bluuebunny/crossref_metadata_2025 huggingface dataset:
Treatment of genitourinary carcinoma in dogs using nonsteroidal anti‐inflammatory drugs, mitoxantrone, and radiation therapy: A retrospective study
Authors: Clerc‐Renaud Benoit , Gieger Tracy L. , LaRue Susan M. , Nolan Michael W.
Published: February 2021

Background

Locoregional tumor control and prolonged survival for dogs with genitourinary carcinoma (CGUC) reportedly are achievable using treatment with radiotherapy (RT) with or without adjunctive chemotherapy and nonsteroidal anti‐inflammatory drugs (NSAIDs).

Objectives

To characterize event‐free and overall survival after treatment of CGUC using NSAIDs, mitoxantrone (MTX), and a standardized RT protocol (57 Gy in 20 fractions).

Animals

Fifty‐one client‐owned dogs treated between 2008 and 2017.

Methods

Dogs were retrospectively categorized into treatment groups: (a) first‐line concurrent chemoradiotherapy (≥1 dose of MTX started within 1 month of RT); (b) first‐line chemotherapy (MTX administered for >1 month before RT without tumor progression); (c) RT as a salvage procedure (MTX, surgery or both with subsequent locoregional tumor progression before RT). Treatment‐induced toxicoses, event‐free survival (EFS), and overall survival times (OSTs) were recorded. The influence of demographics, staging, and treatment‐related factors on survival was assessed using Cox proportional hazards modeling.

Results

Median EFS and OST for all dogs were 260 and 510 days with no significant differences among groups 1 (n = 39), 2 (n = 4), and 3 (n = 8). Both EFS and OST were shorter in dogs with moderate to severe clinical signs (P < .001 and P < .001, respectively); OST was shorter in dogs with prostatic involvement (P = .02). Permanent urinary incontinence developed in 16 dogs (31%) at a median of 70 days postirradiation; other toxicoses were mild and self‐limiting.

Conclusions and Clinical Importance

Mild clinical signs and lack of prostate involvement were associated with favorable prognosis for survival. Client education regarding the risk of urinary incontinence is warranted.
Understanding Culture Through Pictures and a Thousand Words
Authors: Briody Elizabeth K. , Rodríguez‐Mejía Fredy , King Julia , Berger Edward
Published: February 2021

As the adage goes, a picture is worth a thousand words. Yet, anthropologists have not typically sought study‐participant drawings. Using a protocol in which a request for a drawing was embedded, this study captures the internal dynamics of three successful university‐based teams. Our questions followed a specific Describe–Draw–Explain sequence. All interviewees offered some novel element in their drawings (Draw step) beyond what they conveyed in their verbal descriptions (Describe step), while 85 percent of them again offered additional detail in the Explain step. The data also revealed stark and surprising cultural contrasts across teams, including one that was understood best as a network that could be activated upon demand. Gathering drawings is a fast yet valid and reliable method when the prescribed sequence of questions is followed. Another virtue of this approach is that the interviews can be conducted virtually, essential during the COVID‐19 era.
Combined effect of obesity and metabolic profile on glomerular dysfunction in hypertensive subjects
Authors: Bennouar Salam , Bachir Cherif Abdelghani , Temmar Mohamed , Fauvel Jean‐Pierre , Bouafia Mohamed Tahar , Abdi Samia
Published: February 2021

Aim

The aim of this study is to explore the individual and combined effects of obesity and metabolic profile on the impairment of glomerular function among hypertensive subjects.

Methods

This is a cross‐sectional study enrolling 499 hypertensive subjects. Based on body mass index values and metabolic profile, they were assigned to one of four metabolic phenotype groups: MHNO: metabolically healthy non‐obese, MHO: metabolically healthy but obese, MUHNO: metabolically unhealthy but non‐obese, and MUHO: metabolically unhealthy and obese. The effect of the interaction between obesity and metabolic profile was tested on an additive scale, for both microalbuminuria and reduced estimated glomerular filtration rate (eGFR).

Results

After adjustment for confounding factors, the highest risk of both microalbuminuria and decreased eGFR was found among patients of the MUHO group (OR = 6.0 [2.13], p < 0.0001, OR = 5.4 [1.26], p = 0.03, respectively). Analysis of the additive interaction indicates that 51% and 53% of the risk of microalbuminuria and its combination with low eGFR respectively is explained by the co‐occurrence of obesity and metabolic disorder. The mechanism of this interaction is synergistic (synergy index = 2.6, [1.5.3]).

Conclusion

The decline of glomerular function in hypertensive subjects is significantly exacerbated by the interaction between obesity and metabolic disorders. The management of such high‐risk subjects requires, in addition to the therapeutic regimen, an adequate dietary and physical program in order to preserve glomerular function.
Reviewing Pseudoloma neurophilia infections in the popular zebrafish model
Authors: Caballero‐Huertas Marta , Soto Manu , Ribas Laia
Published: February 2021

