bluuebunny/crossref_metadata_2025 huggingface dataset:
Detecting axonal injury in individual patients after traumatic brain injury
Authors: Jolly Amy E , Bălăeţ Maria , Azor Adriana , Friedland Daniel , Sandrone Stefano , Graham Neil S N , Zimmerman Karl , Sharp David J
Published: October 2020

Poor outcomes after traumatic brain injury (TBI) are common yet remain difficult to predict. Diffuse axonal injury is important for outcomes, but its assessment remains limited in the clinical setting. Currently, axonal injury is diagnosed based on clinical presentation, visible damage to the white matter or via surrogate markers of axonal injury such as microbleeds. These do not accurately quantify axonal injury leading to misdiagnosis in a proportion of patients. Diffusion tensor imaging provides a quantitative measure of axonal injury in vivo, with fractional anisotropy often used as a proxy for white matter damage. Diffusion imaging has been widely used in TBI but is not routinely applied clinically. This is in part because robust analysis methods to diagnose axonal injury at the individual level have not yet been developed. Here, we present a pipeline for diffusion imaging analysis designed to accurately assess the presence of axonal injury in large white matter tracts in individuals. Average fractional anisotropy is calculated from tracts selected on the basis of high test-retest reliability, good anatomical coverage and their association to cognitive and clinical impairments after TBI. We test our pipeline for common methodological issues such as the impact of varying control sample sizes, focal lesions and age-related changes to demonstrate high specificity, sensitivity and test-retest reliability. We assess 92 patients with moderate-severe TBI in the chronic phase (≥6 months post-injury), 25 patients in the subacute phase (10 days to 6 weeks post-injury) with 6-month follow-up and a large control cohort (n = 103). Evidence of axonal injury is identified in 52% of chronic and 28% of subacute patients. Those classified with axonal injury had significantly poorer cognitive and functional outcomes than those without, a difference not seen for focal lesions or microbleeds. Almost a third of patients with unremarkable standard MRIs had evidence of axonal injury, whilst 40% of patients with visible microbleeds had no diffusion evidence of axonal injury. More diffusion abnormality was seen with greater time since injury, across individuals at various chronic injury times and within individuals between subacute and 6-month scans. We provide evidence that this pipeline can be used to diagnose axonal injury in individual patients at subacute and chronic time points, and that diffusion MRI provides a sensitive and complementary measure when compared to susceptibility weighted imaging, which measures diffuse vascular injury. Guidelines for the implementation of this pipeline in a clinical setting are discussed.
Abnormal dorsal attention network activation in memory impairment after traumatic brain injury
Authors: Mallas Emma-Jane , De Simoni Sara , Scott Gregory , Jolly Amy E , Hampshire Adam , Li Lucia M , Bourke Niall J , Roberts Stuart A G , Gorgoraptis Nikos , Sharp David J
Published: October 2020

Memory impairment is a common, disabling effect of traumatic brain injury. In healthy individuals, successful memory encoding is associated with activation of the dorsal attention network as well as suppression of the default mode network. Here, in traumatic brain injury patients we examined whether: (i) impairments in memory encoding are associated with abnormal brain activation in these networks; (ii) whether changes in this brain activity predict subsequent memory retrieval; and (iii) whether abnormal white matter integrity underpinning functional networks is associated with impaired subsequent memory. Thirty-five patients with moderate-severe traumatic brain injury aged 23–65 years (74% males) in the post-acute/chronic phase after injury and 16 healthy control subjects underwent functional MRI during performance of an abstract image memory encoding task. Diffusion tensor imaging was used to assess structural abnormalities across patient groups compared to 28 age-matched healthy controls. Successful memory encoding across all participants was associated with activation of the dorsal attention network, the ventral visual stream and medial temporal lobes. Decreased activation was seen in the default mode network. Patients with preserved episodic memory demonstrated increased activation in areas of the dorsal attention network. Patients with impaired memory showed increased left anterior prefrontal activity. White matter microstructure underpinning connectivity between core nodes of the encoding networks was significantly reduced in patients with memory impairment. Our results show for the first time that patients with impaired episodic memory show abnormal activation of key nodes within the dorsal attention network and regions regulating default mode network activity during encoding. Successful encoding was associated with an opposite direction of signal change between patients with and without memory impairment, suggesting that memory encoding mechanisms could be fundamentally altered in this population. We demonstrate a clear relationship between functional networks activated during encoding and underlying abnormalities within the structural connectome in patients with memory impairment. We suggest that encoding failures in this group are likely due to failed control of goal-directed attentional resources.
Sex-specific relationships between urbanization, parasitism, and plumage coloration in house finches
Authors: Sykes Brooke E , Hutton Pierce , McGraw Kevin J
Published: October 2020

