bluuebunny/crossref_metadata_2025 huggingface dataset:
Effects of Reiki Versus Physiotherapy on Relieving Lower Back Pain and Improving Activities Daily Living of Patients With Intervertebral Disc Hernia
Authors: Jahantiqh Farnaz , Abdollahimohammad Abdolghani , Firouzkouhi Mohammadreza , Ebrahiminejad Vahid
Published: March 2018

Patients with intervertebral disc herniation (IVDH) seek complementary and conventional medical therapies to manage related problems. This study aimed to determine the effectiveness of Reiki compared with physiotherapy to relieve the lower back pain intensity and to improve the activities of daily living (ADL) in the IDVH patients. In this clinical trial study, 60 patients with IVDH were randomly assigned to one of the Reiki, physiotherapy, and drug therapy groups. The severity of pain and the ADL were measured using visual analog scale (VAS) pain and ADL–Instrumental ADL questionnaire before and after the intervention. A significant difference was found in pain intensity and ADL improvement between Reiki and the drug therapy. However, there was no significant difference between Reiki and physiotherapy groups in managing pain and improving ADL. Reiki and physiotherapy are effective methods in managing pain and improving ADL in patients with IVDH; however, Reiki is more cost-effective and faster treatment method than physiotherapy.
The Aqueous Crude Extracts of Montanoa frutescens and Montanoa grandiflora Reduce Immobility Faster Than Fluoxetine Through GABAA Receptors in Rats Forced to Swim
Authors: Rodríguez-Landa Juan Francisco , Cueto-Escobedo Jonathan , Flores-Aguilar Luis Ángel , Rosas-Sánchez Gilberto Uriel , Rovirosa-Hernández María de Jesús , García-Orduña Francisco , Carro-Juárez Miguel
Published: March 2018

Background.

Montanoa frutescens and Montanoa grandiflora have been indistinctly used for centuries in traditional Mexican medicine for reproductive impairments, anxiety, and mood disorders. Preclinical studies support their aphrodisiac and anxiolytic properties, but their effects on mood are still unexplored.

Methods.

The effects of 25 and 50 mg/kg of M frutescens and M grandiflora extracts were evaluated on days 1, 7, 14, 21, and 28 of treatment, and compared with fluoxetine (1 mg/kg) and Remotiv (7.14 mg/kg) in Wistar rats. The participation of GABAA receptor in the effects produced by the treatments was explored.

Results.

Montanoa extracts reduced immobility since day 1 of treatment, while fluoxetine and Remotiv required 14 days. The GABAA antagonism blocked the effects of Montanoa extracts, but not of fluoxetine or Remotiv.

Conclusions.

Montanoa extracts prevented quickly the stress-induced behaviors in the swimming test through action at the GABAA receptor, exerting a protective effect different to the typical antidepressants drugs.
Pulmonary vascular endothelium: the orchestra conductor in respiratory diseases
Authors: Huertas Alice , Guignabert Christophe , Barberà Joan A. , Bärtsch Peter , Bhattacharya Jahar , Bhattacharya Sunita , Bonsignore Maria R. , Dewachter Laurence , Dinh-Xuan Anh Tuan , Dorfmüller Peter , Gladwin Mark T. , Humbert Marc , Kotsimbos Tom , Vassilakopoulos Theodoros , Sanchez Olivier , Savale Laurent , Testa Ugo , Wilkins Martin R.
Published: March 2018

The European Respiratory Society (ERS) Research Seminar entitled “Pulmonary vascular endothelium: orchestra conductor in respiratory diseases - highlights from basic research to therapy” brought together international experts in dysfunctional pulmonary endothelium, from basic science to translational medicine, to discuss several important aspects in acute and chronic lung diseases. This review will briefly sum up the different topics of discussion from this meeting which was held in Paris, France on October 27–28, 2016. It is important to consider that this paper does not address all aspects of endothelial dysfunction but focuses on specific themes such as: 1) the complex role of the pulmonary endothelium in orchestrating the host response in both health and disease (acute lung injury, chronic obstructive pulmonary disease, high-altitude pulmonary oedema and pulmonary hypertension); and 2) the potential value of dysfunctional pulmonary endothelium as a target for innovative therapies.
Aberrant epithelial differentiation by cigarette smoke dysregulates respiratory host defence
Authors: Amatngalim Gimano D. , Schrumpf Jasmijn A. , Dishchekenian Fernanda , Mertens Tinne C.J. , Ninaber Dennis K. , van der Linden Abraham C. , Pilette Charles , Taube Christian , Hiemstra Pieter S. , van der Does Anne M.
Published: March 2018

It is currently unknown how cigarette smoke-induced airway remodelling affects highly expressed respiratory epithelial defence proteins and thereby mucosal host defence.

Localisation of a selected set of highly expressed respiratory epithelial host defence proteins was assessed in well-differentiated primary bronchial epithelial cell (PBEC) cultures. Next, PBEC were cultured at the air–liquid interface, and during differentiation for 2–3 weeks exposed daily to whole cigarette smoke. Gene expression, protein levels and epithelial cell markers were subsequently assessed. In addition, functional activities and persistence of the cigarette smoke-induced effects upon cessation were determined.

