bluuebunny/crossref_metadata_2025 huggingface dataset:
When donor funding leaves: an interrupted time-series analysis of the impact of integrating direct HIV care and treatment into public health services in a region of Johannesburg
Authors: Lince-Deroche Naomi , Leuner Rahma , Meyer-Rath Gesine , Pillay Yogan , Long Lawrence
Published: October 2019

Background

Early in South Africa’s HIV response, donor-funded organizations directly provided HIV treatment through Comprehensive HIV Care, Management and Treatment sites (CCMTs), using their own and government staff. From 2012 to 2014 the donor-funded CCMT model was phased out, leaving nurses in South Africa’s public clinics responsible for delivery of antiretroviral treatment (ART) services. We aimed to examine the impact on resources, staff workloads, and service delivery throughout this period of integration of HIV treatment into primary health clinics.

Methods

We conducted an Interrupted Time-Series Analysis (ITSA) using data from three public clinics, including one former CCMT site, in one administrative region of Johannesburg. The ITSA was complemented by visual inspection of the data in Excel. We compared trends in expenditure, clinical staffing levels, patient headcounts, and services rendered at the clinics during four periods: pre-CCMT (2004–2007), CCMT operational (2007–2012), CCMT closure (2012–2014), and post-CCMT (2014–2016). Data were drawn from the country’s District Health Information System, a national HIV treatment database, local budget and expenditure reports, National Health Laboratory Service charge records, and staff records.

Results

Closure of the CCMT differentially impacted the study clinics. As expected, ART services decreased at Clinic 1, where the CCMT was co-located, and increased at Clinics 2 and 3 possibly reflecting redistribution of patients. Despite a reduction in patient headcounts post-CCMT, Clinic 1 experienced a decrease in staff and a large increase in patients seen per clinical staff member per month. In contrast, Clinics 2 and 3 increased or maintained stable workforces, and staff workloads post closure were similar to pre-closure levels. Other primary care services—contraception and immunisations—seemed largely unaffected at Clinics 1 and 2. At Clinic 3, service delivery reduced, but this was accompanied by lowered patient headcounts generally, likely due to clinic renovations.

Conclusions

In this study, integration of HIV treatment into primary healthcare services did not result in large-scale reductions in overall service delivery. One facility did experience increased staff workloads, but we were unable to assess service quality. To mitigate potential problems, monitoring systems should be introduced in advance and acknowledge the disparate and decentralised management of various data sources.
Biomarkers associating endothelial dysregulation in pediatric-onset systemic lupus erythematous
Authors: Lee Wan-Fang , Wu Chao-Yi , Yang Huang-Yu , Lee Wen-I , Chen Li-Chen , Ou Liang-Shiou , Huang Jing-Long
Published: October 2019

Background/purpose

Endothelium is a key element in the regulation of vascular homeostasis and its alteration can lead to the development of vascular diseases. Systemic lupus erythematosus (SLE) is a systemic autoimmune disease with potential extensive vascular lesions, involving skin vessels, renal glomeruli, cardiovascular system, brain, lung alveoli, gastrointestinal tract vessels and more. We aimed to assess endothelial dysregulation related biomarkers in pediatric-onset SLE (pSLE) patient serum and elucidate its correlation with their clinical features, laboratory parameters, and the overall disease activity.

Methods

Disease activities were evaluated by SLE disease activity index (SLEDAI). Patient characteristics were obtained by retrospective chart review. Six biomarkers associated with endothelial dysregulation, including Angiopoietin-1 (Ang-1), Angiopoietin-2 (Ang-2), Tie2, Vascular endothelial growth factor(VEGF), thrombomodulin, and a disintegrin-like and metalloprotease with thrombospondin type 1 motif (ADAMTS13) were tested through enzyme-linked immunosorbent assay (ELISA) measurement.

Results

This study comprised 118 pSLE patients. Data from 40 age-matched healthy controls were also obtained. The mean diagnostic age was 13 ± 4.12 years-old and 90.7% are females. Serum levels of VEGF, Tie2, thrombomodulin were significantly higher while serum ADAMTS13 was lower in active pSLE patients when compared to those with inactive diseases (allp < 0.05). In organ specific association, serum thrombomodulin level was higher in pSLE patient with renal involvement, and serum ADAMTS13 levels was negatively associated with neurological involvement (p < 0.05). A cutoff of thrombomodulin at 3333.6 pg/ml best correlated renal involvement. (AUC = 0.752,p < 0.01).

Conclusion

Endothelial dysregulation associating proteins seems to be potent biomarkers for pSLE activity as well as organ involvement in pSLE patients. These biomarkers may be beneficial in understanding of the vascular pathogenesis and disease monitoring.
The association of infant feeding patterns with food allergy symptoms and food allergy in early childhood
Authors: Mathias Joacy G. , Zhang Hongmei , Soto-Ramirez Nelis , Karmaus Wilfried
Published: October 2019

Background

The role of infant feeding for food allergy in children is unclear and studies have not addressed simultaneous exposures to different foods. The goal of this study was to analyze existing data on feeding practices that represent realistic exposure and assess the risk of food allergy symptoms and food allergy in children.

