bluuebunny/crossref_metadata_2025 huggingface dataset:
Clinical academic careers for general practice nurses: a rapid evidence assessment
Authors: Bradbury Andrew , Shortland Sue , Jones Sarahjane , Hewett Fraser , and Karen Storey
Published: October 2020

Background

Clinical academics are health professionals who provide direct patient care alongside engaging in health research. Despite the generally agreed consensus that such roles enhance evidence-based care, availability and uptake has been sporadic in non-medical professions. With no data readily available regarding general practice nurses undertaking clinical academic roles, there is a need to understand the barriers and enabling factors that impact general practice nurses considering or pursuing a clinical academic career.

Aims

This review aims to address the question ‘What are the barriers and enablers relevant to general practice nurses in the UK pursuing clinical academic careers?’ by providing an overview of the relevant existing literature and drawing out the implications for policy and practice.

Methods

Literature published in the past 10 years was systematically searched. Using agreed inclusion criteria, papers were first screened on titles and abstracts, with papers included at this stage reviewed as full texts.

Results

Thirteen papers met the criteria for inclusion. The extraction and synthesis of findings allowed for the development of three themes: roles and responsibilities; embarking on a clinical academic career; and organisational research culture.

Conclusions

Findings suggest that infrastructure developments are required across higher education institutions and general practice organisations to bring about a cultural change to equip and empower general practice nurses to consider and pursue clinical academic careers.
Association between estimated pulse wave velocity and the risk of stroke in middle-aged men
Authors: Jae Sae Young , Heffernan Kevin S , Kurl Sudhir , Kunutsor Setor K , Laukkanen Jari A
Published: October 2020

Background

Increased aortic stiffness, assessed as carotid-femoral pulse wave velocity (cfPWV), contributes to cerebrovascular damage and is predictive of cerebrovascular events.

Aims and methods

We sought to examine the association between estimated pulse wave velocity (ePWV), a proxy of carotid-femoral pulse wave velocity, and stroke and its subtypes (ischemic and hemorrhagic) in a prospective cohort of 2666 men (aged mean 53.1, range 42–61 years) enrolled in the Kuopio Ischemic Heart Disease cohort study.

Results

During a median 28-year follow-up, 471 incident stroke (397 ischemic and 94 hemorrhagic) events occurred. After adjusting for several established and emerging risk factors including age and pulse pressure, comparing the p versus bottom quartiles of ePWV, there was an increased risk of stroke (hazard ratio [HR] 2.37, 95% Confidence Interval [CI]: 1.57–3.58), ischemic stroke (HR 2.23, 95% CI, 1.42–3.50), and hemorrhagic stroke (HR 3.57, 95% CI, 1.45–8.76).

Conclusion

These findings demonstrate that ePWV is independently associated with the risk of stroke in middle-aged men.
Effect of riociguat on pulmonary arterial compliance in the PATENT and CHEST studies
Authors: Thenappan Thenappan , Al‐Naamani Nadine , Ghio Stefano , Ghofrani Hossein‐Ardeschir , Hassoun Paul M. , Pritzker Marc , Torbicki Adam , Nikkho Sylvia , Busse Dennis , Preston Ioana R.
Published: October 2020

Pulmonary arterial compliance is a measure of the pulsatile afterload of the right ventricle. Lower pulmonary arterial compliance is associated with reduced right ventricular function and worse prognosis in pulmonary hypertension. The effect of pulmonary vasodilators on pulmonary arterial compliance has not been evaluated in detail in pulmonary arterial hypertension or chronic thromboembolic pulmonary hypertension. In this post hoc analysis of patients with pulmonary arterial hypertension and chronic thromboembolic pulmonary hypertension in the PATENT and CHEST studies, we evaluated the change in pulmonary arterial compliance with riociguat versus placebo. Association of pulmonary arterial compliance with clinical outcomes was assessed using Kaplan–Meier and Cox proportional hazards analyses. Compared with placebo, riociguat significantly improved pulmonary arterial compliance in patients with pulmonary arterial hypertension or chronic thromboembolic pulmonary hypertension. Pulmonary arterial compliance at baseline was associated with survival and clinical worsening‐free survival in pulmonary arterial hypertension but only with clinical worsening‐free survival in chronic thromboembolic pulmonary hypertension. In patients with pulmonary arterial hypertension, pulmonary arterial compliance at follow‐up ≥1.6 mL/mmHg was associated with better outcomes than pulmonary arterial compliance <1.6 mL/mmHg. In patients with chronic thromboembolic pulmonary hypertension, pulmonary arterial compliance at follow‐up did not predict outcomes. Cox proportional hazards analyses showed no association between change in pulmonary arterial compliance and outcomes in patients with pulmonary arterial hypertension or chronic thromboembolic pulmonary hypertension. In conclusion, riociguat improved pulmonary arterial compliance in patients with pulmonary arterial hypertension or chronic thromboembolic pulmonary hypertension. Pulmonary arterial compliance at baseline or follow‐up, rather than change in pulmonary arterial compliance, is of prognostic importance for outcomes.
How to Respond to a Complaint Positively – Good Practice
Authors: Brooks Janine
Published: October 2020

