bluuebunny/crossref_metadata_2025 huggingface dataset:
Frailty as a risk factor for postoperative complications in adult patients with degenerative scoliosis administered posterior single approach, long-segment corrective surgery: a retrospective cohort study
Authors: Li Bin , Meng Xianglong , Zhang Xinuo , Hai Yong
Published: April 2021

Background

With the population aging worldwide, adult degenerative scoliosis (ADS) is receiving increased attention. Frailty, instead of chronological age, is used for assessing the patient’s overall physical condition. In ADS patients undergoing a posterior approach, long-segment corrective surgery, the association of frailty with the postsurgical outcomes remains undefined.

Methods

ADS patients who underwent a posterior approach, long-segment fusion at the Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University (CMU), Beijing, China, in 2014–2017 were divided into the frailty and non-frailty groups according to the modified frailty index. Major postoperative complications were recorded, including cardiac complications, pneumonia, acute renal dysfunction, delirium, stroke, neurological deficit, deep wound infection, gastrointestinal adverse events, and deep vein thrombosis. Radiographic measurements and health-related quality of life (HRQOL) parameters were recorded preoperatively and at 2 postoperative years.

Results

A total of 161 patients were included: 47 (29.2%) and 114 (70.8%) in the frailty and non-frailty groups, respectively. Major postoperative complications were more frequent in the frailty group than the non-frailty group (29.8% vs. 10.5%, P = 0.002). Multivariable logistic regression analysis showed that frailty was independently associated with major complications (adjusted odds ratio [aOR] = 2.77, 95% confidence interval [CI] 1.12–6.89, P = 0.028). Radiographic and HRQOL parameters were improved at 2 years but with no significant between-group differences.

Conclusions

Frailty is a risk factor for postoperative complications in ADS after posterior single approach, long-segment corrective surgery. Frailty screening should be applied preoperatively in all patients to optimize the surgical conditions in ADS.
The increased motion of lumbar induces ligamentum flavum hypertrophy in a rat model
Authors: Wang Baojian , Gao Chunyu , Zhang Ping , Sun Wu , Zhang Jingru , Gao Jinghua
Published: April 2021

Background

The purpose of this study was to establish a novel rat model for ligamentum flavum (LF) hypertrophy using increased motion of lumbar and to elucidate the etiology of (LFH).

Methods

A total number of 30 male rats were used. The increased motion of lumbar was induced by surgical resection of L5/6 posterior elements (n = 15). The other rats underwent a sham operation (n = 15). After 8 weeks, all rats were taken lateral plain X-rays. The LF from L5/6 in both groups were harvested to investigate histological, immunohistological, and real-time PCR analysis.

Results

According to radiological results, the disc height ratio, flexion ratio, and extension ratio were larger in the rats in the experimental group than that of in the sham group. The HE staining showed that the LF thickness in the experimental group significantly increased in comparison to the sham group. The Masson trichrome staining showed that the ratio of elastic fibers to collagen fibers in experimental group was lower than that in the sham group. The protein and gene expression of TGF-β1, TNF-α, IL-1β, and Col 1 were significantly higher in the experimental group than that in the sham group.

Conclusion

A relatively safe, simple, and rapid rat model of LFH using increased motion of lumbar was established. The increased motion of lumbar could lead to high expression of inflammatory and fibrotic factors in LF, causing the accumulation of collagen fibers and decreasing of elastic fibers.
Implementation of written structured feedback into a surgical OSCE
Authors: Sterz J. , Linßen S. , Stefanescu M. C. , Schreckenbach T. , Seifert L. B. , Ruesseler M.
Published: April 2021

Background

Feedback is an essential element of learning. Despite this, students complain about receiving too little feedback in medical examinations, e.g., in an objective structured clinical examination (OSCE). This study aims to implement a written structured feedback tool for use in OSCEs and to analyse the attitudes of students and examiners towards this kind of feedback.

Methods

The participants were OSCE examiners and third-year medical students.

This prospective study was conducted using a multistage design. In the first step, an unstructured interrogation of the examiners formed the basis for developing a feedback tool, which was evaluated and then adopted in the next steps.

Results

In total, 351 students and 51 examiners participated in this study.

A baseline was created for each category of OSCE station and was supplemented with station-specific items. Each of these items was rated on a three-point scale. In addition to the preformulated answer options, each domain had space for individual comments.

A total of 87.5% of the students and 91.6% of the examiners agreed or rather agreed that written feedback should continue to be used in upcoming OSCEs.

Conclusion

The implementation of structured, written feedback in a curricular, summative examination is possible, and examiners and students would like the feedback to be constant.
Cost-effectiveness analysis of flucytosine as induction therapy in the treatment of cryptococcal meningitis in HIV-infected adults in South Africa
Authors: Miot Jacqui , Leong Trudy , Takuva Simbarashe , Parrish Andrew , Dawood Halima
Published: April 2021

Background

Cryptococcal meningitis in HIV-infected patients in sub-Saharan Africa accounts for three-quarters of the global cases and 135,000 deaths per annum. Current treatment includes the use of fluconazole and amphotericin B. Recent evidence has shown that the synergistic use of flucytosine improves efficacy and reduces toxicity, however affordability and availability has hampered access to flucytosine in many countries. This study investigated the evidence and cost implications of introducing flucytosine as induction therapy for cryptococcal meningitis in HIV-infected adults in South Africa.

