bluuebunny/crossref_metadata_2025 huggingface dataset:
A Gene-Expression Predictor for Efficacy of Induction Chemotherapy in Locoregionally Advanced Nasopharyngeal Carcinoma
Authors: Lei Yuan , Li Ying-Qin , Jiang Wei , Hong Xiao-Hong , Ge Wen-Xiu , Zhang Yuan , Hu Wei-Han , Wang Ya-Qin , Liang Ye-Lin , Li Jun-Yan , Cho William C S , Yun Jing-Ping , Zeng Jing , Chen Jie-Wei , Liu Li-Zhi , Li Li , Chen Lei , Xie Fang-Yun , Li Wen-Fei , Mao Yan-Ping , Liu Xu , Chen Yu-Pei , Tang Ling-Long , Sun Ying , Liu Na , Ma Jun
Published: July 2020

Background

Induction chemotherapy (IC) followed by concurrent chemoradiotherapy is the mainstay treatment for patients with locoregionally advanced nasopharyngeal carcinoma. However, some patients obtain little benefit and experience unnecessary toxicities from IC. We intended to develop a gene-expression signature that can identify beneficiaries of IC.

Methods

We screened chemosensitivity-related genes by comparing gene-expression profiles of patients with short-term tumor response or nonresponse to IC (n = 95) using microarray analysis. Chemosensitivity-related genes were quantified by digital expression profiling in a training cohort (n = 342) to obtain a gene signature. We then validated this gene signature in the clinical trial cohort (n = 187) and an external independent cohort (n = 240). Tests of statistical significance are 2-sided.

Results

We identified 43 chemosensitivity-related genes associated with the short-term tumor response to IC. In the training cohort, a 6-gene signature was developed that was highly accurate at predicting the short-term tumor response to IC (area under the curve [AUC] = 0.87, sensitivity = 87.5%, specificity = 75.6%). We further found that IC conferred failure-free survival benefits only in patients in the benefit group (hazard ratio [HR] = 0.54, 95% confidence interval [CI] = 0.34 to 0.87; P = .01) and not on those in the no-benefit group (HR = 1.25, 95% CI = 0.62 to 2.51; P = .53). In the clinical trial cohort, the 6-gene signature was also highly accurate at predicting the tumor response (AUC = 0.82, sensitivity = 87.5%, specificity = 71.8%) and indicated failure-free survival benefits. In the external independent cohort, similar results were observed.

Conclusions

The 6-gene signature can help select beneficiaries of IC and lay a foundation for a more individualized therapeutic strategy for locoregionally advanced nasopharyngeal carcinoma patients.
Energy expenditure during pregnancy: a systematic review
Authors: Savard Claudia , Lebrun Audrée , O’Connor Sarah , Fontaine-Bisson Bénédicte , Haman François , Morisset Anne-Sophie
Published: July 2020

Context

Contrary to nutritional guidelines, accumulating evidence shows that pregnant women’s energy intakes remain stable throughout trimesters. Although pregnant women may eat below their needs or underreport their energy intakes, it is also relevant to question how energy requirements – estimated through measurements of energy expenditure (EE) – change throughout pregnancy.

Objective

This review examined prospective studies that measured EE during pregnancy, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.

Data sources

PubMed/MEDLINE, Web of Science, Embase, and CINAHL databases were searched to identify relevant publications up to November 14, 2019.

Study selection

All studies that measured EE prospectively and objectively during pregnancy were included in this systematic review. Two authors independently screened 4852 references. A total of 32 studies were included in the final analysis.

Data extraction

One author extracted data and assessed the risk of bias and a second author did so for a random sample of studies (n = 7; 22%).

Data analysis

Increases in resting EE ranged from 0.5% to 18.3% (8–239 kcal), from 3.0% to 24.1% (45–327 kcal), and from 6.4% to 29.6% (93–416 kcal) between early and mid-, mid- and late, and early and late pregnancy, respectively. Increases in total EE ranged from 4.0% to 17.7% (84–363 kcal), from 0.2% to 30.2% (5–694 kcal), and from 7.9% to 33.2% (179–682 kcal) between early and mid-, mid- and late, and early and late pregnancy, respectively. Participants were mainly of normal weight, although many studies did not report important covariates such as prepregnancy body mass index and gestational weight gain adequacy.

Conclusions

Additional high-quality longitudinal studies (ie, with multiple objective measurements of EE in all periods of pregnancy while considering important confounding variables, like gestational weight gain) are required.
RETRACTED: Lepton number violation in a unified framework
Authors: Kawamura Yuta , Matsuo Yamato , Morozumi Takuya , Salim Adam Apriadi , Shimizu Yusuke , Tokunaga Yuya , Toyota Naoya
Published: July 2020

We study the time evolution of lepton family number for a neutrino that forms an SU(2) doublet with a charged lepton. The lepton family number is defined through a weak basis of the SU(2) doublet in which the charged lepton mass matrix is a real and diagonal one. The lepton family number carried by the neutrino is defined with a left-handed current of the neutrino family. We study the time evolution of the lepton family number operator for the Majorana neutrino. To be definite, we introduce the mass term at $t=0$ and study the time evolution of the lepton family number for the later time. Since the operator in the flavor eigenstate is continuously connected to that of the mass eigenstate, the creation and annihilation operators for the flavor eigenstates are related to those of the mass eigenstates. The total lepton number of the Majorana neutrino is conserved. By choosing a specific flavor eigenstate of the neutrino as an initial state, we compute the time evolution of all lepton family numbers. They are sensitive to Majorana and Dirac phases and are also sensitive to the absolute mass and mass hierarchy of neutrinos.
Unconstrained Capital? Multinational companies, structural power, and collective goods provision in dual VET
Authors: Unterweger Daniel Franz
Published: July 2020

