7% L or D type curve). A total of 73 patients (73.7%) underwent lumbar fusion and 50 (50.5%) underwent thoracic fusion. Correlation analyses demonstrated a significant association between pre- and postoperative LL and TK. Multilinear regression demonstrated that LL supine and pelvic incidence were significant predictors of postoperative LL ( r2 = 0.568, P < .001). LL supine, TK supine, and age were significant predictors of postoperative TK ( r2 = 0.490, P < .001).

Conclusion:

Preoperative supine films are superior to standing in predicting postoperative alignment at 1-year follow-up. Anticipation of undesired alignment changes through supine imaging may be useful in mitigating the risk of iatrogenic malalignment.
The Accessory Medial Portal for Anterior Cruciate Ligament Reconstruction: A Safe Zone to Avoid Neurovascular Complications
Authors: Plancher Kevin D. , Alwine Jeffrey T. , Chan Jimmy J. , Petterson Stephanie C.
Published: September 2020

Background:

The accessory medial portal (AMP) used for anatomic anterior cruciate ligament reconstruction (ACLR) is gaining popularity. This portal is routinely created at 60° of knee flexion, placing the infrapatellar branch of the saphenous nerve (IBSN) and, less commonly, the descending and superior medial genicular arteries at risk.

Purpose/Hypothesis:

The purpose of this study was to identify a safe zone for AMP placement in ACLR to minimize the risk of injury to the IBSN. We hypothesized that increased knee flexion angles would decrease the risk to neurovascular structures when creating an AMP.

Study Design:

Descriptive laboratory study.

Methods:

A total of 20 cadaveric (10 matched pairs) knees were used for dissection to identify the IBSN and other neurovascular structures. A 30° arthroscope was used to make the central medial portal and AMP at 3 knee flexion angles (60°, 90°, and 110°). Distances were measured from the AMP to branches of the IBSN. Safety of AMP placement was analyzed by assessing the frequency at which spinal needles pierced a neurovascular structure or violated a safe zone.

Results:

The superior IBSN was significantly closer to the AMP than inferior IBSN. The AMP was significantly farther from the superior IBSN at 110° (8.56 ± 5.28 mm) compared with 60° (5.63 ± 5.00 mm; P = .015) and 90° (6.69 ± 5.03 mm; P = .006). A triangular safe zone was identified at 110° of knee flexion. No neurovascular structures were pierced, and the IBSN was not present in the safe zone. At 90°, the IBSN was not pierced; however, the IBSN did violate the safe zone at 90° of knee flexion.

Conclusion:

The superior IBSN is at risk for iatrogenic injury with an AMP placed at 60° of knee flexion. The nerve moved distally with knee flexion. While no neurovascular structures were compromised at 90° of knee flexion, the nerve was found to course through the safe zone. A safe zone at 110° of knee flexion decreases the risk of neurovascular injury and makes the AMP safe for ACLR.

Clinical Relevance:

The AMP at 60° of knee flexion for ACLR poses risk to the IBSN. The IBSN did violate the safe zone at 90° of flexion. We recommend creating an AMP with increased knee flexion to 110° to decrease the risk of iatrogenic injury. When establishing an AMP, one should aim for the center of the defined safe zone, given that the spinal needle used in this study has a smaller diameter than a stab incision.
The Neurocognitive and Behavioral Profiles of 3 Brothers With Becker Muscular Dystrophy
Authors: Hellebrekers Danique M. J. , Vles Johan S. H. , Klinkenberg Sylvia , Hendriksen Jos G. M.
Published: September 2020

Becker muscular dystrophy patients generally carry in-frame mutations in the dystrophin gene, allowing the production of partially functional dystrophin protein. The presence of cognitive and behavioral comorbidities and the relation with the location of mutations has been scarcely investigated in Becker. This case report describes the neurocognitive and behavioral profiles of 3 brothers with Becker carrying an in-frame deletion of exons 45-48. The 3 cases underwent 2 consecutive neuropsychological assessments of which one assessment took place when they completed their primary education (age range of the cases: 11.2 -12.1 years). Intellectual abilities were normal to high and all cases had difficulties with processing speed and math. The brothers differed in intellectual abilities, executive functions, working memory, attention and reading abilities. Variability in cognitive development was noted as well. This report suggests that cognitive and behavioral functions in Becker vary regardless of gene mutation and exposer to similar environmental factors.
Education Through TIME: Representations of U.S. Education on TIME Magazine Covers
Authors: Kachorsky Dani , Reid Stephanie F. , Chapman Kathryn
Published: September 2020

