bluuebunny/crossref_metadata_2025 huggingface dataset:
Human papillomavirus vaccine effectiveness within a cervical cancer screening programme: cohort study
Authors: Acuti Martellucci C , Nomura S , Yoneoka D , Ueda P , Brotherton JML , Canfell K , Palmer M , Manzoli L , Giorgi Rossi P , De Togni A , Palmonari C , Califano A , Saito E , Hashizume M , Shibuya K
Published: August 2020

Objective

To assess the effectiveness of an HPV vaccination programme in reducing the risk of cervical abnormalities identified at subsequent screening.

Design

Retrospective cohort study using administrative health data.

Setting

General population of Ferrara Province, Italy.

Population

Female residents born in 1986–1993 and participating in the organized cervical screening programme in 2011–2018, who were eligible for HPV vaccination in catch‐up cohorts.

Methods

Logistic regression to evaluate the potential association between abnormal cervical cytology and one, two, three or at least one dose of HPV vaccine.

Main outcome measures

Cervical abnormalities, as predicted by low‐grade or high‐grade cytology, by number of vaccine doses, stratified by age.

Results

The sample consisted of 7785 women (mean age 27.5 years, SD 2.3). Overall, 391 (5.0%) were vaccinated with ≥1 dose and 893 (11.5%) had abnormal cytology. Women receiving at least one vaccine dose were significantly less likely to have an abnormal cytology (adjusted odds ratio 0.52; 95% confidence interval 0.34–0.79). Similar results were observed for women receiving a single dose, for both bivalent and quadrivalent vaccines, and applying buffer periods (excluding cytological outcomes within 1 month, 6 months and 1 year of the first dose).

Conclusions

In the context of an organised cervical screening programme in Italy, catch‐up HPV vaccination almost halved the risk of cytological abnormalities.

Tweetable abstract

Among Ferrara women, vaccination against human papillomavirus halved the risk of screening cervical abnormalities.
Understanding immunopathological fallout of human coronavirus infections including COVID‐19: Will they cross the path of rheumatologists?
Authors: Kabeerdoss Jayakanthan , Danda Debashish
Published: August 2020

Severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) infection causing coronavirus disease 2019 (COVID‐19) is the biggest pandemic of our lifetime to date. No effective treatment is yet in sight for this catastrophic illness. Several antiviral agents and vaccines are in clinical trials, and drug repurposings as immediate and alternative choices are also under consideration. Immunomodulatory agents like hydroxychloroquine (HCQ) as well as biological disease‐modifying anti‐rheumatic drugs (bDMARDs) such as tocilizumab and anakinra received worldwide attention for treatment of critical patients with COVID‐19. This is of interest to rheumatologists, who are well versed with rational use of these agents. This brief review addresses the understandings of some of the common immunopathogenetic mechanisms in the context of autoimmune rheumatic diseases like systemic lupus erythematosus (SLE) and COVID‐19. Apart from demographic comparisons, the role of type I interferons (IFN), presence of antiphospholipid antibodies and finally mechanism of action of HCQ in both the scenarios are discussed here. High risks for fatal disease in COVID‐19 include older age, metabolic syndrome, male gender, and individuals who develop delayed type I IFN response. HCQ acts by different mechanisms including prevention of cellular entry of SARS‐CoV‐2 and inhibition of type I IFN signaling. Recent controversies regarding efficacy of HCQ in management of COVID‐19 warrant more studies in that direction. Autoantibodies were also reported in severe acute respiratory syndrome (SARS) as well as in COVID‐19. Rheumatologists need to wait and see whether SARS‐CoV‐2 infection triggers development of autoimmunity in patients with COVID‐19 infection in the long run.
Outpatient Treatment of Low‐risk Pulmonary Embolism in the Era of Direct Oral Anticoagulants: A Systematic Review
Authors: Maughan Brandon C. , Frueh Lisa , McDonagh Marian S. , Casciere Bryan , Kline Jeffrey A.
Published: August 2020

Background

Clinical guidelines have supported outpatient treatment of low‐risk pulmonary embolism (PE) since 2014, but adoption of this practice has been slow. Direct oral anticoagulant (DOAC) therapy for venous thromboembolism (VTE) is now as common as vitamin K antagonist treatment, but data are sparse regarding outcomes for patients with low‐risk PE treated with DOACs as outpatients. We conducted a systematic review of literature on outcomes of outpatient management for PE, including comparisons to inpatient treatment and differences by anticoagulant class.

Methods

We searched Medline, Embase, PubMed, CENTRAL, clinicaltrials.gov, and ICTRN for studies published from January 1980 through February 2019 using a predefined strategy developed with a medical librarian. We included English‐language randomized controlled trials (RCTs) and prospective nonrandomized trials (NRTs) of adult patients diagnosed with acute, symptomatic PE, and discharged from the emergency department or within 48 hours. Our primary outcome included four major adverse outcomes (all‐cause mortality, PE‐related mortality, recurrent VTE, and major bleeding) within 30 and 90 days. A preplanned subanalysis of high‐quality studies assessed outcomes associated with different anticoagulation treatment classes.

Results

Our initial search identified 6,818 records, of which 12 studies (four RCT, eight NRT) with a total of 3,191 patients were included in the review. All RCTs and six NRTs were determined to have low to moderate risk of bias and were classified as high quality. Outpatients in these studies (n = 1,814) had rates of 90‐day major adverse outcomes below 1%, including all‐cause mortality (0.7%, 95% confidence interval [CI] = 0.4% to 1.2%), PE‐related mortality (0.06%, 95% CI = 0.01% to 0.3%), recurrent VTE (0.8%, 95% CI = 0.5% to 1.4%), and major bleeding (0.8%, 95% CI = 0.5% to 1.4%). Exploratory analysis revealed no association between anticoagulant treatment class and rates of major adverse outcomes.

