bluuebunny/crossref_metadata_2025 huggingface dataset:
Diagnosis of tuberculosis pleurisy with three endoscopic features via pleuroscopy
Authors: Lee Chung-Shu , Li Shih-Hong , Chang Chih-Hao , Chung Fu-Tsai , Chiu Li-Chung , Chou Chu-Liang , Wang Chih-Wei , Lin Shu-Min
Published: February 2021

Background:

Tuberculosis (TB) is a constant threat even with a worldwide active public health campaign. Diagnosis of TB pleurisy is challenging in the case of pleural effusion of unknown origin after aspiration analysis. The study was designed to demonstrate a simple image interpretation technique to differentiate TB pleurisy from non-TB pleurisy using semi-rigid pleuroscopy.

Methods:

The study retrospectively enrolled 117 patients who underwent semi-rigid pleuroscopy from April 2016 to August 2018 in a tertiary hospital. We analyzed the possibility of TB pleurisy using three simple pleuroscopic images via semi-rigid pleuroscopy.

Results:

Among 117 patients, 28 patients (23.9%) were diagnosed with TB pleurisy. Sago-like nodules/micronodules, adhesion, and discrete distribution were noted in 20 (71.4%), 20 (71.4%), and 19 (67.9%) patients with TB pleurisy, respectively. Sago-like nodules/micronodules, adhesion, and discrete distribution were noted in six (6.7%), 37 (41.6%), and no (0.0%) patients with non-TB pleurisy, respectively. The positive and negative predictive values of any two out of three pleuroscopic patterns for TB pleurisy were 100.0% and 93.7%, respectively.

Conclusions:

A high positive predictive value for TB pleurisy was demonstrated by the presence of any two out of the three characteristic features. Absence of all three features had an excellent negative predictive value for TB pleurisy. Our diagnostic criteria reconfirm that pleuroscopic images can be used as predictors for TB pleurisy in patients with undiagnosed pleural effusion. The reviews of this paper are available via the supplementary material section.
Inflammatory Profile of Antrochoanal Polyps in the Caucasian Population – A Histologic Study
Authors: Warman Meir , Kamar Matias Alma , Yosepovich Ady , Halperin Doron , Cohen Oded
Published: February 2021

Background

Antrochoanal polyp (ACP) is a rare and unique unilateral nasal polyp. In contrast to diffuse primary chronic rhinosinusitis (d-CRS) the inflammatory profile of ACP in the Caucasian population have not been determined.

Objective

The purpose of the study is to describe and differentiate the inflammatory features of ACP compared with d-CRS and its phenotypic subgroups and hypertrophic turbinates (HT) in the Caucasian population, and compare the mast and plasma cell marker expression of each pathology.

Methods

A retrospective case control study of 96 patients operated on between the years 2005–2017. Nasal biopsies of ACPs, d-CRS and HTs were compared. A comparison of the different phenotypic subgroups of d-CRS was made as well. Demographics, comorbidities, and histologic and immunohistochemical (IHC) staining of mast (CD117) and plasma cell (CD138) receptor antibodies, were compared and analyzed.

Results

A total of 96 patients were included, consisting of 40 (41.6%) ACP, 36 (37.5%) d-CRS and 20 (20.8%) HT patients. ACPs displayed a significantly higher level of edema and intramural cysts compared to the other groups. Squamous metaplasia was demonstrated in ACP (27.5%) and d-CRS (25.6%), but not in HT. The ACP group was characterized by neutrophilic predominant infiltrates as opposed to the eosinophilic predominance in the d-CRS group, especially in eosinophilic CRS and central compartment allergic disease. ACP presented lower levels of both mast and plasma cells compared to d-CRS and HT in IHC staining.

Conclusions

ACP in the Caucasian population has unique features of cyst formation and edema which is compatible with its clinical presentation. It is characterized by neutrophilic predominant infiltrates and expresses lower levels of mast and plasma cells as demonstrated by IHC.
Educational Informed Consent Video Equivalent to Standard Verbal Consent for Rhinologic Surgery: A Randomized Controlled Trial
Authors: Penn Joseph P. , Nallani Rohit , Dimon Erin L. , Daniels Taylor C. , Sykes Kevin J. , Chiu Alexander G. , Villwock Mark R. , Villwock Jennifer A.
Published: February 2021

Background

Informed consent is an integral part of pre-operative counseling. However, information discussed can be variable. Recent studies have explored the use of multimedia in providing informed consent for rhinologic surgery.

Objective

To measure impact of an educational video (Video) compared to verbal informed consent (Verbal) on knowledge gained, alleviation of concerns, and efficiency.

Methods

Patients undergoing endoscopic sinus surgery (ESS), septoplasty, or ESS+septoplasty were prospectively enrolled and randomized to receive Video or Verbal consent. The Video group watched an educational video; the Verbal group received standard verbal consent from an Otolaryngology resident per institutional protocol. Both groups had the opportunity to discuss questions or concerns with their attending surgeon. Prior to, and after, consent was signed, both groups completed surveys regarding knowledge of purpose, risks, and benefits of surgery as well as surgical concerns. Decision regret and patient satisfaction were also assessed post-operatively.

Results

77 patients were enrolled (39 Video, 38 Verbal). Demographics were not significantly different between groups. Overall knowledge significantly improved (p < 0.005) and concerns significantly decreased (p < 0.001) following consent in both groups. Improvements in these metrics were equivalent between groups (p < 0.02). Furthermore, resident time to complete consent, patient satisfaction, and decision regret were not significantly different between groups.