Methods

The Infant Feeding Practices Study II conducted by the CDC and US-FDA enrolled pregnant women and collected infant feeding information using nine repeated surveys. Participants were re-contacted after 6 years. Food allergy data were collected at 4, 9, 12, and 72 months. In total, 1387 participants had complete infant feeding pattern data for 6 months and information on food allergy symptoms and doctors’ diagnosed food allergy. Feeding patterns constituted six groups: 3-months of feeding at breast followed by mixed feeding, 3-months of breast milk and bottled milk followed by mixed feeding, 1-month of feeding at breast followed by mixed feeding, 6-months of mixed feeding i.e., concurrent feeding of breast milk, bottled milk and formula, 2–3 months of formula followed by formula and solid food, and formula and solid food since the first month. To estimate risks of food allergy, we used linear mixed models, controlling for potential confounders.

Results

Of the 328 children with food allergy symptoms in infancy and at 6 years, 52 had persistent symptoms from infancy. Children exposed to mixed feeding had a higher risk of food allergy symptoms (Risk Ratio [RR] 1.54; 95% Confidence Interval [CI] 1.04, 2.29) compared to 3-months of feeding at breast adjusted for confounding. No statistically significant risk of infant feeding patterns was found for doctors’ diagnosed food allergy. Paternal allergy posed a higher risk for food allergy symptoms (RR 1.36; 95% CI 1.01, 1.83). Prenatal maternal smoking increased the risk for doctors’ diagnosed food allergy (RR 2.97; 95% CI 1.53, 5.79).

Conclusions

Analysis of this prospective birth cohort suggest that introduction of multiple feeding source may lead to food allergy symptoms. Future efforts are needed to determine acceptable approaches to improve the ascertainment of food allergy in children and the role of infant feeding.
Effects of reflexology on premenstrual syndrome: a systematic review and meta-analysis
Authors: Hasanpour Marzieh , Mohammadi Mohammad Mehdi , Shareinia Habib
Published: October 2019

Background

Premenstrual syndrome (PMS) refers to a set of somatic and psychological symptoms that occur cyclically in the luteal phase of a menstrual cycle. There is no report of final result of reflexology on PMS. Therefore, the present study aimed to determine the effect of reflexology on PMS through a systematic review and meta-analysis study.

Method

The present study was a systematic review and meta-analysis that was conducted by searching in 8 electronic databases including PubMed, EMBASE, Cochrane Library, Web of Science, ProQuest, Scopus, Google Scholar, and SID until December 28, 2018. In this regard, interventional studies, which examined the impact of reflexology on women with premenstrual syndrome, were included. These studies were published during 1993 to 2018. The Cochrane Collaboration’s Risk of Bias Tool was used to assess the quality of studies. Meta-analysis was performed by the help of CMA 2 software.

Results

Nine out of 407 studies finally remained after screening, and quantitative and quantitative analyses were performed on them. The total number of research samples was 475. The mean treatment time with reflexology was 40.55 min per session that was performed in 6 to 10 sessions of treatment in 66.67% of studies. According to the meta-analysis and based on the random effects model, the reflexology could decrease the severity of PMS in the intervention group compared to the control group (SMD = − 2.717, 95% CI: − 3.722 to − 1.712). Meta-regression results indicated that the duration of intervention sessions (β = − 0.1124, 95% CI − 0.142 to − 0.084, p < 0.001) had a significant impact on the severity of PMS. Reflexology could also significantly affect somatic (SMD = − 1.142, 95% CI: − 1.481 to − 0.803) and psychological (SMD = − 1.380, 95% CI: − 2.082 to − 0.677) symptoms arising from PMS.

Conclusion

In general, results of the present study indicated that the reflexology could relieve PMS symptoms, so that overall scores, somatic and psychological symptoms of PMS decreased by applying the reflexology intervention. Furthermore, an increase in the length of reflexology time in each session increased its efficiency. Reflexology can be used as an effective intervention in a patient care program by nurses and its efficiency can be enhanced by increasing intervention time in each reflexology treatment session.
Painless destructive thyroiditis in a patient with resistance to thyroid hormone: a case report
Authors: Nagamine Tomoko , Noh Jaeduk Yoshimura , Emoto Naoya , Kogai Takahito , Hishinuma Akira , Okajima Fumitaka , Sugihara Hitoshi
Published: October 2019

Background

Resistance to thyroid hormone (RTH) usually features a syndrome of inappropriate secretion of thyroid-stimulating hormone (SITSH) without suppression of the typical high thyroid hormone levels. However, some patients with RTH show thyroid-stimulating hormone (TSH) suppression due to thyrotoxicosis. We report a case of painless thyroiditis in a patient with RTH that was misdiagnosed as Graves’ disease because of TSH-suppressed thyrotoxicosis.

Case presentation

A sixteen-year-old boy consulted a local general physician for fatigue. He had a goiter, and biochemical analysis showed TSH < 0.1 μIU/mL, free triiodothyronine (FT3) of 2.70 pg/mL, and free thyroxine (FT4) of 3.6 ng/dL. He was diagnosed with Graves’ disease and was treated with 20 mg thiamazole. One year later, he was referred to the department of endocrinology because of SITSH. He was finally diagnosed with RTH due to the finding of a heterozygous missense mutation (methionine 334 threonine) in the thyroid hormone receptor β gene. Three years after cessation of thiamazole, his hyperthyroxinemia showed marked exacerbation with TSH suppression. We diagnosed him with painless destructive thyroiditis because of low technetium-99 m (Tc-99 m) uptake in the thyroid. Extreme hyperthyroxinemia was ameliorated, with a return to the usual SITSH levels, within 1 month without any treatment.

