bluuebunny/crossref_metadata_2025 huggingface dataset:
Fetal sex and maternal insulin resistance during mid-pregnancy: a retrospective cohort study
Authors: Yamashita Hiroshi , Yasuhi Ichiro , Koga Megumi , Sugimi So , Umezaki Yasushi , Fukuoka Misao , Suga Sachie , Fukuda Masashi , Kusuda Nobuko
Published: September 2020

Background

Recent studies have suggested that fetal sex influences maternal glucose and insulin metabolism during pregnancy. We examined whether fetal sex is associated with maternal insulin resistance and the β-cell function during mid-pregnancy.

Methods

This retrospective study included singleton pregnant women who underwent a 75-g oral glucose tolerance test (OGTT) at 24–34 weeks of gestation due to positive diabetic screening. In addition to plasma glucose (PG), we measured plasma insulin during the OGTT to obtain surrogate indices associated with insulin resistance (IR), including homeostasis assessment model (HOMA) -IR and insulin sensitivity index (IsOGTT), and β-cell function, including insulinogenic index (II), HOMA-β, and area under the curve of insulin response. We compared these indices between women carrying male fetuses to those carrying female fetuses.

Results

The study population included 617 women (mean age, 32.4 ± 4.9 years) with a mean pre-pregnancy body mass index (BMI) of 22.6±4.5. They underwent the 75g-OGTT at 29.0 ± 2.5 weeks. Two hundred fifty-eight (42%) women were diagnosed with gestational diabetes (GDM). There was no significant difference in maternal age, pre-pregnancy BMI, gestational age at OGTT, PG at OGTT, or the prevalence of GDM between women with a male fetus (n=338) (male group) and those with a female fetus (n=279) (female group). Regarding the indices of IR, IR was significantly higher and insulin sensitivity was lower in the female group than in the male group (HOMA-IR: 7.0 [5-9.6] vs. 6.2 [4.6-8.8], p< 0.05; IsOGTT: 5.86 [4.29-7.83] vs. 6.29 [4.59-8.84], p< 0.01) (median [quartile range]). These differences remained significant after adjustment for maternal age, pre-pregnancy BMI, gestational age and fasting PG at OGTT, and the diagnosis of GDM. In contrast, the β-cell function did not differ between the two groups.

Conclusion

Maternal IR during mid-pregnancy was significantly higher in women carrying a female fetus than in those with a male fetus. The sex of the fetus may affect maternal insulin sensitivity during mid-pregnancy.
Upregulation of long non-coding RNA LOC284454 may serve as a new serum diagnostic biomarker for head and neck cancers
Authors: Fan Chunmei , Wang Jinpeng , Tang Yanyan , Zhang Shanshan , Xiong Fang , Guo Can , Zhou Yanhong , Li Zheng , Li Xiaoling , Li Yong , Li Guiyuan , Zeng Zhaoyang , Xiong Wei
Published: September 2020

Background

Identification of effective diagnostic and prognostic biomarkers of cancer is necessary for improving precision medicine. Long non-coding RNAs (lncRNAs) play an important regulatory role in tumor initiation and progression. The lncRNA LOC284454 is distinctly expressed in various head and neck cancers (HNCs), as demonstrated by our previous bioinformatics analysis. However, the expression levels and functions of LOC284454 in cancer are still unclear.

Methods

We investigated the dysregulation of lncRNAs in HNCs using the GEO database and found that LOC284454 was highly expressed in HNCs. Serum samples from 212 patients with HNCs and 121 normal controls were included in this biomarker study. We measured the expression of LOC284454 in the sera of HNC patients and normal controls using RT-qPCR. Receiver operating characteristics (ROC) analysis is an important statistical method that is widely used in clinical diagnosis and disease screening. ROC was used to analyze the clinical value of LOC284454 in the early diagnosis of HNCs.

Results

LOC284454 was significantly upregulated in the sera of patients with nasopharyngeal carcinoma, oral cancer, and thyroid cancer. LOC284454 upregulation had good clinical diagnostic value in these cancers, as evaluated by area under the ROC curve values of 0.931, 0.698, and 0.834, respectively.

Conclusions

LOC284454 may be a valuable serum biomarker for HNCs facilitating the early diagnosis of malignant cancers. Further studies are needed to elucidate the mechanisms underlying the involvement of LOC284454 in HNCs. This study provides the first evidence that LOC284454 may be a serum biomarker for HNCs.
Major depressive disorder and its association with adherence to antiretroviral therapy and quality of life: cross-sectional survey of people living with HIV/AIDS in Northwest Ethiopia
Authors: Asrat Biksegn , Lund Crick , Ambaw Fentie , Garman Emily Claire , Schneider Marguerite
Published: September 2020

Background

Major depression is believed to affect treatment adherence and overall quality of life (QoL) of people living with HIV/AIDS (PLWHA). Comorbid major depression contributes to a two-fold higher risk of mortality among PLWHA. Understanding the relationships of major depression, adherence to antiretroviral therapy (ART) and QoL is important to identify areas for intervention. The aim of this study is to examine relationship of major depressive disorder (MDD) and adherence to ART with QoL, and to investigate socio-demographic and clinical factors associated with MDD, adherence and QoL among PLWHA in Northwest Ethiopia.