Conclusion

Among patients with low‐risk PE treated as outpatients, few patients experienced major adverse outcomes such as mortality, recurrent VTE, or major bleeding within 90 days.
Effect of genotyped bulls with different numbers of phenotyped progenies on quantitative trait loci detection and genomic evaluation in a simulated cattle population
Authors: Takeda Masayuki , Uemoto Yoshinobu , Satoh Masahiro
Published: August 2020

The objective of this study was to assess the effect of genotyped bulls with different numbers of phenotyped progenies on quantitative trait loci (QTL) detection and genomic evaluation using a simulated cattle population. Twelve generations (G1–G12) were simulated from the base generation (G0). The recent population had different effective population sizes, heritability, and number of QTL. G0–G4 were used for pedigree information. A total of 300 genotyped bulls from G5–G10 were randomly selected. Their progenies were generated in G6–G11 with different numbers of progeny per bull. Scenarios were considered according to the number of progenies and whether the genotypes were possessed by the bulls or the progenies. A genome‐wide association study and genomic evaluation were performed with a single‐step genomic best linear unbiased prediction method to calculate the power of QTL detection and the genomic estimated breeding value (GEBV). We found that genotyped bulls could be available for QTL detection depending on conditions. Additionally, using a reference population, including genotyped bulls, which had more progeny phenotypes, enabled a more accurate prediction of GEBV. However, it is desirable to have more than 4,500 individuals consisting of both genotypes and phenotypes for practical genomic evaluation.
Breed differences in macrophage infiltration and senescence state in adipose tissues of Wagyu and Holsteins
Authors: Yamada Tomoya , Kamiya Mituru , Higuchi Mikito
Published: August 2020

Obesity stimulates the macrophage infiltration and senescence state in adipose tissues of humans and rodents. The adipogenesis capacity of Japanese Black cattle (Wagyu) is higher than that of Holsteins. We hypothesized that breed differences between Wagyu and Holsteins may affect the level of macrophage infiltration and senescence state in adipose tissues. The macrophage infiltration, senescence marker gene expression and activity of senescence‐associated β‐galactosidase (SA‐βgal) in visceral and intramuscular adipose tissue of Wagyu were higher than those of Holsteins. In contrast, there were no differences in macrophage infiltration, senescence marker gene expression and activity of SA‐βgal in subcutaneous adipose tissue between the breeds. Expression of p53 gene, the master regulator of macrophage infiltration and senescence state, in visceral and intramuscular adipose tissue of Wagyu was higher than that of Holsteins. In contrast, there was no difference in the expression of p53 gene in subcutaneous adipose tissue between the breeds. These results suggest that breed differences in macrophage infiltration and senescence state in adipose tissues of Wagyu and Holsteins are affected by p53 expression.
Relationship between Toxoplasma gondii seroprevalence and lamb marking in South Australian sheep flocks
Authors: Lanyon SR , O'Handley RM
Published: August 2020

Objective

Toxoplasmosis in sheep has negative impacts on reproductive performance. This study aimed to estimate the prevalence in Toxoplasma gondii infection in the South Australian sheep population, and assess any association between within‐flock prevalence and reproductive efficiency (measured by lamb marking percentage), climatic region and rainfall.

Methods

A total of 875 individual mixed‐age breeding ewes from 29 South Australian properties were blood sampled with an average of 30.2 ewes per property (min 28, max 32). Sera were tested for T. gondii‐specific IgG antibody using a commercial Modified Agglutination Test kit.

Results

Overall, 209 of 875 (23.9%; 95% confidence interval [CI] 16.3% to 31.4%) of individual ewes tested seropositive for T. gondii‐specific IgG antibodies, with a flock level seroprevalence of 28/29 (96.6%, 95% CI 96.6% to 100%). On individual farms, the seroprevalence ranged from 0% to 93.3%. Analysis showed that Kangaroo Island properties had significantly higher mean seroprevalence than any mainland climatic regions, and that the mainland regions did not significantly differ from each other. Linear regression revealed a significant association between seroprevalence and lamb marking percentage, with a slope of −5.4% lamb marking per +10% seroprevalence.
The limits of direct modulation of emotion for moral enhancement
Authors: Carman Mary
Published: August 2020

Assuming that moral enhancement is morally permissible, I contend that a more careful theoretical treatment of emotion and the affective landscape is needed to advance both our understanding and the prospects of interventions aimed at moral enhancement. Using Douglas’ proposal for the direct modulation of counter‐moral emotions as a foil for discussion, I argue that the direct modulation of emotion fails to address underlying aspects of an agent’s psychology that will give rise to a range of counter‐moral motives beyond the emotion that is targeted. This is because the direct modulation of emotion does not accommodate the fact that an emotional episode or emotional disposition is part of a network of other dispositions and responses, against a backdrop of our having cares and goals, as well as other cognitive content that can mediate how we apprehend a situation. By focusing on emotion rather than on moral capacity as other critiques have done, I thus argue that direct modulation is likely to be ineffective, and, more positively, by drawing out patterns of connections across the affective landscape, we can better tease out what it is that we should really be targeting if we are to achieve robust and meaningful moral change.
Reverse Inclusion: Black Francophones in the Interface between Anti‐Black Racism and Linguicism
Authors: Madibbo Amal
Published: August 2020