Conclusion

The present case demonstrates that diagnosing RTH is difficult when patients show hyperthyroxinemia with complete suppression of TSH to undetectable levels, and the data lead to misdiagnosis of RTH as Graves’ disease. The initial diagnosis is important, and Tc-99 m scintigraphy is useful for the differential diagnosis of thyrotoxicosis accompanying RTH.
Soil domestication by rice cultivation results in plant-soil feedback through shifts in soil microbiota
Authors: Edwards Joseph , Santos-Medellín Christian , Nguyen Bao , Kilmer John , Liechty Zachary , Veliz Esteban , Ni Jiadong , Phillips Gregory , Sundaresan Venkatesan
Published: October 2019

Background

Soils are a key component of agricultural productivity, and soil microbiota determine the availability of many essential plant nutrients. Agricultural domestication of soils, that is, the conversion of previously uncultivated soils to a cultivated state, is frequently accompanied by intensive monoculture, especially in the developing world. However, there is limited understanding of how continuous cultivation alters the structure of prokaryotic soil microbiota after soil domestication, including to what extent crop plants impact soil microbiota composition, and how changes in microbiota composition arising from cultivation affect crop performance.

Results

We show here that continuous monoculture (> 8 growing seasons) of the major food crop rice under flooded conditions is associated with a pronounced shift in soil bacterial and archaeal microbiota structure towards a more consistent composition, thereby domesticating microbiota of previously uncultivated sites. Aside from the potential effects of agricultural cultivation practices, we provide evidence that rice plants themselves are important drivers of the domestication process, acting through selective enrichment of specific taxa, including methanogenic archaea, in their rhizosphere that differ from those of native plants growing in the same environment. Furthermore, we find that microbiota from soils domesticated by rice cultivation contribute to plant-soil feedback, by imparting a negative effect on rice seedling vigor.

Conclusions

Soil domestication through continuous monoculture cultivation of rice results in compositional changes in the soil microbiota, which are in part driven by the rice plants. The consequences include a negative impact on plant performance and increases in greenhouse gas emitting microbes.
sli is required for proper morphology and migration of sensory neurons in the Drosophila PNS
Authors: Gonsior Madison , Ismat Afshan
Published: October 2019

Neurons and glial cells coordinate with each other in many different aspects of nervous system development. Both types of cells are receiving multiple guidance cues to guide the neurons and glial cells to their proper final position. The lateral chordotonal organs (lch5) of the Drosophila peripheral nervous system (PNS) are composed of five sensory neurons surrounded by four different glial cells, scolopale cells, cap cells, attachment cells and ligament cells. During embryogenesis, the lch5 neurons go through a rotation and ventral migration to reach their final position in the lateral region of the abdomen. We show here that the extracellular ligand sli is required for the proper ventral migration and morphology of the lch5 neurons. We further show that mutations in the Sli receptors Robo and Robo2 also display similar defects as loss of sli, suggesting a role for Slit-Robo signaling in lch5 migration and positioning. Additionally, we demonstrate that the scolopale, cap and attachment cells follow the mis-migrated lch5 neurons in sli mutants, while the ventral stretching of the ligament cells seems to be independent of the lch5 neurons. This study sheds light on the role of Slit-Robo signaling in sensory neuron development.
Correction to: Transcriptome analyses of tumor-adjacent somatic tissues reveal genes co-expressed with transposable elements
Authors: Chung Nicky , Jonaid G. M. , Quinton Sophia , Ross Austin , Sexton Corinne E. , Alberto Adrian , Clymer Cody , Churchill Daphnie , Navarro Leija Omar , Han Mira V.
Published: October 2019

Following publication of the original article [1], the authors reported errors in Table 2 wherein all "KZFP” in the gene names should be changed to “ZNF”.
Genome sequence of a pathogenic Corynebacterium ulcerans strain isolated from a wild boar with necrotizing lymphadenitis
Authors: Busch Anne , Möller Jens , Burkovski Andreas , Hotzel Helmut
Published: October 2019

Objectives

Corynebacterium ulcerans can colonize a wide variety of animals and also humans are infected, typically by zoonotic transmission. Symptoms range from skin ulcers or systemic infections to diphtheria-like illness. In contrast, Corynebacterium pseudotuberculosis is widely distributed among herds of sheep, goats and other farm animals, where it causes high economic losses due to caseous lymphadenitis. Here we describe the genome sequence of an atypical C. ulcerans strain isolated from a wild boar with necrotizing lymphadenitis. This strain has similarities to C. pseudotuberculosis.

Data description

Genome sequence data of C. ulcerans isolate W25 were generated, analyzed and taxonomical relationship to other Corynebacterium species as well as growth properties of the isolate were characterized. The genome of C. ulcerans W25 comprises 2,550,924 bp with a G+C content of 54.41% and a total of 2376 genes.
Anti-Toxoplasma activity of Sorghum bicolor-derived lipophilic fractions
Authors: Abugri Daniel A. , Jaynes Jesse M. , Witola William H.
Published: October 2019

Objective

Toxoplasma gondii, an intracellular zoonotic parasite, infects approximately a third of the world population. Current drugs for treatment of T. gondii infection have been challenged with ineffectiveness and adverse side effects. This necessitates development of new anti-Toxoplasma drugs. Sorghum bicolor [Moench] leaf extract has been used in African traditional medicine for the management of anemia and treatment of infectious diseases. We tested the in vitro anti-Toxoplasma inhibitory activity of S. bicolor’s oil-like crude extracts and fractions against T. gondii and determined their cytotoxic effects on human host cells.

