bluuebunny/crossref_metadata_2025 huggingface dataset:
Interventions to reduce burnout of physicians and nurses
Authors: Zhang Xiu-jie , Song Yingqian , Jiang Tongtong , Ding Ning , Shi Tie-ying
Published: June 2020

Objective:

Numerous systematic reviews and meta-analyses on the interventions to reduce burnout of physicians and nurses have been published nowadays. This study aimed to summarize the evidence and clarify a bundled strategy to reduce burnout of physicians and nurses.

Methods:

Researches have been conducted within Cochrane Library, PubMed, Ovid, Scopus, EBSCO, and CINAHL published from inception to 2019. In addition, a manual search for relevant articles was also conducted using Google Scholar and ancestral searches through the reference lists from articles included in the final review. Two reviewers independently selected and assessed, and any disagreements were resolved through a larger team discussion. A data extraction spreadsheet was developed and initially piloted in 3 randomly selected studies. Data from each study were extracted independently using a pre-standardized data abstraction form. The the Risk of Bias in Systematic reviews and assessment of multiple systematic reviews (AMSTAR) 2 tool were used to evaluate risk of bias and quality of included articles.

Results:

A total of 22 studies published from 2014 to 2019 were eligible for analysis. Previous studies have examined burnout among physicians (n = 9), nurses (n = 6) and healthcare providers (n = 7). The MBI was used by majority of studies to assess burnout. The included studies evaluated a wide range of interventions, individual-focused (emotion regulation, self-care workshop, yoga, massage, mindfulness, meditation, stress management skills and communication skills training), structural or organizational (workload or schedule-rotation, stress management training program, group face-to-face delivery, teamwork/transitions, Balint training, debriefing sessions and a focus group) and combine interventions (snoezelen, stress management and resiliency training, stress management workshop and improving interaction with colleagues through personal training). Based on the Risk of Bias in Systematic reviews and AMSTAR 2 criteria, the risk of bias and methodological quality included studies was from moderate to high.

Conclusions:

Burnout is a complicated problem and should be dealt with by using bundled strategy. The existing overview clarified evidence to reduce burnout of physicians and nurses, which provided a basis for health policy makers or clinical managers to design simple and feasible strategies to reduce the burnout of physicians and nurses, and to ensure clinical safety.
Changes of retinal and choroidal capillary blood flow in macula after an acute intraocular pressure elevation
Authors: Ma Ziwei , Pan Xuefeng , Zhou Danni , Zhu Zhuangzhi , Xu Aiping , Shi Peng , Chen Hong
Published: June 2020

The aim of this study was to investigate the changes of retinal vessel density (VD) and choriocapillary blood flow area (CBFA) in macula after an acute intraocular pressure (IOP) elevation observed using optical coherence tomography angiography.

This was a prospective comparative study of subjects with narrow anterior chamber angles who underwent laser peripheral iridotomies (LPIs). The IOP was measured before and 1 hour after the LPI. The retinal VDs and CBFAs of the macula were measured using optical coherence tomography angiography at the baseline and 1 hour after the LPI.

A total of 88 eyes of 88 individuals were enrolled in our study, and 70 eyes of 70 individuals finally completed the study with a mean IOP rise of 10.2 ± 7.5 mm Hg after the LPI. The VDs and areas of foveal avascular zone of all of the subjects did not differ significantly between the measurements obtained at the baseline and 1 hour after the LPI (P > .05). However, there were statistically significant differences in the CBFAs at the baseline and 1 hour after the LPI (P < .05). Based on the magnitude of the rise in the IOP, we divided the subjects into three groups: group A = IOP rise ≤ 10 mm Hg, group B = 10 mm Hg < IOP rise ≤20 mm Hg, and group C = IOP rise > 20 mmHg. The VDs of the macula measured at the baseline were significantly different from the measurements obtained 1 hour after the LPI in group C in either the superficial retinal layer or deep retinal layer (P < .05). Compared with baseline, the CBFAs measured at 1 hour after the LPI were decreased in group B and group C (P < .05).

In these subjects with narrow antenior chamber, the blood flow in macula began to be affected with the acute IOP rise greater than 10 mm Hg. It was confirmed that the retina and choroid showed some different ability to regulate its blood flow in response to changes in IOP.
Critically ill patients with COVID-19 with ECMO and artificial liver plasma exchange
Authors: Liu Jian , Dong Yong-Quan , Yin Jie , He Guojun , Wu Xiaoxin , Li Jianping , Qiu Yunqing , He Xuelin
Published: June 2020

COVID-19 is an emerging infectious disease capable of causing severe pneumonia. We aimed to characterize a group of critically ill patients in a single-center study.

This was a retrospective case series of 23 patients with confirmed COVID-19-related critical illness in the intensive care unit (ICU) of a hospital in Hangzhou Zhejiang Province between January 22 and March 20, 2020.

Of the 23 critically ill patients, the median age was 66 years (interquartile range [IQR] 59–80 years). The median time from disease onset to ICU admission was 10 days (IQR 6–11 days), to mechanical ventilation (MV) was 11 days (IQR 7.75–13 days), to artificial liver plasma exchange was 12 days (IQR 9.75–14.75 days), and to extracorporeal membrane oxygenation (ECMO) was 22 days (IQR 17.5–30 days). Nine patients required high flow oxygen. Fourteen patients received MV. Six required ECMO. Nine received artificial liver plasma exchange. Mortality was 0 at day 28.