Method

A cross-sectional study was conducted in the ART clinic of Felege-Hiwot referral hospital in Northwest Ethiopia from July to October 2019. Adult PLWHA were selected using a systematic random sampling technique. Data were collected using interview administered questionnaires and chart reviews. Mini International Neuropsychiatric Interview and WHOQOL-HIV-BREF-Eth instruments were used to measure MDD and QoL respectively. Adherence to ART was assessed using pill count data from patients’ adherence monitoring chart. Univariate and multivariate Poisson regressions were used to assess associations of socio-demographic and clinical factors with MDD and adherence to ART. A multivariate linear regression was used to examine the associations of both MDD and adherence with overall QoL.

Result

Of the total of 393 invited participants, 391 (99.5%) completed the interviews. MDD was negatively associated with overall QoL: participants with MDD had a lower QoL score of 0.17 points compared to those with no MDD. MDD was associated with reduced adherence to ART when functional disability was controlled (RR = 1.43; 95%CI = 1.05, 1.96; p = 0.025). However, there was no statistical association between adherence to ART and overall QoL. Functional disability was associated with both MDD (RR = 5.07; 95%CI = 3.27,7.86; p < 0.001) and overall QoL (β = 0.29; 95%CI = 0.21,0.36; p < 0.001).

Conclusion

The relationship between MDD and QoL indicates the need for feasible, acceptable and evidence-based mental health interventions to reduce depression and improve overall QoL of PLWHA. We recommend future studies investigate causal relationships of MDD, adherence to ART and QoL of PLWHA to better understand priority areas for intervention.
Identification of plasma lipid species as promising diagnostic markers for prostate cancer
Authors: Chen Xiaoli , Zhu Yong , Jijiwa Mayumi , Nasu Masaki , Ai Junmei , Dai Shengming , Jiang Bin , Zhang Jicai , Huang Gang , Deng Youping
Published: September 2020

Background

Prostate cancer is a very common and highly fatal in men. Current non-invasive detection methods like serum biomarker are unsatisfactory. Biomarkers with high accuracy for diagnostic of prostate cancer are urgently needed. Many lipid species have been found related to various cancers. The purpose of our study is to explore the diagnostic value of lipids for prostate cancer.

Results

Using triple quadruple liquid chromatography electrospray ionization tandem mass spectrometry, we performed lipidomics profiling of 367 lipids on a total 114 plasma samples from 30 patients with prostate cancer, 38 patients with benign prostatic hyperplasia (BPH), and 46 male healthy controls to evaluate the lipids as potential biomarkers in the diagnosis of prostate cancer. Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway database was used to construct the potential mechanism pathway. After statistical analysis, five lipids were identified as a panel of potential biomarkers for the detection of prostate cancer between prostate cancer group and the BPH group; the sensitivity, specificity, and area under curve (AUC) of the combination of these five lipids were 73.3, 81.6%, and 0.800, respectively. We also identified another panel of five lipids in distinguishing between prostate cancer group and the control group with predictive values of sensitivity at 76.7%, specificity at 80.4%, and AUC at 0.836, respectively. The glycerophospholipid metabolism pathway of the selected lipids was considered as the target pathway.

Conclusions

Our study indicated that the identified plasma lipid biomarkers have potential in the diagnosis of prostate cancer.
Selective digestive decontamination solution used as “lock therapy” prevents and eradicates bacterial biofilm in an in vitro bench-top model
Authors: Pérez-Granda María Jesús , Alonso Beatriz , Zavala Ricardo , Latorre María Consuelo , Hortal Javier , Samaniego Rafael , Bouza Emilio , Muñoz Patricia , Guembe María
Published: September 2020

Background

Most preventing measures for reducing ventilator-associated pneumonia (VAP) are based mainly on the decolonization of the internal surface of the endotracheal tubes (ETTs). However, it has been demonstrated that bacterial biofilm can also be formed on the external surface of ETTs. Our objective was to test in vitro the efficacy of selective digestive decontamination solution (SDDs) onto ETT to prevent biofilm formation and eradicate preformed biofilms of three different microorganisms of VAP.

Methods

We used an in vitro model in which we applied, at the subglottic space of ETT, biofilms of either P. aeruginosa ATCC 15442, or E. coli ATCC 25922, or S. aureus ATCC 29213, and the SDDs at the same time (prophylaxis) or after 72 h of biofilm forming (treatment). ETT were incubated during 5 days with a regimen of 2 h-locks. ETT fragments were analyzed by sonication and confocal laser scanning microscopy to calculate the percentage reduction of cfu and viable cells, respectively.

Results

Median (IQR) percentage reduction of live cells and cfu/ml counts after treatment were, respectively, 53.2% (39.4%—64.1%) and 100% (100%–100.0%) for P. aeruginosa, and 67.9% (46.7%–78.7%) and 100% (100%–100.0%) for E. coli. S. aureus presented a complete eradication by both methods. After prophylaxis, there were absence of live cells and cfu/ml counts for all microorganisms.

Conclusions

SDDs used as “lock therapy” in the subglottic space is a promising prophylactic approach that could be used in combination with the oro-digestive decontamination procedure in the prevention of VAP.
Diagnosis of Rare Diseases: a scoping review of clinical decision support systems
Authors: Schaaf Jannik , Sedlmayr Martin , Schaefer Johanna , Storf Holger
Published: September 2020

Background

Rare Diseases (RDs), which are defined as diseases affecting no more than 5 out of 10,000 people, are often severe, chronic and life-threatening. A main problem is the delay in diagnosing RDs. Clinical decision support systems (CDSSs) for RDs are software systems to support clinicians in the diagnosis of patients with RDs. Due to their clinical importance, we conducted a scoping review to determine which CDSSs are available to support the diagnosis of RDs patients, whether the CDSSs are available to be used by clinicians and which functionalities and data are used to provide decision support.

