bluuebunny/crossref_metadata_2025 huggingface dataset:
Unanticipated Admission Following Outpatient Ligament Reconstruction and Tendon Interposition: An Analysis of 3966 Cases
Authors: Hresko Andrew M. , Kleiner Justin E. , Kosinski Lindsay R. , Goodman Avi D. , Gil Joseph A.
Published: July 2020

Background: Hand surgeons in the United States commonly perform ligament reconstruction and tendon interposition (LRTI) to address debilitating thumb carpometacarpal arthritis. The objective of this investigation was to examine the characteristics that place patients at risk for unanticipated inpatient admission after a planned outpatient LRTI. Methods: The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) datasets from years 2009 to 2016 were used to identify patients with a primary Current Procedural Terminology code for LRTI (25445, 25447). Only outpatient, nonemergent, and elective procedures were considered. Univariable and multivariable regression were used to determine risk factors and postoperative complications associated with increased likelihood of unanticipated admission, defined as length of initial hospital stay greater than 0 days. Statistical significance was set at P < .05. Results: Of 3966 patients who underwent outpatient LRTI, 134 (3.4%) had unplanned admission. On multivariable regression, age ≥ 65 years (odds ratio [OR] = 1.50), white race (OR = 4.44), and chronic steroid use (OR = 2.42) were significant predictors of unplanned admission. History of smoking, obesity, hypertension, diabetes, American Society of Anesthesiologists classification, and anesthesia method were not associated with admission. Patients who had unplanned admission had increased rate of reoperation (2.5% vs 0.3%) compared with nonadmitted patients. There was no difference in rate of postoperative infection, deep vein thrombosis, wound dehiscence, or 30-day mortality. Conclusions: Age ≥ 65 years, chronic steroid use, and white race were significant predictors of unplanned admission following LRTI. Identifying patients with these characteristics will be critical in risk adjusting the anticipated cost of the episode of care in outpatient LRTI.
Role of intrarenal resistive index and ElastPQ® renal shear modulus in early diagnosis and follow-up of diabetic nephropathy: A prospective study
Authors: Krishnan Venkatram , Malik Amita
Published: July 2020

Introduction

We aimed to establish baseline normal values of ElastPQ® (Philips Healthcare, Bothell, Washington, USA) renal shear modulus, evaluate changes in intrarenal resistive index and renal shear modulus in various stages of diabetic nephropathy, their diagnostic potential and role in follow-up.

Methods

Our prospective observational study was performed over two years. In total, 130 adult cases with diabetic nephropathy and 130 normal adult controls were selected. Diabetic nephropathy was confirmed by persistent albuminuria on 24-hour urinary albumin testing at three month intervals and staged by albuminuria quantification. Measurement of intrarenal resistive index and renal shear modulus in all subjects was performed and their variation with stage of nephropathy was statistically analyzed using Pearson’s correlation. Receiver operating characteristic curves were plotted and their individual and combined diagnostic potentials were assessed. Statistical significance was tested using t tests and analysis of variance. Interrater agreement was tested using Cohen’s kappa coefficient.

Results

Mean intrarenal resistive index was significantly higher for cases (mean 0.72 ± 0.05) than controls (mean 0.62 ± 0.04) and showed significant age variation (p < 0.05). Normal values of ElastPQ® renal shear modulus ranged from 3.87 to 4.72 kPa and was significantly higher for cases (mean 8.59 ± 1.77 kPa) than controls (mean 4.32 ± 0.45 kPa) and showed significant differences between each stage of nephropathy, being highest in stage 2. Maximum diagnostic accuracy was at 0.65 (sensitivity 90%, specificity 76.2%, area under curve 0.916) for intrarenal resistive index and at 5.31 kPa (sensitivity 90.8%, specificity 84.6%, area under curve 0.923) for renal shear modulus. Combination of the two further improved diagnostic performance (highest accuracy of 89%, sensitivity 81.7%, specificity 96.3%).

Conclusions

Normal range of ElastPQ® renal shear modulus values could be established. Intrarenal resistive index and renal shear modulus can be used as imaging parameters for early diagnosis and follow-up of diabetic nephropathy.
Cisplatin plus capecitabine concomitant with intensity-modulated radiation therapy in non-metastatic anal squamous cell carcinoma: the experience of a single research cancer center
Authors: Rotundo Maria Saveria , Zampino Maria Giulia , Ravenda Paola Simona , Bagnardi Vincenzo , Peveri Giulia , Dell’Acqua Veronica , Surgo Alessia , Trovato Cristina , Bottiglieri Luca , Bertani Emilio , Petz Wanda Luisa , Fumagalli Romario Uberto , Fazio Nicola
Published: July 2020

Background and Aims:

The standard treatment of non-metastatic anal squamous cell carcinoma (ASCC) consists of chemotherapy with mitomycin (MMC) plus 5-fluorouracil (5FU) for 1–2 cycles concomitant with pelvic radiotherapy. Subsequent studies introduced cisplatin (CDDP) combined with 5FU, with unclear results. We evaluated the doublet capecitabine (C) and CDDP as a possible alternative to MMC-5FU regimen concomitant with intensity-modulated radiation therapy (IMRT).