Collective goods provision, most prominent in coordinated market economies, depends on certain institutional conditions that constrain employer behavior and trigger cooperation. Increased capital mobility, characterized by new exit opportunities for business and an influx of multinational companies not anchored in their new home-countries’ institutional environment, loosens those ‘beneficial constraints’. I argue that these challenges do not lead to convergence between globalized locations as the structural power of business depends on the type of firms attracted by local institutional comparative advantages. Comparing collective skill formation in two heavily globalized cantons of Switzerland, I show that a region fundamentally relying on low-tax policies sees its hands increasingly tied in the face of globalization. It must accordingly reshape collective goods provision around policies favored by business. In contrast, a location with more diverse comparative advantages is able to implement more compelling policy elements that punish uncooperative firms.
The Roundabout Model for Adjunct Clinical Nurse Faculty Retention
Authors: Yoder Carolyn M. , Earle Melinda , Deane Susan
Published: July 2020

The Roundabout Model was created to address the need for developing and retaining adjunct clinical faculty. Three interrelated evidence-based practices form the Roundabout Model: education, mentoring, and ongoing evaluation. Implementation of the model at one private not-for-profit school of nursing in the Midwest resulted in improved adjunct clinical faculty retention, from 50 percent to 100 percent, as well as improved student and clinical agency satisfaction. Students rated 88 percent of adjunct clinical faculty 3.5 or above on a 4.0 scale. Clinical agency complaints were reduced from three to four annually to zero.
Rapid Micro-induction of Buprenorphine/Naloxone for Opioid Use Disorder in a Critically ill Intubated Patient: A Case Report
Authors: Hamata Basia , Griesdale Donald , Hann Jessica , Rezazadeh-Azar Pouya
Published: July 2020

Background:

Buprenorphine/naloxone has been shown to be an effective treatment of opioid use disorder. According to the Canadian National clinical practice guideline on the management of opioid use disorders, given the superior safety profile of buprenorphine/naloxone and its potential for flexible take-home dosing in comparison to other opioid agonist medication it is strongly recommended to initiate opioid agonist treatment with buprenorphine/naloxone as the preferred first-line treatment when possible. Due to its pharmacological properties induction can be challenging, requiring the cessation of all opioids for a certain amount of time to avoid the risk of precipitated withdrawal symptoms. For this reason, buprenorphine/naloxone is not initiated for the treatment of opioid use disorder in critically ill patients where continuous infusion of opioids are required for maintenance of sedation resulting in a missed opportunity for first line treatment of that patient's opioid use disorder.

Case Summary:

We present a case of a 29-year-old female with opioid use disorder admitted for infective endocarditis and septic shock requiring intubation for hypoxic respiratory failure secondary to bilateral lung septic emboli with a high opioid debt requiring higher than typical doses of fentanyl and dexmedetomidine infusions to maintain sedation with clinical objective sign of inadequate treatment of her pain and opioid withdrawal. She was successfully started on buprenorphine/naloxone using a rapid micro-induction technique that did not cause precipitated withdrawal or require cessation of her fentanyl infusion.

Conclusion:

This case illustrates a new method for starting buprenorphine/naloxone in a critically ill intubated patient, where buprenorphine/naloxone was never a consideration in this specific patient population.

Scientific Significance:

This method can be used to minimize barriers to opioid agonist therapy in intubated patients
Improving resident education through unstable chicken hips: a novel way to teach an infant hip examination
Authors: Geswell Matthew , Sinha Neha , Mandel Mark , Wheatley Benjamin , Mirenda William , Seeley Mark
Published: July 2020

Current clinical screening for infantile hip dysplasia relies on combined Ortolani and Barlow maneuvers, which have a quoted sensitivity and specificity of 74–98 and 84–99%, respectively. Teaching this delicate physical examination maneuver is difficult as it requires a distinct tactile feel. The purpose of this study is to validate a benchtop learning grocery-bought chicken simulator model of newborn hip instability through a pre- and post-test surveys. This model of hip dysplasia uses whole chickens. A posterior capsulotomy of the chicken’s hip joint was performed to create instability. Provocative maneuvers to dislocate and relocate the hip were taught by a pediatric orthopedic surgeon. All participants completed an anonymous pre- and post-training surveys. A total of 58 participants were included in the study: 10 medical students, 13 pediatric residents, 15 orthopedic residents, and 20 orthopedic or pediatric attending physicians. The pediatric residents had performed the Barlow/Ortolani tests more than the orthopedic residents (96.15 ± 83.19 vs. 37.53 ± 60.89; P = 0.01); however, fewer pediatric residents reported feeling a positive examination (31 vs. 67%). The majority of the group agreed that the simulation felt and moved like an infant’s hip (3.95 and 4.13; Likert five-point scale). The participants unanimously agreed that the model could be used to teach someone new to pediatrics the basic steps of the examination (4.91; Likert five-point scale) and should be implemented in the teaching curriculum (100%). The current study validates the benchtop model in teaching the clinical steps in detecting hip dysplasia. The model improved confidence and comfort level for all participants and proved to be a valuable tool for resident education in multiple specialties. By improving education with this model, we hope to improve early identification of hip dysplasia with increased accuracy across subspecialties.
Cardiac morphological and functional changes induced by C-type natriuretic peptide are different in normotensive and spontaneously hypertensive rats
Authors: Caniffi Carolina , Prentki Santos Estefanía , Cerniello Flavia M. , Tomat Analía L. , González Maglio Daniel , Toblli Jorge E. , Arranz Cristina
Published: July 2020