Methods

We searched PubMed for CDSSs in RDs published between December 16, 2008 and December 16, 2018. Only English articles, original peer reviewed journals and conference papers describing a clinical prototype or a routine use of CDSSs were included. For data charting, we used the data items “Objective and background of the publication/project”, “System or project name”, “Functionality”, “Type of clinical data”, “Rare Diseases covered”, “Development status”, “System availability”, “Data entry and integration”, “Last software update” and “Clinical usage”.

Results

The search identified 636 articles. After title and abstracting screening, as well as assessing the eligibility criteria for full-text screening, 22 articles describing 19 different CDSSs were identified. Three types of CDSSs were classified: “Analysis or comparison of genetic and phenotypic data,” “machine learning” and “information retrieval”. Twelve of nineteen CDSSs use phenotypic and genetic data, followed by clinical data, literature databases and patient questionnaires. Fourteen of nineteen CDSSs are fully developed systems and therefore publicly available. Data can be entered or uploaded manually in six CDSSs, whereas for four CDSSs no information for data integration was available. Only seven CDSSs allow further ways of data integration. thirteen CDSS do not provide information about clinical usage.

Conclusions

Different CDSS for various purposes are available, yet clinicians have to determine which is best for their patient. To allow a more precise usage, future research has to focus on CDSSs RDs data integration, clinical usage and updating clinical knowledge. It remains interesting which of the CDSSs will be used and maintained in the future.
Stakeholder views of podiatry services in the UK for people living with arthritis: a qualitative study
Authors: Dando Charlotte , Bacon Dawn , Borthwick Alan , Bowen Catherine
Published: September 2020

Background

The aim of this study was to explore the views of stakeholders in podiatry services, patients, commissioners and general practitioners (GP), to further understand experiences of referral, access and provision of treatment in the National Health Service (NHS) for foot problems for patients living with arthritis.

Method

To explore in‐depth individual views and experiences of stakeholders in podiatry services, 19 patients who had arthritis (osteoarthritis and/or rheumatoid arthritis) participated in one of four focus groups. In addition, seven commissioners and/or GPs took part in semi structured interviews. A purposive sampling strategy was adopted for all focus groups and semi structured interviews. To account for geographical variations, the focus groups and semi structured interviews were conducted across two predetermined regions of the United Kingdom (UK), Yorkshire and Hampshire. Data was rendered anonymous and transcribed verbatim. Thematic analysis was employed to identify key meanings and report patterns within the data.

Results

Five key themes derived from the focus groups and interviews suggest a variety of factors influencing referral, access and provision of treatment for foot problems within the UK. 1. Systems working together (navigation of different care pathways, access and referral opportunities for people with OA or RA, education around foot health services for people with OA or RA); 2.Finance (financial variations, different care systems, wasting resources); 3. Understanding what podiatry services have to offer (podiatrists are leaders in foot health services, service requirements in relation to training standards and health needs); 4. Person factors of foot pain (arthritis is invisible, affects quality of life, physical and mental wellbeing); 5. Facilitators of foot care (NICE guidelines, stakeholder events, supporting self‐management strategies).

Conclusion

The findings indicate that patients, commissioners and GPs have very similar experiences of referral, access and provision of treatment for foot problems, for patients living with arthritis. Essentially, commissioners and GPs interviewed called for a transformational approach in current systems to include newer models of care that meet the footcare needs of individual patient circumstances. Patients interviewed called for better signposting and information about the different services available to help them manage their foot health needs. To address this, we have formulated a signposting pack for all stakeholders to help them facilitate access to appropriate clinicians ‘at the right time, in the right place’ to manage foot health problems.
Ascending aorta pseudoaneurysm simulating mediastinal lymphoma in computed tomography, a possible diagnostic error: a case report
Authors: Chiocchi Marcello , Spiritigliozzi Luigi , Di Tosto Federica , Benelli Leonardo , D’Errico Francesca , Presicce Matteo , Pugliese Luca , Ricci Francesca , De Stasio Vincenzo , Di Donna Carlo , Pasqualetto Monia , Colella Dionisio Ferdinando , Floris Roberto
Published: September 2020

Background

An ascending aortic pseudoaneurysm is a severe and rare complication following cardiothoracic surgery. This case report demonstrates its possible misinterpretation and the consequent importance of multidisciplinary evaluation.

Case presentation

We present a case of an 18-year-old Caucasian man with Marfan syndrome who developed an ascending aortic pseudoaneurysm about 1 year after undergoing cardiac surgery with the Bentall procedure. Computed tomographic examination of the thoracic aorta and positron emission tomography–computed tomography initially suggested a lymphomatous pathology. However, these imaging results were in contrast to the transesophageal echocardiogram and the laboratory data that showed negative results for hematological pathology. A second computed tomographic scan redirected the diagnosis toward a pseudoaneurysm.

Conclusion

This case demonstrates the utility of close communication and interdisciplinary consultation between cardiovascular radiologists and the cardiac surgery team, which are mandatory in order to maximize their diagnostic skills in identifying postoperative complications.
Calvarial bone grafts to augment the alveolar process in partially dentate patients: a prospective case series
Authors: Yousif Ahmed , Raghoebar Gerry M. , Putters Thomas F. , Vissink Arjan , Schortinghuis Jurjen
Published: September 2020

Background

Calvarial bone grafts as a pre-implant augmentation procedure are mostly used to reconstruct the edentulous maxilla, although calvarial grafts could also be used in the partially dentate patients needing extensive bone grafting.

