bluuebunny/crossref_metadata_2025 huggingface dataset:
Medicines postpartum in Sweden and coverage in Janusmed Breastfeeding
Authors: Asplund A. B. , Sköld P. Dreher , Lind L. Karlsson , Cesta C. E. , Dahl M. L. , Jonsson E. Wikström , Andersson M. L.
Published: July 2023

Purpose

The purpose of this article is (1) to investigate which medicines are prescribed and dispensed to women the first 6 months postpartum, (2) to identify medicines dispensed postpartum but not recommended during breastfeeding, and (3) to find medicines commonly dispensed postpartum, but not currently included in Janusmed Breastfeeding.

Methods

In this register-based cohort study covering births between January 2017 and August 2019, the Swedish Medical Birth Register (MBR), the Prescribed Drug Register, and Janusmed Breastfeeding were linked to identify medicines dispensed to women during the first 6 months postpartum, and how they are covered and classified in Janusmed Breastfeeding.

Results

During the first 6 months postpartum, 66% of women purchased at least one prescription medicine from the pharmacy. The most common medicines were contraceptive agents, analgesics, antibiotics, and glucocorticoids. A third of the 30 most commonly dispensed medicines have no information available about the safety of use in breastfeeding. The most dispensed medicines, where the database advises against use in breastfeeding, included several antitussive agents, a local anaesthetic, and several gestagens. The most commonly dispensed medicines not covered by the Janusmed Breastfeeding were medicines for dry eyes, for assisted reproduction, and HIV.

Conclusion

Prescribed medicines compatible with breastfeeding are more common during the first 6 months postpartum than medicines not compatible with breastfeeding, but medicines which lack evidence for safety in breastfeeding are still commonly used.
Image quality of spectral brain computed tomography angiography using halved dose of iodine contrast medium
Authors: Fransson Veronica , Mellander Helena , Ramgren Birgitta , Andersson Henrik , Arena Francesco , Ydström Kristina , Ullberg Teresa , Wassélius Johan
Published: July 2023

Purpose

Reduction in iodinated contrast medium (CM) dose is highly motivated. Our aim was to evaluate if a 50% reduction of CM, while preserving image quality, is possible in brain CT angiography (CTA) using virtual monoenergetic images (VMI) on spectral CT. As a secondary aim, we evaluated if VMI can salvage examinations with suboptimal CM timing.

Methods

Consecutive patients older than 18 years without intracranial stenosis/occlusion were included. Three imaging protocols were used: group 1, full CM dose; group 2, 50% CM dose suboptimal timing; and group 3, 50% CM dose optimized timing.

Attenuation, noise, signal-to-noise ratio (SNR), and contrast-to-noise ratio (CNR) were measured in the internal carotid artery, M2 segment of the middle cerebral artery, and white matter for conventional images (CI) and VMI (40–200 keV). Qualitative image quality for CI and VMI (50 and 60 keV) was rated by 4 experienced reviewers.

Results

Qualitatively and quantitatively, VMI (40–60 keV) improved image quality within each group. Significantly higher attenuation and CNR was found for group 3 VMI 40–50 keV, with unchanged SNR, compared to group 1 CI. Group 3 VMI 50 keV also received significantly higher rating scores than group 1 CI. Group 2 VMI (40–50 keV) had significantly higher CNR compared to group 3 CI, but the subjective image quality was similar.

Conclusion

VMI of 50 keV with 50% CM dose increases qualitative and quantitative image quality over CI with full CM dose. Using VMI reduces non-diagnostic examinations and may salvage CTA examinations deemed non-diagnostic due to suboptimal timing.
From Conservation to Connection: Exploring the Role of Nativeness in Shaping People’s Relationships with Urban Trees
Authors: Kaplan Haylee , Prahalad Vishnu , Kendal Dave
Published: July 2023

Deciding whether to plant native or non-native trees in public urban green spaces is becoming complex and conflicted, and decisions purely based on biotic nativeness are likely to be hamstrung as climate change and rising urban heat push many native species beyond their natural ranges. Importantly, tree selection considerations by urban planners and environmental managers will have to move beyond a primary focus on securing conservation and ecological outcomes, to elucidate and engage with a growing interest in the socio-cultural values and services of urban trees. Building on emerging theoretical perspectives, this place-based study explores the role that perceptions of nativeness have in shaping people’s relationships with native and non-native urban trees and landscapes in an Australian city. Nativeness was associated with a range of subjective meanings including cultural identity, political expression, nature connection, desirable and undesirable traits, and environmental and cultural compatibility. Our findings emphasise that the ways in which urban trees and green spaces are valued and experienced is likely mediated by people’s perceptions of nativeness and its importance relative to other attributes. To provision and sustain green spaces that meet the diverse needs and preferences of urban publics, planners and managers need to elucidate and incorporate the nuanced, place-based and multifaceted subjective meanings of nativeness into urban greening decision-making and practice.
Targeting pan-essential pathways in cancer with cytotoxic chemotherapy: challenges and opportunities
Authors: Rudd Sean G.
Published: July 2023