Objective:

Inflammation and fibrosis are key mechanisms in cardiovascular remodeling. C-type natriuretic peptide (CNP) is an endothelium-derived factor with a cardiovascular protective role, although its in-vivo effect on cardiac remodeling linked to hypertension has not been investigated. The aim of this study was to determine the effects of chronic administration of CNP on inflammatory and fibrotic cardiac mechanisms in normotensive Wistar rats and spontaneously hypertensive rats (SHR).

Methods:

Twelve-week-old male SHR and normotensive rats were infused with CNP (0.75 μg/h/100 g) or isotonic saline (NaCl 0.9%) for 14 days (subcutaneous micro-osmotic pumps). Echocardiograms and electrocardiograms were performed, and SBP was measured. After treatment, transforming growth factor-beta 1, Smad proteins, tumor necrosis factor-alpha, interleukin-1 and interleukin-6, nitric oxide (NO) system and 2-thiobarbituric acid-reactive substances were evaluated in left ventricle. Histological studies were also performed.

Results:

SHR showed lower cardiac output with signs of fibrosis and hypertrophy in left ventricle, higher NO-system activity and more oxidative damage, as well as higher pro-inflammatory and pro-fibrotic markers than normotensive rats. Chronic CNP treatment-attenuated hypertension and ventricular hypertrophy in SHR, with no changes in normotensive rats. In left ventricle, CNP induced an anti-inflammatory and antifibrotic response, decreasing both pro-fibrotic and pro-inflammatory cytokines in SHR. In addition, CNP reduced oxidative damage as well as collagen content, and upregulated the NO system in both groups.

Conclusion:

Chronic CNP treatment appears to attenuate hypertension and associated end-organ damage in the heart by reducing inflammation and fibrosis.
Sustaining improvements in relational coordination following team training and practice change: A longitudinal analysis
Authors: Blakeney Erin Abu-Rish , Ali Hebatallah Naim , Summerside Nicole , Lavallee Danielle C. , Kragen Benjamin , Willgerodt Mayumi A. , Weiner Bryan J. , Spacciante Leah , Zierler Brenda K.
Published: July 2020

Background

Poor communication is a leading cause of errors in health care. Structured interprofessional bedside rounds are a promising model to improve communication.

Purpose

The aim of the study was to test if an intervention to improve communication and coordination in an inpatient heart failure care unit would result in lasting change.

Methodology/Approach

The relational coordination (RC) survey was administered to seven workgroups (i.e., nurses, physicians) at baseline (2015) and three subsequent years following the intervention (team training, leadership development workshops, and structured interprofessional bedside round implementation). Descriptive analysis and mixed-effects models were used to assess the impact of the intervention on improving RC.

Results

During the study period (2015–2018), 344 participants completed the survey for an overall response rate of 53.5% (n = 643). Postintervention, the RC index significantly increased from 3.79 to 4.08 (p < .001) and remained significantly higher over 2 years, with an RC index of 4.12 and 4.04, respectively (p < .001). The range of RC scores between and within workgroups narrowed over time, with nonrotating workgroups showing the most improvements.

Conclusion

Findings indicate that positive changes as a result of the intervention have been sustained, despite high rates of turnover among all workgroups. Notably, positive change in RC was found to be more pronounced for nonrotating workgroups compared to team members who rotate within the hospital (i.e., pharmacists who rotate to other units every month).

Practice Implications

This intervention holds promise for teams seeking best practice models of “high-reliability” care organization and delivery. Sustained changes from this intervention represent an important area of future practice-based research.
TREATMENT OF BILATERAL DIFFUSE UVEAL MELANOCYTIC PROLIFERATION WITH INTRAVITREAL STEROID IMPLANTS
Authors: Gemperline Taylor P. , Smith Bradley T.
Published: July 2020

Background/Purpose:

To report a case of bilateral diffuse uveal melanocytic proliferation (BDUMP) treated with intravitreal steroid implants.

Method:

Bilateral diffuse uveal melanocytic proliferation was diagnosed and treated with intravitreal steroid implants (both dexamethasone 0.7 mg [intravitreal dexamethasone implants] and fluocinolone acetonide 0.18 mg [intravitreal fluocinolone acetonide implants]) and monitored every 2 weeks to 4 weeks with optical coherence tomography.

Results:

Intravitreal dexamethasone implants improved visual acuity and central retinal thickness for 10 weeks, was best from 4 to 6 weeks, and recurred by 14 weeks after treatment. Intravitreal fluocinolone acetonide implants improved visual acuity and central retinal thickness for 20 weeks after treatment without edema recurrence. No retinal detachments were observed over 1 year of treatment.

