bluuebunny/crossref_metadata_2025 huggingface dataset:
Patients’ reasons for non-use of digital patient-reported outcome concepts: A scoping review
Authors: Nielsen Amalie Søgaard , Kidholm Kristian , Kayser Lars
Published: July 2020

Data from digitally administered patient reported outcomes (PROs) is used more and more in routine healthcare for long-term conditions as a part of daily clinical practice. This literature study reviews empirical studies of digital PRO to examine patients’ reasons for non-use of digitally administered PRO data in routine care. This scoping review searched through PubMed, Embase, Web of Science and PsycINFO databases, reporting on study population, intervention, duration of intervention and motivational factors alongside stated reasons for nonparticipation or dropout for each study. The patients’ reasons for not participating, either from study start or by dropout, were analysed through a thematic approach.

Fifty-one studies were included, published from 2010 to 2019, mostly from Europe and the Unites States covering different long-term conditions. The reasons for non-use are manifold and cover the themes of ability to use PRO, engagement, emotional distress and technical barriers.

Several reasons are given explaining why patients with long-term conditions are not using digitally administered PRO as intended. This should be taken into account in the design phase of digital PRO interventions and considered in conversations with patients during the intervention.
Risk factors for MEK-associated retinopathy in patients with advanced melanoma treated with combination BRAF and MEK inhibitor therapy
Authors: Booth Andrew E. C. , Hopkins Ashley M. , Rowland Andrew , Kichenadasse Ganessan , Smith Justine R. , Sorich Michael J.
Published: July 2020

Background:

Retinopathy is a common adverse event with mitogen-activated extracellular signal-regulated kinase (MEK) inhibitors. Little is known about the pathophysiology of MEK inhibitor-associated retinopathy (MEKAR). Since MEKAR has many similarities to central serous chorioretinopathy (CSCR), they may share common risk factors. The aim of this study was to evaluate the association between baseline characteristics and MEKAR in melanoma patients initiating MEK inhibitor treatment.

Methods:

Data from patients treated with cobimetinib and vemurafenib for advanced melanoma in the coBRIM trial were subjected to secondary analysis. Consistent with CSCR risk factors, assessed baseline characteristics included: age, gender, past ocular disease, weight, hypertension, diabetes, dyslipidemia, glomerular filtration rate (eGFR) and corticosteroid use. Associations between characteristics and retinopathy events (any grade and symptomatic) were evaluated using univariate logistic regression and represented as odds ratios (OR).

Results:

A total of 247 patients were treated with cobimetinib and vemurafenib, of whom 72 (29%) had retinopathy of any grade and 33 (13%) had symptomatic retinopathy. Patients with a history of ocular disease were at significantly higher risk of retinopathy (any grade, 44%; symptomatic, 22%) than those with no ocular disease history (any grade, 22%; symptomatic, 10%). Individuals with a history of ocular inflammation or infection were at highest risk: 4 of 5 developed symptomatic retinopathy during MEK inhibitor therapy. Increased age was associated with a higher risk of any grade retinopathy {decade increase OR [95% confidence interval (CI)] = 1.03 (1.01–1.05); p = 0.009}, while increasing eGFR was significantly associated with a decreased risk of any grade retinopathy [0.98 (0.96–0.99); p = 0.004]; the associations were not statistically significant with symptomatic retinopathy. Other assessed CSCR risk factors were not significantly associated with MEKAR.

Conclusion:

Age, glomerular filtration rate and history of ocular disease (particularly inflammatory eye disease) were associated with a risk of MEK inhibitor induced retinopathy. Patients who are at increased risk of MEKAR may benefit from more regular ophthalmologic assessment during treatment.
Clinicopathologic significance of nuclear HER4 and phospho-YAP(S127) in human breast cancers and matching brain metastases
Authors: Kalita-de Croft Priyakshi , Lim Malcolm , Chittoory Haarika , de Luca Xavier M. , Kutasovic Jamie R. , Day Bryan W. , Al-Ejeh Fares , Simpson Peter T. , McCart Reed Amy E. , Lakhani Sunil R. , Saunus Jodi M.
Published: July 2020

Background:

Human epidermal growth factor receptor-4 (HER4) and yes-associated protein-1 (YAP) are candidate therapeutic targets in oncology. YAP’s transcriptional coactivation function is modulated by the HER4 intracellular domain (HER4-ICD) in vitro, but the clinical relevance of this has not been established. This study investigated the potential for targeting the HER4-YAP pathway in brain metastatic breast cancer.

Methods:

We performed immuno-phenotypic profiling of pathway markers in a consecutive breast cancer series with 25 years of clinical follow up ( n = 371), and patient-matched breast and metastatic brain tumours ( n = 91; 30 pairs).