Zebrafish is a worldwide used animal model to better understand cultured fish species; thus, in the last two decades, zebrafish facilities have been created in many aquaculture research centres. However, and despite the attempts of rigorous aseptic conditions for animal husbandry in wet laboratory facilities, the presence of parasites cannot be underestimated. The microsporidium Pseudoloma neurophilia, which mostly affects the central nervous system, has been listed as the most prevalent parasite in reared zebrafish. The emergence of P. neurophilia is usually detected when the individual presents irreversible morphological and/or behavioural symptoms, and consequently, the spread of the disease is inevitable, indicating that the infection is expanded across rearing tanks. This review attempts, for the first time, to collect and discuss the current information on P. neurophilia life cycle, target tissues and symptomatology of the infection occurred in zebrafish. Due to its vertical transmission together with the increasing presence of zebrafish as a model in reproduction‐related problems found in aquaculture, it is highlighted, among others, the sexual dimorphism of the pathogenic effects and the possible transgenerational implications of parasitic infections. Further, to date none effective treatments have been described, so here we provide in detail available diagnostic methods, discussing the importance of the early detection, giving safety‐rearing recommendations to decrease the presence of P. neurophilia. Our intention is to minimize parasite outbreaks in zebrafish facilities, which, on the one hand, can compromise zebrafish welfare, and on the other hand, could interfere furtively in the resulting research previously designed for improving aquaculture production but also other biomedical‐related research.
A novel modified thaw‐siphon method for extracting cryoprecipitate: The Bokutoh‐siphon method
Authors: Nishimura Shigeko , Teratani Miyuki , Igarashi Tomoko , Nakahara Michiyo , Hazama Yuki , Ohtani Sae , Fujita Hiroshi
Published: February 2021

Background

Cryoprecipitate (CRYO) is neither produced nor supplied by the Japanese Red Cross Society. A novel CRYO extraction method established in‐house by modifying a thaw‐siphon technique was demonstrated in this study.

Study Design and Methods

A pack of fresh frozen plasma was thawed and equally divided into two bags for CRYO extraction by different methods. CRYO was extracted from the blood plasma using a standard centrifugation method and our modified thaw‐siphon method (Bokutoh‐siphon method; B method). The two different CRYOs extracted were analyzed to compare the differences in the amount of fibrinogen recovered, clotting factors extracted, and clotting activity.

Results

The amount of fibrinogen in the CRYO extracted using the B‐siphon method was similar to that obtained using the standard method (recovery of fibrinogen: B‐siphon method: 71.2% vs. standard method: 61.0%). The amount of clotting XIII factor extracted using the B‐siphon method was significantly lower than those extracted using the standard method. On the other hand, clotting II, V factors, and C1q esterase inhibitor not concentrated in CRYO content from the B‐siphon method were significantly higher than that from the standard method.

Conclusion

A new in‐house CRYO preparation method was established by modifying a previously used thaw‐siphon method. A coagulation factor‐rich CRYO was extracted from plasma frozen at −40°C along with the first fraction of thawed plasma, without using a large‐capacity refrigerated centrifuge for blood bags.
Transfusion profile, clinical characteristics, comorbidities and outcomes of 3014 hospitalized patients diagnosed with COVID‐19 in Brazil
Authors: Dalmazzo Leandro Felipe Figueiredo , de Almendra Freitas Alyne Ferreira , Alves Brunna Eulálio , Cardoso Diogo Kloppel , de Carvalho Eduardo Ferro , Akil Fabiana , da Cunha Vieira Perini Fernanda , Pires Karina Todeschini , de Aguiar Ludmila Coutinho , Moraes Mara Cabral , Madeira Maria Isabel Ayrosa , Alves Pablo Raphael Gomiero , Watanabe Ruth Helena Perdiz , da Silva Sá Teixeira Silvia Helena , Pereira Tatiana Covas , de Lourdes Rosa Pessoa Viviani , Vieira Sérgio Domingos
Published: February 2021

Background

The novel coronavirus disease‐2019 (COVID‐19) caused a sudden and unexpected increase in the number of hospital admissions and deaths worldwide. The impact of social distancing on blood stocks was significant. Data on the use of blood products by patients with COVID‐19 are scarce.

Material and methods

A retrospective observational study was conducted by analysing the medical records of 3014 hospitalized COVID‐19 patients in 16 Brazilian hospitals. Individual data related to clinical, laboratory and transfusion characteristics and outcomes of these patients were collected. Patients characteristics association with mortality and transfusion need were tested independently by logistic regression models.

Results

Patients mean age was 57·6 years. In 2298 (76·2%) patients, there was an underlying clinical comorbidity. A total of 1657 (55%) patients required admission to intensive care unit (ICU), and 943 (31%) patients required ventilatory support and orotracheal intubation (OTI). There was a total of 471 (15·6%) deaths among all patients. 325 patients (10·7%) required blood transfusion; 3187 blood products were transfused: 1364 red blood cells in 303 patients, 1092 platelet units in 78 patients, 303 fresh frozen plasma in 49 patients and 423 cryoprecipitates in 21 patients. The mortality among patients who received transfusion was substantially higher than that among the total study population.

Conclusion

Need for transfusion was low in COVID‐19 patients, but significantly higher in patients admitted to ICU and in those who needed OTI. Knowledge of the transfusion profile of these patients allows better strategies for maintaining the blood stocks of hospitals during the pandemic.
Classification of neoplastic and inflammatory brain disease using MRI texture analysis in 119 dogs
Authors: Wanamaker Mason W. , Vernau Karen M. , Taylor Sandra L. , Cissell Derek D. , Abdelhafez Yasser G. , Zwingenberger Allison L.
Published: February 2021

