bluuebunny/crossref_metadata_2025 huggingface dataset:
Case report: cardiac herniation following robotic-assisted thymectomy
Authors: Espey John , Acosta Stephen , Kolarczyk Lavinia , Long Jason
Published: March 2020

Background

The first reported case of cardiac herniation was in 1948 and occurred following pericardiectomy during a lung cancer resection. Although rare, this potentially fatal surgical complication may occur following any operation in which a pericardial incision or resection is performed. The majority of literature on cardiac herniation involves case reports after intrapericardial pneumonectomy. Currently, there are no reports of cardiac herniation after thymectomy with pericardial resection.

Case presentation

A 44-year-old Asian female with symptomatic myasthenia gravis was referred for thymectomy. Originally thought to have Bell’s Palsy, her symptoms began with right eyelid drooping and facial weakness. Over time, she developed difficulty holding her head up, upper extremity weakness, difficulty chewing and dysarthria. These symptoms worsened with activity. She was found to have positive acetylcholine receptor binding antibody on her myasthenia gravis panel. A preoperative CT scan demonstrated a 3.5 cm × 2 cm anterior mediastinal mass along the right heart border and phrenic nerve. A complete thymectomy, via right-sided robotic-assisted approach was performed en bloc with a portion of the right phrenic nerve and a 4 cm × 4 cm portion of pericardium overlying the right atrium and superior right ventricle. Upon undocking of the robot and closure of the port sites, the patient became acutely hypotensive (lowest recorded blood pressure 43/31 mmHg). The camera was reinserted and demonstrated partial cardiac herniation through the anterior pericardial defect toward the right chest. An emergent midline sternotomy was performed and the heart was manually reduced. The patient’s hemodynamics stabilized. A vented Gore-Tex 6 cm × 6 cm patch was sewn along the pericardial edges with interrupted 4–0 prolene to close the pericardial defect.

Conclusion

This potentially fatal complication, although rare, should always be considered whenever there is hemodynamic instability entry or resection of the pericardium during surgery. We now routinely sew in a pericardial patch using our robotic surgical system for any defect over 3 cm × 3 cm that extends from the mid- to inferior portions of the heart.
Completing the ENCODE3 compendium yields accurate imputations across a variety of assays and human biosamples
Authors: Schreiber Jacob , Bilmes Jeffrey , Noble William Stafford
Published: March 2020

Recent efforts to describe the human epigenome have yielded thousands of epigenomic and transcriptomic datasets. However, due primarily to cost, the total number of such assays that can be performed is limited. Accordingly, we applied an imputation approach, Avocado, to a dataset of 3814 tracks of data derived from the ENCODE compendium, including measurements of chromatin accessibility, histone modification, transcription, and protein binding. Avocado shows significant improvements in imputing protein binding compared to the top models in the ENCODE-DREAM challenge. Additionally, we show that the Avocado model allows for efficient addition of new assays and biosamples to a pre-trained model.
PCR-based molecular identification of two intermediate snail hosts of Schistosoma mansoni in Cameroon
Authors: Tchami Mbagnia Mureille Carole , Melachio Tanekou Tito Trésor , Kengne Fokam Alvine Christelle , Nguiffo Nguete Daniel , Wondji Charles Sinclair , Njiokou Flobert
Published: March 2020

Background

Snails of the genus Biomphalaria are intermediate hosts of Schistosoma mansoni, the causative agent of the human intestinal schistosomiasis. Two Biomphalaria species (Biomphalaria pfeifferi and Biomphalaria camerunensis) are involved in the transmission in Cameroon, where the disease is present nationwide. However, difficulty in the identification of both vectors impedes proper assessment of the epidemiological burden caused by each species. To overcome this issue, we designed a PCR-based molecular diagnostic tool to improve the identification of these species.

Methods

We analyzed the internal transcribed spacer 2 (ITS2) region of Biomphalaria ribosomal DNA (rDNA) using polymerase chain reaction amplification (PCR) and restriction fragment length polymorphism (RFLP).

Results

The amplification of the ITS2 region of Biomphalaria snails resulted in a 490 bp fragment and produced two profiles for each species after digestion with the restriction enzyme Hpa II. The profile 1 (Bc-HpaII-1: 212-bp and 139-bp bands) for B. camerunensis, was common in all the sampling points; the profile 2 (Bc-HpaII-2: 212-bp and 189-bp bands), was only observed in the Lake Monoun Njindoun sampling site. Biomphalaria pfeifferi profile 1 (Bpf-HpaII-1: 211-bp and 128-bp bands) was common in most of B. pfeifferi sampling points; the profile 2 (Bpf-HpaII-2: 289-bp and 128-bp bands) was only observed in Mokolo (Far North Cameroon).The second restriction enzyme TaqαI, revealed three band profiles, Bc-TaqαI-1 (243-bp, 136-bp and 118-bp bands) and Bc-TaqαI-2 (244-bp, 136-bp and 99-bp) for B. camerunensis and Bpf-TaqαI-1 (242-bp, 135-bp and 107-bp bands) for B. pfeifferi. Sequencing analysis revealed the occurrence of six haplotypes for B. camerunensis and three haplotypes for B. pfeifferi. The level of gene flow was low and the Biomphalaria populations were not in demographic expansion according to neutrality tests (Tajima’s D and Fu’s Fs).

