bluuebunny/crossref_metadata_2025 huggingface dataset:
Deep Brain Stimulation for Dystonia
Authors: Lotia Mitesh
Published: June 2020

The past two decades have revealed substantial benefits of bilateral pallidal deep brain stimulation (DBS) in patients with medication-refractory primary dystonia. There is a growing body of evidence now describing not only short-term but also long-term benefits up to 10 years following DBS. These benefits are often sustained, requiring minimal long-term modification. Pallidal programming for dystonia may be complex owing to the gradual onset of benefits and often delayed development of side effects. There is a relative scarcity of evidence-based recommendations for standardized programming methods. This chapter reviews essential factors to consider for appropriate patient selection and discusses strategies for initial and follow-up programming. Finally, the chapter describes the potential short-term and long-term adverse effects, while considering various strategies to mitigate them.
Stimulation-Induced Dyskinesia, Interleaving Settings, and Management of Subthalamic Nucleus Deep Brain Stimulation in DYT1 Dystonia
Authors: Mitchell Kyle T. , Dodenhoff Kristen A. , Starr Philip A. , Ostrem Jill L.
Published: June 2020

DYT1 dystonia is a primary dystonia with potential for significant symptomatic improvement after bilateral deep brain stimulation (DBS) of the globus pallidus interna (GPi). GPi is the historical target of choice for this disease. This chapter presents a case of an adolescent with disabling generalized DYT1 dystonia who underwent bilateral subthalamic nucleus (STN) DBS as part of a prospective clinical trial. While limb and cervical dystonia dramatically improved with DBS, programming was limited by stimulation-induced bilateral limb dyskinesia, including in the left arm, which was previously unaffected by dystonia. After years of evolving symptoms and complex programming, bilateral interleaved settings using both a contact in motor STN and the most dorsal DBS contact in the zona incerta resulted in sustained, near-complete resolution of dystonia without side effects. This case illustrates the use of the STN as an effective DBS target for primary dystonia, although complex programming was necessary to mitigate stimulation-induced dyskinesia.
Deep Brain Stimulation in Adult Huntington Disease for Treatment of Axial Dystonia
Authors: Karl Jessica A. , Shannon Kathleen , Slavin Konstantin , Metman Leo Verhagen
Published: June 2020

Huntington disease (HD) is a progressive neurodegenerative disorder characterized by chorea and cognitive and psychiatric disturbances. Dystonia is also a common symptom, and a recent case study points toward 50% of HD patients having truncal dystonia. Although tetrabenazine is approved for treatment of Huntington chorea, no medications have proved efficacious for the dystonia and bradykinesia that become more prominent as the disease progresses. Although several reports have outlined the effect of globus pallidus interna (GPi) deep brain stimulation (DBS) in HD patients with a choreic phenotype, less is known about the effect of DBS in HD patients with a predominately dystonic phenotype. When specific symptoms known to respond well to DBS, such as dystonia, interfere significantly with a patient’s quality of life, and optimal medical management has failed, DBS could be considered a viable option. This case reports demonstrates the utility of bilateral GPi DBS for dystonia in a patient with HD, so long as there is no neuropsychiatric impairment that would interfere with the patient’s comprehension of the potential risks of surgery. The patient and caregivers should have realistic expectations of outcomes and be willing to follow through with regular programming.
Bilateral Globus Pallidus Deep Brain Stimulation for Dystonia and Dystonic Tremor in Spinocerebellar Ataxia 17
Authors: Shukla Aparna Wagle , Zeilman Pamela R.
Published: June 2020

Spinocerebellar ataxia 17 (SCA17) is a rare form of autosomal dominant cerebellar ataxia. SCA17 results from trinucleotide repeat expansions and has no effective symptomatic treatments to date. This chapter describes a case of SCA17 with dystonic symptoms that presented during adolescence. Symptoms were generalized in distribution and were accompanied with a dystonic tremor of the arms. Because many medication trials did not alleviate the patient’s symptoms, he underwent bilateral globus pallidus interna (GPi) deep brain stimulation (DBS) surgery. Several DBS programming sessions were performed. Dystonia and dystonic tremor were controlled with the settings adjusted at high pulse widths and low frequencies. Furthermore, the cyclic mode of stimulation was employed to mitigate the capsular side effects. Two years after DBS surgery, the patient presented with cerebellar ataxia that prompted an extensive workup, including genetic testing and revision of his diagnosis from generalized dystonia to a dystonia syndrome. The patient continues to endorse symptomatic benefits with DBS for dystonia and dystonic tremor 11 years after surgery, despite a diagnosis of dystonia syndrome. The current case of SCA17 cerebellar ataxia indicates that bilateral GPi DBS is a potential option for the long-term symptomatic treatment of dystonia and tremor symptoms manifesting as a part of a clinical syndrome.
Social aspects of primary care
Authors: Simon Chantal , Everitt Hazel , van Dorp Françoise , Hussain Nazia , Nash Emma , Peet Danielle
Published: June 2020

This chapter in the Oxford Handbook of General Practice explores the social aspects of primary care, from social factors and health to multicultural medicine. It includes the general practitioner’s role in cases of domestic violence and with patients who are the victims of crime. It provides guidance on patients with occupational illness and who need time off work for illness, as well as certification of fitness to work and fitness to make decisions, drive, and other activities. It also looks at dealing with bereavement, grief, and coping with loss, and provides advice for claiming benefits for low-income and sickness and disability, as well as pensions.
Medicines and prescribing
Authors: Simon Chantal , Everitt Hazel , van Dorp Françoise , Hussain Nazia , Nash Emma , Peet Danielle
Published: June 2020