In this article, I contend that first generation of Black African Francophone immigrants in Canada regress through the three phases of immigration, which are settlement, adaptation, and integration. This plight occurs while immigrants ought to be progressing from a phase of immigration to a succeeding one. It is generated by linguicism and anti‐Black racism that afflict Black Francophones. Settlement is largely successful, adaption is largely a failure, while integration is completely a failure. This critical analysis problematizes a quandary about Canada and paves the way for implementing mechanism to improve the inclusion of Black Francophones.
Far‐Right Framing Processes on Social Media: The Case of the Canadian and Quebec Chapters of Soldiers of Odin
Authors: Gagnon Audrey
Published: August 2020

In recent years, Canada has witnessed an increase in visibility of far‐right groups and activities. This phenomenon is particularly interesting as it contrasts with the broader Canadian context of acceptance of immigrants and support for multiculturalism. How do far‐right groups represent themselves and their claims to the public considering the dominant discursive environment in which they operate? Moreover, are far‐right groups’ discourse and rhetoric marked by contextual differences? This paper analyzes the way the distinct Canadian and Quebec chapters of the vigilante group Soldiers of Odin (SOO) use their public Facebook pages, comparatively. This research demonstrates that both SOO chapters negotiate their self‐representation by employing cultural elements that are salient and meaningful in their respective sociopolitical contexts and that can be exploited to infer motivations.
Mapping the body, voicing the margins: Using body maps to understand children’s embodied experiences of violence in Kingston, Jamaica
Authors: D’souza Nicole A. , Guzder Jaswant , Hickling Frederick , Groleau Danielle
Published: August 2020

The study explores how children in an inner‐city community of Jamaica deal with everyday violence. Using an art‐based method called body mapping, we explored the ways children made sense of issues related to power, vulnerability, risk and resilience. The findings show how children's narratives and memories of their bodies merged with broader social and cultural structures governing their lives. Expressing their embodied experiences through the body mapping exercise, the children challenged and resisted normative sociocultural schemes of how they should be in the world by creating, re‐envisioning and re‐contextualising their bodies via a method that engaged with affective modes of knowledge.
The crosstalk between lncRNAs and the Hippo signalling pathway in cancer progression
Authors: Tu Chao , Yang Kexin , Wan Lu , He Jieyu , Qi Lin , Wang Wanchun , Lu Qiong , Li Zhihong
Published: August 2020

LncRNAs play a pivotal role in the regulation of epigenetic modification, cell cycle, differentiation, proliferation, migration and other physiological activities. In particular, considerable studies have shown that the aberrant expression and dysregulation of lncRNAs are widely implicated in cancer initiation and progression by acting as tumour promoters or suppressors. Hippo signalling pathway has attracted researchers’ attention as one of the critical cancer‐related pathways in recent years. Increasing evidences have demonstrated that lncRNAs could interact with Hippo cascade and thereby contribute to acquisition of multiple malignant hallmarks, including proliferation, metastasis, relapse and resistance to anti‐cancer treatment. Specifically, Hippo signalling pathway is reported to modulate or be regulated by widespread lncRNAs. Intriguingly, certain lncRNAs could form a reciprocal feedback loop with Hippo signalling. More speculatively, lncRNAs related to Hippo pathway have been poised to become important putative biomarkers and therapeutic targets in human cancers. Herein, this review focuses on the crosstalk between lncRNAs and Hippo pathway in carcinogenesis, summarizes the comprehensive role of Hippo‐related lncRNAs in tumour progression and depicts their clinical diagnostic, prognostic or therapeutic potentials in tumours.
Lesion‐targeted cytology to improve cytological sampling for atypical polypoid adenomyomas of the uterus: A case series and review of the literature
Authors: Omori Makiko , Kawai Masataka , Ogawa Tatsuyuki , Sasatsu Satoko , Fukasawa Hiroko , Nakazawa Kumiko , Kondo Tetsuo , Hirata Shuji
Published: August 2020

Objective

Atypical polypoid adenomyomas (APAs) are uncommon tumours consisting of atypical endometrioid glands and fibromyomatous stroma. Identifying the biphasic nature of atypical glandular components and spindle mesenchymal components without atypia is crucial for the cytological diagnosis of APA. We investigated the utility of lesion‐targeted cytology (LTC) to directly collect firm spindle components.

Methods

We recruited seven consecutive surgical patients who underwent cytological examinations before surgery and were diagnosed with APA on postoperative histological examinations. Cytological smears were obtained by routine sampling in five cases and by targeted sampling using transvaginal ultrasonography, that is, LTC, in two cases. We retrospectively analysed the cytological findings from our cases and compared them to those of APA cases previously reported in the English literature.

Results

Among 5/7 cases that involved routine cytological sampling, normal cytological findings were found in 2 and atypical glandular cells were found in 3, but spindle cells from mesenchymal components were not detected. In contrast, among 2/7 cases in which sampling involved LTC, spindle cells without atypia, in addition to atypical glandular cells were found.