Results:

Membrane localisation of phospho-HER4 [pHER4(Y1162)] was infrequent in primary breast cancer, but very frequent in brain metastases (5.9% versus 75% positive), where it was usually co-expressed with pHER3(Y1289) ( p < 0.05). The presence of YAP in tumour cell nuclei was associated directly with nuclear pERK5(T218/Y210) ( p = 0.003). However, relationships with disease-specific survival depended on oestrogen receptor (ER) status. Nuclear pYAP(S127) was associated with smaller, good prognostic ER+ breast tumours (log-rank hazard-ratio 0.53; p = 9.6E−03), but larger, poor prognostic triple-negative cancers (log-rank hazard-ratio 2.78; p = 1.7E−02), particularly when co-expressed with nuclear HER4-ICD ( p = 0.02). This phenotype was associated with stemness and mitotic instability markers (vimentin, SOX9, ID1, SPAG5, TTK, geminin; p < 0.05). YAP expression in brain metastases was higher than matched primary tumours; specifically, nuclear pYAP(S127) in ER-negative cases ( p < 0.05). Nuclear YAP was detected in ~70% of ER-negative, HER4-activated brain metastases.

Discussion:

Our findings suggest that the canonical-mechanism where Hippo pathway-mediated phosphorylation of YAP ostensibly excludes it from the nucleus is dysfunctional in breast cancer. The data are consistent with pYAP(S127) having independent transcriptional functions, which may include transducing neuregulin signals in brain metastases. Consistent with mechanistic studies implicating it as an ER co-factor, nuclear pYAP(S127) associations with breast cancer clinical outcomes were dependent on ER status.

Conclusion:

Preclinical studies investigating HER4 and nuclear YAP combination therapy strategies are warranted.
Carbon-based fully printable self-powered ultraviolet perovskite photodetector: Manganese-assisted electron transfer and enhanced photocurrent
Authors: Xu Shuhong , Huang Guangguang , Wang Chunlei , Shao Haibao , Cui Yiping
Published: July 2020

In this work, we improved the photocurrent of self-powered ultraviolet photodetector via doping manganese in CsPbCl3 perovskite nanocrystals light harvester. The doped manganese in nanocrystals has the following three features to assist electron transfer from CsPbCl3 nanocrystals to titanium dioxide: (i) the fast exciton-to-manganese energy transfer process benefits for competing electrons with perovskite exciton recombination, (ii) the charge carrier lifetime is very long for manganese d-states due to its spin and orbital forbidden transition, and (iii) the electrons can effectively transfer to the titanium dioxide layer from 4T1 of manganese d-states due to the smaller energy barrier. Based on the above, the self-powered photocurrent density of photodetectors has nearly twice enhancement from 0.08 mA·cm−2 to 0.14 mA·cm−2 and a high responsivity up to 7.3 mA·W−1 was achieved at 340 nm.
Students’ discursive moves in two distinct literacy modes: Comparing approaches in a grade 10 English classroom
Authors: Toncic Jason
Published: July 2020

This exploratory sociolinguistic study examined D/discourses and writing modes in a Grade 10 English literature classroom wherein students answered literature-based questions by means of both traditional and new literacies approaches. Studies conducted at the intersection of classroom instruction and online affinity spaces are still surprisingly under-reported in the academic literature; thus, the purpose of this small study was to contribute to new literacies studies research within classroom contexts by examining what happened when students responded to teacher-given prompts in two distinct modes: a traditional, essay-style response and a live, backchannel chat. This study compared the language use and some of the discursive moves that students made when composing written answers via both modes in order to provide insights for educators who may seek to use new literacies in their classrooms. Findings add to the discussion about what I see as the self-limiting aspects of traditional essayist-literacy (i.e. Academic English) favored by schools and the benefits of socially constructed literacy events facilitated by classroom-based online affinity spaces. Interestingly, findings suggest that this is not an either-or dichotomy, but that students in this study seemed to co-construct their literary analysis in the liminal space between Academic English and online chat discourse.
It Is All About Location: Smartphones and Tracking the Spread of COVID-19
Authors: Frith Jordan , Saker Michael
Published: July 2020

Mobile phone location data have become tied to understandings of and responses to the COVID-19 pandemic. Data visualizations have used mobile phone data to inform people about how mobility practices may be linked to the spread of the virus, and governments have explored contact tracing that relies upon mobile phone data. This article examines how these uses of location data implicate three particular issues that have been present in the growing body of locative media research: (1) anonymized data are often not anonymous, (2) location data are not always representative and can exacerbate inequality, and (3) location data are a key part of the extension of the surveillance state.
The possible role of hydration in concussions and long-term symptoms of concussion for athletes. A review of the evidence
Authors: Clark James E , Sirois Emily
Published: July 2020

The purpose of this review is to address what is known, speculated, and hypothesized regarding the issue of hydration and concussions. Based on the question, “What impact does hydration have on the relative risk for suffering concussive injuries along with long-term ramifications that have been associated with concussive (and repeated subconcussive) traumas to the cerebral cortex?,” a search of available literature was performed through June 2019. Deducing from the available literature, we can stipulate that changes in hydration within the cerebral cortex increase the likelihood for disruption of neurofilament proteins, dysregulation of membrane dynamics of the neurons and exacerbate inflammation responses following head trauma. As such, it can be speculated that differences in incidence rates may be attributed to difference in tissue fluid based on athlete demographics, level of whole-body water balance, and degree of tissue dehydration more than selection of sport. Moreover, tissue hydration in combination with other inflammation factors provides the scaffolding for the development of long-term issues (e.g. chronic traumatic encephalopathy) associated with repetitive head trauma in athletes.
Subcontractor Selection Process Through Vendor Bids: A Case of An Outsourcing Service in Construction
Authors: Ramalingam Shobha
Published: July 2020