Expression of the polymeric immunoglobulin receptor, secretory leukocyte protease inhibitor and long and short PLUNC (palate, lung and nasal epithelium clone protein) was restricted to luminal cells and exposure of differentiating PBECs to cigarette smoke resulted in a selective reduction of the expression of these luminal cell-restricted respiratory host defence proteins compared to controls. This reduced expression was a consequence of cigarette smoke-impaired end-stage differentiation of epithelial cells, and accompanied by a significant decreased transepithelial transport of IgA and bacterial killing.

These findings shed new light on the importance of airway epithelial cell differentiation in respiratory host defence and could provide an additional explanation for the increased susceptibility of smokers and patients with chronic obstructive pulmonary disease to respiratory infections.
Cost-effectiveness ofKRAS,EGFRandALKtesting for decision making in advanced nonsmall cell lung carcinoma: the French IFCT-PREDICT.amm study
Authors: Loubière Sandrine , Drezet Alexandre , Beau-Faller Michèle , Moro-Sibilot Denis , Friard Sylvie , Wislez Marie , Blons Hélène , Daniel Catherine , Westeel Virginie , Madroszyk Anne , Léna Hervé , Merle Patrick , Mazières Julien , Zalcman Gérard , Lacave Roger , Antoine Martine , Morin Franck , Missy Pascale , Barlesi Fabrice , Auquier Pascal , Cadranel Jacques
Published: March 2018

ALKrearrangement andEGFR/KRASmutations constitute the primary biomarkers tested to provide targeted or nontargeted therapies in advanced nonsmall cell lung cancer (NSCLC) patients. Our objective was to assess the cost-effectiveness of biomarker testing for NSCLC.

Between 2013 and 2014, 843 treatment-naive patients were prospectively recruited at 19 French hospitals into a longitudinal observational cohort study. Two testing strategies were compared,i.e.with “at least one biomarker status known” and “at leastKRASstatus known”, in addition to “no biomarker testing” as the reference strategy. The Kaplan–Meier approach was employed to assess restricted mean survival time. Direct medical costs incurred by hospitals were estimated with regard to treatment, inpatient care and biomarker testing.

Compared with “no biomarker testing”, the “at least one biomarker status known” strategy yielded an incremental cost-effectiveness ratio of EUR13 230 per life-year saved, which decreased to EUR7444 per life-year saved with the “at leastKRASstatus known” testing strategy. In sensitivity analyses, biomarker testing strategies were less costly and more effective in 41% of iterations.

In summary, molecular testing prior to treatment initiation proves to be cost-effective in advanced NSCLC management and may assist decision makers in defining conditions for further implementation of these innovations in general practice.
Elastase activity on sputum neutrophils correlates with severity of lung disease in cystic fibrosis
Authors: Dittrich A. Susanne , Kühbandner Iris , Gehrig Stefanie , Rickert-Zacharias Verena , Twigg Matthew , Wege Sabine , Taggart Clifford C. , Herth Felix , Schultz Carsten , Mall Marcus A.
Published: March 2018

Neutrophil elastase (NE) is a key risk factor for severity of cystic fibrosis (CF) lung disease. Recent studies identified increased NE activity on the surface of airway neutrophils from CF-like mice and patients with CF. However, the role of surface-bound NE in CF lung disease remains unknown. We determined the relationship between surface-bound NE activity and severity of lung disease in CF.

Surface-bound NE activity was measured on sputum neutrophils from 35 CF patients and eight healthy controls using novel lipidated Förster resonance energy transfer reporters and correlated with free NE activity, neutrophil counts, interleukin-8, myeloperoxidase and antiproteases in sputum supernatant, and with lung function parameters.

Surface-bound NE activity was increased in CF compared to healthy controls (p<0.01) and correlated with free NE activity (p<0.05) and other inflammation markers (p<0.001). Surface-bound and free NE activity correlated with forced expiratory volume in 1 s % predicted (p<0.01 and p<0.05), but only surface-bound NE activity correlated with plethysmographic functional residual capacity % pred (p<0.01) in patients with CF.

We demonstrate that surface-bound NE activity on airway neutrophils correlates with severity of lung disease in patients with CF. Our results suggest that surface-bound NE activity may play an important role in the pathogenesis and serve as novel biomarker in CF lung disease.
Integration of multi-omics datasets enables molecular classification of COPD
Authors: Li Chuan-Xing , Wheelock Craig E. , Sköld C. Magnus , Wheelock Åsa M.
Published: March 2018

Chronic obstructive pulmonary disease (COPD) is an umbrella diagnosis caused by a multitude of underlying mechanisms, and molecular sub-phenotyping is needed to develop molecular diagnostic/prognostic tools and efficacious treatments.

The objective of these studies was to investigate whether multi-omics integration improves the accuracy of molecular classification of COPD in small cohorts.

Nine omics data blocks (comprising mRNA, micro RNA, proteomes and metabolomes) collected from several anatomical locations from 52 female subjects were integrated by similarity network fusion (SNF). Multi-omics integration significantly improved the accuracy of group classification of COPD patients from healthy never-smokers and from smokers with normal spirometry, reducing required group sizes from n=30 to n=6 at 95% power. Seven different combinations of four to seven omics platforms achieved >95% accuracy.