Patients and Methods:

We carried out a retrospective study on 67 patients affected by stage I–III ASCC, treated with CDDP (60–70 mg/m2 every 21 days for two courses) plus C (825 mg/m2 twice daily for 5 days/week) chemotherapy concomitant with IMRT for curative intent.

Results:

At a median follow up of 41 months, the clinical complete response calculated at the 6-month time-point (6-moCR), the 6-month objective response rate and the 6-month disease control rate were 93%, 94%, and 99%, respectively. Disease-free survival rates at 1, 2, and 3 years were 89%, 87%, and 85%, while the overall survival rates at 1 and 2 years were 100% and 95%. The colostomy-free survival rates were 90% at 1 year and 88% at 2 years. Grade 3–4 acute adverse events were reported in 61% of patients; predominantly skin toxicity (46%) and limited hematological toxicity (12%).

Conclusion:

In this retrospective study, chemotherapy with C plus CDDP concomitant with IMRT proved safe and effective, and may represent a possible alternative option to standard MMC-containing regimen for curative intent.
Metastatic pulmonary adenocarcinoma to the nasopharynx at first clinical presentation: A case report and review of literature
Authors: Iqneibi Shahad , Nazzal Jamil , Amoudi Runa , Owda Basma , Al-Ibraheem Akram , Yaser Sameer , Al-Hussaini Maysa
Published: July 2020

Metastatic carcinomas in the nasopharynx are a rarity. We report a case of a 54-year-old male patient who presented with a history of recurrent epistaxis. On evaluation, a mass in the right Rosenmüller fossa was detected, which was biopsied and diagnosed as a poorly differentiated adenocarcinoma, immunoreactive for thyroid transcription factor-1, consistent with metastatic pulmonary adenocarcinoma. Fluorodeoxyglucose–positron emission tomography/computed tomography (FDG-PET/CT) scan confirmed the presence of a mass in the upper lobe of the left lung, proven pathologically to be a poorly differentiated pulmonary adenocarcinoma, with an immunoprofile similar to the nasopharyngeal tumor. The patient underwent palliative chemotherapy, and was then shifted to immunotherapy. He is currently alive and disease free 50 months after the initial diagnosis was made. The unusual presentation of a metastatic carcinoma in the nasopharynx will be discussed, along with a review of literature. The role of immunotherapy in cancer control and greater longevity will also be presented.
One year later: Highlighting the challenges and opportunities in disseminating a breathing-retraining digital behaviour change intervention
Authors: Ainsworth Ben , Bruton Anne , Thomas Mike , Yardley Lucy
Published: July 2020

Digital behaviour change interventions can provide effective and cost-effective treatments for a range of health conditions. However, after rigorous evaluation, there still remain challenges to disseminating and implementing evidence-based interventions that can hinder their effectiveness ‘in the real world’. We conducted a large-scale randomised controlled trial of self-guided breathing retraining, which we then disseminated freely as a digital intervention. Here we share our experience of this process after one year, highlighting the opportunities that digital health interventions can offer alongside the challenges that must be addressed in order to harness their effectiveness. Whilst such treatments can support many individuals at extremely low cost, careful dissemination strategies should be proactively planned in order to ensure such opportunities are maximised and interventions remain up to date in a fast-moving digital landscape.
Mothers’ perceptions of the quality of maternity services at Finnish maternity units: A cross-sectional study
Authors: Kortet Saija , Melender Hanna-Leena , Klemetti Reija , Kääriäinen Maria , Kaakinen Pirjo
Published: July 2020

Knowledge about mothers’ perceptions of the quality of Finnish maternity services is limited. The aim of this cross-sectional study was to describe mothers’ perceptions of the quality of Finnish maternity services, and to identify background factors associated with them. The data were collected from 1,760 mothers in autumn 2016. Descriptive statistics were used. This study is reported in accordance with STROBE. Most mothers (84%) considered the quality of the maternity services good. The mean response values for the quality of patient education (3.9), staff knowledge and skills (4.3), and hospital environment (4.3) were good. Parity and mode of childbirth were associated with perceptions of the quality of maternity services. Based on the results, development of midwifery and nursing practices should focus on sufficient pain relief, adequate duration of skin-to-skin contact, breastfeeding counselling and opportunities for mothers to reflect on their birth experience afterwards. Moreover, the study results can be used for education. Challenges for future research are presented.
Social media, religion and shifting boundaries in globalizing China
Authors: Lim Francis KG , Sng Bee Bee
Published: July 2020

This article examines how Chinese Christians utilize social media to forge online communities and how religion is integrated into believers’ daily lives using the concept of intercontextuality. The intercontextuality of online communication enables Chinese Christian users to communicate about their daily routines and Christian values on a regular basis, thus allowing them to align their Christian concerns with wider social issues. At the same time, Christian users of social media are cognizant and wary of the highly restrictive political context of China. They often maintain a boundary between the ‘religious’ and the ‘political’, thus avoiding attracting the unwanted attention of the authorities. The article concludes with some reflections on the political implication of the study’s findings.
Sensitive Questions and Trust: Explaining Respondents’ Behavior in Randomized Response Surveys
Authors: Krumpal Ivar , Voss Thomas
Published: July 2020