Subcontractors handle a large portion of the work in construction projects. The ability of the general contractor to deliver projects on time, within budget and with the expected level of quality are significantly dependent on the performance of subcontractors. Thus, selecting the right subcontractor for the right task is a determining factor for project success. Literature has identified several criteria for subcontractor selection that predominantly includes financial capacity, ability to complete on time and reputation and quality of workmanship. However, as projects are becoming more global and complex, ensuring selection and award through a fair and competitive formal process becomes imperative. Nevertheless, an understanding of a formal process, backing the selection criteria, seems to be lacking; more so in the context of engineering outsourcing services. Vendor bid analysis is one such service, wherein the general contractor packages the bids received from several subcontractors to a team in a different country who evaluate and enable the general contractor to select and award the subcontractors for project tasks. To this end, an exploratory case study was conducted in an outsourcing firm in India that provide services to general contractors in the USA to understand the formal process of subcontractor selection across organizational boundaries along with its inherent risks and challenges. Data was collected through a participatory research approach, supplemented with participant observation and team interviews which were analysed through inductive reasoning and cross-case comparison methods. The findings showed a formalized 5-phase process across the organizational interface that included assess, identify, evaluate, negotiate and optimize phases. Further, delving into the evaluate, negotiate and optimize phases, the nuances in outsourced projects and the firms strategy to overcome them were evident, such as selection criteria and negotiation strategy adopted in the case of a single bidder with high pricing to mitigate probable bid-rigging practices or ensuring constant training to overcome the challenges due to lack of trade and country specific know-how. In addition, through a reflective approach, the value addition services provided to the general contractor aimed to optimize the process and improve project governance. These findings are expected to provide practical implication for firms in similar business and act as a steppingstone to conduct further robust research.
Lumbar Plexus Block versus Peri-capsular Injection for Hip Arthroscopy: A Single-Blinded Randomized Controlled Trial
Authors: Polmear Michael , Christensen Daniel , Salfiti Catherine , Wolff Andrew , Scanaliato John
Published: July 2020

Objectives:

To perform a single-blinded, randomized controlled trial comparing pericapsular injection versus lumbar plexus blockade for post-operative pain control following arthroscopic surgery on the hip.

Methods:

70 consecutive patients undergoing hip arthroscopy were prospectively assessed over a six-month period from 2017 to 2018. Patients were randomly allocated to 1 of 2 groups. 35 patients received a lumbar plexus blockade by a single anesthesiologist, while 35 patients received a pericapsular injection of 30cc of ropivacaine and 12mg of morphine. Post-operative pain in the post-anesthesia care unit (PACU) as measured by the numeric rating scale (NRS), time to discharge, PACU morphine equivalents and adverse effects were collected by PACU staff. Post-operative day (POD) 1 and POD 2 narcotic use was obtained through a phone call with the patient on post-operative day 2.

Results:

We found no statistically significant difference in PACU pain scores at all time-points, although there was a trend towards lower pain for patients receiving a pericapsular injection. PACU and short-term narcotic demand did not differ significantly between the two arms. Time to discharge from the PACU did not differ. There were no major adverse events reported for either intervention.

Conclusion:

Pericapsular injection provides equivalent analgesia when compared to lumbar plexus injection. It is a safe, time-saving intervention that allows for efficient post-operative analgesia for patients undergoing hip arthroscopy.
Superior Labrum Anterior-Posterior (SLAP) Repair Versus Subpectoral Biceps Tenodesis for Isolated SLAP II Lesions in Overhead Athletes Aged Younger 35 Years: A Comparison of Minimum Two-Year Outcomes
Authors: Horan Marilee , Dekker Travis , Goldenberg Brandon , Dornan Grant , Peebles Liam , Provencher Matthew , Millett Peter , Lacheta Lucca
Published: July 2020

Objectives:

In young overhead athletes with isolated superior labrum anterior-posterior (SLAP) type II lesions it remains unclear if patients benefit more from either SLAP repair or biceps tenodesis. The purpose of our study is to evaluate clinical outcomes and return to sports rates in overhead athletes suffering from symptomatic SLAP type II lesions who have undergone either biceps tenodesis or SLAP repair.

Methods:

A retrospective analysis of prospectively collected data was performed in patients who underwent subpectoral biceps tenodesis (group I) or SLAP repair (group II) for the treatment of isolated SLAP type II lesions, were younger than 35 years at time of surgery, participated in overhead sports, and were at least two years out from surgery. Clinical outcomes were assessed by the use of the American Shoulder and Elbow Society Score (ASES), Single Assessment Numerical Evaluation Score (SANE), Quick Disabilities of the Arm, and Shoulder and Hand Score (QuickDASH) and the General Health SF-12 physical component. Return to sports and patient satisfaction were documented. Clinical failures requiring revision surgery and complications were reported.

Results:

Minimum 2-year follow-up was obtained in 12/14 (85.7%) patients in group I and in 23/27 (85%) patients in group II. Preoperative baseline scores between both groups showed no significantdifferences (p > 0.05). When group I was compared to group II, no significant differences inpostoperative outcome scores were detected (p > 0.05). For biceps tenodesis (Group I) vs SLAP repair (Group II): ASES score was mean 91.6 ± 11.3 vs 88.6 ± 16.9, SANE score was mean 77.5 ± 28.0 vs. 82.3 ± 24.4, QuickDASH score was mean 9.2± 12.2 vs 9.4 ± 14.5, and SF-12 was mean 52.0 ± 6.1 vs 52.6 ± 7.8. No difference in return to sports rate (91% vs 91%, p > .05) was noted. 1 patient in group I and 2 patients in group II failed.