Conclusion:

Intravitreal steroid implants resulted in visual acuity improvement and central retinal thickness reduction for up to 20 weeks and may protect against retinal detachments in patients with bilateral diffuse uveal melanocytic proliferation.
Correlations Between Subjective Evaluation of Quality of Life, Visual Field Loss, and Performance in Simulated Activities of Daily Living in Glaucoma Patients
Authors: Azoulay-Sebban Line , Zhao Zhanlin , Zenouda Ariel , Lombardi Marco , Gutman Emmanuel , Brasnu Emmanuelle , Hamard Pascale , Sahel José-Alain , Baudouin Christophe , Labbé Antoine
Published: July 2020

Precis:

Glaucoma patients displayed alterations in their quality of life (QoL) and their ability to perform activities of daily living. The visual field (VF) of the worse eye might serve as a good marker for QoL evaluation.

Purpose:

The purpose of this study was to explore the correlations between VF defects, performance in simulated activities of daily living, and subjective evaluation of QoL in glaucoma patients.

Methods:

Thirty-two patients with glaucoma and 10 age-matched control subjects were included. All participants answered a QoL questionnaire and underwent an assessment of visual function including monocular and binocular best-corrected visual acuity, binocular contrast sensitivity test (LogCS), and monocular and binocular VF. All subjects also carried out a series of simulated activities of daily living in a controlled environment.

Results:

Glaucoma patients had lower QoL scores compared with controls for the composite score, near and distance activities, social functioning, mental health, role difficulties, dependency, and color vision. With regard to performance in the simulated mobility task, the number of mobility incidents was higher for glaucoma patients than for control subjects. For the reaching and grasping tasks, the overall movement duration for small objects was significantly longer in glaucoma patients compared with controls. The VF mean deviation of the worse eye was correlated with most of the QoL subscores. Mobility incidents as well as the reaching and grasping task parameters were not significantly correlated with QoL scores.

Conclusions:

Glaucoma patients showed an alteration of performance in simulated daily living activities, associated with a decreased QoL. There was no clear correlation between alterations in QoL and ability to perform activities of daily living. The QoL related to vision was mostly correlated to the visual function of the worse eye.
Revival of older antibiotics for the therapy of urinary tract infections: old, but gold Part 1: Antimicrobial susceptibility of extended-spectrum β-lactamase-producing and AmpC β-lactamase-producing Escherichia coli isolates
Authors: Gajdács Márió , Ábrók Marianna , Lázár Andrea , Burián Katalin
Published: July 2020

The most prevalent causative agent of urinary tract infections (UTIs) is uropathogenic Escherichia coli, corresponding to 50–90% of uncomplicated, around 30–70% of nosocomial UTIs. There has been renewed interest toward the clinical value of older, nonβ-lactam antibiotics (including fosfomycin, nitrofurantoin, trimethoprim/sulfamethoxazole) used for the therapy UTIs caused by drug resistant bacteria, including AmpC-producing or an extended-spectrum β-lactamases (ESBL)-producing Gram-negative strains. The aim of our study was to determine the resistance levels of AmpC-producing or ESBL-producing E. coli strains, against the relevant ancillary antibiotics that may be used in the treatment of UTIs. Isolates were collected from the time period between 1 January 2013 and 31 December 2017 from patients with uncomplicated and complicated UTIs treated at the Albert Szent-Györgyi Clinical Center (Szeged, Hungary). Antibiotic susceptibility testing was carried out using the Kirby-Bauer method. Out of the 10 837 isolates, n = 2010 (18.5%; 402 ± 43 isolates/year) E. coli isolates were either AmpC-producers or ESBL-producers, whereas n = 1398 (12.8%; 280 ± 12 isolates/year) produced the two groups of β-lactamases simultaneously. The highest levels of coresistance overall was seen for ciprofloxacin (68.2%), followed by trimethoprim-sulfamethoxazole (58.6%), whereas resistance levels were lower in regards to gentamicin (39.0%), fosfomycin (20.3%) and considerably lower for nitrofurantoin (11.1%). Our analysis of urine-specific AmpC-producing or ESBL-producing E. coli isolates is a useful addition to the literature, as clinicians may rely on this data for empiric antibiotic selection for UTI.
Documentation of Symptoms in Children Newly Diagnosed With Cancer Highlights the Need for Routine Assessment Using Self-report
Authors: Bradford Natalie K. , Bowers Alison , Chan Raymond Javan , Walker Rick , Herbert Anthony , Cashion Christine , Condon Paula , Yates Patsy
Published: July 2020

Background

Symptom management is a cornerstone of quality care and has the potential to vastly influence patient experiences. The supportive care needs of children, however, are not well described.

Objective

The aims of this study were to describe documentation about assessment and occurrence of symptoms in medical records of children with cancer and to compare the profile of documented symptoms with child self-report.

Methods

Twelve weeks of medical records of children (8–18 years) newly diagnosed with cancer were reviewed, and data were extracted regarding symptom assessment and occurrence. A second cohort of children attending oncology outpatients completed the electronic Symptom Screening in Pediatrics self-report of symptom bother. They also answered additional questions about other symptoms and the experience of self-report. We evaluated the profile of symptoms recorded as assessed by healthcare providers and self-reported by children.