The randomized response technique (RRT) is an indirect question method that uses stochastic noise to increase anonymity in surveys containing sensitive items. Former studies often implicitly assumed that the respondents trust and comply with the RRT procedure and, therefore, are motivated to give truthful responses. However, validation studies demonstrated that RRT may not always be successful in eliciting truthful answering—even when compared with direct questioning. The article theoretically explores and discusses the conditions under which this assumption is consistent (or inconsistent) with the survey respondents’ rational behavior. First, because P(A| Yes) > P(A| No), both types of respondents, A (with sensitive trait) and non-A (without sensitive trait), have an incentive to disregard the instructions in the RRT mode. In contrast, respondents type non-A have no incentive to lie in the direct questioning mode. Thus, the potential for social desirability bias is (theoretically) higher in the RRT mode. Second, a basic game theoretic approach conceptualizes the survey interview as a social interaction between the respondent and the interviewer within the context of norms and mutual expectations. It is argued that the respondent’s choice to answer truthfully depends on (a) the respondents’ estimated likelihood that the interviewer honors trust and (b) a relative comparison of the utility from conforming to “the norm of truthfulness” versus its costs. Finally, we review previous empirical evidence and show that our theoretical model can explain both successes and failures of the RRT.
Endoscopic Submucosal Tunnel Dissection as a Novel Therapeutic Technique in Patients With Barrett’s Esophagus
Authors: Inayat Faisal , Weissman Simcha , Malik Adnan , Munir Badria , Iqbal Shahzad
Published: July 2020

With the ameliorated resectability prowess of endoscopic techniques, a myriad of diseases previously treated by major ablative surgeries are now endoscopically curable. Endoscopic submucosal tunnel dissection (ESTD) is a relatively new technique that has diversified endoscopic application. Although ESTD has frequently been used for the resection of esophageal neoplastic lesions, the clinical evidence pertaining to its efficacy in the treatment of circumferential Barrett’s esophagus remains sparse. In this study, we evaluated ESTD as a potential therapeutic technique in patients with Barrett’s esophagus-related high-grade dysplasia. The tunneling strategy helped achieve complete en bloc resection at an increased dissection speed, without any procedural complications. This article illustrates that ESTD can be a feasible, safe, and effective treatment for dysplastic Barrett’s esophagus. Future research should aim to stratify the potential risks and complications associated with this optimization of endoscopic submucosal dissection in patients with superficial esophageal lesions.
Papillary Thyroid Carcinoma With Cystic Changes in a Patient With Prior History of Toxic Nodule
Authors: Fortuna Gliceida Maria Galarza , Rios Paola , Rivero Ailyn , Zuniga Gabriela , Dvir Kathrin , Pagacz Michael M. , Manzano Alex
Published: July 2020

Thyroid nodules are palpable on up to 7% of asymptomatic patients. Cancer is present in 8% to 16% of those patients with previously identified thyroid nodules. Papillary thyroid carcinoma (PTC) is the most common type of thyroid cancer, accounting for approximately 85% of thyroid cancers. Although most appear as solid nodules on ultrasound imaging, a subset of 2.5% to 6% has cystic components. The presence of cystic changes within thyroid nodules decreases the accuracy of fine needle aspiration (FNA) in the diagnosis of thyroid cancer, given the difficulty of obtaining appropriate cellular content. This becomes a diagnostic and therapeutic challenge. We present a case of a 31-year-old female with a 1-month history of palpitations, fatigue, and night sweats, who underwent evaluation, and was diagnosed with subclinical hyperthyroidism. She presented 4 years later with compressive symptoms leading to repeat FNA, showing Bethesda III-atypia of undetermined significance and negative molecular testing. Thyroid lobectomy revealed PTC with cystic changes. This case is a reminder that patients with hyperfunctioning thyroid nodule should have closer follow-up. It poses the diagnostic dilemma of how much is good enough in the evaluation and management of a thyroid nodule. Early detection and action should be the standard of care.
The Use of Complementary and Alternative Medicine Strategies, Opioids, and Nonsteroidal Anti-Inflammatory Drugs (NSAIDS) Among Patients Attending a Free Clinic
Authors: Kamimura Akiko , Howard Sullivan , Weaver Shannon , Panahi Samin , Ashby Jeanie
Published: July 2020

The purpose of this study was to describe the use of opioids and complementary and alternative medicine (CAM) among uninsured free clinic patients. A self-administered paper survey was collected to describe the use of opioids, complementary, and alternative medicine, and other pain relievers from 877 free clinic patients from January to April 2018. The US born English speakers are more likely to use CAM, nonprescription pain relievers, and prescription opioids, and to be more knowledgeable about opioids compared to non-US born English speakers and Spanish speakers. The main source of opioids for free clinic patients is a health care facility other than a free clinic as well as friends. Although nonprescription pain relievers are commonly used among free clinic patients, CAM is less common to use for pain control. More health education programs are needed to increase the knowledge of opioid risks among free clinic patients as well as other underserved population.
Teaching About Gender Harassment: An Experiential Approach
Authors: Quijada Maria Alejandra
Published: July 2020