Methods

A decision analytic cost-effectiveness and cost impact model was developed based on survival estimates from the ACTA trial and local costs for flucytosine as induction therapy in HIV-infected adults with cryptococcal meningitis in a public sector setting in South Africa. The model considered five treatment arms: (a) standard of care; 2-week course amphotericin B/fluconazole (2wk AmBd/Flu), (b) 2-week course amphotericin B/flucytosine (2wk AmBd/5FC), (c) short course; 1-week course amphotericin B/flucytosine (1wk AmBd/5FC) (d) oral course; 2-week oral fluconazole/flucytosine (oral) and e) 1-week course amphotericin B/fluconazole (1wk AmBd/Flu). A sensitivity analysis was conducted on key variables.

Results

The highest total treatment costs are in the 2-week AmBd/5FC arm followed by the 2-week oral regimen, the 1-week AmBd/5FC, then standard of care with the lowest cost in the 1-week AmBd/Flu arm. Compared to the lowest cost option the 1-week flucytosine course is most cost-effective at USD119/QALY. The cost impact analysis shows that the 1-week flucytosine course has an incremental cost of just over USD293 per patient per year compared to what is currently spent on standard of care. Sensitivity analyses suggest that the model is most sensitive to life expectancy and hospital costs, particularly infusion costs and length of stay.

Conclusions

The addition of flucytosine as induction therapy for the treatment of cryptococcal meningitis in patients infected with HIV is cost-effective when it is used as a 1-week AmBd/5FC regimen. Savings could be achieved with early discharge of patients as well as a reduction in the price of flucytosine.
Understanding inequities in health and health systems in Latin America and the Caribbean: a thematic series
Authors: Ruano Ana Lorena , Rodríguez Daniela , Rossi Pablo Gaitán , Maceira Daniel
Published: April 2021

Latin America, with its culturally and ethnically diverse populations, its burgeoning economies, high levels of violence, growing political instability, and its striking levels of inequality, is a region that is difficult to define and to understand. The region’s health systems are deeply fragmented and segmented, which poses great challenges related to the provision of quality of care and overall equity levels in health and in Latin American society at large. Market, social, and political forces continue to push towards the poorly regulated privatization of public health care in many countries within the region, in detriment of public healthcare services where management capacities are limited.

In this first collection of papers, we showcase how the region has tackled, with different levels of success, the incorporation of innovative health system reforms aimed at strengthening governance, participation, and the response to the growing epidemiological and demographic demands of its diverse population. We are delighted that this Special Collection will remain open to house future papers from Latin America and the Caribbean. The region has important experiences and lessons to share with the world. We look forward to learning more about how researchers and practitioners continue to experiment and innovate in their struggle to reach equity in health for all. This thematic series is a platform where the region’s lessons and approaches can be shared with the global community of Health Policy and Systems Researchers.
The good, the bad, and the environment: developing an area-based measure of access to health-promoting and health-constraining environments in New Zealand
Authors: Marek Lukas , Hobbs Matthew , Wiki Jesse , Kingham Simon , Campbell Malcolm
Published: April 2021

Background

Accounting for the co-occurrence of multiple environmental influences is a more accurate reflection of population exposure than considering isolated influences, aiding in understanding the complex interactions between environments, behaviour and health. This study examines how environmental ‘goods’ such as green spaces and environmental ‘bads’ such as alcohol outlets co-occur to develop a nationwide area-level healthy location index (HLI) for New Zealand.

Methods

Nationwide data were collected, processed, and geocoded on a comprehensive range of environmental exposures. Health-constraining ‘bads’ were represented by: (i) fast-food outlets, (ii) takeaway outlets, (iii) dairy outlets and convenience stores, (iv) alcohol outlets, (v) and gaming venues. Health-promoting ‘goods’ were represented by: (i) green spaces, (ii) blue spaces, (iii) physical activity facilities, (iv) fruit and vegetable outlets, and (v) supermarkets. The HLI was developed based on ranked access to environmental domains. The HLI was then used to investigate socio-spatial patterning by area-level deprivation and rural/urban classification.

Results

Results showed environmental ‘goods’ and ‘bads’ co-occurred together and were patterned by area-level deprivation. The novel HLI shows that the most deprived areas of New Zealand often have the most environmental ‘bads’ and less access to environmental ‘goods’.

Conclusions

The index, that is now publicly available, is able to capture both inter-regional and local variations in accessibility to health-promoting and health-constraining environments and their combination. Results in this study further reinforce the need to embrace the multidimensional nature of neighbourhood and place not only when designing health-promoting places, but also when studying the effect of existing built environments on population health.
Study problems and depressive symptoms in adolescents during the COVID-19 outbreak: poor parent-child relationship as a vulnerability
Authors: Wang Jingyi , Wang Hao , Lin Haijiang , Richards Marcus , Yang Shuyue , Liang Hongbiao , Chen Xiaoxiao , Fu Chaowei
Published: April 2021

Background

Little is known about the prevalence of and risk factors for adolescent mental health problems during the COVID-19 outbreak. We aimed to investigate the prevalence of depressive symptoms, their association with study-relevant problems, and the moderating effect of parent-child relationship among Chinese adolescents during the school closures.

Methods

We performed a cross-sectional analysis with data collected in middle and high schools in Taizhou, China. Students completed an online survey between April 16 and May 14, 2020. Depressive symptoms were assessed using the Children’s Depression Inventory. Three types of study problems were recorded, including having difficulty in studying at home, dislike of remote learning, and excessive screen entertainment time. Parental relationships were categorized into good or normal relationship and poor relationship. Linear regression and logistic regression analyses were conducted to investigate the associations between study-relevant problems and depressive symptoms.