This article gives an overview of complaints, what they are, the underlying reasons why patients make complaints and gives some guidance on how to respond well to complaints. The ethical perspective of complaints is considered, in particular, that patients have a right to make a complaint if they are unsatisfied by the care and treatment they receive from dental professionals. As professionals we have a duty to respect that right and respond appropriately. A short case example is included to demonstrate the use of reflective learning and reflective models to help maximise the learning from complaints. Complaints are valuable feedback and the essence of quality improvement for dental practices and dental professionals; they are a natural part of patient engagement.
Dental Management of Patients with Dementia in Primary Dental Care
Authors: Moosajee Sukina , Rafique Sobia , Daly Blánaid
Published: October 2020

Dementia is an umbrella term for a set of symptoms that include memory loss, changes in mood and problems with reasoning, attention and communication. It is a progressive condition and there is ample evidence that oral health declines as the severity of dementia increases. Most of this decline is attributable to the effects of cognitive impairment on oral hygiene capability and/or acceptance of help from others in supporting oral hygiene. Factors such as altered salivary flow, taste change, use of high-energy food supplements and syrup-based medications also contribute to the risk of oral and dental diseases. In its role as part of the wider health and social care network, the primary dental care team can make an important contribution to securing the oral health of people living with dementia.
Dento-Legal Implications in Primary Care Oral Surgery
Authors: Lawrence Clare , Lawrence Clare
Published: October 2020

The purpose and intention of this article is to help provide an overview and understanding of the dento-legal issues which can arise when treating patients who are undergoing oral surgery procedures in primary care. The focus will be on the initial stages of assessment, diagnosis and treatment planning, which are essential factors required to appropriately fulfil the requirement of obtaining valid consent. The importance of getting consent right has been highlighted in the context of the Montgomery case and which is further supported by the requirement and importance of accurate and full record keeping in this regard. Examples and appropriate consideration of clinical areas will be discussed with the intention of demonstrating the key points.
An Update of Gorlin-Goltz Syndrome
Authors: Hasan Aliya , Akintola Dapo , Hasan Aliya , Akintola Dapo
Published: October 2020

Gorlin-Goltz syndrome encompasses a variety of clinical signs and symptoms including important oral manifestations which general dental practitioners should be aware of. In light of the risk of malignancy it is important to be aware of this syndrome and recognise the need for early referral for multidisciplinary management. This paper aims to discuss Gorlin-Goltz syndrome, the pathophysiology of the condition and address the wide range of clinical manifestations. The author will pay particular attention to the oral manifestations of the condition and the management of such anomalies.
Prevention and Management of Postoperative Pain in Oral Surgery
Authors: Bailey Edmund , Bailey Edmund
Published: October 2020

Post-operative pain is an area of oral surgery that concerns both patients and practitioners. Adequate management of pain and anxiety in oral surgery is an essential component of any oral surgery service. In this paper, we explore the science behind pain and the drugs available to manage post-operative pain. Discussion is focussed on the analgesics available on the dental practitioners' formulary and the evidence base supporting their use. We explore the beneficial and adverse effects of these analgesics. We also discuss recent controversies relating to non-steroidal anti-inflammatory drugs and opioids. Based on the evidence available, we have developed a protocol to assist practitioners when advising and prescribing analgesics for their patients.
Psychological Interventions for Persistent Orofacial Pain
Authors: Barker Sarah , Urbanek Monika , Penlington Chris
Published: October 2020

Persistent pain has been defined as pain lasting beyond the normal time of healing (up to six months), often in the absence of observable tissue pathology. It includes a range of conditions which are likely to present in the dental setting including temporomandibular disorders, burning mouth syndrome, persistent dentoalveolar pain, trigeminal nerve injury, trigeminal neuralgia and atypical facial pain.

This article reviews psychological interventions for pain. This includes interventions that have been researched in a range of persistent pain settings, including but not limited to those that have been directly applied to persistent orofacial pain (POFP).

All current psychological interventions for persistent pain are underpinned by a biopsychosocial understanding of the complex and multifactorial nature of pain. The main currently applied interventions are described, along with their rationale and selected relevant research. To date, psychological treatments which have been shown to persistent pain demonstrate small but consistent improvements in pain, disability and quality of life compared to standard care.

A stepped care approach to service provision is outlined, with practical ideas for administering routine psychological measures to help stratify patients towards the appropriate care pathway.
Childhood atopic dermatitis as a precursor for developing attention deficit/hyperactivity disorder
Authors: Xu Yang-chun , Wang Jin-peng , Zhu Wen-jing , Li Ping
Published: October 2020

