bluuebunny/crossref_metadata_2025 huggingface dataset:
Evaluation of mental health stigma on medical education: an observational study with Portuguese medical students
Authors: Pinto Inês C. , Bernardo Margarida , Sousa Sara , Curral Rosário
Published: July 2020

Background:

The Portuguese mental health care plan emphasizes that health care professionals can be a source of stigma against people with mental illness enhancing self-stigma and leading to a decrease in the search for help and adherence to treatment.

Methods:

In this exploratory study, we surveyed 111 first and last year students from the Faculty of Medicine of the University of Porto, Portugal, using the Portuguese version of the Attribution Questionnaire AQ-27 to assess the attitudes toward mental illness.

Results:

The students showed a significant difference in the segregation dimension, and in some items related with pity and coercion in the end of the course. These results express a positive will to integrate people with mental illness in community, a decrease of pity and a valorization of the pharmacological treatment in this kind of disease. The previous personal experience of psychiatric problems decreases the level of segregation and psychological problems increase the motivation to help.

Conclusion:

Final-year students express more positive and less discriminatory attitudes toward people with severe mental illness than first-year students. This is likely due to education and contact opportunities promoted throughout the medical school, as well as due to the experience of having gone to a psychology or psychiatric consultation. Knowledge of stigma levels of future medical doctors is therefore crucial for the prevention of attitudes that could condition the provision of medical care.
Laboratory Analysis Techniques for the Perinatal Microbiome
Authors: Malloy Emily , Kates Ashley , Watson Lauren , VandeVusse Leona , Safdar Nasia , Hanson Lisa
Published: July 2020

The microbiome is composed of many organisms and is impacted by an intricate exchange between genetics and environmental factors. The perinatal microbiome influences both the developing fetus and the pregnant person. The purpose of this article is to describe the tests that are currently available for laboratory analysis of the perinatal microbiome in relationship to probiotic interventions. This article focuses on the bacterial component of the microbiome. Although adverse outcomes associated with the perinatal microbiome have been studied, a comprehensive understanding of the physiologic perinatal microbiome is still emerging. Early efforts to influence the perinatal microbiome through probiotics are currently under investigation. Unique terminology is defined, and the microbial composition of perinatal microbiota is summarized. The outcomes of studies of antenatal probiotics are summarized. Microbiome testing and analysis are defined and compared. Implications for perinatal care and probiotics research are presented.
Comparison of the efficacy between concurrent chemoradiotherapy with or without adjuvant chemotherapy for stage II nasopharyngeal carcinoma
Authors: Chen Jing , Liu Tongxin , Sun Quanquan , Jin Ting
Published: July 2020

Background:

Although common, the use of concurrent chemoradiotherapy with adjuvant chemotherapy for stage II nasopharyngeal carcinoma (NPC) is controversial due to its undefined clinical benefits. We, therefore, conducted a retrospective cohort study to investigate whether adjuvant chemotherapy confers survival gains to stage II NPC patients.

Methods:

In this study, we examined whether combining adjuvant chemotherapy (AC) and/or concurrent chemotherapy with radiotherapy (CCRT) improved survival in patients with stage II NPC. Three hundred thirty-five stage II NPC patients were retrospectively analyzed between June 2003 and June 2016 and received CCRT; some patient groups also received AC every 3 weeks for 2 to 3 cycles.

Results:

The median follow-up duration was 72 months for all patients (range, 26–151 months) and the estimated 5-year locoregional relapse-free survival (LRRFS), distant metastasis-free survival (DMFS), progression-free survival (PFS), and overall survival (OS) rates were 95.1%, 97.8%, 93.5%, and 94.3%. At the last follow-up, there were no statistically significant differences among the CCRT and CCRT+AC groups in 5-year LRRFS (95.2% vs 94.9%, P = .599), DMFS (98.5% vs 92.4%, P = .152), PFS (93.8% vs 90.2%, P = .599), or OS (95.5% vs 93.9%, P = .682) rates.

Conclusion:

The analyses revealed that a combined regimen was not an independent prognostic factor for any survival outcome. However, patients who received CCRT plus AC experienced more acute adverse events than those who received CCRT alone. Thus, the addition of AC to CCRT did not improve survival outcomes, but was associated with higher incidences of acute treatment-associated toxicities than CCRT alone in patients with stage II NPC.
Phenotypic spectrum and genetic analysis in the fatal cases of Schaaf-Yang syndrome
Authors: Chen Xuefei , Ma Xiaolu , Zou Chaochun
Published: July 2020

Rationale:

Schaaf-Yang syndrome, a rare imprinted hereditary disease caused by MAGEL2 variants, manifests as developmental delay/intellectual disability, neonatal hypotonia, feeding difficulties, contractures, and autism spectrum disorder.

Patient concerns:

Patient 1 and 2 were infant girls presenting facial dysmorphisms, contractures of interphalangeal joints, neonatal hypotonia, feeding difficulties, congenital heart diseases, and respiratory complications. Besides, Patient 2 presented with delayed psychomotor development.

Diagnosis:

Whole-exome sequencing was performed and heterozygous mutations of the MAGEL2 gene were detected in the patients. They were diagnosed as Schaaf-Yang syndrome.

Interventions:

The patients received supportive treatment including mechanical ventilation, parenteral nutrition and gastric tube feeding.