Historically, studies of condition-dependent signals in animals have been male-centric, but recent work suggests that female ornaments can also communicate individual quality (e.g., disease state, fecundity). There also has been a surge of interest in how urbanization alters signaling traits, but we know little about if and how cities affect signal expression in female animals. We measured carotenoid-based plumage coloration and coccidian (Isospora spp.) parasite burden in desert and city populations of house finches Haemorhous mexicanus to examine links between urbanization, health state, and feather pigmentation in males and females. In earlier work, we showed that male house finches are less colorful and more parasitized in the city, and we again detected such patterns in this study for males; however, urban females were less colorful, but not more parasitized, than rural females. Moreover, contrary to rural populations, we found that urban birds (regardless of sex) with larger patches of carotenoid coloration were also more heavily infected with coccidia. These results show that urban environments can disrupt condition-dependent color expression and highlight the need for more studies on how cities affect disease and signaling traits in both male and female animals.
Germline variants are associated with increased primary melanoma tumor thickness at diagnosis
Authors: Mangantig Ernest , MacGregor Stuart , Iles Mark M , Scolyer Richard A , Cust Anne E , Hayward Nicholas K , Montgomery Grant W , Duffy David L , Thompson John F , Henders Anjali , Bowdler Lisa , Rowe Casey , Cadby Gemma , Mann Graham J , Whiteman David C , Long Georgina V , Ward Sarah V , Khosrotehrani Kiarash , Barrett Jennifer H , Law Matthew H
Published: October 2020

Germline genetic variants have been identified, which predispose individuals and families to develop melanoma.

Tumor thickness is the strongest predictor of outcome for clinically localized primary melanoma patients. We sought to determine whether there is a heritable genetic contribution to variation in tumor thickness. If confirmed, this will justify the search for specific genetic variants influencing tumor thickness.

To address this, we estimated the proportion of variation in tumor thickness attributable to genome-wide genetic variation (variant-based heritability) using unrelated patients with measured primary cutaneous melanoma thickness. As a secondary analysis, we conducted a genome-wide association study (GWAS) of tumor thickness.

The analyses utilized 10 604 individuals with primary cutaneous melanoma drawn from nine GWAS datasets from eight cohorts recruited from the general population, primary care and melanoma treatment centers. Following quality control and filtering to unrelated individuals with study phenotypes, 8125 patients were used in the primary analysis to test whether tumor thickness is heritable. An expanded set of 8505 individuals (47.6% female) were analyzed for the secondary GWAS meta-analysis. Analyses were adjusted for participant age, sex, cohort and ancestry.

We found that 26.6% (SE 11.9%, P = 0.0128) of variation in tumor thickness is attributable to genome-wide genetic variation. While requiring replication, a chromosome 11 locus was associated (P < 5 × 10−8) with tumor thickness. Our work indicates that sufficiently large datasets will enable the discovery of genetic variants associated with greater tumor thickness, and this will lead to the identification of host biological processes influencing melanoma growth and invasion.
Profound bilateral deafness complicating aortic arch surgery
Authors: Carré Fabienne , Mamelle Elisabeth , Ferrier Suzanne , Achouh Paul
Published: October 2020

Hearing loss is a rare complication of cardiac surgery; bilateral profound deafness has never been reported in this setting. A 45-year-old male presented with profound bilateral sudden deafness following arch surgery and frozen elephant trunk. Patient’s presentation, surgery details and aetiological mechanisms are discussed.
Development of the Diaphragmatic Paralysis Questionnaire: a simple tool for patient relevant outcome
Authors: Kosse Nils Jurriaan , Windisch Wolfram , Koryllos Aris , Lopez-Pastorini Alberto , Piras Denis , Schroiff Hans-Willi , Straßmann Stephan Eric , Stoelben Erich , Schwarz Sarah Bettina
Published: October 2020

OBJECTIVES

Measurement tools of health-related quality of life (HRQL) that are specific for the underlying disorder are inevitably needed to assess HRQL changes following specific treatment strategies. The aim of the current study was to develop a questionnaire assessing HRQL in patients with unilateral diaphragmatic paresis.

METHODS

Firstly, topics of health impairments covering physical, psychological, social and functional aspects were predefined by a physician expert panel to ensure face validity. Secondly, all predefined topics were rated by a patient group with unilateral diaphragmatic paresis (untreated: n = 11; postoperative: n = 9) using a 5-point Likert scale ranging from ‘not relevant at all’ (−2) to ‘absolutely relevant’ (+2) to guarantee content validity. Thirdly, only relevant topics (0 to +2) were used for item development, while non-relevant items (<0) were not subject for item development.

RESULTS

In total, 20 patients rated a total of 43 topics covering a broad spectrum of health impairment. 21 were considered as relevant for item development. Items are answered on a 5-point Likert scale ranging from ‘completely untrue’ (−2) to ‘always true’ (+2). The Diaphragmatic Paralysis Questionnaire (DPQ) Summary Score ranges from 0 (worst HRQL) to 100 (best HRQL). Finally, the German DPQ was professionally translated and transculturally adapted into English, Italian, Dutch, French, Greek and Spanish, using translation/back-translation procedures.

CONCLUSIONS

The DPQ is the first diseases-specific HRQL measure developed for patients with diaphragmatic paresis. In addition, the DPQ is available in 7 languages free of charge for non-profit purposes.