Magnetic resonance imaging is the primary method used to diagnose canine glial cell neoplasia and noninfectious inflammatory meningoencephalitis. Subjective differentiation of these diseases can be difficult due to overlapping imaging characteristics. This study utilizes texture analysis (TA) of intra‐axial lesions both as a means to quantitatively differentiate these broad categories of disease and to help identify glial tumor grade/cell type and specific meningoencephalitis subtype in a group of 119 dogs with histologically confirmed diagnoses. Fifty‐nine dogs with gliomas and 60 dogs with noninfectious inflammatory meningoencephalitis were retrospectively recruited and randomly split into training (n = 80) and test (n = 39) cohorts. Forty‐five of 120 texture metrics differed significantly between cohorts after correcting for multiple testing (false discovery rate < 0.05). After training the random forest algorithm, the classification accuracy for the test set was 85% (sensitivity 89%, specificity 81%). TA was only partially able to differentiate the inflammatory subtypes (granulomatous meningoencephalitis [GME], necrotizing meningoencephalitis [NME], and necrotizing leukoencephalitis [NLE]) (out‐of‐bag error rate of 35.0%) and was unable to identify metrics that could correctly classify glioma grade or cell type (out‐of‐bag error rate of 59.6% and 47.5%, respectively). Multiple demographic differences, such as patient age, sex, weight, and breed were identified between disease cohorts and subtypes which may be useful in prioritizing differential diagnoses. TA of MR images with a random forest algorithm provided classification accuracy of inflammatory and neoplastic brain disease approaching the accuracy of previously reported subjective radiologist evaluation.
Bayesian Analysis of Japanese Pressurized Water Reactor Surveillance Data for Irradiation Embrittlement Prediction
Authors: Takamizawa Hisashi , Nishiyama Yutaka
Published: February 2021

The goal of this study was to identify the chemical component variables that should be used in irradiation embrittlement prediction and to determine the uncertainty of prediction of irradiation embrittlement of reactor pressure vessel (RPV) steels. To this end, statistical analysis using a Bayesian nonparametric (BNP) method was performed for Japanese pressurized water reactor (PWR) surveillance test data whose neutron fluence ranged from 3 × 1018 to 1.2 × 1020 n/cm2 (E > 1 MeV). The BNP method is a machine learning statistical method that takes the complexity and uncertainty of input variables into account. Statistical analysis using an index to select the most suitable combination of input variables revealed that four variables, namely, neutron fluence and Cu, Ni, and Si contents, were the most effective combination for embrittlement prediction. Cu content had the largest effect on the degree of embrittlement, followed by Ni and Si, in that order. The shift in the reference nil-ductility temperature (ΔRTNDT) was also calculated using the probability distribution obtained by the BNP method. The overall standard deviation of the residuals between the calculated and measured values of ΔRTNDT was 8.4 °C, which was comparable to that of the current Japanese embrittlement correlation method (JEAC4201-2013). The 95% credible interval (CI) of the posterior distribution of ΔRTNDT (i.e., the range in which data can exist when the uncertainty of input data is taken into consideration) calculated by the BNP method was identical to or smaller than the margin in the current Japanese embrittlement correlation method described in JEAC4201-2013. This result indicates that an adequate margin is provided in JEAC4201-2013.
Novel Pressure Vessel for Pressurizing Corrosive Liquids With Applications in Accelerated Life Testing of Composite Materials
Authors: Fontaine Dillon , Marshall Anthony , Shukla Arun
Published: February 2021

A system was designed for high-pressure accelerated life testing (ALT) of composite materials exposed to saline water solutions or other potentially corrosive media. The system was comprised primarily of a large stainless steel pressure vessel with the capability to perform extended pressure holds of up to 41.3 MPa at temperatures up to 70 °C. Using a nylon fabric-reinforced Buna-N rubber diaphragm as a media isolator and an inert ceramic coating on all wetted surfaces of the vessel, 3.5% saline water solutions were successfully held at test pressures and temperatures for extended periods with no evidence of corrosion or other degradation even after several days of exposure. Pressurization was achieved through a hydraulic pump system, which contained pressure monitoring equipment and valves and was isolated from the saline water by the diaphragm. The temperature of the entire vessel and contents was maintained by complete immersion in a heated, filtered water bath. The efficacy of using an elastomeric diaphragm to transfer large pressures between two near-incompressible fluids without mixing was shown, provided adequate reinforcement in the form of an interwoven fabric was provided to prevent tearing and extrusion from the extreme through-thickness stresses, particularly at clamping locations. Discussion on the effects of temperature, material, thickness, reinforcement, and sealing methods on the effectiveness and repeatability of the system is provided, and a demonstration of an accelerated test on a carbon–fiber composite is also presented.
Efficient Theoretical and Numerical Methods for Solving Free Vibrations and Transient Responses of a Circular Plate Coupled With Fluid Subjected to Impact Loadings
Authors: Ji Ming , Inaba Kazuaki
Published: February 2021

This paper presents an easy-to-use theoretical method and an efficient numerical method for solving free vibrations and transient responses of a circular plate coupled with fluid subjected to impact loadings and provides insights into various coupling cases with these developed methods. The Kirchhoff plate theory, Mindlin–Reissner plate theory, and the linear velocity potential function are used. The wet mode of the coupled system is described as the superposition of dry modes of the plate, which has been considered in few studies. The natural frequencies and corresponding mode shapes are solved using the orthogonality of dry modes. The transient responses of the plate are then solved using the superposition of the wet modes and the orthogonality of dry modes. To validate the theoretical results, an efficient and flexible finite element method is proposed and verified by comparing with commercial software. The four-node mixed interpolation of the tensorial component quadrilateral plate finite element (MITC4) and the eight-node acoustic pressure element are used to model the plate and the fluid, respectively. The theoretical and numerical methods provide reliable and accurate results. Parametric studies are performed to investigate the influence of geometric sizes, plate material properties, and fluid properties on the natural frequencies of the coupled system. A coupling parameter of fluid–structure interaction is proposed. The nondimensional added virtual mass incremental (NAVMI) factor decreases as the coupling parameter increases. Besides, the influence of fluid on wet modes of the plate decreases with the order.
Critical Analysis of the New High Cycle Fatigue Assessment Procedure From ASME B31.3—Appendix W
Authors: Jaćimović Nikola , Helgesen Sondre Luca
Published: February 2021