This chapter in the Oxford Handbook of General Practice explores all aspects of prescribing in general practice. It reviews NHS prescriptions and how to write prescriptions, including prescriptions for special groups, repeat prescribing, and management of medicines. It also discusses adverse drug reactions, licensing of medicines, how to handle controlled drugs, and non-drug interventions and complementary medicine.
Chronic disease and elderly care
Authors: Simon Chantal , Everitt Hazel , van Dorp Françoise , Hussain Nazia , Nash Emma , Peet Danielle
Published: June 2020

This chapter in the Oxford Handbook of General Practice explores chronic disease and elderly care in general practice. It examines chronic disease management, multimorbidity, genetics and genomics, and medically unexplained symptoms (MUS). It covers the assessment of pain and neuropathic pain, as well as the principles of pain control and pain-relieving drugs including morphine and other strong opioids. It also reviews all aspects of normal ageing, including falls in older people, prescribing for older people, elderly care and disability management, maintaining independence, and carers.
Endocrinology
Authors: Simon Chantal , Everitt Hazel , van Dorp Françoise , Hussain Nazia , Nash Emma , Peet Danielle
Published: June 2020

This chapter in the Oxford Handbook of General Practice explores endocrinology in general practice. It covers symptoms of endocrine disease, including diabetes mellitus. It examines the organization, monitoring, and management of diabetes, treatment of type 2 diabetes, insulin, hypoglycaemia, diabetic renal disease, cardiovascular and skin diabetic complications, eye and nerve diabetic complications, and the diabetic foot. It also explores lumps in the thyroid gland, goitres, thyroid disorders, hypercalcaemia, hypocalcaemia, adrenal disorders, and pituitary problems.
Musculoskeletal problems
Authors: Simon Chantal , Everitt Hazel , van Dorp Françoise , Hussain Nazia , Nash Emma , Peet Danielle
Published: June 2020

This chapter in the Oxford Handbook of General Practice explores musculoskeletal problems encountered in general practice. It covers symptoms of musculoskeletal disease, neck and low back pain, and problems with the shoulder, elbow, wrist, hand, hip, knee, ankle, and foot. It explores sports medicine and the management of sporting injuries. It examines bone disorders, rickets, osteomalacia, osteoporosis, osteoarthritis, rheumatoid arthritis, spondyloarthropathies, and crystal-induced arthritis. It also discusses connective tissue disease, polymyalgia and giant cell arteritis, tiredness, and chronic fatigue syndrome.
Dermatology
Authors: Simon Chantal , Everitt Hazel , van Dorp Françoise , Hussain Nazia , Nash Emma , Peet Danielle
Published: June 2020

This chapter in the Oxford Handbook of General Practice explores dermatology in general practice. It covers skin assessment, treatment of skin conditions, changes in skin colour and eruptions, itching and blistering of the skin, erythema, pigmentation disorder, hair and sweat gland problems, nail changes, and atopic and other eczemas. It discusses ulcers, urticaria, angio-oedema, acne, psoriasis, lichen planus, keratinization disorders, pityriasis, and seborrhoeic warts. It examines sunlight and the skin, benign skin tumours, and skin cancer. It also explores bacterial skin infection, viral skin infection, fungal infection, and infestation.
Emergencies
Authors: Simon Chantal , Everitt Hazel , van Dorp Françoise , Hussain Nazia , Nash Emma , Peet Danielle
Published: June 2020

This chapter in the Oxford Handbook of General Practice explores emergencies in general practice. It covers emergency patient encounters from warning signs for acute severe illness through to managing a resuscitation attempt outside hospital. It details adult basic life support, paediatric basic life support, the choking adult, the choking child, and the unconscious patient. It explores anaphylaxis, sepsis, meningitis, encephalitis, haemorrhage, shock, chest pain, palpitations, acute coronary syndrome, acute breathlessness, pulmonary embolism, and pneumothorax. It discusses acute asthma in adults and children, acute abdominal pain, fitting and funny turns, endocrine and obstetric emergencies, and resuscitation of the newborn. It explores fractures, head injury, facial injury, scalds, burns, and poisoning. It examines overdose, suicide, disturbed behaviour, compulsory treatment of patients with mental illness, and environmental emergencies.
Detection of glyceraldehyde and glycerol in VUV processed interstellar ice analogues containing formaldehyde: a general formation route for sugars and polyols
Authors: Layssac Y , Gutiérrez-Quintanilla A , Chiavassa T , Duvernay F
Published: June 2020