Atopic dermatitis (AD) is a skin disease characterized by chronic inflammatory condition that shows hallmark presentations in terms of sleep disturbances, pruritus, and psychological stress, and an association with increased attention deficit/hyperactivity disorder (ADHD) risk. A number of studies have suggested for the co-occurrence of the two diseased conditions. In terms of global prevalence, AD and ADHD almost exhibit a parallel increment according to epidemiological data. In addition, recent reports indicate AD to show a temporal association with later onset of ADHD. Although several studies suggest for the potential link between AD and ADHD, currently there is no definitive answer to this regard. Furthermore, epidemiological evidence of co-occurrence does not ascertain a pathophysiological link between the two conditions. The pathophysiological basis behind the association of AD and ADHD also remain poorly elucidated. The objective of this review is to present an extensive account of AD and associated comorbidities with a special attention toward ADHD as well as to elaborate on the mechanisms underlying their association. The review can provide healthcare providers with the recent updates on AD-ADHD association and help them while dealing with such patients. In general, AD and ADHD show a positive association in majority of the cross-sectional studies. However, large longitudinal studies are required to draw any conclusion on the temporal nature of such association.
Cationic drugs and COVID-19
Authors: Brenna Oreste Vittore , Torretta Sara , Pignataro Lorenzo , Di Berardino Federica
Published: October 2020

Given the sharp spreading of COVID-19 pandemic all around the world, our attention was brought to consider that that many cationic drugs (i.e. those characterized by the presence, at physiological pH value, of one or more cationic groups, both primary, secondary, tertiary and guanidinic aminic groups) could have any effect in impairing SARS-CoV2 entry in the host cell. This could open to new therapeutic chances against COVID-19.
Student Journal Club to Improve Cultural Humility with LGBTQ Patients
Authors: Thomas Melissa , Balbo Jane , Nottingham Kelly , Forster Lisa , Chavan Bhakti
Published: October 2020

Health degree programs provide opportunities to reduce disparities in care for LGBTQ patients by exposing students to LGBTQ communities and current health issues. However, LGBTQ content is mostly absent from medical school curricula. This mixed method assessment study, conducted during the 2018 to 2019 academic year, examined the feasibility of implementing a medical student journal club focused specifically on LGBTQ health issues as a complementary training tool to support efforts to create an inclusive educational environment. Compared to the pre-test, mean response scores increased for most of the parameters including familiarity with LGBTQ healthcare issues, confidence in the ability to identify harmful medical provider practices, and reading and assessing scientific literature. Qualitative data showed increased confidence, comfort and knowledge about LGBTQ health barriers. This study offers a framework for using a journal club to provide an effective platform for enhancing students’ LGBTQ cultural humility and research literacy.
Duration of Surgery and Learning Curve Affect Rotator Cuff Repair Retear Rates: A Post Hoc Analysis of 1600 Cases
Authors: Elkins Ashleigh R. , Lam Patrick H. , Murrell George A.C.
Published: October 2020

Background:

Arthroscopic rotator cuff repair can be quite complex and time consuming, particularly early in the surgeon’s learning curve.

Hypothesis:

Patients who have undergone rotator cuff repair with shorter operative times will be less likely to have a rotator cuff retear at 6 months postoperatively.

Study Design:

Case-control study; Level of evidence, 3.

Methods:

This study was an analysis of data from 1600 consecutive patients (670 partial-thickness and 930 full-thickness tears) who had rotator cuff repair performed by a single surgeon utilizing an arthroscopic, single-row, knotless inverted mattress suture anchor technique. All patients underwent ultrasound at 6 months postoperatively to determine repair integrity. Moving average analysis was performed for the variables of operative time and case number to evaluate the surgeon’s learning curve.

Results:

For early cases, the mean operative time was approximately 35 minutes. After approximately 450 cases, the operative time plateaued at approximately 20 minutes. The mean operative time for the cohort (±SEM) was 22 ± 0.3 minutes, and the mean retear rate was 13%. Increased operative time was associated with a retear ( r = 0.18; P < .001). Multiple logistic regression analysis revealed that the variables with the most independent effect on retears were larger tear size (Wald statistic = 36; P < .001), lower case number (ie, less surgeon experience) (Wald statistic = 28; P < .001), older patient age (Wald statistic = 23; P < .001), full-thickness tears (Wald statistic = 13; P < .001), and lower surgeon-rated repair quality (Wald statistic = 8; P = .004). Operative time was not a significant independent factor contributing to retears.

Conclusion:

Operative time and rotator cuff retear rates decreased as surgical team experience increased. The hypothesis of this study, however, was not supported. The reduced retear rate was not related to a reduction in operative time per se but rather to improved surgical team experience and patient factors, such as improved healing with smaller tears in younger patients.
Risk-assessment models for VTE and bleeding in hospitalized medical patients: an overview of systematic reviews
Authors: Darzi Andrea J. , Repp Allen B. , Spencer Frederick A. , Morsi Rami Z. , Charide Rana , Etxeandia-Ikobaltzeta Itziar , Bauer Kenneth A. , Burnett Allison E. , Cushman Mary , Dentali Francesco , Kahn Susan R. , Rezende Suely M. , Zakai Neil A. , Agarwal Arnav , Karam Samer G. , Lotfi Tamara , Wiercioch Wojtek , Waziry Reem , Iorio Alfonso , Akl Elie A. , Schünemann Holger J.
Published: October 2020