The prevalence of sexual harassment in the workplace has become more visible thanks to the #MeToo movement. For college students about to enter the workforce, it is important to understand and learn to address situations surrounding gender-based harassment. I present here a series of situations that provide students with the opportunity to discuss behaviors they might experience or witness at work. This experiential exercise focuses on providing students with tools to manage small but disturbing offenses that can, if nipped in the bud, lessen the likelihood of more significant workplace problems. The exercise complements organizational behavior, women in business, contemporary issues in management, business law, human resources, and other courses.
After the facts: Producing, using and contesting knowledge in two spatial-environmental conflicts in the Netherlands
Authors: Roth Dik , Köhne Michiel , Rasch Elisabet Dueholm , Winnubst Madelinde
Published: July 2020

While the problematic role of knowledge in controversial policy processes is widely acknowledged, relatively little is known about how protesting citizen groups involved in such controversies construct, mobilize and use knowledge. This article explores these issues in two conflicts about planned interventions in the Netherlands. The first case, about energy policies, concerns protests against plans for shale gas extraction. In the second case, concerning flood risk management, citizens organized protests against a planned ‘bypass’ of the River Waal. To better understand the role of citizen groups as knowledge actors, we analyse how these groups organized and strategized their protests and produced, used and contested knowledge to claim voice in decision-making. The study shows the key role of citizen groups as knowledge actors in contested planning processes, and of their knowledge strategies in internally divided communities. It also shows the importance of the source and type of knowledge and how it is constructed, mobilized and used in various stages of resistance against policy plans.
In Vitro Antioxidant Activities of the Aqueous and Methanolic Stem Bark Extracts of Piliostigma thonningii (Schum.)
Authors: Moriasi Gervason , Ireri Anthony , Ngugi Mathew Piero
Published: July 2020

Oxidative stress has been recognized as a key driver of many ailments affecting humankind. Free radicals attack biologically important biomolecules, impairing their functioning, thereby initiating and exacerbating diseases. As a comeback, antioxidant therapies have been proposed as novel approaches to ameliorating oxidative stress–associated diseases including chronic ones. Antioxidants are thought to employ multifaceted and multitargeted mechanisms that either restore oxidative homeostasis or prevent free radical buildup in the body, which overwhelm the endogenous defenses. Plants have been used for many ages across time to manage human diseases, and have a host of antioxidant phytocompounds. Piliostigma thonningii is traditionally used for the management of inflammation, malaria fever, rheumatism, and insanity, among other diseases caused by a disturbed redox state in the body. In this study, in vitro antioxidant activities of the methanolic and aqueous stem bark extracts of P. thonningii were evaluated using the in vitro antilipid peroxidation, the 1,1-diphenyl-2-picryhydrazyl (DPPH) free radical scavenging, and the ferric reducing antioxidant power assay methods. The obtained results revealed remarkable antioxidant activities of the studied plant extracts as evidenced by the low IC50 and EC50 values. These antioxidant activities could be due to the presence of antioxidant phytochemicals like flavonoids, carotenoids, tannins, and phenols, among others. Therefore, the therapeutic potency of this plant could be due to its antioxidant properties. This study recommends in vivo antioxidant efficacy testing of the studied plant extracts, as well as isolation and characterization of bioactive antioxidant compounds that are potent against oxidative stress.
Rare earth element geochemistry of altered pyroclastic rocks in the Hashtjin area of north-west Iran
Authors: Nouri Tohid , Tehrani Parvin Najafzadeh , Masoumi Rahim , Christidis George E.
Published: July 2020

This study evaluates the rare earth element (REE) geochemistry in altered trachyandesitic ignimbrites, tuff and lava flows in the Hashtjin area by assessing chondrite-normalized REE patterns and Y/Ho geochemical ratios. Modifications in the REE patterns took place along altered fault zones that were affected by hypogene and supergene alterations. The precursor volcanic and pyroclastic rocks contain phenocrysts of plagioclase accompanied by augite, zircon, apatite and pyrite. Based on X-ray diffraction analysis, the main mineral assemblages of the altered units consist of kaolinite as the main clay mineral, SiO2 polymorphs (quartz and cristobalite) and anatase as a minor constituent. The chondrite-normalized REE patterns of argillic samples reveal fractionation of light REEs (LREEs) compared to heavy REEs (HREEs), together with a marked Eu anomaly and a weak W-type tetrad effect related to the weak non-charge radius control (CHARAC) behaviour of REEs and slightly higher Y/Ho and Zr/Hf ratios. The relationship between the Y/Ho and Zr/Hf ratios and recognizable T3 and T4 effects (tetrad effect) suggests that an increasing degree of water–rock interaction occurred during hypogene alteration processes by acidic hydrothermal fluids that were overprinted by supergene alteration. Water–rock interaction and adsorption by Mn-oxides and clay minerals are considered to have played important roles in determining the close to non-CHARAC behaviour of REEs during the argillic alteration of the pyroclastic rocks in the Hashtjin area.
Single-molecule analysis of subtelomeres and telomeres in Alternative Lengthening of Telomeres (ALT) cells
Authors: Abid Heba Z. , McCaffrey Jennifer , Raseley Kaitlin , Young Eleanor , Lassahn Katy , Varapula Dharma , Riethman Harold , Xiao Ming
Published: July 2020

Background

Telomeric DNA is typically comprised of G-rich tandem repeat motifs and maintained by telomerase (Greider CW, Blackburn EH; Cell 51:887–898; 1987). In eukaryotes lacking telomerase, a variety of DNA repair and DNA recombination based pathways for telomere maintenance have evolved in organisms normally dependent upon telomerase for telomere elongation (Webb CJ, Wu Y, Zakian VA; Cold Spring Harb Perspect Biol 5:a012666; 2013); collectively called Alternative Lengthening of Telomeres (ALT) pathways. By measuring (TTAGGG) n tract lengths from the same large DNA molecules that were optically mapped, we simultaneously analyzed telomere length dynamics and subtelomere-linked structural changes at a large number of specific subtelomeric loci in the ALT-positive cell lines U2OS, SK-MEL-2 and Saos-2.