Results

Using data from 6435 adolescents, we found that the prevalence of depressive symptoms was 17.7%. All the study problem measures were associated with more severe depressive symptoms. There was a moderating effect of the parental relationship on the associations between study problems and depressive symptoms. The association between number of study problems and depressive symptoms was stronger in adolescents with a poor parent-child relationship (regression coefficient 4.34 [95% CI 2.97, 5.72]) than those with a good or normal relationship (2.55 [2.35, 2.75]), p for interaction 0.002, on multivariable adjustment.

Conclusions

Study problems due to school closures were particularly problematic for adolescents who had poor parent-child relationships. Public health initiatives could help students to adjust study habits and improve parent-child relationships, thereby protecting against the development of depression.
Reduced spatial resolution MRI suffices to image and quantify drought induced embolism formation in trees
Authors: Meixner Marco , Foerst Petra , Windt Carel W.
Published: April 2021

Background

Magnetic resonance imaging (MRI) is uniquely suited to non-invasively and continuously monitor embolism formation in trees. Depending on the MRI method used, quantitative parameter maps of water content and MRI signal relaxation behavior can be generated. The ability to measure dynamic differences in water content and relaxation behavior can be used to detect xylem embolism formation, even if xylem conduits are too small to be spatially resolved. This is especially advantageous when using affordable small-scale low-field MRI scanners. The amount of signal that can be obtained from an object strongly depends on the strength of the magnetic field of the imager’s magnet. Imaging at lower resolutions thus would allow to reduce the cost, size and weight of the MRI scanner and to shorten image acquisition times.

Results

We investigated how much spatial resolution can be sacrificed without losing the ability to monitor embolism formation in coniferous softwood (spruce, Picea abies) and diffuse porous beech (Fagus sylvatica). Saplings of both species were bench dehydrated, while they were continuously imaged at stepwise decreasing spatial resolutions. Imaging was done by means of a small-scale MRI device, utilizing image matrix sizes of 128 × 128, 64 × 64 and 32 × 32 pixels at a constant FOV of 19 and 23 mm, respectively. While images at the lowest resolutions (pixel sizes 0.59 × 0.59 mm and 0.72 × 0.72 mm) were no longer sufficient to resolve finer details of the stem anatomy, they did permit an approximate localization of embolism formation and the generation of accurate vulnerability curves.

Conclusions

When using MRI, spatial resolution can be sacrificed without losing the ability to visualize and quantify embolism formation. Imaging at lower spatial resolution to monitor embolism formation has two advantages. Firstly, the acquisition time per image can be reduced dramatically. This enables continuous imaging at high time resolution, which may be beneficial to monitor rapid dynamics of embolism formation. Secondly, if the requirements for spatial resolution are relaxed, much simpler MRI devices can be used. This has the potential to make non-invasive MR imaging of embolism formation much more affordable and more widely available.
Differential methylation EPIC analysis discloses cisplatin-resistance related hypermethylation and tumor-specific heterogeneity within matched primary and metastatic testicular germ cell tumor patient tissue samples
Authors: Lobo João , Constâncio Vera , Leite-Silva Pedro , Guimarães Rita , Cantante Mariana , Braga Isaac , Maurício Joaquina , Looijenga Leendert H. J. , Henrique Rui , Jerónimo Carmen
Published: April 2021

Testicular germ cell tumors (TGCTs) are among the most common solid malignancies in young-adult men, and currently most mortality is due to metastatic disease and emergence of resistance to cisplatin. There is some evidence that increased methylation is one mechanism behind this resistance, stemming from individual studies, but approaches based on matched primary and metastatic patient samples are lacking. Herein, we provide an EPIC array-based study of matched primary and metastatic TGCT samples. Histology was the major determinant of overall methylation pattern, but some clustering of samples related to response to cisplatin was observed. Further differential analysis of patients with the same histological subtype (embryonal carcinoma) disclosed a remarkable increase in net methylation levels (at both promoter and CpG site level) in the patient with cisplatin-resistant disease and poor outcome compared to the patient with complete response to chemotherapy. This further confirms the recent results of another study performed on isogenic clones of sensitive and resistant TGCT cell lines. Differentially methylated promoters among groups of samples were mostly not shared, disclosing heterogeneity in patient tissue samples. Finally, gene ontology analysis of cisplatin-resistant samples indicated enrichment of differentially hypermethylated promoters on pathways related to regulation of immune microenvironment, and enrichment of differentially hypomethylated promoters on pathways related to DNA/chromatin binding and regulation. This data supports not only the use of hypomethylating agents for targeting cisplatin-resistant disease, but also their use in combination with immunotherapies and chromatin remodelers.
Imitation and recognition of facial emotions in autism: a computer vision approach
Authors: Drimalla Hanna , Baskow Irina , Behnia Behnoush , Roepke Stefan , Dziobek Isabel
Published: April 2021

Background

Imitation of facial expressions plays an important role in social functioning. However, little is known about the quality of facial imitation in individuals with autism and its relationship with defining difficulties in emotion recognition.

Methods

We investigated imitation and recognition of facial expressions in 37 individuals with autism spectrum conditions and 43 neurotypical controls. Using a novel computer-based face analysis, we measured instructed imitation of facial emotional expressions and related it to emotion recognition abilities.

Results

Individuals with autism imitated facial expressions if instructed to do so, but their imitation was both slower and less precise than that of neurotypical individuals. In both groups, a more precise imitation scaled positively with participants’ accuracy of emotion recognition.