Outcomes:

Whole-exome sequencing revealed de novo heterozygous c.1996dupC pathogenic mutations in the MAGEL2 gene in the 2 patients. They died due to respiratory failure at the age of 20 days and 98 days, respectively.

Lessons:

Our results indicate that MAGEL2 variants can cause congenital heart disease and fatal respiratory complications, broadening the phenotypic spectrum and adding to the fatal cases of Schaaf-Yang syndrome. We highly suggest that the MAGEL2 gene should be added to gene-panels or gene-filters in next-generation sequencing-based diagnostics, which is of great significance for early diagnosis and early intervention of Schaaf-Yang syndrome patients.
The incidence and risk factors of sessile serrated adenomas in left side colon cancer patients after curative surgery
Authors: Kim Myung Hee , Moon Hee Seok , Kwon In Sun , Kim Ju Seok , Kang Sun Hyung , Sung Jae Kyu , Lee Eaum Seok , Kim Seok Hyun , Lee Byung Seok , Jeong Hyun Yong
Published: July 2020

Sessile serrated adenomas (SSAs) are precursors of colorectal cancer (CRC). However, there are limited data on detection rates of this premalignant lesion during colonoscopy surveillance in patients with a history of left side colonic resection for cancer. We aimed to identify the incidence and risk factors of SSAs in post-left side colectomy patients.

We retrospectively reviewed the medical records of patients who had undergone left side colectomy for colon and rectal cancer between September 2009 and September 2016 and had at least 1 follow-up colonoscopy. Patient baseline characteristics, SSA diagnoses and characteristics, and colonoscopy information were collected.

In total, 539 patients were enrolled. At the first follow-up (mean duration 11.5 months), 98 SSAs were identified (22.2%). At the second follow-up (mean duration 25.8 months), 51 SSAs were identified in 212 patients (24.0%). Multivariate analysis showed that alcohol intake (hazard ratio [HR] 1.524; 95% confidence interval [CI] .963–2.411, P = .041), excellent bowel preparation (HR 2.081; 95% CI 1.214–3.567, P = .049), and use of a transparent cap (HR 1.702; 95% CI 1.060–2.735, P = .013) were associated with higher SSA incidence in the first surveillance colonoscopy, while body mass index (BMI) ≥ 25.0 (HR 1.602; 95% CI 1.060–2.836) was associated with a significantly increased risk of SSAs in the second surveillance.

Considering the endoscopic appearance of SSAs, adequate bowel preparation and use of transparent caps during postoperative surveillance colonoscopy can increase the diagnosis rate. Modification of alcohol intake and BMI may reduce the incidence of SSAs in left side colon cancer patients.
Effects of Sihogayonggolmoryeo-tang (Saikokaryukotsuboreito or Chai-Hu-Jia-Long-Gu-Mu-Li-Tang) for insomnia disorder with prehypertension or stage 1 hypertension
Authors: Lee Boram , Jeong Yeong-Eun , Park Hyo-Ju , Choi Young-Eun , Kim Hoseok , Kim Bo-Young , Yang Changsop , Jung In Chul
Published: July 2020

Background:

Insomnia and hypertension are diseases with a high prevalence and a known association with each other. Sihogayonggolmoryeo-tang (SYM) is an herbal medicine traditionally used for the treatment of insomnia disorder concurrent with hypertension. However, no scientific clinical evidence exists supporting the effects of SYM on these disorders. This study aims to explore the feasibility, effectiveness, and safety of SYM for the treatment of insomnia disorder with concurrent prehypertension or stage 1 hypertension.

Methods:

A prospective, randomized, wait-list controlled, parallel, pilot clinical trial has been designed for a study to be conducted in Daejeon, Republic of Korea. Thirty insomnia disorder patients with prehypertension or stage 1 hypertension will be randomly assigned to a SYM or wait-list group at a 1:1 ratio. The SYM group will be administered SYM granules twice a day for 4 weeks and followed-up for 2 weeks while the wait-list group will not receive SYM granules. All participants in both groups will be given brochures with instructions for maintaining sleep hygiene and lifestyle modifications to reduce hypertension. Data will be collected at baseline and at 2, 4, and 6 weeks after allocation. The primary outcome is the Insomnia Severity Index score at 4 weeks post-treatment. The secondary outcomes will consist of the Pittsburgh Sleep Quality Index, sleep diary, systolic and diastolic blood pressure, brachial-ankle pulse wave velocity, ankle-brachial index, atherosclerosis biomarkers, the Hospital Anxiety and Depression Scale, the 5-level EuroQol-5 dimensions, and the Patient Global Impression of Change. Adverse events and laboratory test results will be monitored to assess the safety. Data will be recorded in electronic case report forms and analyzed using SPSS Statistics, Version 24.0.

Discussion:

This is the first clinical trial to explore the effectiveness and safety of SYM for the treatment of insomnia disorder concurrent with prehypertension or stage 1 hypertension. The results of this study can form the foundation for a future multicenter, large-scale, confirmatory clinical trial.

Trial registration:

Clinical Research Information Service, KCT0005001 (registered on May 8, 2020).
Effects of Tai Chi Yunshou on upper limb function and balance in stroke survivors
Authors: Luo Xiao-Chao , Zhou Jin , Zhang Yong-Gang , Liu Yao-Yao , Li Jia-Jia , Zheng Zhen , Tong Feng , Feng Fen
Published: July 2020

Background:

Functional disability is the most common disorder that occurs after stroke and seriously affects the quality of life of stroke survivors. Tai Chi Yunshou (TCY), a fundamental form of Tai Chi, is a simple, convenient, and economical exercise therapy from ancient China. Some clinical trials have reported that it improves upper limb function and balance during stroke rehabilitation. Thus, we plan to conduct a systematic review to investigate the effects of TCY in stroke survivors.