Results

Significant inhibitory activities against the growth of T. gondii tachyzoites were observed for the crude extract (IC50 = 3.65 µg/mL), the hexane-methanol fraction (IC50 = 2.74 µg/mL), and the hexane fraction (IC50 = 3.55 µg/mL) after 48 h of culture. The minimum cytotoxicity concentrations against HFF were 34.41, 16.92 and 7.23 µg/mL for crude extract, hexane-methanol and hexane fractions, respectively. The crude extract and fractions showed high antiparasitic effects with low cytotoxic effects. Further studies to determine synergistic activities and modes of action would provide impetus for the development of new toxoplasmosis drugs or nutraceuticals.
Live cell imaging of macrophage/bacterium interaction demonstrates cell lysis induced by Corynebacterium diphtheriae and Corynebacterium ulcerans
Authors: Weerasekera Dulanthi , Hahn Jonas , Herrmann Martin , Burkovski Andreas
Published: October 2019

Objectives

In frame of a study to characterize the interaction of human macrophage-like cells with pathogenic corynebacteria, Corynebacterium diphtheriae and Corynebacterium ulcerans, live cell imaging experiments were carried out and time lapse fluorescence microscopy videos were generated, which are presented here.

Data description

The time lapse fluorescence microscopy data revealed new insights in the interaction of corynebacteria with human macrophage-like THP-1 cells. In contrast to uninfected cells and infections with non-pathogenic C. glutamicum used as a control, pathogenic C. diphtheriae and C. ulcerans showed highly detrimental effects towards human cells and induction of cell death of macrophages.
A 5 year retrospective analysis of common intestinal parasites at Poly Health Center, Gondar, Northwest Ethiopia
Authors: Ayelgn Meseret , Worku Ligabaw , Ferede Getachew , Wondimeneh Yitayih
Published: October 2019

Objective

Intestinal parasites are present throughout the world in varying degrees of prevalence due to many factors. The aim of this study was to determine the 5-year trend prevalence of intestinal prevalence among patients who had been suspected for intestinal parasite infections. A retrospective study was conducted from 2009 to 2013 at Poly Health Center Gondar, Northwest Ethiopia. Samples were examined using direct saline wet mount methods. Statistical analysis was done using SPSS version 20 software and a P-value of < 0.05 was considered statistically significant. The results were presented in tables and graphs.

Results

During the study period, a total of 13,329 stool samples were requested for intestinal parasite diagnose and 5510 (41.3%) laboratory-confirmed cases were reported with a fluctuating trend. Ten different parasites were reported in each year with Entamoeba histolytica/dispar (16.8%) being the predominant parasite followed by Giardia lamblia (11.4%) and Ascaris lumbricoides (6.7%). Both males (49%) and females (51%) were equally affected (P = 0.14). The intestinal parasite was reported in all age groups in the area but the highest and the lowest prevalence were reported in age groups of 20–29 years and 40–49 years, respectively (26.5% vs 6.4%) (P < 0.001).
Evaluation of polysaccharide intercellular adhesion (PIA) and glycerol teichoic acid (Gly-TA) arisen antibodies to prevention of biofilm formation in Staphylococcus aureus and Staphylococcus epidermidis strains
Authors: Gholami Sanaz Amir , Goli Hamid Reza , Haghshenas Mohammad Reza , Mirzaei Bahman
Published: October 2019

Objective

Staphylococcus aureus and S. epidermidis as opportunistic pathogens, notable for their frequency and severity of infections are recognized as the most usual reasons for medical device-associated infections that strike hospitalized patients and also immunocompromised individuals. In this study, the polysaccharide intercellular adhesion (PIA) and Glycerol teichoic acid) Gly-TA) as two major macromolecules in the biofilm formation process were purified under the native condition and their structure was analyzed by using colorimetric assays and Fourier Transform Infrared spectroscopy (FTIR). Afterward, the immune response of macromolecules and the mixture of them were assessed by measuring total IgG titers. Subsequently, biofilm inhibitory effects of raising antibodies to biofilm former S. aureus and S. epidermidis were evaluated.

Results

Obtained data were shown a significant rise in levels of antibodies in immunized mice with mentioned antibodies in comparison with the control group. According to the obtained findings, mentioned antibodies could eliminate S. aureus and S. epidermidis biofilm formation in vitro assays. This survey confirms the proposal that immunization of mice with a mixture of Gly-TA and PIA vaccine could be secure and protected against S. epidermidis and S. aureus infection.
A meta-analysis of two high-risk prospective cohort studies reveals autism-specific transcriptional changes to chromatin, autoimmune, and environmental response genes in umbilical cord blood
Authors: Mordaunt Charles E. , Park Bo Y. , Bakulski Kelly M. , Feinberg Jason I. , Croen Lisa A. , Ladd-Acosta Christine , Newschaffer Craig J. , Volk Heather E. , Ozonoff Sally , Hertz-Picciotto Irva , LaSalle Janine M. , Schmidt Rebecca J. , Fallin M. Daniele
Published: October 2019

Background

Autism spectrum disorder (ASD) is a neurodevelopmental disorder that affects more than 1% of children in the USA. ASD risk is thought to arise from both genetic and environmental factors, with the perinatal period as a critical window. Understanding early transcriptional changes in ASD would assist in clarifying disease pathogenesis and identifying biomarkers. However, little is known about umbilical cord blood gene expression profiles in babies later diagnosed with ASD compared to non-typically developing and non-ASD (Non-TD) or typically developing (TD) children.