Multiple risk-assessment models (RAMs) for venous thromboembolism (VTE) in hospitalized medical patients have been developed. To inform the 2018 American Society of Hematology (ASH) guidelines on VTE, we conducted an overview of systematic reviews to identify and summarize evidence related to RAMs for VTE and bleeding in medical inpatients. We searched Epistemonikos, the Cochrane Database, Medline, and Embase from 2005 through June 2017 and then updated the search in January 2020 to identify systematic reviews that included RAMs for VTE and bleeding in medical inpatients. We conducted study selection, data abstraction and quality assessment (using the Risk of Bias in Systematic Reviews [ROBIS] tool) independently and in duplicate. We described the characteristics of the reviews and their included studies, and compared the identified RAMs using narrative synthesis. Of 15 348 citations, we included 2 systematic reviews, of which 1 had low risk of bias. The reviews included 19 unique studies reporting on 15 RAMs. Seven of the RAMs were derived using individual patient data in which risk factors were included based on their predictive ability in a regression analysis. The other 8 RAMs were empirically developed using consensus approaches, risk factors identified from a literature review, and clinical expertise. The RAMs that have been externally validated include the Caprini, Geneva, IMPROVE, Kucher, and Padua RAMs. The Padua, Geneva, and Kucher RAMs have been evaluated in impact studies that reported an increase in appropriate VTE prophylaxis rates. Our findings informed the ASH guidelines. They also aim to guide health care practitioners in their decision-making processes regarding appropriate individual prophylactic management.
Augmenting emergency granulopoiesis with CpG conditioned mesenchymal stromal cells in murine neutropenic sepsis
Authors: Ng Julie , Guo Fei , Marneth Anna E. , Ghanta Sailaja , Kwon Min-Young , Keegan Joshua , Liu Xiaoli , Wright Kyle T. , Kamaz Baransel , Cahill Laura A. , Mullally Ann , Perrella Mark A. , Lederer James A.
Published: October 2020

Patients with immune deficiencies from cancers and associated treatments represent a growing population within the intensive care unit with increased risk of morbidity and mortality from sepsis. Mesenchymal stromal cells (MSCs) are an integral part of the hematopoietic niche and express toll-like receptors, making them candidate cells to sense and translate pathogenic signals into an innate immune response. In this study, we demonstrate that MSCs administered therapeutically in a murine model of radiation-associated neutropenia have dual actions to confer a survival benefit in Pseudomonas aeruginosa pneumo-sepsis that is not from improved bacterial clearance. First, MSCs augment the neutrophil response to infection, an effect that is enhanced when MSCs are preconditioned with CpG oligodeoxynucleotide, a toll-like receptor 9 agonist. Using cytometry by time of flight, we identified proliferating neutrophils (Ly6GlowKi-67+) as the main expanded cell population within the bone marrow. Further analysis revealed that CpG-MSCs expand a lineage restricted progenitor population (Lin−Sca1+C-kit+CD150−CD48+) in the bone marrow, which corresponded to a doubling in the myeloid proliferation and differentiation potential in response to infection compared with control. Despite increased neutrophils, no reduction in organ bacterial count was observed between experimental groups. However, the second effect exerted by CpG-MSCs is to attenuate organ damage, particularly in the lungs. Neutrophils obtained from irradiated mice and cocultured with CpG-MSCs had decreased neutrophil extracellular trap formation, which was associated with decreased citrullinated H3 staining in the lungs of mice given CpG-MSCs in vivo. Thus, this preclinical study provides evidence for the therapeutic potential of MSCs in neutropenic sepsis.
Evaluation of disease severity in bronchiectasis using impulse oscillometry
Authors: Yamamoto Yuji , Miki Keisuke , Tsujino Kazuyuki , Kuge Tomoki , Matsuki Takanori , Fukushima Kiyoharu , Oshitani Yohei , Kagawa Hiroyuki , Yoshimura Kenji , Miki Mari , Kida Hiroshi
Published: October 2020

Although the diagnostic value of impulse oscillometry (IOS) in bronchiectasis for the differential diagnosis of healthy subjects has been researched, the usefulness of each IOS parameter for predicting disease severity in bronchiectasis has not been thoroughly investigated. In addition, the usefulness of IOS in patients with nontuberculous mycobacteria (NTM) infection has not been reported. This study aimed to determine the predictive significance of respiratory impedance and detect the other most significant IOS parameters for predicting disease severity in bronchiectasis patients and to validate the usefulness of IOS in patients with NTM infection.

A total of 206 patients with bronchiectasis who attended clinics at the National Hospital Organization Osaka Toneyama Medical Center were included. Chest high-resolution computed tomography, spirometry and IOS were performed. Hospital admissions, mortality and disease severity indices for bronchiectasis (Bronchiectasis Severity Index (BSI), FACED, and E-FACED scores) were calculated to assess disease severity. The patients were divided into subgroups with and without NTM infection, and subgroup analyses were performed.

Respiratory reactance, especially resonant frequency (fres), correlated with both BSI and FACED score better than respiratory resistance. Inspiratory but not expiratory impedance was strongly correlated with BSI, FACED and E-FACED scores. Inspiratoryfreswas the most useful predictor, increasing as the disease became more severe. The usefulness of IOS was almost equivalent in patients both with and without NTM infection.