Methods:

This review will follow the Preferred Reporting Items for Systematic Reviews and Meta-analyses statement. We will search English and Chinese databases for randomized controlled trials on TCY for stroke survivors from the dates when the databases were established to 1 July 2020. The English databases will include MEDLINE (PubMed), EMBASE (embase.com), and the Cochrane Central Register of Controlled Trials (Cochrane Library). In addition, the Chinese databases will include the Chinese National Knowledge Infrastructure, the Chinese Biomedical Literature Database, the Chinese Science and Technology Periodical Database, the Wanfang database, and the Chinese Dissertation Database. The primary outcomes will include upper limb function and balance function, as measured by the Fugl-Meyer assessment and Berg balance scale, respectively. Two reviewers will independently screen the studies on the basis of the inclusion criteria and extract data. Review Manager (v5.3) will be used for data synthesis, and Cochrane Collaboration's tool will be used to assess the risk of bias. A fixed effects model or a random effects model will be selected based on the level of heterogeneity. The grading of recommendations assessment, development, and evaluation system will be used to evaluate the quality of the outcomes.

Results:

This systematic review results will be carried out after the completion of the protocol.

Conclusions:

This protocol aims to guide a systematic review and meta-analysis investigating the effects of JCY on upper limb function and body balance in stroke survivors, which will provide evidence for post-stroke rehabilitation training.

PROSPERO registration number:

CRD42020169549.
Type 2 diabetes mellitus caused by Gitelman syndrome-related hypokalemia
Authors: He Guangyu , Gang Xiaokun , Sun Zhonghua , Wang Ping , Wang Guixia , Guo Weiying
Published: July 2020

Introduction:

Gitelman syndrome (GS) is an autosomal-recessive disease caused by SLC12A3 gene mutations. It is characterized by hypokalemic metabolic alkalosis in combination with hypomagnesemia and hypocalciuria. Recently, patients with GS are found at an increased risk for developing type 2 diabetes mellitus (T2DM). However, diagnosis of hyperglycemia in GS patients has not been thoroughly investigated, and family studies on SLC12A3 mutations and glucose metabolism are rare. Whether treatment including potassium and magnesium supplements, and spironolactone can ameliorate impaired glucose tolerance in GS patients, also needs to be investigated.

Patient concerns:

We examined a 55-year-old Chinese male with intermittent fatigue and persistent hypokalemia for 17 years.

Diagnoses:

Based on the results of the clinical data, including electrolytes, oral glucose tolerance test (OGTT), and genetic analysis of the SLC12A3 gene, GS and T2DM were newly diagnosed in the patient. Two mutations of the SLC12A3 gene were found in the patient, one was a missense mutation p.N359K in exon 8, and the other was a novel insert mutation p.I262delinsIIGVVSV in exon 6. SLC12A3 genetic analysis and OGTT of 9 other family members within 3 generations were also performed. Older brother, youngest sister, and son of the patient carried the p.N359K mutation in exon 8. The older brother and the youngest sister were diagnosed with T2DM and impaired glucose tolerance by OGTT, respectively.

Interventions:

The patient was prescribed potassium and magnesium (potassium magnesium aspartate, potassium chloride) oral supplements and spironolactone. The patient was also suggested to maintain a high potassium diet. Acarbose was used to maintain the blood glucose levels.

Outcomes:

The electrolyte imbalance including hypokalemia and hypomagnesemia, and hyperglycemia were improved with a remission of the clinical manifestations.

Conclusion:

GS is one of the causes for manifestation of hypokalemia. SLC12A3 genetic analysis plays an important role in diagnosis of GS. Chinese male GS patients characterized with heterozygous SLC12A3 mutation should be careful toward occurrence of T2DM. Moreover, the patients with only 1 SLC12A3 mutant allele should pay regular attention to blood potassium and glucose levels. GS treatment with potassium and magnesium supplements, and spironolactone can improve impaired glucose metabolism.
Efficacy and safety of the traditional Chinese medicine tonifying kidney (bu shen) therapy in patients with hypertension
Authors: Tang Zhuoran , Sun Yize , Wang Chao , Liu Xiang , Qi Xin , Ma Di , Zhao Haibin
Published: July 2020

Background:

Hypertension becomes increasingly an alarming global health concern. There is a growing interest in treatment of traditional Chinese medicine (TCM), and tonifying kidney therapy (bushen, TKT) has been extensively used in the treatment of hypertension according to TCM theory. In this article, we outline the protocol of research projects and methods to examine comprehensively the effectiveness and safety of TKT in treating hypertensive patients.

Methods:

We will collect randomized controlled trails (RCTs) that report the application of TKT for patients with hypertension from electronic databases including PubMed, EMBASE, CENTRAL, CNKI, VIP, CBM, and Wanfang database. Time of literature retrieval is set from the beginning of database construction to the end of June, 2020. Two reviewers will independently perform literature screening, data extraction, and quality assessment of included literature, and any divergences will be worked out via discussion. The primary outcomes include total efficacy rate, systolic and diastolic blood pressure change will be assessed. The secondary outcomes include clinical symptoms and adverse events will also be assessed. RevMan5.3 software will be applied to analyzing data included studies.