Results

One thousand three hundred sixteen symptoms were identified in 3642 assessments. The symptoms most commonly documented by medical and nursing staff were nausea, pain, and appetite. Allied health staff most frequently documented fatigue, feeling scared, or sad. Forty-eight children completed self-report for the same symptoms and identified fatigue, appetite, and taste were the most bothersome. Children were positive about the experience of completing self-report.

Conclusion

This study adds further to the evidence about the importance of obtaining information beyond routine clinical assessment from children themselves.

Implications for Practice

Healthcare providers do not routinely identify all distressing symptoms during clinical encounters. Use of patient-reported outcome measures in children is feasible and acceptable and empowers children to communicate about symptoms, which can facilitate prompt intervention.
Effects of a Roy’s Adaptation Model–Guided Support Group Intervention on Sexual Adjustment, Body Image, and Perceived Social Support in Women With Breast Cancer
Authors: Erol Ursavaş Figen , Karayurt Özgül
Published: July 2020

Background

The side effects of local and systemic treatments for breast cancer negatively impact the body image, sexual functioning, and social life of women on treatment for breast cancer. One of the ways to help these women adapt to their disease and cope with the effects of the disease and the side effects of its treatment is through support groups.

Objective

The aim of this study was to investigate the effect of a support group intervention, guided by Roy’s Adaptation Model, on sexual adaptation, body image, and perceived social support in women on treatment for cancer.

Methods

The study had a quasi-experimental design with pretests and posttests and a control group. The sample included 79 women, 42 in the control group and 37 in the intervention group. Data were gathered with demographic and clinical forms, the Sexual Adjustment and Body Image Scale, and the Multidimensional Scale of Perceived Social Support. The intervention group received a support group intervention guided by Roy’s Adaptation Model.

Results

The intervention group had significantly higher scores for perceived social support, post body image, impact on sexual functioning, and friendly and significant others than the control group did.

Conclusion

The Roy’s Adaptation Model–based support group intervention contributes positively to physiologic, self-concept, role-function, and interdependence modes by creating a positive effect on body image, improving sexual functions, and increasing social support for women on treatment for breast cancer.

Implications for Practice

This support group intervention may enhance care outcomes in women on treatment for cancer and could thus be incorporated into standard care for this patient group.
The Understanding of Dignity Among In-Hospital Patients Living With Incurable Esophageal Cancer
Authors: Missel Malene , Bergenholtz Heidi Maria
Published: July 2020

Background

Dignity is an inherent value in palliative care, but understanding dignity among people living with and hospitalized for incurable esophageal cancer has not been explored.

Objective

The aim of this study was to empirically explore the meaning of dignity in people hospitalized with incurable esophageal cancer.

Methods

A qualitative hermeneutic approach, inspired by Gadamer, guided the research process and interpretation of the transcribed interviews. Eighteen patients participated in the study.

Results

The meaning of dignity was revealed as reverential response in care relationships and eating as an undignifying activity. A balance of the healthcare system’s framework with the lifeworld of the patient was significant in preserving dignity and gave patients a sense of reverent response. Patients were unable to eat ordinary daily meals, which affected their perception of own body and identity, including interactions with others. The resulting bodily changes and social consequences were of crucial importance to the perceived dignity.

Conclusions

A dialogical and understanding approach is significant in making the patient feel worthy, consequently helping to uphold a sense of dignity. The changing and decaying body due to eating difficulties bears witness to illness, altering the individual’s sense of self, in turn threatening the dignity of identity.

Implication for Practice

The care should be based on a reverential response based on the patients’ lifeworld. In doing so, storytelling might be a way. Palliative care for these people needs to stress that patients share other aspects of life that is not totally dominated by their illness, inability to eat, and unrecognizable body.
Scoring Interpersonal Violence Measures
Authors: Williams Jessica Roberts , Burton Candace W. , Anderson Jocelyn C. , Gonzalez-Guarda Rosa M.
Published: July 2020

Background

Interpersonal violence, such as intimate partner violence, sexual assault, and adverse childhood experiences, is a significant global health concern. A major challenge to nurses and others working in the field of interpersonal violence deals with the complexity involved in measuring interpersonal violence. Numerous validated instruments exist; however, there is no standard approach for scoring these instruments. There is also a tendency to examine different forms of violence separately, not accounting for the known co-occurrence of violence. This has led to confusion as the interpretation of results often differs depending on the specific method used.

Objectives

The purpose of this article is to summarize the major methods for scoring interpersonal violence measures and implications of each approach with a specific focus on co-occurrence.

Methods

The article begins with a summary of the primary goals of measuring interpersonal violence, major methods for scoring interpersonal violence measures, along with scoring challenges. We then provide a case exemplar examining the relationship between interpersonal violence and posttraumatic stress disorder symptoms to illustrate how scoring methods can affect study results and interpretation of findings.

Results

Our article shows that each scoring method provides a different picture of the distribution of interpersonal violence experiences and varies regarding the ease of interpretation. Scoring methods also affect interpretation of associations between interpersonal violence and other factors, such as having statistical power to detect significant associations. Accounting for the co-occurrence is critical for making accurate inferences by identifying potential confounding interactions between different types of violence.