This study examined how TIME Magazine has visually represented and communicated ideas about education from TIME Magazine’s inception in 1923 through 2019. Drawing on theories of visual culture and social semiotic approaches to multimodality, the researchers conducted a qualitative multimodal content analysis of 115 covers that featured content related to education and schooling. The findings included (a) names and places are used to suggest authority, power, or relevance in education circles; (b) learning and schooling are presented as having not changed over time; (c) overgeneralized and metonymic representations can stand for broad categories of education stakeholders; (d) schools are presented as in need of fixing; and (e) schools are perceived as sites for larger, sociopolitical debates.
Clinical Response to Two Formulas in Infants with Parent-Reported Signs of Formula Intolerance: A Multi-Country, Double-Blind, Randomized Trial
Authors: Vivatvakin Boosba , Estorninos Elvira , Lien Reyin , Lee Hung Chang , Hon Kam Lun Ellis , Lebumfacil Jowena , Cercamondi Colin I , Volger Sheri
Published: September 2020

Background:

Signs of feeding intolerance are common in formula-fed infants. We evaluated the clinical response to a partially hydrolyzed 100% whey protein formula with high sn-2 palmitate and reduced lactose (FA) and to an alpha-lactalbumin-enriched whey-predominant intact protein formula with full lactose (FB) in healthy full-term infants with parent-reported signs of feeding intolerance.

Methods:

In a double-blind, parallel-group trial in 6 Asian study centers, exclusively formula-fed infants aged 30 to 90 days, whose parents reported fussiness-crying for ≥2 hours/day plus gassiness and/or stooling difficulty, and intended to switch formula, were randomly assigned to FA (n = 130) or FB (n = 129) for 14 days. Primary endpoint was daily duration of fussiness-crying. Secondary endpoints included gassiness, spitting-up, vomiting, sleep pattern, Infant Gastrointestinal Symptom Questionnaire (IGSQ) Index, infant temperament and maternal anxiety.

Results:

Mean ± SE minutes/day of fussiness-crying in the 256 analyzed infants (FA, n = 127 and FB, n = 129) substantially decreased from baseline to study end in FA (291 ± 14 to 140 ± 8; –52%, P < .001), and FB (313 ± 14 to 153 ± 11, –51%, P < .001) with no difference between groups. Similarly, gassiness, spitting-up, vomiting and sleep pattern significantly improved by study end for both formulas. Mean ± SE IGSQ index scores significantly decreased from baseline to study end (FA: 44.5 ± 0.9 to 28.6 ± 0.7; FB: 44.5 ± 0.8 to 29.0 ± 0.7; P < .001) with no differences between groups. Infant temperament and maternal anxiety also improved significantly in both groups by study end.

Conclusion:

Switching from standard, full-lactose, intact whey/casein infant formulas to either study formula resulted in an improvement of gastrointestinal symptoms and associated behaviors in infants with signs of feeding intolerance.

Trial Registration:

https://clinicaltrials.gov , NCT02021058
Diabetes-Related Distress and Associated Characteristics in Patients With Type 2 Diabetes in an Urban Primary Care Setting in Greece
Authors: Kintzoglanakis Kyriakos , Vonta Paraskevi , Copanitsanou Panagiota
Published: September 2020

Background

Diabetes-related distress (DRD) is a common psychological issue of people living with diabetes. International guidelines advise to take DRD into consideration in diabetes care but evidence for Greece is scarce. In the present study we aimed to estimate the frequency of DRD as assessed by Diabetes Distress Scale (DDS) and to examine its connections with clinical and sociodemographic characteristics among patients with type 2 diabetes mellitus (T2D) in urban primary care (PC) in Greece.

Methods

This descriptive survey included adults with a diagnosis of T2D of at least six months under medication treatment attending a novel, public urban PC unit. Patients with other forms of diabetes, dementia, and psychosis were excluded. Patients were screened for DRD with DDS instrument and correlations were made between DRD and clinical and sociodemographic characteristics.

Results

In 135 eligible participants the frequency of moderate to high levels of DRD (DDS ≥ 2) was 24.4% and of high levels of DRD (DDS ≥ 3) was 7.4%. Emotional burden (EB) subscale was significantly correlated with younger age, insulin use, duration of insulin use, and the number of insulin injections per day. Longer diabetes duration showed significant correlation with DDS total, EB, and regimen distress. Participants with lower income, sedentary lifestyle, micro-vascular complications, more episodes of hypoglycaemia, and higher levels of glycated haemoglobin (HbA1c) experienced significantly higher distress.