Conclusions

The PCR-RFLP technique revealed genetic diversity in Biomphalaria snails, and the combination with the morphological method could improve the identification of B. pfeifferi and B. camerunensis in Cameroon. This could help focus on the infection to evaluate the transmission risk with respect of the different species and to develop efficient and cost-effective control measures.
Inhibition of effector B cells by ibrutinib in systemic sclerosis
Authors: Einhaus Jakob , Pecher Ann-Christin , Asteriti Elisa , Schmid Hannes , Secker Kathy-Ann , Duerr-Stoerzer Silke , Keppeler Hildegard , Klein Reinhild , Schneidawind Corina , Henes Joerg , Schneidawind Dominik
Published: March 2020

Objective

Systemic sclerosis (SSc) is a connective tissue disease with a significant morbidity and reduced survival of patients. Effective treatment and clinical control of the disease remain challenging. In particular, the development of pulmonary and cardiac fibrosis and pulmonary hypertension are severe complications responsible for excessive mortality. Currently available treatment strategies only alleviate symptoms and slow disease progression. Here, we investigated the therapeutic potential of ibrutinib, a Bruton’s tyrosine kinase (BTK) inhibitor used in B cell malignancies, to alter B cell pathology in SSc in an in vitro model of autoimmunity.

Methods

PBMCs and sorted B cells of 24 patients with SSc were used for functional testing after stimulation with hypomethylated DNA fragments (CpG) to induce an innate immune response. The effects of ibrutinib on cytokine production, autoantibody release, and activation of the transcription factor NFκB were evaluated.

Results

Ibrutinib was able to reduce the production of the profibrotic hallmark cytokines IL-6 and TNF-α mainly from the effector B cell population in patients with SSc. Importantly, small doses of ibrutinib (0.1 μM) preserved the production of immunoregulatory IL-10 while effectively inhibiting hyperactivated, profibrotic effector B cells. In a flow cytometry analysis of phosphorylated NFκB, an important transcription factor in the induction of innate immune responses in B cells, significantly less activation was observed with ibrutinib treatment.

Conclusion

Our data could pave the avenue for a clinical application of ibrutinib for patients with SSc as a novel treatment option for the underlying pathogenetic immune imbalance contributing to disease onset and progression.
Unexpected presentation of accessory breast cancer presenting as a subcutaneous mass at costal ridge: a case report
Authors: Thasanabanchong Peeradech , Vongsaisuwon Mawin
Published: March 2020

Background

During embryogenesis, bilateral thickening of ectoderm from anterior axillary folds to inguinal folds, called mammary ridges or milk lines, develops into breast tissues. Only a pair in the pectoral area is spared from regression and continuously develops into normal breasts. Accessory breasts can result if the regression process is incomplete. These ectopic breasts can change physiologically and pathologically similar to normal breasts. Unsurprisingly, they are capable of turning malignant. Reported cases show the most common area for accessory breast cancer to be the axillary area. We report a rare case of accessory breast cancer over the costal ridge.

Case presentation

We present the case of a 51-year-old Asian woman who complained of an enlarged mass lower to her left breast developed over the period of 3 months while on contraceptive pills. Unaware that the mass could be an accessory breast, the primary doctor had prescribed oral contraceptives. After our patient had noticed that the mass was obviously growing, she decided to consult a surgeon as the mass continued to grow. Expected to be benign, the mass was investigated by ultrasonography and then excised surgically. A pathology report identified the mass to be a carcinoma of the ectopic breast tissue. However, sentinel lymph node biopsy showed no nodal metastasis of all four lymph nodes. Following surgery, she received chemotherapy, radiation, and antihormonal treatment. After 2 years of postoperative follow up, she remained free of disease.

Conclusions

This patient was diagnosed as having accessory breast cancer which presented with a subcutaneous mass. As this condition is exceptionally rare but curable by early treatments, we recommend surgeons to consider potential malignancy when patients present with a subcutaneous mass.
Metastatic malignant melanoma with neuroendocrine differentiation: a case report and review of the literature
Authors: Juhlin Carl Christofer , Zedenius Jan , Haglund Felix
Published: March 2020

Background

Metastatic neuroendocrine carcinoma often presents as carcinoma of unknown primary. Although most cases display immunohistochemical positivity for neuroendocrine markers, subsets of cases display reduced or negative expression for some of these proteins. The identification of metastatic neuroendocrine carcinomas is even more complicated by the occurrence of unrelated tumor types with focal neuroendocrine differentiation.

Case presentation

Our patient was a 74-year-old man of Middle Eastern ethnicity. An initial biopsy of a soft tissue metastasis displayed a neuroendocrine profile indicative of a metastatic neuroendocrine carcinoma, positive for CD56 and synaptophysin, and focally for ISL LIM homeobox 1 and insulinoma-associated protein 1. The Ki-67 index was 50%. Chemotherapy was initiated, but our patient progressed. Scrapings from a pathological hip fracture 3 months later revealed focal synaptophysin immunoreactivity and widespread melanoma antigen, human melanoma black 45, and SOX10 positivity, which are indicative of metastatic malignant melanoma with focal neuroendocrine differentiation.