Conclusion

Use of an educational video was equivalent to standard verbal informed consent for patients undergoing rhinologic surgery. Otolaryngologists can consider developing procedure-specific videos to allow allocation of time to other tasks, standardized education of patients, and streamlining of the informed consent process.
Survival prediction in glioblastoma on post-contrast magnetic resonance imaging using filtration based first-order texture analysis: Comparison of multiple machine learning models
Authors: Priya Sarv , Agarwal Amit , Ward Caitlin , Locke Thomas , Monga Varun , Bathla Girish
Published: February 2021

Objective

Magnetic resonance texture analysis (MRTA) is a relatively new technique that can be a valuable addition to clinical and imaging parameters in predicting prognosis. In the present study, we investigated the efficacy of MRTA for glioblastoma survival using T1 contrast-enhanced (CE) images for texture analysis.

Methods

We evaluated the diagnostic performance of multiple machine learning models based on first-order histogram statistical parameters derived from T1-weighted CE images in the survival stratification of glioblastoma multiforme (GBM). Retrospective evaluation of 85 patients with GBM was performed. Thirty-six first-order texture parameters at six spatial scale filters (SSF) were extracted on the T1 CE axial images for the whole tumor using commercially available research software. Several machine learning classification models (in four broad categories: linear, penalized linear, non-linear, and ensemble classifiers) were evaluated to assess the survival prediction performance using optimal features. Principal component analysis was used prior to fitting the linear classifiers in order to reduce the dimensionality of the feature inputs. Fivefold cross-validation was used to partition the data iteratively into training and testing sets. The area under the receiver operating characteristic curve (AUC) was used to assess the diagnostic performance.

Results

The neural network model was the highest performing model with the highest observed AUC (0.811) and cross-validated AUC (0.71). The most important variable was the age at diagnosis, with mean and mean of positive pixels (MPP) for SSF = 0 being the second and third most important, followed by skewness for SSF = 0 and SSF = 4.

Conclusions

First-order texture features, when combined with age at presentation, show good accuracy in predicting GBM survival.
The role of acalabrutinib in adults with chronic lymphocytic leukemia
Authors: Fakhri Bita , Andreadis Charalambos
Published: February 2021

The treatment landscape of chronic lymphocytic leukemia (CLL) has significantly changed in the past decade. This paradigm shift is due to the introduction of novel agents to the field. The two major classes of drugs that have contributed to this dramatic evolution include the Bruton tyrosine kinase (BTK) inhibitors and BCL2 inhibitors. Ibrutinib was the first-in-class drug which was initially approved by the US Food and Drug Administration (FDA) for the treatment of patients with relapsed/refractory and later for patients with treatment-naïve CLL. Despite encouraging efficacy outcomes, its use has been associated with cardiovascular and gastrointestinal toxicities likely due to off-target inhibition of ITK, TEC and EGFR family kinases. The next generation of BTK inhibitors was developed to be more selective with less off-target inhibition with the prospect to improve tolerability without compromising efficacy. Acalabrutinib, a selective covalent BTK inhibitor, is a second generation BTK inhibitor. The focus of this review is on two major phase III trials that resulted in the FDA approval of acalabrutinib in 2019. The ELEVATE TN trial investigated acalabrutinib with or without obintuzumab versus chlorambucil–obinutuzumab in older and frail patients with previously untreated CLL. The ASCEND trial explored acalabrutinib versus chemoimmunotherapy in patients with relapsed/refractory CLL. Both trials demonstrated superiority of the acalabrutinib-containing arms in terms of both efficacy and tolerability. Unfortunately, the availability of new generation BTK inhibitors has not resulted in mitigating the financial toxicities associated with these potentially life-long treatments.
Tissue-engineered autologous peritoneal grafts for bladder reconstruction in a porcine model
Authors: Chen Biao , Chen Xia , Wang Wenjia , Shen Jun , Song Zhiqiang , Ji Haoyu , Zhang Fangyuan , Wu Jianchen , Na Jie , Li Shengwen
Published: February 2021

Ileal neobladder construction is a common treatment for patients with bladder cancer after radical cystectomy. However, metabolic disorders caused by transposed bowel segments occur frequently. Bladder tissue engineering is a promising alternative approach. Although numerous studies have reported bladder reconstruction using acellular and cellular scaffolds, there are also disadvantages associated with these methods, such as immunogenicity of synthetic grafts and incompatible mechanical properties of the biomaterials. Here, we engineered an autologous peritoneal graft consisting of a peritoneal sheet and the seromuscular layer from the ileum. Three months after the surgery, compared with the neobladder made from the ileum, the reconstructed neobladder using our new method showed normal function and better gross morphological characteristics. Moreover, histopathological and transcriptomic analysis revealed urothelium-like cells expressing urothelial biomarkers appeared in the neobladder, while no such changes were observed in the control group. Overall, our study provides a new strategy for bladder tissue engineering and informs a variety of future research prospects.
An Environmental Scan of Ambulatory Care Quality Indicators for Patients With Advanced Kidney Disease Currently Used in Canada
Authors: Hingwala Jay , Molnar Amber O. , Mysore Priyanka , Silver Samuel A.
Published: February 2021

Background:

Quality indicators can be used to identify gaps in care and drive frontline improvement activities. These efforts are important to prevent adverse events in the increasing number of ambulatory patients with advanced kidney disease in Canada, but it is unclear what indicators exist and the components of health care quality they measure.