Conclusion

DRD screening is important in urban PC and in more susceptible patients as those on more insulin injections per day, with longer diabetes duration, higher levels of HbA1c, lower income, sedentary lifestyle, and more episodes of hypoglycaemia.
Repurposing a novel anti-cancer RXR agonist to attenuate murine acute GVHD and maintain graft-versus-leukemia responses
Authors: Thangavelu Govindarajan , Wang Chao , Loschi Michael , Saha Asim , Osborn Mark J. , Furlan Scott N. , Aoyama Kazutoshi , McDonald-Hyman Cameron , Aguilar Ethan G. , Janesick Amanda S. , Chandraratna Roshantha A. , Refaeli Yosef , Panoskaltsis-Mortari Angela , MacDonald Kelli P. , Hill Geoffrey R. , Zeiser Robert , Maillard Ivan , Serody Jonathan S. , Murphy William J. , Munn David H. , Blumberg Bruce , Brown Chrysothemis , Kuchroo Vijay , Kean Leslie S. , Hippen Keli L. , Noelle Randolph J. , Blazar Bruce R.
Published: September 2020

The nuclear receptor (NR) subclass, retinoid X receptors (RXRs), exert immunomodulatory functions that control inflammation and metabolism via homodimers and heterodimers, with several other NRs, including retinoic acid receptors. IRX4204 is a novel, highly specific RXR agonist in clinical trials that potently and selectively activates RXR homodimers, but not heterodimers. In this study, in vivo IRX4204 compared favorably with FK506 in abrogating acute graft-versus-host disease (GVHD), which was associated with inhibiting allogeneic donor T-cell proliferation, reducing T-helper 1 differentiation, and promoting regulatory T-cell (Treg) generation. Recipient IRX4204 treatment reduced intestinal injury and decreased IFN-γ and TNF-α serum levels. Transcriptional analysis of donor T cells isolated from intestines of GVHD mice treated with IRX4204 revealed significant decreases in transcripts regulating proinflammatory pathways. In vitro, inducible Treg differentiation from naive CD4+ T cells was enhanced by IRX4204. In vivo, IRX4204 increased the conversion of donor Foxp3− T cells into peripheral Foxp3+ Tregs in GVHD mice. Using Foxp3 lineage-tracer mice in which both the origin and current FoxP3 expression of Tregs can be tracked, we demonstrated that IRX4204 supports Treg stability. Despite favoring Tregs and reducing Th1 differentiation, IRX4204-treated recipients maintained graft-versus-leukemia responses against both leukemia and lymphoma cells. Notably, IRX4204 reduced in vitro human T-cell proliferation and enhanced Treg generation in mixed lymphocyte reaction cultures. Collectively, these beneficial effects indicate that targeting RXRs with IRX4204 could be a novel approach to preventing acute GVHD in the clinic.
A randomized phase 2 trial of pomalidomide in subjects failing prior therapy for chronic graft-versus-host disease
Authors: Curtis Lauren M. , Ostojic Alen , Venzon David J. , Holtzman Noa G. , Pirsl Filip , Kuzmina Zoya J. , Baird Kristin , Rose Jeremy J. , Cowen Edward W. , Mays Jacqueline W. , Mitchell Sandra A. , Parsons-Wandell Laura , Joe Galen O. , Comis Leora E. , Berger Ann , Pusic Iskra , Peer Cody J. , Figg William D. , Cao Liang , Gale Robert Peter , Hakim Frances T. , Pavletic Steven Z.
Published: September 2020

Steroid-refractory chronic graft-versus-host disease (cGVHD) is a therapeutic challenge. Sclerotic skin manifestations are especially difficult to treat. We conducted a randomized phase 2 clinical trial (#NCT01688466) to determine the safety, efficacy, and preferred dose of pomalidomide in persons with moderate to severe cGVHD unresponsive to corticosteroids and/or subsequent lines of therapy. Thirty-four subjects were randomized to receive pomalidomide 0.5 mg per day orally (n = 17; low-dose cohort) or 2 mg per day at a starting dose of 0.5 mg per day increasing to 2 mg per day over 6 weeks (n = 17; high-dose cohort). The primary endpoint was overall response rate (ORR) at 6 months according to the 2005 National Institutes of Health cGVHD Response Criteria. Thirty-two patients had severe sclerotic skin and received a median of 5 (range, 2-10) previous systemic therapies. ORR was 47% (95% confidence interval, 30-65) in the intention-to-treat analyses. All were partial responses, with no difference in ORR between the cohorts. ORR was 67% (45%-84%) in the 24 evaluable subjects at 6 months. Nine had improvement in National Institutes of Health joint/fascia scores (P = .018). Median change from the baseline in body surface area involvement of skin cGVHD was −7.5% (–10% to 35%; P = .002). The most frequent adverse events were lymphopenia, infection, and fatigue. Eight subjects in the high-dose cohort had dose decreases because of adverse events. There was 1 death in the low-dose cohort from bacterial pneumonia. Our data indicate antifibrotic effects of pomalidomide and possible association with increases in concentrations of blood regulatory T-cell and interleukin-2. Pomalidomide 0.5 mg per day is a safe and effective therapy for advanced corticosteroid-refractory cGVHD.
Analysis of risk factors for anastomotic leakage after lower rectal Cancer resection, including drain type: a retrospective single-center study
Authors: Kinugasa Tetsushi , Nagasu Sachiko , Murotani Kenta , Mizobe Tomoaki , Ochi Takafumi , Isobe Taro , Fujita Fumihiko , Akagi Yoshito
Published: September 2020