Conclusions

Malignant melanoma may display neuroendocrine differentiation, and the entity should be considered a rare differential diagnosis when assessing biopsies of suspected neuroendocrine carcinomas.
PTEN inhibitor VO-OHpic attenuates GC-associated endothelial progenitor cell dysfunction and osteonecrosis of the femoral head via activating Nrf2 signaling and inhibiting mitochondrial apoptosis pathway
Authors: Yao Xudong , Yu Shengnan , Jing Xingzhi , Guo Jiachao , Sun Kai , Guo Fengjing , Ye Yaping
Published: March 2020

Background

Glucocorticoid (GC)-associated osteonecrosis of the femoral head (ONFH) is the most common in non-traumatic ONFH. Despite a strong relationship between GC and ONFH, the detailed mechanisms have remained elusive. Recent studies have shown that GC could directly injure the blood vessels and reduce blood supply in the femoral head. Endothelial progenitor cells (EPCs), which were inhibited quantitatively and functionally during ONFH, play an important role in maintaining the normal structure and function of vascular endothelium. Phosphatase and tensin homolog (PTEN) is a tumor suppressor gene that promotes cell apoptosis, and its expression was found to be elevated in GC-associated ONFH patients. However, whether direct inhibition of PTEN attenuates GC-associated apoptosis and dysfunction of the EPCs remains largely unknown.

Methods

We investigated the effect of, VO-OHpic, a potent inhibitor of PTEN, in attenuating GC-associated apoptosis and dysfunction of EPCs and the molecular mechanism. SD rats were used to study the effect of VO-OHpic on angiogenesis and osteonecrosis in vivo.

Results

The results revealed that methylprednisolone (MPS) obviously inhibit angiogenesis of EPCs by inducing apoptosis, destroying the normal mitochondrial structure, and disrupting function of mitochondria. VO-OHpic treatment is able to reverse the harmful effects by inhibiting the mitochondrial apoptosis pathway and activating the NF-E2-related factor 2 (Nrf2) signaling. Si-Nrf2 transfection significantly reduced the protective effects of VO-OHpic on EPCs. Our in vivo studies also showed that intraperitoneal injection of VO-OHpic obviously attenuates the osteonecrosis of the femoral head induced by MPS and potently increases the blood supply in the femoral head.

Conclusion

Taken together, the data suggests that inhibition of PTEN with VO-OHpic attenuates apoptosis and promotes angiogenesis of EPCs in vitro via activating Nrf2 signaling pathway and inhibiting the mitochondrial apoptosis pathway. Moreover, VO-OHpic also mitigates GC-associated ONFH and potentiates angiogenesis in the femoral head.
Sex-specific and shared expression profiles of vulnerability and resilience to trauma in brain and blood
Authors: Kim Grace S. , Uddin Monica
Published: March 2020

Background

While post-traumatic stress disorder (PTSD) is defined by behavioral/cognitive symptoms most directly relevant to brain function, it can be considered a systemic disorder characterized by a distinct inability to reinstate homeostasis after trauma.

Methods

In this study, we conducted a secondary analysis of gene expression profiles in key PTSD-relevant tissues, namely blood, amygdala, and hippocampus, from a rat model of PTSD, to identify sex-specific and shared processes associated with individual differences in response to recent trauma exposure.

Results

Our findings suggest both shared and sex-specific mechanisms underlying individual differences associated with vulnerability and resilience to trauma in hippocampus, amygdala, and blood. By disentangling cell composition from transcriptional changes, we found higher proportions of hippocampal oligodendrocytes in the PTSD-like, extreme behavioral response (EBR) group for both sexes and also identified modules for transcriptional activity associated with group differences (i.e., response to trauma) in the hippocampus that appeared to be sex-specific. By contrast, we found prominent sex differences, but no group differences, in amygdalar cell composition, and both shared and sex-specific modules representing PTSD-relevant transcriptional activity in the amygdala. Across amygdala and hippocampus, both sex-specific and shared processes were relevant to an overarching framework for EBR implicating disrupted TNFα/NFκΒ signaling and excitatory/inhibitory imbalance in dysregulated synaptic/structural plasticity with important implications for fear learning and memory. Our main finding in peripheral blood was consistent with the human literature and identified wound healing processes and hemostasis to be upregulated in the resilient, minimal behavioral response (MBR) group across sexes, but disrupted in a sexually dimorphic manner in the EBR group.

Conclusion

In contrast to the varied characterization of the PTSD-like EBR group, characterization of MBR across blood, amygdala, and hippocampus suggests a common theme of upregulated wound healing and extracellular matrix (ECM) remodeling shared between sexes. In all, we identified differential oligodendrocyte proportions in hippocampus between PTSD-like EBR and resilient MBR, and identified processes and pathways that characterize the EBR and MBR-associated transcriptional changes across hippocampus, amygdala, and blood. The sex-specific mechanisms involved in EBR may contribute to the pronounced disparity in risk for PTSD, with women much more likely to develop PTSD.
A three layered histone epigenetics in breast cancer metastasis
Authors: Nandy Debparna , Rajam Sruthy Manuraj , Dutta Debasree
Published: March 2020