Inspiratory reactance measured by IOS is useful for estimating disease severity in bronchiectasis. Inspiratoryfresbest predicts disease severity in bronchiectasis patients both with and without NTM infection.
The use of β2-adrenoreceptor agonists in viral bronchiolitis: scientific rationale beyond evidence-based guidelines
Authors: Nino Gustavo , Rodríguez-Martínez Carlos E. , Castro-Rodriguez Jose A.
Published: October 2020

Despite scientific evidence proving that inhaled β2-adrenergic receptor (β2-AR) agonists can reverse bronchoconstriction in all ages, current guidelines advocate against the use of β2-AR bronchodilators in infants with viral bronchiolitis because clinical trials have not demonstrated an overall clinical benefit. However, there are many different types of viral bronchiolitis, with variations occurring at an individual and viral level. To discard a potentially helpful treatment from all children regardless of their clinical features may be unwarranted. Unfortunately, the clinical criteria to identify the infants that may benefit from bronchodilators from those who do not are not clear. Thus, we summarised the current understanding of the individual factors that may help clinicians determine the highest probability of response to β2-AR bronchodilators during viral bronchiolitis, based on the individual immunobiology, viral pathogen, host factors and clinical presentation.
A comprehensive analysis of the microbiota composition and gene expression in colorectal cancer
Authors: Zhang Qian , Zhao Huan , Wu Dedong , Cao Dayong , Ma Wang
Published: October 2020

Background

The dysregulation of gut microbiota is pivotal in colorectal carcinogenesis. Meanwhile, altered gut microbiome may affect the development of intestinal diseases through interaction with the host genes. However, the synergy between the altered gut microbiota composition and differential expression of specific genes in colorectal cancer (CRC) remains elusive. Thus, we integrated the data from 16S rRNA gene sequences and RNA sequences to investigate the potential relationship between genes and gut microbes in patients with CRC.

Results

Compared with normal samples, the presence of Proteobacteria and Fusobacteria increased considerably in CRC samples; conversely, the abundance of Firmicutes and Spirochaetes decreased markedly. In particular, the genera Fusobacterium, Catenibacterium, and Shewanella were only detected in tumor samples. Meanwhile, a closely interaction between Butyricimonas and Clostridium was observed in the microbiome network. Furthermore, a total of 246 (differentially expressed genes) DEGs were identified between tumor and normal tissues. Both DEGs and microbiota were involved in bile secretion and steroid hormone biosynthesis pathways. Finally, genes like cytochrome P450 family 3 subfamily A member 4 (CYP3A4) and ATP binding cassette subfamily G member 2 (ABCG2) enriched in these two pathways were connected with the prognosis of CRC, and CRC patients with low expression level of CYP3A4 and ABCG2 had longer survival time.

Conclusion

Identifying the complicated interaction between gut microbiota and the DEGs contributed to further understand the pathogenesis of CRC, and these findings might enable better diagnosis and treatment of CRC patients.
Anesthesia departments’ readiness for the COVID-19 pandemic; a nationwide cross-sectional study in Israel
Authors: Cohen Barak , Baar Yuval , Fein Shai , Matot Idit
Published: October 2020

Background

The Coronavirus infectious disease 2019 (COVID-19) brings anesthesiologists and intensive care physicians to the mainstay of clinical workload and healthcare managements’ focus. There are approximately 900 anesthesiologists in Israel, working in non-private hospitals. This nationwide cross-sectional study evaluated the readiness and involvement of anesthesia departments in Israel in management of the COVID-19 pandemic. The impact on anesthesiologists’ health, workload, and clinical practices were also evaluated.

Methods

An online questionnaire was distributed to all of anesthesia department chairs in Israel on April 14th. Each response was identifiable on the hospital level only. Informed consent was waived since no patient data were collected.

Results

Response rate was 100%. A decrease of at least 40% in operating-room activity was reported by two-thirds of the departments. Anesthesiologists are leading the treatment of COVID-19 patients in 19/28 (68%) Israeli hospitals. Israel Society of Anesthesiologists’ recommendations regarding intubation of COVID-19 patients were strictly followed (intubations performed by the most experienced available physician, by rapid-sequence induction utilizing video-laryngoscopy, while minimizing the number of people in the room - about 90% compliance for each). Anesthesiologists in most departments use standard personal protective equipment when caring for COVID-19 patients, including N95 masks, face shields, and water-proof gowns. Only one anesthesiologist across Israel was diagnosed with COVID-19 (unknown source of transmission). All department chairs reported emerging opportunities that advance the anesthesia profession: implementation of new technologies and improvement in caregivers’ clinical capabilities (68% each), purchase of new equipment (96%), and increase in research activity (36%).

Conclusions

This nationwide cross-sectional study had a complete response rate and therefore well-represents the anesthesia practice in Israel. We found that Israeli anesthesia departments are generally highly involved in the health system efforts to cope with the COVID-19 pandemic. Anesthesia and airway management are performed in a remarkably comparable manner and with proper protection of caregivers. Ambulatory anesthesia activity has dramatically decreased, but many departments find opportunities for improvement even in these challenging times.
Combination of medical and surgical management in successful treatment of caesarean scar pregnancy: a case report series
Authors: Pristavu Anda , Vinturache Angela , Mihalceanu Elena , Pintilie Radu , Onofriescu Mircea , Socolov Demetra
Published: October 2020

Background

There is no clear consensus on the management of caesarean scar pregnancy (CSP), a complex and life-threatening condition. The objective of this study was to present a novel approach to management of CSP that combines medical therapy of multidose methotrexate and mifepristone with active surgical management by uterine curettage and consecutive local haemostasis.