Methods

In 7 consecutive partially dentate patients needing bone grafting because of a large bony defect as a result of trauma (n = 1), oligodontia (n = 1), failed previous bone augmentation (n = 1), or atrophy (n = 4), the alveolar process was reconstructed with calvarial bone as a pre-implant procedure.

Results

A total of 30 implants was placed either immediate at the time of bone grafting (13 implants) or after a healing time of 4 months when immediate placement was not possible (17 implants). One wound dehiscence occurred that needed secondary intervention. During follow-up (40 ± 14 months), one implant was lost due to peri-implantitis with an infected osteosynthesis screw. Marginal peri-implant bone loss was 0.65 ± 0.47 mm during this period.

Conclusion

Calvarial bone is a sound extra-oral donor site when aiming for reconstruction of a large bony defect of the alveolar process of partially dentate patients.
Successful treatment of recurrent volvulus in the afferent limb of the pouch following proctocolectomy for ulcerative colitis: a case report
Authors: Itabashi Michio , Bamba Yoshiko , Aihara Hisako , Tani Kimitaka , Nakagawa Ryousuke , Koshino Kurodo , Ohki Takeshi , Ogawa Shinpei , Inoue Yuji , Yamamoto Masakazu
Published: September 2020

Background

Pouch volvulus after proctocolectomy for ulcerative colitis is a very rare postoperative complication. The common site of pouch volvulus has been reported to be the ileal pouch–anal anastomosis and the middle part of the pouch, but no reports on pouch volvulus in the afferent limb of the pouch have been observed. Here, we report the case of a patient with afferent limb volvulus who underwent afferent limbpexy, but required reoperation 7 months later.

Case presentation

A 38-year-old man with refractory ulcerative colitis had undergone open proctocolectomy 10 years ago at another hospital. He had been aware of lower abdominal pain and bowel movement difficulty for 2 years. After repeated bowel obstruction, he was referred to our hospital for surgery. Based on the radiographic findings, we diagnosed a pouch volvulus and performed an operation. Laparoscopically, counterclockwise rotation of the afferent limb of the pouch was recognized. Moreover, the ileal mesentery was adhered and fixed to the presacral space 20 cm from the oral side of the pouch. The antimesenteric side of the afferent limb was fixed using interrupted stiches on the left peritoneal wall of the pelvis. He was discharged uneventfully 18 days after surgery, and defecation improved immediately. However, he was readmitted 7 months after surgery with the same abdominal pain and defecation difficulty. A similar finding was found and diagnosed as recurrent volvulus. Therefore, we performed a laparoscopic surgery. The same volvulus as in the previous surgery was confirmed. The site fixed during the previous surgery showed scars, but the afferent limb was free. The dilated ileum that contained the volvulus was excised only on the oral side of the pouch and an intraluminal anastomosis was performed on the anterior wall of the pouch. He had a good postoperative course and was discharged.

Conclusion

Proper diagnosis of volvulus based on the characteristic imaging findings is important. In principle, bilateral row fixation of the rotated ileum is the basic procedure for volvulus. However, fixation with this technique is sometimes difficult. Therefore, this procedure is one of the useful options for the fixation of difficult or recurrent cases.
Population structure and regeneration of Himalayan endemic Larix species in three high-altitude valleys in Nepal Himalaya
Authors: Dhamala Man Kumar , Aryal Prakash Chandra , Suwal Madan Krishna , Bhatta Sijar , Bhuju Dinesh Raj
Published: September 2020

Background

The Himalayan forests are of great importance to sustain the nature and community resource demands. These forests are facing pressures both from anthropogenic activities and ongoing global climatic changes. Poor natural regeneration has been considered a major problem in mountainous forests. To understand the population structure and regeneration status ofLarix(Larix griffithianaandLarix himalaica), we conducted systematic vegetation surveys in three high-altitude valleys namely Ghunsa (Kanchenjunga Conservation Area, KCA), Langtang (Langtang National Park, LNP), and Tsum (Manaslu Conservation Area, MCA) in Nepal Himalaya. The average values of diameter at breast height (DBH), height, and sapling height were compared for three sites and two species using Kruskal-Wallis test. Population structure was assessed in terms of proportion of seedlings, saplings, and trees. Regeneration was analyzed using graphical representation of frequencies of seedlings, saplings, and trees in histograms.

Results

The results showed that the population structure ofLarixin terms of the proportion of seedling, sapling, and tree varied greatly in the three study areas. KCA had the highest record of seedling, sapling, and tree compared to other two sites. Seedlings were the least among three forms and many plots were without seedlings. We found no seedling in MCA study plots. The plot level average DBH variation among sites was significant (Kruskal-Wallisχ2= 7.813, df = 2,p= 0.02) as was between species (Kruskal-Wallisχ2= 5.9829, df = 1,p= 0.014). Similarly, the variation in average tree height was significant (Kruskal-Wallisχ2= 134.23, df = 2,p< 0.001) among sites as well as between species (Kruskal-Wallisχ2= 128.01, df = 1,p< 0.001). All the sites showed reverse J-shaped curve but more pronounced for KCA and MCA. In comparing the two species,Larix griffithianahas clear reverse J-shaped diameter distribution but notLarix himalaica.