Background

We investigated the correlations between surgery-related factors and the incidence of anastomotic leakage after low anterior resection (LAR) for lower rectal cancer.

Methods

A total of 630 patients underwent colorectal surgery between 2011 and 2014 in our department. Of these, 97 patients (15%) underwent LAR and were enrolled in this retrospective study. Temporary ileostomy was performed in each patient.

Results

Anastomotic leakage occurred in 21 patients (21.7%). Univariate analysis showed a significant association between operative duration (p = 0.005), transanal hand-sewn anastomosis (p = 0.014), and operation procedure (p = 0.019) and the occurrence of leakage. Multivariate regression reanalysis showed that underlying disease (p = 0.044), transanal hand-sewn anastomosis (p = 0.019) and drain type (p = 0.025) were significantly associated with the occurrence of leakage. The propensity-score analysis showed that closed drainage were 6.3 times more likely to have anastomotic leakage than open drainage in relation to the amount of postoperative drainage (ml), according to the inverse probability of treatment-weighted analysis.

Conclusions

Our results indicate that underlying disease, transanal hand-sewn anastomosis, and closed drain may be a risk and predictive factors for anastomotic leakage after LAR for lower rectal cancer. The notable finding was that closed drainage was related to the occurrence of anastomotic leakage and closed drainage was correlated with less volume of postoperative drain discharge than open drain.
Plasmid mediated penicillin and tetracycline resistance among Neisseria gonorrhoeae isolates from Kenya
Authors: Kivata Mary Wandia , Mbuchi Margaret , Eyase Fredrick , Bulimo Wallace Dimbuson , Kyanya Cecilia Katunge , Oundo Valerie , Mbinda Wilton Mwema , Sang Willy , Andagalu Ben , Soge Olusegun O. , McClelland Raymond Scott , Distelhorst John
Published: September 2020

Background

Treatment of gonorrhea is complicated by the development of antimicrobial resistance inNeisseria gonorrhoeae(GC) to the antibiotics recommended for treatment.Knowledge on types of plasmids and the antibiotic resistance genes they harbor is useful in monitoring the emergence and spread of bacterial antibiotic resistance. In Kenya, studies on gonococcal antimicrobial resistance are few and data on plasmid mediated drug resistance is limited. The present study characterizes plasmid mediated resistance inN. gonorrhoeaeisolates recovered from Kenya between 2013 and 2018.

Methods

DNA was extracted from 36 sub-cultured GC isolates exhibiting varying drug resistance profiles. Whole genome sequencing was done on Illumina MiSeq platform and reads assembledde-novousing CLC Genomics Workbench. Genome annotation was performed using Rapid Annotation Subsystem Technology. Comparisons in identified antimicrobial resistance determinants were done using Bioedit sequence alignment editor.

Results

Twenty-four (66.7%) isolates had both β-lactamase (TEM) and TetM encoding plasmids. 8.3% of the isolates lacked both TEM and TetM plasmids and had intermediate to susceptible penicillin and tetracycline MICs. Twenty-six (72%) isolates harbored TEM encoding plasmids. 25 of the TEM plasmids were of African type while one was an Asian type. Of the 36 isolates, 31 (86.1%) had TetM encoding plasmids, 30 of which harbored American TetM, whereas 1 carried a Dutch TetM. All analyzed isolates had non-mosaicpenAalleles. All the isolates expressing TetM were tetracycline resistant (MIC> 1 mg/L) and had increased doxycycline MICs (up to 96 mg/L). All the isolates had S10 ribosomal protein V57M amino acid substitution associated with tetracycline resistance. No relation was observed between PenB and MtrR alterations and penicillin and tetracycline MICs.