Conclusion:

This study showed that both techniques of SLAP repair and subpectoral biceps tenodesis provide excellent clinical results with high return to overhead sports rate and low failure rate in a young and high-demanding patient cohort for the treatment of isolated SLAP type II lesions.
Venting the Central Compartment of the Hip Prior to Distraction Minimizes Overall Hip Distraction Forces
Authors: Dillon O , Mortensen Alex , Adeyemi Temitope , Ohlsen Suzanna , Maak Travis , Aoki Stephen
Published: July 2020

Objectives:

Arthroscopic hip surgery requires application of ipsilateral lower extremity traction to achieve adequate joint distraction and hip central compartment access. Higher traction forces applied to the lower extremity allow greater hip joint distraction, improving the working space, in order minimize iatrogenic chondral and labral injury. However, greater traction forces have demonstrated a higher potential for iatrogenic traction related injuries. Controversy exists about the clinical relevance of procedural modifications, such as venting the hip, as a means of reducing the amount of traction force required to safely distract the hip joint. This study was designed to evaluate the difference between no venting versus venting the hip prior to application of traction on the overall amount of traction needed to distract the hip joint during hip arthroscopy.

Methods:

A total of 55 hips in 54 consecutive patients undergoing primary arthroscopic hip surgery were retrospectively reviewed. Prior to any instrumentation, interval fluoroscopic images of the operative hip joint were taken at 0, 25, 50, 75, and 100 pound-force (lb-f) (0, 11.3, 22.7, 34.0, and 45.4 kilogram-force (kg-f)) of applied traction. The hip was then taken off traction and the joint was vented using a standard hip access 14-gauge spinal needle and injected with 20 milliliters of air. Before any additional intervention, traction was again applied to the operative extremity and fluoroscopic images were obtained at the same traction force intervals. Joint displacement was measured at each traction force interval both before and after venting. Fluoroscopic images were scaled based on AP pelvis radiographs in order to obtain millimeteric joint space measurements.

Results:

The mean difference in hip joint displacement without venting and with venting was 0.29, 2.24, 4.06, 4.13, and 3.80mm at 25, 50, 75, and 100 lbs-f of traction, respectively. Paired samples t-testing demonstrated statistically significant increases in distraction distance (p<0.01) at all levels of traction (Table 1). Prior to venting, 0%, 7.3%, 27.8%, 44.0% of hips distracted at least 10 mm at 25, 50, 75, and 100 lbs-f of traction, respectively. After venting, 14.6%, 45.0%, 74.0%, 86% of hips distracted at least 10 mm at 25, 50, 75, and 100 lbs-f of traction, respectively (Figure 1).

Conclusion:

This study demonstrates that venting the hip prior to the application of traction significantly increases the amount of distraction distance achieved for a given traction force at multiple levels of traction. With venting of the hip, the percentage of hips achieving at least 10mm of distraction for 100lbsf almost doubled. These findings suggest venting the hip prior to application of traction could serve to reduce the maximal amount of traction required to safely instrument the hip arthroscopically. [Table: see text][Figure: see text]
Higher Percentage of Patients Return to Work than Sport Following Tibial Tubercle Anteromedialization
Authors: Bloom David , Hoberman Alex , Fliegel Brian , Alaia Michael , Jazrawi Laith , Strauss Eric , Kingery Matthew
Published: July 2020

Objectives:

Tibial tubercle anteromedialization (AMZ) is a commonly performed procedure for patients with patellofemoral instability or patellofemoral osteochondral disease. While the clinical outcomes following the procedure are good, the time needed to return to work and sport remains unclear.

Methods:

Patients who underwent AMZ for either patellofemoral instability or patellofemoral osteochondral lesions with a minimum follow-up time of 1-year were identified. Patients were asked to complete a series of patient reported outcomes surveys including specific queries regarding their return to work and return to athletic activity.

Results:

109 patients (mean age: 30.74±9.90 years, 72.3% female) were included with a mean follow-up of 3.40±1.97 years. 64 patients underwent AMZ for patellofemoral instability and 45 as part of their treatment for patellofemoral osteochondral disease. Of the 80 patients who were involved in sport prior to injury, 75.0% returned to athletics at a mean 9.21±5.46 months (range 1-24 months). 104 patients (95.4%) returned to work at a mean time of 2.96±3.33 months (range 0.25 to 24 months). There was a significant difference in time of return-to-work between those with a physically-demanding job and those with a sedentary job (4.26±3.82 months vs 2.25±1.81 months, p = 0.015).