Conclusion

The varied responses ofLarixmanifested through regeneration status from spatially distinct areas show that regeneration limitations might be more pronounced in the future. In all the three studied valleys, regeneration ofLarixis found to be problematic and specifically forLarix griffithianain MCA andLarix himalaicain LNP. To address the issues of disturbances, especially serious in LNP, management interventions are recommended to sustain the unique Himalayan endemic conifer.
Primitive techno-economic study of bio-diesel and bio-active compound production from microalgae
Authors: Abdo Sayeda M. , El Diwani Guzine I. , El-Khatib Kamel M. , Abo El-Enin Sanaa A. , El-Galad Mohammed I. , Basily Haidy S. , Ali Gamila H.
Published: September 2020

Background

Microalgae cells can be identified as a potential source for new and renewable energy. The economic investigation for biodiesel and bio-active compound production from the microalgae community (Bloom), which are collected from the high rate algal pond (HRAP) constructed to treat municipal wastewater at Zenin wastewater treatment plant, Giza, was the main target of study.

Results

The microscopical examination showed that Scenedesmus obliquus is the dominant species. The total carotenoids were extracted using jojoba oil and determined by high-performance liquid chromatography (HPLC) to reach 81.44 μg/g. The biodiesel production through acid transesterification reaction recorded 70.6% of fatty acid methyl ester content with high cetane number (44) and low acid value. Such results prove that the obtained biodiesel has better ignition quality. The total phenolic and flavonoid compounds have been derived from the remaining biomass to give 5.36 ± 0.03 and 1.50 ± 0.19 mg/g respectively. Finally, total proteins and carbohydrates content in algal cells were recorded 54.3 and 1.5 mg/g successively

Conclusion

The preliminary economic evaluation showed that the production of biodiesel and carotenoids from the microalgae growing in municipal wastewater can be considered, as a techno-economic feasible process.
Screening of the SHOX/PAR1 region using MLPA and miRNA expression profiling in a group of Egyptian children with non-syndromic short stature
Authors: Eid Ola M. , Eid Maha M. , Abdelrahman Amany H. , Abdel kader Rania M. A. , Farid Marwa , Mahrous Rana , Mekkawy Mona K. , Kamel Alaa K. , Mazen Inas , El-Bassyouni Hala T.
Published: September 2020

Background

Short stature is defined as a body height below the third percentile, based on chronological age, or 2 standard deviations (SD) below the national height standard. The prevalence of short stature is around 2% of children worldwide. Several gene deficiencies have been associated with the etiology of short stature. The SHOX is an important candidate gene for short stature, as its haploinsufficiency underlies syndromic and non-syndromic short stature. Partial and complete duplications of SHOX have been reported in patients with short stature. Proper genetic diagnosis of these children allows for appropriate therapeutic approaches to be administered. Since copy number variation (CNV) is a possible mechanism of interhuman variability and pathogenic disease, the multiplex ligation-dependent probe amplification technique (MLPA) can be used as an initial screening technique. Cartilage tissue expresses specific microRNAs (miRNAs), which play an essential role in the regulation of chondrocyte proliferation and differentiation during growth plate development. We aimed to assess the SHOX/PAR1 region using CNV profiling for non-syndromic short stature in Egyptian children with and without growth hormone deficiency using the MLPA technique and expression profiling of miR-1, miR-15a, and miR-140 using quantitative real-time polymerase chain reaction (qRT-PCR) in a group of Egyptian children with non-syndromic short stature.

Results

Of the fifty cases included in this study, different CNVs were detected in ten children (20%), in/outside the SHOX region. Moreover, in children with short stature, the expression level of miRNA-140 was significantly different from that of healthy controls.

Conclusions

This is one of the first studies that have assessed CNVs in the SHOX/PAR1 region in a group of Egyptian children with short stature. MLPA analysis of SHOX/PAR1 identified different CNVs in children with non-syndromic short stature, suggesting that the MLPA should be used as an initial screening technique in short children, as proper genetic diagnosis of these children leads to implementation of the appropriate therapeutic approach. Alterations in the levels of miRNA-140 in children with short stature suggest that changes in the expression levels of this miRNA are associated with the pathogenesis of short stature.
Improving adherence to guideline recommendations in dementia care through establishing a quality improvement collaborative of agents of change: an interrupted time series study
Authors: Laver Kate , Cations Monica , Radisic Gorjana , de la Perrelle Lenore , Woodman Richard , Fitzgerald Janna Anneke , Kurrle Susan , Cameron Ian D. , Whitehead Craig , Thompson Jane , Kaambwa Billingsley , Hayes Kate , Crotty Maria
Published: September 2020

Background

Non-pharmacological interventions including physical activity programmes, occupational therapy and caregiver education programmes have been shown to lead to better outcomes for people with dementia and their care partners. Yet, there are gaps between what is recommended in guidelines and what happens in practice. The aim of this study was to bring together clinicians working in dementia care and establish a quality improvement collaborative. The aim of the quality improvement collaborative was to increase self-reported guideline adherence to three guideline recommendations.

Methods

Interrupted time series. We recruited health professionals from community, hospital and aged care settings across Australia to join the collaborative. Members of the collaborative participated in a start-up meeting, completed an online learning course with clinical and quality improvement content, formed a quality improvement plan which was reviewed by a team of experts, received feedback following an audit of their current practice and were able to share experiences with their peers. The primary outcome was self-reported adherence to their guideline recommendation of interest which was measured using checklists. Data were collected monthly over a period of 18 months, and the study used an interrupted time series design and multilevel Poisson regression analysis to evaluate changes in self-reported adherence.