Cytotoxic chemotherapy remains a key modality in cancer treatment. These therapies, successfully used for decades, continue to transform the lives of cancer patients daily. With the high attrition rate of current oncology drug development, combined with the knowledge that most new therapies do not displace standard-of-care treatments and that many healthcare systems cannot afford these new therapies; cytotoxic chemotherapies will remain an important component of cancer therapy for many years to come. The clinical value of these therapies is often under-appreciated within the pre-clinical cancer research community, where this diverse class of agents are often grouped together as non-specific cellular poisons killing tumor cells based solely upon proliferation rate; however, this is inaccurate. This review article seeks to reaffirm the importance of focusing research efforts upon improving our basic understanding of how these drugs work, discussing their ability to target pan-essential pathways in cancer cells, the relationship of this to the chemotherapeutic window, and highlighting basic science approaches that can be employed towards refining their use.
Excessive vincristine exposure in a child being treated for acute lymphoblastic leukaemia with underlying Dubin–Johnson syndrome: a case report
Authors: Barnett Shelby , Nyein Aye Chan , Galler Martin , Jamieson David , Davies Michelle , Connor Philip , Veal Gareth J.
Published: July 2023

Background

Dubin–Johnson syndrome is a rare benign autosomal recessive condition that causes an isolated increase of conjugated bilirubin in the serum. Impaired biliary excretion is due to mutation in the multiple drug-resistance protein 2 gene (MRP2).

Case presentation

We describe the case of a 4-year-old girl being treated for acute lymphoblastic leukaemia who had a history of conjugated hyperbilirubinaemia and persistently elevated bilirubin levels on initiation of chemotherapy. During treatment for leukaemia, she was diagnosed with Dubin–Johnson syndrome for the underlying condition. Following administration of vincristine at the recommended dose of 1.5 mg/m2, an abnormally high vincristine exposure was observed (AUC > 200 µg/L*h), approximately 3 times higher than previously reported exposures in a comparable clinical setting. Vincristine dose reductions were applied on subsequent cycles of treatment and resulted in markedly reduced drug exposures, within the normal target range.

Conclusion

This case provided a rare opportunity to assess the impact of MRP2 mutations associated with Dubin–Johnson syndrome on the pharmacokinetics of vincristine and strongly indicates that a marked dose reduction should be recommended. Clinicians should be made aware of the potential for altered drug disposition for agents such as vincristine in patients with this rare genetic condition.
Healthcare utilization and unmet needs of patients with antisynthetase syndrome: An international patient survey
Authors: Weiss M. , Holzer M. T. , Muehlensiepen F. , Ignatyev Y. , Fiehn C. , Bauhammer J. , Schmidt J. , Schlüter S. , Dihkan A. , Scheibner D. , Schneider U. , Valor-Mendez L. , Corte G. , Gupta L. , Chinoy H. , Lundberg I. , Cavagna L. , Distler J. H. W. , Schett G. , Knitza J.
Published: July 2023

Antisynthease syndrome (ASSD) is a rare, complex and understudied autoimmune disease. Internet-based studies can overcome barriers of traditional on-site research and are therefore very appealing for rare diseases. The aim of this study was to investigate patient-reported symptoms, diagnostic delay, symptoms, medical care, health status, working status, disease knowledge and willingness to participate in research of ASSD patients by conducting an international web-based survey. The multilingual questionnaire was created by an international group of rheumatologists and patients and distributed online. 236 participants from 22 countries completed the survey. 184/236 (78.0%) were female, mean age (SD) was 49.6 years (11.3) and most common antisynthetase antibody was Jo-1 (169/236, 71.6%). 79/236 (33.5%) reported to work full-time. Median diagnostic delay was one year. The most common symptom at disease onset was fatigue 159/236 (67.4%), followed by myalgia 130/236 (55.1%). The complete triad of myositis, arthritis and lung involvement verified by a clinician was present in 42/236 (17.8%) at disease onset and in 88/236 (37.3%) during the disease course. 36/236 (15.3%) reported to have been diagnosed with fibromyalgia and 40/236 (16.3%) with depression. The most reported immunosuppressive treatments were oral corticosteroids 179/236 (75.9%), followed by rituximab 85/236 (36.0%). 73/236 (30.9%) had received physiotherapy treatment. 71/236 (30.1%) reported to know useful online information sources related to ASSD. 223/236 (94.5%) were willing to share health data for research purposes once a year. Our results reiterate that internet-based research is invaluable for cooperating with patients to foster knowledge in rare diseases.
Length–weight relationships and condition factors of six notothenioid fish species occurring off King George Island and Northern Victoria Land (Antarctica)
Authors: Kim Jihun , Lee Seungyeon , Nguyen Phuong Thi , Han Dong-Won , Kim IL-Chan , Kim Jin-Hyoung
Published: July 2023

This research was conducted to study length–weight relationships (LWR) and condition factors of six Antarctic notothenioidei fish species including blackfin icefish (Chaenocephalus aceratus), single-angle icefish (Chionodraco hamatus), marbled rockcod (Notothenia rossii), black rockcod (Notothenia coriiceps), emerald rockcod (Trematomus bernacchii), and dusky rockcod (Trematomus newnesi) from the King Sejong Station on King George Island and Jang Bogo Station on the Northern Victoria Land. A total of 232 specimens were collected by fishing on the icebreaking research vessel ARAON from December 2020 to February 2021. The LWR parameters and condition factors differed depending on species, which can be affected by their distribution, species characteristics, and gravidity status. The exponent b values in LWR (W = aLb) ranged from 2.593 to 5.184. Four species including C. aceratus, C. hamatus, N. rossii, and T. bernacchii followed positive allometric growth, T. newnesi followed negative allometric growth, and only N. coriiceps showed isometric growth. These results can be helpful in understanding the ecological and growth conditions of six fish species living in the Antarctic Ocean, providing more information for future research on Antarctic fish.
Assessment of glenoid bone loss and other osseous shoulder pathologies comparing MR-based CT-like images with conventional CT
Authors: Feuerriegel Georg C. , Kronthaler Sophia , Weiss Kilian , Haller Bernhard , Leonhardt Yannik , Neumann Jan , Pfeiffer Daniela , Hesse Nina , Erber Bernd , Schwaiger Benedikt J. , Makowski Marcus R. , Woertler Klaus , Karampinos Dimitrios C. , Wurm Markus , Gersing Alexandra S.
Published: July 2023