Conclusion

High-level gonococcal penicillin and tetracycline resistance in the sampled Kenyan regions was found to be mediated by plasmid borneblaTEMandtetMgenes. While the African TEM plasmid, TEM1 and American TetM are the dominant genotypes, Asian TEM plasmid, a new TEM239 and Dutch TetM have emerged in the regions.
HIV prevention is not all about HIV – using a discrete choice experiment among women to model how the uptake and effectiveness of HIV prevention products may also rely on pregnancy and STI protection
Authors: Vickerman Peter , Quaife Matthew , Kilbourne-Brook Maggie , Mvundura Mercy , Eakle Robyn , Terris-Prestholt Fern
Published: September 2020

Introduction

In sub-Saharan Africa, considerable HIV-burden exists among women. Anti-retroviral (ARV) based prevention products could decrease this burden, and their uptake could be increased if they also protect against pregnancy and sexually transmitted infections (STI).

Methods

A discrete choice experiment (DCE) was undertaken in South Africa (2015) through a household survey of adult females (n = 158) and adolescent girls (n = 204) who self-reported HIV-negative status. The DCE was used to project the uptake (percentage using product) of oral pre-exposure prophylaxis (PrEP), vaginal rings, and injectable long-lasting ARV agents among these women, and how uptake could depend on whether these products protect against pregnancy or STI acquisition. Uptake estimates were used to model how each product could decrease a women’s HIV acquisition risk.

Results

In adolescent women, there will be limited uptake (< 6% for any product) and impact (< 4% decrease in HIV acquisition risk) of new products unless they provide pregnancy protection, which could quadruple use and impact. Adult women have weaker preference for pregnancy protection, with moderate use (< 17% for each) and impact (< 14 percentage point decrease) if they only provide HIV protection. All women had highest preference for injectable ARVs, with oral PrEP having high preference if injectable ARVs are not available. Adult women will use the ring, but adolescent women will not. Importantly, even with three additional prevention products, all providing pregnancy and STI protection, > 14% of women will remain unprotected and > 31% of the baseline acquisition risk will remain.

Conclusions

Incorporating multiple prevention components into new ARV-based prevention products may increase their uptake and impact among women.
Differences in mortality in patients undergoing surgery for infective endocarditis according to age and valvular surgery
Authors: Østergaard Lauge , Smerup Morten Holdgaard , Iversen Kasper , Jensen Andreas Dalsgaard , Dahl Anders , Chamat-Hedemand Sandra , Bruun Niels Eske , Butt Jawad Haider , Bundgaard Henning , Torp-Pedersen Christian , Køber Lars , Fosbøl Emil
Published: September 2020

Background

Infective endocarditis (IE) is associated with high mortality. Surgery may improve survival and reduce complications, but the balance between benefit and harm is difficult and may be closely related to age and type of surgical intervention. We aimed to examine how age and type of left-sided surgical intervention modified mortality in patients undergoing surgery for IE.

Methods

By crosslinking nationwide Danish registries we identified patients with first-time IE undergoing surgical treatment 2000–2017. Patients were grouped by age < 60 years, 60–75 years, and ≥ 75 years. Multivariable adjusted Cox proportional hazard analysis was used to examine factors associated with 90-day mortality.

Results

We included 1767 patients with IE undergoing surgery, 735 patients < 60 years (24.1% female), 766 patients 60–75 years (25.8% female), and 266 patients ≥75 years (36.1% female). The proportions of patients undergoing surgery were 35.3, 26.9, and 9.1% for patients < 60 years, 60–75 years, and > 75 years, respectively. Mortality at 90 days were 7.5, 13.9, and 22.3% (p < 0.001) for three age groups. In adjusted analyses, patients 60–75 years and patients ≥75 years were associated with a higher mortality, HR = 1.84 (95% CI: 1.48–2.29) and HR = 2.47 (95% CI: 1.88–3.24) as compared with patients < 60 years. Factors associated with 90-day mortality were: mitral valve surgery, a combination of mitral and aortic valve surgery as compared with isolated aortic valve surgery, age, diabetes, and prosthetic heart valve implantation prior to IE admission.