Complex organic molecules (COMs) have been identified toward high- and low-mass protostars as well as molecular clouds. Among them, sugar-like and polyol two carbon-bearing molecules such as glycolaldehyde (GA) and ethylene glycol (EG) are of special interest. Recent laboratory experiments have shown that they can efficiently be formed via atom addition reactions between accreting H-atoms and CO molecules or via energetic processes (UV, electrons) on ice analogues containing methanol or formaldehyde. In this study, we report new laboratory experiments on the low-temperature solid state formation of complex organic molecules – the first sugar glyceraldehyde and its saturated derivative glycerol – through VUV photolysis performed at three different temperatures (15, 50, and 90 K) of astrochemically relevant ices composed of water and formaldehyde. We get evidence that the species production depends on the ice temperature during photolysis. The results presented here indicate that a general scheme of aldose and polyol formation is plausible and that heavier COMs than GA and EG could exist in interstellar environments. We propose a general pathway involving radical-formaldehyde reactions as common initiation step for aldose and polyol formation. Future telescope observations may give additional clues on their presence in star-forming regions as observations are currently limited because of the detection thresholds.
Defeating stochasticity: coalescence time-scales of massive black holes in galaxy mergers
Authors: Nasim Imran , Gualandris Alessia , Read Justin , Dehnen Walter , Delorme Maxime , Antonini Fabio
Published: June 2020

The coalescence of massive black hole binaries (BHBs) in galactic mergers is the primary source of gravitational waves (GWs) at low frequencies. Current estimates of GW detection rates for the Laser Interferometer Space Antenna and the Pulsar Timing Array vary by three orders of magnitude. To understand this variation, we simulate the merger of equal-mass, eccentric, galaxy pairs with central massive black holes and shallow inner density cusps. We model the formation and hardening of a central BHB using the fast multiple method as a force solver, which features a O(N) scaling with the number N of particles and obtains results equivalent to direct-summation simulations. At N ∼ 5 × 105, typical for contemporary studies, the eccentricity of the BHBs can vary significantly for different random realizations of the same initial condition, resulting in a substantial variation of the merger time-scale. This scatter owes to the stochasticity of stellar encounters with the BHB and decreases with increasing N. We estimate that N ∼ 107 within the stellar half-light radius suffices to reduce the scatter in the merger time-scale to ∼10 per cent. Our results suggest that at least some of the uncertainty in low-frequency GW rates owes to insufficient numerical resolution.
A kinase-independent function for AURORA-A in replisome assembly during DNA replication initiation
Authors: Guarino Almeida Estrella , Renaudin Xavier , Venkitaraman Ashok R
Published: June 2020

The catalytic activity of human AURORA-A kinase (AURKA) regulates mitotic progression, and its frequent overexpression in major forms of epithelial cancer is associated with aneuploidy and carcinogenesis. Here, we report an unexpected, kinase-independent function for AURKA in DNA replication initiation whose inhibition through a class of allosteric inhibitors opens avenues for cancer therapy. We show that genetic depletion of AURKA, or its inhibition by allosteric but not catalytic inhibitors, blocks the G1-S cell cycle transition. A catalytically inactive AURKA mutant suffices to overcome this block. We identify a multiprotein complex between AURKA and the replisome components MCM7, WDHD1 and POLD1 formed during G1, and demonstrate that allosteric but not catalytic inhibitors prevent the chromatin assembly of functional replisomes. Indeed, allosteric but not catalytic AURKA inhibitors sensitize cancer cells to inhibition of the CDC7 kinase subunit of the replication-initiating factor DDK. Thus, our findings define a mechanism essential for replisome assembly during DNA replication initiation that is vulnerable to inhibition as combination therapy in cancer.
Effective Antimicrobial StewaRdship StrategIES (ARIES): Cluster Randomized Trial of Computerized Decision Support System and Prospective Review and Feedback
Authors: Heng Shi Thong , Wong Joshua , Young Barnaby , Tay Hui Lin , Tan Sock Hoon , Yap Min Yi , Teng Christine B , Ang Brenda , Lee Tau Hong , Tan Hui Ling , Lew Thomas W , Lye David Chien , Ng Tat Ming
Published: June 2020

Background

Prospective review and feedback (PRF) of antibiotic prescriptions and compulsory computerized decision support system (CDSS) are 2 strategies of antimicrobial stewardship. There are limited studies investigating their combined effects. We hypothesized that the use of on-demand (voluntary) CDSS would achieve similar patient outcomes compared with automatically triggered (compulsory) CDSS whenever broad-spectrum antibiotics are ordered.

Methods

A parallel-group, 1:1 block cluster randomized crossover study was conducted in 32 medical and surgical wards from March to August 2017. CDSS use for piperacillin-tazobactam or carbapenem in the intervention clusters was at the demand of the doctor, while in the control clusters CDSS use was compulsory. PRF was continued for both arms. The primary outcome was 30-day mortality.

Results

Six hundred forty-one and 616 patients were randomized to voluntary and compulsory CDSS, respectively. There were no differences in 30-day mortality (hazard ratio [HR], 0.87; 95% CI, 0.67–1.12), re-infection and re-admission rates, antibiotic duration, length of stay, or hospitalization cost. The proportion of patients receiving PRF recommendations was not significantly lower in the voluntary CDSS arm (62 [10%] vs 81 [13%]; P = .05). Appropriate indication of antibiotics was high in both arms (351/448 [78%] vs 330/433 [74%]; P = .18). However, in geriatric medicine patients where antibiotic appropriateness was <50%, prescription via compulsory CDSS resulted in a shorter length of stay and lower hospitalization cost.