Results

Our results revealed loci-specific ALT telomere features. For example, while each subtelomere included examples of single molecules with terminal (TTAGGG) n tracts as well as examples of recombinant telomeric single molecules, the ratio of these molecules was subtelomere-specific, ranging from 33:1 (19p) to 1:25 (19q) in U2OS. The Saos-2 cell line shows a similar percentage of recombinant telomeres. The frequency of recombinant subtelomeres of SK-MEL-2 (11%) is about half that of U2OS and Saos-2 (24 and 19% respectively). Terminal (TTAGGG) n tract lengths and heterogeneity levels, the frequencies of telomere signal-free ends, and the frequency and size of retained internal telomere-like sequences (ITSs) at recombinant telomere fusion junctions all varied according to the specific subtelomere involved in a particular cell line. Very large linear extrachromosomal telomere repeat (ECTR) DNA molecules were found in all three cell lines; these are in principle capable of templating synthesis of new long telomere tracts via break-induced repair (BIR) long-tract DNA synthesis mechanisms and contributing to the very long telomere tract length and heterogeneity characteristic of ALT cells. Many of longest telomere tracts (both end-telomeres and linear ECTRs) displayed punctate CRISPR/Cas9-dependent (TTAGGG) n labeling patterns indicative of interspersion of stretches of non-canonical telomere repeats.

Conclusion

Identifying individual subtelomeres and characterizing linked telomere (TTAGGG) n tract lengths and structural changes using our new single-molecule methodologies reveals the structural consequences of telomere damage, repair and recombination mechanisms in human ALT cells in unprecedented molecular detail and significant differences in different ALT-positive cell lines.
Feasibility of laryngeal mask anesthesia combined with nerve block in adult patients undergoing internal fixation of rib fractures: a prospective observational study
Authors: Cao Jun , Gao Xiaoyun , Zhang Xiaoli , Li Jing , Zhang Junfeng
Published: July 2020

Background

The laryngeal mask airway (LMA) is occasionally used in internal fixation of rib fractures. We evaluated the feasibility of general anesthesia with an LMA associated to a thoracic paravertebral block (TPB) and/or an erector spinae plane block (ESPB) for internal fixation of rib fractures.

Methods

Twenty patients undergoing unilateral rib fracture fixation surgery were enrolled. Each patient received general anesthesia with an LMA combined with TPB and/or ESPB, which provided a successful blocking effect. All patients received postoperative continuous analgesia (PCA) with 500 mg of tramadol and 16 mg of lornoxicam, and intravenous injection of 50 mg of flurbiprofen twice a day. Our primary outcomes including the partial pressure of arterial oxygen (PaO2) and arterial carbon dioxide (PaCO2) were measured preoperatively and on the first day after surgery. Secondary outcomes including the vital signs, ventilation parameters, postoperative numerical rating scale (NRS) pain scores, the incidence of postoperative nausea and vomiting (PONV), perioperative reflux and aspiration, and nerve block-related complications were also evaluated.

Results

Thirteen men and seven women (age 35–70 years) were enrolled. Six (30%) had a flail chest, nine (45%) had hemothorax and/or pneumothorax, and two (10%) had pulmonary contusions. The postoperative PaO2 was higher than the preoperative value (91.2 ± 16.0 vs. 83.7 ± 15.9 mmHg, p = 0.004). The preoperative and postoperative PaCO2 were 42.1 ± 3.7 and 43.2 ± 3.7 mmHg (p = 0.165), respectively. Vital signs and spontaneous breathing were stable during the surgery. The end-tidal carbon dioxide concentrations (EtCO2) remained within an acceptable range (≤ 63 mmHg in all cases). NRS at T1, T2, and T3 were 3(2,4), 1(1,3), and 0(0,1), respectively. None had PONV, regurgitation, aspiration, and nerve block-related complications.

Conclusions

The technique of laryngeal mask anesthesia combined with a nerve block was feasible for internal fixation of rib fractures.

Trial registration

Current Controlled Trials ChiCTR1900023763. Registrated on June 11, 2019.
The predictive value of lymphocyte-to-monocyte ratio in the prognosis of acute coronary syndrome patients: a systematic review and meta-analysis
Authors: Quan Xiao-Qing , Wang Run-Chang , Zhang Qing , Zhang Cun-Tai , Sun Lei
Published: July 2020

Background

The association between the lymphocyte-to-monocyte ratio (LMR) and prognosis in the patients with acute coronary syndrome (ACS) is not fully understood. We performed this systematic review and meta-analysis to evaluate the correlation between LMR and mortality or major adverse cardiac events (MACE) in patients with ACS.

Methods

A systematic search was performed in PubMed, MEDLINE, EMBASE, the Cochrane Library, Scopus, and Web of science. The association between LMR and mortality/MACE was analyzed in patients with ACS. The search was updated to April 15, 2020.