Case presentation

We report on a prospective case series of six women with first trimester pregnancy, in whom the diagnosis of CSP was confirmed by 2D and color Doppler transvaginal ultrasound and serial hormone chorionic gonadotropin (hCG) testing. Women were between 23 and 36 years old and had at least one previous delivery by caesarean. At admission, gestational age ranged between 6 to 14 weeks, and serum hCG levels between 397 and 23,000 mUI/ml. Upon decision of pregnancy termination, medical management was undertaken in all cases and 1 mg/kg systemic Methotrexate was administered between 1 and 5 daily doses. Mifepristone was part of the treatment in cases with live pregnancy. Surgical management was employed for the cases were an embryo was seen by ultrasound, being prompted by inadequate response to Methotrexate and/or signs of miscarriage with vaginal bleeding. Curettage combined with local isthmic balloon or vaginal pack tamponade prevented further complications. High treatment rates with preservation of fertility was achieved in all patients except one who underwent hysterectomy for invasive placentation. Ultrasound and hCG levels surveillance ensured that the resolution of pregnancy was achieved.

Conclusion

Women with history of delivery by caesarean section should be carefully monitored in future pregnancies for prompt diagnosis of CSP. Early diagnosis of CSP allows selection of successful conservative therapy. Through this case series we contribute with our experience to the body of knowledge about the management of this serious complication of early pregnancy.
Cost-effectiveness analysis of fruquintinib for metastatic colorectal cancer third-line treatment in China
Authors: Peng Zhi , Hou Xingduo , Huang Yangmu , Xie Tong , Hua Xinyang
Published: October 2020

Background

In this study, we analyze the cost-effectiveness of fruquintinib as third-line treatment for patients with metastatic colorectal cancer in China, especially after a recent price drop suggested by the National Healthcare Security Administration.

Methods

A Markov model was developed to investigate the cost-effectiveness of fruquintinib compared to placebo among patients with metastatic colorectal cancer. Effectiveness was measured in quality-adjusted life years (QALY). The Chinese healthcare payer’s perspective was considered with a lifetime horizon, including direct medical cost (2019 US dollars [USD]). A willing-to-pay threshold was set at USD 27,130/QALY, which is three times the gross domestic product (GDP) per capita. We examined the robustness of the model in one-way and probabilistic sensitivity analysis.

Results

Fruquintinib was associated with better health outcomes than placebo (0.640 vs 0.478 QALYs) with a higher cost (USD 20750.9 vs USD 12042.2), resulting in an incremental cost-effectiveness ratio (ICER) of USD 53508.7 per QALY. This ICER is 25% lower than the one calculated before the price drop (USD 70952.6 per QALY).

Conclusion

After the price negotiation, the drug becomes cheaper and the ICER is lower, but the drug is still not cost effective under the standard of 3 times GDP willing-to-pay threshold. For patients with metastatic colorectal cancer in China, fruquintinib is not a cost-effective option under the current circumstances in China.
Obsessive compulsive disorder in very young children – a case series from a specialized outpatient clinic
Authors: Brezinka Veronika , Mailänder Veronika , Walitza Susanne
Published: October 2020

Background

Paediatric obsessive-compulsive disorder (OCD) is a chronic condition often associated with severe disruptions of family functioning, impairment of peer relationships and academic performance. Mean age of onset of juvenile OCD is 10.3 years; however, reports on young children with OCD show that the disorder can manifest itself at an earlier age. Both an earlier age of onset and a longer duration of illness have been associated with increased persistence of OCD. There seems to be difficulty for health professionals to recognize and diagnose OCD in young children appropriately, which in turn may prolong the interval between help seeking and receiving an adequate diagnosis and treatment. The objective of this study is to enhance knowledge about the clinical presentation, diagnosis and possible treatment of OCD in very young children.

Case presentation

We describe a prospective 6 month follow-up of five cases of OCD in very young children (between 4 and 5 years old). At the moment of first presentation, all children were so severely impaired that attendance of compulsory Kindergarten was uncertain. Parents were deeply involved in accommodating their child’s rituals. Because of the children’s young age, medication was not indicated. Therefore, a minimal CBT intervention for parents was offered, mainly focusing on reducing family accommodation. Parents were asked to bring video tapes of critical situations that were watched together. They were coached to reduce family accommodation for OCD, while enhancing praise and reward for adequate behaviors of the child. CY-BOCS scores at the beginning and after 3 months show an impressive decline in OCD severity that remained stable after 6 months. At 3 months follow-up, all children were able to attend Kindergarten daily, and at 6 months follow-up, every child was admitted to the next level / class.