Conclusions

In patients undergoing surgery for IE, mortality increased significantly with age and 1 in 5 died above age 75 years. Mitral valve surgery as well as multiple valve interventions augmented mortality further.
ADIPOQ single nucleotide polymorphisms and breast cancer in northeastern Mexican women
Authors: Cerda-Flores Ricardo M. , Camarillo-Cárdenas Karen Paola , Gutiérrez-Orozco Gabriela , Villarreal-Vela Mónica Patricia , Garza-Guajardo Raquel , Ponce-Camacho Marco Antonio , Castruita-Ávila Ana Lilia , González-Guerrero Juan Francisco , Rodríguez-Sánchez Iram Pablo , Calderón-Garcidueñas Ana Laura , Rodríguez-Gutierrez Hazyadee Frecia , Arellano-Barrientos Juan Carlos , Gutierrez Oscar Vidal , Saldaña Hugo Alberto Barrera , Garza-Rodríguez María Lourdes
Published: September 2020

Background

Adiponectin gene (ADIPOQ) polymorphisms have been shown to affect adiponectin serum concentration and some have been associated with breast cancer (BC) risk. The aims of this study were to describe the frequency of single nucleotide polymorphisms (SNPs) ofADIPOQin Mexican women with BC and to determine if they show an association with it.

Methods

DNA samples from 397 patients and 355 controls were tested for theADIPOQgene SNPs: rs2241766 (GT) and rs1501299 (GT) by TaqMan allelic discrimination assay. Hardy–Weinberg equilibrium (HWE) was tested. Multiple SNP inheritance models adjusted by age and body mass index (BMI) were examined for the SNP rs1501299.

Results

We found that in the frequency analysis of rs1501299 without adjusting the BMI and age, the genotype distribution had a statistically significant difference (P = 0.003). The T allele was associated with a BC risk (OR, 1.99; 95% CI 1.13–3.51, TT vs. GG; OR, 1.53; 95% CI 1.12–2.09, GT vs. GG). The SNP rs2241766 was in HW disequilibrium in controls. In conclusion, the rs1501299 polymorphism is associated with a BC risk.

Conclusions

Identification of the genotype of these polymorphisms in patients with BC can contribute to integrate the risk profile in both patients and their relatives as part of a comprehensive approach and increasingly more personalized medicine.
RNA-Seq identifies condition-specific biological signatures of ischemia-reperfusion injury in the human kidney
Authors: Park Meeyoung , Kwon Chae Hwa , Ha Hong Koo , Han Miyeun , Song Sang Heon
Published: September 2020

Background

Acute kidney injury (AKI) is defined as a sudden event of kidney failure or kidney damage within a short period. Ischemia-reperfusion injury (IRI) is a critical factor associated with severe AKI and end-stage kidney disease (ESKD). However, the biological mechanisms underlying ischemia and reperfusion are incompletely understood, owing to the complexity of these pathophysiological processes. We aimed to investigate the key biological pathways individually affected by ischemia and reperfusion at the transcriptome level.

Results

We analyzed the steady-state gene expression pattern of human kidney tissues from normal (pre-ischemia), ischemia, and reperfusion conditions using RNA-sequencing. Conventional differential expression and self-organizing map (SOM) clustering analyses followed by pathway analysis were performed. Differential expression analysis revealed the metabolic pathways dysregulated in ischemia. Cellular assembly, development and migration, and immune response-related pathways were dysregulated in reperfusion. SOM clustering analysis highlighted the ischemia-mediated significant dysregulation in metabolism, apoptosis, and fibrosis-related pathways, while cell growth, migration, and immune response-related pathways were highly dysregulated by reperfusion after ischemia. The expression of pro-apoptotic genes and death receptors was downregulated during ischemia, indicating the existence of a protective mechanism against ischemic injury. Reperfusion induced alterations in the expression of the genes associated with immune response such as inflammasome and antigen representing genes. Further, the genes related to cell growth and migration, such as AKT, KRAS, and those related to Rho signaling, were downregulated, suggestive of injury responses during reperfusion. Semaphorin 4D and plexin B1 levels were also downregulated.

Conclusions

We show that specific biological pathways were distinctively involved in ischemia and reperfusion during IRI, indicating that condition-specific therapeutic strategies may be imperative to prevent severe kidney damage after IRI in the clinical setting.
Pregnancy vs. paycheck: a qualitative study of patient’s experience with employment during pregnancy at high risk for preterm birth
Authors: Wheeler Sarahn M. , Massengale Kelley E. C. , Adewumi Konyin , Fitzgerald Thelma A. , Dombeck Carrie B. , Swezey Teresa , Swamy Geeta K. , Corneli Amy
Published: September 2020

Background

Pregnant women with a history of preterm birth are at risk for recurrence, often requiring frequent prenatal visits for close monitoring and/or preventive therapies. Employment demands can limit uptake and adherence to recommended monitoring and preterm birth prevention therapies.