Clinical trial registration

German clinical trials register: DRKS00017056
Prevalence and clinicopathological/molecular characteristics of mismatch repair protein-deficient tumours among surgically treated patients with prostate cancer in a Japanese hospital-based population
Authors: Kagawa Makoto , Kawakami Satoru , Yamamoto Azusa , Suzuki Okihide , Eguchi Hidetaka , Okazaki Yasushi , Akagi Kiwamu , Tamaru Jun-ichi , Arai Tomio , Yamaguchi Tatsuro , Ishida Hideyuki
Published: October 2020

Background

The prevalence and molecular characteristics of deficient mismatch repair prostate cancer in the Japanese population have scarcely been investigated.

Methods

Immunohistochemistry for mismatch repair proteins (MLH1, MSH2, MSH6 and PMS2) was performed in formalin-fixed paraffin-embedded sections prepared from resected primary prostate cancers in patients who underwent prostatectomy at our institution between January 2001 and May 2016. Genetic and/or epigenetic alterations of mismatch repair genes were investigated in patients with any loss of mismatch repair protein expression in the tumour.

Results

Of the 337 patients, four (1.2%) showed loss of mismatch repair protein expression on immunohistochemistry. All four patients showed loss of both MSH2 and MSH6 protein expression. Genetic testing was performed in two of the four patients, demonstrating no pathogenic germline alterations were present. In each of these two patients, at least one somatic alteration inactivating MSH2 without MSH2 hypermethylation was identified, leading to the diagnosis of supposed ‘Lynch-like syndrome’. Patients with deficient mismatch repair prostate cancer were at a significantly higher stage (pT2pN0 vs. pT3-4pN0/pTanypN1, P = 0.02) and had a greater Gleason score (<8 vs. ≥8, P < 0.01) than those with proficient mismatch repair prostate cancer.

Conclusions

The prevalence of deficient mismatch repair prostate cancer in the Japanese hospital-based prostatectomized population was extremely low. To improve screening efficacy for deficient mismatch repair prostate cancer, screening candidates can be limited to patients with locally advanced, node-positive and/or Gleason score of 8 or greater prostate cancer. Universal tumour screening for Lynch syndrome seems ineffective in patients with prostate cancer.
Phenotypic Insecticide Resistance in Anopheles gambiae (Diptera: Culicidae): Specific Characterization of Underlying Resistance Mechanisms Still Matters
Authors: Medjigbodo Adandé A , Djogbenou Luc S , Koumba Aubin A , Djossou Laurette , Badolo Athanase , Adoha Constantin J , Ketoh Guillaume K , Mavoungou Jacques F
Published: October 2020

An effective control of malaria vectors requires an extensive knowledge of mechanisms underlying the resistance-phenotypes developed by these vectors against insecticides. We investigated Anopheles gambiae mosquitoes from Benin and Togo for their intensity of insecticide resistance and we discussed the involvement of genotyped mechanisms in the resistance-phenotypes observed. Three- to five-day-old adult mosquitoes emerged from field and laboratory An. gambiae larvae were assayed using WHO tube intensity tests against various doses of deltamethrin: 1× (0.05%); 2× (0.1%); 5× (0.25%); 7.5× (0.375%) and those of pirimiphos-methyl: 0.5× (0.125%); 1× (0.25%). Members of An. gambiae complex were screened in field populations using polymerase chain reaction (PCR) assays. The presence of kdrR(1014F/1014S) and ace-1R(119S) mutations was also investigated using TaqMan and PCR-RFLP techniques, respectively. Anopheles gambiae from field were very resistant to deltamethrin, whereas KisKdr and AcerKdrKis strains displayed 100% mortality rates at 2× the diagnostic dose. In contrast, the field mosquitoes displayed a low resistance-intensity against 1× the diagnostic dose of pirimiphos-methyl, whereas AcerKis and AcerKdrKis strains showed susceptibility at 0.5× the diagnostic dose. Anopheles gambiae s.s., Anopheles coluzzii, and Anopheles arabiensis were identified. Allelic frequencies of kdrR (1014F) and ace-1R (119S) mutations in the field populations varied from 0.65 to 1 and 0 to 0.84, respectively. The field An. gambiae displayed high-resistance levels against deltamethrin and pirimiphos-methyl when compared with those of the laboratory An. gambiae-resistant strains. These results exhibit the complexity of underlying insecticide resistance mechanisms in these field malaria vectors.
The interaction between wheat roots and soil pores in structured field soil
Authors: Zhou Hu , Whalley William R , Hawkesford Malcolm J , Ashton Rhys W , Atkinson Brian , Atkinson Jonathan A , Sturrock Craig J , Bennett Malcolm J , Mooney Sacha J
Published: October 2020

Wheat (Triticum aestivum L.) root growth in the subsoil is usually constrained by soil strength, although roots can use macropores to elongate to deeper layers. The quantitative relationship between the elongation of wheat roots and the soil pore system, however, is still to be determined. We studied the depth distribution of roots of six wheat varieties and explored their relationship with soil macroporosity from samples with the field structure preserved. Undisturbed soil cores (to a depth of 100 cm) were collected from the field and then non-destructively imaged using X-ray computed tomography (at a spatial resolution of 90 µm) to quantify soil macropore structure and root number density (the number of roots cm–2 within a horizontal cross-section of a soil core). Soil macroporosity changed significantly with depth but not between the different wheat lines. There was no significant difference in root number density between wheat varieties. In the subsoil, wheat roots used macropores, especially biopores (i.e. former root or earthworm channels) to grow into deeper layers. Soil macroporosity explained 59% of the variance in root number density. Our data suggested that the development of the wheat root system in the field was more affected by the soil macropore system than by genotype. On this basis, management practices which enhance the porosity of the subsoil may therefore be an effective strategy to improve deep rooting of wheat.
On the Application of International Law to Palestinian Refugees
Authors: Albanese Francesca P , Takkenberg Lex
Published: October 2020