Conclusions:

At a minimum follow-up time of 1 year, patients who underwent AMZ were found to have a return to sport rate of 75% with a mean time of 9.21 months to return to athletic activity. Over 95% of AMZ patients had returned to work at 1 year post-procedure. Patients required an average of 3 months to return to work, although those with physically demanding jobs required slightly more time. Data from the current study is useful in setting expectations for patients undergoing tibial tubercle anteromedialization (AMZ) for patellofemoral instability or patellofemoral osteochondral disease.
Medical Students’ Empathy Level Differences by Medical Year, Gender, and Specialty Interest in Akdeniz University
Authors: Akgün Özge , Akdeniz Melahat , Kavukcu Ethem , Avcı Hasan Hüseyin
Published: July 2020

Background:

As an important feature in patient-physician communication for both primary and clinical care, empathy is one of the basic competencies that physicians should possess. The primary aim of this study was to evaluate the level of empathy among medical students in all years of medical training using two different instruments: the Jefferson Scale of Physician Empathy (for clinical empathy level) and the Toronto Empathy Questionnaire (for general empathy level).

Materials and Methods:

This study is a cross-sectional descriptive study conducted in 2017-2018 academic year with students studying at Akdeniz University Faculty of Medicine. Data collection form, Toronto Empathy Questionnaire (TEQ) and Jefferson Scale of Physician Empathy (JSPE) was applied to the students by the researchers. The statistical analysis was carried out by using IBM-SPSS version 23 for Mac OS. T-test, ANOVA test, Spearman and Pearson correlation analysis were used for comparisons.

Results:

The mean TEQ score of the students was 52.8/65 and the JSPE-S score was 80.3/100. TEQ scores of students increased up to 4th year and then decreased, but the difference between the years was not statistically significant. The third year students’ JSPE-S scores were significantly higher than that of the sixth year students.

Conclusion:

While the clinical empathy levels of medical students decreased significantly after 3rd year, the general empathy levels decreased less. This result shows us that we should review our medical education curriculum and educational environment, and should initiate initiatives, and devote more time to empathy education in order to prevent the decrease in empathy level and increase empathy during medical education.
A Patient-Narrative Video Approach to Teaching Fibromyalgia
Authors: Leeds Frederic Stuart , Sommer Evan M , Andrasik Wyatt J , Atwa Kareem M , Crawford Timothy N
Published: July 2020

Introduction:

Although fibromyalgia is one of the most common and clinically important rheumatologic entities, physicians frequently report that their training fails to prepare them to manage this disease. Many medical schools devote insufficient time and attention to the subject of fibromyalgia, resulting in training gaps that can manifest as failures of both knowledge and empathy. There is a need for evidence-based, time-efficient methods for teaching this important subject. We have developed a narrative-driven video presentation for clerkship students and sought to evaluate its impact on fibromyalgia-related knowledge and attitudes.

Methods:

Fibromyalgia: A Patient’s Perspective (FPP), a 13-minute video, was presented to third-year medical students (N = 54). Surveys of knowledge and attitudes were collected before and after the video. Composite scores, as well as Knowledge and Attitudes subscales, were computed, and paired t tests were used to compare pre/post means for these scales, as well as for individual questions. Mann-Whitney U and Kruskal-Wallis tests were used to identify correlations between survey scores and student sex and specialty of interest.

Results:

Between pre-experience and post-experience surveys, there were statistically significant differences for 11 of 15 questions (73%). The composite score increased from 3.8 (SD = 0.44) to 4.2 (SD = 0.47) ( P < .0001). Knowledge and Attitude subscale scores also increased, from 4.0 (SD = 0.5) to 4.38 (SD = 0.5) ( P < .0001) and 3.6 (SD = 0.5) to 3.93 (SD = 0.5) ( P < .0001), respectively. Students reported favorable impressions of the video, with 87% agreeing that the video was helpful to learners and 79% disagreeing that a lecture would be preferable to the video. No differences in scores by sex or intended specialty were observed.

Conclusion:

The FPP video demonstrates promise as a tool for enhancing both knowledge of and positive, empathic attitudes toward fibromyalgia in medical learners. It may serve as a useful resource for educators looking to further develop their clinical pain management curricula.
Pediatric Bilateral Condylar High Displaced Fracture: Ten Years Follow-Up
Authors: Paggi Claus Jonathas Daniel , Almeida Matheus Spinella , Santos Felipe Daniel Burigo dos , Chagas Júnior Otacilio
Published: July 2020

The treatment of mandibular condylar fractures is a controversial topic in maxillofacial surgery. Open surgery with anatomic reduction and internal rigid fixation is well established in the literature and appears to be the most common approach. Nonsurgical therapies are indicated to intracapsular fractures, medial condylar displacement, and pediatric trauma. The high capacity of tissue remodeling and articular adaptation are important factors to support nonsurgical treatment in pediatric patients. The purpose of this article is to present a case of a pediatric mandibular bilateral condylar fracture treated with closed reduction with 10 years of follow-up and a discussion based on the literature.
Endoscopic Transoral Image‐Guided Retrieval of Infratemporal Fossa Foreign Bodies
Authors: Lehmann Ashton E. , Scangas George A. , Jafari Aria , Metson Ralph
Published: July 2020

Removal of foreign bodies from the infratemporal fossa is surgically challenging and fraught with risks. This report describes our experience with a minimally invasive transoral technique, utilizing endoscopic and image guidance technology, for retrieval of infratemporal fossa foreign bodies in 6 patients. The technique was successfully applied in all cases with identification and retrieval of the foreign bodies, which included 4 hypodermic needles broken off during dental injections, a cottonoid surgical sponge lost during a facial fracture repair, and a maxillary molar displaced during attempted extraction. Complications were limited to transient postoperative lingual and inferior alveolar nerve sensory deficits in 1 patient.
Shareholder internationality and importing activities of emerging market firms
Authors: Wang Pei , Vega Salas William Gonzalo
Published: July 2020