Objective:

We sought to identify, categorize, and evaluate quality indicators currently in use across Canada for ambulatory patients with advanced kidney disease.

Design:

Environmental scan of quality indicators currently being collected by various organizations.

Setting:

We assembled a 16-member group from across Canada with expertise in nephrology and quality improvement.

Patients:

Our scan included indicators relevant to patients with chronic kidney disease in ambulatory care clinics.

Measurements:

We categorized the identified quality indicators using the Institute of Medicine and Donabedian frameworks.

Methods:

A 4-member panel used a modified Delphi process to evaluate the indicators found during the environmental scan using the American College of Physicians/Agency for Healthcare Research and Quality criteria. The ratings were then shared with the full panel for further comments and approval.

Results:

The environmental scan found 28 quality indicators across 7 provinces, with 8 (29%) rated as “necessary” to distinguish high-quality from poor-quality care. Of these 8 indicators, 3 were measured by more than 1 province (% of patients on a statin, number of patients receiving a preemptive transplant, and estimated glomerular filtration rate at dialysis start); no indicator was used by more than 2 provinces. None of the indicators rated as necessary measured timely or equitable care, nor did we identify any measures that assessed the setting in which care occurs (ie, structure measures).

Limitations:

Our list cannot be considered as an exhaustive list of available quality indicators at hand in Canada. Our work focused on quality indicators for nephrology providers and programs, and not indicators that can be applied across primary and specialty providers. We also focused on indicator constructs and not the detailed definitions or their application. Last, our panel does not represent the views of other important stakeholders.

Conclusions:

Our environmental scan provides a snapshot of the scope of quality indicators for ambulatory patients with advanced kidney disease in Canada. This catalog should inform indicator selection and the development of new indicators based on the identified gaps, as well as motivate increased pan-Canadian collaboration on quality measurement and improvement.

Trial registration:

Not applicable as this article is not a systematic review, nor does it report results of a health intervention on human participants.
Immunoglobulin-A Vasculitis With Renal Involvement in a Patient With COVID-19: A Case Report and Review of Acute Kidney Injury Related to SARS-CoV-2
Authors: Li Nicholas L. , Papini Adam B. , Shao Tiffany , Girard Louis
Published: February 2021

Rationale:

Acute kidney injury is a common complication of COVID-19 and is associated with significantly increased mortality. The most frequent renal biopsy finding with SARS-CoV-2 infection is acute tubular injury; however, new onset glomerular diseases have been reported. The development of persistent urinary abnormalities in patients with COVID-19 should prompt consideration for renal biopsy to rule out glomerulonephritis.

Presenting Concerns:

A 30-year-old man with no prior medical history presented to the emergency department with symptoms of COVID-19 and new onset painful purpuric rash, arthralgia, and abdominal pain. SARS-CoV-2 infection was confirmed with nucleic acid testing and laboratory investigations revealed preserved renal function with dysmorphic hematuria and nephrotic range proteinuria.

Diagnosis:

A skin biopsy of the purpuric rash was performed, which demonstrated leukocytoclastic vasculitis. Renal biopsy revealed focally crescentic and segmentally necrotizing IgA nephropathy. Overall, given the clinical syndrome of glomerulonephritis with purpuric rash, arthralgia, and abdominal pain, the presentation is most in keeping with a diagnosis of IgA vasculitis in the setting of COVID-19.

Interventions:

The patient was treated conservatively for COVID-19 in the community. A 7-day course of prednisone was started for the vasculitic rash. IgA nephropathy was managed conservatively with blood pressure control and RAAS blockade with losartan.

Outcomes:

With conservative management, the patient’s COVID-19 symptoms resolved completely and he did not require hospital admission. Following prednisone therapy, the patient’s rash, arthralgia, and abdominal pain improved. However, despite resolution of COVID-19, hematuria and proteinuria persisted. With the initiation of RAAS blockade, renal function remained stable and proteinuria improved dramatically at 6 weeks.

Novel Findings:

De novo glomerulonephritis is a renal manifestation of SARS-CoV-2 infection beyond acute tubular injury. IgA vasculitis appears to be a rare complication of COVID-19.
Impaired Autobiographical Memory Flexibility in Iranian Trauma Survivors With Posttraumatic Stress Disorder
Authors: Piltan Maryam , Moradi Ali Reza , Choobin Mohammad Hassan , Azadfallah Parviz , Eskandari Sara , Hitchcock Caitlin
Published: February 2021

Reduced ability to retrieve specific autobiographical memories is a well-defined feature of posttraumatic stress disorder (PTSD), and science-driven interventions have emerged to improve memory specificity and thereby symptoms. However, research in depressed samples indicates that the ability to flexibly move between retrieval of specific and general memory types (i.e., memory flexibility) may more accurately conceptualize autobiographical memory deficits in emotional disturbance. In this study, we evaluated memory specificity and memory flexibility in Iranian trauma survivors ( N = 63) with and without PTSD relative to community control participants. Trauma-exposed participants had experienced a serious road-traffic accident. Results indicated that individuals with PTSD experienced reduced memory specificity and memory flexibility relative to trauma-exposed participants and community control participants. A small sample size limits the strength of conclusions, although good statistical power was obtained. Findings suggest that reduced memory flexibility may be a transdiagnostic marker of emotional disturbance and support further development of memory flexibility interventions for PTSD.
The Association of Adverse Childhood Experiences and Resilience With Health Outcomes in Adolescents: An Observational Study
Authors: Hall Ashleigh , Perez Alberly , West Xandria , Brown Maryilyn , Kim Ella , Salih Zainab , Aronoff Stephen
Published: February 2021