Methods

Genome-wide transcript levels were measured by Affymetrix Human Gene 2.0 array in RNA from cord blood samples from both the Markers of Autism Risk in Babies-Learning Early Signs (MARBLES) and the Early Autism Risk Longitudinal Investigation (EARLI) high-risk pregnancy cohorts that enroll younger siblings of a child previously diagnosed with ASD. Younger siblings were diagnosed based on assessments at 36 months, and 59 ASD, 92 Non-TD, and 120 TD subjects were included. Using both differential expression analysis and weighted gene correlation network analysis, gene expression between ASD and TD, and between Non-TD and TD, was compared within each study and via meta-analysis.

Results

While cord blood gene expression differences comparing either ASD or Non-TD to TD did not reach genome-wide significance, 172 genes were nominally differentially expressed between ASD and TD cord blood (log2(fold change) > 0.1,p < 0.01). These genes were significantly enriched for functions in xenobiotic metabolism, chromatin regulation, and systemic lupus erythematosus (FDRq < 0.05). In contrast, 66 genes were nominally differentially expressed between Non-TD and TD, including 8 genes that were also differentially expressed in ASD. Gene coexpression modules were significantly correlated with demographic factors and cell type proportions.

Limitations

ASD-associated gene expression differences identified in this study are subtle, as cord blood is not the main affected tissue, it is composed of many cell types, and ASD is a heterogeneous disorder.

Conclusions

This is the first study to identify gene expression differences in cord blood specific to ASD through a meta-analysis across two prospective pregnancy cohorts. The enriched gene pathways support involvement of environmental, immune, and epigenetic mechanisms in ASD etiology.
Clustering K-SVD for sparse representation of images
Authors: Fu Jun , Yuan Haikuo , Zhao Rongqiang , Ren Luquan
Published: October 2019

K-singular value decomposition (K-SVD) is a frequently used dictionary learning (DL) algorithm that iteratively works between sparse coding and dictionary updating. The sparse coding process generates sparse coefficients for each training sample, and the sparse coefficients induce clustering features. In the applications like image processing, the features of different clusters vary dramatically. However, all the atoms of dictionary jointly represent the features, regardless of clusters. This would reduce the accuracy of sparse representation. To address this problem, in this study, we develop the clustering K-SVD (CK-SVD) algorithm for DL and the corresponding greedy algorithm for sparse representation. The atoms are divided into a set of groups, and each group of atoms is employed to represent the image features of a specific cluster. Hence, the features of all clusters can be utilized and the number of redundant atoms are reduced. Additionally, two practical extensions of the CK-SVD are provided. Experimental results demonstrate that the proposed methods could provide more accurate sparse representation of images, compared to the conventional K-SVD and its existing extended methods. The proposed clustering DL model also has the potential to be applied to the online DL cases.
Psychodynamic case formulations without technical language: a reliability study
Authors: Sørbye Øystein , Dahl Hanne-Sofie J. , Eells Tracy D. , Amlo Svein , Hersoug Anne Grete , Haukvik Unn K. , Hartberg Cecilie B. , Høglend Per Andreas , Ulberg Randi
Published: October 2019

Background

To bridge the gap between symptoms and treatment, constructing case formulations is essential for clinicians. Limited scientific value has been attributed to case formulations because of problems with quality, reliability, and validity. For understanding, communication, and treatment planning beyond each specific clinician-patient dyad, a case formulation must convey valid information concerning the patient, as well as being a reliable source of information regardless of the clinician’s theoretical orientation. The first aim of the present study is to explore the completeness of unstructured psychodynamic formulations, according to four components outlined in the Case Formulation Content Coding Method (CFCCM). The second aim is to estimate the reliability of independent formulations and their components, using similarity ratings of matched versus mismatched cases.

Methods

This study explores psychodynamic case formulations as made by two or more experienced clinicians after listening to an evaluation interview. The clinicians structured the formulations freely, with the sole constraint that technical, theory-laden terminology should be avoided. The formulations were decomposed into components after all formulations had been written.

Results

The results indicated that most formulations were adequately comprehensive, and that overall reliability of the formulations was high (> 0.70) for both experienced and inexperienced clinician raters, although the lower bound reliability estimate of the formulation component deemed most difficult to rate - inferred mechanisms - was marginal, 0.61.

Conclusions

These results were achieved on case formulations made by experienced clinicians using simple experience-near language and minimizing technical concepts, which indicate a communicative quality in the formulations that make them clinically sound.

Trial registration

linicalTrials.gov Identifier: NCT00423462. 10.1007/s00432-018-2781-7., January 18, 2007.
Performance evaluation of Cerenkov luminescence imaging: a comparison of 68Ga with 18F
Authors: olde Heuvel J. , de Wit-van der Veen B. J. , Vyas K. N. , Tuch D. S. , Grootendorst M. R. , Stokkel M. P. M. , Slump C. H.
Published: October 2019

Background

Cerenkov Luminescence Imaging (CLI) is an emerging technology for intraoperative margin assessment. Previous research only evaluated radionuclide 18-Fluorine (18F); however, for future applications in prostate cancer, 68-Gallium (68Ga) seems more suitable, given its higher positron energy. Theoretical calculations predict that 68Ga should offer a higher signal-to-noise ratio than 18F; this is the first experimental confirmation. The aim of this study is to investigate the technical performance of CLI by comparing 68Ga to 18F.