In light of the increasing efforts made by emerging market firms to engage in international business through importing activities, identifying the characteristics that motivate importing business and contribute to its success is practically and theoretically meaningful. Drawing upon a knowledge-based view (KBV), we examine how the shareholder internationality affects a firm’s importing activities. We hypothesize that the shareholder internationality can facilitate a firm’s import initiation and contribute to the diversity of importing countries of origin. Moreover, the divergence of shareholders’ nationality backgrounds may hinder import initiation, but motivate importing from dispersed countries of origin during the import development process. A longitudinal analysis of Colombian firms supports our hypotheses.
Evolutionary directions of single nucleotide substitutions and structural mutations in the chloroplast genomes of the family Calycanthaceae
Authors: Dong Wenpan , Xu Chao , Wen Jun , Zhou Shiliang
Published: July 2020

Background

Chloroplast genome sequence data is very useful in studying/addressing the phylogeny of plants at various taxonomic ranks. However, there are no empirical observations on the patterns, directions, and mutation rates, which are the key topics in chloroplast genome evolution. In this study, we used Calycanthaceae as a model to investigate the evolutionary patterns, directions and rates of both nucleotide substitutions and structural mutations at different taxonomic ranks.

Results

There were 2861 polymorphic nucleotide sites on the five chloroplast genomes, and 98% of polymorphic sites were biallelic. There was a single-nucleotide substitution bias in chloroplast genomes. A → T or T → A (2.84%) and G → C or C → G (3.65%) were found to occur significantly less frequently than the other four transversion mutation types. Synonymous mutations kept balanced pace with nonsynonymous mutations, whereas biased directions appeared between transition and transversion mutations and among transversion mutations. Of the structural mutations, indels and repeats had obvious directions, but microsatellites and inversions were non-directional. Structural mutations increased the single nucleotide mutations rates. The mutation rates per site per year were estimated to be 0.14–0.34 × 10− 9for nucleotide substitution at different taxonomic ranks, 0.64 × 10− 11for indels and 1.0 × 10− 11for repeats.

Conclusions

Our direct counts of chloroplast genome evolution events provide raw data for correctly modeling the evolution of sequence data for phylogenetic inferences.
Accuracy assessment of dental age estimation with the Willems, Demirjian and Nolla methods in Spanish children: Comparative cross-sectional study
Authors: Paz Cortés Marta Macarena , Rojo Rosa , Alía García Esther , Mourelle Martínez Maria Rosa
Published: July 2020

Background

The objective of this study was to evaluate and compare the validity and accuracy of the Willems, Demirjian and Nolla methods in predicting chronological age in a Spanish ethnicity population.

Methods

A sample of 604 orthopantomographs of Spanish children aged 4 to 13 years was evaluated by two independent evaluators. Descriptive statistics were applied to calculate the chronological age and dental age, presenting the mean and standard deviation. The difference between dental age and chronological age was calculated for each method. A positive result indicated an overestimation and a negative figure indicated an underestimation. The Wilcoxon test for paired data and Spearman’s correlation coefficient were applied by age groups and sex to compare the chronological age and dental age of each method (that of Willems, Demirjian and Nolla). Statistical tests were performed at a 95% confidence level.

Results

The interexaminer agreement was 0.98 (p = 0.00), and the intraexaminer agreement was 0.99 (p = 0.00). The Willems method significantly overestimated the age of boys (0.35 years (0.93)) and girls (0.17 years (0.88)). The Demirjian method significantly overestimated the age of boys (0.68 years (0.95)) and girls (0.73 years (0.94)). The Nolla method significantly underestimated age in boys (0.44 years (0.93)) and girls (0.82 years (0.98)).

Conclusions

In the Spanish population, the use of the Demirjian method for legal and medical purposes is frequent. This study reveals that the Willems method is more appropriate due to its greater precision in estimating dental age.
Structure and surgical dissection layers of the bare area of the liver
Authors: Ishii Takamichi , Seo Satoru , Ito Takashi , Ogiso Satoshi , Fukumitsu Ken , Taura Kojiro , Kaido Toshimi , Uemoto Shinji
Published: July 2020

Background

The bare area was reportedly formed by direct adhesion between the liver and diaphragm, meaning that the bare area lacked serosal components. This study aimed to analyze the structure of the bare area by an integrated study of surgical and laparoscopic images and pathological studies and describe surgical procedures focusing on the multilayered structure.

Methods

Several surgical specimens of hepatectomy were analyzed histologically to evaluate the macroscopic structure of the bare area. Laparoscopic images and cadaver anatomy of the bare area were also examined.

Results

The multilayered structure of the bare area comprised the liver, sub-serosal connective tissue, liver serosa, parietal peritoneum, retroperitoneal connective tissue, epimysium of the diaphragm, and diaphragm, in order from the liver to the diaphragm. The liver serosa and the parietal peritoneum fused with each other. This multilayered structure of the bare area is observed almost constantly. There are two layers in the dissection of the bare area in surgical procedures, an outer layer of the fused peritoneum (near the diaphragm) and an inner layer of the fused peritoneum (near the liver). Laparoscopic images enabled us to recognize the multilayered structure of the bare area.