Discussion

The application of different scoring methods leading to varying interpretations highlights the need for researchers to be purposeful when selecting a method and even applying multiple methods when possible. Recommendations are provided to assist researchers and providers when making decisions about the use of scoring methods in different contexts.
New Approach to Microscopy of Gram-Stained Urethral Smear: The Kissing Slide Method
Authors: Sarier Mehmet , Demir Meltem , Turgut Hasan , Hizel Aydan , Emek Mestan , Kukul Erdal , Sepin Nevgun
Published: July 2020

Background

The effectiveness of microscopy of Gram-stained smear (GSS) for the detection of male urethral infection is debatable, especially in cases with low inflammation and no visible urethral discharge. This clinical study compared GSS samples collected with the conventional swab method and our new technique, the kissing slide method, together with polymerase chain reaction results to demonstrate the effectiveness of this new method in men with acute urethritis.

Methods

The study included 64 men who presented to the urology outpatient clinic with complaints of acute urethritis between October 2019 and January 2020. Two GSS samples were collected from each patient, first using the kissing slide method (applying the slide directly to the urethral mucosa), followed by the conventional method. The results were compared with polymerase chain reaction findings.

Results

The patients' mean age was 37.4 ± 7.8 years, and 68.7% had no visible urethral discharge on physical examination. At a GSS threshold of ≥5 polymorphonuclear leukocytes/high-power field, sensitivity values were 60% (95% confidence interval [CI], 42.32%–75.41%) for the kissing slide method and 23.33% (95% CI, 11.79%–40.93%) for the conventional method. At a threshold of ≥2 polymorphonuclear leukocytes/high-power field, sensitivity values with the kissing slide and conventional methods were 80% (95% CI, 62.69%–90.5%) and 50% (95% CI, 33.15%–66.85%) in all patients, and 66.67% (95% CI, 41.71%–84.82%) and 20% (95% CI, 7.047%–45.19%) in cases without visible urethral discharge, respectively.

Conclusion

The new kissing slide method is a noninvasive alternative method that may have better sensitivity than the conventional GSS sampling method in the diagnosis of male acute urethritis. Randomized studies are needed to verify these findings.
Barriers to Access to New Gonorrhea Point-of-Care Diagnostic Tests in Low- and Middle-Income Countries and Potential Solutions: A Qualitative Interview-Based Study
Authors: Ferreyra Cecilia , Redard-Jacot Maël , Wi Teodora , Daily Jennifer , Kelly-Cirino Cassandra
Published: July 2020

Background

To assess the potential market for 2 hypothetical diagnostic tests, one for Neisseria gonorrhoeae/Chlamydia trachomatis (NG/CT) detection and one for NG antimicrobial resistance (AMR) marker identification.

Methods

This is a qualitative interview-based study. Semistructured interviews with global- and country-level experts were performed. Interviewees were provided with simplified versions of Foundation for Innovative New Diagnostics/World Health Organization–developed target product profiles for each test. Interviewees were asked to comment on use cases, test characteristics, and factors that may influence test adoption.

Results

Twenty-one experts were interviewed, including 15 country-level experts (from South Africa, India, Zimbabwe, Ghana, China, Peru, Kenya, and Cambodia). Interviewees welcomed an NG/CT point-of-care test, with near-universal preference for a test that could detect symptomatic and asymptomatic infections. Interviewees also saw value in a test that could be used to screen high-risk populations. Factors that may drive adoption of the NG/CT test identified by interviewees included price, cost-effectiveness, evidence of public health benefit, and World Health Organization guidance. Interviewees felt that AMR test use would likely be limited to patients failing first-line treatment.

Conclusions

Although the potential target population for an NG/CT diagnostic test in low- and middle-income countries is sizeable, there are areas of uncertainty relating to the price of the test and its intended use, warranting further research to determine the most effective positioning. An NG AMR test would likely be used very selectively.
Evaluation of the Reproducibility of Bolus Transit Quantification With Contrast-Enhanced Ultrasound Across Multiple Scanners and Analysis Software Packages—A Quantitative Imaging Biomarker Alliance Study
Authors: Averkiou Michalakis A. , Juang Eric K. , Gallagher Madison K. , Cuevas Maria Alejandra , Wilson Stephanie R. , Barr Richard G. , Carson Paul L.
Published: July 2020

Objectives

Contrast enhanced ultrasound (CEUS) is now broadly used clinically for liver lesion detection and characterization. Obstacles to the efforts to quantify perfusion with CEUS have been the lack of a standardized approach and undocumented reproducibility. The use of multiple scanners and different analysis software packages compounds the degree of variability. Our objectives were to standardize a CEUS-based approach for quantification of perfusion-related parameters of liver lesions and to evaluate the variability of bolus transit parameters (rise time [RT], mean transit time [MTT], peak intensity, and area under the curve) obtained from various clinical ultrasound scanners and analysis software.

Materials and Methods

Bolus transit as a way of evaluating perfusion has been investigated both in vivo and in vitro in the past but without establishing its reproducibility. We developed a tissue flow phantom that produces time-intensity curves very similar to those extracted from clinical cine loops of liver lesions. We evaluated the variability of the bolus transit parameters with 4 commercial scanners (Philips iU22, Philips EPIQ, GE LOGIQ E9, and Siemens Acuson Sequoia) and 3 different analysis software packages in multiple trials (15 per scanner).