Results

A total of 5 studies comprising 4343 patients were included in this meta-analysis. The results showed that lower LMR predicted higher short-term mortality/MACE (hazard ratio [HR] = 3.44, 95% confidence interval [CI]: 1.46–8.14, P <  0.05) and long-term mortality/MACE (HR = 1.70, 95% CI: 1.36–2.13, P <  0.05). In the subgroup analysis, there was still statistical significance of long-term mortality/MACE in all subgroups.

Conclusions

This study suggested that lower LMR value might be associated with higher short-term and long-term mortality/MACE in ACS patients. Especially for younger ACS patients, low LMR was more closely associated with poor prognosis.
The phenotypic and molecular characteristics of antimicrobial resistance of Salmonella enterica subsp. enterica serovar Typhimurium in Henan Province, China
Authors: Dong Nian , Li Yongrui , Zhao Jiayong , Ma Hui , Wang Jinyan , Liang Beibei , Du Xinying , Wu Fuli , Xia Shengli , Yang Xiaoxia , Liu Hongbo , Yang Chaojie , Qiu Shaofu , Song Hongbin , Jia Leili , Li Yan , Sun Yansong
Published: July 2020

Background

Salmonella enterica subsp. enterica serovar Typhimurium infections continue to be a significant public health threat worldwide. The aim of this study was to investigate antibiotic resistance among 147 S. Typhimurium isolates collected from patients in Henan, China from 2006 to 2015.

Methods

147 S. Typhimurium isolates were collected from March 2006 to November 2015 in Henan Province, China. Antimicrobial susceptibility testing was performed, and the resistant genes of ciprofloxacin, cephalosporins (ceftriaxone and cefoxitin) and azithromycin were detected and sequenced. Clonal relationships were assessed by multilocus sequence typing (MLST) and pulsed-field gel electrophoresis (PFGE).

Results

Of the 147 isolates, 91.1% were multidrug resistant (MDR), with 4.1% being resistant to all antibiotic classes tested. Of concern, 13 MDR isolates were co-resistant to the first-line treatments cephalosporins and ciprofloxacin, while three were also resistant to azithromycin. Seven PFGE patterns were identified among the 13 isolates. All of the isolates could be assigned to one of four main groups, with a similarity value of 89%. MLST assigned the 147 isolates into five STs, including two dominant STs (ST19 and ST34). Of the 43 ciprofloxacin-resistant isolates, 39 carried double gyrA mutations (Ser83Phe, Asp87Asn/Tyr/Gly) and a single parC (Ser80Arg) mutation, including 1 isolate with four mutations (gyrA: Ser83Phe, Asp87Gly; parC: Ser80Arg; parE: Ser458Pro). In addition, 12 isolates not only carried mutations in gyrA and parC but also had at least one plasmid-mediated quinolone resistance (PMQR) gene. Among the 32 cephalosporin-resistant isolates, the most common extended-spectrum β-lactamase (ESBL) gene was blaOXA-1, followed by blaCTX-M, blaTEM-1, and blaCMY-2. Moreover, the mphA gene was identified in 5 of the 15 azithromycin-resistant isolates. Four MDR isolates contained ESBL and PMQR genes, and one of them also carried mphA in addition.

Conclusion

The high level of antibiotic resistance observed in S. Typhimurium poses a great danger to public health, so continuous surveillance of changes in antibiotic resistance is necessary.
Initiation of peritoneal dialysis in a patient with chronic renal failure associated with tetralogy of Fallot: a case report
Authors: Abe Tetsuya , Aoyama Togo , Sano Keiko , Miyasaka Ryoma , Yamazaki Takuya , Honma Yukari , Tominaga Hiroshi , Ida Maoko , Arao Aya , Sakakibara Mayuko , Hashimoto Keiko , Takahashi Haruka , Sakai Takeshi , Naito Shokichi , Koitabashi Toshimi , Sano Takashi , Takeuchi Yasuo
Published: July 2020

Background

Tetralogy of Fallot is the most common cyanotic congenital heart disease. Patients with the condition have a high risk of developing chronic kidney disease. Treatment of kidney disease in patients with complex hemodynamics presents unique challenges. However, there are very few reports on the treatment of end-stage renal failure in patients with tetralogy of Fallot.

Case presentation

We present a rare case of peritoneal dialysis in a 47-year-old man with tetralogy of Fallot who had not undergone intracardiac repair. Peritoneal dialysis successfully removed fluids and solutes without adversely affecting the patient’s hemodynamics. Our patient was managed with peritoneal dialysis for 5 years before he succumbed to sepsis secondary to digestive tract perforation.