This chapter explores the legal foundations of the Palestinian refugee question, reviewing their status under various branches of international law – as refugees, stateless persons, civilians protected under international humanitarian law, internally displaced persons, or, simply, as human beings entitled to human rights. International law as it stood in the early twentieth century, is relevant to the Palestinian refugee question. Since 1948, the evolution of its various branches – notably international humanitarian law (IHL), international human rights law (IHRL), international refugee law (IRL), and the frameworks to address statelessness and prevent internal displacement – have consolidated and evolved in ways that should benefit Palestinian refugees. IRL determines the foundation of the legal status of Palestinians as refugees and the standards of treatment specific to that status. IHRL, as the body of international law with the widest application, has the potential to improve significantly the status and conditions of Palestinian refugees. Meanwhile, IHL remains an important, composite protection framework whenever humanity fails. Thus, the failure to bring a just resolution to the plight of Palestinian refugees is ultimately attributable to the protracted lack of political will, rather than inadequacy of the legal framework and the persistence to treat their plight in political terms, as an outcome of war, a humanitarian crisis, and an issue for negotiation.
The Quest for Durable Solutions
Authors: Albanese Francesca P , Takkenberg Lex
Published: October 2020

This concluding chapter focuses on the quest for just and durable solutions, exploring the challenges and opportunities that have emerged through the various attempts at resolving the Palestinian refugee question. Solutions for Palestinian refugees have been sought since May of 1948. The work of the General Assembly; the UN Mediator for Palestine; the United Nations Conciliation Commission for Palestine (UNCCP); the Security Council in the aftermath of the Six Day War; the various peace initiatives and negotiations since the Madrid peace conference in 1991, have all included attempts to find solutions to the plight of the refugees. However, decades of Arab–Israel and Israeli–Palestinian peace efforts have not succeeded in bringing a resolution of the Palestinian refugee issue within reach. The chapter argues that a fundamental paradigm shift is necessary to advance solutions for Palestinian refugees. Moving the question from the essentially bilateral approach of the last decades back to the multilateral arena of the United Nations; ensuring respect for the international law governing the resolution of refugee problems, as informed by international practice; and moving beyond the ‘politics of suffering’ that dominate the Palestinian refugee discourse are key elements to progress towards just and durable solutions for Palestinian refugees. The New York Declaration on Refugees and Migrants, which called for the development of a Global Compact on Refugees, offers an opportunity to pursue solutions for Palestinian refugees.
Classification of Armed Conflicts
Authors: Akande Dapo
Published: October 2020

This chapter provides an overview of the rules by which situations of violence are classified as international armed conflicts (IACs) or non-international armed conflicts (NIACs) for the purposes of international humanitarian law. The chapter commences with an examination of the history of the distinction between these two types of conflict. It then considers the consequences of the distinction and whether it still has validity. The chapter then discusses legal concepts relevant to the two categories, and examines the criteria for the existence of IACs and NIACs. The final sections of the chapter turn to the situations where it is most difficult to classify situations of violence: cases of foreign intervention in internal conflicts; conflicts in which multinational forces are engaged; and transnational conflicts between a state and a non-state armed group.
Persons Covered by International Humanitarian Law: Main Categories
Authors: Hill-Cawthorne Lawrence
Published: October 2020

This chapter identifies the main categories of persons deemed to be in need of protection in situations of armed conflict, according to which the rules of international humanitarian law (IHL) are structured. The two principal categories of persons under the law of international armed conflict (IAC) are combatants/prisoners of war (POWs) and civilians. This categorization lies at the heart of one of the key principles of IHL, that of the distinction between combatants (being, generally, lawful targets) and civilians (being, generally, not lawful targets). These two principal categories are then further divided, with special (additional) rules applying to certain persons falling within each sub-category—including the wounded, sick, and shipwrecked; women; children; the elderly, disabled, and infirm; refugees and internally displaced persons (IDPs); mercenaries and spies; journalists; and the missing and the dead. For some of these categories of persons, such as women and displaced persons, the rules remain very basic and inadequate for the contemporary challenges faced in armed conflicts. What is more, many of these categories are even less clearly defined under the law of non-international armed conflict (NIAC).
Protection of the Natural Environment
Authors: Payne Cymie R
Published: October 2020