Thanks to the advancement in science and technology and a significant number of cancer research programs being carried out throughout the world, the prevention, prognosis and treatment of breast cancer are improving with a positive and steady pace. However, a stern thoughtful attention is required for the metastatic breast cancer cases—the deadliest of all types of breast cancer, with a character of relapse even when treated. In an effort to explore the less travelled avenues, we summarize here studies underlying the aspects of histone epigenetics in breast cancer metastasis. Authoritative reviews on breast cancer epigenetics are already available; however, there is an urgent need to focus on the epigenetics involved in metastatic character of this cancer. Here we put forward a comprehensive review on how different layers of histone epigenetics comprising of histone chaperones, histone variants and histone modifications interplay to create breast cancer metastasis landscape. Finally, we propose a hypothesis of integrating histone-epigenetic factors as biomarkers that encompass different breast cancer subtypes and hence could be exploited as a target of larger population.
Research on the risk of block chain technology in Internet finance supported by wireless network
Authors: Chen Yu , Zhang Yayun , Zhou Bo
Published: March 2020

In this paper, a cascaded depth learning framework is constructed. A cascaded depth model is successfully implemented by studying and analyzing the specific feature transformation, feature selection, and classifier algorithm used in the framework. A feature combination method based on enhanced feature selection and classification is proposed according to the different features learned by each layer of the model. Combining block chain cryptography technology, distributed technology, consensus accounting mechanism of technology innovation, transaction data encapsulation into specific format data unit, encapsulated into a linear list in chronological order, using encryption algorithm trading transparency, traceability of data, security, credibility, and uniqueness in financial data analysis. The experimental results show that with the increase of the number of model layers, our method can significantly improve the classification accuracy. This result also verifies that the proposed model can learn more effective data representation features and also verifies the effectiveness of the proposed feature combination method.
CMBF-based dynamic selection for heterogeneous massive MIMO systems
Authors: Zhang Yinghui , Zhang Biao , Mu Yifan , Song Kun , Gao Jing , Liu Yang
Published: March 2020

In this paper, an optimal coordinated multipoint beamforming (CMBF) scheme is proposed for heterogeneous networks (HetNets) with massive multiple input multiple output (MIMO) systems for energy efficiency (EE), taking into account the maximum transmission power of the base station (BS) with the limitation on the power consumption of the static circuit. This paper analyzes the influence of the different parameters on the EE and derives a closed-form expression. We investigate the different cooperation schemes, considering the influence of the number of antennas of small base station (SBS) and macro base station (MBS), the quality of service (QoS), and the number of different service users. Therefore, the best parameters can be selected for optimizing EE with the different scenarios in HetNets with massive MIMO systems. Theoretical derivation and simulations show that the amount of BS antennas, achievable rate constraints, quantity of service users, and cooperative schemes all have the vital influences on the EE for the CMBF design. Therefore, the proposed optimization framework enables us to identify key system parameters, and obtain the better system design for the massive MIMO HetNets.
Text and phone calls: user behaviour and dual-channel communication prediction
Authors: Hayat Shamaila , Rextin Aimal , Idris Adnan , Nasim Mehwish
Published: March 2020

The contact list size of modern mobile phone users has increased up to hundreds of contacts, making contact retrieval a relatively difficult task. Various algorithms have been designed to predict the contact that a user will call at a given time. These algorithms use historical call data to make this prediction. However, modern mobile users do not just make calls, but also rely on various communication channels like text messages and calls to maintain their social relations. Despite the prevalence of multiple communication channels, predictive analysis of these channels has not been studied so far. Hence, this study deliberated on proposing a predictive model for dual-channel (text and calls). This study initially investigated the dual-channel communication behaviour of smartphone users by using a mixed approach i.e. subjective and objective data analysis and found many peculiarities. It was observed that the preferred communication channel was different for various contacts, even for a single user. Although the cost-effective texts were found to be more popular over phone calls, a significant proportion of user pairs seemed to prefer calls for most of their communication. A generic predictive framework for the dual-channel environment was proposed based upon these findings. This model predicts the next communication event by modelling temporal information of call and text on a 2D plane. This framework has three variations which not only predict the person who will be contacted at a particular time but also predict the channel of communication (call or text). Finally, the performance of different versions of the algorithm was evaluated using real-world dual-channel data. One version of the predictive model outperformed the other variations with a prediction accuracy over 90 percent, while the other variations also performed well.
Enriched continuum for multi-scale transient diffusion coupled to mechanics
Authors: Waseem Abdullah , Heuzé Thomas , Stainier Laurent , Geers Marc G. D. , Kouznetsova Varvara G.
Published: March 2020