Conclusions

Lesion‐targeted cytology is useful to assess mesenchymal components of APAs and may improve the cytological diagnosis of APA.
Endocrinology and immunology of acne: Two sides of the same coin
Authors: Zouboulis Christos C.
Published: August 2020

Current experimental research on acne pathophysiology has revealed a more complicated background than the classically reported four‐factor aetiology. Cells of the pilosebaceous unit, which represent the template for the development of acne lesions, seem to be parallelly affected by endocrinological/metabolic factors as well as inflammatory/immunological ones that cooperate in sebocyte differentiation and lipogenesis. Indeed, the unique programme of sebocyte terminal differentiation and death, the so called holocrine secretion, is influenced by inflammatory and metabolic (lipid) signalling with common denominator the selective regulation of peroxisome proliferator‐activated receptors. Autophagy provides substrates for energy generation and biosynthesis of new cell structure proteins contributing to the normally increased sebaceous gland metabolic functions, which are also regulated by extracellular calcium signalling, essential lipids and hormones. The ultimate differentiation product of human sebocytes, sebum, co‐regulates the inflammatory sebocyte status. Sebum composition is controlled among others by Propionibacterium acnes and other bacteria, sexual hormones, neuropeptides, endogenous opioids and environmental agents, which may function as endocrine disruptors. Diet may also be an important source of substrates for the synthesis of pro‐inflammatory and anti‐inflammatory sebaceous lipids. Sebum changes might induce inflammation and initiate underlying immune mechanisms leading to acne lesions. Current new therapeutic efforts on acne concentrate on anti‐inflammatory/immunologically active concepts, which are able to regulate sebaceous lipogenesis. At last, current molecular studies based on published molecular data sets confirmed the major role of inflammation in acne development.
Quantifying the effect of landscape structure on transport costs for biorefinery of agricultural and forestry wastes in Malaysia
Authors: Ong Chulee , Deprés Gabrielle , Hollebecq Jean‐Eudes , Shaiffudin Hishamudin Mohammad O. , Kamaruddin Norfaryanti , Anugerah Adhe R. , Amir Mustafa Amira N. , Roda Jean‐Marc
Published: August 2020

In the context of climate change, sustainable biorefinery helps to mitigate carbon emissions. This paper examines how landscape structure metrics allow us to better understand the economics of agricultural and forestry wastes transportation. To verify that the landscape structure plays a significant role, we quantify the fragmentation of various lignocellulosic feedstock in Malaysia, as a typical tropical country. Fragmentation is compared with the variations of truck size, transport distance, and biomass nature. We use GRASS GIS to develop a series of transport cost maps, to quantify feedstocks, to run various biomass transport simulations, optimize locations of potential biorefineries, and to compute landscape structure metrics. We find that the cost of 1 million tonnes feedstock increases by more than 4 USD/tonne for every added unit of edge density (fragmentation index). It also increases by more than 6 USD/tonne for every added 100 km of average transportation. The average truck size has also a strong nonlinear relation to the cost with −84 USD/tonne when changing from 3‐ to 26‐tonne trucks. To our knowledge, this is the first paper to address simultaneously fragmentation with the other classical logistic factors in a tropical country like Malaysia. It has strong implications for policymakers: the importance of the landscape structure makes a seemingly abundant biomass not viable for biorefineries if too fragmented compared to a much less abundant one, but more concentrated. It also implies that in tropical countries where the landscape is typically very fragmented, multi‐crop feedstocks could be considered for sustainable biorefineries.
Optimizing serum total carbon dioxide concentration during short and nocturnal frequent hemodialysis using lactate as dialysate buffer base
Authors: Leypoldt John K. , Kraus Michael A. , Collins Allan J.
Published: August 2020

Introduction

Definitive clinical studies to determine the optimal dialysate lactate concentration to prescribe during frequent hemodialysis when using the NxStage System One dialysis delivery system at low dialysate flow rates have not been reported.

Methods

We used clinical data from patients who transferred from in‐center thrice‐weekly hemodialysis (ICHD) to daily home hemodialysis using the NxStage System One and the H+ mobilization model to calculate acid generation rates in patient sub‐groups during the FREEDOM study. Assuming those acid generation rates were representative, we then predicted using the H+ mobilization model the effect of using dialysate lactate concentrations of 40 and 45 mEq/L on predialysis serum total carbon dioxide (tCO2) concentrations in patients who transfer from ICHD to short and nocturnal frequent hemodialysis prescriptions used in current clinical practice; the prescriptions evaluated varied by treatment frequency, dialysate volume per treatment, and treatment times.

Findings

With frequencies of four to six treatments per week and treatment times of 170 to 210 minutes per treatment, the effect of dialysate lactate concentration was primarily dependent on weekly dialysate volume. For weekly dialysate volumes of 150 to 160 L per week, use of dialysate lactate concentrations of 45 mEq/L, but not 40 mEq/L, resulted in an increase of predialysis serum tCO2 concentration. When longer treatment times typical of nocturnal frequent hemodialysis were evaluated, model predictions showed that the use of dialysate lactate concentration of 45 mEq/L may not be appropriate for many patients because of excessive increases in predialysis serum tCO2 concentration. Reducing dialysate volume from 60 to 30 L may limit the increase in predialysis serum tCO2 concentration when patients transfer from ICHD to nocturnal frequent hemodialysis.

Discussion

Predictions from the H+ mobilization model show that dialysate lactate concentration and weekly dialysate volume are the primary prescription parameters for optimizing predialysis serum tCO2 concentration during short and nocturnal frequent hemodialysis.
Obstacles to compassion‐giving among nursing and midwifery managers: an international study
Authors: Papadopoulos I. , Lazzarino R. , Koulouglioti C. , Aagard M. , Akman Ö. , Alpers L.‐M. , Apostolara P. , Araneda Bernal J. , Biglete‐Pangilinan S. , Eldar‐Regev O. , González‐Gil M.T. , Kouta C. , Krepinska R. , Lesińska‐Sawicka M. , Liskova M. , Lopez‐Diaz A. L. , Malliarou M. , Martín‐García Á. , Muñoz‐Salinas M. , Nagórska M. , Ngunyulu R.N. , Nissim S. , Nortvedt L. , Oconer‐Rubiano M.F. , Oter‐Quintana C. , Öztürk C. , Papp K. , Piratoba‐Hernandez B. , Rousou E. , Tolentino‐Diaz M. Y. , Tothova V. , Zorba A.
Published: August 2020

Aim

To explore nursing and midwifery managers’ views regarding obstacles to compassion‐giving across country cultures.