Conclusions

Voluntary broad-spectrum antibiotics with PRF via CDSS did not result in differing clinical outcomes, antibiotic duration, or length of stay. However, in the setting of low antibiotic appropriateness, compulsory CDSS may be beneficial.
Reforming the UK financial system to promote regional development in post-COVID Britain
Authors: Collier Paul , Mayer Colin
Published: June 2020

The UK government faces a massive post-COVID problem in restructuring failing companies and rebuilding its already depressed regions. A missing part of the solution is to link government as well as private-sector funding to the financing of small and medium-sized enterprises (SMEs) in the regions. The institutional structure that is required has precedents in the UK, which can be used as the basis for reforming the funding of its SMEs.
Microstructure in the Machine Age
Authors: Easley David , López de Prado Marcos , O’Hara Maureen , Zhang Zhibai
Published: June 2020

Understanding modern market microstructure phenomena requires large amounts of data and advanced mathematical tools. We demonstrate how machine learning can be applied to microstructural research. We find that microstructure measures continue to provide insights into the price process in current complex markets. Some microstructure features with high explanatory power exhibit low predictive power, while others with less explanatory power have more predictive power. We find that some microstructure-based measures are useful for out-of-sample prediction of various market statistics, leading to questions about market efficiency. We also show how microstructure measures can have important cross-asset effects. Our results are derived using 87 liquid futures contracts across all asset classes.
Brain functional connectivity upon awakening from sleep predicts interindividual differences in dream recall frequency
Authors: Vallat Raphael , Nicolas Alain , Ruby Perrine
Published: June 2020

Why do some individuals recall dreams every day while others hardly ever recall one? We hypothesized that sleep inertia—the transient period following awakening associated with brain and cognitive alterations—could be a key mechanism to explain interindividual differences in dream recall at awakening. To test this hypothesis, we measured the brain functional connectivity (combined electroencephalography–functional magnetic resonance imaging) and cognition (memory and mental calculation) of high dream recallers (HR, n = 20) and low dream recallers (LR, n = 18) in the minutes following awakening from an early-afternoon nap. Resting-state scans were acquired just after or before a 2 min mental calculation task, before the nap, 5 min after awakening from the nap, and 25 min after awakening. A comic was presented to the participants before the nap with no explicit instructions to memorize it. Dream(s) and comic recall were collected after the first post-awakening scan. As expected, between-group contrasts of the functional connectivity at 5 min post-awakening revealed a pattern of enhanced connectivity in HR within the default mode network (DMN) and between regions of the DMN and regions involved in memory processes. At the behavioral level, a between-group difference was observed in dream recall, but not comic recall. Our results provide the first evidence that brain functional connectivity right after awakening is associated with interindividual trait differences in dream recall and suggest that the brain connectivity of HR at awakening facilitates the maintenance of the short-term memory of the dream during the sleep–wake transition.
Enhancing Functional Risk Stratification in Contemporary Cardiac Rehabilitation
Authors: Kellar Garrett , Allsup Kelly , Delligatti Amanda , Althouse Andrew D. , Forman Daniel E.
Published: June 2020

Purpose:

Current American Association of Cardiovascular and Pulmonary Rehabilitation guidelines rely primarily on cardiovascular disease (CVD)-centered metrics to stratify risk and guide care. Yet, contemporary CVD patients are often older and are more likely to have risks attributable to rudimentary functional impairments that can have disproportionate bearing on management and prognosis. In this study, we stratified risk using novel indices of physical function as well as traditional indices of CVD in patients enrolling in phase II cardiac rehabilitation (CR). We hypothesized that risk stratification (RS) using functional criteria would be nonconcordant with CVD RS in a significant number of patients, thus inferring the conceptual value of CR management priorities that are better tailored for distinctive functional risks in many patients.

Methods:

This was a retrospective analysis of a comprehensive quality improvement database with 489 patients. Risk stratification using novel functional indices (ie, gait speed, Timed Up and Go, hand grip, sit to stand, tandem stand, and a 6-min walk test) was compared with RS using traditional CVD criteria.

Results:

Using functional RS, 97 patients were determined to be high risk versus 235 at low risk. Using CVD RS in the same cohort, 227 patients had high risk versus 161 who had low risk. Functional RS was consistent with CVD RS only 42.9% of the time.

Conclusion:

Functional RS and CVD RS varied in the same patients. Enhanced assessment of functional risks adds important prognostic refinement and greater potential to tailor exercise therapy, nutrition, and other CR caregiving priorities.
Connection of GLI1 variants to congenital heart disease susceptibility
Authors: Guan Weiwei , Zhang Jun , Chen Jie
Published: June 2020

The purpose of this study was to investigate the relationship between glioma-associated oncogene homolog 1 (GLI1) rs2228226 and rs10783826 polymorphisms and congenital heart disease (CHD) risk in a Chinese Han population.

Genotyping for our interested polymorphisms was performed using polymerase chain reaction-restriction fragment length polymorphism in 106 CHD patients and 112 healthy controls. Hardy–Weinberg equilibrium status in the control group was also checked via χ2 test. Differences in genotype and allele frequencies between the case and control groups were analyzed adopting Chi-Squared test as well, and the relative risk of CHD resulting from GLI1 genetic variants was checked via calculating odds ratio (OR) and 95% confidence interval (95%CI).

CC genotype of rs2228226 showed significantly higher frequency in CHD patients than in controls (P = .011), indicating that it increased the disease risk (OR = 3.257, 95%CI = 1.280–8.287). Similarly, C allele of the polymorphism elevated CHD incidence by 1.609 folds, compared with G allele (OR = 1.609, 95%CI = 1.089–2.376). However, rs10783826 was not correlated with the occurrence of CHD.