Objectives

To evaluate and compare the diagnostic performance of CT-like images based on a 3D T1-weighted spoiled gradient-echo sequence (T1 GRE), an ultra-short echo time sequence (UTE), and a 3D T1-weighted spoiled multi-echo gradient-echo sequence (FRACTURE) with conventional CT in patients with suspected osseous shoulder pathologies.

Materials and methods

Patients with suspected traumatic dislocation of the shoulder (n = 46, mean age 40 ± 14.5 years, 19 women) were prospectively recruited and received 3-T MR imaging including 3D T1 GRE, UTE, and 3D FRACTURE sequences. CT was performed in patients with acute fractures and served as standard of reference (n = 25). Agreement of morphological features between the modalities was analyzed including the glenoid bone loss, Hill-Sachs interval, glenoid track, and the anterior straight-line length. Agreement between the modalities was assessed using Bland-Altman plots, Student’s t-test, and Pearson’s correlation coefficient. Inter- and intrareader assessment was evaluated with weighted Cohen’s κ and intraclass correlation coefficient.

Results

All osseous pathologies were detected accurately on all three CT-like sequences (n = 25, κ = 1.00). No significant difference in the percentage of glenoid bone loss was found between CT (mean ± standard deviation, 20.3% ± 8.0) and CT-like MR images (FRACTURE 20.6% ± 7.9, T1 GRE 20.4% ± 7.6, UTE 20.3% ± 7.7, p > 0.05). When comparing the different measurements on CT-like images, measurements performed using the UTE images correlated best with CT.

Conclusion

Assessment of bony Bankart lesions and other osseous pathologies was feasible and accurate using CT-like images based on 3-T MRI compared with conventional CT. Compared to the T1 GRE and FRACTURE sequence, the UTE measurements correlated best with CT.

Clinical relevance statement

In an acute trauma setting, CT-like images based on a T1 GRE, UTE, or FRACTURE sequence might be a useful alternative to conventional CT scan sparing associated costs as well as radiation exposure.

Key Points

• No significant differences were found for the assessment of the glenoid bone loss when comparing measurements of CT-like MR images with measurements of conventional CT images.

• Compared to the T1 GRE and FRACTURE sequence, the UTE measurements correlated best with CT whereas the FRACTURE sequence appeared to be the most robust regarding motion artifacts.

• The T1 GRE sequence had the highest resolution with high bone contrast and detailed delineation of even small fractures but was more susceptible to motion artifacts.
Physicochemical characterization and biological response of PDMS/CS/PVA/GEN semi-interpenetrating networks as a function of CS/PVA/GEN ratio for tissue engineering
Authors: Benítez-Martínez Jorge Alejandro , Garnica-Palafox Itzel Marisol , Rodríguez-Hernández Adriana , Pérez-Calixto Daniel , Vázquez-Victorio Genaro , Hernádez-Gordillo Agileo , Sánchez-Arévalo Francisco Manuel
Published: July 2023

We demonstrated that the combination of poly(dimethylsiloxane) (PDMS) and a hybrid hydrogel based on chitosan/poly(vinyl alcohol)/genipin (CS/PVA/GEN)—with ratios 7:3 (SIPNs1), 5:5 (SIPNs2), and 3:7 (SIPNs3) (w/w)—were useful for obtaining semi-interpenetrated polymeric networks (SIPNs). These SIPNs successfully combined the PDMS’s elasticity, the PVA’s swelling capability, and the excellent biological response of CS and GEN. Noticing these features are desirable in materials intended for biomedical applications such as wound healing and tissue engineering. Through evaluating the influence of PDMS and CS/PVA/GEN hybrid hydrogel ratios on the physico-chemical, mechanical, and the response of seeded cells, we found contact angles between 55$$^{\circ }$$

∘

and 75$$^{\circ }$$

∘

, while the swelling percentage was enhanced up to three times concerning blank PDMS. Besides, the elastic moduli presented values between 1 and 1.6 MPa. The fibroblasts seeded on the tested semi-interpenetrating polymeric networks were viable, and no cytotoxic effects were found. The cells presented fusiform shapes indicating an excellent attachment to the material’s surface. The highest cell densities were found for SIPNs1 and SIPNs2, suggesting that these compositions in a membrane shape could potentially be used in wound healing/dressing or as a scaffold for tissue engineering.

Graphical abstract
Prospective evaluation of functional outcomes in 395 patients with an ileal neobladder 1 year after radical cystectomy
Authors: Bahlburg Henning , Schuster Fabian , Tully Karl Heinrich , Butea-Bocu Marius Cristian , Reike Moritz , Roghmann Florian , Noldus Joachim , Mueller Guido
Published: July 2023

Purpose

This study aims to report on functional outcomes in a large cohort of patients who underwent inpatient rehabilitation (IR) in a highly specialized, high-volume German urologic rehabilitation center after radical cystectomy (RC) and creation of an ileal neobladder (INB).