For the first time, a quantitative relationship between multi-omics data integration and accuracy of data-driven classification power has been demonstrated across nine omics data blocks. Integrating five to seven omics data blocks enabled 100% correct classification of COPD diagnosis with groups as small as n=6 individuals, despite strong confounding effects of current smoking. These results can serve as guidelines for the design of future systems-based multi-omics investigations, with indications that integrating five to six data blocks from several molecular levels and anatomical locations suffices to facilitate unsupervised molecular classification in small cohorts.
Acute respiratory distress syndrome in mechanically ventilated patients with community-acquired pneumonia
Authors: Cilloniz Catia , Ferrer Miquel , Liapikou Adamanthia , Garcia-Vidal Carolina , Gabarrus Albert , Ceccato Adrian , Puig de La Bellacasa Jorge , Blasi Francesco , Torres Antoni
Published: March 2018

Our aim was to assess the incidence, characteristics, aetiology, risk factors and mortality of acute respiratory distress syndrome (ARDS) in intensive care unit (ICU) patients with community-acquired pneumonia (CAP) using the Berlin definition.

We prospectively enrolled consecutive mechanically ventilated adult ICU patients with CAP over 20 years, and compared them with mechanically ventilated patients without ARDS. The main outcome was 30-day mortality.

Among 5334 patients hospitalised with CAP, 930 (17%) were admitted to the ICU and 432 required mechanical ventilation; 125 (29%) cases met the Berlin ARDS criteria. ARDS was present in 2% of hospitalised patients and 13% of ICU patients. Based on the baseline arterial oxygen tension/inspiratory oxygen fraction ratio, 60 (48%), 49 (40%) and 15 (12%) patients had mild, moderate and severe ARDS, respectively.Streptococcus pneumoniaewas the most frequent pathogen, with no significant differences in aetiology between groups. Higher organ system dysfunction and previous antibiotic use were independent risk factors for ARDS in the multivariate analysis, while previous inhaled corticosteroids were independently associated with a lower risk. The 30-day mortality was similar between patients with and without ARDS (25%versus30%, p=0.25), confirmed by propensity-adjusted multivariate analysis.

ARDS occurs as a complication of CAP in 29% of mechanically ventilated patients, but is not related to the aetiology or mortality.
Omalizumab effectiveness in patients with severe allergic asthma according to blood eosinophil count: the STELLAIR study
Authors: Humbert Marc , Taillé Camille , Mala Laurence , Le Gros Vincent , Just Jocelyne , Molimard Mathieu
Published: March 2018

Omalizumab is a monoclonal anti-IgE antibody used to treat severe allergic asthma (SAA). The aim of the STELLAIR study was to determine the importance of pre-treatment blood eosinophil count as a predictive measure for response to omalizumab.

This retrospective real-life study was conducted in France between December 2015 and September 2016 using medical records of SAA omalizumab-treated patients. Response to omalizumab was assessed by three criteria: physician evaluation, reduction of ≥40% in annual exacerbation rate and a combination of both. Response rate was calculated according to blood eosinophil count measured in the year prior to omalizumab initiation.

872 SAA omalizumab-treated patients were included by 78 physicians (723 adults (age ≥18 years) and 149 minors (age 6–17 years)). Blood eosinophil count was ≥300 cells·µL−1in 52.1% of adults and 73.8% of minors. By physician evaluation, 67.2% of adults and 77.2% of minors were responders and 71.1% adults and 78.5% minors had a ≥40% reduction in the exacerbation rate. In adults, the response rate for combined criteria was 58.4% (95% CI 53.2–63.4%) for blood eosinophils ≥300 cells·µL−1(n=377) and 58.1% (95% CI 52.7–63.4%) for blood eosinophils <300 cells·µL−1(n=346).

This study shows that a large proportion of patients with SAA have a blood eosinophil count ≥300 cells·µL−1, and suggests that omalizumab effectiveness is similar in “high” and “low” eosinophil subgroups.
The 16 April 2016 Ecuador Earthquake Damage Assessment Survey
Authors: Villalobos Enrique , Sim Chungwook , Smith-Pardo J. Paul , Rojas Pedro , Pujol Santiago , Kreger Michael E.
Published: March 2018

A damage assessment survey of 169 low-rise reinforced concrete buildings was conducted following the 16 April 2016 Ecuador earthquake. Forty-four percent of the buildings surveyed sustained severe structural damage. Using the collected data, seismic vulnerability indices were calculated to examine their correlation with damage observations. It was found that 92% of the buildings with observed severe structural damage had calculated wall and column index pairs (WI, CI) that satisfied the relation WI+CI/2 < 0.2%. The frequency of damage was lower for higher-priority index values, defined as the sum of CI+WI. Furthermore, frequency of damage in buildings with captive columns was observed to decrease with window height-to-column height ratios of more than 20%.
Physical and Numerical Simulations of the Seismic Response of a 1,100 kV Power Transformer Bushing
Authors: Ma Guo-Liang , Xie Qiang , Whittaker Andrew S.
Published: March 2018