Conclusions

Disseminating knowledge about the clinical presentation, diagnosis and treatment of early OCD may shorten the long delay between first OCD symptoms and disease-specific treatment that is reported as main predictor for persistent OCD.
Developing a model of best practice for teams managing crisis in people with dementia: a consensus approach
Authors: Yates Jennifer , Stanyon Miriam , Challis David , Coleston-Shields Donna Maria , Dening Tom , Hoe Juanita , Jawahar Kaanthan , Lloyd-Evans Brynmor , Moniz-Cook Esme , Poland Fiona , Streater Amy , Trigg Emma , Orrell Martin
Published: October 2020

Background

Teams delivering crisis resolution services for people with dementia and their carers provide short-term interventions to prevent admission to acute care settings. There is great variation in these services across the UK. This article reports on a consensus process undertaken to devise a Best Practice Model and evaluation Tool for use with teams managing crisis in dementia.

Methods

The Best Practice Model and Tool were developed over a three stage process: (i) Evidence gathering and generation of candidate standards (systematic review and scoping survey, interviews and focus groups); (ii) Prioritisation and selection of standards (consultation groups, a consensus conference and modified Delphi process); (iii) Refining and operationalising standards (consultation group and field-testing).

Results

One hundred sixty-five candidate standards arose from the evidence gathering stage; were refined and reduced to 90 through a consultation group exercise; and then reduced to 50 during the consensus conference and weighted using a modified Delphi process. Standards were then operationalised through a clinical consultation group and field-tested with 11 crisis teams and 5 non-crisis teams. Scores ranged from 48 to 92/100. The median score for the crisis teams was 74.5 (range 67–92), and the median score for non-crisis teams was 60 (range 48–72).

Conclusions

With further psychometric testing, this Best Practice Model and Tool will be ideal for the planning, improvement and national benchmarking of teams managing dementia crises in the future.
Can climatic factors explain the differences in COVID-19 incidence and severity across the Spanish regions?: An ecological study
Authors: Cacho Pedro Muñoz , Hernández José L. , López-Hoyos Marcos , Martínez-Taboada Víctor M.
Published: October 2020

Background

Environmental factors play a central role in seasonal epidemics. SARS-CoV-2 infection in Spain has shown a heterogeneous geographical pattern This study aimed to assess the influence of several climatic factors on the infectivity of SARS-CoV-2 and the severity of COVID-19 among the Spanish Autonomous Communities (AA.CC.).

Methods

Data on coronavirus infectivity and severity of COVID-19 disease, as well as the climatic variables were obtained from official sources (Ministry of Health and Spanish Meteorological Agency, respectively). To assess the possible influence of climate on the development of the disease, data on ultraviolet radiation (UVR) were collected during the months before the start of the pandemic. To analyze its influence on the infectivity of SARS-CoV-2, data on UVR, temperature, and humidity were obtained from the months of highest contagiousness to the peak of the pandemic.

Results

From October 2019 to January 2020, mean UVR was significantly related not only to SARS-CoV-2 infection (cumulative incidence -previous 14 days- × 105 habitants, rho = − 0.0,666; p = 0.009), but also with COVID-19 severity, assessed as hospital admissions (rho = − 0.626; p = 0.017) and ICU admissions (rho = − 0.565; p = 0.035). Besides, temperature (February: rho = − 0.832; p < 0.001 and March: rho = − 0.904; p < 0.001), was the main climatic factor responsible for the infectivity of the coronavirus and directly contributed to a different spread of SARS-CoV-2 across the Spanish regions.

Conclusions

Climatic factors may partially explain the differences in COVID-19 incidence and severity across the different Spanish regions. The knowledge of these factors could help to develop preventive and public health actions against upcoming outbreaks of the disease.
Lipid metabolism gene-wide profile and survival signature of lung adenocarcinoma
Authors: Li Jinyou , Li Qiang , Su Zhenyu , Sun Qi , Zhao Yong , Feng Tienan , Jiang Jiayuan , Zhang Feng , Ma Haitao
Published: October 2020

Background

Lung cancer has high morbidity and mortality across the globe, and lung adenocarcinoma (LUAD) is the most common histologic subtype. Disordered lipid metabolism is related to the development of cancer. Analysis of lipid-related transcriptome helps shed light on the diagnosis and prognostic biomarkers of LUAD.

Methods

In this study, expression analysis of 1045 lipid metabolism-related genes was performed between LUAD tumors and normal tissues derived from the Cancer Genome Atlas Lung Adenocarcinoma (TCGA-LUAD) cohort. The interaction network of differentially expressed genes (DEGs) was constructed to identify the hub genes. The association between hub genes and overall survival (OS) was evaluated and formed a model to predict the prognosis of LUAD using a nomogram. The model was validated by another cohort, GSE13213.

Results

A total of 217 lipid metabolism-related DEGs were detected in LUAD. Genes were significantly enriched in glycerophospholipid metabolism, fatty acid metabolic process, and eicosanoid signaling. Through network analysis and cytoHubba, 6 hub genes were identified, includingINS,LPL,HPGDS,DGAT1,UGT1A6, andCYP2C9. High expression ofCYP2C9,UGT1A6, andINS, and low expressions ofDGAT1,HPGDS, andLPL, were associated with worse overall survival for 1925 LUAD patients. The model showed that the high-risk score group had a worse OS, and the validated cohort showed the same result.