ASME B31.3, the leading process piping system design code, has included in its 2018 edition a new procedure for evaluation of high cycle fatigue in process piping systems. As stated in the Appendix W of ASME B31.3-2018, this new procedure is applicable to any load resulting in the stress range in excess of 20.7 MPa (3.0 ksi) and with the total number of cycles exceeding 100,000. However, this new procedure is based on the stress range calculation typical to ASME B31 codes which underestimates the realistic expansion stress range by a factor of ∼2. While the allowable stress range used typically for fatigue evaluation of piping systems is adjusted to take into consideration this fact, the new fatigue design curves seem not to take it into account. Moreover, the applicability of the new design procedure (i.e., welded joint fatigue design curves) to the components which tend to fail away from the bends is questionable. Two examples are presented at the end of the paper in order to substantiate the indicated inconsistencies in the verification philosophy.
Dynamics of Shock Waves Interacting With Laminar Separated Transonic Turbine Flow Investigated by High-Speed Schlieren and Surface Hot-Film Sensors
Authors: Börner Marcel , Niehuis Reinhard
Published: February 2021

The results presented in this paper are based on experimental investigations on a generic transonic low pressure turbine profile at high subsonic exit Mach numbers. Here, the flow on the suction side reaches a maximum isentropic Mach number of approximately 1.2 and features a large separation bubble in a transonic flow regime characterized by surface hot-film measurements. The measurements are supplemented by Schlieren images recorded with a high-speed camera at 19.2 kHz. A highly unsteady normal shock wave on the suction side is observable upstream of the trailing edge. It is interacting with laminar separated flow which is rarely documented in literature. The interaction of the normal shock with the boundary layer flow seems to amplifies the ongoing transition process over the separation bubble and the flow reattaches shortly downstream. A statistical analysis of the Schlieren images reveals characteristic low frequencies of the shock wave motions and a pulsation of the separation bubble. Additionally, the statistical information of the time-dependent signal from the surface hot-film sensors demonstrate the instabilities influencing the boundary layer linked to the unsteadiness in the main flow.
Exploring complex graphs using three-dimensional quantum walks of correlated photons
Authors: Ehrhardt Max , Keil Robert , Maczewsky Lukas J. , Dittel Christoph , Heinrich Matthias , Szameit Alexander
Published: February 2021

Correlated photons undergo quantum walks on 3D graphs governed by their spatial and polarization degrees of freedom.
Diversified transcriptional responses of myeloid and glial cells in spinal cord injury shaped by HDAC3 activity
Authors: Wahane Shalaka , Zhou Xianxiao , Zhou Xiang , Guo Lei , Friedl Marie-Sophie , Kluge Michael , Ramakrishnan Aarthi , Shen Li , Friedel Caroline C. , Zhang Bin , Friedel Roland H. , Zou Hongyan
Published: February 2021

Transcriptional maps reveal diverse responses of immune and glial cells in spinal cord injury.
Long-lived charge separation following pump-wavelength–dependent ultrafast charge transfer in graphene/WS
2
heterostructures
Authors: Fu Shuai , du Fossé Indy , Jia Xiaoyu , Xu Jingyin , Yu Xiaoqing , Zhang Heng , Zheng Wenhao , Krasel Sven , Chen Zongping , Wang Zhiming M. , Tielrooij Klaas-Jan , Bonn Mischa , Houtepen Arjan J. , Wang Hai I.
Published: February 2021

Ultrafast spectroscopies shed light on charge carrier transfer and recombination across van der Waals heterostructures.
Late-stage stitching enabled by manganese-catalyzed C─H activation: Peptide ligation and access to cyclopeptides
Authors: Kaplaneris Nikolaos , Kaltenhӓuser Felix , Sirvinskaite Giedre , Fan Shuang , De Oliveira Tiago , Conradi Lena-Christin , Ackermann Lutz
Published: February 2021

Earth-abundant manganese catalyst enabled the expedient synthesis of cyclic peptides via activation of inert C─H bonds.
Insulin signaling in AgRP neurons regulates meal size to limit glucose excursions and insulin resistance
Authors: Dodd Garron T. , Kim Seung Jae , Méquinion Mathieu , Xirouchaki Chrysovalantou E. , Brüning Jens C. , Andrews Zane B. , Tiganis Tony
Published: February 2021

The importance of hypothalamic insulin signaling on feeding and glucose metabolism remains unclear. We report that insulin acts on AgRP neurons to acutely decrease meal size and thereby limit postprandial glucose and insulin excursions. The promotion of insulin signaling in AgRP neurons decreased meal size without altering total caloric intake, whereas the genetic ablation of the insulin receptor had the opposite effect. The promotion of insulin signaling also decreased the intake of sucrose-sweetened water or high-fat food over standard chow, without influencing food-seeking and hedonic behaviors. The ability of heightened insulin signaling to override the hedonistic consumption of highly palatable high-fat food attenuated the development of systemic insulin resistance, without affecting body weight. Our findings define an unprecedented mechanism by which insulin acutely influences glucose metabolism. Approaches that enhance insulin signaling in AgRP neurons may provide a means for altering feeding behavior in a nutrient-dense environment to combat the metabolic syndrome.
Loss of Interleukin-10 (IL-10) Signaling Promotes IL-22-Dependent Host Defenses against Acute Clostridioides difficile Infection
Authors: Cribas Emily S. , Denny Joshua E. , Maslanka Jeffrey R. , Abt Michael C.
Published: February 2021