Power transformers and bushings are key pieces of substation equipment and are vulnerable to the effects of earthquake shaking. The seismic performance of a 1,100 kV bushing, used in an ultra-high voltage (UHV) power transformer, is studied using a combination of physical and numerical experiments. The physical experiments utilized an earthquake simulator and included system identification and seismic tests. Modal frequencies and shapes are derived from white noise tests. Acceleration, strain, and displacement responses are obtained from the uniaxial horizontal seismic tests. A finite element model of the 1,100 kV bushing is developed and analyzed, and predicted and measured results are compared. There is reasonably good agreement between predicted and measured responses, enabling the finite element model to be used with confidence for seismic vulnerability studies of transformer-bushing systems. A coupling of the experimental and numerical simulations enabled the vertically installed UHV bushing to be seismically qualified for three-component ground shaking with a horizontal zero-period acceleration of 0.53 g.
A Framework to Evaluate the Benefit of Seismic Upgrading
Authors: Galanis Panagiotis , Sycheva Anastasia , Mimra Wanda , Stojadinović Božidar
Published: March 2018

Earthquakes are among the most catastrophic natural disasters. Existing buildings constructed in earthquake prone locations prior to 1970s generally do not meet the criteria of modern seismic design codes. Structural seismic upgrading is a very effective strategy to mitigate the earthquake risk for existing structures. However, in many cases, seismic upgrade design is criticized as overly conservative resulting in expensive structural interventions. The present study proposes a framework that combines key elements of the performance-based seismic design with the actuarial “frequency-severity” method to perform a cost-benefit analysis of structural seismic upgrading. A curve that quantifies the avoided losses and casualties for different levels of partial seismic upgrade at the site of interest is introduced. This curve provides a tool that enables engineers to optimize rapidly, at a preliminary design level, the seismic upgrading strategy using a cost-benefit analysis. The proposed framework is applied to existing residential buildings located in two different seismic hazard environments, namely Zurich (Switzerland) and L'Aquila (Italy), to identify the optimal seismic upgrading level.
Performance-Based Probabilistic Seismic Slope Displacement Procedure
Authors: Macedo Jorge , Bray Jonathan , Abrahamson Norman , Travasarou Thaleia
Published: March 2018

Engineers often use simplified seismic slope displacement procedures to evaluate the seismic performance of earth structures and natural slopes. Current state of practice procedures typically separate the estimation of the ground motion intensity measure ( IM) from the estimate of seismic displacement ( D), given the selected IM hazard level. Thus D is estimated based on a single IM value. A straightforward performance-based seismic slope assessment procedure is proposed, which considers the full range of potential IM values to estimate seismic slope displacements directly related to a hazard level. Seismic performance is assessed through either a Newmark-type seismic displacement estimate or a calibrated seismic coefficient that can be used in pseudostatic slope stability analyses. The procedures were developed for a wide range of earth systems for shallow crustal earthquakes and subduction zone earthquakes. Currently employed simplified slope displacement procedures do not provide consistent assessments of the actual seismic slope displacement hazard. The proposed procedures can be readily used in practice to perform rigorous performance-based seismic slope displacement hazard assessments.
Comprehensive Knowledge and Uptake of Cervical Cancer Screening Is Low Among Women Living With HIV/AIDS: The Case of Northwestern Ethiopia
Authors: Belachew Sewunet Admasu , Netere Adeladlew Kassie , Mersha Amanual Getnet , Abebe Sileshi Ayele , Mekuria Abebe Basazn , Erku Daniel Asafw
Published: March 2018

Abstract 1

Purpose

In Ethiopia, cervical cancer is the second most common type of cancer in women, and is approximately 8 times more common in HIV-infected women; however, data on the knowledge of HIV-infected women of cervical cancer and the acceptability of screening is scarce in Ethiopia. The current study aimed to assess the level of knowledge of cervical cancer and the uptake of screening among HIV-infected women in Gondar in northwestern Ethiopia.

Methods

A cross-sectional, questionnaire-based survey was conducted in 302 HIV-infected women who attended the outpatient clinic of the University of Gondar referral and teaching hospital from March 1, 2017, to March 30, 2017. Descriptive statistics and univariable and multivariable logistic regression analyses were also performed to examine factors that are associated with the uptake of cervical cancer screening service.

Results

Overall, only 64 respondents (21.2%) were knowledgeable about cervical cancer and screening, and only 71 respondents (23.5%) underwent screening in their lifetimes. Age between 21 years and 29 years (adjusted odds ratio [AOR], 2.78; 95% CI, 1.71 to 7.29), perceived susceptibility to the development of cervical cancer (AOR, 2.85; 95% CI, 1.89 to 6.16), and comprehensive knowledge of cervical cancer (AOR, 3.02; 95% CI, 2.31 to 7.15) were found to be strong predictors of cervical cancer screening service uptake.

Conclusion

Knowledge and uptake of cervical cancer screening among HIV-infected women was found to be poor. Taking into consideration the heightened importance of comprehensive knowledge for increasing the number of participants in cervical cancer screening services, different stakeholders working on cancer and HIV/AIDS should provide a customized health promotion intervention for, and create awareness among, HIV-infected women, as well as improve the accessibility of cervical cancer screening services in rural areas.

AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST

No COIs from the authors.
Measuring Knowledge Change and Skills Improvement in Participants of a Comprehensive Cervical Cancer Prevention Training Program in Low-Resource Areas in Texas and Mozambique
Authors: Lopez Melissa S. , Parra Sonia , Salcedo Mila , Baker Ellen , Milbourne Andrea , Lorenzoni Cesaltina , Luis Elvira , Mabota Flora , Fontes-Cintra Georgia , Moretti-Marques Renato , Ogburn Anthony , Gowen Rose , Robles Eduardo , Tavares Jose H. , Schmeler Kathleen
Published: March 2018

Abstract 5

Purpose

There are more than 530,000 new cases of cervical cancer and 275,000 related deaths annually worldwide. More than 85% of cases and deaths occur in low- and middle-income countries and some areas of the United States. There is a shortage of medical specialists to provide prevention, screening, and treatment services in these regions. Needed are programs that are focused on increasing the clinical capacity to improve cancer prevention services via innovative, locally held, hands-on training courses in conjunction with regular telementoring. Locally held, hands-on training courses for colposcopy, cervical biopsy, and loop electrosurgical excisional procedures using innovative training models and theoretical practical lectures were held in conjunction with telementoring using Project ECHO (Extension for Community Health Outcomes).

Methods

We initiated a cervical cancer prevention education program with two complementary components: locally held, hands-on training courses using innovative teaching aids that were developed by Rice University, and Project ECHO telementoring using regularly held videoconferences to ensure regular mentoring. These innovative training models are low cost (< $80 USD) and allow course participants to simulate different cervical cancer screening and early treatment techniques, including VIA, colposcopy, cervical biopsies, cryotherapy, and loop electrosurgical excisional procedures.

Results

To date, four hands-on training programs have been held in Mozambique (n = 2) and underserved areas of Texas, including the Rio Grande Valley (n = 1) and Laredo (n = 1). In addition, since 2014, 99 ECHO telementoring sessions have been held with providers in the Rio Grande Valley and Laredo (average, n = 23 providers) as well as Mozambique (average, n = 11 providers).

Conclusion

Through this cervical cancer prevention education program, we have found that locally held, hands-on training courses using innovative models, complemented with Project ECHO telementoring, is an innovative way to improve cervical cancer screening and prevention efforts in low-resource settings. Evaluation is ongoing to determine the efficacy of these programs compared with traditional training methods. Funding: The Cancer Prevention Research Institute of Texas, The University of Texas MD Anderson Sister Institution Network Fund, The University of Texas MD Anderson Cancer Center Moon Shots program, and The Prevent Cancer Foundation.

AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST

No COIs from the authors.
Cervical Cancer Screening in Transgender Men in El Salvador: A Pilot Study
Authors: Meléndez Mario , Herrera Alejandra , Hernández Xavier , Rodríguez Bryam , Soler Montserrat , Alfaro Karla , Masch Rachel , Cremer Miriam , Maza Mauricio
Published: March 2018

Abstract 27

Purpose

Transgender persons are particularly vulnerable to a lack of adequate health care, particularly with regard to sexual and reproductive health. In El Salvador, where cervical cancer is a leading cause of cancer death, transgender men are at high risk of developing this disease. Whereas the Papanicolaou test is the most widely used screening method for cervical cancer, there are reports of high numbers of unsatisfactory results among transgender men compared with nontransgender persons. Human papillomavirus (HPV) testing may be a more viable screening option in this population. In this pilot study, we assessed the feasibility of cervical cancer screening among transgender men using a self-sampling HPV test as an alternative to the Papanicolaou test.

Methods

Participants were transgender men of the Organización Generación Hombres Trans El Salvador (Trans Men Generation Organization of El Salvador) between age 19 and 55 years. After obtaining informed consent, a questionnaire was administered to 24 participants to collect sociodemographic, lifestyle, and sexual behavior data, and to assess knowledge about cervical cancer prevention. Participants then performed a vaginal, self-sampling HPV test. Participants who received a positive HPV result were offered a colposcopy evaluation.

Results

Almost all participants—23 of 24—agreed to conduct vaginal self-sampling. Of these, three (13%) of 23 participants tested positive, with the remainder obtaining a negative result. Colposcopies and biopsies were accepted by all three participants who tested positive. One participant was diagnosed with CIN3, whereas two2 were diagnosed with CIN1.

Conclusion

There is limited information on cervical cancer prevention among transgender men, particularly in low and middle-income countries. Use of HPV self-sampling tests is a viable method that can significantly improve participation in and acceptance of screening in this vulnerable population. HPV testing may reduce the number of unsatisfactory results generated when using Papanicolaou tests as a screening method.

AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST

No COIs from the authors.
High Acceptability of Human Papillomavirus Self-Sampling Among Nonattenders of a Public Cervical Cancer Screening Program in El Salvador
Authors: Maza Mauricio , Melendez Mario , Cremer Miriam , Masch Rachel , Alonzo Todd , Castle Philip , Alfaro K. , Soler Montserrat , Conzuelo Gabriel , Gage Julia
Published: March 2018

Abstract 29

Purpose

In high-income countries, human papillomavirus (HPV) self-sampling has been demonstrated to increase adherence to cervical cancer prevention initiatives in underscreened women. El Salvador recently completed the Cervical Cancer Prevention in El Salvador (CAPE) program using a high-risk HPV test as the screening method. Although successful, 12% of targeted women did not attend their screening appointments. HPV self-sampling may offer the opportunity to reach these nonattending women. In the current study, we evaluated HPV self-sampling as a way to increase screening among CAPE nonattenders and to report factors that impact self-sampling acceptability in a low- to middle-income country.