Limitations

Given the study’s focus on adults with autism without intellectual impairment, it is unclear whether the results generalize to children with autism or individuals with intellectual disability. Further, the new automated facial analysis, despite being less intrusive than electromyography, might be less sensitive.

Conclusions

Group differences in emotion recognition, imitation and their interrelationships highlight potential for treatment of social interaction problems in individuals with autism.
Bacteremic cholangitis due to Raoultella planticola complicating intrahepatic bile duct stricture 5 years post-laparoscopic cholecystectomy: a case report
Authors: Blihar David , Phuu Phenyo , Kotelnikova Svetlana , Johnson Edward
Published: April 2021

Background

Raoultella Planticola is a facultative anaerobic, gram-negative, water- and soil-dwelling rod bacterium rarely reported as a cause of human disease. However, the number of reported R. planticola infections is growing, without a concomitant increase in research on the microbe or its pathogenesis. Previous genomic studies demonstrating genetic similarities between R. planticola and Klebsiella pneumoniae suggest that capsule biosynthesis, mucoid phenotype, biofilm production, and lipopolysaccharide (endotoxin) synthesis may all be potential virulence factors of R. planticola. We present a unique case of R. planticola infection of the biliary tract 5 years after biliary surgery in a patient with no previously documented risk factors. We also use in silico techniques to predict virulence factors of R. planticola.

Case presentation

This case report is the first to discuss a R. planticola infection in the biliary tract of late onset post-surgery (5 years) in a Caucasian patient with no previously documented risk factors.

Conclusions

An in-depth search of the current literature did not yield other similar cases of R. planticola infections. Moreover, to the best of our knowledge, our case is the first case of R. planticola isolated from post-endoscopic retrograde cholangiopancreatography (ERCP) as part of biliary sepsis not associated with gastroenteritis. The late onset of the infection in our patient and the results of the in silico analysis suggest that R. planticola may have survived exposure to the host immune system through the creation of an intracellular biofilm or in a non-culturable but viable state (NCBV) for the 5-year period. The in silico analysis also suggests that biofilms, enterobactin, and mucoid phenotype may play a role in the pathogenesis of R. planticola. However, further research is needed to illuminate the significance of pili, capsule biosynthesis, and lipopolysaccharide (LPS) in the virulence of R. planticola. Lastly, as our patient did not have any risk factors previously associated with R. planticola, we suggest that biliary tract stricture, cholecystitis, and prior surgery may be possible novel risk factors.
Adipose-derived stem cells combined with platelet-rich plasma enhance wound healing in a rat model of full-thickness skin defects
Authors: Ni Xuejun , Shan Xiuying , Xu Lili , Yu Wenjun , Zhang Mingliang , Lei Chen , Xu Nating , Lin Junyu , Wang Biao
Published: April 2021

Background

Wound healing is impaired in patients with diabetes due to the multifactorial etiology of the disease, which limits the therapeutic efficacy of various approaches. This study hypothesizes that the combination of adipose-derived stem cells (ADSCs) and platelet-rich plasma (PRP) might achieve optimally efficient diabetic wound healing.

Methods

ADSCs were isolated from the adipose tissues of Sprague-Dawley (SD) rats. PRP was prepared by using a two-step centrifugation technique. A diabetic wound model was established on the backs of SD rats to evaluate the effect of ADSCs incorporated into PRP. Hematoxylin and eosin staining, immunofluorescence, and immunohistochemistry were performed to observe the changes in neovascularization. ELISA and Western blot were utilized to detect the angiogenesis-related protein expression levels. The proliferation of endothelial cells was assessed by the MTS assay.

Results

ADSCs incorporated into PRP induced a higher wound closure rate than ADSCs, PRP, and negative control. The expression levels of VEGF, p-STAT3, and SDF-1 in the ADSC+PRP group were higher than those in the other groups. Moreover, the proliferation of endothelial cells was strongly stimulated by treatment with the combination of ADSC-conditioned medium (ADSC-CM) and PRP.

Conclusions

PRP enhanced diabetic wound healing induced by ADSCs, and its promoting effect involved neovascularization.
Refinement of matching costs for stereo disparities using recurrent neural networks
Authors: Emlek Alper , Peker Murat
Published: April 2021

Depth is essential information for autonomous robotics applications that need environmental depth values. The depth could be acquired by finding the matching pixels between stereo image pairs. Depth information is an inference from a matching cost volume that is composed of the distances between the possible pixel points on the pre-aligned horizontal axis of stereo images. Most approaches use matching costs to identify matches between stereo images and obtain depth information. Recently, researchers have been using convolutional neural network-based solutions to handle this matching problem. In this paper, a novel method has been proposed for the refinement of matching costs by using recurrent neural networks. Our motivation is to enhance the depth values obtained from matching costs. For this purpose, to attain an enhanced disparity map by utilizing the sequential information of matching costs in the horizontal space, recurrent neural networks are used. Exploiting this sequential information, we aimed to determine the position of the correct matching point by using recurrent neural networks, as in the case of speech processing problems. We used existing stereo algorithms to obtain the initial matching costs and then improved the results by utilizing recurrent neural networks. The results are evaluated on the KITTI 2012 and KITTI 2015 datasets. The results show that the matching cost three-pixel error is decreased by an average of 14.5% in both datasets.
Depression in adults with sickle cell disease: a systematic review of the methodological issues in assessing prevalence of depression
Authors: Oudin Doglioni Damien , Chabasseur Vincent , Barbot Frédéric , Galactéros Frédéric , Gay Marie-Claire
Published: April 2021

Background

Sickle cell disease (SCD) as other chronic medical conditions is commonly complicated by depression or other psychiatric symptoms. Results reported in studies present a large variation. Thus, synthetic data are needed to understand impact of depression in adults with SCD. The aim of this literature review is to analyse the methodology used in the studies assessing depression and discuss the different prevalence levels reported.