Mortality was 0 at day 28 in our single-center study. Extracorporeal membrane oxygenation reduced the requirements for ventilator support. Artificial liver plasma exchange significantly reduced inflammatory cytokine levels. These supportive therapies helped to extend the patients’ survival times and increase the chance of follow-up treatments.
Association of Protein and Genetic Biomarkers With Response to Lumbar Epidural Steroid Injections in Subjects With Axial Low Back Pain
Authors: Schaaf Stephen , Huang Wan , Perera Subashan , Conley Yvette , Belfer Inna , Jayabalan Prakash , Tremont Katie , Coelho Paulo , Ernst Sara , Cortazzo Megan , Weiner Debra , Vo Nam , Kang James , Sowa Gwendolyn
Published: June 2020

Objective

The purpose of this observational study was to examine the association of protein and genetic biomarkers with pain and pain-related disability in individuals with axial low back pain undergoing epidural steroid injections.

Design

Forty-eight adults with axial low back pain undergoing an epidural steroid injection were recruited from an academic medical center. Blood samples were assayed at baseline and follow-up for plasma proteins and functional single-nucleotide polymorphisms associated with pain. Data regarding pain and function were collected at baseline and follow-up. The characteristics of responders (defined as 50% improvement in pain score) and nonresponders were compared, and the association between response and baseline biomarkers was examined.

Results

Thirty-five percent of subjects were responders to injection. Responders had lower baseline plasma levels of chondroitin sulfate 846 and higher neuropeptide Y and serotonin levels than nonresponders, and baseline neuropeptide Y level correlated with change in disability levels. In addition, subjects with the variant allele for the catechol-O-methyltransferase single-nucleotide polymorphism demonstrated increased odds of responding to the injection.

Conclusions

These data identify candidates who may have utility for patient selection for spinal procedures and provide support for exploration in prospective studies to assess and validate their predictive ability.
Long-Term Health-Related Quality of Life after Four Common Surgical Treatment Options for Breast Cancer and the Effect of Complications: A Retrospective Patient-Reported Survey among 1871 Patients
Authors: Kouwenberg Casimir A. E. , de Ligt Kelly M. , Kranenburg Leonieke W. , Rakhorst Hinne , de Leeuw Daniëlle , Siesling Sabine , Busschbach Jan J. , Mureau Marc A. M.
Published: June 2020

Background:

Differences in quality-of-life outcomes after different surgical breast cancer treatment options, including breast reconstruction, are relevant for counseling individual patients in clinical decision-making, and for (societal) evaluations such as cost-effectiveness analyses. However, current literature shows contradictory results, because of use of different patient-reported outcome measures and study designs with limited patient numbers. The authors set out to improve this evidence using patient-reported outcome measures in a large, cross-sectional study for different surgical breast cancer treatment options.

Methods:

Quality of life was assessed through the EQ-5D-5L, European Organization for Research and Treatment of Cancer Quality of Life Questionnaires C30 and BR23, and the BREAST-Q. Patients with different treatments were compared after propensity-weighted adjustment of pretreatment differences. The EQ-5D was used to value the effect of surgical complications.

Results:

A total of 1871 breast cancer patients participated (breast-conserving surgery, n = 615; mastectomy, n = 507; autologous reconstruction, n = 330; and implant-based reconstruction, n = 419). Mastectomy patients reported the lowest EQ-5D score (mastectomy, 0.805, breast-conserving surgery, 0.844; autologous reconstruction, 0.849; and implant-based reconstruction, 0.850) and functioning scores of the C30 questionnaire. On the BREAST-Q, autologous reconstruction patients had higher mean Satisfaction with Outcome, Satisfaction with Breasts, and Sexual Well-being scores than implant-based reconstruction patients. Complications in autologous reconstruction patients resulted in a substantially lower quality of life than in implant-based reconstruction patients.

Conclusions:

This study shows the added value of breast conservation and reconstruction compared with mastectomy; however, differences among breast-conserving surgery, implant-based reconstruction, and autologous breast reconstruction were subtle. Complications resulted in poorer health-related quality of life.
Nonsurgical Rhinoplasty: A Systematic Review of Technique, Outcomes, and Complications
Authors: Williams Lauren C. , Kidwai Sarah M. , Mehta Karan , Kamel George , Tepper Oren M. , Rosenberg Joshua D.
Published: June 2020

Background:

Nonsurgical rhinoplasty using filler injections has become a common procedure in cosmetic practices. This is offered to patients that prefer a temporary outcome or would like to avoid general anesthesia. In addition, it can be used in postrhinoplasty patients to correct nasal deformities or irregularities. This systematic review highlights common filler types and injection techniques, and associated patient satisfaction and complications to further guide practitioners.

Methods:

A systematic review was performed using keywords and Medical Subject Headings search terms. PubMed, EmBase, the Cochrane Library, and Scopus were searched using the appropriate search terms. Data collected from each study included patient satisfaction and complications, in addition to injection material, location, and technique.