The relationship between Adverse childhood experiences (ACEs), resilience, and health outcomes has not been as thoroughly studied in adolescents. Adolescents completed the ACEs Questionnaire and a validated resilience measure (Child Youth Resilience Measure, or CYRM). Poor health outcome was having 1 or more: obesity, hypertension, and/or depression. 34.5% of teens had a poor health outcome, 38.6% had ACE scores of 4 or more, and resilience ranged from 45 to 84 (mean = 74.6). By univariate and bivariate analysis, ACEs (OR = 1.11, 95% CI = 1.03-1.19, P = .0039; OR = 1.08, 95% CI = 1.0-1.16, P = .045) and resilience (OR = 0.95, 95% CI = 0.92-0.98, P = .0016; OR = 0.96, 95% CI = 0.93-0.99, P = .016) were significantly associated with poor health outcome. Resilience relationship subscale was significantly associated with reduced health risk (OR = 0.85, 95%CI = 0.75-0.95, P = .005). ACEs are associated with poor health outcomes in adolescents, resilience is inversely related, and the caregiver relationship may be the driving force.
The Relationship Between Language Barrier in Non-Arabic Nurses and Anxiety in Cardiovascular Patients: A Cross-Sectional Descriptive Study
Authors: Almualem Jassem , Darwish Amal , AlFaraj Ahmed
Published: February 2021

Patients with cardiac conditions may suffer from anxiety related to prognosis and further rehabilitation. Anxiety could be exacerbated by different factors including miscommunication, which could be attributed to the linguistic barrier, that exists among health care providers. At Saud Al-Babtain Cardiac Center (SBCC), nurses who are non-native Arabic speakers could have difficulty communicating disease-related information at different stages of nursing care. Is it possible to identify the language barrier as a source of anxiety for admitted patients with cardiac diseases? In this cross-sectional, descriptive study, 50 patients were included following the diagnosis of cardiac disease and post-cardiac surgery. A questionnaire that measures anxiety level showed that patients who were handled by Arabic-speaking nurses reported less collective mean for the anxiety domain statements of (20.08) versus those who were handled by Non-Arabic-speaking nurses (28.55, P value = .041). Our finding indicates that anxiety levels increased when there was a language barrier between nurses and patients, which could affect the quality of care delivery at SBCC.
SARS-CoV-2 Seropositivity among Dental Staff and the Role of Aspirating Systems
Authors: Sarapultseva M. , Hu D. , Sarapultsev A.
Published: February 2021

Introduction:

Health care workers (HCWs) are at a high risk of infection owing to occupational exposure to patients and virus-contaminated surfaces.

Objectives:

The study was aimed to reveal and compare the seroprevalence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection among patient-facing HCWs across 3 dental clinics equipped with different types of aspirating systems.

Methods:

This retrospective cohort study included 157 HCWs (43.58 ± 1.66 y) from 3 dental clinics in Ekaterinburg (Russian Federation) who reported to work during the coronavirus disease pandemic. All HCWs underwent serological testing once a week to detect immunoglobulin G and M antibodies against the SARS-CoV-2. The V6000 aspirating system with a vacuum controller (dry or semidry mode) and high-efficiency particulate air (HEPA) filters was used at clinics A and B, and the aspirated aerosol and air were evacuated and dissipated into the atmosphere. The VS900 aspirating vacuum pump without HEPA filters was used at clinic C. The aspirated aerosol and air were evacuated and dissipated into the operatories. All dental clinics followed the same recommendations for dental patient management and types of personal protective equipment used.

Results:

The estimated prevalence of SARS-CoV-2 infection was 11.5% (19 HCWs) over a 5-mo follow-up (May to August 2020). The prevalence of infection was unaffected by sex or the role of the member in the dental team (dentist/dental assistant). The prevalence of SARS-CoV-2 infection (+) was significantly higher at clinic C (equipped with an aspirating vacuum pump without HEPA filters) than at other clinics.

Conclusion:

The type of aspirating system used and the presence of HEPA filters could affect the prevalence of SARS-CoV-2 infection across dental clinics. Therefore, we recommend the use of aspirating systems installed with HEPA filters, which evacuate and dissipate aerosols into specialized areas.

Knowledge Transfer Statement:

This report confirms that dentists, being patient-facing HCWs, are at a high risk of acquiring the SARS-CoV-2 infection and identifies gaps in the protection of patients and staff in dental settings.
Assessing Medical Students’ Knowledge of the Deaf Culture and Community in Puerto Rico: A Descriptive Study
Authors: Kung Michael S , Lozano Andrea , Covas Vicente J , Rivera-González Lorena , Hernández-Blanco Yllen Y , Diaz-Algorri Yaritza , Chinapen Sandra
Published: February 2021

Background:

Effective communication between health care professionals and Deaf and Hard of Hearing (D&HH) patients remains a challenge. Literature regarding health professionals’ knowledge of the D&HH community and their barriers toward health care access is limited in Puerto Rico and suggests a need for research. Therefore, this descriptive study aims to evaluate future physician’s knowledge about the Deaf culture and community in a student cohort at San Juan Bautista School of Medicine (SJBSM), with the objective of guiding our results toward improving our curriculum.