Conclusions

In this paper, we discuss the importance of monitoring acid–base balance, changes in cyanosis, and hyperviscosity syndrome during peritoneal dialysis in patients with tetralogy of Fallot. Lower leg edema and B-type natriuretic peptide level were useful monitoring parameters in this case. This case illustrates that with attention to the patient’s unique requirements, peritoneal dialysis can provide successful renal replacement therapy without compromising hemodynamics in patients with tetralogy of Fallot.
Tumoral and stromal expression of MMP-2, MMP-9, MMP-14, TIMP-1, TIMP-2, and VEGF-A in cervical cancer patient survival: a competing risk analysis
Authors: Azevedo Martins Jordana Maria , Rabelo-Santos Silvia Helena , do Amaral Westin Maria Cristina , Zeferino Luiz Carlos
Published: July 2020

Background

Expression of matrix metalloproteases 2, 9 and 14 (MMP-2, MMP-9, MMP-14), tissue inhibitors of metalloprotease 1 and 2 (TIMP-1, TIMP-2) and vascular endothelial growth factor A (VEGF-A) is involved in tumor invasion and metastasis via extracellular matrix degradation and angiogenesis. This study aimed to assess whether the expression of MMP-2, MMP-9, MMP-14, TIMP-1, and TIMP-2 in tumors and in the adjacent stroma is associated with cervical cancer prognosis.

Methods

This study analyzed a retrospective cohort of 64 patients. Protein expression was previously obtained by immunohistochemistry from biopsies containing both tumor and stroma. The expression and percentage of stained cells were categorized as high or low according to the cutoff points by using ROC curves. The follow-up data was collected from diagnosis to the last clinical visit. Clinical status categorized as alive without disease, alive with disease, death due to other causes, and death from the disease. The relative risk of death from the disease was evaluated according to the proteins expression using a cause-specific Cox regression model with a 95% confidence interval (95%CI). For the significant associations (p < 0.05), survival curves of patients with low and high expression were plotted for the competing risk survival curve analyses.

Results

High expression levels of stromal MMP-2 (RR; 95%CI: 3.91; 1.17–13.02) and stromal TIMP-2 (RR, 95%CI: 8.67; 1.15–65.27) were associated with a greater relative risk of death from the disease and with lower survival (p = 0.03; p = 0.04) than lower expression levels. Low expression levels of stromal MMP-9 (RR, 95%CI: 0.19; 0.05–0.65) and tumoral MMP-9 (HR, 95%CI: 0.19; 0.04–0.90) were protective factors against death from the disease and were associated with poorer survival.

Conclusions

High expression levels of MMP-2 and TIMP-2 in the stroma were significantly associated with poor survival in cervical cancer patients. High expression of MMP-9 was associated with a favorable cervical cancer prognosis.
Visual outcomes and safety after bilateral implantation of a trifocal presbyopia correcting intraocular lens in a Korean population: a prospective single-arm study
Authors: Kim Tae-im , Chung Tae-Young , Kim Myoung Joon , Lee Kyounghwa , Hyon Joon Young
Published: July 2020

Background

To investigate the 3-month postoperative performance and safety after implantation of a trifocal intraocular lens (IOL) in a Korean population.

Methods

This was a clinical, prospective, multicenter, single-arm study. Forty-four subjects (88 eyes) with bilateral cataract with expected postoperative corneal astigmatism of < 1.00 diopter (D) and no ocular disease or eye condition underwent bilateral implantation of the AcrySof IQ® PanOptix IOL (TFNT00). Postoperative examination at 3 months included binocular defocus curve; binocular best corrected distance visual acuity (BCDVA); monocular/binocular uncorrected VA (UCVA) at distance (4 m), intermediate (60 cm), and near (40 cm); contrast sensitivity under photopic conditions with/without glare; and subjective outcomes, including satisfaction and spectacle independence.

Results

Binocular defocus curve at 3 months after bilateral implantation showed VA of 0.1 logMAR or better from + 0.5 D through − 2.5 D. Binocular BCDVA mean ± SD at 4 m was − 0.05 ± 0.07 logMAR. Binocular and monocular UCVA was 0.03 ± 0.1 and 0.08 ± 0.12 logMAR (4 m), − 0.00 ± 0.11 and 0.05 ± 0.13 logMAR (60 cm), and 0.03 ± 0.12 and 0.09 ± 0.13 logMAR (40 cm), respectively. Contrast sensitivity with glare was 1.67 ± 0.13, 1.91 ± 0.17, 1.54 ± 0.21, and 1.14 ± 0.20 log units at 3, 6, 12, and 18 cycles/degree, respectively. At near and intermediate distances, 84 and 77% of subjects reported good/excellent satisfaction, and 84 and 91% of subjects reported spectacle independence, respectively.

Conclusions

In a Korean population, visual performance of the trifocal TFNT00 IOL 3 months postoperatively was < 0.1 logMAR for binocular UCVA at all distances, with high subject satisfaction and spectacle independence.

Trial registration

www.ClinicalTrials.gov (NCT03268746). Registered August 31, 2017.
Progress towards reducing sociodemographic disparities in breastfeeding outcomes in Indonesia: a trend analysis from 2002 to 2017
Authors: Saputri Nurmala Selly , Spagnoletti Belinda Rina Marie , Morgan Alison , Wilopo Siswanto Agus , Singh Ankur , McPake Barbara , Atun Rifat , Dewi Rika Kumala , Lee John Tayu
Published: July 2020

Background

Improving breastfeeding practice is important for reducing child health inequalities and achieving several Sustainable Development Goals. Indonesia has enacted legislation to promote optimal breastfeeding practices in recent years. We examined breastfeeding practices among Indonesian women from 2002 to 2017, comparing trends within and across sociodemographic subgroups.