Methods

Nonattending and underscreened women age 30 to 59 years from the Paracentral region of El Salvador were invited to participate (N = 2,019). Women were visited at home and offered self-sampling with an HPV test. Women who provided consent also received a series of questionnaires to collect demographic and test acceptability data. After tests were analyzed, women were provided with results during another home visit. HPV-positive women were asked to make an appointment at a local clinic to undergo colposcopy, biopsy, and, if eligible, cryotherapy treatment. Women with contraindications for cryotherapy were referred to appropriate treatment or follow-up.

Results

Of 1,989 eligible women, 94% accepted the HPV self-sampled test. Of these, 11.8% (n = 221) tested positive. All but 13 women attended the colposcopy appointment, and 190 women received cryotherapy. Biopsy results revealed low-grade precancer in 6.3% of women, whereas 12.6% received diagnoses of high-grade precancer. Reasons for not attending the original CAPE appointment included logistic concerns, but also discomfort with male providers, confidentiality fears, and misconceptions regarding HPV, cervical cancer, and the screening procedure.

Conclusion

HPV self-sampling was shown to be overwhelmingly acceptable to nonattending and underscreened rural women in El Salvador. This method may be a feasible alternative that circumvents barriers to cervical cancer screening in low- to middle-income countries.

AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST

No COIs from the authors
Pattern of Chemotherapy-Related Adverse Effects Among Adult Patients With Cancer Treated at Gondar University Referral Hospital, Ethiopia: A Cross-Sectional Study
Authors: Belachew Sewunet Admasu , Erku Daniel Asfaw , Mekuria Abebe Basazn , Gebresillassie Begashaw Melaku
Published: March 2018

Abstract 32

Purpose

Adverse drug reactions (ADRs) are a global problem and constitute a major clinical problem in terms of human suffering. The high toxicity and narrow therapeutic index of chemotherapeutic agents makes oncology pharmacovigilance essential. The objective of the current study was to assess the pattern of ADRs that occur in patients with cancer who were treated with chemotherapy in a tertiary care teaching hospital in Ethiopia.

Methods

A cross-sectional study over a 2-year period from September 2013 to August 2015 was conducted in patients with cancer who underwent chemotherapy at Gondar University Referral Hospital Oncology Center. Data were collected directly from patients and their medical case files. Reported ADRs were assessed for causality using the WHO causality assessment scale and Naranjo’s algorithm. Severities of the reported reactions were also assessed using National Cancer Institute Common Terminology Criteria for Adverse Events (version 4.0). Pearson’s χ2 test was used to examine the association between two categorical variables.

Results

A total of 815 ADRs were identified from 203 patients who were included in the study. The most commonly occurring ADRs were nausea and vomiting (18.9%), infections (16.7%), neutropenia (14.7%), fever and/or chills (11.3%), and anemia (9.3%). Platinum compounds (31.4%) were the most common group of drugs that caused ADRs. Of reported ADRs, 65.8% were grades 3 to 4 (severe level), 29.9% were grades 1 to 2 (mild level), and 4.3% were grade 5 (toxic level). Significant association was found between age, number of chemotherapeutic agents, and dose of chemotherapy with the occurrence of grades 3 to 5 toxicity.

Conclusion

The high incidence of chemotherapy-related ADRs among patients with cancer is of concern. Establishing an effective ADR monitoring and reporting system—oncopharmacovigilance—and creating awareness among health care professionals of the importance of ADR reporting may help prevent the problem.

AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST

No COIs from the authors.
Intrathecal Drug Delivery Systems for Refractory Pancreatic Cancer Pain: Observational Follow-up Study Over an 11-Year Period in a Comprehensive Cancer Center
Authors: Carvajal Gabriel , Dupoiron Denis , Seegers Valerie , Lebrec Nathalie , Boré François , Dubois Pierre-Yves , Leblanc Damien , Delorme Thierry , Jubier-Hamon Sabrina
Published: March 2018

BACKGROUND:

Pancreatic cancer is the fourth leading cause of cancer-related death in Europe and the United States. Studies have demonstrated that patients with pancreatic cancer have a high prevalence of pain, with rates varying from 47% to 82%. Analgesia using intrathecal drug delivery systems (IDDS) has been poorly studied specifically in this population.

METHODS:

The IDDS for pancreatic cancer pain was a follow-up observational study designed to evaluate 11-year results of IDDS for refractory pancreatic cancer pain at the Institut de Cancérologie de L’Ouest, Paul Papin in France. Patients were followed from March 2006 to April 2017. Patients were selected for IDDS based on multidisciplinary meeting discussion. All IDDS-treated patients were prescribed a combined intrathecal analgesics regimen through a catheter placed according to painful metameric level. Postimplant assessment of pain was determined using a numerical rating scale (NRS). Patients were followed via day-hospital visits and telephone calls at least monthly until death. Pain scores were compared using the Wilcoxon signed rank test. Overall survival (OS) was estimated using the Kaplan–Meier method and compared between groups by log rank tests.

RESULTS:

Ninety-three patients received IDDS, and total therapy duration accounts for 10,300 IDDS days. Implanted patients suffered from severe pain before implantation (median presurgical NRS, 8 [interquartile range, 7–9]) despite a median 360 mg (260–600) oral morphine equivalent daily dose. Median OS in the whole cohort after intrathecal treatment start was 82 days (95% confidence interval, 59–95). Median OS after surgery for implantable pump was 91 days (83–111) and for external pump 27 days (20–49; P < .0001). IDDS was associated with pain relief with a significant statistical difference between preimplantation NRS pain score and 1 week (median, −6 [−7 to −4]; P < .001), 1 month (median, −5 [−6 to −3]; P < .001), and 3 months (median, −6 [−7 to −4]; P < .001). Severe pain (NRS score, ≥7) decreased from 89.2% before surgery to 4.5% after 1 week, 6.7% after 1 month, and 10.3% after 3 months of IDDS implant (P < .01). Global complications rate was low, consistent with published literature.