Methods:

Medical students answered a survey to evaluate their knowledge of D&HH patients. The survey consisted of 3 parts testing awareness, exposure, and knowledge of the Deaf community. Responses from the Knowledge section were graded using an answer key, and correct answers were added to create an overall continuous sum score per participant, with higher scores meaning higher knowledge. Participants were also asked to write in possible issues deaf patients may face when hospitalized, apart from communication problems. All data were recorded and used for descriptive analysis.

Results:

158 (68%) medical students participated. 63% reported exposure to D&HH people, and 80% were aware of the Deaf culture. 21% of students answered to have attended an American Sign Language (ASL) class, and 86% expressed interest in taking an ASL class. The overall percentage of correct answers from all the medical groups evaluated was 39%, with increasing percent knowledge as medical student year increased. The most frequently listed problem by respondents that deaf patients may face when hospitalized was dealing with an emergency in the hospital, such as the fire alarm.

Conclusion:

Students from clinical years (MSIII & MSIV) showed a better understanding of the Deaf culture than students in pre-clinical years (MSI & MSII). Nevertheless, the knowledge was limited in all groups. The information generated is not only valuable for our school but the healthcare community as well. The literature related to Deaf culture, particularly in the medical setting in Puerto Rico, is limited. Therefore, there exists a need to continue investigating ways to improve medical students’ education of the Deaf culture and community.
Stress-driven two-phase integral elasticity for Timoshenko curved beams
Authors: Vaccaro Marzia S , Pinnola Francesco P , de Sciarra Francesco Marotti , Canadija Marko , Barretta Raffaele
Published: February 2021

In this research, the size-dependent static behaviour of elastic curved stubby beams is investigated by Timoshenko kinematics. Stress-driven two-phase integral elasticity is adopted to model size effects which soften or stiffen classical local responses. The corresponding governing equations of nonlocal elasticity are established and discussed, non-classical boundary conditions are detected and an effective coordinate-free solution procedure is proposed. The presented mixture approach is elucidated by solving simple curved small-scale beams of current interest in Nanotechnology. The contributed results could be useful for design and optimization of modern sensors and actuators.
Impacts of interpersonal distancing on-board trains during the COVID-19 emergency
Authors: Coppola Pierluigi , De Fabiis Francesco
Published: February 2021

Introduction

The COVID-19 emergency and the cities lockdown have had a strong impact on transport and mobility. In particular, travel demand has registered an unprecedented overall contraction, dramatically dropping down with peaks of - 90%-95% passengers for public transport (PT). During the re-opening phase, demand is gradually resuming the levels before the crisis, although some structural changes are observed in travel behaviour, and containment measures to reduce the risk of contagion are still being applied, affecting transport supply.

Objective

This paper aims at assessing to what extent keeping a one-meter interpersonal distancing on-board trains is sustainable for public transport companies.

Method

The analysis is based on travel demand forecasting models applied to two case-studies in Italy: a suburban railway line and a High-speed Rail (HSR) line, differentiated by demand characteristics (e.g. urban vs. ex-urban) and train access system (free access vs. reservation required).

Results

In the suburban case, the results show the need of new urban policies, not only limited to the transport domain, in order to manage the demand peaks at the stations and on-board vehicles. In the ex-urban case, the outputs suggest the need for public subsidies in order for the railways undertakings to cope with revenue losses and, at the same time, to maintain service quality levels.
Care-giver identity impacts offspring development and performance in an annually social bumble bee
Authors: Costa Claudinéia P. , Fisher Kaleigh , Guillén Blanca M. , Yamanaka Naoki , Bloch Guy , Woodard S. Hollis
Published: February 2021

Background

The developmental fates of offspring have the potential to be influenced by the identity of their care-givers and by the nature of the care that they receive. In animals that exhibit both parental and alloparental care, such as the annually eusocial insects, the influence of care-giver identity can be directly assessed to yield mechanistic and evolutionary insights into the origins and elaboration of brood care. Here, we performed a comparative investigation of maternal and worker brood care in bumble bees, a pollinator group where mothers (queens) rear the first offspring in the nest, and then daughters (workers) assume this role upon their emergence. Specifically, we compared the effects of queen and worker brood care on offspring development and also offspring performance, for a set of traits related to sensory biology, learning, and stress resistance.

Results

We found that queen-reared workers were smaller-bodied than worker-reared offspring, suggesting that bumble bee queens influence body size determination in their offspring. We also found that queen-reared workers were more resistant to starvation, which might be beneficial for early nesting success. These maternal influences could not be explained by feeding rate, given that we detected a similar offspring feeding frequency in both queens and workers.