Infection with the bacterial pathogen
Clostridioides difficile
causes severe damage to the intestinal epithelium that elicits a robust inflammatory response. Markers of intestinal inflammation accurately predict clinical disease severity.
Elements in the LftR Repressor Operator Interface Contributing to Regulation of Aurantimycin Resistance in Listeria monocytogenes
Authors: Hauf Samuel , Engelgeh Tim , Halbedel Sven
Published: February 2021

Listeria monocytogenes
is an environmental bacterium that lives in the soil but can infect humans upon ingestion, and this can lead to severe invasive disease. Adaptation to these entirely different habitats involves massive reprogramming of transcription.
New Data on Stratigraphy and Distributions of Glendonites from the Carolinefjellet Formation (Middle Aptian–Lower Albian, Cretaceous), Western Spitsbergen
Authors: Mikhailova K. Yu. , Rogov M. A. , Ershova V. B. , Vasileva K. Yu. , Pokrovsky B. G. , Baraboshkin E. Yu.
Published: February 2021

The Aptian deposits on Spitsbergen Island are poorly studied. Moreover, there were no published data on fossil distribution in the Aptian and Albian in the vicinity of the town of Longyearbyen. This article provides new data on ammonite-based biostratigraphy of the Carolinefjellet Formation, indicating the presence of Beds with Tropaeum arcticum (middle Aptian) and Beds with Grantziceras (lower Albian). The age of the formation was verified and the presence of lower Albian strata was justified. The results of microscopic and isotope studies of five samples of glendonites collected from the middle Aptian of the Carolinefjellet Formation section are presented. Glendonites from the Carolinefjellet Formation are composed of three calcite phases: ikaite-derived calcite and two successive types of cement, which fill cavities and develop partially after the first-phase calcite. The O and C isotope compositions of glendonites were measured in five bulk samples from the middle Aptian interval of the section. The δ18O isotope composition of glendonites is significantly different from that of seawater, indicating the input of diagenetic fluids; the δ13C values are characteristic of sedimentary organic matter and methanotrophy. For the first time, findings of ammonites allowed us to clarify the stratigraphic intervals of glendonite occurrence and associated cold-climate episodes and prove the early Albian age of glendonites from the top of the Carolinefjellet Formation.
Quality of life of children treated for unilateral hearing loss: a systematic review and meta-analysis
Authors: Nicolas Sarah , Gallois Yohan , Calmels Marie-Noëlle , Deguine Olivier , Fraysse Bernard , Marx Mathieu
Published: February 2021

Objective

To evaluate the treatments’ consequences for unilateral hearing loss in children.

Design

Systematic review and meta-analysis (CRD42018109417). The MEDLINE, CENTRAL, ISRCTN and ClinicalTrials databases were searched between September 2018 and May 2019. Articles were screened and data were collected independently by two authors following the Cochrane and Preferred Reporting Items for Systematic review and Meta-Analysis guidelines. The risk of bias was evaluated using the Cochrane tool, the Newcastle-Ottawa Scale, the National Institute of Health, USA tool and considering the risk of confounding. In the studies with the lowest risk of bias, a meta-analysis was conducted.

Interventions

Validated hearing rehabilitation devices.

Patients

6–15 years old children with moderate to profound unilateral hearing loss.

Main outcome measures

The primary study outcome was children’s quality of life. Academic performances were studied as an additional outcome.

Results

731 unique articles were identified from the primary search. Of these, 18 articles met the Population, Intervention, Control, Outcomes and Study design selection criteria. In the eight studies with the lowest risk of bias, two meta-analysis were conducted. There was not enough data on academic results to conduct a meta-analysis. In 73 children included in a fixed effect meta-analysis (two studies), no effect of treatment could be shown (g=−0.20, p=0.39). In 61 children included in a random-effect meta-analysis (six studies), a strong positive effect of hearing treatment on quality of life was demonstrated (g=1.32, p<0.05).

Conclusions

The treatment of unilateral hearing loss seems to improve children’s quality of life. Further research is needed to identify the most effective treatment and its corresponding indications.
Non-uremic calciphylaxis in a woman without end-stage renal disease
Authors: Hodson Meghan , Kaur Gurleen , Lin George , Coates Andrew
Published: February 2021

A woman in her 60s with a history of lower extremity vascular disease presented with extreme pain and wounds in her legs which had kept her from walking for several weeks. The patient’s pain became intolerable throughout her hospital stay despite multiple surgical revascularisations. Biopsy of the patient’s calf wounds revealed evidence of calciphylaxis, a diagnosis which corresponds with this patient’s extreme pain. Our patient had no history of end-stage renal disease.
Isolated thyroid carcinoma in an ectopic thyroid tissue
Authors: Nambiar Gokulnath , Eshwarappa Harish , Kini Hema , Chidanand Dileep
Published: February 2021