Results

The linearity of the system, detection limit, spatial resolution, and uniformity were determined with the LightPath imaging system. All experiments were conducted with clinically relevant activity levels in vitro, using dedicated phantoms. For both radionuclides, a linear relationship between the activity concentration and detected light yield was observed (R2 = 0.99). 68Ga showed approximately 22 times more detectable Cerenkov signal compared to 18F. The detectable activity concentration after a 120 s exposure time and 2 × 2 binning of 18F was 23.7 kBq/mL and 1.2 kBq/mL for 68Ga. The spatial resolution was 1.31 mm for 18F and 1.40 mm for 68Ga. The coefficient of variance of the uniformity phantom was 0.07 for the central field of view.

Conclusion

68Ga was superior over 18F in terms of light yield and minimal detection limit. However, as could be expected, the resolution was 0.1 mm less for 68Ga. Given the clinical constraints of an acquisition time less than 120 s and a spatial resolution < 2 mm, CLI for intraoperative margin assessment using 68Ga could be feasible.
Understanding early childhood education and care utilization in Canada: implications for demand and oversight
Authors: Varmuza Petr , Perlman Michal , White Linda A.
Published: October 2019

This study examined early childhood education and care (ECEC) utilization in Canada, focusing on use of unlicensed home child care (HCC) from an equity perspective. Data from the 2011 cycle of the General Social Survey (GSS) were used. Across Canada, parent responses reveal that 16.6% of children between the age of 12 months and entry to school were in unlicensed HCC. Another 24% of working parents reported having no regular form of non-parental childcare. Families with higher incomes were more likely to report using center-based care. Conversely, lower-income working parents with lower levels of education were more likely to use unlicensed HCC or report using no non-parental care at all. Comparison of parent responses in Ontario, however, where government estimates for the number of licensed and unlicensed HCC spaces are available, revealed that more parents report that their children are in licensed HCC than is possible. The lack of accurate parental reporting calls into question a key assumption of current regulatory systems, which is that parents are informed consumers of ECEC services. Given that many parents misreport the type of HCC their children use, and the equity concerns raised by the overall utilization patterns we found, we argue that governments need to take a more active role in oversight and support of HCC.
A case of primary breast angiosarcoma with multiple discontinuous small lesions
Authors: Sasahara Asako , Tanabe Masahiko , Hayashi Kanako , Konishi Takaaki , Oya Mariko , Sakiyama Kana , Morizono Arisa , Harada Mayumi , Otsuji Kazutaka , Ishibashi Yuko , Sato Ayaka , Kikuchi Yasuko , Niwa Takayoshi , Hinata Munetoshi , Nishioka Kotoe , Seto Yasuyuki
Published: October 2019

Background

Angiosarcoma of the breast is rare. It carries a poor prognosis because of its high risk of local recurrence and distant metastases. Presently, there are still no established systemic therapies. Thus, the main treatment strategy for breast angiosarcoma is complete resection. This underscores the importance of closely monitoring the spread of the tumor lesion, particularly for multifocal angiosarcoma, and to plan an optimal operative procedure. We herein present the successful surgical treatment of a rare case of multifocal primary breast angiosarcoma.

Case presentation

A 43-year-old woman visited our hospital with a growing lump on her right breast accompanied by pain. Clinical and radiological examinations revealed a well-circumscribed 40-mm-diameter tumor at the inner lower quadrant of her right breast. Histological examination of a needle biopsy specimen revealed angiosarcoma. Based on a precise evaluation of the tumor by contrast-enhanced MRI and contrast-enhanced CT scan, a wide local excision with sufficient margins was performed. In the resected specimen, three discontinuous small lesions of angiosarcoma were observed around the main tumor. Therefore, total mastectomy was additionally performed. Pathological examination revealed two other small nodules of angiosarcoma in the remnant right breast, which appeared to be close but not continuous to the defective part of the initial resection. Postoperative follow-up at 1 year showed no signs of recurrence or distant metastasis. Multifocal primary breast angiosarcoma is extremely rare with only two previous reports describing its multifocality.

Conclusions

Owing to its rarity, a standardized surgical treatment for breast angiosarcoma remains controversial. Our case suggests that primary breast angiosarcoma may occasionally present with multifocal tumor. Thus, it is important to keep in mind the multifocality of breast angiosarcoma when assessing its spread by diagnostic imaging and when planning the surgical strategy.
Robot-assisted laparoscopic surgery after placing a self-expanding metallic stent for malignant rectal obstruction: a case report
Authors: Takeyama Hiroshi , Danno Katsuki , Nishigaki Takahiko , Yamashita Masafumi , Yamazaki Masami , Yamakita Tsuyoshi , Nishihara Akihiro , Taniguchi Hirokazu , Mizutani Masayo , Nakamichi Itsuko , Yura Mamoru , Ikeda Kimimasa , Oka Yoshio
Published: October 2019

Background

Approximately 20% of colorectal cancer patients show complete or incomplete bowel obstruction as an early symptom. Preoperative nonsurgical decompression such as placing a self-expanding metallic stent for malignant colorectal obstruction has been shown to be effective for reducing perioperative morbidity and mortality. However, there is a lack of published studies reporting robot-assisted laparoscopic surgery (RALS) after self-expanding metallic stent (SEMS) placement for malignant rectal obstruction (MRO). To our knowledge, this is the first report to do so.