Conclusion

Bumble bee queens have a unique influence on the development of the first offspring in the nest, which they rear, relative to worker-reared workers. We propose that bumble bee brood care has been shaped by a suite of evolutionary and ecological factors, which might include a maternal influence on traits that promote survival of incipient colonies.
A validation study of the 4-variable and 8-variable kidney failure risk equation in transplant recipients in the United Kingdom
Authors: Ali Ibrahim , Kalra Philip A.
Published: February 2021

Background

There is emerging evidence that the 4-variable Kidney Failure Risk Equation (KFRE) can be used for risk prediction of graft failure in transplant recipients. However, geographical validation of the 4-variable KFRE in transplant patients is lacking, as is whether the more extensive 8-variable KFRE improves predictive accuracy. This study aimed to validate the 4- and 8-variable KFRE predictions of the 5-year death-censored risk of graft failure in patients in the United Kingdom.

Methods

A retrospective cohort study involved 415 transplant recipients who had their first renal transplant between 2003 and 2015 and were under follow-up at Salford Royal NHS Foundation Trust. The KFRE risk scores were calculated on variables taken 1-year post-transplant. The area under the receiver operating characteristic curves (AUC) and calibration plots were evaluated to determine discrimination and calibration of the 4- and 8-variable KFREs in the whole cohort as well as in a subgroup analysis of living and deceased donor recipients and in patients with an eGFR< 45 ml/min/1.73m2.

Results

There were 16 graft failure events (4%) in the whole cohort. The 4- and 8-variable KFREs showed good discrimination with AUC of 0.743 (95% confidence interval [CI] 0.610–0.876) and 0.751 (95% CI 0.629–0.872) respectively. In patients with an eGFR< 45 ml/min/1.73m2, the 8-variable KFRE had good discrimination with an AUC of 0.785 (95% CI 0.558–0.982) but the 4-variable provided excellent discrimination in this group with an AUC of 0.817 (0.646–0.988). Calibration plots however showed poor calibration with risk scores tending to underestimate risk of graft failure in low-risk patients and overestimate risk in high-risk patients, which was seen in the primary and subgroup analyses.

Conclusions

Despite adequate discrimination, the 4- and 8-variable KFREs are imprecise in predicting graft failure in transplant recipients using data 1-year post-transplant. Larger, international studies involving diverse patient populations should be considered to corroborate these findings.
A population-based study of preeclampsia and eclampsia in Ecuador: ethnic, geographical and altitudes differences
Authors: Tejera Eduardo , Sánchez Maria Eugenia , Henríquez-Trujillo Aquiles R. , Pérez-Castillo Yunierkis , Coral-Almeida Marco
Published: February 2021

Background

In Ecuador eclampsia and preeclampsia were identified as the third cause of maternal death. Like other Latin-American countries, Ecuador has human settlements living from 0 to more than 4000 m of altitude and comprising a wide ethnic-diversity across all these altitude changes. These characteristics offer the possibility to study a wide variety of possible risk factors for preeclampsia and eclampsia.

Methods

We conducted a population-based retrospective study of all deliveries in Ecuador from 2015 through 2017. The main variables analyzed were: altitude, ethnic self-identification, geographic location, and maternal age. The data comes from the Ecuadorian National Institute of Statistics and Census (INEC) and the Ecuadorian Ministry of Health. Data information regarding maternal parity and socioeconomic status was not available from official records. Logistic regression analysis was used to study the relationship between preeclampsia and eclampsia with the variable of interest. Geospatial statistical analysis was done to identify statistically significant spatial clusters of preeclampsia and eclampsia cases.

Results

The incidence of preeclampsia was estimated between 5.11 (5.05–5.18) and 6.23 (6.16–6.30), and 0.25 (0.23–0.26) for eclampsia. Native American have a lower incidence regarding preeclampsia compared to other ethnic groups. High altitude has a significant odds ratio (OR = 2.31, 1.93–2.78) of preeclampsia. Montubio residing in middle altitude (1500–3500 m) have the highest risk of preeclampsia (OR = 18.13, 9.53–34.50). Afro-Ecuadorians also have an increased risk of preeclampsia associated with altitude (OR = 2.36, 1.78–3.14). Ethnicity was not identified as a risk factor for eclampsia. Early and older maternal age was associated with an increased risk of preeclampsia and eclampsia. Women living more than 20 km from the obstetric unit have an OR = 2.61 (2.32–2.95, p-value< 0.01) and OR = 1.87 (1.82–1.92, p-value< 0.01) of developing eclampsia and preeclampsia respectively.

Conclusions

Preeclampsia is widespread across low and high-altitude areas, while eclampsia is mostly located at lower altitudes. Montubios living at middle or high altitudes represents the ethnic group with a higher risk of preeclampsia. No ethnic effect was identified as a potential risk factor for eclampsia. Moreover, in eclampsia the associated risk of young women seems to be higher than in preeclampsia.
Incidence of multiple births in relation to current regulations in Turkey regarding embryo transfer
Authors: Kahraman Semra , Duzguner Ipek Nur Balin , Duzguner Soner , Sahin Yucel , Sen Cihat
Published: February 2021

Background

Before 2010, there were no regulations in Turkey regarding the number of embryos to be transferred in one cycle. In March 2010, regulations restricting this number were implemented by the Turkish Ministry of Health. These specify the transfer of a maximum of one embryo in the first and second cycles and a maximum of two embryos in subsequent cycles in women aged < 35, and a maximum of two embryos in women aged ≥35 in any one cycle. Our study evaluates the effect of these regulations.

Methods

This large retrospective single center study first evaluates the incidence of multiple pregnancies before and after the implementation of the 2010 regulations. Secondly, it compares the clinical outcomes of double blastocyst transfer (DBT) and single blastocyst transfer (SBT) performed in compliance with these regulations from 2014 onwards.