Background

The benefit of compassionate leadership is being advocated, but despite the fact that health care is invariably conducted within culturally diverse workplaces, the interconnection of culture, compassion and leadership is rarely addressed. Furthermore, evidence on how cultural factors hinder the expression of compassion among nursing and midwifery managers is lacking.

Methods

Cross‐sectional, exploratory, international online survey involving 1 217 participants from 17 countries. Managers’ responses on open‐ended questions related to barriers for providing compassion were entered and thematically analysed through NVivo.

Results

Three key themes related to compassion‐giving obstacles emerged across countries: 1. related to the managers’ personal characteristics and experiences; 2. system‐related; and 3. staff‐related.

Conclusions

Obstacles to compassion‐giving among managers vary across countries. An understanding of the variations across countries and cultures of what impedes compassion to flourish in health care is important.

Implications for nursing practice and policy

Nursing mangers should wisely use their power by adopting leadership styles that promote culturally competent and compassionate workplaces with respect for human rights. Policymakers should identify training and mentoring needs to enable the development of managers’ practical wisdom. Appropriate national and international policies should facilitate the establishment of standards and guidelines for compassionate leadership, in the face of distorted organizational cultures and system‐related obstacles to compassion‐giving.
Microbiological profile and antimicrobial resistance among diabetic foot infections in Lebanon
Authors: Jouhar Lamia , Jaafar Rola F. , Nasreddine Rakan , Itani Omar , Haddad Fady , Rizk Nisrine , Hoballah Jamal J.
Published: August 2020

Diabetic Foot Infection (DFI) is a challenging complication of diabetes mellitus with a high burden in the Middle East where there is a marked increase in diabetes prevalence and complications. Early detection of DFI and the infectious organisms could result in the early initiation of appropriate antibiotic therapy and improved outcomes. DFI microbiological profiles differ between countries. In our region, Western guidelines are used when initiating treatment for DFI in the absence of local guidance. The purpose of our study was to determine the microbiologic profile and antimicrobial susceptibility of the DFI admissions at a large tertiary referral centre in Beirut and review other reported series in Lebanon and our region. This is a retrospective observational study of patients with DFI admitted to the American University of Beirut Medical Centre from January 2008 to June 2017. The bacteriologic isolation and antimicrobial susceptibility tests were performed according to standard microbiological methods. Between 2008 and 2017, 319 diabetic patients with DFU were admitted to AUBMC, and deep‐tissue cultures were taken for 179 patients. From 179 deep tissue cultures, 314 bacterial isolates were obtained. Fifty‐four percent of patients had the polymicrobial infection. Aerobic gram‐negative rods (GNR) were more prevalent than gram‐positive cocci (GPC) (55%, 39%, respectively). The most common isolate was Escherichia coli (15%) followed by Enterococcus (14%) and Pseudomonas aeruginosa (11%). Staphylococcus aureus isolates accounted for 9% with 50% of them being methicillin‐resistant (MRSA). Among Enterobacteriaceae, 37% of isolates were fluoroquinolone‐resistant, 25% were ESBL producers, and 2% were carbapenem‐resistant. Antibiotic resistance was significantly associated with prior usage of antibiotics. Anaerobes were isolated in 1% and Candida species in 5% of isolates. The sensitivity, specificity, PPV, and NPV of swab culture recovery of pathogens compared with deep tissue culture were (76%, 72%, 76%, 72%) and (94%, 81%, 91%, 86%) for gram‐positive and gram‐negative organisms, respectively. The microbiological profile of DFI in Lebanon is comparable to other countries in the MENA region with big differences compared with the West. Therefore, it is imperative to develop local guidelines for antimicrobial treatment. The high prevalence of GNR in DFI and the high fluoroquinolone resistance should be taken into consideration when choosing empiric antibiotics. Empiric treatment for MRSA or Pseudomonas does not appear necessary except for patients with specific risk factors.
Utility of azathioprine, methotrexate and cyclosporine as steroid‐sparing agents in chronic alopecia areata: a retrospective study of continuation rates in 138 patients
Authors: Lai V.W.Y. , Sinclair R.
Published: August 2020

Background

The management of chronic alopecia areata (CAA) is challenging. There is currently no therapy that produces consistent successful hair regrowth. Systemic therapies, including prednisolone and steroid‐sparing agents (SSA), are often tried in patients with CAA. As there are no head‐to‐head clinical trials that compare efficacy of one SSA over another, retrospective studies of treatment in clinical practice may help guide clinical practice.

Objective

To investigate the utility of SSAs in the treatment of AA.

Methods

An electronic medical records search identified patients with AA and those prescribed azathioprine, cyclosporine or methotrexate between 2002 and 2019. Type of AA, treatment duration, reason for cessation, use of concurrent prednisolone, dose of prednisolone and duration of prednisolone use were recorded. The primary outcome was SSA continuation rate at 6 and 12 months.