Results

A total of 45 health professionals (78% therapists) from different sites joined the collaborative and 28 completed all requirements. Data from 1717 checklists were included in the analyses. Over the duration of the project, there was a significant increase in clinician self-reported adherence to guideline recommendations with a 42.1% immediate increase in adherence (incidence rate ratio = 1.42; 95% confidence interval = 1.08–1.87; p = 0.012).

Conclusion

Health professionals working with people with dementia are interested in and willing to join a quality improvement collaborative with the goal of improving non-pharmacological aspects of care. Participation in the collaborative improved the quality of care for people with dementia as measured through self-reported adherence to guideline recommendations. Although there are challenges in implementation of guideline recommendations within dementia care, the quality improvement collaborative method was considered successful. A strength was that it equipped and empowered clinicians to lead improvement activities and allowed for heterogeneity in terms of service and setting.

Trial registration

ACTRN12618000268246
Effect of an Artificial Intelligence Clinical Decision Support System on Treatment Decisions for Complex Breast Cancer
Authors: Xu Fengrui , Sepúlveda Martín-J. , Jiang Zefei , Wang Haibo , Li Jianbin , Liu Zhenzhen , Yin Yongmei , Roebuck M. Christopher , Shortliffe Edward H. , Yan Min , Song Yuhua , Geng Cuizhi , Tang Jinhai , Purcell Jackson Gretchen , Preininger Anita M. , Rhee Kyu
Published: September 2020

PURPOSE

To examine the impact of a clinical decision support system (CDSS) on breast cancer treatment decisions and adherence to National Comprehensive Cancer Center (NCCN) guidelines.

PATIENTS AND METHODS

A cross-sectional observational study was conducted involving 1,977 patients at high risk for recurrent or metastatic breast cancer from the Chinese Society of Clinical Oncology. Ten oncologists provided blinded treatment recommendations for an average of 198 patients before and after viewing therapeutic options offered by the CDSS. Univariable and bivariable analyses of treatment changes were performed, and multivariable logistic regressions were estimated to examine the effects of physician experience (years), patient age, and receptor subtype/TNM stage.

RESULTS

Treatment decisions changed in 105 (5%) of 1,977 patients and were concentrated in those with hormone receptor (HR)–positive disease or stage IV disease in the first-line therapy setting (73% and 58%, respectively). Logistic regressions showed that decision changes were more likely in those with HR-positive cancer (odds ratio [OR], 1.58; P < .05) and less likely in those with stage IIA (OR, 0.29; P < .05) or IIIA cancer (OR, 0.08; P < .01). Reasons cited for changes included consideration of the CDSS therapeutic options (63% of patients), patient factors highlighted by the tool (23%), and the decision logic of the tool (13%). Patient age and oncologist experience were not associated with decision changes. Adherence to NCCN treatment guidelines increased slightly after using the CDSS (0.5%; P = .003).

CONCLUSION

Use of an artificial intelligence–based CDSS had a significant impact on treatment decisions and NCCN guideline adherence in HR-positive breast cancers. Although cases of stage IV disease in the first-line therapy setting were also more likely to be changed, the effect was not statistically significant ( P = .22). Additional research on decision impact, patient-physician communication, learning, and clinical outcomes is needed to establish the overall value of the technology.
Use of Wearable Activity Tracker in Patients With Cancer Undergoing Chemotherapy: Toward Evaluating Risk of Unplanned Health Care Encounters
Authors: Nilanon Tanachat , Nocera Luciano P. , Martin Alexander S. , Kolatkar Anand , May Marcella , Hasnain Zaki , Ueno Naoto T. , Yennu Sriram , Alexander Angela , Mejia Aaron E. , Boles Roger Wilson , Li Ming , Lee Jerry S. H. , Hanlon Sean E. , Cozzens Philips Frankie A. , Quinn David I. , Newton Paul K. , Broderick Joan , Shahabi Cyrus , Kuhn Peter , Nieva Jorge J.
Published: September 2020

PURPOSE

Unplanned health care encounters (UHEs) such as emergency room visits can occur commonly during cancer chemotherapy treatments. Patients at an increased risk of UHEs are typically identified by clinicians using performance status (PS) assessments based on a descriptive scale, such as the Eastern Cooperative Oncology Group (ECOG) scale. Such assessments can be bias prone, resulting in PS score disagreements between assessors. We therefore propose to evaluate PS using physical activity measurements (eg, energy expenditure) from wearable activity trackers. Specifically, we examined the feasibility of using a wristband (band) and a smartphone app for PS assessments.

METHODS

We conducted an observational study on a cohort of patients with solid tumor receiving highly emetogenic chemotherapy. Patients were instructed to wear the band for a 60-day activity-tracking period. During clinic visits, we obtained ECOG scores assessed by physicians, coordinators, and patients themselves. UHEs occurring during the activity-tracking period plus a 90-day follow-up period were later compiled. We defined our primary outcome as the percentage of patients adherent to band-wear ≥ 80% of 10 am to 8 pm for ≥ 80% of the activity-tracking period. In an exploratory analysis, we computed hourly metabolic equivalent of task (MET) and counted 10 am to 8 pm hours with > 1.5 METs as nonsedentary physical activity hours.

RESULTS

Forty-one patients completed the study (56.1% female; 61.0% age 40-60 years); 68% were adherent to band-wear. ECOG score disagreement between assessors ranged from 35.3% to 50.0%. In our exploratory analysis, lower average METs and nonsedentary hours, but not higher ECOG scores, were associated with higher 150-day UHEs.