In this article, we present a computationally efficient homogenization technique for linear coupled diffusion–mechanics problems. It considers a linear chemo-mechanical material model at the fine scale, and relies on a full separation of scales between the time scales governing diffusion and mechanical phenomena, and a relaxed separation of scales for diffusion between the matrix and the inclusion. When the characteristic time scales associated with mass diffusion are large compared to those linked to the deformation, the mechanical problem can be considered to be quasi-static, and a full separation of scales can be assumed, whereas the diffusion problem remains transient. Using equivalence of the sum of virtual powers of internal and transient forces between the microscale and the macroscale, a homogenization framework is derived for the mass diffusion, while for the mechanical case, considering its quasi-static nature, the classical equivalence of the virtual work of internal forces is used instead. Model reduction is then applied at the microscale. Assuming a relaxed separation of scales for diffusion phenomena, the microscopic fields are split into steady-state and transient parts, for which distinct reduced bases are extracted, using static condensation for the steady-state part and the solution of an eigenvalue problem for the transient part. The model reduction at the microscale results in emergent macroscopic enriched field variables, evolution of which is described with a set of ordinary differential equations which are inexpensive to solve. The net result is a coupled diffusion–mechanics enriched continuum at the macroscale. Numerical examples are conducted for the cathode–electrolyte system characteristic of a lithium ion battery. The proposed reduced order homogenization method is shown to be able to capture the coupled behavior of this system, whereby high computational gains are obtained relative to a full computational homogenization method.
Embedded flexibilization and polite employer domination: the case of short-track apprenticeships in Switzerland
Authors: Di Maio Gina , Graf Lukas , Wilson Anna
Published: March 2020

Liberalization pressures challenge countries to adapt their training systems. This is particularly relevant for coordinated market economies with firm-driven but collectively governed apprenticeship systems. Recent literature has identified different liberalization trajectories for these countries. For instance, segmentalism describes the increasing influence of large employers in Germany. In Denmark, state agencies manage increased flexibility in training through embedded flexibilization. In this paper, we identify a new form of embedded flexibilization, characterized by polite employer domination. We find this trajectory of liberalization in Switzerland, which represents another training system heavily based on firm involvement. We illustrate our argument with the example of short-track apprenticeship training, which has been expanded in all three mentioned countries in response to ongoing liberalization and deindustrialization pressures. In Switzerland, the relevant reform was initiated by the state while business adopted a rather passive role initially. Yet, state actors eventually stepped back and delegated key competences to employers, which implies that the employers’ camp asserted their interests in the end while tolerating some concessions for the benefit of disadvantaged groups. Our process tracing reveals that policy makers used layering to implement short-tracks that enhance social inclusion, while simultaneously increasing the scope of employer cooperation.
Detection of defects in atomic-resolution images of materials using cycle analysis
Authors: Ovchinnikov Oleg S. , O’Hara Andrew , Jesse Stephen , Hudak Bethany M. , Yang Shi‐Ze , Lupini Andrew R. , Chisholm Matthew F. , Zhou Wu , Kalinin Sergei V. , Borisevich Albina Y. , Pantelides Sokrates T.
Published: March 2020

The automated detection of defects in high-angle annular dark-field Z-contrast (HAADF) scanning-transmission-electron microscopy (STEM) images has been a major challenge. Here, we report an approach for the automated detection and categorization of structural defects based on changes in the material’s local atomic geometry. The approach applies geometric graph theory to the already-found positions of atomic-column centers and is capable of detecting and categorizing any defect in thin diperiodic structures (i.e., “2D materials”) and a large subset of defects in thick diperiodic structures (i.e., 3D or bulk-like materials). Despite the somewhat limited applicability of the approach in detecting and categorizing defects in thicker bulk-like materials, it provides potentially informative insights into the presence of defects. The categorization of defects can be used to screen large quantities of data and to provide statistical data about the distribution of defects within a material. This methodology is applicable to atomic column locations extracted from any type of high-resolution image, but here we demonstrate it for HAADF STEM images.
Pathological complete response after intraperitoneal paclitaxel and systemic combined chemotherapy in a patient with peritoneal metastases from gastric cancer: a case report
Authors: Meguro Yoshiyuki , Yamaguchi Hironori , Kitayama Joji , Kanamaru Rihito , Matsumoto Shiro , Ui Takashi , Haruta Hidenori , Kurashina Kentaro , Saito Shin , Hosoya Yoshinori , Lefor Alan Kawarai , Sata Naohiro
Published: March 2020

Background

Despite recent progress in systemic chemotherapy, the prognosis of patients with peritoneal metastases from gastric cancer is still poor. Efficacious intraperitoneal and systemic combination chemotherapy regimens to treat patients with peritoneal metastases have recently been developed.

Case presentation

A 74-year-old man with gastric cancer T4b (transverse mesocolon) N3 M1 (peritoneum) received combination chemotherapy with intraperitoneal administration of paclitaxel, intravenous oxaliplatin, and oral S-1. Eight courses of combined chemotherapy had remarkable anti-tumor effects on the primary lesion, lymph node metastases, and peritoneal metastases. Total gastrectomy with regional lymph node dissection was performed. Pathological examination revealed no viable tumor cells in the resected specimens. After gastrectomy, the patient received 25 courses of the same chemotherapy without oxaliplatin and has no evidence of recurrence 24 months later.

Discussion

Therapeutic approaches including systemic chemotherapy, extended resection, and heated intraperitoneal chemotherapy have been used to treat patients with peritoneal metastases. Repeat therapy with intraperitoneal paclitaxel has been used recently. Intraperitoneal administration of paclitaxel results in prolonged retention in the peritoneal cavity with effects against peritoneal metastases. Repeated administration of paclitaxel does not cause adhesions in the peritoneal cavity. When combination chemotherapy is effective, salvage gastrectomy is a promising option with minimal morbidity and mortality.