Conclusions

Histopathological findings showed the bare area to be a multilayered structure. In cases where tumors are located underneath the bare area, it could be important to dissect the bare area, with careful attention to its multilayered structure. Surgical dissection of the bare area in the outer layer of the fused peritoneum could allow a sufficient safety margin.
Adult laryngeal Embryonal Rhabdomyosarcoma: a case report and literature review
Authors: Hu Juanjuan , Lu Dan , Ren Jia , Wen Qiao , Zhou Jing , Gan Weigang , Liu Jun , Liu Shixi , Yang Hui , Zou Jian
Published: July 2020

Background

Laryngeal rhabdomyosarcomas (RMSs) mainly occurred in children, while were extremely rare in adults. Consequently, less information was available to guide clinicians to manage adult RMSs in larynx.

Case presentation

A 42-year-old man presented with a 2-year history of gradually worsening hoarseness. Then, he underwent a surgery with suspension laryngoscope with initially being diagnosed as vocal cord cyst. Unexpectedly, the lesion was proved to be embryonal rhabdomyosarcoma (ERMS), pathologically. Next, he underwent chemoradiotherapy, while the tumor relapsed 18 months after the last treatment. Subsequently, a vertical hemilaryngectomy and a right selective neck dissection was performed, and the chemotherapy according to the anticancer drug sensitivity in vitro was arranged. Until the last check-up 18 months after chemotherapy, the patient did not display clinical or radiological signs of local recurrence and metastases.

Conclusions

Misdiagnosis and missed diagnosis of laryngeal RMSs might appear when tumors presented as smooth protuberance. We reported the first case of laryngeal RMSs in an adult with the multidisciplinary strategy based on the chemosensitivity assay in vitro. Furthermore, a systematic review of the literature was also discussed, highlighting the initial diagnostic pitfalls and subsequent management problems that may occur with this uncommon tumor.
Prognostic impact of estimated remnant-like particle cholesterol in patients with differing glycometabolic status: an observational cohort study from China
Authors: Zhao Qi , Zhang Ting-Yu , Cheng Yu-Jing , Ma Yue , Xu Ying-Kai , Yang Jia-Qi , Zhou Yu-Jie
Published: July 2020

Background

It is uncertain whether estimated remnant-like particle cholesterol (RLP-C) could predict residual risk in patients with different glycometabolic status. This study aimed to evaluate the relationship between estimated RLP-C and adverse prognosis in patients with non-ST-segment elevation acute coronary syndrome (NSTE-ACS) treated with percutaneous coronary intervention (PCI) and to identify the potential impact of glycometabolism on the predictive value of estimated RLP-C.

Methods

The study assessed 2419 participants with NSTE-ACS undergoing PCI at Beijing Anzhen Hospital from January to December 2015. Estimated RLP-C was calculated as follows: total cholesterol (TC) minus low-density lipoprotein cholesterol (LDL-C) and high-density lipoprotein cholesterol (HDL-C). The adverse events included all-cause death, non-fatal myocardial infarction (MI), and ischemia-driven revascularization.

Results

Estimated RLP-C was prominently associated with adverse prognosis in the total population [hazard ratio (HR) 1.291 per 1-SD increase, 95% confidence interval (CI) 1.119–1.490, P <  0.001], independent of confounding risk factors. However, subgroup analysis showed that increasing estimated RLP-C was related to a higher risk of adverse events in the diabetic population only [HR 1.385 per 1-SD increase, 95% CI 1.183–1.620, P <  0.001]. Estimated RLP-C failed to be a significant determinant of adverse prognosis in non-diabetic and pre-diabetic subgroups. The addition of estimated RLP-C to a baseline model including traditional risk factors enhanced the predictive performance both in total and diabetic populations.

Conclusions

High estimated RLP-C level is a significant predictor for recurrent adverse events in patients with diabetes and NSTE-ACS treated with PCI.
Factors distinguishing invasive from pre-invasive adenocarcinoma presenting as pure ground glass pulmonary nodules
Authors: Yang Huan-Huan , Lv Yi-Lv , Fan Xing-Hai , Ai Zhi-Yong , Xu Xiu-Chun , Ye Bo , Hu Ding-Zhong
Published: July 2020

Background

To investigate predictors of pathological invasiveness and prognosis of lung adenocarcinoma in patients with pure ground-glass nodules (pGGNs).

Methods

Clinical and computed tomography (CT) features of invasive adenocarcinomas (IACs) and pre-IACs were retrospectively compared in 641 consecutive patients with pGGNs and confirmed lung adenocarcinomas who had undergone postoperative CT follow-up. Potential predictors of prognosis were investigated in these patients.