CONCLUSION

The use of a wearable activity tracker is generally feasible in a similar population of patients with cancer. A larger randomized controlled trial should be conducted to confirm the association between lower nonsedentary hours and higher UHEs.
The Effect of Ovarian Stimulation on Endothelial Function—A Prospective Cohort Study using Peripheral Artery Tonometry
Authors: Kirshenbaum Michal , Haas Jigal , Nahum Ravit , Aizer Adva , Yinon Yoav , Orvieto Raoul
Published: September 2020

Context

Gonadotropin-releasing hormone agonist (GnRH-a) serves as an alternative to human chorionic gonadotropin (hCG) to trigger final oocyte maturation, while it significantly reduces the risk of ovarian hyperstimulation syndrome (OHSS), probably by attenuating vascular/endothelial activation.

Objectives

The objectives of this work are to compare the effect of different modes of final follicular maturation (hCG vs GnRH-a) following ovarian stimulation (OS) for in vitro fertilization (IVF) on endothelial function.

Design and Setting

A prospective cohort study was conducted at a tertiary medical center.

Participants

Patients age 37 years or younger, undergoing OS for IVF, were allocated into 2 groups according to the type of final follicle maturation: the hCG group (n = 7) or the GnRH-a group (n = 8).

Intervention

Endothelial function was assessed by measurement of the peripheral arterial tonometry in reaction to temporary ischemia at 3 study points: day 3 of menstrual cycle (day 0), day of hCG/GnRH-a administration (day trigger) and day of oocyte pick-up (day OPU). The ratio of arterial tonometry readings before and after ischemia is called the reactive hyperemia index (RHI). Decreased RHI (< 1.67) indicates endothelial dysfunction.

Main Outcome Measures

The main outcomes measures of this study included endothelial function at 3 study points during OS with different modes of triggering final follicular maturation.

Results

The mean RHI values at day 0 were within the normal range for all patients and comparable between both groups (hCG: 1.7 ± 0.3 vs GnRH-a: 1.79 ± 0.4, P = .6). All patients presented a decrease in RHI values on day trigger, which did not differ between the 2 groups (1.62 ± 0.3 vs 1.4 ± 0.2, respectively, P = .2). However, the hCG group demonstrated a further decrease in RHI on day OPU, whereas patients who received GnRH-a had restored normal endothelial function reflected by increased RHI values (1.4 ± 0.2 vs 1.75 ± 0.2, respectively, P = .03).

Conclusions

Triggering final follicular maturation with GnRH-a restored normal endothelial function, whereas hCG trigger resulted in a decrease in endothelial function.
Prevalence of and Sociodemographic Disparities in Influenza Vaccination Among Adults With Diabetes in the United States
Authors: Bhugra Priyanka , Mszar Reed , Valero-Elizondo Javier , Grandhi Gowtham R , Virani Salim S , Cainzos-Achirica Miguel , Vahidy Farhaan S , Omer Saad , Nasir Khurram
Published: September 2020

National estimates describing the overall prevalence of and disparities in influenza vaccination among patients with diabetes mellitus (DM) in United States are not well described. Therefore, we analyzed the prevalence of influenza vaccination among adults with DM, overall and by sociodemographic characteristics, using the Medical Expenditure Panel Survey database from 2008 to 2016. Associations between sociodemographic factors and lack of vaccination were examined using adjusted logistic regression. Among adults with DM, 36% lacked influenza vaccination. Independent predictors of lacking influenza vaccination included age 18 to 39 years (odds ratio [OR] 2.54; 95% confidence interval [CI], 2.14-3.00), Black race/ethnicity (OR 1.29; 95% CI, 1.14-1.46), uninsured status (OR 1.88; 95% CI, 1.59-2.21), and no usual source of care (OR 1.61; 95% CI, 1.39-1.85). Nearly 64% individuals with ≥ 4 higher-risk sociodemographic characteristics lacked influenza vaccination (OR 3.50; 95% CI 2.79-4.39). One-third of adults with DM in the United States lack influenza vaccination, with younger age, Black race, and lower socioeconomic status serving as strong predictors. These findings highlight the continued need for focused public health interventions to increase vaccine coverage and utilization among disadvantaged communities.
A Case Report of Peripheral Nerve Stimulation for Acute Neuropathic Pain in Guillain-Barre Syndrome
Authors: Albright-Trainer Brooke , Provencio Jose Javier , O’Connor Colleen M. , Goldstein Robert , Kohan Lynn , Solorzano Guillermo , Sarkar J. Awnik , Seely Matthew , Theodore Danny , Naik Bhiken I.
Published: September 2020

Guillain-Barre syndrome (GBS) is a peripheral demyelinating neuromuscular disorder occasionally associated with pharmacologically refractory neuropathic pain. We present a case of acute neuropathic pain in a 22-year-old man with GBS managed with percutaneous peripheral nerve stimulation (PNS). Following implantation of leads in the bilateral sciatic, femoral, and brachial plexus nerve distribution, the patient experienced significant pain reduction in both the upper and lower extremities. Analgesic and anxiolytic medications were reduced by 33% on the first day and by 78% on day 21. PNS is a minimally invasive, nonpharmacologic modality for treating acute neuropathic pain in GBS patients.
From Anarchism to State Funding
Authors: Wardhaugh Jessica
Published: September 2020

In 1896 Louis Lumet despised the state and openly yearned for a “red messiah” to sweep away bourgeois culture and politics. By 1904 he was receiving state funding. This article unravels the paradox of his trajectory by focusing on the common concern that eventually united his interests with those of republican governments: the relationship between art and the people. Drawing on hitherto unknown writings by Lumet himself, as well as on little-used archives, the article explores Lumet's anarchist persona and connections in fin de siècle Paris, charts his involvement in the Théâtre d'Art Social and the Théâtre Civique, and examines his role in the state-supported Art pour Tous. The final discussion reveals areas of conflict and convergence in the perception of the people as political actors by both anarchists and the state, raising questions about the theory and practice of cultural democratization.