Results:

Four thousand six hundred thirty-two studies were found based on search criteria. After full-text screening for inclusion and exclusion criteria, 23 studies were included. A total of 1600 patients underwent nonsurgical rhinoplasty, most commonly with hyaluronic acid (73.38 percent), followed by calcium hydroxyapatite (12.44 percent). Nearly 95 percent of patients were satisfied with results, and there were only 26 relatively minor complications reported. There were no reports of vascular complications such as skin necrosis or visual compromise.

Conclusions:

Based on the authors’ review of the literature, nonsurgical rhinoplasty is an effective temporary alternative to traditional augmentation rhinoplasty for corrections of nasal shape with a high degree of patient satisfaction. Complications may be underreported, and thus further investigation is needed to better understand the true incidence of major complications related to vascular compromise.
Long-Term Effect of Multiple Operations on Psychosocial Function in Teenage Cleft Lip and Palate Patients
Authors: Potemra Hi’ilani M. K. , Lin Johnny , Bertrand Anthony A. , De Leon Fransia S. , Alford Jake A. , Hu Allison C. , Wilson Libby , Lee Justine C.
Published: June 2020

Background:

Cleft lip and palate patients undergo a significant number of interventions during their childhood and adolescence. Although the intention of such interventions is to improve psychosocial functioning, there exists a paucity of data on the psychosocial outcomes of the burden of care on cleft children. In this work, the long-term effects of quantity and timing of childhood operations on teenagers with cleft lip and palate were evaluated.

Methods:

Cleft lip and palate patients (aged 14 to 17 years; n = 55) and an age-matched unaffected cohort (n = 14) prospectively enrolled from two institutions were administered the anger, anxiety, and depressive symptoms instruments from the Pediatric Patient-Reported Outcomes Measurement Information System. Total number of operations and operations stratified by age groups (0 to 7, 8 to 10, 11 to 13, and 14 to 17 years) were evaluated in relationship to instrument scores. Descriptive statistics, independent t tests, Pearson correlations, and multiple linear regression analyses were conducted.

Results:

No differences in overall psychosocial functioning were found between the cleft lip and palate and comparison groups. Total quantity of childhood operations did not correlate to psychosocial functioning of cleft lip and palate teenagers. However, multiple linear regression analyses demonstrated that increased number of operations in the 8- to 10-year-old age range predicted increased anxiety and depressive symptoms in teenagers (β = 0.38, p = 0.009; and β = 0.29, p = 0.03, respectively).

Conclusions:

It was previously reported by the authors’ group that the 8- to 10-year-old age range is an at-risk period for psychosocial distress in children with craniofacial anomalies. Their current work demonstrates that increased number of operations during this time frame may result in long-term consequences in anxiety and depression in cleft lip and palate patients.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Risk, II.
Review of 602 Microtia Reconstructions: Revisions and Specific Recommendations for Each Subtype
Authors: Kim Ara , Lee Hojune , Oh Kap Sung
Published: June 2020

Background:

Congenital microtia is highly variable in its clinical presentation, leading to many technical modifications to and controversies over treatment. The authors evaluated how surgical revisions and interdisciplinary interventions were involved in microtia reconstruction according to each subtype.

Methods:

Congenital unilateral microtia patients who underwent two-stage microtia reconstruction from June of 2001 to June of 2019 were reviewed. Patient and surgical variables were collected, including the type, number, and timing of surgical revisions, canaloplasty, and jaw operations. Data were presented in relation to each subtype of microtia (i.e., anotia, small/atypical but usable lobule, typical lobule, concha, and scapha).

Results:

From a total of 602 patients, 407 (67.6 percent) underwent some form of revisions and/or interventions in addition to the two stages of microtia reconstruction, with an average number of 2.2. The majority of small/atypical lobule cases underwent revisions to improve aesthetics, with lobule and inferior sulcus as the most problematic regions. Skin flap necrosis, with an overall rate of 4.0 percent, was most commonly found in the concha type. Except for anotia and small/atypical lobule, nearly one-third of all subtypes underwent canaloplasty, necessitating protective strategies against the circulation-threatening condition. A very small number of jaw operations (up to 7 percent) were performed in all subtypes.

Conclusions:

Over the two-decade cohort study of microtia reconstruction, revision and interdisciplinary operations were used differently for each subtype. An optimal management plan will be established with respect to type-specific conditions, including the level of difficulty in elevating the subcutaneous pedicle, usable vestige, and later effect of canaloplasty.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, IV.
Technical Refinements in Gender-Affirming Top Surgery
Authors: Gonzalez Eduardo , Frey Jordan D. , Bluebond-Langner Rachel
Published: June 2020

Chest masculinization is the most common gender-affirming operation performed. With increased access to care and improved insurance coverage, there has been a marked increase in the number of procedures performed. A video is presented with narration focused on the surgical technique of a “double-incision” mastectomy for gender-affirming chest masculinization. The Fisher grading scale used in technique selection of double-incision versus periareolar mastectomy, based on patient-specific anatomical parameters, is reviewed. Technical pearls for refinement of the double-incision top surgery technique for gender affirmation are then demonstrated.
Getting Good Results in Cosmetic Blepharoplasty
Authors: Alghoul Mohammed S. , Vaca Elbert E. , Mioton Lauren M.
Published: June 2020

Learning Objectives:

After studying this article, the participant should be able to: 1. Accurately diagnose the cosmetic deformity and thoroughly understand the periorbital surface topography. 2. Develop a preoperative plan and pick the right operation. 3. Master technical tips. 4. Rejuvenate the lateral orbital area. 5. Manage complications.