Results

The variability (coefficient of variation) from repeated trials and while using a single scanner and software was less than 8% for RT, less than 12% for MTT, less than 49% for peak intensity, and less than 50% for area under the curve. Currently, it is not possible to directly compare amplitude values from different scanners and analysis software packages owing to the arbitrary linearization algorithm used among manufacturers; however, it is possible for time parameters (RT and MTT). The variability when using a different scanner with the same analysis software package was less than 9% for RT and less than 21% for MTT. The variability when using a different analysis software with the same scanner was less than 9% for RT and less than 15% for MTT. In all the evaluations we have performed, RT is the least variable parameter, while MTT is only slightly more variable.

Conclusions

The present study will lay the groundwork for multicenter patient evaluations with CEUS quantification of perfusion-related parameters with the bolus transit technique. When using the protocol and method developed here, it is possible to perform perfusion quantification on different scanners and analysis software and be able to compare the results. The current work is the first study that presents a comparison of bolus transit parameters derived from multiple systems and software packages.
The Effectiveness and Safety of Botulinum Toxin Injections for the Treatment of Congenital Muscular Torticollis
Authors: Qiu Xin , Cui Zhiwen , Tang Gen , Deng Hansheng , Xiong Zhu , Han Shuai , Tang Shengping
Published: July 2020

Objective:

Botulinum toxin have been used to treat congenital muscular torticollis for the last 25 years; however, few studies have been published with only limited cases and short-term follow-up. The aim of the present study is to systematically review the effectiveness and safety of botulinum toxin injections for congenital muscular torticollis by analyzing these relevant literatures.

Methods:

The authors searched PubMed, Web of Science, EMBASE, Cochrane Library, China Biology Medicine, for all articles about botulinum toxin injections for the congenital muscular torticollis. The MINORS evaluation tool was adopted to evaluate the quality of these studies. Meta-analysis calculations are made by R software 3.6.2.

Results:

This study search involved strict inclusion criteria and targeted data collection. Ten studies were included, with a total of 411 patients, comprising 1 non-randomized experimental study and 9 cases or case series. The results of our meta-analysis of single rate showed that the overall effective rate of botulinum toxin for congenital muscular torticollis was 84% (95% confidence interval [CI] 67%–96%). After botulinum toxin treatment, the conversion rate to surgery was 9% (95% CI 4%–22%), and the adverse reaction rate was 1% (95% CI 0%–3%). The most common adverse reactions among these included studies involve injection site erythema and transient dysphagia.

Conclusion:

Current evidence shows that botulinum toxin injections for the treatment of congenital muscular torticollis is safe and effective, with few serious adverse reactions. Further well-designed, larger randomized trials are warranted.
Palatal Re-Repair With Double-Opposing Z-Plasty in Treatment of Velopharyngeal Insufficiency of Patients With Unilateral Cleft Lip and Palate
Authors: Ahti Veera , Alaluusua Suvi , Rautio Jorma , Saarikko Anne
Published: July 2020

Background:

Velopharyngeal insufficiency (VPI) is a common problem after cleft palate repair that is often related to palatal shortening and insufficient levator reconstruction. For VPI correction in our cleft center, palatal re-repair with double-opposing Z-plasty is the standard operation.

Aims:

To assess the efficacy of double-opposing Z-plasty in treatment of VPI after primary surgery for unilateral cleft lip and palate (UCLP).

Methods:

This retrospective analysis comprised 109 consecutive UCLP patients born between 1997 and 2014 with VPI that required re-operation, and were operated on by 2 highvolume cleft surgeons, followed by perceptual and instrumental (Nasometer) evaluation of velopharyngeal competence (VPC).

Results:

Preoperatively, VPI was severe in 96% (105 of 109) and mild-to-moderate in 4% (4 of 109). Median age at surgery was 5.6 years (range 2.8–21.9). Postoperatively, 84% of patients achieved adequate VPC: 65% (71 of 109) were competent and 19% (21 of 109) borderline competent. Postoperative adequate VPC was 89% (70 of 79) in nonsyndromic Finnish patients, 50% (4 of 8) in syndromic patients, and 82% (18 of 22) in adoption children. Compared to Finnish nonsyndromic patients, patients with syndrome had more residual VPI (P = 0.003), but no statistically significant difference existed for adoption patients (P = 0.251). Complications of the double-opposing Z-plasty included hemorrhage, postoperative mild airway obstruction, and wound-healing problems, each arising in 2 (1.8%) patients. Fourteen (13%) patients needed a second VPI operation.