CONCLUSIONS:

Despite our study’s limitations, results suggest that long-term IDDS for refractory malignant pain due to pancreatic cancer was both efficacious and safe in pancreatic cancer pain. We have demonstrated, in the largest series of IDDS for pancreatic cancer pain reported yet, a clinically and statistically significant pain reduction in patients receiving IDDS.
Anesthesia for Percutaneous Pulmonary Valve Implantation: A Case Series
Authors: Arboleda Salazar Rafael , Heggie Jane , Wolski Piotr , Horlick Eric , Osten Mark , Meineri Massimiliano
Published: March 2018

BACKGROUND:

Twenty percent of patients born with congenital heart disease present with right ventricular outflow tract abnormalities. These patients require multiple surgical procedures in their lifetime. Transcatheter pulmonary valve replacement (TPVR) has become a viable alternative to conventional pulmonary valve and right ventricular outflow tract surgery in pediatric and adult populations. In this retrospective review, we analyze the perioperative management of adult patients who underwent TPVR in our center.

METHODS:

The study consisted of a chart review of patients who underwent TPVR at Toronto General Hospital between 2006 and 2015. Information about preoperative assessment, intraoperative anesthetic management, and intra- and postprocedural complications was collected. Two types of percutaneous valves have been used for a conduit or valve size between 16 and 28 mm. These procedures are done via the femoral, jugular, or subclavian vein under general anesthesia.

RESULTS:

Seventy-nine adults (17–68 years of age) who underwent elective TPVR procedures were included. General anesthesia was used in all cases. Defibrillation was necessary in 1 case, and bradycardia was spontaneously resolved in another 1. Eighty-five percent were successfully extubated at the end of the procedure. Five patients required intraoperative inotropic support. Three patients presented self-resolved hemoptysis. Mechanical ventilation for >24 hours was necessary in 3 cases, 2 of which also required concomitant inotropic support. Four failed deployments and 1 case of persistent conduit stenosis were reported. Three patients required reintubation. All patients were discharged home.

CONCLUSIONS:

Patients undergoing TPVR represent a complex and heterogeneous population. General anesthesia with endotracheal intubation is preferred. Setup for urgent lung isolation and cardiac defibrillation should be considered. Postoperative monitoring and intensive care setting are required. Anesthesiologists with cardiac anesthesia training are probably better suited to manage these patients.
An optimized pipeline for parallel image-based quantification of gene expression and genotyping after in situ hybridization
Authors: Dobrzycki Tomasz , Krecsmarik Monika , Bonkhofer Florian , Patient Roger , Monteiro Rui
Published: March 2018

Advances in genome engineering have resulted in the generation of numerous zebrafish mutant lines. A commonly used method to assess gene expression in the mutants is in situ hybridization (ISH). Because the embryos can be distinguished by genotype after ISH, comparing gene expression between wild type and mutant siblings can be done blinded and in parallel. Such experimental design reduces the technical variation between samples and minimises the risk of bias. This approach, however, requires an efficient method of genomic DNA extraction from post-ISH fixed zebrafish samples to ascribe phenotype to genotype. Here we describe a method to obtain PCR-quality DNA from 95-100% of zebrafish embryos, suitable for genotyping after ISH. In addition, we provide an image analysis protocol for quantifying gene expression of ISH-probed embryos, adaptable for the analysis of different expression patterns. Finally, we show that intensity-based image analysis enables accurate representation of the variability of gene expression detected by ISH and that it can complement quantitative methods like qRT-PCR. By combining genotyping after ISH and computer-based image analysis, we have established a high-confidence, unbiased methodology to assign gene expression levels to specific genotypes, and applied it to the analysis of molecular phenotypes of newly generated lmo4a mutants.
Delayed male germ cell sex-specification permits transition into embryonal carcinoma cells with features of primed pluripotency
Authors: Dawson Emily P. , Lanza Denise G. , Webster Nicholas J. , Benton Susan M. , Suetake Isao , Heaney Jason D.
Published: March 2018

Testicular teratomas result from anomalies in embryonic germ cell development. In 129 inbred mice, teratoma initiation coincides with germ cell sex-specific differentiation and the mitotic-meiotic switch: XX and XY germ cells repress pluripotency, XX germ cells initiate meiosis, and XY germ cells activate male-specific differentiation and mitotic arrest. Here, we report that expression of Nanos2, a gene that is crucial to male sex specification, is delayed in teratoma-susceptible germ cells. Decreased expression of Nanos2 was found to be due, in part, to the Nanos2 allele present in 129 mice. In teratoma-susceptible germ cells, diminished expression of genes downstream of Nanos2 disrupted processes that were crucial to male germ cell differentiation. Deficiency for Nanos2 increased teratoma incidence in 129 mice and induced developmental abnormalities associated with tumor initiation in teratoma-resistant germ cells. Finally, in the absence of commitment to the male germ cell fate, we discovered that a subpopulation of teratoma-susceptible germ cells transition into embryonal carcinoma (EC) cells with primed pluripotent features. We conclude that delayed male germ cell sex-specification facilitates the transformation of germ cells with naïve pluripotent features into primed pluripotent EC cells.
Welche medizinischen Thrombose-prophylaxestrümpfe - knielang oder oberschenkellang - sind effektiver?
Authors: Marshall M. , Wienert V.
Published: March 2018

Es sollte der präventive Effekt knielanger (Wadenstrumpf) und oberschenkellanger (Schenkelstrumpf) medizinischer Thromboseprophylaxestrümpfe (MTPS) evaluiert werden.