Results:

This study will synthesize and analyze all collated data in order to evaluate TKT for the treatment of hypertension involves different aspects in total efficacy rate, systolic and diastolic blood pressure change, clinical symptoms, and adverse events.

Conclusion:

This study will determine the efficacy of TKT in the treatment of hypertension and recommend its clinical value based on the evaluated the effectiveness and security results.

Registration number:

INPLASY202050044.
The effectiveness of different exercise modalities on sleep quality
Authors: Cao Peiye , Cai Ying , Zhang Shifang , Wan Qiaoqin
Published: July 2020

Background:

Recently, the effect of exercise on sleep quality has been paid increasing attention by researchers. A number of systematic reviews and direct meta-analyses have explored the effectiveness of exercise on sleep quality. However, which type of exercise is optimal for sleep quality is still not clear. Therefore, this study aims to adopt network meta-analysis to evaluate the effect of different exercise modalities on sleep quality and find the most effective one for improving sleep quality.

Methods:

The databases searched included PubMed, Web of Science, EMBASE, CENTRAL, PsycINFO, and SPORTDiscus. Studies published in English and from the dates of database inception to October 8, 2019, were included. Besides, we also checked the reference lists of systematic reviews published in recent years. Two independent researchers screened all studies, included the studies that met eligible criteria and will then extract data. The risk of bias will be assessed by the 2 researchers according to the modified Cochrane Risk of Bias Tool. During these processes, any disagreement will be discussed to reach a consensus. STATA 14.0 software will be used for direct meta-analysis and network meta-analysis.

Results:

High-quality synthesis of current evidences will be provided from Pittsburgh sleep quality index. And the effectiveness of different exercise modalities for sleep quality will also be shown.

Conclusion:

This study will provide the evidence of the most effective exercise for better sleep quality.

Registration:

This study was registered with the International Platform of Registered Systematic Review and Meta-Analysis Protocols (registration number: INPLASY202050096).
Molecular profile of a pleomorphic adenoma of the hard palate
Authors: Iida Yoshiyuki , Serizawa Masakuni , Mukaigawa Takashi , Kamijo Tomoyuki , Nakajima Takashi , Asakura Koiku , Kusuhara Masatoshi , Yamaguchi Ken , Onitsuka Tetsuro
Published: July 2020

Rationale:

Pleomorphic adenoma (PA) is the most common benign tumor of salivary glands. PAs have the potential for regional and distant metastases that preserve their benign phenotype; they also have the potential for malignant transformation. The molecular pathogenesis of malignant neoplasms has been studied extensively in recent years, unlike that of benign tumors, such as PA.

Patient concerns:

In this case report, we identified the molecular signatures of a 57-year-old Japanese woman. Our patient presented with a swelling of the hard palate with an erosive appearance.

Diagnoses:

The patient was diagnosed with a right hard palate tumor suspected to be a malignant neoplasm.

Interventions:

Partial maxillary resection and reconstruction were performed.

Outcomes:

There was no obstacle to swallowing or dysarthria after surgery. There was no sign of recurrent palatal tumor 4 years after the operation. Using next generation sequencing, 5 nonsynonymous mutations andCHCHD7-PLAG1fusion genes were detected. Moreover, gene expression profiling indicated the possibility of the activation of several cancer-related signaling pathways. Although thePLAG1gene is predicted to play a crucial role in PA tumorigenesis, its over-expression is reported to mediate multiple downstream factors. In this case, various up- and downregulated RNA signaling pathways, including MAP kinase signaling, PI3K/AKT1/MTOR signaling, JAK/STAT signaling, and PD-L1 signaling, were revealed.

Lessons:

These molecular profiles of PA may elucidate the mechanism of metastasis, preserving its benign phenotype and carcinoma ex PA.
Stroke prevention and guideline adherent antithrombotic treatment in elderly patients with atrial fibrillation
Authors: Gorczyca Iwona , Jelonek Olga , Michalska Anna , Chrapek Magdalena , Wałek Paweł , Wożakowska-Kapłon Beata
Published: July 2020

Patients aged ≥75 years with the diagnosis of atrial fibrillation (AF) are at a higher risk of stroke and, according to recent recommendations, should receive oral anticoagulant (OAC) therapy. This study aimed to assess the recommended prophylactic antithrombotic therapy among patients with AF aged ≥ 75 years and its compliance with current guidelines. We also aimed to identify predisposing factors associated with the administration of non-vitamin K antagonist oral anticoagulants (NOACs) in elderly patients with AF.

This was a retrospective, single-center observational study. Patients with AF aged ≥75 years hospitalized at a reference cardiology center from 2014 to 2017 were included in the analysis.

Among the 1236 eligible patients (43.4% male; mean age, 82 years), OACs were recommended in 90.1% of cases. Of these, 59.8% of patients used NOACs and 40.2% used vitamin K antagonists. Additionally, 3.3% of patients received antiplatelet (AP) therapy and 2.5% were administered low molecular weight heparin. Only 4.5% of patients did not receive any anticoagulant treatment. The majority (89.9%) of patients received relevant prophylactic antithrombotic therapy according to current guidelines; only 1.4% were overtreated and 8.7% were undertreated. The significant predictors of NOAC therapy among patients treated with anticoagulants were non-permanent AF (odds ratio [OR] = 1.68, 95% confidence interval [CI] = 1.30–2.18, P = .0001), age-by 5 years (OR = 1.33, 95% CI = 1.16–1.52, P = .0001), and glomerular filtration rate-by 5 units (OR = 1.06, 95% CI = 1.02–1.10, P = .0066).