GLI1 rs2228226 polymorphism may be a risk factor for CHD in Chinese Han population, but not rs10783826.
Successful superselective embolization with n-butyl cyanoacrylate for hemorrhage from superficial femoral artery branches following blunt trauma
Authors: Oh Chang Hoon , Kim Yook , Lee Jung Hwan , Kim Hong Rye , Go Seung Je
Published: June 2020

Introduction:

In blunt traumatic superficial femoral arterial (SFA) injuries, hemorrhage from the branches without injury to the main artery is rare, but can lead to serious complications, such as compartment syndrome affecting the clinical outcomes. Although open surgical repair has been the standard approach to peripheral vascular injuries, endovascular treatment has become more refined and is now an alternative to open surgery, which potentially involves lower morbidity and mortality rates. However, management of arterial injuries, especially when they involve simple bleeding from small branches of the main artery, can be challenging, and the best treatment options for such injuries remains controversial.

Patient concerns:

Three cases suffered blunt trauma that resulted in hemorrhage from branches of the SFA.

Diagnosis:

All patients underwent selective angiography, which demonstrated active extravasation from branches of the SFA.

Interventions:

All patients were treated using embolization with n-butyl cyanoacrylate (NBCA).

Outcomes:

A post-embolization angiography demonstrated successful hemostasis, with no complications.

Conclusion:

Superselective catheterization using a coaxial technique with a 5-F curved catheter and the smallest caliber microcatheter, and using a permanent liquid embolic agent, such as NBCA, increases the success rate of embolization for cases of hemorrhage from SFA branches.
Minimal weight loss related to a short fasting period causes superior mesenteric artery syndrome in a patient with amyotrophic lateral sclerosis
Authors: Kang Dong-Ha , Baik Sung Woon , Won Yu Hui , Ko Myoung-Hwan
Published: June 2020

Introduction:

Superior mesenteric artery syndrome (SMAS) is rare cause of small bowel obstruction and is characterized by an extrinsic vascular compression of the duodenum. The most common cause of SMAS is known as rapid and significant weight loss.

Patient concerns:

A 61-year-old man who was diagnosed with amyotrophic lateral sclerosis and maintained a stable diet before admission. When the patient re-started feeding by gastrostomy tube after 5 days of therapeutic fasting due to gastric ulcer caused by gastrostomy tube irritation, he presented postprandial vomiting, abdominal distention, and tachycardia. Since fasting, his weight has been reduced by about 3 kg.

Diagnosis:

Based on clinical symptoms and radiological findings, diagnose of SMAS was finally made. Abdomen computed tomography confirmed decreased aortomesenteric distance and tubography confirmed gastric and proximal duodenum distension above the compressed part.

Interventions:

We performed jejunal tube insertion and the amount of feeding through the jejunal tube was gradually increased while maintaining parenteral nutrition.

Outcomes:

The presenting symptoms of the patient gradually improved. Follow-up abdomen computed tomography and tubography showed improvement in duodenal narrowing and stomach distension.

Conclusion:

SMAS should be considered when there is an abrupt observation of symptom of gastrointestinal obstruction in patients with predisposing condition such as a low body weight, even if the weight loss is relatively small.
Personalized trimodal prehabilitation for gastrectomy
Authors: Bausys Augustinas , Luksta Martynas , Kuliavas Justas , Anglickiene Giedre , Maneikiene Vyte , Gedvilaite Lina , Celutkiene Jelena , Jamontaite Ieva , Cirtautas Alma , Lenickiene Svetlana , Vaitkeviciute Dalia , Gaveliene Edita , Klimaviciute Gertruda , Bausys Rimantas , Strupas Kestutis
Published: June 2020

Background:

Surgery is the only potentially curative treatment for gastric cancer, however, it bears a high postoperative morbidity and mortality rate. A recent randomized control trial proposed prehabilitation to reduce the postoperative morbidity in patients undergoing major abdominal surgery. Currently, there is a lack of evidence of using prehabilitation for patients undergoing gastrectomy for gastric cancer. The aim of our study is to demonstrate that home-based prehabilitation can reduce postoperative morbidity after gastrectomy for gastric cancer.

Methods:

PREFOG is a multi-center, open-label randomized control trial comparing 90-days postoperative morbidity rate after gastrectomy for gastric cancer between patients with or without prehabilitation. One-hundred twenty-eight patients will be randomized into an intervention or control group. The intervention arm will receive trimodal home-based prehabilitation including nutritional, psychological and exercise interventions. Secondary outcomes of the study will include physical and nutritional status, anxiety and depression level, quality of life, postoperative mortality rates and full completion of the oncological treatment as determined by the multidisciplinary tumor board.

Discussion:

PREFOG study will show if home-based trimodal prehabilitation is effective to reduce postoperative morbidity after gastrectomy for gastric cancer. Moreover, this study will allow us to determine whether prehabilitation can improve physical fitness and activity levels, nutritional status and quality of life as well as reducing anxiety and depression levels after gastrectomy for gastric cancer.