Methods

Data from four waves of the Indonesia Demographic and Health Surveys were used to estimate changes in breastfeeding practices among women from selected sociodemographic groups over time. We examined three breastfeeding outcomes: (1) early initiation of breastfeeding; (2) exclusive breastfeeding; and (3) continued breastfeeding at 1 year. Multivariate logistic regression was used to assess changes in time trends of each outcome across population groups.

Results

The proportion of women reporting early initiation of breastfeeding and exclusive breastfeeding increased significantly between 2002 to 2017 (p < 0.05), with larger increases among women who: were from higher wealth quintiles; worked in professional sectors; and lived in Java and Bali. However, 42.7% of women reported not undertaking early initiation of breastfeeding, and 48.9% of women reported not undertaking exclusive breastfeeding in 2017. Women who were employees had lower exclusive breastfeeding prevalence, compared to unemployed or self-employed women. Women in Java and Bali had higher increase in early initiation of breastfeeding and exclusive breastfeeding compared to women in Sumatra. We did not find statistically significant decline in continued breastfeeding at 1 year over time for the overall population, except among women who: were from the second poorest wealth quintile; lived in rural areas; did not have a health facility birth; and lived in Kalimantan and Sulawesi (p < 0.05).

Conclusions

There were considerable improvements in breastfeeding practices in Indonesia during a period of sustained policy reform to regulate breastfeeding and community support of breastfeeding, but these were not distributed uniformly across socioeconomic, occupation and geographic subgroups. Concerted efforts are needed to further reduce inequities in breastfeeding practice through both targeted and population-based strategies.
Exploring the role of goal setting in weight loss for adults recently diagnosed with pre-diabetes
Authors: Whitehead Lisa , Glass Courtney C. , Abel Sally L. , Sharp Kiri , Coppell Kirsten J.
Published: July 2020

Background

The management of prediabetes in the community setting is a global priority. We evaluated the feasibility of a 6-month multilevel practice nurse-led prediabetes dietary intervention which involved goal setting. The aim of this paper is to explore the weight loss goals and strategies reported by participants to achieve their weight loss goals as recorded by practice nurses, and report on factors that influenced dietary behaviours.

Methods

This study used a convergent mixed-methods design. A six-month pragmatic non-randomised pilot study with a qualitative process evaluation was conducted in two neighbouring provincial cities in New Zealand. A structured dietary intervention delivered by practice nurses was implemented in four practices in 2014–2016. Content analysis of the text and descriptive statistics were used to analyse the data.

Results

One hundred and fifty seven people with prediabetes were enrolled (85 intervention, 72 control). The intervention group lost a mean 1.3 kg more than the control group (p < .0.001). The majority of the intervention group indicated either a high level of readiness (n = 42, 53%) or some readiness (n = 31, 39%) to make food changes. The majority of weight loss goals aligned with clinical guidelines (between 5 and 10% of body weight). While just over half (n = 47, 55%) demonstrated weight loss at the end of the six month period, the majority of participants did not achieve their predetermined weight loss goal (n = 78, 83%). Gender, ethnicity and budget were not related to weight loss at six months. Readiness to change and reported challenges to making dietary changes were related to weight loss at six months. Negative factors or set-backs included sporadic adherence to diet due to other health problems, change in context or environment and coping with ill health, most notably stress and low mood.

Conclusions

The data relating to weight loss and dietary goals provided insight into the challenges that people faced in making dietary changes for weight loss across a six month period. Simplifying goal setting to those goals with the greatest potential clinical impact or the greatest significance to the person, in a socially supportive environment, may increase the success of goal achievement.

Trial registration

ANZCTR ACTRN1261500080656. Registered 3 August 2015 (Retrospectively registered). https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=366560&isReview=true
A need-based, multi-level, cross-sectoral framework to explain variations in satisfaction of care needs among people living with dementia
Authors: De Poli Chiara , Oyebode Jan , Airoldi Mara , Glover Richard
Published: July 2020

Background

Provision of care and support for people with dementia and family carers is complex, given variation in how dementia manifests, progresses and affects people, co-morbidities associated with ageing, as well as individual preferences, needs, and circumstances. The traditional service-led approach, where individual needs are assessed against current service provision, has been recognised as unfit to meet such complexity. As a result, people with dementia and family members often fail to receive adequate support, with needs remaining unmet. Current research lacks a conceptual framework for explaining variation in satisfaction of care needs. This work develops a conceptual framework mapped onto the care delivery process to explain variations in whether, when and why care needs of people with dementia are met and to expose individual-, service-, system-level factors that enable or hinder needs satisfaction.

Methods

Data collected through 24 in-depth interviews and two focus groups (10 participants) with people with dementia and family carers living in the North East of England (UK) were analysed thematically to develop a typology of care needs. The need most frequently reported for people with dementia (i.e. for support to go out and about) was analysed using themes stemming from the conceptual framework which combined candidacy and discrepancy theories.

Results

The operationalisation of the framework showed that satisfaction of the need to go out was first determined at the point of service access, affected by issues about navigation, adjudication, permeability, users’ resistance to offers, users’ appearance, and systems-level operating conditions, and, subsequently, at the point of service use, when factors related to service structure and care process determined (dis)satisfaction with service and, hence, further contributed to met or unmet need.

Conclusion

The conceptual framework pinpoints causes of variations in satisfaction of care needs which can be addressed when designing interventions and service improvements.