Getting good results in blepharoplasty requires understanding ideal surface topography, accurate diagnosis of the cosmetic deformity, thorough knowledge of anatomy, and careful technique to change the anatomy. Several approaches have been described; however, the procedure continues to have its shortcomings and share of complications that have both functional and cosmetic consequences. This continuing medical education article focuses on getting good results and maximizing success in upper and lower blepharoplasty through the discussion of five major components: diagnosis and understanding of the cosmetic deformity; preoperative planning; technical tips; rejuvenation of the lateral orbital area; and management of complications.
Orofacial outcomes in adolescents with perinatally infected HIV in antiretroviral therapy
Authors: Sampaio Juliana Diogo de Almeida , Jácome-Santos Humberto , Aires Amanda Vieira , Pinheiro João de Jesus Viana , Abreu Lucas Guimarães , Mesquita Ricardo Alves
Published: June 2020

Objective:

To assess the frequency of orofacial outcomes in adolescents with perinatally infected HIV in treatment with antiretroviral therapy (ART).

Design:

A Brazilian institution-based retrospective study analyzing medical charts and medication dispensing data.

Methods:

Medical records of 137 adolescents were reviewed. HIV viral load, CD4+T-cell count (CD4+), ART regimen, nonadherence events, and prolonged ART discontinuation were recorded. The frequency of each outcome was determined. Associations between the most frequent outcomes and both records of undetectable viral load and CD4+at least 500 cells/μl were carried out. Associations of lymphadenitis, Group 1 orofacial manifestations and Group 2 orofacial manifestations with records of Center for Disease Control and Prevention (CDC) category C illness were also performed. Odds ratio (OR), confidence intervals (CI) andPvalues were provided.

Results:

Cervical and submandibular lymphadenitis (45.25%), dental caries (32.84%) and periodontal issues (11.67%) were the most frequent orofacial outcomes. A detectable viral load (OR = 2.61, 95% CI 1.16--5.88) and CD4+less than 500 cells/μl (OR = 2.34, 95% CI 1.13--4.82) were associated with a greater risk of lymphadenitis. Orofacial outcomes associated with HIV were found in adolescents with longer ART discontinuation and a greater number of ART discontinuation events (P < 0.05). No association was found between records of CDC category C illness and group 1 orofacial manifestations, group 2 manifestations or lymphadenitis (P > 0.05).

Conclusion:

Orofacial outcomes, in particular, cervical and submandibular lymphadenitis were common among the adolescents assessed. Long-term ART and long-term exposure to HIV virus may have altered the orofacial outcome profile in adolescents perinatally infected by HIV.
Severe Perineal Trauma in a Brazilian Southeastern Tertiary Hospital: A Retrospective Cohort Study
Authors: Nóbrega Marina Augusto , Pereira Gláucia Miranda Varella , Brito Luiz Gustavo Oliveira , Luz Adriana Gomes , Lajos Giuliane Jesus
Published: June 2020

Objective

This study aimed to investigate the prevalence of severe perineal trauma (obstetric and anal sphincter injury [OASIS]) in a tertiary high-risk pregnancy facility and the associated factors.

Methods

A retrospective electronic chart review on perineal lacerations was performed from the period of April 2017 to February 2019. Obstetric and anal sphincter injury was diagnosed by a rectal examination. Primary outcome was the prevalence of OASIS (third- and fourth-degree perineal tear). Independent variables were maternal, intrapartum, and neonatal characteristics. Univariate and multivariate analyses with logistic regression models were performed. A P value lower than 0.05 was considered significant.

Results

The prevalence of OASIS (third/fourth-degree laceration) was 1.51% (43/2846) in our population. Our population was mostly white (66.3%) and mostly primiparous (52.1%). By comparison, the prevalence of first/second-degree laceration was 43% (1223/2846). Selective episiotomy occurred in 18.73% (517/2761) of patients, and it was not associated with OASIS (P = 0.211). Advanced maternal age (P = 0.196), higher number of vaginal examinations (P = 0.169), fetal presentation (P = 0.533), and duration of second stage (P = 0.757) were not associated with OASIS. Univariate analysis has found that forceps delivery (odds ratio [OR], 3.68 [1.74–7.79]; P = 0.001), neonatal macrossomy (OR, 3.42 [1.02–11.43]; P = 0.045), and larger head circumference (OR, 1.15 [1.02–1.32]; P = 0.026) were risk factors for OASIS, whereas higher gravidity reduced the risk (OR, 0.61 [0.42–0.91] for OASIS. However, after multivariate analysis, only head circumference (OR, 1.86 [1.10–3.14]; P = 0.020) remained as a risk factor.