Trial registration:

ClinicalTrials.gov NCT04223401 (First posted: 10 January 2020).
The effects of dimethylformamide exposure on liver and kidney function in the elderly population
Authors: Hu Zhi-Yong , Chang Jie , Guo Fei-Fei , Deng Han-Yi , Pan Guo-Tao , Li Bing-Yan , Zhang Zeng-Li
Published: June 2020

Dimethylformamide (DMF) is widely used as a solvent in the production of synthetic leather. Previous studies have focused on workers exposed to DMF in leather factories; however, little attention has been paid to the general population. This study was conducted to examine the effects of DMF exposure on elderly residents living near synthetic leather factories. A total of 962 subjects over 60 years of age in proximity to these factories (monitoring points) were enrolled as the exposure group, and 1924 permanent residents living distant from the factories were enrolled as the control group. The exposure group was divided into 3 groups according to their distance from the monitoring points. Physical examination, routine blood tests, and liver and renal function data were collected, and the DMF concentration in the air was analyzed by gas chromatography-mass spectroscopy. The prevalence of abnormal heart rhythm, electrocardiogram and B-mode ultrasound results in the exposure group was significantly greater than in the control group. Aspartate transaminase (AST), alanine transaminase (ALT), and blood urea nitrogen (BUN) levels in the exposure group also were higher than those in the control group (P < .01). There was an effect of distance from leather factories on liver and kidney dysfunction in the 3 exposure groups. Compared with the exposure group at >3 km distance from the source, the prevalence of increased AST, ALT, and BUN in the exposure group at <1 km was significantly greater (P < .001). It was concluded that DMF exposure was related to an increased risk of a cardiac injury and liver and kidney dysfunction.
Effect of Yijinjing exercise on cervical spondylosis
Authors: Zhuang Qian , Feng Huichao , Jing Fushi , Rong Jiao , Lv Yueming , Jing Fujie , Zhang Jing
Published: June 2020

Background:

Cervical spondylosis (CS) is a common disease due to the modern lifestyle. Yijinjin, a kind of traditional Chinese exercise, is frequently used for the prevention of CS by Traditional Chinese Medicine doctors. However, there is no relevant systematic review show its effectiveness and safety. The study aims to evaluate the effectiveness and safety of Yijinjing for patients with CS.

Methods:

The following electronic databases will be searched from the respective dates of database inception to June 1st, 2020: The Cochrane Library, Web of Science, Springer, EMBASE, MEDLINE, the World Health Organization International Clinical Trials Registry Platform, the Chinese Biomedical Literature Database, China National Knowledge Infrastructure, Wanfang database, the Chinese Scientific Journal Database, and other sources. All published randomized controlled trials (RCTs) and blinded researches that are relevant to the subject of interest only will be contained. Two independent researchers will operate article retrieval, duplication removing, screening, quality evaluation, and data analyses by Review Manager (V.5.3.5). Meta-analyses, subgroup analysis and/or descriptive analysis will be performed based on the included data conditions.

Results:

High-quality synthesis and/or descriptive analysis of current evidence will be provided from the neck disability index, neck pain questionnaire questionnaires, patient satisfaction scale and adverse reactions.

Conclusion:

This study will provide the evidence of whether Yijinjing is an effective and safe intervention for people with CS.

PROSPERO registration number:

CRD42020164706.
Effects of hospice care on quality of life and negative emotions in patients with advanced tumor
Authors: Fu Jing , Zeng Yan , Tan Yan , Fu Baiyu , Qiu Haiyan
Published: June 2020

Background:

To evaluate the effect of hospice care on the quality of life and negative emotion of advanced tumor patients systematically, which compared with routine nursing mode, improving the quality of life of advanced tumor patients, reducing the negative emotion of advanced tumor patients, and providing evidence-based medicine for better implementation of targeted service of hospice care.

Methods:

Computer retrieval network electronic database: Retrieval CNKI, Chinese clinical trial registry, WANFANG database, China Biology Medicine disc, CQVIP database, PubMed, Embase, The Cochrane Library, and Web of Science database on the clinical research of hospice care on the quality of life and negative emotions of advanced tumor patients. While dating from the references included in the study, manually retrieving relevant tabloids, papers, and related journals without electronic version. The retrieval strategy adopts the combination of subject words and free words. The range of searching time was from the beginning of each database to April 1, 2020. According to the inclusion and exclusion criteria, the 2 researchers selected the literature and extracted the data independently, and used the Cochrane system evaluator manual 5.1.0 to conduct a bias risk assessment of the literature, which was finally included in the study. If two researchers disagree in the process of literature selection, a third researcher is invited to join in, discuss the issues that have differences, and then make a decision. RevMan 5.3.3 software and Stata 14.0 software were used to conduct the meta-analysis of the included research.

Results:

According to the process of Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P), this study will be carried out strictly, and the results of research will be published publicly in high-quality international academic journals with peer review.

Conclusion:

Through the study, we will arrive at whether hospice care has advantages in improving the quality of life and negative emotion of advanced tumor patients, which compared with routine nursing mode, and the formulation of individualized hospice care strategy to provide the basis for the application of hospice care in the treatment of end stage tumor patients.

Registration:

OSF platform, registration number: 47enh.
Primary vaginal Ewing sarcoma with uterine fibroid
Authors: Xu Maolin , Liu Yulin , Zeng Shue , Wang Hongbin , Weng Gaolong , Li Fang
Published: June 2020

Rationale:

Extra osseous Ewing sarcoma (ES), an uncommon malignant neoplasm, accounts for about 15% of Ewing sarcoma, which mainly affects paravertebral region, lower extremity, chest wall, retroperitoneum, pelvis, and hip. Here is a 54-year-old woman of primary vaginal Ewing sarcoma with uterine fibroid, which has been fewly known or reported.