This chapter focuses on international humanitarian law’s (IHL) limitations on warfare to protect the natural environment from extremely serious damage and to prevent unnecessary or wanton harm. IHL protection of the environment developed from the principle of protection of civilians, and it has similar motives and goals. The chapter then describes a legal regime that is undergoing development. The International Law Commission (ILC) termed the overall topic ‘Protection of the Environment in Relation to Armed Conflict’ (PERAC). The central rules of IHL that are well accepted as customary law provide protection to aspects of the environment that can be considered public or private property, or that are essential to human survival. These aspects of PERAC are firmly rooted in the earliest law of war protections for drinking water, crops, and cultural elements, and in modern domestic environmental law and social norms. Yet protection of the environment during armed conflict as a specific legal obligation is a sufficiently recent international norm that its status as binding law has been more contested than early humanitarian commitments like neutrality of medical personnel. This reflects the tension between recognition of the importance of ecological integrity to peace and the interests of states in retaining freedom in their conduct of military operations.
Occupation
Authors: Vité Sylvain
Published: October 2020

This chapter discusses the phenomenon of ‘occupation’. Occupation refers to this particular phase in international armed conflict (IAC) where a belligerent has overpowered the adverse party and taken control of enemy territories, but the final outcome of the war has not yet been decided. Occupation is thus a transition phase between the end of active hostilities and formal conclusion of the conflict. It is a period where foreign armed forces are responsible for the administration of territories belonging to the defeated state. During this transitory period towards peace, international law seeks to ensure that the rights of the territorial state are not infringed and that local populations are protected against any risk of abuse by potentially hostile authorities. The chapter then looks at the sources, scope, and substance of the law of occupation. While relevant rules mainly fall under international humanitarian law (IHL), it is recognized today that human rights law is also applicable during occupation.
Humanitarian Relief Operations
Authors: Massingham Eve , Thynne Kelisiana
Published: October 2020

This chapter examines humanitarian relief operations in armed conflict. The main tenet of international humanitarian law (IHL) is that human suffering should be limited, even in an environment where causing death and injury is, to a certain extent, legitimate. In amongst the violence and death that characterizes armed conflict in all its forms, humanitarian relief operations seek to assuage the suffering by providing protection and assistance to persons who are affected by the armed conflict. Humanitarian relief actors not only promote IHL to the parties to a conflict, but they also provide protection and assistance to victims of a conflict. States have the primary responsibility to provide humanitarian assistance to their citizens, to provide them with protection, and to respect and ensure respect for IHL. Non-state armed groups engaged in armed conflict also have a responsibility to uphold IHL and provide assistance to people in the territory which they control. However, where the state or armed group is not able to provide such assistance, humanitarian relief actors and organizations can fill the gap. Therefore, like combatants, civilians, and other protected persons, humanitarian relief personnel have specific protections, obligations, and requirements under IHL.
Terrorism, Counter-Terrorism, and International Humanitarian Law
Authors: Saul Ben
Published: October 2020

This concluding chapter addresses the debate about the coverage, adequacy, and effectiveness of international humanitarian law (IHL) in regulating ‘terrorism’. IHL does not recognize any specific legal categories for, or special regime governing, terrorists and terrorist groups. Rather, the general norms of IHL apply to terrorists according to their conduct. IHL was precisely developed as a kind of exceptional or emergency law comprehensively addressing all forms of violence in armed conflict, including that which is labelled ‘terrorist’ in other areas of law. Particularly relevant to terrorism are the general IHL rules on the classification of violence as armed conflict, the categorization of persons during conflict, targeting, detention, criminal liability, and fair trial. Thus, terrorist and counter-terrorist violence may constitute a non-international armed conflict (NIAC) to which IHL applies if the violence is sufficiently intense and organized. The chapter then considers three key legal issues of particular relevance and specificity to terrorism in armed conflict.
Effect of comorbidities on survival in patients >80 years of age at onset of renal replacement therapy: data from the ERA-EDTA Registry
Authors: Helve Jaakko , Kramer Anneke , Abad Diez Jose Maria , Aresté-Fosalba Nuria , Arici Mustafa , Cases Aleix , Collart Frederic , Heaf James , De Meester Johan , Nordio Maurizio , Palsson Runolfur , Pobes Alfonso , Rydell Helena , Reisæter Anna Varberg , Massy Ziad A , Jager Kitty J , Finne Patrik
Published: October 2020

Background

The number of elderly patients on renal replacement therapy (RRT) is increasing. The survival and quality of life of these patients may be lower if they have multiple comorbidities at the onset of RRT. The aim of this study was to explore whether the effect of comorbidities on survival is similar in elderly RRT patients compared with younger ones.

Methods

Included were 9333 patients ≥80 years of age and 48 352 patients 20–79 years of age starting RRT between 2010 and 2015 from 15 national or regional registries submitting data to the European Renal Association–European Dialysis and Transplantation Association Registry. Patients were followed until death or the end of 2016. Survival was assessed by Kaplan–Meier curves and the relative risk of death associated with comorbidities was assessed by Cox regression analysis.

Results

Patients ≥80 years of age had a greater comorbidity burden than younger patients. However, relative risks of death associated with all studied comorbidities (diabetes, ischaemic heart disease, chronic heart failure, cerebrovascular disease, peripheral vascular disease and malignancy) were significantly lower in elderly patients compared with younger patients. Also, the increase in absolute mortality rates associated with an increasing number of comorbidities was smaller in elderly patients.