Methods

Studies involving adults with SCD from 1999 to 2018 were included when providing data on prevalence of depression. It was defined by a psychometric assessment, a structured interview, or a medical record review. PRISMA recommendations were followed.

Results

36 studies are included accordingly to our methodology. Prevalence variation is large, from 0% to more than 85%. We find that the type of assessment tool used plays a major role in this between studies variation. Also, methodological issues arise with respect to psychometric assessment. Moreover, differences emerge between continents, setting of recruitment or time of assessment.

Conclusion

All these issues are discussed to provide insight on depression in adults with sickle cell disease.

Trial Registration

PROSPERO RegistrationCRD42018100684.
Biochar and vermicompost improve growth and physiological traits of eggplant (Solanum melongena L.) under deficit irrigation
Authors: Ebrahimi Mohsen , Souri Mohammad Kazem , Mousavi Amir , Sahebani Navazolah
Published: April 2021

Background

Drought is one of the most important environmental stresses that can adversely influence soil properties, plant growth, and productivity of agricultural crops including eggplant as an important vegetable crop. In recent years, the use of agricultural wastes has been reported as a beneficial and sustainable measure in soil water retention and fertility enhancement. In this study, the effect of date palm and pistachio biochar, vermicompost and a combination of biochar and vermicompost was evaluated on eggplant growth, yield and water use efficiency under deficit irrigation.

Materials and methods

The experiment was done in a split-split plot based on randomized complete block design with three replications and under open field conditions. The main plot was deficit irrigation in three levels of 100, 75 and 50% of plant water requirement (PWR), and the sub-plots were vermicompost in two levels of 0, 1500 g m−2, and biochar in three levels of 0, 500 g m−2 of the pistachio biochar and 500 g m−2 of the date palm biochar.

Results

The results showed that soil amendment with vermicompost and pistachio biochar and 100% PWR showed the best plant growth and performance. The early crop yield was highest under pistachio biochar and 50% PWR, while the total plant yield was highest under combined application of vermicompost and pistachio biochar at 100% PWR. The plant water use efficiency was maximum under mixed application of vermicompost and pistachio biochar at 50% PWR. Application of both pistachio biochar and vermicompost at 100% PWR resulted in the highest leaf concentrations of nitrogen, phosphorus, potassium, iron and manganese. The highest levels of physiologically important stress metabolites, including malondialdehyde, guaiacol peroxidase, superoxide dismutase and catalase enzymes were found in treatments without amendments or only with vermicompost and 50% PWR.

Conclusion

The results indicate that under normal and particularly water deficit conditions, vermicompost and biochar increased eggplant vegetative growth, yield and water use efficiency.
Triple metachronous primary pancreatic and gallbladder cancer associated with pancreaticobiliary maljunction: a case report
Authors: Kuhara Yuta , Hashimoto Yasushi , Hirahara Satoshi , Kubota Haruna , Shirakawa Kenji , Toyota Kazuhiro , Yano Raita , Kobayashi Hironori , Yokoyama Yujiro , Sakashita Yoshihiro , Murakami Yoshiaki , Taniyama Kiyomi , Miyamoto Katsunari
Published: April 2021

Background

Metachronous pancreatic and gallbladder cancer is a rare condition and has a dismal prognosis. Herein, we present a patient with triple metachronous primary pancreatic and gallbladder cancer associated with pancreaticobiliary maljunction who achieved long-term survival after undergoing repeat curative surgery.

Case presentation

A 65-year-old female patient with advanced gallbladder cancer associated with pancreaticobiliary maljunction underwent extended cholecystectomy with extrahepatic bile duct resection. The pathological diagnosis was T3N0M0 stage III A papillary adenocarcinoma with hepatic invasion. During a monthly follow-up, a diffuse hypovascular 2.0 × 1.5-cm mass was detected in the pancreatic head 6.2 years after the initial surgery. Hence, the patient underwent pancreaticoduodenectomy. Histological examination revealed T3N0M0 stage IIA well-differentiated adenocarcinoma without lymph node metastases. Marked inflammatory reaction was observed in the non-cancerous lesions of the proximal pancreatic head parenchyma containing bile pigment within ductular lumens. After 12.5 years from the initial surgery, total pancreatectomy for a 4.0 × 3.0-cm mass in the remnant pancreas was performed. Histological examination revealed T3N1M0 stage IIB moderately differentiated adenocarcinoma with lymph node metastases. Hence, surgical curative resection was achieved. Based on the pathological findings, a definitive diagnosis of triple metachronous pancreatic and gallbladder cancer was made. The pathology suggests no precursor lesions such as pancreatic intraepithelial neoplasia (PanIN) and atypical flat lesions, but marked inflammations in the non-cancerous lesions, strengthening our hypothesis that chronic inflammation induced by the pancreaticobiliary maljunction is related to carcinogenesis of the pancreas. Despite further adjuvant chemotherapy, the patient’s general condition worsened; however, she remained alive 15.2 years after the initial surgery while receiving the best supportive care.