Methods

Data for 842 patients, who underwent three weeks of IR after RC and urinary diversion between April 2018 and December 2019 were prospectively collected. INB patients were surveyed on continence and sexual function. Data were collected at 4 weeks (T1), 6 months (T2), and 12 months (T3) after RC. Multivariate logistic regressions were performed to identify predictors of better functional outcomes.

Results

INB was chosen as urinary diversion in 395 patients (357 male, 38 female). Social continence (maximum of one safety pad/24 h) was reported by 78.3% of men and 64.0% of women at T3. Severe incontinence was reported by 27.3% of men and 44.0% of women. Male sex was identified as an independent predictor for the use of no pads at T3 (OR 4.110; 95% CI 1.153–14.655; p = 0.029). Nerve-sparing surgery was identified as an independent predictor both for the use of only a safety pad (OR 1.918; 95% CI 1.031–3.569; p = 0.040) and good erectile function at T3 (OR 4.377; 95% CI 1.582–12.110; p = 0.004).

Conclusion

Urologists should aspire for nerve-sparing surgery. When advising patients before RC, functional outcomes (continence, sexual function) should be given special attention. Women should be counseled on potentially prolonged urinary incontinence.
Independent, neutral, and monotonic collective choice: the role of Suzumura consistency
Authors: Bossert Walter , Cato Susumu , Kamaga Kohei
Published: July 2023

We examine the impact of Suzumura’s (Economica 43:381–390, 1976) consistency property when applied in the context of collective choice rules that are independent of irrelevant alternatives, neutral, and monotonic. An earlier contribution by Blau and Deb (Econometrica 45:871–879, 1977) establishes the existence of a vetoer if the collective relation is required to be complete and acyclical. The purpose of this paper is to explore the possibilities that result if completeness and acyclicity are dropped and Suzumura consistency is imposed instead. A conceptually similar but logically independent version of the combined axiom that requires the collective decision mechanism to be independent, neutral, and monotonic is employed. In the case of a finite population, we obtain an alternative impossibility theorem if a collective choice rule is assumed to be non-degenerate and a modified no veto requirement is imposed instead of Blau and Deb’s (1977) condition. If the population is countably infinite, the impossibility can be avoided but it resurfaces if our new no veto property is extended to a coalitional variant.
Reduced order model approaches for predicting the magnetic polarizability tensor for multiple parameters of interest
Authors: Elgy James , Ledger Paul D.
Published: July 2023

The magnetic polarizability tensor (MPT) is an economical characterisation of a conducting magnetic object, which can assist with identifying hidden targets in metal detection. The MPT’s coefficients depend on multiple parameters of interest including the object shape, size, electrical conductivity, magnetic permeability, and the frequency of excitation. The computation of the coefficients follow from post-processing an eddy current transmission problem solved numerically using high-order finite elements. To reduce the computational cost of constructing these characterisations for multiple different parameters, we compare three methods by which the MPT can be efficiently calculated for two-dimensional parameter sets, with different levels of code invasiveness. We compare, with numerical examples, a neural network regression of MPT eigenvalues with a projection-based reduced order model (ROM) and a neural network enhanced ROM (POD–NN) for predicting MPT coefficients.
Efficacy and safety of electroacupuncture for secondary constipation: a systematic review and meta-analysis
Authors: Jie Liu , Shiping Liu , Yue Xing , Fuli Zhang
Published: July 2023

Objective

Secondary constipation refers to constipation that occurs after certain diseases or medications, such as acute stroke or opioids, and the efficacy of electroacupuncture for secondary constipation is controversial. So, this study aimed to explore the efficacy and safety of electroacupuncture for secondary constipation through a meta-analysis and systematic review.

Method

We retrieved articles from PubMed, Embase, Cochrane Library, Web of Science, CNKI, Wanfang, and VIP databases up to 28 February 2023. The study was screened strictly according to inclusion and exclusion criteria. Revman5.4 was used for quality evaluation; grade rating was used for index evaluation, and stata15.0 was used for data consolidation analysis.

Result

Thirteen randomized controlled studies, involving a total of 1437 people (722 electroacupuncture and 715 control groups), were included in this review. Meta-analysis results indicated that electroacupuncture significantly improved constipation overall response (RR = 1.31, 95%CI: 1.11, 1.55, P < 0.001), reduced defecation straining score (MD =  − 0.46, 95%CI: − 0.67, − 0.251, P < 0.001), increased weekly complete spontaneous bowel movements (MD = 0.41, 95%CI: 0.20, 0.63, P = 0.002), and increased in the weekly spontaneous bowel movements (MD = 0.80, 95%CI (0.49, 01.11), P < 0.001), and electroacupuncture had no effect on change stool consistency score compared (MD =  − 0.03, 95%CI (− 0.38, 0.33), P = 0.88) and did not increase adverse events (RR = 0.50, 95%CI: 0.18, 1.44, P = 0.20).