Conclusion

Combined chemotherapy with intraperitoneal paclitaxel and systemic chemotherapy followed by gastrectomy is a promising strategy for patients with advanced gastric cancer and peritoneal metastases.
Effects of head motion on postural stability in healthy young adults with chronic motion sensitivity
Authors: Albalwi Abdulaziz A. , Johnson Eric G. , Alharbi Ahmad A. , Daher Noha S. , Cordett Tim K. , Ambode Oluwaseun I. , Alshehri Fahad H.
Published: March 2020

Background

Motion sensitivity, or motion sickness, is common in modern vehicular and visually stimulating environments. Several studies have shown a relationship between motion sensitivity and decreased postural stability. We aimed to evaluate the effects of head motion (horizontal and vertical) on postural stability in healthy adults with and without chronic motion sensitivity (CMS).

Methods

Sixty healthy adult men and women (age, 20–40 years) with CMS (CMS group,n = 30) and without CMS (non-CMS group,n = 30) participated in the study. Postural stability was assessed during three conditions (static, horizontal head motion, and vertical head motion) using computerized dynamic posturography. Group and condition-related differences in equilibrium scores were evaluated.

Results

There was no significant group x condition interaction (F2,114 = 0.9, partial ƞ2 = 0.04,p = 0.35). However, significant condition-related differences in equilibrium scores were observed (F2,114 = 26.4, partial ƞ2 = 0.31,p < 0.001). Equilibrium scores were significantly worse in the horizontal and vertical head motion conditions compared to those in the static condition (p < 0.001), but were comparable in vertical and horizontal head motion conditions (p = 0.27).

Conclusions

Postural stability was lower in the horizontal and vertical conditions compared to the static condition. However, horizontal and vertical head motions had comparable effects on postural stability in both CMS and non-CMS groups, contrary to our expectations.
A minimally invasive surgical approach for the treatment of piriformis syndrome: a case series
Authors: Hogan Elizabeth , Vora Darshan , Sherman Jonathan H.
Published: March 2020

Background

Piriformis syndrome accounts for approximately 6% of patients who present with sciatic pain. There are many treatment options ranging from physical therapy, to trigger point injections, to surgical intervention. We discuss a surgical method that represents a minimally invasive technique for the treatment of piriformis syndrome.

Methods

We describe a novel operative approach and technique for release of the piriformis muscle in the treatment of piriformis syndrome. Described are the preoperative planning, incision and approach, and technique for identifying and releasing the piriformis muscle.

Results

Three patients were treated for piriformis syndrome using the described technique. Each patient displayed successful relief of their symptoms immediately following the surgical procedure and at delayed follow-up.

Conclusion

Early experience with our method of piriformis release suggests that it is well suited for the treatment of piriformis syndrome. The novel integration of pre-operative trigger point localization coupled with intraoperative neuromonitoring allows effective pain relief with minimal morbidity.
Breastfeeding and child survival from 0 to 5 years in Côte d'Ivoire
Authors: Yapo Yomin Virginie
Published: March 2020

Background

One of the main objectives of health policy-makers is to promote children’s growth, development, and survival. The current research evaluates the impact of breastfeeding on infant survival and highlights the major socio-economic determinants of child survival from 0 to 5 years old in Côte d’Ivoire.

Methods

This study uses Probit estimation to evaluate the impact of the type of breastfeeding on the survival of children aged from 0 to 5 years old. The main socio-economic determinants of child survival were identified and analyzed. The sample of the study covers 7776 children under 5 years old drawn from the Côte d'Ivoire Demographic Health Surveys and the Multiple Indicators cluster survey of 2012.

Results

A child is more likely to survive when immediate exclusive breastfeeding was practiced for up to 6 months. The probability of survival increases significantly when the mother lives in a healthy environment, when she has at least a primary school education, and when she plays a leading role in caring for the children. Likewise, when she better controls the market of some breast milk supplement and she chooses the best milk formula to complete feeding for her baby, the child’s chances of survival increase significantly.

Conclusion

Health policy-makers must strengthen programs to promote exclusive breastfeeding up to 6 months through social campaigns. It should also strengthen the capacity of health workers (midwives, nurses, doctors, etc.) to better guide and provide training to mothers and young women about childbearing age to allow them to practice exclusive breastfeeding for up to 6 months. It is only after 6 months that they have to complete infant feeding by providing some semi-solid food rich in vitamins, proteins, and minerals. Taking into account the time constraint when they are engaged in economic activity, they must choose the best formula milk to supplement breastfeeding. It is also important to educate women to improve hygiene in their housing, in their neighborhood and in their community in order to promote the welfare and health of their children.
Inter-rater and test-retest reliability of the “standardized endoscopic swallowing evaluation for tracheostomy decannulation in critically ill neurologic patients”
Authors: Warnecke Tobias , Muhle Paul , Claus Inga , Schröder Jens B. , Labeit Bendix , Lapa Sriramya , Suntrup-Krueger Sonja , Dziewas Rainer
Published: March 2020

Background

Removal of a tracheostomy tube in critically ill neurologic patients is a difficult issue, particularly due to the high incidence of oropharyngeal dysphagia. For an objective evaluation of decannulation readiness the “Standardized Endoscopic Swallowing Evaluation for Tracheostomy Decannulation in Critically Ill Neurologic Patients” (SESETD) – a stepwise evaluation of ‘secretion management’, ‘spontaneous swallows’ and ‘laryngeal sensibility/cough’ – has been introduced. With the recent study detailed data on inter-rater and test-retest reliability are presented.