Conclusions

Larger neonatal head circumference increased in 86% the risk for severe perineal trauma in this cohort of women.
Targeting NLRP3 inflammasome improved the neurogenesis and post-stroke cognition in a mouse model of photothrombotic stroke
Authors: Li Yu-Qin , Chen Ji-Xiang , Li Quan-Wei , Xiao Zheng-Jun , Yuan Tao , Xie Zhao-Hui
Published: June 2020

Post-stroke cognitive impairment (PSCI) severely affects the quality of a survivor’s life, but its neurophysiological basis remains unknown. Neuroinflammation has been considered as an important contributor to PSCI, which could be induced or exacerbated by system inflammation. NACHT-LRR- and pyrin-domain-containing protein 3 (NLRP3) inflammasome is the most widely studied in the initiation of inflammation. Here, using a mouse model of photothrombotic stroke, we demonstrated that NLRP3 activation plays a critical role in PSCI. Intraperitoneal injection of the lipopolysaccharide-activated NLRP3 inflammasome, exacerbated the microglial activation and decreased the number of neurons, impaired the hippocampal neurogenesis, eventually aggravated PSCI. Intraperitoneal injection of MCC950 inhibited the NLRP3 activation, decreased the number of microglia, increased the number of neurons and promoted the hippocampal neurogenesis, eventually improved PSCI. Our results identified NLRP3 inflammasome as an important modifier of neuropathology in PSCI, which could be a could be a potential therapeutic target for PSCI treatment.
Angiopoietin-1 protects neurons by inhibiting autophagy after neuronal oxygen-glucose deprivation/recovery injury
Authors: Yin Zhaoyang , Gong Ge , Zhu Chao , Wang Bin , Sun Chao , Liu Xinhui , Yin Jian
Published: June 2020

Angiopoietin-1 (Ang-1) is a new neuroprotective agent, which can protect neurons from apoptosis. Increased autophagy in neurons subjected to oxygen-glucose deprivation/recovery (OGD/R) injury may lead to autophagic cell death; therefore, the present study investigated the effect of Ang-1 on neurons subjected to OGD/R injury. Neuronal viability was detected by using the Cell Counting Kit-8, which was then used to select the appropriate concentration of Ang-1 and rapamycin used in the OGD/R injury model. The mechanistic role of Ang-1 was observed by detecting the survival rate of neurons and the level of autophagy. Results showed that Ang-1 significantly reduced neuronal cell injury induced by OGD/R and the expression of the autophagy-related proteins LC3 II/I and Beclin-1, and increased the expression of P62/SQSTM1. However, the neuroprotective effects of Ang-1 were counteracted by rapamycin, an autophagy activating agent. The changes of autophagy intensity were further confirmed by transmission electron microscopy observation of autophagosomes. Ang-1 appears to have a neuroprotective role by inhibiting autophagy expression in OGD/R. Thus, these findings could be useful for the treatment of OGD/R injury.
Calcitonin gene-related peptide receptor Calcrl is enriched in hair follicles stem cells and differentially expressed in interfollicular epidermis in murine skin
Authors: Gong Yao , Wei Jiang-Ping , Wang Tim Hua , Zhong Hong-Bing , Liao Xin-Hua
Published: June 2020

Calcitonin gene-related peptide (CGRP) and adrenomedullin are structurally similar neuropeptides acting as potent vasodilators of blood pressure and mediator of inflammation in skin. Revealing the expression pattern of their common receptor-Calcitonin gene-related peptide receptor (Calcrl) in their targeted cells is important to explain the functions of CGRP and adrenomedullin in skin. Our immunostaining results showed that Calcrl is enriched in hair follicles bulge stem cells and differentially expressed in basal stem cells of interfollicular epidermis. In addition, Calcrl expression in interfollicular epidermis is dependent on presence of nerve fibers. Long-term ablation of the murine cutaneous nerve leads to loss of Calcrl expression in interfollicular epidermis but not in hair follicle bulge stem cells. Our results demonstrate a tight interaction between neuronal components and epidermis, and indicates potential roles of Calcrl in epidermal stem cells.
Fine-scale genital morphology affects male ejaculation success: an experimental test
Authors: Chung Meng-Han Joseph , Fox Rebecca J. , Jennions Michael D.
Published: June 2020

The evolution of male genital traits is usually ascribed to advantages that arise when there is sperm competition, cryptic female choice or sexual conflict. However, when male–female contact is brief and sperm production is costly, genital structures that ensure the appropriate timing of sperm release should also be under intense selection. Few studies have examined the role of individual structures in triggering ejaculation. We therefore conducted a series of anatomical manipulations of fine-scale features of the complex intromittent organ (gonopodium) of a freshwater fish with internal fertilization (
Gambusia holbrooki
) to determine their effects on sperm release. Mating in
G. holbrooki
is fleeting (less than 50 ms), so there should be strong selection for control over the timing of sperm release. We surgically removed three features at the tip of the gonopodium (claws, spines, awl-shape) to test for their potential role in triggering ejaculation. We show that the ‘awl-shape' of the tip affects sperm release when a male makes contact with a female, but neither gonopodial claws nor spines had a detectable effect. We suggest that the claws and spines may instead function to increase the precision of sperm deposition (facilitating anchorage and contact time with the female's gonopore), rather than the initiation of ejaculation.
Physiological fractals: visual and statistical evidence across timescales and experimental states
Authors: Kim Jeffrey J. , Parker Stacey , Henderson Trent , Kirby James N.
Published: June 2020