Conclusion:

Double-opposing Z-plasty seems to be a good and safe treatment option for VPI in patients with previously repaired UCLP with a success rate of 84%.
Intraconal Retro-Orbital B-Type Antoni Neurinoma Causing Vision Loss
Authors: Bagaglia Simone Alex , Meduri Alessandro , Inferrera Leandro , Gennaro Paolo , Gabriele Guido , Polito Ennio , Fruschelli Mario , Lorusso Nicola , Tarantello Antonio , Mazzotta Cosimo
Published: July 2020

Schwannoma is a rare benign tumor, originating from Schwann cells of the peripheral nerve sheath. We describe a case of intraconal orbital schwannoma, causing compression to the optic nerve and progressive visual impairment treated with surgical resection. The diagnosis of benign orbital schwannoma was provided by histopathological examination (large spindle cell tumor with AntoniB-type cell pattern) and also with immunohistochemistry (positivity for S-100 protein). The 6 months’ follow-up was performed. The patient was asymptomatic during the 6-month follow-up.
Surgical Treatment of a Child With Acute Cortical Blindness Caused by Depressed Skull Fracture
Authors: Köksal Vaner , Karkucak Ahmet , Yalçinkaya Mirsad
Published: July 2020

Linear skull fractures are relatively common in children, however, it is rarer to see depressed fractures. This report details the case of a 7-year-old boy who was admitted to the emergency department with complete blindness after having experienced an in-car traffic accident. Brain tomography of the patient showed that a large, island-shaped piece of occipital bone was depressed on the visual cortex and superior sagittal sinus in the midline. Presentation of complete loss of vision after an isolated head trauma is very rare, and there are no similar cases in existing literature. The limits of surgical indications for depressed skull fractures are well established in neurosurgical practice. Surgical intervention should be performed immediately, especially in cases where neurological changes develop in the earliest stages after a trauma. The patient underwent emergency surgery to correct the blindness without affecting the vascular neighborhood. The depressed cranium was raised to its original position. The blindness had completely resolved shortly after the patient woke up during the postoperative period.
Risk Factors of Positive Resection Margin in Laparoscopic and Open Liver Surgery for Colorectal Liver Metastases: A New Perspective in the Perioperative Assessment
Authors: Benedetti Cacciaguerra Andrea , Görgec Burak , Cipriani Federica , Aghayan Davit , Borelli Giulia , Aljaiuossi Anas , Dagher Ibrahim , Gayet Brice , Fuks David , Rotellar Fernando , D’Hondt Mathieu , Vanlander Aude , Troisi Roberto I. , Vivarelli Marco , Edwin Bjorn , Aldrighetti Luca , Abu Hilal Mohammad
Published: July 2020

Objective:

To assess the risk factors associated with R1 resection in patients undergoing OLS and LLS for CRLMs.

Background:

The clinical impact of R1 resection in liver surgery for CRLMs has been continuously appraised, but R1 risk factors have not been clearly defined yet.

Methods:

A cohort study of patients who underwent OLS and LLS for CRLMs in 9 European high-volume referral centers was performed. A multivariate analysis and the receiver operating characteristic curves were used to investigate the risk factors for R1 resection. A model predicting the likelihood of R1 resection was developed.

Results:

Overall, 3387 consecutive liver resections for CRLMs were included. OLS was performed in 1792 cases whereas LLS in 1595; the R1 resection rate was 14% and 14.2%, respectively. The risk factors for R1 resection were: the type of resection (nonanatomic and anatomic/nonanatomic), the number of nodules and the size of tumor. In the LLS group only, blood loss was a risk factor, whereas the Pringle maneuver had a protective effect. The predictive size of tumor for R1 resection was >45 mm in OLS and >30 mm in LLS, > 2 lesions was significative in both groups and blood loss >350 cc in LLS. The model was able to predict R1 resection in OLS (area under curve 0.712; 95% confidence interval 0.665–0.739) and in LLS (area under curve 0.724; 95% confidence interval 0.671–0.745).

Conclusions:

The study describes the risk factors for R1 resection after liver surgery for CRLMs, which may be used to plan better the perioperative strategies to reduce the incidence of R1 resection during OLS and LLS.
Predicting the Outcome of Limb Revascularization in Patients With Lower-extremity Arterial Trauma
Authors: Perkins Zane B. , Yet Barbaros , Sharrock Anna , Rickard Rory , Marsh William , Rasmussen Todd E. , Tai Nigel R. M.
Published: July 2020

Objectives:

Estimating the likely success of limb revascularization in patients with lower-extremity arterial trauma is central to decisions between attempting limb salvage and amputation. However, the projected outcome is often unclear at the time these decisions need to be made, making them difficult and threatening sound judgement. The objective of this study was to develop and validate a prediction model that can quantify an individual patient's risk of failed revascularization.

Methods:

A BN prognostic model was developed using domain knowledge and data from the US joint trauma system. Performance (discrimination, calibration, and accuracy) was tested using ten-fold cross validation and externally validated on data from the UK Joint Theatre Trauma Registry. BN performance was compared to the mangled extremity severity score.

Results:

Rates of amputation performed because of nonviable limb tissue were 12.2% and 19.6% in the US joint trauma system (n = 508) and UK Joint Theatre Trauma Registry (n = 51) populations respectively. A 10-predictor BN accurately predicted failed revascularization: area under the receiver operating characteristic curve (AUROC) 0.95, calibration slope 1.96, Brier score (BS) 0.05, and Brier skill score 0.50. The model maintained excellent performance in an external validation population: AUROC 0.97, calibration slope 1.72, Brier score 0.08, Brier skill score 0.58, and had significantly better performance than mangled extremity severity score at predicting the need for amputation [AUROC 0.95 (0.92–0.98) vs 0.74 (0.67–0.80); P < 0.0001].

Conclusions:

A BN (https://www.traumamodels.com) can accurately predict the outcome of limb revascularization at the time of initial wound evaluation. This information may complement clinical judgement, support rational and shared treatment decisions, and establish sensible treatment expectations.