Conclusions

Comorbidities are common in elderly patients who enter RRT, but the risk of death associated with comorbidities is less than in younger patients. This should be taken into account when assessing the prognosis of elderly RRT patients.
A neglected source of household air pollution: a preliminary, mixed methods study of purposely produced household smoke in Wollo, Ethiopia
Authors: Wilkinson R , Afework T , Mortimore A , Phillips D I W , Willcox M , Levene D , Kaba M
Published: October 2020

Background

Ill health associated with household air pollution (HAP) is increasingly recognized as a public health problem in sub-Saharan Africa. To date, attempts to reduce HAP have focussed on smoke from cooking fires and have ignored traditional cultural practices which generate purposely produced smoke (PPS). This study aimed to investigate PPS prevalence, reasons for use and safety perceptions.

Methods

The study was conducted in Wollo, Ethiopia, and used a mixed methods approach of quantitative surveys (analysed descriptively) and qualitative interviews with householders and healthcare workers (analysed thematically).

Results

PPS use was reported by 99% of survey respondents and it was considered a fundamental part of life. Although reasons for use included housekeeping, culture/religion and well-being, coffee ceremony was most commonly cited (44% of respondents). Both householders and healthcare workers appeared to assume PPS is safe, except for people with certain underlying conditions. Healthcare workers felt the lack of evidence of harm from PPS meant there was no justification for intervention.

Conclusion

This study, the first in-depth study of PPS, has shown its use to be widespread, with many perceived benefits and thus a very important part of local culture in this sample Ethiopian community. Consequently, any public health interventions aimed at reducing HAP in this setting need to consider PPS.
Baseline disease activity influences subsequent achievement of patient acceptable symptom state in Sjögren’s syndrome
Authors: Park Eun Hye , Ha You-Jung , Kang Eun Ha , Song Yeong Wook , Scofield R Hal , Lee Yun Jong
Published: October 2020

Objectives

To investigate longitudinal changes of the EULAR SS Patient-Reported Index (ESSPRI) and EULAR SS Disease Activity Index (ESSDAI), and identify factors associated with patient acceptable symptom state (PASS) in patients with primary SS (pSS).

Methods

We assessed ESSPRI, ESSDAI, clinical ESSDAI (ClinESSDAI), EULAR Sicca Score, EuroQoL 5-dimension (EQ-5D), Fatigue Severity Score, Beck Depression Inventory, and patient global assessment (PGA) for pSS, and visual analogue scale (VAS) scores for glandular and extra-glandular symptoms at baseline and follow-up. The responses to the currently available standards of care were evaluated by the PASS, the minimal clinically important improvement (MCII) of ESSPRI and ESSDAI, and a modified SS Responder Index-30 (mSSRI-30) response.

Results

Among 115 patients enrolled, 102 (88.7%) completed a median 3-year follow-up. The ESSPRI, ClinESSDAI and EQ-5D levels remained stable, although the PGA and ESSDAI significantly improved (both P <0.05). Of the 102 patients, 52 (51.0%) patients achieved the PASS at the follow-up and tended to attain the ESSPRI-MCII and mSSRI-30 (both P < 0.001) more frequently than the non-PASS group. Multivariate analysis revealed that the PASS was significantly associated with baseline ESSPRI negatively [odds ratio (OR) 0.609] and ESSDAI positively (OR 1.224). When categorized using baseline ESSPRI and ESSDAI, a subgroup of low ESSPRI and high ESSDAI reached a PASS achievement rate of 79.3%.

Conclusion

Although longitudinal changes in ESSPRI and ClinESSDAI are stable in pSS, baseline ESSPRI and ESSDAI could provide prognostic information on the subsequent achievement of PASS, using currently available treatments. A categorization model using ESSPRI and ESSDAI may have clinical implications.
Does craniofacial morphology relate to sleep apnea severity reduction following weight loss intervention? A patient-level meta-analysis
Authors: Sutherland Kate , Chapman Julia L , Cayanan Elizabeth A , Lowth Aimee B , Hoyos Camilla M , Wong Keith K H , Yee Brendon J , Grunstein Ronald R , Cistulli Peter A , Marshall Nathaniel S
Published: October 2020

Study Objectives

Obesity is a common and reversible risk factor for obstructive sleep apnea (OSA). However, there is substantial unexplained variability in the amount of OSA improvement for any given amount of weight loss. Facial photography is a simple, inexpensive, and radiation-free method for craniofacial assessment. Our aims were (1) to determine whether facial measurements can explain OSA changes, beyond weight loss magnitude and (2) whether facial morphology relates to how effective weight loss will be for OSA improvement.

Methods

We combined data from three weight loss intervention trials in which participants had standardized pre-intervention facial photography (N = 91; 70.3% male, mean ± SD weight loss 10.4 ± 9.6% with 20.5 ± 51.2% apnea–hypopnea index [AHI] reduction). Three skeletal-type craniofacial measurements (mandibular length, lower face height, and maxilla-mandible relationship angle) were assessed for relationship to AHI change following weight loss intervention.

Results

Weight and AHI changes were moderately correlated (rho = 0.3, p = 0.002). In linear regression, an increased maxilla-mandible relationship angle related to AHI improvement (β [95% CI] −1.7 [−2.9, −0.5], p = 0.004). Maxilla-mandible relationship angle explained 10% in the variance in AHI over the amount predicted by weight loss amount (20%). The relationship between weight change and AHI was unaffected by the maxilla–mandible relationship angle (interaction term p > 0.05).