Ectopic thyroid tissue (ETT) is a rare developmental abnormality due to aberrant embryogenesis of the thyroid gland. Although rare (<1%), papillary thyroid carcinoma (PTC) is the most common malignant transformation seen. A 34-year-old man presented with neck nodal swelling, on preoperative evaluation, was found to have PT) in ETT with the normal thyroid gland and nodal metastasis. The patient underwent surgery for PTC along with Sistrunk’s procedure and the histopathology revealed ectopic thyroid carcinoma with a normal thyroid and lymph nodal metastasis. Although a rare entity, the possibility of an ectopic thyroid carcinoma should be considered in differentiated cancers with neck nodes in the setting of a normal thyroid gland. Clinical suspicion and radiological imaging would help improve the preoperative diagnosis which in turn alters the management and thereby providing a better outcome to the patient.
Emergency tracheostomy for failed intubation due to glottic stenosis
Authors: Yap Tessa , Quick Mark , Moore Paige
Published: February 2021

Glottic stenosis can be an unexpected finding during an intubation, causing difficulties that may result in a ‘can’t intubate, can’t ventilate’ situation. We present a case of a patient who required an emergency tracheostomy, in the setting of a failed intubation secondary to glottic stenosis. The patient underwent open laryngotracheal reconstruction, followed by tracheostomy decannulation 2 months post-surgery. This paper highlights the importance of awareness of laryngeal pathology masquerading as respiratory conditions. It also outlines the critical approach to managing ‘can’t intubate, can’t ventilate’ situations.
Cost-effectiveness analysis of preloaded versus non-preloaded Descemet membrane endothelial keratoplasty for the treatment of Fuchs endothelial corneal dystrophy in an academic centre
Authors: Böhm Myriam , Leon Pia , Wylęgała Adam , Ong Tone Stephan , Condron Tracy , Jurkunas Ula
Published: February 2021

Aims

To determine the cost-effectiveness of preloaded Descemet membrane endothelial keratoplasty (pDMEK) versus non-preloaded DMEK (n-pDMEK) for the treatment of Fuchs endothelial corneal dystrophy (FECD).

Methods

From a societal and healthcare perspective, this retrospective cost-effectiveness analysis analysed a cohort of 58 patients with FECD receiving pDMEK (n=38) or n-pDMEK (n=30) from 2016 to 2018 in the Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, USA. Exclusion criteria were previous ocular surgeries (other than uncomplicated cataract surgery), including other keratoplasty procedures, ocular pathological conditions as glaucoma, amblyopia, laser treatments, or any retinal or corneal disease. The main outcome parameters were the incremental cost-utility ratio (ICUR) and net monetary benefit (NMB).

Results

pDMEK was less costly compared with n-pDMEK (healthcare: $13 886 vs $15 329; societal: $20 805 vs $22 262), with a slighter greater utility (QALY 0.6682 vs QALY 0.6640) over a time horizon of 15 years. pDMEK offered a slightly higher clinical effectiveness (+0.0042 QALY/patient) at a lower cost (healthcare: –$1444 per patient; societal: –$1457 per patient) in improving visual acuity in this cohort of patients with FECD. pDMEK achieved a favourable ICUR and NMB compared with n-pDMEK. Based on sensitivity analyses performed, the economic model was robust.

Conclusions

From the societal and healthcare perspective, pDMEK was less costly and generated comparable utility values relative to n-pDMEK. Therefore, pDMEK appears to be cost-effective and cost saving with respect to n-pDMEK. Further long-term follow-up data are needed to confirm these findings.
Comparison of clinical outcomes of conbercept versus ranibizumab treatment for retinopathy of prematurity: a multicentral prospective randomised controlled trial
Authors: Wu Zhenquan , Zhao Jinfeng , Lam Waiching , Yang Mingmin , Chen Lu , Huang Xuelin , Wei Meirong , Yang Hui , Lv Fan , Zhang Fuyan , Zeng Jian , Zhang Guo-Ming
Published: February 2021

Purpose

To compare the recurrence rate and surgical complications of retinopathy of prematurity (ROP) between patients treated with intravitreal injection of conbercept (IVC) and intravitreal injection of ranibizumab (IVR) within 6 months.

Methods

A multicentral prospective, randomised controlled trial was applied from May 2017 to February 2019 for the infants diagnosed as aggressive posterior-ROP, zone I or posterior zone II treatment-requiring ROP by binocular indirect ophthalmoscope and RetCam3. These infants were assigned to randomly receive either intravitreal injection of 0.25 mg conbercept or 0.25 mg ranibizumab. The recurrence rate, fundus fluorescence angiography (FFA) and surgical complications were examined during the follow-up period of 6 months. Recurrent eyes were retreated by laser or another intravitreal injection within the 72 hours.

Results

A total of 30 infant patients (60 eyes) underwent IVC and 30 patients (60 eyes) underwent IVR. A total of 10 eyes (16.67%) in the IVC group and 14 eyes (23.34%) in the IVR group developed recurrence. There was no significant statistical difference in the recurrence rate between the two groups (χ2=0.83, p=0.36). The postmenstrual age (PMA) at first injection was (34.60±3.47) weeks in IVC and (35.14±1.76) in IVR group. In recurrent cases, the mean PMA at second treatment were (43.31±3.85) and (43.43±3.89) weeks in the IVC and IVR group, respectively. The period between two treatments was (8.71±6.62) for the IVC and (8.29±2.56) weeks for the IVR group. All these results showed no significant statistical difference between these two groups. The fluorescein leakage were observed in the eyes of recurrent infants by FFA. There were no other complications in the two groups except for complicated cataract in three eyes.