Conclusion

According to the current studies, the overall relief rate of patients with secondary constipation after electroacupuncture treatment was improved, the defecation pressure score was reduced, the weekly natural defecation was more complete, and adverse reactions were not increased. Electroacupuncture therefore shows potential for treating constipation, but more high-quality studies are needed to confirm these findings.
Vagus nerve inflammation contributes to dysautonomia in COVID-19
Authors: Woo Marcel S. , Shafiq Mohsin , Fitzek Antonia , Dottermusch Matthias , Altmeppen Hermann , Mohammadi Behnam , Mayer Christina , Bal Lukas C. , Raich Lukas , Matschke Jakob , Krasemann Susanne , Pfefferle Susanne , Brehm Thomas Theo , Lütgehetmann Marc , Schädler Julia , Addo Marylyn M. , Schulze zur Wiesch Julian , Ondruschka Benjamin , Friese Manuel A. , Glatzel Markus
Published: July 2023

Dysautonomia has substantially impacted acute COVID-19 severity as well as symptom burden after recovery from COVID-19 (long COVID), yet the underlying causes remain unknown. Here, we hypothesized that vagus nerves are affected in COVID-19 which might contribute to autonomic dysfunction. We performed a histopathological characterization of postmortem vagus nerves from COVID-19 patients and controls, and detected SARS-CoV-2 RNA together with inflammatory cell infiltration composed primarily of monocytes. Furthermore, we performed RNA sequencing which revealed a strong inflammatory response of neurons, endothelial cells, and Schwann cells which correlated with SARS-CoV-2 RNA load. Lastly, we screened a clinical cohort of 323 patients to detect a clinical phenotype of vagus nerve affection and found a decreased respiratory rate in non-survivors of critical COVID-19. Our data suggest that SARS-CoV-2 induces vagus nerve inflammation followed by autonomic dysfunction which contributes to critical disease courses and might contribute to dysautonomia observed in long COVID.
Elucidation of the mechanism of amyloid A and transthyretin formation using mass spectrometry-based absolute quantification
Authors: Shintani-Domoto Yukako , Ode Koji L. , Nomura Seitaro , Abe Hiroyuki , Ueda Hiroki R. , Sakatani Takashi , Ohashi Ryuji
Published: July 2023

Amyloidosis is triggered by the truncation of amyloid precursor proteins, causing organ damages. While previous studies found the truncation of amyloid A (AA) and amyloid transthyretin (ATTR) occurs in C- and N-terminal, respectively, the detailed mechanism of the fibril formation remains unclear. Liquid chromatography mass spectrometry is usually applied for a qualitative purpose, and thus quantification of tryptic peptide residue is difficult. We therefore employed a mass spectrometry-based quantification by isotope-labeled cell-free (MS-QBIC) to analyze the truncation processes in amyloid fibrillogenesis of AA and ATTR using the formalin-fixed paraffin-embedded tissues of autopsy cases. In this study, the process of transthyretin from an 'early fibril state' consisting of full-length ATTR to a 'mature ATTR amyloid fibril' with a truncated low-amyloidogenic segment has been mathematically revealed. The amount of full-length ATTR was nine times higher than in mature fibers. Large cohort studies using MS-QBIC may shed light on the clinical significance of amyloid fibrils.
Risk prediction of second primary malignancies after gynecological malignant neoplasms resection with and without radiation therapy: a population-based surveillance, epidemiology, and end results (SEER) analysis
Authors: Wang Jing , Zhang Chan , Xiang Yaoxian , Han Baojuan , Cheng Yurong , Tong Yingying , Yan Dong
Published: July 2023

Purpose

The association between post-resection radiotherapy for primary gynecological malignant neoplasms (GMNs) and the development of secondary primary malignancies (SPMs) remains a subject of debate. This study represents the first population-based analysis employing a multivariate competitive risk model to assess risk factors for this relationship and to develop a comprehensive competing-risk nomogram for quantitatively predicting SPM probabilities.

Materials and methods

In our study, data on patients with primary GMNs were retrospectively collected from the Epidemiology, Surveillance and End Results (SEER) database from 1973 to 2015. The incidence of secondary malignant tumors diagnosed at least six months after GMN diagnosis was compared to determine potential risk factors for SPMs in GMN patients using the Fine and Gray proportional sub-distribution hazard model. A competing-risk nomogram was constructed to quantify SPM probabilities.

Results

A total of 109,537 patients with GMNs were included in the study, with 76,675 and 32,862 GMN patients in the training and verification sets, respectively. The competing-risk model analysis identified age, primary tumor location, tumor grade, disease stage, chemotherapy, and radiation as risk factors for SPMs in GMN patients. Calibration curves and ROC curves in both training and verification cohorts demonstrated the predictive accuracy of the established nomogram, which exhibited a good ability to predict SPM occurrence.

Conclusions

This study presents the nomogram developed for quantitatively predicting SPM probabilities in GMN patients for the first time. The constructed nomogram can assist clinicians in designing personalized treatment strategies and facilitate clinical decision-making processes.
Implementation and update of guideline-derived quality indicators for cervical cancer in gynecological cancer centers certified by the German Cancer Society (DKG)
Authors: Stuebs Frederik A. , Beckmann Matthias W. , Fehm Tanja , Dannecker Christian , Follmann Markus , Langer Thomas , Wesselmann Simone
Published: July 2023

Purpose

In 2008, the first gynecological cancer centres were certified by the German Cancer Society (DKG). Guideline-based quality Indicators (QIs) are a core element of the certification process. These QI are defined to assess the quality of care within the centres and can serve to measure the implementation of guideline recommendation. This article aims to give an overview of the developing and updating process of guideline based-QIs for women with cervical cancer and presents the QI results from the certified gynaecological cancer centres.