Results

A total of 852 AA patients were identified, among whom 138 patients had been treated with azathioprine, methotrexate or cyclosporine. Of these 138 patients treated with a SSA, 92 (66.7%) continued treatment for at least 12 months: 75.3% (55/73) of azathioprine users, 50% (11/22) of methotrexate users and 60.5% (26/43) of cyclosporine users. At 12 months, 67.3% of azathioprine users required concurrent prednisolone at a mean dose of 5.6 mg daily, 63.6% of methotrexate users required prednisolone at a mean dose of 5 mg daily and 57.7% of cyclosporine users required prednisolone at a mean dose of 8.7 mg daily. The SSA was ceased due to an adverse event in 15.9% of patients and a lack of efficacy in 17.4%.

Conclusion

The most well‐utilized SSA for CAA patients at our clinic was azathioprine. This study highlights that most CAA patients who commence treatment with azathioprine, methotrexate or cyclosporine continue that treatment for at least 12 months and most require concurrent low‐dose prednisolone to maintain remission or promote continued hair regrowth.
Short bowel syndrome and the impact on patients and their families: a qualitative study
Authors: Sowerbutts A. M. , Panter C. , Dickie G. , Bennett B. , Ablett J. , Burden S. , Lal S.
Published: August 2020

Background

Short bowel syndrome (SBS) is a malabsorptive condition that can result in intestinal failure (SBS‐IF). Many patients with SBS‐IF require home parenteral nutrition (PN) for survival. However, PN has profound effects on patients and their family members. The present study aimed to understand the lived experience of SBS‐IF for patients and their families.

Methods

In‐depth semi‐structured qualitative interviews were conducted with 15 patients with SBS‐IF and five adult family members living with someone with SBS‐IF. A patient‐centric approach was taken, with a patient steering group providing input and guidance to develop the interview guide. Key concepts were identified using thematic analysis of interview transcripts.

Results

Patients’ lives were dominated by having SBS‐IF. They described physical impacts that included patient‐reported signs and symptoms and physical restrictions comprising of restrictions on daily life, actives of daily living and physical functioning. In addition, they encountered emotional impacts with a plethora of negative feelings and social impacts, such as difficulties socialising and maintaining relationships. Patients coped by adapting their life around SBS‐IF, having support and adopting an attitude of gratitude and acceptance. Family members were also affected and, along with patients, appreciated the respite of a night off from infusions.

Conclusions

Patients and families face many difficulties with SBS‐IF. Healthcare professionals can support patients by facilitating them explore what others have found beneficial; adapting their life around PN, viewing PN with acceptance and trying to cultivate gratitude. Further research into the support required for families may be beneficial.
Psychometric properties of long‐term care needs questionnaire for older Chinese adults with dementia
Authors: Sun Ning , Jia Rangcheng , Guo Chunyan , Sun Tongda , Dong Xiaoxin , Li Long
Published: August 2020

Aim

Long‐term care needs are important for older adults with dementia in the West, but they have not received enough attention from China. This study evaluated the psychometric properties of a long‐term care needs instrument for older Chinese adults with dementia.

Methods

A total of 1,212 older adults with dementia were recruited from five Chinese cities to complete a 30‐item long‐term care needs questionnaire. The reliability and validity of the questionnaire was evaluated using multiple assessments, including a content validity assessment, Cronbach's alpha, an item‐to‐total correlation test, and exploratory factor analysis.

Results

The questionnaire was divided into four sub‐sections: life care services (eight items), basic and specialist care services (12 items), mental comfort psychological services (four items), and homecare support services (six items). Cronbach's alpha was .93 for the whole questionnaire and ranged from .83 to .92 for the four sub‐questionnaires. The item‐to‐total correlation coefficients for the four sub‐questionnaires were between .68 and .88, and the test–retest correlation coefficient was .88.

Conclusion

Our results validated the reliability and validity of a questionnaire designed to measure the quality of long‐term care services for older Chinese adults with dementia.
Co‐expression gene modules involved in cisplatin‐induced peripheral neuropathy according to sensitivity, status, and severity
Authors: Zhou Rui‐Hao , Chen Chan , Jin Su‐Han , Li Jun , Xu Zi‐Hao , Ye Ling , Zhou Jian‐Guo
Published: August 2020

Chemotherapy‐induced peripheral neuropathy (CIPN) is among the most disabling and frustrating problems for cancer survivors. The neurotoxicity caused by cisplatin varies greatly among patients, and few predictors of appearance, duration of symptoms, susceptibility, or severity are available. A deeper understanding of the mechanisms underlying individual differences in status, severity, or sensitivity in response to cisplatin treatment is therefore required. By analyzing the GSE64174 gene expression profile and constructing a weighted gene co‐expression network analysis (WGCNA) network, we screened gene modules and hub genes related to CIPN status, severity and sensitivity. We first identified the transcriptome profile of mouse dorsal root ganglion (DRG) samples and transformed their genes to human DRG counterparts. We then constructed WGCNA gene modules via optimal soft‐threshold power‐identification and module‐preservation analysis. Comprehensive analysis and identification of module hub genes were performed via functional‐enrichment analysis and significant common hub genes were identified, including “Cytoscape_cytoHubba,” “Cytoscape_MCODE,” and “Metascape_MCODE.” Brown, green, and blue modules were selected to represent CIPN sensitivity, status, and severity, respectively, via trait‐module correlational analysis. Additionally, functional enrichment analysis results indicated that these three modules were associated with some crucial biological functions, such as neutrophil migration, chemokine‐mediated signaling pathway, and PI3K‐Akt signaling pathway. We then identified seven common hub genes via three methods, including CXCL10, CCL21, CCR2, CXCR4, TLR4, NPY1R, and GALR2, related to CIPN status, severity and sensitivity. Our results provide possible targets and mechanism insights into the development and progress of CIPN, which can guide further transformation and pre‐clinical research.
Impact of tocolysis‐intent magnesium sulfate and beta‐adrenergic agonists on perinatal brain damage in infants born between 28–36 weeks' gestation
Authors: Kino Emi , Ohhashi Masanao , Kawagoe Yasuyuki , Sameshima Hiroshi , Kamitomo Masato , Suga Sachie , Yasuhi Ichiro , Funakoshi Toru
Published: August 2020