En 1896, Louis Lumet souhaitait l'effondrement de l'Etat et l'apparition d'un Messie rouge qui balaierait et la culture et la politique bourgeoises. En 1904, il était subventionné par l'Etat. Cet article dévoile le mystère de ce personnage en interrogeant la relation entre l'art et le peuple qui attirait l'attention de Lumet ainsi que des gouvernements de la Troisième République. En s'appuyant sur les écrits peu connus de Lumet lui-même, ainsi que sur des documents d'archives, l'article met en évidence le rôle de Lumet dans les milieux anarchistes. Il retrace sa contribution aux initiatives comme le Théâtre d'art social et le Théâtre civique, et sa participation à l'Art pour tous (avec le soutien de l'Etat). Cette étude fournit la base d'une discussion plus approfondie sur la démocratisation culturelle, où les perspectives anarchistes et officielles se trouvent parfois étrangement rapprochées.
Pugilistic Queer Performance
Authors: Walsh Fintan
Published: September 2020

This article examines the role of pugilistic gesture and form in queer performance, focusing on Franko B’s Milk & Blood (2015) and Cassils’s Becoming an Image (2012). Walsh considers how pugilism functions as a mode for “working out” queer fights—personal and cultural—that offers us a performative complement or reverse-orientation to Sigmund Freud’s psychologically centered idea of “working-through” (1914). Reading these pugilistic performances along the slide between working through and working out—their psychic and material practices and effects—allows us to perceive the body as both the object of loss and trauma and, in practiced form, the key instrument of processing change. It compels us to keep the body at the center of debates of traumatic intervention and negotiation in queer studies and beyond, as the fighting bodies themselves appear to insist.
Structure-function Relationships of Porous Ionic Crystals (PICs) Based on Polyoxometalate Anions and Oxo-centered Trinuclear Metal Carboxylates as Counter Cations
Authors: Shimoyama Yuto , Uchida Sayaka
Published: September 2020

Unique structures and functions of porous ionic crystals (PICs) based on polyoxometalate (POM) anions, which are different from typical porous crystalline materials such as zeolites and metal-organic frameworks (MOFs), can be summarized as follows. (i) Crystal structures of PICs are often flexible since Coulomb interaction works isotropically in a long-range, so that structural transformation occurs to adapt to specific guest molecules. (ii) POMs show reversible redox properties leading to the formation of “redox-active” porous materials. (iii) Ionic building blocks create strong electrostatic fields in the pore, which are suitable for accommodating and stabilizing polar guests and ionic intermediates. (iv) Various cations can be incorporated as counter cations of POMs to fine-tune the functions. The crystal structures and functions of PICs can be controlled by the appropriate choice of molecular cations (macrocations) as ionic building blocks as well as the symmetry, size, and charge of POMs. In particular, oxo-centered trinuclear metal (MIII) carboxylates with a general formula of [M3O(OOCR)6(L)3]+ as macrocations allow controlling the crystal structures of PICs through the bridging ligands (R) and terminal ligands (L). The fine-tuned structures of PICs lead to unique functions in gas/solvent sorption/separation, heterogeneous catalysis, redox-induced ion-uptake/release, synthesis of mixed-valance metal nanoclusters, and so on.
Efficacy and safety of percutaneous microwave ablation for hepatocellular carcinomas <4 cm in difficult location
Authors: Mukund Amar , Ramalingam Ravindran , Anandpara Karan Manoj , Patidar Yashwant , Vijayaraghavan Rajan , Sarin Shiv Kumar
Published: September 2020

Objective:

Tumor location is a critical factor for determining technical success and local recurrence following percutaneous ablation of hepatocellular carcinomas (HCC). The purpose of this retrospective study was to evaluate the safety and outcome measures of percutaneous microwave ablation (pMWA) for HCCs <4 cm in difficult locations.

Methods:

Retrospective review included 81 patients who underwent pMWA for HCCs <4 cm. Fourty-three patients (30 males and 13 females; mean age, 61 years) with 53 HCCs located near the diaphragm, heart, gallbladder, kidney, gastrointestinal tract, large vessel and exophytic location were included under difficult location group. Thirty-eight patients (29 males and nine females; mean age, 60 years) with 48 HCCs in other locations were included under control group. Baseline demographics were recorded. Technical efficacy, local tumor progression (LTP), and complication rates were evaluated.

Results:

Mean follow-up period was 3.4 months (range 1–7). There was no major complication in both the groups; two patients had a mild perihepatic hemorrhage in the difficult location group which was managed conservatively. There was no difference between the groups in the overall technical efficacy rate (84.9% vs 91.7%, p = 0.294), LTP rate (4.4% vs 2.2%. p = 0.57) or complication rate (4.6% vs 0%, p = 0.177).

Conclusion:

Our data suggest that there is no significant difference in technical efficacy, LTP or complication rates for MWA in both difficult and normal locations.

Advances in knowledge:

With proper patient selection, pre-procedural planning and appropriate technique, pMWA is feasible, safe, and effective for small HCCs in difficult location with an acceptable range of complications.