Conclusion

Both IVC and IVR are effective therapies for the treatment of ROP. Conbercept is a new option for treating ROP.
Impact of incident age-related macular degeneration and associated vision loss on vision-related quality of life
Authors: Man Ryan Eyn Kidd , Gan Alfred Tau Liang , Fenwick Eva K , Teo Kelvin Yi Chong , Tan Anna C S , Cheung Gemmy Chui Ming , Teo Zhen Ling , Kumari Neelam , Wong Tien Yin , Cheng Ching-Yu , Lamoureux Ecosse Luc
Published: February 2021

Background

We examined the associations between the 6-year incidence of age-related macular degeneration (AMD) and vision-related quality of life (VRQoL), and the contribution of presenting visual acuity (VA), in an Asian population.

Methods

Fundus images from the Singapore Chinese Eye Study, a population-based cohort study (baseline: 2009–2011; follow-up: 2015–2017), were graded using a modified Wisconsin age-related maculopathy grading system. Incident AMD was defined as no baseline AMD in both eyes and early/late AMD in the worse eye at follow-up. Presenting VA was assessed using the logarithm of the minimum angle of resolution chart at 4 m under standard lighting conditions with habitual correction. Multiple linear regression models determined the associations between AMD incidence with changes in the Rasch-transformed scores of the Reading, Mobility and Emotional VRQoL domains of the 32-item Impact of Visual Impairment (IVI-32) questionnaire, adjusted for traditional confounders. The contribution of presenting VA to changes in VRQoL was also estimated.

Results

Of the 2251 participants without AMD at baseline (mean age (SD): 57.7 (9) years, 51.4% women), 101 (4.5%) and 11 (0.5%) developed incident early and late AMD at follow-up, respectively. Incident late AMD was associated with significant 30.3%, 32.5% and 30.9% decrements in Reading, Mobility and Emotional IVI scores, respectively. The contribution of presenting VA ranged between 1.62% and 4.35% of the observed decrements. No significant associations were noted with incident early AMD.

Conclusion

Incident late AMD had a substantial impact on all aspects of VRQoL, with presenting VA contributing only minimally to this longitudinal relationship.
Enrichment of IGF-1R and PPARγ signalling pathways in orbital inflammatory diseases: steps toward understanding pathogenesis
Authors: Verma Rohan , Choi Dongseok , Chen Allison J , Harrington Christina A , Wilson David J , Grossniklaus Hans E , Dailey Roger A , Ng John , Steele Eric A , Planck Stephen R , Korn Bobby S , Kikkawa Don , Czyz Craig N , Foster Jill A , Kazim Michael , Harris Gerald J , Edward Deepak P , Al-Hussain Haila , Maktabi Azza M Y , Alabiad Chris , Garcia Armando , Rosenbaum James T
Published: February 2021

Background

Orbital inflammatory disease (OID) encompasses a wide range of pathology including thyroid-associated orbitopathy (TAO), granulomatosis with polyangiitis (GPA), sarcoidosis and non-specific orbital inflammation (NSOI), accounting for up to 6% of orbital diseases. Understanding the underlying pathophysiology of OID can improve diagnosis and help target therapy.

Aims

To test the hypothesis that shared signalling pathways are activated in different forms of OID.

Methods

In this secondary analysis, pathway analysis was performed on the previously reported differentially expressed genes from orbital adipose tissue using patients with OID and healthy controls who were characterised by microarray. For the original publications, tissue specimens were collected from oculoplastic surgeons at 10 international centres representing four countries (USA, Canada, Australia and Saudi Arabia). Diagnoses were independently confirmed by two masked ocular pathologists (DJW, HEG). Gene expression profiling analysis was performed at the Oregon Health & Science University. Eighty-three participants were included: 25 with TAO, 6 with orbital GPA, 7 with orbital sarcoidosis, 25 with NSOI and 20 healthy controls.

Results

Among the 83 subjects (mean (SD) age, 52.8 (18.3) years; 70% (n=58) female), those with OID demonstrated perturbation of the downstream gene expressions of the IGF-1R (MAPK/RAS/RAF/MEK/ERK and PI3K/Akt/mTOR pathways), peroxisome proliferator-activated receptor-γ (PPARγ), adipocytokine and AMPK signalling pathways compared with healthy controls. Specifically, GPA samples differed from controls in gene expression within the insulin-like growth factor-1 receptor (IGF-1R, PI3K-Akt (p=0.001), RAS (p=0.005)), PPARγ (p=0.002), adipocytokine (p=0.004) or AMPK (p=<0.001) pathways. TAO, sarcoidosis and NSOI samples were also found to have statistically significant differential gene expression in these pathways.

Conclusions

Although OID includes a heterogenous group of pathologies, TAO, GPA, sarcoidosis and NSOI share enrichment of common gene signalling pathways, namely IGF-1R, PPARγ, adipocytokine and AMPK. Pathway analyses of gene expression suggest that other forms of orbital inflammation in addition to TAO may benefit from blockade of IGF-1R signalling pathways.
Effects of D-allulose on glucose tolerance and insulin response to a standard oral sucrose load: results of a prospective, randomized, crossover study
Authors: Franchi Francesco , Yaranov Dmitry M , Rollini Fabiana , Rivas Andrea , Rivas Rios Jose , Been Latonya , Tani Yuma , Tokuda Masaaki , Iida Tetsuo , Hayashi Noriko , Angiolillo Dominick J , Mooradian Arshag D
Published: February 2021

Introduction

Current dietary guidelines recommend limiting sugar intake for the prevention of diabetes mellitus (DM). Reduction in sugar intake may require sugar substitutes. Among these, D-allulose is a non-calorie rare monosaccharide with 70% sweetness of sucrose, which has shown anti-DM effects in Asian populations. However, there is limited data on the effects of D-allulose in other populations, including Westerners.