Methods

The QIs are derived in a multiple step review process and then implemented in the certification data sheet of the certified centres. The first set of QIs created in 2014 was revised in the update process of the S3-Guideline in 2020. QIs are based on strong recommendations of the evidence-based “Guideline for patients with Cervical Carcinoma” (registry-number: 032/033OL).

Results

In total, there are nine guideline-based QIs for cervical cancer. Four QIs are part of the certification process. In the treatment year 2020, 3.522 cases of cervical cancer were treated in 169 centers. The target values for the four QIs were met in at least 95% of the certified centers. In the guideline update in 2020, a new QI was added to the set of QIs “Complete pathological report on conization findings” and the QI “Exenteration” was removed.

Conclusions

QIs derived from strong recommendations of a guideline are an important tool to make essential parts of patient’s care measurable and enable the centers to draw consequences in process optimization. Over the years, the number of certified centers has grown, and the quality was improved. The certification systems is under constant revision to further improve patient’s care in the future, based on the results of the QI re-evaluation.
Targeting cancer stem cells as a strategy for reducing chemotherapy resistance in head and neck cancers
Authors: Dorna Dawid , Paluszczak Jarosław
Published: July 2023

Purpose

Resistance to chemotherapy and radiotherapy is the primary cause of a poor prognosis in oncological patients. Researchers identified many possible mechanisms involved in gaining a therapy-resistant phenotype by cancer cells, including alterations in intracellular drug accumulation, detoxification, and enhanced DNA damage repair. All these features are characteristic of stem cells, making them the major culprit of chemoresistance. This paper reviews the most recent evidence regarding the association between the stemness phenotype and chemoresistance in head and neck cancers. It also investigates the impact of pharmacologically targeting cancer stem cell populations in this subset of malignancies.

Methods

This narrative review was prepared based on the search of the PubMed database for relevant papers.

Results

Head and neck cancer cells belonging to the stem cell population are distinguished by the high expression of certain surface proteins (e.g., CD10, CD44, CD133), pluripotency-related transcription factors (SOX2, OCT4, NANOG), and increased activity of aldehyde dehydrogenase (ALDH). Chemotherapy itself increases the percentage of stem-like cells. Importantly, the intratumor heterogeneity of stem cell subpopulations reflects cell plasticity which has great importance for chemoresistance induction.

Conclusions

Evidence points to the advantage of combining classical chemotherapeutics with stemness modulators thanks to the joint targeting of the bulk of proliferating tumor cells and chemoresistant cancer stem cells, which could cause recurrence.
The motivation of breast cancer patients to participate in a national randomized control trial
Authors: Wegge-Larsen C. , Mehlsen M. , Jensen A. B.
Published: July 2023

Purpose

Clinical trials are essential for development of better cancer care. Therefore, patient willingness to participate in these trials is important. The aim of this study was to assess motivation and thoughts of breast cancer patients concerning participation in a clinical trial.

Methods

Twenty-one patients participated in two semi-structed interviews about participating in a clinical trial testing the efficacy of cryotherapy for the prevention of chemotherapy-induced peripheral neuropathy in breast cancer patients treated with paclitaxel. The interviews took place before and after the intervention and were coded and categorized following the steps in Braun & Clarke’s thematic analysis to identify motivational factors and experiential themes.

Results

Four overarching themes were identified: (1) reasons to participate in the trial, (2) personal resources, (3) safety, and (4) experience of the randomization. The most frequent reason for participating in the trial was to support research and help others, but many also participated hoping to receive the intervention treatment. The study showed that a surplus of personal resources played an important role when the patients decided to participate in the trial. Differences were found between patients belonging to the intervention and the control group in relation to these themes. Finally, both groups experienced the extra examinations received during the trial as an additional source of safety.

Conclusion

This qualitative study found different factors influencing the experience of participating in a clinical trial, e.g., intervention-status, personal resources, and safety. This knowledge can be valuable when planning future clinical trials involving breast cancer patients.
Thomas Henry Huxley, a stone tablet, coccoliths, and deep-sea sediments in the high Alps
Authors: Bernoulli Daniel , Jenkyns Hugh C.
Published: July 2023

In the mid-1850s, Thomas Henry Huxley, who coined the term ‘coccolith’, described their presence in oceanic sediments dredged from the sea floor. Subsequent recognition of their occurrence in the Upper Cretaceous English Chalk, largely unconsolidated pelagic sediment, and similar, more lithified limestones in the Jurassic of the Alps, led to their being considered major rock-forming elements through much of geological time, although they are now known to be limited to the Late Triassic–Recent interval. Unlike Charles Darwin, who did not travel abroad following the voyage of the Beagle, Huxley made a number of trips to Italy and Switzerland and is recorded as a guest in the exclusive Hotel Kursaal Maloja in the Engadin in 1893. While staying there, he made a number of excursions on foot and his presence was thought significant enough that it is recorded in an inscribed granitic stone tablet, erected in 1896, describing him as’the illustrious writer and naturalist’. His rambles would have led him past outcrops of tectonically emplaced true oceanic calcareous sediment of Early Cretaceous age, here shown to have originally contained coccoliths that were largely destroyed under the imprint of Alpine metamorphism of sub-greenschist to greenschist facies. To this extent, Huxley could have come close to recognizing true oceanic sediments exposed on land, but the dissimilarity between these Swiss Alpine deposits and the friable English Chalk would not obviously have led to the investigation of the former for the organisms he had christened as ‘coccoliths’.
Evidence-based clinical practice guidelines for cholelithiasis 2021
Authors: Fujita Naotaka , Yasuda Ichiro , Endo Itaru , Isayama Hiroyuki , Iwashita Takuji , Ueki Toshiharu , Uemura Kenichiro , Umezawa Akiko , Katanuma Akio , Katayose Yu , Suzuki Yutaka , Shoda Junichi , Tsuyuguchi Toshio , Wakai Toshifumi , Inui Kazuo , Unno Michiaki , Takeyama Yoshifumi , Itoi Takao , Koike Kazuhiko , Mochida Satoshi
Published: July 2023