Method

We conducted a qualitative descriptive study using in-depth interviews (IDIs) of pregnant women with a history of preterm birth. IDIs were conducted by trained qualitative interviewers following a semi-structured interview guide focused on uncovering barriers and facilitators to initiation of prenatal care, including relevant employment experiences, and soliciting potential interventions to improve prompt prenatal care initiation. The IDIs were analyzed via applied thematic analysis.

Results

We described the interview findings that address women’s employment experiences. The current analysis includes 27 women who are majority self-described as non-Hispanic Black (74%) and publically insured (70%). Participants were employed in a range of professions; food services, childcare and retail were the most common occupations. Participants described multiple ways that being pregnant impacted their earning potential, ranging from voluntary work-hour reduction, involuntary duty hour reductions by employers, truncated promotions, and termination of employment. Participants also shared varying experiences with workplace accommodations to their work environment and job duties based on their pregnancy. Some of these accommodations were initiated by a collaborative employee/employer discussion, others were initiated by the employer’s perception of safe working conditions in pregnancy, and some accommodations were based on medical recommendations. Participants described supportive and unsupportive employer reactions to requests for accommodations.

Conclusions

Our findings provide novel insights into women’s experiences balancing a pregnancy at increased risk for preterm birth with employment obligations. While many women reported positive experiences, the most striking insights came from women who described negative situations that ranged from challenging to potentially unlawful. Many of the findings suggest profound misunderstandings likely exist at the patient, employer and clinical provider level about the laws surrounding employment in pregnancy, safe employment responsibilities during pregnancy, and the range of creative accommodations that often allow for continued workplace productivity even during high risk pregnancy.
Maternal birth preparedness and complication readiness in the Greater Accra region of Ghana: a cross-sectional study of two urban health facilities
Authors: Klobodu Cynthia , Milliron Brandy-Joe , Agyabeng Kofi , Akweongo Patricia , Adomah-Afari Augustine
Published: September 2020

Background

High maternal mortality ratios remain a critical public health concern in Ghana. Birth preparedness and complication readiness (BP/CR), which is a component of focused antenatal care, is a safe motherhood strategy intended to promote skilled birth attendance by helping women and their families plan for pregnancy and childbirth, thereby reducing maternal mortality. The objective of this study was to determine the level of BP/CR and to assess factors associated with maternal BP/CR in the Greater Accra Region of Ghana.

Method

A cross sectional descriptive quantitative study was carried out among 300 postnatal women attending the Adabraka Polyclinic and the Greater Accra Regional Hospital both within Accra, the capital city of Ghana. Data were collected with a structured questionnaire which assessed socio-demographic, health facility/provider and social support factors and their associations with BP/CR. Levels of BP/CR were assessed using validated tools. Data from 300 women were analyzed using STATA version 15.0. Logistic regression analysis was conducted to establish associations between BP/CR and socio-demographic, health facility/provider and social support factors.

Results

Approximately 234 (78%) of the women were birth prepared. Strong predictors of BP/CR included having ≥4 antenatal clinic visits (aOR 2.63; 95% CI 1.03–6.73), being employed (aOR 4.07; 95% CI 1.49–11.11) and belonging to maternal health promoting clubs or groups during the antenatal period (aOR 3.00; 95% CI 1.07–8.40) .

Conclusion

BP/CR is generally high among the study population. Predictors of BP/CR are multifactorial and found to cut across all aspects assessed in the study. Therefore, the creation of a BP/CR tool is recommended to routinely monitor trends in maternal birth preparedness in antenatal clinics. This may help to sustain and improve current levels and indicators of BP/CR.
Magnitude and associated factors of husband involvement on antenatal care follow up in Debre Berhan town, Ethiopia 2016: a cross sectional study
Authors: Shine Sisay , Derseh Behailu , Alemayehu Bethlehem , Hailu Gebrehiwot , Endris Hussein , Desta Saba , Birhane Yibeltal
Published: September 2020

Background

Involving the husband in antenatal care follow up have a crucial role in pregnancy outcome and highly recommended by the world health organization. Data on husbands’ involvement during ANC follow up in Debre Berhan town was scarce. Therefore, the objective of this study was to assess the magnitude and factors associated with the husband involvement in accompanying their wife to ANC follow up.

Methods

A cross-sectional study was conducted during the study period among 405 married men whose wife was pregnant in the last year. A multi-stage sampling technique was used to select the study participants. Data were collected using a pre-tested and structured questionnaire. Odds ratio with 95% confidence intervals were used to assess levels of significance.