Case presentation

An 80-year-old man with incomplete paralysis of the lower limbs as well as bladder–rectal disorder due to a spine fracture sustained in a fall accident 26 years ago presented with lower abdominal pain and vomiting. Abdominal multi-detector computed tomography revealed an obstructive rectal tumor with distended bowel on the oral side. Emergency colonoscopy was performed, and an SEMS placed. The patency of SEMS and decompression of the distended bowel was confirmed, and elective RALS was performed 29 days after SEMS placement. To our knowledge, this is the first report of RALS after decompression with SEMS placement for MRO.

Conclusions

RALS after SEMS placement is a safe and feasible therapeutic strategy for MRO.
Anasarca, steatorrhea, and hypoalbuminemia 18 years after total gastrectomy: a case report
Authors: Igata Yu , Okubo So , Ohkura Yu , Ueno Masaki , Udagawa Harushi
Published: October 2019

Background

Pancreatic exocrine insufficiency (PEI) is known to occur after total gastrectomy. We experienced a case of PEI occurring 18 years after surgery, leading to a potentially fatal condition of capillary leak syndrome (CLS).

Case presentation

The case is a 58-year-old man on a healthy diet who underwent total gastrectomy 18 years before. He was admitted for a 3-month history of anasarca, steatorrhea, and hypoalbuminemia. An episode of fever occurred during workup, followed by pulmonary edema and shock. The patient was transferred to the intensive care unit and was started on fluid management with albumin infusion. A multidisciplinary team meeting was held, and a clinical diagnosis of PEI resulted in CLS was made and we started administration of oral pancrelipase to show clinical improvement. The patient was discharged, and he remained asymptomatic for 13 months.

Conclusion

In a post-gastrectomy patient with malnutrition, PEI should be suspected regardless of the period since surgery. When recognized, immediate replenishment of albumin and pancreatic enzymes should be initiated to prevent clinical deterioration.
Metachronous rectal metastasis from pulmonary adenocarcinoma after 11 years of chemo-, immuno-, and radiotherapy for recurrent lesions: a case report
Authors: Suzuki Yozo , Imasato Mitsunobu , Nakahara Yujiro , Naito Atsushi , Mikamori Manabu , Ohtsuka Masahisa , Furukawa Kenta , Moon Jeong Ho , Asaoka Tadafumi , Kishi Kentaro , Yasuoka Hironao , Komuta Kiyoshi , Akamatsu Hiroki
Published: October 2019

Background

Rectal metastasis from pulmonary adenocarcinoma is rare, and it has been regarded as an end-stage phenomenon. Recently, however, advances in lung cancer treatment have improved the chance of long-term survival of patients with unresectable distant metastases. We describe the occurrence and management of metastatic spread of a pulmonary carcinoma to the rectum.

Case presentation

The patient was a 79-year-old woman who had undergone thoracoscopic left lobectomy for pulmonary adenocarcinoma and then, over the next 11 years, various drugs (carboplatin + paclitaxel (as adjuvant therapy), gefitinib, gemcitabine + vinorelbine, S1 (an oral 5-fluorouracil-based drug), carboplatin + pemetrexed + bevacizumab, erlotinib, nivolumab, afatinib, and carboplatin+ S1) were administered, especially for hilar and mediastinal lymph node recurrences. During the eleventh postoperative year, left and right iliac bone metastases were detected, and radiation therapy was undertaken for local control of these lesions. When 18F-fluorodeoxyglucose positron emission tomography was performed for evaluation of the disease, tracer accumulation in the upper rectum was seen. Colonoscopic examination of the rectum revealed an intramural mass with central ulceration, and the mass was diagnosed histologically as an adenocarcinoma. The bone metastases appeared to be controlled, and the patient’s performance status was good, but she had suffered constipation for about a year and desired treatment. Thus, laparoscopic low anterior resection was performed. Histopathologic analysis revealed a moderately differentiated adenocarcinoma existing mainly between the submucosa and serosa, and immunohistochemical analysis showed the tumor to be positive for cytokeratin (CK) 7, negative for CK20, positive for thyroid transcription factor-1, and negative for special AT-rich sequence-binding protein 2 and caudal type homeobox 2, confirming the diagnosis of rectal metastasis from the primary pulmonary adenocarcinoma. The patient recovered well without any change in her functional status. Systemic chemotherapy was resumed, and she continues to do well, now 6 months after surgery.

Conclusions

Surgery may be a good option for the management of an isolated rectal metastasis from pulmonary cancer in patients whose functional status is good.
Location-based parameterization of controlled-source electromagnetic data inversion for the monitoring of hydraulic fracturing with magnetically enhanced proppants
Authors: Noh Kyubo , Ha Lee Ki , Oh Seokmin , Jee Seol Soon , Byun Joongmoo
Published: October 2019

The injection of fluids with electromagnetic (EM) contrast is regarded as a promising tool for EM monitoring. We have developed a novel model-based inversion method, designated as a particle mapping (PM) method, as a fit-for-purpose inversion tool for EM monitoring. The PM method optimizes the location of particles while constraining a priori information on the net physical property-volume products in the inversion domain. In addition, as a regularization method for location-based inversion, a fuzzy clustering method is adopted to integrate the PM method with the geometries of an a priori anomalous distribution. The EM monitoring of hydraulic fracturing is considered as a primary application of the PM method. In particular, numerical experiments focus on the injection of magnetically enhanced proppants and the use of the fracture model as a cluster geometry. Numerical experiments also include situational assumptions of incorrect a priori injected amounts of fluids and the distribution of anomalous regions to fully investigate the practicality of the method. The results indicate not only how clear and intrinsically interpretable the imaging results can be obtained with the PM method but also how known or assumed information on injected fluids and the fracture model can be integrated with the EM inversion.
Pore-pressure diffusion during water injection in fractured media
Authors: Rao Ying , Wang Yanghua
Published: October 2019