The Japanese Society of Gastroenterology first published evidence-based clinical practice guidelines for cholelithiasis in 2010, followed by a revision in 2016. Currently, the revised third edition was published to reflect recent evidence on the diagnosis, treatment, and prognosis of cholelithiasis conforming to the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system. Following this revision, the present English version of the guidelines was updated and published herein. The clinical questions (CQ) in the previous version were reviewed and rearranged into three newly divided categories: background questions (BQ) dealing with basic background knowledge, CQ, and future research questions (FRQ), which refer to issues that require further accumulation of evidence. Finally, 52 questions (29 BQs, 19 CQs, and 4 FRQs) were adopted to cover the epidemiology, pathogenesis, diagnosis, treatment, complications, and prognosis. Based on a literature search using MEDLINE, Cochrane Library, and Igaku Chuo Zasshi databases for the period between 1983 and August 2019, along with a manual search of new information reported over the past 5 years, the level of evidence was evaluated for each CQ. The strengths of recommendations were determined using the Delphi method by the committee members considering the body of evidence, including benefits and harms, patient preference, and cost–benefit balance. A comprehensive flowchart was prepared for the diagnosis and treatment of gallbladder stones, common bile duct stones, and intrahepatic stones, respectively. The current revised guidelines are expected to be of great assistance to gastroenterologists and general physicians in making decisions on contemporary clinical management for cholelithiasis patients.
Single position L5-S1 lateral ALIF with simultaneous robotic posterior fixation is safe and improves regional alignment and lordosis distribution index
Authors: Hernandez Nicholas S. , Diaz-Aguilar L. Daniel , Pham Martin H.
Published: July 2023

Purpose

Minimally invasive single position lateral ALIF at L5-S1 with simultaneous robot-assisted posterior fixation has technical and anatomic considerations that need further description.

Methods

This is a retrospective case series of single position lateral ALIF at L5-S1 with robotic assisted fixation. End points included radiographic parameters, lordosis distribution index (LDI), complications, pedicle screw accuracy, and inpatient metrics.

Results

There were 17 patients with mean age of 60.5 years. Eight patients underwent interbody fusion at L5-S1, five patients at L4-S1, two patients at L3-S1, and one patient at L2-S1 in single lateral position. Operative times for 1-level and 2-level cases were 193 min and 278 min, respectively. Mean EBL was 71 cc. Mean improvements in L5-S1 segmental lordosis were 11.7 ± 4.0°, L1-S1 lordosis of 4.8 ± 6.4°, sagittal vertical axis of − 0.1 ± 1.7 cm°, pelvic tilt of − 3.1 ± 5.9°, and pelvic incidence lumbar–lordosis mismatch of − 4.6 ± 6.4°. Six patients corrected into a normal LDI (50–80%) and no patients became imbalanced over a mean follow-up period of 14.4 months. Of 100 screws placed in lateral position with robotic assistance, there were three total breaches (two lateral grade 3, one medial grade 2) for a screw accuracy of 97.0%. There were no neurologic, vascular, bowel, or ureteral injuries, and no implant failure or reoperation.

Conclusion

Single position lateral ALIF at L5-S1 with simultaneous robotic placement of pedicle screws by a second surgeon is a safe and effective technique that improves global alignment and lordosis distribution index.
Association between vertebral cross-sectional area and lumbar disc displacement – a population-based study
Authors: Ollila Laura , Oura Petteri , Karppinen Jaro , Niinimäki Jaakko , Junno Juho-Antti
Published: July 2023

Purpose

Vertebral dimensions may constitute a potential risk factor for degenerative changes in the spine. Previous studies have found a positive association between vertebral height and both type 2 Modic changes and intervertebral disc height loss. Also, vertebral endplate size has been associated with disc degeneration. However, only a few studies have investigated the association between vertebral dimensions and lumbar disc displacement (LDD). This study aimed to investigate the association between vertebral cross-sectional area (CSA) and LDD among the general middle-aged Finnish population. We hypothesized that larger vertebral CSA is associated with LDD.

Materials and methods

The study was conducted by using data from the Northern Finland Birth Cohort 1966 (NFBC1966). At the age of 46, a subpopulation of NFBC1966 underwent clinical examinations including magnetic resonance imaging (MRI) (n = 1249). MRI scans were used to measure L4 CSA and evaluate the presence of LDD (bulge, protrusion, and extrusion/sequestration) in the adjacent discs. The association between L4 CSA and LDD was analysed using logistic regression, with adjustment for sex, education, body mass index, leisure-time physical activity, smoking, diet, and L4 height.

Results

Larger L4 CSA was associated with LDD; an increase of 1 cm2 in vertebral CSA elevated the odds of LDD relative to no LDD by 10% (adjusted odds ratio 1.10, 95% CI 1.01–1.19). The association was similar among either sex.