Conclusions

Repeat curative surgery for triple metachronous cancer was associated with a favorable prognosis. Both the biliary tract and the pancreas should be closely monitored during follow-up among patients with pancreaticobiliary maljunction, which can be managed with curative surgery.
Comparing the effects of current circumcision techniques on dorsal root ganglia: an experimental study
Authors: Caglar Ozgur , Arslan Remzi , Firinci Binali , Aydin Muhammed Enes , Karadeniz Erdem , Nalci Kemal Alp , Salman Ahmet Bedii , Aydin Mehmet Dumlu
Published: April 2021

Background

Circumcision is a surgical removal process of the preputium. Surgical excision and electric current cause neurodegeneration in the excised tissue-related neural network. This study investigates if circumcision and current surgical methods would cause histopathological changes in the penile tissue innervating pudendal nerve dorsal root ganglia.

Results

Vascular congestion occluded the microvessels, and degenerative changes were detected in postexcised penile tissue. Neuronal angulation, cytoplasmic condensation, nuclear shrinkage, and condensed nuclei were observed in the pudendal nerve ganglia. Moreover, the degenerated neuron (DN) densities of the pudendal nerve ganglia were 5 ± 2, 98 ± 22, 1093 ± 185, 236 ± 43 and 151 ± 19 in the control, the surgical circumcision, the monopolar cautery, the bipolar cautery and the thermocautery groups, respectively.

Conclusions

Although only the pudendal nerve endings are affected secondary to prepusium excision another pudendal axons can be damaged during bleeding control with cautery, the destruction of the neuron that sends this axon initiates a general inflammation in that ganglion. As a result, there may be a somatosensitive innervation defect in extrapenile tissues innervated by this ganglion. High-voltage electric devices should not be used unless obligatory.
The Randomized AMBORA Trial: Impact of Pharmacological/Pharmaceutical Care on Medication Safety and Patient-Reported Outcomes During Treatment With New Oral Anticancer Agents
Authors: Dürr Pauline , Schlichtig Katja , Kelz Carolin , Deutsch Birgit , Maas Renke , Eckart Michael J. , Wilke Jochen , Wagner Harald , Wolff Kerstin , Preuß Caroline , Brückl Valeska , Meidenbauer Norbert , Staerk Christian , Mayr Andreas , Fietkau Rainer , Goebell Peter J. , Kunath Frank , Beckmann Matthias W. , Mackensen Andreas , Neurath Markus F. , Pavel Marianne , Dörje Frank , Fromm Martin F.
Published: April 2021

PURPOSE

Oral anticancer drugs (eg, kinase inhibitors) play an important role in cancer therapy. However, considerable challenges regarding medication safety of oral anticancer drugs have been reported. Randomized, controlled, multicenter studies on the impact of intensified clinical pharmacological/pharmaceutical care on patient safety and patient treatment perception are lacking.

METHODS

Patients were eligible for the randomized, multicenter AMBORA study, if they were newly started on any of the oral anticancer drugs approved in 2001 or later without restriction to certain tumor entities. Patients were randomly assigned to receive either standard of care (control group) or an additional, intensified clinical pharmacological/pharmaceutical care, which included medication management and structured patient counseling, over a period of 12 weeks (intervention group). Primary end points were the number of antitumor drug–related problems (ie, side effects and unresolved medication errors) and patient treatment satisfaction with the oral anticancer therapy after 12 weeks measured with the Treatment Satisfaction Questionnaire for Medication, category convenience.

RESULTS

Two hundred two patients were included. Antitumor drug–related problems were significantly lower in the intervention compared with the control group (3.85 v 5.81 [mean], P < .001). Patient treatment satisfaction was higher in the intervention group (Treatment Satisfaction Questionnaire for Medication, convenience; 91.6 v 74.4 [mean], P < .001). The hazard ratio for the combined end point of severe side effects (Common Terminology Criteria for Adverse Events ≥ 3), treatment discontinuation, unscheduled hospital admission, and death was 0.48 (95% CI, 0.32 to 0.71, P < .001) in favor of the intervention group.

CONCLUSION

Treatment with oral anticancer drugs is associated with a broad range of medication errors and side effects. An intensified clinical pharmacological/pharmaceutical care has considerable, positive effects on the number of medication errors, patient treatment perception, and severe side effects.
Predicting Outcomes in Men With Metastatic Nonseminomatous Germ Cell Tumors (NSGCT): Results From the IGCCCG Update Consortium
Authors: Gillessen Silke , Sauvé Nicolas , Collette Laurence , Daugaard Gedske , de Wit Ronald , Albany Costantine , Tryakin Alexey , Fizazi Karim , Stahl Olof , Gietema Jourik A. , De Giorgi Ugo , Cafferty Fay H. , Hansen Aaron R. , Tandstad Torgrim , Huddart Robert A. , Necchi Andrea , Sweeney Christopher J. , Garcia-Del-Muro Xavier , Heng Daniel Y. C. , Lorch Anja , Chovanec Michal , Winquist Eric , Grimison Peter , Feldman Darren R. , Terbuch Angelika , Hentrich Marcus , Bokemeyer Carsten , Negaard Helene , Fankhauser Christian , Shamash Jonathan , Vaughn David J. , Sternberg Cora N. , Heidenreich Axel , Beyer Jörg ,   for the International Germ Cell Cancer Classification Update Consortium
Published: April 2021

PURPOSE

The classification of the International Germ Cell Cancer Collaborative Group (IGCCCG) plays a pivotal role in the management of metastatic germ cell tumors but relies on data of patients treated between 1975 and 1990.