For fractured reservoirs with low permeability and low porosity, water injection is often needed during hydrocarbon production. We have developed methods to accurately simulate pore-pressure diffusion during water injection and to evaluate the diffusion flux from a complex fracture network. We proposed explicit scalar coefficients of the anisotropic diffusion instead of a diffusion tensor at each lattice, and we assigned these scalar coefficients in an elliptical form, with the major axis aligned with the fracture orientation. Based on these coefficients, we derived mathematical equations for calculating the flux of the pore-pressure diffusion in fracture networks. Numerical simulation of the anisotropic characteristic of diffusion with a prolonged water injection time revealed that although water injection affects pore-pressure distribution mainly along the individual fractures during the early stage, it gradually affects the pore pressure of the media surrounding the fractures and changes the physical property of fractured media.
Randomized Trial of Lenalidomide Versus Observation in Smoldering Multiple Myeloma
Authors: Lonial Sagar , Jacobus Susanna , Fonseca Rafael , Weiss Matthias , Kumar Shaji , Orlowski Robert Z. , Kaufman Jonathan L. , Yacoub Abdulraheem M. , Buadi Francis K. , O’Brien Timothy , Matous Jeffrey V. , Anderson Daniel M. , Emmons Robert V. , Mahindra Anuj , Wagner Lynne I. , Dhodapkar Madhav V. , Rajkumar S. Vincent
Published: October 2019

PURPOSE

Observation is the current standard of care for smoldering multiple myeloma. We hypothesized that early intervention with lenalidomide could delay progression to symptomatic multiple myeloma.

METHODS

We conducted a randomized trial that assessed the efficacy of single-agent lenalidomide compared with observation in patients with intermediate- or high-risk smoldering multiple myeloma. Lenalidomide was administered orally at a dose of 25 mg on days 1 to 21 of a 28-day cycle. The primary end point was progression-free survival, with disease progression requiring the development of end-organ damage attributable to multiple myeloma and biochemical progression.

RESULTS

One hundred eighty-two patients were randomly assigned—92 patients to the lenalidomide arm and 90 to the observation arm. Median follow-up is 35 months. Response to therapy was observed in 50% (95% CI, 39% to 61%) of patients in the lenalidomide arm, with no responses in the observation arm. Progression-free survival was significantly longer with lenalidomide compared with observation (hazard ratio, 0.28; 95% CI, 0.12 to 0.62; P = .002). One-, 2-, and 3-year progression-free survival was 98%, 93%, and 91% for the lenalidomide arm versus 89%, 76%, and 66% for the observation arm, respectively. Only six deaths have been reported, two in the lenalidomide arm versus four in the observation arm (hazard ratio for death, 0.46; 95% CI, 0.08 to 2.53). Grade 3 or 4 nonhematologic adverse events occurred in 25 patients (28%) on lenalidomide.

CONCLUSION

Early intervention with lenalidomide in smoldering multiple myeloma significantly delays progression to symptomatic multiple myeloma and the development of end-organ damage.
Results of a Study Comparing Glycated Albumin to Other Glycemic Indices
Authors: Desouza Cyrus V , Holcomb Richard G , Rosenstock Julio , Frias Juan P , Hsia Stanley H , Klein Eric J , Zhou Rong , Kohzuma Takuji , Fonseca Vivian A
Published: October 2019

Context

Intermediate-term glycemic control metrics fulfill a need for measures beyond hemoglobin A1C.

Objective

Compare glycated albumin (GA), a 14-day blood glucose measure, with other glycemic indices.

Design

24-week prospective study of assay performance.

Setting

8 US clinics.

Participants

Subjects with type 1 (n = 73) and type 2 diabetes (n = 77) undergoing changes to improve glycemic control (n = 98) or with stable diabetes therapy (n = 52).

Interventions

GA, fructosamine, and A1C measured at prespecified intervals. Mean blood glucose (MBG) calculated using weekly self-monitored blood glucose profiles.

Main Outcome Measures

Primary: Pearson correlation between GA and fructosamine. Secondary: magnitude (Spearman correlation) and direction (Kendall correlation) of change of glycemic indices in the first 3 months after a change in diabetes management.

Results

GA was more concordant (60.8%) with changes in MBG than fructosamine (55.5%) or A1C (45.5%). Across all subjects and visits, the GA Pearson correlation with fructosamine was 0.920. Pearson correlations with A1C were 0.655 for GA and 0.515 for fructosamine (P < .001) and with MBG were 0.590 and 0.454, respectively (P < .001). At the individual subject level, Pearson correlations with both A1C and MBG were higher for GA than for fructosamine in 56% of subjects; only 4% of subjects had higher fructosamine correlations with A1C and MBG. GA had a higher Pearson correlation with A1C and MBG in 82% and 70% of subjects, respectively.

Conclusions

Compared with fructosamine, GA correlates significantly better with both short-term MBG and long-term A1C and may be more useful than fructosamine in clinical situations requiring monitoring of intermediate-term glycemic control (NCT02489773).