A marker of engaging in compassion meditation and related processes is an increase in heart-rate variability (HRV), typically interpreted as a marker of parasympathetic nervous system response. While insightful, open questions remain. For example, which timescale is best to examine the effects of meditation and related practices on HRV? Furthermore, how might advanced time-series analyses––such as stationarity––be able to examine dynamic changes in the mean and variance of the HRV signal across time? Here we apply such methods to previously published data, which measured HRV pre- and post- a two-week compassionate mind training (CMT) intervention. Inspection of these data reveals that a visualization of HRV correlations across resting and compassion meditation states, pre- and post-two-week training, is retained across numerous recording timescales. Here, the fractal-like nature of our data indicates that the accuracy of representing HRV data can exist across timescales, albeit with greater or lesser granularity. Interestingly, inspection of the HRV signal at Time 2 compassion meditation versus Time 1 revealed a more highly correlated (i.e. potentially more stable) signal. We followed up these results with tests of stationarity, which revealed Time 2 had a less stochastic (variable) signal than Time 1, and a measure of distance in the time series, which showed that Time 2 had less of an average difference between rest and meditation than at Time 1. Our results provide novel assessment of visual and statistical markers of HRV change across distinct experimental states.
Role of Whole Body CT (WBCT) in Trauma Patients “Life Saver or Needless Radiation Exposure?”
Authors: Alkandari Latifa , Abass Mahdy A , Masoomi Michael , Kannan Shreeram , Ashebu Samuel D , Abdulla Hagrassy
Published: June 2020

Background

Whole-body computed tomography (WBCT) is used indiscriminately in trauma cases, just on the suspicion of them being polytrauma cases. A good clinical examination done pre-emptively could prevent the need for this investigation and its undesired radiation effects. The use of WBCT was assessed in our busy hospital to determine whether there has been an overuse of the WBCT and also to estimate the true incident of clinical injuries.

Methods

Retrospective database analysis of 546 WBCT polytrauma cases for the period of April to October 2018 was performed. All the trauma patients were initially managed and proceed for WBCT according to the American College of Radiology (Major Trauma). We recorded age, gender, mechanism of injury, clinical requests, WBCT findings in regions of the cervical spine, thoracolumbar spine, chest, abdomen and pelvis skeleton injuries (as per our institutional reporting protocol), as well as DLP for each patient scanned. We compared pre-test clinical requests stating the mechanism of injury and clinical query with WBCT findings and categorized the radiological findings, initially into negative and positive findings. The positive findings were further classified into the major and minor injuries. The total numbers in each radiological finding were calculated and inferences discussed.

Results

On analysis of data, we found that 462 patients had been referred due to RTA (84.6%), 47 patients due to FFH (8.6%), ten patients due to blunt trauma (1.8%), 8 patient due to assault (1.5%), while the 5 patients had stable wound (0.09%), five patients had injury due to the fall of a heavy object (0.09%), 3 patients had a buggy injury (0.05%), 3 patients had injury due to fallen on the back (0.05%) and 3 more patients had injury due to other traumas including blast injury, suicide and other injury. We noticed RTA with an 84.7 % score was the most common indication for WBCT referral. Out of 546 cases, 414 patients (75.8 %) were normal (negative finding), where 132 patients (24.2 %) had positive trauma related radiological finding of which 54 patients were found to have a major injury (9.9%). Fractures were scored the highest, 75.6% of all positive finding traumas.

Conclusions

This study re-emphasizes the significance of exercising a good clinical examination in the era of evidence based medicine, which would reduce the high number of unnecessary high dose WBCT, as 462 scans with no positive findings on radiological examinations were nearly normal and only 54 cases (9.9%) had major injuries.
KNOWLEDGE ABOUT SEXUALLY TRANSMITTED DISEASES AMONG THE STUDENTS OF SELECTED MADRASHAS OF DHAKA CITY
Authors: Mahmud Tareq
Published: June 2020

Background

Sexually transmitted diseases have become a silent epidemic that devastates the life of both men and women. In Bangladesh, there has been no national prevalence data on Sexually transmitted diseases.

Aims & objectives

The objectives of the study were to find out the level of knowledge about sexually transmitted diseases among madrasha students.

Methods

A cross-sectional study was conducted in four purposively selected madrashas in Dhaka city. A total randomly selected 390 students of class 9 and 10 were included in this study. A semi structured questionnaire was used to collect data and the responses of students were recorded after obtaining verbal consent.

Results

Mean age of the respondents was 17 and 33.1% of them were from Science group. 54% respondents had average knowledge, 29.5% had good knowledge. Television/radio was the main source of information for majority (68.6%) of the students and around 40% was informed about STDs from their academic study. About 75% of the respondents mentioned that there was microorganism for all STDs as causative agents. More than 70% respondents mentioned that unprotected sexual intercourse and using same syringes with different persons were the mood of transmission of STDs. Condom as the main protector of STDs was seemed by the most. Type of madrasha and academic group were significantly related (P<0.00) with level of knowledge on STDs.