MATERIALS AND METHODS

Data on 9,728 men with metastatic nonseminomatous germ cell tumors treated with cisplatin- and etoposide-based first-line chemotherapy between 1990 and 2013 were collected from 30 institutions or collaborative groups in Europe, North America, and Australia. Clinical trial and registry data were included. Primary end points were progression-free survival (PFS) and overall survival (OS). The survival estimates were updated for the current era. Additionally, a novel prognostic model for PFS was developed in 3,542 patients with complete information on potentially relevant variables. The results were validated in an independent data set.

RESULTS

Compared with the original IGCCCG publication, 5-year PFS remained similar in patients with good prognosis with 89% (87%-91%) versus 90% (95% CI, 89 to 91), but the 5-year OS increased from 92% (90%-94%) to 96% (95%-96%). In patients with intermediate prognosis, PFS remained similar with 75% (71%-79%) versus 78% (76%-80%) and the OS increased from 80% (76%-84%) to 89% (88%-91%). In patients with poor prognosis, the PFS increased from 41% (95% CI, 35 to 47) to 54% (95% CI, 52 to 56) and the OS from 48% (95% CI, 42 to 54) to 67% (95% CI, 65 to 69). A more granular prognostic model was developed and independently validated. This model identified a new cutoff of lactate dehydrogenase at a 2.5 upper limit of normal and increasing age and presence of lung metastases as additional adverse prognostic factors. An online calculator is provided ( https://www.eortc.org/IGCCCG-Update ).

CONCLUSION

The IGCCCG Update model improves individual prognostication in metastatic nonseminomatous germ cell tumors. Increasing age and lung metastases add granularity to the original IGCCCG classification as adverse prognostic factors.
A Queer Romance
Authors: Newman Eric H.
Published: April 2021

This essay argues that the queer romances at the margins of Claude McKay’s Romance in Marseille operate as sites of possibility for a happy, egalitarian social relation that is longed for but not otherwise accessible in the novel. The essay contends that this novel, read against Home to Harlem (1928) and Banjo (1929), offers one of the most sustained, nuanced representations of queer life in McKay’s archive and in early twentieth-century LGBT literature more generally, one in which same-sex-oriented characters are rendered as normal, integral figures in urban life rather than as outré characters whose primary function is to add spice to the narrative. As the novel demonstrates the continuing appeal of queerness as a site for imagining a more liberated, loving form of social organization—one that relishes the pleasure-in-difference that is a hallmark of McKay’s writing—it also anticipates formations within the queer liberationist politics of the decades that followed.
Analgesic and anti-inflammatory activity of Artemisia extracts on animal models of nociception
Authors: IVANESCU Bianca , CORCIOVA Andreia , VLASE Laurian , GHELDIU Ana-Maria , MIRON Anca , ABABEI Daniela Carmen , BILD Veronica
Published: April 2021

Introduction. The study aims to assess the antinociceptive and anti-inflammatory activity of extracts obtained from indigenous species of wormwood: Artemisia absinthium, A. annua, A. vulgaris and A. pontica.
Materials and methods. For these experiments, we employed nociception models using thermal stimulus (hot plate and tail immersion tests, t = 52.5 0C; 30, 60 and 90 minutes testing), chemical stimulus (Zymosan-induced abdominal constriction response test, using distinct lots and testing at 60, 90 and 120 minutes after administration of samples) and pressure stimulus (Randall Selitto test) and an inflammation model for the evaluation of inflammatory edema by Plethysmometer test. Groups of 6 Swiss mice / lot were used, receiving by oral administration the plant extracts suspended in 0.1% CMC-Na. The doses were administered in geometric progression. Chemical analyses were performed by HPLC-MS in order to identify bioactive substances present in extracts: methoxylated flavonoids, sesquiterpene lactones, phytosterols and hydroxycinnamic acids.
Results and discussion. All plant extracts showed antinociceptive action on the models with thermal stimulus, as demonstrated by the ED50 values obtained at different test times. In the models of nociception with chemical and mechanical stimulus, models based on inflammatory mediation, the studied fractions have partially proved their antinociceptive action. Regarding the degree of inhibition of inflammatory edema, the highest potency was exhibited by Artemisia pontica extract (86.5% inhibition for the dose of 100 mg/kg). Hispidulin and eupatorin, known anti-inflammatory compounds, were identified in all extracts, along with caffeic and chlorogenic acids, stigmasterol, campesterol and β-sitosterol.
Conclusions. The obtained results support the use of these plant extracts in moderate intensity pain, triggered by both central and peripheral mechanisms.
Keywords: hot-plate test, tail immersion test, abdominal constrictive response, Randall-Selitto test, inflammatory edema,
Perspectives of Rehabilitation in Diabetic Neuropathy
Authors: TROFIN Dan , MATEI Daniela , STAMATE Teodor , WALTHER Bild , TROFIN Daniela Marilena
Published: April 2021

Abstract
Diabetic Neuropathy (DN) is a complication that affects at least half of the patients with Diabetes Mellitus. Unlike other symptoms and signs that may sooner alarm the patients, DN manifestations tend to be rather silent, and so usually neglected by the patient for a long period of time, which can last for years. Therefore it’s a “hidden complication of diabetes” label. Unfortunately, it is only when symptoms already affect the quality of life that the treatment becomes challenging when it comes to speaking of either etiological, symptomatic or rehabilitation strategies. Early diagnosis can also be tricky while aiming for lifestyle corrections and proper individualized treatment strategies. Rehabilitation methods for DN aim especially towards the improvement of articulation mobility and muscular strength amelioration, the suggested brief review of literature promoting this part of therapy essential for both prevention and amelioration of overall morbidity.
Keywords: diabetic neuropathy, physical therapy, interdisciplinary approach, quality of life,
Challenges regarding rehabilitation treatment in a case of postpartum spastic paraparesis, secondary to a T9 vertebral fracture on the pathologicallybone operated -case report
Authors: IONESCU Elena Valentina , ILIESCU Mădălina Gabriela , ZAMFIR Costică  , DRĂGOI Mădălina Florentina , CALOTA Nicoleta , OBADA Bogdan , IONESCU Ana-Maria , OPREA Doiniţa
Published: April 2021