Conclusions

Regardless of facial morphology, weight loss is similarly moderately predictive of OSA improvement. Increased maxilla-mandible relationship angle, suggestive of retrognathia, was weakly predictive of OSA response to weight loss. Although this is unlikely to be clinically useful, exploration in other ethnic groups may be warranted.
Replication Redux: The Reproducibility Crisis and the Case of Deworming
Authors: Ozier Owen
Published: October 2020

In 2004, a landmark study showed that an inexpensive medication to treat parasitic worms could improve health and school attendance for millions of children in many developing countries. Eleven years later, a headline in The Guardian reported that this treatment, deworming, had been “debunked.” The pronouncement followed an effort to replicate and re-analyze the original study, as well as an update to a systematic review of the effects of deworming. This story made waves amidst discussion of a reproducibility crisis in some of the social sciences. In this paper, I explore what it means to “replicate” and “reanalyze” a study, both in general and in the specific case of deworming. I review the broader replication efforts in economics, then examine the key findings of the original deworming paper in light of the “replication,” “reanalysis,” and “systematic review.” I also discuss the nature of the link between this single paper's findings, other papers’ findings, and any policy recommendations about deworming. Through this example, I provide a perspective on the ways replication and reanalysis work, the strengths and weaknesses of systematic reviews, and whether there is, in fact, a reproducibility crisis in economics.
Postdischarge Outcomes of Adolescents Attending a Long-term Addiction Treatment Program
Authors: Arria Amelia M. , Bugbee Brittany A. , Mader Joel , Smith Jacqueline M. , Winters Ken C.
Published: October 2020

Objectives:

The purpose of this study was to: (1) describe the alcohol and other drug use patterns among adolescents discharged from a unique long-term semiresidential treatment program in Canada; (2) compare graduates and nongraduates on alcohol and other drug use, and 12-step program attendance; and (3) evaluate the relationship between psychosocial outcomes and continuous abstinence during the 2 years following discharge from the program (ie, obtaining education, becoming employed, maintaining a steady relationship with a significant other, and less involvement in deviant behaviors).

Materials and Methods:

Fifty individuals (41 treatment graduates and 9 treatment nongraduates) were interviewed by telephone after discharge. The time interval between discharge from treatment and study interview ranged from 2 to 9 years, with a median of 5 years. Additional data for 48 participants were obtained from administrative records at the treatment program.

Results:

Among the overall sample, 50.0% were abstinent for the first 2 years postdischarge, and maintaining abstinence for 2 years was more prevalent among program graduates than nongraduates (58.5% vs. 11.1%). Nearly all relapses involved alcohol or cannabis. With the exception of being in a serious relationship, continuous abstinence was unrelated to other psychosocial variables.

Conclusions:

This specialized, long-term residential program yielded high continuous abstinence rates for program graduates, but intensive support during and following treatment discharge for these young adults is warranted to improve educational attainment and employment prospects, and decrease deviant behaviors following discharge. Additional research is needed to more fully understand the long-term outcomes of adolescents attending community-based drug treatment programs.
Intrastromal Descemet Membrane Transplantation as a Potential Alternative to Bowman Layer Inlays in Eyes With Advanced Keratoconus
Authors: Oganesyan Oganes , Getadaryan Vostan , Oganesyan Carolina , van Dijk Korine , Melles Gerrit
Published: October 2020

Herein, we report the outcomes of intrastromal Descemet membrane (DM) transplantation in corneas with advanced keratoconus. Three eyes (three patients) showed advanced keratoconus. No eye underwent prior UV-cross-linking or any other ocular surgery. In all eyes, A donor DM was implanted into a mid-stromal pocket and clinical outcomes were evaluated up to 24 months after surgery. All procedures were uneventful. Up to 24 months postoperatively, the DM graft was well-positioned and barely visible within the recipient stroma; all corneas were clear. No eye showed signs of keratoconus progression throughout the follow-up. No changes were observed in uncorrected and best contact lens corrected visual acuity, central endothelial cell density, corneal thinnest point pachymetry, and maximum keratometry values. No early or late postoperative complications were observed. Intrastromal DM transplantation may be an alternative to intrastromal Bowman layer transplantation in advanced keratoconus, to postpone deep anterior lamellar or penetrating keratoplasty.
A digital photograph study evaluating facial taperness and square face perception of Taiwanese females
Authors: Wu Tzu-Ying , Chou Chein-Yu , Liang Yu-Ming , Chang Kuo-Wei , Wu Cheng-Hsien
Published: October 2020

Background:

This study assessed the perception of facial taperness in Taiwanese females among people with dental knowledge and laypersons. Additionally, this study also specified the criteria by which “square face” was defined regarding Taiwanese females’ facial taperness.