A high percentage of AF patients aged ≥75 years receive OACs, mainly NOACs. Most patients are treated according to the current guidelines; under treatment is primarily observed in patients receiving AP therapy. Non-permanent AF, age, and preservation of renal function are significant predictors of NOAC use.
The effect of early trough level of infliximab on subsequent disease course in patients with Crohn disease
Authors: Ishida Natsuki , Miyazu Takahiro , Sugiyama Tomohiro , Tamura Satoshi , Kagami Takuma , Tani Shinya , Yamade Mihoko , Iwaizumi Moriya , Hamaya Yasushi , Osawa Satoshi , Furuta Takahisa , Sugimoto Ken
Published: July 2020

Decreased trough level of infliximab (TLI) is associated with diminished efficacy in patients with Crohn disease (CD). We examined whether TLI at 14 weeks subsequent to the start of infliximab (IFX) treatment would impact long-term clinical course.

Serum IFX levels and antibodies to IFX (ATI) at 14 and 54 weeks after IFX administration were measured in 12 patients with mild to moderate CD. We examined patient background, clinical severity, blood test values, and the relationship between ATI and TLI up to 108 weeks.

We compared the group with TLI < 3 μg/mL at 14 weeks (TLI(14) < 3 group) the group with TLI > 3 μg/mL (TLI(14) ≥ 3 group). Patients in the TLI(14) ≥ 3 group were significantly more likely to use immunomodulators before IFX treatment induction (P = .01). At 54 weeks, 2 cases of ATI production were observed in the TLI(14) < 3 group, but no ATI production was observed in the TLI(14) ≥ 3 group. TLI in the TLI(14) ≥ 3 group at 54 weeks was significantly higher than in the TLI(14) < 3 group (6.5 μg/mL vs 1.0 μg/mL; P < .01). Although CD activity index and serum albumin values in the TLI(14) ≥ 3 group at 14, 54, and 108 weeks significantly improved compared to baseline, these improvements were not observed in the TLI(14) < 3 group. The remission maintenance rate at 108 weeks evaluated with the Kaplan–Meier method was significantly higher in the TLI(14) ≥ 3 group than the TLI(14) < 3 group (100% vs 33.3%; P = .02).

The TLI 14 weeks after IFX treatment in patients with CD affects long-term outcome.
Gliclazide monotherapy increases risks of all-cause mortality and has similar risk of acute myocardial infarction and stroke with glimepiride monotherapy in Korean type 2 diabetes mellitus
Authors: Cho Eun-Hee , Han Kyungdo , Kim Bongseong , Lee Dae Ho
Published: July 2020

Sulphonylureas (SUs) subclasses have different risks of all-cause mortality, acute myocardial infarction (AMI), and stroke. Therefore, we assessed these risks in patients with type 2 diabetes mellitus administered gliclazide, glimepiride, or metformin monotherapy with retrospective cohort study design. Total 195,235 subjects were included in the study who were ≥20 years’ old and prescribed monotherapy for at least 1 year as a first-line therapy for incident diabetes from January 01, 2009 to December 31, 2013 in the National Health Insurance Service Claim data. Incidence and hazard ratios (HRs) of all-cause mortality, AMI, and stroke were compared with glimepiride monotherapy as a reference. Gliclazide monotherapy increased all-cause mortality compared with glimepiride monotherapy. However, the gliclazide and glimepiride groups showed no difference in AMI and stroke incidences. In line with previous studies, metformin monotherapy showed significant clinical benefits in reducing risks of all-cause mortality, AMI, and stroke compared with glimepiride. This population-based cohort study suggested that gliclazide increases risks of all-cause mortality and has similar risk of AMI and stroke with gliclazide monotherapy in Korean.
Fully automatic classification of breast MRI background parenchymal enhancement using a transfer learning approach
Authors: Borkowski Karol , Rossi Cristina , Ciritsis Alexander , Marcon Magda , Hejduk Patryk , Stieb Sonja , Boss Andreas , Berger Nicole
Published: July 2020

Marked enhancement of the fibroglandular tissue on contrast-enhanced breast magnetic resonance imaging (MRI) may affect lesion detection and classification and is suggested to be associated with higher risk of developing breast cancer. The background parenchymal enhancement (BPE) is qualitatively classified according to the BI-RADS atlas into the categories “minimal,” “mild,” “moderate,” and “marked.” The purpose of this study was to train a deep convolutional neural network (dCNN) for standardized and automatic classification of BPE categories.

This IRB-approved retrospective study included 11,769 single MR images from 149 patients. The MR images were derived from the subtraction between the first post-contrast volume and the native T1-weighted images. A hierarchic approach was implemented relying on 2 dCNN models for detection of MR-slices imaging breast tissue and for BPE classification, respectively. Data annotation was performed by 2 board-certified radiologists. The consensus of the 2 radiologists was chosen as reference for BPE classification. The clinical performances of the single readers and of the dCNN were statistically compared using the quadratic Cohen's kappa.

Slices depicting the breast were classified with training, validation, and real-world (test) accuracies of 98%, 96%, and 97%, respectively. Over the 4 classes, the BPE classification was reached with mean accuracies of 74% for training, 75% for the validation, and 75% for the real word dataset. As compared to the reference, the inter-reader reliabilities for the radiologists were 0.780 (reader 1) and 0.679 (reader 2). On the other hand, the reliability for the dCNN model was 0.815.