Aims

Magnesium sulfate has neuroprotective effects in preterm infants. Whether other antepartum treatments interfere with the neuroprotective actions is not well known. This study aims to explore the impacts of antenatal administration of Magnesium sulfate or beta‐2 adrenergic agonists as tocolytic agents on the developing brain in premature infants.

Methods

This is a retrospective cohort study in four tertiary perinatal centers in Japan. We collected data of pregnant women and infants born between 28 and 36 weeks for tocolytic agents, gestational age, sex, antenatal corticosteroid, fetal growth restriction, pathological chorioamnionitis, low umbilical arterial pH values (<7.1), multiple pregnancy, mode of delivery and institutions after excluding clinical chorioamnionitis, non‐reassuring fetal status or major anomalies. Tocolytic agents were categorized into four groups: no‐tocolysis, magnesium sulfate, beta‐2 adrenergic agonists and the combination of them. We conducted multiple comparisons with multivariate analyses using generalized linear regression models to compare the prevalence of a poor perinatal outcome defined as infant's death, brain damage, particularly cerebral palsy and developmental delay.

Results

Among 1083 infants, 39% were no‐tocolysis, 47% were magnesium sulfate, 41% were beta‐2 adrenergic agonists and 27% were combination group, including the duplication. The incidence of poor perinatal outcome was decreased by magnesium sulfate (OR 0.27, 95% CI 0.10–0.72), but not changed significantly by beta‐2 adrenergic agonists (OR 1.28, 95% CI 0.63–2.59) or the combination group (OR 2.24, 95% CI 0.67–7.54), compared with the no‐tocolysis.

Conclusion

The combination therapy for tocolysis with beta‐2 adrenergic agonists diminished the magnesium sulfate neuroprotective action after adjusting for covariables.
Survey on the use of personal protective equipment and COVID‐19 testing of pregnant women in Japan
Authors: Umazume Takeshi , Miyagi Etsuko , Haruyama Yasuo , Kobashi Gen , Saito Shigeru , Hayakawa Satoshi , Kawana Kei , Ikenoue Satoru , Morioka Ichiro , Yamada Hideto
Published: August 2020

Aim

To clarify the status of personal protective equipment (PPE) and coronavirus disease 2019 (COVID‐19) tests for pregnant women, we conducted an urgent survey.

Methods

The survey was conducted online from April 27 to May 1, 2020. Questionnaires were sent to core facilities and affiliated hospitals of the obstetrics and gynecology training program and to hospitals of the national perinatal medical liaison council.

Results

A total of 296 institutions participated in our survey; however, 2 institutions were excluded. Full PPE was used by doctors in 7.1% of facilities and by midwives in 6.8%. Our study also determined that around 65.0% of facilities for doctors and 73.5% of facilities for midwives used PPE beyond the “standard gown or apron, surgical mask, goggles or face shield” during labor of asymptomatic women. N95 masks were running out of stock at 6.5% of the facilities and goggles and face shields at 2.7%. Disposable N95 masks and goggles or face shields were re‐used after re‐sterilization in 12% and 14% of facilities, respectively. Polymerase chain reaction (PCR) testing of asymptomatic patients was performed for 9% of vaginal deliveries, 14% of planned cesarean sections and 17% of emergency cesarean sections. The number of PCR tests for obstetrics and gynecology per a week ranged from zero to five in 92% of facilities.

Conclusion

The shortage of PPE in Japan is alarming. Sufficient stockpiling of PPE is necessary to prevent unnecessary disruptions in medical care. Appropriate guidelines for PPE usage and COVID‐19 testing of pregnant women at delivery are needed in Japan.
Successful treatment of severe intra‐amniotic inflammation and cervical insufficiency with continuous transabdominal amnioinfusion and cerclage: A case report
Authors: Ikeda Masazumi , Ono Takeshi , Tsumura Keisuke , Yamasaki Fumio , Nomiyama Makoto , Yokoyama Masatoshi
Published: August 2020

Severe intra‐amniotic inflammation, even with a negative bacterial culture, can lead to premature labor. We report a 43‐year‐old multiparous woman with severe intra‐amniotic inflammation and cervical insufficiency at 23 weeks and 5 days of gestation. Continuous transabdominal amnioinfusion was started 2 days after the diagnosis. The amniotic fluid interleukin‐6 level normalized after 2 days of treatment. She underwent Shirodkar cervical cerclage on day 7. Despite termination of amnioinfusion and catheter removal on day 16, the pregnancy was maintained without any subsequent treatment. At 33 weeks and 5 days of gestation, an intrauterine Ureaplasma parvum infection and the onset of contractions led to repeat cesarean delivery. The birth weight was 2292 g, and the Apgar scores were 8/8. Both mother and infant had good outcomes. Continuous transabdominal amnioinfusion may have eliminated factors causing intra‐amniotic inflammation, thereby prolonging the pregnancy and improving the infant's prognosis.
Antepartum eclampsia with reversible cerebral vasoconstriction and posterior reversible encephalopathy syndromes
Authors: Ueno Shuntaro , Takeda Jun , Maruyama Yojiro , Makino Shintaro , Miyamoto Nobukazu , Itakura Atsuo
Published: August 2020