Methods

To obtain inter-rater reliability levels both in a group of raters with at least 5 years of experience (‘experts’) and in a group of raters with no or only minor experience using the SESETD (‘non-experts’), for each single item of the protocol and the sum score α-, respectively κ-levels were determined. The ‘experts’ assessed the same videos after a four-week interval to determine test-retest reliability. Ten videos from tracheostomized neurological patients completely weaned from mechanical ventilation were assessed independently by six ‘experts’. 27 ‘non-experts’ applied the SESETD on 5 videos from the same patient population after introduction to the protocol in a one-hour workshop.

Results

For the items ‘secretion management’ and ‘spontaneous swallows’ α-levels were identified at > 0.800 both in the group of ‘experts’ and ‘non-experts’. With regard to the item ‘laryngeal sensibility/cough’ in both groups, the α-level was ≥0.667. With κ-levels of 1.0 for ‘secretion management’, 0.93 for ‘spontaneous swallows’ and 0.76 for ‘laryngeal sensibility/cough’ test-retest reliability showed at least substantial agreement for each item. Intraclass correlation coefficient for the sum score was excellent in both groups (α ≥ 0.90).

Conclusions

The SESETD demonstrates good to excellent agreement for each single item included as well as the sum score in experienced and unexperienced raters supporting its usefulness for implementation in daily clinical routine and as an outcome measure for clinical trials.
Successful thoracic endovascular aortic repair for post-coarctoplasty aneurysm
Authors: Saedi Sedigheh , Aliramezany Maryam , Moosavi Jamal , Saedi Tahereh
Published: March 2020

Background

Aortic coarctation is currently treated by both surgical and transcatheter methods. Patients can present with late complication of prior surgical repair including recoarctation and aneurysm formation. There are limited reports on safety and efficacy of thoracic endovascular aortic repair methods (TEVAR) in post-coarctation repair patients.

Case presentation

We report an adult patient with aortic aneurysm formation following surgical coarctoplasty successfully treated with transcatheter TEVAR method obviating the need for open heart surgery.

Conclusion

Endovascular repair of aneurysms in post-coarctoplasty patients is a promising method and should be considered in those with suitable anatomy based on prior imaging.
Gender differences among ischemic heart disease patients enrolled in a cardiac rehabilitation program
Authors: El Missiri Ahmed Mohamed , Awadalla Hany Mohamed , Almoudi Mosadaq Mustafa
Published: March 2020

Background

Cardiac rehabilitation programs reduce cardiovascular events and mortality in ischemic heart disease patients. The aim of this study was to assess gender differences among ischemic heart disease patients enrolled in a cardiac rehabilitation program regarding adherence to the program, as well as, changes in clinical, laboratory, and echocardiographic parameters.

Results

A prospective study that included 30 men and 30 women with stable ischemic heart disease who had been totally revascularized by percutaneous coronary intervention. Patients were enrolled in a 12-week cardiac rehabilitation program. Assessment of demographics, anthropometric measurements, risk factors, and functional capacity was performed. Lipid profile, glycated hemoglobin, and left ventricular ejection fraction were assessed. Assessments were performed at baseline and after completion of the program.

Time to enrollment in the program was prolonged for women 39.17 ± 40.49 vs. 19.77 ± 10.26 days (p = 0.014). At baseline, more women were diabetic (p = 0.004), hypertensive (p = 0.02), had a larger waist circumference (p = 0.022), a higher BMI (p = 0.011), and higher HbA1c (p = 0.033). More men were active smokers (p < 0.001). After completion of the program, it was found that men attended 19.1 ± 4.77 (79.6%) sessions compared to 15.7 ± 5.72 (65.4%) sessions for women (p = 0.015). Women had more reduction in diastolic BP − 10.93 ± 8.94 vs. − 5.47 ± 12.57 mmHg (p = 0.058). The magnitude of reduction in resting heart rate was significant in men (p = 0.018) but not in women (p = 0.376). The magnitude of reduction in serum total cholesterol and triglycerides was more in men (p = 0.018 and p = 0.014). Women showed more reduction in HbA1c (p = 0.052).