Conclusions

Larger L4 vertebral CSA was associated with LDD in our study sample. Even though smaller vertebral size exposes our vertebrae to osteoporotic fractures, it simultaneously seems to protect us from LDD.
Incidence and presentation of vestibular schwannoma: a 3-year cohort registry study
Authors: Fernández-Méndez Rocio , Wan Yizhou , Axon Patrick , Joannides Alexis
Published: July 2023

Background

Vestibular schwannoma (VS) is the most common benign tumour arising in the lateral skull base. Reported incidence rates of VS vary across geographical locations and over time. There is scarce updated evidence over the past decade on the epidemiology and mode of presentation of VS.

Objective

To describe the epidemiology and mode of presentation of VS in the East of England between 2013 and 2016.

Methods

A retrospective epidemiological analysis of data from a national VS registry and electronic patient records was conducted, including all newly diagnosed adult patients in a UK tertiary referral centre, between April 1st, 2013, and March 31st, 2016.

Results

There were 391 new cases identified resulting in an overall mean incidence of 2.2 VS cases per 100,000 person-year. The incidence rate for all patients in the <40 age group ranged between 0.3 and 0.7 per 100,000 person-year, increasing to a range of 5.7 to 6.1 per 100,000 person-year in the 60–69 age group. The top three combinations of symptoms on presentation per patient were hearing loss and tinnitus (97, 24.8%), hearing loss alone (79, 20.2%) and hearing loss, tinnitus, and balance symptoms (61, 15.6%). The median duration of symptoms was 12 months, with a wide range from 1.4 to 300 months. Age was negatively correlated with tumour size (r = -0.14 [-0.24 to -0.04], p=0.01) and positively correlated with symptom duration (r = 0.16 [0.03–0.29], p=0.02).

Conclusions

The incidence of vestibular schwannoma has increased compared to previous studies in the UK and is similar to incidence rates reported in other countries during the past decade. It peaks in the seventh decade of life, mainly because of an increase in the diagnosis of small tumours with a long duration of audio-vestibular symptoms in older patients, compared to earlier studies.
Prevalence and adverse consequences of delayed diagnosis and misdiagnosis in thrombotic antiphospholipid syndrome. An observational cohort study and a review of the literature
Authors: Ruffatti Amelia , Tonello Marta , Calligaro Antonia , Del Ross Teresa , Favaro Maria , Zen Margherita , Hoxha Ariela , Alaibac Mauro
Published: July 2023

Obiectives

This study aims to prospectively evaluate the frequency and adverse consequences of diagnostic delay and misdiagnosis in a cohort of patients with thrombotic antiphospholipid syndrome (TAPS). In addition, a systematic review of the literature concerning the diagnostic delay and misdiagnosis of TAPS was carried out.

Methods

Patient enrollment occurred between 1999 and 2022. The study group was formed by TAPS patients whose diagnosis was delayed and those who were misdiagnosed. The control group was made up of patients who were timely and correctly diagnosed with TAPS.

Results

The literature review showed 42 misdiagnosed patients, 27 of them were in one retrospective cohort study and 15 in 13 case reports. One hundred sixty-one out of 189 patients (85.2%) received a timely, correct diagnosis of TAPS; 28 (14.8%) did not. The number of patients with diagnostic issues was significantly higher for the first period (1999–2010), and the number of patients with a correct diagnosis was significantly higher for the second one (2011–2022). When the clinical and laboratory characteristics of the patients with delayed diagnosis were compared with those with misdiagnosis, there was a significantly higher number of severe adverse consequences characterized by permanent disability or death in the latter group. The two most common types of misdiagnoses were systemic lupus erythematosus (6 cases, 46.1%) and cardiovascular diseases (4 cases, 30.8%).

Conclusions

The study demonstrates that although knowledge about TAPS has improved over time, diagnostic delays and errors remains to be addressed as they are strongly associated to adverse consequences.

Key Points•Although knowledge of thrombotic antiphospholipid syndrome has improved over time, it is still limited.•Diagnostic delay and misdiagnosis are still an important issue that remains to be addressed as they are strongly associated to adverse consequences.•The three more frequent misdiagnoses are multiple sclerosis, systemic lupus erythematosus and cardiovascular diseases.
Robotic abdominoperineal resection, posterior vaginectomy and abdomino-lithotomy sacrectomy: technical considerations and case vignette
Authors: Kearsey C. C. , Mathur M. , Sutton P. A. , Selvasekar C. R.
Published: July 2023

When working with patients who have locally advanced rectal cancer (LARC) the ability to undertake minimally invasive procedures becomes more challenging but no less important for patient outcomes. We performed a minimally invasive approach to surgery for LARC invading the posterior vagina and sacrum. The patient was a 75-year-old lady who presented with a locally advanced rectal tumour staged T4N2 with invasion into the posterior wall of the vagina and coccyx/distal sacrum. We introduce a robotic abdominoperineal resection, posterior vaginectomy and abdomino-lithotomy sacrectomy using a purely perineal approach with no robotic adjuncts or intracorporal techniques. Final histology showed moderately differentiated adenocarcinoma invading the vagina and sacrum, ypT4b N0 TRG2 R0 and the patient entered surgical follow-up with no immediate intra- or postoperative complications. A literature review shows the need for more minimally invasive techniques when relating to major pelvic surgery and the benefits of a purely perineal approach include less expensive resource use, fewer training requirements and the ability to utilise this technique in centres that are not robotically equipped.