A 39‐year‐old pregnant woman was experienced thunderclap headache due to reversible cerebral vasoconstriction syndrome (RCVS) as a prodromal symptom. Two days after, she was brought to our hospital after an eclamptic seizure at 35 weeks of gestation. After management with magnesium sulphate, a cesarean delivery was performed, and passed without eclamptic seizure recurrence with calcium channel blocker (CCB) administration for hypertension and prophylaxis of another seizure. Antepartum eclampsia is sometimes complicated by headache as a prodromal symptom. Cerebrovascular diseases in the perinatal period include eclampsia, RCVS and posterior reversible encephalopathy syndrome, which have potentially overlapping pathologies. Here, we first report a case of overlapping those three diseases in the antepartum period. Our best literature review showed that antepartum RCVS is severe and has complications besides thunderclap headache, and there is a case report which CCB administration was shown to be effective in the treatment of antepartum RCVS. If thunderclap headache is recognized, prediction of eclampsia and getting better course of RCVS with CCB administration may be possible.
High Resolution Proteome of Lipid Droplets Isolated from the Pennate Diatom Phaeodactylum tricornutum (Bacillariophyceae) Strain pt4 provides mechanistic insights into complex intracellular coordination during nitrogen deprivation
Authors: Leyland Ben , Zarka Aliza , Didi‐Cohen Shoshana , Boussiba Sammy , Khozin‐Goldberg Inna
Published: August 2020

Lipid droplets (LDs) are an organelle conserved amongst all eukaryotes, consisting of a neutral lipid core surrounded by a polar lipid monolayer. Many species of microalgae accumulate LDs in response to stress conditions, such as nitrogen starvation. Here, we report the isolation and proteomic profiling of LD proteins from the model oleaginous pennate diatom Phaeodactylum tricornutum, strain Pt4 (UTEX 646). We also provide a quantitative description of LD morphological ontogeny, and fatty acid content. Novel cell disruption and LD isolation methods, combined with suspension‐trapping and nanoflow liquid chromatography coupled to high resolution mass spectrometry, yielded an unprecedented number of LD proteins. Predictive annotation of the LD proteome suggests a broad assemblage of proteins with diverse functions, including lipid metabolism and vesicle trafficking, as well as ribosomal and proteasomal machinery. These proteins provide mechanistic insights into LD processes, and evidence for interactions between LDs and other organelles. We identify for the first time several key steps in diatom LD‐associated triacylglycerol biosynthesis. Bioinformatic analyses of the LD proteome suggests multiple protein targeting mechanisms, including amphipathic helices, post‐translational modifications, and translocation machinery. This work corroborates recent findings from other strains of P. tricornutum, other diatoms, and other eukaryotic organisms, suggesting that the fundamental proteins orchestrating LDs are conserved, and represent an ancient component of the eukaryotic endomembrane system. We postulate a comprehensive model of nitrogen starvation‐induced diatom LDs on a molecular scale, and provide a wealth of candidates for metabolic engineering, with the potential to eventually customize LD contents.
Comparative pharmacokinetics and pharmacokinetic/pharmacodynamic analysis by nonlinear mixed‐effects modeling of cefquinome in nonpregnant, pregnant, and lactating goats after intravenous and intramuscular administration
Authors: Litterio Nicolás Javier , Lorenzutti Augusto Matías , Zarazaga María del Pilar , Himelfarb Martín Alejandro , San Andrés‐Larrea Manuel Ignacio , Serrano‐Rodríguez Juan Manuel
Published: August 2020

Cefquinome is a fourth‐generation cephalosporin that is used empirically in goats. Different physiologic factors like pregnancy or lactation could determine the pharmacokinetic behavior of drugs in the organism. The objectives of this study are to (a) compare the pharmacokinetics of cefquinome after intravenous and intramuscular administration in adult nonpregnant (n = 6), pregnant (n = 6), and lactating goats (n = 6), at a dose of 2 mg/kg, with rich sampling by nonlinear mixed‐effects modeling, (b) conduct a pharmacokinetic/pharmacodynamic analysis to evaluate the efficacy of the recommended posology in goats with different physiological states, and (c) determine the optimal posology that achieve a PTA value ≥ 90%, taking into account a T > MIC ≥ 60% of a MIC value ≤ 0.25 µg/ml, in the different subpopulations of goats for both routes. Gestation significantly increased Ka and V1, while reduced F0, Cl, and Q. On the other hand, lactation significantly increased V1 and reduced Tk0. Cefquinome concentrations achieved in placental cotyledon, amniotic fluid, and fetal serum indicate a minimal penetration across the placental barrier. Moreover, milk penetration of cefquinome was minimal. The total body clearance of cefquinome for goats was 0.29 L kg−1 hr−1, that is apparently higher than the reported for cows (0.13 L kg−1 hr−1) and pigs (0.16 L kg−1 hr−1). So, the optimal dose regimen for cefquinome after intravenous and intramuscular administration required higher dose and frequency of administration compared with recommendations for cows or pigs. Therefore, 2 mg kg−1 8 hr−1 and 5 mg kg−1 12 hr−1 could be used for IV and IM routes, respectively, for the treatment of respiratory infections caused by P. multocida and M. haemolytica, but only 5 mg kg−1 12 hr−1 by both routes should be recommended for Escherichia coli infections.