Conclusion

Men are more adherent to cardiac rehabilitation programs. Recruitment of women is significantly delayed. Women have a higher cardiovascular risk burden in the form of prevalence of diabetes, hypertension, and obesity. Completion of a cardiac rehabilitation program causes a reduction in BMI, waist circumference, blood pressure measurements, total cholesterol, triglycerides, LDL-C, HDL-C, HbA1c, and LVEDD with an increase in LVEF in both genders. Men show more reduction in resting HR, total cholesterol, and triglyceride levels while women show more reduction in diastolic BP and HBA1c.
Social cognitive deficits in male children with attention deficit hyperactivity disorder in relation to salivary oxytocin level
Authors: Dessoki Hani H. , Amin Omnia R. , Soltan Mohamed R. , Abbas Mohammed M. , Dawoud Mariam E.
Published: March 2020

Background

There is evidence supporting a pathophysiological role of oxytocin in attention deficit hyperactive disorder (ADHD) especially hyperactive and combined subtypes. It is known that children with ADHD show a high rate of social cognitive problems regarding emotion recognition. Oxytocin was assumed to play a role in the emergence of social cognition deficits in ADHD. Aim of this study is to assess social cognition (emotion recognition) deficits in relation to oxytocin level in different subtypes of ADHD among the study group. Forty male patients with ADHD were recruited from psychiatric outpatient clinic of Fayoum University Hospital, were diagnosed according to DSM-5, and were assessed using Conner’s parent rating scale–revised (L). Social cognition measured by CANTAB emotion recognition task (ERT) and the level of salivary oxytocin was measured by ELISA technique.

Results

Combined subtype had been lower in correctly detecting the emotions of fear and anger. Predominately, hyperactive impulsive ADHD subtype was more rapid while detecting the emotions of surprise and disgust. There was significant negative correlation between age of onset of ADHD and errors in detecting the emotion of anger and positive correlation between age of onset of ADHD and errors in detecting the emotion of surprise. Correct detection of the emotion of happiness was associated with increased oxytocin level but the correct detection of the emotion of fear was inversely related to oxytocin level. No statistically significant difference between different subtypes of ADHD regarding salivary oxytocin level.

Conclusion

Oxytocin may play a role in social cognitive deficits in ADHD. The presence of social cognitive deficits in ADHD prompts further investigations to focus on the specificity of these deficits and in turn identify ways of managing them. Studying oxytocin in this population and its relation to social cognitive deficits can support the notion that oxytocin is a biological marker for ADHD.
Perceptions of factors influencing the introduction and adoption of electronic immunization registries in Tanzania and Zambia: a mixed methods study
Authors: Dolan Samantha B. , Alao Mary E. , Mwansa Francis Dien , Lymo Dafrossa C. , Bulula Ngwegwe , Carnahan Emily , Beylerian Emily , Werner Laurie , Shearer Jessica C.
Published: March 2020

Background

As technology has become cheaper and more accessible, health programs are adopting digital health interventions (DHI) to improve the provision of and demand for health services. These interventions are complex and require strong coordination and support across different health system levels and government departments, and they need significant capacities in technology and information to be properly implemented. Electronic immunization registries (EIRs) are types of DHI used to capture, store, access, and share individual-level, longitudinal health information in digitized records. The BID Initiative worked in partnership with the governments of Tanzania and Zambia to introduce an EIR at the sub-national level in both countries within 5 years as part of a multi-component complex intervention package focusing on data use capacity-building.

Methods

We aimed to gather and describe learnings from the BID experience by conducting a framework-based mixed methods study to describe perceptions of factors that influenced scale-up of the EIR. Data were collected through key informant interviews, a desk review, EIRs, and health management information systems. We described how implementation of the EIRs fulfilled domains described in our conceptual framework and used cases to illustrate the relationships and relative influence of domains for scale-up and adoption of the EIR.

Results

We found that there was no single factor that seemed to influence the introduction or sustained adoption of the EIR as many of the factors were interrelated. For EIR introduction, strong strategic engagement among partners was important, while EIR adoption was influenced by adequate staffing at facilities, training, use of data for supervision, internet and electricity connectivity, and community sensitization.

Conclusions

Organizations deploying DHIs in the future should consider how best to adapt their intervention to the existing ecosystem, including human resources and organizational capacity, as well as the changing technological landscape during planning and implementation.
Unrecognized implementation science engagement among health researchers in the USA: a national survey
Authors: Stevens Elizabeth R. , Shelley Donna , Boden-Albala Bernadette
Published: March 2020

Background

Implementation science (IS) has the potential to serve an important role in encouraging the successful uptake of evidence-based interventions. The current state of IS awareness and engagement among health researchers, however, is relatively unknown.

Methods

To determine IS awareness and engagement among health researchers, we performed an online survey of health researchers in the USA in 2018. Basic science researchers were excluded from the sample. Engagement in and awareness of IS were measured with multiple questionnaire items that both directly and indirectly ask about IS methods used. Unrecognized IS engagement was defined as participating in research using IS elements and not indicating IS as a research method used. We performed simple logistic regressions and tested multivariable logistic regression models of researcher characteristics as predictors of IS engagement.

Results

Of the 1767 health researchers who completed the survey, 68% stated they would be able to describe IS. Only 12.7% of the population self-identified as using IS methods. Of the researchers not self-identifying as using IS methods, 86.4% reported using the IS elements “at least some of the time.” Nearly half (47.9%) reported using process/implementation evaluation, 89.2% use IS measures, 27.3% use IS frameworks, and 75.6% investigate or examine ways to integrate interventions into routine health settings. IS awareness significantly reduced the likelihood of all measures of unrecognized IS engagement (aOR 0.13, 95% CI 0.07 to 0.27, p < 0.001).

Conclusion

Overall, awareness of IS is high among health researchers, yet there is also a high prevalence of unrecognized IS engagement. Efforts are needed to further disseminate what constitutes IS research and increase IS awareness among health researchers.