Results

Of 659 pGGNs in 641 patients, 258 (39.1%) were adenocarcinomas in situ, 265 (40.2%) were minimally invasive adenocarcinomas, and 136 (20.6%) were IACs. Respective optimal cutoffs for age, serum carcinoembryonic antigen concentration, maximal diameter, mean diameter, and CT density for distinguishing pre-IACs from IACs were 53 years, 2.19 ng/mL, 10.78 mm, 10.09 mm, and − 582.28 Hounsfield units (HU). Univariable analysis indicated that sex, age, maximal diameter, mean diameter, CT density, and spiculation were significant predictors of lung IAC. In multivariable analysis age, maximal diameter, and CT density were significant predictors of lung IAC. During a median follow-up of 41 months no pGGN IACs recurred.

Conclusions

pGGNs may be lung IACs, especially in patients aged > 55 years with lesions that are > 1 cm in diameter and exhibit CT density > − 600 HU. pGGN IACs of < 3 cm in diameter have good post-resection prognoses.
Brief motivational therapy versus enhanced usual care for alcohol use disorders in primary care in Chile: study protocol for an exploratory randomized trial
Authors: Barticevic Nicolas A. , Poblete Fernando , Zuzulich Soledad M. , Rodriguez Victoria , Bradshaw Laura
Published: July 2020

Background

Harmful alcohol use is a leading cause of global disability and death. However, increased detection and brief intervention capacity of more severe alcohol use disorders has not been accompanied by increased availability of treatment services. Incorporating treatment for such disorders into primary care is of paramount importance for improving access and health outcomes. This study aims to estimate the effectiveness of a Brief Motivational Treatment (BMT) applied in primary care for treatment of these disorders.

Methods

A parallel-group, single-blinded, severity-stratified, randomized clinical trial will test the superiority of BMT over enhanced usual care. Eligible participants will be those seeking treatment and who fulfill DSM-V criteria for alcohol use disorder and criteria for harmful alcohol use. With an estimated a loss to follow-up of 20%, a total of 182 participants will be recruited and equally randomized to each treatment group. The intervention group will receive an adaptation of the motivational enhancement therapy, as manualized in Project MATCH. This treatment consists of four 45-min sessions provided by a general psychologist with at least 3 years of primary care experience. The primary outcome is the change from baseline in the drinks per drinking day during the last 90 days, which will be captured using the Timeline Follow Back method. Secondary outcomes will describe the changes in alcohol use pattern, motivational status, and severity of the disorder.

All participants will be analyzed according to the group they were allocated, regardless of the treatment actually received. Mean differences (MD) will be computed for continuous outcomes and relative risks (RR) and RR reductions (RRR) for dichotomous results. Linear models will deliver the subgroup analyses. Missingness is assumed to be associated with the baseline alcohol use pattern and severity, so a multiple imputation method will be used to handle missing data.

Discussion

This trial aims to test the superiority of BMT over enhanced usual care with a reasonable superiority margin, over which the BMT could be further considered for incorporation into PC in Chile. Its pragmatic approach ultimately aims to inform policymakers about the benefit of including a brief psychosocial treatment into PC.

Trial registration

ClinicalTrials.gov NCT04345302. Registered on 28 April 2020
The role of vaginal palpation in motor learning of the pelvic floor muscles for women with stress urinary incontinence: study protocol for a randomized controlled trial
Authors: de Azevedo Ferreira Letícia , Fitz Fátima Faní , Gimenez Márcia Maria , Matias Mayanni Magda Pereira , Bortolini Maria Augusta Tezelli , Castro Rodrigo Aquino
Published: July 2020

Background

Approximately 30 to 50% of women are unable to correctly perform pelvic floor muscle (PFM) contractions. For women to benefit from a pelvic floor muscle training (PFMT) programme for stress urinary incontinence (SUI), the awareness phase of PFMT cannot be omitted. The purpose of this study is to evaluate whether vaginal palpation together with verbal instructions about PFMs and body awareness techniques helps women with SUI learn how to correctly contract the PFMs and improve their functions.

Methods

This single-centre, double-blind randomized controlled trial with two intervention groups was designed following the standard protocol items for randomized interventional trials (SPIRIT). The results will be reported in a manner consistent with the Consolidated Standards of Reporting Trials (CONSORT) guidelines. Patients with SUI (n = 172) will be recruited. The experimental group will receive verbal instructions about PFM function and body awareness techniques together with vaginal palpation; the control group will receive similar protocol without vaginal palpation. The primary outcome includes the number of fast-twitch muscle fibres assessed by vaginal palpation and visual observation. Secondary outcomes include power and muscular endurance that will be assessed by visual observation and vaginal palpation (Oxford scale), the use of accessory muscles during the voluntary contraction of PFMs, and the self-efficacy and the expectations for the results using the self-efficacy scale of pelvic floor exercises.

Discussion

This study will determine whether vaginal palpation can help women with SUI to correctly perform PFM contractions and improve their functions.

Trial registration

ClinicalTrials.gov NCT 03325543. Registered on 30 November 2017. Study protocol version 1; 30 November 2020. Prospectively registered.
On the existence of three solutions of Dirichlet fractional systems involving the p-Laplacian with Lipschitz nonlinearity
Authors: Guefaifia Rafik , Boulaaras Salah , Kamache Fares
Published: July 2020

A class of perturbed fractional nonlinear systems is studied. The dynamical system possesses two control parameters and a Lipschitz nonlinearity order of $p-1$
p
−
1
. The multiplicity of the weak solutions is proved by means of the variational method and by Ricceri critical points theorems. An illustrative example is analyzed in order to highlight the obtained result.