Methods:

A series of digitally modified photos with different levels of facial taperness (Gonion to Gonion/Zygoma point to Zygoma point—Go-Go/Zy-Zy ratio ranges from 65% to 90%) were randomly arranged and presented to the raters. Visual analog scale (VAS) lines were used for scoring the photos on a scale of 0–100. The true or false question about “defining square face” was incorporated in the same questionnaire. The reliability of the true/false square face question and the esthetic evaluation by VAS were assayed. The receiver operating characteristic curve was used to define the cutoff point on “square face.” The effects on the raters’ genders, orthodontic treatment experience, and their professional background on the perception of a square face were assayed.

Results:

The overall reliability of the raters was within the acceptable range. The VAS score evaluation revealed that the average expectation for best facial taperness was 75%, whereas the facial taperness of over 83% was considered as the square face. The facial taperness reaching to 90% was regarded as the most unattractive. Gender, therapy, and professional experience have no impact on the standard of square facial form evaluation.

Conclusion:

A face with a taperness greater than 83% was evaluated as a square face, and a face with a taperness around 75% was considered as the most attractive.
The current outcomes and future challenges in pediatric vascularized composite allotransplantation
Authors: Azoury Saïd C. , Lin Ines , Amaral Sandra , Chang Benjamin , Levin L. Scott
Published: October 2020

Purpose of review

We review the outcomes and future challenges associated with pediatric vascularized composite allotransplantation, including follow-up data from our bilateral pediatric hand–forearm transplantation.

Recent findings

In 2015, the first heterologous pediatric upper extremity hand–forearm transplant was performed at the Children's Hospital of Philadelphia, and in 2019, the first pediatric neck reconstructive transplantation was performed in Poland. The 5-year follow-up of the pediatric upper extremity recipient demonstrates similar growth rates bilaterally, an increase in bone age parallel to chronologic age, and perhaps similar overall growth to nontransplant norms. The pediatric upper extremity recipient continues to make gains in functional independence. He excels academically and participates in various extracurricular activities. Future challenges unique to the pediatric population include ethical issues of informed consent, psychosocial implications, limited donor pool, posttransplant compliance issues, and greater life expectancy and therefore time to inherit the many complications of immunosuppression.

Currently, we recommend pediatric vascularized composite allotransplantation (VCA) for bilateral upper extremity amputees, preferably on immunosuppression already, and those patients who would have the most potential gain not available through standard reconstructive techniques while being able to comply with postoperative immunosuppression protocols, surveillance, rehabilitation, and follow-up.
Comparison of Perceptions of Spiritual Care Among Patients With Life-Threatening Cancer, Primary Family Caregivers, and Hospice/Palliative Care Nurses in South Korea
Authors: Kang Kyung-Ah , Kim Shin-Jeong
Published: October 2020

This study aimed to compare perceptions of spiritual care among patients with life-threatening cancer, their primary family caregivers, and hospice/palliative care nurses.

Data were collected using both structured and unstructured approaches. Structured questionnaire data were examined using statistical analysis methods, and unstructured data were examined using content analysis to compare the 3 participant groups. The questionnaire revealed that among all 3 groups, spiritual care was commonly perceived to relate to “having the opportunity for internal reflection,” “finding meaning,” “encouraging hope,” and “listening to and being with patients.” Content analysis of the unstructured data revealed 5 themes: “Caring with sincerity,” “Strengthening spiritual resources,” “Alleviating physical pain and discomfort” (among patients and primary family caregivers only), “Improving spiritual care service,” and “Multifaceted cooperation” (among hospice/palliative care nurses only). Our findings suggest that for patients with life-threatening illnesses such as terminal cancer, spiritual care should not be limited to religious practice but should also satisfy inner existential needs, for example, by encouraging hope, providing empathy, and helping patients find meaning in their circumstances.
Immunoexpression of Apoptosis and Cell-cycle Arrest Markers in Oral Lichen Planus
Authors: Pérez-Sayáns Mario , Lorenzo-Pouso Alejandro I. , Chamorro-Petronacci Cintia M. , Suárez-Peñaranda José M. , Padín-Iruegas Elena , González-Moles Miguel A. , Marichalar-Mendía Xabier , García-García Abel , Blanco-Carrión Andrés
Published: October 2020

The expression pattern of a panel of 5 molecular markers (p53, cyclin D1, Ki-67, BCL-2, and BAX) was studied in samples from patients with oral lichen planus (OLP) and normal oral mucosa (NOM) of healthy controls to investigate the implications of cell cycle and apoptosis in OLP. The 59 OLP and 16 NOM biopsies were stained by an inmunoperoxidase technique for p53, cyclin D1, Ki-67, BCL-2, and BAX and assessed microscopically for semiquantitative analysis. Positivity for BCL-2 and Ki-67 was significantly more frequent in NOM than in OLP (P<0.05). p53 levels were upregulated in atrophic/erosive clinical presentations when compared with reticular presentations and in cases with discontinued inflammatory infiltrate. Multivariate analysis through logistic regression showed that BCL-2 in OLP versus NOM was the only significantly altered marker in the present cohort (adjusted odds ratio=12.42; 95% confidence interval: 2.5-61.65; P=0.002). The cell patterns in OLP and NOM are distinct according to the present molecular markers panel. The presence of BCL-2 altered expression may be related to various molecular pathways that connect/link this condition to other autoimmune disorders and also may be involved in complex roles that evoke malignant transformation of OLP.