Results

After the introduction of the 2010 regulations, the multiple pregnancy rate decreased significantly from 37.9 to 15.7%. The singleton live birth rate increased significantly, whereas multıiple live birth rates significantly decreased (p = < 0.001).

When the clinical outcomes of SBT and DBT performed in compliance with regulations from 2014 onwards were evaluated, in patients < 35 years, the multiple pregnancy rate decreased from 47.2% in the DBT group to 1.7% in the SBT group (p = < 0.001). In patients ≥35 years, in the DBT group, the twin birth rate was again high at 28.4%, whereas in the SBT group, it was only 1.8% (p = < 0.001). Importantly, there was no statistically significant difference in clinical pregnancy rates between these two groups.

Conclusion

Turkish regulations have led to an encouragement of double embryo transfer (DET) as a routine practice, with many patients understanding it as an absolute right to have two embryos transferred. The results of our study suggest that, especially in the light of the success of blastocyst transfer, the Turkish regulations should be amended to limit the use of DET and encourage the use of single embryo transfer except in exceptional cases and particularly in women under 35 years old.
Minimal invasive versus open esophagectomy for patients with esophageal squamous cell carcinoma after neoadjuvant treatments
Authors: Chen Dongni , Wang Weidong , Mo Junxian , Ren Qiannan , Miao Huikai , Chen Youfang , Wen Zhesheng
Published: February 2021

Background

Although previous studies have discussed whether the minimally invasive esophagectomy (MIE) is superior to open surgery, the data concerning esophageal squamous cell carcinoma (ESCC) patients underwent neoadjuvant treatment followed by radical resection is limited. The purpose of our study was to compare the short- and long-term clinical outcomes of the two surgical approaches in treating ESCC patients.

Methods

Between January 2010 and December 2016, ESCC patients who had received neoadjuvant therapy and underwent Mckeown esophagectomy at our institute were eligible. The baseline characteristics, pathological data, short-and long-term outcomes of these patients were collected and compared based on the surgical approach.

Results

A total of 195 patients was included in the current study. Compared to patients underwent open surgery, patients underwent MIE had shorter operative time and less intraoperative bleeding (390 min vs 330 min, P = 0.001; 204 ml vs 167 ml, P = 0.021). In addition, the risk of anastomotic leakage was decreased in MIE group (20.0% vs 3.3%, P < 0.001), while the occurrence of other complications did not have statistical significance between two groups. Overall survival (OS) and disease-free survival (DFS) was no difference in patients received neoadjuvant chemotherapy between the two approaches. For the patients underwent neoadjuvant chemoradiotherapy, OS was significantly better in the MIE group (log rank = 6.197; P = 0.013).

Conclusion

Minimally invasive Mckeown esophagectomy is safe and feasible for ESCC patients who underwent neoadjuvant therapy. MIE approach presented better perioperative results than open esophagectomy. The effect of surgical approaches on survival was depending on the scheme of neoadjuvant treatment.
A simulation experiment study to examine the effects of noise on miners’ safety behavior in underground coal mines
Authors: Li Jing , Qin Yaru , Yang Lei , Wang Zhen , Han Ke , Guan Cheng
Published: February 2021

Background

Noise pollution in coal mines is of great concern. Personal injuries directly or indirectly related to noise occur from time to time. Its effects impact the health and safety of coal mine workers. This study aimed to identify if and how the level of noise impacts miners’ safety behavior in underground coal mines.

Methods

In order to study the influence of noise on miners in the mining industry, we built a coal mine noise simulation experiment system, and set the noise test level at 50 dB ~ 120 dB according to the actual working environment at well. We divided the noise gradient into 8 categories and conducted 93 experiments, in which we aim to test miners’ attention distribution, fatigue, and reaction under each level, and the experimental results were analyzed by SPSS22.0 software.

Results

The results show that the increase of environmental noise level will have an impact on the attention, reaction, and fatigue. The noise is positively related to the fatigue, the noise is negatively related to the attention and reaction. In the noise environment, the sensitivity of the personnel to optic stimuli is higher than that to acoustic stimuli. The test indicators of attention, fatigue, and reaction will change significantly, when the noise level is greater than 70 ~ 80 dB.

Conclusions

From the perspective of accident prevention, the noise level can be controlled within the range of less than 70 ~ 80 dB, which can control the occurrence of accidents to a certain extent.
Diet quality in the population of Norway and Poland: differences in the availability and consumption of food considering national nutrition guidelines and food market
Authors: Janowska-Miasik Ewelina , Waśkiewicz Anna , Witkowska Anna Maria , Drygas Wojciech , Markhus Maria Wik , Zujko Małgorzata Elżbieta , Kjellevold Marian
Published: February 2021

Background

Adequate nutrition is a public health challenge due to the increase in the incidence of diet-related diseases. The aim of this study was to examine food and nutrient intakes in the light of the current dietary guidelines of Poland and Norway. This is a suitable model for studying the diet quality in countries with different degrees of government intervention in the food market, which may affect food diversity available for citizens.

Methods

The food diversity on the market was assessed using national food balance sheets. To show the actual food and nutrient intake within countries, data from 24-h recalls from the national surveys, NORKOST 3 from Norwegians and WOBASZ II from Poles, were used. In order to evaluate whether dietary patterns comply with nutritional and dietary recommendations, the Norwegian and Polish recommendations for nutrition and the national food based dietary guidelines (FBDGs) were analyzed.