Patient concerns:

The patient was admitted to our hospital because of vaginal pain. Her uterus showed as parallel position and enlarged as about 3 months of pregnancy size.

Diagnosis:

Magnetic resonance imaging (MRI) and ultrasonography (US) demonstrated 2 heterogeneous masses in the vagina and uterus, respectively. Ultrasound-guided puncture biopsy revealed a malignant tumor in the right lateral vaginal wall.

Interventions:

The patient was treated by hysterectomy, bilateral salpingo-oophorectomy, and tumors excision, with the subsequent treatment of chemotherapy.

Outcomes:

The patient recovered well without local recurrence for >1 year.

Lessons:

Primary vaginal Ewing sarcoma is extremely rare. The treatments of uterine fibroid include uterine artery embolization and surgical options, While wide local excision followed by adjuvant chemotherapy and/or radiotherapy should be recommended for the vaginal ES.
Ultrasound-guided superior laryngeal nerve block assists in anesthesia for bronchoscopic surgical procedure
Authors: Liao Yu-Chen , Wu Wei-Ciao , Hsieh Ming-Hui , Chang Chuen-Chau , Tsai Hsiao-Chien
Published: June 2020

Introduction:

Evolving techniques in the field of therapeutic bronchoscopy have led to the return of rigid bronchoscopy in the treatment of complex central airway disease. Rigid bronchoscopy is typically performed under general anesthesia because of the strong stimulation caused by metal instruments. Anesthesia for rigid bronchoscopy is challenging to administer because anesthesiologists and interventionists share the same working channel: the airway. Previously reviewed anesthetic methods are used primarily for short procedures. Balanced anesthesia with ultrasound-guided superior laryngeal nerve (SLN) block and total intravenous anesthesia might provide anesthesia for a prolonged procedure and facilitate patient recovery.

Patient concerns:

A patient with obstructed endobronchial stent was referred for therapeutic rigid bronchoscopy, which requires deeper anesthesia than flexible bronchoscopy. There were concerns of the stronger stimulation of the rigid bronchoscopy, lengthy duration of the procedure, higher risk of hypoxemia, and the difficulty of mechanical ventilation weaning after anesthesia due to the patients co-morbidities.

Diagnosis:

A 66-year-old female patient presented with a history of breast cancer with lung metastases. Right main bronchus obstruction due to external compression of lung metastases was relieved through insertion of an endobronchial stent, but obstructive granulation developed after 4 months. Presence of the malfunctioning stent caused severe cough and discomfort. Removal of the stent by using a flexible bronchoscope was attempted twice but failed.

Interventions:

Regional anesthesia of the upper airway through ultrasound-guided SLN block combined with intratracheal 2% lidocaine spray was performed to assist in total intravenous anesthesia (TIVA) during rigid bronchoscopy.

Outcomes:

The patient maintained steady spontaneous breathing throughout the procedure without laryngospasm, bucking, or desaturation. Emergence from anesthesia was smooth and rapid after propofol infusion was discontinued. The surgery lasted 2.5 hours without discontinuity, and no perioperative pulmonary or cardiovascular complications were noted.

Conclusion:

Ultrasound-guided SLN block is a simple technique with a high success rate and low complication rate. Application of SLN block to assist TIVA provides sufficient anesthesia for lengthened therapeutic rigid bronchoscopy without interruption and facilitates patient recovery.
Volatile organic compounds analysis as a potential novel screening tool for colorectal cancer
Authors: Zhou Wenchuan , Tao Jinxin , Li Jin , Tao Shaoyu
Published: June 2020

The purpose of this meta-analysis was to assess the usefulness of volatile organic compounds (VOC) as a potential novel biomarker for colorectal cancer (CRC).

We systematically searched PubMed, Embase, Web of Science, and Cochrane Library databases for observational studies (published before November 25th, 2019; no language restrictions) comparing the VOC analysis between patients with CRC and healthy controls. We evaluated the pooled sensitivity, specificity, diagnostic odds ratio, positive and negative likelihood ratio, as well as summary receiver operating characteristic curve and area under the curve.

We identified a total of 10 observational studies that included 381 patients with CRC and 436 healthy controls. Bivariate analysis yielded a pooled sensitivity of 0.82 (95% confidence interval [CI] = 0.77–0.86), specificity of 0.79 (95% CI = 0.71–0.85), positive likelihood ratio of 3.8 (95% CI = 2.8–5.3), and negative likelihood ratio of 0.23 (95% CI = 0.17–0.30). The area under the curve was 0.87 (95% CI = 0.84–0.90). The pooled diagnostic odds ratio was 17 (95% CI = 10–28). Sensitivity analysis indicated that the pooled results were stabilized. The Deeks’ funnel plot asymmetry test (P = .41) suggested no potential publication bias.

Our pooled data confirmed the associations between VOC analysis and CRC, highlighting the usefulness of VOC analysis as a potential novel screening tool for CRC. However, standardization of VOC collection and analysis methods for CRC screening is required in future research.
Inhibition of ITGB1 enhance the anti-tumor effect of cetuximab in colorectal cancer cell
Authors: Yang Xiaohui , Wang Shuai , Yu Weihua , Zheng Yixiong , Wu Yulian
Published: June 2020

Background:

Colorectal cancer is the second commonly seen cancer around the world and accounts for 13% of all human cancers. Among them, 25% of all case were diagnosed with metastasis and 50% occurs metastasis during the development of disease. Cetuximab is a chimeric monoclonal antibody against epidermal growth factor receptor, and is used for treatment of metastatic colorectal cancer alone or combined with chemotherapy or radiation therapy. Integrin-beta 1 (ITGB1), which is also known as CD29, and plays an important role in development of malignant cancers. However, the effect of ITGB1 in promoting the anti-tumor effect of cetuximab is not fully understand.