Results

More than half the 62.5% (252/405) of the husbands were involved in accompanying their wife in ANC follow up. A majority, 92.3% (374/405) of husbands had good communication with their wife during pregnancy and 88.6% (359/405) of husbands discussed with doctor about the health-related condition of their wife. Age category of husbands 30–39 years old (AOR: 1.9; 95%CI: 1.1, 3.2) and the educational status of husbands being illiterate and primary school (AOR: 1.8; 95%CI: 1.1, 3.1) and secondary school (AOR: 3.1; 95%CI: 1.7, 5.7) were significant predictors on accompanying their wife in ANC follow up.

Conclusion

More than half of the husbands were involved in accompanying their wife to ANC follow up. The age and educational status of the husband had significantly associated with an accompanying their wife to ANC follow-up. Educating husbands on the importance of their involvement during pregnancy increase their participation in ANC follow up.
Clinical value of selected markers of angiogenesis, inflammation, insulin resistance and obesity in type 1 endometrial cancer
Authors: Terlikowska Katarzyna M. , Dobrzycka Bozena , Terlikowski Robert , Sienkiewicz Anna , Kinalski Maciej , Terlikowski Slawomir J.
Published: September 2020

Background

It is a well-known fact show that the risk of developing endometrial cancer (type 1 EC) is strongly associated with obesity. In this study, selected markers, such as obesity, insulin resistance, angiogenesis and inflammation markers related to EC type 1 progression and patients’ survival data were analyzed.

Methods

To measure levels of adiponectin, C-reactive protein (CRP), vascular endothelial growth factor-A (VEGF-A), angiopoietin-2 (Ang-2), insulin-like growth factor-1 (IGF-1), insulin and C-peptide in 176 preoperative serum samples, the immunoassay technique (EMIT) has been applied.

Results

Angiopoietin-2 levels increase with age (P = 0.005), FIGO stage (p = 0.042), myometrial invasion (P = 0.009) and LVSI (P < 0.001). The CRP levels increase with age (P = 0.01), as well as the advancement of the FIGO stage (P < 0.001), higher tumor grade (P = 0.012), and myometrial invasion (P < 0.001). A positive correlation between serum Ang-2 and CRP levels was demonstrated (r = 0.44; p < 0.001). Kaplan-Meier survival analysis showed that patients with high CRP levels in serum and Ang-2 presented a worse outcome (P = 0.03 and P = 0.015, respectively). Cox regression analysis of individual predictors revealed that high serum levels of Ang-2, CRP, advanced clinical FIGO stage (P < 0.001, respectively), old age (P = 0.013) were all significant overall survival predictors. By means of multivariate analysis, their predictive significance was confirmed.

Conclusion

Our study provides evidence that serum levels of Ang-2 and CRP may serve as predictors for assessment of the clinical stage of type 1 EC and are significantly associated with poor prognosis. It is likely that angiogenesis and inflammation associated with obesity have a significant impact on EC type 1 progression and survival rate of patients.
Development of the SPARK family member web pages to improve symptom management for pediatric patients receiving cancer treatments
Authors: Watling Cody Z. , McCarthy Clodagh , Theodorakidis Alexandra , Cook Sadie , Vettese Emily , Schechter Tal , Abubeker Hanan , Dupuis L. Lee , Sung Lillian
Published: September 2020

Background

Supportive care Prioritization, Assessment and Recommendations for Kids (SPARK) is a web-based application that facilitates symptom screening and access to supportive care clinical practice guidelines (CPGs) for children and adolescents receiving cancer treatments. Objective was to develop SPARK family member web pages for pediatric patient family members accessing: (1) proxy symptom screening and symptom reports, and (2) care recommendations for symptom management based on CPGs.

Methods

SPARK family member web pages were developed and included access to symptom screening and care recommendations sections. Care recommendations for fatigue and mucositis were created. These were iteratively refined based upon cognitive interviews with English-speaking family members ≥16 years of age until less than two participants incorrectly understood sections as adjudicated by two independent raters.

Results

A total of 100 family members were enrolled who evaluated the SPARK family member web pages (n = 40), fatigue care recommendation (n = 30) and mucositis prevention care recommendation (n = 30). Among the last 10 participants, none said that the SPARK family member web pages were hard or very hard to use, one incorrectly understood one web page, none said either care recommendation was hard to understand and none were incorrect in their understanding of the care recommendations.

Conclusions

We successfully developed SPARK web pages for use by family members of pediatric patients receiving cancer treatments. We also developed a process for translating CPG recommendations designed for healthcare professionals to lay language. The utility of SPARK family member web pages after clinical implementation could be a focus for future research.