Results

Significant differences between the national supplies for most food products were found. Only subtle differences in the national FBDGs and nutritional recommendations were found. Low compliance with the national FBDGs for milk, fish and sugar consumption in Poland was observed. The intakes of most nutrients were in line with the countries’ nutrition recommendations. The intakes of folate and vitamin D by both genders and the intake of iron among women, were inadequate in both countries. Calcium and magnesium intakes were below the recommended intake among the adult population of Poland, additionally, insufficient intake of potassium and thiamine was found among Polish women.

Conclusions

Despite the limited availability of certain food products on the market, the diet of Norwegians was better balanced in terms of food consumed and micronutrient intakes. The good supply of various groups of food has not, however, reduced the problem of widespread deficiency of vitamin D and folic acid in the diet, and action should be taken at national level to eliminate their inadequacy. In view of increasing risk of non-communicable diseases, low compliance with the dietary guidelines requires educational campaigns aimed at increasing dietary literacy in vulnerable groups.
Follow-up results of microendoscopic discectomy compared to day surgery using percutaneous endoscopic lumbar discectomy for the treatment of lumbar disc herniation
Authors: Song Zhaojun , Ran Maobo , Luo Juan , Zhang Kai , Ye Yongjie , Zheng Jiazhuang , Zhang Zhi
Published: February 2021

Background

Percutaneous endoscopic lumbar discectomy (PELD) is satisfactory for hospitalized patients with lumbar disc herniation (LDH). Currently, only a few studies have reported about the day surgery patients undergoing PELD.

Methods

A total of 267 patients with LDH underwent PELD during day surgery and were followed up for at least 3 years. Clinical outcomes were assessed using the visual analog scale (VAS) for leg and lower back pain (VAS-B and VAS-L, respectively) and the Oswestry disability index (ODI). The radiological outcomes, such as lumbar lordosis (LL), sacral slope (SS), the disc-height ratio, and disc instability, were recorded and compared. The clinical effects between patients treated by PELD during day surgery and microendoscopic discectomy (MED) for contemporaneous hospitalized 116 patients with LDH were compared.

Results

Patients treated by PELD had lower blood loss and shorter hospital stay (P <  0.001) compared to those treated by MED. VAS-L, VAS-B, and ODI decreased significantly after PELD than before the operation and 3 years postoperatively. The postoperative VAS-B in the PELD group was significantly decreased than in the MED group (P = 0.001). The complications rate was 9.4% in the PELD group and 12.1% in the MED group (P = 0.471). The 1-year postoperative recurrence rate in the PELD group was much higher than that in MED group (P = 0.042). The postoperative LL and SS in the PELD group improved significantly compared to the values in the MED group (P <  0.001). According to the disc-height ratio at 3-year follow-up, a significant height loss was observed in the MED group than in the PELD group (P = 0.014).

Conclusions

Although the 1-year postoperative recurrence rate was relatively high, the day surgery for LDH undergoing PELD had advantages in terms of less blood loss intraoperatively, short hospital stay, efficacy for back pain, and efficiency to maintain lumbar physiological curvature.
A survey on critical health competences among diabetes educators using the Critical Health Competence Test (CHC Test)
Authors: Hecht Lars , Meyer Gabriele , Steckelberg Anke
Published: February 2021

Background

Diabetes associations claim to have a patient-centered approach in diabetes care including shared decision-making (SDM). Diabetes educators are important healthcare professionals for implementing the concept of informed SDM in diabetes care. They need critical health competences (CHC) in order to provide evidence-based information and to support patients in understanding the risks of the disease and also the possible benefits or harm of the healthcare options. Therefore, we surveyed the CHC of diabetes educators.

Methods

We performed a cross-sectional survey using the validated Critical Health Competences (CHC) Test to measure CHC of certified diabetes educators and trainees in Germany. Diabetes educators were approached via newsletter, mailing lists or in person during the conference of the German Diabetes Association. Trainees were approached during their training sessions. We applied scenario 1 of the CHC test, which comprises 17 items with open-ended and multiple-choice questions. Mean person parameters with a range from 0 to 1000 were calculated to assess the levels of critical health competences and a multiple linear regression analysis was conducted to determine correlations between sociodemographic variables and levels of CHC.

Results

A total of 325 participants, mean age 38.6 (±11.1) years, completed the CHC test; n = 174 (55.5%) were certified diabetes educators and n = 151 (46.5%) were trainees. The participants achieved a mean score of 409.84 person parameters (±88.10) (scale from 0 to 1000). A statistically significant association was found only between the level of education and the level of CHC (b = 0.221; p-value 0.002). Participants with grammar school education achieved higher mean scores compared to participants with secondary school education (432.88 ± 77.72 vs. 396.45 ± 85.95; mean difference 36.42 ± 9.29; 95%CI 18.15 to 54.71; p < 0.0001).

Conclusion

Diabetes educators achieved low competence scores and it can be assumed that they do not have sufficient CHC to conduct consultations based on the SDM principles. Poor CHC among healthcare providers are a major barrier for the implementation of SDM. Core concepts of evidence-based medicine should be implemented into the curricula for diabetes educators in order to increase their levels of CHC.