Methods:

The model of ITGB1 inhibition and overexpression was firstly constructed in LS174T cells, and the viability of cells in each group was detected using CCK-8 assay. The expression of key factors in tumor formation process at transcription level was detected using real-time quantitative polymerase chain reaction method. The expression of key proteins in metastasis process, cell apoptosis and activation of Ras/Raf/MEK signaling pathway was detected using western blotting analysis. And the concentration of key factors of in tumor formation process in cultured medium of LS174T cells were detected using enzyme-linked immunosorbent assay method.

Results:

We found that cetuximab could inhibit the proliferation of LS174T cells, and inhibition of ITGB1 enhanced this effect while overexpression of ITGB1 reduced this effect. We further found that cetuximab could inhibit the expression and secretion of extracellular matrix degradation related molecules in cultured medium and transcription level. Besides, we also found that the expression of key factors in angiogenesis and extracellular matrix degradation related proteins were also reduced after cetuximab treatment. These effects might be mediated by Ras/Raf/MAPK signaling pathway and enhanced after inhibition of ITGB1 expression.

Conclusion:

Inhibition of ITGB1 might be a new therapeutic method in colorectal cancer.
High-intensity interval training for heart failure with preserved ejection fraction
Authors: Zhang Sisi , Zhang Jingxian , Liang Congying , Li Xiaochuan , Meng Xiaoping
Published: June 2020

Background:

The benefits of high-intensity interval training (HIIT) are well-known, there is insufficient evidence about the effects of HIIT on heart failure with preserved ejection fraction (HFpEF).

Method:

Multiple databases include MEDLINE, PubMed, EMBASE, CINAHL, Web of Science, PEDro, Cochrane Library, and Google Scholar are used to search for randomized controlled trials investigating the effects of HIIT on HFpEF. All related articles published with the English language with no time limitation will be included. Two reviews independently conducted the selection, data extraction, and quality assessment. The primary outcome is exercise capacity. The secondary outcomes include quality of life (QoL), blood pressure (BP), ventricular function, and left ventricular diastolic function, symptom improvement, endothelial function, and arterial stiffness. Data analysis is performed with Review Manager Software (Version 5.3).

Result:

This systematic review and meta-analysis aim to evaluate the efficacy of HIIT on HFpEF, its outcome will provide reliable evidence for future studies.

Conclusion:

The findings of this study will be published in a related peer-reviewed journal.

Registration number:

INPLASY202050097
Appendectomy or Not? An Update on the Evidence for Antibiotics Only Versus Surgery for the Treatment of Acute Appendicitis in Children
Authors: Hartford Emily Altick , Woodward George A.
Published: June 2020

Appendicitis is a common diagnosis in children being evaluated in the emergency department. After diagnosis, standard treatment has been surgical appendectomy; however, in recent years there is a growing body of evidence evaluating the possibility of nonoperative management in both children and adults. This review will present the current state of the pediatric literature that suggests patients may be successfully treated with antibiotics alone (ie, without surgery), but that a proportion of these patients will have recurrent appendicitis. Given that the literature regarding the option of antibiotic-only management compared with surgery is not yet definitive, there are many factors for providers to discuss with families and patients when considering treatment for acute appendicitis.
Coarse-grained Force Fields from the Perspective of Statistical Mechanics: Better Understanding the Origins of a MARTINI Hangover
Authors: Jarin Zack , Newhouse James , Voth Gregory A.
Published: June 2020

The popular MARTINI coarse-grained model is used as a test case to analyze the adherence of top-down coarse-grained molecular dynamics models (i.e., models primarily parameterized to match experimental results) to the known features of statistical mechanics for the underlying all-atom representations. Specifically, the temperature dependence of various pair distribution functions, and hence their underlying potentials of mean force via the reversible work theorem, are compared between MARTINI 2.0, Dry MARTINI, and all-atom simulations mapped onto equivalent coarse-grained sites for certain lipid bilayers. It is found that the MARTINI models do not completely capture the lipid structure seen in atomistic simulations as projected onto the coarse-grained mappings, and that issues of accuracy and temperature transferability arise due to an incorrect enthalpy-entropy decomposition of these potentials of mean force. The potential of mean force for the association of two amphipathic helices in a lipid bilayer is also calculated and, especially at shorter ranges, the MARTINI and all-atom projection results differ substantially. The former is much less repulsive and hence will lead to a higher probability of MARTINI helix association in the MARTINI bilayer than occurs in the actual all-atom case. Additionally, the bilayer height fluctuation spectra are calculated for the MARTINI model and – compared to the all-atom results – it is found that the magnitude of thermally averaged amplitudes at intermediate length scales is quite different, pointing to a number of possible consequences for realistic modeling of membrane processes. Taken as a whole, the results presented here can point the way for future coarse-grained model parameterization efforts that might bring top-down coarse-grained models into better agreement with the statistical mechanics of the actual all-atom systems they aspire to represent.