Research design and methods

This was a prospective, randomized, double-blind, placebo-controlled, crossover study conducted in 30 subjects without DM. Study participants were given a standard oral (50 g) sucrose load and randomized to placebo or escalating doses of D-allulose (2.5, 5.0, 7.5, 10.0 g). Subjects crossed-over to the alternate study treatment after 7–14 days of wash out. Plasma glucose and insulin levels were measured at five time points: before and at 30, 60, 90 and 120 min after ingestion.

Results

D-allulose was associated with a dose-dependent reduction of plasma glucose at 30 min compared with placebo. In particular, glucose was significantly lower with the 7.5 g (mean difference: 11; 95% CI 3 to 19; p=0.005) and 10 g (mean difference: 12; 95% CI 4 to 20; p=0.002) doses. Although glucose was not reduced at the other time points, there was a dose-dependent reduction in glucose excursion compared with placebo, which was significant with the 10 g dose (p=0.023). Accordingly, at 30 min D-allulose was associated with a trend towards lower insulin levels compared with placebo, which was significant with the 10 g dose (mean difference: 14; 95% CI 4 to 25; p=0.006). D-allulose did not reduce insulin at any other time point, but there was a significant dose-dependent reduction in insulin excursion compared with placebo (p=0.028), which was significant with the 10 g dose (p=0.002).

Conclusions

This is the largest study assessing the effects of D-allulose in Westerners demonstrating an early dose-dependent reduction in plasma glucose and insulin levels as well as decreased postprandial glucose and insulin excursion in subjects without DM. These pilot observations set the basis for large-scale investigations to support the anti-DM effects of D-allulose.

Trial registration number

NCT02714413.
Switching antipsychotics to support the physical health of people with severe mental illness: a qualitative study of healthcare professionals’ perspectives
Authors: Nash Annabel , Kingstone Tom , Farooq Saeed , Tunmore Jessica , Chew-Graham Carolyn A
Published: February 2021

Objectives

The side effects of antipsychotic medications (APs) can increase the risk of developing physical health conditions. Some APs pose a higher risk than others. Evidence suggests switching to lower risk APs can support physical health outcomes. We sought to explore the views of healthcare professionals about switching antipsychotics to support physical health in people with severe mental illness (SMI).

Design

A qualitative study with semi-structured interviews conducted with general practitioners (GPs), psychiatrists and mental health nurses. The main focus was to explore participants’ views on the physical health of people with SMI, the impact of APs and decision-making about switching medication to support physical health. Data were analysed thematically using principles of constant comparison.

Settings

Participants recruited through primary care and one mental health trust in the West Midlands.

Participants

Interviews were conducted with 9 GPs, 10 psychiatrists and 4 mental health nurses.

Results

Awareness and knowledge of AP side-effects and risk profiles varied considerably between primary and secondary care clinicians. GPs reported limited awareness, while psychiatrists and nurses demonstrated a comprehensive understanding of AP risk profiles and side-effects. Mental health and control of symptoms were prioritised. Switching to promote physical health was considered as a reactive intervention, once side-effects or complications developed. There were a range of views over where responsibility lay for monitoring physical health and consideration of switching. Collaboration between primary and secondary care was identified as a way to address this.

Conclusions

This study presents multidisciplinary perspectives on awareness, decision making, perceived responsibility and barriers to switching APs to support physical health. Collaborative approaches that involve liaison between primary and secondary care, but tailored to the individual patient, may support switching, and present an opportunity to intervene to address the physical health inequalities experienced by individuals with SMI.
Human factors in escalating acute ward care: a qualitative evidence synthesis
Authors: Ede Jody , Petrinic Tatjana , Westgate Verity , Darbyshire Julie , Endacott Ruth , Watkinson Peter J
Published: February 2021

Background

Identifying how human factors affect clinical staff recognition and managment of the deteriorating ward patient may inform process improvements. We systematically reviewed the literature to identify (1) how human factors affect ward care escalation (2) gaps in the current literature and (3) critique literature methodologies.

Methods

We undertook a Qualitative Evidence Synthesis of care escalation studies. We searched MEDLINE, EMBASE and CINHAL from inception to September 2019. We used the Critical Appraisal Skills Programme and the Grading of Recommendations Assessment-Development and Evaluation and Confidence in Evidence from Reviews of Qualitative Research tool to assess study quality.

Results

Our search identified 24 studies meeting the inclusion criteria. Confidence in findings was moderate (20 studies) to high (4 studies). In 16 studies, the ability to recognise changes in the patient’s condition (soft signals), including skin colour/temperature, respiratory pattern, blood loss, personality change, patient complaint and fatigue, improved the ability to escalate patients. Soft signals were detected through patient assessment (looking/listening/feeling) and not Early Warning Scores (eight studies). In contrast, 13 studies found a high workload and low staffing levels reduced staff’s ability to detect patient deterioration and escalate care. In eight studies quantifiable deterioration evidence (Early Warning Scores) facilitated escalation communication, particularly when referrer/referee were unfamiliar. Conversely, escalating concerning non-triggering patients was challenging but achieved by some clinical staff (three studies). Team decision making facilitated the clinical escalation (six studies).

Conclusions

Early Warning Scores have clinical benefits but can sometimes impede escalation in patients not meeting the threshold. Staff use other factors (soft signals) not captured in Early Warning Scores to escalate care. The literature supports strategies that improve the escalation process such as good patient assessment skills.

PROSPERO registration number

CRD42018104745.