Conclusion

Science group respondents had more academic knowledge than the arts group respondents and respondents who belonged to late adolescent group had more knowledge than early adolescent group.
Development and Validation of Postoperative Venous Thromboembolism risk prediction model
Authors: Woo Sang H. , Rhoades Ruben , Ackermann Lily , Cowan Scott W. , Zavodnick Jillian , Marhefka Gregary D.
Published: June 2020

Background

VTE is a serious postoperative complication after surgery with resultant higher morbidity and mortality. Despite years of experience with current risk models, rates continue to be high and more information is needed on individual patient risk in the prophylaxis era.

Research Questions

Can we assess the individualized risk of postoperative venous thromboembolism (VTE) for broad categories of surgery?

Methods

This study was performed using data from the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) Database. Patient data (n=2,875,190) from 2015-2017 were used for study analysis. Eight predictors were selected for the model: age, preoperative platelet count≥450 (×109/L), disseminated cancer, corticosteroid use, serum albumin ≤2.5 g/dL, preoperative sepsis, hospital length of stay and surgery type. The second model included 7 predictors without hospital length of stay. A predictive model was trained using ACS-NSQIP data from 2015-2016 (n=1,859,227) and tested using data from 2017 (n= 1,015,963). Primary outcomes are postoperative 30-day VTE, including deep vein thrombosis (DVT) and/or pulmonary embolism (PE).

Results

VTE occurred in 23,249 patients (0.81%) and 49.9% of VTE occurred after discharge from index hospitalization. The risk prediction model had high AUC (area under the receiver operating characteristic curve) for postoperative VTE of 0.78 (training cohort) and 0.78 (test cohort).

Interpretation

This clinical prediction model is a validated, practical and easy-to-use tool to identify surgical patients at the highest risk of postoperative VTE and provide an individualized assessment of risk based on clinical factors and type of surgery. This prediction model may be used as a tool to assess individualized risk of postoperative VTE and promote broader discussion and awareness of the VTE risk during the perioperative period.
Estimation of Undetected Symptomatic and Asymptomatic cases of COVID-19 Infection and prediction of its spread in USA
Authors: Mahajan Ashutosh , Solanki Ravi , Sivadas Namitha
Published: June 2020

The reported COVID-19 cases in the USA have crossed over 2 million, and a large number of infected cases are undetected whose estimation can be done if country-wide antibody testing is performed. In this work, we estimate this undetected fraction of the population by modeling and simulation approach. We propose a new epidemic model SIPHERD in which three categories of infection carriers Symptomatic, Purely Asymptomatic, and Exposed are considered with different transmission rates that are taken dependent on the lockdown conditions, and the detection rate of the infected carriers is taken dependent on the tests done per day. The model is first validated for Germany and South Korea and then applied for prediction of total number of confirmed, active and death, and daily new positive cases in the United States. Our study also demonstrates the possibility of a second wave of the infection if social distancing regulations are relaxed to a large extent. We estimate that around 12.7 million people are already infected, and in the absence of any vaccine, 17.7 million (range: 16.3-19.2) people, or 5.3% (range: 4.9–5.8) of the population will be infected by when the disease spread ends in the USA. We find the Infection to Fatality Ratio to be 0.93% (range: 0.85-1.01).
Extension and implementation of a system modelling the COVID-19 pandemic in Chile
Authors: Vergara-Hermosilla Gastón , Navas Andrés
Published: June 2020

We modelling the dynamics of the COVID-19 epidemic taking into account the role of the unreported cases. In a first section we extend the model recently introduced/ implemented by Liu, Magal, Seydi and Webb, by considering different transmission rates for the infectious and unreported states, and we couple three new states related to hospitalized and fatalities. In addition, we introduce an operator that incorporates the effects of mitigation measures at the different rates considered in the system. Finally, we implemented the extended model in the Chilean context by considering variable the transmission rates and the fraction of unreported cases, the latter through an argument that uses mortality rates. We conclude with several conclusions and lines of future research.
Safety and efficacy of the portable steam sauna bath for fluid removal in maintenance haemodialysis patients: A pilot phase II clinical trial
Authors: Chandrashekaran Niranjini , Valson Anna T. , Priya Ankita , Subramani Sathya
Published: June 2020

Background

Dry heat, immersive, and Hammam sauna baths have been shown to aid fluid removal in haemodialysis patients but require high ambient temperatures, large volumes of water and sufficient space, all of which limit their widespread use in India. We aimed to study the safety and efficacy of a commercially available, inexpensive, portable steam sauna bath for this purpose.

Methods

In this pilot phase II clinical trial, six adult prevalent haemodialysis patients each underwent 6 sauna sessions lasting 30-60 minutes, on all non-dialysis days, for 2 weeks. Weight, blood pressure, serum urea, creatinine, electrolytes, haematocrit, core body temperature, thermal comfort, and thirst visual analogue scale were measured before and after each session. Karnofsky performance status (KPS) and Dialysis Symptoms Index (DSI) were measured at the beginning and end of the intervention period. The primary end points were per session weight loss and interdialytic weight gain (IDWG).