In den Datenbanken Pubmed, Cochrane Library, HTA-Berichte wurde nach den Stichwörtern „Thromboseprävention” und „Thromboseprophylaxestrümpfe” gesucht, und zwar in systematischen Reviews, Metaanalysen und Leitlinien.

Es finden sich zwei ergiebige Leitlinien und zwei sehr umfangreiche systematische Reviews, alle im Zeitraum von 2010 bis 2015 publiziert.

Die NICE-Leitlinie und die SIGN-Leitlinie empfehlen knielange oder oberschenkellange MTPS, vier Reviews dagegen zeigen keine eindeutigen Ergebnisse in der Prävention von Thrombosen.

Der präventive Effekt beider MTPS ist nicht deutlich unterschiedlich:

- Die Berechnung des präventiven Effekts beider MTPS ist nicht möglich, da die Studien signifikant heterogen sind.

- Der präventive Effekt des oberschenkellangen MTPS, kombiniert mit der Pharmakotherapie, zeigt einen nicht signifikanten positiven Trend.

- Der präventive Effekt eines oberschenkellangen MTPS plus Pharmakotherapie ist effektiver als der eines knielangen MTPS plus Pharmakotherapie.
Improving paper-based discharge process; a continuous full-cycle quality improvement project in low resource setting
Authors: Abdalrahman Ihab B , Mohammed Mohammed Elsanousi Huzaifa , Abdalla Abdelmohaymin A , Abdelaziz Sulaf Ibrahim , Ali Aboaagla Abdalbagi , Osman Dina Nader Mutwakel , Ahmed Ahmed Abdelmoniem , Elwasila Hagir Emad , Mokhtar Mohammed Romaisa Hashim , Dafaalla Mohamed
Published: March 2018

Background: The moment of hospital discharge is a time for vulnerability for many patients and might jeopardize their safety. We found that the current structure of the discharge card at Soba University Hospital (SUH) does not improve the quality of the discharge summary. This hinders the delivery of valid, relevant and adequate health information and can negatively affect outpatient care.  

Methods: We implemented a new discharge card design with structured headings at the Department of Medicine at Soba University Hospital from the beginning of March to April 15th, 2017.  This was coupled with educational sessions highlighting the problems that might occur if there were gaps in patient transition from inpatient to outpatient.

Results: There was a significant improvement in documentation of the majority (>90%) of the items, including name, age, source of admission treating doctor, diagnosis and medication, but there was a drop in documentation of comorbidities. We also noticed that the new discharge summary format significantly improved the documentation of the majority of the headings (all P values were <0.001), yet, there was a drop in documentation of comorbidities and dates for follow up.

Conclusions: Recording of paper-based health records like discharge summaries could be substantially improved by use of well-structured formats and practical training sessions. Improvement is a dynamic process. Some gaps might appear during execution, these need monitoring and continuous improvement to establish sustainability.
Assessment of the Cambridge Neuropsychological Test Automated Battery test in Saudi children with learning disabilities: A case-control study
Authors: Al Backer Nouf , Ateeq Alharbi Koloud , Alfahadi Abdulrahman , Shahid Habib Syed , Bashir Shahid
Published: March 2018

Background: The neuropsychological tests and its subtests are composed of the motor planning task; simple reaction time task and the intradimensional/extradimensional shift (IED) task from the Cambridge Neuropsychological Test Automated Battery (CANTAB) were developed to examine specific components of cognition. The main objective of this study was to examine the reliability of these CANTAB subtests in pediatric patients with learning disabilities (LD) in Saudi Arabia.

Methods: We administered the CANTAB subset test to 92 participants with LD and 68 controls with no LD. The tests performed were motor planning task (MOT), simple reaction time task (SRT) and the intradimensional/extradimensional shift (IED).

Results: There was no significant age difference between the case and the control group (case: 9.2 ± 2.4 years versus controls: 9.0 ± 1.6 years, p=0.544). The IED and MOT were significantly longer among patients with LD versus control (p <0.001). LD cases had a longer SRT time than controls (cases: 1050.4 ± 626.5 versus controls: 815.5 ± 133.9, p=0.003). LD patients completed an average of 3.0 stages, than the controls, who were able to complete a mean of 8.4 IED stages (p<0.001). SRT was significantly longer in the case group (965.9 ± 716.4) compared to the controls (747.7 ± 120.7, p=0.014). LD cases made more errors in the motor screening tasks (MOT-Error) compared to the control group (case: 14.6 ± 4.5 versus controls: 12.4 ± 2.7, p<0.001).

Conclusion: Patients with LD have poor CANTAB subtest results. If these CANTAB subtests do measure cognitive function, this adds to the accumulating evidence of cognitive impairment association in LD, and such studies should remain an active area of research.