Automatic classification of BPE can be performed with high accuracy and support the standardization of tissue classification in MRI.
Orbital infarction syndrome after cerebral aneurysm surgery
Authors: Choi Sung Won , Kang Kyung Tae , Jun Jong Hwa , Jang Ji Hye , Kim Yu Cheol
Published: July 2020

To report the clinical characteristics and retinal abnormalities associated with orbital infarction syndrome after cerebral aneurysm clipping surgery.

In this retrospective case series, we evaluated 4 cases of orbital infarction syndrome using fluorescein angiography, optical coherence tomography, and computed tomography images from January 2011 to May 2014. The medical records of these patients including age, sex, laterality of the eyes, visual acuity, intraocular pressure, duration of the operation, location of the aneurysms, and surgical method with the type of approach used to reach the aneurysmal lesions were evaluated.

Aneurysms were located in either the anterior or the posterior communicating artery. Two patients had subarachnoid hemorrhage arising from a ruptured aneurysm, whereas 2 other patients had unruptured aneurysms. Clipping was performed by 3 different surgeons using the pterional craniotomy. The mean time interval from aneurysmal clipping to awareness of vision loss was 10.75 ± 13.8 days. In all patients, optic atrophy and irreversible deterioration of visual acuity ensued. Retinal edema, retinal vascular abnormality, or choroidal hypoperfusion was identified in these patients.

Orbital infarction syndrome is a rare but devastating complication of brain aneurysm clipping surgery. The associated retinal ischemia is not only due to the involvement of the retinal vessels, but also the choroidal circulation.
Traditional Chinese medicine for myasthenia gravis
Authors: Xie Rongfang , Liu Liting , Wang Ruiqi , Huang Chunhua
Published: July 2020

Background:

Myasthenia gravis (MG) is a disease that is difficult to cure, mainly manifested in the affected skeletal muscle weakness and morbid fatigue, which seriously affects the patients’ daily life and work. A large number of randomized controlled trial have shown that Traditional Chinese medicine (TCM) has a good effect in treating MG. However, due to the variety of TCM treatment methods, its relative effectiveness and safety have not been verified. Therefore, this study will use a network meta-analysis method to verify the effectiveness and safety of different types of TCM in the treatment of MG.

Methods:

We will search the following databases from inception to June 2020: the China National Knowledge Infrastructure, Wanfang Database, Chinese Science and Technology Periodical Database, Chinese Biomedical Literature Database, Pubmed, Embase, Web of Science, and the Cochrane library. Collect all randomized controlled trial of TCM for the treatment of MG, The 2 authors will independently select studies and extract data based on pre-designed inclusion and exclusion criteria. Methodological quality assessment and risk of bias will be assessed using Cochrane bias risk tool. All data analysis will be conducted using Revman5.3, WinBUGS 1.4.3, and Stata14.2 software.

Results:

This study will directly and indirectly compare the different outcome indicators of various studies, and rank the effectiveness of different TCM methods. The main outcome indicators include effectiveness, remission rate (no drug symptoms), relapse rate, clinical absolute score, and relative score. Secondary outcome indicators: including any related adverse reactions, the concentration of acetylcholine receptor antibody in serum.

Conclusion:

The conclusion of this systematic review will provide credible Evidence-based for the relative advantages of different TCM treatment methods for MG.
Coronavirus disease 2019 (COVID-19) in pregnancy: 2 case reports on maternal and neonatal outcomes in Yichang city, Hubei Province, China
Authors: Zheng Tingting , Guo Jianqiang , He Wencong , Wang Hao , Yu Huiling , Ye Hong
Published: July 2020

Rationale:

The outbreak of coronavirus disease 2019 (COVID-19) in 2019 has become a global pandemic. It is not known whether the disease is associated with a higher risk of infection in pregnant women or whether intrauterine vertical transmission can occur. We report 2 cases of pregnant women diagnosed with COVID-19.

Patient concerns:

In all of Yichang city from January 20, 2020, to April 9, 2020, only 2 pregnant women, who were in the late stage of pregnancy, were diagnosed with COVID-19; one patient was admitted for fever with limb asthenia, and the other patient was admitted for abnormal chest computed tomography results.

Diagnoses:

Both pregnant women were diagnosed with COVID-19.

Interventions:

After the medical staff prepared for isolation and protection, the 2 pregnant women quickly underwent cesarean sections. A series of tests, such as laboratory, imaging, and SARS-CoV-2 nucleic acid examinations, were performed on the 2 women with COVID-19 and their newborns.

Outcomes:

One of the 2 infected pregnant women had severe COVID-19, and the other had mild disease. Both babies were delivered by cesarean section. Both of the women with COVID-19 worsened 3 to 6 days after delivery. Chest computed tomography suggested that the lesions due to SARS-CoV-2 infection increased. These women began to exhibit fever or reduced blood oxygen saturation again. One of the 2 newborns was born prematurely, and the other was born at full term. Neither infant was infected with COVID-19, but both had increased prothrombin time and fibrinogen, lactate dehydrogenase, phosphocreatine kinase, and creatine kinase isoenzyme contents.