Conclusions

In this study, a signature of 6 lipid metabolism genes was constructed, which was significantly associated with the diagnosis and prognosis of LUAD patients. Thus, the gene signature can be used as a biomarker for LUAD.
“Food” and “non-food” self-regulation in childhood: a review and reciprocal analysis
Authors: Russell Catherine G. , Russell Alan
Published: October 2020

Background

In developmental science, there is an extensive literature on non-food related self-regulation in childhood, where several domains relating to emotions, actions and cognitions have been identified. There is now growing attention to food related self-regulation in childhood, especially difficulties with ASR, and the consequences for weight gain and adiposity. The aim of this narrative review was to conduct a reciprocal analysis of self-regulation in the food and non-food domains in childhood (referred to as appetite self-regulation (ASR) and general self-regulation (GSR) respectively). The focus was on commonalities and differences in key concepts and underpinning processes.

Methods

Databases and major journals were searched using terms such as self-regulation, appetite self-regulation, or self-regulation of energy intake, together with associated constructs (e.g., Executive Function, Effortful Control, delay-of-gratification). This was followed by backward and forward snowballing.

Results and discussion

The scholarship on GSR in childhood has had a focus on the role of the cognitively-oriented Executive Function (EF), the temperamentally-based Effortful Control (EC) and the recursive interplay between bottom-up (reactive, emotion driven, approach or avoidance) and top-down (cognitive, conscious decision-making) processes. “Hot” and “cool/cold” EF and self-regulation situations have been distinguished. There were some parallels between GSR and ASR in these areas, but uncertainty about the contribution of EF and EC to ASR in young children. Possible differences between the contribution to ASR-related outcomes of delay-of-gratification in food and non-food tasks were apparent. Unique elements of ASR were identified; associated with psychological, biological and neurological responses to food and bottom-up processes. A diverse number of situations or elements connected to ASR exist: for example, energy balance homeostasis, caloric compensation, hunger regulation, satiation, satiety, energy density of food, eating in the absence of hunger, emotional eating, etc.

Conclusions

Self-regulation in food and non-food domains are amenable to a reciprocal analysis. We argue that self-regulation of appetite should be added as a domain under the umbrella of self-regulation in childhood along with the other non-food related domains. This could lead to a broader understanding of self-regulation in childhood, and generate novel lines of enquiry.
Effect of intraoperative dexmedetomidine infusion during functional endoscopic sinus surgery: a prospective cohort study
Authors: Fazel Mohammad Reza , Ahmadi Zeynab Sadat , Akbari Hossein , Abam Fahimeh
Published: October 2020

Background

Dexmedetomidine, an α2 agonist, has well-known anesthetic and analgesic-sparing effects. We designed this study to evaluate the effect of intraoperative dexmedetomidine infusion on intra operative blood loss and postoperative pain in functional endoscopic sinus surgery.

Methods

This prospective cohort study included 90 patients planning to undergo endoscopic sinus surgery, who were randomly divided into three groups. 2 to 2.5 mg/kg of propofol was used in all groups to induce anesthesia. One group received dexmedetomidine 0.2 μg/kg per hour infusion whereas the other group received dexmedetomidine 0.5 μg/kg per hour infusion. The control group received normal saline infusion.

Results

The mean age of patients was 41.02 ± 11.93. 33 patients in the dexmedetomidine 0.2 μg/kg/h group, 30 patients in the dexmedetomidine 0.5 μg/kg/h group and 27 patients in the placebo group. The lowest amount of bleeding was related to the dexmedetomidine 0.5 μg/kg/h group. The volume of bleeding between the three groups was significantly different (p = 0.012). The satisfaction of the surgeon in the dexmedetomidine 0.5 μg/kg/h group was more than other groups. There was a significant relationship between the satisfaction of the surgeon and the treatment groups (p < 0.001). The lowest duration of surgery was related to the dexmedetomidine 0.2 μg/kg/h group. The most Trinitroglycerin (TNG) consumption was in the placebo group and the highest dose of labetalol was in the dexmedetomidine 0.5 μg/kg/h group. There was no significant difference in the TNG and labetalol consumption between three groups. The lowest consumption of morphine and pethidine in the dexmedetomidine 0.5 μg/kg/h group.

Conclusions

Infusion of dexmedetomidine 0.5 μg/kg/h decreased blood loss and consumption of morphine and pethidine in patients who underwent endoscopic sinus surgery.
iMOKA: k-mer based software to analyze large collections of sequencing data
Authors: Lorenzi Claudio , Barriere Sylvain , Villemin Jean-Philippe , Dejardin Bretones Laureline , Mancheron Alban , Ritchie William
Published: October 2020

iMOKA (interactive multi-objective k-mer analysis) is a software that enables comprehensive analysis of sequencing data from large cohorts to generate robust classification models or explore specific genetic elements associated with disease etiology. iMOKA uses a fast and accurate feature reduction step that combines a Naïve Bayes classifier augmented by an adaptive entropy filter and a graph-based filter to rapidly reduce the search space. By using a flexible file format and distributed indexing, iMOKA can easily integrate data from multiple experiments and also reduces disk space requirements and identifies changes in transcript levels and single nucleotide variants. iMOKA is available at https://github.com/RitchieLabIGH/iMOKA and Zenodo 10.5281/zenodo.4008947.