Results

Patients experienced a median weight loss of 0.35 kg, median fall in systolic and diastolic BP of 10 mm Hg and 2 mm Hg respectively (p < 0.001 for all) without significant change in IDWG (p = 0.46). Mean thermal comfort was 5.41 ± 0.56 out of 8, there was no significant increase in thirst (p = 0.06) and no significant change in KPS and DSI scores (p = 1.00 and 0.32 respectively). No adverse events were noted.

Conclusions

The portable steam sauna is safe, but modestly effective for fluid removal in haemodialysis patients, and may not influence IDWG.

Details of each author’s contributions
Breast Cancer Detection Using Quantum Convolutional Neural Networks: A Demonstration on a Quantum Computer
Authors: Bisarya Aradh , Maouaki Walid El , Mukhopadhyay Sabyasachi , Mishra Nilima , Kumar Shubham , Behera Bikash K. , Panigrahi Prasanta K. , De Debashis
Published: June 2020

Deep learning have paved the way for scientists to achieve great technical feats. In an endeavor to hone and perfect these techniques, quantum deep learning is a promising and important tool to utilize to the fullest. Using the techniques of deep learning and supervised learning in a quantum framework, we are able to propose a quantum convolutional neural network and showcase its implementation. Using the techniques of deep learning and supervised learning in a quantum framework, we are able to propose a quantum convolutional neural network and showcase its implementation. We keep our focus on training of the ten qubits system in a way so that it can learn from labeling of the breast cell data of Wisconsin breast cancer database and optimize the circuit parameters to obtain the minimum error. Through our study, we also have showcased that quantum convolutional neural network can outperform its classical counterpart not only in terms of accuracy but also in the aspect of better time complexity.
Healthcare workers’ experiences of working on the frontline and views about support during COVID-19 and comparable pandemics: A rapid review and meta-synthesis
Authors: Billings Jo , Ching Brian Chi Fung , Gkofa Vasiliki , Greene Talya , Bloomfield Michael
Published: June 2020

Healthcare workers across the world have risen to the demands of treating COVID-19 patients, potentially at significant cost to their own health and wellbeing. There has been increasing recognition of the potential mental health impact of COVID-19 on frontline healthcare workers and growing calls to provide psychosocial support for them. However, little attention has so far been paid to understanding the impact of working on a pandemic from healthcare workers’ own perspectives or what their views are about support. This rapid review identified 40 qualitative studies which have explored healthcare workers’ experiences and views from previous pandemics, including and comparable to COVID-19. Meta-synthesis of this qualitative data using thematic analysis derived eight key themes which transcended pandemics, time, and geographical boundaries. This pandemic is not unprecedented; the themes that arose from previous pandemics were remarkably resonant with what we are hearing about the impact of COVID-19 globally today. We have an opportunity to learn from the lessons of these previous pandemics, mitigate the negative mental health impact of COVID-19 and support the longer-term wellbeing of the healthcare workforce worldwide.
Clinical Presentation, Renal Histopathological Findings and Outcome in Patients with Monoclonal Gammopathy and Kidney Disease
Authors: Alfano Gaetano , Delrio Alice , Fontana Francesco , Mori Giacomo , Ferrari Annachiara , Perrone Rossella , Giovanella Silvia , Ligabue Giulia , Magistroni Riccardo , Cappelli Gianni
Published: June 2020

Monoclonal gammopathies have been associated with kidney injury. Nephrotoxicity of the secreted monoclonal (M)-protein relies on a complex interplay between biological characteristics and serum concentration. Little is known about the epidemiology and clinical manifestations of the different types of monoclonal gammopathies in patients with kidney disease.

We enrolled all patients with monoclonal gammopathy who underwent kidney biopsy between January 2000 and March 2017. Data about demographics, clinical manifestations and histological lesions were collected retrospectively.

Monoclonal gammopathy was detected in 174 (13%) patients with a mean age of 66.4±13.1 years. M-protein was secreted by monoclonal gammopathy of undetermined significate (MGUS) (52,8%), myeloma multiple (MM) (25.2%), primary amyloidosis (AL) (9,1%), smoldering MM (7 %), non-Hodgkin lymphoma (NHL) (6.8%) and HL (1.7%). Monoclonal gammopathy of renal significance (MGRS) accounted for 6.5% in patients with MGUS and 14.2% in patients with smoldering MM. Evaluation of kidney biopsy revealed that M-protein was directed involved in causing kidney injury in MM (93.1%) and NHL (8,3%). MM was the only gammopathy significantly associated with an increased risk of kidney injury (odds ratio [OR]=47.5, CI95%, 13.7-164.9; P=<0.001). While there were no significant differences in the progression toward end-stage renal disease or dialysis (P=0.776), these disorders were associated with a different risk of death (P=0.047) at the end of the follow-up.

Monoclonal gammopathy was a frequent finding in patients with kidney disease. Kidney biopsy had a key role in identifying the underlying monoclonal gammopathy and recognizing the causal relationship between M-protein and kidney injury.