Lessons:

SARS-CoV-2 infection was not found in the newborns born to the 2 pregnant women with COVID-19, but transient coagulation dysfunction and myocardial damage occurred in the 2 newborns. Effective management strategies for pregnant women with COVID-19 will help to control the outbreak of COVID-19 among pregnant women.
Psychological symptoms in anophthalmic patients wearing ocular prosthesis and related factors
Authors: Wang Kai Jie , Li Sha Sha , Wang Hai Yan
Published: July 2020

Anophthalmic patients not only cause obvious functional deficits and facial deformities, but lead to poor psychological outcomes, although prosthesis wearing can offer improvements in psychological well-being to some extent. The study aimed to comprehensively evaluate the psychological symptoms and analyze related factors in anophthalmic patients wearing ocular prosthesis.

Total of 150 anophthalmic patients and 120 control subjects were included in this cross-sectional study. Baseline characteristics survey and the symptom checklist-90 scale were completed by all participants to assess the psychological symptoms and analyze their related factors by multivariate analysis.

The anophthalmic patients exhibited the increased levels of somatization, depression, anxiety, and hostility compared with control subjects. The most prominent symptom was hostility with the median score of 1.20. Female patients presented with higher somatization, depression, anxiety, and hostility. Marital status single was positively associated with depression, anxiety, and hostility symptoms. Lower education and cause of enucleation were related to higher levels of hostility.

Anophthalmic patients wearing ocular prosthesis presented with more prominent hostility and somatization besides its higher depression and anxiety symptoms. The findings suggest that for female single anophthalmic patients with low education, especially caused by trauma, timely psychological assessment and intervention should be provided to avoid undesirable consequences.
Habitual volar dislocation of the ulnar head with a locked distal radioulnar joint after distal radius fracture
Authors: Tomori Yuji , Nanno Mitsuhiko , Takai Shinro
Published: July 2020

Rationale:

Habitual volar dislocation of the ulnar head with a locked distal radioulnar joint (DRUJ) is a rare complication after distal radius fracture. We present a case of habitual volar dislocation of the ulnar head in a woman with a dorsally displaced malunited distal radius fracture.

Patient concerns:

A 72-year-old woman presented with occasional painful locking of the forearm in full supination. She had fractured the left distal radius in a fall 6 months previously. The fracture had been treated non-surgically with wrist immobilization in a long and short arm cast for 6 weeks. Physical examination showed no swelling of the left hand. The wrist locked when the forearm was fully supinated, and the patient was not able to pronate her forearm without reducing the ulna by pressing the left ulna down toward the DRUJ. She experienced sharp pain during the reduction procedure and pronation of the left forearm. The affected wrist had 91% motion compared with the contralateral wrist.

Diagnosis:

Radiography and computed tomography showed 28° dorsally angulated malunion of the distal radius and ulnar head subluxation with respect to the radius. Magnetic resonance imaging revealed disruption of the ulnar-side triangular fibrocartilage complex (TFCC) from the ulna fovea.

Interventions:

The patient desired surgery to address the painful click during full supination of her left wrist and the limitations in her activities of daily living. Corrective osteotomy of the distal radius and arthroscopic repair of the ulnar-side tear of the TFCC were performed. The TFCC was arthroscopically repaired to the ulnar fovea to stabilize the DRUJ.

Outcomes:

At 1 year postoperatively, radiography showed complete union of the radius. The affected side had 97% wrist motion compared with the contralateral wrist and a full range of forearm rotation without pain or clicking. The grasp strength was 100% compared with the normal wrist.

Lessons:

Malunited distal radius fracture with concomitant TFCC injury can result in habitual volar dislocation of the ulnar head due to severely dorsally angulated malunion of the radius and avulsion of the ulnar-side TFCC from the ulna fovea. This condition required corrective osteotomy plus TFCC repair.
An infant with coronavirus disease 2019 in China
Authors: Cao Wen , Mai Gang , Liu Zhen , Ren Haoyuan
Published: July 2020

Rationale:

In December 2019, an outbreak of coronavirus disease 2019 (COVID-19) occurred in Wuhan, China. The initial epidemiological investigations showed that COVID-19 occurred more likely in adults, with patients younger than 10 years old accounting for less than 1% of the total number of confirmed cases, and infant infections were more rare. In our case, we present an infant who was only 35 days old when he was tested positive for COVID-19.

Patient concerns:

In this report, a 35 day-old male infant with atypical symptoms had close contact with 2 confirmed patients of COVID-19 who were his grandmother and mother.

Diagnosis:

The patient was diagnosed as COVID-19 after his oropharyngeal swab tested positive for severe acute respiratory syndrome coronavirus 2 by reverse transcription-polymerase chain reaction assay.

Interventions:

The therapeutic schedule included aerosol inhalation of recombinant human interferon α-2b and supportive therapy.

Outcomes:

Two consecutive (1 day apart) oropharyngeal swabs tested negative for severe acute respiratory syndrome coronavirus 2; then, the patient was discharged on February 27, 2020.