Introduction. Pregnancy is a well-known risk factor for asymptomatic hemangiomas discovered incidentally, becoming aggressive or symptomatic, most often in the third trimester of pregnancy, related to hemodynamic and endocrine changes that occur during pregnancy. Many patients experience incomplete spontaneous remission after birth. Material and method. We report the case of a 24-year-old woman, who presented for incomplete paraplegia, pain in the spine, instability of walking of the left lower limb, bilateral plantar paresthesia, possible walking with metal support. Results and discussions. The MRI performed identifies T9 vertebral fracture-compression on pathological bone, T10-T12 vertebral hemangiomas. Conclusions. In order to obtain favorable results, the patient benefited from the support and treatment of a multidisciplinary team: neurosurgeons, imagers, physical and rehabilitation medicine doctors and physiotherapists, and represented a real challenge regarding the complexity of the factors involved.
Keywords: hemangioma, rehabilitation, multidisciplinary team
Από το ηλεκτρονικό κοινοβούλιο στη συμπαραγωγική οπτική αναπαράσταση νομοθετικών και συνταγματικών κειμένων ως μέσο ενεργής δημοκρατικής συμμετοχής των πολιτών
Authors: Παπαλόη Ασπασία
Published: April 2021

Το αντικείμενο της παρούσας μελέτης αφορά στην εξέταση και σύνδεση δύο αντικειμένων: αφενός την εξέταση της χρησιμότητας της οπτικοποιημένης νομικής πληροφορίας, η οποία σχετίζεται με το συντακτικό ρόλο του κοινοβουλίου (δηλαδή το συνταγματικό κείμενο), εν είδει χρήσιμης διαφάνειας, καθώς και η εξέταση της διαδικασίας οπτικοποίησης του επιλεγμένου συνταγματικού δικαιώματος - εν είδει ψηφιακής οπτικής αφήγησης – ενταγμένη σε ένα γενικότερο πλαίσιο ενεργής συμμετοχικής διαδικασίας. Δεδομένου ότι η διαδικασία οπτικοποίησης του δικαιώματος υλοποιήθηκε από τους ίδιους τους συμμετέχοντες, δηλαδή δείγμα Ελλήνων εφήβων, η διαδικασία έλαβε τη μορφή μίας συμπαραγωγικής διαδικασίας. Ως μεθοδολογία υιοθετήθηκε η έρευνα δράσης, σε συνδυασμό με τη μεθοδολογία της σχεδιαστικής σκέψης. Τα αποτελέσματα επί των εργαστηρίων ανέδειξαν ενδιαφέρουσες πτυχές τόσο ως προς τη χρησιμότητα της πληροφορίας και τις έννοιες τόσο της διαφάνειας, όσο και της χρήσιμης διαφάνειας. Έτσι, δεν ακυρώνεται ο χαρακτήρας του (συνταγματικού) κειμένου, αλλά η οπτικοποίησή του ενισχύει τη χρησιμότητά του. Αφενός το συνταγματικό δικαίωμα σε κειμενική μορφή εξυπηρετεί τη διαφάνεια, μια και οι έφηβοι συμμετέχοντες, έχουν διαθέσιμη όλη την πληροφορία. Αφετέρου, η οπτικοποιημένη μορφή του δικαιώματος εξυπηρετεί στην εύχρηστη και πρακτική λήψη του, λαμβάνοντας με γρήγορο τρόπο τις πιο σημαντικές πληροφορίες. Αυτό το συμπέρασμα, επιβεβαιώνει και το δικό μας ισχυρισμό πως η οπτικοποίηση της νομικής πληροφορίας δεν έχει σκοπό την αναίρεση της σημασίας ενός νομοθετικού ή συνταγματικού κειμένου, αλλά δρα συμπληρωματικά. Η διαδικασία που ακολουθήθηκε αποδεικνύει το συνεργατικό της χαρακτήρα, γεγονός που εντυπωσίασε την πλειοψηφία των συμμετεχόντων. Μάλιστα, ενισχύθηκε και από χαρακτηριστικά διασκέδασης και δημιουργικότητας, καταδεικνύοντας πως η ιδέα της συμμετοχής δεν απαιτεί απαραίτητα σοβαρότητα και στείρα επιχειρηματολογία, αλλά με τη χρήση ποικιλίας μεθόδων και με παιγνιώδη τρόπο υπάρχει η δυνατότητα μάθησης. Ακόμη και ο οργανωμένος χαρακτήρας της διαδικασίας έκανε σαφές – όπως προέκυψε από την αξιολόγηση των συμμετεχόντων – πως η διεξαγωγή όλων των σταδίων και μεθόδων ήταν απαραίτητη για την ολοκλήρωση του τελικού αποτελέσματος. Επίσης, ο συνδυασμός και η χρήση αναλογικών και ψηφιακών μεθόδων κατά τη διαδικασία, επιβεβαιώνουν τις αρχές της πραγμάτωσης του Ηλεκτρονικού Κοινοβουλίου.