Lessons:

Strengthening infants’ virus screening in families with infected kins is important for early diagnosis, isolation, and treatment when symptoms are atypical. The infectivity of infants with mild or asymptomatic COVID-19 should not be ignored because this may be a source of transmission in the community.
Syntheses and crystal structures of the anhydride 4-oxatetracyclo[5.3.2.02,6.08,10]dodec-11-ene-3,5-dione and the related imide 4-(4-bromophenyl)-4-azatetracyclo[5.3.2.02,6.08,10]dodec-11-ene-3,5-dione
Authors: Hulsman Andrew , Lorenzana Isabel , Schultz Theodore , Squires Breezy , Stenfors Brock A. , Tolonen Mason , Staples Richard J. , Biros Shannon M. , Winchester William R.
Published: July 2020

The syntheses and crystal structures of the two title compounds, C11H10O3 (I) and C17H14BrNO2 (II), both containing the bicyclo[2.2.2]octene ring system, are reported here [the structure of I has been reported previously: White & Goh (2014). Private Communication (refcode HOKRIK). CCDC, Cambridge, England]. The bond lengths and angles of the bicyclo[2.2.2]octene ring system are similar for both structures. The imide functional group of II features carbonyl C=O bond lengths of 1.209 (2) and 1.210 (2) Å, with C—N bond lengths of 1.393 (2) and 1.397 (2) Å. The five-membered imide ring is nearly planar, and it is positioned exo relative to the alkene bridgehead carbon atoms of the bicyclo[2.2.2]octene ring system. Non-covalent interactions present in the crystal structure of II include a number of C—H...O interactions. The extended structure of II also features C—H...O hydrogen bonds as well as C—H...π and lone pair–π interactions, which combine together to create supramolecular sheets.
Rerefinement of the crystal structure of trichloridosulfonium(IV) hexachloridouranate(V), (SCl3)[UCl6]
Authors: Deubner Holger Lars , Ivlev Sergei I. , Kraus Florian
Published: July 2020

Single crystals of trichloridosulfonium(IV) hexachloridouranate(V) were obtained from the reaction of uranium(IV) chloride with an excess of disulfur dichloride and studied by single-crystal X-ray diffraction. In comparison with the structure model reported previously [Sawodny et al. (1983). Z. Anorg. Allg. Chem.
499, 81–88.], the lattice parameters and fractional atomic coordinates were determined to a much higher precision, leading overall to an improved structure model. The ionic compound contains trigonal–pyramidal (SCl3)+ cations and slightly distorted octahedral [UCl6]− anions. The structure was refined as an inversion twin with a twin ratio of 4.4:1.
Circular cities: the case of Singapore
Authors: Carrière Sann , Weigend Rodríguez Ricardo , Pey Peixun , Pomponi Francesco , Ramakrishna Seeram
Published: July 2020

Purpose

Circular economy (CE), as a new economic paradigm, has gained traction in recent years. Cities' role in driving CE forward has been perceived as being increasingly important to achieve sustainable development (SD). For this reason, there is an urgency to understand what a circular city is and how it might be composed. This research explores the ways in which the city-state of Singapore is transitioning to a CE.

Design/methodology/approach

A systematic literature review on CE and cities was carried out using a bibliometric review and a snowballing technique. This review was performed on academic and on non-academic papers.

Findings

This research has confirmed the lack of robust circular cities case studies. As Singapore has already begun its journey towards circularity, this article examines its current efforts and offers recommendations in the design and implementation of CE policies that may be valuable not just for Singapore but also for high-density and rapidly expanding cities around the world that require a new development pathway to emulate.

Originality/value

This manuscript is the first detailed, independent and comprehensive review of Singapore's approach to CE.
Managing family business tensions: the narrative of family history
Authors: Arteaga Rocio , Uman Timur
Published: July 2020

Purpose

This study explores the family governance structures that family firms employ to manage family business tensions.

Design/methodology/approach

Building on socioemotional wealth perspective and adopting a narrative methodological approach, the study analyses nine unique narratives of representatives of three Swedish family firms.

Findings

The study illustrates how the hybrid arena created between formal and informal family meetings is used as a governance structure for mitigating tensions by reinforcing family relational ties.

Research limitations/implications

Based on the findings, this study suggests how reliance on hybrid arena informs the field of family business management and governance and suggests future research directions.

Practical implications

The findings of this study provide opportunities for family business practitioners, including owners, family members, family firm advisers and other stakeholders, to effectively manage family business tensions and foster socioemotional wealth.

Originality/value

In family firms, tensions can arise due to a desire for the preservation of socioemotional wealth. The authors show that these tensions may be managed by using informal and formal family meetings that create a hybrid arena where family members separate family and business issues and emotional and rational reactions, thereby avoiding negative emotions and creating a culture of harmony within the family.
Quantifying farmers’ climate change adaptation strategies and the strategy determinants in Southwest China
Authors: Sujakhu Nani Maiya , Ranjitkar Sailesh , Yang Hua , Su Yufang , Xu Jianchu , He Jun
Published: July 2020

Purpose

This paper aims to document the adaptation strategies developed by local farmers to adjust to climate change and related hazards in Lijiang Prefecture in Southwest China, and quantify the determinants of the adaptation measures.

Design/methodology/approach

The study conducted a household survey with 433 respondents in Lijiang to documents adaptation measures. The authors used a multivariate probit model to quantify five categories of adaptation measures against a set of household features, extension and information, resources, social network, financial assets and perception variables.

Findings

The most significant determinants consisted of information on early climate warnings and impending hazards, ownership to land and livestock, irrigation membership in community-based organisations, household savings, cash crop farming and perceptions of climate change and its related hazards. Adaptation strategies and policies highlighting these determinants could help to improve climate change adaptation in the region.

Originality/value

This study quantified the determinants of adaptive strategies and mapped important determinants for the region that will provide farmers with the appropriate resources and information to implement the best practices for adapting to climatic changes. The method and findings could be useful and easily replicable for future agriculture policies.